Primary Care Setting Research Articles

Primary Care Referral Delays in Oral Cancer Diagnosis: A Meta-Analysis.

To measure the primary care interval (PCI) in the diagnostic delay of oral cancer and to assess the relation of the referring physician's specialty with disease stage at diagnosis. We meta-analyzed reports of oral/oropharyngeal carcinomas detailing PCI start- and endpoints, i.e., the time needed by a primary care physician to refer a suspected oral cancer patient to a specialist. 17 studies with a total of 2530 patients were eligible; nine provided data on the relative length of PCI, and 10 reported on the impact of the referring professional's specialty on oral cancer diagnostic delay. The average PCI length was slightly longer for general practitioners (GPs) (30.5 days) than for general dental practitioners (GDPs) (27.6 days), while that for the total group was 28.7 days. One-third of the total pre-hospital time spent on diagnosis elapses in GP practices (PCI%: 0.31 [95% CI: 0.23, 0.40]). GDPs refer their patients for treatment at earlier disease stages (TNM I-II) than GPs (Odds Ratio: 0.58; 95% CI: 0.34-0.98). Primary care accounts for a considerable pre-hospital amount of time of what is necessary for reaching a diagnosis of oral cancer patients. This calls for enhancing early oral cancer recognition in primary care settings.

Trends and associated factors of mental health diagnoses in Catalan Primary Care (2010-2019).

The prevalence of mental health disorders has significantly increased in recent years, posing substantial challenges to healthcare systems worldwide, particularly primary care (PC) settings. This study examines trends in mental health diagnoses in PC settings in Catalonia from 2010 to 2019 and identifies associated sociodemographic, clinical characteristics, psychopharmacological treatments, and resource utilization patterns. Data from 947,698 individuals without prior severe mental illness, derived from the Data Analytics Program for Health Research and Innovation (PADRIS), were analyzed for this study. Sociodemographic data, diagnoses, and resource utilization were extracted from electronic health records. Descriptive statistics, chi-square tests, Mann-Whitney tests, and a multivariate binary logistic regression were employed to analyze the data. Over the study period, 172,112 individuals (18.2%) received at least one mental health diagnosis in PC, with unspecified anxiety disorder (40.5%), insomnia (15.7%) and unspecified depressive disorder (10.2%) being the most prevalent. The prevalence of these diagnoses increased steadily until 2015 and stabilized thereafter. Significant associations were found between mental health diagnoses, female sex, lower socioeconomic status, higher BMI, and smoking status in a multivariate binary logistic regression. This study highlights a growing burden of stress-related mental health diagnoses in PC in Catalonia, driven by demographic and socioeconomic factors. These findings may be indicative of broader trends across Europe and globally. Addressing this rising prevalence requires innovative approaches and collaborative strategies that extend beyond traditional healthcare resources. Engaging stakeholders is essential for implementing effective, sustainable solutions that promote mental health in Catalonia and potentially inform similar initiatives worldwide.

Screening and Telephone-Based Intervention for Unhealthy Alcohol Use in a Diverse Federally Qualified Health Center System in Texas.

Screening and brief intervention (BI) can reduce risky alcohol use but has not been widely implemented in primary care settings. We sought to implement a screening and telephone-based program within a Federally Qualified Health Center (FQHC). Prior to this program, adult patients were routinely screened using AUDIT-C with no further systematic follow-up. We designed a team-based, tele-care-centered program to (1) follow-up positive screening results or provider referrals with full AUDIT and (2) provide a social worker-administered two-session BI for patients with AUDIT 4-12; those with high AUDIT scores received BI and were offered pharmacotherapy and/or referral for additional support. Repeat AUDIT was administered at 3-6months. From March 2021 to May 2023, 3959 patients were screened using AUDIT-C, with 632 (16%) screening positive. Mean age was 44; 47% identified as female, 58% as Hispanic/Latino; 43% received care through the county-based Medical Access Program (MAP). Men, those with commercial insurance, and English-speakers were more likely to screen positive. Using telephone outreach to direct referrals and to those screening positive, trained counselors successfully administered the full AUDIT to 412 participants. Initial AUDIT scores were ≤ 12 (n = 281, 68.2%) and > 12 (n = 131, 31.8%). Among patients who completed the initial AUDIT, mean age was 46; 32% identified as female, 86% as Hispanic/Latino, and 66% were insured through MAP. Of the 412, 400 (97%) completed one counseling session and 297 (72%) completed two. Of the 131 with initial AUDIT > 12, 19 received pharmacotherapy and 13 had one or more visits with our addiction medicine service. For the 251 patients with AUDIT data at 3-6months, the mean score change was - 4.1 (95% CI - 3.4, - 4.7). Spanish-speaking patients showed larger decreases than English-speakers; there were no other statistically significant differences. Screening and telephone-based BI reduces unhealthy alcohol use in diverse adult FQHC patients.

The effect of workload on primary care doctors on referral rates and prescription patterns: evidence from English NHS.

This paper investigates the impact of workload pressure on primary care outcomes using a unique dataset from English general practices. Leveraging the absence of General Practitioner (GP) colleagues as an instrumental variable, we find that increased workload leads to an increase in prescription rates of antibiotics as well as in the share of assessment referrals. On the other hand, the quantity and frequency of psychotropics decreases. When there is an absence, workload is intensified mostly on GP partners, and the mode of consultation shifts toward remote interactions as a response to higher workload pressure. The effects are more pronounced for patients above 65years-old and those in Short-staffed practices. Our study sheds light on the intricate relationship between workload pressure and patient care decisions in primary care settings.

Knowledge, attitudes, and self-perceived skills regarding ultrahigh risk (UHR) for psychosis and schizophrenia in primary care physicians: new insights from Tunisia

BackgroundThere is evidence indicating that an important proportion of young people at ultrahigh risk (UHR) for psychosis do consult in primary care, but their identification may be hindered by multiple factors, such as primary care physicians (PCPs)’ limited skills and perceived stigma toward the condition. This study aimed to investigate attitudes/beliefs toward both UHR and schizophrenia and perceived self-efficacy in screening for, diagnosing, and managing these conditions among PCPs. The secondary objective was to determine the potential effects of psychosis level (UHR vs. schizophrenia) on PCP’s views.MethodsA cross-sectional survey was carried out among Tunisian PCPs working in primary care setting in Tunisia (N = 232, 66.4% females, mean age of 47.5 ± 9.9 years). An anonymous paper-and-pencil self-administered questionnaire was adopted to collect data. PCPs were asked to read vignettes describing individuals with UHR and schizophrenia and answer a series of questions that followed.ResultsThe schizophrenia vignette aroused significantly more feelings of “need to help the person” than the UHR vignette (87.8% vs. 88%, p = .022). The perceptions that the person depicted in the vignette is “strange” and “not intelligent” were more frequently endorsed for UHR than schizophrenia (18.7% vs. 16%, p = 0.028, and 8.4% vs. 5.6%, p = 0.043, respectively), whereas the person with schizophrenia was perceived are more dangerous than the UHR person (38.4% vs. 25.2%, p = 0.033). Only 28.9% and 14% of participants agreed that they have the necessary skills to make the diagnosis and manage the condition depicted in the UHR vignette, respectively.ConclusionFindings indicated that a high proportion of our Tunisian PCPs show a deficit in identifying both UHR and schizophrenia diagnoses. Given that PCPs can be key sources of referral of at-risk young help-seekers to specialized early intervention services, urgent interventions are needed to help PCPs enhance their knowledge and reduce stigma associated with psychosis.

Obsessive-Compulsive Disorder in Children and Adolescents: Early Detection in Primary Care Settings.

Obsessive-compulsive disorder (OCD) is a common and potentially debilitating condition affecting approximately 1%-3% of children and adolescents.1,2 It is characterized by obsessions and/or compulsions that are time-consuming or cause clinically significant distress or impairment in school, social, family, or other important areas of functioning. OCD can have a lasting impact on both academic and social functioning. For instance, engaging in rituals can lead to isolation, tardiness, family conflict, sleep alterations, and procrastination. Children with untreated OCD are also at elevated risk of developing substance use, episodes of depression, suicidal ideation and attempts.

Development of a remote implementation support strategy to enhance integration of depression treatment into primary care settings in rural India

IntroductionContextually responsive implementation support strategies are needed to enhance the integration of mental health services into primary health care. Technical assistance is widely used as a core “capacity building” strategy, primarily for increasing the motivation and capacity of individuals (e.g., frontline workers) to adopt evidence-based interventions in healthcare settings. This article documents the systematic design of a technical assistance strategy for supporting primary care staff (e.g., nurses) in integrating depression care, from screening to treatment, aligned with a non-communicable disease program across seven health facilities in the Sehore District of Madhya Pradesh, India.MethodsWe conducted a mapping exercise of local health facilities with dedicated staff and a literature review to inform the development of the technical assistance strategy.ResultsReporting guidelines guided the structure of the strategy protocol. The evidence-supported strategy, called Remote Coaching Support, is tailored to the local setting. It uses quality improvement methods like the Plan-Do-Act-Study cycle and training materials to help coaches deliver support remotely via video/phone-based calls and WhatsApp messaging with the overall goal of increasing uptake and fidelity of depression screening and referral among primary care staff in alignment with an existing non-communicable diseases program.ConclusionThe development of Remote Coaching Support involved iterative improvements through team meetings and practice-training feedback, though limitations exist due to a lack of systematic implementation standards, especially in this setting. This strategy will be tested in increasing scales to refine its application, with effectiveness and acceptability results to be evaluated in a randomized control trial.

Development and implementation of a firearm safety intervention by medical and physician assistant students in an adult primary care setting

Firearm ownership is associated with an increased risk of adverse health outcomes, including violence, suicide, and accidental firearm injury. Numerous medical governing bodies have placed emphasis on firearm screening and counseling within the healthcare setting. However, few physicians discuss firearm ownership and safety with patients, likely due to limited physician familiarity with firearms or perceived risk to the doctor-patient relationship, among other barriers. Clinical trainees have the capability to confidentially screen for unsafe firearm practices and potentially prevent fatal injury. In this study, we provide one of the first reports of a universal firearm screening and safety intervention developed and implemented by medical and physician assistant students in an adult primary care clinic as part of a longitudinal clerkship experience. Students learned the basics of firearm ownership and storage, developed interview skills for sensitive topics, developed a screening tool for safe firearm storage, and gained a better understanding of firearm safety in the community. Through partnership with the Chicago Police Department, students offered firearm cable locks to all patients who screened positive for unsafe firearm storage practices. Overall, this study aimed to assess the feasibility of a universal firearm safety screening tool and intervention in a primary care clinic. We conclude that such a tool is feasible in a student-led primary care clinic, provides unique educational opportunities for students, and can be adopted in numerous healthcare teaching settings. Future steps may include evaluating other ways to promote firearm safety, such as screening for intimate partner violence and/or concomitant mental illness.

Expanding access to sodium-glucose cotransporter 2 inhibitors (SGLT2i) in the Ministry of Health Malaysia - a multiple HTA approach.

Ministry of Health (MOH) Malaysia stakeholders seek primary care access to sodium-glucose cotransporter 2 inhibitor (SGLT2i). Addressing this required a complex decision, selecting among three SGLT2i for two different indications and two practice settings. The options include expanding the existing SGLT2i (empagliflozin) in the MOH Medicines Formulary to primary care and/or having dapagliflozin and/or luseogliflozin as alternatives. This study aimed to conduct a multiple health technology assessment (HTA) to determine the SGLT2i of choice for the MOH setting. The clinical benefits of SGLT2i were assessed through a systematic literature review and affordability was assessed through the development of three budget impact analysis models simulating seventy scenarios. Each model varied by prescribing indications, restrictions, and SGLT2i involved (M1: glycemic control, HbA1c between 6.5 percent and 10 percent, empagliflozin-dapagliflozin-luseogliflozin; M2: cardiovascular benefits, HbA1c less than 10 percent, empagliflozin-dapagliflozin; M3: a composite of M1 and M2). The outcome of the HTA was presented to the MOH decision-makers. Although there was no significant difference in glycemic control between the SGLT2i, differences exist in cardiovascular benefits conferred. Despite having scenarios with lower net budget impact (NBI) in the M1, M2, and M3 models, decision-makers decided to expand empagliflozin use to primary care setting and add dapagliflozin for hospital-only setting for both indications [NBI of $4.38 mil] due to empagliflozin's advantage in reducing risk for cardiovascular death and prior experience of its use in MOH. The multiple HTA approach guided the complex decision-making process by providing a holistic understanding of the decision's impact.

Barriers and enablers to the management of osteoarthritis in primary care in Ireland from the perspective of healthcare professionals and individuals with osteoarthritis: a qualitative study using the Theoretical Domains Framework

ObjectivesTo explore the barriers and enablers to providing and receiving primary care for osteoarthritis (OA) in Ireland from the perspectives of primary care healthcare professionals (HCPs) and individuals with OA.DesignDescriptive...

A digital and nurse-led support intervention, first year after prostate cancer treatment: a single-arm feasibility study in a Swedish primary care setting

BackgroundThe prevalence of patients with prostate cancer is increasing, and the first year after treatment is a vulnerable period for patients as they experience symptoms and unmet needs. Although electronic patient-reported outcomes that focus on patient self-management have demonstrated benefits, evidence is sparse regarding patients with prostate cancer in primary care settings and the role of nurses as a supportive resource. The significant role of primary care in future cancer care is on the agenda. This study aims to test the feasibility of a complex intervention that includes electronic patient-reported outcomes and self-management advice in an app, combined with nurse-led support, in primary care settings during the first year after curative intended prostate cancer treatment.MethodsThe intervention lasted four weeks and was a single-arm study. Feasibility was assessed by examining the recruitment process, retention rate, adherence to the reporting of symptoms in the app, and acceptability of the intervention. Data was collected through (1) logged data from the app that included patient-reported outcomes and self-management advice, (2) field notes by the nurse, and (3) semi-structured interviews with patients. Descriptive statistics were applied to logged data. The interviews and the field notes were analysed using qualitative content analysis.ResultsThe recruitment rate was 55%, yielding 11 patients with high retention as all completed the intervention. Adherence to reporting was 100%, and all functions in the app were used. Individual variation in how patients used the app was found, which was attributed to patients’ current needs. In total, 36 health dialogues with the nurse (virtual, face-to-face, telephone) were performed; all first dialogues lasted longer, while follow-ups were shorter. Patients described that the health dialogues covered relevant subjects and that the combination of using the app and health dialogues was tailored and provided supplementary support. No adverse events occurred; however, a few technical difficulties interfered with the intervention, and the patients gave valuable suggestions for improvement. Furthermore, patients suggested that the intervention should start immediately after treatment.ConclusionAs the patients adhered to and accepted the intervention, it was considered feasible. Findings suggest intervention should start directly after treatment ends.

Plasma p-tau immunoassays in clinical research for Alzheimer's disease.

The revised biomarker framework for diagnosis and staging of Alzheimer's disease (AD) relies on amyloid beta (Aβ) and tau pathologies as core markers, and markers for adjacent pathophysiology, such as neurodegeneration and inflammation. Many of the core fluid biomarkers are phosphorylated tau (p-tau) fragments, with p-tau217 showing a prominent association with Aβ and tau. While positron emission tomography (PET) imaging is well established, plasma p-tau assays are newer and likely to reduce the use of expensive, and less accessible cerebrospinal fluid and PET imaging tests, thereby promoting wider access to AD screening. There is a need for greater understanding of how the various plasma p-tau species reflect different pathological processes of AD and how different immunoassays perform. This review surveys the available immunoassays and highlights their strengths and limitations in different contexts of use. Assays need to be standardized to maximize their impact on AD clinical research, and patient diagnosis and management. HIGHLIGHTS: Different plasma phosphorylated tau (p-tau) species reflect different pathological processes of Alzheimer's disease (AD), with p-tau231 showing the greatest association with the earliest increases in brain amyloid beta (Aβ) accumulation, while p-tau217 shows greater association with both brain Aβ and early tau pathology, and other p-tau and tau fragment species show greater association with later stages of brain tau pathology. Plasma p-tau217 has proven to be an excellent biomarker for AD pathology due to its close association with both brain Aβ and tau pathology, as well as its large dynamic range. Many different assays with varying performance exist for the same p-tau species, with mass spectrometry assays performing uniformly well, and several immunoassays achieving comparable performance. "Round robin" head-to-head studies have been performed to compare different assays for several key plasma biomarkers, including p-tau181 and p-tau217, but additional head-to-head studies are needed, especially for new analytes and for measuring performance in diverse populations. Plasma immunoassays have the potential to increase accessibility of early diagnostic testing for a broad population, including diverse historically under-represented and under-served populations, due to the potential to be implemented globally, including in primary care settings; however, further research is needed to validate the optimal cutoffs for each assay for real-world clinical usage. Eventually, clinical implementation of a two-step workflow may allow standalone use of plasma testing in certain contexts, minimizing the need for confirmation with costly and less accessible cerebrospinal fluid/positron emission tomography testing.

Improving primary healthcare quality in China through training needs analysis

The diagnosis and treatment capability levels of healthcare professionals directly affect the overall quality of medical services. Enhancing these capability levels requires strengthening the professional skill training of healthcare workers, especially those in primary care settings in economically underdeveloped areas. To understand the actual needs for professional skill training among primary healthcare workers, thereby providing data support for targeted training initiatives. An online survey was conducted using convenience sampling and subsequently, snowball sampling from May 10, 2023 to January 31, 2024. The survey included 3811 healthcare workers across China, and 3617 valid questionnaires were recovered. Descriptive analysis was used to compare the professional backgrounds and training needs of healthcare workers at different medical facility levels. Univariate and multivariate logistic regression analyses were employed to explore factors influencing the training of primary healthcare workers. The survey revealed that 70.1% of respondents were female, and 94.2% were from medical facilities below the provincial level, with 43.2% from township-level or lower medical facilities. Significant differences were found in age distribution, work experience, professional titles, educational levels, and training needs among provincial/national, prefectural/county, and township levels (P < 0.05). Busy clinical work schedules were the primary barrier to training participation. Most healthcare workers (78.7%) expected more than four training sessions per year, with the optimal frequency being quarterly. The most anticipated training topics among primary care workers were latest medical guidelines, new technologies/skills, and advanced management concepts, with over 80% interest. Compared with prefectural/county-level facilities, primary care workers at grassroots facilities are more significantly impacted by lower professional titles, lower education levels, weaker medical/technical skills, and insufficient specialized funding (odds ratio > 1, P < 0.001). Training should be tailored to the needs of healthcare workers at different medical facility levels. Particularly for primary care settings, providing special funding support and training in the latest medical guidelines, new technologies/skills, and advanced management concepts are important to improve the composition of titles, education, and professional technicians.

Virtual Primary Care for People With Opioid Use Disorder: Scoping Review of Current Strategies, Benefits, and Challenges

Background There is a pressing need to understand the implications of the rapid adoption of virtual primary care for people with opioid use disorder. Potential impacts, including disruptions to opiate agonist therapies, and the prospect of improved service accessibility remain underexplored. Objective This scoping review synthesized current literature on virtual primary care for people with opioid use disorder with a specific focus on benefits, challenges, and strategies. Methods We followed the Joanna Briggs Institute methodological approach for scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist for reporting our findings. We conducted searches in MEDLINE, Web of Science, CINAHL Complete, and Embase using our developed search strategy with no date restrictions. We incorporated all study types that included the 3 concepts (ie, virtual care, primary care, and people with opioid use disorder). We excluded research on minors, asynchronous virtual modalities, and care not provided in a primary care setting. We used Covidence to screen and extract data, pulling information on study characteristics, health system features, patient outcomes, and challenges and benefits of virtual primary care. We conducted inductive content analysis and calculated descriptive statistics. We appraised the quality of the studies using the Quality Assessment With Diverse Studies tool and categorized the findings using the Consolidated Framework for Implementation Research. Results Our search identified 1474 studies. We removed 36.36% (536/1474) of these as duplicates, leaving 938 studies for title and abstract screening. After a double review process, we retained 3% (28/938) of the studies for extraction. Only 14% (4/28) of the studies were conducted before the COVID-19 pandemic, and most (15/28, 54%) used quantitative methodologies. We summarized objectives and results, finding that most studies (18/28, 64%) described virtual primary care delivered via phone rather than video and that many studies (16/28, 57%) reported changes in appointment modality. Through content analysis, we identified that policies and regulations could either facilitate (11/28, 39%) or impede (7/28, 25%) the provision of care virtually. In addition, clinicians’ perceptions of patient stability (5/28, 18%) and the heightened risks associated with virtual care (10/28, 36%) can serve as a barrier to offering virtual services. For people with opioid use disorder, increased health care accessibility was a noteworthy benefit (13/28, 46%) to the adoption of virtual visits, whereas issues regarding access to technology and digital literacy stood out as the most prominent challenge (12/28, 43%). Conclusions The available studies highlight the potential for enhancing accessibility and continuous access to care for people with opioid use disorder using virtual modalities. Future research and policies must focus on bridging gaps to ensure that virtual primary care does not exacerbate or entrench health inequities.

The integration of dermatology experts into primary care to assess and treat patients with skin lesions is cost-effective: A quasi-experimental study.

The management of patients with skin changes can be challenging in primary healthcare; general practitioners (GPs) often lack the expertise to make accurate assessments and treatment decisions. The standard care pathway for skin changes can result in extended treatment times and costs. This study was designed to evaluate the cost-effectiveness of integrating a dermatologist into the primary care setting to assess and treat patients with skin disorders. The primary outcome was the incremental cost-effectiveness ratio (ICER) for each malignant or pre-malignant skin disease found and treated. The secondary outcomes included ICER for any treated skin finding, number needed to excise to find malignant or pre-malignant skin disease, number of hospital referrals required and changes in quality of life (QoL) in the presence and absence of the integration. This was a quasi-experimental cohort study conducted at three primary healthcare centres in Finland. In the two intervention centres, patients with skin findings visited a dermatologist; in the control centre they visited a GP. Cost-effectiveness was assessed using the incremental cost-effectiveness ratio (ICER). QoL was assessed with the PROMIS v1.2, calculative EQ-5D-3L and PROMIS Anxiety 4a instruments. In total, 186 integration and 176 control patients were included. For an additional patient treated for a (pre-)malignant skin disease, the ICER was €852 lower and with any skin disease €381 lower in the integration group than with standard care. Fewer biopsies were required for each malignant or pre-malignant skin disease in the integration group compared to the control group (2.1 and 6.5 per patient; p < 0.001) and lower proportion of patients were referred to hospital (8.1 vs. 17.1%, p < 0.001). Patient QoL did not differ between groups. The integration of dermatological expertise into primary care settings is cost-effective and can streamline the management of patients with skin conditions without worsening their QoL.

Treatment Algorithms for Continuous Low-Level Heat Wrap Therapy for the Management of Musculoskeletal Pain: An Italian Position Paper.

Musculoskeletal pain (MSP), which impacts bones, muscles, tendons, and ligaments, is a substantial worldwide pain disorder, characterized by muscle soreness, fatigue, inflammation, muscle spasms, sleep disruptions, and functional limitations. MSP is predominantly managed within the primary care setting. Recent consensus recognizes that heat therapy (HT) may provide potential benefits, especially in treating chronic MSP. To develop shared algorithms for the treatment of MSP through local superficial HT (SHT) using continuous low-level heat wrap therapy, a four-member board of experts was designated. Three anatomical sites have been deemed of particular interest regarding potential response to exogenous SHT. Neck and shoulder pain are commonly attributed to traumatic experiences, muscle spasms, postural defects, or poor posture as common potential causes. HT may be helpful for painful contractures, although treatment should be limited in duration to prevent instability. Low back pain, the leading cause of disability, may have either specific or non-specific etiology. SHT, physical therapy, instrumental therapy, manual therapy, therapeutic exercise, motor activity, and trunk orthoses are all potential treatment options. SHT should be considered in chronic degenerative disc disease, non-specific LBP with muscle spasm or contracture, postural and overuse myalgia, and osteoarthritis (OA), excluding the inflammatory phase. Assessment of knee pain includes both a review of the patient's medical history and a careful physical examination. SHT of the knee should be considered in case of muscle spasms, overuse pathology, early OA, and indirect muscle lesions. Patients who receive SHT may experience a reduction in pain, restoration of muscle strength, loosening of stiffness, and an overall improvement in their quality of life. This expert opinion proposes shared algorithms for MSP treatment via local SHT with the aiming to provide practical guidance on its proper application, highlighting specific potentialities as well as contraindications.

Examining Provider Attitudes and Barriers toward Prescribing PrEP within Primary Care Settings in Alabama.

Human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) is an effective HIV prevention tool. Expanding PrEP access and utilization is made possible by incorporating it into primary care practice. This study explored the barriers in and attitudes toward prescribing PrEP to adults among primary care providers (PCPs) in Alabama, a priority HIV jurisdiction with low PrEP uptake. We conducted in-depth interviews grounded in the Health Belief Model with Alabama physicians and advanced practice practitioners in general internal and family medicine, exploring provider experiences in collecting sexual history information from patients and prescribing PrEP. Authors used thematic analysis of transcripts to further investigate the emerging themes. From September 2022 to April 2023, eight PCPs participated in our study. Several themes regarding barriers in and attitudes toward discussing sexual health history emerged: time constraints, knowledge and training, comfort levels, and competing priorities. We identified stigma and knowledge as themes when exploring provider attitudes toward and barriers in prescribing PrEP. When discussing the benefit of PrEP provision in primary care, we also identified themes such as longevity of the patient-provider relationship and accessibility. Participants identified multiple opportunities to increase PrEP provision in primary care beyond provider education and training, such as normalizing the language, consistency in discussing sexual health history, and using streamlined efforts of gathering sexual history information. With barriers hindering PrEP prescribing by Alabama's PCPs, in addition to preexisting healthcare barriers experienced by patients in the US Deep South, immediate attention is warranted. Further exploration into developing policies for streamlining sexual history intake and inclusive medical education and training regarding PrEP is needed in Alabama.

The Role of Nurse Practitioners in Primary Care Settings: A Comprehensive Review

The Role of Nurse Practitioners in Primary Care Settings: A Comprehensive Review

Utilisation and trends of laboratory testing and point-of-care testing in primary care in Germany: an analysis of claims data

ObjectivesGerman general practitioners (GPs) either order laboratory tests from external laboratories (initiated laboratory services (ILS)) or perform point-of-care tests (POCTs) within the GP practice. This study investigated the current use...

Prevalence and incidence of multiple sclerosis in the Netherlands

BackgroundThe rising prevalence estimates of multiple sclerosis (MS) globally underscore the imperative for up-to-date epidemiological data specific to the Netherlands. MethodsData from two Dutch healthcare databases (Nivel Primary Care Database and Vektis Database) comprising both general practices and hospital electronic health records in 2019 were combined to assess age- and sex-standardized MS prevalence and incidence estimates. Differences in prevalence estimates based on latitude and between primary versus secondary care records were examined. ResultsThe age and sex-standardized prevalence estimate was 210.4 per 100,000 inhabitants. Incidence estimate of MS was 7.1 per 100,000 person-years within the year 2019. One-third of the MS cohort from primary care records was not documented in the hospital database over two consecutive years. Prevalence estimates were higher in northern areas versus southern areas (respectively 240.6 versus 208.3 per 100,000 inhabitants). ConclusionAligning results from different global regions, prevalence estimates of MS in the Netherlands have increased significantly over the last decennia, while incidence estimates are stable. The discrepancy between MS records within the primary and secondary care setting could indicate that a substantial proportion of Dutch patients with MS are not under specialized neurological care.