General Practice Care Research Articles

Exploring deep caries management and barriers to the use of vital pulp treatments by primary care dental practitioners.

The European Society of Endodontology outlines best practices for the management of deep caries and the pulp. Despite evidence supporting vital pulp treatments (VPTs) as predictable alternatives to conventional endodontic treatment, studies have shown they are not widely adopted in the UK. This study aimed to explore the barriers to implementation of VPTs by primary care general dental practitioners (GDPs). Qualitative one-to-one semi-structured online interviews were conducted with purposively sampled UK GDPs. Interview transcripts were analysed using reflexive thematic analysis. Recurring themes were iteratively refined as additional transcripts were reviewed. Eleven participants were interviewed. A range of barriers to the provision of VPTs were identified, which aligned with two core themes: 'Motivational barriers to service provision' and 'Educational access & opportunities'. Sub-themes included lack of access to materials and equipment, deficiencies in knowledge of treatment (including protocols, outcomes and prognosis), lack of confidence (in treatment efficacy and clinical ability), time constraints and public dental service funding and remuneration. This study identifies barriers to the widespread adoption of VPTs among primary care GDPs in public and private settings. Economic constraints, practitioner confidence, time limitations and educational gaps are key challenges. Addressing these may require systemic changes such as policy interventions, education and improved resource allocation.

Who visits primary health care general practitioners and why? A register-based study in a Finnish city

ABSTRACT This is a register-based study that examines the distribution of diagnoses made by general practitioners (GPs) in the public primary health care of the city of Vantaa, Finland. Data were gathered from the electronic health record (EHR) system and consisted of every record entered into the EHR system between 1 January 2016 and 31 December 2018. Both absolute numbers and relative proportions of the 10th edition of International Classification of Diseases (ICD-10) diagnosis recordings were reported and calculated. Among GP visits, the 88 most common diagnoses covered 75% of all diagnoses. The most common diagnoses were related to the musculoskeletal (3.8%, ICD code M54) and respiratory systems (6.0%, ICD-10 code J06). Primary health care GP services were mostly used by children (age <5 years) and older adults (>65 years). Health examinations – mostly children’s and maternity clinics appointments/visits – covered 20% of the GP office visits. Women between the ages 15–79 years had relatively more GP visits compared to men. The 88 most commonly recorded diagnoses covered the majority of the GP visits. Health examinations for the healthy were an important part of GPs’ work. In an urban Finnish city, GP services were predominantly used by children and older adults.

Trends in hypertension and hypertension treatment in primary care in general practices in Germany between 2013 and 2022.

There is a scarcity of data on the epidemiology of hypertension and its treatment in Germany in recent years. The present study aimed to investigate trends in the number of adults diagnosed with hypertension and those being prescribed antihypertensive drugs each year in general practices from this country between 2013 and 2022. This retrospective cohort study used data of adults aged ≥18 years continuously collected from 336 general practices in Germany (IQVIA) during 2013-2022. The diagnosis of hypertension and the prescription of antihypertensive drugs were coded using the ICD-10 and the EphMRA classification, respectively. Covariates included the total number of patients, mean (SD) age of patients, and proportion of women per practice. Trends in hypertension diagnosis and treatment were studied using linear regression models. The mean (SD) total number of patients per practice ranged from 2,235 (1,055) in 2013-2,845 (2,090) in 2021 (p-value < 0.001). The mean (SD) age of patients per practice was between 48.4 (21.5) and 50.5 (21.4) years, while the proportion of women was 52.1%-53.9% (p-values < 0.001). After adjusting for covariates, there was a significant decrease in the number of patients diagnosed with hypertension (beta coefficient = -7.91, p-value < 0.001) and treated with any antihypertensive drug per practice per year between 2013 and 2022 (beta coefficient = -5.40, p-value < 0.001). This study identified decreasing trends in the diagnosis and treatment of hypertension in general practices in Germany in the last decade. These data may suggest that the prevention of hypertension has improved in this country in recent years.

Usual care for low back pain and barriers to best practice: A cross-sectional study in Danish general practice.

To describe the current content of low back pain (LBP) care in Danish general practice, the patients' self-management activities, and the clinicians' experienced barriers to providing best practice care. This cross-sectional observational study included adults with LBP seeking care in Danish general practice from August 2022 to June 2023. Patient-reported information included demographics, pain intensity, medical history, treatments, and self-management strategies. Clinicians provided data specific to each consultation, detailing the content of these consultations, and barriers to best practice in the specific cases. The study involved 71 clinicians from 42 general practice clinics, with patient-reported data from 294 patients, and clinician-reported data from 283 (95%) consultations. The mean age for the included patients was 53years, 56% were female, and 31% had been on sick leave for LBP during the previous 3months. Moreover, 44% had seen two or more healthcare professionals in the previous month, 55% had previously undergone diagnostic imaging for LBP, 81% reported using any type of analgesics, and 14% reported using opioids. The majority (91%) reported engaging in self-management activities to alleviate pain. Consultations typically included a physical examination (84%), information about the cause of the pain (74%), and management advice (68%), as reported by clinicians or patients. In general, clinicians reported consultation elements more frequently than patients. Clinicians reported providing best practice care in 84% of cases, with time constraints (23%) and patient expectations (10%) being the most common barriers. This study provides detailed insights into the management of LBP in Danish general practice. It reveals a complex landscape of patient engagement, varying management strategies, and differing perceptions of care content between patients and clinicians. Patients were often engaged in self-management activities and clinicians reported few barriers to providing best practice care.

Quand mettre en route un traitement systémique dans la dermatite atopique ?

Despite the advent of numerous new treatments for atopic dermatitis, many patients, both adults and children, are still on treatment errands and are not receiving sufficient treatment to control their disease in the long term. It is therefore important to identify patients who need systemic treatment when topical treatments are no longer suitable. The decision to initiate a systemic treatment must be based on several factors that go well beyond the marketing authorisation and reimbursement of a drug. This approach involves a multidimensional assessment of the disease’s severity, in which scores have a place if they are feasible in practice and if they take into account the patient’s perception of their symptoms and the impact of the disease on their quality of life. Shared decision-making means that the expectations of the doctor and the patient (or the patient’s family in the case of children) can be harmonised, and a suitable and realistic therapeutic objective can be defined in a collaborative manner. Identifying a patient eligible for systemic treatment at an early stage requires appropriate training in primary care (general practitioner or paediatrician) and a good city-hospital cooperation for the dermatologist or allergist in order to facilitate the patient pathway and guarantee access to «the right treatment at the right time».

A novel case-finding strategy based on artificial intelligence for the systematic identification and management of individuals with osteoporosis or at varying risk of fragility fracture.

Osteoporotic fractures represent a major cause of morbidity and, in older adults, a precursor of disability, loss of independence, poor quality of life and premature death. Despite the detrimental health impact, osteoporosis remains largely underdiagnosed and undertreated worldwide. Subjects at risk for osteoporosis-related fractures are identified either via organised screening or case finding. In the absence of a population-based screening policy, subjects at high risk of fragility fractures are opportunistically identified when a fracture occurs or because of other clinical risk factors (CRFs) for osteoporotic fracture and areal bone mineral density (aBMD) measured by dual-energy X-ray absorptiometry (DXA). This paper describes the development of a novel case-finding strategy, named Osteoporosis Diagnostic and Therapeutic Pathway (ODTP), which enables to identify subjects with osteoporosis or at varying risk of fragility fracture. This strategy is based on a specifically designed software tool, named "Bone Fragility Query" (BFQ), which analyses the electronic health record (EHR) databases of General Practitioners (GPs) to systematically identify individuals who should be prescribed DXA-BMD measurement, vertebral fracture assessment (VFA) and anti-osteoporosis medications (AOM). The ODTP through BFQ tool is a feasible, convenient and time-saving osteoporosis model of care for GPs during routine clinical practice. It enables GPs to shift their focus from what to do (clinical guidelines) to how to do it in the primary health care setting. It also allows a systematic approach to primary and secondary prevention of fragility fractures, thereby overcoming clinical inertia and contributing to closing the gap between evidence and practice for the management of osteoporosis in primary care.

Price and Location on Patient Treatment Decisions Outpatient Care in General Practitioner Practices

Price and Location on Patient Treatment Decisions Outpatient Care in General Practitioner Practices

Norwegian general practitioners’ perceptions of their depression care – a national survey

BackgroundThe General Practitioner (GP) is often the first professional contact for patients with depression. Depression care constitutes a substantial part of GPs’ workload.ObjectiveTo assess how GPs experience their patients’ expectations and their own provision of depression care; further, how their depression care was associated with doctor- and practice-characteristics.MethodsA cross-sectional questionnaire study about depression care in general practice among the GPs in the Norwegian Physician Survey of 2021.ResultsOf the 221 responding GPs, 50% were female and 70% agreed to have constant time pressure due to workload. The GPs believed that patients with depression were interested in their professional assessment (87.2%) and saw them as providers of talking therapy (76,9%). Still, 77,8% of the GPs thought the patients expected a referral. Talking therapy was commonly provided (79.6%) along with consultations of more than 30 min (80.4%). The youngest age group and GPs with shorter patient lists spent more time. Most GPs (92.3%) considered their help to be of great benefit for depressed patients. However, one-fourth of the GPs did not feel competent in providing talking therapy, less frequently reported by the GPs aged 40–54 years.ConclusionsTalking therapy is commonly provided by GPs. However, there is a need to investigate what GP talking therapy implies, and to strengthen GP skills in this regard. Overall, the GPs experience their depression care to be useful for their patients, and do not de-prioritize this although they experience workload pressure.

Advancing integrated paediatric care in Australian general practices: Qualitative insights from the SC4C GP-paediatrician model of care.

The Strengthening Care for Children (SC4C) is a general practitioner (GP)-paediatrician integrated model of care that consists of co-consulting sessions and case discussions in the general practice setting, with email and telephone support provided by paediatricians to GPs during weekdays. This model was implemented in 21 general practices in Australia (11 Victoria and 10 New South Wales). Our study aimed to identify the factors moderating the implementation of SC4C from the perspectives of GPs, general practice personnel, paediatricians and families. We conducted a qualitative study as part of the mixed-methods implementation evaluation of the SC4C trial. We collected data through virtual and in-person focus groups at the general practices and phone, virtual and in-person interviews. Data was analysed using an iterative hybrid inductive-deductive thematic analysis. Twenty-one focus groups and thirty-seven interviews were conducted. Overall, participants found SC4C acceptable and suitable for general practices, with GPs willing to learn and expand their paediatric care role. GPs cited improved confidence and knowledge due to the model. Paediatricians reported an enhanced understanding of the general practice context and the strain under which GPs work. GPs and paediatricians reported that this model allowed them to build trust-based relationships with a common goal of improving care for children. Additionally, they felt some aspects, including the lack of remuneration and the work and effort required to deliver the model, need to be considered for the long-term success of the model. Families expressed their satisfaction with the shared knowledge and quality of care jointly delivered by GPs and paediatricians and highlighted that this model of care provides easy access to specialty services without out-of-pocket costs. Future research should focus on finding strategies to ensure the long-term Implementation of this model of care with a particular focus on the individual stressors in general practices.

Factors influencing referral to maternity models of care in Australian general practice.

In the Australian maternity system, general practitioners play a vital role in advising and directing prospective parents to maternity models of care. Optimising model of care discussions and the decision-making process avoids misaligning women with over or under specialised care, reduces the potential for disruptive care transitions and unnecessary healthcare costs, and is critical in ensuring consumer satisfaction. Current literature overwhelmingly focusses on women's decision-making around model of care discussions and neglects the gatekeeping role of the General Practitioner (GP). This study aimed to explore and describe the factors influencing Australian GPs decision-making when referring pregnant women to maternity models of care. This study used a qualitative descriptive approach. General practitioners (N = 12) with experience referring women to maternity models of care in Australia participated in a semi-structured interview. Interviews occurred between October and November 2021 by telephone or videoconference. Reflexive thematic analysis was facilitated by NVivo-12 data management software to codify and interpret themes from the data. Two broad themes were interpreted from the data. The first theme entitled 'GP Factors', incorporated three associated sub-themes including '1) GPs Previous Model of Care Experience', '2) Gaps in GP Knowledge' and '3) GP Perception of Models of Care'. The second theme, entitled 'Woman's Factors', encapsulated two associated sub-themes including the '4) Woman's Preferences' and '5) Access to Models'. This study provides novel evidence regarding general practitioner perspectives of the factors influencing model of care decision-making and referral. Predominant findings suggest that gaps in GP knowledge regarding the available models of care are present and are largely informed by prior personal and professional experience. Most GPs described referring to models of care they perceive positively and centring their model of care discussions on the woman's preferences and accessibility. The exploration and description of factors influencing model of care decisions provide unique insight into the ways that all stakeholders can experience access to a broader range of models of care including midwifery-led continuity of care models aligned with consumer-demand. In addition, the role of national primary health networks is outlined as a means to achieving this.

“I do not know the advantages of having a general practitioner” - a qualitative study exploring the views of low-acuity emergency patients without a regular general practitioner toward primary care

BackgroundEmergency departments (ED) worldwide have to cope with rising patient numbers. Low-acuity consulters who could receive a more suitable treatment in primary care (PC) increase caseloads, and lack of PC attachment has been discussed as a determinant. This qualitative study explores factors that contribute to non-utilization of general practitioner (GP) care among patients with no current attachment to a GP.MethodQualitative semi-structured telephone interviews were conducted with 32 low-acuity ED consulters with no self-reported attachment to a GP. Participants were recruited from three EDs in the city center of Berlin, Germany. Data were analyzed by qualitative content analysis.ResultsInterviewed patients reported heterogeneous factors contributing to their PC utilization behavior and underlying views and experiences. Participants most prominently voiced a rare need for medical services, a distinct mobility behavior, and a lack of knowledge about the role of a GP and health care options. Views about and experiences with GP care that contribute to non-utilization were predominantly related to little confidence in GP care, preference for directly consulting medical specialists, and negative experiences with GP care in the past. Contrasting their reported utilization behavior, many interviewees still recognized the advantages of GP care continuity.ConclusionUnderstanding reasons of low-acuity ED patients for GP non-utilization can play an important role in the design and implementation of patient-centered care interventions for PC integration. Increasing GP utilization, continuity of care and health literacy might have positive effects on patient decision-making in acute situations and in turn decrease ED burden.Trial registrationGerman Clinical Trials Register: DRKS00023480; date: 2020/11/27.

Rescuing the profession we love: general practice training sector recommendations for improving the attractiveness of general practice training. A qualitative analysis.

To investigate the views of the general practice training sector about responding to recruitment challenges, with the aim of identifying effective initiatives and other solutions. Qualitative study; focus group discussion of recommendations from a medical educator workshop. An initial online appreciative enquiry workshop for medical educators followed by focus group discussions by a broader selection of people involved in general practitioner training (Royal Australian College of General Practitioners fellows, supervisors, practice managers, medical educators, registrars). Key overarching themes and major recommendations for increasing recruitment derived from focus group responses to workshop recommendations, based on qualitative descriptive analysis. The 26 medical educators at the workshop made four major recommendations: increase the number of student and junior doctor clinical placements in general practice; increase exposure of students and junior doctors to general practitioner teachers and educators; improve general practitioner trainee pay and entitlements; and improve the integration of general practice and hospital patient care and professional relationships. Thirty-four semi-structured focus group participants broadly supported the recommendations, provided that supervisors and training practices were adequately compensated for the effects on workloads, income, and patient care. Two overarching themes infused participant responses: "rescuing the profession we love" (reflecting participants' passion for general practice and their sense of threat), and "no idea what general practitioners do" (perceptions of being misunderstood and misrepresented by hospital-based practitioners). Clinicians, educators, and policy makers should work together to increase the number of high quality, adequately supported student and junior doctor placements in general practice, improve intra-professional relationships, and trial new models of general practitioner trainee payment and conditions.

General practitioner care for arterial diseases

General practitioner care for arterial diseases

Saxon Epidemiological Study in General Practice-6 (SESAM-6): protocol of a cross-sectional study

IntroductionGeneral practitioners (GPs) are mostly the first point of contact for patients with health problems in Germany. There is only a limited epidemiological overview data that describe the GP consultation...

Healthcare professionals’ perspectives on the key considerations for digital technology aiding the early detection of dementia-causing diseases: a qualitative approach

Abstract Introduction Digital health technologies (DHTs) can assist with the early detection of dementia-causing diseases.(1) Previous research has highlighted the benefits of involving health care professionals (HCPs) in their design and development.(2) Aim Explore HCPs’ perspectives on the key considerations when using DHTs for the early detection of dementia-causing diseases in healthcare settings. Methods HCPs in the National Health Service with a patient-facing role (independent of speciality or experience) were recruited using online clinical networks. Semi-structured interviews were conducted remotely (over Zoom) exploring their acceptance of DHTs and providing an early detection service, the optimal location for the service, and the challenges surrounding implementation. With the aid of NVivo, we applied an inductive framework approach using the ‘constant comparison’ to identify recurring themes in the data. Results Primary care (general practitioners [n=11]) and secondary care staff (mental health nurses [n=3], dementia specialist nurse [n=1], psychiatrist [n=1], community psychiatric nurse [n=1], care coordinator [n=1]) were interviewed. Three key themes were generated relating to healthcare service users, healthcare professionals, and DHTs (Table 1). HCPs stressed the importance of defining a target healthcare service user group to avoid wasting resources and avoiding contributing towards health inequities in terms of access to the service and post-detection care. Brain Health Centres, which use a combination of clinical and research methods for early detection, were favoured over traditional primary or secondary care settings, due to workload concerns. HCPs suggested training be provided to help interpret results and provide appropriate interventions post detection. Many HCPs were excited about the benefit of collecting longitudinal real-time data that could monitor patients over time but raised concerns around the accuracy of current digital tools. Conclusion Results highlighted important considerations for HCPs when developing and implementing DHTs to aid the early detection of dementia-causing diseases in clinical settings. Participants had an interest in older people’s health, dementia, mild cognitive impairment or digital health, which may have influenced their perspectives; however, our work shows DHTs should not contribute towards health inequities. Future work is needed to explore the perspectives of groups experiencing health inequities within the design, development and implementation of DHTs.

Strategies that facilitate the delivery of exceptionally good patient care in general practice: a qualitative study with patients and primary care professionals

BackgroundIn recent years, proactive strengths-based approaches to improving quality of care have been advocated. The positive deviance approach seeks to identify and learn from those who perform exceptionally well. Central to this approach is the identification of the specific strategies, behaviours, tools and contextual strategies used by those positive deviants to perform exceptionally well. This study aimed to: identify and collate the specific strategies, behaviours, processes and tools used to support the delivery of exceptionally good care in general practice; and to abstract the identified strategies into an existing framework pertaining to excellence in general practice; the Identifying and Disseminating the Exceptional to Achieve Learning (IDEAL) framework.MethodsThis study comprised a secondary analysis of data collected during semi-structured interviews with 33 purposively sampled patients, general practitioners, practice nurses, and practice managers. Discussions explored the key factors and strategies that support the delivery of exceptional care across five levels of the primary care system; the patient, provider, team, practice, and external environment. For analysis, a summative content analysis approach was undertaken whereby data were inductively analysed and summated to identify the key strategies used to achieve the delivery of exceptionally good general practice care, which were subsequently abstracted as a new level of the IDEAL framework.ResultsIn total, 222 individual factors contributing to exceptional care delivery were collated and abstracted into the framework. These included specific behaviours (e.g., patients providing useful feedback and personal history to the provider), structures (e.g., using technology effectively to support care delivery (e.g., electronic referrals & prescriptions)), processes (e.g., being proactive in managing patient flow and investigating consistently delayed wait times), and contextual factors (e.g., valuing and respecting contributions of every team member).ConclusionThe addition of concrete and contextual strategies to the IDEAL framework has enhanced its practicality and usefulness for supporting improvement in general practices. Now, a multi-level systems approach is needed to embed these strategies and create an environment where excellence is supported. The refined framework should be developed into a learning tool to support teams in general practice to measure, reflect and improve care within their practice.

Importance of B-Type Natriuretic Peptide in the Detection of Patients With Structural Heart Disease in a Primary Care Setting.

Early detection and intervention for preclinical heart failure (HF) are crucial for restraining the potential increase in patients with HF. Thus, we designed and conducted a single-center retrospective cohort study to confirm the efficacy of B-type natriuretic peptide (BNP) for the early detection of preclinical HF in a primary care setting. We investigated 477 patients with no prior diagnosis of HF who were under the care of general practitioners. These patients were categorized into 4 groups based on BNP concentrations: Category 1, 0 pg/mL≤BNP≤35 pg/mL; Category 2, 35 pg/mL<BNP≤100 pg/mL; Category 3, 100 pg/mL<BNP≤200 pg/mL; and Category 4, BNP >200 pg/mL. There was a marked and statistically significant increase in the prevalence of preclinical HF with increasing BNP categories: 19.9%, 57.9%, 87.5%, and 96.0% in Categories 1, 2, 3, and 4, respectively. Compared with Category 1, the odds ratio of preclinical HF in Categories 2, 3, and 4 was determined to be 5.56 (95% confidence interval [CI] 3.57-8.67), 23.70 (95% CI 8.91-63.11), and 171.77 (95% CI 10.31-2,861.93), respectively. Measuring BNP is a valuable tool for the early detection of preclinical HF in primary care settings. Proactive testing in patients at high risk of HF could play a crucial role in addressing the impending HF pandemic.

Patients' views on primary care multidisciplinary teams in Scotland: a mixed-methods evaluation.

Expanding primary care multidisciplinary teams (MDTs) was a key component of the 2018 Scottish GP contract, with more than 4700 MDT staff appointed since then. To explore patients' views on primary care MDT expansion in Scotland. A mixed-methods evaluation, which included a postal survey and semi-structured telephone interviews with patients in Scotland. A survey was undertaken of patients who had recently consulted a GP in deprived urban, affluent urban, and remote and rural areas, assessing awareness of five MDT roles and attitudes towards receptionist signposting. In addition, 30 individual interviews were conducted, exploring patients' MDT-care experiences. Of 1053 survey responders, most were unaware of the option of MDT rather than GP consultations for three out of five roles (69% unaware of link worker appointments; 69% mental health nurse; and 58% pharmacist). Reception signposting was less popular in deprived urban areas (34% unhappy versus 29% in remote and rural versus 21% affluent urban; P<0.001), and in patients with multimorbidity (31% unhappy versus 24% in non-multimorbid; P<0.05). Just over two-thirds of interviewees had multimorbidity and almost all reported positive MDT-care experiences. However, MDT care was generally seen as a supplement rather than a substitute for GP care. Around half of patients expressed concerns about reception signposting. These patients were more likely to also express concerns about GP access in general. Both of these concerns were more common in deprived urban areas than in remote and rural or affluent urban areas. MDT care has expanded in Scotland with limited patient awareness. Although patients understand its potential value, many are unhappy with reception signposting to first-contact MDT care, especially those in deprived urban areas living with multimorbidity. This represents a barrier to the aims of the new GP contract.

Teleconsulting in wound care: Connecting the primary care to the wound specialist reduces unnecessary referrals.

In the Netherlands the primary care (General Practitioner or homecare nurse) encounter a variety of wounds ranging from traumatic to diabetic foot ulcers. According to a recent study 82.4% of the patients with a wound can be treated in a primary setting with the GP as medical supervisor. The remaining 17.6% of patients need more extensive care including advice by a specialised doctor, diagnosis and treatment. Prompt analyses and treatment of underlying causes by specialised doctors in a multidisciplinary setting is necessary for treating patients with complicated wound. This article describes the impact of Electronic Health Consultation on all wounds treated in the primary care. And describes the effect on the duration until referral to the hospital and the influence on the amount of unnecessary referrals to the hospital. All data was collected prospectively from June 2020 until October 2021. The study involved a process where primary care could seek advice from a Wound Physician at the Alrijne Wound Centre through a specialised Electronic Health Consultation. A total of 118 patients were analysed. 41/118 (34.7%) patients required a physical consultation with analysis and treatment in the hospital, after teleconsultation. The remaining 77/118 (65.3%) could be treated in primary care after Electronic Health Consultation. The mean duration of wound existence until Electronic Health Consultation was 39.3 days (range 5-271, SD: 38.5). 3/41 (7.3%) of the referrals were unnecessary. Electronic Health Consultation serves as a valuable and efficient tool for enhancing wound care, ultimately contributing to improved patient management and resource allocation within the healthcare system. This article describes the impact of Electronic Health Consultation on all wounds treated in the primary care and the influence on the duration until referral to the hospital and the influence on the amount of unnecessary referrals to the hospital.

Improving mental health in chronic care in general practice: study protocol for a cluster-randomised controlled trial of the Healthy Mind intervention

BackgroundMental health issues are common among patients with chronic physical conditions, affecting approximately one in five patients. Poor mental health is associated with worse disease outcomes and increased mortality. Problem-solving therapy (PST) may be a suitable treatment for targeting poor mental health in these patients. This study protocol describes a randomised controlled trial of the Healthy Mind intervention, a general practice-based intervention offering PST to patients with type 2 diabetes and/or ischaemic heart disease and poor mental well-being.MethodsA stepped-wedge cluster-randomised controlled trial with 1-year follow-up will be conducted in Danish general practice. At the annual chronic care consultation, patients with type 2 diabetes and/or chronic ischaemic heart disease will be screened for poor mental well-being. Patients in the control group will be offered usual care while patients in the intervention group will be offered treatment with PST provided by general practitioners (GPs) or general practice staff, such as nurses, who will undergo a 2-day PST course before transitioning from the control to the intervention group. The primary outcome is change in depressive symptoms after 6 and 12 months. Secondary outcomes include change in mental well-being, anxiety, and diabetes distress (patients with type 2 diabetes) after 6 and 12 months as well as change in total cholesterol levels, low-density lipoprotein (LDL) levels, and blood glucose levels (patients with diabetes) after 12 months. Process outcomes include measures of implementation and mechanisms of impact. We aim to include a total of 188 patients, corresponding to approximately 14 average-sized general practices.DiscussionThe Healthy Mind trial investigates the impact of PST treatment for patients with chronic disease and poor mental well-being in general practice. This will be the first randomised controlled trial determining the effect of PST treatment for patients with chronic diseases in general practice. The results of this study will provide relevant insights to aid GPs, and general practice staff manage patients with poor mental well-being.Trial registrationClinicalTrials.gov NCT05611112. Registered on October 28, 2022.