Lymphoedema secondary to cancer is a relatively neglected and under-researched condition. Few studies report people's experiences of care and treatment provision when living with the condition. Current practice focuses on the physical treatment yet psychosocial needs often remain unmet. A previous study examining the patient perspective identified the theme of being ‘abandoned by medicine’. Perceived lack of support may result in a delayed adaptation and acceptance of this long-term condition and can significantly impact on psychological well-being. We explore this emerging theme alongside others in order to provide a guide to action for improvements for patient benefit.

The central aim was to explore women's views of their care and treatment following a diagnosis with lymphoedema secondary to cancer. This forms part of a larger study aimed at assessing appropriate screening tools to measure psychosocial distress.

A mixed-methods approach was used for the main study. Here we report the qualitative component, derived from in-depth semi-structured interviews conducted in the homes of the participants (n = 14) and focus group discussions (n = 15). In addition, qualitative comments from questionnaire data from a large-scale postal survey are included (n = 104).

Participants identified considerable deficiencies in health care workers’ knowledge and awareness of lymphoedema, which subsequently impacted on the patients’ needs for information, support and understanding. Access to appropriate treatment was patchy and problems were identified with the process of obtaining compression garments, massage and other sources of help. Although lymphoedema is a long-term disfiguring condition, and much is known about how this impacts on patients’ emotional well-being, little attention was paid by health professionals to potential psychosocial consequences. In essence women had to become experts of their own condition and cope as best as they could. We provide recommendations to improve service delivery and address these unmet needs.

To explore GPs’ perceptions of their role in primary prevention, barriers experienced and willingness to accommodate an automated, computer-tailored intervention.

General practice is an attractive setting for primary prevention of chronic disease. Due to constraints in time and knowledge it is underutilised.

Telephone interviews of 13 GPs in Brisbane, Australia, whose patients were previously involved in a lifestyle change research project. Qualitative responses were grouped into themes.

GPs perceived their role in lifestyle change as ‘educators’, ‘supporters’ and ‘prompters’. Smoking and physical activity were addressed more often than alcohol and salt intake. Longer lifestyle-focussed consultations and computer-generated reminders were suggested to overcome barriers. A computer-tailored approach was appreciated due to its minimal impact on practice routine. GPs understand their role in primary prevention but need help to overcome barriers. GP initiated consultations focusing on lifestyle and prevention along with computer support systems could improve capability for prevention in general practice.

To investigate cases of suicide in which there was no healthcare contact, by looking at history of help-seeking and evidence of previous mental health vulnerability. To identify any life events associated with suicide for which individuals did not seek help.

Previous research has suggested that non-consultation is the main barrier to suicide prevention among men. Estimates suggest approximately 22% of men who die by suicide have not consulted their GP in the year before their death. Little is known about the lifetime pattern of engagement with services among these individuals and whether or not this may influence their help-seeking behaviour before death.

Coroner records of suicide deaths in Northern Ireland over 2 years were linked to general practice (GP) records. This identified 63 individuals who had not attended health services in the 12 months before death. Coroner’s data were used to categorise life events associated with the male deaths. Lifetime mental health help-seeking at the GP was assessed.

The vast majority of individuals who did not seek help were males (n=60, 15% of all suicide deaths). Lack of consultation in the year before suicide was consistent with behaviour over the lifespan; over two-thirds had no previous consultations for mental health. In Coroner’s records, suicides with no prior consultation were primarily linked to relationship breakdown and job loss. These findings highlight the limitations of primary care in suicide prevention as most had never attended GP for mental health issues and there was a high rate of supported consultation among those who had previously sought help. Public health campaigns that promote service use among vulnerable groups at times of crisis might usefully be targeted at those likely to be experiencing financial and relationship issues.

Osteoporosis is a highly prevalent and costly disease associated with aging. Previous studies have indicated low intervention rates in primary care; however, there is little research investigating the prescribing patterns of osteoporosis medications by primary-care physicians.

We conducted a population-based retrospective cohort study to examine trends in osteoporosis medication utilization in primary care between 1 January 2000 and 31 December 2009 in Ontario, Canada. All Ontario residents aged 65 years or older and eligible for public health coverage were included in the analysis (∼1.46 million residents in 2000, ∼1.75 million residents in 2009).

Analysis of 10-year data indicates a trend toward higher utilization of osteoporosis medications among elderly primary-care patients. In 2000, 100 038 unique patients were prescribed an osteoporosis medication by a family physician; by 2009, this number increased to 301 679. Age-group analyses suggest an inverted U-shaped pattern, whereby utilization rates increase with advancing age and then decline for the oldest age groups. Utilization rates were the lowest for the 100+ age group.

This study indicates increased utilization of osteoporosis-related medications among elderly primary-care patients over a recent 10-year time period. It is unclear whether the observed increase in utilization is due to higher rates of osteoporosis. Further research is needed to determine the appropriateness of this higher utilization.

To improve the medical waste management (MWM) standards in Tabriz community health centers (CHCs) through clinical audit process.

Management of medical waste is not only a legally necessity but also a social responsibility in health systems. Owing to the potential risks for human health and environmental impacts, MWM is a global concern.

This was an interventional research designed using clinical audit cycle that was implemented in Tabriz CHCs in 2016. MWM was assessed through observation, as well as reviewing relevant documents and interviews with waste workers in CHCs and completion of a researcher-made checklist. Intervention plans were developed and implemented based on the assessment results. To analyze the data, Excel 2016 software was used and information was reported as descriptive statistics through comparison of standards adherence before and after the interventions.

Generally, 30% improvements in MWM standards adherence were experienced (45.8–75.1%) in the CHCs, after the interventions. The greatest improvement was observed in the dimensions of management and education, and separation and collection of medical waste, up to 30 and 28.5%, respectively.

As the results demonstrated, standards of MWM processes were improved in Tabriz CHCs, due to the intervention. Moreover, it was experienced that using systematic method, stakeholders’ participation and evidence-based planning would lead to process improvement. MWM was an ignored issue in primary care that must be more in attention.

The primary objective of this study was to evaluate feasibility and acceptability of Mindfulness-based Wellness and Resilience (MBWR): a brief mindfulness-based intervention designed to enhance resilience and is delivered to interdisciplinary primary care teams.

Burnout is a pervasive, international problem affecting the healthcare workforce, characterized by emotional exhaustion, depersonalization, and decreased professional effectiveness. Delivery models of mindfulness-based resilience interventions that enhance feasibility for onsite delivery, consider cultural considerations specific to primary care, and utilize team processes that are integral to primary care are now needed.

We conducted a mixed-methods feasibility and acceptability trial of MBWR. Primary feasibility and acceptability outcomes were assessed by number of participants recruited, percent of MBWR treatment completer, and attrition rate during the 8-week intervention, and four items on a Likert-type scale. Secondary outcomes of perceived effects were measured by focus groups, an online survey, and self-reported questionnaires, including the Brief Resilience Scale, the Five Facet Mindfulness Questionnaire-Short Form, and the Self-Compassion Scale-Short Form. Participants included 31 healthcare providers on interdisciplinary primary care teams employed a safety-net medical center. In the MBWR group, 68% identified as Latinx, compared to 64% in the control group.

All criteria for feasibility were met and participants endorsed high levels of satisfaction and acceptability. The results of this study suggest that MBWR provides multiple perceived benefits to the individual healthcare provider, cohesion of the healthcare team, and enhanced patient care. MBWR may be a feasible and acceptable method to integrate mindfulness, resilience, and teamwork training into the primary care setting.

Educational practices are indicated to promote the health of people with fibromyalgia in primary health care. We aimed to develop an educative interdisciplinary program intended at the health promotion of individuals with fibromyalgia.

It is a study protocol that was developed following three phases in the city of São Paulo city, Brazil. Qualitative research was carried out, through a focal group, with 12 individuals with fibromyalgia and 10 health professionals. A thematic content analysis was made according to the content proposed by Bardin.

Fibro Friends is an interdisciplinary program with educational approaches that must be performed in 15 meetings, once a week for 1 h and 20 min. Participants were the following professionals: a Physiotherapist, a Doctor, a Psychologist, a Nutritionist, a Nurse, a Pharmacist/Druggist, a Speech Therapist, an Occupational Therapist, a Naturopath, and a Social Worker. A physical exercise program will also be carried out. The professionals must discuss in a lecture, conversation hearing, and/or group dynamic, about strategies to promote health and pain control in fibromyalgia.

Fibro Friends is a program presenting educational interdisciplinary information to individuals with fibromyalgia, being considered a trend to future care. Fibro Friends is a practical guide, logical, and efficient to patients with fibromyalgia at the basic attention to health.

This paper presents findings from an ethnographic study that examined how qualified district nurses’ conceptualized their role in relation to family carers and how they performed this aspect of their role.

A participant observational study involving fieldwork and in-depth interviews with six district nursing teams was undertaken over a 12-month period. Interview transcripts and fieldnotes were analysed by drawing upon the principles of dimensional analysis.

District nurses acted on the assumption that family carers would, by choice or default, provide care. Family carer support was conceptualized as a means of promoting self-care and the patient’s independence from nursing services. The rationale for providing family carer support was based largely on service capacity rather than on carer needs and preferences. Six characteristics of district nursing support for carers were identified: enabling, supporting, mediating, care substitution, crisis prevention and crisis intervention. Family carers were not recipients of district nursing support in their own right but were dependent upon the cared-for person receiving nursing care. This in turn was conditional upon others (general practitioners and hospitals) making appropriate patient referrals. Family carer support was also conditional upon effective communication and family carer receptiveness.

As the scope of home-based nursing continues to increase, district nurses need to take a more active stance in providing family carer support and adopt a family rather than patient-focused approach in order that family carers might be supported more effectively.

Leg ulceration presents a significant health-care problem for patients and it is likely to be associated with pain. Poorly managed persistent pain may lead to insomnia, depression and suicidal ideation. To manage leg ulcer pain effectively, it is necessary first to assess pain, but there is little evidence of this activity in the literature. This study aimed to explore community nurses’ knowledge and beliefs about the management of painful leg ulceration.

A feasibility study surveyed the knowledge and views of a sample of community nurses in the North of England, United Kingdom. Data were collected using a postal questionnaire.

A total of 115 completed questionnaires were returned (response rate = 32%). The majority of the respondents were female (n = 102, 91.8%). The nurses in this clinical study claimed to be aware of the pain that patients with leg ulceration may experience. Over 90% of the patients were aware of the key consequences of this pain, including insomnia, depression, social isolation and others. However, over one-third of the nurses reported that they had not received pain management training. Approximately one half reported not assessing pain appropriately. Nurses reported using pain triggers and severity to diagnose aetiology and complications of leg ulceration.

This study suggested inadequate pain management practices despite the fact that there were a significant number of the nurses who were aware of the associated pain and possible outcomes. Pain assessment was lacking, suggesting a lack of formal pain assessment procedures. They described not using effective pain management techniques and were aware of their need for education in this area.

To map the results of four empirical quantitative and qualitative studies to the Normalization Process Model (NPM) to explain why open access hysterosalpingography (HSG) for the initial management of infertile couples has or has not normalized in primary care.

The NPM is an applied theoretical model to help understand the factors that lead to the routine embedding of a complex intervention in everyday practice. Open access HSG has recently become available for the initial assessment of infertility in primary care.

The results of two qualitative studies (a focus group study and an in-depth interview study with patients and professionals) and two quantitative studies (a pilot survey and a pragmatic cluster-randomized controlled trial) evaluating open access HSG are interpreted by mapping the results to the NPM.

Application of the model shows that open access HSG would confer an advantage to all agencies if they could be sure that the expertise was present and supported within primary care.

Open access HSG was adopted but not normalized into everyday practice. Despite demonstration of modest workability, it has been counteracted by limited integration. Further evaluation of integration within contexts is required.

To analyze scientific literature on the development and implementation of the Chronic Care Model (CCM) in treating chronic diseases in the Italy context. Besides, to evaluate the effects of the activities carried out by the operators participating in the CCM on clinical care.

Italy is the second country globally for longevity, with 21.4% of citizens over 65 and 6.4% over 80. The CCM fits into this context, a care model aimed primarily at patients suffering from chronic diseases, especially in emergencies, as the recent COVID-19 pandemic.

PubMed, Embase, Scopus, Cinahl, and Cochrane Library scientific databases were consulted, and the records selected as relevant by title and abstract by nine independent scholars, and disagreements were resolved through discussion. Finally, the studies included in this review were selected based on the eligibility criteria.

Twenty potentially relevant studies were selected, and after applying the eligibility criteria and screening by the Critical Appraisal Skills Program tool, eight included in this review. The studies showed the effectiveness of CCM for managing patients with heart failure in primary care settings and significant improvements in clinical outcomes, the reduction of inappropriate emergency room access for chronic patients, and the improvement of patients’ overall health with diabetes. The CCM organizational model is effective in improving the management of metabolic control and the main cardiovascular risk factors. Furthermore, this modality also allows doctors to dedicate more space to patients in the disease’s acute phase.

The CCM, with its fundamental pillars of empowering self-management of care, could represent a valid alternative to health management. The managers of health services, especially territorial ones, could consider the CCM for the improvement of the treatments offered.

Studies have established that many depressed adolescent patients do not receive optimal mental health care. Specifically, depression in primary-care settings is underrecognized, undertreated, and stigmatized. Although the seriousness and prevalence of adolescent depression is well known to primary-care physicians, its assessment, diagnosis, and treatment remains a significant problem in general and in rural communities in particular.

In this article, the author accomplishes three aims: (1) summarizes the most current evidence-based guidelines for depression care for adolescents in primary-care settings, (2) reviews the empirical literature on how key patient demographic variables (race, gender, and age) may be correlated with and predictive of variations in evidence-based depression care (assessment, diagnosis, and treatment) for adolescent patients, particularly in rural areas, and (3) provides implications for translating empirical research findings to evidence-based depression care in rural primary-care settings.

We explored the ‘coping reflections’ of elderly couples living alone (without any other family members) during the COVID-19 pandemic in urban Odisha, India.

Evidence worldwide suggests that older people are at increased risk from COVID-19 adverse outcomes and experience greater stress. In our previous community-based study urban dwelling, particularly elderly participants, and living alone reported higher pandemic-associated health care challenges than their rural and residing-with-family counterparts. We intended to explore how the elderly couples living alone coped through this challenging yet stressful situation during the COVID-19 pandemic and what were their key strategies adopted toward this.

We conducted telephonic in-depth interviews (IDIs) with 11 urban elderly couples living alone in Bhubaneswar city of Odisha, India using a semi-structured interview guide. All IDIs were digitally recorded, transcribed into the original language, and translated to English. We used a thematic approach for analysis.

Four themes emerged: (1) Risk appraisal and feeling vulnerable; (2) Safeguarding against COVID-19; (3) Managing routine health care and emergency; and (4) Pursuing mental and psychological well-being. Although fear, anxiety, and loneliness were continuing stressors, many of them learnt to adapt and emerge resilient with the evolving situation. Various elements at the individual, family, community, and organizational levels were conducive to better coping. The companionship and complementary support of spouse, self-health literacy, and digital efficacy, virtual connectedness with family and friends, availability of community pharmacy and diagnostic services in the vicinity, support of neighbors, reengaging with creative leisure time activity, and assurance of a responsive administration at the time of emergency helped them to cruise through the pandemic. Furthermore, watching the re-telecast of prime time serials made these elderly fondly remember their own youth time memories. Self-health monitoring, indoor physical exercise, spiritual practices, continuation of previous prescription, telephonic advice of physicians were add-on strategies that facilitated their physical and psychological well-being during the pandemic.

This study applied a theory-based questionnaire to examine the behaviours and beliefs of all practice staff who may be involved in offering chlamydia screens to young people aged 15–25 years old. We aimed to identify potential influencing factors and examine the organisational constraints, which may be amenable to change.

The National Chlamydia Screening Programme offers opportunistic screening to men and women between 15 and 25 years old who have ever had sexual intercourse and primary care is the second largest source of screens. In England 15.9% of the target group were screened against a target of 17% in 2008. Interventions to improve the frequency of offers have shown effects with volunteer practices.

A survey of 85 General Practices was completed by 55 doctors, nurses and receptionists. Interviews were conducted with 12 staff from three practices.

Respondents were unable to identify the national screening target. Only half record if a patient is sexually active. Half the sample had some recollection of the frequency of offers they made, with a mean of 4 per month. These were predominantly in consultations concerning sexual health. Perceived social norms are favourable to screening and respondents have strong perceived control over offering screens, including to those under 16 who are sexually active. Attitudes towards screening were positive but disadvantages and barriers related to increased pressure on practice resources for longer consultations and contact tracing. There were no differences in beliefs and practice behaviours between medical and nursing staff.

Future interventions should be targeted at increasing the range of consultations in which offers are made, demonstrating how to make offers without increasing consultation time, providing more complete records of sexual activity, screens and results, and encouraging audit and review within the practice to promote practice wide approaches to increasing opportunistic screening.

Guidelines may improve clinical outcomes for depression, but whether they are followed in primary care is uncertain.

To assess general practioners (GPs’) adherence to the National Institute for Health and Clinical Excellence (NICE) guidelines for managing depression in adults (2004).

Anonymized Questionnaire Survey.

Thirty-eight partnerships within one primary care trust in England.

Focused questionnaire incorporating measurable criteria, posted to GPs in May 2007.

The response rate was 67% (143/215 GPs). GPs followed NICE guidelines when screening for depression in patients with physical illness, using selective serotonin reuptake inhibitor antidepressants appropriately and referring to counselling and secondary care. However, 48% GPs did not screen patients with a history of depression, 44% discontinued medication too soon and 38% avoided prescribing for ‘understandable’ moderate depression. GPs identified poor access to cognitive behaviour therapy (CBT) as the greatest barrier to implementing guidelines. Only 41% personally used CBT. Adherence to NICE guidelines was significantly higher for GPs trained in psychiatry and in younger GPs, but was not associated with gender, practice size, possessing the Membership of the Royal College of General Practitioners or reading guidelines. Less than half (38%) of the GPs rated NICE as having a moderate or substantial impact upon their clinical management. The Quality and Outcomes Framework (QOF) had more influence than NICE guidelines upon detection and recording of care, especially in larger practices.

Training more cognitive behaviour therapists, making psychiatry experience mandatory for future GPs and focusing QOF incentives upon treatment outcomes as well as screening may improve adherence to NICE depression guidelines.

Secondary prevention and self-management of coronary heart disease (CHD) are of major importance to people who survive myocardial infarction (MI). This can be facilitated by cardiac rehabilitation (CR; the formal health service programme) and informal CHD self-help groups. Non-participation is an important issue, yet it is poorly understood. Rehabilitation difficulties and prevention challenges have been identified among people following MI, but the particular experience and perspective of CR and CHD group non-participants are largely unknown.

The study aimed to understand non-participation in CR and CHD self-help groups from the perspectives of the non-participants and to provide insight into their experience and that of their ‘significant others’ in rehabilitating in the absence of these resources.

In-depth interviews were conducted with 27 people who had not participated in either hospital-based CR or a CHD group, 6–14 months post-MI, and 17 ‘significant others’ in Lothian, Scotland.

Factors influencing non-participation fell into three broad themes ‘No need/no point’, ‘Not worth it’, and ‘Not possible’. In the latter two categories, non-participation in these resources was often considered a ‘missed opportunity’ and needs had remained unmet. Shifts between categories could occur over time. Non-participation was linked to rehabilitation difficulties for some people and family members. Recommendations to enhance post-MI support are made.