Primary Care Physicians Research Articles

Anticoagulation for Minimally Invasive Glaucoma Surgery: An American Glaucoma Society Survey

Precis: Perspectives and practice patterns regarding perioperative anticoagulation management and minimally invasive glaucoma surgery were queried among surgeons of American Glaucoma Society. Management varied based on surgeon preference and type of procedure performed. Purpose: The purpose of this study was to characterize anticoagulation and antiplatelet practice patterns for minimally invasive glaucoma surgery (MIGS) in the perioperative period. Materials and Methods: This was a survey of surgeons of American Glaucoma Society (AGS) about anticoagulation decision-making for their most performed MIGS procedures. Results: A total of 103 surgeons completed the survey, with 43.6% in an academic setting, 49.5% in a private practice setting, and 6.8% in a mixed practice. Median MIGS per month was 10 (IQR 20-5). The two most performed MIGS were trabecular meshwork (TM) bypass with either device implantation (24.9%) or tissue excision (40.0%). Half of respondents (50.5%) deferred to the primary care physician about anticoagulation most/all the time. Most (59.3%) managed anticoagulation differently for MIGS compared to trabeculectomy and tube implantation. Respondents reported an average of 1.3 (SD 2.5) bleeding complications related to anticoagulation and MIGS in the last year. Bleeding risk perception depended upon the type of surgery (e.g., 74.0% reported no/mild concern regarding surgeries involving TM bypass with device implantation vs. 48.0% reported high concern for TM bypass with tissue excision). Respondents stopped blood thinners at the highest rates for procedures enhancing aqueous outflow through the subconjunctival space and stopped least frequently for iStent implantation. Antiplatelets were held for a longer duration than anticoagulants prior to surgery, and most resumed both agents within 1–4 days after surgery. Conclusions: Anticoagulation management is highly varied, and this study may help to inform practice guidelines and optimize surgical outcomes by elucidating surgeon perspectives toward MIGS and anticoagulation management.

Exploring the attitudes and experiences of Hungarian primary care physicians on the utilisation of digital health solutions.

During the COVID-19 pandemic, digital health solutions ensured the continuity of care especially in primary healthcare practices. COVID-19 accelerated the adoption of digital health solutions. The aim of this study is to describe the digital health-related attitudes and experiences of Hungarian Primary Care Physicians (PCPs) and also analyse the socio-demographic effects on digital health attitudes among PCPs. This study used a quantitative and qualitative mixed methodological approach to examine the digital health-related attitudes and experience of Hungarian PCPs. As part of the "E-physicians and E-patients in Hungary" survey, we conducted an online survey among medical doctors working in Hungary between July 2021 to May 2022. A total of 1,774 questionnaires were received, consisting of 1,576 medical doctors and 198 dentists. Among the medical doctors there were 415 primary care physicians (PCPs). In addition to the online questionnaire survey, qualitative research in the form of semi-structured interviews with doctors was also conducted. These interviews took place between October 2021 and June 2022. A total of 62 interviews were conducted,19 with PCPs. Primary care physicians are more open to technologies that facilitate communication and collaboration with patients, while showing less interest in technologies that support clinical work. Of the demographic variables (age, gender, type of settlement), age was found to have the most significant effect on digital health knowledge, use and intended use. Both the interviews and the multivariate analysis indicate that individuals with greater knowledge, expertise, and experience are more likely to perceive the advantages of digital solutions. This highlights the importance of training, especially given the significant aging population among Hungarian primary care physicians, who may not be accustomed to using these tools naturally. The way PCPs perceive patient expectations regarding the use of digital health tools has a significant impact on the PCPs' use and intended use of digital tools. When looking at perceived patient needs among PCPs the effect of age and municipality type of PCPs is significant. As age increases, the perception of patient needs decreases (from 5.02 to 4.47), and by municipality type, the average number of perceived needs decreases as one moves from larger cities to smaller municipalities (from 4.85 to 4.14). Digital health solutions have the potential to enhance the work of PCPs, but successful implementation requires addressing specific needs, demographic differences, and challenges faced by PCPs. Development of infrastructure, education, and institutional support is necessary to ensure more efficient and higher-quality healthcare delivery through the use of digital technologies.

The development of an online-based rural community of practice framework for addressing health issues among rural citizens: a grounded theory approach.

Health literacy facilitates an individual's ability to interpret and utilize medical information, thereby influencing their quality of life. Despite the benefits, the current oversaturation of information necessitates the support of healthcare professionals. Help-seeking behavior (HSB) is a term that describes the actions taken to assuage health concerns, and timely medical consultations are critical, especially for older individuals in rural areas who often face barriers to accessing care. These challenges are exacerbated by the perceived psychological distance from medical services in rural settings due to past negative experiences; however, the emergence of social media has helped form a bridge, allowing for direct communication with physicians. While consultations with artificial intelligence (AI) do occur, interaction with human physicians remains the gold standard. Thus, this study sought to understand social media's role in facilitating health consultations in rural areas and the implications for primary care education among physicians. This qualitative study, conducted from September 2022 to June 2023, employed a grounded theory approach to analyze information about a social network-based consulting system that utilized the LINE application. Residents posted anonymous health-related concerns, and comments were extracted. Two researchers coded and assessed the data; another specialist reviewed the findings. A total of 621 citizens participated, generating 10,432 posts. The grounded theory approach identified five major themes regarding health-related social networking in rural settings: (1) mutual exploration for information sharing highlighted distrust toward primary care physicians; (2) temporary collaboration resulted in superficial health discussions and relationship-building through empathy; (3) conflicts arising from differing health perspectives and misinformation sharing led to intense debates; (4) anxiety was resolved through shared illness experiences and increased empathy, enhancing psychological safety; and (5) a mutual assistance community was created, characterized by improved health dialogues and HSB among participants. The high engagement with the social network-based consulting system in rural Unnan City highlights technology's pivotal role in facilitating health dialogue and community engagement, despite challenges related to misinformation and health literacy complexities. As a reflection of the community's health perceptions and dynamics, future adaptations should incorporate strategies to combat these challenges while preserving collaboration and support.

Referrals and Black-White Coronary Heart Disease Treatment Disparities: A Qualitative Study of Primary Care Physician Perspectives.

Black-White coronary heart disease (CHD) treatment disparities are well documented, especially regarding the use of high-quality hospitals. Physician referral networks may play a role. To understand how primary care physicians (PCPs) make specialty referrals for CHD treatment and how referrals may contribute to treatment disparities. Qualitative study using semi-structured interviews and focus group discussions. We purposively recruited 45 PCPs (50 invited, 90% response rate) in three metro areas with high Black-White segregation of cardiac care networks (New York City; Chicago; Atlanta). We developed the focus group discussion guide from interviews and current literature. We conducted two focus groups per metro area via Zoom. Two expert team members independently coded the transcripts using inductive techniques and analyzed focus group content and themes using Dedoose. Most participants were male (62.2%), White (57.8%), and practiced for at least 23years. We identified several recurrent themes for factors influencing cardiology referrals. The most frequently mentioned themes were heavy reliance on professional networks, specialist availability, timeliness, communication style, patient geographic and economic constraints, and patient preferences. PCPs used anecdotal and not data-driven evidence to assess hospital quality and viewed Black-White differences in high-quality hospital use as due to patient economic status and preferences or differences in hospital access and provider referral bias. PCPs' referral decisions for CHD treatment are primarily driven by access to specific professional networks and the socioeconomic circumstances of their patients. Nevertheless, PCPs strive to make the best available decisions, leaning into their networks and honoring patient preferences. While PCPs acknowledged existing disparities, they attributed them to patient and system factors rather than provider referral bias. Mitigating disparities will require interventions to improve minority-serving providers' formal and informal connections with high-quality specialists and hospitals, address patient socioeconomic constraints, and train providers to recognize their potential biases and misconceptions.

Skin Cancer Diagnosis by Lesion, Physician, and Examination Type: A Systematic Review and Meta-Analysis.

Skin cancer is the most common cancer in the US; accurate detection can minimize morbidity and mortality. To assess the accuracy of skin cancer diagnosis by lesion type, physician specialty and experience, and physical examination method. PubMed, Embase, and Web of Science. Cross-sectional and case-control studies, randomized clinical trials, and nonrandomized controlled trials that used dermatologists or primary care physicians (PCPs) to examine keratinocytic and/or melanocytic skin lesions were included. Search terms, study objectives, and protocol methods were defined before study initiation. Data extraction was performed by a reviewer, with verification by a second reviewer. A mixed-effects model was used in the data analysis. Data analyses were performed from May 2022 to December 2023. Meta-analysis of diagnostic accuracy comprised sensitivity and specificity by physician type (primary care physician or dermatologist; experienced or inexperienced) and examination method (in-person clinical examination and/or clinical images vs dermoscopy and/or dermoscopic images). In all, 100 studies were included in the analysis. With experienced dermatologists using clinical examination and clinical images, the sensitivity and specificity for diagnosing keratinocytic carcinomas were 79.0% and 89.1%, respectively; using dermoscopy and dermoscopic images, sensitivity and specificity were 83.7% and 87.4%, and for PCPs, 81.4% and 80.1%. Experienced dermatologists had 2.5-fold higher odds of accurate diagnosis of keratinocytic carcinomas using in-person dermoscopy and dermoscopic images compared with in-person clinical examination and images. When examining for melanoma using clinical examination and images, sensitivity and specificity were 76.9% and 89.1% for experienced dermatologists, 78.3% and 66.2% for inexperienced dermatologists, and 37.5% and 84.6% for PCPs, respectively; whereas when using dermoscopy and dermoscopic images, sensitivity and specificity were 85.7% and 81.3%, 78.0% and 69.5%, and 49.5% and 91.3%, respectively. Experienced dermatologists had 5.7-fold higher odds of accurate diagnosis of melanoma using dermoscopy compared with clinical examination. Compared with PCPs, experienced dermatologists had 13.3-fold higher odds of accurate diagnosis of melanoma using dermoscopic images. The findings of this systematic review and meta-analysis indicate that there are significant differences in diagnostic accuracy for skin cancer when comparing physician specialty and experience, and examination methods. These summary metrics of clinician diagnostic accuracy could be useful benchmarks for clinical trials, practitioner training, and the performance of emerging technologies.

Tackling antibiotic resistance-insights from eHealthResp's educational interventions.

Antibiotic resistance (AR) poses a significant challenging issue in public health worldwide. This phenomenon led to the emergence of antibiotic-resistant bacterial strains, making the treatment of respiratory infections increasingly difficult. Educational interventions targeting healthcare professionals are important to improve prescription practices and promote responsible antibiotic use. Digital tools, including clinical decision support systems and mobile applications, have proven to effectively enhance educational interventions and clinical decision-making. The eHealthResp project is one such initiative that includes an online course and a mobile app designed to improve antibiotic use for upper respiratory tract infections (URTIs). The online course provides clinical information and case studies, whereas the mobile app acts as a clinical decision support system for URTIs diagnosis. The purpose of this study is to analyse the utilization patterns of eHealthResp digital tools among primary care physicians and community pharmacists. Results showed that both physicians and pharmacists (n = 35) had favorable progress and high grades when completing the online course assessment. The mobile app data indicated a diverse range of searched cases with different respiratory symptoms, with the most common being acute nasal discharge and pain when swallowing. Most observations presented mild symptoms for less than seven days, suggesting the occurrence of acute self-limited infections. Despite limitations, digital tools show promise in enhancing patient care outcomes for managing URTIs. Future efforts should focus on expanding participation among health professionals and enhancing educational interventions to promote responsible antibiotic use.

Enhanced skin cancer diagnosis: a deep feature extraction-based framework for the multi-classification of skin cancer utilizing dermoscopy images

Skin cancer is one of the most common, deadly, and widespread cancers worldwide. Early detection of skin cancer can lead to reduced death rates. A dermatologist or primary care physician can use a dermatoscope to inspect a patient to diagnose skin disorders visually. Early detection of skin cancer is essential, and in order to confirm the diagnosis and determine the most appropriate course of therapy, patients should undergo a biopsy and a histological evaluation. Significant advancements have been made recently as the accuracy of skin cancer categorization by automated deep learning systems matches that of dermatologists. Though progress has been made, there is still a lack of a widely accepted, clinically reliable method for diagnosing skin cancer. This article presented four variants of the Convolutional Neural Network (CNN) model (i.e., original CNN, no batch normalization CNN, few filters CNN, and strided CNN) for the classification and prediction of skin cancer in lesion images with the aim of helping physicians in their diagnosis. Further, it presents the hybrid models CNN-Support Vector Machine (CNNSVM), CNN-Random Forest (CNNRF), and CNN-Logistic Regression (CNNLR), using a grid search for the best parameters. Exploratory Data Analysis (EDA) and random oversampling are performed to normalize and balance the data. The CNN models (original CNN, strided, and CNNSVM) obtained an accuracy rate of 98%. In contrast, CNNRF and CNNLR obtained an accuracy rate of 99% for skin cancer prediction on a HAM10000 dataset of 10,015 dermoscopic images. The encouraging outcomes demonstrate the effectiveness of the proposed method and show that improving the performance of skin cancer diagnosis requires including the patient's metadata with the lesion image.

Increased use of Dermoscopy in Primary Healthcare Following the Implementation of Teledermatology in Southeast Sweden: A Retrospective Cohort Study of 2,137 Patients.

In the last 5 decades there has been a steady increase in skin cancer incidence globally. As patients wait for treatment before or after referral, the prognosis for those with melanoma worsens. Teledermatology was introduced to help reduce waiting times. The objective of this study was to investigate how the introduction of teledermatology affected management of skin tumours, from primary care physicians to dermatologists. A retrospective cohort study was performed 1 year before and 1 year after introduction of teledermatology in Östergötland County, Sweden. Patients were included from 3 primary healthcare centres by 3 independent observers. A total of 2,139 patients were included in the study. The 2 cohorts were well matched. At 2 of the 3 primary healthcare centres there was a significant increase in the use of dermoscopy, and almost 66% of all referrals were teledermatological in the year following its introduction. There was a trend towards higher diagnostic accuracy in the post-teledermatology cohort. No apparent effect on melanoma referral times was observed. The results of this study confirm previous findings showing the value of teledermatology as well as a novel finding of an increase in dermoscopy use in primary healthcare settings.

Relationships Among Physician Vendor-Derived Proficiency Score, Gender, and Time in the Electronic Health Record

Background and Objectives: Electronic health record (EHR) customization is proposed to mitigate EHR-related burnout. Gender disparities in EHR usage are established, though less is known regarding differences in customization and its impact on EHR time. This study examined gender differences in vendor-derived proficiency score (PS) and its relationship to EHR time. Methods: This was a retrospective observational study of ambulatory EHR use for adult primary care and medical subspecialty physicians at an academic safety-net health care system. The EHR vendor provided a physician PS (0–10), derived from customization and efficiency tool utilization. Primary outcomes were PS, time in system per day, and time in system per appointment stratified by gender. We used multiple variable linear regression to determine whether gender differences persisted with the inclusion of other factors. Results: A total of 228 physicians were included in the study; 122 were women, and 106 were men. Women had higher median PS (7.6 vs 6.6, P=.021) and EHR time per day (150.5 vs 119.9 minutes, P=.013), but no difference in time per appointment (24.7 vs 26.1 minutes, P=.665). After adjusting for potential confounders, gender remained a significant predictor of PS, but not time in EHR. Higher PS was significantly associated with greater time in the system per appointment, but not per day. Conclusions: While women had higher PS than men, gender was not significantly associated with measures of EHR time after adjusting for potential confounders. Higher PS was associated with greater time in the EHR per appointment, suggesting factors that influence EHR time are complex and varied.

Abstract 4131618: Association between Clinical Characteristics and Telomere Length - Factor Analysis of Mixed Data (FAMD)-based Cluster Analysis

Introduction: Telomere length is a marker of cellular aging and is correlated with various cardiovascular risk factors. Aim: To assess the association between clinical characteristics of patients and telomere length in an unselected cohort of patients under the care of primary care physicians. Methods: The LIPIDOGEN study was carried out in the primary care 2015. Patients recruited to LIPIDOGEN cohort (n=1788) were a random subset of patients of LIPIDOGRAM 2015 (n=13,724) study. Patients for LIPIDOGRAM2015/LIPIDOGEN study were recruited in all 16 administrative regions in Poland. Each patient was asked to fill the questionnaire on risk factors, chronic, treatment and lifestyle and also had saliva secured for DNA analyses. Factor Analysis for Mixed Data (FAMD) based cluster analysis was utilized to discern groups of patients with similar clinical profiles and correlate them with relative telomere length (rTL). RTL was measured using quantitative polymerase chain reaction. Results: DNA quality was sufficient for further analyses in 1606 patients. After outlier exclusion, 1,342 patients (59.3% female, mean age 50.2 years) were analyzed. FAMD revealed two distinct clinical characteristic patterns, explaining 41.6% of the total variance in the clinical variables. The first pattern, correlated with male gender and a higher prevalence of MetS, hypertension, diabetes, obesity, greater waist circumference, elevated non-HDL-C and remnant-C levels, was linked to shorter rTL (r = -0.13, p < 0.001). The second pattern, characterized mainly by lipid parameters, showed no significant association with comorbidities or rTL (r = -0.04, p = 0.14). Conclusions: Pattern of clinical characteristics marked by classical cardiovascular risk factors, is inversely related to telomere length, underlining the potential role of metabolic disturbances in cellular aging. The second lipid-centric pattern without significant comorbidities was not associated with telomere length.

Abstract 4136462: Provider understanding of Coronary Artery Calcium Scoring (CAC) testing in Atherosclerotic CArdiovascular Disease risk stratification and Racial Disparities Study (CAC-CARD) to reduce healthcare disparities

Background: Coronary Artery Calcium (CAC) scoring is critical in assessing Atherosclerotic Cardiovascular Disease (ASCVD) risk. Despite its utility, many primary care physicians lack confidence and familiarity with its application. Significant racial disparities in CAC scoring utilization have been observed, potentially affecting patient outcomes. Hypothesis: We hypothesized that a short targeted educational intervention would enhance physicians' confidence, knowledge, and utilization of CAC scoring and awareness of racial disparities. Methods: A pre- and post-intervention study (Image 1) was conducted among 39 physicians at the University of Louisville. The intervention included a 20-minute educational session on CAC scoring and racial disparities. A video summarizing the ACC2018 guidelines for prevention and cholesterol treatment was provided. A summary of key points for clinical practice was given. The ASCVD plus calculator app was provided. Data were collected using a structured questionnaire before and after the intervention. Viewing time and engagement were recorded. Descriptive and inferential statistics analyzed the data. Results: The average correct physician responses increased from a mean of 59.5% pre-intervention to 92.0% post-intervention. Post-intervention, the number of physicians who felt confident or very confident in CAC testing increased from 17.9% to 94.8%. Additionally, 33 out of 39 physicians (84.6%) reported likely to use CAC testing more frequently. Correct responses on racial disparities improved from 59% pre-intervention to 92.0% post-intervention. (Image 2). The average viewing time was 28 minutes. Time spent on the questionnaires was 14 min pre and 12 min post. Conclusion: Our targeted educational intervention significantly enhanced physicians' knowledge and confidence in CAC scoring for ASCVD risk assessment and raised awareness about racial disparities, promoting more equitable practices.

Empowering primary care physicians in child and adolescent psychiatry: a needs assessment on collaborative care in Dubai

BackgroundChild and adolescent psychiatric disorders pose significant public health concerns necessitating prompt intervention. Primary care physicians (PCPs) play a critical role as initial points of contact, facilitating early detection, management, and referral of these conditions. In Dubai, integrating mental health services into primary care faces unique challenges, highlighting the need for systemic reforms and enhanced PCP training.ObjectiveThis study investigated perceptions, barriers, and systemic challenges encountered by PCPs in managing child and adolescent psychiatric conditions in Dubai’s primary care setting. It also assessed family physicians’ involvement and preparedness in this domain.MethodsUsing a mixed-methods approach, we conducted a survey among family physicians in Dubai Health facilities and analyzed patient data from family medicine clinics. The survey evaluated formal training, preparedness, encounter frequency, and referral patterns for psychiatric care in young patients. Qualitative insights from open-ended survey questions provided additional understanding of specific challenges.ResultsFindings revealed significant gaps in formal training, with only 33.3% of respondents trained in child and adolescent psychiatry during medical education, and 21.1% participating in Continuing Medical Education (CME). A majority (54.4%) of PCPs felt unprepared to manage psychiatric care in young patients. Patient data analysis showed a predominance of male patients (59.9%) and identified Autism Spectrum Disorder (43.1%) as the most common condition, emphasizing the reliance on specialized care through a high referral rate (63.1%). Major barriers included time constraints, limited psychiatric knowledge, resistance to mental health services, systemic and structural issues, communication challenges, and resource shortages.ConclusionEnhanced training and systemic reforms are urgently needed to integrate mental health services effectively into Dubai’s primary care. Implementing structured collaborative care models, fostering interdisciplinary collaboration, and addressing systemic barriers are crucial for improving child and adolescent psychiatric condition management. These initiatives promise better patient outcomes and more efficient healthcare resource utilization.

Recommended Elements of a Musculoskeletal Course for Fourth-Year Medical Students: A Modified Delphi Consensus

Background and Objectives: A recognized gap exists between primary care physicians’ training in musculoskeletal (MSK) medicine and the burden of MSK complaints in primary care. Family medicine interns often lack adequate baseline MSK physical exam skills, which prompted a proposal to introduce a fourth-year preceptorship to reinforce MSK education. The aim of this study was to prioritize the most important elements to include in this new clinical rotation. Methods: We employed a three-round, modified Delphi method to derive consensus. Eleven panelists with experience and expertise in MSK training, medical education, or both generated a list of 118 elements. Each panelist then ranked each element by level of importance, and we reviewed the results. The ranking process was repeated two more times with a goal of achieving consensus. Results: Seventy-seven curricular elements (topics, skills, experiences) achieved consensus recommendation by being ranked either “fairly important” or “very important” for inclusion in the curriculum. Twenty-eight items were unanimously ranked “very important,” 42 received a mix of “very important” and “fairly important” rankings, and seven received unanimous ranking of “fairly important.” Three items were unanimously ranked “neither important nor unimportant.” Conclusions: Longitudinal repetition of physical exam skills, reinforcement of relevant anatomy, and incorporation of specific frameworks for approaching MSK care are important components. Physical examination of the shoulder, knee, back, and hip are especially meaningful clinically.

Effects of task-shifting from primary care physicians to nurses: an overview of systematic reviews.

Task-shifting from primary care physicians (PCPs) to nurses is a means of overcoming PCP shortages and meeting the needs of patients receiving primary care. The aim of this overview of systematic reviews is to assess the effects of delegation or substitution of PCPs' activities by nurses on patient relevant, clinical, professional and health services-related outcomes. We conducted a systematic literature search for secondary literature in Medline, Embase, Pubmed, the Cochrane Library, and the Cumulative Index of Nursing and Allied Health Literature (CINAHL). We included systematic reviews and meta-analyses that analysed randomised controlled trials (RCTs) and controlled, prospective trials in English and German. Abstracts and full-text articles were screened independently by two reviewers. Full-text articles were assessed using the Overview Quality Assessment Questionnaire. After data extraction a narrative synthesis was performed. We defined patient-relevant outcomes as our primary outcomes. We included six systematic reviews. The interventions included first contact, history taking and assessment, patient education, review of drug treatment, referrals to GPs and other health professionals, ordering further investigations and ongoing care. Two meta-analyses showed a relative risk reduction of mortality in favour of nurse-led care, whereby the reduction in one analysis was significant. The effect was highest in the group of more highly qualified nurse practitioners (RR 0.19), as opposed to nurse practitioners (RR 0.76) and registered nurses (RR 0.92). Two meta-analyses showed a relative risk reduction in hospital admissions and patient satisfaction. Whereas care conducted by physicians and registered nurses led to the same outcomes, care conducted by nurse practitioners led to better outcomes (RR 0.74). An analysis according to nursing group showed that patients were more satisfied with treatment by registered nurses (SMD 1.37) than with treatment conducted by nurse practitioners and more qualified nurse practitioners (SMD 0.17). In terms of patient-relevant outcomes, no differences were observed between physician-led care and nurse-led care in terms of physical function, quality of life and pain. Nurse-led care is probably as safe or safer than physician-led care in terms of mortality and hospital admissions. However, the impact of nursing staff training has not been sufficiently examined.

Gastric Cancer Risk among Immigrants and Socioeconomic Groups in the Netherlands.

Identification of groups at a high-risk of gastric cancer (GC) could facilitate targeted screening in countries with a low GC incidence. Our aim was to identify such high-risk groups, based on individual-level population data on migration history and socioeconomic status (SES) in the Netherlands. In this retrospective cohort study, patient data from the Netherlands cancer registry were linked to demographic data of Statistics Netherlands in the period 2010-2022. GC incidence rates in the 14 largest immigrant populations were compared to those born in the Netherlands. Odds ratios (ORs) were computed per birthplace and controlled for age, sex and SES. Additionally, we investigated GC risk among second-generation immigrants and by SES. Immigrant populations at a significantly higher GC risk compared to the general population were identified. Specifically, foreign-born first-generation immigrants from Bosnia-Herzegovina (OR: 2.42), Turkey (OR: 2.22) and China (OR: 1.92) showed elevated risk. While low SES increased the odds of developing GC, first-generation immigrants remained at higher risk even after controlling for SES. Second-generation immigrants did not have a significantly higher risk of developing GC. Certain first-generation immigrants remain at an elevated risk for GC despite migration to a low-risk region. Identification of these high-risk groups should be used to facilitate targeted GC prevention. Potential benefits of targeted Helicobacter pylori test-and-treat policy in immigrant populations should be explored in clinical and modelling studies. Primary care physicians should be cognizant of high-risk groups, facilitating the early-detection of cancer within these populations.

Comparing a Model of Augmented Postpartum Primary Care to Usual Care in an Urban Medical Center.

The US faces a maternal health crisis and struggles to deliver recommended postpartum care. In some populations, less than half of mothers attend a postpartum visit. To determine if a two-generation (Two-Gen) model of interdisciplinary, postpartum primary care was associated with increased visit attendance for postpartum care, primary care, and behavioral health. Retrospective study of care delivered at a single, urban, academic, safety-net medical center between 2020 and 2023. Mothers who received postpartum care in Two-Gen and a comparison group who received usual postpartum care. Adjusted logistic regression to estimate the effect of Two-Gen participation on the odds of attending an early (birth-to-3weeks) postpartum visit, later (4-to-12weeks) postpartum visit, OB/GYN visit, and primary care visit. A total of 247 mothers (98 Two-Gen and 149 usual care) were included for analysis. Most identified as Non-Hispanic Black (55%) or Hispanic (34%) and had Medicaid insurance (74%). On average, Two-Gen mothers were younger and more likely to be primiparous. Compared to usual care, Two-Gen mothers had similar rates of early postpartum visits (79% vs 64%; adjusted odds ratio (aOR) 1.70; 95% confidence interval (CI) 0.92-3.14) and were significantly more likely to have a later postpartum visit (92% vs 79%; aOR 2.46; 95%CI 1.06-5.74) in adjusted analyses. Almost all Two-Gen mothers (97%) had a visit with a primary care doctor in the first postpartum year, compared to 19% of mothers receiving usual care (aOR 12.95; 95%CI 6.80-24.68). Of those with behavioral health diagnoses, Two-Gen mothers had higher rates of psychiatrist visits than usual care mothers (49% vs 13%; p = 0.001). Two-Gen clinic participation was associated with high rates of timely postpartum care in a group of predominantly young, publicly insured, racial, and ethnic minority mothers and compared favorably to usual care across multiple metrics, notably utilization of primary and behavioral health care.

Multidisciplinary Approaches in General Medical Practice: Enhancing Collaboration for Better Patient Care

Multidisciplinary approaches in general medical practice have become integral to providing comprehensive, patient-centered care, as the complexity of modern health issues often requires a diverse range of expertise. This review explores the role and benefits of multidisciplinary teams in enhancing patient outcomes, improving resource efficiency, and increasing patient satisfaction in general medical settings. By examining the contributions of various healthcare professionals—including primary care physicians, specialists, allied health professionals, and behavioral health specialists—this review emphasizes how collaborative efforts address complex health needs more effectively than traditional, siloed approaches. Key case studies illustrate successful multidisciplinary practices in managing chronic diseases and complex conditions, highlighting the advantages of coordinated care models. The review also addresses challenges, such as communication barriers, hierarchical dynamics, and logistical constraints, that can hinder effective collaboration. Furthermore, it discusses technological supports, such as electronic health records (EHR) and telemedicine, which facilitate real-time communication and care coordination. The article concludes with recommendations for expanding multidisciplinary teams in primary care, promoting educational initiatives for team-based care skills, and advocating for policy support to institutionalize multidisciplinary approaches in general medicine. These findings suggest that well-coordinated multidisciplinary teams can transform patient care, making it more holistic, efficient, and responsive to individual needs.

Principles of oncological alertness for outpatient therapists using the example of colorectal cancer

Malignant diseases remain an important medical problem, and its solution depends on the effectiveness of identifying the early stages of cancer at the outpatient stage, including the therapeutic level of medical care. Formation of oncological alertness skills in primary care physicians is necessary for early detection and reduction of the incidence of advanced tumor stages and earlier initiation of specialized treatment. Identification of symptoms suspicious for malignant neoplasms using algorithmic approaches and subsequent consultation of the patient by a specialist surgeon or oncologist should improve treatment outcomes. The article considers the principles of oncological alertness applicable at the outpatient stage by therapists and general practitioners using colorectal cancer as an example. A set of specially developed printed materials facilitating the implementation of the principles of oncological alertness is proposed.

Disorders of puberty

Puberty is a critical developmental phase marking the transition from childhood to adulthood, characterised by physical, hormonal and psychological changes. Disorders of puberty can have a significant impact on a person’s growth, development, and psychological well-being. These disorders can cause precocious (early onset) or delayed (late onset) puberty and necessitate a thorough understanding of the underlying mechanisms and clinical presentation to ensure proper diagnosis and treatment. This article provides a comprehensive overview of the hypothalamic–pituitary–gonadal axis and adrenal development leading to physical changes consistent with puberty. This article outlines the physiological physical changes and pubertal milestones and discusses normal variants of puberty to help distinguish physiological from pathological conditions. It then describes the pathophysiology and causes for both precocious and delayed pubertal development, providing guidance for primary care physicians for referral to secondary care. Finally, this article aims to provide succinct guidance on relevant history and clinical findings pertinent to the topic and provides a clinical case for discussion.

Primary care physicians' attitudes, practices, and perceived barriers toward depression screening in older people in the Kingdom of Bahrain

PurposeThis study aimed to explore attitudes, practices, and perceived barriers of primary care physicians (PCPs) toward depression screening in older people.MethodsThis cross-sectional study enrolled PCPs from randomly selected representative primary care centers in Bahrain. A self-administered piloted semi-structured questionnaire was used for data collection.ResultsWe enrolled 248 PCPs in the study (82.3% females, and the mean age = 40 ± 8.7 years). More than half of the participants (54.4%) had a positive attitude toward depression screening in older people. However, only 10.9% of the participants reported systematically screening for this condition without using specific tools for screening in 45.5%. The most reported barriers toward this service are short consultation time (95%), the presence of multiple co-morbidities in this age group (90%), and the absence of guidelines or appropriate training in around 30%. Positive attitudes were significantly higher among older PCPs (p = 0.039), family physician consultants (p = 0.008), those with more than 10 years of work experience (p = 0.024), and those who participated in related educational activities (p = 0.007). Under-screening practice is associated with perceived short consultation time (p = 0.002), insufficient continuous medical education (CME) activities attendance in older people's mental health (p = 0.048) as well as having a general physician's title (p = 0.049). Only the PCPs' job title, Adjusted Odds Ratio (OR) = 3.513, 95 C.I [1.225-10.074] and attendance of CME activities, OR = 1.278, 95 C.I [1.098 – 3.192] remained significant when controlled for age and experience.ConclusionMore training on older people's mental health and provision of screening and management guidelines are priorities to promote older people's mental health in primary care settings.