BackgroundContinuity of care (CoC) is linked to better outcomes. Particularly, older adults and those with chronic conditions, like type 2 diabetes (T2D) and dementia, may benefit from CoC. Individuals with a migration background (MB) face challenges in accessing adequate healthcare. Our aim was to study associations between MB and personal continuity of general practitioner (GP) care among older adults, and in subgroups with T2D and dementia.MethodsObservational cohort study (2013–8) based on electronic records from 48 Dutch general practices linked to data from Statistics Netherlands. We specifically compared adults who migrated to the Netherlands to those without MB. The Herfindahl–Hirschman Index (HHI; low/medium/high) was used to measure CoC. We used multilevel ordinal regression to estimate associations between MB and CoC, adjusted for follow-up time/age/gender/comorbidity/income/practice.Results46 663 individuals aged ≥50 years were included: 72.9% with no MB, 5.7% with Surinamese, 4.3% Moroccan, 2.7% Turkish, 5.1% European, and 9.3% other MB. Compared with those without MB, persons with a Moroccan MB had lower odds of having moderate or high CoC [odds ratio (OR) 0.81, 95% CI 0.74–0.89], and persons with a European MB had higher odds of having moderate or high CoC (OR 1.16, 95% CI 1.07–1.26). Persons with a Moroccan MB in the T2D subgroup had lower odds of having moderate or high CoC (OR 0.75, 95% CI 0.64–0.89). No differences were found in the dementia subgroup.ConclusionsThis study reveals inequalities in personal continuity of GP care by MB in the Netherlands. Interventions to improve CoC should actively incorporate MB groups to promote equitable CoC.

BackgroundSince patients increasingly have online access to their diagnostic test results, general practitioners (GPs) have reduced control over how this information is communicated. This shift introduces new challenges in communication and interaction with patients and requires a better understanding of how GPs experience and manage communication in an evolving digital healthcare landscape.ObjectivesTo explore GPs' experiences and perceived challenges in communicating information about diagnostic test results to patients in the context of increasing digital accessibility.MethodsIn 2024, we conducted a qualitative study using semi-structured interviews with purposively sampled Dutch GPs in the Netherlands. Interviews were audio recorded, transcribed verbatim, and analyzed using thematic analysis. Key themes reflecting experiences and challenges related to the communication of diagnostic test results were identified.ResultsEighteen participants were interviewed in the study. Three overarching themes emerged from the data: (i) managing patient expectations; (ii) purpose-driven communication strategies; and (iii) balancing efficiency and patient engagement in communicating test results.ConclusionsGPs considered patients' online access to diagnostic test results a double-edged sword—while it may support more efficiency in the healthcare process, it also introduces communication challenges, particularly due to patients' misinterpretation of clinically insignificant findings and the use of medical jargon in reports. These findings highlight the need for tailored communication strategies and improvement of information provided in online patient portals.

BackgroundThis cross-sectional study aimed to describe proportions of patients with indications of alcohol consumption using phosphatidylethanol (PEth), the Alcohol Use Disorders Identification Test (AUDIT), and its consumption-focused version (AUDIT-C), in relation to blood pressure (BP) control, overall and by sex.MethodsA total of 270 hypertensive primary care patients (ICD-10: I10.9) were stratified into BP control groups: controlled (<140/90 mmHg), uncontrolled (≥140/90 mmHg), and apparent treatment-resistant hypertension (aTRH; ≥140/90 mmHg with ≥3 antihypertensive drugs). A randomized sample from each stratum was invited, baseline data were collected. Alcohol consumption using predefined categories for PEth and AUDIT, and hazardous use (PEth ≥ 0.122 µmol/L; AUDIT ≥ 8; AUDIT-C ≥ 5 for men, ≥4 for women), were analyzed in relation to BP control groups.ResultsMean age was 67 ± 11 years; 42% were women. PEth indicated high and regular alcohol consumption in 6.4% of controlled, 5.3% of uncontrolled, and 19.2% of aTRH patients (controlled vs. aTRH, P = .027; uncontrolled vs. aTRH, P = .013). AUDIT showed no significant differences in hazardous use between BP groups (P = .865). AUDIT-C identified slightly higher proportions of hazardous use than PEth, across BP groups and sexes. No significant differences were found between BP groups for hazardous use by PEth (P = .339) or AUDIT-C (P = .150).ConclusionsPEth revealed significantly higher alcohol use in the aTRH group, undetected by AUDIT. AUDIT-C and PEth identified more hazardous use than AUDIT, suggesting their potential to prompt alcohol-related discussions and support evidence-based hypertension care. PEth correlated more strongly with AUDIT-C than with AUDIT.Clinical trial registrationRetrospectively registered in Clinical Trials, SLSO2022-0143, 2022-12-10.

BackgroundSkill mix in primary care is increasing, but introducing new roles to general practice is challenging. Concerns have been raised that the skill mix may add to the general practitioners' (GPs') workload. This study examined whether the skill mix was associated with GPs' working hours, time used on management, and burnout.MethodsIn total, 1659 GPs working in 1045 practices completed a survey assessing working hours, time spent on management and administration, and burnout. Burnout was assessed by the Maslach Burnout Inventory (MBI). A composite score of quartile points was calculated for the three subscales of the MBI, and a score ≥9 was categorized as a high level of burnout. Skill mix was measured as the number of nurses, secretaries, and other healthcare professionals (OHCPs) per GP in practice. OHCPs constituted a broad staff category comprising, among others, physiotherapists, midwives, pharmacists, and psychologists. Associations were investigated by generalized linear models for binary outcomes.ResultsEmployment of nurses was associated with a lower probability of burnout, whereas employment of OHCPs was associated with a higher probability of burnout. The latter was found only in partnership GPs, where employment of OHCPs was also associated with an increased number of hours used on management. Skill mix was unrelated to the number of working hours per week.ConclusionsTask-shifting from GPs to nurses might unburden GPs exposed to high workload, but the results suggest caution when it comes to employing OHCPs in primary care, although causality cannot be determined. Studies with experimental designs are needed to clarify causal mechanisms.

BackgroundVirtual care accelerated to the forefront of family physician (FP) care following the COVID-19 pandemic and continues to play a significant role in patient care. The choice between virtual and in-person primary care must be sensitive to patients’ contexts particularly for those with multi-morbidity.ObjectivesThis study explored how to make the choice between virtual and in-person FP care for persons living with multi-morbidity that is acceptable to patients and FPs.MethodsWe conducted a constructivist grounded theory study to understand the processes patients and FPs employ when deciding on the mode of primary care delivery. We used individual interviews to understand the perspectives and expectations of patients with multi-morbidity (2+ chronic conditions) and FPs.ResultsThere were two main themes revealed in data analysis: Considerations in choosing mode of delivery (including reason for visit, impact on access, technological logistics, and reimbursement for virtual care) and Process for choosing mode of delivery (including endorsing the patient choice when possible and scheduling visits).ConclusionThis paper integrated the experience of both patients and FPs to understand how to make the choice between virtual and in-person care. This understanding can support the future of FP care where diverse modes of delivery are employed, but currently technological barriers remain. Clinical scheduling systems that depend on telephone interactions between clinic staff and patients do not always support the process patients and FPs indicated they prefer; that is, one that respects patient preference and FP clinical expertise.

BackgroundBack pain is the leading musculoskeletal reason for visits in general practice. Time constraints on consultations affect diagnostic decisions and the delivery of evidence-based care. This study explored patient and general practitioner (GP) perspectives on digital tools to support decision-making in back pain management.MethodsWe conducted separate focus groups between June and August 2024 with people experiencing back pain and with registered Australian GPs. We analyzed data using thematic analysis with an inductive approach.ResultsWe interviewed 23 participants: 13 with back pain and 10 GPs. Patients appreciated digital decision-support tools for increasing knowledge and clarifying persistent questions after consultations. GPs, in contrast, emphasized red flag screening, symptom monitoring, and time savings. Shared concerns included information trustworthiness, lack of personalization, and cost, while facilitators included integration into practice management systems and GP endorsement.ConclusionsOur findings highlight opportunities to integrate digital decision-support tools at multiple points in GPs’ workflows—before, during, and after consultations—to address the needs of both patients with back pain and GPs. When used before consultations, such tools can help patients prepare by increasing their knowledge, supporting more productive discussions, informing decisions about whether a visit is necessary, and assisting GPs in identifying potential red flags. During consultations, the tools can provide clinicians with updates on current evidence and supply educational resources or prescriptions, particularly for evidence-based lifestyle interventions. After consultations, they can support follow-up by monitoring the patient's condition and addressing any persistent questions that may arise.

The Tanner staging system is recommended to assess pubertal development and to screen for pubertal development disorders. General practitioners (GPs) play a central role in monitoring pubertal development, yet the practical application of the Tanner stages in general practice remains underexplored. To explore the perceptions of GPs regarding Tanner stages and their experiences in performing these assessments in children and adolescents. Two studies were conducted using an inductive qualitative approach. Study 1 examined the views and practices of GPs during puberty assessments. We then asked the doctors to assess the Tanner stages before exploring their personal feelings and the challenges they faced in Study 2. Semi-structured interviews were conducted from November 2022 to November 2023. GPs report that they rarely perform systematic puberty assessments using Tanner stages. Key barriers included insufficient training, lack of confidence in grading, and the sensitive nature of the examination. Participants questioned the clinical utility of Tanner staging, preferring general observation of pubertal onset over precise quantification. GPs remained sceptical about the routine use of Tanner stages in general practice and emphasized the need for additional support, training, and practical tools to enhance implementation. While GPs focus on how to screen for pubertal disorders, the underlying purpose and potential benefits remain less clear to them. Raising GPs' awareness of the importance of identifying pubertal disorders and providing practical strategies is essential for adolescent care. We recommend that GPs systematically check that puberty begins at the expected age in their young patients.

Unnecessary vitamin tests are among the most frequently mentioned low-value care practices among Dutch general practitioners (GPs). Understanding drivers for vitamin testing from a GP's perspective is key for developing effective interventions. This study explored GPs' perspectives on drivers of vitamin D and B12 testing, focusing on potential differences between GPs in practices with high and low testing rates, using the Capability, Opportunity, and Motivation Model of Behaviour (COM-B) behavioural science framework. Laboratory data from 57 primary care centres (PCCs) in the South of the Netherlands (2016-2019) identified the 15 PCCs with the lowest and highest vitamin testing rates. Thirty GPs, one per PCC, were purposively sampled to ensure variation in testing rate and background. Semi-structured interviews (May-July 2020) covered general perceptions, as well as social, cognitive, and motivational factors. Interviews were analysed by mapping factors driving vitamin testing to the COM-B model. Several medical and non-medical factors affecting vitamin D and B12 test ordering in general practice were identified, which could be linked to all three COM-B components at the GP (e.g. education), patient (e.g. informational material), and service level (e.g. laboratory forms). Education, feedback on testing behaviour, evidence-based patient informational material, clear evidence-based guidelines, and modification of laboratory request forms by adding test costs and indications of at-risk groups were identified by participants as promising strategies to reduce unnecessary vitamin testing.

This study aimed to investigate the effects of sleep hygiene education on blood pressure and sleep quality in patients diagnosed with essential hypertension. A randomized controlled trial was conducted with 138 patients with essential hypertension at a family practice center in southern Turkey. Participants completed Pittsburgh Sleep Quality Index (PSQI) and their blood pressure was measured during the initial visit. Patients randomly assigned to the intervention group received sleep hygiene education during the same session. To support adherence, these participants were asked to keep a sleep diary for 8 weeks. At the end of this period, both groups were reassessed using the PSQI and blood pressure measurements. Data were analyzed using SPSS version 22. In our study, completed with 129 participants, sociodemographic characteristics were similar across groups. In the intervention group, the mean reduction in PSQI score was 3.4 points (95% CI: 2.8-4.0; P < 0.001). Systolic blood pressure decreased by 9.7 mmHg (95% CI: 7-12.5; P < 0.001), and diastolic blood pressure decreased by 6.3 mmHg (95% CI: 4.2-8.4; P < 0.001). No significant changes were observed in the control group. Sleep hygiene education delivered in a primary care setting significantly improved sleep quality and reduced blood pressure levels in patients with essential hypertension. This approach may also help prevent complications related to hypertension. Clinical trial registration: ClinicalTrials.gov (Identifier: NCT07257237; registered on 20 November 2025).

Timely diagnosis of dementia is a public health priority, with general practitioners (GPs) central to symptom recognition and assessment. The emergence of biomarkers and anti-amyloid therapies makes accurate, timely diagnosis more critical than ever, introducing new complexities for general practice. Clinical practice guidelines (CPGs) are vital tools to support clinical decision-making, but their applicability to the general practice setting is uncertain. This scoping review analyses how international CPGs define and support the GP's role in the dementia diagnostic process. Following the Arksey and O'Malley scoping review framework, five electronic databases and multiple grey literature sources were searched for dementia CPGs published between 2019 and 2025. Guideline quality was assessed using selected domains of the Appraisal of Guidelines for Research & Evaluation II instrument (AGREE II). Fifteen CPGs from a range of healthcare systems were included. Only two were specifically developed for general practice. While most CPGs positioned GPs as key to timely diagnosis, the recommendations were predominantly developed from a secondary-care perspective and failed to address the fundamental barrier of limited consultation time. Furthermore, practical guidance for GPs on integrating new biomarkers and anti-amyloid therapies was almost absent. A disconnect exists between CPG recommendations and the realities of general practice, rendering much of the guidance aspirational rather than actionable. To be effective, future guidelines must ensure recommendations are feasible, address resource constraints, and establish clear pathways for the new biological era of dementia care. Without this, general practice will remain ill-equipped to meet the growing challenges of dementia diagnosis and management.