BMC primary care最新文献

{"title":"The challenges of prenatal care services during the COVID-19 pandemic: qualitative evidence of primary health care providers' perspective in Iran.","authors":"Edris Kakemam, Faranak Karimiyeganeh, Farzaneh Soltani, Akram Karimi Shahanjarini","doi":"10.1186/s12875-025-02884-0","DOIUrl":"10.1186/s12875-025-02884-0","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic affected almost all healthcare services, including prenatal care. Providing care to pregnant women during the pandemic was affected by general policies related to the control of COVID-19 and thus faced many challenges. Exploring the challenges of prenatal care during the pandemic can be helpful for effective planning and interventions to reduce the fundamental challenges. The present study aimed to explore the midwives' perception of care challenges during the COVID-19 pandemic.</p><p><strong>Methods: </strong>This qualitative research was conducted using conventional content analysis in 13 health centers of Hamadan, Iran, between July and September 2023. A semi-structured interview was conducted with 13 midwives who had experience providing prenatal care services to pregnant mothers during the COVID-19 pandemic and were selected using the purposive sampling method. Granheim and Lundman's 5-step content analysis approach was used for data analysis.</p><p><strong>Results: </strong>Three themes describing challenges to prenatal care during the COVID-19 pandemic emerged, including the unfamiliarity and unpreparedness of the health system in facing COVID-19, disruption in the quantity and quality of services, and socio-economic and systemic challenges.</p><p><strong>Conclusion: </strong>PNC providers have experienced various challenges during the current COVID-19 pandemic. The results of the present study can be used to reduce the problems and challenges of providing prenatal care services in future pandemics. Effective interventions such as strong and managed organizational support, maintaining and sustaining the midwifery staffing, empowering PNC providers, supplying personal protective equipment, adopting strategies to improve mental health, and considering special measures and various incentives for midwives are necessary to overcome similar crises in the future.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"186"},"PeriodicalIF":2.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12107802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144163883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Screening for atrial fibrillation with or without general practice involvement: a controlled study.","authors":"Rakesh N Modi, Efthalia Massou, Peter H Charlton, Andrew Dymond, Kate Williams, James Brimicombe, Ben Freedman, Simon J Griffin, F D Richard Hobbs, Gregory Y H Lip, Richard J McManus, Jonathan Mant","doi":"10.1186/s12875-025-02878-y","DOIUrl":"10.1186/s12875-025-02878-y","url":null,"abstract":"<p><strong>Background: </strong>There has been a drive to increase atrial fibrillation (AF) detection in general practice. However, one-off, opportunistic testing can miss paroxysmal AF and requires significant resource. Paroxysmal AF can be detected through screening that involves repeated ECGs over a period of time, although it is unclear whether screening would need to be led by general practice, and how much support participants require. We aimed to investigate whether AF screening can be delivered remotely by a centralised administration instead of general practice, and to determine the level of support required.</p><p><strong>Methods: </strong>We undertook a controlled comparator study with secondary randomisation in three English general practices. We invited people aged ≥ 70 years to use a hand-held ECG device four times daily for three weeks. Participants were allocated to practice-led or administrator-led screening, with administrator-led support randomised to three different levels. We compared quantity and quality of ECGs obtained in each arm. The primary outcome was proportion of screened participants who recorded ≥ 56 adequate-quality ECGs (2/3 of possible ECGs).</p><p><strong>Results: </strong>Of 288 screened participants, 59 participants received practice-led screening with a telephone consultation to explain the device. The remainder received administrator-led screening: 81 were automatically given a consultation; 74 were offered a consultation, and 74 were not offered a consultation. Most screened participants (280/288, 97.2%) recorded ≥ 56 adequate-quality ECGs. This proportion did not vary significantly between practice-led and administrator-led screening (100.0% vs. 98.8%), or between support levels (94.6% to 98.8%). Practice-led screening led to slightly more adequate-quality ECGs (mean: 83.9 vs 78.3, p < 0.001).</p><p><strong>Conclusions: </strong>AF screening can be successfully delivered remotely, outside general practice, with minimal support.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"185"},"PeriodicalIF":2.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12105410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144153023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary mental health workers addressing youth mental health problems and referrals in general practice: a seven-year time-trend study.","authors":"Marieke Zwaanswijk, Wouter den Hollander, Marieke Boelhouwer, Marieke Spijk-de Jonge, Marike Serra","doi":"10.1186/s12875-025-02879-x","DOIUrl":"10.1186/s12875-025-02879-x","url":null,"abstract":"<p><strong>Background: </strong>Primary mental health workers (PMHWs) support general practitioners in the care for youths who presumably have mental health problems. They provide consultation, screening and triage, short term treatment and transitional care. This study aims to investigate mental health problems presented to and referrals made by PMHWs over a seven-year period (2017-2023).</p><p><strong>Methods: </strong>PMHWs recorded characteristics, mental health problems and referrals for 7393 youths between January 2017 and December 2023. Time trends were analyzed using mixed logistic regression analyses, with year and youths' sex as fixed effects. Analyses were performed for children (0-12 years) and adolescents (13-23 years) separately.</p><p><strong>Results: </strong>From 2018, emotional problems were the main reason for consulting PMHWs in both age groups. Percentages of these problems as assessed by PMHWs increased significantly in recent years. On average, 64.4% of children and 62.0% of adolescents were referred after consulting a PMHW. Children's referrals to secondary mental health care decreased significantly in 2020, but increased in subsequent years. Adolescents' referrals to secondary mental health care showed no significant time trends. Rates of youths without referral were lowest in 2020. In 2023, percentages of children and adolescents being referred to primary mental health care exceeded referral rates to secondary mental health care.</p><p><strong>Conclusions: </strong>The significant increase in emotional problems as assessed by PMHWs is reason for concern. Referrals by PMHWs gradually developed to less intensive and less costly types of care. Since over one third of youths were helped by PMHWs without referral, implementing PMHWs in general practice may be a valuable way to support general practitioners in providing care for youths with mental health problems.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"184"},"PeriodicalIF":2.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12105392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144153004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of a novel differential diagnosis aid for managing patients with unexplained fatigue in primary care: a prospective randomized, controlled, open and multicenter study in primary care.","authors":"Roland von Känel, Stefan Neuner-Jehle, Reto W Kressig, Idris Guessous, Pierre Alexandre Krayenbühl, Lukas Zimmerli, Anne Angelilo-Scherer, Thomas Keller, Caroline Elzner, Karl Pauls, Neige Morin, Edouard Battegay","doi":"10.1186/s12875-025-02873-3","DOIUrl":"10.1186/s12875-025-02873-3","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aims of the study: &lt;/strong&gt;Unexplained fatigue is a common reason for encounters in primary care. However, currently no aid orients physicians in detecting its potential causes. The aim of this study was to evaluate whether the novel Fatigue Differential Diagnostic Aid (FDDA) supported clinicians in better managing unexplained fatigue.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This was a prospective, cluster-randomized, controlled, open, and multicenter study comparing the use of the FDDA vs usual care in patients with unexplained fatigue as the main reason for encounter. The primary endpoint was difference in Patient Global Impression of Change (PGIC) between groups at 3 months. Among pre-defined secondary endpoints were: Difference in change of PGIC between groups at 6 months; percentage of patients with fatigue reduction; mean reduction in fatigue; clinician's confidence in diagnosis; patient satisfaction with quality of care (diagnostic process and treatment); number of clinician-reported visits; number of referrals to specialists; and time until final diagnosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;112 primary care practitioners (PCPs) recruited in Switzerland between 2017 to 2020 were randomly cluster-assigned to the FDDA = 57 or usual care = 55 arm. Of these, 15 (FDDA) and 22 (usual care) PCPs recruited 93 patients (FDDA: n = 40, usual care: n = 53). The achieved sample size was less than planned. There was no difference in PGIC at 3 months between groups (D = 0.06, 95%-CI: -0.41 - -0.53, p = 0.802). Among secondary endpoints, no significant differences occurred in PGIC at 6 months, nor in fatigue reduction. However, in the FDDA group, more patients reported less fatigue at 3 or 6 months (D = 18.9%, 95%-CI: -33.6 - -4.3%, p = 0.011), and increased satisfaction with treatment management at 1 month (FDDA 56.8% vs usual care 25.0%, p = 0.004) and 3 months (FDDA 64.9% vs usual care 31.0%, p = 0.003); the FDDA was also associated with higher total number of visits (median 4.0 vs 3.0, p &lt; 0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this pilot study, the FDDA, a structured diagnostic aid for guiding PCPs in identifying the causes of unexplained fatigue in their patients, was not able to show a global improvement in patient outcomes despite improvements in fatigue and satisfaction with care. The evaluation of fatigue in larger-scale studies is warranted.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Trial registration: &lt;/strong&gt;This trial was retrospectively registered on ClinicalTrials.gov.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Trial registration number: &lt;/strong&gt; NCT05861492. Date of registration: 17th May 2023. The ethics committee of Ethikkommission Nordwest- und Zentralschweiz (EKNZ) had originally voiced the opinion that no registration was required because no drug or intervention was involved, i.e., the study was non-interventional and observational. However, the study authors felt that the study should be retrospectively registered because the FDDA could be interpreted to be an active intervent","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"183"},"PeriodicalIF":2.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of COVID-19 pandemic on glycaemic and blood pressure control among patients with type 2 diabetes in primary care in Hong Kong.","authors":"Chung Ming Wong, Kit Ping Loretta Lai, Man Hei Matthew Luk, Pang Fai Chan","doi":"10.1186/s12875-025-02893-z","DOIUrl":"10.1186/s12875-025-02893-z","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the impact of social distancing measures due to COVID-19 pandemic on glycemic and blood pressure control in primary care in Hong Kong.</p><p><strong>Methods: </strong>This was a retrospective cross-sectional study. Diabetic patients with regular follow-up in 8 public primary care clinics in Hong Kong within the study period were recruited. The outcomes were to detect any difference of HbA1c levels and BP between pre-pandemic group (2019 group) and the 1-year post-pandemic group (2020 group) in all patients and in sub-group analysis of different age groups, sex, body mass index, presence of diabetic complications and different diabetic treatment.</p><p><strong>Results: </strong>There was no statistically significant change in HbA1c level between 2020 and 2019 groups which was 0.019% (95% confidence interval [CI] -0.057% to 0.094%, p = 0.632). There was also no statistically significant change in both systolic and diastolic BP between 2020 and 2019 groups which were -0.143 mmHg (95%CI -1.005 mmHg to 0.719 mmHg, p = 0.745) and 0.148 mmHg (95%CI -0.422 mmHg to 0.718 mmHg, p = 0.611). Subgroup analysis showed that female gender had statistically significant improvement in glycaemic control (HbA1c 6.92% in 2020 group versus HbA1c 7.03% in 2019 group, p = 0.021). Patients with diabetic retinopathy had statistically significant lower diastolic BP (diastolic BP 73 mmHg in 2020 group versus diastolic BP 75 mmHg in 2019 group with p = 0.011).</p><p><strong>Conclusions: </strong>Despite the implementation of various social distancing measures resulting in significant change in lifestyle, COVID-19 pandemic did not worsen glycaemic and blood pressure control in T2DM patients. In fact, slight improvement in glycaemic control among female patients was found.</p><p><strong>Trial registration: </strong>Not applicable.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"182"},"PeriodicalIF":2.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12100898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of mental and physical health outcomes over time in an integrated care setting.","authors":"Dependra Bhatta, Monteic A Sizer, Binod Acharya, Dipendra Banjara","doi":"10.1186/s12875-025-02876-0","DOIUrl":"10.1186/s12875-025-02876-0","url":null,"abstract":"<p><strong>Background: </strong>Integrated care addresses the fragmentation of patient health services and potentially improves the experience of care, reduces healthcare costs, and improves health outcomes. This study assessed the improvements in mental health and physical health outcomes among patients living with mental health challenges and treated in an integrated care setting.</p><p><strong>Methods: </strong>The longitudinal retrospective cohort study evaluated anxiety (GAD-7), depression (PHQ-9), systolic blood pressure, and glycated hemoglobin levels from baseline to the next three assessments recorded from October 1, 2018, to December 31, 2023.</p><p><strong>Results: </strong>At baseline, 239 participants responded to mental health outcome measures, 344 to systolic blood pressure, and 164 to glycated hemoglobin level. The Generalized Estimating Equations analysis showed an improvement in GAD-7 (-1.28 [95% CI, -1.71 to -0.85]) and PHQ-9 (-1.37 [95% CI, -1.73 to -0.92]) scores in successive assessments. The physical health outcomes (Systolic blood pressure (-0.004 [95% CI, -1.34 to 1.35]) and glycated hemoglobin (0.04 [95% CI, -0.07 to 0.15])) remained stable.</p><p><strong>Conclusion: </strong>This study demonstrates that patients with mental health challenges treated in integrated care experience improvements in depression and anxiety symptoms, with stable physical health outcomes.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"181"},"PeriodicalIF":2.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors influencing adoption of self-monitoring of blood pressure among hypertensive patients in primary healthcare in Vietnam: a cross-sectional facility-based study.","authors":"Nguyen Hoang Giang, Nguyen Thi Phuong Lan, Le Thi Kim Anh, Dominika Plancikova, Viera Rusnakova, Nguyen Thi Thang, Jaap A R Koot","doi":"10.1186/s12875-025-02871-5","DOIUrl":"10.1186/s12875-025-02871-5","url":null,"abstract":"<p><strong>Background: </strong>Hypertension is an increasing health problem in low- and middle-income countries such as Vietnam. Self-monitoring of blood pressure (SMBP) is a crucial component of hypertension management in primary healthcare (PHC) and stimulated by healthcare providers. Yet, its adoption remains suboptimal. This study examines the application and contributing factors to adoption of SMBP among hypertensive patients in a PHC setting in Vietnam.</p><p><strong>Methods: </strong>A cross-sectional study was conducted among 989 hypertensive patients managed at commune health stations (CHSs), part of PHC, in two provinces in Vietnam. Participants were selected using systematic random sampling from CHS patient lists. Data were collected through structured interviews and analysed using descriptive statistics and multivariate logistic regression to identify factors contributing to SMBP practices.</p><p><strong>Results: </strong>The prevalence of SMBP among hypertensive patients was 43.1%. Among those who practiced SMBP, 42.3% monitored their blood pressure daily, while 57.7% measured it at least weekly. The majority (80.2%) used home sphygmomanometers, 12% relied on friends or relatives with BP monitoring devices, 7.8% went to a pharmacy of health worker's home to measure BP. Multivariate analysis identified key factors associated with SMBP adoption. Higher educated persons were more engaged in SMBP (p < 0.001). Pensioners were more likely to engage in SMBP than unemployed individuals (OR = 2.2; p < 0.001). Higher knowledge of hypertension management (OR = 1.10; p < 0.001) and regular physical activity (OR = 1.54; p = 0.005) were also positively associated with SMBP practice. Persons living in Ninh Bing were also more likely to apply SMBP (OR = 1.58; p < 0.001).</p><p><strong>Conclusion: </strong>Less than half of hypertensive patients practiced SMBP, highlighting a need for targeted interventions to promote self-monitoring. Key facilitators for patients include better health knowledge, socioeconomic stability, and local healthcare service availability. On the service provision side, strategies to improve SMBP adoption should focus on increasing patient education, ensuring the affordability of BP monitoring devices, and strengthening the role of primary healthcare providers in coaching patients on SMBP. A patient-centred, community-based approach is necessary to enhance hypertension self-management and improve overall cardiovascular health outcomes in Vietnam.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"180"},"PeriodicalIF":2.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093837/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In depth exploration of drivers of community health workers' performance in maternal and child health services: a multistakeholder perspective from rural Indian setting.","authors":"Revadi Gouroumourty, Mukul Maheshwari, Anamika Prasad, Abhijit Pakhare, Ankur Joshi","doi":"10.1186/s12875-025-02851-9","DOIUrl":"10.1186/s12875-025-02851-9","url":null,"abstract":"<p><strong>Background: </strong>Community health workers' (CHWs') performance may be affected by several factors interplaying at the systemic level. There is a need to study those factors in the indigenous context to devise strategies for optimising the CHWs' performance. Hence, this study was conducted to understand the individual, health system and community level drivers of CHWs performance in Maternal and Child Health services and to decipher the interactions between CHWs and their stakeholders.</p><p><strong>Materials and methods: </strong>A qualitative inquiry using pragmatic philosophy in a rural setting of Central India (Madhya Pradesh) was conducted. Firstly, relatively low and high performing CHWs were identified, and their stakeholders were selected through purposive sampling. A total of twenty in-depth interviews of CHWs, including their stakeholders, and two focused group discussions with nineteen participants were conducted. Manual thematic analysis was used to summarise the drivers of CHWs' performance. The 4 Cs subjective realistic model was created. The 4Cs of the model stand for the context of the shared responsibility; the clashes experienced by the CHWs (while working with their peers), complications and subsequent coherent measures from the stakeholders' perspective.</p><p><strong>Results: </strong>The drivers of CHWs' performance were broadly constituted by three categories: contextual level, health system level and intrinsic contentment. The contextual factors include transport availability, community behaviour and heterogeneity in population. The determinants of health system were irregular incentives, scarcity of drugs, lack of peers' support, patronage and benefaction. The intrinsic contentment was represented with sense of lack of recognition, family issues and natural causes. As per the realistic model, the clashes were related to network and transport availability, concurrent surveys, irregular incentives and peer support. These clashes led to the incompletion of tasks by CHWs which further resulted in supervisory challenges for the peers. The coherent measures suggested includes strengthening of supportive supervision and availability of regular incentives and transport.</p><p><strong>Conclusion: </strong>The CHWs' performance was a derivation of inherent context, which was bidirectionally influenced by health systems concerns. The stakeholders' interviews led to in depth understanding of the challenges faced by CHWs thereby adding validity to the qualitative inquiry.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"179"},"PeriodicalIF":2.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and facilitators to implementing a technology-enhanced psychiatric collaborative care model among rural primary care sites: a mixed-methods implementation case study.","authors":"Ryan Kruis, Emily Johnson, Constance Guille, Candace Sprouse-McClam, Andrew Alkis, James McElligott, Jillian Harvey","doi":"10.1186/s12875-025-02839-5","DOIUrl":"10.1186/s12875-025-02839-5","url":null,"abstract":"<p><strong>Background: </strong>Psychiatric collaborative care management (CoCM) has potential to mitigate the challenges rural communities face accessing behavioral health (BH) services. However, implementation of CoCM in rural clinics has proved difficult and may benefit from a tailored approach. This study examines implementation of a telehealth-enabled CoCM program in four rural South Carolina clinics guided by the Dynamic Adaptation Process (DAP), with particular focus on identifying barriers, facilitators, and strategies to support implementation.</p><p><strong>Methods: </strong>This study used a mixed-methods, embedded, chronological case study approach, integrating several data sources collected longitudinally during implementation. Data included surveys, focus groups, key informant interviews, and administrative data. Data were integrated using a weaving approach to develop summaries of each of the DAP phases of program implementation (Exploration, Preparation, Implementation, Sustainment).</p><p><strong>Results: </strong>Initial Exploration implementation activities included workflow development, telehealth platform configuration, building the CoCM provider team, and conducting an assessment among implementation clinics. Scarcity of BH resources was the primary barrier to rural BH treatment, leading to strong anticipated fit of the CoCM pilot among providers. These data informed activities and adaptations in subsequent phases. During the Preparation phase, the CoCM team was trained and site visits were conducted by the remote care manager to build rapport with clinic staff. In Implementation, the pilot launched, receiving 296 referrals and 99 patient enrollments in the first eight months. Post-implementation feedback showed strong provider satisfaction. Patient need, patient interest, and provider engagement with the care manager were identified as the primary facilitators for referral. During the Sustainment phase, workflow, technology, and auditing process improvements took place alongside planning for future program expansion.</p><p><strong>Conclusionl: </strong>The DAP shows great utility for tailoring implementation of CoCM to specific rural settings by providing a roadmap for identifying contextual barriers and facilitators that can be addressed through adaptation and other implementation strategies.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"177"},"PeriodicalIF":2.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potentially inappropriate medication use and comorbidity in association with quality of life in community-dwelling older people: a cross-sectional study in Iran.","authors":"Maryam Shirdozham, Awat Feizi, Majid Rahimi","doi":"10.1186/s12875-025-02882-2","DOIUrl":"10.1186/s12875-025-02882-2","url":null,"abstract":"<p><strong>Background: </strong>Multimorbidity, polypharmacy, and potentially inappropriate medication use in older adults are prevalent and affect their quality of life. This study investigates the interrelationship between potentially inappropriate medication use, comorbidity, and quality of life among older adults in Iran.</p><p><strong>Methods: </strong>This cross-sectional study was conducted on 500 older adults in Isfahan City, Iran. The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, a health-related quality-of-life questionnaire for older adults, and the Charlson Comorbidity Index were used to gather data.</p><p><strong>Results: </strong>Our findings related to older adults living in the Isfahan community showed that the prevalence of PIM was 61.6%, and the most common drug category was painkillers. The average quality of life score was (0.86 ± 0.08), and the worst category was related to sleep status. The average score of the CCI was 3.63 ± 1.40, with the most frequent diseases being hyperlipidemia, hypertension, and diabetes. After adjusting for confounding variables, a negative relationship between CCI (B = -0.009 [SE = 0.0027], P < 0.001) and PIM (B = -0.03 [SE = 0.007], P < 0.001) with quality of life was observed.</p><p><strong>Conclusion: </strong>Potentially inappropriate medication uses and comorbidities are high in our older population, and these variables are negatively associated with quality of life in this population. There are few family physicians trained in geriatrics in Iran. Policymakers should pay attention to these issues.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"175"},"PeriodicalIF":2.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}