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.

To investigate general practitioners’ (GPs’) desire and perceived added value of point-of-care (POC) troponin, its effect on referral decisions, and test requirements.

Excluding acute coronary syndrome (ACS) in primary care remains a diagnostic challenges for GPs. Consequently, referral rates of chest pain patients are high, while the incidence of a cardiovascular problem is only 8–15%. Previous studies have shown that GPs are interested in a POC troponin test. This test could enhance rapid exclusion of ACS, thereby preventing unnecessary patient distress, without compromising safety and while reducing costs. However, using this test is not recommended in current guidelines due to uncertainty in the test’s potential added value, and the lower sensitivity early after symptom onset as compared with troponin tests in a regular laboratory.

An online survey containing 34 questions was distributed among 837 Dutch GPs in June 2015.

A total of 126 GPs (15.1%) completed at least 75% of the questions. 67.1% of GPs believe that POC troponin tests have moderate to very high added value. Although the availability of a POC test is expected to increase the frequency at which troponin tests are used, it likely decreases (immediate) referral rates. Of the responding GPs, 78.3% only accept 10 min as the maximum test duration, 78.1% think reimbursement of the POC device is required for implementation, and 68.9% consider it necessary that it can be performed with a finger prick blood sample. In conclusion, according to GPs, the POC troponin test can be of added value to exclude ACS early on. Actual test implementation will depend on test characteristics, including test duration, type of blood sample required, and reimbursement of the analyzer.

This article presents an interpretation of health promotion within the work of a district nurse (DN).

Literature supports the centrality of health promotion within nursing. It also presents debate about its meaning and suggests uncertainties for educators and practitioners about its relationship to nursing care. Two studies in Scotland on community nurses’ health promotion work with older people suggested that health promotion was evident and recognisable in planned initiatives or projects but could be hidden and unrecognised in day-to-day nursing work with individual patients and their families.

An experienced DN's interpretation of health promotion embedded in her work with a patient with multiple sclerosis is presented. The case was one of a number derived from a study designed in the constructivist paradigm, which addressed health promotion in relation to community nurse education and practice for a range of community nursing roles, including district nursing. The case study data were derived from observation of practice, interviews with the DN and the patient and from field notes.

Health promotion emerged as embedded within day-to-day holistic nursing care. The DN illustrated an understanding of the dimensions of health and of the significance of core health promotion concepts such as education, prevention, advocacy, empowerment, self-esteem and self-efficacy. However, health promotion could be invisible, described as weaved into everything and on the back of other things, and therefore not normally acknowledged and clearly articulated. Embeddedness highlighted the challenge for evaluation, when nursing and health promotion activities are intrinsically related and can be argued as sharing certain principles, processes and outcomes.

Embeddedness is a significant issue for learning in practice. The ability of experienced community nurses to interpret and articulate the concept of health promotion clearly and to make tacit knowledge evident would be of benefit to students.

To investigate the attitudes to health and work of general practitioners (GPs) with training in occupational medicine (OM) compared with non-OM trained GPs, since the introduction of the fit note.

Changes to the UK sickness certification system since 2010 and the introduction of the fit note required GPs to change their focus to what patients can do, rather than what they cannot do in relation to work. In an effort to reduce the UK sickness absence burden, GPs completion of the fit note should help to keep people in work, or assist patients to return to work as quickly as possible after a period of absence.

Questionnaire data were collected via the 7th National General Practitioner Worklife Survey.

Results indicate that responses from GPs who had undertaken training in OM, and GPs having received some form of work and health training in the 12-month period before the study were associated with significantly more positive attitudes to patients’ returning to work and to the fit note. This study reveals evidence of a difference between trained and non-trained GPs in their attitude to the fit note, and to work and health generally. Further work investigating the effect of specific training in OM on the management and recognition of ill-health by GPs is recommended.

This study analyzed Meaningful Use (MU) clinical summaries (CS) given to 100 older adults (⩾65) from 10 family physicians in an urban primary care practice.

In the United States, MU was designed to promote and enhance patient engagement in hospitals and clinics across the country, providing financial incentives to physicians attesting to the Meaningful Use of a certified Electronic Health Record by meeting a series of measures and objectives. The CS is intended to support patient and family engagement by communicating elements discussed during the clinical encounter including an updated medication list, problem list, and plan of care (POC). Despite the $27.7 billion spent distributing MU payments to more than 418,000 Eligible Professionals in ambulatory care to date, there is little discussion in the scholarly literature supporting the use of the CS to facilitate patient engagement.

Ten CS were accessed from each of 10 family physicians during a regular practice week. Directed content analysis and descriptive statistics were used to evaluate the summaries. Key variables of analysis included diagnoses, medications, plan of care content, availability, completeness, health literacy, format, and readability.

CS contained an average of 5.2 diagnoses and 10 medications. Summaries contained vital signs (98%), lab results (9%), smoking status (88%), professional care team members (4%), follow-up appointments (46%), and POC (67%); 37% of CS were judged to be incomplete. Readability scores indicated that a university education was required to understand the CS. CS support patient engagement by supplying information that supports behavior change and self-management, however barriers to patient engagement exist, including (a) access, (b) poor document readability, and (c) a lack of customization to the patient’s experience.

To evaluate the one-year prevalence of diagnosed specific back pain in Region Västra Götaland, inhabiting 1.7 million people.

A retrospective register study.

Data from 2014 to 2019 were extracted from the VEGA register, which holds all health data from all publicly funded health care establishments in Region Västra Götaland. Aggregated data are presented as the one-year prevalence of unique individuals diagnosed with International Statistical Classification of Diseases and Related Health Problems – Tenth Revision codes representing specific back pain.

All inhabitants in Region Västra Götaland.

The one-year prevalence of diagnosed specific back pain stratified by age, sex, and health care level.

In 2019, the one-year prevalence of diagnosed specific back pain in public primary health care centres was 0.82%, rehabilitation care 0.35%, and the combined increase was 156% from 2014. In specialized health care, the diagnosed prevalence during 2014–2019 has remained relatively unchanged. The prevalence was significantly higher among women in primary health care and rehabilitation care. M48.0 (spinal stenosis) and M51.1K (lumbar disc herniation with radiculopathy) were the most common sub-classifications. For M48.0, prevalence increased by age, whereas M51.1K peaked within the 45–64 years category.

The one-year prevalence of diagnosed specific back pain in primary health care was 1.17% in 2019 and has increased since 2014. Women were diagnosed considerably more frequently than men, which is not reflected in surgical treatment prevalence.

To analyse trends in newspaper reporting of British general practitioners’ (GPs’) pay before and after the introduction of the new General Medical Services (GMS) contract.

The introduction of the new GMS contract for GPs in 2004 linked pay to performance. There may have been a range of wider consequences from this, including changes in how GPs are portrayed in the media.

We retrospectively analysed the internet archives of five British newspapers over 2001–2008. The search terms ‘doctor’ or ‘GP’ and ‘pay’ were used in a text search. After checking the relevance of full text articles, we randomly sampled included articles to achieve a quota of up to five articles per newspaper per year. We scored article content using criteria to determine whether GPs were depicted in a positive or negative manner. Summary scores for each article were plotted using locally weighted scatterplot smoothing (LOWESS). We used a grounded approach to identify key themes.

Newspaper coverage of GPs’ salaries became unfavourable following the introduction of the new contract. Initial recognition of GPs’ demanding working conditions and relatively poor rewards for public service transformed into concerns about unfairly excessive income and poor use of public money. Although public trust in GPs has remained fairly robust to media criticism, it cannot be taken for granted as continued negative newspaper coverage of their pay may start to erode public trust in the profession.

The primary purpose of this study is to understand primary care practices’ perceived constraints to engaging in research from micro-, meso-, and macro-level perspectives.

Past research has spotlighted various barriers and hurdles that primary care practices face when attempting to engage in research efforts; yet a majority of this research has focused exclusively on micro- (physician-specific) and meso-level (practice-specific) factors. Minimal attention has been paid to the context – the more macro-level issues such as how these barriers relate to primary care practices’ role within the dominant payment/reimbursement model of US health-care system.

Semi-structured focus groups were conducted in five US practices, all owned by an independent academic medical center. Each had participated in at least one research study but were not part of a practice-based research network or affiliated with a medical school. Data were analyzed using NVIVO-9® by using a multistep coding process.

The perceived constraints offered by the participants echoed those featured in previous studies. Secondary analyses of the interconnected nature of these factors highlighted a valuable and sensitive ‘Flow’ that is evident at the individual, interaction, and organizational levels of primary care practice. Engaging in research appears to pose a significant threat to the outcomes of Flow (ie, revenue, patient health outcomes, and the overall well-being of the practice). It is posited that the risk of not meeting expected productivity-based outcomes, which appear to be dictated by current dominant reimbursement models, frames the overall process of research-related decision making in primary care. Within the funding/reimbursement models of the US health-care system, engaging in research does not appear to be advantageous for primary care practices.

The aim of the study was to determine in adults the risk perception for cardiovascular disease (CVD) and the associated factors.

CVDs are the leading cause of death globally. In adults, perceptions related to the risk for CVDs have a considerable effect on decision-making processes related to one’s own health.

A cross-sectional study was conducted with 453 adult people from April to June 2019 in İzmir, Turkey. Data were collected with a sociodemographic characteristics questionnaire, perception of risk of heart disease scale (PRHDS), and health perception.

The mean PRHDS score of adults was 48.88 ± 8.12. The risk perception for CVD was influenced by variables that were age, gender, education, marital status, employment status, health perception, familial cardiovascular disease history, chronic disease status, smoking status, and body mass index. Although CVDs are the most prominent cause of disease-related death in the world, risk perception for CVD was found to be low among the individuals included in this study. This finding indicates the importance of informing individuals about CVD risk factors, raising awareness, and training.

Southeastern Appalachian Ohio has more than double the national average of diabetes and a critical shortage of healthcare providers. Paradoxically, there is limited research focused on primary care providers’ experiences treating people with diabetes in this region. This study explored providers’ perceived barriers to and facilitators for treating patients with diabetes in southeastern Appalachian Ohio.

We conducted in-depth interviews with healthcare providers who treat people with diabetes in rural southeastern Ohio. Interviews were transcribed, coded, and analyzed via content and thematic analyses using NVivo 12 software (QSR International, Chadstone, VIC, Australia).

Qualitative analysis revealed four themes: (1) patients’ diabetes fatalism and helplessness: providers recounted story after story of patients believing that their diabetes was inevitable and that they were helpless to prevent or delay diabetes complications. (2) Comorbid psychosocial issues: providers described high rates of depression, anxiety, incest, abuse, and post-traumatic stress disorder among people with diabetes in this region. (3) Inter-connected social determinants interfering with diabetes care: providers identified major barriers including lack of access to providers, lack of access to transportation, food insecurity, housing insecurity, and financial insecurity. (4) Providers’ cultural understanding and recommendations: providers emphasized the importance of understanding of the values central to Appalachian culture and gave culturally attuned clinical suggestions for how to use these values when working with this population.

Evidence-based interventions tailored to Appalachian culture and training designed to increase the cultural competency and cultural humility of primary care providers may be effective approaches to reduce barriers to diabetes care in Appalachian Ohio.

Improving the informational quality of referrals from primary to secondary care and appropriately re-directing referrals is an important goal of clinical commissioning groups in England. Based on the available empirical evidence, a referral management and booking service that combined referral guidelines, online referral templates and administrative and clinical triage, was developed by a primary care trust in southeast London.

A pilot study of 13 out of 46 practices in the trust was conducted using a mixed methods approach. Referral numbers were investigated by analysing changes in practices’ rates of first outpatient attendances in secondary care. Informational referral quality was assessed by analysing triage outcomes. Semi-structured interviews were used to inquire about practices’ evaluation of the new system. Structured telephone interviews were conducted to assess patients’ satisfaction.

Overall rates of first outpatient attendances declined more strongly for pilot practices than controls. The number of referrals challenged for being incomplete or having insufficient clinical information decreased. The rate of referrals challenged by clinical triage for not conforming to referral guidelines was well below the rate of inappropriate referrals published in the literature. Interviews with practices revealed a number of themes and a broad range of attitudes. Patients were highly satisfied.

Findings provided favourable evidence for the effectiveness of the new referral management system. They were, however, preliminary. If referrals into secondary care continued to be reduced on a long-term basis, the system would be cost effective despite the time and effort required for clinical triage.

The migration process may impose stress on the mental health of immigrants.

To describe the experiences of immigrant men of Kurdish ethnicity during and after migration to Sweden with regard to mental health issues.

Using the grounded theory method, we conducted a focus group interview with four Kurdish men and in-depth individual interviews with 10 other Kurdish men.

A model with two major themes and interlinked categories was developed. The themes were (1) protective factors for good mental health (sense of belonging, creation and re-creation of Kurdish identity, sense of freedom, satisfaction with oneself) and (2) risk factors for poor mental health (worry about current political situation in the home country, yearning, lack of sense of freedom, dissatisfaction with Swedish society).

The study provides insights into the psychological and emotional experiences of immigrant men of Kurdish ethnicity during and after migration to Sweden. It is important for primary health care providers to be aware of the impact that similar migration-related and life experiences have on the health status of immigrants, and also to be aware that groups are comprised of unique individuals with differing experiences and reactions to these experiences. The findings highlight the common themes of the men's experiences and suggest ways to ameliorate mental health issues, including feeling like one is seen as an individual, is a full participant in society, and can contribute to one's own culture.

The purpose of this study is to understand different roles that interpreters play in a pediatric, limited English proficient (LEP) health care encounter and to describe what factors within each role inform physicians’ assessment of the overall quality of interpretation.

Language barriers contribute to lower quality of care in LEP pediatric patients compared to their English-speaking counterparts. Use of professional medical interpreters has been shown to improve communication and decrease medical errors in pediatric LEP patients. In addition, in many pediatric encounters, interpreters take on roles beyond that of a pure language conduit.

We conducted 11 semi-structured interviews with pediatricians and family medicine physicians in one health system. Transcripts were audio-recorded and transcribed verbatim. We analyzed our data using directed content analysis. Two study team members coded all transcripts, reviewed agreement, and resolved discrepancies.

Physicians described four different interpreter roles: language conduit, flow manager, relationship builder, and cultural insider. Within each role, physicians described components of quality that informed their assessment of the overall quality of interpretation during a pediatric encounter. We found that for many physicians, a high-quality interpreted encounter involves multiple roles beyond language transmission. It is important for health care systems to understand how health care staff conceptualize these relationships so that they can develop appropriate expectations and trainings for medical interpreters in order to improve health outcomes in pediatric LEP patients.

This study aimed to assess the health outcome of four epidemic-prone infectious diseases, in the context of a Primary Health Care project implemented in a protracted refugee setting along the Thai–Myanmar border.

Refugees settled at the Thai–Myanmar border are fully dependent on support for health services, shelter, food, education, water, and sanitation. The Non-Governmental Organization Malteser International developed an integrated Primary Health Care program in close cooperation with trained camp residents over 25 years in the two settlements under its supervision. The project has been funded by the European Commission Civil Protection and Humanitarian Aid Operations (DG ECHO).

This was a retrospective primary health care project evaluation. All-cause mortality; morbidity trends in malaria, lower respiratory tract infections (LRTIs), watery diarrhea, and dysentery; and health service utilization covering a time span of 18 years were assessed. Programmatic changes in the Primary Health Care (PHC) project and events with a potential effect on health of the target population were examined.

Despite the continuous drain of trained health care workers, the volatile influx of refugees, and the isolated location of the two camps, the initial basic curative health care developed into an integrated and comprehensive PHC project including a SPHERE-compliant water, sanitation, and hygiene program. Malaria, LRTIs, watery diarrhea, and dysentery morbidity dropped twelve, three, two, and fivefold, respectively, over the 18-year period evaluated while the health services utilization dropped from 7.1 to 2.9 consultations per refugee/year. The international community may face situations where integration of refugees into the health services of the host country is not possible. In such a context, integrated and evidence-based PHC adequately funded and implemented by one health agency is an effective and relevant approach to reduce the infectious diseases burden under the constraints of semipermanent living conditions.

Patients living with chronic pain are typically resource intensive, their care requirements are long term and referral to secondary care is not always expeditious. To provide more appropriate, accessible and cost-effective care, Tower Hamlets Primary Care Trust reviewed the needs of the patients, their current care and the numbers requiring treatment for non-malignant chronic pain, initially starting with musculoskeletal pain.

We estimated the number of people with chronic pain being treated outside general practice by the NHS in Tower Hamlets. A working group established set criteria to define a chronic pain patient. We surveyed appropriate clinicians to determine the approximate number of patients who fitted our inclusion criteria, the approximate number of follow-up appointments they required and their care pathways. Secondly, we estimated the cost of care for chronic pain patients using NHS national tariff and reference cost data. We also took a convenience sample of chronic pain patients and recorded their history of care.

The routes and pathways of care are complex and multiple. We estimate between 4.0% and 5.5% of new patients in rheumatology, orthopaedics, occupational therapy and musculoskeletal physiotherapy and up to 90% in the pain clinic are people living with chronic pain. The cost of this care ranged from £296 for a course of physiotherapy to £1911 for a patient seen in physiotherapy, orthopaedic and the pain clinics.

There is no facility in current management information services that identifies people being treated for non-specific chronic pain; therefore, estimating both the numbers and costs for treating these people is difficult. National tariff and notional cost data provide estimates only, of an ‘average patient’; the real cost of these patients is unknown.

The primary aim of our study is to identify physicians who have witnessed a complication attributed to sodium-glucose cotransporter (SGLT2) inhibitors. The secondary aim is to determine the type, severity, and setting of the event (inpatient versus outpatient).

Diabetes is an increasing public health burden with 9.9% of Canadians expected to be diagnosed with it in 2020. A prominent change with respect to treatment options since the publication of the revised Diabetes Canada guidelines in May 2016 concerned the SGLT2 inhibitors. Their favorable clinical profile has increased interest among clinicians, but there is still reason for caution. Because these drugs are new, the balance of benefits versus risks is not well understood.

We conducted a cross-sectional survey of all in-practice physicians (excluding pediatricians). Data were collected through an online survey.

Our survey identified 154 physicians who have identified one or more adverse drug reactions (ADRs) related to SGLT2 inhibitor use. A total of 173 ADRs were identified. In total, 20.6% of family physician respondents had witnessed one or more ADRs. The most common complication is mycotic infection (82 cases) with 47% identified as a low level of severity and occurring mostly in the outpatient setting. The second most common complication is diabetic ketoacidosis (43 cases) with 67% identified as a high level of severity and occurring mostly in the inpatient setting. Other identified complications include hyperkalemia (6 cases), renal insufficiency (15 cases), and even amputation (2 cases). Our survey is the first to document real-world complications from SGLT2 inhibitors. In the outpatient setting, mycotic infections are most common and most often benign. In the inpatient setting, diabetic ketoacidosis is the most common and is severe. This is an important take-home message for family physicians to tailor their practice and vigilance according to the practice setting.

The aim of this paper is to explore school nurses’ experiences of teaching Sex and Relationships Education (SRE) as part of the primary school curriculum. In particular, it focuses on the questions that the children ask during the lessons and the strategies the nurses employ in managing those questions.

School-based SRE is an important aspect of children’s education. However, it is a highly politicised and controversial area, which is a matter of concern to a number of stakeholders. In the primary school setting, school nurses are commonly involved in delivery of the programme. Their input is particularly valued, because they are ‘specialist outsiders’ who create an environment that is conducive to discussion of sensitive topics. To date, there is little understanding of the skills that they employ in managing the educational needs of primary school children within the confines of a pre-agreed school curriculum.

Semistructured focus group interviews were conducted with small groups of school nurses from a single geographical location in the Midlands region of England. Data were analysed using a thematic analysis approach.

Data identified the ways in which the nurses viewed and responded to the children’s agenda, which was realised in the form of questions. In particular, it focuses on what they deemed to be inappropriate questions and the basis on which this label was applied. Five strategies for managing these inappropriate questions were identifiable from the data. Their deployment is explored in relation to the tensions implicit in the realisation of sexualised realities in a classroom setting.

The study purpose was to provide evidence of validity for the Primary Health Care Engagement (PHCE) Scale, based on exploratory factor analysis and reliability findings from a large national survey of regulated nurses residing and working in rural and remote Canadian communities.

There are currently no published provider-level instruments to adequately assess delivery of community-based primary health care, relevant to ongoing primary health care (PHC) reform strategies across Canada and elsewhere. The PHCE Scale reflects a contemporary approach that emphasizes community-oriented and community-based elements of PHC delivery.

Data from the pan-Canadian Nursing Practice in Rural and Remote Canada II (RRNII) survey were used to conduct an exploratory factor analysis and evaluate the internal consistency reliability of the final PHCE Scale.

The RRNII survey sample included 1587 registered nurses, nurse practitioners, licensed practical nurses, and registered psychiatric nurses residing and working in rural and remote Canada. Exploratory factor analysis identified an eight-factor structure across 28 items overall, and good internal consistency reliability was indicated by an α estimate of 0.89 for the final scale. The final 28-item PHCE Scale includes three of four elements in a contemporary approach to PHC (accessibility/availability, community participation, and intersectoral team) and most community-oriented/based elements of PHC (interdisciplinary collaboration, person-centred, continuity, population orientation, and quality improvement). We recommend additional psychometric testing in a range of health care providers and settings, as the PHCE Scale shows promise as a tool for health care planners and researchers to test interventions and track progress in primary health care reform.