Background: Accurate documentation of vital signs during triage is essential for early recognition of clinical deterioration in surgical and orthopedic patients. In high-volume rural hospitals, incomplete recording of physiological parameters may compromise patient safety. This clinical audit aimed to assess baseline documentation of vital signs during triage and evaluate the impact of a structured, low-cost intervention. Methods: A prospective clinical audit was conducted in a rural district hospital managing surgical, orthopedic, and trauma patients. Adult patients undergoing routine triage in outpatient and emergency departments were included. Five vital signs were audited: pulse, blood pressure, temperature, respiratory rate, and oxygen saturation (SpO2). Baseline data were collected for 250 consecutive patients. A structured intervention consisting of a triage checklist, reminder posters, and brief staff education was introduced. A reaudit was performed for 250 consecutive patients using identical methodology. Documentation rates were compared using Chi-square testing. Results: Baseline documentation rates were highest for pulse (72%) and blood pressure (75.2%), while respiratory rate was least frequently recorded (40%). Following intervention, documentation improved significantly across all parameters, including pulse (96%), blood pressure (97.2%), temperature (92%), respiratory rate (84.8%), and SpO2 (90%) (P < 0.001 for all comparisons). Complete documentation of all five vital signs increased from 32% at baseline to 79.2% following intervention. Conclusion: Implementation of a structured triage documentation checklist significantly improved recording of vital signs in a resource-limited rural hospital. Low-cost workflow interventions may enhance patient safety and support standardized triage practices across primary care and district hospital settings.
Introduction: During the COVID-19 delta wave, healthcare systems in India were overwhelmed, necessitating large-scale home-based management. Standard domiciliary kits primarily focused on symptomatic relief, with limited attention to key pathophysiological mechanisms such as early inflammation and COVID-associated coagulopathy. This study evaluated clinical outcomes associated with a pathophysiology-informed home-care regimen. Methodology: A prospective observational study was conducted in a primary care setting in Andhra Pradesh, India, during April–May 2021. Sixty consecutive adults with mild severe acute respiratory syndrome coronavirus 2 infection received a home-care regimen comprising aspirin (150 mg daily for 28 days), along with prednisolone (10 mg twice daily) and azithromycin (250 mg twice daily) for 7 days. Outcomes were compared with 60 contemporaneous family-member controls managed at government facilities using standard care (doxycycline, ivermectin, and paracetamol). Patients were followed up virtually for 14 days. Primary outcomes included symptom resolution and hospitalization. Results: In the study group, 59/60 (98.3%) patients achieved symptom resolution within 7 days, with 1 (1.7%) requiring hospitalization. In the control group, 8/60 (13.3%) required hospitalization due to worsening hypoxemia (odds ratio: 0.11, 95% confidence interval: 0.01–0.91; P = 0.02). Persistent symptoms at day 14 were less frequent in the study group (13.3% vs. 63.3%; P < 0.001). Conclusions: This observational study documented differences in clinical outcomes during the delta wave. However, selection bias, use of family member controls, and nonrandomized design limit causal inference. These findings reflect crisis-era clinical decision-making and do not support deviation from current evidence-based guidelines.
Background: The existing ST-segment elevation myocardial infarction (STEMI)-non-ST-STEMI (NSTEMI) classification often overlooks patients with total occlusion who do not meet the STEMI criteria on electrocardiography (ECG). This study primarily examines patients who initially presented with NSTEMI but were found to have a total occlusion upon early angiography, and explores the correlation between their ECG findings and the angiographic results. Materials and Methods: This is a prospective observational study carried out in the Department of Medicine at JIPMER from April 2023 to June 2024. The study involved patients admitted with a diagnosis of NSTEMI in either the medicine or cardiology departments. Following a comprehensive clinical examination, patients underwent angiography, and the proportion of patients with total occlusion was determined. In addition, their ECG findings were correlated. Results: 33.66% of patients were diagnosed with occlusion myocardial infarction (OMI) based on coronary angiography within 96 h. The majority were male (79.4%) with an average age of 55.15 years. Of the 34 OMI patients, 41.2% showed ECG indicators, but the sensitivity and specificity were 41.17% and 68.65%, respectively. The most common vessel affected by total OMI was the right coronary artery (RCA; 41.2%), followed by the left circumflex artery (LCx; 26.5%), with the inferolateral wall being most often involved. Intervention occurred in 20.58% of OMI patients and 32.83% of non-OMI patients. Conclusion: The study found a significant number of acute coronary syndrome-NSTEMI patients with OMI, where elevated troponin levels were more common. The RCA and LCx were the most frequently affected vessels, with the inferolateral wall often involved. ECG indicators showed low sensitivity and specificity for detecting OMI.
Background: Transfusion-dependent hemoglobinopathies such as β-thalassaemia major and sickle cell disease require lifelong or recurrent blood transfusions, predisposing patients to progressive iron overload and multi-organ complications. In resource-limited settings, inadequate monitoring and poor chelation adherence contribute substantially to morbidity and healthcare burden. Aim and Objectives: To estimate the prevalence and severity of posttransfusion iron overload and to evaluate its association with systemic complications and direct medical costs among transfusion-dependent hemoglobinopathy patients in central India. Materials and Methods: A hospital-based analytical cross-sectional study was conducted over 2 years (May 2019–April 2021) at a tertiary care teaching hospital in central India. A total of 456 transfusion-dependent patients with β-thalassaemia major or sickle cell disease were included. Iron overload was defined as serum ferritin ≥1000 µg/L in the presence of normal C-reactive protein and categorized as mild (1000–2499 µg/L), moderate (2500–4999 µg/L), or severe (≥5000 µg/L). Hepatic, endocrine, cardiac, and renal complications were assessed using clinical and laboratory parameters. Multivariable logistic regression analysis was performed to identify factors independently associated with systemic complications. Results: Iron overload was present in 427 patients (93.6%), with 315 patients (69.0%) demonstrating moderate-to-severe overload. Severe iron overload was more common among patients with β-thalassaemia major than sickle cell disease. Hepatic dysfunction, diabetes mellitus, cardiac abnormalities, and renal impairment were observed in 35.5%, 10.3%, 19.3%, and 11.4% of patients, respectively. Increasing iron overload severity showed significant graded associations with all major systemic complications. Severe iron overload independently predicted hepatic dysfunction (aOR]4.8; 95% CI: 2.9–7.9), diabetes mellitus (aOR 3.2; 95% CI: 1.7–6.0), cardiac abnormalities (aOR 2.7; 95% CI: 1.6–4.5), and renal impairment (aOR 2.3; 95% CI: 1.3–4.1). Irregular or absent chelation therapy was consistently associated with higher complication risk. Median 6-month direct medical costs increased progressively from INR 32,000 in patients with no/mild overload to INR 78,000 in those with severe overload. Conclusion: Posttransfusion iron overload is highly prevalent among transfusion-dependent hemoglobinopathy patients in central India and is strongly associated with significant hepatic, endocrine, cardiac, and renal morbidity, along with increased healthcare costs. Early detection, routine ferritin-based monitoring, and improved long-term chelation adherence are essential to reduce preventable complications and healthcare burden in resource-limited settings.
Background: Diabetes is a chronic progressive disease with potential complications. Effective management requires lifestyle modification and active patient self-care along with medical therapy. This study assessed self-care practices among diabetic patients attending a primary care center in Chennai. Methods: A cross-sectional study was conducted at an Urban Primary Health Centre in Chennai, Tamil Nadu. A total of 196 diabetic patients (age >30 years, diabetes duration d6 months) were enrolled. The patients with end-stage complications were excluded. A locally adapted, Tamil-translated questionnaire covering diet, physical activity, medication adherence, foot care, and blood-glucose monitoring was administered. Mean scores were calculated for each self-care domain, and adherence was compared across demographic subgroups using Student’s t-test. Results: Adherence was highest for blood-glucose monitoring (98.5%) and medication use (97.5%). Dietary adherence was low. Only 39.8% spaced meals appropriately, 27.0% consumed recommended fruits/vegetables, and 61.0% did not include high-fiber/high-protein foods. Educated participants had significantly better dietary adherence than uneducated ones. Seventy-five percent reported ≥30 min of routine physical activity daily, with males and externally employed participants significantly more active (P = 0.03). Foot care adherence was moderate. 90.3% used footwear, 69.9% examined their feet daily, but 13.8% did not check the inner part of their footwear. Conclusion: Among diabetic patients at this primary care center, adherence was highest for medication and blood-glucose monitoring, moderate for physical activity and foot care, and lowest for diet. Adherence to diet was higher among males than females. Educated participants adhered to the diet better than uneducated participants. Males and externally employed individuals were more physically active. Targeted interventions are needed to improve diet and foot care practices in this population.
Preventive health care remains underutilized in India despite its proven benefits in reducing morbidity, mortality, and healthcare costs. With rising chronic diseases such as diabetes and cardiovascular conditions, the urgency for proactive health management has never been higher. Yet, societal apathy, lack of awareness, infrastructural gaps, and low perceived value hinder its adoption. Many prefer curative over preventive care, viewing regular checkups as unnecessary unless symptomatic. The undervaluation of Preventive and Social Medicine (PSM) (Syn. Community Medicine) within medical education and society further compounds the issue, discouraging future healthcare professionals from pursuing this specialty. Complex health systems, cost concerns, and limited motivation also prevent timely screenings and lifestyle modifications. A shift toward preventive-focused public policies, stronger health insurance integration, better public awareness, and greater recognition of PSM professionals is imperative. India must reorient its healthcare paradigm – valuing prevention as much as cure – to safeguard public health and ensure sustainable outcomes.
Background: There is no head-to-head trial comparing rosuvastatin 5 mg and atorvastatin 20 mg for the treatment of dyslipidemia. There is considerable cost difference between the two therapies and in a country where out-of-pocket expenditure is high, we plan to compare the safety, efficacy, and cost-effectiveness of rosuvastatin 5 mg and atorvastatin 20 mg in patients with dyslipidemia. Materials and Methods: We compared rosuvastatin 5 mg (n = 33) with atorvastatin 20 mg (n = 31) in adult (>18 years), newly diagnosed, treatment naive patients visiting medicine outpatient department who are eligible for statin therapy. Both the drugs were administered once daily. Lipid profile was done at baseline and after 6 weeks of therapy. The primary efficacy endpoint was the percentage change from baseline low-density lipoprotein cholesterol (LDL-C) levels after 6 weeks. Results: Sixty-four patients completed the study. Both treatments resulted in a significant reduction from baseline in LDL-C, total cholesterol (TC), and triglycerides (TGs). The percentage reduction in TC, LDL-C, and TGs was 27%, 37%, and 21% in rosuvastatin group as compared to 30%, 39%, and 25% in the atorvastatin group, respectively. Cost-effectiveness analysis showed that atorvastatin costs twice as that of rosuvastatin for the same amount of benefit. Conclusions: The study found both the treatments are comparable in terms of safety and efficacy. The higher cost-effectiveness of rosuvastatin 5 mg as compared to atorvastatin 20 mg, makes the former preferred initial treatment of dyslipidemia.
Context: Noncommunicable diseases (NCDs), especially diabetes and hypertension, pose a rising public health concern in India, disproportionately affecting low- and middle-income countries. Aim: Project Jagriti implemented a structured community-based intervention across 15 districts of India to generate awareness, early detection, and adoption of healthier behaviour related to NCD prevention and management. Subjects and Methods: We employed quantitative cross-sectional studies to evaluate the effectiveness of the intervention through baseline and endline data collection conducted on independent random samples to assess the change in awareness, knowledge, and practices of adults (above 35 years). We surveyed 2525 participants at the baseline and 3030 at the end line. Results: The findings reported a significant dose-response relationship between participation in Jagriti sessions and improved knowledge scores and health practices, such as regular health checkups and monitoring of salt intake. Structural equation modelling showed that higher education and participation in the intervention group were significantly associated with higher knowledge scores, which in turn were linked to improvements in diet, physical activity, salt intake, and health check-ups. Conclusions: Project Jagriti led a community-based, culturally-relevant intervention that can drive meaningful improvements in NCD-related awareness and behaviours. Scaling up of such models is important for improving India’s NCD control goals and achieving SDG targets.
Background: Excessive screen time is a serious condition which is effects on health and leads to various physical and mental health problems, especially in adolescents. Now a days common health issues related to Excessive screen time is like sleep disturbances, behavioral problems, anxiety, depression,poor academic performances etc. and finally lead to increase the risk of cardiovascular diseases. Aim: To assess the effect of screen time among MBBS students and its correlation with sleep quality and mental health. Methodology: An institution based cross-sectional study was conducted among undergraduate MBBS students in Government Medical College Srikakulam, Andhra Pradesh. A total of 200 students were recruited in this study by simple random sampling, and data were collected through interview basis. Results: This study found that, majority of the participants (47%) were belonged to age between 19 and 20 years, followed by 35% of the participants were between 21 and 22 years. The mean age of the study participant was 20.17 ± 1.37 years. Pittsburgh Sleep Quality Index scale, in which good quality of sleep was found highest among 1st-year MBBS students (33.3%), followed by 3rd-year MBBS students (28.7%) and poor sleep quality was maximum among final-year MBBS students (30.97%), followed by 2nd-year MBBS students (28.31%). Moreover, according to DASS-21 scale, the overall prevalence stress was 26.5%, anxiety was 44.5%, and depression was 39%. Conclusions: This study found that those who are spent screen time >4 h showed mild-to-moderate stress, anxiety, and depression according to DASS-21 scale. Hence, it is very important information to create awareness among the students on the negative effect of screen time on their mental health.
Strengthening the quality of primary care services is central to achieving the targets set under Sustainable Development Goal 3. In India, primary health centers (PHCs) serve as the first point of contact for basic healthcare services; however, the extent and focus of evidence-based quality improvement (QI) initiatives within the PHCs remain unclear. This scoping review aims to study the landscape of QI initiatives operationalized in Indian PHCs and identify existing gaps in the literature to strengthen primary care. The study was conducted using Arksey and O’Malley framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. MEDLINE, Embase, and Google Scholar were searched using predefined keywords for studies describing QI interventions in Indian PHCs. Studies conducted in referral facilities or private settings were excluded. Data were extracted using the Epicollect-5 software and synthesized using a logic framework aligned with the World Health Organization health system building blocks and Universal Health Coverage dimensions. Of 769 records screened, 12 studies met the inclusion criteria. Half of the initiatives focused on maternal and child health, while less than a tenth addressed noncommunicable diseases. Rapid-cycle methods were used in half of the studies. All interventions addressed governance and leadership, whereas less than a fifth focused on health financing. Reported outcomes predominantly reflected improvements in effectiveness, with limited attention to efficiency. Structured QI initiatives in Indian PHCs remain limited in number, with most focusing on maternal and child health. Thus, this study highlights the need to broaden efforts to include efficiency, financing, and noncommunicable disease care in QI practices across Indian PHCs to strengthen primary care.
Introduction: Globally, commercial determinants of tobacco play a substantial role in influencing tobacco usage. This context remains underexplored, particularly in remote regions such as western Rajasthan, located in the arid Thar Desert. Therefore, this study was conducted to explore how these commercial factors influence tobacco use in this part of Rajasthan, with the goal of informing policy interventions. Methodology: A cross-sectional study was conducted for stakeholder mapping across the tobacco supply chain and associated influencers in western Rajasthan. We identified and categorized stakeholders along a power–interest (PI) matrix before seeking out the views of policymakers, health professionals, nongovernmental organizations (NGOs), industry, enforcement officers, educators, and consumers via semi-structured interviews. Thematic analysis was conducted to extract key themes among: accessibility, affordability, marketing strategies, regulation loopholes, and public health concerns. Results: Direct and indirect stakeholders were identified through an analysis of the tobacco supply chain. Stakeholder analysis using a PI matrix revealed diverse perspectives and roles influencing tobacco use in western Rajasthan. High-power, high-interest stakeholders such as government health departments and enforcement agencies were actively engaged but faced industry lobbying and enforcement challenges. High-power, low-interest groups such as manufacturers and large traders resisted stronger controls due to economic interests. Low-power, high-interest stakeholders – NGOs, educators, and frontline health workers – were dedicated to awareness and behavior change but limited by cultural norms and misinformation. Small retailers and consumers (low power and low interest) contributed to persistent demand, often unaware of manipulative marketing. Media actors were found to both support cessation and indirectly glamorize tobacco use. Conclusions: The study’s insights highlight an urgent need to address and further study the commercial determinants of tobacco use, contributing to more effective tobacco cessation in western Rajasthan.
Background: Healthcare workers form the backbone of any functioning healthcare system. This group includes not only the professionals but also the support healthcare workers. Stress among the latter can significantly impact the quality of care provided to the patients. Therefore, it is essential to recognize the level of stress experienced by support healthcare workers, along with the factors that contribute to it within healthcare facilities. Objectives: The objective of this study was to assess the level of stress and its determinants among the support healthcare workers in a tertiary care hospital and to determine the impact of stress on their health. Materials and Methods: A cross-sectional study was conducted over a period of 3 months, from October to December 2023, among three categories of support healthcare workers. The level of stress was measured using the Perceived Stress Scale-10. Data on sociodemographic characteristics, habits, and health problems were collected using a pre-structured questionnaire. Data analysis was performed using SPSS software. Results: The prevalence of low, moderate, and high perceived stress was 19.8%, 74.6%, and 5.6%, respectively. The participants with age 30 years and below have 96% less chances of having stress than compared to the participants above 30 years old (odds ratio [OR]: 0.04 [0.012–0.132], P < 0.001). The participants who skip breakfast have 5.11 times higher odds of having stress compared to the participants who eat breakfast (OR: 5.11 [1.521–17.146], P = 0.008). Conclusion: Around three-fourth of the participants perceive a moderate level of stress. Extending stress management programs to the support healthcare workers helps in the effective delivery of health care to the patients.
In India, tobacco use is highly prevalent, yet evidence on nicotine dependence (ND) and its severity across the demographic groups are limited. This protocol outlines the approach to estimate the pooled prevalence and severity of ND among the tobacco users in India, stratified by age, gender, region, tobacco type, and rural–urban setting. This review was registered in PROSPERO (CRD420251133993) and follows Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 guidelines. We will do a literature search in the following database: PubMed, Cochrane Library, Embase, and Scopus, along with gray sources. Both community-based and hospital-based studies that assessed ND using any validated questionnaire, including but not limited to the Fagerström Test for Nicotine Dependence (FTND) or FTND-ST (Smokeless Tobacco) will be included. The study selection, data extraction, and risk-of-bias assessment (Newcastle–Ottawa Scale) will be done by two independent reviewers, and disagreements will be resolved through discussion or by a third reviewer. The pooled prevalence will be estimated using a random-effects model with 95% confidence interval. Planned subgroup and sensitivity analyses will be conducted. Publication bias will be assessed using deviation from expected inverse variance plots, quantified by the Luis Furuya–Kanamori index (±1 indicating no asymmetry and >±2 indicating major asymmetry). The certainty of evidence will be evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach. This review may address a key evidence gap by generating pooled estimates of ND and its severity among tobacco users in India and also support policymakers, public health professionals in strengthening tobacco control measures, enhancing cessation services, and designing targeted interventions supporting Sustainable Development (SDG) Goals 3 and 3.a to reduce premature noncommunicable disease mortality.
Background: Preterm neonates are vulnerable to brain injury due to immature cerebral autoregulation and fluctuating cerebral blood flow (CBF). Kangaroo mother care (KMC) has emerged as a potential neuroprotective intervention beyond its established benefits in thermoregulation and growth. Objective: The objective of this study was to evaluate the effect of KMC on cerebral hemodynamics in stable preterm neonates using Transcranial Doppler Sonography (TCDS) of the middle cerebral artery (MCA). Materials and Methods: This prospective interventional study was conducted at a Level 3 neonatal intensive care unit from March 2023 to September 2024. Fifty-seven hemodynamically stable preterm neonates (28 0/7–36 6/7 weeks’ gestational age) underwent TCDS assessment of MCA parameters and physiological monitoring at three time points: pre-KMC, at 60 min of KMC, and 60 min after stopping KMC. CBF parameters, including peak systolic velocity (PSV), end-diastolic velocity (EDV), mean velocity (MV), resistive index (RI), and pulsatility index (PI), were measured alongside vital signs. Results: The study included 31 males (54.4%) and 26 females (45.6%) with a mean gestational age of 34.03 ± 2.67 weeks and birth weight of 1.87 ± 0.50 kg. During KMC, significant improvements were observed: PSV increased from 45.04 ± 2.26 to 46.78 ± 2.23 cm/s (P < 0.0001), EDV from 11.05 ± 1.14 to 12.26 ± 1.15 cm/s (P < 0.0001), and MV from 22.38 ± 1.49 to 23.77 ± 1.45 cm/s (P < 0.0001). Resistance indices decreased significantly: RI from 0.76 ± 0.01 to 0.74 ± 0.02 (P < 0.0001) and PI from 1.52 ± 0.06 to 1.46 ± 0.06 (P < 0.0001). Heart rate decreased (147.81 ± 9.13–142.42 ± 7.71 bpm, P < 0.0001), whereas peripheral oxygen saturation increased (94.75 ± 2.35–96.00 ± 2.16%, P < 0.0001). Strong positive correlations were found between gestational age, birth weight, and cerebral flow parameters. Conclusions: KMC significantly improves cerebral hemodynamics in stable preterm neonates by enhancing CBF velocities and reducing vascular resistance. These findings support the integration of KMC as a neuroprotective strategy in neonatal intensive care, particularly in resource-limited settings.
Background: Complications of type 2 diabetes mellitus (T2DM) significantly contribute to morbidity and mortality, especially in the resource-limited settings. Awareness of these complications is the key to effective prevention and management. The objective of the study is to assess the knowledge and awareness of diabetic complications among T2DM patients and to identify sociodemographic factors associated with awareness levels. Materials and Methods: A cross-sectional study was conducted from September to November 2024 among 100 T2DM patients aged ≥18 years, with at least 1 year of diagnosed diabetes, attending a tertiary care hospital in Krishna district. Data were collected using a structured questionnaire and analyzed using the SPSS v29. Results: The majority were aged 51–60 years (34%), male (56%), and from rural areas (78%). Only 53% had good glycemic control. Retinopathy (40%) and peripheral neuropathy (38%) were the most reported complications. Awareness was the highest for retinopathy (63%) and lowest for stroke (25%). Awareness of preventive measures such as diet (74%), exercise (73%), and smoking cessation (64%) varied significantly based on family history and blood sugar control. Conclusions: Despite high medication adherence, awareness of certain complications remains inadequate. Targeted educational strategies are needed, especially in rural and lower-literacy populations, to improve diabetic outcomes.
Background: Diversity in the diet is recommended by public health nutritionists for promoting an optimal diet, and it also reflects the three pillars of food security: availability, utilization, and accessibility. In India, there are a very limited number of studies focusing on dietary diversity. Objectives: The present study was conducted to study dietary diversity (through adequate dietary diversity [ADD] score) and its determinants among the adult population (20–59 years) of the Agra district. Materials and Methods: A community-based cross-sectional study was conducted between August 2023 and December 2023 in the field practice area attached to urban health training center under the department of community medicine. A validated questionnaire of diet diversity by Food and Agriculture Organization was utilized for the calculation of dietary diversity score (DDS), which also included information about sociodemographic variables. Data Analysis was performed using Epi Info™, version 7.2. and Jamovi software Version 2.4.14. Results: The mean dietary diversity score (DDS) for the study population from the nine food groups was 4.07 ± 0.95. Only 34% of respondents had ADD, i.e., score more than 5. The most common food groups consumed by the participants were oils and fats (100%), followed by starchy staples (99.5%) and other fruits and vegetables (70%). SES, education, and occupation have a significant association with ADD. Conclusion: The findings of this study emphasize the need for targeted public health interventions and policies to improve dietary diversity, particularly among lower socioeconomic groups, to ensure better nutrition and health outcomes.
Opposition to the integration of family medicine in India has persisted despite decades of global evidence, national scholarship, and statutory recognition supporting its central role in effective health systems. This study presents a chronologically grounded analysis of the intellectual, policy, educational, and legislative developments that collectively undermine arguments against the family medicine specialty. Beginning with late 20th-century health systems research that established primary care as a cornerstone of equitable and cost-effective health care, the analysis traces subsequent global policy endorsements, medical education reforms, and comparative international evidence demonstrating the indispensability of trained family physicians. Indian academic discourse and health system experience further highlight the systemic consequences of neglecting generalist clinical practice, including fragmented care, overcrowded tertiary facilities, and workforce maldistribution. The enactment of the National Medical Commission Act represents a decisive statutory affirmation of family medicine’s legitimacy and necessity. When examined in this chronological context, resistance to family medicine in India emerges not as an evidence-based position but as a manifestation of institutional inertia, specialist-centric bias, and implementation failure. The study concludes that integrating family medicine is essential for strengthening primary care, improving system efficiency, advancing equity, and fulfilling national policy and legislative commitments.
