Electronic medical record (EMR) systems in primary care present an opportunity to address frailty, a significant health concern for older adults. Researchers in the UK used Read codes to develop a 36-factor electronic frailty index (eFI), which produces frailty scores for patients in primary care settings.

We aimed to translate the 36-factor eFI to a Canadian context.

We used manual and automatic mapping to develop a coding set based on standardized terminologies used in Canada to reflect the 36 factors of the eFI. Manual mapping was completed independently by two coders, followed by group consensus among the research team. Automatic mapping was completed using Apelon TermWorks. We then used EMR data from the British Columbia Canadian Primary Care Sentinel Surveillance Network. We searched structured data fields related to diagnoses and reasons for patient visits to develop a list of free text terms associated with any of the 36 factors.

A total of 3768 terms were identified; 3021 were codes. A total of 747 free text terms were identified from 527,521 reviewed data entries. Of the 36 frailty factors, 24 were captured mostly by codes; 7 mostly by free text; and 4 approximately equally by codes and free text. Three key findings emerged from this study: (1) It is difficult to capture frailty using only standardized terminologies currently used in Canada and a combination of standardized codes and free text terms better captures the complexity of frailty; (2) EMRs in primary care can be better optimized; (3) Output from this study allows for the development of a frailty screening algorithm that could be implemented in primary care settings to improve individual and system level outcomes related to frailty.

A crucial step towards improving the care of people with fibromyalgia is understanding current practice. Our systematic review aims to address this by synthesising the global evidence around healthcare use in people with fibromyalgia, including its variation across groups of people, geographical locations, and over time.

Fibromyalgia is a chronic condition characterized by widespread pain alongside a broad range of non-pain symptoms. Its substantial impact on peoples’ lives and high prevalence mean that ensuring people with fibromyalgia receive evidence-based and appropriate care is a clinical and research priority. Whilst guidelines recommend that people with fibromyalgia receive a prompt diagnosis, care that focuses on non-pharmacological interventions, and in many countries should be predominantly managed in the community, existing evidence indicates they often wait many years for a diagnosis, commonly receive long-term opioid medicines, and see multiple hospital specialists.

Relevant databases will be searched, with 25% of screening, data extraction, and quality appraisal conducted by two reviewers. Eligible studies will have evaluated healthcare use in adults with fibromyalgia using data obtained from electronic health record, registry, or insurance databases (providing generalizable findings in large, representative datasets). Data will be synthesized using meta-analysis and/or synthesis without meta-analysis where possible.

By providing an in-depth analysis of healthcare use and its variation in people with fibromyalgia, the results from this systematic review could be used to benchmark practice, inform targeted management strategies to those with the highest levels of healthcare use (and therefore care need), and provide insight into whether certain countries require specific guideline/policy changes.

The purpose of this study was to report on the prevalence of hypertension and anaemia, and types of medications prescribed to expectant mothers attending antenatal clinics at Intermediate Hospital Katutura in Windhoek, Namibia.

Millennium Development Goals 4 and 5 speak to reduction of child mortality and improvement of maternal health by 2015, respectively. Gestational hypertension is a major contributor to maternal and perinatal mortality and is reported to affect up to 10% of women world-wide. Prevalence of anaemia among pregnant women is reported higher in low- and middle-income countries than in developed countries.

This was a cross-sectional study involving the review of outpatient and clinic health records for patients attending antenatal clinics at Intermediate Hospital Katutura, Windhoek during October to November 2022. Data for patients on first antenatal clinic visit were obtained from facility antenatal clinic patient registers while that of follow-up patients were from patient health passports. All expectant mothers over 18 years of age who had provided written consent to participate, were included. Data collected were: age, body weight, haemoglobin concentration, blood pressure, gravida, number of babies delivered, pregnancy stage, comorbidities, and prescribed medications. The results were summarised using descriptive statistics. A p-value <0.05 is considered to be statistically significant.

354 records were included: 303 (85.6%) first visit, and 51 follow-up (14.4%). There was a significant correlation between systolic blood pressure (BP) and body weight (r = 0.31, p < 0.001). 13.5% of first-time visitors had haemoglobin levels lower than the normal range (11 g/dL). Difference in haemoglobin levels between trimesters 1 and 3 were significant (p < 0.001). Methyldopa was prescribed for all hypertensive expectant mothers. To reduce the incidences of anaemia and hypertension during pregnancy, women of childbearing age should be encouraged to attend antenatal visits earlier in pregnancy and to take measures for body weight reduction, respectively.

In the United States, roughly one million pregnancies occur every year from the misuse and discontinuation of oral contraceptives – which may be affected by an individual’s exposure to social determinants of health (SDOH). For those experiencing poorer SDOH, significant barriers may exist when family planning. Thus, our primary objective is to examine associations between domains of SDOH and contraceptive use as well as pregnancy intention using the Behavior Risk Factor Surveillance System (BRFSS).

A cross-sectional analysis of 2017 BRFSS was conducted using the SDOH module to examine differences in family planning. We used bivariate and multivariable logistic regression models to measure associations, via odd ratios, between SDOHs and contraceptive use and pregnancy intention controlling for other sociodemographic variables.

We found that individuals experiencing negative SDOH who reported running out of food (AOR: 0.65; CI: 0.50-0.86), were unable to afford balanced meals (AOR: 0.64; CI:0.49-0.84), or had no money left at the end of the month (AOR: 0.45; CI: 0.32-0.64) were less likely to have used contraceptive methods compared to those not experiencing challenges within these SDOH domains. Among women not utilizing contraceptive methods, individuals not intending to get pregnant were more likely to report difficulty affording balanced meals or having financial stability compared to women attempting to become pregnant.

Our study found that the SDOH domains of monthly financial instability and food insecurity are significantly associated with women not using contraceptive measures but not wanting to become pregnant. Addressing barriers to contraceptive access and FP is becoming more important with shifting policies regarding women’s reproductive healthcare. For women seeking contraceptive and FP advice, increased funding may help provide a solution.

This study aims to evaluate the effect of smokers’ nicotine addiction levels and physical activity capacities (aerobic capacities) on exhaled carbon monoxide (CO) measurement values in respiratory air.

This study is a cross-sectional epidemiological descriptive type study. About 146 smokers, aged 18 and above, who applied to Hacettepe University Family Medicine outpatient clinics between March and May 2023 were included in the study. The Fagerström Test for Nicotine Dependence (FTND) and 6-minute walk test (6-MWT) were performed to the participants, and the relationship of the data with exhaled CO level was examined.

In the data we obtained, it was observed that the addiction score evaluated by the FTND had a positive, moderately statistically significant effect on the CO level (r = 0.483 p < 0.001). Although the percentage of aerobic capacity (physical activity capacities) assessed by the 6-MWT appeared to have a very weak negative relationship with the exhaled CO level, it was found to be not statistically significant (r = −0.112 p = 0.177).

The data we obtained showed that smoking addiction has harmful effects such as increasing CO in the body, but there is no relationship between physical activity and the amount of exhaled CO. It has been observed that quitting smoking and complying with lifestyle change recommendations are an important necessity for a healthier life. To improve patients’ overall health outcomes, family physicians are crucial in helping patients quit smoking and encouraging lifestyle modifications. This study might have encouraged the reflection of smoking habits and thus motivated quitting.

This study explores the perspectives of cancer lay health providers and civil society on the barriers and facilitators to cancer detection and treatment among women.

In 2010, the Moroccan Ministry of Health implemented a national plan for cancer care and control. Activities focused on strengthening multisectoral collaboration in cancer care and control, including promoting early detection in primary care. Despite progress in reducing women’s cancer mortality, socio-cultural challenges impede further gains. Elucidating the perspectives of the community-based and civil society allied in cancer control is critical to addressing cancer disparities.

Data were collected through in-depth interviews with cancer lay health advisors (n = 10) and civil society members (n = 10) on topics of challenges and opportunities to improve care-seeking and treatment. Data were analysed using thematic analysis and guided by the socio-ecological model.

Barriers and facilitators to early diagnosis and treatment were identified at levels of the individual, family, community/societal, and the health system. Barriers to early detection include taboo and stigma, fear of death, and gender norms and roles. Financial and geographic barriers, lack of psychosocial support, and poor health system/provider communication were major deterrents related to treatment. Results suggest intervention targets to reduce late-stage presentation for women, including enhancing educational efforts and augmenting community outreach linkages to primary care.

To synthesize evidence on approaches used in the co-design of maternal and early childhood primary care interventions with structurally marginalized populations.

Involving end-users when developing health interventions can enhance outcomes. There is limited knowledge on how to effectively engage structurally marginalized populations (i.e., groups that are affected by structural inequities resulting in a disproportionate burden of social exclusion and poor health) when co-designing maternal child primary care interventions.

A rapid scoping review was conducted by searching EMBASE and CINAHL for studies indexed between January 2010 and December 2024. Peer-reviewed studies describing co-designed health interventions or services tailored to structurally marginalized populations during prenatal, postpartum, or early childhood periods were included if they reported on one or multiple steps of a co-design process in community-based primary care practices in high-income countries.

Of the 5970 records that were screened, nine studies met the inclusion criteria. The co-designed interventions included three eHealth tools, a health- and social-care hub, a mental health service, a health literacy program, an antenatal care uptake intervention, an inventory of parenting support strategies, and a fetal alcohol spectrum disorder prevention campaign. Women, mothers, fathers, and health- and social-service providers contributed to the co-design process by participating in workshops, focus groups, individual interviews, or surveys. They provided feedback on intervention prototypes, existing resources, and new intervention designs or practice models. Ethical and practical considerations related to the population and context (e.g., marginalization) were not consistently addressed.

This synthesis on intervention co-design approaches with structurally marginalized populations can provide guidance for primary care organizations that are considering maternal child health intervention co-design with this clientele. Future work should include a critical reflection on the ethical and practical considerations for co-design with structurally marginalized populations in the context of maternal and early child care.

Quality improvement programmes (QIPs) are designed to enhance patient outcomes by systematically introducing evidence-based clinical practices. The CONQUEST QIP focuses on improving the identification and management of patients with COPD in primary care. The process of developing CONQUEST, recruiting, preparing systems for participation, and implementing the QIP across three integrated healthcare systems (IHSs) is examined to identify and share lessons learned.

This review is organized into three stages: 1) development, 2) preparing IHSs for implementation, and 3) implementation. In each stage, key steps are described with the lessons learned and how they can inform others interested in developing QIPs designed to improve the care of patients with chronic conditions in primary care.

Stage 1 was establishing and working with steering committees to develop the QIP Quality Standards, define the target patient population, assess current management practices, and create a global operational protocol. Additionally, potential IHSs were assessed for feasibility of QIP integration into primary care practices. Factors assessed included a review of technological infrastructure, QI experience, and capacity for effective implementation.

Stage 2 was preparation for implementation. Key was enlisting clinical champions to advocate for the QIP, secure participation in primary care, and establish effective communication channels. Preparation for implementation required obtaining IHS approvals, ensuring Health Insurance Portability and Accountability Act compliance, and devising operational strategies for patient outreach and clinical decision support delivery.

Stage 3 was developing three IHS implementation models. With insight into the local context from local clinicians, implementation models were adapted to work with the resources and capacity of the IHSs while ensuring the delivery of essential elements of the programme.

Developing and launching a QIP programme across primary care practices requires extensive groundwork, preparation, and committed local champions to assist in building an adaptable environment that encourages open communication and is receptive to feedback.

To understand mental suffering from the point of view of the people affected.

A qualitative study was carried out with 22 users of Primary Health Care units in Ribeirão Preto, São Paulo, Brazil. The data were collected through individual interviews using the Oral Life History technique and analysed using Thematic Analysis.

Two categories emerged: ‘Vulnerabilities in the life history of people with mental suffering’ and ‘Perceiving and living with suffering and/or mental disorder’. The experience was permeated by situations of violence, poverty and abandonment, from childhood to adulthood. The recognition of mental suffering and its consequences was based on behavioural changes and work difficulties, which did not lead them to seek immediate treatment. The difficulty of living with suffering and/or mental disorder is directly related to adherence to treatment.

Subjective aspects present in human life are still disregarded and the late search for professional help seems to result in the stigma and self-stigma of people with mental suffering and/or disorders.

To evaluate sex differences in the triage and assessment of chest pain in Dutch out-of-hours primary care (OOH-PC).

Prior research illustrated differences between women and men with confirmed cardiac ischemia. However, information on sex differences among patients with undifferentiated chest pain is limited and current protocols used to assess chest pain in urgent primary care in the Netherlands do not account for potential sex differences.

A retrospective cohort study of consecutive patients who contacted a large OOH-PC facility in the Netherlands in 2017 regarding chest pain. We performed descriptive analyses on sex differences in patient and symptom characteristics, triage assessment, and subsequent clinical outcomes, including acute coronary syndrome (ACS).

A total of 1,802 patients were included, the median age was 54 years, and 57.6% were female. Compared to men, women less often had a history of cardiovascular disease (CVD) (16.0% vs 25.8%, p < 0.001) or cardiovascular risk factors (49.3% vs 56.0%, p = 0.005). Symptom characteristics were comparable between sexes. While triage urgencies were more frequently altered in women, the resulting triage urgencies were comparable, including ambulance activation rates (31.1% and 33.5%, respectively, p = 0.33). Musculoskeletal causes were the most common in both sexes; but women were less likely to have an underlying cardiovascular condition (21.1% vs 29.6%, p < 0.001), including ACS (5.4% vs 8.5%, p = 0.019).

Women more frequently sought urgent primary care for chest pain than men. Despite a lower overall risk for cardiovascular events in women, triage assessment and ambulance activation rates were similar to those in men, indicating a potentially less efficient and overly conservative triage approach for women.

Interventions based on testing and communication training have been developed to reduce antibiotic prescribing in primary healthcare (PHC) for the treatment of acute lower respiratory infections (ALRTIs). However, research based on the experiences of PHC clinicians participating in ALTRIs interventions to reduce antibiotic prescribing in Barcelona is scanty.

This study aimed to explore the perceptions and experiences of clinicians (physicians and nurses) on an intervention to reduce antibiotic prescription in PHC in Barcelona (Spain). This intervention was a randomised controlled study (cRCT) based on three arms: 1) use of a C-reactive protein (CRP) rapid test; 2) enhanced communication skills; and 3) combination of CRP rapid test and enhanced communication skills. In addition, the study aimed to explore the impact of COVID-19 on the detection of ALRTIs.

This qualitative study used a socio-constructivist perspective. Sampling was purposive. Participants were selected based on age, sex, profession, intervention trial arm in which they participated, and the socioeconomic area of the PHC where they worked. They were recruited through the healthcare centres participating in the study. Nine participants (7 women and 2 men) participated in two focus groups, lasting 65–66 min, in September–October 2022. Framework analysis was used to analyse the data.

Three themes were identified: ‘(The intervention) gave us reassurance’: intervention experiences among health professionals. This theme includes accounts of clinicians’ satisfaction with the intervention, particularly with CRP testing to support clinical diagnoses; ‘We don’t have time in primary healthcare’: structural and community resources in healthcare services. This theme encompasses clinicians’ experiences on healthcare pressures and PHC organisational structures barriers to PHC interventions; and ‘I only did three CRP’: impact of COVID-19 pandemic on the intervention. The last theme focuses on the impact of the COVID-19 pandemic on the intervention’s implementation.

CPR testing and promoting communication skills can be useful tools to support clinical decisions for ALRTIs. Structural barriers (e.g., healthcare pressures) and social inequities amongst service users were acknowledged as the main barriers for the implementation of ALRTIs interventions.

This study investigated the factors influencing the mental health of rural doctors in Hebei Province, to provide a basis for improving the mental health of rural doctors and enhancing the level of primary health care.

The aim of this study was to understand the mental health of rural doctors in Hebei Province, identify the factors that influence it, and propose ways to improve their psychological status and the level of medical service of rural doctors.

Rural doctors from 11 cities in Hebei Province were randomly selected, and their basic characteristics and mental health status were surveyed via a structured questionnaire and the Symptom Checklist-90 (SCL-90). The differences between the SCL-90 scores of rural doctors in Hebei Province and the Chinese population norm, as well as the proportion of doctors with mental health problems, were compared. Logistic regression was used to analyse the factors that affect the mental health of rural doctors.

A total of 2593 valid questionnaires were received. The results of the study revealed several findings: the younger the rural doctors, the greater the incidence of mental health problems (OR = 0.792); female rural doctors were more likely to experience mental health issues than their male counterparts (OR = 0.789); rural doctors with disabilities and chronic diseases faced a significantly greater risk of mental health problems compared to healthy rural doctors (OR = 2.268); rural doctors with longer working hours have a greater incidence of mental health problems; and rural doctors with higher education backgrounds have a higher prevalence of somatization (OR = 1.203).

Rural doctors who are younger, male, have been in medical service longer, have a chronic illness or disability, and have a high degree of education are at greater risk of developing mental health problems. Attention should be given to the mental health of the rural doctor population to improve primary health care services.

We assessed patient experience of care, comparing current and past smokers, and whether frequency of advice to quit smoking impacts patient rating of care.

Experience of care may be a concern for people who smoke and affect their partnership with healthcare providers.

We surveyed adults aged over 35 years who had visited a general practitioner (GP) for health care in the past year (n = 611 current and n = 275 ex-smokers). Questions assessed smoking history, experience of care, anticipation of stigma, and perceptions of smoking cessation advice received in general practice.

Fewer than half (48.8%) of current smokers reported ‘always’ or ‘usually’ being advised to quit smoking, or being advised in a way that motivated them to quit by a GP or other care provider at their GP practice. Current smokers tended to delay or avoid help seeking when needed and experienced more anticipation of stigma in healthcare settings. Conversely, respondents who reported being advised to quit more frequently rated overall quality of care more highly. These data show that asking about smoking and providing advice to quit smoking was acceptable to most respondents and associated with higher ratings of quality of care. However, advice should be provided in a way that motivates patients, without exacerbating the stigma associated with smoking, which may impact help seeking.

The objectives of this study were to study the psychometric properties of the Implementation Drivers Scale (IDS), for the mhGAP programme, both clinical and community; to test its structural validity, and to propose an instrument to accompany the implementation of the mhGAP in similar contexts. For this purpose, a cross-sectional quantitative methodology study was conducted.

Mental health programmes proposed in low- and middle-income countries to address gaps in care have implementation problems.

A cross-sectional quantitative methodology study was conducted. During 2022 and 2023, the instrument was administered to 204 individuals, including primary care professionals (50%), national administrative leaders (19.11%), and community strategy leaders. Three departments of Colombia participated, two with low levels of implementation in mental health programmes and one with high levels of implementation of programmes and services.

The Kaiser-Meyer-Olkin factor analysis resulted in 0.861, which indicated the suitability of the data for a factor analysis. Bartlett’s Test of Sphericity had a value of 2480.907 (153 degrees of freedom, p <.001). The exploratory factor analysis explained variance of 66.781%. The four factors proposed in the AIF model (System enablers for implementation, Accessibility of the strategy, Adaptability and acceptability, and Strategy training and supervision) were confirmed, with all items with loadings greater than 0.4. For the entire instrument, a Cronbach’s alpha was 0.907. The IDS could contribute to the monitoring of some components of mhGAP implementation, both clinical and community-based, in low- and middle-income settings through appropriate validation processes.

To support policymakers in enhancing access to eye care for the population aged 45 years and older in Pakistan, this study aims to identify and quantify the barriers that hinder effective eye care delivery to this group. Additionally, it seeks to explore patients’ experiences with the Sehat Sahulat (health insurance) programme in the context of eye care services.

Accessible eye care services can reduce avoidable blindness by delivering timely, high-quality interventions. In Pakistan, the lack of primary eye care burdens overcrowded hospitals and combined with economic challenges, limits access for underprivileged populations. To address this, a nationwide health insurance scheme – the Sehat Sahulat programme (SSP) was introduced to reduce out-of-pocket (OOP) expenses and improve healthcare access for economically disadvantaged groups.

Using an exploratory sequential mixed methods design, an initial qualitative phase explored participant experiences and identified specific barriers. The qualitative study provided the basis for the development of a customized survey tool. The survey tool was then used in a second phase to obtain quantitative data to capture the magnitude of barriers and costs associated with accessing eye care in Pakistan.

Numerous considerable barriers were identified including illiteracy, long travel times, female gender, old age, mobility issues, and costs, all of which limited access to eye care in Pakistan. Awareness surrounding use of the SSP was poor, with the programme seldom used towards eye care costs. This study highlights patient experiences with eye care in urban and rural Pakistan, including enablers and barriers to accessing eye care. Improvements should focus on educating the public on eye health, increasing availability of eye care services in rural areas, improving accessibility within eye care facilities, addressing gender disparities, and reducing costs associated with eye care treatments, potentially through advancement of the SSP.

The European General Practitioners Research Network (EGPRN) designed and validated a comprehensive definition of multimorbidity using a systematic literature review and qualitative research throughout Europe. Identification of risk factors for decompensation would be an interesting challenge for family physicians (FPs) in the management of multimorbid patients. The aim was to assess which items from the EGPRN’s definition of multimorbidity could identify outpatients at risk of decompensation at 24 months.

A cohort study. About 120 multimorbid patients from Western Brittany, France, were included by general practitioners between 2014 and 2015. The status “decompensation” (hospitalization of at least 7 days or death) or “nothing to report (NTR)” was collected at 24 months of follow-up.

At 24 months, there were 44 patients (36.6%) in the decompensation group. Two variables were significant risk factors for decompensation: the number of visits to the FP per year (HR = 1.06 [95% CI 1.03–1.10], P < 0.001) and the total number of diseases (HR = 1.12 [95% CI 1.013–1.33], P = 0.039).

FPs should be warned that a high number of consultations and a high total number of diseases may predict death or hospitalization. These results need to be confirmed by large-scale cohorts in primary care.

The aim of this study was to explore primary health care professionals’ (PHCP) experiences of frailty assessment with the Tilburg Frailty Indicator (TFI) with focus on feasibility aspects.

Primary health care (PHC) is often the first point of contact for older people and assessment of frailty is therefore often recommended in this setting. There is however a lack of awareness of frailty in PHC. The TFI has been proposed as a suitable instrument for frailty assessment in PHC. It consists of 25 questions, where ten questions aim to identify risk factors for frailty and 15 questions assess physical, psychological, and social frailty. There are no previous studies of feasibility aspects of TFI in PHC.

A qualitative interview study with physicians, nurses, and physiotherapists that had used TFI in face-to-face interviews during a care visit. Interviews were transcribed and the text was thematically analyzed using qualitative content analysis.

Nine interviews were performed. The PHCPs experiences were expressed in one theme: TFI is useful and feasible but requires time and knowledge. TFI was described as easy to use and providing a holistic assessment of the patient. Using the TFI was time-consuming but provided useful information for care planning. In conclusion, the TFI could be a clinically useful tool to assess frailty in PHC. The result indicates a need of educational efforts to increase knowledge about frailty and a need for primary health care to adjust to older people in order to allow care visits to include both assessment and management of frailty.