Primary Care Setting Research Articles

Engaging primary care patients at risk for suicide in mental health treatment: user insights to inform implementation strategy design

BackgroundGiven that the majority of suicide decedents visit primary care in the year preceding death, primary care has been identified as a key setting in which to engage patients at risk for suicide in mental health services. The objective of this research was to identify barriers and facilitators to engagement in mental health services among primary care patients at risk for suicide to inform the development of strategies to increase engagement.MethodsSeventy-four semi-structured qualitative interviews were conducted with primary care patients (n = 20), primary care (n = 18) and behavioral health (n = 12) clinicians, mental health intake coordinators (n = 4), and health system and clinic leaders (n = 20). Patients who had been referred for mental health services from primary care and reported an elevated score (≥ 1) on item 9 on the Patient Health Questionnaire at the time of referral were eligible to participate. Eligible clinicians and leaders were employed in a primary care or behavioral health setting in a single large health system with an integrated mental health program. Interviews typically lasted 30–60 min, were completed over video conference or phone, and were coded by members of the research team using a rapid qualitative analysis procedure.ResultsParticipants were primarily female (64.9%), white (70.3%) and non-Hispanic/Latine (91.9%). The most identified barriers to mental health care engagement were waitlists, capacity limits, insurance, patient characteristics, communication, collaboration, and/or difficulties surrounding travel. The most commonly cited facilitators of engagement included telehealth, integrated care models, reminders, case management support, psychoeducation, motivational enhancement, and scheduling flexibility. Concrete suggestions for improving engagement in mental health services included increasing communication between providers, streamlining referral and intake processes, providing reminders and follow ups, and advocacy for increased reimbursement for suicide risk assessment.ConclusionsResults underscore the myriad barriers patients at risk for suicide encounter when attempting to engage in mental health care in a primary care setting. Facilitators of engagement and suggestions for improving connections to care were also identified, which can inform the design of implementation strategies to improve engagement in mental health services among primary care patients at risk for suicide.Trial registrationClinicalTrials.gov Identifier: NCT05021224 (Registered August 19, 2021).

Effects of a Gender-Balancing Strategy on Resident Panels in a Primary Care Setting.

Patients oftenprefergender concordance when choosing a primary care practitioner. In a trainee setting, this may lead to unequal training opportunities for male and female resident physicians. Residency leadershipmay be interested in ways to promotebalance in patient empanelment. To assess the efficacy of an intervention to equalize imbalance in patient gender on resident primary care panels. Observational cohort study. Categorial internal medicine residents beginning residency in 2020. The panels of internal medicine residents were manually rebalanced at the beginning of training for a new cohort of residents with the goal of having similar numbers of male and female patients on each resident's panel. Panel data was observed for 2 years following intervention. Number of male patients, number of female patients, and overall panel size were compared between male and female residents at baseline, 6 months, and 24 months. The analysis included 28 female residents and 20 male residents. After rebalancing, baseline panels had similar numbers of male patients (median of 50 on both male and female residents' panels; average panel 54.7% male) and female patients (median of 41.5 on female residents' panels and 41 on male residents' panels; average panel 45.3% female). At the end of the follow-up period, a significant difference was observed in the median number of male patients (59.5 and 43.5; p < 0.001) and female patients (33.5 and 48.5; p < 0.001) between male and female residents, but no difference was observed in overall panel size. A steady drift towards gender concordance was observed over 2 years following a rebalancing intervention. Program leadership overseeing primary care empanelment for resident physicians may consider periodic rebalancing of panels in addition to other interventions to ensure equal training opportunities and best prepare residents for future practice.

Planetary Health in Rehabilitation: A Call to Arms… and legs, gait aids, and other equipment.

Sometimes out of necessity and sometimes out of convenience, medicine is wasteful. Resource stewardship is a critical and expanding field for reducing wasteful practices. Numerous international organizations are driving resource stewardship globally, including >20 countries worldwide participating in Choosing Wisely initiatives. However, opportunities for environmental stewardship have been long overlooked. Planetary health, climate action, and environmental stewardship in medicine consider opportunities which offer a co-benefit to the planet while improving or maintaining appropriate patient care across the healthcare continuum, including acute care, transitions in care, and post-acute care, as well as in primary, secondary, and tertiary care settings. As rehabilitation is necessary across all healthcare settings, developing a culture amongst rehabilitation care providers that is conscientious about planetary health is imperative for sustainability of rehabilitation medicine and the health of our planet. We devised a recommendation for Choosing Wisely Canada's planetary health focus: don't dispose of adaptive equipment, mobility devices, orthoses, and prostheses that could be reused or recycled. This brief report discusses 1) why rehabilitation providers should engage with planetary health and climate action; 2) the rationale for the Choosing Wisely Canada Physical Medicine & Rehabilitation planetary health recommendation, and 3) existing avenues and novel opportunities for rehabilitation care providers worldwide to reduce waste in rehabilitation.

Referral pathway and competency profiles of primary care physiotherapists and kinesiologists for physical activity interventions for diabetes: a modified Delphi study

BackgroundHigh quality diabetes care is an essential service in primary care settings since the prevalence and associated complications of diabetes is increasing. Physical activity is effective for the prevention and management of diabetes yet is underutilized in diabetes care. Exercise professionals have specialized skills to deliver physical activity interventions, but effective interprofessional collaboration for diabetes care requires role clarity. This study established the competencies of entry-level physiotherapists and kinesiologists for physical activity interventions for diabetes care in primary care settings and used these competencies to develop clinical tools to promote role clarity in interprofessional care teams.MethodsWe used a modified Delphi process. Eleven physiotherapy and three kinesiology subject matter experts participated in two rounds of Delphi surveys to develop discipline and context specific competencies. These competencies were used to draft competency profiles and a referral pathway tool. Eleven of the participants then participated in a focus group for member-checking of the tools. Descriptive statistics and content analysis were used to analyze quantitative and qualitative data respectively.ResultsThe modified Delphi process resulted in 38 physiotherapy and 27 kinesiology competencies that identify the distinct roles of physiotherapists and kinesiologists in delivering physical activity interventions for diabetes care. The physiotherapy competencies describes their unique role in supporting people with all types of diabetes to engage in physical activity despite complex medical or physical barriers. The kinesiology competencies indicate where these professionals may require additional training, especially when working with people living with type 1 diabetes or who are pregnant. All developed tools had good face validity and were seen to be potentially useful tools by the subject matter experts.ConclusionsThe findings highlight that both physiotherapists and kinesiologists have fundamental skills and abilities to deliver physical activity interventions to people living with diabetes, but that different exercise professionals may be needed depending on the complexity of the clinical profile. The developed clinical tools support improved interprofessional collaboration by clarifying physiotherapy and kinesiology roles in delivering physical activity interventions for diabetes care and highlighting how the two distinct professions can contribute to addressing the growing diabetes epidemic in primary care.

A 5-Year Mortality Prediction Model for Prostate Cancer Patients Based on the Korean Nationwide Health Insurance Claims Database.

Prostate cancer is the fourth most common cancer and eighth leading cause of cancer-related mortality worldwide. Its incidence is increasing in South Korea. This study aimed to investigate a predictive model for the 5-year survival probability of prostate cancer patients in a Korean primary care setting. This retrospective study used data from the nationwide insurance claims database. The main outcome was survival probability 5 years after the initial diagnosis of prostate cancer. Potential confounding factors such as age, body mass index (BMI), blood pressure, laboratory results, lifestyle behaviors, household income, and comorbidity index were considered. These variables were available in the national health check-up information. A Cox proportional hazards regression model was used to develop the predictive model. The predictive performance was calculated based on the mean area under the receiver operating characteristic curve (AUC) after 10-fold cross-validation. The mean 5-year survival probability was 82.0%. Age, fasting glucose and gamma-glutamyl transferase levels, current smoking, and multiple comorbidities were positively associated with mortality, whereas BMI, alkaline phosphatase levels, total cholesterol levels, alcohol intake, physical activity, and household income were inversely associated with mortality. The mean AUC after 10-fold cross-validation was 0.71. The 5-year survival probability model showed a moderately good predictive performance. This may be useful in predicting the survival probability of prostate cancer patients in primary care settings. When interpreting these results, potential limitations, such as selection or healthy user biases, should be considered.

Predicting buprenorphine adherence among patients with opioid use disorder in primary care settings

BackgroundMedications for opioid use disorder (MOUD), including buprenorphine, are effective treatments for opioid use disorder (OUD) and reduce risk for overdose and death. Buprenorphine can be prescribed in outpatient primary care settings to treat OUD; however, prior research suggests adherence to buprenorphine in these settings can be low. The purpose of this study was to identify the rates of and factors associated with buprenorphine adherence among patients with OUD in the first six months after a new start of buprenorphine.MethodsData were extracted from the electronic health record (EHR) from a large integrated health system in the upper Midwest. Patients with OUD (N = 345; Mean age = 37.6 years, SD 13.2; 61.7% male; 78% White) with a new start of buprenorphine between March 2019 and July 2021 were included in the analysis. Buprenorphine adherence in the first six months was defined using medication orders; the proportion of days covered (PDC) with a standard cut-point of 80% was used to classify patients as adherent or non-adherent. Demographic (e.g., age, sex, race and ethnicity, geographic location), service (e.g., encounters, buprenorphine formulations and dosage) and clinical (e.g., diagnoses, urine toxicology screens) characteristics were examined as factors that could be related to adherence. Analyses included logistic regression with adherence group as a binary outcome.ResultsLess than half of patients were classified as adherent to buprenorphine (44%). Adjusting for other factors, male sex (OR = 0.34, 95% CI = 0.20, 0.57, p < .001) and having an unexpected positive for opioids on urine toxicology (OR = 0.42, 95% CI = 0.21, 0.83, p < .014) were associated with lower likelihood of adherence to buprenorphine, whereas being a former smoker (compared to a current smoker; OR = 1.82, 95% CI = 1.02, 3.27, p = .014) was associated with greater likelihood of being adherent to buprenorphine.ConclusionsThese results suggest that buprenorphine adherence in primary care settings may be low, yet male sex and smoking status are associated with adherence rates. Future research is needed to identify the mechanisms through which these factors are associated with adherence.

Roles and experiences of nurses in primary health care during the COVID-19 pandemic: a scoping review

BackgroundNurses form the frontline of the healthcare system’s response to both epidemics and pandemics, and this was especially the case during the novel coronavirus disease (COVID-19) pandemic. Although the influence of COVID-19 on nursing roles has attracted interest, there is no integrated knowledge of nurses’ roles and experiences in primary health care settings during the COVID-19 pandemic. Thus, this study identifies the roles and experiences of nurses in primary health care during the COVID-19 pandemic.MethodsA scoping review study design and the Joanna Briggs Institute methodology were used. The study searched five electronic databases (PubMed, CINAHL, EMBASE, Scopus, and PsychINFO) and included studies published in English from March 2020 to June 2023 that focused on the roles and experiences of nurses (participants) during COVID-19 (concept) in primary health care settings (context).ResultsFourteen articles were selected for review, involving a total of 1,487 nurses as study participants. The various roles undertaken by nurses in primary health care settings were categorized as comprehensive care providers, supporters and empowerers, coordinators and collaborators, information navigators, and change agents. Challenges and strategies are multilevel intrapersonal, interpersonal, organizational, community, and societal issues, but are not mutually exclusive.ConclusionsThe pandemic-induced challenges revealed primary health care nurses’ vital and indispensable roles and resilience. They also fostered a heightened awareness of technological influence on the progression of primary health care in the current milieu. Policymakers and healthcare organizations need to integrate primary health care nurses’ expanding and emerging roles within the scope of practice, ensuring their effective implementation without excessive regulatory constraints. This study emphasizes the importance of developing multilevel interventions to address the support needs of primary health care nurses through a system-based approach. Building a strong infrastructure to support nurses’ self-care, offering continuing professional development opportunities, and securing official government recognition will be essential for enhancing the resilience of primary healthcare nurses in preparation for future, potentially devastating pandemics.

First Contact Physiotherapy: A 4-Year Service Evaluation of UK Primary Care Data.

The First Contact Physiotherapist (FCP) role offers patients direct access to musculoskeletal (MSK) specialists in primary care settings and is designed to reduce GP workload while providing high-quality care. Despite positive early evaluations of FCP services, there remains a need for up-to-date assessments of their impact. To evaluate the FCP model of care implemented in an NHS Primary Care Network (PCN) against pre-defined service objectives. A service evaluation was conducted using data from April 2020 to March 2024. Key performance indicators were based on national FCP evaluation criteria. Data included appointment utilisation, wait times, referral patterns, patient and staff satisfaction surveys, and audit results from clinical data. Over 4years, 12,185 patients were seen. Of these, 69% of patients were seen as true first contacts. The majority of patients (86.4%) were managed within primary care, with a referral rate of 8.5% to outpatient physiotherapy and 5.1% to orthopaedics. Patient satisfaction was high, with 82% rating their FCP experience as excellent or outstanding. The FCP service successfully met its objectives by reducing GP workload and providing effective care. However, there was an increase in outpatient physiotherapy referrals over the 4-year period. Staff satisfaction was generally positive, though some highlighted concerns about appointment duration and workload. This evaluation demonstrates that FCP services provide a viable solution for managing MSK conditions in primary care. Future research should explore the most effective MSK service delivery models and incorporate digital solutions for comprehensive outcome and experience measures.

Pilot implementation study of a web-based men’s health screening app in primary care during COVID-19: a mixed-methods approach

BackgroundThe traditional delivery of healthcare services, including crucial preventive measures such as health screenings, faced significant disruption due to the COVID-19 pandemic. In response, eHealth technology emerged as a practical alternative for conducting screening services. This pilot study introduces ScreenMen, a web-based app for men’s health screening, implemented in a primary care setting. The study aims to assess patient uptake and healthcare provider’s acceptability and feasibility of implementing ScreenMen, emphasizing the importance of implementation science research in healthcare innovation.MethodsThis study employed a mixed-method explanatory sequential design, using a tailored implementation intervention to implement ScreenMen in an urban health clinic. Quantitative phase focused on patient uptake of ScreenMen and healthcare provider involvement, utilizing Google Analytics and provider questionnaires. Qualitative phase, using in-depth interviews with providers, explored factors influencing uptake and implementation. Data analysis employed means and percentages for quantitative data and framework analysis for qualitative data.ResultsWe invited 47 healthcare providers to attend the ScreenMen implementation workshop, with 26 participating, resulting in a 55.3% participation rate. Throughout the five-month study, there were 75 recorded accesses, with a completion rate of 20%. The primary way users accessed the app was through QR codes on buntings (38.7%), followed by postcards (12%). In qualitative interviews with three healthcare providers, it was found that the Identify and prepare champions strategy was helpful, as these champions led the implementation and encouraged other providers to promote ScreenMen. The use of QR codes on buntings, part of the Provide education and training strategy, was effective due to their visibility in patient waiting areas. However, the Mandate change strategy was considered ineffective, as providers felt obligated rather than motivated to implement ScreenMen.ConclusionThis study highlighted the uptake of ScreenMen and found barriers and facilitators during the pilot implementation. Two useful strategies were Identify and prepare champions and QR codes while Mandate change was not helpful. Further studies are needed to study the effectiveness of these implementation strategies to implement web-based apps.Trial registrationClinical Trial Number: NCT06388473 (Retrospectively registered 05/04/2024).

Information and Communications Technology-Based Monitoring Service for Tailored Chronic Disease Management in Primary Care: Cost-Effectiveness Analysis Based on ICT-CM Trial Results.

Information and communications technology-based tailored management (TM) intervention is a novel automatic system in which a smartphone app for the management of patients with hypertension and diabetes, the provider web, and Bluetooth devices are linked. However, little evidence exists regarding the cost-effectiveness of the interventions using mobile apps. This study aimed to assess the cost-effectiveness of TM intervention for adult patients with hypertension or diabetes in primary care compared with usual care (UC). Cost-effectiveness analysis using a Markov model was conducted from the Korean health care system perspective. Based on 6-month outcome data from an information and communications technology-based tailored chronic disease management (ICT-CM) trial, effectiveness over a lifetime beyond the trial periods was extrapolated using a cardiovascular disease risk prediction model. Costs were estimated using ICT-CM trial data and national health insurance claims data. Health utility weights were obtained from the Korea National Health and Nutrition Examination Survey. In the base-case analysis, compared with UC, TM was more costly (US $23,157 for TM vs US $22,391 for UC) and more effective (12.006 quality-adjusted life-years [QALYs] for TM vs 11.868 QALYs for UC). The incremental cost-effectiveness ratio was US $5556 per QALY gained. Probabilistic sensitivity analysis showed that the probability of TM being cost-effective compared with UC was approximately 97% at an incremental cost-effectiveness ratio threshold of US $26,515 (KRW 35 million) per QALY gained. Compared with UC, TM intervention is a cost-effective option for patients with hypertension or diabetes in primary care settings. The study results can assist policy makers in making evidence-based decisions when implementing accessible chronic disease management services.

Patient out-of-pocket expenditure in primary care comparing high income, middle income and low-income countries

Background: Out-of-pocket health expenditures (OOPHE) in primary care can pose a significant financial burden on individuals and households, particularly in low- and middle-income countries. Understanding the factors influencing OOPHE is crucial for developing effective policies to improve healthcare access and affordability. Objective: This systematic review aimed to identify and analyze the factors influencing OOPHE in primary care settings across high-, middle-, and low-income countries. Methods: A comprehensive search of electronic databases was conducted to identify relevant studies. Included studies were assessed for quality and data were extracted to identify key factors influencing OOPHE. Results: Demographic characteristics, socioeconomic factors, healthcare utilization, system factors, and cultural factors were all found to influence OOPHE. Lower income levels, limited insurance coverage, frequent healthcare utilization, and higher disease severity were consistently associated with higher OOP costs. Conclusion: The findings highlight the significant burden of OOP expenditures on individuals and households. Policymakers should prioritize strategies to expand health insurance coverage, improve access to primary care services, negotiate lower prices for healthcare goods, and address underlying socioeconomic factors. Further research is needed to explore the impact of specific interventions and the role of cultural factors in shaping OOP expenditures.

A virtual assistant for primary care's food and nutrition surveillance system: Development and validation study in Brazil

ObjectiveThe study aimed to develop and validate a conversational agent (chatbot) designed to support Food and Nutrition Surveillance (FNS) practices in primary health care settings. MethodsThis mixed-methods research was conducted in three stages. Initially, the study identified barriers and challenges in FNS practices through a literature review and feedback from 655 health professionals and FNS experts across Brazil. Following this, a participatory design approach was employed to develop and validate the chatbot's content. The final stage involved evaluating the chatbot's user experience with FNS experts. ResultsThe chatbot could accurately understand and respond to 60 different intents or keywords related to FNS. Themes such as training, guidance, and access emerged as crucial for guiding FNS initiatives and addressing implementation challenges, primarily related to human resources. The chatbot achieved a Global Content Validation Index of 0.88. ConclusionThe developed chatbot represents a significant advancement in supporting FNS practices within primary health care. Practice implicationBy providing an innovative, interactive, educational tool that is both accessible and reliable, this digital assistant has the potential to facilitate the operationalization of FNS practices, addressing the critical need for effective training and counseling in developing countries.

Embedding Physical Therapy in the Pediatric Primary Care Setting: Qualitative Analysis of Pediatricians' Insights on Potential Collaborative Roles and Benefits.

The growing need for collaborative healthcare teams to meet complex health challenges has led to physical therapists (PTs) being embedded in adult primary care settings for many years now. However, this model of care has not been found in pediatrics. This qualitative study sought to gain insights from pediatricians on the potential of embedding pediatric PTs in primary care. Participants were nine pediatricians practicing in both urban and rural, hospital-based and private settings. Semi-structured interviews were recorded, transcribed, and analyzed via thematic analysis per published methods, assuring trustworthiness. Three overarching themes emerged: pediatricians' priorities aligned with the Quadruple Aim of Healthcare, embedded PTs could fill multiple roles in pediatrics, and they could see a wide variety of patients, highlighting real potential benefits in primary care. Participants endorsed in-office focused treatments, screening to determine optimal care pathways, and ongoing patient follow-up as potential PT roles in this setting. Providers thought that PTs could help manage care for musculoskeletal complaints, high-risk infants, medically complex children, autism, and obesity. An advanced-trained PT having attributes of confidence, adaptability, and open-mindedness was desired. All participants endorsed pediatric primary care PTs as having potentially high value in their practice. This is the first known study on the potential of embedding a PT in the pediatric primary care setting, offering valuable insights from pediatricians to be leveraged in implementation planning.

Testing the Feasibility, User Experiences, and Preliminary Effect of Conversation Cards for Adolescents © For Behavior Change and Collaborative Goal Setting in Primary Care: A Pilot Randomized Controlled Trial

Our team developed Conversation Cards for Adolescents© (CCAs), a tool to help adolescents and health care providers (HCPs) communicate and collaboratively set behavior change goals. The objectives of this pilot randomized controlled trial were to test the feasibility, user experience, and preliminary effect of using CCAs with adolescents in primary care, focusing on behavior change and collaborative goal setting among adolescents. From March 2019 to September 2022, adolescents were recruited from the Northeast Community Health Centre (Edmonton, AB). Adolescents were randomized (1:1) to one of two groups: CCA + goal setting (experimental group) or goal setting alone (control group). Data were collected from both groups at baseline and at 3-weeks post-baseline. In total, 31 adolescents completed the trial (terminated early due to COVID-19). The study demonstrated high practicality. Adolescents reported positive user experiences with CCAs, citing attractiveness, clarity, efficiency, and dependability. No group differences were detected for behavior changes at 3-weeks post-baseline (p > .05), although adolescents in the experimental group qualitatively described improved rapport and communication with HCPs. CCAs can be used practically in a primary health care setting to facilitate communication and rapport with adolescents; however, their effect in enabling behavior change should be investigated in a multi-site, larger-scale trial.

Characteristics of advanced practice nurses’ clinical competence in primary healthcare settings: a scoping review protocol

Objective: This scoping review aims to identify the clinical competency characteristics, in terms of knowledge, skills, and attitudes, of advanced practice nurses in primary care settings. Introduction: Although much has been written about the competencies of advanced practice nurses, more detail about the skills, knowledge, and attitudes that inform their clinical competency in primary health care needs to be ascertained. This will promote the development, implementation, and evaluation of advanced nursing practice in contexts where it is unavailable. Inclusion criteria: Studies that address the clinical competency characteristics of advanced practice nurses in primary health care settings will be considered for inclusion. Methods: This review will be conducted according to JBI methodology for scoping reviews. A comprehensive search will be conducted in PubMed, CINAHL (EBSCOhost), Web of Science, Scopus, Virtual Health Library (VHL), Scientific Electronic Library Online (SciELO), Embase (Elsevier), Science Direct (Elsevier), Cochrane Library, and Google Scholar for primary and secondary qualitative, quantitative, and mixed methods studies on the topic of relevance. Gray literature will be searched in DART-E, TESES CAPES, CAUL (Australian Digital Theses), and Theses Canada Editorials. Letters, editorials, commentaries, conference abstracts, and documents published by advanced practice nurses’ associations will also be considered for inclusion. Two independent reviewers will screen the studies at title and abstract and full text. The same reviewers will extract relevant data using an instrument developed by the reviewers. These data will be presented in a narrative synthesis to facilitate the analysis of the evidence found. Review registration: Open Science Framework https://osf.io/tnrjz/

The perpetual evidence-practice gap: addressing ongoing barriers to chronic pain management in primary care in three steps.

Most management of chronic pain, a serious illness affecting the physical and psychological wellbeing of millions, occurs in primary care settings. Primary care practitioners (PCPs) attempt to provide evidence-based practices to treat chronic pain. However, there continues to be a gap between the care people receive and the evidence. The objectives for this study were to (1) explore determinants of evidence-based chronic pain management and (2) develop a novel approach to using implementation science to address the evidence-practice gap. A convenience sample of twenty-one Pennsylvania PCPs participated in one-time semi-structured telephone interviews. Interviews were transcribed verbatim and both deductive and inductive approaches were used during analysis. We used the Consolidated Framework for Implementation Research (CFIR) and the Expert Recommendations for Implementing Change (ERIC) to inform our analysis and findings. We identified determinants of evidence-based chronic pain management across the CFIR domains of Intervention Characteristics, Characteristics of Individuals, and the Outer Setting and reported implementation strategies. Based on identified themes, we developed a three-step process to support the ongoing and pragmatic implementation of evidence-based chronic pain management in primary care settings. Previous efforts exist to integrate implementation science into chronic pain management; yet a gap persists. Implementation approaches should prioritize the needs of people living with chronic pain and their families. Further, future approaches or strategies used should build on the current three-step model to include the fourth step of tailoring existing implementation strategies to the specific needs of chronic pain in the clinical context.

Adapting behavioral activation for patients receiving medications for opioid use disorder in primary care: a pilot study.

Effective adjunctive therapeutic treatments for patients with opioid use disorder (OUD) on medication for OUD (MOUD) in primary care settings are needed to address high rates of mental illness and stress. Behavioral activation (BA) is a brief, evidence-based therapy that has potential to improve quality of life in people with OUD. The purpose of this pilot study was to evaluate the feasibility and acceptability of values-based BA (VBA) as an adjunct treatment for patients receiving MOUD in primary care. Participants were recruited for a single-arm pilot trial of BA in a primary care setting. VBA was adapted for people with OUD and included 4-6 sessions delivered over 12 weeks with a behavioral health consultant, either in-person or virtually. Feasibility was assessed as recruitment percent and pace and retention percent. Acceptability was assessed with the Client Satisfaction Questionnaire-8 (CSQ-8). Participants completed self-report measures of well-being, depression, substance use, and psychological processes of change at baseline, mid-intervention (6-weeks), and post-intervention (12-weeks). Participants engaged in a brief interview about their experiences at the end of the intervention. Twenty-one participants enrolled in the intervention (66.7% female, M age = 44.0 years, 19% of those invited). Participants completed an average of 5.1 BA sessions (SD = 1.6) and most (90%) were retained through 12 weeks. Participants rated the intervention as highly acceptable on the CSQ-8 (M = 30.4/32.0, SD = 1.6). In qualitative interviews, participants reported that working with the therapist and setting values-based goals were helpful, while also recommending more tailoring to patients' needs and offering the program early in MOUD treatment. Preliminary efficacy data suggest the program was associated with small to moderate improvements in life satisfaction (Cohen's d = 0.25) and positive affect (d = 0.62), whereas there were no changes in depression (d = 0.09) or negative affect (d = -0.07) in a group with low depression at baseline. VBA adapted for patients on MOUD in primary care was feasible to deliver and acceptable to participants. Minor modifications to the target population and treatment manual could increase the program's impact. Future studies will test the efficacy of the intervention in improving quality of life and OUD treatment outcomes. https://clinicaltrials.gov/study/NCT05262725, Unique ID: NCT05262725.

Point-of-care tests to manage acute respiratory tract infections in primary care: a systematic review and qualitative synthesis of healthcare professional and patient views.

To review the evidence on healthcare professionals' (HCPs) and patients' views of the use of point-of-care tests (POCTs) in the management of acute respiratory tract infections (RTIs) in primary care settings. We conducted a systematic review of studies up to 28 April 2023. We included studies that included qualitative methods and results; focused on HCPs' and/or patients' views/experiences of POCTs for acute RTIs; and were conducted in primary care settings. We conducted a thematic synthesis to identify how their views on POCTs and interventions can support test use (PROSPERO registration: CRD42019150347). We included 33 studies, developing 9 categories each for HCP and patient data. We identified 38 factors affecting POCT use: 28 from HCPs and 10 from patients. Factors exist outside and within consultations, and post-consultations, illustrating that some cannot be addressed by HCPs alone. Fourteen interventions were identified that could address factors and support POCT use, with 7 interventions appearing to address the most factors. Some interventions were beyond the scope of HCPs and patients and needed to be addressed at system and organizational levels. Both groups had mixed views on the use of POCTs and highlighted implementation challenges. This review highlights numerous factors affecting POCT use in primary care. Policy-makers planning to implement POCTs are likely to achieve more by providing multi-faceted interventions that target factors outside, within, and post-consultation. Some interventions may need to be already established before POCT introduction. Whilst evidence beyond general practice is limited, similar factors suggest that similar context-tailored interventions would be appropriate.

Diagnostic accuracy of signs and symptoms in acute coronary syndrome and acute myocardial infarction

Background Acute coronary syndrome (ACS) and acute myocardial infarction (AMI) account for a large portion of cardiovascular deaths. Signs and symptoms for these syndromes, such as chest pain, are non-specific and can be caused by a variety of non-cardiac conditions, especially in low-prevalence settings such as general practice. The diagnostic value of these signs and symptoms can be assessed using diagnostic meta-analyses, but the last one dates from 2012. Methods We performed a diagnostic meta-analysis in accordance with PRISMA guidelines. We searched PubMed, Embase and CENTRAL from 2006 to 2024. We included studies that assessed the diagnostic accuracy of thirteen different signs and symptoms. We divided patients into two subgroups (AMI and ACS) on which analysis was performed independently. Results We selected 24 articles for inclusion. Our analysis indicates that signs and symptoms have a limited role in the diagnosis of AMI or ACS. The most useful (highest diagnostic odds ratios, DOR) in the diagnosis of AMI were pain radiating to both arms (DOR 2.95 (95%CI 1.57–5.06)), absence of chest wall tenderness (DOR 3.51 (95%CI 1.64–6.61)), pain radiating to the right arm (DOR 5.17 (95%CI 1.77–11.9)) and sweating (DOR 5.75 (95%CI 2.51–11.4)). For ACS these were pain radiating to the right arm (DOR 3.9 (95%CI 0.7–12.6)) and absence of chest wall tenderness (DOR 7.73 (95%CI 2.19–19.8)). Conclusion We report the accuracy of thirteen signs and symptoms in the diagnosis of AMI and ACS. These can be useful to calibrate general practitioners’ diagnostic assessment of chest pain in primary care settings.

Identificação e intervenção precoce de primeiro episódio psicótico em cenários não especializados

The diagnosis and early intervention of a first episode psychosis is directly related to its prognosis. It is the initial phase of a psychotic disorder, which is a severe mental illness characterized by delusions, hallucinations and/or disorganized behaviour or speech. Commonly, the first assistance to these patients are done by a non-psychiatrist in an emergency or primary care setting. The practitioners must be able to identify and properly manage this condition, without delaying the diagnosis, screening and initiation of the proper treatment.