Abstract Aim: To map publication growth, collaboration, knowledge structure, and thematic change in artificial intelligence (AI) research in primary health care (PHC) and general practice and assess whether attention has expanded from model development to validation, implementation evaluation, and governance. Background: PHC AI research covers risk stratification, screening, diagnostic support, clinical decision support, and workflow optimization. However, publication growth and changing hotspots do not directly indicate clinical implementation or practical value. Methods: Web of Science Core Collection was searched for AI- and PHC-related records published from 1 January 2015 to 19 October 2025. Of 1,481 records, 1,261 articles and review articles were screened using titles, abstracts, and author keywords, Python-developed term lexicons, weighted scoring, and manual adjudication. Records lacking a specific PHC application, focused on public or consumer health, or insufficiently relevant were excluded. The main sample included 1,123 papers for bibliometric, collaboration, thematic, citation, and bibliographic coupling analyses. A supplementary search identified 599 candidates to assess omissions due to terminological variation; 142 remained after 457 exclusions and were added to form a 1,265-paper sensitivity corpus used only for keyword-frequency, co-occurrence, and annual trend reruns. Annual output was assessed for 2015 to 2024; 2025 was retained as an incomplete-year observation but excluded from complete-year comparisons. Findings: Annual output rose from 6 papers in 2015 to 220 in 2024 and increased continuously after 2018. Sensitivity analyses confirmed a stable thematic structure centred on AI, machine learning, PHC, electronic health records, screening and diagnosis, with overall increases in standardized AI- and PHC-term frequencies. Bibliographic coupling identified multiple application settings and model-evaluation topics. Model validation became more common; implementation/workflow remained visible, governance/regulation emerged after 2018, and fairness/bias and explainability were more prominent from 2022 to 2024. These findings indicate broader research attention, but do not demonstrate routine AI use or improved clinical outcomes.
Abstract Objectives: To assess the association of the doctor–patient relationship with adherence to treatment (AT) and lifestyle recommendations in patients with multimorbidity. Design: Multicentre, descriptive, cross-sectional study. Setting: Primary care. Participants: 202 patients diagnosed with two or more chronic pathologies, from 23 health centres. Interventions: Self-administered questionnaires validated in our setting: Therapeutic Adherence Scale (EAT, for its acronym in Spanish) and perception of doctor–patient relationship (PREMEPA questionnaire). Descriptive, bivariate analysis, and multivariate modelling (log-linear analysis). Main outcomes measures: Categorical adherence score according to the Therapeutic Adherence Scale (EAT) and categorical doctor–patient relationship score according to the Physician-Patient Relationship Perception Questionnaire (PREMEPA questionnaire). Results: 56.1% of the patients were women and 67% were over 60 years of age. Adherence was high in 52.2%, with very high adherence in 42.8%. Adequate doctor–patient relationship was reported by 86.6% of patients. There was a statistically significant but weak association (Cramer’s V = 0.182) between doctor–patient relationship and adherence ( p < 0.05), with a higher degree of relationship found in women and those over 60 years of age. Generalized linear statistical analysis showed a significant model with a positive association between AT and empathy, courtesy, patient participation in decision-making and return. Conclusions: Adequate doctor–patient relationship was associated with greater adherence to treatment. Empathy was the component of doctor–patient relationship that showed the strongest association with adherence. Courtesy and patient participation are favourable factors for adequate adherence.
Abstract Aims: This study aimed to examine the associations among complication risk perception, gender role stress, and symptom management self-efficacy in patients with Type 2 diabetes mellitus and to identify factors associated with these constructs. Methods: This analytical cross-sectional study was performed at the endocrinology outpatient clinic of a hospital. The sample consisted of 500 Type 2 DM patients (250 women, 250 men). Study data were gathered through the Individual Information Form (IIF), Risk Perception Survey–Diabetes Mellitus Scale (RPS-DM), Symptom Management Scale for Self-Efficacy (SMSSE), Feminine Gender Role Stress Scale (FGRSS), and Masculine Gender Role Stress Scale (MGRSS). The data were analyzed using the Mann–Whitney test, Kruskal–Wallis H test, Spearman correlation coefficients, and binary logistic regression. Results: It was determined that both in women and men, it was found that as gender role stress increased, composite and environmental risk perceptions increased, and symptom management self-efficacy decreased ( p < 0.001). According to logistic regression analysis, when risk knowledge increases in women, self-efficacy will increase (OR: 0.595), and composite risk perception will decrease (OR: 7.377). When composite risk perception increases in men, self-efficacy will decrease (OR: 16.933). Conclusions: Complication risk perception and gender role stress were associated with symptom management self-efficacy among patients with Type 2 DM, with these associations differing by sex. Future interventional studies are needed to determine whether addressing these factors improves symptom management for self-efficacy. The findings may also help nurses recognize sex-specific differences when planning individualized patient care.
Abstract Aim: To describe and understand areas of concordance and discordance between the perceptions and experiences of family physicians and policymakers regarding the implementation and use of virtual care within the Nova Scotian primary care system. Background: COVID-19 brought rapid change to primary care delivery and accessibility. Virtual care rapidly expanded, facilitating primary care access amidst public health restrictions. Health systems leaders facilitated access to virtual care, developed and implemented guidelines, and created new billing codes. Providers integrated virtual care and operation changes into practice. Methods: Semi-structured interviews with family physicians ( n = 20), policymakers ( n = 9) and a family physician/policymaker ( n = 1) were conducted to understand virtual care implementation and outcomes in Nova Scotia, Canada, identifying benefits and challenges. Findings: All participants discussed patient confidentiality concerns, overreliance potential, and virtual care to promote patient care access. Family physicians discussed provider privacy and burnout. Policymakers discussed virtual care increasing capacity for accepting new patients and challenges evaluating virtual care billing codes. Providers and policymakers shared concerns and policy directions for development and expansion of virtual care. As there is little research from policymaker perspectives on virtual care, reconciling these viewpoints is crucial for effectiveness and sustainability.
Abstract Background: Malnutrition is prevalent among community-dwelling older adults (OAs), particularly those using healthcare services, and the number of affected individuals is expected to increase with ongoing population ageing. Early and systematic identification of OAs at risk of malnutrition is recommended as a key first step in prevention and management. However, a significant gap exists between recommended nutritional practices and their implementation in routine care. Aim: This article aims to describe the development process of a complex intervention for early detection of malnutrition risk among community-dwelling OAs (≥65 years) in a Danish homecare setting. Methods: The development process was overall framed by the Medical Research Council (MRC) framework and guided by the IdentifyiNg and assessing different approaches to DEveloping compleX intervention framework. Eleven iterative actions were undertaken, including systematic consideration of contextual conditions, key uncertainties, stakeholder engagement, review of published evidence, and development of the intervention’s programme theory. Findings: The development process resulted in an intervention comprising four activities: A. An interprofessional workgroup. B. Learning activities for homecare staff. C. Conversations with OAs and their informal caregivers. D. Systematic and continuous screening followed by an action guide. Activities C and D covered the screening procedure, and activities A and B the implementation strategy for this procedure. The developed intervention was designed to support nutritional self-care among OAs and facilitate early identification of malnutrition risk in homecare settings. Subsequent feasibility testing of the intervention was conducted between August 2024 and December 2025. It is reported elsewhere.
