Abstract Background Shared decision making (SDM) is a core element of patient-centred care, aligning treatment decisions with patients’ preferences and values. Primary care clinical pharmacists (PCCPs) are well positioned to support SDM within interprofessional teams. This study examined patients’ experiences of SDM with PCCPs in British Columbia's Pharmacists in Primary Care Network (PCN) Program and factors associated with those experiences. Methods A cross-sectional survey was distributed to patients who completed an appointment with a PCCP between May 2022 and September 2023. Those who reported that a decision was made about their care completed the nine-item Shared Decision Making Questionnaire (SDM-Q-9). Linear regression with Box–Cox transformation identified demographic, psychological, and clinical factors associated with SDM-Q-9 scores. Subgroup analyses were conducted by age and appointment type. Results Of the 2714 patients invited, 823 responded, 630 were eligible, and 604 completed the SDM-Q-9. The median total score was 77.8 (IQR 62.2–91.1), indicating moderately strong agreement that SDM occurred. Unadjusted analyses showed higher SDM scores among patients aged <65 and those with in-person appointments. In adjusted models, demographic and clinical factors explained little variance (adjusted R2 = 0.05), whereas psychological factors—such as expectations of the PCCP, understanding of medications, motivation to engage with community pharmacists, and overall experience—accounted for most variance (final adjusted R2 = 0.39). Conclusion Patients reported high levels of SDM with PCCPs. Experiences were driven mainly by perceptions and beliefs rather than demographics or clinical complexity, suggesting PCCPs engage patients equitably and strengthen collaborative medication decision making.
Abstract Background Female urinary incontinence (UI) affects one in three women and is frequently managed suboptimally. The app-based treatment URinControl demonstrated cost-effectiveness. However, implementation in Dutch primary care is limited. This study aimed to identify key barriers to implementation and develop strategies to support the uptake of URinControl in primary care settings. Methods We conducted a cross-sectional survey among Dutch general practitioners (GPs), community pharmacists, and supporting personnel working in general practice or local pharmacies. Barriers were identified using the Consolidated Framework for Implementation Research (CFIR). Potential implementation strategies were selected using the CFIR–Expert Recommendations for Implementing Change (ERIC) matching tool. Results A total of 174 healthcare professionals completed the questionnaire. Key barriers from both GP and pharmacy perspectives included doubts about the relative advantage of the app, limited knowledge of urinary incontinence and the app, organizational constraints, and limited digital skills among patients. In pharmacies, additional barriers included limited opportunity to discuss UI and concerns about financing. Based on these findings, five implementation strategies were developed. Interpretation Effective implementation of an evidence-based digital app for urinary incontinence in primary care requires improved awareness, knowledge, and support for healthcare professionals, as well as better structural integration of digital health tools into routine practice. Broader policy and societal shifts toward acceptance of eHealth are also needed. We also translated barriers into five tailored, theory-informed strategies addressing clinician education, patient engagement, workflow integration, financing, and collaboration between general practice and community pharmacy settings across the Netherlands in routine care implementation.
Abstract This is an overview of how information theory offers a rigorous and intuitive framework for understanding diagnostic reasoning in primary care. Primary care clinicians frequently encounter patients early in their illness trajectory, when symptoms are vague, evolving, or non-specific, creating high diagnostic uncertainty. Information theory, through its core concepts of entropy, information content, and information gain, provides a structured way to quantify this uncertainty and understand how it changes as new clinical information is gathered. Entropy reflects the uncertainty associated with the breadth of the differential diagnosis; information content captures how surprising or discriminating a finding is; and information gain describes how much a particular question, sign, or test reduces uncertainty. Applied to the consultation, these principles explain why rare but specific features are disproportionately informative, why sequences of low-yield tests may add little value, and how targeted history-taking can outperform broad investigation. The framework complements Bayesian reasoning, hypothetico-deductive approaches, and intuitive pattern recognition by clarifying the informational value that underpins each. Through clinical examples, the paper illustrates how information theory sharpens diagnostic strategy, supports efficient use of investigations, and helps clinicians navigate uncertainty with greater clarity and safety. Ultimately, it positions diagnosis as a scientific process of uncertainty reduction central to primary care practice.
Abstract Background Polypharmacy and complex medication regimens are common in home healthcare; however, their impact on physicians’ perceived burden remains unclear. This study examined the associations of polypharmacy and medication regimen complexity with physicians’ perceived burden in home healthcare. Methods A cross-sectional study was conducted at seven home care support clinics and hospitals in Japan. Physicians completed a self-administered questionnaire for patients aged ≥18 years who were receiving home healthcare. Linear mixed-effects models were used to examine the association between the number of medications (categorized into three levels), medication regimen complexity index-Japanese (MRCI-J) scores (categorized into quartiles), and physicians’ perceived burden (assessed using a 0–100 mm visual analog scale), with physicians treated as a random effect. Results Data were collected from 506 patients, of whom 503 were included in the analyses. The mean patient age was 82.4 years, and the median number of medications was six. The mean score for the physicians’ perceived burden was 33.6 mm. Excessive polypharmacy and the highest MRCI-J quartile were significantly associated with greater physician burden even after adjustment for covariates (regression coefficient = 8.20, 95% confidence interval (CI): 4.07–12.33; regression coefficient = 7.84, 95% CI: 3.61–12.07, respectively). Conclusions In home healthcare, excessive polypharmacy and complex medication regimens were significantly associated with increased physician burden. These findings underscore the potential benefits of optimizing pharmacotherapy through interprofessional collaboration with community pharmacists to reduce physician workload. Further research is required to identify effective interventions for mitigating this burden. Clinical trial registration: UMIN000056282.
Abstract Background Continuity of primary care is central to older adults’ health and wellbeing, but entry into long-term care can disrupt established care relationships. Objectives This study aimed to characterize how continuity of care evolves across the transition into long-term care and the post-entry period, comparing facility-based and home-based care, with analyses stratified by metropolitan and non-metropolitan location. Methods A national cohort study of Australians aged ≥65 who entered long-term care in 2019 and had at least three primary care visits within 6 months was conducted. Transitional continuity was defined by whether individuals continued seeing their pre-entry provider. Post-entry continuity was measured using the Usual Provider Index. Cohort differences were examined using regression models. Results Among 69 081 entrants (home-based = 27 915; facility-based = 41 166), 72% of those entering facilities changed to a new provider, compared with 10% in home-based long-term care, p < .001. In facility-based long-term care, switching to a new provider was more common in metropolitan areas than in non-metropolitan areas. Post-entry continuity was high in both settings, with 78%–80% of visits delivered by a usual provider. Conclusions Entry into facility-based long-term care substantially disrupts established primary care relationships, but continuity is rapidly re-established after entry. The greater disruption observed in metropolitan areas suggests that factors beyond relocation, such as primary care availability and delivery models, shape transitional continuity. These findings identify long-term care entry as a key intervention point while indicating that post-entry care models effectively consolidate continuity.
