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Introduction: Family medicine physicians take care of a diverse population of patients with a variety of acute and chronic diseases. These patients include family, friends, and acquaintances who may ask for direct medical care or help in accessing healthcare products and services within or outside of officially approved procedures. This is ethically challenging due to an ambiguous medical code of ethics, but it is commonly accepted as normal behavior by society. The aim of this study was to explore family medicine physicians' perspectives regarding the benefits, difficulties, and ethics of responding to medical care requests and/or favors from family, relatives, friends, and acquaintances and to make recommendations. Methods: The study sample consisted of junior and senior family medicine physicians working in primary healthcare centers affiliated with the Ministry of Health in Saudi Arabia. In-depth semi-structured interviews were conducted to collect data. Using social exchange theory, this qualitative study explores how family medicine physicians perceive and handle requests for medical favors from family members and others. Results: Semi-structured interviews were conducted with 19 family medicine physicians (six focus groups) with clinical experience ranging from 3 to 20 years. The data analysis identified three themes: perceived benefits and costs of cultural and social connectedness, shortcomings in patient management and healthcare systems, and recommendations to address challenges between physicians and patients who are relatives. Discussion and Conclusions: This study shows that treating others outside of normal access to healthcare services presents several ethical, moral, and professional challenges. Therefore, policy adaptation requires understanding this intricate dilemma and improving laws, system regulations, and guidelines for physicians and community members to improve access to care, reduce system abuse, empower providers, and enhance community awareness and compliance. [ABSTRACT FROM AUTHOR]

Objective: The causal effect of successive population-wide lockdowns in response to increased COVID-19 cases on mental health has yet to be examined using robust methods. A natural experiment design underpinned by objective data can improve our understanding surrounding the definitive impact of social distancing restrictions. Methods: The study employed a natural experiment design underpinned by objective data. Health service cost for visits to general practitioners and psychologists and medication dispensing costs served as objective measures of mental health. Difference-in-difference (DID) estimators, which in this study quantify differences in spending changes between groups over time, were produced based on three comparisons: Victoria 2020 lockdown comparison, Victoria 2021 lockdown comparison, and New South Wales (NSW) 2021 lockdown comparison. Specifically, differences in public health service spending during lockdown periods and the same timeframe in 2019 for Victoria and NSW, and control groups (remaining states and territories), were compared. Results: Positive estimator values indicate that public health service spending for Victoria and NSW increased more during lockdown periods compared to control states and territories. The Victorian lockdowns of 2020 and 2021, but not the NSW lockdown of 2021, resulted in increased public spending for general practitioner mental health consults (2020 DID estimator: $8498.96 [95% CI $4012.84, $12,373.57], 2021 DID estimator: $6630.06 [95% CI $41.27, $13,267.20], all monetary values in AUD$) and short visits to psychologists (2020 DID estimator: $628.82 [95% CI $466.25, $796.00], 2021 DID estimator: $230.11 [95% CI $47.52, $373.98]). The first Victorian lockdown in 2020 and the NSW lockdown in 2021 resulted in greater spending on short visits to clinical psychologists. Spending on long visits to psychologists and clinical psychologists and medication spending did not change. Conclusions: Strict lockdowns can have an adverse impact on population mental health. The impact is particularly evident in those who have a history of previous mental health concerns but does not necessitate extra use of medications, suggesting that psychological care can address the adverse impact of the lockdowns. What is known about the topic? Previous research varied in methodology, using self-reports and healthcare data to understand COVID-19 social distancing public health measures' effects on mental health. What does this paper add? This study introduces robust, objective data via a natural experiment design, examining the impact of successive lockdowns on mental health service usage and medication expenditures in specific Australian regions. What are the implications for practitioners? Findings highlight the need for flexible mental health services that can swiftly respond to increased demands during prolonged restrictions, without necessarily increasing medication use, guiding future policy and resource allocation. [ABSTRACT FROM AUTHOR]

Objective: Explore stakeholder perspectives of the benefits of continuously training general practitioners in the same rural or remote practice in distributed locations via the Remote Vocational Training Scheme (RVTS). Design, setting, participants: Online one‐hour semi‐structured interviews were conducted with 27 RVTS staff, participants and supervisors from all states and territories between 16 October and 24 November 2023. Data were deductively and inductively coded by stakeholder type and the range of benefits, and the findings were informed by insights from a project reference group and a stakeholder advisory group. Questions explored the benefits of the RVTS — a program which supports doctors already working in rural, remote and First Nations communities to train towards general practice or rural generalist fellowship while remaining in the same practice. Main outcomes measures: Perspectives on the nature and spread of benefits. Results: Broad benefits were perceived to flow to four system‐level stakeholders: communities, health services, participants and policy makers. Perceived participant and community benefits were doctors staying longer in distributed locations with tailored place‐based supports and training, doctors building relationships with patients, and doctors learning through longitudinal care. Health service benefits included reduced reliance on locums, improved continuity of accessible and appropriate services in areas otherwise facing major recruitment and retention issues, and the doctors having more time to contribute to improving service quality and upskilling local staff. Policy‐maker benefits were sustaining safe and high quality services for distributed populations with high needs. Conclusion: The RVTS model was perceived to offer diverse benefits for different system stakeholders which could improve quality of learning, service delivery and community care. It also aligned with key policy directions for a distributed and sustainable generalist workforce under the goals of the National Medical Workforce Strategy 2021–2031 and the directions set by the independent review of overseas health practitioner regulatory settings led by Robyn Kruk. However, models like the RVTS largely rely on distribution levers to recruit more doctors to the locations it supports. [ABSTRACT FROM AUTHOR]

Objective: To develop theory about how and why the supervision and support model used by the Remote Vocational Training Scheme (RVTS) addresses the professional and non‐professional needs of doctors (including many international medical graduates) who are training towards general practice or rural generalist fellowship while based in the same rural or remote practice. Design, setting, participants: We conducted a realist evaluation based on the RAMESES II protocol. The initial theory was based on situated learning theory, networked ecological systems theory, cultural theory and geographical narcissism theory. The theory was developed by collecting empirical data through interviews with 27 RVTS stakeholders, including supervisors, participants and RVTS staff. The theory was refined using a project reference and a stakeholder advisory group and confirmed using individual meetings with experts. Main outcomes measures: Theory about how the contexts of person, place and program interacted to address professional and non‐professional needs. Results: The RVTS program offers remote access to knowledgeable and caring supervisors, real‐time tailored advice, quality resources and regular professional networking opportunities, including breaks from the community. It worked well because it triggered five mechanisms: comfort, confidence, competence, belonging and bonding. These mechanisms collectively fostered resilience, skills, professional identity and improved status; they effectively counteracted the potential effects of complex and relatively isolated work settings. Conclusion: This theory depicts how a remotely delivered supervision and support model addresses the place and practice challenges faced by different doctors, meeting their professional and non‐professional needs. The participants felt valued as part of a special professional group delivering essential primary health care services in challenging locations. The theory could be adapted and applied to support other rural and remote doctors. [ABSTRACT FROM AUTHOR]

Background: Opioid-related harms and opioid use disorder (OUD) are health priorities requiring urgent policy responses. There have been many calls for improved OUD care in primary care, as well as increasing involvement of primary care providers in countries like Canada and Australia, which have been experiencing high rates of opioid-related harms. Methods: Using Starfield's 4Cs conceptualization of primary care functions, we examined how and why primary care systems may be suited towards, or pose challenges to providing OUD care, and identified health system opportunities to address these challenges. We conducted 14 semi-structured interviews with 16 key informants with experience in opioid use policy in Canada and Australia. Results: Primary care was identified to be an ideal setting for OUD care delivery due to its potential as the first point of contact in the health system; the opportunity to offer other health services to people with OUD; and the ability to coordinate care with other health providers (e.g. specialists, social workers) and thus also provide care continuity. However, challenges include a lack of resources and support for chronic disease management more broadly in primary care, and the prevailing model of OUD treatment, where addictions care is not seen as part of comprehensive primary care. Additionally, the highly regulated OUD policy landscape is also a barrier, manifesting as a 'regulatory cascade' in which restrictive oversight of OUD treatment passes from regulators to health providers to patients, normalizing the overly restrictive nature and inaccessibility of OUD care. Conclusions: While primary care is an essential arena for providing OUD care, existing sociocultural, political, health professional, and health system factors have led to the current model of care that limits primary care involvement. Addressing this may involve structurally embedding OUD care into primary care and strengthening primary care in general. [ABSTRACT FROM AUTHOR]

AbstractObjectivesMethodResultsConclusionThe use of digital healthcare technologies to enhance healthcare delivery has seen significant growth. However, a notable a notable research gap exists in the application of clinical scales for menopause management by general practitioners (GPs). This study aims to investigate willingness of GPs to use specific menopausal scale tools in the care of females for menopause management.An anonymous online survey was developed, which received responses from 348 French GPs in 2023. Multiple backward logistic regression was performed to identify the factors influencing the willingness to use a practical menopause management scale.In total, 87.93% of GPs are not familiar with the Greene Climacteric Scale and 90.52% are not familiar with the Menopause Quick 6 scale. In contrast, 90.52% would be interested in having access to such scales. The willingness to use a menopause management scale is associated with caring for menopausal females (odds ratio [OR] = 6.13, 95% confidence interval [CI] [2.08–18.08], p = 0.001), less experience (OR = 7.10, 95% CI [2.05–25.22], p = 0.002), the importance of health prevention in daily practice (comparing ‘very important’ to ‘not’, OR = 12.98, 95% CI [1.68–97.60], p = 0.004) and the use of a digital scale in daily practice for menopausal management (OR = 2.13, 95% CI [1.04–5.83], p = 0.014).Future research is essential in representative population to confirm these findings in menopause management. [ABSTRACT FROM AUTHOR]

The decision of the House of Lords in Gillick v West Norfolk Area Health Authority carved out a safe space for competent minors to confidentially access sexual and reproductive health care and advice in the UK. Ireland is one of the few common law jurisdictions that has not endorsed Gillick or a similar mature minor doctrine, nor has it securely legislated for the right to consent of those aged 16 and 17 years. The legal lacuna created by this deficiency has left young persons in Ireland seeking sexual and reproductive healthcare, and the clinicians who provide this, in a challenging place. While this void has been partially filled with policy statements by bodies such as the Irish College of General Practitioners and the Health Service Executive, nonetheless the legal shortcomings leave both a sense of insecurity, and real world difficulties for adolescents seeking to access to sexual and reproductive healthcare. [ABSTRACT FROM AUTHOR]

Purpose: Prior research has shown that the majority of those bereaved by suicide express a need for mental health care services. However, there is a lack of knowledge about these individuals' use of primary health care. The objective of our study was to estimate the association between suicide bereavement and general practitioner (GP) consultations for mental health reasons. Methods: A population-wide, register-based cohort study identifying 25,580 individuals bereaved by suicide. Estimations of increases in consultation rate were modeled through individual fixed-effects linear analyses adjusted for age and time-period. Results: Overall, 35% of those bereaved by suicide had a GP consultation for mental health reasons during the first 1–2 months, and 53% after two years. In the month immediately after bereavement by suicide, there was a large increase in the consultation rate with a GP for mental health reasons. In the months that followed, the consultation rate gradually decreased. One year after bereavement, the consultation rate stabilized at a somewhat higher level than before the death. The increase in consultation rate was evident across all kinship groups, and the increase was greatest for partners and smallest for siblings. Women had more contact with the GP before the suicide and a greater increase in contact than men. Conclusion: Our findings suggest that many of those bereaved by suicide seek assistance from primary health care, and that some are in need of prolonged follow-up from the GP. Health governments should be aware of this and seek to strengthen the GPs knowledge of the needs and challenges associated with this patient group. Measures should also be taken to remove barriers to contact the health care system, especially for men and bereaved siblings. [ABSTRACT FROM AUTHOR]

Background: As primary care is an important infrastructure for the entire health system, the employment structure choices of family physicians—whether to work in a managed care organization or be self-employed, can impact all effectiveness parameters of healthcare: quality, access, health equity, patients' experiences, and cost-effectiveness. The aim of this study is to assess the push and pull factors influencing family physicians' employment choices. Methods: This study employed a qualitative approach to explore the experiences of family physicians (FPs) who choose to work a self-employment practice. We conducted semi-structured interviews with twenty-seven self-employed FPs in Israel, selected through purposive and snowball sampling. The interviews were conducted via Zoom, recorded, and transcribed verbatim. Data analysis followed thematic analysis framework. The analysis yielded 10 themes, which were organized into two categories: pull and push factors. Results: Pull factors, i.e., factors that attract family physicians to become self-employed, included professional self-fulfillment, higher income, professional and business autonomy, working with secretaries according to one's personal choice, designing the space of the clinic, and flexibility in working hours. Push factors, i.e., factors that demotivated family physicians to work under managed care and pushed them to choose self-employment included low control over the work environment, workload, decreased professional and organizational autonomy, managerial pressures on quality measures, engagement in marketing activities, and tensions with non-medical staff in the Health Maintenance Organization. Conclusions: There are obvious implications of this work for Health Maintenance Organizations' policy makers. Balancing managerial pressure and tensions between family physicians and non-medical administration and ensuring suitable working conditions increased physicians' control over the work environment, and professional autonomy may decrease push factors and retain family physicians as Health Maintenance Organization-employed. Understanding pull factors may help to develop a strategy for maximizing cooperation with self-employed family physicians and reinforce physicians' linkage to the healthcare system's treatment objectives. [ABSTRACT FROM AUTHOR]

Background: Healthcare systems around the globe are facing challenges. There are increasing demands and costs at the same time as a diminishing health workforce. Without change, healthcare will become unsustainable. The Dutch government is searching for solutions, one of which is relocating healthcare. Relocating healthcare from expensive institutions to sites closer to patients' homes is an important part of this. This relocation is expected to reduce costs and lessen shortages of personnel. However, although citizens have an important stake in this, little is known about how they think about this topic. This research aims at investigating citizens' perspectives on relocating care. Methods: In December 2021, three open-ended questions were sent to 1,500 members of Nivel's Dutch Healthcare Consumer Panel, 796 respondents responded. In addition, two citizen platforms were organised in March and April 2022. A total of 23 citizens participated. Results: Our results indicated that the following aspects are important for citizens in healthcare delivery: being treated by someone with expertise in the area of their need, familiarity with the healthcare provider and the treatment of less complex care close to home. When certain conditions are met, citizens prefer treatment for less complex care from their general practitioner rather than in a hospital. The most important condition is that the general practitioner has the right expertise regarding their health question. The willingness to relocate care from the general practitioner to other healthcare providers or to self-care is also present. One of the problems, however, is that citizens often do not know to which healthcare provider they should go or what they should do to increase self-care. Conclusion: From a citizens' perspective, relocating care is an acceptable solution for keeping healthcare sustainable in the future, provided that certain conditions are met. [ABSTRACT FROM AUTHOR]

Aim and Objectives Background Design Methods Results Conclusions Relevance to clinical practice Reporting Method Patient of Public Contribution To provide an in‐depth insight into the barriers, facilitators and needs of district nurses and nurse assistants on using patient outcomes in district nursing care.As healthcare demands grow, particularly in district nursing, there is a significant need to understand how to systematically measure and improve patient outcomes in this setting. Further investigation is needed to identify the barriers and facilitators for effective implementation.A multi‐method qualitative study.Open‐ended questions of a survey study (N = 132) were supplemented with in‐depth online focus group interviews involving district nurses and nurse assistants (N = 26) in the Netherlands. Data were analysed using thematic analysis.Different barriers, facilitators and needs were identified and compiled into 16 preconditions for using outcomes in district nursing care. These preconditions were summarised into six overarching themes: follow the steps of a learning healthcare system; provide patient‐centred care; promote the professional's autonomy, attitude, knowledge and skills; enhance shared responsibility and collaborations within and outside organisational boundaries; prioritise and invest in the use of outcomes; and boost the unity and appreciation for district nursing care.The preconditions identified in this study are crucial for nurses, care providers, policymakers and payers in implementing the use of patient outcomes in district nursing practice. Further exploration of appropriate strategies is necessary for a successful implementation.This study represents a significant step towards implementing the use of patient outcomes in district nursing care. While most research has focused on hospitals and general practitioner settings, this study focuses on the needs for district nursing care. By identifying 16 key preconditions across themes such as patient‐centred care, professional autonomy and unity, the findings offer valuable guidance for integrating a learning healthcare system that prioritises the measurement and continuous improvement of patient outcomes in district nursing.Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines.No patient or public contribution. [ABSTRACT FROM AUTHOR]

Background Population-based expanded carrier screening (ECS) involves screening for multiple recessive diseases offered to all couples considering a pregnancy or during pregnancy. Previous research indicates that in some countries primary care professionals are perceived as suitable providers for ECS. However, little is known about their perspectives. We therefore aimed to explore primary care professionals' views on population-based ECS. Methods Four online focus groups with 14 general practitioners (GPs) and 16 community midwives were conducted in the Netherlands. Results Our findings highlight various perspectives on the desirability of population-based ECS. Participants agreed that ECS could enhance reproductive autonomy and thereby prevent suffering of the child and/or parents. However, they also raised several ethical, societal, and psychological concerns, including a tendency towards a perfect society, stigmatization, unequal access to screening and negative psychosocial consequences. Participants believed that provision of population-based ECS would be feasible if prerequisites regarding training and reimbursement for providers would be fulfilled. most GPs considered themselves less suitable or capable of providing ECS, in contrast to midwives who did consider themselves suitable. Nevertheless, participants believed that, if implemented, ECS should be offered in primary care or by public health services rather than as hospital-based specialized care, because they believed a primary care ECS offer increases access in terms of time and location. Conclusions While participants believed that an ECS offer would be feasible, they questioned its desirability and priority. Studies on the desirability and feasibility of population-based ECS offered in primary care or public health settings are needed. [ABSTRACT FROM AUTHOR]

Aims: Increasing numbers of patients with advanced heart failure and significant comorbidity and social barriers are considered for left ventricular assist devices (LVADs). We sought to examine health care utilization post‐LVAD implantation, including the influence of individual‐level socio‐economic position and multimorbidity. Methods and results: We conducted a Danish nationwide cohort study linking individual‐level data from clinical LVAD databases, the Scandiatransplant Database, and Danish national medical and administrative registries. Socio‐economic position included cohabitation status, educational level, and employment status. Multimorbidity was defined as two or more chronic conditions from at least two chronic disease groups. Health care utilization (hospital activity, general practice activity, and redeemed medical prescriptions) within 2 years post‐discharge after LVAD implantation was evaluated using descriptive statistics at 0.5 year intervals. We identified 119 patients discharged alive with first‐time LVAD implanted between 2006 and 2018. The median age of the patients was 56.1 years, and 88.2% were male. Patients were followed until heart transplantation, LVAD explantation, death, 31 December 2018, or for 2 years. The median follow‐up was 0.8 years. The highest median use of health care services was observed 0–0.5 years post‐LVAD discharge compared with the subsequent follow‐up intervals: 0.5–1, 1–1.5, and 1.5–2 years, respectively. The median (interquartile range) number of hospitalizations was 10 (7–14), bed days 14 (9–28), outpatient visits 8 (5–12), telephone contacts with a general practitioner 4 (2–8), and total redeemed medical prescriptions 26 (19–37) within 0–0.5 years post‐LVAD discharge compared with the median utilization within the consecutive follow‐up periods [e.g. within 0.5–1 year: hospitalizations 5 (3–8), bed days 8 (4–14), outpatient visits 5 (3–8), telephone contacts 2 (0–5), and redeemed medical prescriptions 24 (18–30)]. The median use of health care services was stable from 0.5 years onwards. The median number of hospitalizations and bed days was slightly higher in patients living alone with a low educational level or low employment status within 0–0.5 years post‐LVAD implantation. Finally, the median number of in‐hospital days and redeemed prescriptions was higher among patients with pre‐existing multimorbidity. Conclusions: Among patients who underwent LVAD implantation, health care utilization was high in the early post‐LVAD discharge phase and was influenced by socio‐economic position. Multimorbidity influenced the number of in‐hospital days and redeemed prescriptions during the 2 year follow‐up. [ABSTRACT FROM AUTHOR]

Family doctors serve as the initial contact for individuals seeking regular medical service like routine physical exam, diagnosis, and treatment of illness. Nonetheless, immigrant population who do not speak the official language usually prefers receiving healthcare in their own mother tongues. Past studies have focused on exploring accessibility to family doctors speaking Mandarin Chinese, which is not mutually intelligible with another major Chinese language called Cantonese. Despite the significant number of Cantonese‐speaking population in the Greater Toronto Area (GTA) and a recent wave of immigration from Hong Kong, China (hereafter "Hong Kong") to Canada, little knowledge has been obtained regarding the geographic accessibility to Cantonese‐speaking family doctors. This study seeks to fill the knowledge gap of spatial accessibility to Cantonese‐speaking family doctors in the GTA by using the two‐step floating catchment area (2SFCA) method. By considering the vulnerability in terms of spatial accessibility and attractiveness to the new immigrants from Hong Kong, we have unveiled that more than 90% of neighbourhoods, with below‐median accessibility scores across all five thresholds yet high likelihood of attracting new Hong Kong immigrants, are clustered within four lower‐tier municipalities of Markham, Toronto, Richmond Hill, and Vaughan. This study not only sheds lights on the knowledge gap but also provides timely guidance in formulating public health policies in light of the incoming Cantonese‐speaking immigrants from Hong Kong. [ABSTRACT FROM AUTHOR]

Introduction: Physicians working in primary health care (PHC) centers are the first contact for patients and expected to deal with emergencies. Emergency care training in PHC settings has been neglected globally, especially in low to middle income countries. Adequate preparation becomes especially important during periods of conflict. The study objectives are to identify the barriers facing PHC physicians when dealing with emergency cases in the northern region of Palestine during the current conflict. Methods: A cross-sectional study was conducted with 179 physicians working in the 10 PHC centers distributed among 5 northern governances in Palestine. The study period was from July through December 2023. Data were collected electronically using a self-administered questionnaire, which was adapted from a comprehensive literature review. The questionnaire's internal validity was confirmed by a Cronbach's alpha coefficient of [0.85], indicating high reliability. Results: The ages of the physicians ranged from 25 to 60 years, with a mean ± SD of 35.3 ± 8.15 years. A significant majority (91.6%) were not boarded in any specialty. Most physicians (85.5%) had attended Basic Life Support (BLS) courses, whereas 45.2% and 72% had never attended Advanced Cardiovascular Life Support (ACLS) or Advanced Trauma Life Support (ATLS) courses, respectively. Physicians with emergency department experience (P = 0.002) and those who had attended ACLS courses (P < 0.001) reported significantly higher perceived competence in managing emergency cases. Conclusion: Emergency services at PHC centers in northern Palestine are operational but require significant enhancements. There is a critical need for increased availability of essential equipment, supplies, and medications. Additionally, implementing comprehensive training programs in emergency management, particularly ACLS, is essential to improve the competence and performance of PHC physicians in emergency situations. [ABSTRACT FROM AUTHOR]

Introduction: Due to the very high prevalence of mental pathology in early life (up to 20%), correct diagnosis and immediate treatment in early life is a global health priority. Objective: The aim of this study was to evaluate the degree of validity of the diagnoses of ADHD and ASD made in Primary Health Care Services (PHCS), comparing them with definitive diagnoses issued in the Child and Adolescent Mental Health Units (CAMHU). Methodology: 183 patients were included in this study, being referred from Primary Health Care (PHC) to Vecindario's CAMHU, in Gran Canaria, Spain. Evaluation was retrospective and included the following variables: age, sex, perinatal history, adopted minor, family psychiatric history, referring physician's diagnosis of suspicion, definitive diagnosis in the CAMHU, subsequent follow-up and psychopharmacological treatment. To analyze the degree of quality of the referrals, we calculated the percentage of cases that matched the suspected diagnosis of the referring physicians (pediatricians or general practitioners (GP)) and the definitive confirmation diagnosis (issued by the child and adolescent psychiatrist). Results: 75.4% of the sample were males, with a mean age of 8.22 years, 7.7% had a perinatal history, and 17.5% had a family psychiatric history. 65.6% of them were referred with a suspected diagnosis of ADHD, 62.7% were confirmed and 26.27% were rejected. 31.7% were referred to the CAMHU with a suspected diagnosis of ASD. This entity was confirmed in 75.8% and rejected in 10.3%; 5.1% of them were finally diagnosed with ADHD. Only 2.7% were referred for a combined suspicion of ADHD and ASD, but 9.8% of children were finally diagnosed with both diagnoses (ADHD and ASD) concomitantly. Conclusion: The validity of the diagnostic suspicions made in the PHCS was very high: 62.7% for ADHD and 75.8% for ASD; obtaining notably higher percentages than in previous studies. [ABSTRACT FROM AUTHOR]

Simple Summary: Communication by health professionals impacts the mental health of cancer patients. This research sought to further explore this matter by studying the possible relationships between communication and a patient's depression, anxiety, quality of life, coping strategies, and perception of their state of health. A total of 177 patients diagnosed with cancer answered a battery of questionnaires on these aspects. Our findings show that oncologists are better at delivering a cancer diagnosis than other healthcare professionals and that communication by them can impact patients' mental and health variables. We believe that there is a need to implement better communication strategies among all healthcare professionals to facilitate the task of breaking bad news to patients. This will have a positive impact on patients' emotional states and health while reducing stress and burnout among the healthcare professionals themselves. The field of healthcare is increasingly adopting a humanistic perspective in the physician–patient relationship. One of the more salient aspects being studied is the communication between the two. This study serves a dual purpose. Our initial aim was to study how a cancer diagnosis is disclosed to patients by different physicians (GPs/other specialists/oncologists). Secondly, we set out to study how the way in which oncologists normally communicate with their patients impacts variables such as a patient's anxiety, depression, coping mechanisms, and perception of both their health and their quality of life. A total of 177 patients answered a battery of questionnaires on sociodemographic and disease data: the SPIKES protocol, the EORTCQLQ-COMU26, and the ADAF screening questionnaire. The analyses recorded medium or high scores for some of the steps in the SPIKES protocol when delivering the diagnosis, and significant differences were observed for some of them among different physicians. The level of a cancer patient's satisfaction with the communication by oncologists was related to their levels of anxiety, depression, vulnerability, and perception of their health and quality of life. Better communication strategies are called for among all healthcare professionals to facilitate the task of breaking bad news to their patients. [ABSTRACT FROM AUTHOR]

The U.S. healthcare sector is a large and important industry. However, relatively little is known about the localization and colocalization patterns of healthcare services within an urban area. By using Yelp data from over 3000 healthcare service establishments in the Phoenix area, this paper applies a recent spatial econometric technique to the analysis of healthcare services. The results reveal that spatial concentration varies across distances and types of healthcare services. Localization is more prevalent at closer distances, and general practitioners tend to be more dispersed than specialists. Colocalization with hospitals is most likely for specialists while family practices and dentistry services tend to locate away from hospitals. Different types of location patterns across different types of healthcare services are relevant for informing policies addressing healthcare access and competition in healthcare markets. [ABSTRACT FROM AUTHOR]

Background: Peripheral artery disease (PAD) is common and associated with future cardiovascular events. PAD is underdiagnosed, which limits opportunities to address secondary prevention of cardiovascular disease. It is unknown how closely guidelines for detection of PAD are followed in primary care. Aim: To survey GPs' attitudes to diagnosis and follow-up of patients with PAD. Design & setting: Online survey of GPs in England and the Republic of Ireland (RoI). Method: GPs’ approaches to management of PAD were assessed using likelihood ratings (scales of 0–10) and discrete questions. Findings were summarised as proportions, or median and interquartile ranges (IQR). Results: In total, 111 responses were analysed; 68 (61%) from England and 43 (39%) from the RoI. Considering a hypothetical patient at risk of PAD, likelihood of GPs enquiring about PAD symptoms (leg pains: 3/10 or erectile dysfunction: 2/10) was low. GPs in the RoI compared with GPs in England more often examined the heart (10/10 versus 7/10) or carotid vessels (5/10 versus 1/10). Lower limb pulses were palpated in response to symptoms or signs of PAD. In England 25% of practitioners, and in the RoI 55% of practitioners, reported that they do not measure ankle-brachial index (ABI). Conclusion: Currently, detection of PAD is generally triggered by 'classical' leg claudication symptoms, while known vascular risk factors appear to elicit little consideration. ABI measurement is not performed by many practitioners, suggesting that a proportion of vascular referrals must be based on history and examination findings alone. Opportunities to recognise PAD are missed. [ABSTRACT FROM AUTHOR]

Background: The inverse care law states that availability of good medical care varies inversely with the need for it in the population served. In 2019, the main medical union and the Department of Health in the Republic of Ireland (RoI), agreed on funding a social deprivation practice grant for general practices in urban deprived areas. Aim: To examine the implementation and impact of the social deprivation practice grant in participating general practices. Design & setting: A mixed-methods study with sequential design based in Irish general practice. Method: Data were collected using a questionnaire and online semi-structured interviews with GPs and practice staff. Data were analysed separately, and the findings compared to examine the extent to which they converged or diverged. Results: There were 25 survey responses and nine interviews. All practices reported the grant was beneficial and most practices utilised the grant to fund additional doctor hours (17/25). Both surveys and interviews indicated that a small amount of additional funding allowed additional clinical need in areas of deprivation to be addressed, but there were some barriers identified in accessing the grant and implementing planned expenditure. Conclusion: Delivery of health care in areas of socioeconomic deprivation presents significant challenges. While there were some problems with implementation, the introduction of a small, targeted grant for general practices in areas of social deprivation allowed those practices to enhance their services, with tailored initiatives seeking to meet the needs of their patient populations. [ABSTRACT FROM AUTHOR]

Introduction: The COVID-19 pandemic has had a negative impact on both pre-hospital and in-hospital care. General practitioners (GPs) are the basis of prehospital medical care. During the pandemic, a number of vulnerabilities were identified in the structure and organization of practices' activities that could have impact resulting in increased risk of patient contamination. The objective of this publication is to present part of the first results of a survey of patient opinion regarding the safety of the medical care received during the pandemic from GPs in the Plovdiv region. Material and methods: Presented are the results of a study conducted during October 2021-February 2022 among 60 patients (40 with complaints close to the symptoms of COVID-19 and 20 with other complaints) regarding the impact of the available at the beginning of the pandemic practices' medical infrastructure and the organization of the diagnostic-treatment process by the GP for assuring the patient safety. Results and discussion: The opinion of patients regarding ensuring their safety in GP practices is summarized in the analysis of the answers received from the respondents to the ten-questions questionnaire. The existing infrastructure of the buildings in which GP practices are deployed is reported as a vulnerability, increasing the risk of contamination of patients seeking medical care and in need of optimization in accordance with the accumulated experience. The organization of admission and the diagnostic-treatment process in GP practices. As well as the coordination between the structures of pre-hospital and hospital units are reported as resilient to the challenges of the biological damaging factor and is evaluated as a factor guaranteeing the safety of patients. The organization of sanitary transport has been identified as the most significant vulnerability, which also needs optimization. [ABSTRACT FROM AUTHOR]

Aims: This commentary uses the Tasmanian Palliative and End of Life Care Policy Framework (2022; the TPE Framework) to reflect upon palliative care services delivered by a rural Tasmanian general practice. Context: Rural populations have challenges in accessing many healthcare services, including palliative care. General practitioners (GPs) and other primary healthcare workers are frequently relied upon to deliver palliative care in rural Australia. Palliative care is often needed before the end‐of‐life phase and patients prefer this to be delivered in the community or at home. GPs face challenges and barriers in continuing to deliver home‐based palliative care services. Approach: All Medical Benefit Scheme billings for after‐hours or home‐based palliative care provided by the practice, between September 2021 and August 2022, were identified and patient demographic and clinical details collated. To further understand this data, nine GPs were surveyed to explore their attitudes to provision of palliative care service to the local rural communities they serve. These data highlighted several priority areas of the TPE Framework. The TPE Framework is used here to add to the shared understanding of palliative care service delivery in a rural community, and to see if GP's responses align with the priorities of the TPE Framework. Of the 258 after‐hours and home‐visits delivered over a 12‐month period, almost 58% (n = 150) were for palliative care. Patients receiving palliative care were generally older than non‐palliative patients visited (79.9 years vs. 72.0 years respectively; p = 0.004). Patients not at imminent risk of death (64.0%) were more frequently recipients of home‐visits. Of the nine GPs responding to the survey, most intended to continue home visits for palliative patients. Disincentives to providing palliative care during home visits included a lack of time during the day (or after hours), low levels of interdisciplinary coordination or role‐definition, and inadequate remuneration. Conclusion: Existing frameworks can be used as an implementation and evaluation guide to help understand local palliative care services. Using a Framework, a rural general practice in Tasmania reflected on their provision of palliative care services. Providing holistic palliative care services from a rural general practice is desirable and achievable with a coordinated, team‐based approach. Access to and integration with specialist services remains a key component of community‐based palliative care pathways. [ABSTRACT FROM AUTHOR]

Purpose 'Low-value' clinical care and medical services are 'questionable' activities, being more likely to cause harm than good or with disproportionately low benefit relative to cost. This study examined the predictive ability of the QUestionable In Training Clinical Activities Index (QUIT-CAI) for general practice (GP) registrars' (trainees') performance in Australian GP Fellowship examinations (licensure/certification examinations for independent GP). Methods The study was nested in ReCEnT, an ongoing cohort study in which Australian GP registrars document their in-consultation clinical practice. Outcome factors in analyses were individual registrars' scores on the three Fellowship examinations ('AKT', 'KFP', and 'OSCE' examinations) and pass/fail rates during 2012–21. Analyses used univariable and multivariable regression (linear or logistic, as appropriate). The study factor in each analysis was 'QUIT-CAI score percentage'—the percentage of times a registrar performed a QUIT-CAI clinical activity when 'at risk' (i.e. when managing a problem where performing a QUIT-CAI activity was a plausible option). Results A total of 1265, 1145, and 553 registrars sat Applied Knowledge Test, Key Features Problem, and Objective Structured Clinical Exam examinations, respectively. On multivariable analysis, higher QUIT-CAI score percentages (more questionable activities) were significantly associated with poorer Applied Knowledge Test scores (P  = .001), poorer Key Features Problem scores (P  = .003), and poorer Objective Structured Clinical Exam scores (P  = .005). QUIT-CAI score percentages predicted Royal Australian College of General Practitioner exam failure [odds ratio 1.06 (95% CI 1.00, 1.12) per 1% increase in QUIT-CAI, P  = .043]. Conclusion Performing questionable clinical activities predicted poorer performance in the summative Fellowship examinations, thereby validating these examinations as measures of actual clinical performance (by our measure of clinical performance, which is relevant for a licensure/certification examination). Key message What is already known on this topic—   Frequent performance of 'Questionable' clinical activities—activities more likely to cause harm than good or whose benefit is disproportionately low compared with its cost—can be seen a marker of the quality of health care delivery and clinical competence. Summative medical licensure/certification examination performance should reflect clinically important attributes of the candidate and provide confidence of future patient safety. What this study adds—   This study demonstrates that the Royal Australian College of General Practitioners' (RACGPs') summative examination performance reflects clinical performance as assessed by a measure of 'questionable' actions in clinical practice. Performance on all three individual examination components—Applied Knowledge Test (a multiple-choice examination), Key Features Problem (a short answer plus multiple responses selection examination), and Objective Structured Clinical Exam (a clinical skills station examination), plus pass/fail status—was predicted by 'questionable' clinical practice. How this study might affect research, practice or policy—   The findings provide evidence for the validity of the RACGP Fellowship examination and similar licensure/certification examinations. [ABSTRACT FROM AUTHOR]

Introduction. New Zealand's health care system faces significant shortages in health care workers. To address workforce challenges and meet the population's health needs, health care systems around the world have introduced new clinical roles, such as physician associates/assistants (PAs) into existing health care teams. Aim. This article aims to examine the benefits, challenges, and broader implications of regulating PAs in the context of New Zealand's primary care sector, with a specific emphasis on how it may impact general practice. Methods. A range of literature surrounding the role, impact, and perception of PAs were selected and included in this article. Results. The PA profession can significantly strengthen New Zealand's primary care workforce, improving patient access and continuity of care. However, the global deployment of PAs has faced scrutiny due to concerns about its potential risks to patient safety and the overall viability of such a role. Discussion. If regulated, the PA profession can reshape New Zealand's primary care, offering a partial solution to current medical staff shortages. Trained under a generalised medical model similar to doctors, PAs possess the necessary skills to perform both routine and non-routine medical tasks. This dual capability can significantly improve primary care service provision, reduce existing workloads, and allow for a more efficient deployment of doctor expertise. However, medico-legal issues and the supervisory burden can impede widespread integration into general practice. Despite challenges, the success of the PA role relies on mutual trust, respect, and support from other clinical team members within primary health care. [ABSTRACT FROM AUTHOR]

This document is a commentary on an article published in the journal European Radiology. The article discusses the competence and contributions of radiologists to cardiac CT and MR imaging across Europe. It highlights the increasing importance of these imaging modalities in cardiovascular disease management and the need for standardization and collaboration to ensure optimal patient care. The analysis of the European Society of Cardiovascular Radiology (ESCR) registry reveals a significant increase in cardiac CT and MR examinations, with suspected coronary artery disease and suspected myocarditis being the most common indications for these imaging studies. The majority of examinations were reported by radiologists, but interdisciplinary collaboration was also emphasized. The document concludes that radiologists play a critical role in the accurate diagnosis and management of cardiovascular diseases and calls for further efforts to improve cardiovascular imaging and care. The raw data from the ESCR registry is available for data sharing and exchange. [Extracted from the article]

This editorial discusses the importance of optimizing access to primary care services for young people aged 10-25 years in England and Australia. It highlights the need for youth-friendly primary care services that address the unique physical, biological, and psychosocial development and health needs of young people. The article identifies barriers to accessing care, such as inconvenient opening hours and concerns about trust and confidentiality. It suggests potential solutions, including extended and youth-friendly hours, digital provision of care, integration of primary care services into non-medical settings, and enhanced cooperation with other health services. The article concludes by proposing six principles to make primary care services more youth-friendly and improve access for young people. [Extracted from the article]

Background: Healthcare systems around the world are facing significant challenges because higher costs and an increase in demand for care has not been matched by a corresponding growth in the health workforce. Without reform, healthcare systems are unsustainable. Relocating care, such as from hospitals to general practices, is expected to make a key contribution to ensuring healthcare remains sustainable. Relocating care has a significant impact upon general practitioners (GPs). Therefore, we investigated which care, according to GPs, could be relocated and under which conditions. Method: GPs were recruited through Nivel's GPs network on eHealth and innovation, located in the Netherlands. One exploratory focus group and 12 in-depth interviews were conducted. Interview transcripts were analyzed using the qualitative research principles of thematic analysis. Results: According to the participants, some diagnostic and follow-up care could be relocated from hospitals to GPs once certain prerequisites are fulfilled. An important condition of relocating care from the hospital to the GP is that GPs have sufficient time to take over these tasks. The types of care that can be relocated from the GP to other settings are those questions where the medical knowledge of the GP can offer nothing extra or where problems in navigating the health system cause patients to either turn to, or stay with, their GP. Conclusion: Care should first be relocated from the GP to other settings before attempting to organize the relocation of care from the hospital to the GP. When this, and other conditions are met, some diagnostic and follow-up care can be relocated from the hospital to the GP. [ABSTRACT FROM AUTHOR]

Homogeneous waiting group (HWG) criteria are central to the patient referral process, guiding primary care physicians and hospitalists in directing patient care to specialists. This cross-sectional observational study, conducted in South Tyrol, Italy, in 2023, aimed to assess the implementation and impact of HWG criteria on healthcare from the perspective of general practitioners and hospital physicians. A questionnaire was developed to gain knowledge about referral practices as perceived by general practitioners and specialists. The survey included 313 participants (82 general practitioners and 231 hospital physicians) and was designed to capture a range of factors influencing the application of HWG criteria, including communication and collaboration practices. The results showed moderate levels of familiarity with HWG criteria and opinions about the need for criteria refinement among hospitalists, indicating that further education and refinement of these criteria are warranted. Both general practitioners and hospital physicians expressed dissatisfaction with the current specialist referral system, highlighting the significant gaps in effective communication and collaboration. The survey also demonstrated the influence of patient demands and waiting times on referral practices, and the need for streamlined and accessible specialist care. This study highlights the need for improvement and adaptation of HWG criteria to better meet the needs of healthcare providers and patients in South Tyrol. By addressing the identified gaps in communication, collaboration, and education related to the HWG system, the efficiency, effectiveness, and patient-centeredness of the referral process can be improved, ultimately leading to better health outcomes. [ABSTRACT FROM AUTHOR]

Background:There is evidence that telemedicine can be used safely, easily, and cost-effectively in primary health care services. This study aims to determine family physicians' opinions regarding the potential advantages, disadvantages, and usage areas of telemedicine in primary health care services. Methods:This study was designed with a qualitative case study. The Standards for Reporting Qualitative Research (SRQR) checklist was followed throughout the research process. Interviews were conducted with family physicians working in a provincial center using snowball sampling in the study. MaxQDA 20 software was used for analysis process, and themes and subthemes were identified through a deductive-reflective thematic analysis method. The family physicians who participated in the study are between 29 and 56. In addition, family medicine specialists, general practitioners, and academic department heads were included in the study. Family physicians are evenly distributed in terms of gender and professional experience. Results:All interviewed family physicians stated that they had not received professional or technical training in delivering telemedicine. It was observed that family physicians had different perspectives on telemedicine in primary care. The data obtained in the study were analyzed under the main themes of the advantages, disadvantages, and services that can be provided in primary telemedicine. Physicians have different views on telemedicine, including negative, undecided, and positive opinions. Conclusion:It is understood that many services could be delivered remotely if the scope, procedures, and processes of the services to be provided are determined with guidelines. It is recommended that family physicians receive professional and technical training in telemedicine. [ABSTRACT FROM AUTHOR]

Background and Objective: Menopause can be associated with many clinical manifestations: vasomotor symptoms, urogenital problems, and additional psychological disturbances, such as anxiety, mood changes, and sleep alterations. The prolonged lack of hormones also increases the risk of long-term consequences. Hormone Replacement Treatment (HRT) in menopause consists of the administration of estrogen, alone or associated to progesterone, to relieve these uncomfortable disturbances and to prevent the onset of other pathologic conditions. The aim of this study is to examine the prevalence of HRT use in a sample of menopausal women and their experience with menopause and HRT. This study also investigates the knowledge of general practitioners (GPs) and gynecologists about HRT and its prescription. Materials and Methods: We conducted a cross-sectional population survey on 126 women of 50–59 years in an industrial city in the North of Italy, Vercelli (Novara), in Eastern Piedmont. We also presented a questionnaire on the topic to 54 medical doctors (GPs and gynecologists) of the same area. Results: The prevalence of HRT use in our sample was 11.9%. In total, a good percentage of the users affirmed to be satisfied with HRT. Additionally, a minority of women reported being ideally against the use of replacement hormones, were advised against using HRT by doctors, and did not use it because of the fear of side effects. We found a positive association between patient education, health care attitude, and HRT usage. A significant number of women knew about HRT from the media, and most of them were not informed by a health professional. Despite this, the interviewed doctors considered their knowledge about HRT as 'good' and would recommend HRT: only 5.6% would not prescribe it. Conclusions: Our results highlight the need for information about HRT among patients and health professionals, along with the need for more effective communication, evaluation, and suggestion of treatment. [ABSTRACT FROM AUTHOR]

Background: Regular physical activity (PA) results in extensive physical, psychological, and social benefits. Despite primary care being a key point of influence for PA behaviours in the UK, research indicates poor application of PA interventions in this context. To address this, the Royal College of General Practitioners' (RCGP) developed and implemented the Active Practice Charter (APC). The aim of the study was to evaluate the perceived impact and acceptability of the APC initiative from the perspective of primary healthcare professionals (PHPs). Methods: An online exploratory cross-sectional survey was designed to assess the perceived impact, experiences, and challenges of the APC initiative, from the perspective of PHPs. The survey was distributed by the RCGP via email to 184 registered APC practices across the UK. Results: Responses were reviewed from staff (n = 33) from 21 APC practices. Initiatives used by APC practices included: educational programmes, partnerships with PA providers, referral systems, and infrastructure investment. Perceived benefits included: increased awareness about PA, staff cohesion, and improved well-being. However, staff felt the APC had limited effect due to implementation barriers, including: a lack of engagement, time, resources, and funding. Conclusion: This is the first evaluation of any nationwide UK-based initiative engaging GP practices in promoting PA. Acknowledging the limitations in response rate, although support exists for the RCGP APC, the evaluation highlights challenges to its implementation. Nonetheless, the wide reach of the RCGP, combined with the cited staff and patient benefits, demonstrates the significant potential of the APC initiative. Given the need to address physical inactivity nationally, further development the APC offers a possible solution, with further research required to overcome the challenges to implementation. [ABSTRACT FROM AUTHOR]

The rapid deployment of virtual primary care visits served as a first-line response to COVID-19 and can now be examined for insights, particularly as virtual care is playing an ongoing role in patient care and consultations. Input from primary care providers directly responsible for virtual care delivery is needed to inform policies and strategies for quality care and interactions. The overarching goal of this research study was to examine the use of virtual care as a mechanism for primary healthcare delivery. A phenomenological approach investigated the shift in primary care service delivery as experienced by primary care providers and initiated during the COVID-19 pandemic. Focus groups were conducted with primary care providers (n = 21) recruited through email, advertisements, and professional organizations, exploring how virtual care was delivered, the benefits and challenges, workflow considerations, and recommendations for future use. Integrating virtual care was performed with a great deal of autonomy as well as responsibility, and overwhelmingly depended on the telephone. Technology, communication, and workflow flexibility are three key operational aspects of virtual care and its delivery. Providers highlighted cross-cutting themes related to the dynamics of virtual care including balancing risk for quality care, physician work/life balance, efficiency, and patient benefits. Primary care providers felt that virtual care options allowed increased flexibility to attend to the needs of patients and manage their practice workload, and a few scenarios were shared for when virtual care might be best suited. However, they also recognized the need to balance in-person and virtual visits, which may require guidelines that support navigating various levels of care. Overall, virtual care was considered a good addition to the whole 'care package' but continued development and refinement is an expectation for optimizing and sustaining future use. [ABSTRACT FROM AUTHOR]

Almost 300 million people are living with chronic hepatitis B infection worldwide and most remain undiagnosed and at risk for liver cancer. In 2015 the World Health Organization (WHO) developed guidelines for the prevention, care, and treatment of persons with chronic hepatitis B and in early 2023 began to work on updating these guidelines. In March 2023, a self-administered, anonymous online survey was launched, aiming to identify patient preferences related to the clinical management of hepatitis B including current management, treatment, and care experiences, preferences regarding engagement with providers, and preferences related to simplifying hepatitis B care access. A sample of 560 individuals living with hepatitis B (self-identified as HBsAg positive) from 76 countries completed the survey. Key findings demonstrated that less than half (49%, N = 268) of participants regularly visited a doctor to check the health of their liver (every 6–12 months), with 37% of participants prescribed antiviral medication by a specialist (82%, N = 167) or general practitioner (13%, N = 26). Participants reported not being actively involved in care decision making with their providers (42%, N = 217), with an overwhelming majority wanting to participate in hepatitis B management and treatment choices (85%, N = 435). Participants provided qualitative and quantitative details using open-ended responses within the survey about challenges with medication affordability and receiving care from a knowledgeable provider. Overall findings demonstrated key gaps in care, management, and treatment access related to hepatitis B: identifying these gaps can be used to identify areas for improvement along the care continuum for viral hepatitis. The survey found a need for the comprehensive simplification of clinical management and health care services related to hepatitis B. A thematic analysis of the open-ended survey responses highlighted major overarching themes including the cost and access burdens associated with hepatitis B management and treatment, and challenges in finding knowledgeable providers. Results from this mixed methods survey were used to inform the WHO hepatitis B guidelines update. Efforts should continue to explore public health approaches to address barriers and facilitators to testing, care, and treatment for people with hepatitis B to improve awareness of hepatitis B and access, care, and treatment among patients and providers. [ABSTRACT FROM AUTHOR]

Background: In contemporary medical practice, ambulatory anorectal surgeries have become the standard for proctological procedures. The rate of unplanned healthcare utilization following these procedures in our hospital is unknown. Objectives: This study aims to assess the incidence of unplanned healthcare utilization following ambulatory anorectal surgeries. Design: A retrospective observational study. Setting: University Hospital of Antwerp. Materials (Patients) and Methods: Patients who underwent ambulatory anorectal surgeries during a period of three years, from 2017 to 2019. Sample Size: One hundred and twenty-eight patients. Main Outcome Measures: The incidence of unplanned medical healthcare utilization. Results: Among the 124 patients included in the study, 55 (44.4%) sought medical attention from the emergency department or their general practitioners within the first 30 postoperative days. The reasons for these unplanned returns varied: 16 patients (29.6%) experienced wound problems, 15 patients (27.8%) reported postoperative pain, four patients (6.7%) encountered administrative issues, seven patients (13%) sought information or reassurance, and six patients (11.1%) had other reasons. Notably, no significant risk factors associated with unplanned returns were identified. Conclusions: Nearly half of the patients who underwent ambulatory anorectal surgery sought medical care before their scheduled follow-up appointments, indicating a need for enhanced preoperative and postoperative patient counseling. In addition, earlier follow-up consultations and a review of pain medication prescriptions must be considered. Limitations: Retrospective design constraints leading to possible data exclusions. Conflict of Interest: The authors have no conflict of interest to declare. [ABSTRACT FROM AUTHOR]

Objective: To compare health service use (HSU) between migrants and non-migrants in Germany. Methods: Using data from the population-based German National Cohort (NAKO), we compared the HSU of general practitioners, medical specialists, and psychologists/psychiatrists between six migrant groups of different origins with the utilization of nonmigrants. A latent profile analysis (LPA) with a subsequent multinomial regression analysis was conducted to characterize the HSU of different groups. Additionally, separate regression models were calculated. Both analyses aimed to estimate the direct effect of migration background on HSU. Results: In the LPA, the migrant groups showed no relevant differences compared to nonmigrants regarding HSU. In separate analyses, general practitioners and medical specialists were used comparably to slightly more often by first-generation migrants from Eastern Europe, Turkey, and resettlers. In contrast, the use of psychologists/psychiatrists was substantially lower among those groups. Second-generation migrants and migrants from Western countries showed no differences in their HSU compared to non-migrants. Conclusion: We observed a low mental HSU among specific migrant groups in Germany. This indicates the existence of barriers among those groups that need to be addressed. [ABSTRACT FROM AUTHOR]

Background: The health and economic burden of antimicrobial resistance (in Australia is significant. Interventions that help guide and improve appropriate prescribing for acute respiratory tract infections in the community represent an opportunity to slow the spread of resistant bacteria. Clinicians who work in primary care are potentially the most influential health care professionals to address the problem of antimicrobial resistance, because this is where most antibiotics are prescribed. Methods: A cluster randomised trial was conducted comparing two parallel groups of 27 urban general practices in Queensland, Australia: 13 intervention and 14 control practices, with 56 and 54 general practitioners (GPs), respectively. This study evaluated an integrated, multifaceted evidence-based package of interventions implemented over a 6-month period. The evaluation included quantitative and qualitative components, and an economic analysis. Results: A multimodal package of interventions resulted in a reduction of 3.81 prescriptions per GP per month. This equates to 1280.16 prescriptions for the 56 GPs in the intervention practices over the 6-month period. The cost per prescription avoided was A$148. The qualitative feedback showed that the interventions were well received by the GPs and did not impact on consultation time. Providing GPs with a choice of tools might enhance their uptake and support for antimicrobial stewardship in the community. Conclusions: A multimodal package of interventions to enhance rational prescribing of antibiotics is effective, feasible and acceptable in general practice. Investment in antimicrobial stewardship strategies in primary care may ultimately provide the important returns for public health into the future. Clinicians who work in primary care are potentially the most influential health care professionals to address the problem of antimicrobial resistance, because this is where most antibiotics are prescribed. We demonstrated that the implementation of a multimodal package of interventions for acute respiratory tract infections in general practice resulted in a reduction of prescriptions and were well received. Providing GPs with a choice of tools might enhance their uptake and support for antimicrobial stewardship in the community. [ABSTRACT FROM AUTHOR]

Aims: To identify the challenges and opportunities among primary health care nurses and general practitioners (GPs) in the care of older people with urinary incontinence (UI) and other chronic conditions in China. Background: UI is highly prevalent among community‐dwelling older people with chronic conditions but is underreported and poorly managed. Understanding the factors that affect primary health care professionals' practices in their care for this population is imperative to foster nurse‐led UI care services. Design: A qualitative descriptive study. Methods: Four focus groups were held with 24 primary health care nurses and GPs in Changsha, Hunan Province, China, between July and September 2021. A reflective thematic analysis was used to identify themes. Results: This study revealed misconceptions regarding older people living with UI and other chronic conditions in primary care health professional participants. Moreover, primary health care nurses had very limited autonomy in UI diagnosis and initiating care interventions for this patient population. By reflecting on practices, participants recognized various practical solutions to improve the detection and management of UI. Participants also identified barriers to accessing care services in older people with UI. They suggested changes in the health care system to achieve universal access to UI care services for older people. Conclusion: Nurse‐led UI care services in primary health care for community‐dwelling older people with chronic conditions are in high demand but are underdeveloped due to professional and health care system factors. Impact: Findings from this study provide new insights into challenges faced by primary health care professionals and illuminate practical solutions to address these challenges. Reporting Methods: Adherence to COREQ guidelines was maintained. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Background: Primary care physicians play a key role in initiating opioid therapy. However, knowledge gaps in opioid use and pain management are significant barriers to providing optimal care. This research study aims to investigate the educational needs of primary care physicians regarding opioid therapy and opioid use in pain management. Methods: A computer-assisted web interview (CAWI) protocol was used to collect data from primary care physicians. Drug selection criteria, knowledge of opioid substitutes and dosage, and practical use of opioid therapy were evaluated. Results: While 84% of participating physicians (724 respondents) reported initiating opioid treatment, only a minority demonstrated accurate opioid dosage calculations. Significant discrepancies between physicians' self-perceived knowledge and their clinical skills in opioid prescribing and pain management were observed. In total, 41% of physicians incorrectly indicated dose conversion rates for tramadol (the most frequently used drug according to 65% of responders). Conclusions: Targeted educational programs are essential to bridge the knowledge gap and increase physicians' competence in pain management. The proper self-assessment of one's own skills may be the key to improvement. Further research should focus on developing specialized educational courses and decision-support tools for primary care physicians and examining the impact of interprofessional pain management teams on patient outcomes. [ABSTRACT FROM AUTHOR]

Objective: Few patients achieve full control of their coronary artery disease (CAD) risk factors. Follow-up, such as cardiac rehabilitation, is important to increase adherence to lifestyle changes and treatment, to improve the patient's risk profile, and to treat established complications of CAD clinical events. However, the type of follow-up patients receive varies. Therefore, the aim of this research note was to describe and compare patients' self-reported use of health services, the type of follow-up patients reported to prefer, and the type of information patients reported to be important, in two countries with different follow-up practices after PCI. Results: We included 3417 patients in Norway and Denmark, countries with different follow-up strategies after PCI. The results showed large differences between the countries regarding health services used. In Denmark the most frequently used health services were consultations at outpatient clinics followed by visits to the general practitioner and visits to the fitness centre, whereas in Norway visits to the general practitioner were most common, followed by rehospitalisation and no follow-up used. However, patients found the same type of follow-up and information important in both countries. Patients' perceived need for follow-up and information decreased over time, suggesting a need for early follow-up when the patients are motivated. Trial registration: NCT03810612 (18/01/2019). [ABSTRACT FROM AUTHOR]

Background: Primary care is internationally recognised as one of the cornerstones of health care. During the COVID-19 pandemic, primary care physicians were assigned a variety of tasks and thus made a significant contribution to a country's pandemic response. They were expected to perform a variety of tasks, such as diagnosing and treating people with COVID-19, maintaining health care for all other patients, as well as several public health tasks, such as diagnostic testing and vaccination, protecting patients and staff from infection, and serving as community trusted persons. In Austria, there are no structured levels of care, no definition of the role of the general practitioner during a pandemic is given, and no specific support structures are present. The aim of this study was to assess the views and experiences of primary care physicians regarding supportive and hindering factors for pandemic preparedness in Austria. Methods: Qualitative study using semi-structured interviews. A total of 30 general practitioners were interviewed, with particular attention to an equitable distribution in small, medium and large primary care facilities. Qualitative content analysis was performed. Results: Interviewees described a wide range of infection control, organisational and communication measures that they had implemented. They made changes to practise equipment, found makeshift solutions when supplies were scarce, and established communication and information pathways when official communication lines were inadequate. Conclusion: General practitioners took on essential tasks and showed a high level of understanding of their role in the pandemic response. This was achieved mainly at an informal level and with high personal commitment. Their functioning in the absence of structural regulations and support shows that they had a clear intrinsic understanding of their responsibilities. To ensure reliability and sustainability and to reduce their burden, it will be necessary to clarify the role and tasks of a general practitioner and to provide the necessary support. This concerns both infrastructural support and communication and information strategies. As part of the reform to strengthen primary care, primary care needs to be seen, valued and involved in decision-making processes. [ABSTRACT FROM AUTHOR]

Objective: This primary care study examined time trends in the incidence of anorexia nervosa (AN) and bulimia nervosa (BN) in the Netherlands across four decades. Methods: A nationwide network of general practitioners, serving approximately 1% of the total Dutch population, recorded newly diagnosed patients with AN and BN in their practices from 1985 to 2019 (2,890,978 person‐years). DSM‐IV diagnostic criteria were consistently used and the same psychiatrist was responsible for the final diagnostic decision. Incidence rates (IRs) were calculated for: the total population (all ages), females overall, and females per 5‐year age category. Time trends in IRs were analyzed using JoinPoint regression analyses. Results: In four decades, the incidence of AN among 10‐ to 14‐year‐old females increased significantly from 8.6 to 38.6 per 100,000 person‐years (average period percentage change [APPC] = 56.7; 95% confidence interval [CI] = 6.5–130.6. The overall incidence of AN was stable, with IRs ranging from 6.0 (95% CI = 4.3–8.1) to 8.4 (95% CI = 6.4–10.8). The IR of BN decreased significantly from 8.7 (95% CI = 6.7–11.0) to 3.2 (95% CI = 2.0–4.9) in the 2000s, before leveling off in the 2010s (IR 3.2; 95% CI = 2.0–4.8). Discussion: The incidence of AN among 10‐ to 14‐year‐old girls increased significantly over four decades. Both biological and sociocultural factors, for example, early pubertal timing and the impact of social media, might explain this. In other age groups and overall, the incidence of AN remained stable. The significant decrease of the incidence of BN in the previous decades halted in the last decade. Public Significance: An important finding of the present study is that for 10‐ to 14‐year‐old girls, the risk for developing anorexia nervosa has increased significantly over 40 years. More healthcare facilities for younger people are needed, and prevention programs could include social media use. For bulimia nervosa, the general decrease in the occurrence of new cases has halted in the 2010s. [ABSTRACT FROM AUTHOR]

Introduction: Rural and under-resourced urban communities face unique challenges in addressing patients' social determinants of health needs (SDoH). Community health workers (CHWs) can support patients experiencing social needs, yet little is known about how rural and under-resourced primary care clinics are screening for SDoH or utilizing CHWs. Methods: Interviews were conducted with primary care clinic providers and managers across a geographically large and predominately rural state to assess screening practices for SDoH and related community resources, and perspectives on using CHWs to address SDoH. Interviews were conducted by phone, recorded, and transcribed. Data were analyzed using thematic analysis. We completed interviews with 27 respondents (12 providers and 15 clinic managers) at 26 clinics. Results: Twelve (46.1%) clinics had a standardized process for capturing SDoH, but this was primarily limited to Medicare wellness visits. Staffing and time were identified as barriers to proper SDoH screening. Lack of transportation and affordable medication were the most cited SDoH. While respondents were all aware of CHWs, only 8 (30.8%) included a CHW on their care team. Perceived barriers to engaging CHWs included cost, space, and availability of qualified CHWs. Perceived benefits of engaging CHWs in their practice were: assisting patients with navigating resources and programs, relieving clinical staff of non-medical tasks, and bridging language barriers. Conclusions: Rural and under-resourced primary care clinics need help in identifying and addressing SDoH. CHWs could play an important part in addressing social needs and promoting preventive care if financial constraints could be addressed and local CHWs could be trained. [ABSTRACT FROM AUTHOR]

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Addressing equity in healthcare is fundamental for delivering safe care to vulnerable patients, especially during COVID-19. This paper aims to identify barriers and enabling factors for general practitioners (GPs) in delivering safe and equitable care during the COVID-19 pandemic. Semi-structured interviews took place during May–July 2020 among 18 Flemish and 16 Dutch GPs. Thematic analysis of the interviews demonstrated that while GPs acknowledged a smooth information flow by governments and professional organizations on care guidelines, the fast-changing information challenged them to stay up to date. Media communication facilitated information dissemination but also fueled misinformation and miscommunication, creating unrealistic patient expectations. Certain guidelines and patient reluctance delayed necessary care. A shortage of personal protective equipment made GPs concerned about patient safety during face-to-face contacts. Teleconsultations became a popular alternative, but posed increased patient safety risks. GPs struggled to identify and reach vulnerable patients. Equitable care was hindered by time constraints; thus, having the appropriate materials facilitated such care. An interprofessional collaboration involving paramedical, social, and city services benefited patient safety and equity in healthcare. However, limitations in this collaboration pressured GPs. The unprecedented and resource-constrained environment challenged GPs' capacity to provide the healthcare quality they aspired to deliver. A well-structured collaborative network involving all stakeholders could benefit safe and equitable care in future pandemics. [ABSTRACT FROM AUTHOR]

This document contains summaries of several articles from the Australasian Journal of Dermatology. The first article describes a surgical technique for the complete excision of an ungual fibrokeratoma, a type of tumor. The second article discusses the use of radiofrequency ablation as a versatile tool for the surgical treatment of various skin lesions. The third article examines the management of keratinocyte cancers in elderly patients, taking into account comorbidities and frailty. The fourth article provides an update on the factors associated with poor outcomes in patients with cutaneous squamous cell carcinoma with perineural invasion. The fifth article presents an update on the outcomes of concurrent perineural invasion and lymphovascular invasion in keratinocyte cancers. The final article discusses the risks of using electrosurgery in dermatology procedures and highlights the importance of occupational health and safety guidelines. [Extracted from the article]

Background Institutions are established patterns of recurrent social relationships playing a fundamental part in all our lives. The family is the best-known institution, but other 'total' institutions serve as organisations directly affecting the lives of many individuals in the healthcare sector. Objective This paper examines the sociological theory of institutionalisation as applied to individuals admitted to aged-care facilities, where the complete life-rounds of inmates occur within clearly defined limits. The study provides a framework to enable general practitioners, nurses and healthcare professionals to better appreciate the processes involved as individuals adapt to their new environment. Discussion Sociology provides valuable insights for healthcare providers in understanding how individuals adapt to their loss of independent living and find themselves subjected to intimate regulation in the total institution. The biopsychosocial model of healthcare delivery is better understood when we as health professionals have greater insights to appreciate the competing processes at work. [ABSTRACT FROM AUTHOR]

Objective: This cross-sectional study investigates the characteristics and practices of mental health care services implementing Open Dialogue (OD) globally. Methods: A structured questionnaire including a self-assessment scale to measure teams' adherence to Open Dialogue principles was developed. Data were collected from OD teams in various countries. Confirmatory Composite Analysis was employed to assess the validity and reliability of the OD selfassessment measurement. Partial Least Square multiple regression analysis was used to explore characteristics and practices which represent facilitating and hindering factors in OD implementation. Results: The survey revealed steady growth in the number of OD services worldwide, with 142 teams across 24 countries by 2022, primarily located in Europe. Referrals predominantly came from general practitioners, hospitals, and self-referrals. A wide range of diagnostic profiles was treated with OD, with psychotic disorders being the most common. OD teams comprised professionals from diverse backgrounds with varying levels of OD training. Factors positively associated with OD self-assessment included a high percentage of staff with OD training, periodic supervisions, research capacity, multi-professional teams, self-referrals, outpatient services, younger client groups, and the involvement of experts by experience in periodic supervision. Conclusion: The findings provide valuable insights into the characteristics and practices of OD teams globally, highlighting the need for increased training opportunities, supervision, and research engagement. Future research should follow the development of OD implementation over time, complement selfassessment with rigorous observations and external evaluations, focus on involving different stakeholders in the OD-self-assessment and investigate the long-term outcomes of OD in different contexts. [ABSTRACT FROM AUTHOR]

Background: Improving the coordination and integration of health services is recognised nationally and internationally as a key strategy for improving the quality of diabetes care. The Australian Diabetes Alliance Program (DAP) is an integrated care model implemented in the Hunter New England Local Health District (HNELHD), New South Wales (NSW), in which endocrinologists and diabetes educators collaborate with primary care teams via case-conferencing, practice performance review, and education sessions. The objective of this study was to report on general practitioners' (GPs) perspectives on DAP and whether the program impacts on their skills, knowledge, and approach in delivering care to adult patients with type 2 diabetes. Methods: Four primary care practices with high rates of monitoring haemoglobin A1c (HbA1c) levels (> 90% of patients annually) and five practices with low rates of monitoring HbA1c levels (< 80% of patients annually) from HNELHD, NSW provided the sampling frame. A total of nine GPs were interviewed. The transcripts from the interviews were reviewed and analysed to identify emergent patterns and themes. Results: Overall, GPs were supportive of DAP. They considered that DAP resulted in significant changes in their knowledge, skills, and approach and improved the quality of diabetes care. Taking a more holistic approach to care, including assessing patients with diabetes for co-morbidities and risk factors that may impact on their future health was also noted. DAP was noted to increase the confidence levels of GPs, which enabled active involvement in the provision of diabetes care rather than referring patients for tertiary specialist care. However, some indicated the program could be time consuming and greater flexibility was needed. Conclusions: GPs reported DAP to benefit their knowledge, skills and approach for managing diabetes. Future research will need to investigate how to improve the intensity and flexibility of the program based on the workload of GPs to ensure long-term acceptability of the program. [ABSTRACT FROM AUTHOR]

Background: During the COVID-19 pandemic, clinical services were severely disrupted, restricted, or withdrawn across the country. People living with Inflammatory Bowel Disease (IBD) – an auto-immune disorder for which medical treatment often results in immunosuppression, thus requiring regular monitoring—may have struggled to access clinical support. As part of a larger qualitative study, we investigated experiences of access to clinical services during the pandemic, and patient concerns about and preferences for services in the future. Methods: This exploratory qualitative study used semi-structured interviews to explore participants' experiences of clinical services across the UK during the pandemic. All data were collected remotely (March – May 2021) using online video-calling platforms or by telephone. Audio files were transcribed professionally and anonymised for analysis. Data were analysed using thematic analysis. Results: Of the eight themes found across all data, four related specifically to accessing GP, local (district) hospital, and specialist (tertiary) referral services for IBD: 1) The Risk of Attending Hospital; 2) Missing Routine Monitoring or Treatment; 3) Accessing Care as Needed, and 4) Remote Access and The Future. Conclusions: Our findings support other studies reporting changes in use of health services, and concerns about future remote access methods. Maintenance of IBD services in some form is essential throughout crisis periods; newly diagnosed patients need additional support; future dependence on IBD services could be reduced through use of treatment / self-management plans. As the NHS digitalises it's future services, the mode of appointment—remote (telephone, video call), or in-person – needs to be flexible and suit the patient. [ABSTRACT FROM AUTHOR]