Primary Care Physicians Research Articles

Ulcer Symptoms Concealing Primary Jejunal Follicular Lymphoma: A Case Report

<p>胃腸道淋巴瘤的臨床表現多樣且非特異，往往難以區分良性或惡性。內視鏡和放射學檢查的表現也不具特定性。在胃腸道，淋巴瘤是一種相對罕見的腫瘤，佔胃腸道惡性腫瘤的1%–8%，初發性胃、小腸和十二指腸淋巴瘤的比例約為10:3:1。濾泡性淋巴瘤主要發生在十二指腸，瀰漫性大B細胞淋巴瘤在胃和迴腸，黏膜相關淋巴組織淋巴瘤在胃，套細胞淋巴瘤在末端迴腸、空腸和結腸，而腸病相關T細胞淋巴瘤多在空腸。對於濾泡性淋巴瘤，觀察也是一種選擇，手術介入通常僅適於複雜的臨床狀況，如腸阻塞或穿孔。</p> <p>本篇病例報告一位74歲男性個案，十八年前出現反覆性上腹痛、腹部脹氣、打嗝、腹瀉，偶有便秘，多次上消化道內視鏡檢查診斷胃與十二指腸潰瘍，治療後症狀仍然存在。兩年後出現嘔吐，全套血液、生化、糞便檢驗皆無異常，上消化道內視鏡顯示多發性胃與十二指腸潰瘍，無幽門桿菌感染。腹部超音波顯示明顯胃擴張，電腦斷層檢查未發現腸阻塞或狹窄。小腸鏡顯示第三至第四部分十二指腸狹窄，組織切片為B細胞型態淋巴瘤。個案接受手術，術中發現在屈氏韌帶下方約5 cm處近端空腸有一4.8 cm × 3.0 cm × 1.3 cm環狀腫瘤併腸繫膜數顆腫大淋巴結，予以切除9.8 cm空腸與淋巴結並接受腸道吻合。病理診斷為第2級濾泡性淋巴瘤。術後接受化學治療及定期追蹤。至今已過十六年，病人情況良好。定期追蹤檢查並無復發。</p> <p>藉此病例報告提醒基層醫師面對反覆性消化性潰瘍時，必需將消化道淋巴瘤列入鑑別診斷。</p> <p> </p><p>It is challenging to distinguish benign gastrointestinal tumors from malignant ones due to their diverse and nonspecific symptoms, and endoscopic and radiological findings often lack specificity. Lymphoma is relatively uncommon in the gastrointestinal tract, constituting 1%-8% of malignant tumors with a primary tumor ratio of approximately 10:3:1 for the stomach, small intestine, and duodenum. Follicular lymphomas mainly occur in duodenum, diffuse large B-cell lymphomas in stomach and ileum, MALT lymphomas in stomach, mantle cell lymphomas in terminal ileum, jejunum, and colon, and enteropathy-associated T-cell lymphomas in jejunum. For the treatment of follicular lymphomas, observation remains a viable option, while surgical intervention is usually reserved for complicated clinical conditions, such as intestinal obstruction or perforation. </p> <p> This case report features a 74-year-old male with recurrent epigastric pain, abdominal distention, hiccups, diarrhea and occasional constipation since he was diagnosed with duodenal ulcers eighteen years ago. Repeated panendoscopic examinations showed gastric and duodenal ulcers. Symptoms persisted after treatment and were followed by vomiting two years later. Comprehensive blood, biochemical, and stool analyses revealed no abnormalities. Panendoscopic examination showed multiple ulcers in the stomach and duodenum without Helicobacter pylori infection. Abdominal ultrasound indicated significant gastric dilation, and computed tomography scan revealed neither intestinal obstruction nor stenosis. Small intestinal fiberscope found stenosis in the third to fourth portions of the duodenum, and tissue biopsy suggested B-cell lymphoma. Intraoperatively, a circumferential tumor measuring 4.8 cm × 3.0 cm × 1.3 cm was identified, located approximately 5 cm proximal to the Ligament of Treitz. It was accompanied by enlarged mesenteric lymph nodes. The excision of 9.8 cm of the jejunum, along with lymph node dissection, was followed by anastomosis. Surgical pathology confirmed grade II follicular lymphoma. Postoperatively, the patient receives chemotherapy and undergoes regular follow-up. The patient has remained in good medical condition over these sixteen years. Follow-up examinations did not show tumor recurrence. This case report aims to remind primary care physicians to consider gastrointestinal lymphoma early in the differential diagnosis of recurrent peptic ulcers.</p> <p> </p>

Exploring primary care physician biases in adolescent contraceptive counseling

Objective(s)While previous literature has shown clinician bias in adult contraceptive counseling, less is known on the biases clinicians may exhibit when counseling adolescents about contraception. Our study aimed to describe long-acting reversible contraception (LARC) counseling and prescribing practices of adolescent-serving clinicians. Study designThis study used a cross-sectional discrete choice experiment mixed methods design. We sent a survey containing vignettes and items pertaining to demographics and beliefs to a convenience sample of adolescent-serving clinicians across the United States. ResultsOf 296 clinicians, 80% were in pediatrics, and had geographic, practice setting, gender, and racial diversity. Most clinicians reported being up-to-date with current literature regarding contraception. Sixty-eight percent of respondent’s practices administer contraceptive injections, but only 17% place intrauterine devices (IUDs). Of those who do insert IUDs, nearly half inserted five or fewer within the last year. Patients’ younger age and Hispanic ethnicity were associated with lower odds, and history of pregnancy was associated with higher odds, of clinicians’ recommending LARC. Across all vignettes, the top five reasons clinicians chose their first-choice method for the patient were adherence or compliance, efficacy, side effects, patient age, and reversibility. Conclusion(s)Clinicians often recommend contraceptives based on adherence, efficacy, and age, and we found younger age, minoritized race or ethnicity, and history of pregnancy were all associated with LARC recommendations, indicating potential biases against teen parents and assumptions about adolescents’ priorities. This may impede the provision of patient-centered contraceptive counseling for adolescents, and highlights the need for improved education and practice changes post-Dobbs. ImplicationsWe found that clinicians demonstrated several biases in how they provide contraceptive recommendations to adolescent patients. These biases were often associated with their personal beliefs and experiences. Our findings can guide the development of future interventions aimed at improving adolescent reproductive health counseling and care delivery in primary care settings.

P153 NATIONAL SURVEY OF ARGENTINE DOCTORS ON HYPERTENSION

Background and Objective: Hypertension (HTN) is the leading cardiovascular risk factor, yet its control remains low. Identifying factors influencing diagnosis, potential clinical inertia, and the measuring devices used is crucial. Objective: This study aims to understand factors in medical practice affecting HTN knowledge and control, and to assess the availability and use of blood pressure (BP) measurement devices. Methods: This observational, cross-sectional study is based on a 25-question self-administered survey by the Argentine Society of Hypertension (SAHA) and the Argentine Society of Medicine (SAM), targeting doctors treating HTN patients in Argentina. This report focuses on BP measurement. Results: A total of 1,042 responses were received, with women comprising 45.8% (n:471). Responses came from 430 cardiologists (41.7%), 380 internists (36.8%), 68 HTN specialists (6.6%), 54 primary care physicians (5.2%), and 100 from other specialties (9.7%). An own validated automatic arm BP monitor was used by 44.5%, a manual aneroid by 36.5%, an institution's validated automatic arm monitor by 10.9%, and a fixed wall aneroid by 8.2%. BP was measured in all patients by 89% of respondents, sometimes by 8.5%, and only if the patient was hypertensive by 1.7%. Ambulatory blood pressure monitoring (ABPM) was always requested before treatment by 25.2%, sporadically by 34%, never by 4.1%, and only for BP between 130/85 mmHg and 159/99 mmHg by 36.7%. The 24-hour ABPM values for initiating pharmacological treatment were >140/90 mmHg (40.9%), >135/85 mmHg (39%), and >130/80 mmHg (20.1%). Conclusions: Discrepancies exist in HTN patient care. Only 20% of doctors start pharmacological treatment at 24-hour ABPM values above 130/80 mmHg. Enhancing education and information could improve HTN control strategies.

Knowledge, Attitude, and Practice of Breastfeeding among South Indians: A Cross-sectional Study

Introduction: Research shows that exclusively breastfed infants have a 13% lower mortality risk. However, only 37% of infants in Low and middle income country (LMIC) are exclusively breastfed. Materials and Methods: This cross-sectional study was conducted in a Chennai hospital’s outpatient department, focusing on pediatrics. The study commenced after obtaining ethical clearance (99/IEC-SMMCHRI). Breastfeeding knowledge, attitude, and practice (KAP) scales were developed by modifying existing KAP tools. The KAP questionnaire was based on the World Health Organization. The same was applied to 250 consenting mothers. Results: Participants had a mean age of 27 years, with the youngest mother at 19 and the oldest at 40. Forty-one percent had finished high school, and 37% had completed undergraduate studies. Eighty-eight percent had strong breastfeeding comprehension, and 96% had a favorable attitude. However, only 32% exclusively breastfed. The study found significant correlations between knowledge and behavior (χ2 = 4.27, P = 0.04) and between attitude and behavior (χ2 = 5.69, P = 0.017). Mothers with adequate knowledge tended to follow recommended feeding practices, and those with a positive attitude displayed good practices. Conclusion: Despite positive attitudes toward breastfeeding, the cultural practice of introducing prelacteal food hinders exclusive breastfeeding, leading to negative outcomes. While there have been some improvements in exclusive breastfeeding rates, addressing this disparity could reduce child mortality rates. The outcomes of the research will be highly beneficial for primary care physicians in their efforts to promote exclusive breastfeeding among expectant mothers.

Disparities in Rates of Multitarget Stool DNA Test Completion for Colorectal Cancer Screening.

The aim was to assess patient adherence to multitarget stool DNA testing as well as factors associated with adherence. In the United States, disparities in colorectal cancer screening exist along racial and socioeconomic lines. While some studies suggest that stool-based screening tests may help reduce the screening gap, the data for multitarget stool DNA testing is unclear. We conducted a single-center retrospective cohort study on multitarget stool DNA testing ordered between April 2020 and July 2021. We calculated the proportion of patients who completed testing and used multivariate logistic regression to identify covariates associated with test adherence. Among 797 patients ordered for multitarget stool DNA testing, 481 patients (60.4%) completed testing. Adherence rates by patient subgroups ranged from 35.8% to 78.1%. Higher test adherence was found in Asian patients (odds ratio 2.65, 95% CI 1.36-5.18) and those who previously completed colorectal cancer screening (OR 1.45, 95% CI 1.01-2.09), while Black patients (OR 0.58, 95% CI 0.39-0.87), patients with resident primary care physicians (OR 0.34, 95% CI 0.21-0.56), and patients contacted through an outreach program (OR 0.47, 95% CI 0.25-0.87) had lower adherence. A significant proportion of patients ordered for multitarget stool DNA testing did not complete testing. Differences in adherence rates among patient subgroups may be reflective of underlying disparities in health care access.

P043 PREACH IMPLEMENTATION PROJECT A SOCIO-ECOLOGICAL FRAMEWORK FOR HYPERTENSION IN PAKISTAN

Background: Worldwide hypertension prevalence is projected to reach 1.56 billion by 2025, affecting 29% of the global population according to the WHO1. It contributes to 7.5 million deaths, 3.7% of total disability-adjusted life years (DALYs) and is responsible for causing stroke in 54% of hypertensives2,3. Pakistan has a prevalence of 43% hypertension with merely 12.5% of controlled hypertensives4,5. There is a pressing need for a national level intervention through uniform clinical approaches for optimum hypertension prevention, treatment and control6, 7. Through PREACH project, we prioritize primary care physicians as first-line responders and are training them on standardized hypertension guidelines to alleviate the burden from tertiary care hospitals. To detect new onset hypertension the project also incorporates early surveillance and community level screenings. Objectives: • To build capacity of practitioners on standardized guidelines endorsed by health ministry, PCS (Pakistan Cardiac Society) & PHL (Pakistan Hypertension League) • To raise community awareness, to screen and develop self-referral pathways to specialty care • To develop a robust national hypertension registry • To include hypertension in essential primary healthcare packages Methodology: Hypertension guidelines are developed. Accredited national certified workforce of more than 14,000 general practitioners (GPs) will be built through guidelines trainings via train the trainer model. Impact assessment studies will be done to assess training effectiveness and implementation at clinics. Community mobilization and awareness campaigns will be run to identify and direct self-referral pathway to an accredited GP. Development of national hypertension registry as a centralized system for data collection to report actual disease burden. Ministry of health will be advocated to prioritize hypertension management via multi-sectoral collaboration i.e. medical societies, academic, non-profit and private-sector for incorporations into annual development programs. Results \Conclusion: We aim to create an impact in the lives of 4.3 million beneficiaries (anti-hypertensive naïve hypertensive patients of Pakistan) by increasing self-referral of hypertensive cases to specialists through PREACH implementation project at all healthcare service delivery levels.

Preventability and manageability of adverse drug reactions in COVID-19 with mucormycosis: An observational study.

In the intricate landscape of healthcare amid the COVID-19 pandemic, the emergence of mucormycosis as a severe complication posed a significant challenge to primary healthcare. This study delved into the complexities of adverse drug reactions (ADRs) in COVID-19 patients with mucormycosis undergoing treatment with conventional amphotericin B. Ethically approved and meticulously conducted, the study scrutinized 154 ADRs in depth, shedding light on their classification, outcomes, and interventions in COVID patients with mucormycosis. A descriptive analysis was carried out to report the findings of this study. The findings revealed that a substantial proportion (85.6%) of these ADRs were manageable, emphasizing the need for vigilant monitoring and timely interventions. Notably, gender disparities surfaced, indicating potential gender-specific responses to amphotericin B. Causality assessments based on the WHO-UMC scale classified the majority of ADRs as certain, providing a robust foundation for understanding the intricate relationships between amphotericin B and the observed adverse events. This research not only categorizes ADRs as preventable and manageable but also offers practical insights into their nature and the diverse strategies employed for their management. The study's outcomes underline the importance of personalized healthcare approaches that can be adopted by primary care physicians for effective patient care.

Improving the management of chronic kidney disease in primary care by enhancing laboratory reports with additional information and follow-up procedures

Identifying people at risk for progressive chronic kidney disease and connecting them with recommended care is crucial for providing timely and optimal treatment. The ASSIST-CKD (A programme to Spread eGFR [estimated glomerular filtration rate] graph Surveillance for the early identification, Support and Treatment of people with progressive CKD [chronic kidney disease]) trial evaluated the effect of graphical eGFR reporting to primary care physicians on late presentation to a nephrologist in the United Kingdom. Trial data were obtained from the UK Renal Registry. Although the results were neutral, the data generated from the ASSIST-CKD trial are informative and provide useful estimates of the intervention effect. The trial also provides valuable insights into the challenges of implementing complex interventions in busy health care environments, which can be used to guide the designs of future interventions.

Assessing and Comparing Musculoskeletal Knowledge and Red Flag Identification Skills: A Cross-Sectional Study of Physical Therapists and Primary Care Physicians

Background: Musculoskeletal disorders are one of the most common health issues often managed at the level of primary health care. Enabling physical therapists to be first-contact practitioner for patients with musculoskeletal disorders could improve patient access, expedite management, enhance outcomes and reduce costs. However, this role requires a high level of musculoskeletal knowledge and the ability to detect red flags. Objectives: To assess and compare the musculoskeletal knowledge and abilities to identify red flags between physical therapists and primary care physicians (PCPs). Methods: A cross-sectional study was undertaken using an electronic survey assessed participants’ musculoskeletal knowledge and ability to identify red flags. Study participants included physical therapist and PCPs practicing at Ministry of Health hospitals and/or primary care centers in Riyadh, Saudi Arabia. Results: A total of 60 physical therapists and 76 PCPs participated. Good knowledge levels (total score ≥ 75%) were found for 7% of physical therapists compared to 18% of PCPs, and moderate knowledge levels (total score 60-75%) were found in 70% of physical therapists compared to 62% of PCP participants (P=.003). Conclusion: Physical therapists and PCPs demonstrated an overall moderate level of musculoskeletal knowledge and the ability to identify red flags. The results suggest that with further education on red flags identification, physical therapists in Saudi Arabia could potentially act as first-contact practitioners for patients with musculoskeletal conditions.

Working practices and integration of primary health care doctors in remote rural areas in Brazil: a qualitative study

Health care challenges in remote rural municipalities (RRMs) emphasize the importance of primary health care (PHC) and require an expanded scope of practice. Doctors are key actors in this context. The aim of this study was to explore the level of integration of doctors in RRMs and working practices. We conducted a qualitative study involving semi-structured interviews with 46 PHC doctors working in 27 RRMs in Brazil. Content analysis was performed, resulting in the identification of categories of analysis grouped under three core dimensions: doctor training and experience; comprehensive care and timely access; and the community-based approach. Doctors working in RRMs were mainly recent graduates with limited experience who had undertaken their degree outside Brazil, and care was focused on the individual. The findings also revealed weak sociocultural adaptation and a harsh working environment and issues related to social status that reinforced prejudice against rurality and poverty. Practice was limited in scope and care tended to be oriented towards acute problems, disease-centered and focused on the biomedical model of medicine. Barriers to the delivery of comprehensive care include both structural constraints, such as poor facilities and centralization of services in administrative centers, and the lack of professional competencies necessary for PHC in these areas. The findings point to the need to promote an expanded scope of practice in PHC delivery in RRMs, with major public investment in the promotion of training and strengthening career pathways in these areas.

Flight-related determinants of healthcare services utilization of asylum seekers and refugees in Germany: a study based on the German Socio-Economic Panel.

The aim of this study was to analyze the associations between healthcare services utilization and flight-related characteristics of asylum seekers and refugees in Germany. The 2020 wave of the German Socio-Economic Panel's Survey of Refugees was used to compile a sample of asylum seekers and refugees (n = 3134). Healthcare services utilization was measured using the self-reported number of visits to primary care physicians and hospitalization. Only the feeling of being welcome and worries about not being able to stay in Germany were identified as potential flight-related determinants of healthcare services utilization.

CLINICAL CASE OF RARE SMITH-MAGENIS SYNDROME IN NEWBORN CHILD

Aim. The purpose of the work is a comprehensive analysis of chromosomal pathology based on own detection of a rare clinical case of Smith-Magenis syndrome in a newborn child, the results of which may be useful for the detection and prevention of hereditary diseases. Materials and methods. Based on the analysis of literature data, it was found that clinical cases of rare (SMS) in newborns occur with a frequency of 1 in 25,000–1:15,000. This syndrome is caused by a chromosomal rearrangement that leads to the loss of significant segments of one chromosome from the 17th pair of chromosomes. There is a deletion of genetic material in the region of chromosome 17 (17p11.2), which is why SMS is sometimes called 17p syndrome. In this work, the analysis of clinical symptoms and laboratory-instrumental examinations, the main of which are cytogenetic (karyotyping) and molecular genetic methods, were used to confirm the diagnosis of the disease. The results were obtained during the study of the biological material of the lymphocyte culture of the peripheral blood of the child, mother and father. As a result of the cytogenetic study of the child, the karyotype 46, ХУ, del(17) (p11.2p11.2) was established, that is, a male karyotype with an interstitial deletion in the short arm of chromosome 17 within the band 17p11.2. The mother's karyotype is 46, XX, no chromosomal abnormalities were detected. The father's karyotype is 46, XU, no chromosomal abnormalities were detected. A molecular genetic study of blood leukocytes was conducted to establish the presence of microdeletions/microduplications in the corresponding loci. The result of the study is rsa17p11.2(P245)x1. Chromosome imbalance was established in the form of RAI1, DRC3, LLGL1 gene deletion in the 17p11.2 region, which verifies Smith-Magenis syndrome. Conclusions. In the work, a comprehensive analysis of chromosomal pathology was carried out based on the own detection of a clinical case of a rare Smith-Magenis syndrome in a newborn child. A detailed anamnesis, clinical manifestations, a set of laboratory-instrumental studies, the main ones of which are cytogenetic (karyotyping) and molecular genetic methods, are used for targeted examination, verification of the diagnosis and assessment of disease manifestations. The biological material of the peripheral blood culture (lymphocytes, leukocytes) of the child and parents was used. The results of a comprehensive analysis of chromosomal pathology based on one's own clinical case of the rare Smith-Magenis syndrome in a child of the neonatal period can draw the attention of primary care physicians to the study of syndromes of hereditary diseases and, in the differential diagnosis of patients, direct them to a medical-genetic consultation for cyto- and molecular-genetic studies.

КЛИНИКО-ЭПИДЕМИОЛОГИЧЕСКИЕ ОСОБЕННОСТИ БОЛЕЗНИ ЛАЙМА В НОВГОРОДСКОЙ ОБЛАСТИ

Lyme disease is the most common vector-borne disease of the forest zone of the Northern hemisphere of the planet, which is characterized by polymorphism of clinical forms of the infectious process. The polysystemic nature of lesions, the complexity of specific diagnosis and the lack of information to the public and primary care physicians make it difficult to verify the diagnosis and often lead to late diagnosis and the development of irreversible functional disorders. The aim of the study is to study the clinical and epidemiological features of Lyme disease in the Novgorod region. Materials and methods. A retrospective analysis of the epidemic situation in the morbidity of the population of the Novgorod region and a retrospective analysis of the medical histories of hospitalized patients diagnosed with Lyme disease in the Novgorod Regional Infectious Diseases Hospital for the period 2013-2023 were carried out. The results obtained. The high incidence of Lyme disease in the Novgorod region determines a special wariness towards this disease. The number of ticks in nature increases annually (the average number of ticks in nature in 2023 was 1,9 ex/km, and in 2013 – 1,2 ex/km), which is directly related to an increase in the average climatic temperature. Lyme disease is a seasonal disease, and people of retirement age are most often infected. In 90% of cases, patients do not know about the danger of this disease, the possibility of its transition to a chronic form and do not go to medical institutions for specific emergency prevention. The most vulnerable places of tick suction are the abdomen and the inner surface of the shoulder. According to the clinical picture, the erythemic form of the disease prevailed (70,7%), the febrile form (20,3%) and the meningeal form (8,98%) were less common. The majority of patients are admitted to the hospital with early manifestations of the disease by the type of localized erythema. In 94,5% of cases, the diagnosis was confirmed by ELISA, in 8,98% by PCR. In 100% of cases, patients received antibacterial therapy. No complications were detected.

Patterns and correlates of traumatic stress, depression, anxiety, and moral injury in U.S. health care providers late in the COVID-19 pandemic.

Providing health care during the COVID-19 pandemic has been associated with a high mental health burden for health care providers. This study examined patterns of responses and correlates of class membership across commonly assessed mental health symptoms, psychosocial functioning, and moral injury for providers in the United States in Fall 2022. A convenience sample of 1,504 primary care physicians, pediatricians, nurse practitioners, and physician assistants who had been in practice for three or more years (Mage = 46.1 years, SDage = 11.3, 58% male) completed self-report measures in an online, opt-in panel survey from September to November 2022. Using latent class analysis, three classes were identified: No/Low Symptoms (64.8%), High Moral Injury (19.9%), and Elevated Symptoms (15.2%). Several factors were correlated with class membership including age, sex, social support, personal risk of COVID-19, pandemic-related work stressors, proportion of COVID-19 patients seen at the height of the pandemic, and death of a patient due to COVID-19. This study found high levels of mental health symptoms, and problems with psychosocial functioning and moral injury in health care providers well past the pandemic's peak. The results also demonstrated the importance of considering the unique contribution of moral injury to psychosocial functional difficulties experienced by health care providers during the pandemic given their defined role as essential workers. These findings have implications for preventing and managing mental health problems and burnout among providers postpandemic as well as for future pandemics at both the organizational and individual levels. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Relationship of Chronic Disease Burden and Racial-Ethnic Disparities in Depression Treatment.

Chronic disease and depression are closely related, and depression, if left untreated, can worsen physical disease symptoms. Furthermore, treating depression can improve patient outcomes. Generally, treatment for depression is lower in minority groups. The aim of this study was to determine the relationship between chronic disease burden and depression treatment and whether that relationship differs between white to non-white patient visits to primary care physicians. We conducted a quantitative secondary data analysis using data from 2014-2019 National Ambulatory Medical Care Survey (NAMCS). Visits by adults with depression to primary care physicians (n = 3832). Logistic regressions estimated the odds of medication treatment, mental health counseling treatment, and any treatment. Visits by patients with 3 or more chronic conditions had 1.39 times the odds of receiving medication treatment (p-value = 0.06). However, when examining treatment by race, visits by white patients with 1-2 chronic conditions had 3.04 times the odds of receiving mental health treatment (p-value = 0.09) compared to visits by non-white patients and 2.09 times the odds of receiving any treatment (p-value = 0.08) compared to visits by non-white patients. Although not significant at the p < .05 level, the results suggest that the odds of depression treatment is greater during visits by patients with multiple co-occurring chronic conditions compared to visits by people without chronic conditions. It appears that this effect is larger for visits by white patients compared to visits by non-white patients. Further research is needed to confirm these findings and determine how this association impacts minorities distinctly and what could be the reason behind the disparity. These findings could help physicians be aware of ongoing disparities in depression treatment and provide more equitable depression treatment.

Pre-implementation planning for a sepsis intervention in a large learning health system: a qualitative study

BackgroundSepsis survivors experience high morbidity and mortality. Though recommended best practices have been established to address the transition and early post hospital needs and promote recovery for sepsis survivors, few patients receive recommended post-sepsis care. Our team developed the Sepsis Transition and Recovery (STAR) program, a multicomponent transition intervention that leverages virtually-connected nurses to coordinate the application of evidence-based recommendations for post-sepsis care with additional clinical support from hospitalist and primary care physicians. In this paper, we present findings from a qualitative pre-implementation study, guided by the Consolidated Framework for Implementation Research (CFIR), of factors to inform successful STAR implementation at a large learning health system prior to effectiveness testing as part of a Type I Hybrid trial.MethodsWe conducted semi-structured qualitative interviews (n = 16) with 8 administrative leaders and 8 clinicians. Interviews were transcribed and analyzed in ATLAS.ti using a combination deductive/inductive strategy based on CFIR domains and constructs and the Constant Comparison Method.ResultsSix facilitators and five implementation barriers were identified spanning all five CFIR domains (Intervention Characteristics, Outer Setting, Inner Setting, Characteristics of Individuals and Process). Facilitators of STAR included alignment with health system goals, fostering stakeholder engagement, sharing STAR outcomes data, good communication between STAR navigators and patient care teams/PCPs, clinician promotion of STAR with patients, and good rapport and effective communication between STAR navigators and patients, caregivers, and family members. Barriers of STAR included competing demands for staff time and resources, insufficient communication and education of STAR’s value and effectiveness, underlying informational and technology gaps among patients, lack of patient access to community resources, and patient distrust of the program and/or health care.ConclusionsCFIR proved to be a robust framework for examining facilitators and barriers for pre-implementation planning of post-sepsis care programs within diverse hospital and community settings in a large LHS. Conducting a structured pre-implementation evaluation helps researchers design with implementation in mind prior to effectiveness studies and should be considered a key component of Type I hybrid trials when feasible.Trial registrationClinicaltrials.gov, NCT04495946. Registered August 3, 2020.

Evaluation of the post-COVID multidisciplinary outpatient clinic at the Pulmonary Division of the Cantonal Hospital Winterthur from the patient's perspective: a mixed-methods study.

This prospective study, conducted with patients from the multidisciplinary post-COVID outpatient clinic at the Pulmonary Division of the Cantonal Hospital Winterthur, aimed to investigate changes in patients' main symptoms, elements that aided in coping with the condition and satisfaction with the consulting and therapeutic interventions. After obtaining ethical approval, fifty patients were consecutively included in this longitudinal study, which incorporated three survey times post-consultation: t1 (0-7 days), t2 (4-8 weeks) and t3 (4-6 months). The survey comprised standardised questionnaires, including the Hospital Anxiety and Depression Scale, the Post-COVID-19 Functional Status scale and the Chalder Fatigue scale, along with study-specific questions regarding symptoms and reasons for consulting the post-COVID outpatient clinic. Additionally, ten patients were invited to participate in qualitative individual interviews at t2 and t3. The study was conducted between November 2021 and February 2023. The median age of the 50 participants was 47 years (IQR: 36-55), with 66% (33/50) being female. Most participants (66% or 33/50) reported no pre-existing conditions prior to COVID-19 infection, and only six patients required hospitalisation during the acute phase of their infection. Visits to the multidisciplinary post-COVID clinic occurred approximately eight months post-infection, with referrals primarily made by primary care physicians (82% or 41/50). The majority of patients experienced persistent tiredness, exhaustion and fatigue (94% or 47/50), along with reduced physical performance (82% or 41/50), while pain or breathing difficulties were less frequently mentioned. At t1, around half of the patients were fully or partially unable to work, a proportion that reduced to around a third by t3. Symptoms generally decreased over time, with significant improvements observed between t2 and t3. However, subjectively perceived cognitive limitations worsened or were reported more frequently over time. Most patients (96% or 48/50) felt well cared for throughout their consultations. In qualitative interviews, patients highlighted the medical staff's attentiveness and the time dedicated to consultations, which made them feel that their complaints were taken seriously and that they received appropriate information. The results confirmed that the multidisciplinary post-COVID outpatient clinic met most respondents' expectations. Patients found that the attentive interprofessional coaching was most helpful in coping with their illness. However, participants also noted long waiting times and expressed a desire for earlier admission to the clinic.

Relationship between continuity of primary care and hospitalisation for patients with COPD: population-based cohort study from South Korea

ObjectivesThe existing evidence for the impacts of continuity of care (COC) in patients with chronic obstructive pulmonary disease (COPD) is low to moderate. This study aimed to investigate the associations...

Prevalence of Lifestyle Factors Among Primary Care Physicians: A Cross-Sectional Study in Al-Ahsa, Saudi Arabia.

Introduction The importance of a healthy lifestyle has grown in significance on a global scale, as it offers a vital means of preventing and managing a range of related illnesses. Consequently, maintaining a healthy lifestyle is of paramount importance for the prevention and management of non-communicable diseases. The lifestyle behaviors of healthcare workers exert a significant influence on their attitudes and counseling methods, as they play a pivotal role in the promotion of health and the dissemination of lifestyle education to patients and the general population. Objective The objective of this study was to examine the prevalence of lifestyle factors among primary care physicians in Al-Ahsa Governorate, including smoking, body mass index, nutrition, physical activity, and caffeine consumption. Methods The study was conducted between December 2023 and February 2024. A total of 233 primary care physicians in Al-Ahsa were selected through a probability multistage clustering sampling method. Data were collected via the distribution of a self-administered questionnaire to the primary care physicians and were analyzed using the chi-square test. Results A greater proportion of primary care physicians exhibited multiple unhealthy lifestyle factors (166/233, 71.2%). The most prevalent lifestyle factor was low physical activity (169/233, 73%), followed by poor nutrition (121/233, 52%), obesity (120/233, 51.51%), smoking (37/233, 15.88%), and caffeine consumption (22/233, 9%). The majority of primary care physicians with optimal health status are employed in primary healthcare (PHC) facilities situated in the eastern region followed by the southern region in Al-Ahsa Governorate. Conclusion The study findings revealed a prevalence of unhealthy lifestyle factors among the majority of primary care physicians in the Al-Ahsa Governorate. The most prevalent unhealthy lifestyle factor among the participants was low physical activity.

Over-the-Counter Hearing Aids: A Nationwide Survey Study to Understand Perspectives in Primary Care.

The expansion of over-the-counter (OTC) hearing aids has raised inquiries regarding primary care physicians' (PCP) knowledge, perspective, and perceived roles. We aimed to understand PCP perspectives on OTC hearing aids via nationwide online surveys. RedCap survey was distributed to PCPs via online forums and public mailing lists. Outcomes included PCPs' attitudes toward, perceived role surrounding, confidence managing, and knowledge of OTC hearing aids. Regression analyses were performed to identify associated factors including demographics and practice characteristics. Cohort included 111 PCPs primarily working in non-rural (83.8%) outpatient academic medical centers (47.5%), with a mean (SD) of 16.9 (11.6) years practicing. Most reported unfamiliarity (61.3%) with OTC hearing aids but viewed them positively (91.9%). They often perceived themselves as poor sources of OTC hearing aid information (63.1%) but desired involvement (90.1%) and believed associated knowledge is important (98.2%). Rural practice environment was associated with less familiarity toward OTC hearing aids (β = -0.72, [95% CI -1.40 to -0.04]). Respondents answered 5.0 (2.4) of 10 OTC hearing aid knowledge questions correctly. Using 5-point Likert scale, participants reported most confidence recognizing signs/symptoms of hearing loss 3.71 (0.84), but less confidence educating 1.68 (0.96) about and determining candidacy 1.72 (1.05) for OTC hearing aids. Participants reported continuing medical education courses and published guidelines would effectively improve their OTC hearing aid knowledge. PCPs displayed positive attitudes toward OTC hearing aids and valued involvement. Addressing unfamiliarity/knowledge gaps surrounding OTC hearing aids through courses and published guidelines may help clarify misconceptions and promote hearing health care. NA Laryngoscope, 2024.