BMC primary care最新文献

{"title":"Awareness and perceptions of child maltreatment among medical students and interns: a cross-sectional study.","authors":"Sara Owaidah, Reham Alharaz, Sara Aljubran, Zahra Almuhanna, Jawaher AlMusailhi, Turki Abualait, Mona Al-Sheikh, Kholoud Al Ghamdi","doi":"10.1186/s12875-025-02729-w","DOIUrl":"10.1186/s12875-025-02729-w","url":null,"abstract":"<p><p>Child maltreatment is an issue that burdens communities worldwide. Healthcare professionals, medical staff precisely, play a major role in the reporting responsibility, so it is crucial to ensure that none of the maltreatment cases are missed under medical supervision. This study aims to assess the awareness and perceptions of child maltreatment, and factors that affect reporting these cases among medical students and interns in the Eastern Province of Saudi Arabia. A self-administered questionnaire consisting of five categories (demographic data, the most prevalent form of child maltreatment, awareness and perceptions of child maltreatment, awareness of reporting policy, and factors that contribute to lack of reporting) was distributed among the participants electronically. Data were analyzed using a chi-square test along with frequency distribution of the independent variables. Out of 341 participants, 57.2% were females, and the majority were in their senior years. Less than half of the participants (41.9%) believed that the most common form of child maltreatment is physical abuse. Most participants had adequate awareness of both short- and long-term consequences of child maltreatment. However, they believed that community members did not have adequate awareness about the issue. One-third of the participants believed that they received adequate education on the topic during their training. Furthermore, 78.9% of the participants thought that child maltreatment is often missed. Most participants (90.9%) believed that reporting child maltreatment must be mandatory even if the injuries were not fatal. The top three factors that prevented physicians from reporting child maltreatment were lack of understanding of the reporting procedure, fear of destroying family relationships, and doubt of the occurrence of child maltreatment. Early training and exposure to child maltreatment cases is recommended for all healthcare professionals.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"41"},"PeriodicalIF":2.0,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11829432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426695","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":"Exploring effective patient feedback methods for eHealth in general practice.","authors":"Mana Nasori, Marianne Mak-van der Vossen, Marije Holtrop, Jettie Bont","doi":"10.1186/s12875-025-02725-0","DOIUrl":"10.1186/s12875-025-02725-0","url":null,"abstract":"<p><strong>Background: </strong>The use of patient feedback is essential for identifying areas for improvement and tailoring care to the needs of patients, particularly in the context of eHealth, which has increased in adoption due to the pandemic. However, challenges persist in collecting feedback from vulnerable groups, those with severe conditions, or language barriers. Furthermore, concerns exist about the credibility and validity of the feedback received. This study aims to explore various possible forms that general practitioners (GPs) could use to collect patient feedback on eHealth applications in their daily practice.</p><p><strong>Methods: </strong>A Participatory Research (PR) was conducted involving an advisory group, patients, GPs and medical receptionists. The advisory group consisting of GPs, a board member, patient representatives and digital care manager affiliated with the primary care organisation 'Regionale Organisatie Huisartsen Amsterdam' (ROHA). The group provided input throughout the research process from the setup, data collection and interpretation to the finalization phase. Semi-structured interviews were conducted with 13 patients, 8 GPs and 2 medical receptionists. Participants were recruited through purposive sampling. Interviews were coded using Thematic Analysis.</p><p><strong>Results: </strong>Four themes were considered important. First, timing of feedback. Gathering instant feedback immediately after digital interactions was considered important. Secondly, the feedback procedure, whereby feedback should be given through the same communication channel as was used for the doctor-patient contact was valued. Also, participants preferred short and specific surveys, in which they can remain anonymous. Thirdly, for the feedback content some key feedback topics included general experiences, quality of care and technical aspects. The last theme was advertisement. Overall, patients do not want to burden their GP and thus tend to only give feedback if initiated by their GP. GPs themselves pointed out to have limited time for collecting feedback from patients due to their workload.</p><p><strong>Conclusion: </strong>GPs can optimize the feedback collection process by selecting targeted questions and integrating them into existing eHealth applications, thereby investing minimal time from GPs and patients. It is recommended to include automatic selected questions at the end of e-consultations. This integrated approach allows efficient feedback collection without burdening GPs.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"40"},"PeriodicalIF":2.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11823149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416444","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":"Related factors of turnover intention among general practitioners: a cross-sectional study in 6 provinces of China.","authors":"Yanchun Sun, Wei Wang, Fei Yan, Xueqin Xie, Min Cai, Fang Xu, Yi Qian, Yuanyuan Xiao, Chuanzhi Xu, Wenlan Zhao","doi":"10.1186/s12875-025-02728-x","DOIUrl":"10.1186/s12875-025-02728-x","url":null,"abstract":"<p><strong>Background: </strong>Turnover among general practitioners (GPs) is an issue of growing concern. Therefore, identification of the variables which associated with GPs' decision in staying in or leaving their employer institutions is necessary.</p><p><strong>Objective: </strong>The aim of this study was to investigate the relationship between work stress, job satisfaction, and turnover intention, and explore factors associated with turnover intention of GPs in China.</p><p><strong>Methods: </strong>We conducted a cross-sectional survey among GPs in 6 provinces in China, utilizing a combination of stratified and purposive sampling methods, from April to October 2019. Data were collected using self-administered questionnaires and scales measuring their demographic characteristics, work stress, job satisfaction, and turnover intention. Statistical methods such as t test, one-way analysis of variance (ANOVA), multiple linear regression, exploratory factor analysis (EFA), and structural equation modeling (SEM) were used.</p><p><strong>Results: </strong>Out of 386 GPs, 10.4% had higher turnover intention and 31.9% had medium turnover intention. The mean score of the overall perception of turnover intention of GPs was 2.24 on a scale ranging from 1 to 6. Over 80.0% of GPs had moderate to high level work stress. The facets that GPs were most dissatisfied were payment, welfare, training opportunity and career development. professional title, practicing setting, and work intensity associated with turnover intention (P < 0.05) significantly. Work stress, not only directly associated with turnover intention (β = 0.608, P < 0.001), but also presented an indirect association on turnover intention through job satisfaction (β = 0.042, P < 0.05). Meanwhile, job satisfaction also had a direct negative effect on turnover intention (β=-0.345, P < 0.001).</p><p><strong>Conclusions: </strong>Work stress, job satisfaction, professional title, practicing setting, and work intensity were influencing factors on turnover intention in Chinese GPs. Work stress had not only positive direct effects on turnover intention, but also had an indirect effect on turnover intention through job satisfaction as a mediator. Reducing workload, raising income, providing more opportunities for training and career development could potentially contribute to retaining and attracting GPs.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"37"},"PeriodicalIF":2.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11816535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient history of cancer in primary care: a closer look among cancer survivors with chronic conditions in federally qualified health centers.","authors":"Quiera Booker, Rebecca Eary, Viviana Gonzalez, Maishara Muquith, Pallavi Dev, Simon J Craddock Lee, Bijal A Balasubramanian","doi":"10.1186/s12875-025-02727-y","DOIUrl":"10.1186/s12875-025-02727-y","url":null,"abstract":"<p><strong>Purpose: </strong>The prevalence of cancer among patients accessing primary care in federally qualified health centers (FQHCs) is poorly characterized. A patient's history of cancer in addition to common chronic conditions makes providing comprehensive primary care more complex, especially for patients accessing care at FQHCs who often face additional social and economic barriers to care.</p><p><strong>Methods: </strong>Trained auditors conducted a comprehensive electronic medical record audit using a standardized abstraction form to identify cancer history in patients aged ≥ 40 years with two common chronic conditions (diabetes and/or hypertension) and who had at least one visit to an FQHC between January 1 and December 31, 2019. Descriptive statistics were performed.</p><p><strong>Results: </strong>Among 712 adult patients with diabetes and/or hypertension, 46 (6.46%) had a documented history of cancer. For the majority of cancer patients (67.4%), cancer information was documented in the \"Problem List\" section of their medical record.</p><p><strong>Conclusion: </strong>Our study revealed a higher prevalence of cancer in FQHC primary care records than previously reported. Future research should examine whether readily accessible cancer history information in primary care records could enhance comprehensive care delivery for all chronic conditions, including cancer.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"39"},"PeriodicalIF":2.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11823080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Screening and detection of perinatal depression by non-physician primary healthcare workers in Nigeria.","authors":"Bibilola D Oladeji, Olatunde O Ayinde, Toyin Bello, Lola Kola, Phyllis Zelkowitz, Soraya Seedat, Oye Gureje","doi":"10.1186/s12875-025-02730-3","DOIUrl":"10.1186/s12875-025-02730-3","url":null,"abstract":"<p><strong>Background: </strong>Detection of perinatal depression by healthcare providers remain an important barrier to receiving treatment. This study reports on the detection of perinatal depression by frontline non-physician primary healthcare workers (PHCWs) as well as the feasibility, effectiveness and acceptability of routine screening using the 2-item patient health questionnaire (PHQ-2) during antenatal care.</p><p><strong>Method: </strong>Twenty-seven primary healthcare facilities were assigned to screening (n = 11) and non-screening (n = 16) arms. All PHCWs in both arms were trained to diagnose and treat perinatal depression using the WHO mental health gap action intervention guide (mhGAP-IG) while those in the screening arm were trained to routinely screen with PHQ-2 first to determine need for further mhGAP-IG assessment. Perceived usefulness, feasibility and acceptability of routine screening for perinatal depression was explored in key informant interviews on a purposive sample of PHCWs (n = 20) and study participants (n = 22).</p><p><strong>Results: </strong>In the first 6-months following training, the detection rate of perinatal depression was 4.6% at the clinics where PHCW were not routinely screening with the PHQ-2 compared to 11% at the screening clinics. Over the next six months, with refresher training for PHCW in the screening arm and the introduction of monthly supportive supervision for PHCW in both arms, detection rates increased from 4.6 to 7.6% at non-screening clinics and from 11 to 40% at the screening clinics. Over the entire study period only 81 (15.7%) out of the 517 cases of perinatal depression were detected by the PHCWs. Detection of depression by PHCWs was associated with the severity of depression symptoms and routine screening with PHQ-2. The introduction of routine screening was acceptable to both PHCWs and perinatal women. PHCWs reported that the PHQ-2 was useful, easy to administer and feasible for routine use.</p><p><strong>Conclusions: </strong>Improving detection and subsequently the treatment gap for perinatal depression require not just training of frontline healthcare workers but the introduction of additional measures such as universal screening along with supportive supervision.</p><p><strong>Trial registration number: </strong>The main study from which the data for this report was extracted was retrospectively registered 03 December 2019.</p><p><strong>Registration number: </strong>ISRCTN 94,230,307.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"35"},"PeriodicalIF":2.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11816751/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411961","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":"Pregnancy intention, preconception health, health behaviours, and information and health advice seeking among expectant male partners.","authors":"Tristan Carter, Danielle Schoenaker, Jon Adams, Amie Steel","doi":"10.1186/s12875-025-02703-6","DOIUrl":"10.1186/s12875-025-02703-6","url":null,"abstract":"<p><strong>Background: </strong>Attempting pregnancy as a conscious decision (pregnancy intention) can impact the likelihood that a future parent receives or seeks preconception health information, initiates discussions with health professionals, and ultimately optimises their health and behaviours in preparation for healthy pregnancy and child. Knowledge about the relationship between men's preconception health behaviours and their pregnancy intention is only emerging.</p><p><strong>Methods: </strong>This study aimed to describe the preconception health status, behaviours, information- and advice-seeking of male expectant partners, and to explore differences in these preconception factors based on pregnancy intention. An online retrospective cross-sectional survey was completed by male reproductive partners of pregnant females. Their pregnancy intention was assessed using the London Measure of Unplanned Pregnancy (LMUP). Participants were recruited via social media and all variables were self-reported by expectant partners. Chi-square tests examined differences by LMUP categories (planned or ambivalent/unplanned).</p><p><strong>Results: </strong>Of 156 expectant partners who consented to survey participation, 138 completed all LMUP questions and were included in analysis. Most expectant partners reported their partner's current pregnancy as planned (n = 90;65.2%), less than half reported looking for and finding information about becoming pregnant (40.0%). Expectant partners with planned pregnancy more often reported physical exercise three months before pregnancy compared with partners with unplanned/ambivalent pregnancy (p = 0.001). Expectant partners with ambivalent/unplanned pregnancy more often experienced longstanding illness, disability, or infirmity (p = 0.002) or disregarded contraception (p < 0.001). Despite perceiving good or excellent health, and undertaking physical exercise, numerous expectant partners with planned pregnancy had overweight. Further research exploring the reproductive life plan process for males with longstanding chronic illness or disability may help promote pregnancy planning and preconception health amongst this sub-population.</p><p><strong>Conclusions: </strong>Further large-scale studies are needed to enable clinicians to better understand pregnancy intentions and preconception health of males and for policy makers to formulate health policies aimed at supporting male preconception health and awareness.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"36"},"PeriodicalIF":2.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11817563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411954","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":"Management of gout in primary care of Hong Kong in accordance with international guidelines: any gaps to bridge?","authors":"Kamsheung Chan, Lapkin Chiang, Ken Kaming Ho, Yimchu Li, S H Ko, Catherine Xiaorui Chen","doi":"10.1186/s12875-024-02664-2","DOIUrl":"10.1186/s12875-024-02664-2","url":null,"abstract":"<p><strong>Background: </strong>The global prevalence of gout ranges from 1 to 6.8% in different countries, while around 3% in Hong Kong. Sudden elevated serum urate level (SUA) will result in acute arthritis and repeated flare-ups. If not properly managed, tophi formation and joint damage will occur, leading to disabilities. Gout is one of the most common conditions encountered in primary care. This study aims to assess urate control among gout patients managed in primary care settings of Hong Kong and to evaluate its associated risk factors.</p><p><strong>Method: </strong>This was retrospective cross-sectional study. Adult Chinese gout patients who had been followed up in public primary care clinics of Hong Kong from 1 January 2021 to 31 December 2021 were included. Patient demographics, clinical and biochemical parameters were retrieved from the clinical management computer system. Student's t-test was used for analyzing continuous variables and Chi-square test was used for categorical data. Multivariate stepwise logistic regression was used to determine the associated risk factors for poor urate control.</p><p><strong>Results: </strong>Among the 385 gout patients included, 115 (29.9%) met the target serum urate level (TSUL). 4.4% of gout patients developed tophaceous gout, while none of them could achieve the TSUL. 60.3% of gout patients were put on urate-lowering agents (ULT), while allopurinol was the most commonly used, i.e. 95.7%. In multivariate studies, patients who are male (OR 2.59, 95% CI: 1.37-4.87), active smokers (OR 3.17, 95% CI: 1.08-9.33), with chronic kidney disease (CKD) with stage 3a, 3b and 4, (OR 3.24, 3.12 and 10.25 respectively; 95% CI: 1.56-6.73, 1.11-8.76 and 1.08-97.48 respectively) were less likely to meet TSUL whereas those on urate-lowering agents (OR 0.23, 95% CI: 0.13-0.40) were more likely to achieve satisfactory urate control.</p><p><strong>Conclusion: </strong>60.3% of gout patients were treated with urate-lowering agents in public primary care settings in Hong Kong, while only 29.9% of gout patients and none of tophaceous gout patients were adequately treated. Male patients, active smokers or comorbid with CKD stage 3a, 3b and 4 were less likely to achieve target urate control.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"38"},"PeriodicalIF":2.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11817381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411881","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, attitude, and practice (KAP) of primary health physicians towards glucose self-monitoring in patients with type2 diabetes mellitus in Palestine.","authors":"Suha Hamshari, Sondos Hamadneh, Afnan Morshed Ajlone, Ahmad Wajdi Mashni, Mohammad Asem Jubeh","doi":"10.1186/s12875-025-02720-5","DOIUrl":"10.1186/s12875-025-02720-5","url":null,"abstract":"<p><strong>Background: </strong>Type 2 Diabetes Mellitus (T2DM) stands as a significant global health challenge for individuals and societies. In the context of Palestine, T2DM affects about 9.2% of the Palestinian population and contributes to a relatively high complication rate. Effectivemanagement strategies including glucose self- monitoring need to be optimized to improve patient outcomes and alleviate the strain on the healthcare system. One of the physicians' roles in T2DM management is explaining and guiding patients towards the integration of glucose self-monitoring into their personal diabetes management routine. This study investigates the knowledge, attitudes, and practices of primary health care physicians who care for (T2DM) patients in the West Bank regarding glucose self-monitoring.</p><p><strong>Methods: </strong>A cross-sectional study was conducted among physicians working in PHC centers. The study period was from January to March 2024. Data was collected through a self-administered questionnaire.</p><p><strong>Results: </strong>Five hundred ten medical doctors were surveyed and 300 of them replied, giving a response rate of 58.8%. The median age of the respondents was 35.0 [30.0, 41.0] years. Of the respondents, 180 (60.0%) were males. The median duration of practice as a doctor was 9.0 [5.0, 15.0] years. Most, 252 (84.0%), were general practitioners, 38 (12.7%) family medicine specialists, and 10 (3.3%) other specialties. Female respondents and those who saw more patients reported better knowledge (p < 0.05). The majority believed that glucose self-monitoring can improve patient outcomes, knew values of glucose self-monitoring that corresponded to HbA1c control and the microvascular complications of diabetes, and realized the importance of glucose self-monitoring for patients. However, 40% of them are not confident or somewhat confident about interpreting data and adjusting treatment plans. Regarding the respondent's practices, 39.3% of the doctors stated that they would recommend glucose- self monitoring to newly diagnosed type 2 diabetes patients more than one time a day.</p><p><strong>Conclusion: </strong>There was a positive attitude toward glucose self-monitoring among the respondents in the primary healthcare clinics. Conversely, the clinicians' glucose self-monitoring practices were suboptimal. Future research should examine the knowledge, attitudes, and practices of physicians who provide patient care in the private sector.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"33"},"PeriodicalIF":2.0,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392636","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":"Rapid rule-out of acute myocardial infarction using the 0/1-hour algorithm for cardiac troponins in emergency primary care: the OUT-ACS implementation study.","authors":"Tonje R Johannessen, Sven Eirik Ruud, Anne Cecilie K Larstorp, Dan Atar, Sigrun Halvorsen, Beate Nilsen, Odd Martin Vallersnes","doi":"10.1186/s12875-025-02723-2","DOIUrl":"10.1186/s12875-025-02723-2","url":null,"abstract":"<p><strong>Background: </strong>Acute chest pain has a high hospital referral rate due to the limited ability to exclude acute myocardial infarction (MI) in primary care. We aimed to evaluate the effectiveness of implementing the European Society of Cardiology (ESC) 0/1-hour algorithm for high-sensitivity cardiac troponin T (hs-cTnT) testing in emergency primary care.</p><p><strong>Methods: </strong>In a prospective study (April-October 2023), the ESC 0/1-hour algorithm for hs-cTnT was implemented at the main emergency primary care clinic in Oslo, Norway. All consecutive patients ≥ 18 years with acute non-traumatic chest pain having hs-cTnT measurements done were registered. The patients were assigned to MI rule-out, rule-in, or further observation using the algorithm. Patients in the observation group had a 4-hour hs-cTnT measurement done. The outcome measures were the proportion of patients conclusively assessed by the protocol, personnel adherence, reduction in length of stay (LOS) compared to the previous 0/4-hour protocol (historical cohort), and disposition.</p><p><strong>Results: </strong>During six months, hs-cTnT measurements were conducted in 32.6% (995/3053) of chest pain patients (median age 58 years (IQR 45-68); 50.6% female). A single hs-cTnT measurement assigned 24.1% (n = 240/995) towards MI rule-out, suitable for early discharge, increasing to 63.8% after adding a 1-hour measurement. The observation group (319/995, 32.1%) was reduced to 23.0% (229/995) after a 4-hour measurement. A total of 77.0% of the patients were conclusively assigned to either rule-out or rule-in group. The personnel adhered well to the new protocol, with a median 1-hour sampling interval of 63 min (IQR 60-66) and 4.6 h (IQR 4.1-5.5) for the 4-hour sample. The protocol was misinterpreted or overruled in 8.6% of the cases. Compared to the previous 0/4-hour protocol, LOS was reduced by -2.2 h (95% confidence intervals - 2.6 to -1.7). After completed assessment at the clinic, 14.8% were transferred to hospital, where 20 patients were diagnosed with an MI. The remaining patients were sent home or managed in the outpatient setting; any occurrence of MIs in this group is unknown.</p><p><strong>Conclusions: </strong>The ESC 0/1-hour algorithm effectively assesses low-risk acute chest pain in emergency primary care, reinforcing its gatekeeper role by managing these patients at a lower level of care.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"34"},"PeriodicalIF":2.0,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392639","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":"Exploring expressed concerns and uncanny feeling in patients with shortness of breath calling out-of-hours primary care.","authors":"Michelle Spek, Dorien L Zwart, Esther de Groot, Michelle R Timmerman, Maarten van Smeden, Daphne C A Erkelens, Anna S M Dobbe, Mathé Delissen, Frans H Rutten, Roderick P Venekamp","doi":"10.1186/s12875-025-02736-x","DOIUrl":"10.1186/s12875-025-02736-x","url":null,"abstract":"<p><strong>Background: </strong>Patients contacting out-of-hours primary care (OHS-PC) with shortness of breath (SOB) are often concerned. Sometimes, they also have an uncanny feeling; existential anxiety that something is wrong in their body. How concerns and uncanny feeling are related to critical medical conditions that cause SOB is unknown. We therefore explored the relation between expressed concerns and researcher's judged uncanny feeling among patients who contact OHS-PC for SOB with potential life-threatening events (LTEs) as the outcome.</p><p><strong>Methods: </strong>This is an explorative cross-sectional study. We analysed telephone triage conversations from patients with SOB who contacted Dutch OHS-PC between September 2020 and August 2021. We recorded whether patients expressed concerns and we judged whether patients had an uncanny feeling. We calculated odds ratios (ORs) for the association between (i) expressed concerns and (ii) uncanny feeling with the outcome potential LTEs.</p><p><strong>Results: </strong>Of the 1,843 patients with SOB, 43.6% patients expressed concerns and 33.0% had an uncanny feeling. Potential LTEs were similarly present among those who did and did not express concerns (OR: 1.07; 95% CI 0.84-1.37, mOR: 1.07; 95% CI 0.83-1.36), whereas potential LTEs were more often present among those with an uncanny feeling compared to those without such feeling (OR: 1.36; 95% CI 1.06-1.75, mOR: 1.35; 95% CI 1.05-1.74).</p><p><strong>Conclusions: </strong>Among patients who contacted OHS-PC with SOB, a perceived uncanny feeling of the patient was associated with a higher odd of potential LTEs, while patient's expressed concerns were not. Critical reflective interpretation is needed as uncanny feelings are difficult to judge. Nevertheless, our results implicate that further research into uncanny feelings in telephone triage could further improve the understanding of the relation with potential LTEs. Furthermore, this could be used to investigate how triage nurses may become more sensitive to what the patient is feeling but not explicitly saying such as by paying special attention to paralanguage.</p><p><strong>Trial registration: </strong>The Netherlands Trial Register, number: NL9682, registration date: 20-08-2021.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"32"},"PeriodicalIF":2.0,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11806686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143375086","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}