BMC primary care最新文献

{"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":"<p><strong>Aims of the study: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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 < 0.001).</p><p><strong>Conclusions: </strong>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.</p><p><strong>Trial registration: </strong>This trial was retrospectively registered on ClinicalTrials.gov.</p><p><strong>Trial registration number: </strong> 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}

{"title":"Coronary computed tomography angiography in primary care patients with chest pain or dyspnea - a cross-sectional study.","authors":"Erik Stertman, Fade Gabro, Mårten Sandstedt, Oleg Sysoev, Jörg Lauermann, Carl Johan Östgren, Sofia Sederholm Lawesson, Jan Engvall, Staffan Nilsson, Fredrik Iredahl","doi":"10.1186/s12875-025-02877-z","DOIUrl":"10.1186/s12875-025-02877-z","url":null,"abstract":"<p><strong>Aims: </strong>Coronary Computed Tomography Angiography (CCTA) is recommended as a first-line investigation to exclude significant coronary artery stenosis in case of low to intermediate pre-test probability (PTP). The aim was to investigate CCTA findings in relation to the PTP of patients referred directly from primary health care centres.</p><p><strong>Methods/results: </strong>In this retrospective cohort study consecutive primary care CCTA referrals in a Swedish county 1st of June 2021 until 30th Nov. 2022 were included. CCTA reports were obtained for 483 patients ≥ 30 years old, without known CAD and stratified as no CAD, with atheromatosis or with suspected significant stenosis. For the 381 patients with eligible PTP data, the mean age was 60 years and 70% were women. While the median PTP was 11%, significant stenosis was suspected on CCTA in 18%. Among patients with PTP ≤ 15%, CCTA exposed no significant stenosis in 88%. No significant stenosis was found in patients with PTP < 5% true to patient age and gender in a sensitivity analysis (n = 25).</p><p><strong>Conclusions: </strong>CCTA ruled out coronary stenosis as the cause of chest pain and dyspnea in 88% of patients referred from primary care with PTP 5-15%. PTP estimations by primary care physicians in CCTA referrals agreed with the occurrence of suspected significant stenosis among patients with PTP 5-15%, but underestimated it in PTP > 15%. The validity of PTP estimates < 5% was low.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"178"},"PeriodicalIF":2.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112864","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":"What motivates general practitioners of the future: qualitative study of Irish trainees.","authors":"Aisling Egan, Peter Hayes, Andrew O'Regan","doi":"10.1186/s12875-025-02883-1","DOIUrl":"10.1186/s12875-025-02883-1","url":null,"abstract":"<p><strong>Background: </strong>There is a worldwide shortage of general practitioners (GPs). The aim of this study is to explore the perspectives of GP trainees and to understand their motivators and career priorities to inform future GP workforce planning.</p><p><strong>Methods: </strong>A qualitative study, consisting of one-to-one, semi-structured interviews was conducted with GP trainee participants and data were analysed thematically. Every GP trainee currently enrolled in vocational training nationally was invited to participate. 'Social Cognitive Career Theory' and 'Sociocultural Theory' were used as theoretical frameworks to inform the interview guide and its analysis.</p><p><strong>Results: </strong>Seventeen GP trainees were interviewed. One meta-theme was identified from interviews: 'Sustainable work as part of a fulfilling life'. This meta-theme of sustainability threads through each of the five related subthemes: Family, stability and support, burnout aversion, role-modelling, and well supported portfolio careers in practice.</p><p><strong>Conclusion: </strong>Understanding priorities and motivators of GP trainees will inform future healthcare planning, in particular, the type of role to which trainees aspire and the type of health service they in which they will work.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"176"},"PeriodicalIF":2.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112894","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":"Team climate, job satisfaction, burnout and practice performance: results of a national survey of staff in general practices in England.","authors":"Peter Williams, Heather Gage, Bridget Jones, Carole Aspden, Jessica Smylie, Thomas Bird, Morro M L Touray, Phelim Brady, John Campbell, Rupa Chilvers, Catherine Marchand, Stephen Peckham, Suzanne H Richards, Karen Spilsbury, Mark Joy, Simon de Lusignan","doi":"10.1186/s12875-025-02780-7","DOIUrl":"10.1186/s12875-025-02780-7","url":null,"abstract":"<p><strong>Background: </strong>Measures are needed to address recruitment and retention problems in general practice in England. A good team climate, the relational processes of team working, can mitigate pressured work environments, but little is known about it.</p><p><strong>Objectives: </strong>To explore factors associated with more favourable team climates in general practices and investigate associations between team climate and outcomes for staff and practice performance.</p><p><strong>Methods: </strong>All 6475 general practices in England were eligible to take part in an online cross-sectional survey. Clinical and non-clinical staff in practices were invited to participate. Data were gathered using the 14 item version of the Team Climate Inventory; analysis was conducted on 10 items because piloting indicated many participants could not answer four items about practice objectives. Secondary outcomes included single item measures of job satisfaction, intention to remain working in the practice and burnout. Practice performance measures were: attainment in the Quality and Outcomes pay-for-performance system (for clinical effectiveness) and patient experience ratings from the national General Practice Patient Survey. Staff outcomes were analysed, principally by role. Practices in which over 50% of staff participated were included in modelling of practice level outcomes.</p><p><strong>Results: </strong>A total of 9835 individual members of staff from 809 practices participated. Most indicated a favourable team climate in their practice, (mean 3.77, on scale 1-5 best, SD 0.84); 61.3% stated they were mostly or extremely satisfied in their jobs; 26.1% met the criteria for high burnout. General Practitioners, compared to other clinical and non-clinical staff, perceived team climate to be better, and reported less likelihood of leaving, yet lower job satisfaction and higher burnout. In practice-level modelling, team climate improved as practice size decreased. Staff outcomes (job satisfaction, likelihood of remaining in post, less burnout) were associated with a better practice team climate, as were patient experience ratings. Higher GP to patient ratios were associated with improved job satisfaction, less burnout and more favourable patient experience ratings.</p><p><strong>Conclusions: </strong>Policies focussed on improving team climate could improve staff outcomes and contribute to mitigating the workforce crisis in general practice in England. Guidance on fostering good team climates is needed for practices.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"173"},"PeriodicalIF":2.0,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095982","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}