Primary Care Setting Research Articles

Extracting Critical Information from Unstructured Clinicians' Notes Data to Identify Dementia Severity Using a Rule-Based Approach: Feasibility Study.

The severity of Alzheimer disease and related dementias (ADRD) is rarely documented in structured data fields in electronic health records (EHRs). Although this information is important for clinical monitoring and decision-making, it is often undocumented or "hidden" in unstructured text fields and not readily available for clinicians to act upon. We aimed to assess the feasibility and potential bias in using keywords and rule-based matching for obtaining information about the severity of ADRD from EHR data. We used EHR data from a large academic health care system that included patients with a primary discharge diagnosis of ADRD based on ICD-9 (International Classification of Diseases, Ninth Revision) and ICD-10 (International Statistical Classification of Diseases, Tenth Revision) codes between 2014 and 2019. We first assessed the presence of ADRD severity information and then the severity of ADRD in the EHR. Clinicians' notes were used to determine the severity of ADRD based on two criteria: (1) scores from the Mini Mental State Examination and Montreal Cognitive Assessment and (2) explicit terms for ADRD severity (eg, "mild dementia" and "advanced Alzheimer disease"). We compiled a list of common ADRD symptoms, cognitive test names, and disease severity terms, refining it iteratively based on previous literature and clinical expertise. Subsequently, we used rule-based matching in Python using standard open-source data analysis libraries to identify the context in which specific words or phrases were mentioned. We estimated the prevalence of documented ADRD severity and assessed the performance of our rule-based algorithm. We included 9115 eligible patients with over 65,000 notes from the providers. Overall, 22.93% (2090/9115) of patients were documented with mild ADRD, 20.87% (1902/9115) were documented with moderate or severe ADRD, and 56.20% (5123/9115) did not have any documentation of the severity of their ADRD. For the task of determining the presence of any ADRD severity information, our algorithm achieved an accuracy of >95%, specificity of >95%, sensitivity of >90%, and an F1-score of >83%. For the specific task of identifying the actual severity of ADRD, the algorithm performed well with an accuracy of >91%, specificity of >80%, sensitivity of >88%, and F1-score of >92%. Comparing patients with mild ADRD to those with more advanced ADRD, the latter group tended to contain older, more likely female, and Black patients, and having received their diagnoses in primary care or in-hospital settings. Relative to patients with undocumented ADRD severity, those with documented ADRD severity had a similar distribution in terms of sex, race, and rural or urban residence. Our study demonstrates the feasibility of using a rule-based matching algorithm to identify ADRD severity from unstructured EHR report data. However, it is essential to acknowledge potential biases arising from differences in documentation practices across various health care systems.

COVID-19 vaccine hesitancy among unvaccinated individuals in a primary care setting, Pretoria.

South Africa faced challenges while implementing coronavirus disease 2019 (COVID-19) measures such as mass vaccination. Some people rejected or were hesitant to receive government-recommended vaccines. This study explored COVID-19 vaccination hesitancy among unvaccinated individuals in a primary care setting in Pretoria, South Africa. This was an exploratory phenomenological study that included one-on-one interviews with 12 individuals at Temba Community Health Centre in Pretoria, South Africa. The research revealed five themes: perceptions of COVID-19 disease, perceptions of COVID-19 vaccine, factors related to non-vaccination, information sources about the COVID-19 vaccine, and long-term vaccination decisions. There were seven linked sub-themes. Overall, participants had a good understanding of COVID-19 disease, but limited knowledge about the vaccine, causing hesitancy to get vaccinated. Reasons for not getting vaccinated included health-related concerns, safety concerns, personal experiences, and social and political factors. Safety and health-related concerns were prevalent, with adverse vaccine outcomes being the most common concern. Most participants had experienced a historic encounter with a vaccine-related death or illness.Contribution:Vaccine hesitancy should be viewed as a powerful concern from the community, and a key source of worry for the health authorities over any vaccine-related doubt.

Moving from crisis response to a learning health system: Experiences from an Australian regional primary care network

AbstractIntroductionThe COVID‐19 pandemic challenged primary care to rapidly innovate. In response, the Western Victorian Primary Health Network (WVPHN) developed a COVID‐19 online Community of Practice comprising general practitioners (GPs), practice nurses, pharmacists, aged care and disability workers, health administrators, public health experts, medical specialists, and consumers. This Experience Report describes our progress toward a durable organizational learning health system (LHS) model through the COVID‐19 pandemic crisis and beyond.MethodsIn March 2020, we commenced weekly Community of Practice sessions, adopting the Project ECHO (Extension of Community Health Outcomes) model for a virtual information‐sharing network that aims to bring clinicians together to develop collective knowledge. Our work was underpinned by the LHS framework proposed by Menear et al. and aligned with Kotter's eight‐step change model.ResultsThere were four key phases in the development of our LHS: build a Community of Practice; facilitate iterative change; develop supportive organizational infrastructure; and establish a sustainable, ongoing LHS. In total, the Community of Practice supported 83 unique COVID‐19 ECHO sessions involving 3192 h of clinician participation and over 10 000 h of organizational commitment. Six larger sessions were run between March 2020 and September 2022 with 3192 attendances. New models of care and care pathways were codeveloped in sessions and network leaders contributed to the development of guidelines and policy advice. These innovations enabled WVPHN to lead the Australian state of Victoria on rates of COVID vaccine uptake and GP antiviral prescribing.ConclusionThe COVID‐19 pandemic created a sense of urgency that helped stimulate a regional primary care‐based Community of Practice and LHS. A robust theoretical framework and established change management theory supported the purposeful implementation of our LHS. Reflection on challenges and successes may provide insights to support the implementation of LHS models in other primary care settings.

Lifestyle and risk factors associated with elevated prostate-specific antigen levels in rural men: implications for health counseling.

The use of prostate-specific antigen (PSA) for early detection of prostate cancer (PCa) is common but controversial. In rural areas, PSA is widely used for screening because it is convenient and early-stage PCa often shows no symptoms. Studies suggest that PSA levels are linked to factors like unhealthy lifestyles, obesity, lack of exercise, inflammation, and aging. Proper use and interpretation of PSA are crucial for healthcare providers, especially in primary care settings. This study aims to explore the prevalence and factors linked to higher PSA levels in rural men. We conducted a community-based cross-sectional study from March to December 2023 in the western coastal region of Taiwan. Men aged 40-75 years participated, completing a lifestyle questionnaire and providing blood samples for cardiometabolic biomarkers and PSA levels. PSA levels of ≥ 4.0 ng/mL were considered elevated. We used propensity score matching (PSM) and genetic matching (GM) for analysis, followed by regression analysis. In total, 3347 male adults with a mean age of 56.3 years (SD=11.8, range 40-75), and without cancer-related diseases, were enrolled. Findings indicated that 3.9% (n=130) of men aged 40-75 years had a PSA ≥ 4 ng/mL. and many of them did not adopt health-related behaviors, including inadequate servings of vegetables, water intake, and engaging in regular exercise. Furthermore, more than half of the participants had high blood pressure, and over one-quarter exhibited a higher waist-hip ratio and cardiometabolic diseases. After employing propensity score matching (PSM) and genetic matching (GM) with respect to age and education, the multivariate logistic regression model indicated that less water intake (p<0.01), higher waist-hip ratio (> 0.95) (p<0.05), and being diagnosed with cardiometabolic diseases (p<0.05) were significantly associated with a higher serum PSA level. This study revealed that inadequate water intake and obesity related diseases are significant risk factors associated with elevated PSA levels among male adults living in rural areas. It is important for frontline healthcare providers to carefully interpret the meaning of a high PSA level. Additionally, launching a longitudinal study is necessary to further investigate its relation to PCa.

A Comparative Evaluation of Point-of-Care and Laboratory HbA1c Testing in Diabetes Care: An Indian Perspective.

This study aimed to assess the diagnostic performance of a point-of-care (POC) glycated hemoglobin (HbA1c) device in the Indian population against the standard laboratory (high-performance liquid chromatography {HPLC}) method for the effective management of diabetes in India. This study on the diagnostic accuracy of a POC HbA1c device involved 121 participants. These participants were categorized into two groups according to their HbA1c levels - one group with HbA1c values below 6.5% and another group with HbA1c values equal to or greater than 6.5%. The HbA1c levels in enrolled participants were estimated using both the POC device (HemoCueHbA1c 501; Ängelholm, Sweden: HemoCue AB) and the standard HPLC-based method. The level of agreement and concordance between the two test results were assessed by the Bland-Altman plot and Lin's concordance correlation coefficient. Sensitivity, specificity, diagnostic accuracy, positive likelihood, and negative likelihood ratios of POC-HbA1c device were assessed with a 6.5% HbA1c cut-off. The mean HbA1c values obtained by the two methods showed no statistically significant difference with a minimum effect size (Cohen's d = 0.035), indicating there was a negligible difference between these methods. The Bland-Altman plot revealed that most values were within acceptable limits (95% CI: -0.5 to 0.7) and Lin's concordance correlation coefficient showed strong agreement (p < 0.0001).The POC-HbA1c device demonstrated an area under the curve (AUC) of 0.991 (95% CI: 0.953-1.000) with sensitivity, specificity, diagnostic accuracy, positive likelihood, and negative likelihood ratios of 93.62%, 97.30%, 95.87%, 34.64 and 0.07, respectively, compared to the standard diagnostic assay. The diagnostic accuracy, sensitivity, and specificity demonstrated by the POC-HbA1c device to the standard HPLC method offers a viable and practical solution for diabetes management in India. Its ability to provide rapid and reliable results at the point of care can improve patient outcomes, reduce healthcare costs, and enhance access to diabetes care, especially in primary care, remote areas, and resource-limited settings of developing countries like India.

Preclinical Evaluation of Electronic Health Records (EHRs) to Predict Poor Control of Chronic Respiratory Diseases in Primary Care: A Novel Approach to Focus Our Efforts.

Background/Objectives: Managing chronic respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD) within the Spanish Sistema Nacional de Salud (SNS) presents significant challenges, particularly due to their high prevalence and poor disease control rates-approximately 45.1% for asthma and 63.2% for COPD. This study aims to develop a novel predictive model using electronic health records (EHRs) to estimate the likelihood of poor disease control in these patients, thereby enabling more efficient management in primary care settings. Methods: The Seleida project employed a bioinformatics approach to identify significant clinical variables from EHR data in primary care centers in Seville and Valencia. Statistically significant variables were incorporated into a logistic regression model to predict poor disease control in patients with asthma and COPD patients. Key variables included the number of short-acting β-agonist (SABA) and short-acting muscarinic antagonist (SAMA) canisters, prednisone courses, and antibiotic courses over the past year. Results: The developed model demonstrated high accuracy, sensitivity, and specificity in predicting poorly controlled disease in both asthma and COPD patients. These findings suggest that the model could serve as a valuable tool for the early identification of at-risk patients, allowing healthcare providers to prioritize and optimize resource allocation in primary care settings. Conclusions: Integrating this predictive model into primary care practice could enhance the proactive management of asthma and COPD, potentially improving patient outcomes and reducing the burden on healthcare systems. Further validation in diverse clinical settings is warranted to confirm the model's efficacy and generalizability.

Comparative Investigation of Mobile Portable Complex System Functional and Laboratory Diagnostics with Stationary Equipment

The aim of the current study is to evaluate the effectiveness of using mobile portable complex system functional and laboratory diagnostics in patients compared to stationary equipment. The scientific study examined the results of functional and laboratory diagnostics of 123 patients who were at JSC NSMC at the time of diagnosis and treatment. The study covered a 1-year period from January 2023 to December 2023. Patients were divided into two groups: 1 group&amp;nbsp; - 63 patients, who were diagnosed using expert stationary equipment of NNMC; 2 group- 60 patients who were diagnosed using the mobile portable complex Health Examination System HES-7 (Konsung Technology; 2023). Results: Laboratory diagnostics were performed in 63 (100%) patients of the 1&lt;sup&gt;st&lt;/sup&gt; group and in 60 (100%) patients of 2&lt;sup&gt;nd&lt;/sup&gt; group. The compared groups had the same characteristics, for instance anaemia was detected in 4 (6.35%) patients of first group and in 5 (8.33%) patients of the second group. Mortality was not observed in the compared groups. According to all data obtained minor differences in diagnostic findings were found (1 to 6%). In addition, HES-7 demonstrated quite accurate functional analysis: electrocardiography, pulse oximetry, and spirography. Conclusion: The use of the digital mobile complex of functional and laboratory diagnostics Health Examination System HES-7 is safe and can be effectively used in primary health care settings by experienced nursing staff.

Primary care practitioner and patient perspectives on care following bariatric surgery: A meta-synthesis of qualitative research.

Primary care is central to ongoing health care following bariatric surgery and patients indicate a preference for receiving follow-up support by their primary care practitioner (PCP). This meta-synthesis investigates the perspectives of both PCPs and patients in post-bariatric surgery care provided by PCPs. The aim was to synthesize themes from qualitative research to recommend improvements in post-bariatric surgery clinical care in primary care settings. Systematic searches of Scopus, Medline, EMBASE, PsycINFO, the Cochrane Library, and Google Scholar resulted in the inclusion of eight papers in the meta-synthesis. Papers were critiqued using the Critical Appraisal Skills Program (CASP) and thematically coded in Quirkos Cloud. Seven themes were reached by author consensus including stigma and judgment; clinician barriers and facilitators; patient-related support needs; communication considerations; patient context or determinants; health care setting; and adapting to life after surgery. PCPs reported barriers including poor communication and guidance from bariatric surgery centers, limited knowledge and training in bariatric patient care, and patients who may have unrealistic outcomes and poor health literacy. Patients seek comprehensive care from their PCP, however, barriers hindering the provision of this care include adverse surgical outcomes, a poor relationship with their PCP, and limited and short-term follow-up care from the PCP. Insights from this meta-synthesis offer actionable recommendations for PCPs and bariatric surgery centers to enhance patient care immediately.

Usability of a Web-Based App for Increasing Adolescent Vaccination in Primary Care Settings: Think-Aloud and Survey Assessment.

In the United States, only 58% of teens receive the recommended 2 doses of the human papillomavirus vaccine by 15 years of age. Overcoming vaccine hesitancy often requires effective communication between clinicians and parents to address specific concerns. To support this, we developed ProtectMe4, a multilevel, theory-informed web-based intervention designed to address parents' vaccine-related questions and assist clinicians in discussing vaccine concerns for 4 adolescent vaccines. This study aims to evaluate the usability of ProtectMe4 in routine care settings across 3 pediatric primary care clinics. Specifically, the study aims to (1) observe the proposed workflow in practice, (2) identify usability issues experienced by parents and clinicians, and (3) assess the perceptions of both parents and clinicians regarding the app's usability. On designated days in 2020 and 2021, the study team recruited parents of 11- to 12-year-old patients attending appointments with participating clinicians. We conducted think-aloud assessments during routine care visits and administered a usability survey after participants used the app. For parents, we simultaneously video-recorded the app screens and audio-recorded their commentary. For clinicians, observational notes were taken regarding their actions and comments. Timings recorded within the app provided data on the length of use. We reviewed the recordings and notes to compile a list of identified issues and calculated the frequencies of survey responses. Out of 12 parents invited to use the app, 9 (75%) participated. Two parents who were invited outside of the planned workflow, after seeing the clinician, refused to participate. For the parents whose child's vaccination record was identified by the app, the median time spent using the app was 9 (range 6-28) minutes. Think-aloud assessment results for parents were categorized into 2 themes: (1) troubleshooting vaccine record identification and (2) clarifying the app content and purpose. Among the 8 parents who completed the survey, at least 75% (6/8) agreed with each acceptability measure related to user satisfaction, perceived usefulness, and acceptance. These parents' children were patients of 4 of the 7 participating clinicians. Consistent with the planned workflow, clinicians viewed the app before seeing the patient in 4 of 9 (44%) instances. The median time spent on the app per patient was 95 (range 5-240) seconds. Think-aloud assessment results for clinicians were grouped into 2 themes: (1) trust of app vaccine results and (2) clarifying the app content. On the survey, clinicians were unanimously positive about the app, with an average System Usability Scale score of 87.5 (SE 2.5). This mixed methods evaluation demonstrated that ProtectMe4 was usable and acceptable to both parents and clinicians in real-world pediatric primary care. Improved coordination among clinic staff is needed to ensure the app is consistently offered to patients and reviewed by clinicians before seeing the patient.

National Addiction Workshop: A Virtual Adaptation to Support Competency Development in Opioid Use Disorder Management.

Accessible, manualized, skill-based training ready for wide dissemination is needed to prepare healthcare staff to meet the needs of people impacted by the opioid epidemic. A 2-day workshop and simulation training was designed by an interprofessional substance use disorder (SUD) specialty care team, adapted to a virtual platform, manualized, and offered to healthcare staff and trainees from a large healthcare system. The workshop was offered 6 times over the course of 10 months with a total of 177 participants from across the United States enrolled in the training. Interactive experiential learning strategies including games designed to test knowledge, small-group case discussions, video demonstrations of skills, patient panels, and 3 simulations of a patient with chronic pain who developed opioid use disorder in the context of long-term opioid therapy were utilized in efforts to build skills and confidence managing SUDs in primary care and general mental health settings. Of those who completed the post-workshop survey, most found both content and training structure useful, particularly content related to medication management, stigma, and collaborative care. In addition, overall confidence scores in assessing, diagnosing, and treating SUD increased. Skill building exercises, such as interprofessional team simulations, were highlighted as most beneficial. The workshop received national attention leading to a partnership with the healthcare system's simulation center for wider dissemination. Expanding access to SUD treatment requires training healthcare staff to effectively change attitudes, increase knowledge, and improve key skills. This 2-day interprofessional workshop was well-received by participants who reported high acceptability and satisfaction scores and demonstrated improved confidence in the management of SUDs. This type of manualized, collaborative, skill-based learning experience can foster staff preparedness and willingness to conceptualize SUD as a chronic condition amenable to treatment in different healthcare settings.

The Impact of Health Behaviors on Iron Supplementation Adherence and Anemia Prevalence among Pregnant Women: Evidence from a Primary Care Setting in Aceh Tengah, Indonesia

Anemia during pregnancy remains a significant global health concern, particularly in developing countries like Indonesia. However, adherence to iron supplementation programs is often suboptimal, leading to persistent anemia and adverse maternal and neonatal outcomes. This study aimed to investigate the relationship between health behaviors (knowledge, attitudes, and practices) and adherence to iron supplementation among pregnant women in a primary care setting in Aceh Tengah, Indonesia. Additionally, we explored the impact of these factors on anemia prevalence. A cross-sectional study was conducted at the Pegasing Community Health Center in Aceh Tengah, Indonesia. Pregnant women diagnosed with anemia were recruited, and data were collected using questionnaires assessing their knowledge, attitudes, and practices regarding iron supplementation. Hemoglobin levels were measured to determine anemia status. Statistical analyses were performed to examine the relationships between health behaviors, adherence, and anemia prevalence. A total of 59 pregnant women with anemia participated in the study. Adherence to iron supplementation was suboptimal, with 59.3% reporting poor adherence. Knowledge about iron supplementation was generally good (76.3%), but attitudes and practices were less favorable (30.5% and 27.1%, respectively). Statistical analyses revealed a significant association between attitudes and practices related to iron supplementation and adherence. Furthermore, poor adherence was linked to a higher prevalence of anemia. In conclusion, healthy behaviors, particularly attitudes and practices, play a crucial role in iron supplementation adherence among pregnant women in Aceh Tengah, Indonesia. Interventions targeting these behaviors are essential to improve adherence and reduce the burden of anemia in this population.

Electronic Health Record Nudges and Health Care Quality and Outcomes in Primary Care

Nudges have been increasingly studied as a tool for facilitating behavior change and may represent a novel way to modify the electronic health record (EHR) to encourage evidence-based care. To evaluate the association between EHR nudges and health care outcomes in primary care settings and describe implementation facilitators and barriers. On June 9, 2023, an electronic search was performed in PubMed, Embase, PsycINFO, CINAHL, and Web of Science for all articles about clinician-facing EHR nudges. After reviewing titles, abstracts, and full texts, the present review was restricted to articles that used a randomized clinical trial (RCT) design, focused on primary care settings, and evaluated the association between EHR nudges and health care quality and patient outcome measures. Two reviewers abstracted the following elements: country, targeted clinician types, medical conditions studied, length of evaluation period, study design, sample size, intervention conditions, nudge mechanisms, implementation facilitators and barriers encountered, and major findings. The findings were qualitatively reported by type of health care quality and patient outcome and type of primary care condition targeted. The Risk of Bias 2.0 tool was adapted to evaluate the studies based on RCT design (cluster, parallel, crossover). Studies were scored from 0 to 5 points, with higher scores indicating lower risk of bias. Fifty-four studies met the inclusion criteria. Overall, most studies (79.6%) were assessed to have a moderate risk of bias. Most or all descriptive (eg, documentation patterns) (30 of 38) or patient-centeredness measures (4 of 4) had positive associations with EHR nudges. As for other measures of health care quality and patient outcomes, few had positive associations between EHR nudges and patient safety (4 of 12), effectiveness (19 of 48), efficiency (0 of 4), patient-reported outcomes (0 of 3), patient adherence (1 of 2), or clinical outcome measures (1 of 7). This systematic review found low- and moderate-quality evidence that suggested that EHR nudges were associated with improved descriptive measures (eg, documentation patterns). Meanwhile, it was unclear whether EHR nudges were associated with improvements in other areas of health care quality, such as effectiveness and patient safety outcomes. Future research is needed using longer evaluation periods, a broader range of primary care conditions, and in deimplementation contexts.

Development and validation of the Florey Dementia Risk Score web-based tool to screen for Alzheimer's disease in primary care

It is estimated that ∼60% of people with Alzheimer's disease (AD) are undetected or undiagnosed, with higher rates of underdiagnosis in low-to middle-income areas with limited medical resources. To promote health equity, we have developed a web-based tool that utilizes easy-to-collect clinical data to enhance AD detection rate in primary care settings. This study was leveraged on the data collected from participants of the Australian Imaging, Biomarker & Lifestyle (AIBL) study and the Religious Orders Study and Memory and Aging Project (ROSMAP). The study included three phases: (1) constructing and evaluating a model on retrospective cohort data (1407 AIBL participants), (2) performing simulated trials to assess model accuracy (30 AIBL participants) and missing data tolerability (30 AIBL participants), and (3) external evaluation using a non-Australian dataset (500 ROSMAP participants). The auto-score machine learning algorithm was employed to develop the Florey Dementia Risk Score (FDRS). All the simulated trials and evaluation were performed using a web-based FDRS tool. FDRS achieved an area under the curve (AUC) of approximately 0.82 [95% CI, 0.75-0.88], with a sensitivity of 0.74 [0.60-0.86] and a specificity of 0.73 [0.70-0.79]. The accuracy of the simulated pilot trial for 30 AIBL participants with complete record was 87% (26/30 correct), while it only slightly decreased (80.0-83.3%, depending on imputation methods) for another 30 AIBL participants with one or two missing data. FDRS achieved an AUC of 0.82 [0.77-0.86] of 500 ROSMAP participants. The FDRS tool offers a potential low-cost solution to AD screening in primary care. The present study warrants future trials of FDRS for optimization and to confirm its generalizability across a more diverse population, especially people in low-income countries. National Health and Medical Research Council, Australia (GNT2007912) and Alzheimer's Association, USA (23AARF-1020292).

Technology for advancing behavioral health integration: implications for behavioral health practice and policy.

Behavioral health integration (BHI) encompasses the integration of general health, mental health, and substance use care. BHI has promise for healthcare improvement, yet several challenges limit its uptake and successful implementation. Translational Behavioral Medicine published the Continuum-Based Framework by Goldman et al., 2020 to create comprehensive guidance for BHI within primary care settings. Technology can help advance BHI and provide evidence to support it. This commentary describes challenges and illustrative use cases in which technology solutions help organizations achieve BHI through the Continuum-Based Framework domains. Two rounds of semi-structured interviews with field leaders, practice sites, and technology stakeholders identified key barriers in BHI amenable to technology solutions, applications of technologies, and how they facilitate BHI. Findings showed that technology can facilitate the implementation and scaling of BHI by reducing care fragmentation and improving patient engagement, accountability and financial sustainability, provider experience and support, and equitable access to culturally competent care. Continued efforts by stakeholders to address legacy policy and implementation issues (e.g. incentives, investment, privacy, and workforce) are needed to optimize the impact of technology on BHI.

Who Guideline for Non-Surgical Management of Chronic Primary Low Back Pain in Adults in Primary and Community Care Settings

Low back pain is a very common condition that affects most people at some point in their lives. It represents a burden on those affected, reducing their ability to participate in activities of normal life; at the same time, dealing with it increases the economic costs of healthcare. The aim of this guideline was to contribute to WHO activities for reducing the impact of low back pain in adults and to support the WHO approach to integrated care for older people in primary care. In December 2023, the World Health Organization (WHO) published the "WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings". It was developed following the process according to the WHO handbook for guideline development. The team at the WHO Collaborating Centre for Evidence-Based Medicine at the University for Continuing Education Krems (Austria) translated the summary of this guideline for its application in German-speaking countries. The guideline addresses 37 interventions for the treatment of chronic primary low back pain in primary care and provides 24 recommendations and one good practice statement. No recommendations were made regarding twelve interventions due to equivocation or lack of sufficient evidence. The recommended interventions are intended to provide a range of options to support and personalize care for adults with chronic primary low back pain.

Organizational resilience and primary care nurses' work conditions and well-being: a multilevel empirical study in China.

Resilience is crucial for a health system to better prevent and respond to public health threats and provide high-quality services. Despite the growing interest in the concept of resilience in health care, however, there is little empirical evidence of the impact of organizational resilience, especially in primary care settings. As the largest professional group in primary care, primary care nurses are taking more and more responsibilities during their daily practice, which influences both their work conditions and well-being. This study aims to examine the association between organizational resilience and primary care nurses' working conditions and well-being. Using a convenience sampling approach, we recruited 175 primary care nurses from 38 community health centres (CHCs) in four cities in China. Organizational resilience was operationalized as comprising two domains: adaptive capacity and planning capacity, and measured using a 16-item scale. The primary care nurses' working condition indicators comprised variables of psychological safety, organizational commitment, professional commitment, and self-directed learning; well-being indicators included depression and burn-out. Hierarchical linear regression models were built for analysis. We found that the sampled CHCs have a relatively high level of organizational resilience. The organizational resilience was positively associated with the four indicators of working conditions: psychological safety (β = 0.04, P < 0.01), organizational commitment (β = 0.38, P < 0.01), professional commitment (β = 0.39, P < 0.01), and self-directed learning (β = 0.28, P < 0.01). However, organizational resilience was not significantly associated with the two well-being indicators. Furthermore, we found that the adaptive capacity has stronger association compared with planning capacity. Therefore, primary care manager should build resilient organizations, especially the adaptive capacity, in order to enhance primary care nurses' psychological safety, commitment and learning behaviours. Further studies should also be conducted to understand the link between organizational resilience and primary care nurses' well-being.

Lean Six Sigma quality improvement approach to implement clinical practice guidelines for prescribing opiates for chronic pain in a primary care setting

BackgroundImplementing guidelines for chronic opioid management during a clinic merger posed significant challenges. Our aim was to increase the percentage of chronic pain evaluations and urine toxicology tests in patients...

What is known about the challenges people with Parkinson's disease experience with their medicines and what solutions have been explored to overcome them? A scoping review.

The symptomatic management of Parkinson's disease (PD) relies heavily on medications, which increase in complexity as the disease progresses. To describe (i) the extent, range, and nature of research describing the experience and challenges people with PD and their carers have with their medicines for symptomatic treatment, and (ii) any interventions that have been reported in a community setting that address medicine-related challenges experienced by people with PD. The scoping review searched electronic databases (EMBASE, PubMed, and CINAHL). The studies included were full-text articles in English only, including conference abstracts that focussed on patients with PD or their carers and discussed medicines in the primary care setting, even where this was not the primary focus. Thirty-nine papers were taken forward for data extraction. Twenty described patient experience and challenges. Although none were explicitly focussed on medications, they did highlight challenges including the work of taking multiple medications and a desire for non-oral formulations. Nineteen described or tested interventions to support people with PD with their medication including community pharmacist-led reviews, medication compliance aids, and the use of text message reminders. These were all small-scale feasibility and pilot studies, and none were grounded in a methodological framework. Positive outcomes were reported against various scales, but no evidence of scaling up any of the interventions was found. There is very little published research surrounding the challenges people with PD have with their medicines. The published research that does exist alludes to challenges with medicines taking in people with PD but identifies a gap in the detail and understanding. Further work is required to improve our understanding and allow the development of sustainable interventions that support people with PD and their carers.

Implementation of collaborative care for depression in VA HIV clinics: Translating Initiatives for Depression into Effective Solutions (HITIDES): protocol for a cluster-randomized type 3 hybrid effectiveness-implementation trial

BackgroundDepression is the most diagnosed mental health condition among people living with HIV. Collaborative care is an effective intervention for depression, typically delivered in primary care settings. The HIV Translating Initiatives for Depression into Effective Solutions (HITIDES) clinical intervention involves a depression care team housed off-site that supports depression care delivery by HIV care providers. In a randomized controlled trial, HITIDES significantly improved depression symptoms for veterans living with HIV and delivered cost savings. However, no HIV clinics in the Veterans Health Administration (VHA) have implemented HITIDES; as such, it is unclear what implementation strategies are necessary to launch and sustain this intervention.MethodsThis hybrid type-3 effectiveness-implementation trial examines the implementation and effectiveness of HITIDES in 8 VHA HIV clinics randomly assigned to one of two implementation arms. Each arm uses a different implementation strategy package. Arm 1 includes an intervention operations guide; an on-site clinical champion who, with the help of a peer community of practice, will work with local clinicians and leadership to implement HITIDES at their site; and patient engagement in implementation tools. Arm 2 includes all strategies from Arm 1 with assistance from an external facilitator. The primary implementation outcomes is reach; secondary outcomes include adoption, implementation dose, depressive symptoms, and suicidal ideation. We will conduct a budget impact analysis of the implementation strategy packages. We hypothesize that Arm 2 will be associated with greater reach and adoption and that Arm 1 will be less costly.DiscussionPreliminary work identified implementation strategies acceptable to veterans living with HIV and HIV care providers; however, the effectiveness and cost of these strategies are unknown. While the depression care team can deliver services consistently with high quality, the ability of the depression care team to engage with HIV care providers at sites is unknown. Findings from this study will be used to inform selection of implementation strategies for a broad rollout to enhance depression and suicide care for people living with HIV.Trial registrationClinicalTrials.gov ID: NCT05901272, Registered 10 May 2023, https://clinicaltrials.gov/study/NCT05901272

Parental Awareness of Antibiotic Use for Upper Respiratory Tract Infection in Children in Jazan Region, Saudi Arabia.

Upper respiratory tract infections are a prevalent cause of morbidity in children, often managed in primary care settings. These infections are predominantly viral, but antibiotics are sometimes inappropriately prescribed. This misuse, driven by parental pressure and misconceptions, contributes to the growing problem of antibiotic resistance. The impact of parental awareness on antibiotic use practices is significant, as gaps in knowledge can lead to inappropriate use. This study used a cross-sectional design to assess parents' awareness of antibiotic use for upper respiratory tract infections in children in Jazan, Saudi Arabia. Data were collected via a self-administered online questionnaire distributed through social media platforms. Participants were parents aged 18 years and older residing in Jazan. A snowball sampling technique was employed. The questionnaire assessed knowledge, attitudes, and practices regarding antibiotics. The study included 398 participants, with a nearly equal gender distribution of 198 females (49.7%) and 200 males (50.3%). Participants' ages were as follows: 148 (37.2%) were 18-30 years old, 162 (40.7%) were 31-40 years old, and 88 (22.1%) were over 40 years old. Regarding educational attainment, 29 (7.3%) mothers and 36 (9.0%) fathers had primary school education; 117 (29.4%) mothers and 128 (32.2%) fathers had secondary school education; 22 (5.5%) mothers and 33 (8.3%) fathers had intermediate school education; 209 (52.5%) mothers and 175 (44.0%) fathers held a bachelor's degree; and 21 (5.3%) mothers and 26 (6.5%) fathers had a master's degree. Most participants had a moderate income level (270, 67.8%) and resided in Bish (202, 50.8%). The main sources of information about antibiotics were doctors (242, 60.8%) and the internet (90, 22.6%). Perceptions varied, with 147 (36.9%) agreeing and 84 (21.1%) strongly agreeing that antibiotics can prevent complications from infections. A significant proportion believed that inappropriate use could lead to antibiotic resistance (172, 43.2% agreed; 129, 32.4% strongly agreed). Regarding the use of leftover antibiotics, 197 (49.5%) disagreed with using them without consulting a doctor. Interaction with pediatricians showed that 212 (53.3%) always followed pediatrician advice and instructions, while 66 (16.6%) rarely did. The study highlights significant gaps in parental awareness regarding antibiotic use for upper respiratory tract infections in Jazan. Despite some understanding of antibiotic resistance, misconceptions about the efficacy and appropriate use of antibiotics persist. Addressing these gaps through targeted education and improving communication with healthcare providers could enhance antibiotic stewardship and reduce the risk of resistance.