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Primary Care Medical Family Practice - current issue
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Objective</div>The general population’s interest in cardiopulmonary resuscitation (CPR) remains largely unknown. Fewer than one-third of individuals are familiar with CPR, and there are no comprehensive training programs available. This study aimed to examine CPR interest among patients visited in the primary care setting, design a new program, and assess the feasibility and efficacy of the training initiative.<div class="boxTitle">Methods</div>This two-phase project aimed to (i) examine patients’ knowledge and interests and (ii) design and evaluate a training program within the PC setting. Knowledge and interests were assessed using a survey. The training program design adhered to European guidelines. The pilot study assessed effectiveness through self-administered tests, instructor evaluation of the chain of survival, correct use of an automated external defibrillator (AED), and a manikin capable of measuring chest compression.<div class="boxTitle">Results</div>A total of 243 patients participated. Among them, 26.16% had received prior CPR training, only 5% knew how to perform CPR maneuvers, and 84.8% were interested in learning. A 90-min training program was designed. After the training session (<span style="font-style:italic;">N</span> = 50), all participants reported feeling capable of performing CPR techniques using the AED; 94% demonstrated proficiency in AED use, and 20% performed high-quality chest compressions (correct release, depth, and rate).<div class="boxTitle">Conclusion</div>The general population had limited knowledge about CPR but was highly interested in acquiring CPR skills. The PC-based training program enabled bystanders to perform CPR and use AEDs, potentially improving survival rates in out-of-hospital cardiac arrests.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>In 2015, the Australian Diabetes Alliance Program (DAP) was implemented in the Hunter New England Local Health District, New South Wales as a collaboration with the Hunter Medicare Local. DAP integrates specialist teams within primary care practices, delivering case conferencing, practice performance reviews, and education sessions.<div class="boxTitle">Objective</div>To report on practice nurses (PNs) perspectives on the impact of the DAP on their skills, knowledge, and approach in delivering care for adults with type 2 diabetes.<div class="boxTitle">Methods</div>Three primary care practices with high rates of monitoring haemoglobin A1c (HbA1c) levels (> 90% of patients annually) and three practices with lower rates of monitoring HbA1c levels (< 80% of patients annually) from DAP provided the sampling frame. Interviews were conducted with six PNs, which were transcribed and analysed using codebook thematic analysis.<div class="boxTitle">Results</div>Overall, DAP was viewed favourably by PNs. Significant improvements in knowledge and skills were reported relating to administering antihyperglycemic agents, insulin, and other injectable therapy, as well as dietary modifications for diabetes management. PNs transferred this knowledge and skills to other patients not participating in DAP. An improvement in the delivery of diabetes care, rather than a change in approach, was also reported by PNs. However, the amount of preparation required for case conferencing in the program was identified as a burden to PNs.<div class="boxTitle">Conclusions</div>PNs were supportive of DAP and identified knowledge gains that were transferable to other patients. The administrative burdens on PNs need to be considered for scalability of the program.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Purpose</div>There is limited evidence about whether a substance use disorder (SUD) is a barrier to breast cancer screening. Because SUDs are highly prevalent in the USA, it is important to establish whether this patient population is less likely to obtain screening.<div class="boxTitle">Methods</div>This retrospective cohort study included 220 227 patients, with 209 132 having no SUD and 11 095 (5.0%) with SUD based on electronic health record data in a multi-state, Midwestern healthcare system (1 January 2018–31 December 2022). The outcome was the receipt of a mammogram in the 5-year follow-up period. Patients were women aged 40–69 years as of 1 January 2018, with ≥ 2 in-person primary care visits between 2018 and 2022. Covariates included demographics, health services utilization, and physical/psychiatric conditions.<div class="boxTitle">Results</div>Mean age of the sample was 54.7 (± 8.3) years old. After controlling for confounding, women without any SUDs had more than twice the odds of mammogram receipt compared to those with stimulant use disorder (odds ratio [OR] 2.06; 95% confidence interval [CI]: 1.83–2.33). Women with no SUDs had 89% higher odds of mammogram receipt compared to those with opioid use disorder (OR 1.89; 95% CI: 1.76–2.03), followed by “other” SUDs (OR 1.86; 95% CI: 1.69–2.06), sedative use (OR 1.70; 95% CI: 1.43–2.04), cannabis use (OR 1.58; 95% CI: 1.44–1.74), and alcohol use disorders (OR 1.49; 95% CI: 1.41–1.58).<div class="boxTitle">Conclusions</div>Despite the high prevalence of SUDs, evidence of preventive service delivery among individuals with SUDs is still lacking. Further research is needed to investigate other healthcare disparities in preventive service delivery among individuals with SUDs.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Postpartum depression is experienced by approximately 10% of women and affects the health and development of their children. Although it is recommended that all mothers have the opportunity for early detection and intervention for postpartum depression, it is unclear whether early postpartum check-ups help to reduce postpartum depression.<div class="boxTitle">Objective</div>The aim of this study was to assess the effect of 2-week postpartum check-ups on screening positive for postpartum depression in Japan.<div class="boxTitle">Methods</div>This was a population-based cohort study that used the administrative database of Tsuyama, Japan. Participants were women who received postpartum home visits from a public health nurse in Tsuyama during the fiscal years 2017–2019. Data were obtained on participant’s attendance at a 2-week postpartum check-up and their responses on the Edinburgh Postpartum Depression Scale. Owing to the initiation of a publicly funded postpartum check-up programme, participants were pseudo-randomly assigned to receive/not receive a 2-week postpartum check-up. We conducted instrumental variable estimation to assess the causal effects of the check-up on screening positive for postpartum depression.<div class="boxTitle">Results</div>The characteristics of the 1,382 participants did not differ by fiscal year of childbirth. We found a 6.7% (95% confidence interval 2.2–11.2) reduction in the prevalence of screening positive for postpartum depression as an effect of 2-week postpartum check-ups among women received 1-month postpartum home visits.<div class="boxTitle">Conclusion</div>The results suggest that 2-week postpartum check-ups are effective in reducing the prevalence of screening positive for postpartum depression among 1-month postpartum women. Despite some limitations, early postpartum care could reduce postpartum depression.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Introduction</div>A better understanding of the determinants involved in general practitioners’ (GPs) decision-making processes when it comes to prescribing statins as primary prevention in patients with multimorbidity could provide insights for improving implementation of primary prevention guidelines.<div class="boxTitle">Methods</div>We conducted a qualitative study using a deductive framework-based and inductive analysis of GPs’ semi-structured interviews verbatim, from which expertise profiles of prescribers were also drawn. The analytical framework was built from a pragmatic synthesis of the evidence-based medicine, Modelling using Typified Objects (MOT) model of clinical reasoning processes, Theoretical Domains Framework, and shared decision-making frameworks.<div class="boxTitle">Results</div>Fifteen GPs were interviewed between June 2019 and January 2020. Diabetes seemed to represent a specific motivation for deciding about statin prescription for primary prevention purposes; and in situations of multimorbidity, GPs differentiated between cardiovascular and non-cardiovascular multimorbidity. Expert prescribers seemed to have integrated the utilisation of cardiovascular risk calculation scores throughout their practice, whereas non-expert prescribers considered them difficult to interpret and preferred using more of a “rule of thumb” process. One interviewee used the risk calculation score as a support for discussing statin prescription with the patient.<div class="boxTitle">Conclusion</div>Our results shed light on the reasons why statins remain under-prescribed for primary prevention and why non-diabetic multimorbid patients have even lower odds of being prescribed a statin. They call for a change in the use of risk assessment scores, by placing them as decision aids, to support and improve personalised shared decision-making discussions as an efficient approach to improve the implementation of recommendations about statins for primary prevention.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Anti-M antibodies are relatively common and naturally occurring. When anti-M antibodies cross the placenta, they may cause hemolytic disease of the fetus and newborn (HDFN). Anti-M antibodies account for less than 15 cases of HDFN reported in the published English literature. HDFN can lead to foetal anaemia, hydrops fetalis, hypoxia, heart failure, and even death.<div class="boxTitle">Objective</div>To review the general guidelines and propose a less intensive management approach of anti-M antibody during pregnancy through the context of a case report.<div class="boxTitle">Methods</div>We report a 25-year-old healthy pregnant G3P1011 woman presenting for antepartum care. At the time of delivery for the patient’s second pregnancy, she was found to have a positive anti-M blood screen, though she birthed a healthy-term infant. For her current pregnancy, the initial and repeat testings for anti-M were positive.<div class="boxTitle">Results</div>Since multiple samples from this patient were of low levels extensive maternal and foetal monitoring were deemed unnecessary in reflection of further reading and research. The patient had a spontaneous vaginal delivery of her third pregnancy at 38 weeks without complications.<div class="boxTitle">Conclusion</div>Anti-RBC antibodies, including anti-M, are frequently identified in blood type and screening for pregnant patients. Guidelines call for intensive surveillance during pregnancy; however, knowledge of the specific antibody can help to provide more nuanced and less intensive care. As primary care physicians, being familiar with the guideline and the ability to counsel patients on anticipated care during pregnancy can help with family planning, compliance with testing, and patient anxiety and decrease intensive use of services that may not affect outcomes.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Invasive meningococcal disease (IMD) is a severe infectious disease. Although effective preventive and therapeutical strategies are available, the fatality rate remains high in the general population, with an occurrence of meningococcal-related severe sequelae involving 10–20% of survivors. Given the crucial role of general practitioners in recognizing and preventing IMD and its related sequelae, we aim to assess the burden of these conditions in primary care.<div class="boxTitle">Methods</div>Using an Italian primary care database, the incidence rate of IMD was calculated in the period 2000–2019 by capturing the first diagnosis registered during follow-up. As far as meningococcal-related sequelae are concerned, we identified and clinically evaluated each potential sequela during the first 3 months, from 3 to 12 months, and up to 36 months.<div class="boxTitle">Results</div>Among 508 patients diagnosed with IMD, 403 (incidence rate: 0.24 per 10,000 person-years) comprised those diagnosed with IMD in patients aged 15 years or older. We ascertained 104 sequelae (20.4%); 76% of them occurred in those aged 25 or older; 42, 27, and 35 were assessed as short-, medium-, or long-term sequelae, respectively. Overall, 4.7% of IMD patients reported physical sequelae, while 12.2% and 5.7% of patients reported neurological and psychological sequelae, respectively.<div class="boxTitle">Conclusion</div>Our study showed that a substantial proportion of IMD and related sequelae occur in individuals aged over 25, with a non-negligible burden for healthcare systems. As for the paediatric population, effective communication on the relevance of meningococcal vaccination in adults should be proficiently fostered.</span>
<span class="paragraphSection">This is a correction to: Julie Legrand, Isabelle Aubin-Auger, Louise De Bary, Élodie Fossembas, Dan Baruch, Alexandre Malmartel, Sustainable development in general practice, Family Practice, 2023;, cmad003, <a href="https://doi.org/10.1093/fampra/cmad003">https://doi.org/10.1093/fampra/cmad003</a></span>
<span class="paragraphSection">This is a correction notice only for: Rationale, design and initial results of an educational intervention to improve provider-initiated HIV testing in primary care, <span style="font-style:italic;">Family Practice</span>, Volume 38, Issue 4, August 2021, Pages 441–447, <a href="https://doi.org/10.1093/fampra/cmaa139">https://doi.org/10.1093/fampra/cmaa139</a></span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Preventive health care provides opportunity for preventive screenings and health promotion. Mothers of young children may disproportionately experience barriers to preventive care during the COVID-19 pandemic.<div class="boxTitle">Methods</div>We examined delaying and skipping preventive health care during the first year of the COVID-19 pandemic among mothers and described reasons for delaying or skipping care. Mothers of children aged 0–12 years from the United States completed an online survey in February/March 2021 and reported receipt of preventive care during the COVID-19 pandemic, reasons for delaying or skipping care, demographics, and experiences with COVID-19.<div class="boxTitle">Results</div>Participants (<span style="font-style:italic;">N</span> = 306) were on average 35.9 (SD: 6.2) years old, racially/ethnically diverse, and 74.8% had at least a Bachelor’s degree. From March 2020 to March 2021, 16.0% delayed and 20.6% skipped their physical examination, and 20.9% had not planned on receiving a physical examination. The most common reasons for delaying and skipping care were COVID-19 infection concerns, perception that delaying care would not negatively impact health, provider rescheduling, time, and childcare.<div class="boxTitle">Conclusions</div>Primary care teams may need to re-engage mothers who skipped preventive care during the pandemic, including addressing concerns about COVID-19 infection.</span>
<span class="paragraphSection">This is a correction to: Chance R Strenth, Patti Pagels, Jeffrey A SoRelle, Leo Gonzalez, Philip G Day, Nora E Gimpel, Emily I Levy Kamugisha, Rachel M Moore, Elizabeth Mayfield Arnold, Predictors of mood or anxiety problems among transgender individuals seeking hormone therapy, Family Practice, 2022, cmac111, <a href="https://doi.org/10.1093/fampra/cmac111">https://doi.org/10.1093/fampra/cmac111</a></span>
<span class="paragraphSection">This is a correction to: Caroline de Moel-Mandel, Understanding and communicating epidemiological measures of risk and benefit, Family Practice, 2022, cmac117, <a href="https://doi.org/10.1093/fampra/cmac117">https://doi.org/10.1093/fampra/cmac117</a></span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Objective</div>To describe a case of subacute thyroiditis (SAT) secondary to COVID-19 in the primary health care (PHC).<div class="boxTitle">Case description</div>A 51-year-old woman was treated in a PHC facility for flu-like symptoms for 5 days and pain in the lower neck. Symptomatic drugs were prescribed, and the patient was tested for COVID-19. On reassessment, the patient presented a painful oedema on the thyroid gland, dysphagia, and improvement in flu-like symptoms. Nonsteroidal anti-inflammatories were prescribed, and thyroid function analysis and inflammatory markers were collected. Reassessment after 1 week showed positive polymerase chain reaction-rapid test for COVID-19, partial improvement of neck pain, alterations in thyroid hormone tests (suppressed thyroid stimulating hormone and slightly elevated T4), and elevated C-reactive protein. Thyroid gland ultrasonography (USG), anti-thyroglobulin, and anti-thyroid peroxidise (anti-TPO) antibodies were requested and prednisone was prescribed. Anti-thyroglobulin and anti-TPO antibodies were negative; thyroid USG showed a solid nodule in the left lobe (approximately 4 cm), classified as TIRADS-4. The patient was sent to the Endocrinology Service, and a thyroid fine needle aspiration was requested. USG prior to the examination evidenced a complete regression of the nodule, which was diagnosed as an inflammatory pseudo nodule.<div class="boxTitle">Conclusion</div>We presented the case of a patient who was treated in a PHC facility for rare findings of SAT secondary to mild COVID-19, concomitant with a thyroid nodule that had complete remission after approximately 3 months and was interpreted as an inflammatory pseudo nodule secondary to SAT. PHC professionals should be aware of this condition and conduct adequate follow-up of these patients.</span>
<span class="paragraphSection">The UN General Assembly in September 2021 will bring countries together at a critical time for marshalling collective action to tackle the global environmental crisis. They will meet again at the biodiversity summit in Kunming, China, and the climate conference (COP26) in Glasgow, UK. Ahead of these pivotal meetings, we—the editors of health journals worldwide—call for urgent action to keep average global temperature increases below 1.5°C, halt the destruction of nature and protect health.</span>
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