BMC primary carePub Date : 2025-04-28DOI: 10.1186/s12875-025-02821-1
Esther T van der Werf, Rachel Perry, Thomas Ostermann, Henrik Szőke, Alyson L Huntley
{"title":"A core outcome set for acute otitis media (COS-AOM) for primary and community care studies.","authors":"Esther T van der Werf, Rachel Perry, Thomas Ostermann, Henrik Szőke, Alyson L Huntley","doi":"10.1186/s12875-025-02821-1","DOIUrl":"https://doi.org/10.1186/s12875-025-02821-1","url":null,"abstract":"<p><strong>Background and objective: </strong>Outcome heterogeneity reported in Acute Otitis Media (AOM) research hinders evidence accumulation. Identification of a Core Outcome Set (COS) to report on in future studies in AOM is warranted.</p><p><strong>Methods: </strong>Phase 1: Candidate outcomes identification by reviewing previously reported outcomes in systematic reviews of AOM. Phase 2: In a Parent and Public Involvement (PPI) meeting candidate outcomes were discussed on their importance, presence, and absence. Phase 3: The clinical perspective of health professionals and pharmacists was anonymously gained through a ranking task. Phase 4: An International Steering Committee (ISC) discussed the ranked outcomes and advised on the final COS.</p><p><strong>Results: </strong>51 candidate outcomes were identified from 3 reviews and summarised to 20 overarching outcomes in Phase 1. Eight parents participated in the PPI meeting. 28 participants (11 GPs, 11 Traditional Complementary and Integrative medicine (TCIM) Professionals, 6 Pharmacists) ranked the 20 outcome cards. Moderate agreement in ranking was reached within all 3 medical groups, with pharmacists showing the highest agreement (0.540) and the TCIM professionals the lowest (0.421). Correlation coefficients between the groups show a sufficiently high agreement (P < 0.01). The ICS confirmed the final COS-AOM including 8 acute outcomes and 2 mid-long-term outcomes. Agreement for each outcome was reached with 100%.</p><p><strong>Conclusion: </strong>The proposed COS defines a minimum set of outcomes to be measured and reported in primary care and community studies on AOM, including TCIM clinical trials, to enhance evidence-based knowledge. Future research should focus on validating commonly used measurement tools for these outcomes and enhancing findings' generalisability beyond the UK, Europe and primary care settings.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"134"},"PeriodicalIF":2.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12036145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047336","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}
BMC primary carePub Date : 2025-04-28DOI: 10.1186/s12875-025-02832-y
Tope Michael Ipinnimo, Olumide Temitope Asake, Oluwafemi Oreoluwa Olowoselu, Taofeek Adedayo Sanni, Abolaji Paul Adekeye, Rasheed Adeyemi Adepoju, Gbenga Damilola Akinlua, Paul Oladapo Ajayi, Oluwole Michael Adeojo, Christiana Aderonke Afolayan, Tolulope Ayodeji Bamidele, Olaoye Michael Faleke, Shina Emmanuel Akomolafe, Olabode Nelson Akingunloye, Akinleye Lawrence Alo, Moses Blessing Dada, Opeyemi Oladipupo Abioye, Olubunmi Tolu Omotunde, Olagoke Olaseinde Erinomo, John Olujide Ojo
{"title":"Breaking bad news: a cross-sectional study assessing SPIKES protocol adherence and other methods employed among medical doctors in Nigeria.","authors":"Tope Michael Ipinnimo, Olumide Temitope Asake, Oluwafemi Oreoluwa Olowoselu, Taofeek Adedayo Sanni, Abolaji Paul Adekeye, Rasheed Adeyemi Adepoju, Gbenga Damilola Akinlua, Paul Oladapo Ajayi, Oluwole Michael Adeojo, Christiana Aderonke Afolayan, Tolulope Ayodeji Bamidele, Olaoye Michael Faleke, Shina Emmanuel Akomolafe, Olabode Nelson Akingunloye, Akinleye Lawrence Alo, Moses Blessing Dada, Opeyemi Oladipupo Abioye, Olubunmi Tolu Omotunde, Olagoke Olaseinde Erinomo, John Olujide Ojo","doi":"10.1186/s12875-025-02832-y","DOIUrl":"https://doi.org/10.1186/s12875-025-02832-y","url":null,"abstract":"<p><strong>Background: </strong>The SPIKES (Setting, Perception, Invitation, Knowledge, Empathy, and Strategy) protocol has been widely used in many developed countries for breaking bad news (BBN), however, serious uncertainty remains in its understanding and implementation in many developing nations. This study aims to assess adherence to SPIKES protocol and its associated factors, in addition to exploring alternative techniques used to BBN among medical doctors in Nigeria.</p><p><strong>Methods: </strong>A cross-sectional study was conducted in Ekiti State, Nigeria among 245 medical doctors selected through a systematic sampling technique in May, 2024. A semi-structured questionnaire, adapted from a previous study was used to collect information on biodata, practice of SPIKES protocol, and an open-ended question that asked how the respondents break bad news. Frequencies, logistic regression, and content analysis (for the open-ended question) were conducted.</p><p><strong>Results: </strong>Overall, 178 (72.7%) doctors fully adhered to the SPIKES protocol with Settings (98.4%), Perception (93.9%), Invitation (76.7%), Knowledge (99.2%), Empathy (98.0%) and Strategy (98.4%). Clinical position(p = 0.002) and education or training(p = 0.034) were significant on bivariate. Predictors of full SPIKES adherence were doctors at public tertiary (AOR = 0.132; 95%CI = 0.029-0.600) and public secondary/primary health facilities (AOR = 0.079; 95%CI = 0.012-0.502) than those in private health facilities; doctors that are pediatricians (AOR = 0.109; 95%CI = 0.023-0.515) than the general practitioners. Content analysis shows many doctors adopt the full SPIKES protocol, use different aspects of it (SPIKES variants viz the Knowledge and Empathy (KE), Setting and Knowledge (SK), and the Setting, Knowledge, and Empathy (SKE)), some use no specific protocol, adopt the religious/spiritual approach, and other (Blunt, Diplomatic and BATHE) methods/Approaches.</p><p><strong>Conclusions: </strong>Achieving consistent BBN practice requires continuous training and more support as shown by variability in adherence influenced by factors such as training and education, healthcare facility, and specialty.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"133"},"PeriodicalIF":2.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12036165/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062324","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}
BMC primary carePub Date : 2025-04-28DOI: 10.1186/s12875-025-02803-3
Ruben Burvenich, Stefan Heytens, David A G Bos, Kaatje Van Roy, Thomas Struyf, Jaan Toelen, An De Sutter, Jan Y Verbakel
{"title":"Safety netting advice for acutely ill children presenting to ambulatory care: exploring parents' opinions, ideas, and expectations through focus group interviews.","authors":"Ruben Burvenich, Stefan Heytens, David A G Bos, Kaatje Van Roy, Thomas Struyf, Jaan Toelen, An De Sutter, Jan Y Verbakel","doi":"10.1186/s12875-025-02803-3","DOIUrl":"https://doi.org/10.1186/s12875-025-02803-3","url":null,"abstract":"<p><strong>Background: </strong>Safety netting advice (SNA) is an essential component of the management of acutely ill children in ambulatory care. However, healthcare professionals use a variety of SNA methods, leading to inconsistencies within and across organisations. Much research has explored the perspective on SNA of parents from the UK, but such research is lacking outside the UK context.</p><p><strong>Methods: </strong>We conducted focus groups with Belgian parents of children 6 months to 12 years old, who were recruited through maximum variation sampling. We transcribed the interviews verbatim. Using a combination of inductive and deductive 'in vivo' coding we developed themes from the data. As per the Grounded Theory approach, we reiterated between data collection, coding, and analysis. After participant validation of provisional themes, we constructed the final thematic framework.</p><p><strong>Results: </strong>Through six focus groups with 30 parents, we identified five themes: (1) Relevant background information; (2) To know what to expect, what to look out for; (3) Instructions on child homecare and when to revisit a physician; (4) Physicians who consider parents' perspectives and contexts; (5) A reliable source that provides SNA only when necessary, possibly in a multimodal way.</p><p><strong>Conclusions: </strong>We identified five themes from Belgian parents' views on SNA, aligning with prior UK research. These findings form an evidence base for developing a consensus statement on the content and form of SNA supported by both parents and experts from high-income countries.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"135"},"PeriodicalIF":2.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12036273/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000481","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}
BMC primary carePub Date : 2025-04-28DOI: 10.1186/s12875-025-02820-2
Agnes Huguet-Feixa, Eva Artigues-Barberà, Joaquim Sol, Xavier Gomez-Arbones, Pere Godoy, Marta Ortega Bravo
{"title":"Vaccine refusal and hesitancy in Spain: an online cross-sectional questionnaire.","authors":"Agnes Huguet-Feixa, Eva Artigues-Barberà, Joaquim Sol, Xavier Gomez-Arbones, Pere Godoy, Marta Ortega Bravo","doi":"10.1186/s12875-025-02820-2","DOIUrl":"https://doi.org/10.1186/s12875-025-02820-2","url":null,"abstract":"<p><strong>Background: </strong>Vaccine refusal and hesitancy represent a crucial challenge to public health, causing delays in vaccination and compromising herd immunity.</p><p><strong>Methods: </strong>To address this issue, we conducted a comprehensive observational study on the adult Spanish population in 2021. Using an online questionnaire, we examined the sociodemographic and sociocultural factors, beliefs, and opinions of those refusing or hesitant about vaccines, as well as their vaccination behaviors by vaccine type and sex.</p><p><strong>Results: </strong>There were 1,312 respondents: 74.5% were female, 73.7% were between 31 and 59 years old, and 71.0% had university studies. Our findings revealed that vaccine refusal rates were relatively low (16.8%), and mainly associated with influenza vaccination (10.3%). Higher refusal rates were observed in those over 60 years old, those expressing hesitancy due to vaccine components, those opposing free and compulsory vaccination, those unaware that vaccination protects the community, and those against consuming cow's milk and using infant formulas for breastfeeding. Vaccine hesitancy was greatest in individuals under 31 years old, women, parents of children under 15 years old, against compulsory vaccination, unaware that vaccination protects the community, with hesitancy due to vaccine costs, and in favour of alternative and complementary treatments.</p><p><strong>Conclusions: </strong>These insights highlight the need for strategies to improve education about vaccination and dispel misconceptions, which are crucial for effectively reducing vaccine refusal and hesitancy across the population.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"132"},"PeriodicalIF":2.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12036127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063093","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}
BMC primary carePub Date : 2025-04-26DOI: 10.1186/s12875-025-02834-w
Eishin Muramatsu, Noriyuki Takahashi, Muneyoshi Aomatsu, Mina Suematsu, Kei Miyazaki
{"title":"Coordinated empathy in attending general practitioners: an interpretive phenomenological approach to constructing a conceptual model of empathy.","authors":"Eishin Muramatsu, Noriyuki Takahashi, Muneyoshi Aomatsu, Mina Suematsu, Kei Miyazaki","doi":"10.1186/s12875-025-02834-w","DOIUrl":"https://doi.org/10.1186/s12875-025-02834-w","url":null,"abstract":"<p><strong>Background: </strong>Empathy in general practice is important because it contributes to patient satisfaction and clinical outcomes. However, few studies have examined the perceptions of empathy of attending physicians, who are skilled medical practitioners. From the perspective of interpretive phenomenology, we conducted the present study to conceptualize perceptions of empathy in attending general practitioners, and to identify experiences that influenced these perceptions.</p><p><strong>Methods: </strong>We conducted four semi-structured interviews with three board-certified attending general practitioners. The transcripts were analyzed using the Steps for Coding and Theorization procedure. The four components of empathy (moral, emotional, cognitive, and behavioral) were used as the theoretical framework for the analysis.</p><p><strong>Results: </strong>We found that the participants exhibited the moral component of empathy, such that they felt they were on a mission to understand and support their patients. Furthermore, they mainly used cognitive empathy to understand the feelings and thoughts of their patients. The participants also used behavioral empathy to convey a sense of understanding to their patients, with the intent of building trust and creating an atmosphere in which the patients felt relaxed and able to speak freely. In contrast, emotional empathy was less frequent because the participants observed emotional boundaries related to professionalism.</p><p><strong>Conclusions: </strong>This study revealed new details about how attending general practitioners coordinate the four components of empathy and how they balance humanistic care with their objective standpoint as physicians. These findings are important in that they provide a model for physicians in terms of providing empathetic care while maintaining professional boundaries.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"130"},"PeriodicalIF":2.0,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12032810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054303","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}
BMC primary carePub Date : 2025-04-26DOI: 10.1186/s12875-025-02822-0
Laura O'Connor, Sarah Delaney, Michelle Hanlon, Peter Hayes, Caroline McCarthy, Brian E McGuire, Denis Mockler, Patrick J Murphy, Louise O'Grady, Maryrose Tarpey, Andrew W Murphy, Susan M Smith
{"title":"Identifying research priorities for chronic disease management in primary care: results of an Irish James Lind Alliance Priority Setting Partnership.","authors":"Laura O'Connor, Sarah Delaney, Michelle Hanlon, Peter Hayes, Caroline McCarthy, Brian E McGuire, Denis Mockler, Patrick J Murphy, Louise O'Grady, Maryrose Tarpey, Andrew W Murphy, Susan M Smith","doi":"10.1186/s12875-025-02822-0","DOIUrl":"https://doi.org/10.1186/s12875-025-02822-0","url":null,"abstract":"<p><strong>Background: </strong>Chronic conditions are extremely common, with approximately 1 million people in Ireland currently affected by the four most common chronic conditions alone. This is expected to significantly increase in the near future due to Ireland's aging population. Identifying the priorities of patients, carers, and healthcare professionals for primary care research in chronic condition management could ensure future work is relevant and that resulting service changes and policy decisions align with the needs of those most affected.</p><p><strong>Methods: </strong>An initial survey to collect potential research questions about the management of all chronic diseases was shared with patients, carers, and healthcare professionals from March to May 2023. Submissions were sorted and checked against existing evidence resulting in a list of 30 unanswered questions. An interim priority setting survey was shared in late 2023, and a final workshop to rank the top ten research priorities took place in January 2024.</p><p><strong>Findings: </strong>The first survey resulted in 350 individual statements (n = 185 participants). Seventy-three respondents had a chronic disease and 72 were primary healthcare professionals. Rankings were informed by an initial priority setting survey (n = 108), followed by an in-person workshop (n = 16) to decide the final order.</p><p><strong>Interpretation: </strong>The resulting top ten research priorities offer a starting point for funding bodies and researchers to ensure that future primary care research in chronic condition management is relevant, meaningful, and impactful. The top ten priorities reflect current Irish and global challenges in healthcare, with top items including communication, non-pharmacological treatments, and multidisciplinary care.</p><p><strong>Funding: </strong>This work was funded by the Health Research Board, as a work package of the Primary Care Clinical Trial Network (HRB CTN 2021-002).</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"131"},"PeriodicalIF":2.0,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12032698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024755","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}
BMC primary carePub Date : 2025-04-25DOI: 10.1186/s12875-025-02836-8
Linlin Zhao, Bingjie Chang, Qinghua Hu, Xiaolei Chen, Juan Du, Shuang Shao
{"title":"The health care needs of multidimensional frail elderly patients with multimorbidity in primary health-care settings: a qualitative study.","authors":"Linlin Zhao, Bingjie Chang, Qinghua Hu, Xiaolei Chen, Juan Du, Shuang Shao","doi":"10.1186/s12875-025-02836-8","DOIUrl":"https://doi.org/10.1186/s12875-025-02836-8","url":null,"abstract":"<p><strong>Purpose: </strong>Our study aimed to explore the health care needs of older adults with multimorbidity assessed as multidimensional frailty from their perspective in Beijing, China, in primary health-care settings.</p><p><strong>Methods: </strong>This study was conducted using a qualitative approach involving semi-structured interviews of 21 participants at the Outpatient clinic, in four primary health care institutions (PHCIs), Beijing, China. The subjects were drawn from a cross-sectional survey that assessed multidimensional frailty in older adults with multimorbidity. The participants meeting the criteria were selected through purposive sampling until subject saturation. The interviews were transcribed and organized verbatim and then subjected to thematic analysis using inductive approach.</p><p><strong>Results: </strong>A total of four themes on the needs of the multidimensional frail elderly patients with multimorbidity were identified, including improving physical functioning, adjusting psychological status, obtaining social support, and choosing health care modalities. Improving physical functioning was their co-occurring need, regardless of the score on the physical frailty dimension. In contrast, it is when increased psychological and social frailty has an impact on physical functioning that might drive patients to develop psychological and social demands.</p><p><strong>Conclusion: </strong>This exploratory study is helpful to understand the healthcare needs of the multidimensionally frail elderly patients with multimorbidity from the perspectives of individuals, families, and society, in turn formulate healthcare promotion strategies. Appropriate policies and measures should be taken, such as integrating multidimensional frailty assessments into current multimorbidity management protocols, developing personalized interventions centered on patient needs, conducting family function assessments and caregiver training programs, and enhancing the integration of social resources.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"128"},"PeriodicalIF":2.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12032638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000544","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}
BMC primary carePub Date : 2025-04-25DOI: 10.1186/s12875-025-02826-w
D Ribas Seguí, MJosé Forcadell, Angel Vila-Córcoles, Cinta de Diego-Cabanes, Olga Ochoa-Gondar, Francisco Martin Lujan, Eva Satué Gracia
{"title":"Classification rule for ten year MACE Risk in primary care tarragona older adults with type2 diabetes: a CHAID decision-tree analysis.","authors":"D Ribas Seguí, MJosé Forcadell, Angel Vila-Córcoles, Cinta de Diego-Cabanes, Olga Ochoa-Gondar, Francisco Martin Lujan, Eva Satué Gracia","doi":"10.1186/s12875-025-02826-w","DOIUrl":"https://doi.org/10.1186/s12875-025-02826-w","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular disease is the leading cause of mortality among individuals with Type 2 Diabetes Mellitus (T2DM). This study developed a simple tool to predict the 10-year risk of major adverse cardiovascular events (MACE) in T2DM patients over 60 years within primary care.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted on patients with T2DM who were over 60 years old in Tarragona, spanning from 01/01/2009-31/12/2018. Primary outcome was MACE, which included acute myocardial infarction (AMI), stroke, and cardiovascular death, all of which were identified using ICD-9 diagnostic codes. Other variables were age, sex, comorbidities, risk factors, as well as clinical and laboratory parameters. A Chi-Square Automatic Interaction Detector (CHAID) decision tree classification was utilized to assess the 10-year risk of developing a new MACE.</p><p><strong>Results: </strong>Five thousand five hundred fifty-four patients with T2DM were identified. Among the 4,666 with T2DM and without previous MACE, 779 patients went on to develop a new MACE. The CHAID model categorizes individuals into three risk groups based on the primary predictor variable, which is age. For patients under the age of 71 with hypertension, having HDL-c levels less than 39 mg/dL increases the risk of developing a new MACE to 19.9%. Among individuals aged 71 to 75 years, having fasting glucose levels greater than 177 mg/dL elevates the risk to 27.2%.</p><p><strong>Conclusion: </strong>Classification trees based on CHAID allow for the development of decision rules and simplify the stratification of cardiovascular risk in patients with T2DM, making it a valuable tool for risk assessment within a primary care setting.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"129"},"PeriodicalIF":2.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12032696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043661","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}
BMC primary carePub Date : 2025-04-25DOI: 10.1186/s12875-025-02816-y
Laura J Damen, Britt Beerman, W M Meijer, B J Knottnerus, J D De Jong, L H D Van Tuyl
{"title":"Barriers to the use of direct access according to allied health professionals; an exploration among Dutch physiotherapists, dietitians, and health insurers.","authors":"Laura J Damen, Britt Beerman, W M Meijer, B J Knottnerus, J D De Jong, L H D Van Tuyl","doi":"10.1186/s12875-025-02816-y","DOIUrl":"https://doi.org/10.1186/s12875-025-02816-y","url":null,"abstract":"<p><strong>Introduction: </strong>General practices experience high workloads and increasing volume of patients. But not all patients require GP care. We previously reported that GPs observed that allied health professionals frequently request referrals even when patients initially seek direct access to care. This study, therefore, explored the barriers to the use of direct access as identified by allied health professionals and health insurers.</p><p><strong>Methods: </strong>Seventeen in-depth interviews were conducted comprising six dietitians, seven physiotherapists, and four health insurers. The interviews were recorded, transcribed, and analysed using the qualitative research principles of thematic analysis.</p><p><strong>Results: </strong>The main key themes that derived from the interviews included: (1) policy, (2) motivation, and (3) public profile, which were further subdivided into sub-themes. While health insurers claimed to not impose any specific requirements for the use of direct access, allied health professionals faced several policy-related challenges with direct access. For instance, dietitians reported reduced treatment time under direct access and claimed lower reimbursement for intake appointments compared to those following referrals-an assertion denied by insurers. Other reasons for not using direct access include greater uncertainty about potentially overlooking health issues during the initial intake. Additionally, some physiotherapists and dietitians perceive direct access as less convenient than obtaining a referral, for example as it involves fewer regulations from health insurers and therefore saves time. Public profile also played a role in the use of direct access. Dietitians noted limited patient awareness of their services and the availability of direct access, unlike physiotherapists, who benefited from public campaigns and effective management strategies.</p><p><strong>Conclusions: </strong>Despite the small sample size, this study showed a gap between the perspectives of allied health professionals and the health insurers that need to be further explored. Direct access has inadvertently increased the workload for some allied health professionals, particularly dietitians. This is an unintended outcome of a system intended, ironically, to reduce pressure on care. The use of direct access could be improved by carrying out further investigations and addressing the challenges faced by allied health professionals.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"127"},"PeriodicalIF":2.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12032724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063454","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}
BMC primary carePub Date : 2025-04-25DOI: 10.1186/s12875-025-02828-8
Clarisse Dibao-Dina, Lydia Nasri, Céline Dagot, Jean-Philippe Fouquet, Sophie Rideau, Vincent Dumas, Guillaume Neff, Véronique Payen, Delphine Rube-Millon, Marie Lemaile, Jacques-Alexis Nkodo, Vincent Camus, Bertrand Fougère, Bruno Giraudeau, Dominique Beauchamp, Laura Foucault-Fruchard, Cécile Renoux, Jean Robert
{"title":"Correction: Identifying the needs of natural caregivers caring for a person with dementia: a mixed method study.","authors":"Clarisse Dibao-Dina, Lydia Nasri, Céline Dagot, Jean-Philippe Fouquet, Sophie Rideau, Vincent Dumas, Guillaume Neff, Véronique Payen, Delphine Rube-Millon, Marie Lemaile, Jacques-Alexis Nkodo, Vincent Camus, Bertrand Fougère, Bruno Giraudeau, Dominique Beauchamp, Laura Foucault-Fruchard, Cécile Renoux, Jean Robert","doi":"10.1186/s12875-025-02828-8","DOIUrl":"https://doi.org/10.1186/s12875-025-02828-8","url":null,"abstract":"","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"126"},"PeriodicalIF":2.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12023648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047343","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}