Objective Collaborative management of medication in healthcare of older adults raises a significant concern, a population particularly vulnerable to adverse drug interactions and medication-related complications. Despite extensive research exploring this issue and proposing solutions such as training programmes and medication review protocols, inappropriate prescribing continues to be prevalent among the older population. Previous years ago, we conducted a preliminary investigation among general practitioners that identified challenges in multidisciplinary collaboration between healthcare professionals as a major contributing factor, underscoring the need for a more in-depth analysis.This study aims to examine and prioritise healthcare providers’ perspectives on the multidisciplinary management of prescribing in older adults. By considering the practical realities faced by all professionals involved, the goal is to propose innovative, collaborative approaches to optimise prescribing practices in this population.Design A qualitative, participatory approach was employed using the group analysis method.Setting The research process encompassed three distinct phases: (1) a shared analysis of prescribing challenges based on real-world experiences; (2) validation and refinement of findings through iterative discussions; (3) development of actionable strategies for improvement.Participants Thirteen healthcare professionals participated, including one general practitioner, one geriatrician, three community pharmacists, one clinical pharmacist, four independent nurses, one hospital nurse, one nurse manager from a care home and a care home medical coordinator.Results Thematic analysis revealed three core challenges in interdisciplinary prescribing management: communication failures, unclear distribution of responsibility and role ambiguity, and the complexity of the healthcare environment. ‘Operational Pressure’ emerged as a cross-cutting analytical dimension rather than a standalone theme, permeating and connecting these three challenges. Proposed solutions included: (1) establishing an intersectoral geriatric care coordinator to improve coordination between hospital and community care settings; (2) developing standardised recommendations for patient transitions across hospitals, homes and care facilities; and (3) enhancing communication frameworks among healthcare providers to streamline interdisciplinary collaboration.Conclusion This study provides a comprehensive analysis of collaborative prescribing management across home care, care homes and hospital settings. By proposing innovative strategies to strengthen interprofessional collaboration, it highlights practical solutions for improving medication management in older adults. Additionally, the findings emphasise the need for further research to assess the impact of healthcare providers’ roles and evaluate the effectiveness of an intersectoral care coordinator in optimising patient outcomes.
Objective To synthesise five purposively selected service-level primary palliative care interventions in six sub-Saharan African countries to identify the contextual barriers and facilitators and the implementation strategies employed to address them.Setting Primary palliative care studies that have taken place in sub-Saharan Africa in the last 5 years.Design We used an implementation-focused formative evaluation design involving semi-structured interviews with every site lead (n=7) supplemented by a review of study-related documentation. Data were analysed using framework analysis underpinned by the relevant constructs of the Consolidated Framework for Implementation Research.Participants Site leads from each of the five studies were interviewed.Results Facilitators to implementing primary palliative care interventions included the following: (1) the relative advantage compared with standard care (ie, person-centred approach, expansion to those with non-cancer conditions), (2) primary care worker champions within sites, (3) broad sustained engagement with policymakers, managers, healthcare workers, patients and families and (4) availability of linked healthcare records. Barriers included the following: (1) inconsistent staffing and training needs for the diverse workforce, (2) fragmented referral pathways, (3) inconsistent national and local policies and (4) physical infrastructural limitations.Conclusion Context-specific facilitators, barriers and recommendations should be considered to bolster the implementation process of future primary palliative care interventions. Advocacy is needed to ensure adequate investments in the design, equipping and staffing of primary healthcare in sub-Saharan Africa to properly support patients and their families.
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.
