Our aim was to evaluate the implementation process of a comprehensive cardiovascular disease prevention program in general practice, to enhance understanding of influencing factors to implementation success and sustainability, and to learn how to overcome barriers.

Cardiovascular disease and its risk factors are the world’s leading cause of mortality, yet can be prevented by addressing unhealthy lifestyle behavior. Nevertheless, the transition toward a prevention-oriented primary health care remains limited. A better understanding of factors facilitating or hindering implementation success and sustainability of prevention programs, and how barriers may be addressed, is needed. This work is part of Horizon 2020 project ‘SPICES’, which aims to implement validated preventive interventions in vulnerable populations.

We conducted a qualitative process evaluation with participatory action research approach of implementation in five general practices. Data were collected through 38 semi-structured individual and small group interviews with seven physicians, 11 nurses, one manager and one nursing assistant, conducted before, during, and after the implementation period. We applied adaptive framework analysis guided by RE-AIM Qualitative Evaluation for Systematic Translation (RE-AIM QuEST) and Consolidated Framework for Implementation Research (CFIR).

Multiple facilitators and barriers affected reach of vulnerable target populations: adoption by primary health care providers, implementation and fidelity and intention to maintain the program into routine practice. In addition, our study revealed concrete actions, linked to implementation strategies, that can be undertaken to address identified barriers. Prioritization of prevention in general practice vision, ownership, and shared responsibility of all team members, compatibility with existing work processes and systems, expanding nurse’s roles and upskilling competence profiles, supportive financial and regulatory frameworks, and a strong community – health care link are crucial to increase implementation success and long-term maintenance of prevention programs. COVID-19 was a major barrier to the implementation. RE-AIM QuEST, CFIR, and participatory strategies are useful to guide implementation of prevention programs in primary health care.

To examine health care practitioners’ views of the support women, partners, and the couple relationship require when affected by birth trauma, barriers to gaining such support, and potential improvements.

Ongoing distress following psychologically traumatic childbirth, also known as birth trauma, can affect women, partners, and the couple relationship. Birth trauma can lead to post traumatic stress symptoms (PTSS) or disorder (PTSD). Whilst there is a clear system of care for a PTSD diagnosis, support for the more prevalent experience of birth trauma is not well-defined.

An online survey of health care practitioners’ views of the support parents require for birth trauma, barriers to accessing support, and potential improvements. Practitioners were recruited in 2018 and the sample for the results presented in the article ranged from 95 to 110.

Practitioners reported differing needs of support for women, partners, and the couple as a unit. There was correlation between practitioners reporting having the skills and knowledge to support couples and feeling confident in giving support. The support most commonly offered by practitioners to reduce the impact on the couple relationship was listening to the couple. However practitioners perceived the most effective support was referral to a debriefing service. Practitioners observed several barriers to both providing support and parents accessing support, and improvements to birth trauma support were suggested.

Practitioners indicate that some women, partners, and the couple as a unit require support with birth trauma and that barriers exist to accessing effective support. The support that is currently provided often conflicts with practitioners’ perception of what is most effective. Practitioners indicate a need to improve the identification of parents who need support with birth trauma, and more suitable services to support them.

The family medicine residents and final year medical students are challenged with increased workload and they experience various emotions during their clinical trainings. They are confronted with uncertainties in their role descriptions and they witness illness, suffering and deaths as part of their everyday duties which may lead to burnout. Only several studies have focused on these experiences to find out what the family medicine residents and medical students were literally feeling.

The aim of this study was to explore the family medicine residents’ and final year medical students’ emotions during their clinical trainings.

This qualitative study was performed with 15 family medicine residents and 24 final-year medical students using a convenience sample from two medical faculties to explore and analyze their emotions. Data were gathered by means of focus group interviews, including six interviews conducted and recorded through online meetings. Data were analyzed for themes using a thematic analysis approach. Since the interviews reached saturation in terms of content, the interviews were terminated at the end of sixth focus group meetings. Each interview took an average of 45–60 min.

Three main themes emerged from the data regarding residents’ and interns’ emotions. These were the “clinical climate’s role”, “emotions during patient encounters” and “coping strategies with negative emotions”. The most commonly encountered emotions were tension and anxiety followed by frustration and uncertainty.

The family medicine residents and final-year medical students are challenged with emotions during their clinical trainings. Therefore, medical educators have to be aware of the need to support them in reflecting their emotions by prioritizing residents’and interns’ well-being.

The aim of this study was to assess the provision of information to, and seeking of information by, patients newly diagnosed with polymyalgia rheumatica (PMR) in primary care.

PMR is an inflammatory rheumatological condition of older people that can be treated with long-term oral glucocorticoids. Management usually requires the patient to understand the potential complications of treatment and the disease, as well as involvement in reducing treatment dose. This may be complex for patients to understand.

Data are taken from the baseline phase of the PMR Cohort study, which recruited newly diagnosed patients with PMR from UK primary care. Participants provided information on their PMR symptoms, general health and sociodemographics. They also completed items regarding information provision by their doctor at diagnosis, its usefulness and their own search for information.

A total of 652 people responded to the baseline survey. In all, 399 (62.7%) had received written information from their doctor; 237 (98%) found it useful; 265 (42.9%) would have liked more information; and 311 (48.4%) sought out more information. Those who were not given information and did not seek it out tended to be older and have poorer internet access.

Information provided at diagnosis to patients with PMR is useful, but more than a third did not receive any. This is concerning when PMR requires self-management and vigilance for red flags. Doctors should make use of the resources already available to them to support patients and should specifically ensure that these are available to more elderly patients and those without internet access.

Caregiver-mediated intervention (CMI), based on parent skills training, is a family-mediated intervention model for children with neurodevelopmental disorders, in particular autism spectrum disorder. This study aimed to evaluate the effectiveness of CMI.

Thirty-three children (aged 22–69 months from our department) and their caregivers participated in a two-week training course of ten 90-minute lessons. Caregivers were encouraged to try their best to apply intervention skills in both home routines and play routines to encourage the development of cognition, motion, social adaptability, and behavior of children. Demographic information, video-recorded data, and diagnostic scales were collected at two key time points: baseline and post-training (PT – within six months).

Three aspects were assessed – primary variables, secondary variables, and correlation analyses. Results showed an improvement in PT in (1) Adult/Child Interaction Fidelity Rating (P < 0.01) and (2) adaptability of Gesell Developmental Scale and stereotyped behaviors and limited interests of Autism Diagnostic Observation Schedule (P < 0.05, P < 0.01). Moreover, a negative correlation occurred between caregiver skill improvement and parent education (P < 0.05), but without correlations with other demographics.

As an efficacious family intervention for both children and their caregivers, CMI is worth being generalized widely.

E-cigarettes (ECs) are gaining popularity in Turkey among smokers. With the rapid increase of EC consumption, it is important to ascertain how family physicians (FPs) perceive ECs as they play a key role in providing smoking cessation services.

Our main objectives were to determine FPs’ level of awareness and harm reduction perceptions of ECs and to delineate the factors associated with their counseling practices.

This was a cross-sectional study with descriptive and analytical components. Data were collected through questionnaires. Questions mainly focused on demographic characteristics, knowledge and own use of ECs, general attitudes towards ECs, and daily practices while performing counseling on tobacco use. In order to control confounding factors, logistic regression analysis was performed.

Among a total of 271 FPs, 49.1% (n = 133) were males and the median age (IQR) was 41 years (32–46). Almost one-fifth of the FPs (n = 52) reported that they did not provide counseling services to their smoking patients. Only 26.6% (n = 72) of the FPs stated that they felt confident enough to advise patients on smoking cessation. Of the FPs, 6.6% have stated that they have recommended ECs to their patients for smoking cessation with the strategy of harm reduction. Factors associated with providers’ recommendation of ECs to their patients as a harm reduction strategy included ‘believing that ECs help smokers to quit, ECs could be vaped in closed areas, and ECs were healthier than combustible tobacco products’.

In our study, FPs stated lack of confidence to advice patients on smoking cessation. Furthermore, they recommended ECs to their smoking patients as a harm reduction strategy. FPs’ confidence should be increased with the trainings based on recent evidence on ECs.

To collaboratively explore the cultural acceptance of the Pepi-Pod® program as an alternate safe sleep space and to explore the process of implementing the Pepi-Pod® program in a mainstream health service for Aboriginal families living in urban South Australia.

Aboriginal and Torres Strait Islander infants continue to die from sudden infant death syndrome (SIDS) and sudden unexpected death in infancy (SUDI) at rates three to four times greater than other infants born in Australia despite Council of Australian Governments commitment to halve the gap in the Indigenous infant mortality rate by 2018. The Pepi-Pod® program is evidenced in New Zealand and Queensland to provide a culturally appropriate safe sleep alternative that contributes to the reduction of SIDS and SUDI. We have no evidence of acceptability or feasibility when offered through mainstream services in metropolitan South Australia.

With a focus on decolonizing the research process through a two-way process for mutual learning between Aboriginal and non-Aboriginal team members and community, a novel qualitative design was employed including photo elicited yarning sessions (n = 7), focus groups (n = 2), and field notes (n = 15).

Four themes emerged: ‘you don’t have to worry’; ‘a way of sharing knowledge’; ‘it looks like a bread box?’ and ‘need for consistent safe sleep messages’. The findings suggest that participants believe the Pepi-Pod® program may enrich Aboriginal families’ lives evoking feelings of comfort and safety; however, the design could be improved to make them more culturally appropriate. There was confusion around safe sleep processes and education with a call for streamlining safe sleep messaging.

Knee pain affects 25% of the population aged over 55 years and is the most common complaint of pain among those consulting for primary care. However, a large proportion do not seek help, with up to 50% of those with the most severe form of pain not consulting. Little is known about why this appears to be happening. Our aim was to examine whether consultations for concurrent comorbid disease had any influence on an individual's likelihood of consulting for knee-related problems in primary care.

This was a case–crossover control study of patients aged over 50 years from three North Staffordshire practices with knee pain followed over a three-year period. All comorbid consultations for the same period were identified. The date of knee consultation cases were identified, and within-subject control days for the same individual were determined for 12 months previously or later where there was no knee consultation. McNemar's test for matched pairs was then carried out to assess whether consultation for either a chronic or acute condition in the preceding three months was associated with knee consultation.

A total of 281 participants were included in the case–crossover analysis. There was a lower frequency of chronic comorbid consultations in the three months preceding knee consultation than in either the previous (OR = 0.30; 95% CI 0.11, 0.74) or later control windows (OR = 0.56; 95% CI 0.27, 1.09). There was no difference in the frequency of acute comorbid consultations.

This study suggests that consultations for knee problems are preceded by a period of relatively fewer consultations for other chronic comorbid conditions. Patients might choose to consult for their knee problem when comorbid issues are not a priority. Future research might investigate whether certain comorbid conditions have a greater effect than others, and whether a proactive approach such as screening for knee disorders might improve prognosis?

To identify shortcomings in existing models of patient behaviour change, and present the development and testing of a novel approach using practitioner facilitation and person-focussed conversations that identifies and addresses behaviours at an earlier stage than current models.

Systematic strategies used by health professionals to change patient behaviours began with motivational interviewing and brief intervention approaches for serious addictive behaviours. Practitioners typically presume they should drive the process of patient behaviour change. Attempts to transfer these approaches to primary care, and a broader range of health risk behaviours, have been less successful. The TADS programme (Tobacco, Alcohol and Other Drugs, later Training and Development Services) began teaching motivational interviewing and brief interventions to practitioners in New Zealand in 1996. Formal and informal evaluations showed that practitioners used screening tools that patients rejected and that led to incomplete disclosure, used language that did not engage patients, failed to identify the behaviours patients wished to address and therefore misdirected interventions.

Iterative development of new tools with input from patients and primary care clinicians.

The TADS programme developed a questionnaire whose results remained private to the patient, which enabled the patient to identify personal behaviours that they might choose to change (the TADS Personal Assessment Choice Tool). This was assisted by a brief conversation that facilitated and supported any change prioritised by the patient (the TADS Brief Opportunistic Interaction). The need for this approach, and its effectiveness, appeared to be similar across adults, youth, different ethnic groups and people in different socio-economic circumstances. Behaviours patients identified were often linked to other health risk behaviours or early-stage mental health disorders that were not easily detected by practitioner-driven screening or inquiry. The long-term effectiveness of this approach in different populations in primary health care settings requires further evaluation.

In early 2010, Liverpool Primary Care Trust (PCT) undertook a project to establish whether a care profiles methodology could be used to commission end-of-life (EoL) services. The Department of Health (DH) originally used them for a variety of services in the 1990s. The project sought to adapt the original care profiles structure for commissioning purposes, and produce a series of care profiles that would cover the full EoL care pathway.

The DH required PCTs in England to undertake local reviews of EoL services ahead of its publication of the National EoL Strategy in 2008. Related cross-sector work in Liverpool highlighted the need for a means of specifically commissioning EoL services. It was contended that care profiles offered the opportunity to set service requirements in respect of skill mix, delivery, quality and outcomes for each stage of the EoL pathway, which could be costed subsequently.

An iterative approach was adopted involving workshops and consensus, based on action learning events, which incorporated and adapted past approaches for developing care profiles. Four half-day workshops were held, each targeting one EoL stage, with the outputs evaluated by an external reference group. A full cross-section of commissioning, provider and service user interests were involved.

The project was successful, with its recommendations subsequently used to commission EoL services across Liverpool. It was concluded that the basic service requirements for EoL care are the same, irrespective of the related disease. The strength of care profiles is their simplicity and flexibility. They complement and augment integrated care pathways, and by requiring the recording of outcomes throughout the care process, they aid quality and audit processes. They should be transferable to other conditions, with benchmarking enabling improved efficiency. They represent the type of clinically relevant and detailed vehicle essential for clinical commissioning groups.

To assess the regulation of the Chinese healthcare system in assisting a nationwide implementation of general practitioner (GP) services.

Along with the perennial problems of unaffordable and inequitable healthcare, a rapidly ageing population and the increasing burden of non-communicable diseases pose challenges to the Chinese healthcare system. Recognising these challenges and to satisfy people’s demands for more and better healthcare, China has initiated a plan, named ‘Healthy China 2030’, based on the findings from a two-year joint study by the World Health Organization (WHO) and the World Bank Group (WBG) in collaboration with Chinese agencies. The Chinese healthcare plan, officially approved in 2016, is an attempt to use the people-centred, integrated care (PCIC) model recommended by the WHO and WBG to shape the Chinese healthcare system. In accordance with PCIC, China began the implementation of gatekeeping primary care by introducing GP services to local communities.

A comparative analysis was employed to point out the importance of introducing GP services. A systematic assessment was carried out to evaluate the regulatory sector of the Chinese healthcare system, including a critical review of related legal norms and a theoretical exploration of external impediments (eg, cultural attitudes, government capacity and interest groups).

Results demonstrate that the current regulatory sector of the Chinese healthcare system needs to be improved in order to assist the nationwide implementation of GP services and to strengthen its gatekeeping role. Major deficiencies include the problematic relationship between legal norms and health policies, the lack of effective and consistent new legislation, the low rate of social acceptance, and lack of support from agencies. To address those challenges, this paper recommends that preliminary efforts be devoted, in part, to two changes in the legal structure: enacting a specific law, and creating an independent regulatory oversight body.