BMC primary care最新文献

{"title":"Integrated model of secondary fracture prevention in primary care (INTERCEPT): protocol for a cluster randomised controlled multicentre trial.","authors":"Mawson Wang, Alice Knight, Anastassia Demeshko, Christian M Girgis, Patrick Bolton, Anurina Das, Andrew Auwyang, Brett Williams, Daniel Moses, Catherine D'Este, Markus J Seibel","doi":"10.1186/s12875-024-02601-3","DOIUrl":"https://doi.org/10.1186/s12875-024-02601-3","url":null,"abstract":"<p><strong>Background: </strong>Osteoporotic fractures signal severely compromised bone strength and are associated with a greatly increased risk of refracture. Despite the availability of effective and safe medications that reduce fracture risk, 70-80% of patients are inadequately investigated or treated for osteoporosis following an initial fracture, constituting a significant 'osteoporosis care gap'. Optimal methods of bridging this gap with primary care at the forefront of secondary fracture prevention remain undetermined. This protocol describes a cluster randomised controlled trial to evaluate the effectiveness of a novel integrated model of secondary fracture prevention and management in primary care.</p><p><strong>Methods: </strong>The cluster randomised controlled trial involves multiple branches of a community-based radiology provider (CRP), a hospital-based secondary fracture prevention program (SFPP) and numerous primary care practices in metropolitan Sydney that refer to either the CRP or SFPP. Using natural language processing tools, patients diagnosed with a potential osteoporotic fracture will be identified by automatically screening radiology reports generated at the CRP or SFPP. The primary care practices that these patients attend will be randomised (1:1) to either the intervention or usual care. The intervention consists of (i) electronic and fax alerts informing the practice/primary care physician that their patient has been diagnosed with a potential osteoporotic fracture; (ii) provision of osteoporosis management guidelines and (iii) follow-up surveys at 4 weeks and 6 months. Practices in the usual care (control) group will receive no alerts and provide usual care. The primary outcome is the proportion of patients undergoing a bone density scan and/or filling a prescription for osteo-protective pharmacotherapy within 3 months of the initial diagnostic imaging report. Secondary outcomes are the proportion of patients: (i) undergoing an osteoporosis-related blood test within 3 months of the initial diagnostic imaging report; (ii) initiated on a chronic disease management plan within 3 months of the diagnostic report, and (iii) filling a second prescription for osteo-protective pharmacotherapy within 9 months post initial diagnostic imaging report. Outcomes will be obtained through de-identified linked data from Medical Benefits Schedule and Pharmaceutical Benefits Scheme held by the Australian Institute of Health and Welfare.</p><p><strong>Discussion: </strong>This is the first randomised trial to integrate case-detection of potential osteoporotic fractures in a hospital and community setting with direct alerts to the patient's primary care provider. This study will determine whether such an intervention is effective in improving investigation and/or treatment rates of osteoporosis in patients with a potential osteoporotic fracture.</p><p><strong>Trial registration: </strong>This study is registered with the Australian New Ze","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"25 1","pages":"349"},"PeriodicalIF":2.0,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11438153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333664","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":"\"Like an umbrella, protecting me from the rain until I get to my destination\": Evaluating the implementation of a tailored primary care model for urban marginalized populations.","authors":"Soha Khorsand, Carol Geller, Alison Eyre, Hounaida Abi Haidar, Haifeng Chen, Corina Lacombe, Monisha Kabir, Andrew Mclellan","doi":"10.1186/s12875-024-02563-6","DOIUrl":"https://doi.org/10.1186/s12875-024-02563-6","url":null,"abstract":"<p><strong>Background: </strong>Improving health equity and access to the highest possible standard of health care is a key issue of social accountability. Centretown Community Health Centre in Ottawa, Canada has iteratively developed a program to target and serve marginalized and complex populations since 1999. The program implementation was evaluated using a validated implementation framework.</p><p><strong>Methods: </strong>Quantitative and qualitative data were collected through a health records extraction (n = 570), a client complexity assessment tool (n = 74), semi-structured interviews with clients and key stakeholders (n = 41), and a structured client satisfaction survey (n = 30). Data were analyzed using descriptive statistics and inductive thematic analysis.</p><p><strong>Results: </strong>Five hundred and seventy unique clients were seen between November 1-30, 2021. A third of clients (34%) did not have a provincial health card for access to universal health care services, and most (68%) were homeless or a resident of rooming houses. Most clients who reported their income (92%) were at or below Canada's official poverty line. The total mean complexity score for clients seen over a one-month period (n = 74) was 16.68 (SD 6.75) where a total score of at least 13 of 33 is perceived to be a threshold for client biopsychosocial complexity. Clients gained the majority of their total score from the Social support assessment component of the tool. Clients (n = 31) and key informants (n = 10) highlighted the importance of building relationships with this population, providing wrap-around care, and providing low-barrier care as major strength to the Urban Health program (UH). Key areas for improvement included the need to: i) increase staff diversity, ii) expand program hours and availability, and iii) improve access to harm reduction services. Clients appeared to be highly satisfied with the program, rating the program an average total score of 18.50 out of 20.</p><p><strong>Conclusions: </strong>The program appears to serve marginalized and complex clients and seems well-received by the community. Our findings have relevance for other health care organizations seeking to better serve marginalized and medically and socially complex individuals and families in their communities.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"25 1","pages":"347"},"PeriodicalIF":2.0,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11437737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333659","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":"Navigating delayed diagnoses, self-neglect, and lost livelihoods: a qualitative exploration of fisherfolk's health perspectives and management of non-communicable diseases in Kerala, India.","authors":"Surya Surendran, Gloria Benny, Jaison Joseph, Devaki Nambiar","doi":"10.1186/s12875-024-02575-2","DOIUrl":"https://doi.org/10.1186/s12875-024-02575-2","url":null,"abstract":"<p><strong>Introduction: </strong>Non-Communicable Diseases (NCDs) place a significant burden on India's healthcare system, accounting for approximately 62% of all deaths in the country in 2017. The southern Indian state - Kerala - has some of the highest rates of NCDs. Within the state, the fisherfolk community has a high prevalence of risk factors such as tobacco use and alcohol consumption. Working in the fisheries industry demands physical exertion, night shifts alongside extended periods of time at sea (for seafaring fisherfolk). Evidence is scant on how these conditions relate to the health-seeking experiences of fisherfolk, particularly in the context of NCDs. We conducted a qualitative study in two districts of Kerala to fill this gap.</p><p><strong>Methods: </strong>In-depth individual and small group interviews- as per participant preference -  with male and female fishing community members living with NCDs were conducted between October 2022 and February 2023 in two districts of Kerala. Interviews were conducted to explore community members' experiences with health-seeking for NCDs. Transliterated English transcripts were coded using ATLAS.ti software and analysed using thematic analysis with inductive generation of codes, with indexing against Levesque, Harris, and Russell's 2013 access to healthcare framework.</p><p><strong>Results: </strong>Thirty-three interviews with 42 participants were conducted. We found that NCDs were usually diagnosed late- either when admitted/consulted for other illnesses or when the symptoms became unbearable. Health-seeking patterns differed between seafaring and inland fishing subgroups, who were sampled from two districts in the state. Seafaring fisherfolk preferred public facilities for regular checkups and medicines while in-land fisherfolk relied on private facilities, although it was considered expensive. Ability to seek care was impacted by the working hours of the health centre which did not suit their working hours. Health constaints and related expenses also impacted their financial status and occupation, with some opting for less strenuous jobs.</p><p><strong>Conclusion: </strong>This study highlights the NCD-related health-seeking experiences of the fisherfolk community in Kerala, India. Fisherfolk reported self neglect, delayed diagnosis, cost and livelihood constraints owing to the onset of NCDs, even as dual practice and medicine access in the public sector were appreciated. Overall, larger studies and policymaking processes should consider in depth the experiences faced by particular economic groups like fisherfolk, who may face unique health and care-seeking challenges.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"25 1","pages":"354"},"PeriodicalIF":2.0,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11437729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333566","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":"Treatment burden in multimorbidity: an integrative review.","authors":"Ji Eun Lee, Jihyang Lee, Rooheui Shin, Oonjee Oh, Kyoung Suk Lee","doi":"10.1186/s12875-024-02586-z","DOIUrl":"10.1186/s12875-024-02586-z","url":null,"abstract":"<p><strong>Background: </strong>People living with multimorbidity experience increased treatment burden, which can result in poor health outcomes. Despite previous efforts to grasp the concept of treatment burden, the treatment burden of people living with multimorbidity has not been thoroughly explored, which may limit our understanding of treatment burden in this population. This study aimed to identify the components, contributing factors, and health outcomes of treatment burden in people with multiple diseases to develop an integrated map of treatment burden experienced by people living with multimorbidity. The second aim of this study is to identify the treatment burden instruments used to evaluate people living with multimorbidity and assess the comprehensiveness of the instruments.</p><p><strong>Methods: </strong>This integrative review was conducted using the electronic databases MEDLINE, EMBASE, CINAHL, and reference lists of articles through May 2023. All empirical studies published in English were included if they explored treatment burden among adult people living with multimorbidity. Data extraction using a predetermined template was performed.</p><p><strong>Results: </strong>Thirty studies were included in this review. Treatment burden consisted of four healthcare tasks and the social, emotional, and financial impacts that these tasks imposed on people living with multimorbidity. The context of multimorbidity, individual's circumstances, and how available internal and external resources affected treatment burden. We explored that an increase in treatment burden resulted in non-adherence to treatment, disease progression, poor health status and quality of life, and caregiver burden. Three instruments were used to measure treatment burden in living with multimorbidity. The levels of comprehensiveness of the instruments regarding healthcare tasks and impacts varied. However, none of the items addressed the healthcare task of ongoing prioritization of the tasks.</p><p><strong>Conclusions: </strong>We developed an integrated map illustrating the relationships between treatment burden, the context of multimorbidity, people's resources, and the health outcomes. None of the existing measures included an item asking about the ongoing process of setting priorities among the various healthcare tasks, which highlights the need for improved measures. Our findings provide a deeper understanding of treatment burden in multimorbidity, but more research for refinement is needed. Future studies are also needed to develop strategies to comprehensively capture both the healthcare tasks and impacts for people living with multimorbidity and to decrease treatment burden using a holistic approach to improve relevant outcomes.</p><p><strong>Trial registration: </strong>DOI: https://doi.org/10.17605/OSF.IO/UF46V.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"25 1","pages":"352"},"PeriodicalIF":2.0,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11438421/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A qualitative exploration of changes and mechanisms of changes in a psychoeducational intervention for family dementia caregivers.","authors":"Stephanie Kipfer, Cedric Mabire, Jean Vézina, Andrea Koppitz, Sandrine Pihet","doi":"10.1186/s12875-024-02602-2","DOIUrl":"https://doi.org/10.1186/s12875-024-02602-2","url":null,"abstract":"<p><strong>Background: </strong>'Learning to feel better… and help better' is a psychoeducational intervention that aims to empower family caregivers of people with dementia by helping them cope better with the daily stress of dementia caregiving. The intervention has been adapted to a Swiss context and evaluated with a mixed-method design, yielding promising results in caregivers, such as a reduced subjective burden and improved self-efficacy. Qualitative findings have provided insight into potentially relevant intermediate changes that must be further explored to better understand how the intervention precipitates the achieved changes. We aim to qualitatively explore such changes, related mechanisms and key intervention components in the context of this intervention.</p><p><strong>Methods: </strong>A constructivist grounded theory approach was used to achieve this aim. Changes, related mechanisms and key intervention components were identified by exploring the following: 1) longitudinal qualitative data, collected from 13 family caregivers via interviews performed before, during and after the intervention (39 interviews total) and 2) cross-sectional post-intervention interview data collected from 22 family caregivers (22 interviews).</p><p><strong>Results: </strong>Experiencing calmness was the most important change for caregivers in the context of this intervention. The calmness model, developed based on the qualitative analysis, illustrates the intermediate changes that contributed to calmness, such as being able to cope with daily life and experiencing positive interactions with the family member with dementia. Related key intervention components were the coping strategy 'reframing', employed in diverse ways by the caregivers to reduce daily stress, and the didactic method 'active skills' training', which involved active participation by the caregivers and the guidance of a professional group leader. One important factor hampering changes in caregivers was having difficulties accepting the caregiver role or accepting the losses due to dementia.</p><p><strong>Conclusion: </strong>The calmness model offers valuable insight into how this intervention can benefit family caregivers and aid in developing interventions targeting similar mechanisms and changes.</p><p><strong>Trial registration: </strong>ISRCTN13512408 (registration date 17.05.2021, retrospectively registered).</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"25 1","pages":"353"},"PeriodicalIF":2.0,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11437664/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333660","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":"Diabetes knowledge, attitudes and practices among Chinese primary care physicians: a cross-sectional study.","authors":"Linhua Pi, BinBin He, Dongxue Fei, Xiajie Shi, Zhiguang Zhou","doi":"10.1186/s12875-024-02600-4","DOIUrl":"https://doi.org/10.1186/s12875-024-02600-4","url":null,"abstract":"<p><strong>Background: </strong>Type 2 diabetes mellitus (T2DM) is a public health crisis that requires adequate knowledge, attitudes, and practices (KAP) by health care providers to prevent or delay the progression of the disease. This study aimed to assess the KAP regarding T2DM among primary care providers (PCPs) in Central China.</p><p><strong>Methods: </strong>This multicenter cross-sectional study was conducted among 971 PCPs using self-employed KAP questionnaires. Questionnaires were designed to evaluate KAP regarding T2DM among PCPs, and was measured with SPSS software. Descriptive statistics, the Pearson correlation coefficients and multiple regression models used to analyze the data.70%, 80% and 70% of total values were considered as the cut-off point for defining good knowledge, positive attitude and correct practice.</p><p><strong>Results: </strong>A total of 971 PCPs with a mean age of 44.0 ± 10.2 years were evaluated. 620 (63.9%) PCPs worked at village clinic and 605 (62.3%) PCPs have been working more than 20 years. Only 26.3% of the respondents participated in Continued Medical Education (CME) programs regarding diabetes in the past year due to Covid-19 pandemic. Overall, despite positive attitudes toward diabetes, there were substantial gaps in knowledge and practices. The PCPs scored 7.25 out of 14 points on the knowledge subscales, 7.13 out of 8 on the attitude subscales, and 4.85 out of 11 on the practice subscales. Gender, age, practice setting, professional titles, duration of practice and CME attendance were significant predictors of knowledge; Age, practice setting and duration of practice were significant predictors of attitudes; and family history of diabetes affected PCP practices.</p><p><strong>Conclusions: </strong>Despite positive attitudes toward diabetes, there were substantial gaps in knowledge and practices. These findings call for action from relevant health authorities and policy makers to improve PCPs' KAP regarding diabetes in Central China.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"25 1","pages":"348"},"PeriodicalIF":2.0,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11438114/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333663","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":"Adaptation of French general practitioners for the management of nursing home patients during COVID-19 in 2020: a multilevel analysis.","authors":"Veronique Orcel, Tiphanie Bouchez, Aline Ramond-Roquin, Yann Bourgueil, Vincent Renard, Sylvain Gautier, Julien Le Breton","doi":"10.1186/s12875-024-02560-9","DOIUrl":"https://doi.org/10.1186/s12875-024-02560-9","url":null,"abstract":"<p><strong>Background: </strong>To describe French general practioners' (GPs) adaptation strategies to ensure follow-up care of nursing home patients during the first wave of COVID-19 (May 2020) and to identify factors associated with each strategy.</p><p><strong>Methods: </strong>A national cross-sectional study was conducted with online questionnaires in May 2020 among GPs practicing in France (metropolitan and overseas) and usually providing nursing home visits before pandemic. The outcome was defined as the GPs' adaptation strategies for managing nursing home patients and was categorized into four groups: Maintenance of Nursing Home Visits NHV (reference), Stopping NHV, Numeric adaptation (teleconsultations only), Mixed adaptation (NHV and teleconsultations). The probability of adaptation strategies was analyzed by multilevel logistic models in which the GPs represented level 1 and the counties level 2. We applied three random-intercept multilevel logistic models with the county of GP's practice as random effect.</p><p><strong>Results: </strong>This analysis included 2,146 responses by GPs coming from 98 French counties. Overall, 40.4% of GPs maintained NHV, while other strategies were: Stopping visits (24.1%), Numeric adaptation (15.4%), Mixed adaptation (20.1%). Several individual (age, training GP, perceived status of being at high risk of severe COVID, compliance with temporary delegation of the patient's management) and territorial factors (excess mortality rate due to COVID-19, GPs' density, proportion of over-75s, presence of reinforcement measures for nursing home patients) were identified as associated with each strategy.</p><p><strong>Conclusions: </strong>This study highlights a rapid adaptation of general practice to keep supporting nursing home patients. Heterogeneity of adaptation strategies could reflect both the lack of national guidelines and the heterogeneity among GPs' usual practices. Policymakers should take actions at a territorial level (subnational) to strengthen support to nursing home patients considering adaptations to the local context of the pandemic outbreak and perspective of local actors.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"25 1","pages":"350"},"PeriodicalIF":2.0,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11437827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333661","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":"Supporting alcohol brief interventions and pharmacotherapy provision in Australian First Nations primary care: exploratory analysis of a cluster randomised trial.","authors":"Monika Dzidowska, K S Kylie Lee, James H Conigrave, Scott Wilson, Noel Hayman, Rowena Ivers, Julia Vnuk, Paul Haber, Katherine M Conigrave","doi":"10.1186/s12875-024-02598-9","DOIUrl":"10.1186/s12875-024-02598-9","url":null,"abstract":"<p><strong>Introduction: </strong>Primary care provides an important opportunity to detect unhealthy alcohol use and offer assistance but many barriers to this exist. In an Australian context, Aboriginal Community Controlled Health Services (ACCHS) are community-led and run health services, which provide holistic primary care to Aboriginal and Torres Strait Islander peoples. A recent cluster randomised trial conducted with ACCHS provided a service support model which showed a small but significant difference in provision of 'any treatment' for unhealthy alcohol use. However, it was not clear which treatment modalities were increased.</p><p><strong>Aims: </strong>To test the effect of an ACCHS support model for alcohol on: (i) delivery of verbal alcohol intervention (alcohol advice or counselling); (ii) prescription of relapse prevention pharmacotherapies.</p><p><strong>Methods: </strong>Intervention: 24-month, multi-faceted service support model.</p><p><strong>Design: </strong>cluster randomised trial; equal allocation to early-support ('treatment') and waitlist control arms.</p><p><strong>Participants: </strong>22 ACCHS.</p><p><strong>Analysis: </strong>Multilevel logistic regression to compare odds of a client receiving treatment in any two-month period as routinely recorded on practice software.</p><p><strong>Results: </strong>Support was associated with a significant increase in the odds of verbal alcohol intervention being recorded (OR = 7.60, [95% CI = 5.54, 10.42], p < 0.001) from a low baseline. The odds of pharmacotherapies being prescribed (OR = 1.61, [95% CI = 0.92, 2.80], p = 0.1) did not increase significantly. There was high heterogeneity in service outcomes.</p><p><strong>Conclusions: </strong>While a statistically significant increase in verbal alcohol intervention rates was achieved, this was not clinically significant because of the low baseline. Our data likely underestimates rates of treatment provision due to barriers documenting verbal interventions in practice software, and because different software may be used by drug and alcohol teams. The support made little impact on pharmacotherapy prescription. Changes at multiple organisational levels, including within clinical guidelines for primary care, may be needed to meaningfully improve provision of alcohol treatment in ACCHS.</p><p><strong>Trial registration: </strong>ACTRN12618001892202 (retrospectively registered on 21/11/2018).</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"25 1","pages":"351"},"PeriodicalIF":2.0,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11438139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333568","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":"The role of family doctors in developing primary care systems in Asia: a systematic review of qualitative research conducted in middle-income countries 2010-2020.","authors":"Biyun Li, Margo Turnbull","doi":"10.1186/s12875-024-02585-0","DOIUrl":"https://doi.org/10.1186/s12875-024-02585-0","url":null,"abstract":"<p><strong>Background: </strong>The Asia Pacific Region's middle-income countries (MICs) face unique challenges in the ongoing development of primary care (PC) systems. This development is complicated by systemic factors, including rapid policy changes and the introduction of private healthcare services, as well as the mounting challenges associated with ageing populations and increasing rates of chronic diseases. Despite the widespread acknowledgement of the importance of family doctors in the development of PC services, relatively little is known about how these roles have developed in Asian MICs. To address this gap, this systematic review presents a synthesis of recent research focused on the role of family doctors within the PC systems of MICs in the Asia Pacific Region.</p><p><strong>Methods: </strong>We searched six electronic databases (CINAHL Complete, Embase, PsycINFO, PubMed, Web of Science, and Index Medicus for the South-East Asia Region and Western Pacific) for peer-reviewed qualitative literature published between January 2010 and December 2020. The quality of the studies was evaluated using the Critical Appraisal Skills Programme tool. Eighteen articles were included in the analysis. Findings from these articles were extracted and synthesised using qualitative thematic synthesis. We used the Rainbow Framework to analyse the interconnections within health systems at the macro, meso and micro levels.</p><p><strong>Results: </strong>Our analysis of the included articles showed that family doctors play a crucial role in bridging the gap between hospitals and communities. They are essential in adopting holistic approaches to health and wellbeing and are in a unique position to try and address social, psychological, and biological aspects of health. Our findings also highlight the influence of policy changes at the macro level on the role and responsibilities of family doctors at the meso (organisational) and micro (interpersonal) levels.</p><p><strong>Conclusions: </strong>Limited research has explored the role of family doctors in the ongoing development of primary care systems in MICs in the Asia Pacific Region. The findings of this review have significant implications for policymakers and healthcare administrators involved in ongoing improvements to and strengthening of PC systems. Areas of particular concern relate to policy linked with training and workforce development, insurance systems and public awareness of what primary care services are.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"25 1","pages":"346"},"PeriodicalIF":2.0,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11437615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333569","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":"Care needs of patients with the post-COVID syndrome in Dutch general practice: an interview study among patients and general practitioners.","authors":"Corinne Rijpkema, Bart J Knottnerus, Rinske van den Hoek, Lisa Bosman, Liset van Dijk, Robert A Verheij, Isabelle Bos","doi":"10.1186/s12875-024-02597-w","DOIUrl":"https://doi.org/10.1186/s12875-024-02597-w","url":null,"abstract":"<p><strong>Background: </strong>The post-COVID syndrome (PCS) has a large impact on an individual's daily life. The wide variety of symptoms in PCS patients and the fact that it is still relatively new makes it difficult for general practitioners (GPs) to recognize, diagnose and treat patients with PCS, leading to difficulties in assessing and fulfilling healthcare needs. It is largely unknown what the experiences of Dutch patients and GPs are with PCS and, therefore, we gained insight into the different aspects of living with PCS and the associated healthcare needs.</p><p><strong>Methods: </strong>Semi-structured interviews were performed with 13 self-reported PCS patients (varying in sex, age, education, and health literacy) and 6 GPs (varying in gender, age, and type of practice) between January-July 2022. Patients and GPs were most likely unrelated (not in the same practices). The data have been analysed using the Thematic Analysis method.</p><p><strong>Results: </strong>Experiences appeared to vary between two types of PCS patients that emerged during the interviews: (1) individuals with good pre-existing health status (PEHS) who are severely affected by PCS and have difficulty recovering and (2) individuals with poorer PEHS whose health became even poorer after COVID-19 infection. The interviews with PCS patients and GPs revealed two main themes, in which the types of patients differed: (1) aspects of living with PCS; individuals with good PEHS mainly experience symptoms when overstimulated, while individuals with poorer PEHS generally feel exhausted continuously. (2) Healthcare experiences; GPs emphasized that individuals with good PEHS seem to benefit from support in distributing their energy by careful planning of daily activities, whereas individuals with poorer PEHS require support in activation. Patients and GPs emphasised the importance of taking patients seriously and acknowledging their symptoms. Finally, the patients interviewed indicated that some GPs doubted the existence of PCS, resulting in insufficient recognition.</p><p><strong>Conclusion: </strong>Awareness of the differences in needs and experiences of the two types of PCS patients could contribute to more appropriate care. Acknowledgement of PCS by GPs as a real syndrome is important for patients and plays an important role in coping with or recovering from PCS. A multidisciplinary person-centred approach is important and can be coordinated by a GP.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"25 1","pages":"355"},"PeriodicalIF":2.0,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11439229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333662","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}