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The safe and effective treatment of patients accessing multiple NHS services relies upon efficient communication between primary care, secondary care, and out of hours providers. There is a theoretical risk to patient safety from delays in these processes, to which paper communications are particularly vulnerable. When letters are received they must be reviewed and prioritised in order of clinical importance, a process that requires both time and clinical resources. This is relevant to the challenge of resource allocation to maximise patient benefit. This retrospective study investigated the impact on patient safety of 249 clinical letters reporting routine clinical encounters in secondary care and out of hours services that were delayed by an average of 18-24 months to a suburban London general practice. No clinical harm could be attributed to the delay. This small study did not suggest delays in routine communications pose a significant risk to patient safety. Conversely, it questions the efficiency and benefit to patients of prioritising clinical time to reviewing routine letters. The adoption of fully integrated, shared electronic patient records with the function to highlight clinically urgent or important communications might ease clinician workload, to the ultimate benefit of patient care. [ABSTRACT FROM AUTHOR]

In the United Kingdom, people with non-white ethnicities are more likely to report being in worse health conditions and have poorer experiences of healthcare services than white counterparts. The voices of those of Black ethnicities are often merged in literature among other non-white ethnicities. This literature review aims to analyse studies that investigate Black participant experiences of primary care in the UK. We conducted a systematic literature review searching Medline, Web of Science, EMBASE, SCOPUS, Social Policy and Practice, CINAHL plus, Psych INFO and Global Health with specific search terms for appropriate studies. No publish date limit was applied. 40 papers (39 articles and 1 thesis) were deemed eligible for inclusion in the review. A number of major themes emerged. Patient expectations of healthcare and the health seeking behaviour impacted their interactions with health systems in the UK. Both language and finances emerged as barriers through which some Black participants interacted with primary care services. (Mis)trust of clinicians and the health system was a common theme that often negatively impacted views of UK primary care services. The social context of the primary care service and instances of a cultural disconnect also impacted views of primary care services. Some papers detail patients recognising differential treatment based on ethnicity. The review included the voices of primary care professionals where descriptions of Black patients were overwhelmingly negative. Views and experiences of Black groups may be radically different to other ethnic minorities and thus, should be teased out of broader umbrella terms like Black and Asian Minority Ethnic (BAME) and Black Minority Ethnic (BME). To address ethnicity-based health inequalities, culturally sensitive interventions that engage with the impacted community including co-designed interventions should be considered while acknowledging the implications of being racialised as Black in the UK. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the performance of a sample of general practitioner (GP) trainers in the multiple choice paper (MCP) of the Membership Examination of the Royal College of General Practitioners (MRCGP) and to obtain their views of the content of the paper and its relevance to general practice using a written knowledge test and self-administered questionnaire. The participants were volunteer GP trainers in the Northern, Wessex, Kent, Surrey and Sussex (KSS) and Northwest deaneries of the UK. The trainers completed a shortened version of an MRCGP MCP paper under examination conditions and provided feedback immediately afterwards. Of 191 trainers invited to participate, 86 (45%) sat the paper and of these, 81 completed the questionnaire. Most trainers believed that the paper assessed knowledge of common or important topics relevant to general practice, that the majority of questions were appropriate, clear and unambiguous and that time pressure was not a problem. Trainers performed significantly better compared to registrars overall, and in questions on medicine related to general practice and practice administration but not research methodology or critical appraisal. They did so without making prior preparation. The findings from this group of trainers lend support to the face validity and content validity of the MRCGP MCP examination as an assessment of applied knowledge of general practice. [ABSTRACT FROM AUTHOR]

In this paper we contribute to the emerging literature on the effect of the COVID-19 pandemic on the gender gap in research productivity. We extend previous studies by considering men and women academics from science and non-science disciplines through an analysis of data from academics at 14 universities across two countries (seven in Australia and seven in Canada) and focusing on the role of primary caregiving. Our empirical approach used logistic regressions and the Blinder–Oaxaca decomposition technique. The latter enabled us to ask: 'How much of the gender gap in perceived productivity during the pandemic is due to gender differences in primary care responsibilities?' Within the sample (N = 2,817) of academics, 33% of women and 25% of men reported that their perceived publication ability decreased a lot during the pandemic. This is an eight percentage-point gender gap in perceived publication ability. Statistical analysis revealed that two-fifths (40%) of this gap may be explained by gender differences in having primary responsibility for the care of children. Gender differences in other characteristics such as age, discipline, and increased teaching and administrative work were not, as a group, significant. There were also no differences between Australia and Canada. The findings are important, particularly for the pursuit of gender equality within academia. In the absence of specific mitigating interventions, research disruptions in 2020 may have long-lasting career scarring effects (e.g. hiring, promotion, tenure) and, as a result, see women further disadvantaged within the academy. [ABSTRACT FROM AUTHOR]

A significant proportion of primary care consultations now happen remotely. Although the vast majority occur safely, a recent study highlighted areas of risk which may be compounded by the limited training many GPs have received in remote consulting. To provide safe remote services, consideration needs to be given to adapting practice workflow to optimise remote care. Patients less suitable for remote consulting, either due to disease, extremes of age, disability or for social reasons should be identified and prioritised for face-to-face encounters. Training supports both the development of individual communication skills for remote care, and effective team working. Practice-based group learning events can be used to share experiences, identify resources, and consider the risks in remote care and how they can be mitigated. The paper presents some fictionalised cases, illustrating where patients came to harm, as a result of a remote consultation, and where harm was averted due to actions taken by practice teams. These can be used to support critical thinking and discussion within practice development meetings and tutorials with trainee GPs and other practice staff. Using the paper as a basis for reflection, teaching and action can facilitate the delivery of safer remote care. [ABSTRACT FROM AUTHOR]

There is an increasing demand for the rapid implementation of technologies that can address persisting and evolving needs of the health sector. However, to make technologies work in local health settings, a mutual alignment between technologies and local context is needed. Despite existing scholarship on health technology implementation, few have examined how human and non-human actors move towards technology implementation. Using the mobilities lens, we explore how healthcare providers negotiated the varied and conflicting movements of human and non-human entities in health technology implementation. We draw our findings from the experiences of Filipino primary care workers in implementing electronic medical records (EMR) in rural health units. We argue that conflicting speeds of mobilities make visible the workarounds employed by healthcare providers. These workarounds provide spaces for technology users to perform their routine practices and spaces for technologies to perform its work. Furthermore, we show how attention to mobility and speed reveals how preoccupation with fast-tracked, rapid intervention implementation may undermine the value of technologies in the practice of their intended beneficiaries. We conclude this article by discussing how a focus on mobility can further complicate the discussion on health technology implementation. [ABSTRACT FROM AUTHOR]

The article announces the deadline for submission of the manuscripts about the research examining any aspect of the use of clinical assessment devices in relation to medical illnesses. The topics of interest which include the assessment of psychopathology in primary care settings, use of personality assessment in medical settings, assessment of psychological factors involved in biological variables or chronic disease and problems in the assessment of psychotropic drug effects are also presented.

The purpose of this scoping review is to update the recent progress of EPAs research in GME, focusing on the topical concern of EPAs effectiveness, and to provide a reference for medical researchers in countries/regions interested in introducing EPAs. Guided by Arksey and O'Malley's framework regarding scoping reviews, the researchers, in January 2021, conducted a search in five databases to ensure the comprehensiveness of the literature. After the predetermined process, 29 articles in total were included in this study. The most common areas for the implementation and evaluation of EPAs were Surgery (n = 7,24.1%), Pediatric (n = 5,17.2%) and Internal medicine (n = 4,13.8%), a result that shows a relatively large change in the research trend of EPAs in the last two years. Prior to 2018, EPAs research focused on internal medicine, psychiatry, family medicine, and primary care. The articles in the category of EPAs implementation and evaluation had four main themes: (1) validation of EPAs (n = 16,55.2%); (2) describing the experience of implementing EPAs (n = 11,37.9%); (3) examining the factors and barriers that influence the implementation and evaluation of EPAs (n = 6,20.6%); and (4) researching the experiences of faculty, interns, and other relevant personnel in using EPAs. Training programs were the most common EPAs implementation setting (n = 26,89.6%); direct observation and evaluation (n = 12,41.4%), and evaluation by scoring reports (n = 5,17.2%) were the two most common means of assessing physicians' EPA levels; 19 papers (65.5%) used faculty evaluation, and nine of these papers also used self-assessment (31.0%); the most frequently used tools in the evaluation of EPAs were mainly researcher-made instruments (n = 37.9%), assessment form (n = 7,24.1%), and mobile application (n = 6,20.7%). Although EPAs occupy an increasingly important place in international medical education, this study concludes that the implementation and diffusion of EPAs on a larger scale is still difficult. [ABSTRACT FROM AUTHOR]

An introduction is presented which discusses various papers related to delivery of primary care services and hospital operations including matching patient and physician preferences, case study on improve staffing decisions at mass immunization clinics and outpatient appointment scheduling.

The majority of expectant mothers report sleep alterations during pregnancy and almost 40% report poor sleep quality. There is growing evidence that sleep quality (SQ) during pregnancy influences maternal health. This review focuses on how SQ during pregnancy relates to maternal health-related quality of life (HRQoL). The review also aims to identify whether this relation varies between pregnancy trimesters, and for different subdomains of HRQoL. A systematic review was performed according to PRISMA guidelines and registered on Prospero in August 2021 with ID no: CRD42021264707. Pubmed, Psychinfo, Embase, Cochrane, and trial registries were searched up to June 2021. Studies with any design that investigated the relation between SQ and quality of life/HRQoL in pregnant women, published in English, and peer-reviewed, were included. Two independent reviewers screened titles, abstracts, and full texts, and extracted data from the included papers. The quality of the studies was evaluated using the Newcastle-Ottawa Scale. Three hundred and thirteen papers were identified in the initial search, of which 10 met the inclusion criteria. Data included 7330 participants from six different countries. The studies had longitudinal (n = 1) or cross-sectional designs (n = 9). In nine studies SQ was reported subjectively by self-report questionnaires. Actigraphic data was available from two studies. HRQoL was assessed by validated questionnaires in all studies. Due to high levels of clinical and methodological heterogeneity in included studies, a narrative synthesis was employed. Nine studies found that poor sleep quality was related to a lower overall HRQoL during pregnancy. Effect sizes were low to medium. This relation was reported most during the third trimester. Especially sleep disturbances and subjective low SQ seemed to be related consistently to lower HRQoL. Furthermore, an indication was found that SQ might have a relation with the mental and physical domain of HRQoL. The social and environmental domain may also be associated with overall SQ. Despite the scarcity of studies available, this systematic review found evidence that low SQ is related to low HRQoL during pregnancy. An indication was found that the relationship between SQ and HRQoL during the second trimester might be less prominent. [ABSTRACT FROM AUTHOR]

Primary care physicians played an important role in the global response during the COVID-19 pandemic, but with the absence of laboratory and diagnostics services, the move to telehealth and the focus on respiratory assessment, they faced increased uncertainty when making clinical decisions. This paper aims to examine the impact of the pandemic on decisions made by primary care physicians, as measured by referrals to chest X-ray and laboratory tests and by prescriptions of antibiotics. We conducted a retrospective study of all visits recorded with fever or cough, presenting to 209 community clinics in Southern Israel during the years 2018–2022. We describe changes in outcome rates across time and use multivariate generalised linear mixed effects model to compare the odds of referrals and prescriptions between periods, while accounting for gender, age, clinic sector, visit type, diagnosis, and season. In total, 609,823 visits to primary care physicians complied with the cohort definitions. Social restrictions were associated with a decline in all measured outcomes for primary care physician decisions, most prominently among ages 20-59, for throat culture referral during the first lockdown (OR = 0.46) and for cephalosporine prescription during the second lockdown (OR = 0.55). This trend persisted following the cancellation of the restrictions. Despite higher uncertainty during the COVID-19 social restrictions, the overall course of clinical decision-making processes was maintained, and was associated with a reduction in the use of auxiliary resources, which can improve the quality of patient care by lowering costs and supporting prevention of future antibiotics resistance. [ABSTRACT FROM AUTHOR]

Objective. Health behavior research suggests that perceived social norms impact health decisions. This study aimed to (a) examine reasons for vaccine hesitancy among a sample of college students compared to a clinical sample (b) examine the accuracy of perceptions of others' receptivity and intention to seek out the COVID-19 vaccine, and (c) determine whether greater self-other normative discrepancies (SODs) were associated with increased likelihood to seek out the COVID-19 vaccine. Participants. Participants included 227 students at a Northeastern private college and 140 patients seeking medical care. Methods. College students completed an online, anonymous survey. Patients completed a paper-and-pencil survey distributed at appointment check-in. Results. Compared to their perceptions of others, participants had more positive beliefs about vaccines. The most common reason prompting individuals to seek out the vaccine was to return to "normal life." Conclusions. Future research might examine use of social norms interventions to decrease vaccine hesitancy. [ABSTRACT FROM AUTHOR]

London Journal of Primary Care wishes to develop a network of collaborating sites to better understand how to achievecommunity-oriented integrated care and health promotionin different contexts. A collaborating site can do more than submit papers. It can develop its own domain on the LJPC website, contribute to the development of LJPC policy, and stimulate discussions with other collaborating sites. At any time a collaborating site can opt out. In addition to securing papers for publication, a site might nurture a network of supporters, teach people to use multiple research and quality improvement methods, develop a system of governance for locally led inquiries, develop case studies of community-oriented integrated care and health promotion and facilitate within-site and between-site learning and change. [ABSTRACT FROM PUBLISHER]

Private primary care providers are usually the first site where afflictions come under institutional view. In the context of poverty, the relationship between illness and care is more complex than a simple division of responsibilities between various actors--with care given by kin, and diagnosis and treatment being the purview of providers. Since patients would often visit the provider with family members, providers are attuned to the patients' web of kinship. Providers would take patients' kinship arrangements into account when prescribing diagnostic tests and treatments. This paper terms this aspect of the clinical encounter as 'kin testing' to refer to situations/clinical encounters when providers take into consideration that care provided by kin was conditional. 'Kin testing' allowed providers to manage the episode of illness that had brought the patient to the clinic by relying on clinical judgment rather than confirmed laboratory tests. Furthermore, since complaints of poor health also were an idiom to communicate kin neglect, providers had to also discern how to negotiate diagnoses and treatments. Kinship determined whether the afflicted bodies brought to the clinics were diagnosed, whether medicines reached the body, and adherence maintained. The providers' actions make visible the difference that kinship made in how health is imagined in the clinic and in standardized protocols. Focusing on primary care clinics in Patna, India, we contribute to research that shows that kinship determines care and management of illnesses at home by showing that relatedness of patients gets folded in the clinic by providers as well. [ABSTRACT FROM AUTHOR]

Health care systems expect primary care clinicians to manage panels of patients and improve population health, yet few have been trained to do so. An interprofessional panel management (PM) curriculum is one possible strategy to address this training gap and supply future primary care practices with clinicians and teams prepared to work together to improve the health of individual patients and populations. This paper describes a Veterans Administration (VA) sponsored multi-site interprofessional PM curriculum development effort. Five VA Centers of Excellence in Primary Care Education collaborated to identify a common set of interprofessionally relevant desired learning outcomes (DLOs) for the PM and to develop assessment instruments for monitoring trainees' PM learning. Authors cataloged teaching and learning activities across sites. Results from pilot testing were systematically discussed leading to iterative revisions of curricular elements. Authors completed a retrospective self-assessment of curriculum implementation for the academic year 2015–16 using a 5-point scale: contemplation (score = 0), pilot (1), action (2), maintenance (3), and embedded (4). Implementation scores were analyzed using descriptive statistics. DLOs were organized into five categories (individual patients, populations, guidelines/measures, teamwork, and improvement) along with a developmental continuum and mapped to program competencies. Instruction and implementation varied across sites based on resources and priorities. Between 2015 and 2016, 159 trainees (internal medicine residents, nurse practitioner students and residents, pharmacy residents, and psychology post-doctoral fellows) participated in the PM curriculum. Curriculum implementation scores for guidelines/measures and improvement DLOs were similar for all trainees; scores for individual patients, populations, and teamwork DLOs were more advanced for nurse practitioner and physician trainees. In conclusion, collaboratively identified DLOs for PM guided development of assessment instruments and instructional approaches for panel management activities in interprofessional teams. This PM curriculum and associated tools provide resources for educators in other settings. [ABSTRACT FROM AUTHOR]

Introduction: Caregivers' adherence to Child Primary Care (CPC) health recommendations is particularly relevant for the protection of children's health and promotion of their optimal development. Nevertheless, there are currently no measures to assess it, as the majority of measures are focused on pharmacological treatment adherence instead of adherence to preventive health recommendations. Thus, this paper describes the development and validation of a new instrument to assess caregivers' adherence to CPC health recommendations regarding children aged between 2 years and 6 years old, which would also be sensitive to the specificities of caregivers in more vulnerable conditions—the CPC-Adherence Scale. Methods: Six hundred sixty-two parents (93.4% women; 6.6% immigrant), living in Portugal and with children aged between 2 years and 6 years, participated in a cross-sectional study using a paper or electronic protocol. The protocol was composed by: (1) the CPC-Adherence Scale; (2) questions regarding experiences in CPC; (3) the European Task Force on Patient Evaluation of General Practice Care (EUROPEP); (4) socio-demographic information. Results: The exploratory and confirmatory factor analyses supported a 2-factor solution: (1) Adherence to a safe psychomotor development (n = 14 items; Cronbach's Alpha = 0.894); (2) Adherence to nutritional counseling (n = 6 items; Cronbach's Alpha = 0.608). The CPC-Adherence Scale showed good content and criterion-related validity. It discriminated levels of adherence of caregivers with different levels of knowledge about CPC recommendations, satisfaction with care and different socio-economic and immigrant t status. Discussion: The CPC-Adherence Scale is an innovative and promising measure that may play a relevant role on future research and intervention for the promotion of adherence behaviors in a primary prevention context. [ABSTRACT FROM AUTHOR]

Clinical research in primary care is relatively scarce. Practice-based research networks (PBRNs) are research infrastructures to overcome hurdles associated with conducting studies in primary care. In Norway, almost all 5.4 million inhabitants have access to a general practitioner (GP) through a patient-list system. This gives opportunity for a PBRN with reliable information about the general population. The aim of the current paper is to describe the establishment, organization and function of PraksisNett (the Norwegian Primary Care Research Network). We describe the development, funding and logistics of PraksisNett as a nationwide PBRN. PraksisNett received funding from the Research Council of Norway for an establishment period of five years (2018–2022). It is comprised of two parts; a human infrastructure (employees, including academic GPs) organized as four regional nodes and a coordinating node and an IT infrastructure comprised by the Snow system in conjunction with the Medrave M4 system. The core of the infrastructure is the 92 general practices that are contractually linked to PraksisNett. These include 492 GPs, serving almost 520,000 patients. Practices were recruited during 2019–2020 and comprise a representative mix of rural and urban settings spread throughout all regions of Norway. Norway has established a nationwide PBRN to reduce hurdles for conducting clinical studies in primary care. Improved infrastructure for clinical studies in primary care is expected to increase the attractiveness for studies on the management of disorders and diseases in primary care and facilitate international research collaboration. This will benefit both patients, GPs and society in terms of improved quality of care. Practice-based research networks (PBRNs) are research infrastructures to overcome hurdles associated with conducting studies in primary care Improved infrastructure for clinical studies in primary care is expected to increase the attractiveness for studies on the management of disorders and diseases in primary care and facilitate international research collaboration We describe PraksisNett, a Norwegian PBRN consisting of 92 general practices including 492 GPs, serving almost 520,000 patients An advanced and secure IT infrastructure connects the general practices to PraksisNett and makes it possible to identify and recruit patients in a novel way, as well as reuse clinical data PraksisNett will benefit both patients, GPs and society in terms of improved quality of care This paper may inform and inspire initiatives to establish PBRNs elsewhere [ABSTRACT FROM AUTHOR]

Objective: Research and PhDs are relatively rare in family medicine and primary care. To promote research, regular one-year research courses for primary care professionals with a focus on clinical epidemiology were started. This study explores the academic outcomes of the first four cohorts of research courses and surveys the participants' perspectives on the research course. Design: An electronic survey was sent to the research course participants. All peer-reviewed scientific papers published by these students were retrieved by literature searches in PubMed. Setting: Primary care in Finland. Subjects: A total of 46 research course participants who had finished the research courses between 2007 and 2012. Results: Of the 46 participants 29 were physicians, eight nurses, three dentists, four physiotherapists, and two nutritionists. By the end of 2014, 28 of the 46 participants (61%) had published 79 papers indexed in PubMed and seven students (15%) had completed a PhD. The participants stated that the course taught them critical thinking, and provided basic research knowledge, inspiration, and fruitful networks for research. Conclusion: A one-year, multi-professional, clinical epidemiology based research course appeared to be successful in encouraging primary care research as measured by research publications and networking. Activating teaching methods, encouraging focus on own research planning, and support from peers and tutors helped the participants to embark on research projects that resulted in PhDs for 15% of the participants. [ABSTRACT FROM AUTHOR]

Objective: Previous guidelines and planning documents have identified the key role primary care providers play in delivering mental health care, including the recommendation from the WHO that meeting the mental health needs of the population in many low and middle income countries will only be achieved through greater integration of mental health services within general medical settings. This position paper aims to build upon this work and present a global framework for enhancing mental health care delivered within primary care. Methods: This paper synthesizes previous guidelines, empirical data from the literature and experiences of the authors in varied clinical settings to identify core principles and the key elements of successful collaboration, and organizes these into practical guidelines that can be adapted to any setting. Results: The paper proposes a three-step approach. The first is mental health services that any primary care provider can deliver with or without the presence of a mental health professional. Second is practical ways that effective collaboration can enhance this care. The third looks at wider system changes required to support these new roles and how better collaboration can lead to new responses to respond to challenges facing all mental health systems. Conclusions: This simple framework can be applied in any jurisdiction or country to enhance the detection, treatment, and prevention of mental health problems, reinforcing the role of the primary care provider in delivering care and showing how collaborative care can lead to better outcomes for people with mental health and addiction problems. [ABSTRACT FROM AUTHOR]

Ethically challenging or controversial medical procedures have prompted increasing requests for the exercise of conscientious objection, and caused concerns about how and when it should be practised. This paper clarifies definitions, especially with regard to discrimination, and explores the restrictions, duties, and practical limitations, in order to suggest criteria for its practice. It also argues that a conscientious refusal to treat, where there is therapeutic doubt, is a valid form of conscientious objection. An email survey sent to General Practitioners (GPs), explored the adherence to the suggested criteria, and assessed the outcomes, in terms of acceptability, impact, and difficulties experienced by the GPs, their colleagues and their patients. The results demonstrate high acceptability of conscientious objection, and better outcomes when the suggested criteria are adhered to. The GPs would support education to improve the practice of conscientious objection to a professional level, which could further improve outcomes and acceptability. [ABSTRACT FROM AUTHOR]

Rural communities experience a significant asthma burden. We pilot tested the implementation of Easy Breathing, a decision support program for improving primary care provider adherence to asthma guidelines in a rural community, and characterized asthma risk factors for enrollees. We implemented Easy Breathing in two rural primary care practices for two years. Patient demographics, exposure histories, asthma severity, asthma medications, and treatment plans were collected. Providers' adherence to guidelines included the frequency of children with persistent asthma who were prescribed guidelines-based therapy and the frequency of children with a written asthma treatment plan on file. Clinicians provided feedback on the feasibility and acceptability of Easy Breathing using a validated survey tool and through semi-structured interviews. Two providers implemented the program. Enrollment included 518 children, of whom 135 (26%) had physician-confirmed asthma. After enrollment into Easy Breathing, 75% of children with asthma received a written asthma treatment plan All children with persistent asthma were prescribed an anti-inflammatory drug as part of their treatment plan. Providers (n = 2) rated Easy breathing as highly acceptable (M = 4.5), feasible (M = 4.5), and appropriate (M = 4.5). Qualitative feedback was positive, with suggestions to integrate the paper-based program into the electronic health record system for broader uptake. Enrollees with asthma were more likely to have a family history of asthma and endorse exposure to tobacco smoke and cockroaches. Easy Breathing shows promise as a decision support system that can be implemented in rural, medically underserved communities via primary care. [ABSTRACT FROM AUTHOR]

This paper explores the symbolic and boundary object value of the traditional paper prescription in the context of the planned move to the wider use of electronic prescribing in primary care in the UK and many other countries. It is argued that the traditional paper prescription possesses symbolic value and has been occasionally recognised but more often ignored in favour of the ultimate social object that is the medicine. This paper argues that considering the physical prescription as a boundary object within Star and Griesemer's typology as a 'standardised form' recognises its significance for a range of actors, including not just doctors and patients, but also pharmacists and other stakeholders, in areas such as professional authority, the ceremony of the medical consultation, patient autonomy, surveillance, financial income, as well as medicine supply. The paper goes on to reflect on this boundary object interpretation in the context of the current move to the electronic transfer of prescriptions and it is argued that this may threaten the existing boundary object and its associated value. It also raises broader concerns as to what happens when boundary objects are modified or replaced. [ABSTRACT FROM AUTHOR]

This paper presents a description of a multigroup-based psychotherapy program for Turkish-speaking individuals provided by an innovative primary care mental health service in London. As of 2021, the project offers two types of therapy: a year-long horticultural group, which is a blend between talking therapy and gardening, and a 20-week psychotherapy group. Both were designed to engage the particularly complex Turkish-speaking patient population in the London Borough of Hackney. The project is grounded in group psychotherapy and borrows elements from different theoretical orientations and therapeutic modalities including community psychology, group analytic therapy, horticultural therapy, attachment theory, and dynamic therapies. Here, we present how the program was created and developed and the specifics of the groups, together with the main themes and dynamics that emerged in the therapeutic process. The program evaluation and outcomes are illustrated by several clinical case vignettes throughout the paper. [ABSTRACT FROM AUTHOR]

Patients with polycystic ovary syndrome (PCOS) report dissatisfaction with the diagnostic process and are more likely to have overweight or obesity. We wanted to understand the role that primary care physicians (PCPs) play in the diagnosis of PCOS and how they contribute to treatment of patients with PCOS and obesity. A cross-sectional online survey was completed by 251 patients with PCOS and obesity (BMI ≥30 kg/m2) and 305 healthcare providers (PCPs, obstetricians/gynecologists, reproductive and general endocrinologists). This paper focuses on the 75 PCPs treating patients with PCOS and obesity. In the most common patient journey, we found that most patients with PCOS and obesity (53%) have initial discussions about PCOS symptoms with PCPs. However, less than one quarter of patients receive a PCOS diagnosis (22%) or initial treatment (24%) for PCOS from a PCP. One quarter of patients also reported receiving a misdiagnosis from a PCP prior to their PCOS diagnosis. Compared to other healthcare providers surveyed, PCPs were the least comfortable making a PCOS diagnosis. Compared to PCPs without an obesity management focus, PCPs with an obesity management focus were more likely to diagnose patients themselves (38% vs 62%) and initiate PCOS treatment themselves (42% vs 57%). According to PCPs, difficulty with obesity management (47%) was the top reason that patients with PCOS and obesity stop seeing them for PCOS management. PCPs are often the initial medical touchpoint for patients with PCOS and obesity. However, PCPs play a smaller role in diagnosis and treatment of PCOS. Increasing education on obesity management may encourage PCPs to diagnose and treat more patients with PCOS and offer strategies to help patients with obesity management. Polycystic ovary syndrome (PCOS) is a condition where women may make more male hormones than usual, have irregular periods, and have trouble getting pregnant. PCOS can look very different in different patients. This can make it difficult to diagnose. Patients with PCOS are more likely to have obesity (unhealthy excess weight). Having obesity can make patients' PCOS worse and losing weight is an important treatment for PCOS. We wanted to learn more about what patients with PCOS and obesity experience as they try to manage their PCOS and the role of primary care doctors in diagnosing and treating patients with PCOS. To better understand this journey, 251 patients with PCOS and obesity and 75 primary care doctors who treat patients with PCOS and obesity took an online survey. Most patients (53%) first talked about PCOS symptoms with a primary care doctor. However, less than 25% of patients received a PCOS diagnosis or first treatment from a primary care doctor. One quarter of all patients said they were misdiagnosed by a primary care doctor before being diagnosed with PCOS. Primary care doctors were less comfortable than specialist doctors in diagnosing and treating patients with PCOS. Primary care doctors with a focus on weight management were more likely than other primary care doctors to diagnose and treat patients with PCOS themselves. Giving primary care doctors more educational support with PCOS diagnosis and weight management could help patients with PCOS get diagnosed earlier and treated better. [ABSTRACT FROM AUTHOR]

Background: General practitioners (GPs) have a key role in palliative care provision for patients with advanced cancer. Continuity is valued by patients with such needs but is limited within current primary care systems. Exploration of the facilitators of and barriers to continuity in this complex context is required. Aim: To identify facilitators of and barriers to continuity with GPs in primary palliative care among people with advanced cancer and/or their close persons. Design: Mixed-methods systematic review with content and thematic analyses. Data sources: Keyword searches were carried out in five databases (Ovid MEDLINE(R), Ovid EMBASE(R), CINAHL, Web of Science, and Cochrane), policy documents and grey literature search engines in December 2020. Evidence was reviewed using relevant quality appraisal tools; data were extracted and tabulated. Findings were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, and the review was prospectively registered on PROSPERO. Results: Seventeen studies were included. Six studies originated from the UK; six from Europe; three from Canada; and two from Australia. Two studies were mixed-methods, four presented quantitative data, and 11 papers reported on qualitative studies. Four themes were developed: (1) the role of GPs in facilitating continuity; (2) the role of patients and/or close persons in facilitating continuity; (3) changing needs throughout the disease trajectory; and (4) the organisational context in primary care. Conclusions: Facilitators of and barriers to continuity in primary palliative care are outlined. Further research is required to explore how patients and/or their close persons experience continuity in primary palliative care. Specifically, the work required of them to achieve their desired level of continuity, and their capacity for action in this context, needs further attention. [ABSTRACT FROM AUTHOR]

The article discusses various papers about the contributions and works of Doctor Alexis Brook, published within the issue, including one about the works of Brook in general practice, ophthalmology and gastroenterology, a review of Brook's career, and another about a research on Brook's work on patients in primary care with eye conditions.

The pooled worldwide prevalence of low-back pain-related presentations in primary care varies between 6.8% and 28.4% in the high-income countries rendering it a major healthcare/economy problem. To best manage this complex bio-psycho-social condition a 360-degree approach is needed, as the psycho-social components are often more important than the scant pathophysiology. Pattern analysis of cannabis users suggested that attempts to alleviate musculo-skeletal pain is often seen as a major drive to use cannabinoids. Unlike NSAIDs/opioids, cannabidiol might directly affect more than one modality of pain signaling/perception. The 2019 guideline of the National Institute for Clinical Excellence recommended further studies with cannabidiol in pain medicine because of its excellent safety profile and presumed therapeutic potential. Therefore, we have researched relevant databases for pharmaco-physiological papers published between 2000 and 2021 to collate evidence in a narrative fashion to determine the clinical rationale for this cannabinoid in low-back pain. Observational research reported good results with CBD in pain and fear reduction, which are both key factors in low-back pain. Given the paucity of high-quality evidence, further research is needed to determine the efficacy/non-inferiority of CBD in primary/emergency care setting, using multimodal assessment of various patient-reported outcomes. [ABSTRACT FROM AUTHOR]

Building fair, equitable, and beneficial partnerships between institutions collaborating in research in low- and middle-income countries (LMIC) and high-income countries (HIC) has become an integral part of research capacity building in global health in recent years. In this paper, we offer an example of an academic collaboration between the University of California Los Angeles, Center for Health Policy and Research (UCLA CHPR) and the University of Philippines, Manila, College of Public Health (UPM CPH) that sought to build an equitable partnership between research institutions. The partnership was built on a project to build capacity for research and produce data for policy action for the prevention and care of non-communicable diseases (NCDs) through primary healthcare in the Philippines. The specific objectives of the project were to: (1) locally adapt the Primary Care Assessment Tool for the Philippines and use the adapted tool to measure facility-level primary care delivery, (2) conduct focus group discussions (FGDs) to gather qualitative observations regarding primary care readiness and capacity, and (3) conduct a comprehensive population-based health survey among adults on NCDs and prior healthcare experience. We describe here the progression of the partnership between these institutions to carry out the project and the elements that helped build a stronger connection between the institutions, such as mutual goal setting, cultural bridging, collaborative teams, and capacity building. This example, which can be used as a model depicting new directionality and opportunities for LMIC-HIC academic partnerships, was written based on the review of shared project documents, including study protocols, and written and oral communications with the project team members, including the primary investigators. The innovation of this partnership includes: LMIC-initiated project need identification, LMIC-based funding allocation, a capacity-building role of the HIC institution, and the expansion of scope through jointly offered courses on global health. [ABSTRACT FROM AUTHOR]

We developed and implemented a person-centered navigation model integrated in primary care where patients were referred to the Access to Resources in the Community (ARC) study by their primary care provider (PCP). The purpose of this paper is to explore the lay navigators' learning experience as reflected in their journals and present implications for education and health promotion practice. Sixty-six journal entries from two navigators were analysed. To code the data, we used a newly developed framework based upon the theory-informed lay navigator training programme. Five unique themes were identified: 1) Gaining and Building Trust, 2) Developing Empathy, 3) Experiencing Hope and Optimism, 4) Feeling Helplessness and 5) Celebrating Gains and Successes. The five themes identified paint a sequential picture of the journey of leading individuals from primary care to health and social community resources. This innovative approach has expanded our understanding of how navigators learn in practice, more specifically how they learn from patients and how they develop knowledge and skills in person-centered care. Incorporating reflective journaling as a regular practice provides situational awareness and leads to enhanced learning. Practising person-centered care also develops when a trusting and empathetic relationship is established. [ABSTRACT FROM AUTHOR]

The link between social inequality and health has been widely recognized, as there are systematic differences in health between people from lower and higher social classes. Furthermore, the complexity and multidimensionality of health and social problems has resulted in primary health care services that are increasingly integrating the approach of interprofessional collaboration between medical professionals and social workers. Despite this current focus, there is a lack of empirical insights into patients' experience of the quality of care resulting from these collaborations. This paper aims to contribute to knowledge by adopting a research approach that captures the narratives of patients in vulnerable situations from a primary care center by conducting semi-structured interviews. Through content analysis, data was analyzed according to five themes: (1) availability, (2) accessibility, (3) affordability, (4) comprehensibility, and (5) usefulness. The results suggest a positive role for interprofessional collaboration between medical professionals and social workers within a primary health care setting. This includes the opportunity for giving greater attention to social rights and collaboration within the local community. [ABSTRACT FROM AUTHOR]

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Objective. To identify GPs' attitudes towards sickness certification. Design. Systematic search and narrative review identifying themes around attitudes towards sickness certification. Results. Eighteen papers were identified for inclusion in the review; these included qualitative, quantitative, and systematic reviews. The papers were predominantly from Scandinavia and the UK. Three themes were identified from the literature: conflict, role responsibility, and barriers to good practice. Conflict was predominantly centred on conflict between GP and patients regarding the need for a certificate, but there was also conflict between all stakeholders. Role responsibility focused on the multiple roles GPs had to fulfil, and barriers to good practice were identified both within and outside the healthcare system. Conclusion. Any potential for changing the certification system needs to focus on reducing the potential for conflict, clarification of the roles of all stakeholders, and improving access to specialist occupational health and rehabilitation services. [ABSTRACT FROM AUTHOR]

Aim: This three part systematic review gathered all the current evidence on the use, quality and effects of pelvic examination (abdominal palpation, bimanual vaginal examination ± visualisation of the cervix) in primary care in diagnosing gynaecological cancer. Research questions • Do primary care practitioners perform pelvic examination during the assessment of symptoms, which are potentially indicative of gynaecological cancer? (RQ1) • What is the quality of pelvic examination performed in primary care, in terms of technical competence and interpretation of findings? (RQ2) • Is pelvic examination associated with the referral of patients with gynaecological cancer, and if so, in what way? (RQ3) Methods: PRISMA guidelines were followed. MEDLINE, EMBASE and Cochrane databases were searched using a combination of four terms, their MeSH terms and synonyms: pelvic examination; primary care; competency and gynaecological cancer. Inclusion and exclusion criteria were defined. Citation lists of all identified papers were searched. Two authors (PW and PM or CMB or CB) independently screened titles, abstracts and the full texts of publications. Data extraction was performed by PW and duplicated in all papers by a second reviewer (PM, CMB or CB). Paper quality was assessed using CASP methodology.Results: Nine hundred fifty four references were identified: 21 met the inclusion criteria: 5 RQ1; 6 RQ2; 10 RQ3. Examination rates prior to referral were generally low: one paper identified pre-referral PE in 52% of the patients; remaining papers demonstrated examination in less than half of the patients with suspicious symptoms. No papers explored GPs' competence at performing PE directly; but one paper identified 39% of 'clinically suspicious' cervices referred for colposcopy as having no abnormality. Pre-referral PE was associated with reduced diagnostic delay and early stage diagnosis.Conclusions: Pre-referral pelvic examination in symptomatic women appears to be under-performed, despite urgent suspected cancer referral guideline recommendation to do so (Healthcare Improvement Scotland 2014 ; National Institute for Health and Care Excellence 2015 ). While no evidence was found to confirm GPs' competence for performing PE, there was an association with shorter diagnostic delay and better outcomes in those women where it was performed. [ABSTRACT FROM AUTHOR]

This paper summarises a ten-year conversation within London Journal of Primary Care about the nature of community-oriented integrated care (COIC) and how to develop and evaluate it. COIC means integration of efforts for combined disease-treatment and health-enhancement at local, community level. COIC is similar to the World Health Organisation concept of a Community-Based Coordinating Hub - both require a local geographic area where different organisations align their activities for whole system integration and develop local communities for health. COIC is a necessary part of an integrated system for health and care because it enables multiple insights into 'wicked problems', and multiple services to integrate their activities for people with complex conditions, at the same time helping everyone to collaborate for the health of the local population. The conversation concludes seven aspects of COIC that warrant further attention. [ABSTRACT FROM AUTHOR]

The need for support for good mental health is enormous. General support for good mental health is needed for 100% of the population, and at all stages of life, from early childhood to end of life. Focused support is needed for the 17.6% of adults who have a mental disorder at any time, including those who also have a mental health problem amongst the 30% who report having a long-term condition of some kind. All sectors of society and all parts of the NHS need to play their part. Primary care cannot do this on its own. This paper describes how primary care practitioners can help stimulate such a grand alliance for health, by operating at four different levels – as individual practitioners, as organisations, as geographic clusters of organisations and as policy-makers. [ABSTRACT FROM PUBLISHER]

Background: Evidence has shown that there is a significant problem with medication safety when patients are transferred between settings. The role of community pharmacists and hospital pharmacists in facilitating transition of care has been well-researched. However, with the developing role of pharmacists in general practice as part of a multi-disciplinary team, little is known about their role in improving transition of care when patients move from secondary to primary care. The key objective of this scoping review is to understand the nature and extent of the role of primary care pharmacists for patients recently discharged from secondary care. Methods: This scoping review will follow the Joanna Briggs Institute (JBI) methodology for scoping review underpinned by the Arksey and O'Malley methodology and reported in accordance with the Preferred Reporting Items for Systematic Reviews Extension for Scoping Reviews (PRISMA-ScR) guidelines. The following electronic databases will be systematically searched: MEDLINE, EMBASE, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science and NICE Evidence. Reference lists of included full texts will be searched for relevant papers, in addition to grey literature which includes websites of relevant professional organisations. Primary studies, published in the English language that involved a primary care pharmacist-led intervention post-hospital discharge will be included. Two independent reviewers will screen studies against eligibility criteria and use a piloted data extraction form to extract data related to the review questions. The data will be presented in tabular form and assessed for key themes to identify gaps and inform future research. Discussion: This scoping review will map current evidence surrounding the role of primary care pharmacists in the post-hospital discharge care of patients. Findings will inform ongoing research to support safer transfer-of-care post-hospital discharge and identify ways in which collaboration between healthcare professionals can be improved. This review anticipates guiding the inclusion of patient and public involvement (PPI) at the consultation stage to validate and build on the findings. [ABSTRACT FROM AUTHOR]

Clinical guidelines for managing low back pain (LBP) emphasise patient information, patient education and physical activity as key components. Little is known about who actually receives information. This study investigates to what extent information at the first consultation with general practitioner (GP), chiropractor (DC) and physiotherapist (PT) in Danish primary care is provided to patients with LBP. This cross-sectorial study was conducted as a prospective survey registration of LBP consultations at the three primary health care professions in Denmark. Clinicians ticked off a paper survey chart during or after consultations with patients who visited the clinic for LBP (Approval number: ID # 11.220). 33 GPs, 43 DCs and 61 PTs registered first-time consultations. The primary outcome was provision of information, overall and across care settings. The overall proportion of patients provided with information was 72%, but this varied among professions (GP, 44%; DC, 76%; and PT, 74%). Provision of information increased to 78% if patients had increased emotional distress or back-related leg pain below the knee. The strongest association with provision of information was having two or three signs of elevated distress (OR 2.58 and 5.05, respectively, p= 0.00) or physical disability (OR 2.55, p= 0.00). In more than a quarter of first-time consultations, patient information was not provided. Large variation in providing information was found across the settings. The proportion provided with information increased for sub-populations having elevated distress or back-related leg pain below the knee. Clinical guidelines recommend patient information, patient education and physical activity for managing low back pain (LBP) • Information is not provided in more than a quarter of first-time consultations in Danish primary care settings that manage these patients. • Information increased for the sub-populations having elevated distress and back-related leg pain below the knee. • The conducted primary care surveys monitored clinical activity and illustrated variations in provision of information. [ABSTRACT FROM AUTHOR]

This paper examines employment and skills training for community caregivers within the expanded public works programme in South Africa. The paper argues that, as currently conceptualised, the skills and learnership programmes for community caregivers fail to take full advantage of the prevailing labour market realities. Therefore, the paper argues for strategic reconceptualisation of the programme to include learnerships for community caregivers that impart more mid-level to higher-level skills to meet current and future labour market demands particularly in primary health care. This, it is argued, will address the scarcity of skills in the health sector of the economy. Furthermore, the proposed programme will simultaneously have positive impacts on unemployment, the primary health care system and the socio-economic well-being of community caregivers. [ABSTRACT FROM PUBLISHER]

In low-resource and high HIV prevalence settings, schools are increasingly called upon as sites of care and support for vulnerable children. It is therefore crucial to understand the processes through which teachers take on pastoral care roles in response to the needs of vulnerable learners. As pastoral care is often contingent on teacher's being aware of learner's vulnerabilities and needs, we examine information-sharing between learners, their parents, and teachers. We draw on eight individual interviews conducted with teachers from three rural primary schools located in high HIV prevalence settings of the Siaya district of Western Kenya. The interviews were recorded, transcribed, and analysed using thematic network analysis. Our analysis revealed that HIV-related stigma made it difficult for vulnerable learners to disclose their vulnerabilities to teachers, fearing the repercussions of what might happen if other members of the school community would become aware of their association with HIV. When teachers sought out parents for more information, they were often met with denial of their vulnerabilities. This paper provides valuable insights into some of the difficulties primary school teachers face in ascertaining the pastoral care needs of vulnerable learners. It highlights that HIV-related stigma is a critical barrier for teachers to adopt a pastoral care role in high HIV prevalence communities of western Kenya. [ABSTRACT FROM AUTHOR]

In early 2020, when the first COVID-19 cases were confirmed in Switzerland, the federal government started implementing measures such as national stay-at-home recommendations and a strict limitation of health care services use. General practitioners (GPs) and their at-risk patients faced similar uncertainties and grappled with subsequent sensemaking of the unprecedented situation. Qualitative interviews with 24 GPs and 37 at-risk patients were conducted which were analyzed using thematic analysis. Weick's (1993) four sources of -resilience – improvisation, virtual role systems, attitudes of wisdom and respectful interaction – heuristically guide the exploration of on-the-ground experiences and informal ways GPs and their at-risk patients sought to ensure continuity of primary care. GPs used their metaphorical Swiss army knives of learned tools as well as existing knowledge and relationships to adapt to the extenuating circumstances. Through improvisation, GPs and patients found pragmatic solutions, such as using local farmer apple brandy as disinfectant or at-home treatments of clavicle fractures. Through virtual role systems, GPs and patients came to terms with new and shifting roles, such as "good soldier" and "at-risk patient" categorizations. Both parties adopted attitudes of wisdom by accepting that they could not know everything. They also diversified their sources of information through personal relationships, formal networks, and the internet. The GP-patient relationship grew in importance through respectful interaction, and intersubjective reflection helped make sense of shifting roles and ambiguous guidelines. The empirical analysis of this paper contributes to theoretical considerations of sensemaking, resilience, crisis settings and health systems. [ABSTRACT FROM AUTHOR]

This paper describes an interprofessional clinical learning experience for students within two primary care safety-net sites. An interprofessional team of faculty at one university partnered with two safety-net systems to provide students opportunities to work in an interprofessional team providing care for socially and medically complex patients. Our evaluation outcomes are student-centered, focusing on students' perceptions of caring for medically underserved populations and satisfaction with the clinical experience. Students reported positive perceptions of the interprofessional team, clinical experience, primary care, and caring for underserved populations. Strategic development of partnerships between academic and safety-net systems to offer learning opportunities can increase future healthcare providers' exposure and appreciation for interprofessional care of underserved populations. [ABSTRACT FROM AUTHOR]

The aim of this study was to provide evidence of the acceptability of the primary care psychology services that have been enhanced by the employment of assistant psychologists in Ireland to the parents of children with psychological difficulties. Data were collected from a sample of 74 parents who responded to quantitative and qualitative questions on the experience of service questionnaire. Reflexive thematic analysis was used to analyse the questionnaire responses. On average 88% of participants selected 'certainly true' in response to the statements in the experience of service questionnaire statement they were 'Totally satisfied'. Three major themes were developed; 'communication is more than talking', 'structure can facilitate or impede', and 'emotional reactions'. 'Communication is more than talking' is organised around communication The 'structure can facilitate or impede' acknowledges that systems influence psychological supports. 'Emotional reactions' captured parents' experiences, such as joy, frustration, and solidarity. The results demonstrate that the newly enhanced mental health service is acceptable to parents. Their voices provide ideas about what helps and hinders their experience of care. [ABSTRACT FROM AUTHOR]

Scotland is faced with pernicious health inequalities, which stem from inequalities in living conditions and the societal structures that create them. While action is needed to address the wider structural causes of health inequalities, the role of general practitioners (GPs) merits attention due to health care's potential to mitigate or exacerbate health inequalities. Minimal research, however, has explored how GPs understand the fundamental causes of health inequalities nor how they conceptualise their role in mitigating these. This paper aims to fill this gap using in-depth qualitative interviews with 24 GPs working in some of Scotland's most socio-economically disadvantaged, urban areas. Using Raphael's SDH discourse framework, this paper found clear linkages between GPs' perceptions of their patients, how they defined the 'problem' of health inequalities, and what they thought could be done to tackle them in disadvantaged areas. In general, there was convergence on how interviewees viewed their role in mitigating health inequalities through their work with individual patients. However, greater variation was found when describing the boundaries of their role and how far these extended beyond individual encounters. Specifically, only those GPs fluent in discussing structural causes of health inequalities discussed obligations to change local systems via strengthening community linkages and to influence higher level policies related to the SDH. This suggests that while there is a degree of what Metzl and Hansen deem 'structural competency' amongst some GPs working in disadvantaged areas, the scope remains to deepen this competency more broadly. [ABSTRACT FROM AUTHOR]

Summary This paper discusses the concept of interprofessional learning based on empirical data from an evaluation of an interprofessional learning project that was set in a British primary health care centre. A process evaluation methodology was chosen to collect the data using semi-structured interviews and focus groups with stakeholders and staff to gather their experiences and views of the project and documentary data from records written over the lifetime of the project. The paper argues that an interprofessional learning culture requires time to become embedded in everyday practice and to achieve such a culture, shared values, aims and clear communication are essential. The data suggest that there is a need to recognize responsibility for one's own learning as individuals as well as learning as teams of work colleagues if interprofessional learning is to be successful. However, even when these pre-requisites of interprofessional learning are agreed and acknowledged openly in the workplace, participants in the development of a learning culture need to recognize that there are structural controls which influence and constrain such developments which are external to participants and beyond their immediate control. [ABSTRACT FROM AUTHOR]

The aim of this paper is to examine the role of health promotion in locality commissioning teams—as pre-cursors of Primary Care Groups—drawing on the experiences of a project in the West Midlands. Wider implications for the workings of the new Primary Care Groups will be drawn. The paper will consider some fundamental differences between health promotion and other public health approaches. Using a model of health promotion practice, it will show how the practice of different stakeholders in locality commissioning can be made sense of by these different and in some cases incommensurable paradigms. Our argument is that being able to model practice so as to make these paradigmatic differences explicit and to acknowledge diversity and inconsistency is a prerequisite for healthy collaboration. [ABSTRACT FROM AUTHOR]

Interprofessional care provided in a free community-based clinic that focuses on chronic health conditions and health promotion provides an innovative solution to improve societal health. Many existing clinics provide a range of professions, but few include allied health services such as occupational and physical therapy. This paper provides a description of the development and implementation of an expanded faculty-guided student-led community-based primary care clinic that includes occupational and physical therapists as part of an interprofessional collaborative practice model. A detailed description and explanation of the partners involved, the institutional missions that drive this work, the logistics completed that enabled the 'doors to open,' faculty and student roles, and initial outcomes will be provided. A review of the service delivery model, lessons learned, and future directions for the clinic will also be offered. [ABSTRACT FROM AUTHOR]

Motorcyclists' increased likelihood of involvement in motor vehicle collisions increases their risk of brain injury or death. Despite irrefutable evidence of the protective capabilities of motorcycle helmets, their use among riders is not ubiquitous. This paper is a functional guide to motorcycle helmet safety, assisting clinicians in promoting helmet use and treating patients with motorcycle-related injuries. First, five commonly held myths that promote unhelmeted riding are dispelled. Then, clinicians are prepared to assist their patients in choosing an appropriate helmet through an in-depth presentation of motorcycle helmet construction, testing, and sizing. Discussion of patient care considerations for first responders, emergency medicine practitioners, and primary care providers will empower all-level clinicians to act as patient advocates. Finally, ethical and legal considerations regarding motorcycle helmet use are clarified. Equipping clinicians with applicable knowledge of motorcycle helmet safety will translate to safer roads and fewer motorcyclist patients. [ABSTRACT FROM AUTHOR]

Background: Globally, non-communicable diseases (NCDs) are recognised as a leading cause of morbidity and mortality. Medications and medicines optimisation play an important role in the management of modifiable physiological risk factors and NCDs. The importance of lifestyle interventions in prevention of modifiable risk factors is also well established. The aim of this paper was to describe the quantity of type 2 diabetes mellitus (T2DM), hypertension and dyslipidaemia prescribing in Qatari primary care settings. Its findings will provide necessary information to inform pharmaceutical policy and practice. Methods: The study was undertaken in Qatar's publicly funded primary health care centres. Data sources for this study comprised electronic medical records. The Anatomical Therapeutic Chemical (ATC) drug classification system was used to classify the medications prescribed. The number and proportion of medications by age, sex, nationality and diagnosis (T2DM, hypertension and dyslipidaemia) were reported. Results: A total 81,569 individuals were included (18–29 years 2.4%; 30–39 years 11.7%; 40–49 years 25.4%; 50–59 years 31.9% and ≥ 60 years 28.6%). 55.6% participants were male. On average 10.2 medications were prescribed per person and 2.3 medications were included in each prescription. T2DM medications were most prescribed (N = 361,87780,799; 43.2%) followed by hypertension (N = 303,086; 36.2%) and dyslipidaemia (N = 172,163; 20.5%). Of the total medications prescribed, 72% (N = 605,488) were prescribed in individuals aged 50 years and above. Men were prescribed 62% (N = 515,043) medications while women were prescribed 38% (N = 322,083) medications. Southern Asians (N = 330,338; 39%) were prescribed most medication followed by Qataris (N = 181,328; 22%) and Northern African (N = 145,577; 17%). Conclusions: In Qatar's primary care settings, average medications prescribed per patients were found to be higher compared to other populations. While medications were actively prescribed for the 3 conditions, the study found variations by medication type, age, gender and nationality. Rational guidelines for the utilisation of medications need to be established with the support of real-world evidence. [ABSTRACT FROM AUTHOR]

While the COVID-19 pandemic now affects the entire world, countries have had diverse responses. Some responded faster than others, with considerable variations in strategy. After securing border control, primary health care approaches (public health and primary care) attempt to mitigate spread through public education to reduce person-to-person contact (hygiene and physical distancing measures, lockdown procedures), triaging of cases by severity, COVID-19 testing, and contact-tracing. An international survey of primary care experts' perspectives about their country's national responseswas conducted April to early May 2020. This mixed method paper reports on whether they perceived that their country's decision-making and pandemic response was primarily driven by medical facts, economic models, or political ideals; initially intended to develop herd immunity or flatten the curve, and the level of decision-making authority (federal, state, regional). Correlations with country-level death rates and implications of political forces and processes in shaping a country's pandemic response are presented and discussed, informed by our data and by the literature. The intersection of political decision-making, public health/primary care policies and economic strategies is analysed to explore implications of COVID-19's impact on countries with different levels of social and economic development. [ABSTRACT FROM AUTHOR]