Primary Care Treatment Research Articles

Vécu de patients dans la prise en soin d’une néoplasie par leur médecin généraliste. Étude qualitative de narrations de cas

Little research has been done on the follow-up of patients in the active phase of treatment in primary care. This study aimed to build up a corpus of authentic clinical situations and carry out an inductive analysis of the data. Research in two stages: case study and qualitative analysis of verbatims. The authors conducted individual interviews using an interview guide. The questions targeted their experiences, focusing on their relationship with their general practitioner. Six themes were identified. The announcement of the diagnosis was a key moment. Patients emphasised their general practitioner's responsiveness and coordination, and stressed his involvement. They consulted him regularly during the active phase of treatment, and asked for information. They felt confident. The need to facilitate access to the general practitioner was noted, particularly in the event of a real or perceived emergency. The increase in the prevalence and incidence of cancer means that general practitioners need to be heavily involved. The authorities are advocating a strengthening of the general practitioner's "pivotal role", without clearly defining it. A perceived lack of skills may be an obstacle to general practitioner involvement. Training in cancer during the 3rd cycle of general medical studies is inadequate. By compiling and analysing a corpus of cases, it would be possible to redefine the training objectives and list the skills required to manage cancer patients.

Combining cohorts of prospectively collected and linked data to improve health after release from prison

BackgroundWhile people who experience incarceration have remarkably poor health profiles, undertaking research to inform evidence-based responses is complicated by difficulties of recruiting people in prison; high rates of socioeconomic marginalisation, study attrition; and legislative and financial barriers to linked data research. There are many advantages to pooling data from multiple studies involving people who experience incarceration, including greater statistical power and geographic and participant heterogeneity. However, there are also challenges that need to be addressed. MethodsWe combined four prospective cohort studies of adults released from prisons in four Australian states. Pre-release interviews, and validated screening assessments, were linked to primary care, medicine dispensing, hospital, alcohol and other drug treatment services, ambulatory mental health, ambulance, corrective services, and death records. Data were harmonised by team members reviewing variable definitions and categories within subject domains. ResultsThe combined cohort consists of 4,232 adults, including 1,544 Indigenous people and 905 women, with a median age of 31 years. Data linkage will enable a median of 9.3 years of prospective follow-up after release from incarceration. Differences in data structures, coding systems between and within datasets, changes over time, and grouping of records belonging to the same event were also addressed. ConclusionThis combined multi-site cohort study is an example of a complex, policy-oriented data linkage project. It was developed to underpin evidence-based, culturally appropriate interventions, health policy and service development for people who were incarcerated. This presentation will discuss the processes and pitfalls experienced while building a multi-sectoral, multi-jurisdictional data linkage project.

Child mental health treatment access and retention in integrated primary care and traditional outpatient services.

There are disparities in child mental health treatment access and treatment retention in terms of race and ethnicity, socioeconomic status (SES), and insurance coverage. Institutions have invested in the integrated primary care (IPC) treatment model with the goal of improving treatment access and promoting child mental health equity. This study compared treatment attendance in an outpatient psychiatry clinic (OPC) versus an IPC clinic to assess whether the IPC was associated with reduced disparities in access to care and treatment retention. This study assessed whether there were differences in who is connected to care from the intake appointment to first follow-up appointment. Results showed that the IPC clinic served a more diverse patient population than the OPC clinic in terms of SES, race, and ethnicity. Differences in treatment attendance in the IPC and OPC were also found. After controlling for race, ethnicity, insurance, and distance from patient's home zip code to clinic, the IPC treatment setting was associated with poorer intake and follow-up appointment attendance. The IPC model may be more accessible to historically underserved youth, but the treatment setting does not inherently eliminate disparities in child mental health treatment retention. Replication of this study has the potential to contribute to the external validity of study findings, improve quality assurance policies, and develop equitable workflow policies. Future research is needed to identify factors that can improve treatment attendance for populations who face greater retention barriers and to shine light on ways that healthcare systems may inadvertently maintain disparity in treatment retention.

Study protocol of a proposed Neurofeedback-Assisted Mindfulness Training Program on symptoms of anxiety and psychological distress associated with smartphone use in young adults: a randomized controlled trial.

Nomophobia is a specific phobia characterized by the appearance of anxiety, nervousness, discomfort and distress when the mobile phone is not used and is considered an emerging public health problem because of the negative consequences on the physical and mental health of young people and adolescents, especially women. Neurofeedback-Assisted Mindfulness Training Programs may prove beneficials for improving self-control abilities, a key ability in addressing addictive behaviors. The main objective of this study is to evaluate the impact, in a young population aged 18-35 years, of an intervention based on Neurofeedback-Assisted Mindfulness Training Program (NAMTP) on disorders associated with problematic use of mobile phones. The effect of the intervention on the total score in the nomophobia test and habits of internet and social network use, as well as on signs of depression, anxiety and stress will be analyzed. As a secondary objective, the effect of the intervention on signs of insomnia will be analyzed. Randomized, controlled clinical-trial with two-parallel groups. 40 young adults (18-35 years) will be included and randomly assigned to Intervention Group-NAMTP or Control Group (CG). The NAMTP will include a total of 25 sessions (2-3/week) during 3-months. Each session will have a duration of 10/15 min. The instrument to be used for the neurofeedback sessions is MUSE® (InteraXon Inc.). Study variables will be collected at the baseline visit and at the final visit (3-months after randomization). During these visits, questionnaires will be administered to evaluate the main and secondary variables that will include the Smartphone Addiction Scale-Short Version, Nomophobia Questionnaire, Depression, Anxiety and Stress Scale 21-item (DASS-21) and Athens Insomnia Scale. This trial will make an important contribution to the need for evidence of effective education programs and other primary care interventions through new non-invasive interventions in reducing the risk of developing addictions to new technologies and alleviating the symptoms of discomfort associated with this problem. The project was approved by the Clinical Research Ethics Committee of the Salamanca Health Area (CEIm Code: PI 2023 071340). ClinicalTrials.gov, http://www.Clinicaltrials.gov/ct2/show/NCT06188910.

Analyzing childhood (0-59 months) malnutrition determinants in five West African Countries of Gabon, Gambia, Liberia, Mauritania, and Nigeria using survey logistic regression-insights from DHS data

BackgroundMalnutrition is one of the most critical health challenges confronting public health agencies in developing nations. This study aimed to determine the scope and underlying factors contributing to malnutrition in West African countries, specifically Gabon, Gambia, Liberia, Mauritania, and Nigeria.MethodFor this secondary data analysis, this study drew upon the demographic and health surveys (DHS) conducted within these West African nations. These surveys employed a complex sampling design involving a combination of stratification and cluster sampling in two stages, with varying probabilities of selection leading to weighted samples that effectively represented different components of the population. Given the intricacies of this sampling design, it is paramount to account for them when analyzing the survey data. To address this concern, this study applied a survey logistic regression model, which accommodates factors such as stratification, clustering, and sampling weights and departs from the assumption of independence inherent in the ordinary logistic regression model.ResultsThe outcomes of this model revealed several variables that emerged as statistically significant (p < 0.05) determinants of malnutrition. These influential factors encompass the region of the respondent, the current age of the mother, the highest level of education attained by the mother, the source of drinking water, the type of toilet facility, the household’s wealth status, the age and gender of the child, and whether the child experienced a fever in the preceding two weeks.ConclusionThese findings demonstrate with poignant clarity the importance of primary health care interventions in the recognition and management of malnutrition. The countries of interest should invest in public health care interventions including community workshops and outreach programs. Workshops may occur at primary health care facilities during queue waits, or health workers may work with community leaders to perform workshops in areas of high foot traffic, such as places of worship, shopping hubs and collection points for financial aid or grants.

Therapeutic inertia in obesity management among people living with obesity from the perspective of general/family practitioners in Canada: A mixed-methods study.

This mixed-methods study aimed to explore factors contributing to therapeutic inertia among people living with obesity in Canada from the perspective of general/family practitioners (GP/FPs). One-on-one interviews and online surveys guided by the Theoretical Domains Framework were conducted. A total of 20 general/family practitioners were interviewed and 200 general/family practitioners were surveyed. Key findings from interviews were used to guide the development of the survey. Spearman's correlation analysis evaluated the association between general/family practitioners theme domain scores and their familiarity with the 2020 Canadian Adult Obesity Clinical Practice Guidelines. The 200 general/family practitioners surveyed provided representation across Canada, with diversity in age, background, and gender. The most prominent domains related to therapeutic inertia that were positively influenced by familiarity with Clinical Practice Guidelines were Beliefs about Capabilities (rs = .27; p < .01), Skills (rs = .23; p < .01), Behavioural Regulation (rs = .24; p < .01) and Emotions (rs = .23; p < .01). Irrespective of their familiarity with Clinical Practice Guidelines, most general/family practitioners reported that environmental and contextual barriers impact obesity management. Particularly, while financial barriers were reported by participants regardless of Clinical Practice Guidelines familiarity, general/family practitioners familiar with Clinical Practice Guidelines more often reported having time to discuss obesity management with patients. This study identified perceptions, resource and training considerations that contribute to healthcare decision-making and therapeutic inertia in obesity management among general/family practitioners and highlighted key areas to target with interventions in primary care to facilitate obesity management, which should be multi-faceted, with a focus on incorporating obesity education into healthcare providers training programs and improving systemic and financial support.

Glycemic status and effect on mortality: Multifactorial prevention programme for cardiovascular disease in Finnish primary care

AimsTo compare 13-year mortality rates in normoglycemic, prediabetic and diabetic subjects attending a community-based screening and intervention programme. MethodsPopulation survey identified 2569 cardiovascular disease (CVD) white risk subjects aged 45–70 years and without manifested CVD or diabetes. Oral glucose tolerance test was performed, and multifactorial intervention was provided. Effect of glycemic status on mortality was estimated in models adjusted for age, gender, education years, smoking, body mass index, mean arterial pressure, total cholesterol, and physical activity. ResultsOf the subjects, 2055 (77 %) were normoglycemic, 380 (14 %) had prediabetes and 224 (9 %) diabetes. Compared to the normoglycemic group, the fully adjusted hazard ratios (HR) for all-cause mortality were 1.34 (95 % CI: 0.98–1.83) in the prediabetes group and 2.31 (95 % CI: 1.62–3.31) in the diabetes group. Standardized mortality rates were 0.63 (95 % CI: 0.54–0.73), 0.91 (95 % CI: 0.69–1.18), and 1.55 (95 % CI: 1.19–2.02) in the normoglycemic, prediabetes, and diabetes groups, respectively. The most common cause of death was cancer (42 % of all deaths), followed by CVD (28 %). Conclusions/interpretationScreen-detected diabetes carries a substantial risk of death even after primary care intervention. The pattern of excess mortality has shifted towards cancer deaths.

The Role of Microbiome in Cardiovascular Health: Insights for Primary Care Interventions.

Cardiovascular diseases (CVDs) remain the leading cause of morbidity and mortality worldwide, highlighting the urgent need for effective prevention strategies. Emerging research suggests that the gut microbiome is critical in cardiovascular health, influencing pathophysiological processes associated with CVDs. This narrative review explores the intricate relationship between the gut microbiome and cardiovascular health, mainly focusing on how microbial composition affects inflammation, lipid metabolism, and endothelial function. Additionally, we discuss the implications of gut microbiome modulation through dietary interventions, prebiotics, and probiotics as potential therapeutic strategies for primary care practitioners. By emphasizing the importance of the microbiome in cardiovascular risk management, this review aims to inform primary care interventions that leverage microbiome research to improve patient outcomes and prevent CVDs. Ultimately, understanding and integrating gut health into cardiovascular care may provide a novel approach to enhancing cardiovascular resilience and reducing disease burden.

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.

Evaluation of the impact of an online video game as an educational intervention on sexual health and the prevention, diagnosis, and treatment of sexually transmitted infection: A randomized controlled trial protocol

BackgroundThe incidence of sexually transmitted infections (STIs) is increasing, especially among young people. Tools are needed to increase knowledge about sex education and STI prevention and treatment. Gamification can be a good training tool for both young people and health professionals. The primary objective of this study is to assess the impact of a training intervention on STI prevention, detection, and treatment in primary care professionals.Methods/designMulticentre cluster randomized controlled trial.Groups of primary care professionals will receive an intervention (online video game on sex education and STIs [SEXIT]) and will be compared with control groups that will not receive the intervention. Group assignments will be randomized by clusters.The study will consist of a pre-post evaluation of the intervention: a knowledge test will be administered before and after the intervention and 3 months after the intervention. This test will also be carried out on the same time sequence in the control groups. The impact of the training intervention will be assessed over a 6-month period, focusing on various variables associated with the clinical management of STIs. This evaluation entails the clinical records of diagnostic tests and antibiotic prescriptions related to the clinical approach to STIs.The required sample size is 262 (131 per group).DiscussionCompared with those in the control group, improvements in knowledge and clinical behavioural outcomes after the intervention are expected for participants in the intervention groups. We plan to develop an educational video game to increase the knowledge about sexuality, STIs and violence.Protocol registered at ISRCTN with reference number ISRCTN17783607.

Assessment of the Short-Term Efficacy of a Wet-Cupping Therapy Session in Alleviating Symptoms of Fibromyalgia Syndrome: A Single-Arm Clinical Trial

Fibromyalgia holds significant importance in both primary care and physical treatment settings due to its high prevalence and the challenges associated with its diagnosis and management. This study aims to assess the short-term efficacy of a wet-cupping therapy session in alleviating symptoms of Fibromyalgia Syndrome (FMS). This study employed a prospective, single-arm intervention design. Baseline and post-treatment evaluations encompassed a comprehensive battery of assessment tools: Socio-Demographic Questionary, Visual Analog Scale (VAS) for Pain, Fatigue Severity Scale (FSS), Beck Depression Scale (BDS), Fibromyalgia Impact Questionnaire (FIQ). A total of 20 eligible individuals were enrolled in the study. Significant alterations in pain perception, as measured by the VAS, were evident both prior to treatment and at the end of the first week of treatment (p &lt; 0.001). Additionally, significant favorable effects of the treatment were observed on FSS and BDS levels during the initial week of therapy (p = 0.001, p = 0.01; respectively). Moreover, a marked improvement was identified in FIQ scores after treatment compared to baseline (p &lt; 0.001). Across all evaluated clinical indicators, cupping therapy exhibited a significant positive influence on FMS. In conclusion, wet cupping therapy yields favorable outcomes in terms of pain perception, fatigue reduction, mood enhancement, and the overall impact of fibromyalgia syndrome. Thus, it offers a promising avenue for therapeutic intervention among individuals afflicted by this condition.

Partnerships with primary care providers: Opportunities to prevent eating disorders and mitigate their progression in young people

ABSTRACT Epidemiologic research has identified numerous interpersonal and individual risk factors for and warning signs of emerging eating disorders in adolescents. These findings have informed public health prevention and treatment strategies, including translation of findings to clinical recommendations for primary care providers (PCPs). A next step in this translational work could include a comprehensive approach where PCPs are seen as partners in efforts to improve population health outcomes. PCPs have great potential to implement high-yield interventions that prevent or attenuate the course of adolescent eating disorders. To illustrate this potential, we present a case that highlights missed opportunities for a PCP to prevent, detect, and intervene during a patient’s developing eating disorder. We then relate the case to two emerging research programs that utilize PCP partnerships: one trains PCPs in Strengths-Based Adolescent Healthcare to improve eating disorder prevention; the other adapts Family-Based Treatment for primary care to improve early access to evidence-based treatment. In addition to these promising areas of research, efforts are needed to widen requirements for eating disorder curricula in medical training programs and to address weight stigma in primary care. Together these efforts will help PCPs become effective partners in the prevention and treatment of eating disorders.

The Management of Depression and Anxiety in Primary Care: Examining Predictors of Adherence to a Psychopharmacological Collaborative Care Management Program for Veterans.

Collaborative care management (CoCM) is an evidenced based approach to psychiatric treatment in primary care, yet literature examining factors associated with program adherence is lacking. This study analyzed predictors of adherence to a CoCM model of psychopharmacological treatment of depression and anxiety in primary care by conducting a retrospective cohort analysis on Veterans referred to a large VA Medical Center's CoCM program over an 18-month period. Baseline characteristics, symptomatic assessments, and covariates of interest were collected. For the primary outcome, the association between covariates and programmatic completion were analyzed. Secondary analyses assessed improvements in psychiatric symptoms. A total of 757 Veterans with depressive or anxiety disorders were included, and 256 completed the CoCM program. Baseline covariates associated with differences in completion rates included the following: age, contact with psychology prior to referral, baseline PHQ-9, baseline GAD-7, and a number of comorbid psychiatric/substance abuse covariates. After controlling for baseline differences, age remained a significant positive predictor of completion (OR 1.019, 95% CI 1.008‒1.030) and cannabis use a significant negative predictor (OR 0.507, 95% CI 0.275‒0.934). Both early improvement in PHQ-9 (OR 1.864, 95% CI 1.210‒2.872) and GAD-7 (OR 1.762, 95% CI 1.154‒2.691) scores were positive predictors. Secondary analyses showed that programmatic completion was associated with greater reductions in psychiatric symptoms. Results identified a number of modifiable parameters associated with differences in completion rates and greater symptomatic reduction for those who complete the program. Additional studies should be conducted examining interventions to optimize CoCM programs by supporting positive predictors while minimizing negative predictors.

Pharmacist-led primary care interventions to promote medicines optimisation and reduce overprescribing: a systematic review of UK studies and initiatives

ObjectivesTo systematically review and synthesise evidence on the effectiveness and implementation barriers/facilitators of pharmacist-led interventions to promote medicines optimisation and reduce overprescribing in UK primary care.DesignSystematic review.SettingUK primary care.MethodsWe searched...

Occupational therapists’ experiences of photo-supported conversations – An intervention in primary health care

Background The health-promoting intervention BeWell™, which includes photo-supported conversations, is intended for people with stress-related illnesses. Its focus is on improving the individual’s health and well-being by addressing what contributes to well-being from the patient’s own perspective. There is no current knowledge of the experiences of occupational therapists of using BeWell™ in primary health care. It is thus important to gain knowledge of their experiences of using this intervention as part of investigating its feasibility. Aim To describe the occupational therapists’ experiences of photo-supported conversations about well-being (BeWell™) with patients diagnosed with stress-related illnesses. Material and methods Six occupational therapists, working in primary health care, who had conducted the photo-supported conversations about well-being (BeWell™), were interviewed individually, and one focus group discussion was also conducted. Systematic text condensation was used as the analysis method. Results Three main themes with two to three subgroups in each were identified; Discovering well-being through images, Enhancing patient’s own efforts towards well-being, and Contributing to one’s own well-being. Conclusions and significance The results provide important knowledge for the continued research work with BeWell™ by investigating how the users of the intervention experienced it.

Development of a peer-delivered primary care intervention to improve veteran mental health treatment engagement.

Veteran engagement in mental health treatment (MHT) remains low. Peer specialists (PS) are well positioned to implement interventions addressing barriers to MHT engagement, given their familiarity with the process. This study aimed to develop and assess the acceptability of a primary care-based, PS-delivered intervention to improve MHT initiation. Aim 1 utilized modified Delphi methods with a committee of 12 stakeholders (e.g., PS, psychologists, and veteran patients) who provided input on the proposed PS-delivered MHT engagement intervention. The proposed intervention components included questionnaires to identify barriers to engagement and targeted strategies for the barriers (e.g., motivational interviewing, cognitive restructuring). Aim 2 consisted of qualitative interviews with veterans entering MHT, focused on acceptability and feasibility, and gathered additional feedback for the intervention drafted in Aim 1. PS in primary care also reviewed the intervention and provided feedback. Results from Aim 1 demonstrated the acceptability of PS utilizing questionnaires in their work with Veterans, emphasized the importance of rapport building, and provided consensus on the identification of tailored treatment strategies. Veterans entering MHT (n = 9) reported that they were excited about the option of PS being involved in treatment engagement. PS (n = 18) also reported the overall acceptability of the intervention and provided feedback impacting the implementation of the intervention. Incorporating primary care PS into MHT engagement is acceptable. This study serves as the first step in developing a PS-delivered intervention to improve engagement in veteran MHT with input from a diverse group of stakeholders. Implications and future directions will be explored. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Effects of an exercise intervention in primary care after robot-assisted radical cystectomy for urinary bladder cancer: a randomised controlled trial

IntroductionAfter radical cystectomy physical activity is important to reduce risk of complications, but patients with urinary bladder cancer have difficulties in achieving general recommendations on physical activity and exercise. The aim of this randomised controlled trial was therefore to evaluate the effects of a physical exercise programme in primary care, following discharge from hospital after robot-assisted radical cystectomy for urinary bladder cancer.Materials and MethodsPatients with urinary bladder cancer scheduled for robot-assisted radical cystectomy at Karolinska University Hospital, Sweden between September 2019 and October 2022 were invited to join the study. At discharge, they were randomised to intervention or active control group. The intervention group was planned to start exercise with physiotherapist in primary care during the third week; the programme included aerobic and strengthening exercises, twice a week for 12 weeks, and daily walks. The control group received unsupervised home-based exercise with daily walks and a sit-to-stand exercise. Assessments were conducted before surgery, at discharge and after four months regarding the primary outcome physical function (Six-minute walk test), and secondary outcomes physical activity, pain, health-related quality of life, fatigue, and psychological wellbeing.ResultsNinety patients were included, mean (sd) age 71.5 (8.5) years. An intention-to-treat analysis showed no intervention effect on the primary outcome physical function, or on pain or psychological wellbeing, but effect on physical activity with a difference from discharge to four months with a median (IQR) of 4790 (3000) and 2670 (4340) daily steps in the intervention and control group, respectively (p = 0.046), and for fatigue, and health-related quality of life, in favour of the intervention group.ConclusionBoth the intervention and control groups improved physical function, but the patients who exercised in primary care experienced additional positive effects on physical activity, fatigue, and health-related quality of life. Hence, exercise in primary care after discharge from hospital could be a promising method after radical cystectomy for urinary bladder cancer.Trial registrationThe study was registered in Clinical Trials with registration number NCT03998579, 20,190,607.

Learning implementation of a guideline based decision support system to improve hypertension treatment in primary care in China: pragmatic cluster randomised controlled trial

ObjectiveTo evaluate the effectiveness of a clinical decision support system (CDSS) in improving the use of guideline accordant antihypertensive treatment in primary care settings in China.DesignPragmatic, open label, cluster randomised...

The Feasibility of an Educational Course for General Practitioners on Otolaryngologic Morbidity.

Objective To test feasibility by enhancing the knowledge and skills of general practitioners (GPs) in managing ear, nose, and throat (ENT) morbidity within primary care settingsthrough a three-hour educational course. Methods A structured course focused on common ENT disorders was conducted. Case morbidity was selected based on appropriate criteria. The participants (n=34) were GPs randomly assigned to control and intervention groups. A questionnaire assessed knowledge, attitudes, and practices (KAP)before and after the course using proper analysis. Results The intervention group showed significant improvement in responses within five of sixteen questions (p<0.05). Participants demonstrated greater knowledge responsiveness in relation to epistaxis and CENTOR criteria, while knowledge response improvement was poor in regard to vestibular morbidity. Overall improvement in KAP scores (p<0.05), with high effect sizes, was achieved before and after the seminar. Conclusions The three-hour ENT course for GPs was found to be feasible, emphasizing the need for targeted short-duration courses within GP educationsupported by locally relevant information on common ENT conditions. Future research should explore the long-term impact of similar collaborative interventions in primary care.

Multilevel perspectives on the implementation of the collaborative care model for depression and anxiety in primary care

BackgroundThe Collaborative Care Model (CoCM) is an evidence-based mental health treatment in primary care. A greater understanding of the determinants of successful CoCM implementation, particularly the characteristics of multi-level implementers, is needed.MethodsThis study was a process evaluation of the Collaborative Behavioral Health Program (CBHP) study (NCT04321876) in which CoCM was implemented in 11 primary care practices. CBHP implementation included screening for depression and anxiety, referral to CBHP, and treatment with behavioral care managers (BCMs). Interviews were conducted 4- and 15-months post-implementation with BCMs, practice managers, and practice champions (primary care clinicians). We used framework-guided rapid qualitative analysis with the Consolidated Framework for Implementation Research, Version 2.0, focused on the Individuals domain, to analyze response data. These data represented the roles of Mid-Level Leaders (practice managers), Implementation Team Members (clinicians, support staff), Innovation Deliverers (BCMs), and Innovation Recipients (primary care/CBHP patients) and their characteristics (i.e., Need, Capability, Opportunity, Motivation).ResultsMid-level leaders (practice managers) were enthusiastic about CBHP (Motivation), appreciated integrating mental health services into primary care (Need), and had time to assist clinicians (Opportunity). Although CBHP lessened the burden for implementation team members (clinicians, staff; Need), some were hesitant to reallocate patient care (Motivation). Innovation deliverers (BCMs) were eager to deliver CBHP (Motivation) and confident in assisting patients (Capability); their opportunity to deliver CBHP could be limited by clinician referrals (Opportunity). Although CBHP alleviated barriers for innovation recipients (patients; Need), it was difficult to secure services for those with severe conditions (Capability) and certain insurance types (Opportunity).ConclusionsOverall, respondents favored sustaining CoCM and highlighted the positive impacts on the practice, health care team, and patients. Participants emphasized the benefits of integrating mental health services into primary care and how CBHP lessened the burden on clinicians while providing patients with comprehensive care. Barriers to CBHP implementation included ensuring appropriate patient referrals, providing treatment for patients with higher-level needs, and incentivizing clinician engagement. Future CoCM implementation should include strategies focused on education and training, encouraging clinician buy-in, and preparing referral paths for patients with more severe conditions or diverse needs.Trial registrationClinicalTrials.gov(NCT04321876). Registered: March 25,2020. Retrospectively registered.