BMC primary care最新文献

{"title":"Considerations in referring older patients to hospital in acute situations: a qualitative study based on the experiences of healthcare providers.","authors":"Cindy Cardol, Britt Wagenaar, Hanneke Merten, Yvonne de Man, Jeroen Hasselaar, Linda van Eikenhorst, Cordula Wagner","doi":"10.1186/s12875-026-03453-9","DOIUrl":"10.1186/s12875-026-03453-9","url":null,"abstract":"<p><strong>Background: </strong>Hospital referral in acute situations is a complex process with a significant impact on older adults. This study aims to explore the considerations of healthcare providers from both primary and secondary care when deciding whether or not to refer an older patient to the hospital in acute situations. By including perspectives of different health care providers, this study seeks to provide a more comprehensive understanding of the decision-making process.</p><p><strong>Methods: </strong>In February 2025, three online semi-structured focus group discussions were conducted with 16 primary and secondary healthcare providers. Three case studies (two hip fractures, one COPD exacerbation) guided the discussion. Data were analysed using a combination of inductive and deductive thematic analysis and were iteratively clustered and visualized around four key consideration factors.</p><p><strong>Results: </strong>Twenty subthemes were identified and mapped onto four overarching main themes, corresponding to the four key consideration factors: patient-related (e.g. network, quality of life, patient and family preferences, emotional status and living situation), healthcare provider-related (e.g. professional attitude, collaboration and familiarity with patients), case-specific (e.g. age, medical history, activities of daily living (ADL) and mobility, cognitive functioning, frailty, prognosis, the acuity of situation, alternative treatment, and risk of complications) and structural factors (e.g. ability to arrange appropriate care and the patients' increasing care demand).</p><p><strong>Conclusions: </strong>Decision-making in hospital referrals is not determined solely by the acute condition, but is a complex and dynamic process. This highlights the importance of strengthening interprofessional communication and collaboration, addressing the shortages in the availability of appropriate patient care, and extending advance care planning (ACP) practices by involving family members to support more patient-centred referral decisions.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13584258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148537841","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":"Changes in publicly insured general practitioner consultations before and after workplace injury: interrupted time series by consultation duration and care plans in Australia.","authors":"Preeti Maharjan, Michael Di Donato, Daniel Griffiths, Danielle Mazza, Alex Collie","doi":"10.1186/s12875-026-03477-1","DOIUrl":"10.1186/s12875-026-03477-1","url":null,"abstract":"<p><strong>Background: </strong>General practitioners (GPs) are central to the treatment and management of injured workers. Australian workers' compensation funds GP consultations for work-related injuries. Almost all other GP consultations are subsidised by public healthcare insurance (Medicare Benefit Scheme). This study aimed to examine changes in publicly-insured GP consultations before and after injury for injured workers with long-duration claims, focusing on consultation duration types and GP-provided mental health and chronic diseases management plans.</p><p><strong>Methods: </strong>This retrospective cohort study using interrupted time series analysis included 3,755 injured workers and 10,113 community individuals with injury/index date between 2006 and 2016. We compared monthly changes in rates (per 1000 workers) of six GP consultation types for 12-month before and 24-months after injury. Acute and long-term changes were examined both overall (combining all consultation types) and separately by consultation type. Consultation types include four duration-based levels: A (0-6 min), B (6-20 min), C (20-40 min), and D (40-60 min), and two types describing mental health and chronic disease management plans.</p><p><strong>Results: </strong>After injury, injured workers received an additional 1,600 Medicare-subsidised GP consultations per 1,000 workers per year compared to the community group. Post-injury, the largest increase in monthly consultation rates was observed for Level D consultations (IRR: 2.37, 95% CI: 1.35, 4.20), while the smallest increment was observed for Level B consultations (IRR: 1.45, 95% CI: 1.32, 1.59). Monthly GP mental health care and chronic disease development plan rates increased by 84% (IRR: 1.84, 95% CI: 1.17, 2.93) and 20% (IRR: 1.20, 95% CI: 0.78, 1.86) post injury, respectively; however, the monthly rates of these consultations were small (maximum 25/1000 workers) Following these initial increases immediately post-injury, monthly consultation rates decreased by 3% to 9% and by 24-months post-injury had returned to levels observed in the comparison group.</p><p><strong>Conclusion: </strong>All six types of publicly insured GP consultations increased temporarily in the initial months following injury, regardless of worker's compensation status. These consultations remained elevated above pre-injury levels for over 12 months, likely reflecting delayed claim acceptance or increased care needs. These findings highlight the need of a comprehensive, whole-person approach to recovery that addresses both immediate and broader healthcare needs.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148498400","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":"Association of food insecurity with physical and mental health in primary care: a cross-sectional study in Ankara, Turkey.","authors":"Hakan Tüzün, Kadir Serdar Yılmaz, Cansu Özbaş, Özge Tonbuloğlu Altıner, Müberra Erkaya Tosun","doi":"10.1186/s12875-026-03483-3","DOIUrl":"10.1186/s12875-026-03483-3","url":null,"abstract":"<p><strong>Background: </strong>Food insecurity (FI) is the inability to consume adequate diets for a healthy and active life, mainly due to structural causes. It aimed to examine the association between FI with physical and mental health-related quality of life (HRQoL).</p><p><strong>Methods: </strong>It was implemented through face-to-face interviews with individuals selected by convenience sampling who applied to selected Family Health Centers in Sincan/Ankara. A logistic regression model was created to examine factors related to FI. Linear regression models of Physical Component Summary (PCS-12) and Mental Component Summary (MCS-12) scores of SF-12 (Short Form 12) were created. Independent factors of models include socioeconomic factors and the presence of non-communicable diseases (NCDs).</p><p><strong>Results: </strong>The prevalence of mild, moderate, and severe FI was 14.3%, 14.7%, and 9.3%, respectively. The risk of FI is higher in the lowest-income group (aOR: 12.416) and the income group immediately above it (aOR: 6.573) than in the highest-income group. In the fully adjusted linear regression model including socioeconomic variables and the presence of non-communicable diseases (NCDs), severe FI was associated with lower PCS-12 scores compared with food security (β = -0.079, p < 0.01). Mild (β = -0.174, p < 0.001), moderate (β = -0.217, p < 0.001), and severe FI (β = -0.233, p < 0.001) were associated with lower MCS-12 scores, showing a graded association across FI severity categories.</p><p><strong>Conclusion: </strong>FI was common among primary healthcare users in this study and was most strongly associated with low income. The persistence of the association between severe FI and physical HRQoL after adjustment for NCDs underscores FI's relevance to physical HRQoL in primary care populations. Its negative association with mental HRQoL was stronger and more consistent than that observed for physical HRQoL, underlining its importance for community mental health. Integrating FI screening and developing primary care-based interventions may help mitigate its adverse effects.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148474400","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":"Self-reported infections in Norway: a study of incidence, doctor visits, antibiotic use, and absence from work.","authors":"Ingrid K Rebnord, Knut Erik Emberland, Ingeborg Forthun, Siri Waage, Guri Rortveit, Bjørn Bjorvatn","doi":"10.1186/s12875-026-03478-0","DOIUrl":"10.1186/s12875-026-03478-0","url":null,"abstract":"<p><strong>Background: </strong>Infections are common and frequently lead to doctor visits, use of antibiotics, and absence from work.</p><p><strong>Objective: </strong>To investigate frequency of different self-reported infections and the impact on doctor visits, antibiotic use, and absence from work.</p><p><strong>Method: </strong>A cross-sectional study based on an online survey in Norwegian primary care, focusing on infections. Individuals between 25 and 70 years of age, were recruited by general practitioners (GPs) through the Norwegian Primary Care Research Network. The respondents reported different types of infections they had experienced in the last 3 months, and if the infection resulted in a GP visit, use of antibiotics or absence from work. Descriptive analyses were used to estimate proportions and multivariate logistic regressions to assess predictors for absence from work.</p><p><strong>Results: </strong>In total, 74.5% of the respondents reported to have experienced an infection during the last 3 months. Respiratory infections were reported by 63.7%, among these cases, 50.9% reported common cold (95% CI 47.6-54.2), 31.5% influenza-like illness (95% CI 28.4-34.5) and 17.9% COVID-19 (95% CI 15.2-20.5). Among those reporting respiratory tract infections, only 18.6% (95% CI 16.4-20.8) visited a GP. Bronchitis/pneumonia most often led to a GP visit (52.8%, 95% CI 36.3-71.0) and antibiotic prescription (25.0%, 95% CI 11.5-40.7). Respiratory tract infections and gastrointestinal infections had the greatest impact on sickness absence from work. Of these, COVID-19 was the strongest predictor for absence from work (OR 9.29, 95% CI 5.8-14.8).</p><p><strong>Conclusion: </strong>Respiratory tract infections were the most common type of self-reported infection, and while only one in five visited the GP, the impact on work absence was large. COVID-19 gave the greatest risk of absenteeism.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660301/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148474413","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":"Patient-specific variables predicting triage outcomes of ear, nose, throat referrals from primary care for dysphonia.","authors":"Christopher Payten, Duy Duong Nguyen, Kelly Weir, Catherine Madill","doi":"10.1186/s12875-026-03435-x","DOIUrl":"10.1186/s12875-026-03435-x","url":null,"abstract":"<p><strong>Background: </strong>Patients with dysphonia are referred to Speech-Language Pathologists (SLP) or Ear Nose and Throat (ENT) surgeons from General Practitioners (GPs) for specialist assessment. Accurate referral information is needed to determine the assessment-pathway and priority. This study aimed to examine which patient-specific information provided in GP referral documents predicted clinicians' triage outcomes.</p><p><strong>Methods: </strong>This was an IRB-approved retrospective study of electronic medical records of 150 voice-disordered adults aged ≥ 18 years referred to a tertiary hospital specialist ENT department between March 1, 2019, and July 1, 2020. Data collected included demographics, voice symptoms, risk factors, and medical history. ENT clinicians triaged all patients to either SLP or ENT assessment-pathway and recommended a priority categorisation. The predictive values of documented information in the referral on assessment triage outcome were analysed using logistic regression.</p><p><strong>Results: </strong>Eighty referrals reported hoarseness as the only symptom, only eight reported three or more symptoms. Female gender, previous smoking history, and current smoking history significantly predicted the ENT-pathway for initial assessment. The same variables plus previous thyroid surgery significantly predicted triage to high-priority assessment. However, a quarter of referral letters did not include information about smoking and alcohol consumption.</p><p><strong>Conclusion: </strong>Gender and smoking history were significant predictors of triage outcomes. No significant association was found between referral symptoms and the triage outcomes. The exclusion of relevant lifestyle and health information likely impacted decision-making at triage. More detailed information specific to voice disorder risk factors included in GP written referrals may provide critical missing details required to prioritise referrals accurately.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148474398","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":"Differences in patient-reported outcomes across multimorbidity profiles in primary care: evidence from the first cycle of the OECD Patient Reported Indicator Surveys (PaRIS).","authors":"Candan Kendir, Nicolas Larrain, Michael van den Berg, Frederico Guanais, Niek Klazinga, Dionne Kringos, Mieke Rijken, Jose M Valderas","doi":"10.1186/s12875-026-03460-w","DOIUrl":"10.1186/s12875-026-03460-w","url":null,"abstract":"<p><strong>Background: </strong>Multimorbidity is a growing challenge for healthcare systems worldwide, yet policymakers and healthcare professionals often lack evidence on how distinct multimorbidity profiles (capturing co-occurrence of chronic conditions) relate to patient-reported outcomes and experiences. This study examines how mutually exclusive multimorbidity profiles are associated with physical health, mental health, and well-being and whether these associations are modified by healthcare experiences.</p><p><strong>Methods: </strong>We analysed data from 102 786 primary care patients aged ≥ 45 years participating in the OECD Patient-Reported Indicator Surveys (PaRIS) across 19 countries (2023-2024). Self‑reported chronic conditions were grouped into five mutually exclusive multimorbidity profiles. Physical and mental health outcomes were assessed using PROMIS^® Global Health T-scores, and well-being using WHO-5 Well-being Index. Multilevel mixed-effects models estimated associations between multimorbidity profiles and outcomes, controlling for age, gender, education and number of chronic conditions. Interactions with patient-reported person-centredness and continuity of care were examined.</p><p><strong>Results: </strong>Multimorbidity profiles showed differences in self-reported health, with profiles including mental health conditions associated with both poorer physical and mental health outcomes. Compared with the cardiometabolic-only reference group, physical health scores were significantly lower among patients with cardiometabolic + mental + other (b=-2.07) and mental and/or other‑only profiles (b=-2.94) (p < 0.05). Profiles including mental health conditions were associated with lower scores on mental health outcomes. Well‑being was similarly poorer, with the largest declines observed in cardiometabolic + mental (b=-12.65) and cardiometabolic + mental + other profiles (b=-12.08). While person‑centredness was positively associated with all health outcomes, it did not meaningfully modify the relationship between the health outcomes and multimorbidity profiles, with only limited interaction effects observed. Continuity of care showed overall limited effects.</p><p><strong>Conclusion: </strong>Differences in patient-reported outcomes suggest that health systems may need to better adapt to the needs of people with multimorbidity. Profiles involving mental health conditions are associated with poorer patient‑reported outcomes, stressing the importance of implementing person-centred integrated care models within primary care and beyond. Investing in systems that systematically assess patient-reported outcomes among people with multiple chronic conditions in primary care may support policymakers and practitioners in improving care delivery.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656520/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148474386","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":"Theories and theoretical frameworks used in general practice career choice research: a scoping review.","authors":"Faith Yong, Jordan Fox, Priya Martin, Matthew McGrail","doi":"10.1186/s12875-026-03475-3","DOIUrl":"10.1186/s12875-026-03475-3","url":null,"abstract":"<p><strong>Background: </strong>The number of medical graduates choosing to specialise as a general practitioner (GP) has not kept pace with need. Understanding how GP specialisation decisions are made has never been more critical. To date, much of the literature in GP specialisation choice is pragmatic and practice-focused, less strongly underpinned by existing theories or theoretical frameworks relating to the decision-making process of medical students or junior doctors. Our aim was to scope the evidence on the use of theories and theoretical frameworks in general practice career choice selection research.</p><p><strong>Methods: </strong>The review was conducted and reported in accordance with JBI guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). PubMed, Web of Science, Embase, and Scopus databases were searched. Only contexts where specialty decisions mostly occur after medical school graduation (e.g. Australia, United Kingdom) were considered for inclusion. Titles and abstracts of all articles were dual-screened against inclusion criteria, followed by full text review of articles.</p><p><strong>Results: </strong>After removing duplicates, 2,396 titles and abstracts were screened followed by full-text review which identified 30 studies meeting the inclusion criteria. Of these, eight were from Australia, 20 from the UK, one from New Zealand, and one was multi-national. Most studies utilised qualitative methodology (N = 21) or mixed methods (N = 6). These draw from 15 distinct theories/frameworks, while 15 studies explained implicit theories. Twenty-two studies produced some form of theory or framework as an outcome within the study. Subsequent citation of these frameworks has generally been low. There was clear agreement that GP career decision-making was complex.</p><p><strong>Conclusions: </strong>Our review identified the application and production of many different frameworks relating to GP specialty decision making, both from adapting explicit theories from a range of disciplines and professions, and identification of implicit theories. Researchers undertaking future studies around general practice career decisions are encouraged to utilise and build upon existing theories and frameworks, rather than creating new ones, to avoid duplication of results.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148474362","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":"General practice workforce retention strategies: an umbrella review.","authors":"L Jefferson, S Golder, A Castro-Avila, E Webster, H Anderson","doi":"10.1186/s12875-026-03446-8","DOIUrl":"10.1186/s12875-026-03446-8","url":null,"abstract":"<p><strong>Objective: </strong>We summarise international evidence of interventions to support retention of the general practice workforce, mapping evidence by country, method and workforce group.</p><p><strong>Design: </strong>Umbrella overview of reviews. We mapped evidence according to occupational group, intervention type and outcome to identify trends and gaps. Varied study designs were included, though only reviews with evaluations of workforce interventions were included. Exploratory studies describing factors associated with retention were excluded.</p><p><strong>Setting: </strong>International primary care and general practice.</p><p><strong>Participants: </strong>General practice workforce, with studies grouped by general practitioners, nurses working in general practice and mixed health professional groups.</p><p><strong>Main outcome measures: </strong>Workforce retention, including length of employment, stability rates, settlement rates, vacancy rates, unfilled positions, turnover numbers or rates, attrition rates, intentions to stay, leave and return.</p><p><strong>Results: </strong>Of the 4,919 articles identified through database searching (Medline, Embase, PsycInfo and Medrxiv 6th February 2025) and citation tracking, we included five reviews. The majority of evidence was concentrated in Australia and the US and there was a lack of policy evaluations in some fields. While stronger evidence exists for interventions such as professional development and fostering supportive environments, mixed findings were reported on financial incentives and limited formal evaluations were found for some intervention types, and professional groups.</p><p><strong>Conclusion: </strong>This overview of research underscores the need for more research evaluating interventions to support the general practice workforce, particularly across wider international settings.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13651347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148457854","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 practitioner prescribing and patient adoption of anti-inflammatory maintenance and reliever therapy (MART) for adult asthma: a qualitative study.","authors":"Judith Dyson, Helena Cummings, Gemma Williams, Vieshal RajaGopal, Michael Watt, Tamsin Morris, Michael G Crooks","doi":"10.1186/s12875-026-03443-x","DOIUrl":"10.1186/s12875-026-03443-x","url":null,"abstract":"<p><strong>Background: </strong>Asthma was traditionally treated with separate corticosteroid (ICS) containing ('preventer') and short-acting beta-agonist (SABA; 'reliever') inhalers. But overuse of SABA-reliever inhalers is common and associated with poor outcomes. Clinical guidelines increasingly recommend using combined ICS and formoterol (ICS-formoterol) as an anti-inflammatory reliever. While ICS-formoterol use as a reliever only, without maintenance doses, has only recently been licenced in the United Kingdom; use as both preventer and reliever (Maintenance and Reliever Therapy; MART) has been recommended for many years. Despite the evidenced benefits of this approach, MART uptake in the UK has been low.</p><p><strong>Methods: </strong>We studied the barriers and facilitators to primary care practitioners' prescribing and adult asthma patients' adoption of MART. We recruited practitioners and patients from a network of general practices that had participated in the SENTINEL programme to address SABA over-use and support MART adoption. Semi-structured, theoretically underpinned interviews were conducted with both groups. Data analysis involved deductive coding to the theoretical domains framework (a comprehensive framework including all potential determinants of practitioner and health behaviours) followed by inductive coding within domains.</p><p><strong>Results: </strong>Fourteen themes were identified, with novel findings. Facilitators were practitioner knowledge and skills, and practice prescribing and appointment systems. Practitioner barriers mostly related to available resources, changes to treatment following emergency hospital presentations, and managing patient barriers to MART adoption and maintenance. Patient barriers included: psychological dependence on SABA-relievers and associated fear of discontinuation lack of understanding of the rationale for change to MART; and reluctance to change caused by concerns about difficulty getting an appointment if their asthma control deteriorated. Some practitioner barriers reported by previous studies (e.g., guideline knowledge and asthma management skills) were identified as facilitators in our study, potentially due to SENTINEL Programme participation.</p><p><strong>Conclusions: </strong>The Global Initiative for Asthma (GINA) endorse ICS-formoterol as the preferred reliever in asthma, making it vital to understand barriers and facilitators to clinician and patient adoption in practice. We identified unique and previously unreported barriers and facilitators for both groups with potential to inform strategies to support practitioner and patient concordance with anti-inflammatory reliever-based asthma treatment and implementation of evidence-based, guideline-recommended care.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148457904","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":"Scale-up evaluation results of a multi-level approach using mailed immunochemical test (FIT) and patient navigation to increase colorectal cancer screening rates in rural clinic settings.","authors":"Jessica J Currier, Jennifer Coury, Emily Myers, Erin S Kenzie, Amanda F Petrik, Brittany Badicke, Margaret McLain McDonnell, Maryan Carbuccia Abbott, Gloria D Coronado, Melinda M Davis","doi":"10.1186/s12875-026-03428-w","DOIUrl":"10.1186/s12875-026-03428-w","url":null,"abstract":"<p><strong>Background: </strong>Colorectal cancer (CRC) screening effectively reduces CRC mortality and morbidity, yet screening rates remain below US national targets in rural and low-resourcedd settings. An effective intervention to improve screening is mailed fecal immunochemical tests (FIT) combined with patient navigation. However, these multicomponent interventions have been unevenly adopted across health systems and organizations, and studies of how to spread effective system-level approaches are limited.</p><p><strong>Methods: </strong>We conducted a mixed-methods evaluation of a multi-component scale-up approach designed to increase CRC screening rates in rural, low-resourced primary care clinics, based on findings from the SMARTER CRC pragmatic trial. The approach included five scale-up activities: (1) an Extension for Community Healthcare Outcomes (ECHO) tele-mentoring program; (2) patient navigation training; (3) webinars on process design and communication strategies; (4) technical assistance; and (5) dissemination of the Colorectal Cancer Screening Outreach for Rural Populations Facilitation Guide. We measured engagement in scale-up activities, adoption of mailed FIT and patient navigation outreach, and modifications to organizations' CRC screening programs.</p><p><strong>Results: </strong>A total of 47 participants from 25 organizations participated in scale-up activities. Participants were most commonly from clinical practices (28%), hospital-based systems (24%), and community organizations (20%). All organizations participated in the ECHO series (100%, n = 25), and some also engaged in additional scale-up activities. Most organizations (84%, n = 21) reported having a CRC screening program at baseline. Engagement in ECHO and other scale-up activities influenced adoption and modification of CRC screening patient outreach strategies for most organizations (69%, n = 17). Participation led to modifications in existing programs.</p><p><strong>Conclusion: </strong>Participation in multifaceted scale-up activities increased organizational knowledge and engagement in CRC screening patient outreach within rural, low-resourced clinic settings. These activities also supported the refinement of existing CRC screening programs through the adoption and modification of outreach strategies. These findings can inform future efforts to optimize scale-up approaches for CRC screening and other complex interventions in rural, low-resourced healthcare settings.</p><p><strong>Trial registration: </strong>Registered at clinicaltrial.gov (NCT04890054) and at the NCI's Clinical Trials Reporting Program (CTRP # NCI202101032) on May 11, 2021.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148450828","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}