Each year, physical traumas affect over one billion people worldwide, generating a substantial burden in terms of mortality, disability and productivity loss. The period following hospital discharge, encompassing the transition to home, short-term stays in rehabilitation facilities, as well as outpatient and community-based follow-up care, represents a critical phase in the recovery process for trauma injury patients. Yet, this phase remains poorly documented. We aim to (1) Map data on assessment strategies for various outcomes among trauma survivors after hospital discharge, including the tools used and how they are administered, as well as the resources required, and the barriers and facilitators to their implementation, and (2) Compare the feasibility of implementing the assessment strategies while considering response rates, resource use, costs and sustainability.
We will conduct a scoping review using the Joanna Briggs Institute methodology. We will search MEDLINE, Embase, CINAHL, Scopus and PsycINFO for studies published since 1990 to reflect the evolution of contemporary follow-up practices, including the emergence of Patient-Reported Outcome Measures and digital tools. There will be no language restrictions. We will consider all studies involving trauma survivors, focusing on the evaluation of postdischarge health outcomes. Two independent reviewers will screen studies and extract data on population characteristics, assessment strategies and feasibility. Results will be analysed thematically and presented narratively. We will present counts and percentages for each assessment strategy, along with its characteristics and associated barriers and facilitators. Subgroup analyses will also be conducted based on clinical and social determinants and contextual factors.
Ethics approval is not required for this review. The results of this scoping review will be shared through publication in a peer-reviewed journal, conference presentations and our network of knowledge users.
DOI 10.17605/OSF.IO/KZHS4
To assess the use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1 RA) among patients with coexisting ischaemic heart disease (IHD) and type 2 diabetes (T2D) in primary care, in relation to European guidelines.
Cross-sectional observational study.
209 primary healthcare centres in Region Västra Götaland, Sweden (population 1.8 million in 2023).
14 414 patients with registered prevalent diagnoses of coexisting IHD and T2D, September 2023, in QregPV, the regional primary care quality of care register in Region Västra Götaland. Data on dispensed drugs were retrieved from the regional prescribed drug register, Digitalis.
The primary outcome was the proportion of patients with dispensed SGLT2i or GLP-1 RA in relation to sex, age and primary healthcare centres (including private vs public ownership). The secondary outcome was estimated additional prescription costs.
SGLT2i was dispensed to 37.2%, less often to women (adjusted OR (aOR) 0.64 (95% CI 0.59 to 0.70)). GLP-1 RA was dispensed to 10.0%, with no sex difference (aOR 1.04 (95% CI 0.92 to 1.18)). Use of SGLT2i and GLP-1 RA declined with age (p
SGLT2i and GLP-1 RA were underutilised in patients with coexisting IHD and T2D. The sex disparity in SGLT2i use warrants attention, as does the substantial variation between primary healthcare centres and the challenges of implementing costly cardioprotective therapies.
by Mylaine Breton, Catherine Lamoureux-Lamarche, Véronique Deslauriers, Djamal Berbiche, Maude Laberge, Annie Talbot, Aude Motulsky, Marie-Pascale Pomey, Isabelle Gaboury
BackgroundAccess to primary care is an important component of health systems. Given the barriers experienced by unattached patients to accessing primary care in Quebec (Canada), the Ministry of Health mandated the province-wide implementation of Primary care access points for unattached patients (Guichet d’accès première ligne; GAP), an organizational innovation designed to orient patients to the most appropriate professional or service. This study aims to 1) document the factors associated with unmet healthcare needs after receiving GAP services and 2) assess whether those factors vary by GAP orientation.
MethodsThis cross-sectional study builds on data collected between April and July 2024 using an online patient questionnaire. All patients with a valid email address registered on the centralized waiting list for unattached patients in three local health territories (LHTs) received an email invitation to participate in the survey. The total sample included 20,282 participants who responded to the questionnaire and used the GAP.
ResultsThe findings showed that younger age, self-reporting poor/fair physical and mental health, receiving services in LHT 3 and reporting an emergency room visit were associated with increased likelihood of reporting unmet needs. Stratified analyses suggested that some characteristics (age, use of emergency room) were associated with unmet needs across orientations, while others (self-reported physical and mental health) were associated with specific orientations.
ConclusionThis study serves as a first step in deepening our understanding from a patient perspective of how to better plan primary care services and improve unattached patients’ experiences using the GAP. The findings showed that patients oriented to other professionals than a medical appointment with a family physician had the highest percentage of unmet needs. The next step involves an in-depth exploration of the reasons for patients’ unmet needs, enabling the development of more precise and effective strategies to address them.