The primary objective of this study is to assess the workload situation within Iran’s primary healthcare (PHC) sector, with an emphasis on identifying workforce needs and ascertaining any existing shortages or surpluses.

Over the past four decades, the establishment of PHC in Iran has been a significant accomplishment for the country’s healthcare system. Iran places substantial importance on achieving universal health coverage through PHC, aligning with global health goals, and acknowledging the critical role of human resources in this context. This commitment has enabled widespread and inclusive access to PHC services for both urban and rural populations across the nation. The primary objective of this study is to assess the workload situation within Iran’s PHC sector, with an emphasis on identifying workforce needs and ascertaining any existing shortages or surpluses.

In 2023, a retrospective cross-sectional survey in Iran’s PHC sector sampled 1,212 individuals from 557 units across seven districts. Units were selected based on predetermined criteria for proportional representation of eligible occupational groups. Data was collected using tailored electronic questionnaires, covering facility and individual characteristics, working time, activities, and support tasks. Shortages or surpluses were assessed using Workload Indicators of Staffing Need (WISN) ratios under various scenarios, utilizing data from 2022 registration systems. Adjusted time data-informed workload pressure calculations.

Customizing the WISN protocol to each country’s context is crucial, involving stakeholders in study design, including sample selection and data collection methods. Contextual facility information aids analysis, necessitating standardized data collection approaches for diverse registration systems.

This study aimed to identify how frequent poor mental health days, a depressive disorder diagnosis, frequent poor physical health days, or physical inactivity affect annual foot examinations in individuals with diabetes.

Diabetes mellitus (DM), particularly type 2, is a growing problem in the United States and causes serious health complications such as cardiovascular disease, end-stage renal disease, peripheral neuropathy, foot ulcers, and amputations. There are guidelines in place for the prevention of foot ulcers in individuals with diabetes that are not often followed. Poor mental health and poor physical health often arise from DM and contribute to the development of other complications.

We performed a cross-sectional analysis of the 2021 Behavioural Risk Factor Surveillance System dataset to determine the relationship between annual foot examinations and frequent poor mental health days, a depressive disorder diagnosis, frequent poor physical health days, or physical inactivity using a bivariate logistic regression model. The regression model was controlled for age, sex, race/ethnicity, health insurance, level of education, current smoking status, and Body Mass Index (BMI) category.

Our results showed that 72.06% of individuals with frequent poor mental health days received a foot check, compared with 76.38% of those without poor mental health days – a statistically significant association (AOR: 1.25; 95% CI: 1.09–1.43). Of those reporting a sedentary lifestyle, 73.15% received a foot check, compared with 77.07% of those who were physically active, which was also statistically significant (AOR: 1.31; 95% CI: 1.14–1.49). Although individuals reporting depressive disorder diagnoses and frequent poor physical health days had lower rates of foot examinations, these results were not statistically significant. To reduce rates of foot ulcers and possible amputations, we recommend the implementation of counselling or support groups, increased mental health screening, educational materials, or exercise classes.

Primary health care (PHC) delivered in Austria’s newly established primary health care units (PHCU) is based on interprofessional collaboration (IPC) between health care and social professionals.

This study aims to explore the requirements and challenges in IPC in Austrian PHCUs from the perspective of health care and social professionals.

15 semi-standardized, online, mono-professional focus group interviews were conducted with a total of 58 professionals with the following backgrounds: biomedical sciences, dietetics, medical training therapy, medicine, midwifery, nursing, occupational therapy, office assistance, orthoptics, pharmacy, physiotherapy, psychotherapy, radiography, social work, and speech therapy. The participants were representatives from PHC practice (especially PHCUs), respective educational institutions, and professional organizations. The data were inductively analysed using qualitative content analysis according to Mayring.

The analysis displayed two main fields discussed by the participants, the setting for IPC and the professional relationships. The content analysis revealed three and four topics, respectively, within the main discussion fields. Within the setting for IPC, these topics were elaborated on (1) the operational area where IPC takes place in PHC, (2) the structural and organizational premises for this cooperation in PHCUs, and (3) the observed benefits of PHCUs for patients. Regarding the professional relationships, these topics were discoursed: (1) successful IPC, (2) challenges in IPC, (3) competencies required for IPC, and (4) previous and present corresponding training content.

Austrian health care and social professionals aim to get more involved in PHC in general and PHCUs specifically. They see opportunities and also challenges for their professional groups. Specific training is desired focusing on the unique requirements of Austrian PHCUs and equipping the workforce for the intensive, necessary, and beneficial collaboration between multiple professional groups in the increasingly important setting.

To summarize the findings from the PHC Measurement and Improvement (PHCMI) initiative in the World Health Organization WHO Eastern Mediterranean Region (EMR) and highlight key lessons to build PHC-oriented health systems.

To support countries in enhancing their commitment to the primary health care (PHC) approach, the WHO Regional Office for the Eastern Mediterranean (EMRO) established the PHCMI initiative in 2019 to evaluate PHC performance and identify priorities for improvement.

Building on the experience of the global PHC Performance Initiative (PHCPI), PHCMI updated the master indicator list through iterative processes and reflecting country priorities. Progress in five domains: system/structure, inputs, processes, outcomes, and impact was assessed. Existing policy documents, data sources, and key informant interviews were used in the assessment.

Of the 21 countries and one territory, 14 participated in the assessment including Afghanistan, Bahrain, Egypt, I.R. of Iran, Iraq, Jordan, Lebanon, Libya, Morocco, Oman, Pakistan, occupied Palestinian territory, Qatar, and Yemen. Despite the observed heterogeneity in PHC implementation, most countries reported that public primary care services were acceptable, accessible, and affordable. Strong leadership, the existence of PHC-related national health policies, and the engagement of stakeholders were key success factors.

Areas for additional attention include the need to increase investment in PHC, increase the PHC workforce, enhance equitable distribution of the workforce, expand training of primary care clinicians, improve health information systems, and inform the population on the benefits of preventive care. Health systems should be more tailored to the PHC approach and encouraged towards a more holistic view of the PHC approach.

The PHCMI initiative provides a foundation for an open discourse for advancing universal health coverage (UHC) and health security in EMR and re-orienting health systems towards the PHC approach.

This study aims to assess the effect of primary health care (PHC) service provision continuity on inpatient admissions for people with chronic diseases in Estonia.

Non-communicable diseases (NCDs) were collectively responsible for more than 7 out of 10 deaths worldwide in 2019. As the burden of NCDs increases, PHC has an increased role of coordinating care management. High-performing PHC can reduce unnecessary hospitalizations. Estonia has a strong PHC system focusing on multidisciplinary care. Yet it has not been evaluated for its effect on hospitalizations. Therefore, it is imperative to evaluate PHC continuity to improve care for NCD patients.

This study used routinely collected electronic medical billing data of the Estonian population aged 15 years or older from 2005 to 2020 identifying patients with seven ambulatory care sensitive chronic (ACSC) conditions. We developed an indicator to describe the continuity of PHC. Charlson Comorbidity Index (CCI) was used to assess the impact of comorbidities and we controlled the patient’s age, gender, county of residency and socio-economic status. We estimated multilevel logistic regression models with family doctor patient list random effects to assess how the odds of hospitalization depend on continuity of care, allowing for confounders.

We identified that 45% of the adult Estonian population had at least one of the target diagnoses. Among the target population, 96% had contact with their PHC providers. We found that there is a non-linear relationship between PHC continuity and patient outcomes. Any contact with PHC provider during the past 5 years decreases odds for hospitalization, but hospitalization risk is higher for people who are elderly and have higher CCI score. We found that after accounting for patient characteristics, differences among patient lists minimally impact outcomes. Further research should explore policies to better support family doctors in reducing hospitalizations for chronic patients.

The rural-oriented tuition-waived medical education program in China, started in 2010, provides free medical education to students committed to serving in rural areas to address medical staff shortages. Despite its success in training and deploying graduates, retaining them post-obligation remains challenging. This study explores the mechanisms behind the turnover intentions of rural-oriented medical students in Western China, offering insights for their retention.

Semi-structured interviews were conducted with 47 rural-oriented medical students and 30 health clinic directors in Nanning City. Interview data were analysed using grounded theory, and open, axial and selective coding was applied.

Through three levels of coding analysis, 34 tree nodes, 13 sub-categories and 3 main categories were identified from the interviews with rural-oriented medical students and health clinic directors. 3 main categories were Subjective Norms, Behavioural Attitudes, and Perceived Behavioural Control.

A model of turnover intention among rural-oriented medical students was developed. This model can serve as a valuable reference for future policy optimization concerning China’s rural order-directed medical students.

To describe the prevalence and characteristics of hearing loss in a self-referred adult cohort in low-income South African communities and to evaluate the effectiveness of a cerumen management protocol within a community-based service setting.

Hearing loss affects 1.5 billion people globally, with a disproportionate impact on individuals in low- and middle-income countries (LMICs) and the elderly, often attributed to age-related factors and cerumen impaction. Despite the high prevalence, access to ear and hearing care remains challenging, particularly in LMICs, such as Africa.

A total of 227 participants aged 43–102 were recruited from two community centres in low-income South African communities for hearing evaluation and cerumen management for those with cerumen impaction. A cross-sectional, predominantly quantitative approach was used.

Video otoscopy of 448 ears revealed normal findings in 57.9%, cerumen impaction in 29.1%, and other abnormalities in 1.3%. The prevalence of confirmed hearing loss was 97.8%, primarily mild (45.8%), and sensorineural hearing loss (SNHL) was the most common (55.3%). Cerumen impaction accompanied hearing loss in 28.4% of cases. Post-treatment, 50.9% of participants with cerumen impaction showed normal otoscopy results, with mean hearing improvements of 16.2 dB (±17.9 SD) in the left ears and 15.8 dB (±17.2 SD) in the right ears, though overall significance was limited.

The high prevalence of hearing loss and cerumen impaction in low-income communities emphasizes the importance of ear care in primary healthcare (PHC) settings, especially for the elderly. Effective community-based cerumen management highlights the potential of integrating community resources and task-shifting strategies for cost-effective ear care in resource-limited settings.

To analyze the sociodemographic characteristics and trends in clinical and analytical parameters among individuals with chronic kidney disease (CKD) in Aragon (Spain), who remain uninfected with COVID-19 during the first year of pandemic. The secondary objectives were to identify the associated comorbidities and their evolution throughout the pandemic, as well as to determine the cases that got worse and their possible relationship with the control of the main risk factors.

CKD is a major public health problem worldwide. Studies encompassing national, European, and global contexts, show a rise in the prevalence of CKD, with a significant decrease in life quality, high morbidity and mortality, and increased healthcare costs. In this scenario, primary care is a cornerstone for the early detection of CKD and for the management of progression factors. To date, there are few publications regarding the evolution of the CKD population throughout the pandemic that are not related to hospitalizations or complications due to COVID-19.

We conducted a retrospective longitudinal study with real-world data from the population over 16 years of age registered in Aragon (Spain), collecting data from electronic health records. The variables included were sociodemographic, analytical and clinical (glomerular filtration rate, cholesterol, triglycerides, glycated haemoglobin, and blood pressure) and comorbidities (hypertension, dyslipidemia, obesity, diabetes, and smoking). The data were archived and processed using the SPSS v22.0 software package.

During the first six months of COVID-19 pandemic, the clinical parameters of people with CKD were poorly controlled, although there was a later improvement which could be related to the progressive recovery of health services. The glycated haemoglobin value found was low, which makes us suspect possible overtreatment. There is a high prevalence of high blood pressure, diabetes, dyslipidemia, obesity and smoking. Interventions targeting these factors could help reduce the burden of CKD.

Changing dynamics are pushing institutions to focus on care delivery innovation. To address the shortage of general practitioners (GPs), an Italian health district recently introduced a new primary care model called Primary Health Point (PHP) to provide primary integrated care to its population.

To investigate the healthcare professionals’ (HCPs) experience regarding the introduction of the PHP and to describe its process of care delivery.

Qualitative study design with a grounded theory approach and convenience sampling. Interviews were conducted using a semi structured guide to explore the experience of HCPs working at the PHP. The development of open coding was followed by the creation of categories. The analysis was conducted utilizing NVivo software.

Twelve HCPs working at the PHP were interviewed and highlighted the model structure. The themes were the context and the antecedents that identified the most common health complaints and the patients with more needs and reflected on the traditional GP model; the process, which highlighted the complexity of interdisciplinary teamwork and the role of the Family and Community Nurse (FCN) in the new model; the outcome identified the factors mediating satisfaction with the care delivered by the PHP.

The PHP has been considered a possible alternative to the GP model by its end users. It addresses disease pathway coordination, referrals, and medication management, focusing on chronic and older adult populations. It features interdisciplinary workflows with rotating physicians and consistent family nurse support. Proactive monitoring and a focus on disease education benefit fragile patients.

The funding of primary care is subject to intense debate internationally. Three main funding models predominate: capitation, pay-for-performance, and fee-for-service. A number of systematic reviews regarding the effect of primary care funding structures have been published, but not synthesized through an equity lens. Given the urgent need for evaluating funding models and addressing inequalities, a reliable, synthesized evidence base concerning the effects of funding on inequalities is imperative.

This umbrella review aims to systematically evaluate all systematic reviews available on the effect of different primary care funding models in high-income countries on inequalities in funding, access, outcomes, or experience from inception until 2024.

Three databases (MEDLINE, EMBASE, Cochrane) and a machine learning living evidence map were searched. Abstracts and titles were double screened, before two authors independently screened full texts, extracted data, and performed quality assessments utilizing the AMSTAR2 tool.

The search identified 2480 unique articles, of which 14 were included in the final review. Only one review compared reimbursement systems; capitation systems were more equitable between ethnic groups compared to pay-for-performance in terms of primary care access, continuity, and quality. Twelve reviews reviewed the impact of the introduction of pay-for-performance models, predominantly focusing on the Quality and Outcomes Framework (QOF) in the UK. Synthesized findings suggest that QOF’s introduction coincided with reduced socioeconomic health inequalities in the UK overall, but not in Scotland. Overall, inequalities in age narrowed, but inequalities measured by sex widened. One review found evidence that targeting funding for minority groups, with poorer health, was effective. A further review found that introducing privately provided general practices in Sweden and allowing patients to choose these over public-owned options generally benefitted those with higher income and lower health needs. We identify a range of gaps in the literature, which should inform future research.

Childhood morbidity is a precursor and contributor to under-five child mortality. Community-based primary healthcare programs are culturally responsive and low-cost strategies for delivering maternal and child health services in rural communities.

To evaluate the equity effect of the Ghana Essential Health Intervention Program (GEHIP) – a five-year community-based primary healthcare program – on childhood morbidity.

GEHIP was implemented in the Upper East region of Northern Ghana. Household baseline and end line surveys conducted in 2010/2011 and 2014/2015, respectively, from both intervention and comparison districts were used to assess three childhood morbidity conditions: maternal recall of neonatal illness, the incidence of diarrhoea, and fever. Difference-in-differences analysis, mean comparison test, and multivariate logistic regressions are used to assess the effect of GEHIP exposure on these three childhood morbidity conditions.

Baseline sample data of 2,911 women and end line sample of 2,829 women were included in this analysis. There was generally more reduction in all three childhood morbidity conditions in intervention communities relative to comparison communities. Diarrhoea and fever had a statistically significant treatment effect (AOR = 0.95, p-value<0.01 and AOR = 0.94, p-value<0.001). Results of equity analysis indicate significant mean reductions for both the poor and non-poor for neonatal illness and diarrhea, while only the intervention group had a significant reduction for both poor and non-poor for fever. Regression analysis shows no significant equity/inequity effects of GEHIP on the incidence of diarrhoea and fever. Neonatal illness, however, shows significant effects of wealth within the intervention group.

This study shows that GEHIP contributed significantly to childhood morbidity reduction. This implies that community-based strategies have the potential to improve child health and contribute to the attainment of the United Nations sustainable development goal related to child health. Specific targeted measures are recommended to ensure both the poor and relatively better-off benefit from interventions.

To report on the design and results of an innovative nurse practitioner (NP)-led specialist primary care service for children facing housing instability.

During 2017–2018, children aged 0–14 years represented 23% of the total population receiving support from specialist homeless services in Australia. The impact of housing instability on Australian children is considerable, resulting in disengagement from social institutions including health and education, and poorer physical and mental health outcomes across the lifespan. Current services fail to adequately address health and educational needs of children facing housing insecurity. Research identifies similar circumstances for children in other high-income countries. This paper outlines the design, and reports on results of, an innovative NP-led primary care service for children facing housing instability introduced into three not-for-profit faith-based services in one Australian state.

Between 2019 and 2021, 66 children of parents experiencing housing instability received standardized health assessment and referral where appropriate by a NP. Data from the standardized tool, such as condition and severity, were recorded to determine common conditions. In addition, comprehensive case notes recorded by the NP were used to understand potential causes of conditions, and referral needs, including potential barriers.

The 66 children assessed were aged between 7 weeks to 16 years. Developmental delay, low immunization rates, and dental caries were the most common conditions identified. Access to appropriate services was inhibited by cost, disengagement, and COVID-19.

Given their advanced skills and knowledge, embedding NPs in specialist homeless services is advantageous to help vulnerable children.

Cardiovascular disease (CVD) poses a substantial global health burden, necessitating effective and scalable interventions for primary prevention. Despite the increasing recognition of peer-based interventions in managing chronic diseases, their application in CVD prevention still needs to be explored.

We describe the protocol of a quasi-experiment to evaluate the effectiveness of a peer-led digital health lifestyle intervention, MYCardio-PEER, for a low-income community at risk for CVD. This study aims to assess the effectiveness of MYCardio-PEER in improving the participants’ knowledge, lifestyle behaviours and biomarkers related to CVD. Secondarily, we aim to assess the adherence and satisfaction of participants towards MYCardio-PEER.

A minimum total sample of 68 low-income community members at risk for CVD will be recruited and allocated either to the control group or the intervention group. Participants in the control group will receive standard lifestyle advice and printed materials for CVD prevention, while the intervention group will participate in the 8-week MYCardio-PEER intervention program. The participants will be assessed at Week 0 (baseline), Week 8 (post-intervention) and Week 20 (post-follow-up).

We anticipate a net improvement in CVD risk score, besides investigating the effectiveness of the intervention program on CVD-related knowledge, biomarkers, and diet and lifestyle behaviours. The successful outcome of this study is essential for various healthcare professionals and stakeholders to implement population-based, cost-effective, and accessible interventions in reducing CVD prevalence in the country.

Trial registration: ClinicalTrials.gov (NCT06408493)

The aim of this study was to perform a systematic literature review of the purpose, design, and use of family trees by family physicians (FPs).

Family trees offer a valuable contribution to understanding the relevance of the patient’s family history in comprehensive primary healthcare provision. There is little research on the role of family trees in the everyday practice of FPs. Studies often focus on specific diseases and their context: however, a comprehensive exploration of the usefulness of family trees is crucial for FPs.

A systematic literature review was conducted through a keyword search in the PubMed and Cochrane databases. Based on the inclusion and exclusion criteria selected, 24 studies were identified and a qualitative analysis was performed.

A total of 369 publications were identified across 32 fields. Twenty-four studies were included in the final analysis according to the QUOROM statement. The results underscore the role of family trees and highlight the value of this tool’s multidimensionality. The use of this tool directs FPs to consider a genetic cause and a possible referral to a geneticist. The value of a family tree lies in the personalized patient-oriented treatment in connection with hereditary risks for chronic diseases. For FPs, the greatest challenge in treating patients is determining their risk of developing a chronic disease or cancer. Using a family tree can improve the quality of their healthcare.

The use of technology including digital decision support tools has become more ubiquitous in general practice. Australian GPs’ use of digital decision support tools, the sentiments, and associations with practitioner and practice characteristics. Positive and negative sentiments were considered facilitators and barriers to the uptake of digital decision support tools.

Secondary analysis of a cross-sectional study was undertaken with data from the Medicine in Australia: Balancing Employment and Life (MABEL) survey was analysed. 3,126 GPs responded from a total of 27,829 participants representing all types of physicians, surveyed in September 2018. Descriptive statistics was used to examine facilitators and barriers to GP uptake of digital decision support tools, and multivariable logistic regression was used to examine its associations with practitioner and practice characteristics.

2240 GPs in this study (83.8%) reported using digital decision support tools with largely positive sentiments regarding technology use in consultations. Reservations include privacy concerns, system incompatibility, and lack of support. Those using digital decision support tools were more likely to be female, younger and bulk-billing.

Perceived facilitators of digital decision support tools in Australian general practice include improvements in patient outcomes, satisfaction, care processes, and saving time. Barriers include concerns about data privacy, lack of support, incompatibility, and being time-consuming. There was higher uptake amongst bulk-billing and female practitioners. Further research on the clinical usefulness of digital decision support tools and its impact on decision-making in general practice would be of value.

Diabetes is a global health concern, and early identification of high-risk individuals is crucial for preventive interventions. Finnish Diabetes Risk Score (FINDRISC) is a widely accepted non-invasive tool that estimates the 10-year diabetes risk. This study aims to validate the FINDRISC in the Turkish population and develop a specific model using data from a nationwide cohort.

The study used data of 12249 participants from the Türkiye Chronic Diseases and Risk Factors Survey. Data included sociodemographic variables, lifestyle factors, and anthropometric measurements. Multivariable logistic regression was employed using FINDRISC variables to predict incident type 2 diabetes mellitus (T2DM). Two country-specific models, one incorporating the waist-to-hip ratio (WHR model) and the other waist circumference (WC model), were developed. The least absolute shrinkage and selection operator (LASSO) algorithm was used for variable selection in the final models, and model discrimination indexes were compared.

The optimal FINDRISC cut-off was 8.5, with an area under the curve (AUC) of 0.76, demonstrating good predictive performance in identifying T2DM cases in the Turkish population. Both WHR and WC models showed similar predictive accuracy (AUC: 0.77). Marital status and education were associated with increased diabetes risk in both country-specific models.

The study found that the FINDRISC tool is effective in predicting the risk of type 2 diabetes in the Turkish population. Models using WHR and WC showed similar predictive performance to FINDRISC. Sociodemographic factors may play a role in diabetes risk. These findings highlight the need to consider population-specific characteristics when evaluating diabetes risk.

To assess the impact of a person-centred culturally sensitive approach in primary care on the recognition and discussion of mental distress in refugee youth.

Refugee minors are at risk for mental health problems. Timely recognition and treatment prevent deterioration. Primary care is the first point of contact where these problems could be discussed. However, primary care staff struggle to discuss mental health with refugees.

Guided by the needs of refugees and professionals we developed and implemented the Empowerment intervention, consisting of a training, guidance and interprofessional collaboration in four general practices in the Netherlands.

This mixed-method study consisted of a quantitative cohort study and semi-structured interviews. The intervention was implemented in a stepped wedge design. Patient records of refugee youth and controls were analysed descriptively regarding number of contacts, mental health conversations, and diagnosis, before and after the start of the intervention.

Semi-structured interviews on experiences were held with refugee parents, general practitioners, primary care mental health nurses, and other participants in the local collaboration groups.

Findings:

A total of 152 refugees were included. Discussions about mental health were significantly less often held with refugees than with controls (16 versus 38 discussions/1000 patient-years) but increased substantially, and relatively more than in the control group, to 47 discussions/1000 patient-years (compared to 71 in the controls) after the implementation of the programme.

The intervention was much appreciated by all involved, and professionals in GP felt more able to provide person-centred culturally sensitive care.

Person-centred culturally sensitive care in general practice, including an introductory meeting with refugees, in combination with interprofessional collaboration, indeed results in more discussions of mental health problems with refugee minors in general practice. Such an approach is assessed positively by all involved and is therefore recommended for broader implementation and assessment.