Non-drug interventions (NDIs) are underused in primary care, despite established effectiveness, safety, cost-benefit and guidelines. Existing research exploring barriers and enablers to NDI use primarily focuses on patients' perspectives, leaving general practitioners' (GPs') perspectives underexplored, despite their critical role in NDI delivery. The objective of this study is to explore Australian GPs' experiences and perspectives on the use of NDIs in primary care. An interview study informed by realist methodology. Transcripts were abductively analysed, with a sample analysed by two researchers, using the Theoretical Domains Framework, which allows identification of individual and contextual factors that influence behaviour, and discussed in team meetings to develop themes. Interviews took place either in person or online via Zoom, were audio-recorded and transcribed verbatim. A convenience sample of GPs working in Australian primary care. 14 GPs were interviewed for an average of 59 min. Four themes were developed representing the latent mechanisms underlying GPs' prescription and use of NDIs. (1) Obtaining and sharing knowledge: GPs' learning about NDIs is limited through medical school and continuing education, highlighting gaps in tertiary and specialty training. Sharing knowledge occurs bidirectionally. GPs share their learnt knowledge about NDIs with patients, who in turn share their lived experience knowledge. (2) Considering the patient: patient characteristics, circumstances and actual or perceived expectations influenced GPs' NDI prescription. Influences included financial status, therapeutic relationship, patient motivation, presenting condition and medication expectation. (3) Influence of primary care environment: time constraints, billing and policies influenced when and how GPs used and prescribed NDIs. Interprofessional collaboration and distributing patient resources were strategies used by GPs to overcome barriers. (4) NDIs part of GPs' role and identity: NDIs were prescribed as first-line treatments, preventative strategies or as an adjuvant to medication for both acute or chronic conditions, highlighting NDIs as core to GPs' role and care. This study reveals the interplay of factors and mechanisms influencing Australian GPs' use of NDIs, including systemic, educational and interpersonal dynamics. To optimise the integration of NDIs in primary care, prioritised training, clearer guidance and better access to evidence-based resources are required.

In recent years, the prevalence of diabetes in China has increased significantly, and approximately 11.9% of Chinese adults had diabetes in 2020. Moreover, there are several rigorous challenges in diabetes prevention and glycaemic control, especially at the primary medical care level. In order to guide primary healthcare providers in providing comprehensive and continuous care to affected patients, the Office for Primary Diabetes Care of the National Basic Public Health Service Program and the Chinese Diabetes Society issued national guidelines for the prevention and control of diabetes at the primary care level in 2025. The management objects were adults with type 2 diabetes aged ≥18 years. The main contents include basic requirements for management, health management process, diagnosis, screening, evaluation, treatment, recognition and management of acute complications, traditional Chinese medicine, referral and health management and education.

‌ObjectiveTo analyse trends in mental and substance use disorders among Asian children aged 5–14 years, identify key risk factors (eg, bullying, abuse, lead exposure) and compare gender/age disparities using Global Burden of Disease (GBD) 2021 data.‌DesignCross-sectional analysis of the GBD 2021 database, focusing on prevalence, disability-adjusted life years (DALYs) and risk factor associations.‌SettingPopulation-based study across Asian countries, examining the burdens of mental health, especially substance use disorders in high-prevalence regions.‌ParticipantsChildren aged 5–14 years in Asia, with gender-stratified subgroups (boys vs girls).‌ResultAnxiety, conduct disorders and autism were primary contributors to mental health burdens. Substance use disorders, though less prevalent, rose notably among boys. Girls showed higher burdens of anxiety/depressive disorders. Bullying and childhood abuse were strongly linked to these conditions. Gender disparities in DALYs highlighted boys’ vulnerability to substance use and girls to internalising disorders.‌ConclusionUrgent, region-specific interventions are needed to address bullying, lead exposure and abuse, with gender-sensitive strategies. The study calls for targeted research and policies to mitigate rising mental health challenges in Asian children.

ObjectiveDiabetes remission has emerged as an achievable treatment goal, shifting the focus of care from increasing medication use to restoring metabolic health. While clinical trials show that remission is possible in controlled settings, evidence remains limited regarding its implementation in routine care within middle-income, rice-based dietary contexts. This study aims to explore healthcare provider experiences with implementing diabetes remission services in Thailand, focusing on dietary strategies, deprescription practices and patient management in routine care settings.DesignQualitative study using semi-structured, in-depth interviews, supplemented by structured questionnaires and programme documents.SettingThirteen healthcare facilities across six Thai regions and two national-level professional or policy organisations.Participants17 key informants purposively sampled for regional, institutional and professional diversity, including physicians, nurses, dietitians and national programme leaders. Data were collected and analysed iteratively until no new insights emerged. Thematic content analysis was conducted in QDA Miner Lite v3.0 with investigator triangulation.ResultFive major themes emerged: key strengths, success factors, nutritional approaches and lifestyle modification, implementation challenges, and development strategies. Multidisciplinary teamwork, personalised care plans and regular monitoring facilitated service delivery. Culturally adapted dietary strategies, such as low-carbohydrate Thai-style meals and intermittent fasting, were widely used. Challenges included unclear clinical guidelines, limited staffing and technological disparities. Medication deprescription varied across sites due to the absence of standardised protocols. Healthcare providers emphasised the need for community engagement and policy support to enable scale-up. Real-world implementation of diabetes remission services is feasible but challenged by systemic constraints and contextual variability. Flexible, culturally tailored approaches, empowered care teams and supportive policy frameworks are essential for sustainability.ConclusionThese findings provide practical insights for scaling remission programmes in other middle-income settings. Flexible, culturally tailored clinical pathways, empowered teams and supportive policy and financing are required to sustain outcomes and expand coverage.

ObjectiveDemographic changes, increasing prevalence of chronically ill and multimorbid patients and the ongoing shortage of general practitioners (GPs) collectively present significant challenges for European general practice. Task delegation from GP to practice nurse (PN)-led patient consultations could be a potential solution to tackle those challenges.Therefore, this study aimed to examine the attitudes of GPs and PNs towards PN-led consultations in general and for specific conditions.DesignCross-sectional survey using a self-developed, pretested questionnaire, conducted between September 2023 and November 2024. The questionnaire assessed attitudes towards PN-led consultations, conditions within PN-led consultations, possible benefits and concerns regarding PN-led consultations, sociodemographic characteristics and characteristics on GP offices (GPOs). We performed descriptive statistics, univariable and multivariable regression analyses using SPSS V.27.SettingGPOs located in the German federal states of Saxony-Anhalt and Saxony.ParticipantFrom 2071 contacted GPOs, 437 GPs and 339 PNs participated (GP response rate: 21.1%).ResultsThe majority of GPs (61.7%) and PNs (61.2%) were open towards PN-led consultations. In multivariable analysis, GPs showed greater openness if they had prior positive delegation experiences (OR=5.88, 95% CI (3.01 to 11.48)) or already delegated special tasks (OR= 5.34, 95% CI (2.29 to 12.46)). GPs were less open if they worked in urban GPOs (OR=0.44, 95% CI (0.22 to 0.88)) or owned a single GPO (OR=0.41, 95% CI (0.20 to 0.83)). In multivariable analysis, PNs were more open towards PN-led consultations if they had prior positive delegation experiences (OR=3.03, 95% CI (1.12 to 8.18)) and advanced PN training (OR=3.50, 95% CI (1.44; 8.51)).The three most accepted conditions by GPs and PNs for PN-led consultations were chronic wounds, diabetes mellitus and arterial hypertension.ConclusionOur findings demonstrate broad openness among both GPs and PNs towards PN-led consultations in German GPOs in general, and for various acute and chronic conditions. PN-led consultations are already partially practised. The results indicate considerable potential for further delegation beyond current national agreements.Future pilot studies should further develop PN roles and provide evidence of feasibility and non-inferiority of PN-led consultations compared to GP-led consultations. Conditions and participant characteristics investigated may serve as a foundation for study design and participant recruitment.

Patients often expect antibiotics for self-limiting diseases, pressuring providers to prescribe antibiotics unnecessarily. These expectations also contribute to the unsafe practice of taking antibiotics without a prescription (non-prescription use), such as pills retained from prior prescriptions or antibiotics from non-medical sources. Previous work shows that non-prescription use is due to strong, widely held misconceptions regarding the curative power of antibiotics. To reduce unnecessary use of antibiotics, we developed and pilot-tested a patient-focused, bilingual (English and Spanish) educational tool with patient and provider stakeholder input. The tool, a trifold brochure, included information on safe antibiotic use, potential antibiotic harms and symptom management with over-the-counter medications. Using a qualitative design, we conducted a two-phase study to (1) develop a provider-patient communication tool and (2) pilot-test the tool in primary care clinics. Development of the tool involved patient advisory board meetings and healthcare professional (HCP) focus groups. Pilot-testing of the tool was done through semistructured interviews of randomly recruited patients from primary clinic waiting rooms and their providers. Publicly funded safety net primary care clinics in Texas. Patients (n=18) and HCPs (nurses, medical assistants, pharmacists, nurse practitioners and physicians) (n=14) from participating clinics. Themes were extracted from the qualitative data. Main themes from the development phase highlighted the need to create a simple tool to make it clear that antibiotics are not used to treat viral infections, pain or allergies and that using antibiotics without consulting a medical professional is not safe. During pilot-testing, providers noted the tool helped adjust patients' antibiotic expectations. Providers felt that the tool gave them credibility in scenarios where antibiotics were not indicated. Patients felt that the tool provided alternatives to antibiotics for symptom relief. Patients and providers found the tool useful in supporting patient-provider communication around antibiotic use. A stakeholder-driven, patient-focused educational tool addressing inappropriate antibiotic use facilitated patient-provider communication around antibiotic usage and helped manage patients' antibiotic expectations. Embedding this tool into a community-facing intervention may reduce use of antibiotics without a prescription.

ObjectiveThe primary objective was to evaluate the impact of clinical decision support (CDS) tool integration into primary care visits on depression screening and follow-up rates and to assess whether CDS use improves adherence to Health Resources and Services Administration (HRSA) guidelines for depression screening and follow-up.DesignThis quality improvement evaluation study employed quantitative and qualitative components conducted in parallel to provide complementary insights. Modified Poisson regression with generalised estimating equation (GEE) was used to assess the association between CDS tool use and meeting HRSA criteria for depression screening and follow-up. In addition, semi-structured interviews explored perspectives on the implementation and utility of CDS tools.SettingThis study was conducted at a federally qualified health centre in Minnesota.ParticipantThe dataset included 12 338 patient encounters attributed to 8647 unique patients, covering 2 years of data. Five care providers were recruited through purposive sampling for the semi-structured interviews.ResultCDS use was significantly associated with an increased likelihood of meeting HRSA depression screening and follow-up criteria (relative risk 1.44, 95% CI 1.34 to 1.55; p<0.001). Qualitative findings suggested that while providers found CDS tools useful, workflow challenges and human-centred practices shaped their effectiveness.ConclusionIntegrating CDS tools into primary care workflows can enhance adherence to depression screening and follow-up guidelines. However, their effectiveness relies on supportive person-centred approaches, including collaboration and previsit preparation. These findings highlight the need for a balanced approach that integrates technological interventions with human interaction to enhance clinical practices. Future research should investigate how CDS tools are used in practice, address barriers to their adoption and develop strategies to promote their broader use while fostering continued learning among providers.

Background Limited evidence has investigated the effect of a healthy lifestyle on mortality in patients with inflammatory bowel disease (IBD). We aimed to assess the relationship between a healthy lifestyle and all-cause mortality in IBD, as well as the underlying metabolic mechanisms in a prospective cohort. Methods Overall, 5052 IBD patients free of cancer (aged 57.0±8.0 years, 48.5% men) were included from UK Biobank cohort. A healthy lifestyle was defined as a normal body mass index, never smoking, moderate alcohol consumption, regular physical activity, adequate sleep duration and healthy diet. The primary outcome was all-cause mortality. Lifestyle-related metabolic signatures were constructed by linear regression and elastic net regression in patients with metabolomics data. A multivariable Cox proportional hazards model was used to assess associations between lifestyle, metabolic signature and all-cause mortality. The mediation effect of lifestyle-related metabolic signatures was estimated through the Cox marginal structural model. Results During a median of 14.6 years’ follow-up, 583 deaths were identified. Compared with unfavourable lifestyle, those with favourable lifestyle showed significantly lower risk of all-cause mortality in IBD (HR=0.56, 95% CI 0.46 to 0.68), ulcerative colitis (UC) (HR=0.61, 95% CI 0.48 to 0.79) and Crohn’s disease (HR=0.49, 95% CI 0.36 to 0.67), and 18.9% of the reduced risk was mediated by metabolic signature. Metabolic signature was significantly associated with lower all-cause mortality, with HR of 0.65 (95%CI 0.49 to 0.85) for values above versus below the median and 0.73 (95%CI 0.64 to 0.83) for per SD increase. Subgroup and sensitivity analyses demonstrated similar results. Conclusion A healthy lifestyle is associated with lower mortality in IBD patients. This beneficial effect may be mediated by metabolic signatures and related to favourable metabolic alterations.