Primary Care Research Articles

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.

Punch grafting technique for hard-to-heal wound management in primary care: a feasibility study.

Chronic wounds present a major health challenge for patients and put considerable financial burdens on healthcare systems all over the world. Consequently, there is an urgent need to develop and implement wound management strategies that enhance health-related quality of life, while effectively reducing costs for this patient population. Autologous punch grafting is emerging as a promising treatment to address these needs. This study aims to evaluate the feasibility for implementing autologous punch grafting technique in individuals with difficult-to-heal wounds. A feasibility study was conducted using an uncontrolled, non-randomised pre-post intervention design. The results indicated that autologous punch grafting technique can be effectively performed for chronic leg wounds in primary care by trained personnel. This method enhances patients' quality of life, reduces pain and promotes wound healing progression.

Основные направления совершенствования диабетологической помощи в условиях поликлиники (по результатам социологического исследования).

A sociological assessment of satisfaction with outpatient care for patients with diabetes mellitus in the Republic of North Ossetia-Alania was carried out. The results of the study make it possible to identify the main problems faced by patients at the primary health care level and identify possible ways to level them. The purpose of the study: to assess the satisfaction of patients with diabetes mellitus with the quality of medical care provided in outpatient settings. Materials and methods. The questionnaires of 450 patients with diabetes mellitus, urban (66%) and rural (34%) residents were analyzed. Of these, 45% are men and 55% are women aged 39–59 years (39.0%), 60–79 years (36.0%), over 80 years (6.0%). The questionnaire included 12 questions on various aspects of the clinic’s activities. Data processing and analysis were performed using the IBM SPSS Statistics 27.0.1 software and analytical complex. Results. A study of the satisfaction of patients with diabetes mellitus with outpatient medical care has revealed a number of organizational and medical problems. The regularity of visits to the endocrinologist by patients is one of their main conditions for the effectiveness of therapeutic and preventive measures and dispensary supervision. A fairly high percentage (72%) visit the clinic from 2 to 5 times a year. It is alarming that 28% of patients visit an endocrinologist only once a year, which is a sign of low adherence to treatment on the part of patients. Rural residents visit an endocrinologist less often than urban residents. Young people are more often dissatisfied with the time that the doctor spends at the reception and more often face rude treatment from the medical staff. The comorbidity of diabetes mellitus requires the provision of high-quality medical care in accordance with the expectations of patients, which is provided with logistical equipment and staffing Conclusion. The results obtained are an indicator of the quality of medical care and indicate the presence of problem areas in the activities of medical organizations providing outpatient care to patients with diabetes mellitus. Special attention should be paid to the organization of dispensary follow-up in order to reduce the risks of developing complications of the disease. It is necessary to increase the availability of primary health care by making appropriate management decisions at the level of regional health authorities.

Boundary-work of primary care physicians using telemedicine technologies for communication.

Implementing telemedicine technologies (TT) for patient-physician communication leads to the emergence of new structures of boundaries. Hence, boundary work theory can provide a useful lens for examining how primary care physicians (PCPs) experience TT. The objective of this research was to examine the experiences of PCPs in using TT in their communication with patients. During 2023 in-depth interviews were conducted with 20 Israeli PCPs: family physicians and pediatricians. The concept of boundary work emerged as a focal point, with three forms of boundary work identified in the PCPs' descriptions of their TT experiences: collaborative, competitive, and configurational. Interviewees described improved collaboration with patients who find it difficult to get to the clinic and better service for administrative issues. However, they reported constant power struggles to maintain their authority. They expressed concern about treatment failure and suggested that healthcare organizations reconfigure TT so that it can be used to provide optimal care. They suggested that healthcare organizations should instruct physicians how to best manage TT consultations and regulate its usage. This article demonstrates that while implementing TT in primary care has many advantages, it uncovers boundary work for maintaining power and authority that both PCPs and healthcare organizations should take into account in practice as well as in policy.

Addressing the Human Experience of Chronic Kidney Disease: ACall to Transform Kidney Care.

Chronic kidney disease (CKD), a long-term condition in which kidney function declines over time, is a growing global healthcare concern. CKD can have a major impact on the quality of life of patients and their caregivers. Recent research by the International Society of Nephrology highlights that current treatment strategies and policies do not fully address patients' needs. This commentary provides patient insights into the real-life concerns of those who are living with CKD, with main concerns focusing on relationships and support, work and finances, and awareness, prevention, and intervention. Strong support networks are essential for patients and caregivers, but the burden of CKD can make it difficult to maintain personal connections. Limiting disease progression and providing mental health support can help patients and caregivers to maintain their relationships. Work or education can be challenging to manage with CKD; however, employers and educational institutions can create supportive environments that meet the diverse needs of people with CKD. Although delaying disease progression can preserve patient quality of life, people are often unaware of their disease prior to diagnosis, the severity of their CKD, and the risk factors for progression. This presents an opportunity to involve patients in their care by improving education about the benefits of maintaining kidney health. Early identification and holistic intervention could slow disease progression and protect the well-being of patients with CKD and their caregivers. This commentary brings together the diverse perspectives of patients and patient advocacy groups, as well as primary care and specialist healthcare professionals, to advocate for a transformation of CKD management that encourages patient self-care and that prioritizes timely intervention.A patient perspective video and a graphical abstract are available with this article. Addressing the Human Experience of Chronic Kidney Disease: A Call to Transform Kidney Care. Watch Lweendo Hamusankwa discuss his experience of living with chronic kidney disease, from how it impacted his family life to the importance of support networks and patient-facing information. Lweendo advocates for patients to be educated on CKD progression, treatment options, and lifestyle interventions to encourage people to manage their own health and well-being.

Optimizing Care Planning for Older Adults in Primary Care

Optimizing Care Planning for Older Adults in Primary Care

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.

К вопросу о критериях и показателях оценки организации качества и эффективности диспансерного наблюдения пациентов с психическими расстройствами.

An important area of improving mental health protection of the population is to increase the efficiency of dispensary observation of patients in psychiatric medical organizations, which allows achieving stabilization or improvement of their health, thereby increasing the quality of life of both patients and their relatives. To make the necessary management decisions on the part of the management of medical organizations aimed at improving the quality indicators of the organization and the efficiency of dispensary observation, appropriate information support is necessary. However, there are currently no separately developed criteria for assessing dispensary observation in the framework of primary specialized health care for mental disorders. Purpose of study is to substantiate the basic principles of systematization of criteria and indicators for assessing the organization of quality and efficiency of dispensary observation of patients with mental disorders for the purpose of monitoring and correct assessment of quality with subsequent adoption of adequate management decisions. Materials and methods. To systematize the criteria and indicators for assessing the organization of quality and efficiency of dispensary observation of patients with mental disorders, we used regulatory documents defining the activities of the psychiatric care system of the constituent entity of the Russian Federation, primary accounting and reporting medical forms, and the results of expert assessment. Results. Organizational and methodological approaches to the development and scientific substantiation of indicators for assessing the organization of quality and effectiveness of dispensary observation of patients with mental disorders included work with regulatory documents and analytical indicators used in the work of the OGBUZ «IOPD» and an expert assessment of the indicators of the effectiveness of dispensary observation of patients with mental disorders. The criteria and indicators for assessing the organization of quality and effectiveness of dispensary observation of patients with mental disorders were systematized into three groups, including a number of subgroups, which allows you to correctly assess the activities of the district psychiatrist’s office for dispensary observation of patients with mental disorders. Findings. Thus, the criteria and indicators for assessing the organization of quality and effectiveness of dispensary observation of patients with mental disorders allow you to receive information and make adequate management decisions regarding improving the structural efficiency of the psychiatric service as a whole, determine further actions to link them to regulatory documents and their subsequent digitalization. In general, the proposed methodological approaches make it possible to form an appropriate system of indicators for each hierarchical level of management of the psychiatric service.

Analysis of Expectations in Routine Appointments: A Cross-Sectional Study in Portugal

Preventive medicine is a subject of study due to the increasing evidence that it can cause more harm than good, and the population's interest in routine appointments is widely recognized. The main objective of this study was to understand users' expectations regarding routine appointments in primary health care and compare them to doctors' perceptions regarding these expectations. We carried out a cross-sectional observational study in 2023 through the application of two questionnaires: one for adult patients and another for family physicians. The invitations to answer the questionnaire via Google Forms were shared on specific social networks. For elderly patients, the questionnaire was conducted in-person by one of the researchers. It consisted of 25 questions about preventive attitudes during appointments, analytical tests and their frequency, and recommendations based on sex and age, differing in the language used. A sample of 225 patients and 100 general and family medicine doctors was obtained. The patients selected an average of 7.8 ± 9.7 preventive attitudes during the consultation, and the doctors judged that they would have selected 4.6 ± 2.9 (p = 0.001). Cardiac and pulmonary auscultation (82.6%), physical exercise quantification (74.7%), and smoking habits assessment (72.9%) were the most selected measures, the most selected tests being blood glucose measurement (81.8%), lipid profile (80.4%), and urine analysis (75.1%). For 68.2% of patients, routine check-ups should be annual, with 88.0% of doctors believing that patients would want this frequency. The socioeconomic level of the population did not significantly influence the results. It is important that general practitioners / family doctors are aware of patients' expectations. In this sample, patients revealed a greater appreciation for a higher number of preventive medical measures during consultations and more periodic analytical testing than thought by the doctors. Doctors also judged that users would show greater interest in the frequent implementation of screening programs.

Reliability of a portable toe pressure photoplethysmography device compared to a stationary laser doppler flowmeter.

The study aimed to investigate the reliability of a portable toe pressure (TP) photoplethysmography device (PPG) by comparing it to a stationary laser Doppler flowmeter (LD) used in the Helsinki University Hospital. The study evaluated if lower limb arterial circulation could be reliably evaluated with the portable PPG which is more affordable and mobile than the stationary LD. TPs were measured from 102 toes of 54 patients in the vascular surgery outpatient clinic, vascular surgery ward and interventional radiology recovery ward of Helsinki University Hospital. According to the study protocol TPs were measured twice with the PPG device. If the difference between the values was over 10 mmHg, a third measurement was done and two of the closest values were selected for the final analysis. The lowest value displayed by the PPG device was 30 mmHg. Lower than 30 mmHg values were reported as 25 mmHg in the analysis. The repeatability and reliability of the PPG measurements were compared to the LD with Bland Altman plots. Most patients had rest pain (n = 29) or claudication (n = 9). Prior to TP measurement, 24 patients had undergone lower limb revascularization through either a hybrid (n = 3), open (n = 10) or endovascular (n = 11) procedure. The mean absolute difference between PPG and LD measurement values was 15 mmHg (95% confidence interval 12-18 mmHg). 87.5% of lower limbs with significant arterial insufficiency (TP <60 mmHg with LD, n = 49) had a PPG measurement value of <60 mmHg. Conversely, 84.8% of lower limbs that did not exceed the ischemia criterion of TP ≥60 mmHg with LD had a PPG measurement value of ≥60 mmHg. Mean absolute difference of two consecutive PPG measurement values was 4 mmHg (95% CI 3-5 mmHg). The PPG device is a light and affordable option for the assessment of lower limb arterial circulation in primary health care. It is moderately reliable to exclude significant lower limb arterial insufficiency and may reduce unnecessary referrals to the vascular surgery clinic. The repeatability of the PPG device is satisfactory. However, it requires training to use, and the results must always be interpreted with consideration for the patient's clinical status.

Validation and optimization of smart eye camera as teleophthalmology device for the reduction of preventable and treatable blindness in Nigeria.

Limited resources and staffing hinders efforts to reduce preventable blindness, especially in low- to middle-income countries. The slit-lamp examination (SLE), which is essential for ophthalmology practices, is often unavailable in primary and secondary eye care facilities due to the high costs and lengthy training required for operation. We conducted a cross-sectional, multicentre study exploring the potential for a smart eye camera (SEC; a tele-ophthalmology handheld device developed by OUI Inc., Japan) to address the limitations of the SLE. Ocular diagnoses, visual acuity assessments and examinations of the eyes were performed independently using both a conventional SLE and a SEC. Four independent assessors (blind to the study) reviewed the images captured by the SEC and the SLE as administered by separate investigators. All analyses were performed using R version 4.2.2 for macOS at a 5% level of statistical significance. The results of the image quality analysis demonstrated that the number of higher-quality images was significantly higher (p < 0.05) for the images captured using the SEC device compared to the SLE machine. Remarkably, up to 96% accuracy of diagnosis was recorded with SEC. Evaluation of diagnostic accuracy rates derived from images obtained from both machines revealed a degree of divergence in assessments among evaluators, yielding a Fleiss's Kappa value of 0.092. The sensitivity analysis for the SEC device revealed a reasonably strong capacity to correctly identify true positive cases, with an average sensitivity score of 90%. The results of this study indicate that SEC can effectively evaluate anterior segment lesions in ophthalmology.

Establishing a telemedical supported trans-sectoral collaboration network from community support to emergency care for outpatient care recipients: study protocol of a prospective non-randomized complex intervention study with a pragmatic approach, Stay@Home – Treat@Home

BackgroundDemographic changes in Germany are increasing the number of outpatient care recipients, who often resort to emergency care due to difficulties accessing timely outpatient medical care. Previous studies suggest that early detection and telemedical interventions could reduce unnecessary hospitalizations. The new form of healthcare aims to provide continuous, flexible healthcare for outpatient care recipients using digital technologies to detect health deteriorations and facilitate interventions at home. The goal of our study is to evaluate, whether the number of emergency situations and hospital stays will be reduced, and health outcomes will be improved compared to standard care.MethodsIn this prospective non-randomized complex intervention study with a pragmatic approach, we aim to evaluate a new form of healthcare focused on establishing an interdisciplinary network for outpatient care in the homes of care-dependent individuals. Utilizing a digital interactive health diary, health data will be gathered from participants, caregivers, and healthcare providers, covering both stable primary care and acute situations. A telemedical network will coordinate measures, including non-medical aid, nursing care, and medical assistance. A total of 1,500 participants will be recruited for the intervention group, matched with a control group from health insurance data. A second control group with n=300 will provide self-reported measures. The study is planned to span eight quarters, with data collected from the digital interactive health diary and health insurance records. Evaluation perspectives include health insurance, patients, and healthcare providers, assessing utilization and costs compared to standard care, health status, health-related quality of life, care dependency, interdisciplinary cooperation, and usability of the new technology.DiscussionDemographic change results in a larger older people population, exacerbating mobility issues and care dependency, worsened by the shortage of medical personnel. Stay@Home – Treat@Home aims to enable home health monitoring and care, reducing hospitalizations. The digital interactive health diary supports direct communication, allows remote monitoring, and empowers patients and caregivers to manage health changes. Nursing aid personnel and physicians can access entries for informed interventions. The development of the digital interactive health diary aims to improve the situation of care-dependent individuals. Evaluating its effectiveness and efficiency is crucial for the development and implementation of new technologies.Trial registrationGerman Clinical Trials Register, ID: DRKS00034260, registered on May 14, 2024 (retrospectively registered): https://drks.de/search/de/trial/DRKS00034260 and https://who.int/clinical-trials-registry-platform/network/who-data-set.

Medical emergencies in primary dental practice

Background: Medical emergencies can and do present in primary care dental practices. Approximately 60% of dentists experience at least one emergency a year. This article was prompted by several recent interactions; one being an anaphylaxis where the responding paramedics were unfamiliar with dental therapists and, most recently, where first responders were unfamiliar with the availability of oxygen within a primary dental practice. Aims: This article aims to enhance paramedics’ knowledge of dental team members that may be present, their scope of practice, what qualifications they may have, what equipment is available, what drugs can be administered and the most frequently presenting medical emergencies. Methods: This article reviews and consolidates medical emergency guidance and regulations for primary dental practice. Findings: There is limited guidance concerning what drugs dental care professionals can and cannot administer during a medical emergency. Going forward, additional guidance from regulators is needed. Conclusion: Responding emergency services need to be aware of all dental professionals they may encounter as well as their qualifications and limitations to ensure patients receive gold standard care.

Inter‐rater agreement for detection of potentially inappropriate medication according to explicit and implicit STOPP criteria

The Screening Tool of Older Person's Prescriptions (STOPP) is used to detect potentially inappropriate medication. Version 2 includes 80 criteria, whereof two can be considered implicit as their detection primarily relies on the assessor's expertise: (A1) drugs without indication and (A2) drug treatment beyond recommended duration. To explore the inter‐rater agreement for detection of explicit and implicit criteria, data on consecutive primary care patients from a previous study (n = 302, 65–99 years of age) were used, including independent assessments of the 78 explicit criteria (23 556 assessments) and the two implicit criteria (604 assessments) by two specialist physicians. Overall, 123 (0.5%) explicit and 10 (2%) implicit criteria were fulfilled according to both physicians. The positive agreement for a criterion being fulfilled was 56% for explicit and 16% for implicit criteria, with kappa values of 0.56 and 0.09. Discordant detection of furosemide and proton pump inhibitors was common using explicit and implicit criteria.

The feasibility of integrating an alcohol screening clinical decision support tool into primary care clinical software: a review and Australian key stakeholder study

BackgroundThis study explored the feasibility of integrating a clinical decision support tool into general practice clinical management software in Australia to prompt for alcohol screening among patients who are pregnant or planning a pregnancy. The study aimed to increase understanding of what is an appropriate and acceptable clinical decision support tool, the circumstances when a prompt to use such a screening tool should occur, and the barriers and enablers of successful implementation.MethodsThis feasibility study employed a mixed methods approach and purposive sampling to identify key stakeholders to interview. Participants included vendors of clinical software used in Australian general practice, clinicians in general practice, and relevant others. Data from a literature review and 23 interviews were analysed leading to recommendations which were ‘sense-tested’ by an additional 22 stakeholders.ResultsAlthough there are at least 18 clinical software packages used in Australian general practice, it is feasible to integrate an alcohol screening tool for pregnancy into software for the majority of general practices in Australia. The AUDIT-C alcohol screening tool for pregnancy was widely accepted as suitable for such a purpose. Clinicians suggested the greatest barriers to screening were lack of time within antenatal consultations and insufficient remuneration for longer consultations. Many clinicians saw opportunity for introducing a multifunctional antenatal tool that could incorporate screening and clinical decision support for alcohol, tobacco and other substance use, mental health, domestic and family violence and potentially other areas informing healthy pregnancy. It could also be used opportunistically for preconception screening and counselling. Deployment of the tool could be supported by an education campaign from professional associations.ConclusionThe integration of a tool for screening for alcohol use among women who are pregnant or planning pregnancy into general practice clinical software is feasible; however, a multifunctional antenatal screening tool, incorporating other psychosocial elements, was considered more useful than a stand-alone alcohol screening tool. Codesign is needed with vendors and end-users to develop an acceptable tool that can be widely implemented. Issues with GP renumeration need also to be addressed to encourage alcohol screening pre-pregnancy and in the early months of pregnancy.

A systems perspective on gaps in the person-centered sick leave and rehabilitation process: a Swedish interview study

Background Consensus on priorities to optimize the sick leave and rehabilitation process (SRP) is lacking. Objective To explore perspectives of stakeholders in the SRP on bridging the gap between desired process scope, and actual practice, from a multi-professional, multi-organizational, and interdisciplinary approach. Design and setting Focus group interviews were conducted with various SRP frontline professionals in Region Västra Götaland, Sweden, using purposive sampling to capture a range of experiences. Participants discussed their perceptions of critical changes and priorities needed to meet patients’ SRP needs in a primary care context. All interviews were analyzed using systematic text condensation, as described by Malterud. Subjects General practitioners (n = 6), rehabilitation coordinators and licensed healthcare professionals from primary healthcare (n = 13), administrators from the Social Insurance Agency, the Employment Agency and Social Services (n = 12). Results Through data analysis, the following themes emerged: 1) The need for rules and regulations to enable coherent process governance 2) Challenges and opportunities in person-centered SRP: Professional collaboration, organizational priorities, and the need for enhanced leadership, and 3) Balancing resources and patient needs in the SRP: How to improve care quality and accessibility. In summary, participants mainly discussed how to improve process efficiency and quality of care while balancing available resources and a heavy workload. A main goal was to prevent negative spirals of suboptimal decision-making in individual cases, which could lead to increased work, unfortunate outcomes, and patient suffering. Conclusions This qualitative study indicated that gaps between a desired process scope and actual practice might be bridged by enabling coherent cross-organizational process governance, prioritizing person-centered ways of working, and balancing available resources and workload. The above changes were believed to improve process quality and overall efficiency. Trial registration The study project plan was pre-registered on September 21st, 2020, in the database FOU i VGR (researchweb.org), project number 274941.

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.

Results from a UK consensus about the optimal prescribing of medium strength triple therapy in uncontrolled adult asthma patients in the NHS

ABSTRACT Context: An inhaled corticosteroid (ICS) in combination with a long-acting β2-agonist (LABA) is a common treatment approach for asthma patients not controlled on ICS alone, but a significant proportion of patients remain uncontrolled on this combination and treatment adherence can also be a challenge. One of the options for adults whose asthma is uncontrolled in an ICS/LABA is the addition of a long-acting muscarinic receptor antagonist (LAMA), an approach commonly referred to as ‘triple therapy’. The use of medium-strength ICS/LABA/LAMA is established in treating chronic obstructive pulmonary disease but is less well-established in asthma. Lack of clarity exists regarding who should prescribe ICS/LABA/LAMA and in which patients, and this is compounded by a lack of consistency among guidelines. Aims: To define the optimal prescribing of medium-strength ICS/LABA/LAMA triple therapy in adult asthma patients uncontrolled on ICS/LABA. Methods and Material: Using a modified Delphi method, a panel of experts developed 39 Likert scale statements across six key domains. These statements were used to develop an online survey that was distributed to healthcare providers (HCPs) working with adult asthma throughout the UK. The threshold for consensus was set at 75%. Results: In total, 314 responses were received from primary and secondary care stakeholders involved in the management of asthma. On analysis, 22/39 statements reached a very strong agreement (≥90%) and 16/39 attained strong agreement (≥75% and &lt; 90). From these results, the panellists developed a set of twelve recommendations to help define how an optimal approach for prescribing triple therapy in patients who are uncontrolled on an ICS/LABA can be achieved. Conclusions: The strength of agreement shows that HCPs support the use of medium-strength ICS/LABA/LAMA triple therapy in appropriate asthma patients, and that clarity is needed regarding how best this can be achieved. The proposed set of recommendations provides such guidance to support the prescribing of triple therapy in primary care.

Barriers to suicide prevention in primary care: A qualitative study among general practitioners in Germany

BackgroundSuicide is a global public health issue and general practitioners (GPs) are important frontline responders to ensure treatment for persons experiencing suicidality. Although valid assessment tools and guidelines for managing suicidality in primary care are available, previous studies suggest that these are not yet sufficiently adhered to. Knowledge about the challenges experienced by GPs in identifying and managing suicidality among their patients is needed for the development of interventions to improve suicide prevention within primary care. AimThe current study seeks to examine the challenges GPs in Germany encounter when managing suicidality among patients in primary care. MethodsWe conducted qualitative online interviews with 15 GPs practising in Germany. Data were analysed using qualitative content analysis. ResultsWe included a diverse sample of mainly early-practise GPs (mean age: 42 years; w = 9, m = 6). GPs in our study reported 1) difficulties in identifying suicidality, 2) uncertainty and insufficient knowledge, 3) responsibility and discomfort and 4) challenges due to the health care system. ConclusionsOur findings suggest that GPs in Germany would benefit from specialised trainings to increase their knowledge and reduce uncertainties in handling suicidality among their patients. Reported challenges could be an important focus of successful suicide prevention.

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.