We aimed to explore participant perspectives on social prescribing (SP) for mental health and well-being and the acceptability of community pharmacists (CP) as members of SP pathways that support people with mild to moderate depression and anxiety.

SP aims to support people with poor health related to socio-demographic determinants. Positive effects of SP on self-belief, mood, well-being, and health are well documented, including a return to work for long-term unemployed.

The study was set in a city in southwest England with diverse cultural and socio-demographics. We recruited SP stakeholders, including CP, to either one of 17 interviews or a focus group with nine members of the public.

An inductive iterative approach to thematic analysis produced four superordinate themes: (1) offering choice a non-pharmacological option, (2) supporting pharmacy communities – ‘it is an extension of what we do’, (3) stakeholder perspectives – pharmacists are very busy and their expertise unknown by some, and (4) potential for pharmacy in primary care.

Stakeholders viewed CP as local to and accessible by their community. Pharmacists perceived referral to SP services as part of their current role. General practitioner participants considered pharmacy involvement could reduce their workload and expand the primary healthcare team. Importantly, general practitioners and CP viewed SP as a non-pharmacological alternative to prescribing unnecessary antidepressants and reduce associated adverse effects. All participants voiced concerns about pharmacy dispensing busyness as a potential barrier to involvement and pharmacists requesting mental health training updates.

Key findings suggest CP offer a potential alternative to the general practitioner for people with mild to moderate depression and anxiety seeking access to support and health information. However, CP need appropriately commissioned and funded involvement in SP, including backfill for ongoing dispensing, medicines optimization, and mental health first aid training.

This study investigates the level of knowledge and utilization of colorectal cancer (CRC) and prostate cancer (PCa) early detection measures (EDMs) over a period of 12 years in general practice from the patient’s perspective.

The role of general practitioners (GPs) in EDMs for CRC and PCa in Germany is not well-documented with comprehensive data.

We conducted a patient-centric survey in the German federal state of Berlin-Brandenburg at a 12-year interval to examine the role of GPs in EDMs for CRC and PCa. In 2009, 55 GPs were tasked with informing 50 consecutive male patients, each aged over 35, about participating in a survey study (study phase 1/SP1). To evaluate changes over 12 years, a new survey involving 50 male patients from each of 150 GPs was conducted from October 2021 to March 2022 (SP2).

We thoroughly reviewed the questionnaires of 890 patients, with 755 in SP1 and 135 in SP2. Patients showed greater awareness of recommendations regarding colonoscopy compared to prostate-specific antigen (PSA) testing. GPs were the most frequently reported source of information for both EDMs in our cohort. Comparing the two study phases, no significant difference in specific awareness of colonoscopy or PSA testing was found among men eligible for EDMs. However, there was a notable increase in the role of health insurance companies as a source of information about colonoscopy over time. Nearly 60% of included patients underwent colonoscopy and/or PSA testing as EDMs.

The number of EDMs performed among study participants did not increase over time. Our study confirms that GPs remain the primary source of information about EDMs among the study participants.

This position paper focuses on healthy ageing for the frailest and institutionalized older adults in the context of the recent pandemic. The paper aims to identify and discuss hindering and promoting factors for healthy ageing in this context, taking both health safety and a meaningful social life into account, in a pandemic situation and beyond.

The recent COVID-19 pandemic has highlighted the vulnerability of frail older adults residing in long-term care institutions. This is a segment of the older population that does not seem to align well with the recent policy trend of healthy and active ageing. The need for healthy ageing in this population has been voiced by professionals and interest organizations alike, alluding to inadequate support systems during the pandemic, conditioned by both previous and newly emerging contextual factors. Supporting healthy ageing in older adults in nursing homes and other residential care settings calls for attending to meaningful social life as well as to disease control.

Findings and early conclusions leading up to the position paper were presented with peer discussions involving healthcare professionals and researchers at two joint EFPC PRIMORE workshops 2021 and 2022, as well as other international research seminars on long-term care. The following aspects of long-term care and COVID-19 were systematically discussed in those events, with reference to relevant research literature: 1. Long-term care policies, 2. pre-COVID state of long-term care facilities and vulnerability to the pandemic, 3. factors influencing the extent of spread of infection in long-term care facilities, and 4. the challenge of balancing between strict measures for infection control and maintaining a meaningful social life for residents and their significant others.

A policy shift towards ageing at home and supporting the healthiest of older adults seems to have had unwarranted effects both for frail older adults, their significant others, and professional care staff attending to their needs. Resulting insufficient investment in primary health care staff and in the built environment for frail older adults in nursing homes were detrimental both for the older adults living in nursing homes, their significant others, and staff. More investment in staff and in physical surroundings might improve the quality of care and the social life of older adults in nursing homes in a non-pandemic situation and be a resource for primary health care staff ensuring both protection from health hazards and a meaningful social life for frail older adults in a pandemic or epidemic situation. As for investing in the physical surroundings, smaller nursing homes are advantageous, with singular resident rooms and for developing out-and indoor spaces for socializing and for meeting with families and other visitors. Regarding investment in staff, there is a documented need for educated staff in full-time positions. Use of part-time or temporary staff should be limited.

This article outlines the implementation and deployment strategy defined by the Catalan healthcare system which sought to promote a plan to strengthen and transform primary care in order to provide high-quality healthcare services whilst making an optimal use of resources across the Catalan region.

Following the COVID-19 pandemic, the Catalan healthcare system initiated a plan to enhance primary care services. The Lean methodology has been used extensively in other sectors for process improvement. More recently, it has been adopted in large hospitals, showing good results, so Lean was selected as the most appropriate method to achieve this project’s goal. The Process Office of the Catalan Health System, which is made up of experts in Lean methodology, has been involved in defining and deploying the strategy to all 374 Primary Care Teams (PCTs) within the Catalan healthcare system.

The deployment strategy was executed in four phases (each consisting of a number of sessions): (1) explaining the project’s goals and training the professionals in the methodology; (2) assessing the current status regarding the processes with the various PCTs; (3) identifying and implementing improvement projects; and (4) defining key performance indicators to monitor the impact of the projects.

As a conclusion, this project has allowed to successfully define and implement a standard at a strategic and deployment level of a project for primary care improvement that may be replicated in other regions. The key elements to ensure success have been the following: leadership, implementation of an improvement methodology, standardization of sessions, and involvement and training of front-line professionals.

Early and collaborative interventions are desirable to prevent long-term sick leave and promote sustainable return-to-work (RTW). The aim of this study was to evaluate if the use of the Capacity Note – a brief intervention promoting early and structured communication between general practitioners (GPs), patients, and employers – had an impact on length of sick leave in patients with common mental disorders (CMDs) in primary healthcare.

In a pragmatic trial, GPs at eight primary healthcare centres were randomized to provide the intervention or control and recruited eligible patients: employed women and men, 18-64 years, who visited a GP due to CMD and became or were (<4 months) full- or part-time sick-listed. Patients in the intervention group (n=28) used the Capacity Note in addition to usual care. Patients in the control group (n=28) received usual care. Outcomes of interest were time until full RTW, sick leave status at end of follow-up (17 months), number of sick leave episodes during follow-up, and number of sick leave days at 6, 12, and 17 months of follow-up.

The proportion of patients with full RTW at the end of follow-up was 79.2% in the intervention group and 84.6% in the control group. Time until full RTW was 102 and 90 days (median) in intervention and control group, respectively. We found no statistically significant differences between the groups for any of the outcomes.

Despite efforts to increase the number of participants, the study ended up with a small sample. This prohibited us from drawing any final conclusions about the effect of the intervention. Obstacles to recruitment of patients and use of the intervention are discussed.

The COVID-19 pandemic has impacted patient’s visits to general practitioners (GPs). However, it is unclear what the impact of COVID-19 has been on the interaction among the local primary care clinics, the GP Department within the hospital and specialists.

The interaction among GPs referring to hospital-based specialists and specialists to local doctors was determined, comparing pre-pandemic 2019 and 2020 during the pandemic.

Reduced referrals from GPs to specialists were consistent with the reduction in specialist referrals back to the local doctors, which dropped by approximately 50% in 2020, particularly in the two most common chronic conditions (hypertension and diabetes mellitus).

Reduced referral of patients from local clinics to Tongren Hospital is probably due to the extensive online training provided to the local GPs to become more competent in handling local patients via telehealth. Our data provide some insight to assist in combatting the pandemic of COVID-19, offering objective evidence of the impact of COVID-19 on patient management by GPs.

This review aims to identify the mechanistic relationships related to periodontal diseases and its possible association with changes in human milk composition and the composition and function of infants’ gut microbiome.

Maternal health conditions, especially inflammatory, are associated with altered human milk composition. It is not known whether maternal oral inflammatory diseases, including periodontal diseases, deleteriously affect human milk composition.

A narrative review was conducted according to SANRA, the Scale for the Assessment of Narrative Review Articles, guidelines. PubMed, Google Scholar, and Cochrane database of systematic reviews were searched from September 2019 up to December 2023 using keywords such as breast/human milk, maternal health/infections, and periodontal diseases. Reference lists of relevant articles were also screened. Our primary outcome of interest was human milk composition (i.e., any changes in macronutrients, immunological components, etc.). Secondary outcomes included changes in human milk microbiome and subsequent changes in the infant gut microbiome. Outcomes were synthesized using a narrative approach where the existing evidence and current literature were summarized. No risk of bias assessment of the studies was performed in this review.

The search yielded no studies investigating the relationship between periodontal diseases in nursing mothers and changes in human milk composition. However, a dose–response relationship exists between the severity of periodontal diseases and the risk of adverse pregnancy outcomes such as preterm birth. Mastitis and diabetes affected milk lipids. Immunoglobulin A (sIgA) was increased in mastitis, whereas reduced concentrations were reported in diabetes. Potential biological pathways through which periodontal diseases can negatively affect human milk composition include the systemic dissemination of inflammatory cytokines like IL-6, PGE2, and tumor necrosis factor (TNF)-β that can be up-regulated by bacterial by-products. This biological plausibility needs to be investigated, given the potentially negative impact on the quality of human milk that could be caused by periodontal inflammation.

This paper presents the development of the METRIC toolkit, aimed at enhancing primary healthcare interventions in the context of hepatitis C control, thus contributing to the World Health Organization’s global strategy to achieve the elimination of the disease by 2030.

At the global level, most people living with hepatitis C are unaware of their condition. As such, the eradication of hepatitis C necessitates comprehensive strategies within primary healthcare settings, as it provides an opportunity to reach the general population, facilitates the identification of potential patients who may be unfamiliar with hepatitis C, and guides them toward adequate care. Herein, we propose the METRIC toolkit as a means to optimize the efficiency and efficacy of healthcare services dedicated to hepatitis C control.

The development of the METRIC toolkit was guided by a thorough review of pertinent literature, focusing on primary healthcare interventions in hepatitis C control. Key components were identified, encompassing systematic problem identification, solution formulation, outcome evaluation, and feedback integration.

The METRIC toolkit represents a valuable resource for strengthening primary healthcare interventions in hepatitis C control. By fostering a culture of continuous improvement and data-driven decision-making, this framework holds promise in advancing the global agenda towards hepatitis C elimination. However, its successful application requires careful consideration of contextual factors and ongoing adaptation to local needs and circumstances.

Developing an appropriate context-based school-age obesity prevention programme, understanding the root causes of obesity in real-life situations is vital. The objectives of this study were to explore the risk factors of school-age obesity based on Ecological System Theory (EST) and develop mutual problem-solving guidelines for school-age obesity prevention.

Participation Action Research (PAR) was used as the study design. The data collection employed focus group discussions, in-depth interviews, participant’s observations, together with the procedures of Appreciation, Influence, and Control (AIC) with 55 school key informants.

Risk factors supported by EST at all level included high-calorie intake; sedentary lifestyles; perceptions of ‘Chubby are cute’; indulgent parenting, including limited exercise area in school. PAR process guarantees the sustained context-based prevention guidelines.

The results could be used as a policy-driven for school-based participation and environmental support in order to promote health-promoting school.

Primary healthcare (PHC) plays a crucial role in improving health outcomes and reducing healthcare burden, especially in low-to-middle-income countries (LMICs). However, PHC has not received adequate attention in Pakistan despite its recognized importance. This study aims to examine the current state of PHC in Pakistan, identifying factors compromising its quality and effectiveness.

To find relevant data, the authors conducted a thorough literature search on PubMed, Google Scholar, and Cochrane Library from inception till 2 July 2022, without any language restriction. The following keywords were employed during the literature search, separated by Boolean operators AND, OR: “Primary Healthcare”, “PHC”, “Healthcare primary”, “Primary Health”, and “Pakistan”.

Pakistan’s PHC infrastructure shows promise, with a considerable number of healthcare facilities in place. However, various factors hinder its effectiveness and compromise the quality of care provided. Insufficient investment, resource constraints, inadequate training of healthcare providers, lack of oversight, and limited access to essential medicines and equipment are some of the key challenges observed. Improving PHC in Pakistan is vital for addressing the population’s healthcare needs, particularly in rural areas. Adequate investment, enhanced training programs, improved oversight mechanisms, and increased availability of essential resources are necessary to strengthen the PHC system. By prioritizing PHC and addressing the identified challenges, Pakistan can enhance healthcare access, reduce healthcare burden, and improve overall health outcomes for its population.

It is high time LMICs like Pakistan recognize PHC as the most economically feasible pathway toward accomplishing healthcare targets and adopt adequate measures to elevate its standards.

We will examine the processes of change in psychological practice that have been altered by the lockdown.

During the COVID-19 pandemic, low-income populations, notably residents of social homes or shelters, were shown to be particularly susceptible to contagion. During lockdown, telephone-based psychological consultations became the norm.

In this qualitative research, we carried out semi-structured interviews with 10 psychologists working in social homes or shelters. Interviews were transcribed verbatim. Data were studied using consensus qualitative research.

During lockdown, participants felt that isolation increased while medical and social support decreased. Psychologists had to adapt their work methods and work more closely with on-site staffs. After lockdown, there was an increase in mental health issues. Participants perceived that telephone consulting seemed to facilitate access to psychological help. Although psychologists have quickly adapted, a decrease in the quality of clinical work was a general assessment. Results stress the necessity to train French psychologists in telemental health practices.

This study aimed to assess the operational efficiency of Sub-District or Tambon Health Promoting Hospitals (THPHs) in Thailand’s Eastern Economic Corridor (EEC) and to propose management guidelines for future improvements.

The current state of Thailand’s public health demonstrates that government policy has prioritized equal access to public health services in all areas. This increases the need for primary public health services, yet resources are limited and cannot be increased to meet the growing demand. The only effective way to address this issue is to develop the efficiency of public health operations.

The sample consisted of 104 THPHs in Chachoengsao, a province in Thailand’s EEC. Data for five input and seven output variables were collected between September 18 and November 15, 2023. An online survey was conducted to gather the required data for fiscal year 2022. Data envelopment analysis was used to measure the efficiency of THPHs.

The average efficiency index of the 104 THPHs was 0.9066, with about 60% having an efficiency index of 1.00. When classified by size, it was found that the efficiency levels of the THPHs grew with size, considering that the average efficiency index of the small, medium, and large THPHs was 0.8642, 0.9140, and 0.9417, respectively. The proportion of efficient THPHs also increased with size, at 58.14%, 60.00%, and 66.67%, respectively. Regarding efficiency improvement targets, small THPHs had the highest output targets (28.40%), followed by medium THPHs (15.31%) and large THPHs (9.91%). For the inefficient THPHs, some management guidelines were made to improve their future performances.

Training can improve healthcare providers’ cultural competence and increase their awareness of bias and discrimination in medical decision-making. Cultural competences training is lacking in the education of dieticians in the Netherlands. The aim of this study was to describe the pilot-implementation of a cultural competence training for dieticians and preliminary evaluation of the training.

A training was developed based on Seeleman’s cultural competence framework and previously held interviews with migrants, dieticians, and experts. The training consisted of a mixture of didactic and experiential methods, alternating knowledge transfer with exercises to increase awareness, reflection, and feed-back on recorded consultations, and communication training with migrant training actors. The training was piloted in 8 participating dieticians and preliminary mixed-method evaluation was done using a Cultural Competence Questionnaire, Experience Evaluation Questionnaire, and consultation observations.

The questionnaires showed that dieticians were positive about the training. They found it valuable and educational. Participants reported an increase in self-perceived cultural competence and attitudes. Knowledge and skills remained approximately the same. The observations showed that dieticians applied the teach-back method and discussed treatment options more often after training. There was no increase in the use of visual materials.

The training was well appreciated and, although a small-scale pilot, this mixed-method study suggests an ability to change cultural competence. The combination of a self-assessment instrument and consultation observations to evaluate cultural competence was highly valuable and feasible. These encouraging results justify a broader implementation of the training.

From education to healthcare and management processes, it is important to address the experience in health within its own complexity, context, and uniqueness. At this point, qualitative studies come to the fore and this increases the need for practical guides and models for qualitative studies. Qualitative studies have a paradigm that is different from quantitative research and its paradigm ontologically, epistemologically, and methodologically. These differences are reflected in the design of the research as well as the analysis, interpretation, and reporting of qualitative data. From such a point of view, this paper first briefly outlines the design process of qualitative studies and then proposes a model for the analysis, interpretation, and reporting of qualitative data.

The three core concepts of the model are ‘contextuality’, ‘reflectivity’, and ‘narrativity’. Such a conceptual/theoretical framework transforms qualitative data analysis, interpretation, and reporting processes into processes that are carried out with a reflective approach within their specific contexts.

Taking this into account, by considering a contextual, reflective, and narrative approach, two frameworks, namely, the ‘Contextual (Multiple) Reading and Analysis Framework’ consisting of three stages and seven steps, and the ‘Contextual Understanding, Interpretation and Reporting Framework’ consisting of four stages, were developed. This provides a practical guide to contextual and reflective data analysis, interpretation, and reporting for the use of those conducting qualitative studies.

Although psychological interventions can be used to improve chronic pain management, underserved individuals (i.e., racially minoritized and socioeconomically disadvantaged) may be less likely to engage in such services. The purpose of this study was to examine whether offering a psychological intervention for chronic pain in a primary care clinic could be a method in which to successfully engage underserved patients.

There were 220 patients with chronic pain in a primary care clinic located in a socioeconomically and racially diverse city who were approached to discuss enrolment in a pilot randomized controlled trial of a five-session psychological intervention for chronic pain. Patients were introduced to the study by their primary care provider using the warm handoff model. We compared whether there were sociodemographic differences between those who enrolled in the study and those who declined to enrol.

There were no differences between those who enrolled and those who declined enrolment with regard to race, age, insurance type, and household income. However, females were more likely to enrol in the study compared to males.

Recruiting patients to participate in a trial of a psychological intervention for chronic pain in a primary care clinic appeared to be effective for engaging Black patients, patients with lower income, and those with government insurance. Thus, offering a psychological intervention for chronic pain in a primary care clinic may encourage engagement among racially minoritized individuals and those with lower socioeconomic status.

The goals of this investigation were to 1) identify and measure exposures inside homes of individuals with chemical intolerance (CI), 2) provide guidance for reducing these exposures, and 3) determine whether our environmental house calls (EHCs) intervention could reduce both symptoms and measured levels of indoor air contaminants.

CI is an international public health and clinical concern, but few resources are available to address patients’ often disabling symptoms. Numerous studies show that levels of indoor air pollutants can be two to five (or more) times higher than outdoor levels. Fragranced consumer products, including cleaning supplies, air fresheners, and personal care products, are symptom triggers commonly reported by susceptible individuals.

A team of professionals trained and led by a physician/industrial hygienist and a certified indoor air quality specialist conducted a series of 5 structured EHCs in 37 homes of patients reporting CI.

We report three case studies demonstrating that an appropriately structured home intervention can teach occupants how to reduce indoor air exposures and associated symptoms. Symptom improvement, documented using the Quick Environmental Exposure and Sensitivity Inventory Symptom Star, corresponded with the reduction of indoor air volatile organic compounds, most notably fragrances. These results provide a deeper dive into 3 of the 37 cases described previously in Perales et al. (2022).

We address the long-standing dilemma that worldwide reports of fragrance sensitivity have not previously been confirmed by human or animal challenge studies. Our ancient immune systems’ ‘first responders’, mast cells, which evolved 500 million years ago, can be sensitized by synthetic organic chemicals whose production and use have grown exponentially since World War II. We propose that these chemicals, which include now-ubiquitous fragrances, trigger mast cell degranulation and inflammatory mediator release in the olfactory-limbic tract, thus altering cerebral blood flow and impairing mood, memory, and concentration (often referred to as ‘brain fog’). The time has come to translate these research findings into clinical and public health practice.

The current study aims at describing sexually transmitted infections (STI) surveillance data collected from 2015 to 2020 as well as investigating patients’ characteristics and risk factors in the sample population.

Reported STI cases are continuously increasing in Europe. In Belgium, 94.1% of citizens have a regular general practitioner (GP) or are affiliated to a general practice. By using GPs for surveillance, STIs can be monitored in the general population. Between January 2015 and December 2020, the Sentinel General Practitioners (SGP) network retrospectively reported five STIs: chlamydia, gonorrhoea, genital warts, herpes, and syphilis.

In the SGP network database on STIs, participating GPs report on case-by-case basis through paper or online registration forms. We performed descriptive statistics, X2 test and logistic regression using SAS® 9.4. Multivariate multiple logistic regression was performed to investigate the relationship between STIs and patients’ characteristics.

During the study period, 1009 cases were reported, corresponding to an episode-based incidence estimated at 121 per 100,000 inhabitants. The majority of patients (59.8%) were men, and 83.6% were under age 30. Among female patients 92.7% had heterosexual contacts whereas 64.4% of male patients did. Women were more likely to be diagnosed with chlamydia (odds ratio [OR] 1.56; 95% confidence interval [CI] 1.12–2.17) and herpes (OR 1.72, 95% CI 1.04–2.86) than men.

In this study, STI surveillance data were in agreement with literature. Continuous surveillance through the SGP network remains an important tool to obtain information about populations at risk and STI incidence in the general population.

The concept of lifestyle-based risk scores is known but not evaluated in most rural communities of low- to mid-income countries. This study investigated the correlation of lifestyle scores with health indices.

This was a descriptive cross-sectional investigation. A total of 203 participants (141 females and 62 males), 18–90 years, had anthropometric assessments and lifestyle scores determined from a 12-item framework. Data analysis included average age in different health conditions, lifestyle scores in age groups, and correlations with age.

Average age of healthy subpopulation was 39 years while diabetes, hypertension, and obesity subpopulations were 58, 64, and 56 years, respectively. The percentage of participants whose activities of daily living (ADL) were unaffected by ill-health decreased with age (P < 0.0001), and lifestyle scores also decreased with age (P < 0.01) and negatively correlated with physical activities.

This report contributes to diabetes cardiovascular complications management. Sedentary ADL factors need integration in healthy lifestyle education especially among the elderly.

To understand young women’s views of cervical screening, what obstacles they face, and what encourages them when considering attending their cervical screening.

Cervical screening figures have been steadily decreasing in the United Kingdom (UK). There is limited research on this trend, especially around views and knowledge of young women, aged 20–24 years, have before they are eligible for cervical screening.

This qualitative study conducted 15 semi-structured Zoom in-depth interviews to discuss young women’s knowledge and perceptions of cervical screening in 2022. Participants were based in the UK. Thematic analysis was used to systematically manage, analyse, and identify themes including cervical screening knowledge; perceptions of cervical screening; barriers to cervical screening; and facilitators of cervical screening.

The findings demonstrate significant gaps in knowledge and negative perceptions of cervical screening. Barriers to attending cervical screening were perceived pain and embarrassment. Facilitators suggested to promote attendance were ensuring access to appointments, creating pop-up clinics, and utilising incentives. The level of knowledge demonstrated by the participants, their negatively framed perceptions; and the vast number of barriers identified present substantial factors that could affect future attendance to cervical screening. Overall, action needs to be taken to prevent decreasing cervical screening attendance rates and eradicate any barriers women may experience.