Lack of access to primary care providers (PCPs) is a significant hurdle to receiving high-quality comprehensive health care and creates greater reliance on emergency departments and walk-in clinics.

We conducted a rapid review and analysis of the literature that discusses approaches to increasing access to continuous care for patients with no PCP (‘unattached patients’).

Five distinct themes across 38 resources were identified: financial incentives for patients and providers, health care organization, policy intervention, virtual care and health information technology (HIT), and medical education. Approaches that increased attachment were primary care models that combined two or more of these and reflected the Patient’s Medical Home (PMH) model.

Although there are individual initiatives that could allow for temporary relief, long-term and community-wide success lies in designing models of primary care that use multiple tools, meet the needs of the community, and are supported by regional, provincial, and national policies.

In the crowded field of leadership research, Indigenous leadership remains under-researched. This article explores the Leadership Model of an Aboriginal Community Controlled Primary Health Care Organisation providing services to the Yolngu people of remote northern Australia: the Miwatj Health Aboriginal Corporation (Miwatj).

The limited research which does exist on Indigenous leadership points to unique challenges for Indigenous leaders. These challenges relate to fostering self-determination in their communities, managing significant community expectations, and navigating a path between culturally divergent approaches to management and leadership.

Guided by Indigenous methodology and using a mixed methods approach, semi-structured interviews, self-reported health service data, organisational and publicly available documents, and literature were analysed using a framework method of thematic analysis to identify key themes of the Miwatj Leadership Model.

The Miwatj Leadership Model is underpinned by three distinctive elements: it offers Yolngu people employment opportunities; it supports staff who want to move into leadership positions and provides capacity building through certificates and diplomas; and it provides for the physical, emotional, and cultural wellbeing of all Yolngu staff. Furthermore, the model respects traditional Yolngu forms of authority and empowers the community to develop, manage and sustain their own health. The Miwatj Leadership Model has been successful in providing formal pathways to support Indigenous staff to take on leadership roles, and has improved the accessibility and acceptability of health care services as a result of Yolngu employment and improved cultural safety.

Translating the Miwatj Leadership Model into other health services will require considerable thought and commitment. The Miwatj Leadership Model can be adapted to meet the needs of other health care services in consideration of the unique context within which they operate. This study has demonstrated the importance of having a formal leadership model that promotes recruitment, retention, and career progression for Indigenous staff.

We report on a formative project to develop an organization-level planning framework for obesity prevention and management services.

It is common when developing new services to first develop a logic model outlining expected outcomes and key processes. This can be onerous for single primary care organizations, especially for complex conditions like obesity.

The initial draft was developed by the research team, based on results from provider and patient focus groups in one large Family Health Team (FHT) in Ontario. This draft was reviewed and activities prioritized by 20 FHTs using a moderated electronic consensus process. A national panel then reviewed the draft.

Providers identified five main target groups: pregnancy to 2, 3–12, 13–18, 18+ years at health risk, and 18+ with complex care needs. Desired outcomes were identified and activities were prioritized under categories: raising awareness (eg, providing information and resources on weight-health), identification and initial management (eg, wellness care), follow-up management (eg, group programs), expanded services (eg, availability of team services), and practice initiatives (eg, interprofessional education). Overall, there was strong support for raising awareness by providing information on the weight-health connection and on community services. There was also strong support for growth assessment in pediatric care. In adults, there was strong support for wellness care/health check visits and episodic care to identify people for interventions, for group programs, and for additional provider education.

Joint development by different teams proved useful for consensus on outcomes and for ensuring relevancy across practices. While priorities will vary depending on local context, the basic descriptions of care processes were endorsed by reviewers. Key next steps are to trial the use of the framework and for further implementation studies to find optimally effective approaches for obesity prevention and management across the lifespan.

The aim of this study was to explore healthcare professionals’ experiences of working with extended home visits for parents.

It is essential to identify parents, both expectant and with a newborn child, who need support in their parenting abilities at an early stage because children’s health and well-being are affected by their home environment as well as by their parents’ health and social relationships. Home visits represent a cost-effective way of identifying and supporting families with a newborn. Further research is needed to explore healthcare professionals’ experiences working with extended home visits for parents.

This was a qualitative interview study focusing on an intervention introduced in the Enhanced Parenting—Extended Home Visits project in Sweden. Data were collected via 13 semi-structured interviews with healthcare professionals who provide the intervention in antenatal care (midwives) and child health care (CHC nurses and family supporters), and a qualitative content analysis was performed.

Data analysis resulted in one theme and four categories. The theme – to provide multidimensional adapted professional support, – and the four categories – strengthened collaboration between professionals enriches their work. Home visits provide time for conversation, which promotes continuity of care and relationships with parents; being humble guests in parents’ homes provides insight; and home visits provide the opportunity to strengthen parenting and participation in the family centre. The goals of the Enhanced Parenting—Extended Home Visits project were to strengthen parents’ confidence in their parenting abilities and to build trusting relationships with healthcare professionals. The conclusion of this study, from the participants’ perspective, is that these goals can be achieved with the intervention.

Extended home visits seem to help healthcare professionals provide collaborative, multi-professional support for parents, both expectant and with a newborn child, with unique support needs.

Creating a stable and long-term relationship called ‘longitudinality’ between the population and general practitioners is crucial for the family physician program. The constant change of family physicians (FPs) can deteriorate longitudinality. This study aims to reveal what factors people usually consider when choosing a new FP or changing their current FP.

A qualitative study with a thematic analysis approach was carried out in Ilam province, Iran, in 2019. Purposeful sampling with a maximum variation strategy was followed to select the key informants. We did 34 interviews with following groups: patients (rural residents); FPs; and experts from Iran Health Insurance Organization, Ilam University of Medical Sciences, and Health Network Development Center. Data were analyzed using a thematic analysis to identify and contextualize the preferences of people in choosing a FP in rural areas. All the processes related to data coding and emerging themes were carried out using MAXQDA 2012 software.

The content of the interviews was categorized into 2 main themes, 6 sub-themes, and 39 codes. The first theme was ‘family physician characteristics’ including four sub-themes: general behaviors, social and physical characteristics, professional expertise, and pharmaceutical prescriptions. The second theme was ‘health center’ consisting of two sub-themes including location and physical features and properties of the health center.

Some of the factors extracted from the interviews may have a different effect on the choice of people with different demographics. For instance, patients may have different ideas about the age, gender, years of medical practice, and finally, language and origin of the birthplace of FPs. Quantitative studies are needed to rank the factors identified in this study according to their significance for choosing FP and reveal patients’ preferences for each factor.

The aim of this study was to assess the feasibility of the national electronic primary health care (PHC) database in Kyrgyzstan in producing information on the disease burden of the patient population and on the processes and quality of care of noncommunicable diseases (NCDs) in PHC.

Strengthening of the PHC is essential for low- and middle-income countries (LMICs) to tackle the increasing burden of NCDs. Capacity building and quality improvement require timely data on processes and quality of care.

A data extraction was carried out covering four PHC clinics in Bishkek in 2019 to pilot the use of the national data for quality assessment purposes. The data included patient-level information on all appointments in the clinics during the year 2018 and consisted of data of altogether 48 564 patients. Evaluation indicators of the WHO Package of Essential NCD Interventions framework were used to assess the process and outcome indicators of patients with hypertension or diabetes.

The extracted data enabled the identification of different patient populations and analyses of various process and outcome indicators. The legibility of data was good and the structured database enabled easy data extraction and variable formation on patient level. As an example of process and outcome indicators of those with hypertension, the blood pressure was measured at least on two occasions of 90% of women and 89% of men, and blood pressure control was achieved among 61% of women and 53% of men with hypertension. This study showed that a rather basic system gathering nationally patient-level data to an electronic database can serve as an excellent information source for national authorities. Investments should be made to develop electronic health records and national databases also in LMICs.

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.

To develop a conceptual framework that can be used for the integration of community health nursing (CHN) practice, education, and research within a Nursing Centre (NC) model.

New forms of training and support are needed to equip nurses to manage the complex and costly challenges facing health care systems. The NC model provides scope to address these challenges by integrating nursing practice, education, and research. However, there is little information about how these constructs are integrated or how education is constituted within the model.

This study used an embedded single case study design across three Nursing Centres (NCs) in West Java Indonesia. Semi-structured interviews and a review of relevant documents were conducted. Interview participants were recruited purposively to select stakeholders with rich information, including clients, nurses, nursing students and lecturers who have been using the NC model, as well as the head of the co-located Community Health Centres. Data was analysed using thematic analysis, pattern matching and cross-unit synthesis.

Four components relevant to integration in the NC were identified, namely (1) client-centred care as the shared common ground for integration in the NC; (2) nursing education using a service learning approach; (3) the NC as a model for reviving CHN services; and (4) service improvement through research and community service activities. The service learning approach was identified as appropriate because it links services with the learning process and this serves to address the interests of both practice and education institutions. The conceptual framework identified in this study can be used to improve the functionality of NCs in Indonesia and be considered for use internationally.

The purpose of this study is to evaluate an educational programme, ‘Diabetes Connect: Connecting Professions’, which was developed to enhance communication across primary care networks, to support best practice in clinical interventions and progress multidisciplinary team work to benefit patients in diabetes care.

A total of 26 workshops were successfully delivered for 309 primary care professionals across the state of Queensland in Australia from November 2011. It consists of two separate, but complementary training elements: a series of online clinical education training modules and state-wide interprofessional learning workshops developed to enhance professional competencies. The evaluation design included completion of online surveys by the participants at two time points: first upon registering for the online modules or workshops; second, one week after attending a workshop. The survey included questions to evaluate the change in role performance measures.

Overall, significant increases in participants’ current knowledge, perceived ability to adopt this knowledge at work and willingness to change professional behaviour in the short term were observed.

The study suggests that for maximum benefit both, workshop and online training, should be combined and made available widely. Future programmes should use a randomised trial design to test the delivery model.

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.

To conduct a local evaluation of the use of the educational resource: Suicide in Children and Young People: Tips for GPs, in practice and its impact on General Practitioners (GPs)’ clinical decision making.

This Royal College of General Practitioners (RCGP) resource was developed to support GPs in the assessment and management of suicide risk in young people.

The dissemination of the educational resource took place over a nine month period (February 2018–October 2018) across two Clinical Commissioning Groups in West Midlands. Subsequently, a survey questionnaire on GPs’ experiences of using the resource was sent to GPs in both Clinical Commissioning Groups (CCGs).

Sixty-two GPs completed the survey: 21% reported that they had used the resource; most commonly for: (1) information; (2) assessing a young person; and (3) signposting themselves and young people to relevant resources. Five out of thirteen GPs (38.5%), who responded to the question about whether the resource had an impact on their clinical decision making, reported that it did; four (30.7%) responded that it did not; and four (30.7%) did not answer this question. Twenty out of thirty-two GPs (62.5%) agreed that suicide prevention training should be part of their NHS revalidation cycle. The generalizability of the findings is limited by the small sample size and possible response and social desirability bias. The survey questionnaire was not validated. Despite the limitations, this work can be useful in informing a future large-scale evaluation of the RCGP online resource to identify barriers and facilitators to its implementation.