Primary Care Setting Research Articles

Assessment of muscle strength in elderly as a screening method for sarcopenia in primary care: a scoping review

ObjectivesTo identify and map the available evidence for whether a test of handgrip strength (HGS) and/or the chair stand test (CST) have been used as screening tools for the detection...

A qualitative study about the public's perception of primary care providers.

With the growth of physician associates/assistants (PAs) and NPs providing primary care services, we sought to understand the public's perception of the different types of healthcare providers (HCPs) they might encounter in a clinical setting, such as primary care. This study aimed to evaluate public perceptions about various types of primary care providers (PCPs), identify public preferences for PCPs in relation to experience and training, and examine public preferences for PCP credentials. We conducted semistructured interviews with adults, and used inductive and deductive coding and reflexive thematic analysis to analyze the data. We reached thematic saturation after 12 completed interviews. Participants reported confusion about the types of HCPs they might encounter in a primary care setting (for example, physician, PA, NP). Participants who reported a preference for a physician valued more years in training and their role in the hierarchy of medicine; those who reported a preference for a PA or NP indicated that compassion, patience, and longer clinic visit times were most important to them. Previous reports suggested that the public might be confused by the different types of HCPs they might encounter during a primary care visit. Participants identified specific characteristics that are important when they are choosing their PCP. A direct, coordinated marketing campaign may be needed to educate the public and reduce confusion about different types of PCPs, how they contribute to safe and high-quality care, and ensure preference-concordant care.

Barriers to Effective Cellulitis Management in a Primary Care Setting: An Audit Report

Barriers to Effective Cellulitis Management in a Primary Care Setting: An Audit Report

Value-based outcome evaluation methods used by occupational therapists in primary care: a scoping review.

This scoping review aimed to map how occupational therapists evaluate the outcomes of services they provide within primary care. This evidence was considered in relation to how identified outcome evaluation methods align to principles of value-based health care. Primary care services are experiencing unprecedented demands. Occupational therapy is an allied health profession that supports health and care provision in primary care, using a timely and proactive approach. There has been a notable increase in occupational therapy roles across primary care services in the past decade; however, the mechanisms for evaluating outcomes and the wider impact of these services remain under-researched. The aim of value-based health care, a global transformative approach, is to establish better health outcomes for individuals and communities through addressing value in system-wide care. However, it is not yet clear how evaluation methods used within occupational therapy align to the principles of a value-based agenda. Peer-reviewed journal articles and gray literature written in English were included to identify outcome evaluation methods used by occupational therapists to evaluate the effectiveness and impact of occupational therapy services provided in a primary care setting. Outcome evaluation methods used exclusively for the purpose of conducting research and not for capturing data within an occupational therapy primary care setting as part of routine clinical practice were excluded. This review followed JBI methodology for scoping reviews. The literature search was undertaken during June and July 2022. The following databases were searched from their earliest dates of availability: Cochrane Library, MEDLINE via Ovid, Embase via Ovid, CINAHL via EBSCOhost, Scopus, AMED, and Web of Science. Two reviewers extracted data, supported by use of an extraction form developed by the reviewers. Findings were mapped using a framework developed based on key principles of value-based health care. From 2394 articles, 16 eligible studies were included in the review. Of these, 9 were quantitative and 7 were of mixed methods design. Studies were from the UK, USA, Sweden, Spain, and Canada. The occupational therapy services represented were mainly heterogeneous. Four services were part of multidisciplinary programs of care and 12 services were specific to occupational therapy. Identified outcome evaluation methods broadly aligned to principles of value-based health care, with most alignment noted for measures demonstrating the aim of establishing better health. A wide range of evaluation methods were described to address both individual-level and service-level outcomes, with the use of patient-reported outcome measures identified in 13 studies. To capture patient experience, most studies reported a variety of methods. The aim of reducing the per capita cost of health care was least represented in the literature. This scoping review highlights a multifaceted but inconsistent approach to measuring the outcomes of occupational therapy provided in primary care. This has implications for establishing effectiveness and capturing data at scale to assist with wider planning of care and to enable the profession to demonstrate its contribution to value-based health care. Open Science Framework https://osf.io/hnaq4/.

A cluster randomised controlled trial investigating the efficacy of family-centred obesity management program in primary care settings: A study protocol.

The study aims to test the efficacy of a family-centred healthy lifestyle program in primary care health centres among children with overweight or obesity, evaluating the results at 3, 6, and 9 months post-intervention. A single-blind, randomised controlled cluster study where participants will be blinded to group assignment to reduce bias will be followed. The intervention comprises a 6-month program with intensive and maintenance behavioural therapies, including dietary modifications and guidelines for physical activity, administered by a multidisciplinary team. Participants will be assigned to an intervention group or a treatment-as-usual control group. Primary health centres in Seeb Wilayat, serving densely populated areas and willing to participate, will be included. Randomisation will be conducted at the cluster level to improve recruitment efficiency. A sample size calculation will ensure adequate power to detect significant differences. Ethical approval is granted and informed consent/assent will be obtained from all participants. The proposed study focusses on testing the efficacy of a family-centred healthy lifestyle program in primary care centres through a controlled, randomised study. Successful outcomes could lead to informed interventions, improvements in the health system, policy recommendations, positive community impacts, information on behavioural therapies, and improved long-term health outcomes for affected children and their families. This study will contribute to the literature by providing a culturally sensitive and evidence-based solution to a pressing public health issue, which can be adapted to similar contexts in Oman and beyond.

“A bit of a cough, tired, not very resilient – is that already Long-COVID?” perceptions and experiences of GPs with Long-COVID in year three of the pandemic. a qualitative interview study in Austria

BackgroundLong-COVID is a new multisectoral healthcare challenge. This study aims at understanding experiences, knowledge, attitudes and (information) needs that GPs had and have in relation to Long-COVID and how these evolved since the beginning of the COVID-19 pandemic.MethodsThe study used an exploratory qualitative research design using semistructured interviews. A total of 30 semistructured interviews with GPs in different primary care settings (single practices, group practices, primary care centres) were conducted between February and July 2022. The data were analysed using qualitative thematic content analysis with the software Atlas.ti.ResultsThis is the first study that empirically investigated Long-COVID management by GPs in Austria during the third year of the pandemic. All GPs indicated having experience with Long-COVID. In cities, GPs tended to have slightly better networks with specialists. The GPs who already worked in teams tended to find the management of Long-COVID easier. The symptoms that the physicians described as Long-COVID symptoms corresponded to those described in the international literature, but it is unclear whether syndromes and symptomes such as Post-Exertional-Malaise, autonomic dysfunction such as postural tachycardia syndrome or Mast-Cell-Overactivation-Syndrom, and cognitive dysfunctions were also recognized and correctly classified since they were never mentioned. Most GPs reacted quickly by granting the needed sick leaves and by seeing and discussing with the patients often.The treatment of the patients is described as an enormous challenge and frustrating for patient and GP if the treatment does not yield to significantly improved health also due to the high costs for the patient.ConclusionLong-COVID will continue to preoccupy our health care systems for a long time to come, as new variants of COVID-19 will continue to produce new patients without adequate prevention strategies. Therefore, it is not a question of if but when good support for GPs and adequate care pathways for people with Long-COVID will be implemented. Specific contact points that are familiar with therapy-refractory postacute infection syndromes like the postacute COVID condition as a subgroup of Long-COVID are urgently needed.

Improving Collaborative Management of Multiple Mental and Physical Health Conditions: A Qualitative Inquiry into Designing Technology-Enabled Services for Eliciting Patients' Values

People with multiple chronic conditions (MCC) face challenges planning health care collaboratively with primary care clinicians, particularly when their priorities conflict. These challenges intensify with symptoms of anxiety or depression. Elicitation of patients' values is promoted as a means to aligning patient and clinician priorities in primary care, and as a component of psychotherapy for anxiety and depression. But, these approaches remain siloed. We conducted a qualitative interview study to understand patients' preferences for Technology Enabled Services (TESs) to coordinate values elicitation across primary and mental health care settings. Many participants preferred face-to-face elicitation by a mental health clinician; some preferred elicitation via telehealth and some preferred self-directed elicitation. Participants' preferences were influenced by: 1) how they perceived the rationale and benefits of values elicitation; 2) how they perceived the training and credibility of people facilitating elicitation; and 3) how they perceived their own capacity to engage in values elicitation. Participants also shared numerous concerns about values elicitation that warrant critical examination of TESs to support it.

Post-pandemic patient safety: have the characteristics of incidents with harm changed? Comparative observational study in primary care via review of medical records with a trigger tool

BackgroundThe COVID-19 pandemic generated or accelerated healthcare changes, some of which persist thereafter (e.g., healthcare reorganisation, remote consultation). Such changes entail novel risks for patient safety.MethodsAimTo compare the characteristics of patient safety incidents with harm (PSIH) in primary care before the pandemic and at present.Design and settingCross-sectional, comparative, observational study conducted within the entire Primary Care Service of the Madrid region with observations at two time points (2018 and 2021/2022).ParticipantsPatients > 18 years of age with at least one consultation in the previous year. The necessary sample size was established at N1 = 2,000 for the first time point and N2 = 2,700 for the second. Sampling was performed by simple randomisation for the first group and by clusters followed by simple randomisation for the second.Main measurementsAge, gender, presence of PSIH in the medical record, and characteristics of the PSIH, specifically avoidability, severity, place of occurrence, nature, and contributory factors. Triggers validated in primary care were employed to screen the patients’ medical records and those containing any trigger were reviewed by three nurse-physician teams who underwent previous training.AnalysisComparative analysis using Fisher’s exact test.ResultsA total of 63 PSIHs and 25 PSIHs were found for the first and second samples, respectively. The comparison of the characteristics of PSIH before the pandemic and currently was: avoidable 62% vs. 52% (p = 0.47), mild 51% vs. 48% (p = 0.57), in the primary care setting 73% vs. 64% (p = 0.47), respectively. Although no statistically significant differences were observed globally in the nature of the incidents (p = 0.13), statistically significant differences were found for diagnostic errors, with pre-pandemic rates of 6% vs. 20% at present (p < 0.05). Finally, no significant differences were found in the contributory factors.ConclusionsNo differences were found in the avoidability, severity, place of occurrence, or contributory factors of PSIHs before the pandemic and currently. In terms of the nature of these incidents, the outcomes revealed an increase in diagnostic errors (excluding diagnostic tests), which could be attributed to a greater frequency of remote consultations and a decrease in the longitudinality of care resulting from the shortage of professionals.

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

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

Accuracy of the Screening Tool for Autism in Toddlers and Young Children in the primary care setting.

Specialists conduct autism evaluations using tools that are expensive and difficult to get trained on. Families often wait a long time and travel far to get a diagnosis for their child. To help with this problem, primary care practitioners can be trained to provide evaluations in local communities. However, usable and accurate tools developed for non-specialists are needed. The Screening Tool for Autism in Toddlers and Young Children (STAT) was created for this purpose, but limited research has been done on accuracy of the tool in community primary care. This study tested the STAT when used by primary care practitioners as part of a diagnostic evaluation in 130, 14- to 48-month-old children. We tested (1) STAT agreement with the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2), and diagnosis based on an expert research evaluation, and (2) the relationship between STAT classification, primary care practitioner diagnosis, and expert diagnosis. STAT classification matched the ADOS-2 in 77% of cases and expert diagnosis in 78% of cases. Autistic children incorrectly classified by the STAT were older, had higher developmental and adaptive skills, and fewer autism symptoms. In 86% of cases, the STAT classification agreed with primary care practitioner diagnosis. STAT classification, primary care practitioner diagnosis, and expert diagnosis agreed in 73% of cases. Overall, the STAT shows good accuracy when used by primary care practitioners as part of a community primary care autism evaluation.

Under Documentation of Anemia in Older Adults in Primary Care Practices

Introduction: Anemia is prevalent in adults over the age 65 years, and its occurrence increases with age. The common causes of anemia in this population include nutrient deficiencies, acute or chronic inflammation and unexplained anemia of aging. Anemia in older adults is associated with poorer quality of life, decreased function, falls, fractures, hospitalization, long-term care placement and higher mortality. It was our hypothesis that despite these well documented adverse consequences anemia is under recognized in the primary care setting. Methods: This retrospective study evaluated patients aged 65 and older who were followed at internal medicine primary care clinics throughout northern Virginia over a one-year period from January to December 2023. The study population was identified using a slicer dicer program from the electronic health record, filtering for patients aged 65 and older who had a Medicare annual wellness exam in 2023. For this analysis, the study population was limited to approximately 1,500 patients, and chart reviews were performed on these patients. The World Health Organization's (WHO) definition of anemia, which specifies hemoglobin levels below 12 g/dL in women and below 13 g/dL in men, was used as the study definition for anemia. Any hemoglobin levels from 2022 to 2024 that met this definition was identified to have anemia. The primary objective was to identify the percentage of anemia cases correctly recognized and documented as a problem on the patients' problem list. Results: Out of the 1525 randomly-selected from a broad network of primary care internal medicine practices, there were 643 males and 882 females, and the age group breakdown was 724 patients aged 65 to 74, 629 patients aged 75 to 84, and 172 patients aged 85 and older. From this study population, 310 patients were identified to have anemia. The breakdown of the anemia patients were 154 males and 156 females, and the age group was 113 patients aged 65 to 74, 127 patients aged 75 to 84, and 70 patients aged 85 and older. The prevalence of anemia was 24% for males and 18% for females. For the age groups, the prevalence was 16% for aged 65 to 74, 20% for aged 75 to 84, and 40% for aged 85 and older. Out of the 310 patients with anemia, only 103 patients had anemia listed on the problem list. This indicates that only 33% of anemic patients had anemia correctly documented, while 67% did not. There were no significant differences in the recognition of anemia between sex and age groups. Anemia was correctly noted as a problem in 48 males (31%) and 55 females (35%). Additionally, anemia was correctly identified in 35 patients (31%) aged 65 to 74, 43 patients (34%) aged 75 to 84, and 25 patients (36%) aged 85 and older. Conclusions: There is a significant under-recognition of anemia in the geriatric population at the primary care setting. The rates of under-recognition are comparable between sexes and across different age groups. However, anemia has been found to be more prevalent in females and with increased age. This unaddressed anemia likely contributes to a chronic decline in function and quality of life, particularly in the frailer and more vulnerable population. Increased awareness and appropriate management of anemia in primary care settings can help prevent its associated negative effects.

Evaluation of Heavy Menstrual Bleeding in Adolescents within the Primary Care Setting

Evaluation of Heavy Menstrual Bleeding in Adolescents within the Primary Care Setting

Enhancing Capacity for Primary Care Research in Cancer Survivorship: National Cancer Institute Meeting Report.

Many components of long-term cancer follow-up and survivorship care are managed in the primary care context. Given the important role that primary care has in survivorship care, it is critical to ensure that teams in these settings are prepared to address long-term needs. Evidence-based strategies to deliver survivorship care in primary care settings in the US remain limited. The National Cancer Institute (NCI) Office of Cancer Survivorship (OCS) conducted a day-long virtual event, Enhancing Capacity for Primary Care Research in Cancer Survivorship: A Workshop for Action, on February 28, 2024, to discuss research needs addressing the intersection between primary care and cancer survivorship. Topics discussed to advance this area of research included: system-level interventions, methods and measurement, and mentorship and research team building, especially for early career researchers. The purpose of this report is to provide a summary of the key findings. Gaps and opportunities include: (1) health systems-level research that investigates primary care practice-level capacity, (2) identification and characterization of the targeted cancer survivor populations for primary care research; (3) leveraging electronic medical records to track relevant patient outcomes throughout survivorship; and (4) development/creation of communities of practice to support and build research capacity. Team science approaches were identified as a core strategy to advance survivorship research. The meeting closed with a reflection and call to action focused on building collaborations that span different research areas, disciplines, and organizations and building a broad network of a primary care practice focused research.

Odontogenic Infections: Management in Ambulatory Care Settings for Nurse Practitioners

Dental insurance and access to care need substantial improvement in the United States, given their current inadequacies that contribute to suboptimal oral and physical health outcomes and escalate national health care expenditures. The disparities in access to dental care exacerbate oral health disparities across socioeconomic lines. With their broad reach and comprehensive approach to health care, nurse practitioners are uniquely positioned to play a pivotal role in enhancing oral health outcomes. They can effectively integrate preventive measures and early intervention strategies for conditions such as odontogenic infections, thereby reducing emergency department visits and improving overall patient health. This clinical feature critically examines evidence-based practices for the presentation, diagnosis, and management of odontogenic infections within primary care settings. Disseminating this knowledge aims to empower nurse practitioners to deliver timely and effective care, ultimately fostering more significant equity and accessibility in dental health services nationwide.

How First Nations peoples living in the Torres Strait and Northern Peninsula Area describe and discuss social and emotional well-being.

This study was the first phase of a broader project designed to develop a new tool to screen social and emotional well-being (SEWB). Its objective was to identify words used by First Nations people living in the Torres Strait (Zenadth Kes) and Northern Peninsula Area (NPA) to describe and discuss SEWB. We pay our respects to Elders past and present. We acknowledge the First Nations peoples who took part in this project as holders of their cultural knowledge now and forevermore. This study took place in community and primary health care settings located on islands of the Torres Strait and NPA of Australia. Twelve yarns with 35 community members and health professionals were led by Torres Strait Islander members of the project team between August and December 2022. This study employed a descriptive qualitative design. Yarning, an Australian First Nations relational method, was used to share stories about SEWB. All but one yarn was audio recorded and subsequently professionally transcribed. Inductive thematic analysis was used to analyse the yarns. Worry, sad and stress were the words most often used by participants to describe feelings of low SEWB. Signs of low SEWB included behaviour change, particularly significantly reduced community engagement. Worry is not a word that is used in Australian mainstream tools that screen for psychological distress. Findings of this study indicate that a question that asks about worries should be included when screening for low SEWB in Australian First Nations peoples living in the Torres Strait and NPA.

Epidemiological Investigation of Disease Patterns, Accessibility, and Patient Characteristics Following the Introduction of Dermatology Specialty Clinics Within Primary Care Settings in Qatar.

Introduction Dermatological diseases are commonly presented in primary care settings and are associated with health implications and psychiatric comorbidity, which has a negative impact on the overall quality of life of the patients. The service users' characteristics and the prevalence of the different types of dermatological diseases are an under-researched area in the state of Qatar. The aim of the study is to investigate the prevalence of commonly presenting dermatological diseases such as diseases of the skin and subcutaneous tissues, dermatitis and eczema, and disorders of skin appendageswithin primary care settingsand highlight patient characteristics accessing dermatological healthcare services at primary healthcare centers within its parent organization Primary Health Care Corporation (PHCC). Methods The study population included in the research was composed of both Qataris and non-Qataris registered at a PHCC health center between 1 January 2017 and 31 December 2020. The demographic and diagnosis data were extracted from the electronic medical records (EMR) for the defined population. A comparison analysis (reported as odds ratio and inverse odds ratio) was conducted to evaluate the frequency and distribution of cases at "Primary Care Dermatology Patients Care Services" before and after the introduction of dermatology specialty clinics services in PHCC. Results A total of 937,553 patients' data was retrieved for the study registered at a PHCC health center between 1 January 2017 and 31 December 2020. Adults aged 18 to 59 constituted more than two-thirds of the study sample (68.3%, n=640313). The commonly occurring dermatological diseases that were diagnosed during this four-year time period after the introduction of dermatology specialty clinics were namely diseases of the skin and subcutaneous tissue (n=249197, 73%), dermatitis and eczema (n=91653, 27%) and disorders of skin appendages (n=67933, 20%). The probability of having a clinical encounter with neoplasm was increased by 2.17 times after introducing the specialized clinics within PHCC. Conclusion The disease pattern of dermatological diseases and patient characteristics present vital health information to better understand the workload and training needs of Family Physicians working in dermatology specialty clinics and to further improve the quality of service and target high-risk patient sub-groups. The findings of the study can also be utilized for future designing and re-designing of the service, particularly in the context of innovative strategies such as complex care management and patients presenting with co-morbidities including dermatological or cutaneous diseases.

A Brief Review on Normal Pressure Hydrocephalus Diagnosis in Primary Neuropsychiatric Care Settings

Normal pressure hydrocephalus (NPH) is clinically characterized by the triad of mental deterioration, gait disturbance, and urinary incontinence. Correct diagnosis and referral of patients is important because NPH is a potentially treatable cause of cognitive decline and should be distinguished from more common forms of irreversible dementia. Unfortunately, it remains to be a rather underdiagnosed and controversial neuropsychiatric entity even in countries with modern healthcare systems. The diagnostic process is complicated by diverse clinical presentations, especially when the classical triad is incomplete or atypical such as with psychiatric symptoms. This manuscript aims to briefly review atypical clinical presentations of NPH and basic radiologic findings associated with it, and outline some recommendations to primary care physicians for diagnosis and referral.

Empowering Thai community pharmacists in combating antimicrobial resistance: Qualitative insight and sentiment analysis

BackgroundAntimicrobial resistance (AMR) is increasing globally and poses a significant public health challenge. Community pharmacists, especially in primary care settings, play a pivotal role in mitigating the irrational use of antibiotics, a key driver of AMR. ObjectivesThis study aims to explore qualitative insights from community pharmacists regarding antibiotic supply and usage, analyze sentiments related to AMR, and highlight the crucial role of community pharmacists in AMR stewardship at the primary care/community level. MethodsThis study engaged community pharmacists in Thailand through semi-structured interviews to obtain in-depth insights into the antibiotic supply and perceptions of AMR. Additionally, sentiment analysis, which evaluates the emotional tone of the pharmacists' responses, was conducted to enrich the findings. ResultsInterviews with 23 community pharmacists highlighted the practices, challenges, and strategies related to antibiotic supply and use. Key findings include the identification of barriers such as patient demand and lack of awareness about antimicrobial resistance (AMR), alongside strategies for improvement such as public education and professional development. Sentiment analysis reveals a cautiously optimistic perspective toward enhancing rational antibiotic use, underscoring the importance of comprehensive approaches that combine education, ethics, and regulatory measures to address the complexities of antibiotic management at community pharmacies. ConclusionThis study underscores the necessity of public awareness, pharmacist–patient relationships, and regulatory reforms for the rational use of antibiotics in community pharmacies. These findings emphasize that pharmacist education and adherence to professional ethics are essential for mitigating antimicrobial resistance and promoting rational antibiotic use.

Asthma prescribing trends, inhaler adherence and outcomes: a Real-World Data analysis of a multi-ethnic Asian Asthma population

Inhaled corticosteroid (ICS) is the mainstay therapy for asthma, but general adherence is low. There is a paucity of real-world inhaler prescribing and adherence data from Asia and at the population level. To address these gaps, we performed a real-world data analysis of inhaler prescribing pattern and adherence in a multi-ethnic Asian asthma cohort and evaluated the association with asthma outcomes. We performed a retrospective analysis of adult asthma patients (aged ≥18 years) treated in the primary and specialist care settings in Singapore between 2015 to 2019. Medication adherence was measured using the medication possession ratio (MPR), and categorised into good adherence (MPR 0.75-1.2), poor adherence (MPR 0.75) or medication oversupply (MPR > 1.2). All statistical analyses were performed using R Studio. 8023 patients, mean age 57 years, were evaluated between 2015 and 2019. Most patients were receiving primary care (70.4%) and on GINA step 1–3 therapies (78.2%). ICS-long-acting beta-2 agonist (ICS-LABA) users increased over the years especially in the primary care, from 33% to 52%. Correspondingly, inpatient admission and ED visit rates decreased over the years. Between 2015 and 2019, the proportion of patients with poor adherence decreased from 12.8% to 10.5% (for ICS) and from 30.0% to 26.8% (for ICS-LABA) respectively. Factors associated with poor adherence included minority ethnic groups (Odds ratio of MPR 0.75–1.2: 0.73–0.93; compared to Chinese), presence of COPD (OR 0.75, 95% CI 0.59–0.96) and GINA step 4 treatment ladder (OR 0.71, 95% CI 0.61–0.85). Factors associated with good adherence were male gender (OR 1.14, 95% CI 1.01–1.28), single site of care (OR 1.22 for primary care and OR 1.76 for specialist care), GINA step 2 treatment ladder (OR 1.28, 95% CI 1.08–1.50). Good adherence was also associated with less frequent inpatient admission (OR 0.91, 95% CI 0.84–0.98), greater SABA overdispensing (OR 1.66, 95% CI 1.47–1.87) and oral corticosteroids use (OR 1.10, 95% CI 1.05–1.14). Inhaled corticosteroid (ICS) adherence has improved generally, however, poor adherence was observed for patients receiving asthma care in both primary and specialist care, and those from the minority ethnicities.

Scoping review of enablers and challenges of implementing pharmacogenomics testing in the primary care settings

IntroductionPharmacogenomic testing (PGx) plays a crucial role in improving patient medication safety, yet ethical concerns and limitations impede its clinical implementation in the primary care settings.AimsTo systematically review the current...