OBJECTIVE:To analyse the temporal trend of stroke incidence from 2019 to 2024 in Macao and evaluate its relationship with hypertension (HTN) and type 2 diabetes mellitus (T2DM) management within a universal health coverage (UHC) system. DESIGN:Retrospective observational study using routinely collected electronic health records. SETTING:Macao Health Bureau's primary care system, which provides free, publicly funded community health services to all residents. PARTICIPANTS:Macao residents aged ≥15 years with a confirmed diagnosis of ischaemic or haemorrhagic stroke recorded in the Macao Health Bureau medical system between 1 January 2019 and 31 December 2024 (n=8265). RESULTS:Age-standardised stroke incidence declined from 250.03 per 100 000 in 2019 to 219.95 per 100 000 in 2022, followed by a rebound in 2023-2024 which may partly reflect pandemic-related data entry delays. Over 88% of patients with pre-existing HTN or T2DM had documented healthcare follow-up in the year preceding their stroke. Stroke incidence among these high-risk patients declined and the interval from diagnosis to stroke onset lengthened significantly, yet a substantial stroke burden persisted. CONCLUSION:High healthcare engagement was associated with improved risk monitoring and delayed stroke onset. However, the persistent stroke burden suggests that achieving high coverage alone is not sufficient-ongoing quality improvement in chronic disease management is essential to translate engagement into better outcomes.
To provide a practical, comorbidity-aligned approach to headache management in primary care, emphasising therapies that can address headache and coexisting chronic conditions while reducing polypharmacy and medication interaction risk. Narrative clinical review using targeted literature searches and guideline synthesis. Contemporary clinical guidelines, systematic reviews, meta-analyses, randomised controlled trials and other clinically applicable evidence addressing the diagnosis and management of headache disorders in adults were prioritised. Evidence relevant to primary care, comorbidity-aligned treatment selection, non-pharmacologic interventions, medication-overuse headache and office-based procedures was emphasised. PubMed/MEDLINE and major headache guideline sources were searched through 7 August 2026. Reference lists of selected publications were also reviewed to identify additional clinically relevant evidence. Most headache disorders can be managed in primary care using a structured approach that confirms the headache phenotype, screens for secondary causes, identifies comorbidities and aligns treatment with the patient’s broader clinical needs. Selecting therapies that benefit both headache and coexisting conditions may reduce medication burden and improve adherence and tolerability. Non-pharmacologic interventions and structured follow-up are important components of care. Recognition and management of medication overuse can improve outcomes, while selected office-based procedures may provide additional options when used with appropriate attention to evidence limitations, patient selection and clinician competence. Comorbidity-aligned headache care offers primary care clinicians a practical framework for individualising treatment, limiting unnecessary medication layering and integrating pharmacologic and non-pharmacologic strategies. This approach may improve headache outcomes while supporting management of the patient’s overall health. This narrative review was not prospectively registered.
OBJECTIVE:To analyse the prevalence, the annual rate of insomnia diagnosis and the associated pharmacological prescription in Central Catalonia during the 2018-2024 period. DESIGN:Population-based retrospective observational study using collected electronic primary care health records (ECAP) from 2018 to 2024. Sociodemographic and clinical characteristics, insomnia prevalence, annual diagnosis rates and associated pharmacological prescribing patterns were analysed. SETTING:Primary care centres in Central Catalonia, Spain. PARTICIPANTS:Adult population of Central Catalonia diagnosed with insomnia between 2018 and 2024. RESULTS:The prevalence of insomnia increased by 43.4% during the study period, reaching 11.17% (95% CI 11.05 to 11.28) in 2024. The factors associated with higher prevalence were advanced age, female sex, residence in urban areas, polypharmacy and mental health comorbidity. The percentage of people with insomnia receiving pharmacological treatment increased from 47.88% (2018) to 55.11% (2024). Among patients receiving pharmacological treatment, anxiolytics were the most frequently prescribed medication class (36.68% in 2018 to 39.44% in 2024), followed by hypnotics and sedatives. CONCLUSION:The prevalence of insomnia and the use of pharmacological treatments among patients with insomnia-including anxiolytics, hypnotics and sedatives-have increased in recent years. These findings demonstrate the need to improve strategies in managing insomnia in primary care in order to promote the use of the first-line tool in the treatment of insomnia, cognitive behavioural therapy and thereby minimise pharmacological overprescription.
Objective Adverse childhood experiences (ACEs), positive childhood experiences (PCEs) and adult protective and risk factors have each been associated with health outcomes but have rarely been examined together. We examined associations among ACEs, PCEs, adult protective and risk factors, and adult mental, behavioural, and physical health outcomes, including whether adult factors were independently associated with health after accounting for childhood experiences.Design Cross-sectional observational study.Setting California, USA.Participants Data were analysed from 24 453 adults categorised into 5 age categories (18–25, 26–39, 40–54, 55–64 and ≥65 years) participating in the 2021 California Health Interview Survey, a statewide representative survey.Analysis Outcomes included multiple mental, behavioural and physical health indicators, including composite measures of any physical condition and any mental/behavioural health condition. Weighted logistic regression models examined associations and interactions among ACEs, PCEs, adult protective and risk factors, and health outcomes, adjusting for age, gender and race/ethnicity. Additional models examined adult factors independent of ACEs and PCEs.Results Greater ACE exposure was associated with higher odds of most poor health outcomes, whereas higher PCE exposure was generally associated with lower odds across mental, behavioural and physical health outcomes. Compared with individuals with high ACE exposure and low PCE exposure, progressively less ACE exposure was associated with progressively lower odds of any mental/behavioural health condition (moderate ACEs OR=0.59, 95% CI 0.50 to 0.70; no ACEs OR=0.30, 95% CI 0.24 to 0.37) and any physical condition (moderate ACEs OR=0.75, 95% CI 0.64 to 0.88; no ACEs OR=0.58, 95% CI 0.45 to 0.75). Adult protective and risk factors remained independently associated with health outcomes after accounting for ACEs and PCEs. Higher cumulative protective factor exposure was associated with lower odds of any mental/behavioural health condition (OR=0.49, 95% CI 0.42 to 0.57) and any physical condition (OR=0.63, 95% CI 0.53 to 0.74).Conclusions Adult protective and risk factors were associated with health outcomes independent of ACEs and PCEs, extending prior ACE and PCE research beyond childhood experiences. Findings highlight the importance of healthcare and public health approaches that address both childhood and adult adversity and strengthen protective resources and supportive environments.
Objectives The retrospective component of this mixed method study leveraged implementation science to assess the execution of an acute-on-demand telehealth (AODTH) service pioneered in a Singapore public primary care institution using video consultation (VC) targeting the local multiethnic population.Design A study was conducted using electronic medical records and AODTH service data from 2023 to 2024. The data were computed to determine the implementation outcomes based on the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework: demographics of users (Reach); conversion to in-patient consultations (Effectiveness); AODTH uptake (Adoption); defaulters, post-VC referral to emergency or specialist outpatient services, medical certification (Implementation); purpose and service utility trend (Maintenance).Descriptive statistics, Pearson’s χ2 test and regression analyses were executed to report implementation outcomes and associated factors.Setting Data were obtained from a primary care clinic (polyclinic) in eastern Singapore.Participants AODTH users aged ≥18 years who used the service between 2023 and 2024 were included. No exclusion criteria were applied.Results 39 811 AODTH VCs were completed by 17 603 unique users, including 44.4% males and Chinese (59%) and Malay (24%) ethnicity. Senior adults aged 65 years and older represented only 2.5% of users and 1.2% of VCs. Monthly VC volumes in 2024 exceeded those in 2023, with some months recording nearly double the consultation numbers and surpassing 2500 VCs in the second half of 2024. Mean default (6.6%) and conversion (2.2%) rates showed a decreasing trend from 2023 to 2024. Referrals to emergency or specialist outpatient services constituted 5.6% of VCs. Acute medical conditions accounted for 82.7% of VCs, chronic disease management 12.4% and other reasons 4.9%, with upper respiratory tract infections comprising almost half of acute cases. Over half (50.9%) of consultations were not prescribed medications, of which 72.3% were issued sick leave. 81.3% of users had two or fewer sick leave issuances, including those with none.Conclusion Although AODTH outreach to older adults was low, the service was effective for acute medical management with low in-person consultation conversion despite the lack of physical examination. The rising trends of AODTH users and VCs over 2 years reflect gradual service adoption, while low defaulter and referral rates reflect an appropriate implementation framework. Prevalent medical certification is likely the cornerstone to maintain AODTH service as a means for recovery from acute illnesses.
Fragmented care in older adults often results in duplicated testing, delayed decision-making and unclear clinical responsibility. These challenges are particularly pronounced in community and home-based primary care settings, where multiple providers contribute to care without formal coordination structures. Although comprehensive multidimensional geriatric evaluation is recommended, its complexity limits routine implementation. This article proposes a pragmatic framework integrating assessment of daily functioning, cognitive screening, mood assessment and mobility evaluation with targeted laboratory testing guided by clinical findings. A central principle of this model is clinical accountability, defined as the responsibility of the clinician who performs assessment and interprets findings to integrate diagnostic results into patient management and follow-up. In this framework, accountability refers specifically to responsibility for documenting findings, initiating appropriate follow-up evaluation and ensuring communication of clinically significant results. By linking brief multidimensional assessment, problem-oriented testing and explicit responsibility for follow-up, this practice-informed communication offers a pragmatic, adaptable approach for family physicians and community-based clinicians working in fragmented care environments. It is presented as a practice-informed proposal rather than a validated framework, consensus statement or guideline.
Objectives Radioactive iodine (RAI) is commonly administered after thyroid cancer surgery and is generally considered low risk. Its use in women of reproductive age, however, is increasingly debated. Most research has focused on cancer outcomes, fertility or short-term psychological effects, with limited attention to symptoms relevant to primary care after treatment. Evidence describing post-treatment symptom burden, mental health outcomes and primary care utilisation in this population is limited. This study examines whether RAI treatment after thyroid cancer surgery in women of reproductive age is associated with an increase in disease-related symptom burden, new mental health diagnoses and greater primary care utilisation within the first year following treatment.Methods This retrospective cohort study used the TriNetX database to compare adult women of reproductive age (18-49) with thyroid cancer who underwent thyroidectomy from 1 January 2000 to 1 January 2024 by RAI treatment status. Propensity score matching was performed to balance baseline demographic and clinical characteristics. Outcomes within 1 year included new diagnoses of fatigue and malaise, generalised anxiety disorder, depressive episodes, sleep disorders, cognitive symptoms, adjustment disorders and primary care utilisation. Standardised mean differences (SMD) compared baseline characteristics and risk differences with 95% CIs and risk ratios (RR) with 95% CIs compared outcomes between cohorts.Results Before propensity score matching, patients receiving RAI had higher prevalence of obesity (SMD 0.269), hypertension (SMD 0.189), diabetes (SMD 0.127) and mental health conditions (SMD 0.370). After matching, 10 882 patients were analysed. RAI-treated patients experienced significantly higher rates of fatigue and malaise (RR 1.239, 95% CI 1.031 to 1.490; p=0.022), depressive episodes (RR 1.344, 95% CI 1.043 to 1.732; p=0.022), sleep disorders (RR 1.281, 95% CI 1.006 to 1.630; p=0.044) and primary care visits (RR 1.476, 95% CI 1.330 to 1.638; p<0.001).Conclusion RAI treatment in women of reproductive age may be associated with increased symptom burden and primary care utilisation in the first year following thyroid cancer treatment. These findings underscore the importance of anticipatory guidance, symptom screening, coordinated survivorship care and further research to define optimal survivorship care pathways for this population.
OBJECTIVE:Osteoporosis is a major contributor to morbidity and mortality worldwide, yet underdiagnosis and undertreatment remain pervasive across diverse health systems, including Singapore's mixed public-private primary care landscape. In 2025, the Agency for Care Effectiveness (ACE), Ministry of Health, Singapore, updated its national clinical guideline 'Osteoporosis: Diagnosis and Management' to address these persistent gaps. This paper describes the development of the guideline and examines its implications for primary care using conceptual frameworks. DESIGN:The guideline was developed using a transparent, GRADE-aligned adaptation process that incorporated 10 high-quality international guidelines, local epidemiological and cost data, and formal RAND-UCLA consensus from a multidisciplinary Expert Group. SETTING:Singapore's mixed public-private primary healthcare system. PARTICIPANTS:Oversight was provided by ACE's internal team, with content expertise drawn from a 21-member multidisciplinary expert group (EG), of whom 10 members (47.6%) were practising in public and private primary care settings. The panel included primary care physicians, specialists (ie, endocrinologists, rheumatologists, geriatricians, gynaecologists, orthopaedic surgeons), nurses and pharmacists, ensuring representation across care levels and disciplines. RESULTS:The updated guideline comprises six recommendations spanning risk assessment, lifestyle optimisation, diagnostic thresholds, pharmacologic treatment and referral for complex presentations. Key adaptations include earlier case finding in men, pragmatic vitamin D guidance, locally derived treatment thresholds for osteopenia and selective use of anabolic agents for patients at very high fracture risk. Conceptual analysis using Starfield's 4Cs (comprehensive, continuous, coordinated and first-contact care) and ACE's multilevel impact model, highlighted how the guideline may strengthen primary care functions and influence policy-level, organisational-level, clinician-level and patient-level pathways. CONCLUSION:Singapore's experience illustrates how mixed health systems can translate global evidence into concise, context-appropriate primary care guidance that supports system redesign and strengthens longitudinal management of chronic disease. Five transferable lessons emerge for similar systems: targeted adaptation of international evidence, pragmatic contextualisation of recommendations to local workflows and resources, strategic use of conditional recommendations, alignment of guideline implementation with broader system reforms and anchoring of chronic disease management in primary care.
Objective To identify which chronic conditions and patient characteristics contribute to increases in the number of regularly visited facilities (RVF), a measure of polydoctoring, among adults with multimorbidity in Japan.Design Retrospective cohort study using individual fixed-effects Poisson regression models to estimate within-person associations between the onset of each chronic condition and changes in RVF. This approach controlled for all time-invariant personal characteristics. Effect modification by age, geographic region and baseline multimorbidity was also assessed.Setting A nationwide health claims database covering multiple insurance systems in Japan, including municipal National Health Insurance, Employees’ Health Insurance and the Long-Life Medical Care System.Participants 4 696 790 adults with two or more chronic conditions and two or more consecutive years of follow-up.Results The onset of examined chronic conditions was associated with changes in RVF, with substantial variation in effect size across conditions. The strongest association was observed for malignancy (RR=1.102; 95% CI 1.101 to 1.103), followed by osteoporosis (RR=1.065; 95% CI 1.064 to 1.065), arthritis (RR=1.061; 95% CI 1.060 to 1.061), obesity (RR=1.049; 95% CI 1.044 to 1.055), stroke (RR=1.044; 95% CI 1.041 to 1.048) and cardiovascular disease (RR=1.043; 95% CI 1.042 to 1.044). Associations between disease onset and RVF were consistently attenuated among individuals aged ≥75 years and those with higher baseline multimorbidity while differences between urban and rural residents were minimal.Conclusion Substantial heterogeneity was observed in the magnitude of RVF increases across chronic conditions, with particularly strong associations for malignancy, osteoporosis and arthritis. Attenuated effects among older adults and individuals with higher multimorbidity suggest that patient capacity and treatment burden may influence patterns of healthcare utilisation. These findings underscore condition-specific drivers of care fragmentation and may inform more tailored care-coordination strategies for people living with multimorbidity.
A promising integrated care approach is Panel Management, first described by Kaiser Permanente as a set of tools and processes for population-oriented care that are applied systematically at the level of a primary care panel. We aimed to develop an advanced panel management approach towards an iterative process across settings and boundaries. We define Panel Management Next Level as a structured set of tools and processes—based on medical and social needs—that are applied systematically at the level of a patient panel sharing a similar risk on adverse health events, with healthcare professionals directing proactive care for their empanelled patients. There are four iterative steps: (1) empanelment of (patient) groups that share a similar risk; (2) allocation of the appropriate intervention to each panel based on medical and social needs; (3) surveillance of care gaps and (4) effect and process evaluation. In conclusion, Panel Management Next Level is a proactive, integrated care approach which can be embedded in and across different settings. Challenges are multimorbidity, integrated information technology (IT) systems and alternative payment models. Panel Management Next Level has the potential to reach the quadruple aim of improved patient experience, improved population health and improved healthcare professional experience while reducing the costs of care.
Objective To characterise the organisational role configurations of physiotherapists in direct access (DA) models and describe how general practitioner (GP) gatekeeping for musculoskeletal (MSK) conditions is redistributed across health systems.Design Secondary qualitative content analysis of organisational descriptions reported in published DA/first-contact physiotherapy (FCP) studies, using a structured extraction matrix and Enhancing Transparency in Reporting the synthesis of Qualitative research (ENTREQ) reporting standards. Configuration dimensions were informed ex ante by gatekeeping and task-shifting frameworks; configurations themselves were identified inductively. A dimension of operationalised treatment authority was derived during revision from existing extraction-matrix fields.Setting Primary care settings across high-income health systems, including Beveridge-type (UK, Sweden), Bismarck-type (Netherlands, France) and pluralistic systems (USA), identified through a companion systematic review prospectively registered on the Open Science Framework (osf.io/897ub).Participants 19 empirical DA/FCP primary studies were eligible for the source review; 14 contained sufficient organisational detail for configuration mapping.Results Four configurations were empirically observed and a fifth was theoretically anticipated but not found. Autonomous first-contact MSK clinician models predominated (12 of 14 studies, predominantly Beveridge-type systems) and differentiated into two subconfigurations on the basis of operationalised treatment authority: front-end assessment and signposting (type 3a, 4 studies, including the National Health Service FCP programme) and full-episode autonomous management (type 3b, 8 studies). Protocol-governed triage with mandatory post hoc medical validation (type 2) and advanced practice with extended scope (type 4) were each observed as illustrative variants supported by a single study. DA redistributed rather than abolished gatekeeping.Conclusions In well-documented implementations, DA physiotherapy is most commonly configured as a first-contact model that redistributes GP gatekeeping for MSK conditions. This exploratory typology provides a framework for hypothesis generation and future primary research, particularly in under-represented Bismarck-type health systems.
Objective Early screening for autism spectrum disorder (ASD) is critical for timely intervention, making the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) a widely adopted tool globally. However, a recent systematic synthesis of its comparative accuracy is lacking. This review aimed to evaluate the screening accuracy of the M-CHAT-R/F against other ASD screening instruments.Design A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A narrative synthesis was employed to integrate findings across diverse study designs and methodological quality was assessed using the Joanna Briggs Institute checklist.Eligibility criteria Peer-reviewed, English-language observational studies published between January 2020 and October 2025 that compared the accuracy metrics of the M-CHAT-R/F with alternative screening tools.Information sources Scopus, PubMed, ScienceDirect and ProQuest.Results From 172 identified articles, six high-quality studies encompassing 12 633 participants aged 12–48 months were analysed. The synthesis revealed a complex performance profile for the M-CHAT-R/F. While its sensitivity for detecting potential cases was highly inconsistent, its negative predictive value remained consistently high, reliably identifying children who screened negative. Conversely, the tool demonstrated variable specificity and a persistently low positive predictive value, indicating a substantial false-positive burden and reduced confidence in positive results. Furthermore, the M-CHAT-R/F’s accuracy was highly age-dependent, with performance degrading outside the optimal 16–30-month window compared with other specialised tools.Conclusions The M-CHAT-R/F may not be an optimal instrument in every clinical setting. Its clinical utility may be limited by variable sensitivity and a lower positive predictive value, potentially creating a higher false-positive burden. Clinicians and health systems should consider adopting age-specific, tiered screening protocols to improve diagnostic efficiency and better allocate intervention resources.
Objective To synthesise the available evidence on the reported role of family physicians in health systems in the Americas.Design A scoping review was conducted following the methodology of the Joanna Briggs Institute. The results were grouped into thematic categories and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines.Eligibility criteria Peer-reviewed articles and relevant grey literature published between 2010 and 2025 examining the role or impact of family physicians within health systems in the Americas. Studies that did not explicitly address family physicians or lacked accessible full text were excluded.Information sources A comprehensive search was performed in PubMed, Scopus, Embase, LILACS and the Virtual Health Library (BIREME). Grey literature was identified through institutional repositories, policy reports and targeted searches of official websites.Results Of 1397 records identified, 34 studies met the inclusion criteria. Most publications were produced between 2013 and 2024 and represented diverse health system contexts across the region. The attributes most frequently associated with family physicians were comprehensiveness, accessibility, continuity of care, coordination and family and community orientation. Across multiple national settings, the included studies consistently reported that stronger integration of family physicians within primary healthcare systems was associated with improved access to services, greater continuity of care, more efficient coordination across levels of care and a more rational use of diagnostic and therapeutic resources.Conclusions Family physicians appear to represent an important component of effective primary healthcare systems in the Americas. Their integration within health services is associated with improved service accessibility, greater care continuity and more efficient resource use. Strengthening family medicine workforce capacity and its institutional role may contribute to more equitable, resilient and sustainable health systems across the region.Trial registration number Protocol registered and available on this OSF project https://osf.io/pnf2b/.
Evidence-based medicine (EBM) has standardised care by reducing variance, yet its reliance on linear, reductionist models often fails the patient in primary care, especially the multimorbid patient. Current clinical guidelines assume that biological inputs lead to predictable outputs, effectively treating the human body as a machine. However, the patient, especially the multimorbid patient, functions as a complex adaptive system, characterised by emergent behaviours where small perturbations can lead to disproportionate outcomes. This paper argues that the ‘straight-line thinking’ of current EBM is mathematically insufficient for general practice. Through clinical vignettes, we demonstrate how single-disease guidelines create unsustainable treatment burdens. Furthermore, we present a rationale for how non-linear analyses of physiological signals can predict frailty years before clinical diagnosis. We propose that family medicine must integrate soft computing methodologies—such as fuzzy logic, fractal analysis and causal inference—not as technological novelties but as the theoretical necessity required to map the non-linear topology of human health. This perspective reframes family medicine not as an exception to evidence-based practice but as the clinical setting where complexity-aware evidence is most critically needed.
Primary healthcare (PHC) plays an important role in the healthcare system, yet the shortage of qualified primary healthcare physician (PHP) restricts the quality of diagnostic and treatment services provided by PHC institutions. The rapid development and prevalence of artificial intelligence (AI) offer a solution to this challenge. Existing research primarily focused on two themes: evaluating the performance of AI tools and investigating PHPs' attitudes and use intention to such AI. There are three main modes used to evaluate the performance of AI tools: evaluation of single AI tool, comparison across different AI tools and comparison between AI tool and physicians. Confusion metrics and examination are two types of indicators primarily used to assess these products. PHPs generally hold positive attitudes and use intentions towards AI tools. According to the technology acceptance model, influential factors of PHPs' attitudes and use intention can be categorised into usefulness and ease of use. Limitations and future research directions are also discussed in this article, which provides insights for future research and practice to improve AI tools assisting PHPs in diagnostic and treatment tasks and promote AI adoption in PHC.
Objective Effectively administering person-centred care (PCC) in primary healthcare hinges on healthcare providers and their work environment embodying, endorsing and actively engaging in PCC principles. Therefore, it is crucial to investigate the extent to which person-centred practice is implemented among healthcare providers, the working environment and organisational support.Design This mixed-method cross-sectional study was conducted through a translated and validated questionnaire comprising 59 items covering three distinct domains: attributes of healthcare providers (prerequisites), the context in which care is delivered (care environment) and the extent of providing care (care processes). Associations between regions, job categories, clinic type and service year duration with the PCC practice level were analysed and stratified according to the 17 constructs. All comments from the free-text responses were thematically analysed.Setting Public primary healthcare clinics within the Malaysian central zone regions of Selangor and Kuala Lumpur-Putrajaya.Participants A total of 3800 primary healthcare providers, including family medicine specialists, medical officers, medical assistants, pharmacists, pharmacist assistants, nurses, occupational therapists, physiotherapists and dietitians.Results ‘Developed interpersonal skills’ (mean: 5.77, SD: 0.819), ‘being committed to the job’ (mean: 5.48, SD: 0.892) and ‘knowing self’ (mean: 5.44, SD: 0.990) were among the constructs with the highest scores. Meanwhile, ‘supportive organisational system’ (mean: 4.62, SD: 1.188) and ‘clarity of beliefs and values’ (mean: 4.84, SD: 0.953) had lower mean scores, suggesting areas for improvement in teamwork and organisational support. The findings also underscored significant disparities in scoring, potentially stemming from differences in work cultures and hierarchical dynamics, particularly regarding shared decision-making and inclusivity among seniority levels.Conclusion Recognising the impact of seniority, workload and diverse work cultures among different job categories, leveraging each other’s strengths can catalyse successful PCC implementations. The pursuit of instilling and implementing PCC practices calls for a comprehensive organisational transformation, emphasising the need for sustained efforts to enhance support structures and facilitate shared decision-making within healthcare organisations.
