Conectar
Chronic dyspnoea is a prevalent and clinically significant symptom, often indicative of underlying cardiorespiratory disease. It is frequently under-reported by patients and under-recognised in primary care, with these challenges exacerbated in rural and remote communities where disease burden is greater and patients experience barriers to timely diagnosis and management. The BREATHE SMART trial aims to implement and evaluate an innovative, fully digital self-screening system for chronic dyspnoea, integrated into general practice workflows and information technology infrastructure. This approach seeks to enhance early detection and management of chronic cardiorespiratory conditions across diverse practice settings.
This multisite proof-of-concept study will test a software platform delivering a preconsultation self-screening questionnaire across 40 general practices in urban, rural and remote Australia. The system identifies eligible patients (≥18 years, consenting to SMS communication with their practice), issues an automated SMS that administers a validated dyspnoea screening questionnaire, and summarises responses for integration into the electronic medical record. Process evaluation will assess acceptability and utility using deidentified audit data, software metrics and qualitative feedback from patients, staff and general practitioners (GPs) via surveys, interviews and focus groups. Approximately 12 000 patients will be screened over 12 months. Primary outcomes will include the proportion completing self-screening and prevalence of chronic dyspnoea and secondary outcomes will include the rate of newly diagnosed chronic dyspnoea-related conditions (ie, asthma, chronic obstructive pulmonary disease and heart failure) in the preceding 12 months and during the intervention period.
Ethics approval was granted by the University of New South Wales Human Research Ethics Committee (HREC) (iRECS6645) and the University of Notre Dame Australia HREC (2024-155). Participating practices and each GP will provide written, informed consent. All patients being screened will provide electronic informed consent. Results of the study will be disseminated through various forums, including peer-reviewed publications and presentation at national and international conferences. Following the study, participating practices will be provided with a summary of the findings of the study, together with a full copy of any publications and a plain language statement for participants, which will be made available in the practices.
ACTRN12624001451594.
The rise in administrative burden on physicians is becoming increasingly recognised as a significant contributor to burnout and job dissatisfaction among primary care practitioners. Human scribes (HS) and digital/artificial intelligence scribes (DS) have emerged as potential tools to reduce clerical workload and improve physician well-being. There has been extensive research conducted on HS, and DS show promise but require validation across diverse healthcare settings. This scoping review aims to assess the effects of HS and DS in primary care settings to evaluate their impact on administrative work, job satisfaction, burnout and clinical operational efficiency.
This review will follow the Arksey and O’Malley framework with enhancements from Levac et al, along with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) reporting guidelines. A comprehensive search strategy was developed, including Ovid MEDLINE, Ovid Embase and Scopus databases in June 2025 with an academic health sciences librarian. Database searches will be conducted between March and June 2026. The inclusion criteria consist of empirical research on licensed physicians in primary care settings that implement HS or DS systems and measure physician-related outcomes. Two researchers will review and extract data independently using Covidence. The results will be analysed through thematic methods followed by descriptive summarisation.
This review conducts an analysis of existing publications without needing ethical clearance. Findings will be disseminated through peer-reviewed publications and presented at academic conferences where possible. The research team will make supporting materials accessible via the Open Science Framework.
To explore patient experiences with the RELEASE (Redressing long-term antidepressant use) toolkit resources, including antidepressant hyperbolic tapering plans designed to minimise withdrawal symptoms as part of the RELEASE trial’s implementation evaluation to understand what aspects of the toolkit work well and identify areas where refinement could enhance future implementation. The RELEASE intervention, a multistrategy intervention codesigned with general practitioners (GPs) and patients to prompt and support stopping long-term (>12 months) antidepressants, is being evaluated in an effectiveness-implementation hybrid type-1 cluster randomised controlled trial in general practice.
One-to-one semistructured qualitative interviews using reflexive thematic analysis to identify patterns of shared meaning.
General practice, south-east Queensland, Australia.
Adult participants (aged 18 years or older) taking an antidepressant long-term allocated to the intervention arm of the RELEASE trial.
31 participants with an average duration of antidepressant use of 16.5 years (range 1–30 years) were interviewed. Seven themes were identified. Across seven themes, participants described how the RELEASE toolkit resources prompted reflection on their antidepressant use, supported informed conversations with GPs, and offered tapering plans that were both structured enough to instil confidence and flexible enough to help participants feel in control of their tapering journey. They also identified barriers, including beliefs that very small tapering doses were unnecessary, difficulty accessing the mini-doses required for hyperbolic tapering and the challenge of managing withdrawal symptoms. For those who successfully stopped, the transition was associated with a renewed sense of autonomy. Participants also offered practical suggestions to strengthen the toolkit and its broader implementation.
The RELEASE toolkit resources played a meaningful role in prompting and supporting informed shared decision-making and guiding attempts to stop antidepressants. Clearer messaging about the potential for withdrawal symptoms and access to mini-doses for tapering are needed to support patients to safely stop antidepressants.
ACTRN12622001379707p; Pre-results.
Vision reduction is linked to reduced quality of life, self-care capacity, increased fall risk, cognitive decline and depression. Prevalence increases with age. In response, WHO recommends regular vision assessment at primary care level, such as general practice (GP), for adults +50 years. However, research on detection of age-related vision reduction in GP is limited. The objective is to assess the feasibility and clinical utility of implementing vision screening in Danish general practice following an annual control consultation for patients aged ≥70 years with minimum one chronic condition.
Complex health intervention in a Danish general practice setting. Testing a patient baseline questionnaire with 18 items on self-reported vision and quality of life in combination with three vision tests: Colenbrander Mixed Contrast Card Test for near vision, Amsler Grid test and Confrontational Visual Field Test. 18–20 GP clinics and 450 patients are planned to be included. After GP consultation, all patients visit a collaborating optometrist for a comprehensive vision assessment including refraction, intraocular pressure measurement, fundus photography and optical coherence tomography (OCT). Data and pictures from the optometrist are evaluated by an ophthalmologist, who refers to further follow-up and/or treatment if deemed necessary.
Feasibility outcomes: patient recruitment rate, patient adherence, as well as patients’ and health providers’ experiences with the intervention. Clinical outcomes: GP staff assessment of patient vision and patient-reported assessment compared with ophthalmologic assessment. This includes identifying the need for new glasses and detecting eye diseases that require further evaluation, monitoring or treatment. This study will provide evidence on the feasibility of integrating vision screening into routine general practice, potentially helping expedient referrals and improving detection and access to primary eye-health care for older adults.
The study is registered and approved by Danish Research Ethics and Data Protection, VEK F-23070033 and in ClinicalTrials.gov: NCT07015034. Findings will be disseminated in peer-review journals, academic conferences and with the public through patient organisations and public health events.
ClinicalTrials.gov; identifier: NCT07015034.
Problems with healthcare provision in general practice are already present and expected to worsen in the future. Therefore, retaining medical professionals in the long-term. An important factor in deciding on a profession is its compatibility with one’s own life. This study aimed to examine general practitioners’ working environment, social environment, their current work-life integration and potential changes enabled by interprofessional working concepts.
A qualitative approach was used, with guided focus group interviews with 37 general practitioners followed by individual interviews with 10 general practitioners. The interviews were verbatim transcribed and analysed using the framework method. The primary analyses were conducted, overall and separately for each gender. A professional group also carried out analyses. The subgroup analyses are based purely on qualitative trends.
Both genders and all professional groups perceived work-life integration as necessary. Men tended to report a better work-life integration than women. Women were more likely to work part-time and emphasised difficulties with childcare. When establishing interprofessional concepts, participants hope for more opportunities for delegation and co-determination, which can go hand in hand with reduced workload.
In this current study, women tended to perceive a greater degree of double burden both in their job and leisure time than men did. Beyond these gender and professional group differences, there were also tendencies towards differences between women with and without children. The findings indicate that work-life integration is an important factor in the professional setting of general practice. Particularly given the increasing number of female general practitioners, the establishment of part-time and childcare options is necessary.
Population ageing and the rise in chronic diseases are driving a shift from residential models to home care where family carers play a key role. Although education programmes have shown benefits, limited attention has been paid to how family caregivers can be effectively trained to prevent unintentional mistakes in home care and to how they should be prepared to respond to them related to the care they provide.
This scoping review aims to examine education programmes that enhance family caregivers’ knowledge and skills to promote safe home care, prevent unintentional mistakes and mitigate their impact on both care recipients and family caregivers.
This study follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) methodology for scoping reviews.
Comprehensive searches were conducted in PubMed, Scopus and Embase in April 2024.
The review included studies on family caregivers in home-based care, focusing on education programmes promoting safe practices; quantitative, qualitative and mixed-methods designs were eligible while studies on professional care or unrelated to home safety were excluded.
Extracted data included study characteristics, education type, target population and safety-related outcomes, which were summarised descriptively to map the available evidence.
31 studies on home safety education programmes for family caregivers across oncological, neurological, chronic and paediatric conditions were identified, mostly from the USA and conducted in hospital, home and other health and care facilities. Randomised controlled trials predominated and were generally high quality. Education programmes targeting technical, daily living and self-care skills improved caregiver burden, knowledge, preparedness and quality of life although physical health outcomes showed limited change.
Evidence indicates that structured education programmes enhance family caregivers’ knowledge, preparedness, competence and psychological well-being, supporting safer home care. While current education programmes are mostly short-term and caregiver-centred, this review identifies core technical, daily life and self-care competencies to guide future education programmes, highlighting the need for co-designed, rigorously evaluated education programmes that include patient safety outcomes and caregiver emotional support.
Remote consultations (video, telephone, text) have become integral to the delivery of primary care and are promoted by government initiatives. While many find these more convenient, they may also discriminate against those with lower digital literacy and present a barrier to empathy by removing some non-verbal communication. The aim of this realist review is to understand how therapeutic empathy can be effectively expressed during remote consultations in general practice across different situations and for different people.
This realist review will follow the methodological framework proposed by Pawson and colleagues, which includes the following five steps: (1) identify existing theories to develop an initial programme theory; (2) systematically search bibliographic databases to identify relevant literature; (3) select, extract and organise data; (4) synthesise evidence to develop context-mechanism-outcome configurations; (5) refine and finalise programme theory. This iterative process will be guided by a Content Expert Group consisting of patients, carers, clinical staff working in general practice and representatives from national stakeholder groups. The final programme theory will inform the development of evidence-based recommendations to help clinical staff working in general practice express empathy during remote consultations.
This review does not require ethics approval. Findings will be disseminated through peer-reviewed journals, national and international conferences and through relevant professional associations and primary care networks in the UK.
CRD420261306014.
Cardiovascular disease (CVD) is the leading cause of death worldwide and is associated with a broad range of physical, emotional and social burdens. Existing tools such as Systematic Coronary Risk Evaluation and WHO CVD risk charts identify clinical risk factors but fail to capture patient-perceived burden and the risk of burden awareness. The Assessment of Burden of Chronic Conditions (ABCC)-tool, a validated, person-centred instrument, offers a more holistic approach. The aim of the current study is to develop and validate a new module within the ABCC-tool for patients with an elevated cardiovascular (CV) risk or CVD (cardiovascular risk management (CVRM) module).
A mixed-methods design was used across four phases and expert meetings to identify the items for the module. All phases took place in the Netherlands. Phase 1 (literature search) was performed in 2021, phase 2 (semistructured interviews) was completed between January and October 2021, phase 3 (survey) was completed in November 2023 and December 2024, and phase 4 (semistructured interviews) was completed in January 2025.
Phase 2 involved 14 experts by experience (patients with CVD or people at elevated risk) and 10 healthcare professionals in the field of CVD. Phase 3 included 86 healthcare professionals. Phase 4 included 12 experts by experience. In total, four expert meetings took place, attended by three experts by experience, nine healthcare professionals and seven researchers.
The module was refined iteratively, using qualitative and quantitative insights at each phase of development. The model was only finalised after thorough content validation.
No suitable patient-reported outcome measures (PROMs) focusing specifically on CVRM were identified in the literature. Interviews revealed significant burdens in terms of physical, emotional and social burdens. Feedback from expert meetings and validation rounds led to substantive refinement. The final module contains 10 items and was deemed valid by both experts by experience and healthcare professionals.
The CVRM module of the ABCC-tool has been systematically developed and validated in terms of content. The final module focuses on the multidimensional burden of CVD and dealing with its risk factors and aims to support self-management. The module complements existing risk assessment tools by focusing on the burden experienced by the patient and the burden resulting from risk awareness.
Weight loss through combined lifestyle interventions (CLIs) can slow down knee osteoarthritis (OA) progression. However, gender-related factors may influence both the implementation of and participation in CLIs. Therefore, the aims were to identify gender-related facilitators and barriers to CLI implementation among healthcare professionals (HCPs) and uptake and adherence among individuals with early-stage knee OA and overweight or obesity.
Semi-structured interviews were conducted in this qualitative study. Thematic analysis, combining inductive and deductive approaches, was performed according to the Consolidated Framework for Implementation Research (CFIR) domains.
HCPs and individuals with knee OA and overweight or obesity were interviewed in Dutch between December 2023 and May 2024.
16 HCPs who referred or delivered a CLI and 23 individuals with knee OA and overweight or obesity who participated in a CLI were purposively recruited. 16 participants identified themselves as women and 7 as men; no other gender identities were reported.
HCPs experienced resistance to CLIs of both men and women. Additionally, HCPs perceived that women were more open and available to participate in CLIs, tended to prioritise others over themselves and often lacked familial support compared with men. Women valued trust, preferred female HCPs and struggled with self-prioritisation. Men were motivated by female HCPs and participants due to their empathy and interaction. Across men and women, barriers included conflicting HCP advice, work stress, caregiving tasks and lack of discipline, while social environment support was a key facilitator.
Addressing gender-related facilitators and barriers in the design and implementation of the CLI may improve long-term engagement and efficacy in individuals with knee OA and overweight or obesity.
Overview of Medical Research in the Netherlands (OMON), managed by the CCMO: NL75367.078.20
The general practitioner workforce (GPWF) is an important factor influencing primary care capacity. Many countries face GP shortages and substantial challenges in workforce development. However, the factors and mechanisms shaping GPWF development remain insufficiently understood.
To explore key challenges affecting GPWF development and their interrelationships in the primary care system of Beijing, China.
Between October and December 2024, directors and GPs from 18 community health centres were recruited using purposive sampling. Data were collected through a focus group discussion and in-depth interviews; thematic analysis was conducted in line with Merriam and Tisdell’s approach. A causal loop diagram (CLD) was then developed to identify and visualise dynamic relationships among factors influencing the GPWF development.
The participants comprised 10 directors and 8 GPs from urban and suburban areas, with a predominance of women and those holding senior professional titles. Participants had diverse educational and professional backgrounds. Three major themes were identified: (1) rising demand for GP services, (2) supply challenges in the GPWF, and (3) challenges to GPs’ professional sustainability. Across these themes, 12 subthemes and 10 key variables were identified. The CLD reflected participants’ perceptions of how these variables interacted and illustrated potential reinforcing interactions among them.
The development of the GPWF in Beijing is constrained by multiple interrelated challenges. Addressing these challenges entails coordinated policy actions to strengthen workforce planning and training, enhance job attractiveness, improve the alignment between training and practice, and reinforce professional support and continuing professional development, thereby promoting the sustainability of the GPWF.
The shortage of general practitioners in many countries remains a persistent issue and is likely to become more severe in the future. Multiple factors influencing the attitude of medical students towards general practice have been identified. The aim of this scoping review is to describe the scope of the evidence on the influence of teaching general practice in medical school (eg, lectures, seminars, internships) on medical students’ attitude towards this discipline and to identify knowledge gaps.
We will apply a mixed studies scoping review design. Quantitative, qualitative and mixed-methods studies exploring the influence of general practice education in medical school (exposure) on the attitudes (outcome) of medical students (population) will be included. The outcome will be any measured or reported change in medical students’ attitude towards general practice as a discipline. A systematic search in MEDLINE through PubMed, Cochrane, Embase, the Education Resources Information Centre and PsycInfo, as well as forward and backward citation tracking, will be conducted starting from 2015, published in English or German. Titles, abstracts and full texts will be screened and data will be extracted independently by two reviewers. Results will be tabulated and summarised narratively and interpreted according to the framework of the affective domain.
By identifying and linking educational formats with levels of the affective domain, this approach may help educators understand how medical training can influence the attitude towards and interest in primary care and improve the development of professional identity formation and general practice focused curricula.
This scoping review does not require ethical approval. The results will be disseminated through publications in peer-reviewed journals and presentations at national and international conferences.
The protocol of this scoping review has been registered on OSF (DOI: 10.17605/OSF.IO/UFJCR).
To characterise post-stroke depression (PSD) diagnostic and treatment patterns in an outpatient primary care setting, including timing, screening methods, therapeutic interventions and associations with mortality.
A retrospective cohort study.
Maccabi Healthcare Services, the second largest Healthcare Maintenance Organisation in Israel, covering more than 2.7 million citizens between 2016 and 2022.
Participants were adult patients with a new stroke diagnosis between 2016 and 2022 and a subsequent diagnosis of depression according to International Classification of Diseases clinical criteria or antidepressant medication initiation. Patients with a diagnosis of depression or antidepressant treatment prior to stroke were excluded from the study.
Primary outcomes included PSD diagnosis rates, time to diagnosis and treatment, use of screening questionnaires, specialty of the physician making the diagnosis and all-cause mortality. Secondary outcomes included referral rates to mental health services, rehabilitation participation and its impact on mortality.
Among 11 499 patients, PSD occurred in 4620 (40.2%) patients. Primary care physicians diagnosed 53.1% of cases based on clinical assessment; only 4.5% of patients underwent Patient Health Questionnaire-2 screening. Most diagnoses occurred in the first year (53.4%). Antidepressants, predominantly selective serotonin reuptake inhibitors (58.3%), were initiated within 30 days in 65.1% of diagnosed patients. Patients with PSD demonstrated higher rehabilitation participation (69.5% vs 48.5%, p
In this cohort, in an outpatient primary care setting, primary care physicians diagnosed the majority of PSD cases, predominantly relying on clinical criteria, without using screening tools. The majority of PSD diagnoses occurred during the first year after stroke (53.1%), suggesting that repeated evaluation might be appropriate during this follow-up period. Early antidepressant treatment and enhanced rehabilitation engagement may positively influence mortality outcomes in patients with PSD. Low utilisation of standard screening tools and mental health referrals represents an area for potential improvement in PSD management.
To investigate how patients with sarcoma present prior to diagnosis—through a general practitioner (GP) or another healthcare professional (HCP)—and describe presenting symptoms.
International observational cohort study.
Data were obtained from the longitudinal ‘QUality of life and Experiences of Sarcoma Trajectories’ (QUEST) cohort study, conducted across the Netherlands, the United Kingdom (UK), Australia and New Zealand.
Among 572 patients, 487 (85.1%) started their diagnostic trajectory at the GP (subcohort 1) and 85 (14.9%) with another HCP (subcohort 2)—mainly medical specialists treating unrelated conditions (36/85; 42.4%). Soft tissue sarcoma patients most often reported swelling, whereas bone sarcoma patients reported unexplained pain. Notably, 31/85 (36.5%) of subcohort 2 were asymptomatic. Reasons for delaying GP visits included assuming symptoms were minor and expecting them to resolve. Patients sought care when, among others, symptoms persisted and worsened.
Most patients first consulted a GP, underlining the role of primary care in sarcoma diagnosis internationally. Due to rarity and nonspecific symptoms, faster diagnosis remains challenging, requiring improvements in both primary and specialist care.
NCT03441906; Results.
Social prescribing has provided a lifeline to people, capturing the importance of quality support offered via community connections. It has not been exempt from difficulties, resulting in low-quality evidence on effectiveness in part due to high drop-out rates and lack of controls. While these have been the focus of recent research, less attention has been paid to the safety implications of social prescribing. This review aims to understand safety implications of social prescribing interventions and to build a dark logic model of how harms are produced.
Using review of review (umbrella) methodology, we searched nine databases to June 2024.
Medline/Ovid, Embase, PsycINFO, Cochrane Library/Wiley, Web of Science and Scopus) were searched from 1 January 2010 to 3 June 2024.
Included reviews were systematic/scoping/narrative reviews or meta-analyses, which synthesised primary data collected from any person in receipt, involved in delivery or the commissioning of social prescribing interventions. The context of the review was social prescribing interventions/services based in primary healthcare (statutory) or third sector (non-statutory) in any country. Only reviews that were published in English and in peer-reviewed journals were included.
Two independent reviewers extracted data from included reviews using the Typology of Harms Framework (which includes five categories of harms associated with interventions: physical, psychological, group/social, equity and opportunity harms) and to build a dark logic model to understand what contributes to these harms.
Sixteen reviews were included, reporting on social prescribing research including a link worker. Of the identified harms, we found that opportunity harms (harm related to the cost, inappropriate or ineffective interventions) were most reported. There was also evidence extracted to suggest plausible psychological, equity (impact caused by inequity in provision, delivery or access) and group/social harms (impact that overly or inadvertently excludes a person). No physical harms were identified.
Social prescribing, as with any delivery of care, has the potential to cause harm. We identified a range of potential harms (psychological, group/social, equity or opportunity harm) from social prescribing; however, it is unlikely to be an exhaustive list. We provide two clear outcomes: (1) the need for robust design of social prescribing research, including collection of data on the incidence and prevalence of harms, (2) recognition of the potential for harm from social prescribing and to address these where practicable.
Long-term cancer survivors may suffer from significant bio-psycho-social burden even years after treatment. Yet, a structured approach to detect and address bio-psycho-social burden of long-term cancer survivors in primary care is missing in Germany, although family physicians are the primary medical contact for most patients. In this paper, we describe the DELPHIN study aiming to develop and test a structured care model for long-term cancer survivors. The DELPHIN study and intervention will facilitate networking of regional medical and non-medical services. This protocol describes the intervention as well as the pilot study.
The DELPHIN study comprises a developmental and a feasibility phase. In the developmental phase, we will assess (1) the current care needs of long-term cancer survivors (n=1000) using a cross-sectional questionnaire survey; (2) in an additional cross-sectional questionnaire survey, we will address medical and non-medical care providers to assess current care practice for this patient group (n≥250); (3) a qualitative interview study with both long-term cancer survivors (n=12) and family physicians (n=10) will assess patients’ needs and barriers for effective care. Results will then be triangulated to inform development of the DELPHIN intervention. The intervention shall include the following elements: the DELPHIN mobile app for patients with a digital screening tool, a digital treatment plan, a survivorship passport and information on regional medical and non-medical providers. Additionally, a DELPHIN website and a DELPHIN eLearning tool for family physicians will be developed. The subsequent feasibility study will follow 100 long-term cancer survivors using the DELPHIN app for 4 months, with two assessments (t0=baseline; t1=4 months follow-up) regarding the usability of the app and their health-related quality of life. The eLearning tool will be tested by 50 family physicians using three measurement points to evaluate learning success (ta=before; tb=directly after eLearning; tc=after 4 weeks).
The DELPHIN study seeks to address cancer survivors’ unmet bio-psycho-social needs through implementing a digital mobile application. Positive results in the feasibility study will provide the basis for a future effectiveness study and integration into routine care.
The study was reviewed by the Ethics Committee of the University of Bonn, Germany (No: 2024-409 BO) which did not object to the study.
DRKS00035726.
To examine Australian General Practitioners’ (GPs) confidence in initiating oral anticoagulants (OACs) for patients with atrial fibrillation (AF), and their practices for monitoring treatment adherence.
Cross-sectional online survey.
GPs practising in metropolitan, regional and rural/remote locations in Australia.
1765 Australian GPs recruited through professional GP networks.
GPs’ self-reported confidence initiating OACs; practices monitoring patient adherence and persistence; and perceived barriers to adherence. Demographic data including clinical experience and geographic location were collected. 2 analyses were used to examine associations between the key outcome variables and GP location and clinical experience.
Of 1765 respondents, 83.1% had practised for >10 years and 27.6% worked in regional or rural/remote areas. Overall, only 50.2% reported high confidence initiating OACs in patients with CHA2DS2-VA score ≥2 (a cumulative stroke risk score with a score of 1 for: congestive heart failure, hypertension, diabetes, vascular disease and age 65-74 years and 2 for: stroke/transient ischaemic attack, age ≥ 75 years). Unsurprisingly, confidence was higher among GPs with >10 years experience (51.5%) compared with 5–10 years (44.9%) and
Only half of GPs reported high confidence initiating OAC treatment, and approximately a quarter do not routinely monitor medication adherence or persistence. Targeted strategies to improve confidence and align practices with guideline recommendations are required. Appropriate education should be developed targeting the specific issues underlying lack of confidence in initiating OAC and the practice of referring newly diagnosed patients to cardiology. Further research into implementing systems for monitoring and improving adherence and persistence would be worthwhile in the context of these findings.
Physician burnout is a global crisis compromising healthcare sustainability and patient safety. Balint groups, a structured case-based discussion intervention focusing on the doctor-patient relationship, are increasingly used to mitigate this distress. However, existing evidence regarding their efficacy remains fragmented. This systematic review and meta-analysis aims to evaluate the effectiveness of Balint groups in reducing physician burnout and improving secondary psychological outcomes, while also assessing implementation characteristics.
We will search MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL, PsycINFO and major Chinese databases (China National Knowledge Infrastructure, Wanfang Data and SinoMed) from inception to 31 May 2026, supplemented by grey literature and trial registries. The formal search has not yet commenced and is planned to begin on protocol publication. We will include both randomised controlled trials (RCTs) and non-randomised studies of interventions (non-randomised trials (NRTs), including non-controlled before-after studies) that evaluate Balint groups for practising physicians. The primary outcome is the change in burnout severity, with priority given to the emotional exhaustion subscale of the Maslach Burnout Inventory; however, data from other validated tools, such as the Oldenburg Burnout Inventory, will also be extracted and synthesised if reported. Secondary outcomes include stress and anxiety as psychological comorbidities closely associated with burnout, and job satisfaction, adherence and medical errors as its downstream occupational consequences. Two reviewers will independently screen studies, extract data and assess risk of bias using the Cochrane RoB 2.0 tool for RCTs and the Effective Public Health Practice Project tool for NRTs. Data synthesis will be conducted separately for RCTs (between-group effects) and NRTs (within-group effects) using random-effects models. Heterogeneity will be explored via subgroup analyses (eg, career stage) and, where data permit, meta-regression. The certainty of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation approach.
Ethical approval is not required as this study synthesises primary data from published research. Findings will be disseminated through a peer-reviewed journal publication and conference presentations to inform interventions for physician well-being.
CRD420251142526.
The Needs Assessment Tool-Cancer (NAT-C) is a consultation guide to identify, triage and reduce unmet patient needs.
We aimed to assess NAT-C fidelity, mechanisms of action and implementation issues in UK primary care as part of a clinical and cost-effectiveness cluster randomised controlled trial of the NAT-C for people with cancer compared with usual care (registration: ISRCTN15497400).
Design: a mixed-methods process evaluation informed by normalisation process theory (NPT). Setting: 21 participating general practices in England were randomised to be trained to conduct an NAT-C guided consultation with people with cancer (excluding those in remission). General practitioner fidelity of intervention and clinical action resulting from the NAT-C consultation was noted. Two Normalisation MeAsure Development Questionnaire surveys were distributed to trained clinicians before (Survey 1) and after delivery of ≥2 NAT-C consultations (Survey 2). Semi-structured interviews were conducted with clinicians (post delivery ≥2 NAT-C consultations) and key stakeholders in primary and cancer care. Fidelity, action and paired before/after survey data were analysed using descriptive statistics. Interview data were analysed using a deductive thematic framework approach (NPT-informed). Data were narratively synthesised with cross-tabulated key findings.
Of the 360/376 (96%) NAT-C consultations delivered, 258/360 (72%) resulted in clinical action, including 50 (13%) external referrals. 14 paired before (Survey 1, n=53) and after (Survey 2, n=29) responses. Survey 1 showed positive responses across all NPT domains, but while continuing to see relevance, usefulness and legitimacy, Survey 2 highlighted concerns about insufficient resources and management support. 16 clinician participants (eight GPs, eight key stakeholders; 50% male) completed interviews. Following synthesis, we identified five themes: (1) the perceived value of the NAT-C; (2) ‘champions’ are important at all levels (practice, regionally and nationally); (3) research evidence is seen as important, but influences implementation indirectly through policy, clinical guidelines and resourced initiatives; (4) adequate resources are fundamental for implementation beyond practice level and (5) NAT-C practicalities; training is adequate, but robust functional information technology systems are needed.
Implementation requires champions and clinicians ‘buy-in’ to the patient value to legitimise use. In the context of current primary care pressures, resources were seen as essential to embed the NAT-C, but financial incentives were viewed with mixed feelings.
To assess whether the Marburg Heart Score (MHS) and INTERCHEST score may improve telephone triage of chest pain by providing better diagnostic discrimination compared with the triage protocol from the Netherlands Triage Standard (NTS).
Prospective diagnostic accuracy study.
Large regional out-of-hours primary care (OOH-PC) facility in Alkmaar, the Netherlands.
A total of 1254 eligible patients contacted the OOH-PC facility (median age 56.0 years, 57.9% female) between December 2022 and May 2023. The study was completed and verbal informed consent obtained in 280 (22.3%) patients.
Triage assistants asked study questions in addition to the NTS protocol to complete the MHS and INTERCHEST score.
Discrimination (C-statistics) and diagnostic test properties (eg, sensitivity/specificity) were used; the reference standard was the occurrence of a major event (ie, composite of all-cause mortality, and urgent cardiovascular and non-cardiovascular conditions) or acute coronary syndrome (ACS) within 6 weeks.
A major event occurred in 36 patients (12.9%), including 13 (4.6%) ACS cases. For predicting major events, the MHS and INTERCHEST scores showed C-statistics of 0.67 (95% CI 0.57 to 0.77) and 0.64 (95% CI 0.54 to 0.74), respectively, compared with 0.62 (95% CI 0.53 to 0.71) for the NTS protocol. For ACS, C-statistics were 0.62 (95% CI 0.45 to 0.79), 0.59 (95% CI 0.43 to 0.75), and 0.62 (95% CI 0.49 to 0.75) for MHS, INTERCHEST and NTS, respectively. Regarding test characteristics, the MHS and INTERCHEST score showed higher point estimates for specificity (27.9% and 26.6%) vs the NTS (19.7%), but at the expense of lower sensitivity (88.9% and 86.1% versus 97.2%) for major events. For ACS, a similar pattern was observed (specificity 26.2% and 25.5% vs 18.4; sensitivity 84.6% and 84.6% vs 100.0%).
Simple clinical decision rules (MHS and INTERCHEST) have comparable, modest discriminative ability and diagnostic properties compared with the current protocol for telephone triage of acute chest pain in Dutch OOH-PC.
Netherlands Trial Register (TRACE – NL-OMON20102).
Primary care is facing multiple crises, including an increase in health misinformation. Digital health messaging by primary care providers has been shown to reach a diverse patient population. With the uptake of Generative Artificial Intelligence (GenAI) usage in healthcare, there is an important opportunity to rapidly create messages that are tailored to different populations and conditions. However, thoroughly assessing artificial intelligence (AI)-generated content is essential, as GenAI raises concerns regarding its accuracy, understandability, actionability and bias perpetuation. We aim to investigate whether digital health messages created by GenAI are evaluated as non-inferior compared with those created by human experts.
The AI-CARE (AI to Create Accessible and Reliable patient Education materials) study is a double-blind, crossover, non-inferiority randomised controlled trial. Data collection began on 30 May 2025, and is expected to be completed at the end of May 2026. Over 12 months, 192 messages on 48 topics will be written: half by primary care and public health experts and half by a GenAI tool (OpenAI’s ChatGPT). Review Panels composed of 24 primary care providers and 24 patients will evaluate these messages using an Evaluation Grid developed to assess the messages’ quality of information, adaptation to the target audience, relevance and usefulness, and readiness to be shared with patients. Evaluations will be completed via online REDCap (Research Electronic Data Capture) surveys and the order in which the 192 messages appear will be randomised and will vary between individuals. Participants and analysts will be blinded to the generation source. The primary outcome will be the Clarity and Understandability score.
The Research Ethics Boards of the Hôpital Montfort (24-25-11-038) and the University of Ottawa (S-12-24-11153) formally approved this study in December 2024. Reported data will be grouped and anonymised for dissemination in peer-reviewed scientific journals and conferences.
FreshRSS 