BMC primary care最新文献

{"title":"Evaluate effects of the National Essential Public Health Service Program on hypertension control of Chinese community-dwelling people during the COVID-19 epidemic: a population-based multi-centre retrospective longitudinal study.","authors":"Yuan Liu, Wenjing Cheng, Yanzhen Kang, Feiran Wei, Han Li, Xiaoqing Ma, You Ge","doi":"10.1186/s12875-025-02927-6","DOIUrl":"10.1186/s12875-025-02927-6","url":null,"abstract":"<p><strong>Background: </strong>The National Essential Public Health Service Program was launched in 2009 to improve hypertension control of Chinese adults in primary care settings. Current research evidence regarding effectiveness of the National Essential Public Health Service Program on hypertension control during the COVID-19 epidemic was limited. To fulfil the research gap, this study aimed to evaluate hypertension control of the National Essential Public Health Service Program during the COVID-19 epidemic. It was anticipated that our study findings could demonstrated whether the National Essential Public Health Service Program was effective on hypertension control during the COVID-19 epidemic, which could provide policy making guidance on whether strategies to improve hypertension control of the National Essential Public Health Service Program during epidemics were necessary.</p><p><strong>Method: </strong>This study was designed as a retrospective longitudinal study. People registering with the NEPHSP as hypertensive patients and consistently accepted hypertension care services of the NEPHSP between January 1, 2019 to January 8, 2023 were included in this study. The participants were included from 1393 primary care settings in 14 districts. The study outcomes included clinical, lifestyle, and anti-hypertensive treatment indicators. The study data were extracted from the structural patient information recorded in the Residence Health Record System. Using Generalized Estimating Equations model, we evaluated the hypertension control of the National Essential Public Health Service Program during the COVID-19 epidemic.</p><p><strong>Results: </strong>411183 participants were included. Systolic blood pressure and diastolic blood pressure mean values increased by 1.83 mm Hg (95% CI, 1.78 to 1.88, P < 0.001) and 0.04 mm Hg (95% CI, 0.01 to 0.07, P < 0.001) during the COVID-19 epidemic. Systolic blood pressure and diastolic blood pressure control rates decreased by 7.92% (-0.35, 95% CI, -0.36 to -0.34, P < 0.001) and 8.27% (-0.31, 95% CI, -0.33 to -0.30, P < 0.001). Cardiovascular and cerebrovascular diseases diagnosis increased 8.04% (0.60, 95% CI, 0.58 to 0.61, P < 0.001) and 6.24% and (0.69, 95% CI, 0.68 to 0.71, P < 0.001) during the COVID-19 epidemic.</p><p><strong>Conclusion: </strong>Hypertension control of the National Essential Public Health Service Program declined during the COVID-19 epidemic. Structural telemedicine systems should be predefined to ensure efficient delivery of hypertension care services during epidemics. Strategies for ensuring timely referral and mental health interventions should be performed during epidemics.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"227"},"PeriodicalIF":2.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651377","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 study of a new metric for estimating early-onset colorectal cancer risk in male veterans: \"Colon Age\".","authors":"Thomas F Imperiale, Michael Cheng, Melissa R Thomas, Marianne S Matthias","doi":"10.1186/s12875-025-02854-6","DOIUrl":"10.1186/s12875-025-02854-6","url":null,"abstract":"<p><strong>Background: </strong>In several Western nations, cancers of the colon and rectum have been steadily increasing in persons younger than age 50. Although the age at which to begin colorectal cancer (CRC) screening in the U.S. was lowered to 45 years in 2018, uptake of screening in persons aged 45-49 has been slow. Based on risk factors for CRC prior to age 50 and population-based CRC prevalence data, we previously defined a new metric for estimating the risk of CRC prior to age 50 called \"Colon Age\". The objective of this study was to obtain qualitative data on the acceptance, feasibility, and clinical utility of this metric from patients and primary care providers.</p><p><strong>Methods: </strong>With permission from their providers, we recruited a convenience sample of average-risk male patients 35-49 years of age during their primary care appointment. Primary care providers were recruited through email invitation. Following informed consent, two interviewers conducted semi-structured qualitative interviews with participants. Interviews were conducted until saturation was reached. Interviewers were not involved in the tool's development. The audio-recorded interviews were transcribed, de-identified, and analyzed using the constant comparison method.</p><p><strong>Results: </strong>Thirty-one (23 male Veteran patients, 8 primary care providers) interviews were conducted. Patients (mean age 47 years, 100% male) expressed willingness to follow screening recommendations from their provider, although most were unaware of other screening options beyond colonoscopy. Overall, patients expressed acceptance of the Colon Age concept and tool, finding it easy to understand, helpful for staying informed of their health, and a way to empower themselves in their screening decisions. Providers (mean age 53 years; 50% female) also found the tool acceptable, commenting on its usefulness for starting screening conversations with patients and improving screening uptake. Providers questioned the tool's time commitment, consistency with practice guidelines, and the process of tool development.</p><p><strong>Conclusions: </strong>In this age of precision medicine, the Colon Age tool-despite some limitations-appears to be useful to patients and providers in individualizing risk for CRC and may improve uptake of screening in persons younger than age 50.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"226"},"PeriodicalIF":2.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12265148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644234","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":"Enhanced crisis resilience of general practitioner-centred care: a retrospective cohort study of patients with coronary artery disease during the COVID-19 pandemic in Germany.","authors":"Catriona Friedmacher, Dorothea Lemke, Renate Klaaßen-Mielke, Anastasiya Glushan, Angelina Müller, Kateryna Karimova","doi":"10.1186/s12875-025-02917-8","DOIUrl":"10.1186/s12875-025-02917-8","url":null,"abstract":"<p><strong>Background: </strong>Structured, comprehensive provision of primary care services has been shown to provide better outcomes in chronic disease management. In 2004, Germany introduced a programme of general practitioner (GP)-centred healthcare to strengthen the primary care sector. Crises such as pandemics, world conflict and climate events can result in significant challenges for the provision of routine healthcare requiring rapid reorganisation of existing models of care provision. The objective of this study was to assess the impact of the COVID-19 pandemic on the provision of chronic disease surveillance services and the treatment of patients with coronary artery disease (CAD) by GPs in the federal state of Baden-Württemberg, Germany over the years 2019-2020 to examine if the previously demonstrated benefits of GPCC participation were maintained throughout the COVID-19 pandemic.</p><p><strong>Methods: </strong>Retrospective cohort study monitoring 170,466 CAD patients, conducted using biannually aggregated German insurance claims data (AOK-BaWü), comparing 2019 (pre-pandemic) with 2020 (COVID-19 pandemic), examining access (contacts), therapy (e.g. statin therapy), and clinical outcomes (acute myocardial infarction, angina pectoris, stroke, invasive procedures and pacemaker/defibrillator).</p><p><strong>Results: </strong>Patients enrolled in the GP-centred care programme (GPCC) had more frequent cohort-specific contacts, increasing during the pandemic, compared to those receiving standard care. Statin prescriptions were higher in the GPCC group and appear to be maintained over the study period. GPCC participation has demonstrated lower risks of all listed clinical outcomes in comparison to standard care and these established advantages of GPCC participation with respect to clinical outcomes were maintained during 2020 despite the challenges of the COVID-19 pandemic.</p><p><strong>Conclusion: </strong>Structured, comprehensive GP-centred care in Germany demonstrated resilience the challenges of the COVID-19 pandemic and was associated with better continuity of care for patients with coronary artery disease (CAD) and a maintained lower risk of CAD complications. These differences could be explained by the structured and comprehensive provision of primary care services and enhanced coordination with secondary care, allowing practices to maintain care effectively despite the challenges of the COVID-19 pandemic.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"225"},"PeriodicalIF":2.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12257840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638822","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":"Rehabilitation needs at rural primary health care settings: perspectives of health center nurses in Burera district of Rwanda.","authors":"Marie Josée Dukuzimana, Jean Baptiste Ukwizabigira, Clement Muhire, Kaisa Jokinen, David K Tumusiime, Kari-Pekka Murtonen, Emmanuel Ngwakongnwi","doi":"10.1186/s12875-025-02921-y","DOIUrl":"10.1186/s12875-025-02921-y","url":null,"abstract":"<p><strong>Background: </strong>Resource-limited countries face challenges of integrating rehabilitation services into primary healthcare. This is always hindered by many factors such as poor healthcare policy, a shortage of healthcare providers, limited knowledge among healthcare providers, and resource constraints. This study aimed to understand rehabilitation needs in primary care and explore current management practices for rehabilitation services in primary care with the goal of generating evidence to inform policies and interventions for the improvement of rehabilitation services at primary care.</p><p><strong>Methods: </strong>The study used a descriptive qualitative study design. Data collection involved the focus group discussion (FGD) of ten health nurses from Burera District, each nurse had a minimum of one year of working experience in the outpatient services at health center. A semi structured interview guide was used during data collection to explore rehabilitation needs at primary care and to understand the current management practices of disability cases presented at health center. The data were analyzed thematically by the research team.</p><p><strong>Results: </strong>Data analysis revealed three major themes: Nurses' understanding and experience with rehabilitation services. Disability cases presenting at the health center and their unmeet rehabilitation needs, and Navigating the current management practices of disability cases at rural health centers. Participants stressed the need for rehabilitation services by mentioning disability cases that need rehabilitation encountered at health centers. However, rehabilitation services for such disabilities are very limited at all health centers. The current management practice showed rehabilitation services that are available at few health centers such as mental and primary eye care services. In addition, participants emphasized limited involvement of nurses in rehabilitation service delivery.</p><p><strong>Conclusion: </strong>The integration of rehabilitation services in primary care is crucial to ensure rehabilitation services for all. However, this demands strategic resource distribution, to establish rehabilitation services with specialized rehabilitation professionals at all health centers. In addition, task sharing to involve nurses and community health workers in rehabilitation service delivery at primary care will increase service availability. Furthermore, implementation of community-based rehabilitation is crucial for enhancing service accessibility and utilization mainly in rural settings.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"224"},"PeriodicalIF":2.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12257668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638823","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":"Stigma among primary care providers: characterizing attitudes and behaviors in the care of people with chronic hepatitis in the Philippines.","authors":"Naeema Hopkins-Kotb, Jhaki Mendoza, Manu Gaspar, Martin Fernandez, Jae-Ann Sumalo, Timothy Mercado, Jovein Alcantara, Joshua Bartolome, Diana Rose de Silva, Janus P Ong, Todd M Pollack, David B Duong, Bethany Holt","doi":"10.1186/s12875-025-02915-w","DOIUrl":"10.1186/s12875-025-02915-w","url":null,"abstract":"<p><strong>Background: </strong>Stigma is a key barrier to compassionate primary health care delivery and people-centered care (PCC), but is understudied among primary care providers (PCPs). Hepatitis B and C have a significant burden of disease in the Philippines, where there is limited awareness of and access to screening and treatment. Patient-reported stigma has been identified as a significant barrier to hepatitis care in the Philippines, but PCP stigma-related attitudes and behaviors have not been explored in this context.</p><p><strong>Methods: </strong>In this study, we assessed primary PCP-reported stigma-related attitudes and behaviors toward patients with hepatitis B and C. We surveyed primary PCPs in Tarlac, Philippines working within a network of healthcare facilities that have been part of an initiative to decentralize hepatitis care to the primary care level and prioritize PCC.</p><p><strong>Results: </strong>We found that PCPs' self-reported attitudes toward patients with hepatitis B and C reflect a strong sense of responsibility to provide care, and comfort with sensitive history-taking, but also pervasive attitudes of pity and blame. PCPs' self-reported behaviors showed commitment to providing equal care, but variation in infection control practices suggesting misconceptions about transmission risk.</p><p><strong>Conclusions: </strong>Our results provide essential insight into PCPs' stigma-related attitudes and behaviors that will serve as a baseline for future comparison with patient-reported experiences. These findings underscore the critical role of primary care in addressing stigma and improving hepatitis care in the Philippines, highlighting the importance of training, resource allocation, and people-centered care strategies.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"223"},"PeriodicalIF":2.0,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12255113/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621495","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":"GPs' experienced challenges and strategies for supporting patient self-management in disease management programs for type 2 diabetes mellitus and coronary heart disease - a qualitative study.","authors":"Larisa Pilic, Kira Molkentin, Alina Herrmann, Marcus Redaèlli, Lisa Kupsch, Lion Lehmann, August-Wilhelm Bödecker, Beate Sigrid Müller, Stephanie Stock, Stefan Wilm","doi":"10.1186/s12875-025-02896-w","DOIUrl":"10.1186/s12875-025-02896-w","url":null,"abstract":"<p><strong>Background: </strong>Effective self-management (SM) is essential for improving health and preventing severe complications in patients with lifestyle-related chronic conditions, such as type 2 diabetes mellitus (T2DM) and CHD. Thus, enhancing patients' SM through self-management support has become an integral part of chronic care programs worldwide. However, information on the current focus on SM in German disease management programs (DMPs) is very limited. The aim of this study was to understand general practitioners' (GPs') experiences and strategies for promoting SM.</p><p><strong>Methods: </strong>An exploratory qualitative design was selected, resulting in the conduct of five focus group discussions with 20 GPs in August and September 2020. The GPs were recruited from the teaching practices of the University Hospital Cologne through purposive sampling. Their experiences and opinions on SM were assessed in questions blocks using a semi-structured interview guide and analysed by a multi-professional team employing Kuckartz' method of qualitative content analysis.</p><p><strong>Results: </strong>The focus group discussions were structured around three main categories: (1) GPs' perceived patient SM in the DMPs for T2DM and CHD, (2) GPs' perceptions of factors influencing patient motivation for SM, and (3) strategies fostering patient motivation for SM. Discussions revolved around patients' motivation and capabilities to implement a sustainable SM in their daily lives. Many GPs followed a patient-centered approach to foster SM in their patients, considering various challenging individual, social and institutional factors that influence SM in chronically ill patients.</p><p><strong>Conclusion: </strong>GPs regularly support their patients' SM as a routine part of the DMP through ongoing consultations and education. However, they face several challenges in facilitating sustainable patient SM, which requires support by additional and standardized measures beyond the current DMP care to be effective.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"222"},"PeriodicalIF":2.0,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12255095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621493","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":"Impact of the COVID-19 era on preventative primary care for children 0-5 years old: a scoping review.","authors":"Helen Valkanas, Kimberley McFadden, Isabella Mignacca, Xin Qi, Mackenzie Jordan, Imaan Bayoumi, Patricia Li","doi":"10.1186/s12875-025-02913-y","DOIUrl":"10.1186/s12875-025-02913-y","url":null,"abstract":"<p><strong>Background: </strong>Restrictions to routine preventative primary care well child visits (WCV) during COVID-19 may have affected a variety of outcomes for young children including growth, development, and the identification and management of developmental delays. To better understand the effect of the pandemic on these outcomes, we conducted a scoping review of studies published between March 2020 and April 2024. The objectives of this scoping review were to determine the impact of the COVID-19 era on WCV attendance and developmental outcomes in children 0-5 years old.</p><p><strong>Results: </strong>23 articles met inclusion criteria. Most studies were conducted in the U.S. The overall COVID-19 era WCV rate was lower compared to pre-COVID visit rates. Higher rates of missed WCVs and reduced access were reported for racialized children and those from families with lower socioeconomic status. Studies measuring developmental outcomes found associations between children born during the pandemic and increased rates of expressive language delays, decreased personal-social skills, increased delays in achieving verbal, motor, and overall cognitive performance milestones, increased externalizing behaviours, and decreased prosocial behaviour. No study examined the impact of WCV attendance rates on developmental outcomes.</p><p><strong>Conclusions: </strong>During the COVID-19 pandemic, infants, toddlers, and young children attended fewer preventative primary care visits and pandemic-born children were more likely to show signs of developmental delay. This review highlights the need for further research to better understand the longitudinal impact of reduced access to preventative primary care and child health outcomes, including the early detection of, and referral for, developmental delays.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"221"},"PeriodicalIF":2.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12247245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621494","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":"\"Those risks, that preventative work, that is the bedrock of family medicine\": A foucauldian discourse analysis of communicating risk for type 2 diabetes among primary care providers.","authors":"Wendy M Blunt, Jennifer D Irwin, Robert J Petrella, Jacob Shelley, Maxwell J Smith","doi":"10.1186/s12875-025-02899-7","DOIUrl":"10.1186/s12875-025-02899-7","url":null,"abstract":"<p><p>With estimates suggesting 350 million individuals are at-risk for type 2 diabetes (T2D), there is an urgent need to critically understand the processes of risk communication with primary care providers. Prior research has shown that primary care is the most likely place where initial conversations with a patients about T2D risk occur, but there remains a paucity of research exploring what may govern this communication. The purpose of this study was to critically explore discourses of risk for preventing T2D from the perspective of primary care providers. Semi-structured interviews (n = 14) were conducted with primary care providers including family physicians (n = 4), medical residents (n = 2), nurses (n = 3), dietitians (n = 4), and a pharmacist (n = 1) working in family health team (FHT) clinics in Southwestern, Ontario, Canada. Foucauldian Discourse Analysis through thematic analysis was applied to analyze the data and generate themes detailing how provider communications about risk for T2D are governed through discourse. Themes included: (1) patient-centred practice; (2) diagnosing prediabetes; (3) contextualizing symptoms; (4) time contingent; (5) adapting to patient knowledge; (6) carefully discussing weight; and (7) age as a balancing act. Overall, providers note using discourses of patient-centred practice to guide approaches to communicating about risk for T2D to patients. There are tensions with fulfilling this ideal patient-centred approach from more powerful discourses of prediabetes, assumptions about patient knowledge, and age that may override the ability to be patient-centred with communications about risk for T2D.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"220"},"PeriodicalIF":2.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12243163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610450","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 complex relationship between treatment burden of multimorbidity and self-care in multimorbid patients with hypertension.","authors":"Kyoung Suk Lee, Jihyang Lee","doi":"10.1186/s12875-025-02916-9","DOIUrl":"10.1186/s12875-025-02916-9","url":null,"abstract":"<p><strong>Background: </strong>Multimorbid patients with hypertension experienced treatment burden from managing multiple chronic conditions. Although treatment burden can adversely affect self-care, several qualitative studies have suggested a complex relationship between the two factors. This study aimed to identify patient groups based on the level of multimorbidity treatment burden and self-care adherence and explore factors associated with these patient groups. We also examined if patients transitioned to a different group over six months and which factors were associated with either transitioning into or remaining in the ideal group (Lower burden with higher self-care) at six months.</p><p><strong>Methods: </strong>This longitudinal study included hypertensive patients with at least two comorbidities (n = 484); 302 participants completed the 6-month follow-up. Patients were categorized into four groups based on multimorbidity treatment burden and self-care adherence levels: All-low (13.8%); Lower burden with higher self-care (26.0%); Higher burden with lower self-care (35.3%); and All-high (24.8%) groups. Multinomial logistic regression was used to explore factors associated with group membership, with the Lower burden with higher self-care group as the reference group. Binary logistic regression was used to explore factors associated with transitioning into or remaining in the ideal group at six months.</p><p><strong>Results: </strong>Older age, higher levels of health literacy, better subjective cognitive function, and greater shared decision-making decreased the likelihood of being in the All-low group. Lower depressive symptoms and higher subjective cognitive function decreased the likelihood of being in both Higher burden with lower self-care and All-high groups, while older age and greater shared decision-making were only associated with the Higher burden with lower self-care group. Patients in the All-low and All-high groups frequently transitioned to another group over six months, while the other two groups remained stable. At six months, participants who were male and had higher health literacy, better subjective cognitive function, and greater involvement in shared decision-making were more likely to belong to the ideal group.</p><p><strong>Conclusions: </strong>Our study observed the complex relationship between multimorbidity treatment burden and self-care adherence in multimorbid patients with hypertension. Interventions aimed at improving shared decision-making considering patients' circumstances (e.g., emotional status) may alleviate treatment burden and enhance self-care adherence.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"219"},"PeriodicalIF":2.0,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12239294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602409","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":"Assessing physicians' agreement and the completeness of the decision aid 'arriba Diabetes': a cross-sectional study.","authors":"Nicole Lindner, Marie-Christine Hoffmann, Jörg Haasenritter, Jan K Woike, Norbert Donner-Banzhoff","doi":"10.1186/s12875-025-02887-x","DOIUrl":"10.1186/s12875-025-02887-x","url":null,"abstract":"<p><strong>Background: </strong>Guidelines for type 2 diabetes emphasise individualised treatment goals, yet implementation remains challenging in primary care. To address this, we developed the \"arriba Diabetes\" software, a patient-centred decision support tool. The software provides individualised recommendations for intensity of treatment based on four inputs: age, comorbidities, treatment burden preference, and risk reduction preference.</p><p><strong>Methods: </strong>In a cross-sectional evaluation study in German primary care, we included 34 general practitioners (GPs) and 152 patients. The primary aim of this study was to evaluate the \"arriba Diabetes\" software by assessing the agreement between its treatment intensity recommendation and physicians' clinical judgement. Additionally, we explored the cases of disagreement, the distribution of patient-specific inputs and physicians' perspectives on the software's usability.</p><p><strong>Results: </strong>The \"arriba Diabetes\" recommendations aligned in 87% of cases with GPs' recommendation, and 87% of the doctors would use \"arriba Diabetes\" in the future. Patients had a median age of 68 years with a low comorbid load (median 3 on a scale 0-10). Patients expressed a moderate preference for higher treatment burden (median 6 on a scale 0-10) and a high preference to reduce organ complications in the future (median 8 on a scale 0-10). Acceptance of therapy burden correlated positively with the preference to reduce organ damage (Spearman correlation coefficient: +0.49).</p><p><strong>Conclusions: </strong>Recommendations of \"arriba Diabetes\" were well aligned with GPs' recommendations. Implementation of the \"arriba Diabetes\" software has the potential to promote patient-centred and evidence-based diabetes treatment decisions in primary care.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"218"},"PeriodicalIF":2.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12235830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144593051","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}