The critical importance of a closer and structural involvement of primary care in research has been increasingly recognized over the last several years, and has been the object of extensive conceptual and institutional debates and proposals. There is, however, still a gap between the consistency of the recommendations and their translation into practice.

Based on the most recent literature on the integration of the paradigm of efficacy (evidence-based medicine) with the one on outcomes-effectiveness, as well as on the experience gained with large collaborative studies performed by Italian general practitioners (GPs), the paper discusses the reasons for giving priority to what could be done to bridge the gap and the conditions of feasibility.

Specifically, the results obtained most recently in a large-scale, epidemiological and experimental project with a prospective cohort of ∼12 500 subjects included by 860 GPs across the country in the field of cardiovascular risk prevention (the Rischio e Prevenzione Study) provide the concrete framework for an agenda of action proposed as a way forward, which appears to be highly critical for visibility and cultural autonomy of GPs also at the European level.

Primary health care (PHC) supported long-term care facilities (LTCFs) in attending COVID-19 patients. The aim of this study is to describe the role of PHC in LTCFs in Europe during the early phase of the pandemic.

Retrospective descriptive study from 30 European countries using data from September 2020 collected with an ad hoc semi-structured questionnaire. Related variables are SARS-CoV-2 testing, contact tracing, follow-up, additional testing, and patient care.

Twenty-six out of the 30 European countries had PHC involvement in LTCFs during the COVID-19 pandemic. PHC participated in initial medical care in 22 countries, while, in 15, PHC was responsible for SARS-CoV-2 test along with other institutions. Supervision of individuals in isolation was carried out mostly by LTCF staff, but physical examination or symptom’s follow-up was performed mainly by PHC.

PHC has participated in COVID-19 pandemic assistance in LTCFs in coordination with LTCF staff, public health officers, and hospitals.

Health care is provided under the conditions in which people live and under the rules and regulations of a prevailing health system. As a consequence, ‘local’ circumstances are an important determinant of the actual care that can be provided and its effects on the health of individuals and populations. This plays in particular, but not exclusively, a role in community-based primary health care. Although this is generally accepted, there is little insight in the impact of the setting and context in which health care is provided on the outcome of care.

This paper argues the case to use this natural variation within and between countries as an opportunity to be used as a form of natural experiment in health research.

We argue that analysing and comparing outcomes across settings, that is comparative outcomes of interventions that have been performed under different health care conditions will improve the understanding of how the real-life setting in which health care is provided – including the health system, the socio-economic circumstances and prevailing cultural values – do determine outcome of care.

To facilitate comparison of research findings across health systems and different socio-economic and cultural contexts, we recommend a more detailed reporting of the conditions and circumstances under which health research has been performed. A set of core variables is proposed for studies in primary health care.

To explore the factors influencing the completion of the IB113 form for the Department for Work and Pensions (DWP), as an exemplar of how general practitioners (GPs) manage and report patient information to external bodies.

In UK, GPs complete IB113 forms for their patients approaching longer-term sickness absence, who may be exempt from the incapacity benefit linked medical examination. The DWP has expressed concerns about the quality of such reports, and GP organizations have raised objections to completing such forms. The content of returned forms is variable, and may be subject to a number of influences.

Qualitative interviews with purposive sampling of GPs and practice managers (PMs).

Primary Care practices in the North East of England.

GPs and PMs were interviewed using a semi-structured topic guide about completing IB113 forms for the DWP about their patients entering long-term incapacity. The transcribed data were analysed thematically using the framework analysis method.

Whilst the IB113 appears superficially straightforward to complete, our results demonstrate levels of overlapping complexity that add ranges of subjectivity and selectivity onto factual reporting, including practice protocols, the gathering and managing of information, the doctor–patient relationship, and doctor’s personal views on systems.

The recording and reporting of patient related data by GPs is subject to complex influences, which need to be understood and managed to improve the relevance and quality of reports to third parties.

To conduct advanced psychometric analysis of Primary Care Assessment Tool (PCAT) in Tibet and identify avenues for metric performance improvement.

Measuring progress toward high-performing primary health care can contribute to the achievement of sustainable development goals. The adult version of PCAT is an instrument for measuring patient experience, with key elements of primary care. It has been extensively used and validated internationally. However, only little information is available regarding its psychometric properties obtained based on advanced analysis.

We used data collected from 1386 primary care users in two prefectures in Tibet. First, iterative confirmatory factor analysis examined the fit of the primary care construct in the original tool. Then item response theory analysis evaluated how well the questions and individual response options perform at different levels of patient experience. Finally, multiple logistic regression modeling examined the predicative validity of primary care domains against patient satisfaction.

A best final structure for the PCAT-Tibetan includes 7 domains and 27 items. Confirmatory factor analysis suggests good fit for a unidimensional model for items within each domain but doesn’t support a unidimensional model for the entire instrument with all domains. Non-parametric and parametric item response theory analysis models show that for most items, the favorable response option (4 = definitely) is overwhelmingly endorsed, the discriminability parameter is over 1, and the difficulty parameters are all negative, suggesting that the items are most sensitive and specific for patients with poor primary care experience. Ongoing care is the strongest predictor of patient satisfaction. These findings suggest the need for some principles in adapting the tool to different health system contexts, more items measuring excellent primary care experience, and update of the four-point response options.

Work ability and work ability assessments have become important both in health care and in relation to granting sick leave. There are different interpretations of work ability among the different professionals involved, and there is no consensus on how work ability should be assessed.

The aim was to analyse how a group of experienced and specially trained physiotherapists (PTs) in primary health care (PHC) perceived their professional role in work ability assessments during 14 months.

We conducted a prospective focus group study and applied qualitative content analysis to the data.

There was a need to emphasise the PTs’ role both within PHC and also in relation to others involved. The PHC organisation was not really prepared to direct work-disabled patients to PTs before physicians. In addition, the PTs themselves needed to reorganise to better meet the requirements. The PTs underlined the advantage of their frequent and extended meetings with patients. This made it possible to assess, follow and facilitate work ability and to determine patients’ resources. The PTs believed that they could contribute to structured assessments, which was positive for themselves and also in their communication with physicians and patients. The PTs later took more initiatives in work ability questions and believed that they could be responsible for work ability assessments to a greater extent. They found it most valuable to have had the opportunity to reflect on work ability, while working in the focus groups, and also to have been the subjects for further education. This made them more prepared to handle work ability questions when compared with other colleagues.

To examine whether different methods of administration of a patient questionnaire (PQ) assessing a doctor’s professional performance can influence the quality of data collected.

Patient surveys are important information sources regarding a doctor’s professional performance. Previous research across a range of patient outcomes suggests that the method of administration can influence response rates and ratings, although no data that explore how this might influence patients’ assessments of a doctor’s professional performance are available.

A volunteer sample of 13 UK doctors from primary care settings undertook a cross-sectional patient survey. Seven doctors distributed patient surveys using exit and touch-tone telephone administration, and six doctors used exit and postal administration. A consecutive sample of up to 40 patients per doctor completed each method of administration; postal and touch-tone surveys were administered retrospectively, whereas the exit surveys were administered prospectively. The GMC (General Medical Council) PQ included nine performance evaluation questions. We examined the response rates, item completion rates and response profiles of exit survey responses with those obtained from either postal or touch-tone telephone methods.

The administration methods influence the quality and comparability of data obtained. The exit survey response rate was higher than touch-tone (82.1% versus 37.5%; P < 0.0001) or postal survey (no reminder) (76.7% versus 60.8%; P < 0.0001) administration, but comparable to the postal survey after one reminder (78.3% versus 75.0%; P = 0.39). Item completion rates were comparable for exit and touch-tone surveys (highest rates of missing data 4.1% and 4.6%, respectively), but exit surveys resulted in more missing values than postal surveys (10.3 to 11.7% versus 1.1 to 3.9%). Response profiles varied. Both touch-tone and postal surveys yielded significantly more critical ratings than the exit survey (three of nine items).

Mixing administration methods requires caution when the data are used to create benchmarks against which a doctor’s performance is assessed.

The maternal mortality ratio (MMR) is not only an important indicator of maternal and infant safety, but also a sign of the development of economy, education, and medical care in a country. In the last 60 years, the Chinese government has implemented various strategies and policies to reduce the MMR, especially in the rural areas.

This study aimed to discuss the strategies developed by the Chinese government, showing the successful experience of Chinese intervention programs and highlighting the challenges to the government in the context of current economic and social status.

This study probed into the Chinese government’s efforts and achievements in the MMR reducing by reviewing the relevant health policies, extracting the data from China Health Statistics Yearbook of 2015, analyzing the reduction of maternal death in rural areas and the major causes from 1991 to 2015, comparing the MMR trend in urban and rural areas, and discussing the changes of the situation in China.

Although it seems that Chinese government’s efforts have brought evangel to the rural pregnant women and significantly reduced rural maternal mortality, the government still needs to develop more equitable and flexible primary health care policies to narrow the imbalance in health resource allocation and pay more attention to the health care for the rural-to-urban migration in China.

This report examined the impact and extent that spatial access to primary care physicians (PCPs) and social neighbourhood-/community-level factors have on diabetes prevalence for Toronto and Chicago.

The two-step floating catchment area method was used to compute spatial access scores. Bivariate correlation and multivariate linear regression identified the factors that were associated with, and/or predicted, diabetes prevalence.

Potential spatial access to PCPs had no strong associations with diabetes prevalence. Low socio-economic status factors and certain ethnic groups were strongly associated with diabetes prevalence for both cities. For Toronto, South American place of birth, households below poverty and high school-level education predicted diabetes prevalence. African ethnicity and households below poverty predicted diabetes prevalence for Chicago.

Although this report found no strong association between diabetes prevalence and access to PCPs, contextual factors significant in past individual-level diabetes studies were associated with diabetes prevalence at the neighbourhood/community level for Toronto and Chicago.

Identifying patients with chronic musculoskeletal pain using database searches is difficult, as chronic pain is not represented with a unique diagnostic code in electronic primary care records.

This paper describes the development and implementation of a search strategy to identify patients with chronic musculoskeletal pain in primary care databases to invite them to participate in a randomised controlled trial.

We used an exploratory, iterative approach. The first phase involved consultations with IT specialists, practice managers and doctors to gain an understanding about the processes and issues of electronic coding. In the second and third phases, we determined the most appropriate search terms and strategies. In the final phase, we tested, modified and re-tested the search strategy until the quantity and quality of the output appeared good enough to be used in general practices with different IT systems. This strategy was then implemented to recruit participants for a trial.

We identified three main search ‘domains’: prescribing, coding and attendance. We found the most useful identifier for chronic pain was the use of repeat medication. Wide variations in coding terms for chronic pain were seen between practices and individuals. Understanding ‘coding cultures’ were necessary to inform the electronic searches. In the case of chronic pain, searching on repeat medication for analgesia, low dose antidepressants and carefully selected coding terms captured most relevant patients.

To report an evaluation of health professionals’ participation in a distance-learning physical activity training course developed in a low socio-economic region of São Paulo city, Brazil.

In countries with public universal health systems, physical activity promotion in primary health care settings can reap results, particularly given that such interventions have the potential to reach a large percentage of the population. However, few studies proposed physical activity training for health professionals in low- and middle-income countries. Brazil is a continental country and has the Unified Health System which incorporates family health teams in over 85% of Brazilian cities.

The physical activity training was part of the fifth module of an educational intervention throughout a distance-learning course focusing on health professionals at M’Boi Mirim district in São Paulo city. The training totaled 3 h and had five themes of physical activity: (1) concepts, definitions benefits; (2) evaluation; (3) recommendation; (4) interventions; (5) physical activity counseling. The opinion of health professionals was evaluated after training by two open questions.

Out of 106 professionals who took part of the course, only 22.6% (n=24) had accessed the fifth module. These professionals were predominantly female (79.2%), nurses (66.7%) and aged 30 years or older. Responses highlighted the course approach focused on physical activity for improving patient’s quality of life and well-being, disease prevention and health improvements. Regarding the themes for improvement, the health professionals identified that there was a need to experience physical activity classes first-hand, and the need to link physical activity counseling to the local venues that provide structured physical activity programs. We recommend that further training courses can be conducted based on this model for health professionals to promote physical activity to the community in Brazil.

The aim of this article is to provide UK-based primary health care research and development workers with a review of the current range of published, aggregated socio-demographic indicators that can be combined with health and health care datasets, for the purposes of monitoring locality health profiles and planning primary health care. Non-UK readers should nevertheless find the review of some relevance to their own national contexts.

There is an increasing range of resources available for such purposes and many of these datasets are equally useful outside of geographic work. The 2001 census introduced important changes to what routine data are available, as will the 2011 census. These changes have been paralleled by developments in the availability of socio-demographic indicators and the increasing popularity of geographic information systems. Health data can now be combined with those from socio-demographic more efficiently to produce what are termed value-added datasets.

We review recent and planned developments in key data sources currently available in the UK and examine they can be used to monitor inequalities in primary health care inequalities and their role in the integration of primary health care needs mapping and forecasting with the spatial planning of areas undergoing regeneration.

Recent and planned developments in the availability of both socio-demographic datasets in tandem with parallel developments in spatial technologies have provided a flexible, potent geographical methodology for primary health care research and development. The current consultation process for the 2011 census provides those involved with primary health care research and development an opportunity to influence future developments.

Low socioeconomic status (SES) is a barrier for cardiovascular disease (CVD) risk screening and a determinant of poor CVD outcomes. This study examined the associations between access to health-promoting facilities and participation in a CVD risk screening program among populations with low SES residing in public rental flats in Singapore.

Data from Health Mapping Exercises conducted from 2013 to 2015 were obtained, and screening participation rates of 66 blocks were calculated. Negative binomial regression was used to test for associations between distances to four nearest facilities (i.e., subsidized private clinics, healthy eateries, public polyclinics, and parks) and block participation rate in CVD screening. We also investigated potential heterogeneity in the association across regions with an interaction term between distance to each facility and region.

The analysis consisted of 2069 participants. The associations were only evident in the North/North-East region for subsidized private clinic and park. Specifically, increasing distance to the nearest subsidized private clinic and park was significantly associated with lower [incidence rate ratio (IRR) = 0.88, 95% confidence interval (CI): 0.80–0.98] and higher (IRR = 1.93, 95%CI: 1.15–3.25) screening participation rates respectively.

Our findings could potentially inform the planning of future door-to-door screenings in urban settings for optimal prioritization of resources. To increase participation rates in low SES populations, accessibility to subsidized private clinics and parks in a high population density region should be considered.

The purpose of this study was to explore how patients with diabetes and multimorbidity experience self-management support by general practitioners (GPs), nurses and medical secretaries in Norwegian general practice.

Self-management support is recognised as an important strategy to improve the autonomy and well-being of patients with long-term conditions. Collaborating healthcare professionals (cHCPs), such as nurses and medical secretaries, may have an important role in the provision of self-management support. No previous study has explored how patients with diabetes and multimorbidity experience self-management support provided by cHCPs in general practice in Norway.

Semi-structured interviews with 11 patients with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) with one or more additional long-term condition were performed during February–May 2017.

Patients experienced cHCPs as particularly attentive towards the psychological and emotional aspects of living with diabetes. Compared to GPs, whose appointments were experienced as stressful, patients found cHCPs more approachable and more likely to address patients’ questions and worries. In this sense, cHCPs complemented GP-led diabetes care. However, neither cHCPs nor GPs were perceived to involve patients’ in clinical decisions or goal setting during consultations.