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Background: The use of a standardized national chronic noncommunicable disease (CNCD) registry is of immense benefit in addressing the CNCD burden in Trinidad and Tobago (T&T). This study seeks to assess the outcomes of a paper-based CNCD registry implemented in the primary health-care centers in South Trinidad. Methods: At the South-West Regional Health Authority, a standardized paper-based registry was implemented in 2017, at the 33 public primary health-care clinics. Following this, a CNCD Registry Assessment Survey was administered cross-sectionally to 94 end-users to evaluate the implementation outcomes of the registry. The outcome domains – feasibility, penetration, acceptability, sustainability, fidelity, uptake, and costs were analyzed using summary statistics. Results: Fifty-five percent of end-users responded. Most responses came from the primary care physicians 1 (50.0%) of County Caroni. Most respondents were from County Caroni, 19 (36.5%) and St. Patrick, 19 (36.5%). Ninety-one percent of end-users thought that the CNCD registry was easily adopted. For 85.9% of end-users, the registry had fidelity (85.9%); 84.2% thought it was well accepted; feasible (82.7%); easily penetrated (82.7%), and appropriate (76.0%). Forty-two percent thought that the cost of implementation was high, while 30.8% were neutral. Seventy-one percent thought that the paper-based CNCD registry should be sustained, and 94.2% of end-users thought that an electronic CNCD registry should be implemented. Conclusion: It is possible and feasible to implement a standardized paper-based registry. Through this process, we were able to define the prevalence of five CNCDs and two risk factors of overweight/obesity and smoking for the chronic disease clinic population. Subsequently, we would like to implement a digitized CNCD registry.

Primary care healthcare professionals (PCHPs) are pivotal in managing chronic diseases and present a unique opportunity for nutrition-related disease prevention. However, the active involvement of PCHPs in nutritional care is limited, influenced by factors like insufficient education, lack of resources, and time constraints. In this position paper The European Society for Clinical Nutrition and Metabolism (ESPEN) promotes the active engagement of PCHPs in nutritional care. We emphasize the importance of early detection of malnutrition by screening and diagnosis, particularly in all individuals presenting with risk factors such as older age, chronic disease, post-acute disease conditions and after hospitalization for any cause. ESPEN proposes a strategic roadmap to empower PCHPs in clinical nutrition, focusing on education, tools, and multidisciplinary collaboration. The aim is to integrate nutrition into medical curricula, provide simple screening tools for primary care, and establish referral pathways to address malnutrition systematically. In conclusion, we urge for collaboration with PCHP organizations to raise awareness, enhance nutrition skills, facilitate dietitian accessibility, establish multidisciplinary teams, and promote referral pathways, thereby addressing the underestimated clinical challenge of malnutrition in primary care. [ABSTRACT FROM AUTHOR]

BackgroundPrimary care practices are responding to calls to incorporate patients' social risk factors, such as housing, food, and economic insecurity, into clinical care. Healthcare likely relies on the expertise and resources of community-based organizations to improve patients' social conditions, yet little is known about the referral process.ObjectiveTo characterize referrals to community-based organizations by primary care practices.DesignQualitative study using semi-structured interviews with healthcare administrators responsible for social care efforts in their organization.ParticipantsAdministrators at 50 diverse US healthcare organizations with efforts to address patients' social risks.Main measuresApproaches used in primary care to implement social needs referral to community-based organizations.ResultsInterviewed administrators reported that social needs referrals were an essential element in their social care activities. Administrators described the ideal referral programs as placing limited burden on care teams, providing patients with customized referrals, and facilitating closed-loop referrals. We identified three key challenges organizations experience when trying to implement the ideal referrals program: (1) developing and maintaining resources lists; (2) aligning referrals with patient needs; and (3) measuring the efficacy of referrals. Collectively, these challenges led to organizations relying on staff to manually develop and update resource lists and, in most cases, provide patients with generic referrals. Administrators not only hoped that referral platforms may help overcome some of these barriers, but also reported implementation challenges with platforms including inconsistent buy-in and use across staff; integration with electronic health records; management and prioritization of resources; and alignment with other organizations in their market.Conclusion and relevanceReferrals to community-based organizations were used in primary care to improve patients' social conditions, but despite strong motivations, interviewees reported challenges providing tailored and up-to-date information to patients.

Family medicine is the internationally recognized nomenclature for the academic discipline, knowledge domain, and medical specialty of primary care doctors, working in the community setting. Family medicine is defined as a specialty of medicine which is concerned with providing comprehensive care to individuals and families by integrating biomedical, behavioral, and social sciences in the community setting. The distinction of family medicine lies in the tradition of medical generalism, promoting whole person care, in a life cycle mode; providing optimal preventive, promotive, and curative healthcare services in a wide spectrum of setting from home to hospital. In 2016, 92nd report of the department-related parliamentary standing committee on health and family welfare on the “Functioning of the Medical Council of India” has emphasized the need for postgraduate in family medicine. The committee report has noted that “the medical education system is designed in a way that the concept of family physicians has been ignored. The committee recommends that the Government of India in coordination with State Governments should establish robust PG Programs in Family Medicine and facilitate introduction of Family Medicine discipline in all medical colleges. This will not only minimize the need for frequent referrals to specialist and decrease the load on tertiary care but also provide continuous healthcare for the individuals and families. The successive National Health Policies of Government of India–NHP 2002 and 2017 have emphasized the need of family medicine training in India. The recently enacted National Medical Commission Act 2019 has mandated NMC to promote training in family medicine at both undergraduate and postgraduate levels. Therefore, in the background of the stated policies of the Government of India the concept of family doctors, which was earlier neglected should be institutionalized within the mainstream medical education system of India. It is now time to accelerate and upgrade family medicine training and thereby strengthen the concept of comprehensive primary care in India. This white paper presents the review of family medicine training in India and proposes a way forward.

Urgent care practice (UCP) is a novel concept for India. Urgent care primarily deals with injuries or illnesses requiring immediate care. Medical emergency and urgency can happen anywhere unannounced. Research has shown that 90% of the morbidities can be resolved within the community by primary care physicians lead teams. Given the changing professional demands, non-specialists tend to refer away far too many cases to specialists, undermining generalist medical care, particularly in Indian settings. The spillover of the patient load from the primary care setting to the tertiary care centers is enormous leading to resource mismatch. Family physicians and other primary care providers are best positioned to develop practices and provide good quality urgent care to society. Family physicians, general practitioners, and medical officers are already functioning as the frontline care providers for any emergency or medical urgency arising within communities. Urgent care is essentially ambulatory care or outpatient care outside of a traditional hospital emergency room. "UCP aims to provide timely support, which is easily accessible with a focus on good clinical outcomes, e.g. survival, recovery, lack of adverse events, and complications. Core interventions of urgent care are centered on the 4Rs - Rescue, Resuscitate, Relate, and Refer. At present, there are no available, established training model for future faculty, residents, and medical students on "UCP" in India.

The world is passing through a global pandemic of COVID 19. The number of positive cases has crossed over twenty thousand as of April 2020. Like everyone else, it is indeed a very challenging situation for family physicians and primary care providers as most of the guidelines presently have focused on screening, quarantine, isolation, and hospital-based management. Limited information or clarity is available on running small private clinics during pandemic times. The key concern is professional obligation versus risks of community transmission. Family physicians see routine flu-like illnesses throughout the year with seasonal variation within their practices. This document is intended to develop consensus and standard practices for the family physicians and other primary care providers during the pandemic, ensuring optimal continuity of care. This document was reviewed by the national executive of the Academy of Family Physicians of India and approved for dissemination among members. However, due to the dynamic status of the pandemic, all practitioners are advised to closely follow the instructions, guidelines, and advisories of national, state and local health authorities as well.

Aim: This article is a report of a study protocol designed to explore what factors inform healthcare professionals' clinical decision‐making when providing end of life care for people with dementia in primary care. Design: The proposed study will adopt a qualitative study design, utilizing an ethnographic approach. Methods: A mixed sample group of registered healthcare professionals, including district nurses, specialist nurses and general practitioners, will be purposively sampled and recruited from one health board in Wales, which will cover three settings in primary care. A multi‐method approach will be utilized to provide rich data, including non‐participant observation, semi‐structured interviews, and review of key documents. Data will be managed using NVivo 12 and analysed thematically. Ethics approval was gained in April 2022. Discussion: Little is known about the end of life care decision‐making process of healthcare professionals caring for people with dementia in primary care settings. This study will therefore address this pertinent gap. The study findings may also be transferable to healthcare professionals working in similar clinical settings across the UK. Impact It is anticipated that this study will inform the subsequent development of an intervention that can be used by healthcare professionals to support decision making and subsequently the provision of quality end of life care in primary care for people with dementia. [ABSTRACT FROM AUTHOR]

Background: Practice-based research networks (PBRNs) have been recognized as essential laboratories and mechanisms for developing primary care research. This scoping review aims to examine and map the features and development trends of productivity, research categories, and methods in original primary care research conducted by global PBRNs between 1991 and 2023. Methods: We have assembled an interdisciplinary team that will undertake this scoping review, following the framework developed by Arksey and O'Malley. Targeted literature includes original primary care research conducted by PBRNs, published from January 1, 1991, to December 31, 2023. An integrated search strategy will gather publications from 3 electronic databases (PubMed, Web of Science, and Embase), 16 major primary health care journals, and 364 relevant organizations. Two experienced researchers will independently screen the titles, keywords, and abstracts of all references and extract data regarding eight key elements. Disagreements between the reviewers will be resolved through group discussions, moderated by a third reviewer. Articles to be included will (1) be conducted in the primary care context, (2) be led by PBRNs, (3) provide a full report of original research, and (4) be published in a peer-reviewed journal between the aforementioned dates in any language. Exclusions encompass reviews, letters, commentaries, case reports, and conference papers. Final data will be displayed using tables and charts according to different conceptual categories. Discussion: This scoping review is one of the initial attempts to delineate the development trends and features of primary care research conducted by PBRNs. This study will provide reference information for researchers in countries/regions that are building their research infrastructure and capacity in general practice, family medicine, and primary care. Systematic review registration: Registered in OSF on July 25, 2022 (https://osf.io/zgv9c). [ABSTRACT FROM AUTHOR]

Background: Primary care practices are responding to calls to incorporate patients' social risk factors, such as housing, food, and economic insecurity, into clinical care. Healthcare likely relies on the expertise and resources of community-based organizations to improve patients' social conditions, yet little is known about the referral process.Objective: To characterize referrals to community-based organizations by primary care practices.Design: Qualitative study using semi-structured interviews with healthcare administrators responsible for social care efforts in their organization.Participants: Administrators at 50 diverse US healthcare organizations with efforts to address patients' social risks.Main Measures: Approaches used in primary care to implement social needs referral to community-based organizations.Results: Interviewed administrators reported that social needs referrals were an essential element in their social care activities. Administrators described the ideal referral programs as placing limited burden on care teams, providing patients with customized referrals, and facilitating closed-loop referrals. We identified three key challenges organizations experience when trying to implement the ideal referrals program: (1) developing and maintaining resources lists; (2) aligning referrals with patient needs; and (3) measuring the efficacy of referrals. Collectively, these challenges led to organizations relying on staff to manually develop and update resource lists and, in most cases, provide patients with generic referrals. Administrators not only hoped that referral platforms may help overcome some of these barriers, but also reported implementation challenges with platforms including inconsistent buy-in and use across staff; integration with electronic health records; management and prioritization of resources; and alignment with other organizations in their market.Conclusion and Relevance: Referrals to community-based organizations were used in primary care to improve patients' social conditions, but despite strong motivations, interviewees reported challenges providing tailored and up-to-date information to patients. [ABSTRACT FROM AUTHOR]

Roma populations’ low health status and limited access to health services, including primary care, has been documented in many European countries, and warrants specific health policies and practices. A variety of experiences shows how primary care can adjust its practices to reduce the barriers to primary care for Roma populations.

This position paper aims to increase awareness among primary care practitioners and policymakers about the specific and complex health needs of people who experience incarceration. We focus on the importance of primary care and of continuity of care between prison and community. We highlight what is known from the literature on the health of people who experience incarceration, on the organisation of prison health care, and on the role of primary care both during and after detention. We present three case descriptions of detainees' encounters with the organisation of prison health care in three European countries. Finally, we describe the position that the European Forum for Primary Care takes. Prisoners and ex-prisoners have a worse physical and mental health compared with a cross-section of the population. However, access to good quality treatment and care is often worse than in the outside situation. In particular, well-organised primary care in the prison context could benefit prisoners and, indirectly, society at large. Moreover, continuity of care between the community and the prison situation needs improvement. [ABSTRACT FROM AUTHOR]

All primary care clinicians should signpost patients who are overweight or obese to weight management programmes - either directly commissioned or commercial groups. MEDICAL EDUCATION WITH RELEVANCE TO PRIMARY CARE The winner of category 3 (Medical Education with Relevance to Primary Care) was a "realist review" that attempts to produce one or more theories to explain particular phenomena. The Research Paper of the Year (RPY), awarded by the Royal College of General Practitioners (RCGP), gives recognition to an individual or group of researchers who have undertaken and published an exceptional piece of research relating to general practice or primary care. [Extracted from the article]

Background: Digital health interventions have been shown to improve data quality and health services in low- and middle-income countries (LMICs). Nonetheless, in LMICs, systematic assessments of time saved with the use of digital tools are rare. We ran a set of cluster-randomized controlled trials as part of the implementation of a digital maternal and child health registry (eRegistry) in the West Bank, Palestine. Objective: In the eRegTime study, we compared time spent on health information management in clinics that use the eRegistry versus the existing paper-based documentation system. Methods: Intervention (eRegistry) and control (paper documentation) arms were defined by a stratified random subsample of primary health care clinics from the concurrent eRegQual trial. We used time-motion methodology to collect data on antenatal care service provision. Four observers used handheld tablets to record time-use data during one working day per clinic. We estimated relative time spent on health information management for booking and follow-up visits and on client care using mixed-effects linear regression. Results: In total, 22 of the 24 included clinics (12 intervention, 10 control) contributed data; no antenatal care visits occurred in the other two clinics during the study period. A total of 123 and 118 consultations of new pregnancy registrations and follow-up antenatal care visits were observed in the intervention and control groups, respectively. Average time spent on health information management for follow-up antenatal care visits in eRegistry clinics was 5.72 minutes versus 8.10 minutes in control clinics (adjusted relative time 0.69, 95% CI 0.60-0.79; P<.001), and 15.26 minutes versus 18.91 minutes (adjusted relative time 0.96, 95% CI 0.61-1.50; P=.85) for booking visits. The average time spent on documentation, a subcategory of health information management, was 5.50 minutes in eRegistry clinics versus 8.48 minutes in control clinics (adjusted relative time 0.68, 95% CI 0.56-0.83; P<.001). While the average time spent on client care was 5.01 minutes in eRegistry clinics versus 4.91 minutes in control clinics, some uncertainty remains, and the CI was consistent with eRegistry clinics using less, the same, or more time on client care compared to those that use paper (adjusted relative time 0.85, 95% CI 0.64-1.13; P=.27). Conclusions: The eRegistry captures digital data at point of care during client consultations and generates automated routine reports based on the clinical data entered. Markedly less time (plausibly a saving of at least 18%) was spent on health information management in eRegistry clinics compared to those that use paper-based documentation. This is likely explained by the fact that the eRegistry requires lesser repetitive documentation work than paper-based systems. Adoption of eRegistry-like systems in comparable settings may save valuable and scarce health care resources. [ABSTRACT FROM AUTHOR]

Family medicine is the internationally recognized nomenclature for the academic discipline, knowledge domain, and medical specialty of primary care doctors, working in the community setting. Family medicine is defined as a specialty of medicine which is concerned with providing comprehensive care to individuals and families by integrating biomedical, behavioral, and social sciences in the community setting. The distinction of family medicine lies in the tradition of medical generalism, promoting whole person care, in a life cycle mode; providing optimal preventive, promotive, and curative healthcare services in a wide spectrum of setting from home to hospital. In 2016, 92nd report of the department‑related parliamentary standing committee on health and family welfare on the “Functioning of the Medical Council of India” has emphasized the need for postgraduate in family medicine. The committee report has noted that “the medical education system is designed in a way that the concept of family physicians has been ignored. The committee recommends that the Government of India in coordination with State Governments should establish robust PG Programs in Family Medicine and facilitate introduction of Family Medicine discipline in all medical colleges. This will not only minimize the need for frequent referrals to specialist and decrease the load on tertiary care but also provide continuous healthcare for the individuals and families. The successive National Health Policies of Government of India–NHP 2002 and 2017 have emphasized the need of family medicine training in India. The recently enacted National Medical Commission Act 2019 has mandated NMC to promote training in family medicine at both undergraduate and postgraduate levels. Therefore, in the background of the stated policies of the Government of India the concept of family doctors, which was earlier neglected should be institutionalized within the mainstream medical education system of India. It is now time to accelerate and upgrade family medicine training and thereby strengthen the concept of comprehensive primary care in India. This white paper presents the review of family medicine training in India and proposes a way forward. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the presence of data elements related to diagnosis and treatment of malignant breast cancer in CPRD Aurum compared to those in the previously validated CPRD GOLD.Methods: Females in CPRD Aurum or GOLD with a first-time code for malignant breast cancer, mastectomy, or ≥ 1 prescription for tamoxifen or aromatase inhibitors (2004– 2019) were selected. We compared the presence of the codes for breast cancer diagnosis, surgeries (mastectomy, lumpectomy), tamoxifen and aromatase inhibitor prescriptions, radiation, chemotherapy, and supporting clinical codes (suspected breast cancer, lump symptoms, biopsy, lumpectomy, cancer care, referral/visit to specialist, palliative care). Age standardized incidence rates of breast cancer diagnosis in CPRD Aurum and GOLD were calculated.Results: There were 131,936 eligible patients in CPRD Aurum and 69,102 patients in GOLD. A similar proportion of patients in CPRD Aurum and GOLD had codes for breast cancer diagnosis, mastectomy, drug prescriptions, lump, biopsy, lumpectomy, chemotherapy, and cancer and palliative care coded in their electronic record during follow-up. However, suspected breast cancer, radiation, and referral/visits to specialists were coded more frequently in patients in CPRD Aurum compared to GOLD. Age-standardized incidence rates were similar for CPRD Aurum and GOLD.Conclusion: Overall, there was consistency between data elements related to malignant breast cancer recorded in CPRD Aurum and GOLD, particularly for the most informative clinical details. These findings provide reassurance that breast cancer information recorded in CPRD Aurum is generally comparable to that recorded in the previously validated CPRD GOLD and support the use of CPRD Aurum for breast cancer research. [ABSTRACT FROM AUTHOR]