BMC primary care最新文献

{"title":"Facilitators of good consultations in primary health care clinics in Botswana: a qualitative study of patients' and doctors' views.","authors":"V Setlhare, S Madiba","doi":"10.1186/s12875-026-03473-5","DOIUrl":"10.1186/s12875-026-03473-5","url":null,"abstract":"<p><strong>Background: </strong>The behaviours and attributes of doctors affect the quality of consultations. Although good consultations improve the quality of care, there is a dearth of evidence on factors that facilitate good consultations.</p><p><strong>Aim: </strong>The aim of the study was to explore factors that facilitate good consultations in Botswana public primary healthcare (PHC) clinics from the perspective of doctors and patients.</p><p><strong>Setting: </strong>We conducted the study in public (PHC) clinics in four health districts of Botswana. Patients with a wide range of acute and chronic diseases sought health care from these clinics. Nurses, pharmacists, and non-specialist doctors were some of the healthcare (HCWs) who gave services to these patients.</p><p><strong>Methods: </strong>This was a qualitative study in which consenting adult participants (doctors and patients) with consultation experience were purposively selected to ensure variety in age, gender, work experience, place of residence, education and employment status. Participants were recruited from public PHC clinics in several health districts in Botswana. Audiotaped semi-structured interviews were used to collect data, until saturation. Data were analysed for themes.</p><p><strong>Results: </strong>Seventeen doctors and 32 patients participated in this study. Thematic analysis of the data showed that participants thought the facilitators of good consultations were, creating a conducive environment for the consultation, providing enough time for the consultation, continuity of care, effective communication, and creating an environment to maintain confidentiality.</p><p><strong>Conclusion: </strong>The facilitators of good consultations included creating rapport between doctors and patients, improving the ambience of the consultation rooms, ensuring continuity of care, maintaining effective and mutually acceptable communication, and satisfying patients' desire for the confidentiality of consultations. On deep reflection, we can see that these facilitators are subject to central government, local government, clinic, and individual level factors. These factors interact with each other and are subsumed in a complex interactive health system.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13647736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148426927","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":"Even the COVID-19 pandemic didn´t change anything: insights from a trend study on the cooperation of general practitioners and occupational health physicians in Germany.","authors":"Monika A Rieger, Anke Wagner, Martina Michaelis, Stefanie Joos, Stefan Wilm","doi":"10.1186/s12875-026-03463-7","DOIUrl":"10.1186/s12875-026-03463-7","url":null,"abstract":"<p><strong>Background: </strong>The working fields of general practitioners (GPs) and occupational health physicians (OHPs) overlap manifoldly. Yet, cooperation between both groups is often scarce as has been revealed by studies from several countries. During the COVID-19 pandemic, GPs dealt with many work-related counselling topics. We conducted a trend study surveying German GPs and OHPs in 2014/2015 (GPOP-0 study) and 2023/2024 (GPOP-Trend) to analyse trends regarding a potential change of attitudes towards interdisciplinary cooperation over time, before and after the COVID-19 pandemic.</p><p><strong>Methods: </strong>The trend study used repeated cross-sectional surveys and an identical questionnaire for GPs and OHPs, which was sent by postal mail to both groups. The questionnaire covered topics regarding cooperation and attitudes towards both professional groups, as well as questions to assess the perceived quality of cooperation with regard to counselling purposes specific for the COVID-19 pandemic (only in GPOP-Trend). The statistical analysis followed a prior published analysis plan, and comprised an exploratory factor analysis, Mann-Whitney U tests, and regression analyses.</p><p><strong>Results: </strong>More than 1,000 physicians took part in both surveys (GPOP-0: 585 GPs and 473 OHPs, response rate 35%; GPOP-Trend: 482 GPs and 532 OHPs, response rate: 30%). We identified hardly any cooperation between these two groups during the COVID-19 pandemic. In cases where cooperation took place, it was rated more positively by OHPs than by GPs in retrospect. Comparing the total survey data of both time points revealed that attitudes among GPs and OHPs changed only little over time. The strongest predictor for the attitudes surveyed was the variable \"professional group\" in all regression models. This predictor was also the most relevant, when investigating the influence of different variables during the COVID-19 pandemic on attitudes towards cooperation of GPs and OHPs.</p><p><strong>Conclusions: </strong>Socialization within a professional group seems to be the determining factor, and therefore attitudes remain stable as described by Social Identity Theory. We assume that interventions that focus solely on strengthening cooperation between GPs and OHPs therefore have only a very limited effect. We therefore suggest another approach with interventions targeting primarily on patient outcomes and the design of clear interfaces or clinical pathways.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148414178","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":"Triglyceride-glucose index normalized by waist circumference and life's simple 7 to identify high-risk hypertensive patients in primary care.","authors":"Ana María Armas-Padrón, Miriam Sicilia-Sosvilla, Ana Perdomo-Ramírez, Pedro Ruiz-Esteban, Armando Torres, Domingo Hernández","doi":"10.1186/s12875-026-03457-5","DOIUrl":"10.1186/s12875-026-03457-5","url":null,"abstract":"<p><strong>Background: </strong>Hypertension affects over one billion adults and remains the leading contributor to global cardiovascular mortality. The triglyceride-glucose index normalized by waist circumference (TyG-WC) is emerging as a surrogate measure of insulin resistance and visceral adiposity, both associated with metabolic disorders and higher cardiovascular risk. Ideal cardiovascular health metrics (CVHM) from the American Heart Association's Life's Simple 7 (LS7) are strongly associated with reduced cardiovascular risk. Previous analyses from this cohort also demonstrated significant associations between LS7-derived CVHM and adverse clinical outcomes. However, it remains unclear whether TyG-WC provides additional and complementary prognostic information beyond LS7 in hypertensive patients. Therefore, the prognostic value of assessing the TyG-WC index together with the LS7 score to identify high-risk hypertensive patients in primary care remains largely unexplored.</p><p><strong>Methods: </strong>We conducted a longitudinal cohort study of 243 hypertensive adults from a primary-care center in Tenerife, Spain. Baseline TyG-WC index, LS7 metrics, anthropometric variables, biochemical parameters, and comorbidities were recorded. Outcomes included hypertension-mediated organ damage (HMOD) and related comorbidities (HRC), all-cause hospitalization, and mortality. Participants were followed for a minimum of two years, with HMOD-HRC, all-cause hospitalization, and all-cause mortality data updated through September 2025. Logistic regression analyses evaluated the independent associations of TyG-WC and CVHM with the adverse composite outcome (HMOD-HRC, hospitalization, and death).</p><p><strong>Results: </strong>Higher TyG-WC quartiles were associated with the composite outcome: OR 2.23 (Q2), 2.96 (Q3), and 5.12 (Q4) versus Q1. Associations between CVHM scores and clinical outcomes were consistent with previous findings from this cohort. Only 10.7% of participants achieved 4-5 ideal LS7 metrics, whereas 41.2% had 0-1. Higher CVHM scores were also associated with lower body mass index, waist-to-height ratio, fasting glucose, triglycerides, hs-CRP, and with a lower prevalence of diabetes and cardiovascular disease. TyG-WC increased progressively across poorer CVHM categories.</p><p><strong>Conclusions: </strong>Elevated TyG-WC independently predicted HMOD-HRC, hospitalization, and all-cause mortality. The associations observed for LS7-derived cardiovascular health metrics were consistent with previous reports from this cohort. Assessing both TyG-WC and LS7 may strengthen cardiometabolic risk stratification in hypertensive primary-care populations.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148426997","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":"Caregiver's burden and their relationship to physical activity, exercise self-efficacy, perceived exercise benefits and barriers in caregivers of children with autism spectrum disorder.","authors":"Güllü Aydın Yağcıoğlu, Ayşe Kübra Söyler, Kübra Ersoy Temiz, Turan Emre Özdemir, Berkan Torpil","doi":"10.1186/s12875-026-03468-2","DOIUrl":"10.1186/s12875-026-03468-2","url":null,"abstract":"<p><strong>Background: </strong>Caregivers of children with autism spectrum disorder (CwASD) often face high levels of stress, emotional exhaustion and physical strain due to the complex and demanding nature of caring for a child with special needs. As caregivers' well-being may contribute positively to caregiving and thus reduce caregiver burden, there is a need for studies that elucidate the factors associated with caregiver burden. Therefore, this study aims to examine the relationship between caregiving burden and physical activity, exercise self-efficacy, and perceived exercise benefits and barriers in caregivers of CwASD.</p><p><strong>Methods: </strong>The study population consisted of primary caregivers of a CwASD for at least 1 year. Caregiving burden was assessed using the Zarit Caregiver Burden Scale, physical activity using the International Physical Activity Questionnaire-Short form (IPAQ-SF), exercise self-efficacy using the Exercise Self-Efficacy Scale, and perceived exercise benefit using the Exercise Benefits/Barriers Scale. The relationship between caregiver burden and other parameters was analysed.</p><p><strong>Results: </strong>The study included 55 participants. There was no relationship between caregiver burden and IPAQ-SF, exercise self-efficacy scale, and exercise benefit/barriers scale in caregivers of CwASD (p>0.05). In addition, the caregiving burden was associated with the number of children in the family and duration of care (r: 0.35; p<0.05). According to linear regression, the overall model was not statistically significant (p>0.05) and explained 16.7% of the variance in caregiver burden.</p><p><strong>Conclusions: </strong>The current findings suggest that the burden experienced by caregivers of CwASD may be influenced by factors beyond those related to physical activity. Further research is needed to identify additional determinants of caregiver burden and develop more targeted support approaches.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148426983","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":"Knowledge improvement on premarital HIV counseling with PAUSE^© flipchart versus conventional method: a cluster randomised controlled trial.","authors":"Aznida Firzah Abdul Aziz, Magaletchumi Chelladorai, Chai Eng Tan, Leelavathi Muthupalaniappen","doi":"10.1186/s12875-026-03469-1","DOIUrl":"10.1186/s12875-026-03469-1","url":null,"abstract":"<p><strong>Introduction: </strong>Premarital HIV testing was made mandatory for Muslim couples in Malaysia as an effort to curb the transmission of HIV. The PAUSE© flipchart is a Malay language counselling tool to facilitate consistent and effective pre-test counselling for premarital couples. This study evaluates the effectiveness of the PAUSE© flipchart versus conventional methods in enhancing HIV knowledge at public primary healthcare clinics in Johor Bahru.</p><p><strong>Methods: </strong>A parallel cluster randomised controlled trial was conducted among adult Malay-literate clients who registered for mandatory premarital HIV testing. Cluster randomisation was used to select 8 public primary healthcare clinics from Johor Bharu District to be allocated into intervention and control groups. Clients in the intervention group (n = 90) received counselling using the PAUSE^© flipchart, whereas clients in the control group (n = 90) received routine verbal counselling. HIV knowledge was assessed using the Malay HIV Knowledge Questionnaire before and after counselling. Understandability of the PAUSE^© flipchart was evaluated using the Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P) among clients in the intervention group.</p><p><strong>Results: </strong>Both groups showed significant increases in HIV knowledge post-counselling (p < 0.001). The intervention group had a mean score increase of 6.99 (95% CI [6.01, 7.97]), significantly higher than the control group's 3.99 (95% CI [2.89, 5.09]). Post-counselling scores were higher in the intervention group [mean 19.99 (SD = 1.26) vs. 16.59 (SD = 4.41), p < 0.001]. The PAUSE^© flipchart demonstrated high understandability with a mean score of 95.92 (SD:7.15) among clients.</p><p><strong>Conclusion: </strong>The PAUSE^© flipchart is a highly acceptable, user-friendly, and more effective alternative to conventional premarital HIV counselling, warranting adoption in primary care to standardize and strengthen client education.</p><p><strong>Trial registration: </strong>This trial was retrospectively registered with the Australian New Zealand Clinical Trials Registry on 26 June 2024 (ACTRN12624000788572).</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148414215","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":"Sustainable implementation of practice-based research networks in primary care: a qualitative process evaluation of the Bavarian Research Practice Network (BayFoNet).","authors":"Linda Sanftenberg, Ulrike Stark-Felbinger, Stefanie Eck, Antonius Schneider, Peter Konstantin Kurotschka, Ildikó Gágyor, Stefanie Stark, Thomas Kühlein, Fabian Walter, Marco Roos, Tobias Dreischulte, Jochen Gensichen","doi":"10.1186/s12875-026-03459-3","DOIUrl":"10.1186/s12875-026-03459-3","url":null,"abstract":"<p><strong>Background: </strong>To expand research in general practice, the development of practice-based research networks (PBRNs) has increased considerably in Germany over the last years. In order to implement these structures sustainably and effectively in primary care, it is important to understand the perspective of the GP teams on their role and their experiences in conducting clinical studies within PBRNs. The aim of this analysis was to examine the experiences of GP teams after the implementation and conduct of clinical studies within in the Bavarian Practice-Based Research Network (BayFoNet) retrospectively to derive insights for a sustainable implementation of a German PBRN in primary care.</p><p><strong>Methods: </strong>We conducted semi-structured interviews based on the theoretical concept of the \"Consolidated Framework for Implementation Research\" with practices, which were already members of BayFoNet. The verbatim transcripts were analysed based on Kuckartz's qualitative content analysis.</p><p><strong>Results: </strong>Interviews were conducted with 16 GPs and one medical assistant (MA). As main drivers for a sustainable implementation of a primary care based PBRNs could be identified aspects of intervention characteristics (study design and a research question), the inner setting (teamwork), individual aspects (professional training) as well as facilitators on the level of the outer setting (contribution to evidence and quality). As barriers we identified a reduced interest of the study participants early processes (preparatory steps and participation) as well as missed networking options among peers (inner setting).</p><p><strong>Discussion: </strong>The perspective of the GP teams within our process evaluation confirmed some already known aspects, like the importance of professional development of the practice staff, contribution to evidence, quality and strength in general practice and networking needs. As increasing research-specific experience with clinical research sharpened their needs and requirements, desired processes of participation and the role of non-physician staff in PBRNs have to be further elaborated.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13355365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148414232","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":"Living labs as catalysts for integrated primary care: insights from a comprehensive community survey and co-creative design of community-based prevention and primary care.","authors":"Nele A J De Witte, Kim Helsen, Sascha Vermeylen, Hilde Vandenhoudt, Ingrid Adriaensen, Lieven Janssens, Vicky Van der Auwera","doi":"10.1186/s12875-026-03467-3","DOIUrl":"10.1186/s12875-026-03467-3","url":null,"abstract":"<p><strong>Background: </strong>Societal changes in terms of healthcare needs call for adaptations in the organisation of primary care. Policies and services need to be aligned to communities' needs and a shift towards inclusive integrated care is warranted. However, stakeholder consultation is often limited and does not sufficiently take health literacy into account. To design integrated primary care, we need to gain insight into the characteristics and needs of communities regarding health, health literacy, and health service requirements. Additionally, we need to go beyond assessment and involve relevant stakeholders (including residents in a situation of vulnerability) in co-designing future-oriented and innovative primary care services and prevention activities.</p><p><strong>Methods: </strong>The current project consists of two studies. First, a large cross-sectional survey study was conducted to gain insight into health, health literacy, and preferences for primary healthcare and prevention in a Belgian community. The second study describes an extensive collaboration between a living lab and a local government to design multidisciplinary integrated care services in the community and includes co-creations and further survey data collection.</p><p><strong>Results: </strong>A total of 1078 residents participated in the first study. Perceived health, loneliness and demographic variable were interrelated. Health literacy was associated with age, education, perceived general health, perceived mental health, and loneliness. Participants indicated a need for multidisciplinary healthcare services and endorsed involvement of community policymakers. The multi-step process of the second study, including residents, vulnerable citizens and health professionals, led to tailored insights regarding local strategic actions to promote high-quality future-proof integrated primary care.</p><p><strong>Conclusions: </strong>Targeted recruitment for a community survey and co-creation sessions allowed for the inclusion of a large and rich sample to inform on local healthcare needs and define priorities for future-oriented health care initiatives to the local government. Community participation guided the design and implementation of structurally embedded primary care services and prevention activities. Researchers and policymakers from the wider community can use study processes and results as inspiration for inclusive healthcare redesign.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13640197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148414235","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":"Assessing the performance of Hungary's primary health care system during the COVID-19 pandemic: findings from the cross-sectional PRICOV-19 study.","authors":"Zoltán Lakó-Futó, Krisztián Vörös, Esther van Poel, Sara Willems, Péter Torzsa","doi":"10.1186/s12875-026-03429-9","DOIUrl":"10.1186/s12875-026-03429-9","url":null,"abstract":"<p><strong>Background: </strong>Primary care (PC) has played a crucial role in the fight against the COVID-19 epidemic. The novel challenges have significantly increased the workload for PC workers, leading to negative impacts on their mental health. Hungarian primary care is in the early stage of moving from solo practices to primary health care teams, while the number of elderly physicians increases quickly. The PRICOV-19 study is a multicenter study in 38 countries that comprehensively assesses the performance of PC during the pandemic. This article focuses on the impact of COVID-19 epidemic on resilience and adaptability of PC in Hungary, during the time of structural change.</p><p><strong>Methods: </strong>The questionnaire was sent online to PC practices between April and August 2021 as email links. The 53 questions of the survey were structured around six themes: infection control, patient flow, information acquisition (protocols and knowledge acquisition), patient communication, collegial cooperation, and quality of life of the care workers. To measure the well-being of care workers, the validated Mayo Clinic Wellbeing Index was used.</p><p><strong>Results: </strong>Respondents of the study reported notable limitations to their work environment (91, 4%). In response to these challenges, there was a significant increase in implementation of telemedicine rising from 15.3% before COVID to 36.7%. Almost all PC workers reported a substantial surge in their workload during the pandemic (96.7%). Furthermore, many of them (37.8%) expressed the need for additional training to manage the unprecedented challenges posed by the pandemic. These new tasks had a worrisome impact on PC workers, with 55.2% of respondents expressing concern about the increased workload, and 69% experienced some degree of distress. Longer work experience was associated with better adaptation and better quality of life.</p><p><strong>Conclusion: </strong>The COVID-19 pandemic brought a substantial change in primary car in Hungary, in terms of patient flow, information exchange and communication. While the feeling of being not prepared and lower well-being was common among GPs, adaptation in task shifting and protocol driven telemedicine appeared, especially among more experienced physicians. The process of adjustment in challenging times could be fostered by unambiguous central measurements and through adequate training.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"24 Suppl 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13688806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148414204","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":"Practice-based cardiovascular research in rural primary care: research priorities and implementation insights.","authors":"Signe Burchim, Susan G Miller, Kristin Beima-Sofie, Angela G Spencer, Brekken Selah, Monica Zigman Suchsland, Elena Wadden, Adiya Jaffari, Allison Cole, Steven Elrod, Margaret A Gehring, Ryan Gilles, Charles G Jose, Kelly McGrath, Russell T Baker, Christopher T Longenecker","doi":"10.1186/s12875-026-03451-x","DOIUrl":"10.1186/s12875-026-03451-x","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular disease is the leading cause of death in the United States, and cardiovascular mortality is higher in rural areas than in urban areas. However, innovations in cardiovascular care are typically produced in urban areas where social structures and culture can differ from those of rural areas.</p><p><strong>Methods: </strong>From 2023 to 2024, we surveyed rural-serving primary care health care workers and cardiologists (n = 31) and rural patients (N = 14) in Alaska, Idaho, and Washington about their priorities for cardiovascular health services and disease research in rural areas. We also conducted semi-structured interviews with 27 of the health care workers we surveyed to explore their prior experiences with barriers to and facilitators of intervention implementation. We summarized the quantitative survey results with descriptive statistics and write-in responses using content analysis. To analyze the qualitative interview results, we used thematic analysis.</p><p><strong>Results: </strong>The highest rated research priorities focused on developing data sharing systems for rural clinics and hospitals and strengthening regional connections to support cardiovascular care. Patients also prioritized increasing health insurance coverage in rural communities. Both patients and health care workers rated studying the use of telemedicine and digital tools as their lowest priority but wrote in various technology-related topics as top research priorities. When evaluating key influences on previous implementation experiences, the interview participants highlighted factors including the need for time, money, and dedicated staff to run interventions; organization and provider buy-in; opportunities to partner with other organizations; and the importance of considering patients' perspectives and needs.</p><p><strong>Conclusions: </strong>Rural patients and rural-serving health care workers prioritize cardiovascular research areas that are patient-focused, focus on technology that is feasible in the rural context, and aim to increase resources in rural communities. Funding for rural health care and improving rural healthcare provider shortages remain key issues. However, partnering with other organizations may be a means to support intervention implementation in rural clinics.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392677","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":"Saying goodbye to my doctor: a qualitative study on the experiences of chronically ill patients when facing the termination of a long-term treatment relationship in Hong Kong.","authors":"Judy Yuen-Man Siu","doi":"10.1186/s12875-026-03456-6","DOIUrl":"10.1186/s12875-026-03456-6","url":null,"abstract":"<p><strong>Background: </strong>Having a family doctor is beneficial for patient care. However, it is not uncommon for a treatment relationship to be terminated. Doctors are suggested to implement proper transition procedures should this occur. Nevertheless, the literature shows that patients suffer harm even when a doctor has organized a care transition. Few studies have suggested appropriate procedures for how doctors should transition care upon the ending of the doctor-patient relationship, and the impact on patients following treatment relationship termination has been rarely documented. This study fills the literature gap by investigating a group of chronically ill patients in Hong Kong on how they experienced the termination of a long-term treatment relationship by their family doctors.</p><p><strong>Methods: </strong>This study adopts an explanatory model and critical medical anthropology as the theoretical framework and employs a qualitative descriptive approach with individual semi-structured interviews. The interviews were conducted from June to September 2025 to investigate the experiences of 35 chronically ill patients following the termination of the treatment relationship initiated by their familiar doctors. The coding and analysis of the data were based on a thematic analysis.</p><p><strong>Results: </strong>The experiences of the participants were negative and unpleasant when their treatment relationship was terminated by their doctors. Five themes were derived from the data as follows: feeling uncertain about future care, feeling guilty for the new doctor, feeling abandoned, having no motivation to find a new long-term doctor, and feeling incomplete without a formal goodbye. The international guidelines suggest that doctors mostly emphasize legal and ethical procedures to reduce their legal liability when they terminate a treatment relationship, but the participants expected a humanistic and emotional approach when the treatment relationship was terminated.</p><p><strong>Conclusion: </strong>Micro experiences of the participants could be due to the macro social structure of Hong Kong society. Merely organizing a care transition, which is the current medical guideline and practice when a treatment relationship has to be terminated, may not be enough for patients in this Chinese context. Care transition plans are suggested to emphasize emotional adaptation preparation, as some participants' accounts suggest the importance of symbolic closure resembling ritual transition.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13625427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148400034","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}