BMC primary care最新文献

{"title":"Assessing patient experiences with a Virtual Triage and Assessment Centre (VTAC): a mixed-methods study using an online survey and semi-structured interviews in Renfrew County, Ontario.","authors":"Antoine St-Amant, Cayden Peixoto, Dez Bair-Patel, Martha Heideman, Kayla Menkhorst, Jonathan Fitzsimon","doi":"10.1186/s12875-025-02719-y","DOIUrl":"10.1186/s12875-025-02719-y","url":null,"abstract":"<p><strong>Background: </strong>In March 2020, the Renfrew County Virtual Triage and Assessment Centre (VTAC) was launched as a large-scale, innovative, hybrid healthcare program. VTAC aims to alleviate pressure on emergency departments by providing additional and more equitable access to family physicians and allied health professionals. This study's objective was to evaluate patients' experiences with VTAC.</p><p><strong>Methods: </strong>In this mixed-methods study, we distributed 3,026 surveys, receiving 383 responses that met our inclusion criteria (13%), and conducted 10 semi-structured interviews with Renfrew County residents aged 18 and above who had utilized VTAC at least once since 2023. Survey data were analyzed through descriptive statistics, chi-squared tests, and a multivariate binary logistic regression, while semi-structured interviews were coded and analyzed using reflexive thematic analysis.</p><p><strong>Results: </strong>The majority of survey respondents were aged over 55 (58%), identified as Caucasian (91%) and women (70%), with 76% having college or university-level education. Additionally, 81% were either unattached, or attached to a doctor who was not easily accessible. Our findings demonstrate overall satisfaction with VTAC, with 86% patients reporting that they were satisfied or very satisfied with the program. This was irrespective of demographic characteristics, health status, or appointment modality. In our interviews, four main themes emerged: \"Healthcare in Renfrew County\", \"Accessing VTAC\", \"VTAC Clinical Care\", and \"Improving VTAC\". These themes underscore major difficulties residents encounter in accessing healthcare in Renfrew County and illustrate that services from VTAC align with a genuine population-level need, contributing to mitigating some of these challenges.</p><p><strong>Conclusion: </strong>Renfrew County, like many other underserved regions, is grappling with a crisis of access to healthcare. VTAC addresses this gap by providing timely access to a family doctor. Our findings demonstrate patient acceptability and satisfaction with VTAC, offering insights that could guide the design of similar healthcare programs. This model may also serve as a scalable solution for improving healthcare access in underserved regions facing similar challenges.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"21"},"PeriodicalIF":2.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences between private and public primary health care centers and differences between men and women in antihypertensive care and cardiovascular prevention in all patients with hypertension treated in primary care in Stockholm County, Sweden.","authors":"Per Wändell, Anders Norrman, Julia Eriksson, Charlotte Ivarsson, Hrafnhildur Gudjonsdottir, Maria Hagströmer, Lena Lundh, Jan Hasselström, Boel Brynedal, Christina Sandlund, Axel C Carlsson","doi":"10.1186/s12875-025-02716-1","DOIUrl":"10.1186/s12875-025-02716-1","url":null,"abstract":"<p><strong>Aims: </strong>To study differences in cardiovascular prevention and hypertension management in primary care in men and women, with comparisons between public and privately operated primary health care (PHC).</p><p><strong>Methods: </strong>We used register data from Region Stockholm on collected prescribed medication and registered diagnoses, to identify patients aged 30 years and above with hypertension. Age-adjusted logistic regression was used to calculate odds ratios (ORs) with 99% confidence intervals (99% CIs) using public PHC centers as referents.</p><p><strong>Results: </strong>In total, 119,267 patients with a registered hypertension diagnosis at their primary care center were included; 58,239 men and 61,028 women. In terms of co-morbidities and medications, there were some differences between privately and publicly run PHC: registered diagnosis of dementia, which was higher at private PHC, age-adjusted OR 1.80 (1.24-2.69). For lifestyle counseling, privately run PHC had a higher rate of registered counseling for tobacco 1.17 (1.06-1.29), physical activity 1.13 (1.06-1.17), unhealthy diet 1.08 (1.04-1.13), and counseling according to highest prioritized level of advice stated by national guidelines 1.14 (1.09-1.18). Differences in comorbidities between men and women were found, with higher frequencies of coronary heart disease, congestive heart failure, atrial fibrillation, stroke, diabetes, and gout among men. Regarding antihypertensive treatment, women received less treatment of calcium channel blockers and ACE inhibitors, but more of angiotensin receptor blockers.</p><p><strong>Conclusions: </strong>These findings highlight the need for targeted preventive efforts in PHC, especially for male patients, to address disparities in cardiovascular health outcomes. Small differences in preventive measures between public and privately run PHC suggest generally consistent care across healthcare ownership models.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"20"},"PeriodicalIF":2.0,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043859","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":"Ten pressure points in primary care during COVID-19: findings from an international narrative review.","authors":"Sally Hall Dykgraaf, Anne Parkinson, Michael Wright, William C W Wong, Jane Desborough, Lauren Ball, Elizabeth Sturgiss, Garang M Dut, Katelyn Barnes, Danielle Butler, Steph Davis, Kirsty Douglas, Candan Kendir, Danielle Martin, Robert Marten, Katherine Rouleau, Shannon Barkley, Lucas de Toca, Michael Kidd","doi":"10.1186/s12875-024-02640-w","DOIUrl":"10.1186/s12875-024-02640-w","url":null,"abstract":"<p><strong>Background: </strong>Strong primary care (PC) services are the foundation of high-performing health care systems and can support effective responses to public health emergencies. Primary care practitioners (PCPs) and PC services played crucial roles in supporting global health system responses to the COVID-19 pandemic. However, these contributions have come at a cost, impacting on PC services and affecting patient care. This secondary analysis of data from an integrative systematic review across international PC settings aimed to identify and describe burdens and challenges experienced by PCPs and PC services in the context of their contributions to COVID-19 pandemic responses.</p><p><strong>Methods: </strong>We conducted an integrative systematic review and narrative analysis, searching PubMed/Medline, Scopus, Proquest Central and Cochrane Database of Systematic Reviews, plus reference lists of key publications. Included studies were published in peer-reviewed English or Chinese language journals, and described collective responses to COVID-19 undertaken in PC settings or by PCPs. Narrative data regarding impacts on PC services and challenges experienced by PCPs were extracted and analysed using inductive coding and thematic analysis.</p><p><strong>Results: </strong>From 1745 screened papers 108, representing 90 countries, were included. Seventy-eight contained data on negative impacts, challenges or issues encountered in PC. Ten 'pressure points' affecting PC during COVID-19 were identified, clustered in four themes: demand to adopt new ways of working; pressure to respond to fluctuating community needs; strain on PC resources and systems; and ambiguity in interactions with the broader health and social care system.</p><p><strong>Conclusions: </strong>PCPs and PC services made critical functional contributions to health system responsiveness during the COVID-19 pandemic. However, both practitioners and PC settings were individually and collectively impacted during this period as a result of changing demands in the PC environment and the operational burden of additional requirements imposed on the sector, offering lessons for future pandemics. This study articulates ten empirically derived 'pressure points' that provide an initial understanding of burdens and demands imposed on the international primary care sector during the COVID-19 pandemic. The impact of these contributions should inform future pandemic planning, guided by involvement of PCPs in public health preparedness and policy design.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"19"},"PeriodicalIF":2.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042833","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":"Role of regular medical visits in mitigating increased suicide risk during the early COVID-19 pandemic in Kobe, Japan.","authors":"Daisuke Miyamori, Yasushi Nagasaki, Shuhei Yoshida, Saori Kashima, Wataru Omori, Kei Itagaki, Masanori Ito","doi":"10.1186/s12875-025-02707-2","DOIUrl":"10.1186/s12875-025-02707-2","url":null,"abstract":"<p><strong>Background: </strong>Japan has one of the lowest COVID-19 death rates, while the annual suicide rate in 2020 has risen for the first time since 2007. This study aimed to identify high-risk populations and assess the impact of medical visits on suicide trends post-COVID-19 pandemic in Japan.</p><p><strong>Method: </strong>This quasi-experimental study analyzed a population-based database from Hyogo Prefecture (2012-2022). Interrupted time-series analyses identified level and trend changes in monthly suicide rates per 1 million population during the exposure period (2020-2022) versus the control period (2012-2019). Regular visits to primary care and psychiatry stratified analysis.</p><p><strong>Results: </strong>2181 cases were analyzed, with two-thirds male and a median age of 54. Primary care physicians and psychiatric history were present in 69% and 40% of patients. The study found significant level changes in suicide rates overall (4.14, 95% CI: 1.70, 6.58) among individuals without regular primary care physician visits (2.83, 95% CI: 1.35, 4.32) and without psychiatric visits (2.85, 95% CI: 0.56, 5.14). In contrast, no significant changes were observed in individuals with regular primary care (0.99, 95% CI: -0.78, 2.76) or regular psychiatric visits (0.59, 95% CI: -0.98, 2.16). The trend changes were not significant in any of the groups.</p><p><strong>Conclusion: </strong>This study suggests that a history of attending a medical institution may have prevented the rapid increase in suicides during the early stages of the COVID-19 pandemic.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"18"},"PeriodicalIF":2.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11756082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030345","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 the general practitioners' perception of the inter-professional care of rheumatoid arthritis patients (GEPRA-II): a qualitative interview study.","authors":"Anne-Laure Yailian, Audrey Janoly-Dumenil, Emmanuelle Vignot, Aurélie Fontana, Charline Estublier, Cyrille Confavreux, Roland Chapurlat, Claude Dussart, Humbert de Freminville","doi":"10.1186/s12875-025-02713-4","DOIUrl":"10.1186/s12875-025-02713-4","url":null,"abstract":"<p><strong>Background: </strong>A lack of medication adherence among patients with rheumatoid arthritis (RA) has been reported. Inter-professional collaborations seem essential for an optimal therapeutic management of patients. The aim of this study was to analyse the barriers and facilitators of general practitioners (GPs) for the implementation of collaborative support programmes in RA.</p><p><strong>Methods: </strong>A qualitative semi-structured study using face-to-face or telephone interviews was conducted. Eligible participants included French GPs referring patients with RA. Interviews were audio-recorded and then transcribed. Data were analysed using Braun and Clarke's thematic analysis framework with Nvivo^®12 software.</p><p><strong>Results: </strong>Nineteen GPs were interviewed between August 2019 and February 2020. Five themes were identified in the care of their patients with RA. GPs reported being mainly involved in diagnosis and orientation, and frequently asked for pain management and explanation/reformulation of previously given information. They perceived their patients to be adherent to their treatments, although they frequently identified reasons for non-adherence. Regarding their perception of the community-hospital relationship, they sometimes considered it insufficient and expected more immediate interactions. Additionally, most interviewed GPs had no expectation regarding increased collaborations with community pharmacists (CPs) and several GPs were motivated to be more involved in a patient support programme. However, barriers were identified: lack of time and training, and insufficient payment.</p><p><strong>Conclusions: </strong>The implementation of a collaborative patient support programme in RA should be developed taking into account the barriers and facilitators identified by GPs who appeared to be aware of the causes of potential non-adherence, and were particularly interested in receiving more information about the therapeutic monitoring of patients by hospital professionals.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"17"},"PeriodicalIF":2.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11752799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143026071","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":"Evaluation of musculoskeletal complaints, treatment approaches, and patient perceptions in family medicine clinics in a tertiary center in Jordan: a cross-sectional study.","authors":"Moh'd S Dawod, Mohammad N Alswerki, Ahmad F Alelaumi, Jehad Feras AlSamhori, Rana J Rahhal, Lina Khraisat, Eman Mohammad Arabas, Hussein M Bdair, Reem M Alhyari, Mohammad Shahin, Mohammad Abu Hilal, Alaa Y Akel, Aws Khanfar","doi":"10.1186/s12875-025-02715-2","DOIUrl":"10.1186/s12875-025-02715-2","url":null,"abstract":"<p><strong>Background: </strong>Musculoskeletal (MSK) conditions, such as back pain and joint disorders, are common globally and significantly burden healthcare systems. Family medicine clinics serve as the first point of care, requiring providers to manage diverse MSK issues and address gender-specific differences, especially in regions with limited resources, like the Middle East. This study evaluates MSK management, gender differences, and patient perceptions in Jordanian family medicine clinics, aiming to improve care strategies and outcomes in similar settings.</p><p><strong>Methods: </strong>This cross-sectional study included 500 adults with musculoskeletal complaints at a Jordanian teaching hospital (January-June 2024). Data were collected via interviews and records, focusing on patient perceptions and health profiles. Ethical approval and informed consent were obtained. Analysis was conducted in SPSS with p < 0.05 as the significance threshold.</p><p><strong>Results: </strong>In our study of 500 patients (mean age 46.1 years, 61.5% female), key gender differences emerged. Females had a higher prevalence of low back pain (61.9% vs. 38.1%, p = 0.024) and hip pain (100%, p = 0.008), as well as greater anxiety about disease progression (62.2% vs. 37.8%, p = 0.045) and fear of disability (64.2% vs. 35.8%, p = 0.048). Females also reported lower mental health (p = 0.036), sleep quality (p = 0.044), and overall quality of life (p = 0.019). In contrast, males showed higher workload (54.4% vs. 45.6%, p = 0.020), more work-related injuries (82.8%, p < 0.001), and greater disability (p = 0.024) with lower functional status (p = 0.041). These findings underscore significant gender-specific needs in MSK care.</p><p><strong>Conclusion: </strong>Our study reveals notable gender-based differences in musculoskeletal complaints and treatment experiences in a Jordanian tertiary setting. Females reported higher rates of low back and hip pain, more frequent referrals, and lower quality of life, while males experienced greater occupational strain, work-related injuries, and disability.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"16"},"PeriodicalIF":2.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11748281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017278","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":"Communicating certainty via verbal probability phrases: comparing health contexts with no context.","authors":"Yiyun Shou, Lok Him Lee, Joey Elizabeth Yeo, Michael Smithson","doi":"10.1186/s12875-024-02687-9","DOIUrl":"10.1186/s12875-024-02687-9","url":null,"abstract":"<p><strong>Introduction: </strong>Medical professionals often use verbal phrases to communicate uncertainties and certainties with their patients and the general public.</p><p><strong>Objectives: </strong>This study aimed to investigate factors that can influence people's interpretation of probability phrases of certainty and uncertainty communicated by doctors in health and medical settings.</p><p><strong>Methods: </strong>An experimental study with a randomized factorial design was conducted to examine both context-related factors and individual difference factors on participants' interpretation across directions of phrases and frames of the context.</p><p><strong>Results: </strong>Context significantly influenced participants' interpretation of probability phrases regardless of their level of certainty. Participants' self-reported prior beliefs were the main driver of this context effect. When participants were in a state of uncertainty, their reliance on experts significantly reduced the prior beliefs' effect. Finally, refuting probability phrases might provide more reassurance than affirming phrases.</p><p><strong>Conclusion: </strong>People may perceive the outcomes communicated by doctors differently from what the doctors intend to convey, depending on their prior beliefs, reliance on doctors and the direction of phrases. When communicating uncertainties and certainties with patients and general public, it is important for medical professionals to understand audience's prior experiences, and to foster medical trust and audience's reliance on medical professionals to reduce bias in clinical risk communication.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"14"},"PeriodicalIF":2.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017275","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":"Investigating assumptions in motivational interviewing among general practitioners: a qualitative study.","authors":"Paul Aujoulat, Amélie Manac'h, Catherine Le Reste, Delphine Le Goff, Jean Yves Le Reste, Marie Barais","doi":"10.1186/s12875-025-02706-3","DOIUrl":"10.1186/s12875-025-02706-3","url":null,"abstract":"<p><strong>Background: </strong>Unhealthy behaviours contributing to cardiovascular issues, diabetes, strokes, and cancer, pose significant health risks. General practitioners (GPs) are pivotal in guiding behaviour change, with Motivational Interviewing (MI) showing promise. MI, developed by William Miller and Stephen Rollnick, aims to enhance motivation for change. Despite its efficacy in areas like smoking cessation and weight loss, its uptake among French GPs remains uncertain.</p><p><strong>Methods: </strong>This qualitative study was to explore GPs' understanding of MI, its perceived benefits and the obstacles to its implementation in western Brittany (Finistère). Semi-structured interviews, conducted by two female trainees, explored MI knowledge, benefits, and barriers with a thematic analysis.</p><p><strong>Results: </strong>Between November 2020 and May 2021, 11 semi-structured interviews were conducted with GPs. Participants had a limited understanding of MI, often confusing it with persuasion. MI was seen as a patient-centered tool fostering behavioural change, with reported benefits in cancer screening, chronic disease management, and vaccination. However, barriers such as time constraints, limited training availability, and systemic issues hinder its adoption. Participants emphasized MI's utility for challenging cases but noted it was unnecessary for engaged patients. MI could also enhance doctor-patient relationships and physician satisfaction. Overcoming barriers requires addressing logistical issues, integrating MI into training, and promoting its long-term efficiency to improve healthcare outcomes.</p><p><strong>Conclusion: </strong>This study highlighted GPs' limited knowledge of MI but recognized its value in promoting patient-centered care and behaviour change. GPs identified its potential in areas like cancer screening, chronic disease management, and vaccine hesitancy while noting barriers such as time constraints and insufficient training. Addressing these challenges through better integration into training and practice could enhance patient outcomes and provider satisfaction. Focused efforts are needed to translate MI's potential into routine clinical use.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"15"},"PeriodicalIF":2.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017292","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 associated with delayed referrals of patients with sepsis from primary to tertiary healthcare in Blantyre, Malawi: a qualitative study.","authors":"Sylvester Kaimba, Eric Umar","doi":"10.1186/s12875-025-02708-1","DOIUrl":"10.1186/s12875-025-02708-1","url":null,"abstract":"<p><strong>Background: </strong>Sepsis is defined as invasion of pathogens into the blood stream together with the host response to this invasion. Thus, sepsis consists of the systemic inflammatory response syndrome (SIRS)caused by infection. It is a life-threatening condition that requires prompt detection and early definitive medical intervention. Globally, sepsis is common, with an estimated 31.5 million cases per year. Sepsis accounts for a significant in-hospital mortality rate of 17% in high-income countries, while in Malawi, it ranges from 17 to 50%. For Malawi, the trend can be reversed with improvements in patient referral system within the healthcare system. The study sets out to establish factors associate with delay referral of patients with sepsis from primary healthcare to tertiary hospitals and to understand healthcare workers and patients' perspectives on barriers associated with delayed referral of patients with sepsis from primary to tertiary healthcare.</p><p><strong>Methods: </strong>A qualitative descriptive study in six health centres within Blantyre District health office. In-depth interviews were conducted with 22 respondents: healthcare providers [n = 12]; patients [n = 10] using semi-structured interview guides. Purposive sampling techniques were used in selecting healthcare providers (health centre in charges) and patients.</p><p><strong>Results: </strong>The study demonstrating that the main referral pathways for patients with sepsis include community-to-facility and facility-to-facility referrals. Ambulances and personal transport are common transportation mode used during referrals. Primary care facilities face several challenges that delay referrals from primary to tertiary health facility of patients with sepsis, such as lack of referral transport, poor communication, poor road network, shortage of skilled healthcare workers, patient preferences, delayed treatment-seeking action, and ambulances prioritising maternal conditions.</p><p><strong>Conclusions: </strong>Patients' delay and failure to access prompt and timely referral services result from the healthcare system's lack of transport, communication problems, bad road networks and shortage of well-trained personnel. Referral delays have deleterious effects on patient-care outcomes.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"13"},"PeriodicalIF":2.0,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11742747/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017281","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 perspectives on stress after ICU and a short primary care based psychological intervention - results from a qualitative sub‑study of the PICTURE trial.","authors":"Antina Beutel, Linda Sanftenberg, Chris M Friemel, Robert Philipp Kosilek, Maggie Schauer, Thomas Elbert, Ulf-Dietrich Reips, Tomke Schubert, Sabine Gehrke-Beck, Konrad Schmidt, Jochen Gensichen","doi":"10.1186/s12875-024-02698-6","DOIUrl":"10.1186/s12875-024-02698-6","url":null,"abstract":"<p><strong>Background: </strong>Approximately 20-25% of patients who survive medical treatment at an intensive care unit (ICU) develop post-traumatic stress symptoms. There is currently a gap in follow-up care for them. As part of the PICTURE study, general practitioners (GPs) carried out a brief interview-based intervention. The aim of this sub-study is to record the most distressing memories of ICU treatment from the patient's perspective and their evaluation of a GP-based brief psychological intervention.</p><p><strong>Methods: </strong>Participants were recruited from the intervention group of the main PICTURE study using selective sampling. All of them had experienced an ICU stay with mechanical ventilation and severe organ failure in the previous two years. They were interviewed about their experience of psychological stress during their ICU stay and their retrospective evaluation of the intervention. Semi-structured, guideline-based telephone interviews were conducted for this purpose, processed, and analyzed using the structuring qualitative content analysis based on Mayring.</p><p><strong>Findings: </strong>When asked N = 8 patients about the most stressful memory of their stay at ICU, the main themes were helplessness, pain, fixation, inability to communicate and sleep disturbances. The question of amnesia regarding the stay in the ICU was answered affirmatively by half of the interviewees but was not experienced as stressful. The brief trauma-focused intervention carried out by their GPs was well received by all respondents.</p><p><strong>Conclusions: </strong>The interviewees confirm that aversive traumatizing experiences are often associated with intensive care treatment and reinforce each other. These are due to the treatment setting but should be reduced wherever possible. In view of chronification and the lack of specific follow-up treatment options for these patients and the long waiting times for psychotherapy, the implementation of low-threshold treatment options by GPs appears to be ideally suited to closing this gap in care, particularly for patients with mild to moderate symptoms of a post-traumatic stress disorder.</p><p><strong>Trial registration: </strong>The main trial was registered at ClinTrials gov (NCT03315390) and at the German Register of Clinical Trials (DRKS, DRKS00012589) on 17/10/2017.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"12"},"PeriodicalIF":2.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11734548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017296","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}