Future Primary Care Research Articles

Characterizing Oncologist Involvement in an Oncology Nurse-Led Primary Palliative Care Intervention (CONNECT).

Background and Objectives: Mixed success with primary palliative care delivery models may be related to inadequate communication between members of the care team. We sought to describe the previously unexamined role of oncologists in an oncology nurse-led primary palliative care intervention study. Design, Setting, and Subjects: We conducted a secondary analysis of data from Care Management by Oncology Nurses to Address Supportive Care Needs, a cluster-randomized controlled trial of a nurse-led primary palliative care intervention for adults with advanced cancer conducted at 17 community oncology clinics in Western Pennsylvania from 2016 to 2020. Nurses conducted three monthly study visits during which they developed care plans (CPs) with the patient and after which they updated the patient's oncologist. We characterized the level of oncologist involvement with the intervention. Results: Of the 336 patients randomized to receive primary palliative care, 266 completed at least one study visit and 233 (88%) had at least one visit where the oncologist was updated afterward. Across 674 total study visits, the oncologist was updated in 553 (82%) of the visits, signifying the oncologist awareness of the intervention. Of the times the nurse updated the oncologist, a CP was presented 29% of the time (163/553). Conclusion: In a large trial of oncology nurse-led primary palliative care, oncologists were often aware of but infrequently involved with the intervention. Future primary palliative care interventions should consider communication and engagement among team members.

Driving innovation in primary healthcare though co-creation with stakeholders in Switzerland

Abstract Issue/problem Primary healthcare systems worldwide face challenges such as socio-demographic shifts, increasing chronic diseases, rising costs, and workforce shortages, demanding innovative solutions for the future of primary care. Description of the problem Addressing the complex challenges of creating a resilient primary healthcare model involves considering interdependent factors such as health policies, funding, workforce training, technology, and evolving diseases, alongside diverse stakeholder interests. To tackle this, the ‘Health2040: Co-creation of a Future Outpatient Primary Healthcare Model in Switzerland’ project was launched in 2023 to develop a forward-looking model by integrating insights from various stakeholders. Results The project involved 40 stakeholders, including patients, researchers, healthcare professionals, policy-makers, and insurers, in two full-day workshops aimed at co-creating a vision and actionable framework for Switzerland’s future primary care. The first workshop focused on developing and visualizing potential models, while the second targeted the transition to these new models and the creation of an implementation plan. These sessions were underpinned by a comprehensive literature review on emerging primary care models, providing a scientific foundation for the discussions. Lessons Successful co-creation requires significant preparatory efforts and innovative creativity techniques, such as Future Newspapers, brainstorming, games, and user personas. Engaging stakeholders throughout various stages of the project helped to enhance relevance. Feedback from a steering group on the workshop’s concept, methodologies, and evidence synthesis was instrumental. Healthcare practitioners also contributed their insights on patient personas, ensuring the models developed were pertinent to actual healthcare practices. Stakeholder engagement process was essential for fostering innovative ideas and ensuring stakeholder buy-in for the developed solutions. Key messages • Co-creation with stakeholders is a promising way to develop innovative solutions for health systems. • Integrating stakeholder input is crucial at all the project stages, from preparation to evaluation.

Scoping Review of Pediatric Primary Care Educational Literature.

Primary care pediatrics is an important element of pediatric training at all levels, yet trainees often lack clinical competence in this area. This scoping review sought to identify the current research available related to pediatric primary care education for medical students and residents and gaps/areas for improvement. Searches were completed on PubMed MEDLINE, Embase, Scopus, and MedEdPORTAL using the search terms "pediatrics," "education," "curricula," and "primary care." An initial total of 6499 articles was screened down to 102 articles for the final full text review and extraction. The most frequently encountered educational subjects were child development and developmental screening (8.8%), adolescent substance use (7.8%), and vaccines/vaccine hesitancy (6.9%). Several subject areas were underrepresented, including pubertal assessment (0.9%), transgender medicine (0.9%), child passenger safety (0.9%), discipline (0.9%), and sports/orthopedic medicine (0%). This study shows that future pediatric primary care educational studies and innovations are needed to improve trainee competence and comfort.

Diet quality in medical trainees: a cross-sectional assessment comparing medical students and primary care residents using the Rapid Eating Assessment for Participants—shortened version

BackgroundThe diet quality of the US population is significantly unhealthy, with critical long-term implications for the nation’s health. A few studies have explored diet quality in the future primary care workforce. This cross-sectional study quantifies the diet quality of medical students and primary care residents at a Midwestern college of medicine in the United States.Methods250 medical students and 148 primary care residents were surveyed electronically utilizing the Rapid Eating Assessment for Participants—Shortened Version (REAP-S). The survey consists of 13 questions that can be scored on a scale from 1 to 3, along with 3 questions that are not scored. The average REAP-S score for a US omnivorous diet is 32 (range 13 to 39) with higher scores indicating a higher quality diet. We obtained average REAP-S scores for all respondents and descriptive summary statistics for individual REAP-S items. Students’ REAP-S total scores were compared to those of residents and the interaction between student/resident status and BMI category on REAP-S total scores were analyzed using analyses of variance. Differences between students and residents on BMI categories and other outcomes (individual REAP-S items, pandemic dietary and weight changes) were analyzed using Chi-Square Tests of Independence or Fisher’s Exact Tests.ResultsMedical students (n = 99; 39.6% response rate) had a significantly higher mean REAP-S score (30.5, SD = 3.9) than primary care residents (n = 72; 49% response rate) (mean = 28.6, SD = 3.9; p = 0.006). Total mean REAP-S scores were significantly higher for those with BMI < 25 (mean = 30.8, SD = 3.7) than for those with BMI > = 25 (mean = 28.3, SD = 4.0; p < 0.001). There was not a statistically significant interaction between role (student vs. resident) and BMI category on total REAP-S scores (p = 0.39). Most respondents (89.3%) indicated that they were willing to improve their diet.ConclusionOur data suggest that the diet quality of surveyed medical students and primary care residents, as quantified by the REAP-S, is suboptimal. Early detection and improvement of diet quality may be necessary for our medical profession trainees to avert potential long-term adverse cardiometabolic health outcomes, and to optimize the health of our future primary care workforce.

About the textbook “Outpatient Therapy” edited by professors O.Yu. Kuznetsova and E.V. Frolova

The textbook “Outpatient Therapy,” prepared by a team of authors under the guidance of professors O.Yu. Kuznetsova and E.V. Frolova, allows you to implement a competent approach to training the future primary health care doctors. The textbook complies with the Federal State Educational Standard of Higher Education. The book is written at a high scientific and methodological level, it is distinguished by a holistic approach to the coverage of the training material and the focus on the formation of both universal and general professional, and specialized professional competencies in the future doctor. The textbook is intended for students of medical faculties and can be used as the main educational literature in the discipline “Outpatient Therapy”.

Exploring the relationship between cultural and structural workforce issues and retention of nurses in general practice: A qualitative study protocol.

The aim of this study is to understand factors that challenge retention and support nurses to stay in general practice. One in four general practice nurse positions in England expected to be left unfilled within the next 10 years. Cultural and structural issues associated with working in general practice have been linked with nurses leaving general practice, re-evaluating their professional futures, adjusting work-life balance and bringing forward retirement. This has implications for the future of the general practice nursing workforce and patient care more broadly. Exploratory qualitative interview study funded by the General Nursing Council Trust for England and Wales. University of York ethics approval (Ref: HSRGC/2023/586/A) was gained in September 2023. The study will be conducted between September 2023 and August 2024. Qualitative interviews will be conducted with a range of nurses working in, or who have worked in, general practice as well as nurse leaders associated with general practice across England and Wales. Recruitment will be via professional and social media networks and snowballing techniques. We aim to purposively recruit 30-40 participants for maximum variation. Cultural and structural influences which may contribute to retention decisions will be explored. Data will be analysed following framework analysis. This study will explore how underpinning cultural and structural issues may impact on retention of this highly skilled professional group and identify factors to support retention. By exploring factors that support or discourage nurses to remain in general practice, retention strategies can be better planned on order to address the general practice nursing workforce crisis. What problem did the study address? This study will address the retention crisis in nursing in general practice by exploring how cultural and structural issues may impact on retention of this highly skilled professional group and identify factors to support retention. Where and on whom will the research have an impact? From the study findings, recommendations will be developed to inform future policy and practice. Key factors to address attrition will be generated to support employers and policy makers in future primary care workforce planning, as well as supporting nurses, at an individual level, in negotiating their roles in practice. Standards for Reporting Qualitative Research (O'Brien etal., 2014). As this is a workforce study protocol, there is no patient or public contribution.

Ensuring Future Primary Care from a Municipal Perspective

In view of the continuing shortage of general practitioners, ensuring access to (primary) medical care close to home is also becoming increasingly important for local authorities. The aim of the present study was to analyse the current and future provision of primary care from the viewpoint of the municipalities in North Rhine-Westphalia (NRW). From the results, it should be possible to derive future health policy design of a needs-based primary care close to home. In an online survey in spring 2023, we surveyed the mayors or representatives of health departments of all 427 municipalities (396 cities and communities, 31 districts) in NRW in cooperation with the NRW Association of Cities and Municipalities, the NRW Association of Counties and the NRW Association of Cities. The items of the questionnaire (n=28) were developed on the basis of two other surveys on medical care in Lower Saxony and Baden-Württemberg, each with a municipal policy target group. They were tested in repeated pretests. In total, 192 municipalities participated in the survey (response rate: 45.0%). The majority of the municipalities (86.6%) considered the local provision of primary care to be (rather) not ensured within the next 10 years. The municipalities expressed the wish for more opportunities to exert their own influence (79.5% yes or rather yes), but nevertheless considered a stronger commitment, especially of the Associations of Statutory Health Insurance Physicians (85.4%), as well as an intensification of assumption of responsibility by the federal states (72.4%) to be necessary for ensuring primary care. The survey shows that municipalities are quite aware of the problem of future deficits in the supply of general practitioners at the local level. The results also indicate that, in view of increasing supply shortfalls, the municipalities see obligations for the Associations of Statutory Health Insurance Physicians and the federal states to take responsibility and to exert greater political pressure in the future. The municipal perspective is an essential building block in considerations of how primary care can be ensured in the future. The responsible stakeholders should therefore involve the municipal level in the planning and measures to secure primary care more closely than in the past.

A mixed methods analysis of the medication review intervention centered around the use of the ‘Systematic Tool to Reduce Inappropriate Prescribing’ Assistant (STRIPA) in Swiss primary care practices

BackgroundElectronic clinical decision support systems (eCDSS), such as the ‘Systematic Tool to Reduce Inappropriate Prescribing’ Assistant (STRIPA), have become promising tools for assisting general practitioners (GPs) with conducting medication reviews in older adults. Little is known about how GPs perceive eCDSS-assisted recommendations for pharmacotherapy optimization. The aim of this study was to explore the implementation of a medication review intervention centered around STRIPA in the ‘Optimising PharmacoTherapy In the multimorbid elderly in primary CAre’ (OPTICA) trial.MethodsWe used an explanatory mixed methods design combining quantitative and qualitative data. First, quantitative data about the acceptance and implementation of eCDSS-generated recommendations from GPs (n = 21) and their patients (n = 160) in the OPTICA intervention group were collected. Then, semi-structured qualitative interviews were conducted with GPs from the OPTICA intervention group (n = 8), and interview data were analyzed through thematic analysis.ResultsIn quantitative findings, GPs reported averages of 13 min spent per patient preparing the eCDSS, 10 min performing medication reviews, and 5 min discussing prescribing recommendations with patients. On average, out of the mean generated 3.7 recommendations (SD=1.8). One recommendation to stop or start a medication was reported to be implemented per patient in the intervention group (SD=1.2). Overall, GPs found the STRIPA useful and acceptable. They particularly appreciated its ability to generate recommendations based on large amounts of patient information. During qualitative interviews, GPs reported the main reasons for limited implementation of STRIPA were related to problems with data sourcing (e.g., incomplete data imports), preparation of the eCDSS (e.g., time expenditure for updating and adapting information), its functionality (e.g., technical problems downloading PDF recommendation reports), and appropriateness of recommendations.ConclusionsQualitative findings help explain the relatively low implementation of recommendations demonstrated by quantitative findings, but also show GPs’ overall acceptance of STRIPA. Our results provide crucial insights for adapting STRIPA to make it more suitable for regular use in future primary care settings (e.g., necessity to improve data imports).Trial registrationClinicaltrials.gov NCT03724539, date of first registration: 29/10/2018.

Exploring Artificial Intelligence and the Future of Primary Care.

Exploring Artificial Intelligence and the Future of Primary Care.

A121 CROSS-SECTIONAL STUDY OF RESIDENT PHYSICIAN KNOWLEDGE AND PERCEPTIONS REGARDING NON-ALCOHOLIC FATTY LIVER DISEASE IN CANADA

Abstract Background Non-alcoholic Fatty Liver Disease (NAFLD) is a prevalent condition affecting approximately 25% of the Canadian population and is projected to continue increasing. Given the increasing prevalence and complications of NAFLD, it is imperative for future primary care physicians to possess a thorough understanding of NAFLD to enhance patient care. Aims To assess the knowledge and perceptions of primary care resident physicians in Canada concerning NAFLD. Methods We conducted a nationwide cross-sectional survey of resident physicians in primary care specialties to assess their knowledge of NAFLD. Additionally, we evaluated resident perceptions regarding the importance of NAFLD and their exposure and familiarity with the condition. "Reasonable knowledge" was defined as correctly answering more than 50% of the questions. We assessed associations using χ2 testing and multiple logistic regression analysis. Results We received 413 responses, with 252 (61%) from family medicine residents and 161 (39%) from internal medicine residents. Among the respondents, 90% considered NAFLD an important public health issue, but only 7% felt they had adequate exposure to the condition, and 94% expressed a need for more teaching. 59% indicated that they were only slightly familiar or unfamiliar with NAFLD. The majority of respondents correctly identified diabetes (90%), dyslipidemia (96%), and obesity (97%) as risk factors for NAFLD, while fewer recognized obstructive sleep apnea (53%), hypothyroidism (27%) and hypopituitarism (14%) as risk factors. Cardiovascular disease and cirrhosis were reported as the most common causes of mortality from NAFLD by 37% and 35% of respondents, respectively. Up to 59% of respondents reported that non-alcoholic steatohepatitis can be diagnosed through imaging or a blood test. Respondents demonstrated a strong understanding of nonpharmacologic therapies, but only 11% recognized that there are no approved medications for NAFLD. Overall, 35% of the respondents displayed a reasonable knowledge of NAFLD. In univariate analysis, factors associated with greater NAFLD knowledge included internal medicine residency (P=0.001), higher post-graduate year (P=0.003), prior GI or hepatology rotations (P=0.003), and subjective familiarity with NAFLD (Pampersand:003C0.001). However, only higher post-graduate year (P=0.048) and subjective familiarity (P=0.003) remained statistically significant in multivariate analysis. Conclusions Resident physicians perceive NAFLD as an important health issue but significantly lack exposure and knowledge about the condition. Further emphasis and education are needed to bridge these knowledge gaps and improve patient outcomes. Funding Agencies None Endoscopy, Technology &amp; Imaging

Training program for primary care physicians in medical rehabilitation at the Pacifi c Medical University

This article describes the experience of training primary care physicians in the field of medical rehabilitation. The existing procedure for the arrangement of medical rehabilitation prescribes its rules and order of implementation in medical primary health care organizations both in outpatient and day patient settings. The Pacific State Medical University (PSMU) runs training programs for primary care physicians within the 31.05.01 educational program “General Medicine”, direction “02 Healthcare”. In accordance with the curriculum, a training program “Medical Rehabilitation” that includes both lectures and training sessions was developed. This program is aimed at forming the necessary competencies of future primary care physicians in implementing and monitoring the effectiveness of the patient’s medical rehabilitation. Training is carried out at the facilities of the PSMU Institute of Clinical Neurology and Rehabilitation Medicine by specialists having experience in medical rehabilitation and having completed the program “Modern aspects of specialist training in the field of physical and rehabilitation medicine”.

Knowledge of Pre- and Postexposure Prophylaxis for HIV Prevention Among Internal Medicine Residents in the United States.

Prescription rates of pre-exposure prophylaxis (PrEP) have remained low among noninfectious disease providers in the United States despite almost a decade since their introduction. For future primary care doctors, residency is the optimal time to build practice patterns around HIV prevention. We assessed baseline knowledge of PrEP in specific pre- and post-exposure prophylaxis content areas among internal medicine trainees who completed the Physician Education and Assessment Center HIV learning module between 2013 to 2020 (N = 12,060). Resident baseline PrEP knowledge was universally low; despite rising awareness of antiretroviral therapy for PrEP in successive years following the nadir of 41% in 2014, still only 56% of residents affirmed this means of HIV prevention by 2020. Knowledge remained limited regardless of academic year, local HIV prevalence, or training program type. Online module completion increased competence across all content areas. There is still a deficit in HIV prevention knowledge across U.S. internal medicine residents, suggesting insufficient education and exposure to HIV-related care.

Catch them young: Knowledge gaps about drug resistant tuberculosis among Homoeopathy college interns: Apre and post-test study

Background: India is the highest Tuberculosis (TB) burden country in the world. It also has the second highest burden of Multidrug-resistant TB globally. Many precious lives are lost due to Drug-resistant TB (DR TB) every day. To achieve the goal of TB elimination in India, robust primary health care is mandatory. Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy (AYUSH) practitioners provide a quarter of primary health care in India. Since interns working at Homoeopathic Medical college will be the future primary care providers, their awareness about DR TB will help reach the target of End TB by 2025. Objective:The study objective was to assess the knowledge gained by Homoeopathy college interns in the diagnosis and treatment of DR TB following a single-day training session. Materials and methods: This cross-sectional study was carried out among 33 interns of Bharati Vidyapeeth (Deemed to be University) Homoeopathic Medical College, Pune. Aquestionnaire was given in the form of a pre-test before the training session. The training comprised the epidemiology of DR TB, its diagnosis,treatment, counseling, and need for referral. After completion of training, a post-test was given, and scores were calculated. A two-tailed paired sample t-test was used to assess gain in knowledge. The proportion of participants with correct responses for every question was determined and compared before and after training using the McNemar test. P&lt;0.05 was considered statistically significant. Result: The mean pre-test score was 2.30 ± 1.24, while the mean post-test score was 4.24 ± 2.00 (p&lt;0.001). There was less knowledge about the regime for DR TB, pre-treatment evaluation, gene Xpert method, and empirical Anti-tuberculosis Treatment. Conclusion: This study highlights that there are significant gaps in knowledge about DR TB among Homoeopathy college interns. It also showed that a short training session significantly improved their knowledge.

How to improve the capacity of general practitioners? – a Flemish approach

“Barely any region left with freely accessible primary health care in Flanders.” This is one of the many newspaper headlines that was recently published to emphasize the fact that more and more general practitioners refuse to take in new patients, because they run out of capacity to provide patients with proper health care. Where does it go wrong? &#x0D; Accessibilty to general practitioners is a hot topic for the Flemish policymakers. An aging population and an increase of mental health problems asks a lot from the general practitioners, as well as the shift of tasks from hospitals towards primary health care and the growing attention for prevention. However, is there a real shortage in general practitioners? Looking abroad learns that the number of general practitioners might not be the major cause of the capacity problem, but that the true bottleneck might lie in the way of organizing primary health care capacity and accessibility. Embedded in a landscape of health care where general practitioners mostly work on a self-employed base, and the fragmented governmental structure in Belgium as an extra obstacle makes this a major challenge for the near future.&#x0D; A dialogue between policy makers from all Belgian governments was opened to create a common approach: each government will take actions within their own authorities. The Flemish government worked out a plan to counter this massive challenge in primary health care through different initiatives, in cooperation with representatives of the general practitioners on the field, local authorities and umbrella organizations.&#x0D; Flanders commits itself by installing three major fundaments which can create change in the way general practitioners are organized: a first step is to create an accurate and up-to-date database of the current available general practitioners health care services compared with the local care need; in parallel the funding of general practitioners will be expanded in a way which stimulates interdisciplinary collaboration and optimizes health care capacity; on top of that the Flemish government is experimenting with new forms of primary care practices in which integrated care is the keystone and which are supported by local authorities and in close connection with welfare services. &#x0D; These projects described above are in full development. On the working field more and more general practitioners are willing to put their shoulders under these initiatives to create solid solutions for the future. &#x0D; The international audience of this lecture might recognize similar issues they encounter in their own countries and will be able to see similarities and differences compared to the Flemish context. By drawing these parallels one can have a broader view on the approach of improving health care capacity and accessibility. &#x0D; These Flemish projects will be brought together with the initiatives from the other Belgian governments at a roundtable discussion to align all the initiatives on primary health care capacity and create a future proof primary health care capacity in Belgium.

POLICY SERIES: BUILDING TRUST, ADDRESSING BURNOUT AND EXPANDING THE DIRECT CARE WORKFORCE; THE 2022 REPORT TO DHSS AND CONGRESS

Abstract This symposium will review the key points and recommendations of the 2022 report to the Secretary of DHSS and Congress, prepared by the federally appointed Advisory Committee on Interdisciplinary and Community-Based Linkages in a blended didactic and interactive format. Clinician burnout following the Covid-19 pandemic is examined and root causes identified. Erosion of the patient trust in the public healthcare system and the consequences thereof are discussed, enhanced role of Community Health workers as the future primary care workforce is explored to prepare the system to prepare for future challenges.

Use of Simulation to Integrate Behavioral Health Into Primary Care Nurse Practitioner Programs.

Identifying and treating acute and chronic behavioral health conditions is integral to primary care practice, yet primary care nurse practitioner (NP) training models do not meet the demand for integrated behavioral health practices. Simulation offers an effective pedagogical tool for integrating behavioral health training in primary care. With support from federal funding and external consultants, new didactic and complementary simulation curricula in integrated behavioral health care were introduced in the primary care and psychiatric mental health NP programs at a school of nursing. Two rounds of this curricular innovation were implemented and evaluated across specialties. Ninety-seven students participated in the training and reported enhanced behavioral-health assessment and hand-off skills, greater confidence in applying core content, and improved communication skills. Thoughtfully designed simulation offers an important tool for developing integrated behavioral health competencies that will help prepare future primary care clinicians meet the needs of patients and communities. [J Nurs Educ. 2024;63(2):128-133.].

Patients' views and experiences of delayed diagnosis of inflammatory bowel disease: a qualitative study.

Diagnosing inflammatory bowel disease (IBD) can be challenging. Patients have been found to experience significant diagnostic delay, which can lead to poorer clinical outcomes. The reasons for this delay are not fully understood, and exploring patients' perspectives can offer important insights. To explore the views and experiences of patients who self-report a delay in IBD diagnosis. Qualitative methodology using semi-structured interviews. Participants were recruited via social media and a national IBD charity. Interviews were conducted by telephone between December 2018 and February 2019. Data were analysed using thematic analysis and drawing on the constant comparison method. Sixteen interviews were carried out. Ten participants were female and six were male; participants were aged 20-65 years. Four main themes were identified: patient factors contributing to delay; primary care factors contributing to delay; systemic factors contributing to delay; and perceived consequences of delayed diagnosis. Participants reported initially not seeking help due to embarrassment or normalising their symptoms. Having consulted, participants reported further delay in receiving a diagnosis due to their perception that GPs had either mislabelled symptoms, expressed uncertainty, or not taken symptoms seriously. Systemic factors, including lack of access to test results and communication issues across primary and secondary care, were also cited as contributing to delayed diagnosis. Several participants felt that their delayed diagnosis led to poorer clinical outcomes. These findings can support patients and GPs in their conversations about symptoms that may indicate IBD, and potentially contribute to reducing diagnostic delay, as well as informing future primary care interventions.

Incidence and risk factors for polypharmacy among elderly people assisted by primary health care in Brazil

BackgroundPolypharmacy is recognized as a global public health problem and one of the greatest challenges related to the aging population. Few studies have investigated the incidence and risk factors for polypharmacy among elderly individuals. These studies provided important information on the issue but were developed in high-income countries. This study investigates the incidence and risk factors for polypharmacy among elderly people assisted by primary health care over a period of 11 years.MethodsThis was a census-based prospective longitudinal study that included people aged 60 years or older living in a small municipality in the state of Rio Grande do Sul, Brazil. The baseline occurred in 2010 and the second wave of the study occurred in 2021. The study population consisted of elderly individuals who did not use polypharmacy at baseline and were reinterviewed in 2021 (N = 128). Data collection in the first and second waves was performed through a household survey using a structured questionnaire. The dependent variable was polypharmacy, defined as the simultaneous use of 5 or more drugs. The independent variables included sociodemographic, health and functionality factors. For multivariate analyses, Poisson regression with robust variance was used, estimating the relative risk and 95% confidence intervals.ResultsThe incidence of polypharmacy was 46.1% in the 11-year period. The highest number of health problems was a risk factor for polypharmacy (RR = 1.177; 95% CI 1.093–1.267).ConclusionsThe incidence of polypharmacy among elderly people assisted in primary health care in Brazil is high. The number of diseases is a risk factor for polypharmacy. These results have implications for future primary health care practices and may support the development of policies, actions and services aimed at reducing polypharmacy and promoting the rational use of drugs in the population at higher risk.

Evaluating Google trends as a primary care research tool.

Google searches represent a snapshot of the world's interest in different topics and are reflected by Google Trends (GT). GT has gained recent popularity across various areas of healthcare research of interest to GPs, such as the seasonality of particular physical symptoms and population-level suicide risk. As a real-time data source, GT is appealing to healthcare researchers, but whether it has a place in primary care research remains largely unaddressed. To explore how GT can be used to research topics relating to primary care in order to evaluate its utility as a future research tool and inform primary care researchers and GPs on the uses and implications of GT as a research tool. Collect relative search volume data from GT on topics relating to health behaviours and access to/experiences of primary care in order to evaluate the utility of GT as a tool for future primary care research. GT was useful for identifying patterns in health behaviours across time but did not offer any useful information on access to/experiences of primary care. Conducting numerous searches on GT identified various limitations, including internet bias and news bias. GT is an accessible and vast data source. This study demonstrated the potential for GT to play a role in researching health behaviours. However, this study also revealed key limitations of GT, and caution should be exercised by primary care researchers and GPs when using GT for research.

Anxiety disorders and depression are associated with resistant hypertension.

Anxiety and depression can adversely affect the prognosis following cardiovascular diseases (CVDs) and may be associated with resistance to hypertension (HT) treatment. A better understanding of the complex biological substratum of resistant HT complicated by depression and anxiety is crucial for designing future primary care strategies. To evaluate the relationship between anxiety and depression and resistant HT, which will help to look at resistant HT from a broader perspective and aid the development of new strategies for diagnosis and treatment. We used a stratified random sampling method to select HT patients aged 18 and older in primary care setting. A total of 300 consecutive patients with persistent HT who were diagnosed with essential HT and uncontrolled blood pressure (BP) despite antihypertensive therapy were prospectively included in the study. Anxiety and depression were investigated, and scoring was evaluated using the Hospital Anxiety and Depression Scale (HADS). The study included 108 controlled and 91 uncontrolled HT patients. The HADS scales were higher in the controlled HT group compared to the uncontrolled HT group (6 (0-18) compared to 9 (0-20), p = 0.001; 5 (0-17) compared to 7 (0-16), p < 0.001, respectively). Body mass index (BMI) and C-reactive protein (CRP) were also significantly higher in the uncontrolled HT patients compared to the normotensive group. Anxiety was associated with a 2.18 times increased risk of HT and a 1.99 times increased risk of depression. Thus, anxiety and depression predicted resistant HT in both univariate and multivariate analyses. During the treatment of HT, efforts should be made to improve the psychological and social functions of the patients beyond the primary therapy for control of the disease. As such, we hope to draw attention to the importance of psychological factors, especially anxiety and depression, in any field of medicine related to managing resistant HT.