BMC Primary Care

Understanding treatment burden is a critical element to the effective management of Type 2 Diabetes Mellitus (T2DM). The current study aims to address the knowledge gap surrounding treatment burden of T2DM from the patient’s perspective in China’s primary care settings.
A narrative review informed the creation of an a priori coding structure to identify aspects of T2DM treatment burden. Focus groups were conducted, employing a maximum variation sampling strategy to select participants from diverse sociodemographic backgrounds across urban, suburban, rural, and remote areas in China. Participants included adults with T2DM care in primary care settings for over a year and a Treatment Burden Questionnaire score of 25 or higher. Deductive thematic analysis, guided by the coding structure, facilitated a comprehensive exploration and further development of the conceptual framework of T2DM treatment burden.
Four focus groups, each comprising five participants from diverse areas, were conducted. Utilising the Cumulative Complexity Model and Normalisation Process Theory as theoretical underpinnings, the thematic analysis refined the conceptual framework based on the coding structure from the narrative review. Five key themes were refined, encompassing medical information, medication, administration, healthcare system, and lifestyle. Additionally, the financial and time/travel themes merged into a new theme termed "personal resources", illustrating their overlapping within the framework. Participants in these focus groups highlighted challenges in managing medical information, an aspect often underrepresented in prior treatment burden research. The thematic analysis culminated in a finalised conceptual framework, offering a comprehensive understanding of the treatment burden experiences of people with T2DM in China’s primary care settings. This framework includes six key constructs, delineating T2DM treatment burden and associated factors, such as antecedents and consequences.
This study provides insights into the treatment burden of T2DM. A conceptual framework was finalised to deepen the understanding of the multifaceted constructs and the nature of treatment burden in people with T2DM. Furthermore, it emphasises the need to tailor T2DM treatment to individual capacities, considering their personal resource allocation and treatment utilisation.

Kai Lin

Mi Yao

Lesley Andrew

Rouyan Li

Yilin Chen

Jacques Oosthuizen

Moira Sim

Yongsong Chen

BMC Prim. Care

Exploring treatment burden in people with type 2 diabetes mellitus: a thematic analysis in china's primary care settings

探索2型糖尿病患者的治疗负担：中国基层医疗环境中的主题分析

Abstract Background Primary care is often described as slow to change. But conceptualized through complexity theory, primary care is continually changing in unpredictable, non-linear ways through self-organization processes. Self-organization has proven hard to study directly. We aimed to develop a methodology to study self-organization and describe how a primary care clinic self-organizes over time. Methodology We completed a virtual case study of an urban primary care clinic from May-Nov 2021, applying methodological insights from actor-network theory to examine the complexity theory concept of self-organization. We chose to focus our attention on self-organization activities that alter organizational routines. Data included fieldnotes of observed team meetings, document collection, interviews with clinic members, and notes from brief weekly discussions to detect actions to change clinical and administrative routines. Adapting schema analysis, we described changes to different organizational routines chronologically, then explored intersecting changes. We sought feedback on results from the participating clinic. Findings Re-establishing equilibrium remained challenging well into the COVID-19 pandemic. The primary care clinic continued to self-organize in response to changing health policies, unintended consequences of earlier adaptations, staff changes, and clinical care initiatives. Physical space, technologies, external and internal policies, guidelines, and clinic members all influenced self-organization. Changing one created ripple effects, sometimes generating new, unanticipated problems. Member checking confirmed we captured most of the changes to organizational routines during the case study period. Conclusions Through insights from actor-network theory, applied to studying actions taken that alter organizational routines, it is possible to operationalize the theoretical construct of self-organization. Our methodology illuminates the primary care clinic as a continually changing entity with co-existing and intersecting processes of self-organization in response to varied change pressures.

Patricia Thille

Anastasia Tobin

Jenna M. Evans

Alan Katz

Grant M Russell

Evolving through multiple, co-existing pressures to change: a case study of self-organization in primary care during the COVID-19 pandemic in Canada

在多重共存压力下演变：加拿大新冠疫情期间初级保健中的自组织案例研究

Adolescence is a critical period in human life, associated with reduced physical activity and increased sedentary behaviors. In this systematic review and dose-response meta-analysis, we evaluated the association between screen time and risk of overweight/obesity among adolescents.A systematic search in electronic databases, including PubMed, Embase, and Scopus was performed up to September 2021. All published studies evaluating the association between screen time and risk of overweight/obesity among adolescents were retrieved. Finally, a total of 44 eligible studies were included in the meta-analysis.The results of the two-class meta-analysis showed that adolescents at the highest category of screen time were 1.27 times more likely to develop overweight/obesity (OR = 1.273; 95% CI = 1.166-1.390; P < 0.001; I-squared (variation in ES attributable to heterogeneity) = 82.1%). The results of subgrouping showed that continent and setting were the possible sources of heterogeneity. Moreover, no evidence of non-linear association between increased screen time and risk of overweight/obesity among adolescents was observed (P-nonlinearity = 0.311).For the first time, the current systematic review and meta-analysis revealed a positive association between screen time and overweight/obesity among adolescents without any dose-response evidence.The protocol of the current work has been registered in the PROSPERO system (Registration number: CRD42021233899 ).

Purya Haghjoo

Goli Siri

Ensiye Soleimani

Mahdieh Abbasalizad Farhangi

Samira Alesaeidi

Screen time increases overweight and obesity risk among adolescents: a systematic review and dose-response meta-analysis

屏幕时间增加青少年超重和肥胖风险：一项系统综述和剂量-反应元分析

The policy shift towards person-centred integrated primary care systems drives interest in primary care across higher education programs. In Flanders, the Primary Care Academy (PCA) is established to support this policy shift. The PCA focusses on the concepts of goal-oriented care, self-management, and interprofessional collaboration to support the shift towards integrated care and to integrate them in curricula in order to strengthen and develop a futureproof health system. Therefore, the aim of this study is if and how lecturers implement these concepts in the curriculum and what they need for a successful implementation. A sequential explanatory mixed method study design was used combining quantitative and qualitative data. A cross-sectional survey was sent to 276 Flemish health care education programs. Qualitative data was collected through focus groups in which lecturers participated. The results showed that 89% of the higher education programs address goal-oriented care, self-management, and interprofessional collaboration with regard to primary care. Further analysis of courses within the programs reveals that the concept of self-management is covered in only 58%, while goal-oriented care (73%) and interprofessional collaboration (80%) appear more frequently. The level at which the themes are addressed in the courses are often limited to an introduction. The focus groups revealed that primary care is present in education programs, however lecturers are limited aware where primary care is integrated in their own and other programs. Lectures expressed a need for more collaboration between research, education and practice in developing educational content. When new concepts are introduced, lecturers want them to be translated into educational content, learning objectives and competencies. The study shows that the concepts of goal-oriented care, self-management, and interprofessional collaboration are present in higher education programs to a varying degree. Lecturers are eager to implement these new primary concepts but they lack collaboration between education, research and practice. Lecturers indicate the need for a competence profile for primary care professionals as common framework to guide curriculum development.

Lotte Vanneste

Sam Pless

Sandra Martin

Emily Verté

Roy Remmen

Pauline Boeckxstaens

Peter Pype

Reini Haverals

Dagje Boeykens

Dominique Van de Velde

Patricia De Vriendt

Muhammed Mustafa Sirimsi

Peter Van Bogaert

Hans De Loof

Kris Van den Broeck

Sibyl Anthierens

Ine Huybrechts

Peter Raeymaeckers

Veerle Buffel

Dirk Devroey

Bert Aertgeerts

Birgitte Schoenmakers

Lotte Timmermans

Veerle Foulon

Anja Declerq

An De Sutter

Lies Lahousse

Ann Van Hecke

Peter Decat

Rudi Roose

Erica Rutten

Anouk Tuinstra

Vanessa Gauwe

Didier Reynaert

Leen Van Landschoot

Maja Lopez Hartmann

Tony Claeys

Hilde Vandenhoudt

Kristel De Vliegher

Susanne Op de Beeck

Implementing primary care concepts in higher education: a mixed method study in Flanders (Belgium)

在高等教育中实施初级保健概念：比利时佛兰德斯的混合方法研究

Overcrowding in paediatric emergency departments (PEDs) has become a global public health issue, reducing healthcare quality, increasing dissatisfaction, and driving up costs. Overcrowding in PEDs not only affects patient satisfaction and healthcare costs but also can lead to burnout among healthcare professionals. This burnout could potentially result in suboptimal care for truly severe cases, ultimately increasing morbidity and mortality rates among patients requiring urgent attention. This study aims to determine how family health centres can reduce paediatric visits to PEDs and provide recommendations for alleviating overcrowding. This study is a descriptive cross-sectional study. Participants were parents whose children were admitted to the PED at a tertiary hospital located in southeast Turkey. The data were collected between 15/05/2024–26/08/2024. This study was completed with 657 parents. A convenience sampling method was used to recruit participants. SPSS 11.5 software was used for data analysis. The mean age of the parents and children brought to the PED was 31.99 ± 8.51 years and 4.20 ± 4.08 years, respectively. Of the children, 32.1% were admitted to the PED due to fever. Majority of parents (65%) visited the PED outside working hours. 8.8% of parents considered their child's health condition as "very urgent", 54.5% of them considered it as "urgent". The majority of parents thought that the PEDs were overcrowded (82.2%). 50.4% of the parents stated that they trusted the PED, and 52.7% stated that they were satisfied with the PED. More than half of the parents (61.8%) stated that they did not visit their family health centre before visiting the PED. 10.8% of parents reported that they had never visited a family health centre in the last year. Majority of parents (62.7%) stated that they will visit the PED again if their children have the same health problems in the future. Improving the use of family health centres, introducing out-of-hours services, and enhancing parents' health literacy could shift non-urgent visits from PEDs to primary care settings. In addition, making parents more aware of services provided in family health centres could affect parents' health-seeking behaviours and choose to use their GP rather than PED for their children with non-urgent conditions.

Ahmet Butun

The role of family health centres in preventing paediatric emergency department usage of parents of children with non-urgent conditions

家庭健康中心在预防非紧急情况儿童家长使用儿科急诊中的作用

The treatment gap for mental and behavioral health (MBH) in the United States (US) remains a major public health concern. Given the growing need for a robust MBH workforce, particularly for underserved populations, calls for integrated MBH in primary care have been mounting. Family medicine providers, who know and can treat all members of a family within the same setting, are uniquely positioned to manage MBH conditions. With HRSA funding, the University of Utah Family Medicine Residency (UUFMR) seeks to address gaps in mental health services by enhancing or developing MBH training and partnerships. This protocol describes the project's evaluation. The evaluation aims to identify areas to improve training content, describe training capacity, and assess intermediate outcomes of improved trainings. The evaluation consists of three components: analyzing current curriculum and best practices, developing or enhancing trainings with partners, and assessing residents' and graduates' confidence in providing MBH care. The results from this protocol fill gaps in the current literature regarding evaluation methods for provider- and organizational-level outcomes of increased quality and capacity of residency training in MBH. Further, the results provide practical guidance for other residencies seeking to integrate MBH training into their curriculum. Considering the resources committed to the ongoing enhancement of resident education, it is crucial to evaluate the implementation and outcomes of improvements to ensure that limited resources are well-utilized. Assessing the training capacity developed through collaboration supports progress toward creating a high-quality, accessible, and integrated mental and behavioral healthcare system in primary care.

Elena Gardner

Robert W. Owens

Katherine T. Fortenberry

Karly Pippitt

Dominik J. Ose

Susan Cochella

Evaluation of enhanced mental and behavioral health training for family medicine residents: a research protocol

家庭医学住院医师心理健康与行为健康强化培训评估：研究方案

This study aimed to address research gap concerning the perception of the care pathway for knee osteoarthritis (KOA) patients, focusing on both the patient and health professional perspectives in countries with inefficient health systems, such as Slovenia, by examining patient satisfaction with conservative treatment, assessing the perceptions of both patients and health professionals regarding the latter's involvement, and justifying the chosen KOA treatment approaches. A mixed-methods approach was employed, combining quantitative surveys and qualitative interviews with KOA patients (n = 82) and healthcare professionals (n = 68). The care pathway for conservative KOA treatment in Slovenia begins with general practitioners (GPs), who conduct initial examinations, prescribe analgesics, and refer patients to radiologists and orthopaedic surgeons. GPs received high satisfaction ratings (μ = 4.32). Orthopaedic surgeons, who confirm diagnoses and create treatment plans involving physiotherapy, medication, or joint injections, also received high satisfaction scores (μ = 4.47), despite long waiting times. Consultations with radiologists, mentioned less frequently, again received high satisfaction scores (μ = 4.67). Physiotherapists, consulted later, received high satisfaction scores (μ = 4.16) but long waiting times resurfaced. Referrals to rheumatologists occur for systemic diseases or ineffective conservative treatments. Psychologists, occupational therapists, and dieticians are rarely consulted, indicating limited integration into the treatment pathway. A comparison of health professionals' involvement showed that health professionals consider GP involvement less necessary (μ = 2.47) than patients do (μ = 2.82, p = 0.015). The same applies to radiologists (μ = 2.47 vs. μ = 2.87, p = 0.004), reflecting different views on diagnostic imaging. Our qualitative investigation revealed that, due to long waiting times, an alternative care pathway is developing with orthopaedic surgeons as the initial point of contact, bypassing GPs, and highlighted that patients and healthcare professionals differently perceive the latter's treatment roles. The current conservative KOA care pathway lacks initial lifestyle change advice from the GP, referrals for conservative treatments, and a multidisciplinary team engaged in regular treatment monitoring and adjustment. Our mixed-methods research approach highlighted significant differences in perceptions of the treatment process and the roles of health professionals; the knowledge supplied of those differences should support experts and policymakers to optimise care pathways in Slovenia.

Pika Krištof Mirt

Karmen Erjavec

Sabina Krsnik

Petra Kotnik

Mohsen Hussein

A mixed-methods study of patient and healthcare professional perceptions of care pathways for knee osteoarthritis

一项关于患者和医疗保健专业人员对膝骨关节炎护理路径认知的混合方法研究

Abstract Background The COVID-19 pandemic has led to a significant shift in healthcare services, focusing on pandemic response and emergency preparedness. The Oman Ministry of Health implemented various measures to combat and control COVID-19. However, this shift disrupted routine outpatient appointments, particularly for chronic diseases such as diabetes mellitus (DM) and hypertension (HTN). This study aims to assess the pandemic’s effect on diabetes control, by examining glycated haemoglobin (HbA1c), blood pressure (BP), lipid values (particularly low-density lipoprotein (LDL), body weight/ body mass index (BMI), and comparing these measures to pre-pandemic levels. Methods A retrospective cohort study of 223 people with diabetes (PwD), aged 20–95 years who underwent a blood workup in 2019 and 2020 and were registered in Al-Khuwair Health Centre from March to December 2020. Data was extracted from the Al Shifa 3plus System and National Diabetic Register (NDR), and analyzed using SPSS. Results Out of 260 PwD identified, 223 met the inclusion criteria, while 37 were excluded due to recent diagnoses or missing follow-up in 2019. Significant changes were observed in HbA1C, systolic blood pressure (SBP), and BMI from 2019 to 2020. Mean HbA1c increased from 6.9% in 2019 to 7.2% in 2020. Mean SBP rose from 131.22 mmHg in 2019 to 134.84 mmHg in 2020, while mean BMI increased from 30.49 to 30.80. No significant changes were found in LDL levels or diastolic BP. Conclusion The COVID-19 pandemic disrupted healthcare systems globally, and the consequences on health and mortality were not only due to the direct impact of the virus, but also to the modifications in priorities. These interruptions in inconsistent care, had consequences for non-communicable diseases (NCDs) like diabetes. Future strategic plans should be prepared and implemented to manage NCD cases in case of pandemics.

Fakhria Al Rashdi

Salwa Al Harrasi

Mohammed Al Ismaili

AL-Ghaliya AL Yaaqubi

Zeenah Atwan

Celine Tabche

The profound impact of COVID-19 on the control and care of diabetic patients: a comprehensive retrospective cohort study

COVID-19对糖尿病患者控制与护理的深远影响：一项综合性回顾性队列研究

Abstract Background The COVID-19 lockdown had profound effects on society and healthcare. Cardiology departments reported declines in chest pain evaluations and acute coronary syndrome (ACS) diagnoses. However, the pattern of chest pain in primary care is not clear yet. This study aims to assess the impact of the COVID-19 lockdown on the number of patients presenting with chest pain in primary care. Methods Routine primary care data from the Extramural LUMC (Leiden University Medical Center) Academic Network (ELAN) in the Netherlands were used. Chest pain consultations from January 2017 to December 2020 were included. An interrupted time series analysis was performed to compare the incidence rate (IR) of chest pain consultations during the COVID-19 lockdown to the expected IR. Secondary outcomes were the type of consultations, referral proportions, and the IR of registered ACS diagnoses. Results In total 9,908 chest pain consultations were included. During the COVID-19 lockdown the IR was 6.16 per 1000 person-years while the expected IR was 7.55 (95% CI 7.03–8.12). The immediate effect of the lockdown yielded an incidence rate ratio (IRR) of 0.62 (95% CI 0.50–0.77). A similar decrease was seen for ACS diagnoses (IRR 0.62, 95% CI 0.48–0.79), with no compensatory increase after the lockdown (IRR 1.04, 95% CI 0.89–1.21). Face-to-face consultations shifted to telephone consultations ( p &lt; 0.001) and hospital referrals decreased (9.9% vs. 19.0% ( p &lt; 0.001)). Conclusions During the COVID-19 lockdown the number of chest pain consultations and registered ACS diagnoses in primary care decreased significantly. In addition, fewer patients were assessed face-to-face and fewer patients were referred to the hospital.

Simone van den Bulk

Jasper W. A. van Egeraat

Annelieke H. J. Petrus

Mattijs E. Numans

Tobias N. Bonten

Incidence of primary care chest pain consultations during the COVID-19 pandemic: an interrupted time series analysis with routine care data

COVID-19疫情期间初级保健胸痛就诊发生率：基于常规护理数据的中断时间序列分析

Low back pain (LBP) is one of the most frequent reasons for encounter in general practice. Yet results from literature show adherence to clinical practice guidelines is low. Audit & feedback is a well-known strategy to improve adherence to guidelines. Benchmarking is an important step in the audit & feedback process. The objective of this study was to develop data-derived benchmarks for low back pain quality indicators.

Rico Paridaens

Bert Vaes

Steve Van den Bulck

Justine Soetaert

BMC Prim Care

Benchmarks for low back pain in general practice in Flanders: electronic audit of INTEGO

佛兰德地区全科医疗中腰痛治疗的基准：INTEGO电子审计

Abbreviation	BMC Prim. Care
Journal Impact	2.01
Quartiles(Global)	PRIMARY HEALTH CARE(Q2)

ISSN	2731-4553
h-index	89

Publication Information	Publisher: BioMed Central Ltd，Publishing cycle: ，Journal Type: journal，Open Access Journals: Yes
Basic data	Year of publication: 2022，Proportion of original research papers: 95.78%，Self Citation Rate:， Gold OA Rate: 99.70%
Journal Fees	$2690Details
Average review cycle	29 weeks

BMC Primary Care

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