Primary Care Attenders Research Articles

HiCorr: an influenza surveillance model using over-the-counter sales from community pharmacies

Abstract Background In large-scale community transmission, such as seasonal influenza, monitoring geographic trends and estimating the transmission intensity are critical to support public health decision-making. Previous studies have successfully used sales data from over-the-counter (OTC) products in community pharmacies to detect and monitor different epidemiological outbreaks, developing surveillance systems that are able to anticipate the load on primary care services and hospitals by up to 3 weeks. Methods The subset of OTC products sold in Portuguese community pharmacies was selected by correlating sales data to primary care attendance in previous flu seasons. This data pertained to daily coded episodes of influenza-like-illness (International Classification of Primary Care, 2nd Edition, code R80) in the Portuguese health cluster Oeste Sul. By fitting a moving epidemic method to historical sales data and then applying it to daily collected sales data, the developed index was used to anticipate the relative load to the primary care system as well as the start and the peak of epidemic activity for the current flu season. Results were compared to the public health data available on respiratory infections in Portugal. Results The model pinpointed the onset of the 2023-2024 flu epidemic in week 47 and its peak in week 52. The index curve showed a high correlation with the data published by the Portuguese national health service, with no time lag. However, the availability of consolidated public data was delayed, on average, by approximately two weeks. Discussion and conclusions Data from community pharmacies significantly enhance the early detection of seasonal flu trends, while reflecting population distribution. This underscores their invaluable contribution to public health assessments and the potential for improving the timeliness and accuracy of seasonal flu surveillance. Key messages • Community pharmacy data significantly enhance the early detection of seasonal flu trends. • Real world sales data maybe useful to support epidemic surveillance in public health.

Visible damp in a child’s bedroom is associated with increased respiratory morbidity in early life: a multicentre cohort study

ObjectiveHousehold damp exposure is an important public health issue. We aimed to assess the impact of the location of household damp on respiratory outcomes during early life.MethodsHousehold damp exposure was...

Effectiveness and cost-effectiveness of a community intervention in enhancing access to care and improving clinical outcomes for depression: a protocol for a cluster randomised controlled trial in India

BackgroundAlthough depression is the leading cause of disability worldwide, treatment coverage for the condition is inadequate. Supply-side barriers (e.g. shortage of specialist mental health professionals) and demand-side barriers (e.g. lack of awareness about depression) lead to limited availability of evidence-based interventions, poor demand for care, and low levels of adherence to care. The aim of our study is to examine if the addition of a community intervention delivered by community volunteers enhances the population-level impact of an evidence based psychosocial intervention (Healthy Activity Program [HAP]) in routine primary care by increasing demand for HAP and improving HAP adherence and effectiveness.MethodsA hybrid type 2 effectiveness implementation cluster randomised controlled trial will be implemented in the state of Goa, India. Twenty-eight clusters of villages and their associated public sector health centres will be randomly allocated through restricted randomisation. Clusters will be randomly allocated to the ‘Community Model’ or ‘Facility Model’ arms. All clusters will offer the HAP and clusters in the ‘Community Model’ arm will additionally receive activities delivered by community volunteers (“Sangathis”) to increase awareness about depression and support demand for and adherence to HAP. The primary outcomes are Contact Coverage (Patient Health Questionnaire [PHQ-9] score > 4 as a proportion of those screened) and Effectiveness Coverage (mean PHQ-9 score amongst those who score ≥ 15 at baseline, i.e. those who have moderately severe to severe depression) at 3 months post-recruitment. Additional outcomes at 3 and 6 months will assess sustained effectiveness, remission, response to treatment, depression awareness, social support, treatment completion, and activation levels. Economic and disability outcomes will be assessed to estimate incremental cost-effectiveness ratios. Implementation will be evaluated through process data and qualitative data informed by the RE-AIM framework. A minimum of 79488 primary care attenders will be screened for the Contact Coverage outcome, and 588 individuals with PHQ-9 ≥ 15 will be recruited for the Effectiveness Coverage outcome.DiscussionIf effective, our community intervention will have relevance to India’s Ayushman Bharat universal healthcare programme which is scaling up care for depression in primary care, and also to other low- and middle- income countries.Trial registrationRegistered on ClincalTrials.gov (NCT05890222.) on 12/05/2023.

Effectiveness of post-COVID-19 primary care attendance in improving survival in very old patients with multimorbidity: a territory-wide target trial emulation

ObjectivesOlder individuals with multimorbidity are at an elevated risk of infection and complications from COVID-19. Effectiveness of post-COVID-19 interventions or care models in reducing subsequent adverse outcomes in these individuals...

Effectiveness of post-COVID-19 primary care attendance in improving survival in very old patients with multimorbidity: a territory-wide target trial emulation.

Older adults with multimorbidity are at high risk of mortality following COVID-19 hospitalisation. However, the potential benefit of timely primary care follow-up on severe outcomes post-COVID-19 has not been well established. To examine the effectiveness of attending general outpatient within 30 days after discharge from COVID-19 on 1-year survival among older adults aged ≥85 years, with multimorbidity. We emulated a target trial using a comprehensive public healthcare database in Hong Kong. The cloning-censoring-weighting technique was used to minimise immortal time bias and confounding bias by adjusting for demographics, hospitalisation duration and ICU admission, baseline chronic conditions, and medication history. The outcome included all-cause and cause-specific mortality. Of 6183 eligible COVID-19 survivors, the all-cause mortality rate following COVID-19 hospitalisation was lower in general out-patient clinics (GOPC) group compared to non-GOPC group (17.1 versus 42.8 deaths per 100 person-year). After adjustment, primary care consultations within 30 days after discharge were associated with a significantly greater 1-year survival (difference in 1-year survival: 11.2%, 95% CI = 8.1% to 14.4%). We also observed better survival from respiratory diseases in the GOPC group. In a sensitivity analysis for different grace period lengths, we found that the earlier participants had a GOPC visit after COVID-19 discharge, the better the survival. Timely primary care consultations after discharge may improve survival following COVID-19 hospitalisation among older adults aged ≥85 years, with multimorbidity. Expanding primary care services and implementing follow-up mechanisms are crucial to support this vulnerable population's recovery and well-being.

Exploring Loneliness, Trust, and Psychosocial Meanings Among Primary Care Attendees: A Cross-Sectional Study From a General Practice Setting in Crete, Greece.

Loneliness is often associated with behavioral, psychological, social, and mental and physical health aspects, while the relationship between trust and loneliness is still challenging in terms of research. The present study aimed to investigate to what extent loneliness and trust interact and if there is any association between loneliness and routine events or behaviors that affect overall well-being. This cross-sectional sample of 120 participants, aged between 40 and 75 years, was collected from an urban Primary Health Care Unit, between May and July 2023, in a consecutive manner, after criteria application. The University of California, Los Angeles (UCLA) Loneliness Scale (Version 3) and the Personal Trust and Connections Scale (PerTC) were completed. Hierarchical multiple linear regression analysis in steps and multiple logistic regression analysis were performed. The mean age of the participants was 59.8 years and the majority were females (73.3%). Only 10.8% were found to have no Behavioral Risk Factors (BRFs). A higher sense of loneliness was associated with being widowed/unmarried/divorced (unstandardized β=-4.10, p=0.045), not having children (β=-2.80, p=0.038), having more BRFs (β=2.03, p=0.032), or being in contact with fewer friends (β=-0.56, p<0.001). A higher sense of loneliness was related to lower levels of trust (β=-1.29, p=0.032). Lower odds of demonstrating high levels of loneliness were found among married individuals (odds ratio (OR): 0.38; 95% confidence interval (CI) 0.15, 0.95; p=0.039) and those who reported six or more routine contacts or meetings with friends (OR: 0.31; 95% CI 0.13, 0.74; p=0.008). A lower score on the total PerTC scale was related to higher odds of increased loneliness (OR: 2.78; 95%CI 1.01, 7.62; p=0.048). Being married and coming in contact or meeting with more friends was associated with lower odds of reporting high feelings of loneliness, while lower trust was correlated with increased odds of loneliness. Also, persons with more BRFs were found to have a higher loneliness score. Given their inverse correlation, tools that measure levels of loneliness and trust, like the UCLA and PerTC scales, may be used within primary care consultation to offer new insights on health risk behaviors and their possible synergistic influences.

Usability evaluation of the educational website "understanding my diabetes" for Mexican patients with type 2 diabetes.

Diabetes education is an integral part of the treatment for the metabolic control of patients with diabetes. The use of the Internet as a tool for diabetes education, as well as its acceptance, is still under study. To assess the usability of the educational website "I understand my diabetes" designed for patients with type 2 diabetes attending primary care clinics. A cross-sectional study was done in 110 patients with type 2 diabetes from two family medicine clinics, each of whom was assigned a user account on the educational website "Entiendo mi diabetes." The web site assigned a user name and password to each patient. They were able to access the educational website at home. After a 15-day review period, participants were asked to evaluate usability using the Computer System Usability Questionnaire. Additionally, we developed an eight-item questionnaire usability focusing on diabetes care. Sociodemographic data, blood pressure, and anthropometric measurements were recorded. Glucose levels and lipid profiles were also measured. The patients with diabetes had a mean age of 52.7 years and a median of 5 years since they were diagnosed with diabetes. The website received a good usability rating from 89.1% of participants, with favorable assessments in all three dimensions: 87.3% for information, 85.5% for quality, and 88.2% for interface. Regarding usability specifically for diabetes care, 98.2% rated it as having good usability. The website for education about the disease in patients "I understand my diabetes" had an adequate usability evaluation by patients, so they also considered it very useful for diabetes care. The diabetes care instrument had adequate usability and reliability.

End of 2022/23 Season Influenza Vaccine Effectiveness in Primary Care in Great Britain.

The 2022/23 influenza season in the United Kingdom saw the return of influenza to prepandemic levels following two seasons with low influenza activity. The early season was dominated by A(H3N2), with cocirculation of A(H1N1), reaching a peak late December 2022, while influenza B circulated at low levels during the latter part of the season. From September to March 2022/23, influenza vaccines were offered, free of charge, to all aged 2-13 (and 14-15 in Scotland and Wales), adults up to 49 years of age with clinical risk conditions and adults aged 50 and above across the mainland United Kingdom. End-of-season adjusted vaccine effectiveness (VE) estimates against sentinel primary-care attendance for influenza-like illness, where influenza infection was laboratory confirmed, were calculated using the test negative design, adjusting for potential confounders. Results In the mainland United Kingdom, end-of-season VE against all laboratory-confirmed influenza for all those > 65 years of age, most of whom received adjuvanted quadrivalent vaccines, was 30% (95% CI: -6% to 54%). VE for those aged 18-64, who largely received cell-based vaccines, was 47% (95% CI: 37%-56%). Overall VE for 2-17 year olds, predominantly receiving live attenuated vaccines, was 66% (95% CI: 53%-76%). The paper provides evidence of moderate influenza VE in 2022/23.

Prevalence of Steinert's Myotonic Dystrophy and Utilization of Healthcare Services: A Population-Based Cross-Sectional Study.

Myotonic dystrophy type I (MDI) is the most common muscular dystrophy in adults. The main objectives of this study were to determine the prevalence of MDI in the Community of Madrid (CM) (Spain) and to analyze the use of public healthcare services; a population-based cross-sectional descriptive study was carried out on patients with MDI in CM and data were obtained from a population-based registry (2010-2017). A total of 1101 patients were studied (49.1% women) with average age of 47.8 years; the prevalence of MDI was 14.4/100,000 inhabitants. In the women lineal regression model for hospital admissions, being in the fourth quartile of the deprivation index, was a risk factor (regression coef (rc): 0.80; 95%CI 0.25-1.37). In the overall multiple lineal regression model for primary health care (PHC) attendance, being a woman increased the probability of having a higher number of consultations (rc: 3.99; 95%CI: 3.95-5.04), as did being in the fourth quartile of the deprivation index (rc: 2.10; 95%CI: 0.58-3.63); having received influenza vaccines was a protective factor (rc: -0.46; 95%CI: -0.66-(-0.25)). The prevalence of MDI in the CM is high compared to other settings. Moreover, having any level of risk stratification of becoming ill (high, medium or low) has a positive association with increased PHC consultations and hospital admissions.

MISSION ABC: transforming respiratory care through one-stop multidisciplinary clinics – an observational study

ObjectivesThe Modern Innovative Solutions to Improve Outcomes in Asthma, Breathlessness and Chronic Obstructive Pulmonary Disease (COPD) (MABC) service aimed to enhance disease management for chronic respiratory conditions through specialist multidisciplinary...

Sexual and reproductive health and rights of migrant women attending primary care in England: A population-based cohort study of 1.2 million individuals of reproductive age (2009–2018)

BackgroundEvidence on the sexual and reproductive health and rights (SRHR) of migrants is lacking globally. We describe SRHR healthcare resource use and long-acting reversible contraceptives (LARCs) prescriptions for migrant versus non-migrant women attending primary care in England (2009–2018). MethodsThis population-based observational cohort study, using Clinical Practice Research Datalink (CPRD) GOLD, included females living in England aged 15 to 49. Migration was defined using a validated codelist. Rates per 100 person years at risk (pyar) and adjusted rate ratios (RRs) were measured in migrants versus non-migrants for consultations related to all-causes, six exemplar SRHR outcomes, and LARC prescriptions. Proportions of migrants and non-migrants ever prescribed LARC were calculated. FindingsThere were 25,112,116 consultations across 1,246,353 eligible individuals. 98,214 (7.9 %) individuals were migrants. All-cause consultation rates were lower in migrants versus non-migrants (509 vs 583/100pyar;RR 0.9;95 %CI 0.9–0.9), as were consultations rates for emergency contraception (RR 0.7;95 %CI 0.7–0.7) and cervical screening (RR 0.96;95 %CI 0.95–0.97). Higher rates of consultations were found in migrants for abortion (RR 1.2;95 %CI 1.1–1.2) and management of fertility problems (RR 1.39;95 %CI 1.08–1.79). No significant difference was observed for chlamydia testing and domestic violence. Of 1,205,258 individuals eligible for contraception, the proportion of non-migrants ever prescribed LARC (12.2 %;135,047/1,107,894) was almost double that of migrants (6.91 %;6,728/97,364). Higher copper intrauterine devices prescription rates were found in migrants (RR 1.53;95 %CI 1.45–1.61), whilst hormonal LARC rates were lower for migrants: levonorgestrel intrauterine device (RR 0.63;95 %CI 0.60–0.66), subdermal implant (RR 0.72;95 %CI 0.69–0.75), and progesterone-only injection (RR 0.35;95 %CI 0.34–0.36). InterpretationHealthcare resource use differs between migrant and non-migrant women of reproductive age. Opportunities identified for tailored interventions include access to primary care, LARCs, emergency contraception and cervical screening. An inclusive approach to examining health needs is essential to actualise sexual and reproductive health as a human right.

Awareness of Contraceptives and Their Use Among Saudi Women Attending Primary Care Centers in King Abdulaziz Medical City, Riyadh, Saudi Arabia.

Background The objective of this cross-sectional study is to identify the prevalence of contraceptive use and the knowledgeand attitudes of Saudi women towards it. Methods We distributed a survey to Saudi women aged 19-49 attending primary care centers under King Abdulaziz Medical City in Riyadh to identify their views on using contraceptives and what they know about them. We calculated the sample size using the Roasoft sample calculator. Results This study enrolled 432 Saudi women. The number of women who were contraceptive users was 249 (57.6%). Among those who were using contraceptives, the most common reason was the idea of taking care of themselves and avoiding consecutive pregnancies (105, 42.2%). Of the non-users, the most common reason was concerns regarding side effects (41%). The most commonly used contraceptive methods were contraceptive pills (55.6%) and intrauterine devices (IUDs) (17.6%). The most commonly used non-pharmacological contraception methods were withdrawal (17.6%) and rhythm (8.6%). Conclusion In this study, factors associated with contraceptive use among Saudi women were explored.Demographic data, type, attitude, and associations provided insight into factors taken into consideration while developing future contraceptives in addition to improving clinical practice.

Allergic rhinitis

Allergic rhinitis (AR) is a major public health issue worldwide and one of the top-10 reasons for primary care attendance. AR affects between 10 and 25% of people worldwide, including 10–15% of children and 26% of adults in the United Kingdom. Sneezing, nasal itching, rhinorrhoea, nasal congestion, ocular symptoms (irritation and lacrimation), non-productive cough, Eustachian tube dysfunction and chronic sinusitis are all symptoms of AR. AR can be characterised as seasonal (hay fever), perennial, intermittent, persistent, or occupational, depending on the allergens and the pattern and frequency of symptoms. Asthma and conjunctivitis are significantly associated with AR. A clinical history and physical examination are the most important processes in diagnosis. Skin tests can be used to confirm the diagnosis of AR. Patients with AR may experience changes in their everyday activities, emotions, and sleep habits, to the detriment of quality of life. Early detection and treatment can ameliorate the unpleasant effects of AR. Management includes medication, avoidance of exposure to environmental allergens and when appropriate, measures to help with associated asthma and sinusitis. Psychological interventions can also help in the management of AR.

Prevalence of seasonal affective disorder among primary health care attendees in eastern Riyadh-a cross-sectional study

Background: Seasonal affective disorder (SAD), a type of mood disorder, is defined by seasonal depressive symptoms that appear at a particular time of a year. Its burden in Saudi Arabia is poorly understood. In this study, we aimed to estimate the prevalence of and factors associated with seasonal depression among attendees of primary health care centres (PHC) in Eastern Riyadh. Methods: We conducted a cross-sectional study in the PHC of Eastern Riyadh. We systematically sampled participants attending the PHCs the required sample size was achieved. We measured seasonal depression and beliefs using the validated seasonal pattern assessment questionnaire (SPAQ) and seasonal beliefs questionnaire. We presented the mean and standard deviation (SD) of scores obtained and used Student’s t test ANOVA test to compare differences across explanatory variables. We demonstrated internal consistency using Cronbach’s alpha. Results: Among 232 participants, majority were aged 18-35 years (67.2%) and males (60.8%). The mean (SD) score on SPAQ was 1.00 (0.71) and that on the seasonal beliefs was 3.03 (0.69). With a cut-off of 11 on SPAQ, prevalence of SAD was found to be 33.5%. SPAQ score was significantly higher among younger ages, females, single/divorced, Saudis, those with secondary/lower level education and those who earn&lt;50,000 Saudi Riyals (p&lt;0.001). Seasonal beliefs score was significantly higher among younger ages (p=0.013) and Saudis (p=0.001). Both the scales used had high internal consistency (Cronbach’s alpha of 0.901 for SPAQ and 0.847 for seasonal beliefs questionnaire). Conclusions: SAD was a prevalent mental health issue among primary care attendees in Eastern Riyadh. Screening for such conditions at the primary level among high-risk groups should be considered by family physicians.

Environmental risk factors for respiratory infection and wheeze in young children: A multicentre birth cohort study.

Respiratory infections and wheeze have a considerable impact on the health of young children and consume significant healthcare resources. We aimed to evaluate the effect of environmental factors on respiratory infections and symptoms in early childhood. Environmental risk factors including: daycare attendance; breastfeeding; siblings; damp within the home; environmental tobacco smoke (ETS); child's bedroom flooring; animal exposure; road traffic density around child's home; and solid fuel pollution within home were assessed in children recruited to the GO-CHILD multicentre prospective birth cohort study. Follow-up information on respiratory infections (bronchiolitis, pneumonia, otitis media and cold or flu), wheeze and cough symptoms, healthcare utilisation and medication prescription was collected by postal questionnaires at 12 and 24 months. Log binomial and ordered logistic regression models were fitted to the data. Follow-up was obtained on 1344 children. Daycare was associated with increased odds of pneumonia (odds ratio [OR] = 2.39, 95% confidence interval [CI]: 1.04-5.49), bronchiolitis (OR = 1.40, 1.02-1.90), otitis media (OR = 1.68, 1.32-2.14) and emergency department attendance for wheeze (RR = 1.81, 1.17-2.80). Breastfeeding beyond 6 months was associated with a reduced odds of bronchiolitis (OR = 0.55, 0.39-0.77) and otitis media (OR = 0.75, 0.59-0.99). Siblings at home was associated with an increased odds of bronchiolitis (OR = 1.65, 1.18-2.32) and risk of reliever inhaler prescription (RR = 1.37, 1.02-1.85). Visible damp was associated with an increased odds of wheeze (OR = 1.85, 1.11-3.19), and risk of reliever inhaler (RR = 1.73, 1.04-2.89) and inhaled corticosteroid prescription (RR = 2.61, 1.03-6.59). ETS exposure was associated with an increased odds of primary care attendance for cough or wheeze (OR = 1.52, 1.11-2.08). Dense traffic around the child's home was associated with an increased odds of bronchiolitis (OR = 1.32, 1.08-2.29). Environmental factors likely influence the wide variation in infection frequency and symptoms observed in early childhood. Larger population studies are necessary to further inform and guide public health policy to decrease the burden of respiratory infections and wheeze in young children.

The Practice of Herbs Integration Among Patients With Hypertension Attending Primary Care Facilities: A Systematic Review

Introduction: The practice of integrating herbs among patients with hypertension to manage their condition has become more evident across many countries. This systematic review was conducted primarily to determine the prevalence and diversity of herbs used by patients with hypertension attending primary care facilities. Data Sources: Studies were obtained from five electronic databases (September 2019) and references of included studies. Review Methods: Studies performed on patients with hypertension attending outpatient clinics and hospitals that reported prevalence or diversity of herbs were included. Two independent researchers performed screening, quality appraisal and data extraction. Results: Sixteen studies were included in this review. The prevalence of herbs used ranged from 6.5% to 69.0%. The two most common herbs reported were Allium sativum and Vernonia amygdalina. The main reasons patients’ took herbs were to reduce blood pressure, to relieve symptoms of the disease and perception that allopathic medicine was a failure. Age, education level, presence of other family members with hypertension and gender were significantly associated (p&lt;0.05) with the use of herbs. Conclusion: Patients with hypertension who attend outpatient clinics tend to use herbs to complement their allopathic medicine. Further evaluation in the form of randomized controlled trials should be conducted to determine the effectiveness of herbs and herbal medicine in improving hypertension among patients.

Knowledge, Attitude, and Practice of Family Planning Among Saudi Primary Health Care Attendees in Al-Ahsa, Kingdom of Saudi Arabia.

Assessing community awareness and practice of the significance and methods of family planning is critical for improving the effectiveness and quality of services, policies, and planning, which has a positive impact on the health and quality of life of women, children, families, and communities. This study aims to determine Saudi population'sknowledge, attitude, and practice of family planning in Al-Ahsa, Kingdom of Saudi Arabia. A cross-sectional study was conducted in Al-Ahsa, Saudi Arabia.The study included randomly selected participants (male and female Saudi primary health care attendees).All adult Saudi individuals of both genders attending primary health care centers were eligible for inclusion in this study.Data were analyzed using IBM SPSS Statistics for Windows, Version 15 (Released 2006; IBM Corp., Armonk, New York, United States).Descriptive statistics for the prevalence and quantitative variables was used. Results:The study included 672 participants; 78.6% of them were females and 21.4% were males. 23.8% of participants aged between 20 and 30 years old.73.8% of participants heard of family planning before. The source of information about family planning was reported as 36.9% from the Internet, 27.4% from relatives, 21.4% from the doctor, and 14.3% from books.21.4% think that long-term contraceptive use led to permanent infertility.81.0% of the participants said that they tend to use family planning methods. 78.6% of the participants have used a family planning method before, where 25.8%of the participants used natural contraception methods, 21.2%used surgical contraception, 27.3%used condoms, and 12.1%used hormonal tablets, while 13.6%used nothing. However, 65.2% currently use contraceptives. 31.8% use the natural method of family planning currently, 21.2% use surgical methods, and 6.1% use condoms. In comparison to many studies previously mentioned, the rate of family planning utilization was average, as was the level of knowledge and attitude towardfamily planning. However, there were some mistaken beliefs among participants regarding contraceptives. Age,gender, the duration of a marriage, education level, working status, and monthly income were all found to be significantly associated with knowledge of family planning.

Characteristics of patients with panic disorder attended in primary care during the COVID-19 pandemic: A cross-sectional multicenter study

ObjectiveTo assess the prevalence of panic disorder during the second and third waves of the COVID-19 pandemic. DesignCross-sectional multicenter study. SettingPrimary care. ParticipantsParticipating primary care physicians selected patients visiting their primary care centers for any reason over a 16-month period. Main outcome measureDiagnosis of panic disorder was established using The Primary Care Evaluation of Mental Disorders (PRIME-MD) instrument. ResultsOf a total of 678 patients who met the inclusion criteria, 36 presented with panic disorder, with a prevalence of 5.3% (95% confidence interval 3.6–7.0). A total of 63.9% of cases occurred in women. The mean age was 46.7±17.1 years. Socioeconomic difficulties, such as very low monthly income rate, unemployment, and financial constraints to make housing payments and to make ends meet were more frequent in patients with panic disorders as compared to patients without panic disorder. A high level of stress (Holmes–Rahe scale>300), concomitant chronic fatigue syndrome and irritable bowel disease, and having financial difficulties in the past 6 months were associated with factors of panic disorder. DiscussionThis study characterizes patients with panic disorder diagnosed with a validated instrument during the COVID-19 pandemic and identified risk factors for this disease. ConclusionsIn non-selected consecutive primary care attendees in real-world conditions during the COVID-19 pandemic, the prevalence of panic disorder was 5.3%, being more frequent in women. There is a need to enhance primary care resources for mental health care during the duration of the pandemic and beyond.

Frequent attenders in primary health care: a mixed-methods study of patient and staff perspectives.

To understand the frequent attendance phenomenon from the perspective of patients and healthcare professionals and how it can be reduced. Frequent attenders (FAs) are characterised by the consumption of a disproportionate number of medical consultations and a high number of visits per year to primary care physicians (PCP). Although FAs constitute about 10% of all primary clinic attendees, they are responsible for ~40-50% of clinic visits, affecting the efficiency, accessibility and quality of health services provided to other patients. Mixed methods (STROBE Statement: Data S1; COREQ checklist: Data S2). Eighteen FAs were interviewed in a qualitative approach. PCPs and nurses (n = 184) completed a cross-sectional survey. FAs are driven by their personal, emotional and mental state. FAs viewed clinics as a source for information and resolving medical problems. They perceived PCPs as authoritative and knowledgeable, and nurses as treatment managers and mediators between PCPs and patients. In contrast, FAs evoked more negative emotions than positive ones among medical staff. PCPs and nurses attributed frequent visits to FAs' personal and emotional states. A model based on the findings was constructed to provide a framework for grasping frequent attendance from a sociological perspective and for planning and managing it. The accessibility and availability of health services at primary clinics, and collaboration and trust in medical staff facilitate the frequent attendance phenomenon. The frequent attendance phenomenon should be proactively prevented, even before patients become FA, using the model constructed, which serves as a foundation for introducing an intervention program to identify and prevent frequent attendance. PCPs and nurses working in primary care clinics should be made aware of the FA phenomenon and should be educated and given tools to deal with it within the clinic. The process should be facilitated by organisational support. There was no patient or public contribution to the design or conduct of the study, analysis or interpretation of the data, or in the preparation of the manuscript.

Exploring barriers and opportunities to improve osteoporosis care across the acute-to-primary care interface: a qualitative study

SummaryThis qualitative study interviewed general practitioners, patients, and FLS clinicians and identified key challenges facing stakeholders seeking to improve post-fracture osteoporosis care. Local policies and care pathways as an initial strategy may address information and service delivery issues across the acute-primary care divide.IntroductionFracture liaison services (FLS) can be effective for secondary fracture prevention, but long-term adherence to therapies remains suboptimal. Few studies have explored how services manage the transition between tertiary and primary post-fracture care. This study mapped service processes and factors influencing integration of post-clinic care, identifying barriers, supports, and opportunities for seamless healthcare.MethodsQualitative descriptive study using semi-structured interviews with FLS stakeholders at two metropolitan hospitals in New South Wales (NSW) and surrounding general practices.ResultsSeven FLS clinicians, 11 general practitioners (GPs), and seven patients were interviewed. Six key themes emerged on the transition of patient care from tertiary to primary care (PC). Interprofessional communication issues and role ambiguity posed threats to seamless care. Delayed, absent, inaccessible, or poor-quality communication frustrated GPs, while FLS clinicians lacked confidence in existing communication systems and desired bidirectional communication with PC. GPs were confident managing osteoporosis, but FLS clinicians had limited confidence that patients would discuss osteoporosis with their GP and that GPs would action recommendations. Effective PC follow-up required a positive GP–patient relationship and that patients perceived a need to engage with PC. Patient understanding of osteoporosis (influenced by patient education, knowledge, beliefs, and health behaviours) affected PC attendance. Limited public awareness of osteoporosis and healthcare policy deficits contributed to care gaps.ConclusionKey challenges were identified facing stakeholders seeking to improving post-clinic osteoporosis care. Development and implementation of local, integrated acute-community policies and care pathways as an initial intervention may address information and service delivery issues across the acute-PC divide.