Primary Care Setting Research Articles

Design and implementation of a Type-2 hybrid, prospective randomized trial of opioid agonist therapies integration into primary care clinics in Ukraine

IntroductionUkraine has high HIV prevalence, concentrated among people who inject drugs (PWID), mostly of opioids. Maintenance on opioid agonist therapies (OAT) is the most effective evidence-based treatment for opioid use disorder. As PWID experience high morbidity and mortality from preventable and treatable non-communicable diseases, international agencies recommend integrating OAT into primary care centers (PCC). MethodsA randomized, type-2 hybrid implementation trial was carried out to compare outcomes of OAT integration in PCC to OAT delivery at specialty treatment centers (STC) – standard-of-care. Tele-education supporting PCC providers in managing OAT, HIV, tuberculosis and non-communicable diseases along with pay-for-performance incentives were used to facilitate implementation. Consenting patients underwent 1:2 randomization to either STC or PCC. Quality health indicators (QHIs), a composite percentage of recommended primary and specialty services accessed by patients (blood/urine tests, cancer screenings, etc.), were defined as efficacy outcomes and were assessed by participant self-report at baseline and every 6 months over 24 months and electronic chart reviews after the completion of the follow-up. The primary outcome is defined as the difference in composite QHI scores at 24 months, in which a repeated measures likelihood-based mixed model with missing at random assumptions will be used. Providers at PCC completed surveys at baseline, 12 and 24 months to assess implementation outcomes including changes in stigma and attitudes towards OAT and PWID. Preliminary resultsAmong the 1459 participants allocated to STC (N = 509) or PCC (N = 950), there were no differences in clinical and demographic characteristics. Self-reported prevalences were available for HIV (42 %), HCV (57 %), and prior tuberculosis (17 %). Study retention at 6, 12, 18, and 24 months was as 91 %, 85 %, 80 %, and 74 %, respectively. ConclusionPWID have a high prevalence of medical comorbidities and integrating OAT into primary care settings has the potential to improve the health of PWID. Findings from this study can help guide implementation of integrated care in Ukraine and throughout similar low-resource, high-burden countries in the Eastern European and Central Asian region.

Parents’ perceptions of the safe environment for every kid (SEEK) model in the Swedish child health services

BackgroundThe Safe Environment for Every Kid (SEEK) model was developed to address psychosocial risk factors (financial worries, depressive symptoms, major parental stress, alcohol misuse and intimate partner violence) in the pediatric primary care setting but has not been evaluated from the parents’ perspective. To further investigate the usefulness of SEEK, it is important to explore how parents perceive the model.ObjectiveThe aim of the present study was to explore parents’ perceptions of the SEEK model as a part of regular health visits in the Child Health Services in Sweden.Participants and settingEighteen parents (13 women and five men) in two Swedish counties participated in the study.MethodsSemi-structured telephone interviews were conducted, and the resulting data were analyzed using reflective thematic analysis.ResultsThree themes were identified: Acceptance and understanding of the SEEK model in the child health services, The questionnaire as a bridge to a dialogue, and Feeling trust in the system and the child health nurse’s professional competence. Further, an overarching theme was created that encompassed a core meaning of all three themes; SEEK provides a process-oriented framework to receive support in parenting with a focus on child health.ConclusionsThe study showed that parents express both acceptance and understanding of the SEEK model and they perceive that the model provides an avenue for repeated dialogues about the family’s situation during the child’s upbringing and an opportunity to access support if needed.

Centering the role of community health workers in social risk screening, referral, and follow-up within the primary care setting

BackgroundCommunity health workers (CHWs) remain an underutilized resource in social risk diagnostics in the primary care setting. This process evaluation study seeks to assess the role of CHWs in social risk screening, referral, and follow-up through process mapping to identify barriers to the process for future quality improvement efforts.MethodsResearchers at the Arizona Prevention Research Center (AzPRC) engaged with two Federally Qualified Health Centers (FQHCs) in two of Arizona’s major urban areas to evaluate their internal processes for social risk screening and intervention. The Consolidated Framework for Implementation Research (CFIR) was used to direct a process mapping exercise to visually describe the workflow, gaps, and barriers to identifying and addressing social risk.ResultsThe process unveiled key areas for health system improvements in the community setting, the organizational setting, and in the implementation of social risk screening, referral, and follow-up. Further, process maps highlight the potential resources needed for effective CHW integration to address social risk in the primary care setting.ConclusionsOur findings demonstrate the importance of organizational tools, such as process mapping, to assist primary care settings in evaluating internal processes for quality improvement in addressing social risk and in effectively integrating the CHW workforce. Subsequent research will evaluate rates of social risk screening, referral, and follow-up within all of Arizona’s FQHCs and propose models for CHW integration to address social risk in primary care and strengthen social risk screening reach and effectiveness.

A multicomponent personalized prevention program in the primary care setting: a randomized clinical trial in older people with noncommunicable chronic diseases (Primacare_P3 study)

BackgroundMulticomponent interventions based on a comprehensive geriatric assessment (CGA) could promote active aging and improve health status in older people with Noncommunicable Chronic Diseases (NCDs), but conflicting evidences are available.AimTo evaluate the efficacy of a CGA-based multicomponent personalized preventive program (PPP) in reducing unplanned hospitalization rates during 12-month follow-up in community-dwelling older people with NCDs.Materials and methodsIn this randomized clinical trial (RCT), 1216 older adults recruited by 33 general practitioners (GPs) will be randomly allocated to intervention group (IG) or usual care control group (CG). The IG will receive a multicomponent PPP developed on the findings of the CGA-based Multidimensional Prognostic Index short-form (Brief-MPI), including structured interventions to improve functional, physical, cognitive, and nutritional status, to monitor NCDs and vaccinations, and to prevent social isolation. Participants in the CG will receive usual care. Brief-MPI, resilience, and health-related quality of life will be assessed after 6 and 12 months. Moreover, saliva samples will be collected at baseline in IG to measure biomarkers of oxidative stress, inflammatory cytokines, and oral microbiome.Expected resultsThe CGA-based PPP might reduce unplanned hospitalization rates and potentially institutionalization rates, emergency department (ED) and unplanned GP visits, and mortality. Further outcomes explored in the IG will be the adherence to PPP, resilience, health-related quality of life, and multidimensional frailty as assessed by the Brief-MPI.ConclusionsResults will suggest whether the CGA-based multicomponent PPP is able to improve specific outcomes in a primary care setting.Trial registrationClinicalTrials.gov; identifier: NCT06224556; Registered January 25, 2024.

Redirection of low-acuity emergency department patients to nearby medical clinics using an electronic medical support system: effects on emergency department performance indicators

BackgroundOvercrowded emergency departments (EDs) are associated with higher morbidity and mortality and suboptimal quality-of-care. Most ED flow management strategies focus on early identification and redirection of low-acuity patients to primary care settings. To assess the impact of redirecting low-acuity ED patients to medical clinics using an electronic clinical decision support system on four ED performance indicators.MethodsWe performed a retrospective observational study in the ED of a Canadian tertiary trauma center where a redirection process for low-acuity patients was implemented. The process was based on a clinical decision support system relying on an algorithm based on chief complaint, performed by nurses at triage and not involving physician assessment. All patients visiting the ED from 2013 to 2017 were included. We compared ED performance indicators before and after implementation of the redirection process (June 2015): length-of-triage, time-to-initial-physician-assessment, length-of-stay and rate of patients leaving without being seen. We performed an interrupted time series analysis adjusted for age, gender, time of visit, triage category and overcrowding.ResultsOf 242,972 ED attendees over the study period, 9546 (8% of 121,116 post-intervention patients) were redirected to a nearby primary medical clinic. After the redirection process was implemented, length-of-triage increased by 1 min [1;2], time-to-initial assessment decreased by 13 min [-16;-11], length-of-stay for non-redirected patients increased by 29 min [13;44] (p < 0.001), minus 20 min [-42;1] (p = 0.066) for patients assigned to triage 5 category. The rate of patients leaving without being seen decreased by 2% [-3;-2] (p < 0.001).ConclusionImplementing a redirection process for low-acuity ED patients based on a clinical support system was associated with improvements in two of four ED performance indicators.

Health assessments of refugee minors arriving in Norway – a modified Delphi study among health professionals in primary care settings

BackgroundRefugee minors are considered particularly vulnerable to negative health consequences from war, flight and resettlement. Offering health assessments after arrival in a host country could uncover unmet health needs and provide access to treatment. In Norway, a national guide describes these assessments, but little is known about its implementation especially for refugee minors. Thus, the aim of this study was first to explore how health assessments of refugee minors are carried out, second how health professionals perceive the needs of refugee minors and third, the competencies they perceive as necessary to meet the needs of refugee minors.MethodA modified Delphi study in three rounds was conducted using online surveys and one focus group to collect data on the needs and resources of refugee minors, essential factors for a good and health assessment practice. Participants were 54 health professionals responsible for early health assessments of refugee minors, throughout the Norwegian municipalities, working in primary care settings. Quantitative data was analysed descriptively, and qualitative data with content analysis.ResultsHealth assessments of refugee minors were predominantly conducted by public health nurses, but the organisational structures surrounding assessments varied greatly according to the size of the municipalities and to how much resources were allocated. The feeling of safety was found to be paramount to ensure a good start in a new country for refugee minors. The top four competences professionals should have, were ‘general communication skills’, a ‘health professional background’, ‘expertise in children’s health’ and ‘knowledge about the national guide’. To ensure good health services for refugee minors, improved, more comprehensive, and mandatory directives for children and young individuals was highlighted.ConclusionAlthough most refugee minors were invited and attend health assessments, one third of participating municipalities did not offer health assessments to all newcomers and the organisation and content of the assessments were diverse. Several topics, especially mental health, were postponed or not routinely addressed, contrasting with current knowledge of unmet health needs for this group. Missing documentation, practical barriers and providing general health information took time away from doing the actual assessments. The perceived needs of refugee minors were safety and stability, combined with meaningful activities, thus a coordinated effort from several services is necessary. Suggestions for improvements were more time given to assessments, better organisation and co-operation, improved competence and guidelines adjusted for age.

The added value of perineal swabs when screening for asymptomatic methicillin-resistant Staphylococcus aureus colonization and risk factors for perineal carriage

We examined the added value of perineal swabs in addition to nose and throat swabs when screening for Methicillin-resistant Staphylococcus aureus colonization, and risk factors for perineal carriage in 6,642 patients. In our mainly primary care setting, the added value was 9.3%. Patients <3 or ≥80 had the highest risk.

Evaluation of a pharmacist-led multidisciplinary approach to the treatment of latent tuberculosis in refugee patients in the primary care setting

BackgroundTreatment of latent tuberculosis infection (LTBI) is essential for refugee patients who have been relocated to the United States to prevent progression to active infection. ObjectiveThis study aimed to determine the effectiveness of a multidisciplinary team approach, embedded within a primary care clinic, to treatment of LTBI in newly resettled refugee patients compared with a local health department. MethodsThis was a single-center, retrospective chart review of newly resettled refugee patients 18-89 years old with a diagnosis of LTBI. The primary objective was completion rate of LTBI therapy within 1 year of resettlement. Secondary objectives were incidence of adverse events, regimen switches, and adherence rate. ResultsA total of 58 patients were included in the study: 14 individuals through the multidisciplinary clinic and 44 individuals with the local health department. Completion of therapy within 1 year of resettlement was seen in 71.4% of patients (n = 10) in the multidisciplinary clinic compared with 72.7% (n = 32) at the health department. There were 7 patients who underwent a regimen switch, all of whom were in the health department arm. Adverse effects occurred in 14.2% of patients in the multidisciplinary clinic and 15.9% of patients in the health department arm. Treatment adherence was 98.6% in the multidisciplinary clinic and 90.5% in the local health department arm. ConclusionUse of a multidisciplinary team was successful in completion of LTBI treatment in refugee patients, helping to alleviate barriers to treatment completion by ensuring adherence and close follow-up.

The motivating “Ws” of tobacco cessation

ABSTRACT We are all aware of the 5As of tobacco cessation. The training of tobacco cessation revolves around the 5As and 5Rs . 5As and 5Rs summarize all activities that a health professional can do to help tobacco users quit the habit within 3–5 minutes of behavioural counselling in a primary care setting, This opinion article proposes five Ws for the health care professionals to assess the 5 As with few behavioural gesture indicators that can be taken into account for the assessment of tobacco quitting. These can be regarded as supplementary cues during the behaviour counselling for quitting tobacco use. Each of them may be further quantified with a scale. These additional 5Ws added along with 5As of tobacco cessation is for skill enhancement while counselling and empowering the health care professional for tobacco cessation intervention. However this methodology is a proposal and needs to be validated for its psychometric properties.

Primary healthcare practitioners’ perspectives on trauma-informed primary care: a systematic review

BackgroundExposure to domestic and family violence is a pervasive form of complex trauma and a major global public health problem. At the frontline of the health system, primary healthcare practitioners are uniquely placed to support individuals with experiences of trauma, yet their views on trauma-informed primary care are not well understood. This systematic review of qualitative literature sought to explore primary healthcare practitioners’ perspectives on trauma-informed primary care.MethodsEight databases were searched up to July 2023. Studies were included if they consisted of empirical qualitative data, were conducted in general practice or equivalent generalist primary healthcare settings, and included the perspectives of primary healthcare practitioners where they could be distinguished from other participants in the analysis. Thematic synthesis was used for analysis.Results13 papers met inclusion criteria, representing primary care settings from the United States, Canada, Australia, and Norway. Three key themes were developed: Changing the paradigm, Building trust, and Navigating the emotional load. Findings shed light on how primary healthcare practitioners perceive and strive to practise trauma-informed primary healthcare and the challenges of navigating complex, trauma-related work in the primary care environment.ConclusionsThis review supports the need for recognition of the value of primary care in supporting patients with histories of trauma and violence, the development of interventions to mitigate the emotional load worn by primary healthcare practitioners, and further work to develop a deep and consistent understanding of what trauma-informed primary care encompasses.

Prevalence of undiagnosed stage B heart failure among emergency department patients

IntroductionHeart failure (HF) is associated with significant morbidity, mortality, and health care costs. Stage B HF is defined as structural heart disease prior to developing symptomatic HF. If identified early in the disease process, preventative measures may be implemented to slow disease progression to Stage C (symptomatic) or Stage D (refractory) HF. Previous research has focused on outpatient screening for HF in the primary care setting; however, there are limited data on Stage B HF screening in the Emergency Department (ED) setting. The objective of this study was to determine the prevalence of undiagnosed Stage B HF among those with cardiovascular risk factors in the ED setting and identify which risk factors were associated with a greater risk of having Stage B HF. MethodsA prospective, observational study was performed in a single, urban academic ED from 07/2023 to 05/2024. Inclusion criteria were age ≥ 45 years with hypertension, diabetes, obesity, coronary heart disease, previous cardiotoxic chemotherapy, or family history of HF. Exclusion criteria included signs or symptoms of HF, known history of HF, valvular disease, current atrial fibrillation, or primary language other than English. A focused cardiac ultrasound was performed and interpreted by ultrasound-fellowship trained emergency physicians. Sonographers assessed systolic function as ejection fraction <50 % using visual assessment in at least two different views. Sonographers assessed diastolic dysfunction as an E/A ratio < 0.8, or if ≥2 of the following were present: septal e' < 7 cm/s or lateral e' < 10 cm/s, E/e' ratio > 14, or left atrial volume > 34 mL/m2. Descriptive statistics were performed, followed by comparative analyses and regression modeling. Results209 participants were included in the study, with a mean age of 60 years and 51.7 % women. Of these, 125 (59.8 %) had undiagnosed Stage B HF, with 13 (10.4 %) having systolic dysfunction and 112 (89.6 %) having isolated diastolic dysfunction. Among those with isolated diastolic dysfunction, 44 (39.3 %) were grade I, 66 (58.9 %) were grade II, and 2 (1.8 %) were grade III. Predictors of undiagnosed Stage B HF included age (odds ratio 1.06; 95 % CI 1.02 to 1.10) and BMI (odds ratio 1.06; 95 % CI 1.01 to 1.10). ConclusionA large majority of ED patients with cardiovascular risk factors had undiagnosed Stage B HF. Age and obesity were associated with a higher risk of Stage B HF. This provides an opportunity for early identification and intervention for patients with undiagnosed Stage B HF to reduce progression to more severe HF.

The impact of the nurse practice environment, workload, and professional support on job outcomes and standards of care at primary health care clinics in South Africa: A structural equation model approach

BackgroundThere is substantial evidence on the associations between a positive nurse practice environment and improved nurse and patient outcomes, as well as the factors that mediate these associations, in high-income countries and in hospital settings. The knowledge gaps in African and primary health care settings motivated this empirical study. ObjectiveThe objective of this study was to examine the impact of the dimensions of the nurse practice environment, specifically human resource management, foundations for nursing care, and participation in clinic affairs, on job outcomes and standards of care. DesignA cross-sectional study was conducted between November 2021 and June 2022. Setting180 primary health care clinics in two South African provinces of Gauteng and North West. Participants665 nurses of all categories. MethodsA causal model was developed with pathways between the nurse practice environment dimensions and the outcomes of job satisfaction, intention to leave, and standards of care. A set of standardised instruments was used to measure the study variables. Using structural equation modelling, workload and professional support were tested as potential mediators between the nurse practice environment and the outcome variables. ResultsThe nurses scored the domain of foundations for nursing care 71.2 out of 100 on average, indicating high agreement, while the mean scores for nurses’ participation in clinic affairs and human resources management were lower at 68.0 and 61.7 respectively. Although nurses expressed moderate satisfaction with professional support (67.7), they were less satisfied with their workload (52.2). The mean score of overall job satisfaction was moderate (58.9), with 53.8 % of the nurses reporting that they intended leaving the clinic where they were working. Thirty-six percent intended leaving the nursing profession, indicating low intention to stay. The final mediation model was judged to fit the data adequately based on goodness-of-fit indices, confirming that workload and professional support had a mediating role between the nurse practice environment dimensions of interest and both nurses’ job outcomes and standards of care. ConclusionsWe have highlighted the value of supportive practice environments, effective workload management, and enhanced professional support in improving nurses’ job outcomes and satisfaction with standards of care. Improving nurses’ practice environments at primary health care level may have a wide-ranging impact on the performance of the health system. Therefore, primary health care facility managers should ensure that workload is distributed equitably, professional support for nurses is enhanced, and the overall work environment is improved.

Pregnant People-Infant Linkage for Surveillance

Objectives and ApproachAs maternal mortality and morbidity continue to progress, better data is needed to comprehensively understand the problem, especially in underserved populations who are differentially impacted. Surveillance in safety-net populations is complicated by care fragmentation and interoperability challenges between primary care and hospital settings. . AllianceChicago (AC), a health center-controlled network, supports a common data infrastructure across a set of Federally Qualified Health Centers (FQHCs) in Chicago that is further linked to a distributed query infrastructure connecting Chicago’s major health systems known as CAPriCORN. Leveraging electronic health record (EHR) data collected by the AC and CAPriCORN consortium, the objective of this surveillance effort was to connect infant data with maternal data while protecting privacy. We developed a deterministic matching algorithm that utilized multiple approaches and technologies for Pregnant People-Infant (PPI) pair identification. The linkage process involved a five-step method in which each step is recorded within the linkage database and the confidence interval is calculated. ResultsPreliminary analyses are ongoing. Through each step of the linkage process, the confidence interval increased with the increase of matching nodes, highlighting its accumulative accuracy. The result demonstrates the feasibility of linking maternal and baby healthcare characteristics using a range of clinical and demographic variables captured in pseudonymized hospital and ambulatory data. Conclusions and ImplicationsOur approach improves the capacity of EHR data for surveillance while protecting patient privacy and preserving data confidentiality. Triangulating outcomes recorded in different settings can help improve data quality for research and surveillance.

Cultural Adaptation of Skills Training in Affective and Interpersonal Regulation Therapy for Spanish-speaking Caribbean Veterans at the VA Caribbean Healthcare System: A preliminary study of feasibility and acceptability in a Primary Care setting

The U.S. Department of Veterans Affairs has endorsed the Skills Training in Affective and Interpersonal Regulation (STAIR) therapy as an effective intervention for reducing PTSD symptoms, enhancing self-regulation, and improving interpersonal efficacy. However, Spanish-speaking veterans at the VA Caribbean Healthcare System lacked access to STAIR manuals in their preferred language. This study addressed this gap by translating and culturally adapting the STAIR therapy participant manual using the Ecological Validity Model (EVM). The materials were then tested in a randomized intervention with six Caribbean Spanish-speaking male veterans, aged 23-62, diagnosed with PTSD who received mental health services at the Primary Care Mental Health Integration (PC-MHI) level of care. Nonparametric tests were used to evaluate symptom progression, and content analysis was conducted on semi-structured interviews. There were no statistically significant changes in PTSD, emotion regulation, or interpersonal problems within the groups. However, participants in the intervention group reported clinically significant changes regarding PTSD symptoms. Interviews with therapists and STAIR participants highlighted improvements in social engagement and interpersonal boundaries. The intervention was found to be feasible and acceptable at PC-MHI. The culturally adapted Spanish version of the STAIR manual proved to be effective, suggesting that STAIR may be a viable approach for reducing PTSD symptoms and improving interpersonal and self-regulation strategies among Spanish-speaking veterans in primary care settings. A randomized control trial is recommended to further explore its efficacy.

Management and Treatment of Red Eyes in Primary Care

Red eyes are a common complaint in primary care settings, with a plethora of causes and implications. Some etiologies are benign and self-limiting, while others are sight threatening and require urgent referral to an ophthalmologist. Therefore, it is important for primary care physicians to be able to carry out a diligent eye exam, recognize the signs and symptoms of different types of red eye presentations, to initiate appropriate management and treatment and to refer to ophthalmology when needed.

FP4.16 - Impact of Clinician Factors and Judgement Biases on Delayed Referrals and Diagnosis of Colorectal Cancer (CRC)

Abstract Aim Colorectal cancer (CRC) is the 4th most common cancer in the U.K. contributing to 10% of cancer-related fatalities. Despite clear NICE referral guidelines, there are various patient-, clinician- and system-related delays in referrals to the lower gastrointestinal (LGI) services. Our article investigated clinician-associated biases that govern the timeliness of referral to the LGI services. Method Our article is a narrative review. We searched Embase and Ovid Medline databases using a range of terms. Results yielded 36 articles relevant to our topic. Results GP referrals make up 44%-69% of suspected CRC referrals. Yet, national data highlights that emergency presentations range from 14%-30% nationwide, indicating missed opportunity in the primary care setting. Cognitive bias was commonly seen and included GP’s poor familiarity with referral criteria and failure to recognise red flags. Patient cultural and demographical biases played a significant role in decision-making often leading to misappraisal, with the patient’s age being the most common factor. Younger patients were less commonly referred onto the 2-week-wait (2ww) pathway, and faced an average delay in diagnosis of a month with 1.4 times more visits to care providers. In addition, information and communication biases were a recurring theme in the literature which discussed the effects of inadequate histories and physical examinations on missed diagnosis and delayed referrals. Conclusions Unintentional bias delays CRC referrals resulting in a substantial proportion of patients presenting as an emergency with advanced stage cancer that has poorer outcome. We need to increase awareness of these biases and find ways to negate their effects in clinical decision-making.

Evaluating Emotional Eating in Children from the Perspective of Parents: Psychometric Properties of the Parent Version of the Emotional Eating Scale Adapted for Children and Adolescents.

Emotional eating is associated with adverse health outcomes in children, including elevated weight status. Currently, there is not a well-validated parent-report measure of emotional eating for young children. This study assessed the reliability and validity of the 10-item parent version of the Emotional Eating Scale Adapted for Children and Adolescents (EES-C) Short-Form. The participants were 207 parents and 144 children from the southern United States. They completed the parent- and child-report EES-C Short-Form and responded to measures related to child eating behaviors, mood, and gratitude. The parent-report EES-C Short-Form demonstrated good internal consistency reliability (Cronbach's alpha = 0.94). Test-retest reliability was also supported, as evidenced by a medium correlation (ICC = 0.56, p < 0.001) between parent-rated emotional eating across two time points. Additionally, the measure demonstrated a significant correlation with a scale of emotional overeating (r = 0.25, p < 0.001)-a theoretically related construct. Supporting discriminant validity, the measure was not significantly related to a measure of parent-reported gratitude (r = 0.07, p = 0.30). A unidimensional model provided good fit for the data (CFI = 0.997, SRMR = 0.046). The results from the current study provide preliminary evidence supporting the reliability and validity of the parent version of the EES-C Short-Form. For the purpose of screening children in school or primary care settings, the EES-C Short-Form may be practical and helpful in identifying children who may be at risk of developing adverse health outcomes or more-severe eating disorder pathology.

Prostate Cancer Care in Rural Primary Care Contexts: A Narrative Review.

Prostate cancer is highly prevalent among older men and poses significant health challenges, particularly in rural areas where access to specialized care is limited. This narrative review aims to evaluate the quality of prostate cancer care in rural primary care settings, identify gaps, and suggest strategies for improvement. A comprehensive narrative review was conducted using PubMed to identify relevant studies published between April 2000 and August 2024. The search focused on articles discussing prostate cancer management in rural primary care, including challenges, outcomes, and collaborative practices. Thirteen studies met the inclusion criteria and were analyzed to assess the quality of care and potential areas for enhancement. The review highlighted significant disparities in prostate cancer care in rural areas, including limited access to urologists, variability in PSA testing practices, and socioeconomic and geographic barriers. Innovative models like telehealth and 'One Stop' Prostate Clinics(OSPCs) showed promise in addressing these challenges. However, gaps in long-term symptom management and follow-up care persist, emphasizing the need for comprehensive survivorship plans and targeted educational interventions for primary care physicians. Rural primary care settings face unique challenges in managing prostate cancer, necessitating tailored strategies to improve care quality. Enhancing collaboration between primary care physicians and urologists, expanding access to innovative care models, and addressing socioeconomic and geographic disparities are critical to improving outcomes for prostate cancer patients in rural areas. Future research should focus on developing and evaluating these strategies to ensure equitable care for all patients.

How Were European GPs/FPs Involved in the COVID-19 Vaccination Campaign? A European Questionnaire Study about the Experiences of the Vaccinations in 2021.

The SARS-CoV-2 pandemic has become the greatest public health challenge worldwide. Soon after the appearance of the virus in 2019, intensive efforts to develop vaccines were initiated, and by late 2020, delivery of vaccines for the targeted population as a campaign had started. Collect information from European Union countries regarding how and to what extent were family physicians (FPs)/general practitioners (GPs) involved in the vaccination campaigns in 2021 and how these were organized at the national level. A short questionnaire was distributed through the secretariats of WONCA (World Organization of Family Doctors) Europe and the European Forum for Primary Care (EFPC). In most of the countries, participation of FPs/GPs was compulsory. The vaccination was usually centrally organized by governmental authorities. In the beginning, registration (web-based) of patients was required, mainly at the national level. By the middle of 2021, vaccination on a walk-in basis became available in almost every country for the first immunization as well as for the booster injections. The remunerations of GPs/FPs differed; in some countries, no extra payments were offered. The Pfizer vaccine was used in all countries, while in nine countries, non-European Medicines Agency (EMA)-approved vaccines were also given in primary care settings and at vaccination centers. In some countries, professional homepages helped the GPs. The involvement of primary health care (PHC) providers did not correlate to the vaccination coverage of the entire population of the respective countries. It was the highest in the more developed countries with higher living standards, where participation of GPs was voluntary and appropriate financial incentives were offered to them. The vaccination campaign was a professional and logistic challenge and an excellent performance of PCH providers. Experiences gained could be used in the future to manage similar pandemic challenges.

Exploring the Impact of Stigma on Health and Wellbeing: Insights from Mothers with Lived Experience Accessing Recovery Services.

Stigmatisation is the process by which an individual is devalued based on their attributes, characteristics, and/or behaviour, with this often leading to prejudice, social and health-related harms, active discrimination, and microaggressions. The aim of this paper is to show how social harms can occur and how stigma is damaging to the health and wellbeing of a person in recovery. To do so, we focus on the harms that arise from the internalisation of labels that mothers who use drugs encounter in a treatment and recovery setting whilst in active recovery, and how this stigmatisation can manifest negative self-beliefs. Qualitative data was used from two semi-structured focus groups involving females with lived experience of substance use (n = 13). A reflexive thematic analysis approach was used to analyse the interview transcripts, and three themes were identified: (1) the enduring nature of stigma; (2) gender disparity and the need for mothers- and women-only spaces; and (3) stigma as a barrier to services and wellbeing. Findings revealed the enduring nature of stigma amongst mothers who were in active recovery, with women feeling judged more harshly than men and experiencing pressure to live up to a "good mother" ideal whilst in recovery. This paper demonstrates that mothers in recovery are still stigmatised and, as a consequence, approach services with increased sensitivity, with stigma often resulting in disengagement or reluctance to access healthcare settings. We conclude that staff in health, social, and primary care settings need to develop a strong therapeutic alliance with mothers in recovery and promote anti-stigma approaches in their practice, in order to mitigate stigma and reduce harms to health and wellbeing.