Smoking cessation remains beneficial in later life, yet long-term information on smoking status and cessation experiences among older adults attending smoking cessation services is limited. This study descriptively evaluated long-term smoking status and cessation experiences in older adults previously attending a smoking cessation clinic. This study used a retrospectively identified cohort with a one-time long-term telephone outcome assessment. Medical records of adults aged ≥ 60 years who attended a smoking cessation outpatient clinic between January 2015 and March 2020 were reviewed, and telephone follow-up was conducted in October 2024, approximately 4.6–9.8 years after clinic attendance. The primary outcome was self-reported smoking status at interview. Recorded treatment modality reflected the treatment plan documented at baseline; medication initiation, duration, and adherence were not available. Multivariable analyses were exploratory. Of 297 eligible participants, 26 (8.8
Lack of diagnosis and management of hepatitis B and C in Australia contribute to the increasing burden of liver cancer and other adverse outcomes for those affected. The Hepatitis and liver cancer outcomes in general practice: an intervention collaboration (HepLOGIC) study evaluated a point-of-care (POC) tool and an audit tool as an intervention to improve guideline-based hepatitis B and C testing and management in primary care. We evaluated the HepLOGIC intervention using the RE-AIM framework, assessing Reach, Effectiveness, Adoption, Implementation, and Maintenance. A mixed methods evaluation included quantitative assessment of user metrics such as logins and testing and management outcomes between tool users and non-users, as well as qualitative feedback gathered from surveys with clinicians and practice managers. Sixteen practices completed participation in the study, collectively seeing 119,613 patients during the intervention period. Of these 16.5
People Living with HIV (PLWH) are at increased risk for non-communicable diseases (NCDs) including hypertension as the most common CVD risk factor. Integration of hypertension management into HIV care has been identified as an effective strategy, however limited data in the primary health care setting exist in Nigeria [1–5]. We assessed the feasibility of integrating task-shifting strategy for hypertension control (TASSH) in a pilot study of two primary health centers using practice facilitation as our implementation strategy. Two primary health care centers, not planned for inclusion in the larger trial, were recruited to participate in the pilot study. Persons living with HIV aged 18 years and older with elevated blood pressure (BP) between 140 and 179 mm Hg systolic or 90–109 mm Hg diastolic, were recruited. PF was provided by experienced and retired nurses with experience in the primary care setting. The feasibility of using fidelity tools to collect data on the implementation of TASSH and PF within the two pilot sites was tested. A majority of participants (83
Acute respiratory tract infections (ARTIs) account for a large share of inappropriate prescribing in the outpatient setting. Telemedicine may improve prescribing but despite evidence of safety that is comparable to in person visits, some providers remain hesitant. We aimed to develop a risk prediction model to identify patients with ARTI at low-risk for hospitalization. We performed a retrospective analysis of adult primary care visits for patients with an ARTI seen in the outpatient setting at three Boston area hospitals from 2017 to 2021. We used a Lasso regression for the final model to predict admission to an observation or inpatient unit within 14 days post ARTI visit in the derivation cohort and validated the model in two external cohorts. We evaluated prediction performance using the area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) along with their 95
There is an unmet need for Long COVID care within our healthcare system. Primary care clinicians (PCPs) face challenges in providing effective care due to limited relevant Long COVID training and lack of standardized clinical resources. Pre-CME (continuing medical education) survey data indicates that 62
Abstract Background General practitioners (GPs) play an important role in the care of patients with cancer across the entire cancer continuum, from diagnosis to palliative care. Despite their broad range of responsibilities, structures to facilitate the systematic involvement of GPs into cancer care remain insufficient in Germany. To date, the specific role and contribution of GPs within the German cancer care system have not been comprehensively synthesized. Objective This scoping review aimed to summarize the available evidence on GP involvement in cancer care in Germany, including their roles across the cancer trajectory, collaboration with other healthcare providers, and barriers and needs affecting their participation in cancer care. Study selection and analysis A scoping review was conducted according to Arksey & O’Malley. The search was conducted on 2 January 2024 in the databases Cochrane Library, MEDLINE, and Web of Science. Eligible studies examined the role of GPs in the care of patients with cancer or long-term cancer survivors in Germany. Extracted review’s domains (GPs’ roles and responsibilities, collaboration, needs) were derived from an exploratory literature search and a GP advisory board. Findings were synthesized narratively. Studies published before 2008 were excluded. Results The search yielded 646 hits, of which 71 could be included in the full-text screening and 24 in the data extraction. GPs are involved in all phases of cancer care, including diagnosis, active treatment, follow-up care, and palliative care. GPs as “persons of trust” and experts in counselling, provide patient-centered cancer care and emotional support. GPs collaborate with other healthcare providers, but are rarely involved in specific treatment decisions. Deficiencies in communication, information exchange, and role clarification were identified. GPs expressed a need for greater involvement and better information through informal, bidirectional communication with various stakeholders in the oncology healthcare sector. Evidence on GP involvement in survivorship care and the management of comorbidities in patients with cancer was limited. Conclusions Efficient structures for information exchange and knowledge transfer between GPs and other healthcare providers may support continuous and comprehensive care for patients with cancer. Future guidelines should explicitly address the role of GPs and provide clear recommendations for their integration into cancer care pathways. Scoping review registration https://doi.org/10.17605/OSF.IO/T8XEN .
Due to restricted access to health care, maternal mortality rates in low-income countries are unacceptably high. Adequate health-care utilisation has been identified as crucial in the drive to improve maternal health indices. This study aimed to determine the level of utilisation of maternal health services among women attending Antenatal care at Primary Health Care Centres (PHCs) in Abuja, Federal Capital Territory. This study employed a mixed-methods design using the convergent parallel approach. The quantitative arm employed a cross-sectional design with data collected using a semi-structured five-section questionnaire, whereas the qualitative arm consisted of focus group discussions (FGD). The study was conducted over a four-month period, from September 2022 to January 2023. Participants were selected from women receiving antenatal care at 12 primary health care centres in Abuja, using multistage sampling. Quantitative data were analysed using SPSS version 25, while qualitative data were analysed thematically. A p-value of less than 0.05 at the 95
The clinical use of ultrasound by general practitioners has expanded rapidly, but uncertainty persists in clinical practice regarding which indications can improve diagnostic process and which rather represent low-value care. We conducted a systematic review of clinical guidelines published between 2014 and 2024 addressing ultrasound indications relevant to general practitioners. Searches were performed in MEDLINE, Embase, CINAHL, Cochrane, and major guideline repositories. Two reviewers independently screened records, extracted recommendations, and assessed quality using the AGREE II instrument. Recommendations were categorized by clinical condition, level of evidence, and strength of recommendation. Of 4015 records, 108 guidelines were included. A total of 293 recommendations (from 95 guidelines) supported the use of ultrasound (Strength of Recommendation A/B), while 66 recommendations (from 17 guidelines) discouraged its use (Strength of Recommendation D). Most appropriate indications involved cardiovascular, gastrointestinal, musculoskeletal, and respiratory conditions, while the majority of low-value indications were found in the endocrinological, urological, and vascular conditions. Overall, methodological quality ranged from moderate to high: 70 (64.8
In recent years, the hospitalization rate in China has continued to rise, with an increasing prevalence of avoidable hospitalizations. While developed countries have extensively studied avoidable hospitalization, research in China remains limited, particularly regarding the effects of continuity of care on avoidable hospitalization, which has yet to yield consistent conclusions. This evidence gap is especially relevant in high-altitude areas, where hypertension management may be challenged by hypoxia, geographic barriers, uneven medical resources, and fragmented health service delivery. The objective of this study was to investigate the effects of continuity of care on avoidable hospitalization in hypertensive patients. We used 2022–2023 claims data from basic medical insurance in three anonymized cities in high-altitude areas of China. Adults aged ≥ 18 years with at least three hospital visits for hypertension-related conditions in 2022 were included. Continuity of care in 2022 was measured by the Continuity of Care Index (COC), Usual Provider Continuity Index (UPC) and Sequential Continuity Index (SECON). Avoidable hospitalization in 2023 was identified as at least one inpatient admission with a principal diagnosis of hypertension, based on adapted AHRQ Prevention Quality Indicator criteria after applying exclusion rules for major cardiac procedures, dialysis-related chronic kidney disease, transfers, same-day admissions/discharges and missing key data. Separate multivariable logistic regression models were fitted with avoidable hospitalization as the outcome and each continuity index as the main predictor, adjusting for age, sex, ethnic, residence location, insurance type, and number of hospital visits. Among the 13,831 patients, 425 (3.1
High sodium intake is a global health concern, contributing to conditions like hypertension, chronic kidney disease (CKD), and cardiovascular diseases (CVDs). While efforts have been made to reduce sodium in diets, the sodium content in medications is often overlooked, posing additional risks. High sodium content is generally associated with specific pharmaceutical formulations rather than being an inherent component of most medications, particularly effervescent formulations containing sodium salts and macrogol formulations with added electrolytes. This is especially important for older patients, who not only require sodium-restricted diets but also have additional comorbidities such as constipation, complicating sodium management due to multiple medications. This study aims to estimate the proportion of patients aged 60 years or older attending primary care in Spain with conditions or treatments associated with sodium restriction and to describe constipation, laxative use, and exposure to sodium-containing medications in this population. A cross-sectional, observational, non-randomized study was conducted in primary care centers across Spain. Data collection occurred between October 3rd, 2023, and December 29th, 2023. Patients aged 60 years or older attending primary care consultations in person were consecutively included by order of attendance. Clinical and demographic data from 448 patients were analyzed. The study involved 448 patients with an average age of 72.3 years. Of these patients, 80.8
Delayed diagnosis of type 2 diabetes (T2D) increases the risk of diabetes-related health complications. Although signs of T2D are commonly identified in primary care, delays in diagnosis remain a significant challenge. The relationship between patient-level factors (e.g., demographics and healthcare utilization patterns), clinic-specific factors (e.g., primary care location), and the time to T2D diagnosis represents a critical, yet understudied, research area. We conducted a retrospective observational cohort study of 594 adults who received care from two primary care clinics within an integrated healthcare system in the mid-Atlantic region of the United States (2017–2023). Kaplan–Meier survival analysis and time-varying Cox proportional hazards models quantified the time from the first diabetes-range hemoglobin A1c (HgA1c ≥ 6.5
Domestic violence and abuse (DVA) among older adults is an increasingly recognized public health and human rights concern with significant physical, psychological, and social consequences. This systematic review and meta-synthesis aimed to synthesize qualitative evidence on response strategies for older adults experiencing domestic violence and abuse and to identify key factors influencing helpful intervention and support. A systematic review and qualitative meta-synthesis were conducted following PRISMA 2020 and ENTREQ guidelines. Six electronic databases (MEDLINE, CINAHL, PsycINFO, Scopus, Web of Science, and Embase) were searched from inception to February 2026. Qualitative studies exploring response strategies, help-seeking, coping, and professional responses among older adults experiencing domestic violence and abuse were included. Studies addressing abuse by adult children, intimate partners, and other family members within home settings were included, even when authors used “elder abuse” terminology, provided the abuse context was domestic rather than institutional. Study selection, data extraction, and quality appraisal using the Critical Appraisal Skills Programme (CASP) checklist were conducted independently by reviewers. Data were analyzed using thematic synthesis to identify descriptive and analytical themes. A total of 29 qualitative studies were included. Four overarching themes were identified: [1] barriers to disclosure and help-seeking, including fear, stigma, dependency, and generational norms; [2] factors perceived as facilitating helpful responses, such as trust, validation, and accessibility of support services; [3] the role of professional and organizational responses, highlighting the importance of training, screening, and multidisciplinary collaboration; and [4] survivor-centered coping and resilience strategies, including informal support networks and adaptive coping mechanisms. Beyond descriptive synthesis, our analysis generated several novel conceptual insights, including the conceptualization of an “ecology of silence” that reinforces non-disclosure through mutually reinforcing barriers, the identification of a “coping paradox” wherein strategies that protect psychological integrity in the short term may prolong exposure to abuse, and the articulation of professional validation as a mechanism of cognitive transformation rather than merely emotional support. Findings demonstrated that perceived helpful responses require person-centered, trauma-informed, and age-sensitive approaches that address the complex social, relational, and structural contexts of abuse in later life. Response strategies for older adults experiencing domestic violence and abuse must address unique age-related vulnerabilities, structural barriers, and relational dynamics. Stakeholder perspectives indicate that perceived helpful responses involve accessible services, trained professionals, and supportive environments that promote safety, autonomy, and empowerment. The findings underscore the importance of recognizing the diverse relationship contexts in which DVA occurs in later life—including abuse by adult children, intimate partners, and other family members—and the need for responses tailored to these distinct dynamics. These findings provide important implications for policy, practice, and service development, emphasizing the need for integrated, age-appropriate interventions to improve outcomes for older survivors of domestic violence and abuse.
Falls are a major source of disability in later life, but national evidence from Türkiye is limited. We estimated the prevalence and reported locations of falls and examined cross-sectional associations with in-home and away-from-home falls. We analysed the cross-sectional Türkiye Elderly Profile Survey 2023, restricted to the non-institutional household population aged ≥ 65 years (n = 11657; weighted population 8.6 million). Participants retrospectively reported whether they had fallen during the previous 12 months; fallers then reported locations. We estimated survey-weighted prevalences and fitted weighted logistic models with approximate robust confidence intervals. 24.0
Selected ethnic minority communities with cross-stage development in Yunnan, China, represent a unique population that transitioned from historically isolated traditional social structures to modern society. However, limited data exist regarding their health literacy (HL) status amidst rapid epidemiological transitions. This study aimed to assess the prevalence of HL and identify its sociodemographic associated factors within these transitional communities. A cross-sectional survey employing a multi-stage stratified cluster and probability proportional to size (PPS) sampling design was conducted from July to August 2022 among 1,375 residents across 15 counties in five border prefectures of Yunnan Province using the standardized Chinese Adult Health Literacy Questionnaire (CAHLQ). Health literacy adequacy was defined as achieving ≥ 80
Individuals with chronic diseases, such as ischaemic heart disease (IHD) and type 2 diabetes (T2D), are at increased risk of poor mental well-being, which can lead to worse health outcomes and higher mortality. In the Healthy Mind intervention, patients with IHD and/or T2D and poor mental well-being were offered problem-solving therapy (PST). Healthcare professionals guided patients through the structured five-step PST approach, engaging them in selecting problems and solutions to address. The intervention was evaluated in a stepped-wedge cluster-randomised controlled trial (RCT). This process evaluation aims to investigate the implementation of the Healthy Mind intervention. This study used mixed methods. Data sources included RCT monitoring data (PST consultations (N = 153, patient registrations (N = 63)), patient questionnaires (baseline: N = 56; post-intervention: N = 36), healthcare professional questionnaires (N = 51), and purposively sampled semi-structured patient interviews (N = 10). Quantitative data were analysed descriptively while qualitative data were analysed using thematic analysis. Data were integrated using the ‘following a thread’ technique. Most PST consultations (82
Global strategies to address physician maldistribution include recruiting students with rural backgrounds, community-based training, bonded service, financial incentives, and personal and professional support. However, retention after obligatory service remains variable. Jichi Medical University (JMU) in Japan was established to address physician shortages in rural areas through a scholarship loan programme requiring graduates to complete nine years of service in their home prefectures. This study compares post-obligation retention patterns across the Kyushu prefectures and uses Okinawa as a context for secondary-source-based interpretation of why retention may differ across prefectures operating under a shared obligation framework. This descriptive comparative study combined a cross-sectional analysis of retention data from eight Kyushu prefectures using the 2024 JMU Graduate Directory with a secondary-source-based contextual interpretation of Okinawa. Among 641 graduates who had completed medical school at least 10 years previously, retention was operationally defined as practising within the home prefecture on 1 July 2024. Quantitative analyses compared retention rates, prefectural capital concentration, and the ecological correlation between inhabited-island count and retention. The contextual interpretation drew on a review-derived framework linking geographical access conditions, institutional support and training arrangements, and sociocultural embeddedness to physician-retention factors described in previous reviews. Okinawa demonstrated the highest retention rate (84.2
Service classifications and costings are important for measuring the effectiveness and efficiency of health service delivery. This study aimed to develop and test a new classification of primary health care (PHC) by care type and stage of condition, and to pilot this classification by estimating average costs per visit and annual cycle of care for the Northern Territory (NT) Government managed remote clinics in Australia. Patient and service data were gathered from the NT Department of Health Primary Care Information System that uses the International Classification of Primary Care version 2 plus (ICPC) for data collection. PHC financial data were extracted from the NT Government Accounting System. We defined a new framework, the Medical Benefit Groups (MBGs), to classify PHC encounters using spectrum (illness) and continuum (stage of illness and type of care) categories for each visit and annual cycle of care, and calculated the average costs associated with the spectrum and continuum by activity-based costing. Seven continuum categories consolidated ICPC codes: Prevention, Symptoms, Diagnostics, Results, Conditions, Therapeutics and Referrals. Twenty spectrum categories used ICPC alpha codes for chapters and multi-system categories (cancer, injury and infectious disease). Between 2017/18 and 2021/22, a total of 2.2 million visits and 801,000 cycles of care were recorded for 51 remote clinics serving a predominantly Aboriginal population (86
Delayed healthcare-seeking may adversely affect treatment experiences among patients with diabetic retinopathy (DR), but its associated factors and association with treatment satisfaction remain insufficiently understood. Using the Health Promotion Model (HPM) as an integrative framework, this study examined factors associated with delayed healthcare-seeking and explored its association with treatment satisfaction at 6 months among symptomatic patients with DR attending their first specialist ophthalmic consultation. A convergent parallel mixed-methods study was conducted at a regional public hospital in northern China from June 2024 to February 2025. The quantitative component included 235 symptomatic patients with DR. Delay was defined as an interval of ≥ 3 months between symptom onset and the first specialist ophthalmic consultation and was analyzed using hierarchical logistic regression. Treatment satisfaction was analyzed primarily as an exploratory continuous outcome using linear regression, with binary logistic regression as a sensitivity analysis. Nineteen participants completed semi-structured interviews at baseline and 6 months. Quantitative and qualitative findings were analyzed separately and integrated during interpretation guided by the HPM. Overall, 108 (46.0
Considering the increasing number of elderly and patients with dementia, along with the challenges of maintaining accessible healthcare, digital tools present a promising opportunity to alleviate the workload associated with dementia diagnosis and care. Despite this potential, their utilization in the daily practice of primary care remains limited. In this survey study, we assessed opinions of primary care physicians (PCPs) on digital tools, such as web-based cognitive assessments or digital questionnaires for everyday functioning for use in the context of dementia diagnosis and monitoring. Between June 2023 and February 2024, we conducted a web-based survey among PCPs in the Netherlands and Norway. 107 PCPs completed the survey (mean age 47 ± 11 years, 64(60
