BMC primary care最新文献

{"title":"Clinical phenotypes of type 2 diabetes and their association with microvascular complications in primary care: a cluster analysis.","authors":"Alcibíades Segundo Díaz Vera, José Abellán Alemán, Miladi Del Socorro Golac Rabanal, Cédric Marco Detchart, Isabel Arrechea Irigoyen, Manuela García Sánchez, Daime Pérez Feíto, Virginia Íñiguez García, Roberto Dair García de la Rosa, Rosa Eva Perez-Siguas, Hernán Hugo Matta-Solís, Eduardo Percy Matta-Solís, María Lourdes Azcona Cortés, Julieth Paola Sulaiman Rojas, Yohanna Elizabeth Barría Jujihara, Julienne Ntumba Mumba, Martín Andrés Astudillo Astudillo, Carlos José Zhuzhingo Vásquez, Javier Nieto Iglesias, Luis Alberto Díaz Vera, Gonzalo Luis Alonso Salinas","doi":"10.1186/s12875-026-03458-4","DOIUrl":"10.1186/s12875-026-03458-4","url":null,"abstract":"<p><strong>Background: </strong>Type 2 diabetes mellitus is a heterogeneous condition associated with a substantial burden of microvascular complications. Conventional assessment based on isolated clinical variables may not fully capture this heterogeneity. Cluster analysis offers a potential strategy to identify clinically relevant diabetes phenotypes using routinely collected primary care variables.</p><p><strong>Objective: </strong>To identify clinical phenotypes of type 2 diabetes in a primary care population using cluster analysis and to examine their association with prevalent diabetic retinopathy and nephropathy.</p><p><strong>Methods: </strong>A cross-sectional study was conducted using routinely collected data from primary care centres in the Cantabrian Health Service. Centres were randomly selected using probability proportional to size sampling. People with type 2 diabetes mellitus were identified from clinical records, and those with missing key variables were excluded. K-means clustering was applied using routinely collected clinical variables, including body mass index, systolic and diastolic blood pressure, HbA1c, age, and years since diagnosis. Associations between clinical phenotypes and prevalent microvascular complications were assessed using logistic regression models adjusted for age, sex, and years since diagnosis. Model discrimination and calibration were evaluated using the area under the receiver operating characteristic curve (AUC), Hosmer-Lemeshow test, Nagelkerke R², and Brier score.</p><p><strong>Results: </strong>Of 742 initially identified individuals, 680 were included in the final analytical sample. Phenotype assignment was possible for 674 individuals, who were classified into three clinically interpretable diabetes phenotypes: controlled (n = 492), metabolic (n = 146), and hypertensive (n = 36). The prevalence of diabetic retinopathy was 20.5%, 58.2%, and 27.8%, respectively, while the prevalence of diabetic nephropathy was 25.9%, 51.1%, and 27.8%. After adjustment, the metabolic phenotype was associated with higher odds of prevalent retinopathy (OR 4.69, 95% CI 2.99-7.36; p < 0.001) and prevalent nephropathy (OR 2.52, 95% CI 1.67-3.79; p < 0.001) compared with the controlled phenotype. The hypertensive phenotype was associated with prevalent retinopathy (OR 2.43, 95% CI 1.03-5.69; p = 0.042), but not with prevalent nephropathy (OR 1.23, 95% CI 0.56-2.68; p = 0.611). The retinopathy model showed good discrimination (AUC 0.82, 95% CI 0.78-0.86), whereas the nephropathy model showed lower discrimination (AUC 0.67, 95% CI 0.63-0.72). Sensitivity analyses yielded consistent results.</p><p><strong>Conclusions: </strong>Three clinically interpretable diabetes phenotypes were identified in a real-world primary care population and were associated with different patterns of prevalent microvascular complications. The metabolic phenotype showed the highest prevalence and higher adjusted odds of both retinopathy and nephrop","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/PMC13617723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392684","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":"Healthcare professionals' attitudes toward deprescribing in older adults with limited life expectancy in an Ethiopian teaching hospital: a cross-sectional study.","authors":"Tesfaye Yimer Tadesse, Mihiret Kokeb, Henok Wubetu, Gebremariam Genet, Meaza Adugna, Addisu Assfaw Ayen, Zemene Demelash Kifle","doi":"10.1186/s12875-026-03464-6","DOIUrl":"10.1186/s12875-026-03464-6","url":null,"abstract":"<p><strong>Objective: </strong>To assess the Attitudes of Healthcare Professionals Towards Deprescribing in older adults with Limited Life Expectancy.</p><p><strong>Design: </strong>An institution-based, cross-sectional, and quantitative survey was conducted.</p><p><strong>Setting: </strong>Mainly the Oncology ward of the University of Gondar Medical Center in Ethiopia.</p><p><strong>Participants: </strong>Healthcare professionals (HCPs) who worked in the oncology ward and had more than 1 year of experience at the University of Gondar Medical Center.</p><p><strong>Main outcome measures: </strong>Healthcare professionals' attitudes toward deprescribing in older adults with limited life expectancy were assessed using the standardized Healthcare Professionals Attitude Towards Deprescribing (HATD) tool. Data were collected using self-administered questionnaires with physicians, nurses, and pharmacists possessing at least one year of professional experience. A convenience sampling technique was employed, and all participants were briefed on the study's objectives prior to recruitment. Statistical analysis was performed using SPSS version 26. Descriptive statistics summarized the data, while bivariate (chi-square) analyses were conducted to identify significant associations. The significance of these associations was declared at a 95% confidence interval, p < 0.05.</p><p><strong>Results: </strong>Of the 140 HCPs approached, all 140 HCPs (100% response rate) had a mean age of 30.95 ± 3.57 years, with a range of 15 years, and were included in the final analysis. From a total of 140 participants, 86 (61.42%) were males, and 54 (38.58%) were females. From the concern factor domain, 90.70% of the participants believed that stopping medicines would lead to deterioration of the health conditions of their patients. In comparison, 71.52% of the participants felt that patients taking large numbers of medications can benefit from medication deprescribing. Sex and work experience were found to have statistically significant associations with the HCPs' attitudes towards favorable and unfavorable deprescribing practices. A total of 86 physicians were included in the final analysis; of these, 44 (51.20%) exhibited favorable attitudes toward deprescribing. Similarly,19 out of 36 pharmacists (52.80%) and 10 out of 18 nurses (55.60%) demonstrated favorable attitudes (X² = 0.12, P = 0.94).</p><p><strong>Conclusion: </strong>This study revealed that a slight majority of participants held favorable attitudes toward deprescribing, highlighting its potential benefits for older adults with limited life expectancy. Furthermore, work experience and sex were associated with attitude classification in this single-center study.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148383284","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":"Where we fail; First Nations starting dialysis with inadequate nephrology referral time: an IKHealth (improving responsiveness across the continuum of kidney health care in rural and remote Manitoba First Nation communities) substudy.","authors":"James Zacharias, Lorraine McLeod, Tannyce Cook, Reid Whitlock, Josée G Lavoie","doi":"10.1186/s12875-026-03408-0","DOIUrl":"10.1186/s12875-026-03408-0","url":null,"abstract":"<p><strong>Objective: </strong>End-stage kidney disease continues to disproportionally impact the lives of First Nations(FN) peoples. This paper examines the trajectory of chronic kidney disease (CKD) care in FN individuals who started dialysis.</p><p><strong>Methods: </strong>We used health administrative data held at the Manitoba Centre for Health Policy (MCHP) for the period of 2000-2019, which was linked to the Manitoba First Nations Research File to identify Registered FN. Data we used included: Diagnostic Services Manitoba Laboratory Data, Medical Claims, Hospital Discharge Abstracts, Drug Program Information Network Data, Public Canadian Census Files, Manitoba Health Insurance Registry, and Physician Resource File. All records are de-identified. Our primary outcome was to assess the frequency of uninformed dialysis starts among FN.</p><p><strong>Lessons learned: </strong>We identified 1,686 FN people who started dialysis during the study period. Of those, 396 (23.5%) started dialysis within three months of their first nephrology visit. We compared those initiating dialysis within 3 month to other FN with longer nephrology follow-up: as a group, FN initiating dialysis within 3 month of their first nephrology visit were more unwell as evidenced by a significantly higher Elixhauser co-morbidity index (5 vs. 3 P < 0.001), hypertension (70.7% vs. 57.1% p < 0.001) and congestive heart failure (31.1 vs17.4% P < 0.001). Primary care visits in all FN groups with CKD occurred in over 95% and CKD screening was similar in all groups at over 40% a year prior to the first nephrology visit. Less than 70% of FN with CKD were on appropriate preventative medications (69 vs. 68% p = NS)) IMPLICATIONS: Improvements in primary prevention at the primary care level are needed to avoid late nephrology referrals and improve overall care of FN with CKD.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13625310/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148388388","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":"A primary care clinic on the frontline of early cancer detection: a retrospective observational study.","authors":"Yuzo Yago, Mariko Hojo, Tomoyoshi Shibuya, Tetsuro Tsujimoto, Akihito Nagahara","doi":"10.1186/s12875-026-03455-7","DOIUrl":"https://doi.org/10.1186/s12875-026-03455-7","url":null,"abstract":"<p><strong>Background: </strong>Early cancer detection is critical. In Japan, the cancer detection system is diverse, encompassing cancer screenings, health checks, and comprehensive medical checkups (Ningen-dock). However, early detection pathways in primary care clinics remain unclear. This study aimed to investigate the current status of cancer detection and examine the clinical pathways leading to early diagnosis in a primay care clinic.</p><p><strong>Methods: </strong>A retrospective observational study was conducted among cancer cases detected at a single primary care clinic in Japan between April 2009 and March 2023. In total, 17,942 patient charts were reviewed, representing 267,313 individual consultations during the study period. Data collected included cancer type, number, age, sex, smoking, comorbidities, detection pathways, and whether the cancer was early (without distant metastasis) or advanced (with distant metastasis). Multivariable logistic regression was performed to assess the associations between early cancer and both the detection pathways and follow-up by primary care physician. Univariate analyses were performed to evaluate associations between detection pathways and early cancer detection by cancer types.</p><p><strong>Results: </strong>Three hundred forty-seven cases (29 types) were identified, comprising 283 early and 64 advanced. Early cancers had significantly higher detection rates through health screening-related, incidental or follow-up by primary care pathways (p < 0.05), whereas symptomatic detection was significantly less frequent (p < 0.05). For gastrointestinal and respiratory cancers, early detection was significantly associated with health screening-related (p < 0.05), whereas symptomatic detection predominated in advanced (p < 0.05). In hepatobiliary pancreatic, urinary, and other cancers, no significant differences were observed between early and advanced cancers in health screening-related; detection was mostly symptomatic.</p><p><strong>Conclusions: </strong>Cancer screening, health checks, comprehensive medical checkups, asymptomatic examinations, and follow-up by primary care physician might be associated with early cancer detection. However, certain cancer types presented difficulties for early detection. Studies discussing the overall picture of early cancer detection using real-world data from primary care clinics remain limited, and the findings of this study are expected to contribute to building a foundation for secondary prevention policies.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148388431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient and therapist experiences of a self-management group programme for fatigue in primary care: a qualitative study.","authors":"Sharon H Gunnink-Wennink, Edith H C Cup, Yvonne Veenhuizen, Thomas J Hoogeboom, Philip J van der Wees, Nicoline B M Voet, Maud Graff","doi":"10.1186/s12875-026-03450-y","DOIUrl":"10.1186/s12875-026-03450-y","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;As health systems shift care from specialised to primary care settings, questions arise about implementing complex interventions such as self‑management programmes. This is especially relevant for the growing population with chronic neurological disorders requiring long‑term support in primary care. 'Energetic', an interdisciplinary self‑management group programme delivered by occupational therapists and physiotherapists, was originally developed in specialist rehabilitation to improve participation and functional endurance in people with neurological conditions and fatigue. Although effective in specialist care, little is known about how patients and therapists experience its delivery in primary care, where resources and infrastructure differ substantially.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This study examines how patients with chronic neurological conditions and fatigue, and their therapists, experience the implementation and delivery of the Energetic self‑management group programme in primary care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Energetic was implemented in primary care in three regions in the Netherlands. A qualitative study was conducted using semi‑structured interviews with 10 patients and seven therapists (three occupational therapists and four physiotherapists) from three primary care settings. Interviews were audio-recorded and transcribed verbatim. Participants were asked about their experiences with participating in the programme, its implementation and delivery in primary care, and perceived barriers and benefits. Data were analysed using an iterative, inductive thematic approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Three overarching themes were constructed from the data: 1) The content of the programme is considered comprehensive; 2) The programme is believed to strengthen self-management and particpation; and 3) The implementation is experienced to be challenging within the primary care healthcare system. Patients experienced participating in the programme as meaningful, reporting better self-management and participation. Therapists reported similar developments. Regarding implementation therapists described persistent difficulties related to recruitment, organisation, and financing, and noted that system constraints required administrative improvisation to deliver the programme as intended. Differences in perspectives were also apparent: e.g., patients valued access to sports facilities, whereas all therapists considered such facilities difficult to provide within primary care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Patients and therapists experienced the Energetic programme as meaningful and valuable in primary care practice. However, therapists reported problems in recruitment, reimbursement and administrative barriers that constrained the programme's implementation. These findings illustrate how promising programmes can struggle to find their way into routine primary care, and therefore to patients livin","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13445733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148383297","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":"Meeting the primary care needs of communities where they are: mobile primary care clinics, test and try evaluation, Nova Scotia Canada.","authors":"Tara Sampalli, Gail Tomblin Murphy, Jennifer Murdoch, Samantha Lavallée, Meaghan Sim, Mark Embrett, Prosper Koto, Marta MacInnis, Masoumeh Chokami, Alexis Bragman, Julia Guk, Noella Whelan, Holly Gillis, Jeff Fraser, Graeme Kohler, Sarah O'Brien, Lindsay Sutherland, JoAnne Wentzell, Helen Scott-Davidson, Kelly Silver, Matthew Murphy, Steven Carrigan","doi":"10.1186/s12875-026-03442-y","DOIUrl":"10.1186/s12875-026-03442-y","url":null,"abstract":"<p><strong>Background: </strong>Primary care is crucial for reducing health disparities and enhancing population health. The COVID-19 pandemic exacerbated long-standing challenges for Canada in maintaining robust primary care; however, it also presented opportunities for health system transformation. One such transformation was the rapid implementation of Mobile Primary Care Clinics (MPCCs) in the Atlantic Canadian province of Nova Scotia to enhance healthcare accessibility and alleviate pressure on emergency departments (EDs). This evaluation aimed to assess the impact, implementation, and partner experiences of MPCCs as another point of primary care access for Nova Scotians.</p><p><strong>Methods: </strong>The evaluation involved a mixed-methods approach (September 2022-October 2023) guided by implementation outcomes of effectiveness, efficiency, acceptability, and feasibility. Data sources included clinic utilization and cost records, administrative data, patient and provider surveys, and a questionnaire from the implementation team. A scenario-based economic analysis with probabilistic sensitivity analysis (PSA) was performed from a third-party payer perspective. ED diversion estimates were derived by combining survey-reported counterfactual care-seeking behaviour with observed ED utilization within 72 h of an MPCC visit, identified through linkage to provincial administrative data.</p><p><strong>Results: </strong>Across 157 clinic days, 13,019 visits were recorded. The most common presentations were respiratory or dermatological complaints and prescription renewals. Among 1,888 patient survey respondents, 23.7% would have sought ED care, and 7.2% would have gone untreated had an MPCC not been available. ED utilization within 72 h of an MPCC visit occurred in 13.7% of visits. The mean cost per visit was CAD $103 for general primary care clinics and $236 for upper respiratory infection clinics. Scenario-based estimates of potential fiscal offsets from survey-reported ED diversions were $1.95 million (95% CI $0.77-$3.64 million). Surveyed patients (97%) and providers (99%) rated the clinics favorably, citing timely access and interdisciplinary teamwork. Implementation enablers included adequate staffing, clear roles and strong interagency partnerships; key barriers were limited EMR integration and inconsistent public awareness.</p><p><strong>Conclusions: </strong>Preliminary findings show MPCCs have made a positive impact by enabling access to primary care in multiple communities across the province. Estimates of ED diversion-related fiscal offsets are illustrative and should be validated with linked administrative data. As operational planning and integration with primary care continue, ongoing work should address continuity of care, efficiency, equity, and sustainability.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13591896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148355036","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":"Urban residents' choice preferences for hospitals at different tiers and influencing factors: a study based on latent class analysis and Andersen's model of health service utilization.","authors":"Ke Wang, Hang Chen, Yu Jin, Rui Min","doi":"10.1186/s12875-026-03449-5","DOIUrl":"10.1186/s12875-026-03449-5","url":null,"abstract":"<p><strong>Background: </strong>China's health system faces widespread bypassing behavior, where residents prefer high-level hospitals, leading to inefficient primary resource use. This study aimed to identify distinct preference groups in urban residents' choices of hospitals and to examine how predisposing, enabling, and need factors from Andersen's Model differentially influence healthcare-seeking intention across groups.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted in Wuhan, China, from July 2023 to August 2024, involving 2,890 participants. Latent Class Analysis (LCA) was employed to segment the population based on seven consideration attributes for choosing hospitals. Multinomial logistic regression was then used to analyze the influence of predisposing, enabling, and need factors. Specifically, it examined how these factors affected healthcare-seeking intention within each identified latent class.</p><p><strong>Results: </strong>LCA identified four distinct preference groups: the Core Resource Preference Group (29.9%), the Medical Technology Preference Group (35.6%), the High-Quality & Low-Cost Preference Group (11.1%), and the Convenient Transportation Preference Group (23.5%). Healthcare-seeking intention varied significantly: the Medical Technology Group had the highest tertiary hospital selection rate (68.0%), while the Convenient Transportation Group had the highest combined rate for self-medication and primary care (57.6%). Regression analyses revealed heterogeneous influences: in the Core Resource and Convenient Transportation groups, higher confidence in family finances was associated with lower odds of choosing tertiary hospitals. In contrast, in the Medical Technology Group, worse past-year health status increased the likelihood of selecting secondary hospitals. Higher education consistently predicted tertiary hospital use across all groups.</p><p><strong>Conclusion: </strong>Urban residents' hospital-choice preferences are heterogeneous, and the factors influencing their healthcare-seeking intention vary significantly across different preference profiles. These findings suggest that \"one-size-fits-all\" policies are inadequate, and targeted interventions are needed. This study provides empirical evidence for designing more effective, population-specific strategies to promote a rational hierarchical healthcare system. Moreover, these findings indicate that the mechanisms underlying the healthcare-seeking intention of different preference groups require further exploration.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13591714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148364224","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":"Confidence level in diagnosing and treating skin disorders among Palestinian physicians: a cross- sectional study.","authors":"Hamzeh Yacoub, Lareen Othman, Nataly Jomaa, Yazan Alhabil, Zeena Othman, Mayar Abughosh, Leyan Qasrawi, Silvia Halteh, Francis Daibes, Ahmed Alhaj, Zaid Yacoub","doi":"10.1186/s12875-026-03431-1","DOIUrl":"10.1186/s12875-026-03431-1","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Skin disorders are among the most prevalent conditions encountered in primary care, yet dermatology remains underrepresented in medical curricula worldwide. Non-dermatologist physicians frequently manage these conditions with limited training and exposure, potentially compromising diagnostic accuracy and patient outcomes. This study aimed to assess the level of confidence among Palestinian physicians in diagnosing and managing skin disorders and to identify the training-related factors associated with higher diagnostic self-efficacy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A cross-sectional study was conducted among 246 licensed medical doctors practicing in the West Bank, Palestine. Participants were recruited through convenience sampling via professional networks and selected healthcare facilities, with the sample predominantly comprising younger and early-career physicians. Data were collected using a structured, validated self-administered questionnaire through mixed modes (electronic and paper-based). The instrument assessed sociodemographic and professional characteristics, dermatology exposure and training, and diagnostic self-efficacy using Likert-scale items. Diagnostic self-efficacy was dichotomized into below average versus average or above. Descriptive statistics, chi-square tests, and multivariable logistic regression were performed using SPSS version 22. Ethical approval was obtained from AlQuds University Institutional Review Board.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 246 participating physicians, 74.4% were aged 30 years or younger and 58.9% were male. The majority were general practitioners (54.1%) working in hospital settings (79.7%). Most participants (58.9%) reported no formal dermatology training, and 42.3% encountered fewer than 10 dermatological cases in their careers. Most physicians rated their diagnostic skills as average (62.6%), with a mean diagnostic self-efficacy score of 2.92 ± 0.78. No meaningful associations were observed between most sociodemographic characteristics and diagnostic self- efficacy. Training-related factors significantly associated with higher self-efficacy included: dermatology training during medical school (81.2% vs. 64.3%; p = 0.038), exposure to more than three training methods (91.6% vs. 73.3%; p = 0.006), and confidence gained after training (85.6% vs. 63.9%; p = 0.003). In multivariable logistic regression, confidence after training remained an independent predictor of higher self-efficacy (OR = 3.21, 95% CI 1.29-8.11; p = 0.011). Dermatology rotations and lectures were identified as the most effective and most recommended training modalities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Palestinian physicians demonstrate only moderate diagnostic self-efficacy in dermatology, largely attributable to limited training and clinical exposure. Dermatology training, particularly when it meaningfully boosts confidence, is the most important predictor of diagnostic self-efficacy, irres","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13591905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148364263","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":"Psychometric properties and constructs of Patient Reported Experience Measures (PREMs) in primary care: a scoping review.","authors":"Véronique Lowry, Marie-Ève Perron, Pierre-Henri Roux-Levy, Cloé Beaulieu, Vanessa T Vaillancourt, Maxime Sasseville, Marie-Eve Poitras","doi":"10.1186/s12875-026-03436-w","DOIUrl":"10.1186/s12875-026-03436-w","url":null,"abstract":"<p><strong>Background: </strong>Positive patient experience is associated with improved health outcomes and greater adherence to recommended care. Patient-reported experience measures (PREMs) are tools developed to assess these experiences and can be used for multiple purposes, including to inform quality improvement. Patient experience is a complex concept that lacks a standardized definition, with multiple constructs described in the literature. The variety of available PREMs makes it difficult for knowledge users to select those that are valid, reliable, and suitable for their specific practice settings, particularly in primary care. The objective of this scoping review is to identify and describe PREMs developed for the primary care context, the constructs measured and their psychometric properties.</p><p><strong>Methods: </strong>Following the JBI methodology and PRISMA-ScR guidelines, we conducted a scoping review of studies presenting the development or the psychometric properties of PREMs for adults in primary care in an original or a synthesis design. We searched databases (MEDLINE, CINAHL, Scopus) for studies between January 2019 and December 2023. Two independent reviewers screened and selected studies. They extracted PREMs constructs, psychometric properties, number of items, time of completion and tool availability.</p><p><strong>Results: </strong>Seven studies, including three synthesis designs, were included in the review. From these papers, 23 PREMs were included for data extraction. Tools focusing exclusively on a single component of patient experience, a specific population, or a narrowly defined context were excluded. The constructs most frequently represented across identified tools included accessibility, relational aspects, and quality of clinical care or services. However, no tool covered all relevant constructs, highlighting the variability in defining patient experience. Tools ranged from 4 to 74 items, with limited reporting on completion time. Only five tools involved patients in their development, potentially limiting their applicability in routine practice. Psychometric properties varied, with most tools demonstrating acceptable validity and reliability. However, inconsistencies in reporting and testing methods were noted.</p><p><strong>Conclusion: </strong>This review highlights the diversity of PREMs validated for primary care and the variability in their constructs and psychometric properties. Improving conceptual clarity and alignment of patient experience constructs across PREMs, while ensuring meaningful patient involvement in tool development, and rigorous psychometric testing are essential to enhance their utility. This study supports the integration of PREMs into primary care quality improvement initiatives, contributing to more patient-centered healthcare delivery.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13579956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148355018","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":"Layers of complexity: a directed content analysis of implementation determinants for integrative group medical visits for patients with chronic pain in safety-net primary care.","authors":"Isabel J Roth, Paula Tomczak, Kate Ferriola-Bruckenstein, Paula Gardiner, Jennifer Leeman","doi":"10.1186/s12875-026-03439-7","DOIUrl":"10.1186/s12875-026-03439-7","url":null,"abstract":"<p><strong>Background: </strong>Chronic pain impacts a quarter of U.S. adults and is pervasive among populations who rely on safety-net settings (e.g., hospital outpatient clinics and Federally Qualified Health Centers) for chronic pain management. These settings provide care to more than 31 million patients in the US annually, many of whom require ongoing management of chronic pain. Integrative Group Medical Visits (IGMVs) offer a potentially effective and cost-efficient approach to chronic pain management. The purpose of this study was to identify implementation determinants of IGMVs for chronic pain in safety-net settings to inform strategies to speed future scale-up.</p><p><strong>Methods: </strong>We conducted semi-structured interviews with clinicians, administrators, and staff with experience implementing IGMVs for patients with chronic pain in safety-net settings. Interviews were guided by the updated Consolidated Framework for Implementation Research (CFIR), which also informed the codebook for directed content analysis of interview transcripts.</p><p><strong>Results: </strong>A total of 21 interview participants were recruited from ten safety-net settings across the U.S., including clinicians, administrators, staff, and an evaluator. Findings related to 12 CFIR constructs were identified in the analysis, with 2 to 3 constructs identified per CFIR domain. In the Innovation domain, we found that IGMVs are adaptable, complex, incur up-front costs to implement, and yield long-term savings. In the Outer Setting domain, epidemics influence uptake and delivery of IGMVs, and novel financing approaches may facilitate implementation. In the Inner Setting domain, partnerships/connections and tension for change facilitated IGMV implementation; lack of compatibility with setting workflows was a barrier. In the Individual domain, implementation is driven by the motivation of clinician-advocates, and Group Visits Coordinators enhance delivery. In the Implementation Process domain, participants reported engaging clinicians and patients in recruitment, accessing training for clinicians, and adapting for telehealth delivery.</p><p><strong>Conclusions: </strong>While many findings were consistent with previous literature, we identified novel determinants: the complexity of IGMVs; the critical role and motivation of clinician-advocates; and importance of accessing training for innovation deliverers. Developing strategies informed by complexity theory that address these determinants is essential to scaling-up IGMVs in safety-net settings with the goal of increasing access to high-quality care and reducing suffering from chronic pain conditions.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13591782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354990","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}