Primary Care

Primary Care

  • Richard Andrew Stott added an answer:
    Who knows a good definition of acute kidney injury (based on biochemistry data) to be implemented in observational primary care datasets?
    Most observational studies on community-acquired acute kidney injury use hospital admission and relevant ICD codes as their study outcome. However, we have access to a primary care data base that can be linked to laboratory data and this may allow us to additionally study renal outcomes that did not require hospital admission and those that were not primarily attributed to AKI.
    Richard Andrew Stott

    As you are in the UK you could do worse than adopting the nationally mandated AKI alert algorithm ( ).  This should already be being reported by your laboratories on secondary care creatinine requests. Not yet mandated for reporting to primary care but that is the next step of the roll out.

    I do not know of the progress in Tayside but we started reporting the scores to primary care from our laboratories at the beginning of this month.  Score is calculated on all creatinine requests using the laboratory's database. This means the baseline includes inpatient & outpatient creatinine results as well as primary care values.  If there is a level calculated then it comes down the result messaging links to primary care systems as a number 1, 2 or 3 using a dedicated read code so it will drop into the system automatically.

    Your lab may have been calculating values before they started reporting live or you could possibly implement the algorithm and calculate scores for historical data in your database.

  • Adélia Correia added an answer:
    Anybody could share with me articles or thesis about PCAT - Primary Care Assessment Tool?

    I´m studying about Primary Care Assessment Tool, and i`d like to know if someone can help me with articles or thesis about the theme.


    Adélia Correia

    Thanks, Shabir! I'll read it.

  • Juan M Mendive added an answer:
    Primary prevention of depression - can anyone help?
    Primary care environment to prevent depression from opportunistic approach. What is the quality of life implication of that?
    Juan M Mendive

    Muchas gracias Adélia por su valuoisa información y compartirla conmigo. Un abrazo

  • Yusef Hamidzadeh added an answer:
    Does anyone have experience in the use of computerized clinical guidelines to aid in depression management?

    A possible way to promote the implementation of a clinical guideline is to transform it in an interactive computerized tool. I have read some reports about the Texas medication algorithm project (TMAP). Does anyone have experience in the use or knowledge about other computerized clinical guidelines to aid in depression management in primary or secondary care?

    Yusef Hamidzadeh

    non. I interest to health education and promotion.

  • Lisa Renee Miller-Matero added an answer:
    Is there any literature on rate of follow-through for referrals from a behavioral medicine consultant (not pcp) to on-going psychotherapy?

    We are trying to set a goal for rate of follow-through for referrals from our behavioral medicine consultants, who are integrated in our primary care department (community outpatient) to on-going psychotherapy? Does anyone know of literature that suggests a baseline for how many patients that are referred for therapy actually follow through?

    UPDATE 6/25: Note that the referral is actually to a different department. Patients would be getting referred from a primary care appointment in which they meet with a behavioral health consultant. The BH consultant will be referring the Pt. to on-going therapy with a different therapist altogether. What referral follow-through rate should we expect, based on the literature?

    Lisa Renee Miller-Matero

    I have a published study on this and I believe it is a similar format to what you are doing. I am a consultant within a primary care clinic where I receive referrals from PCPs. Most of these are a one time evaluation with referral to a behavioral health clinic for psychotherapy. About 85% of patients followed through with the referral from their PCP to me and of those I suggested to follow up with therapy, about 55% did. Here is the citation for the paper but feel free to contact me for a copy if needed:

    Miller-Matero, L.R., Dubaybo, F., Ziadni, M., Feit, R., Kvamme, R., Eshelman, A., &Keimig, W. (2015). Embedding a psychologist into primary care increases access to behavioral health services. Journal of Primary Care and Community Health, 6, 100-104.

  • Patricia Welch Saleeby added an answer:
    Can anyone help with a review of epidemiological studies on interventions for control of diabetes in primary care setup in rural areas?

    Need interested researchers willing to collaborate on a Review of Epidemiological Studies on interventions for control of Diabetes in primary care setup in rural areas

    Patricia Welch Saleeby

    I am interested. This article might help you:

  • John Lennox Campbell added an answer:
    Does anyone know of good papers regarding implementation of clinical decision support systems in primary care?
    Looking at good (and bad!) examples of successful CDSS implementation in primary care/general practice
    John Lennox Campbell

    ESTEEM full report:

    Published paper in Lancet

  • Diana van Die added an answer:
    How to manage a patient with diabetic neuropathy in primary care?
    Neuropathy is one of the major complication in diabetes mellitus type 2. What can be done for a patient with this condition in a primary care setting besides management for blood glucose control? How effective can it be in affecting the prognosis of complication process?
    Diana van Die

    There is some evidence from clinical trials for Gingko biloba as well as for Oenethera biennis (Evening primrose oil)

  • Susan Wortman-Jutt added an answer:
    Should we routinely screen for depression?

    Depression is a mood disorder that affects the way a person feels, thinks or behaves, which may impair social or occupational functioning, also depression is common in primary care and hospital settings, but it is often not recognised by healthcare professionals. Because depression is potentially treatable, there has been interest in screening patients who present to primary care settings. This has led to calls for screening programmes to aid detection and management.
    Multiple recommendations for clinicians for screening for depression in adults have been published. But the existing evidence on depression screening recommendations are far from unanimously accepted.

    Susan Wortman-Jutt

    In my clinical experience, patients with neurological disorders of almost any kind will benefit from counseling for coping strategies, whether they are formally diagnosed with depression or not, and regardless of whether they're taking anti-depressants (which are also a valuable tool).  I think screening is an excellent idea.  I would add that many people with neurological illnesses are suffering from grief, whether or not it is formally classified as depression.  Patients may be grieving the loss of independence, status, employment, relationships -- the life they knew before their diagnosis.  My subjective observation is that patients who do not find strategies for coping with their loss, will not do as well therapeutically.  So I would say "yes" to screening, but I wouldn't stop there.  Counseling would be a beneficial part of treatment for anyone suffering from a neurological illness, even if criteria for a diagnosis of depression is not met and medications are not necessary..

  • Elenka Brenna added an answer:
    How much do demographic shifts contribute, compared to non-demographic factors, to health care spending in high income countries?

    I would appreciate key reviews/summaries and published/unpublished manuscripts - looking at for example, ageing, expectations, population growth, time-to-death versus inappropriate use of expensive technology, health care practices, etc.

    For example, see

    Atella, et al. The effect of age and time to death on primary care costs: the Italian experience. Soc Sci Med. 2014;114:10-7. 

    Blakely et al. Health system costs by sex, age and proximity to death, and implications for estimation of future expenditure. NZ Med J. 2014;127(1393):12-25.

    Elenka Brenna

    Possibly the paper I wrote jointly with Cinzia Di Novi, (Is caring for older parents detrimental to women’s mental health? The role of the European North–South gradient, DOI 10.1007/s11150-015-9296-7) could be of interest. Although it does not address directly to health care costs, there are some interesting points on the different long term care systems across Europe, according to a North-South gradient. You may see that societal, religious, institutional factors representing the three European macro-areas (respectively Northern Central and Southern Europe) impact on the way the family take care of the elderly. And that the more each Country spends on LTC, the less the families are involved in assisting their older relatives. Hope you will find it interesting.

  • Andrei Gonzales I. added an answer:
    Are you familiar with the notion of complementary and alternative medicine more than conventional primary care?
    Conventional medicine prides itself on being science-based, and shuns alternative medicine for being "unproven," however, many of the non-communicable diseases have been taken care of successfully by alternative medicine. Conventional medicine is still behind and it will send your health into a downward spiral.
    Andrei Gonzales I.

    Thanks Dr. Partha Pratim Dhar, yes I tried to mean that a lot of traditional knowledge are inside of alternative medicine, so they are a lot of applications like Dr Partha mentioned; they are very useful, the problem is that a lot of people dont like this type of medicine because they are not proved scientifically, how ever they are a lot of new publications that are proving this facts, we scientists must try to help in this topics.
    I am aware that in many cases the knowledge of alternative medicine have been misrepresented, used only for trade and deceit and also for illegal things. It is a difficult task trying to keep the original knowledge that many cultures that left, most of this knowledge is dying with their carriers ancestors who had 80-100 years old.
    At this point I dare say that it is possible to mention that many people when they hear about alternative medicine only comes to their minds facts unconvincing, because the most part of the information is already infected, to the point that people believe in such superstitions.

    Another reason why many of knowledge of alternative medicine is not demonstrated is by the difficulty you have when making experiments or controlling the confounding factors in the observations.

    Then the task is to separate objectively all knowledge that show significant solutions and their real applications, but often involves taking a multivariate analysis and even a lot of protocols sustain that the essence of the expression of the fact it is on non physical (touchable) variables (subjective) and non counting this facts could affect the experiment (or observation) (For example the problem with the Masaru Emoto experiments ). To the other hand we must to correct the distorted knowledge.

    There are already people working on this topic, even objectively trying to improve the reputation of alternative medicine.

    A strong example in the application of alternative medicine is the effect of the moon on living organisms through its gravitational field, as this example there are others.

  • Singh Shivakumar added an answer:
    Can a practical clinical review of topics in primary care serve to aid an already existing clinical practice guidelines?

    As a primary care physician, I found that there is a certain gap in practical knowledge that clinical practical guidelines (CPG) seem to offer my fellow colleagues. Hence I embarked on a mission to write a book which not only simplifies pre-existing guidelines but allow physicians to learn the management of a disease by just reading one page. When I happen to discuss this (coincidentally) with an author of the bronchial asthma CPG, he vehemently challenged my idea, saying that everything has been written in the CPG. My argument however, was, my was more practical and it has incorporated everything that the CPG has described. Should I continue this endeavour, as it is tedious, by rewarding for all my primary care colleagues if they read it in the future?

    Singh Shivakumar

    It is indeed a great idea to allow the primary care physicians to learn management of a disease in a single page by utilizing pre- existing guidelines . Please do not prejudge the response of the users . There is so much of information available to primary care doctors that they are overwhelmed by the advances in management . Please have confidence in your approach & do not ask experts , who formulate guidelines & continue your endeavour ,even if it is tedious . Primary care plays an important role in management of diseases & every effort should be made to simplify management of diseases by guiding the physicians .

  • Arthur Leibovitz added an answer:
    Are you aware of exemplar models of community based primary health care and/or integrated models of care for older adults with multimorbidities?
    I'm particularly interested in models that span multiple health and/or social care sectors.
    Arthur Leibovitz

    The key is probably the " case manager"  which  , as mentioned above by Joanne ,

    is now evolving . Pilot projects as to the responsabilities of this position will probably

    give results and recomandations in about 5 years,

  • Saeideh Ghaffarifar added an answer:
    Is the CIPP evaluation approach used for multidisciplinary primary care programs?

    Hi. The CIPP (context, input, process, and product evaluation) evaluation approach has been proposed for healthcare programs (1).

    I am looking for examples/references of this approach in a multidisiplinary primary care program setting.

    Thanks, David

    1. Kennedy-Malone L. Evaluation strategies for CNSs: application of an evaluation model... context, input, process, and product (CIPP) evaluation model developed by Stufflebeam. Clin Nurse Spec. 1996;10:195–198.

    Saeideh Ghaffarifar

    Yes. You can also apply PRECEDE PROCEED model as well as other planning models. 

  • Joan Vaccaro added an answer:
    What are the barriers and facilitators to reporting errors in primary care?

    Patient safety reporting systems despite their limitations are great source of deriving insights into the delivery of safer care. Over the last 10 years, the national reporting and learning system has accrued over 10 million reports of patient safety incidents in England and Wales; most are from hospitals. Why does primary care especially in general practice lag behind?

    Joan Vaccaro

    The US has the Agency for Healthcare Research and Quality (AHRQ). The following link shows how patient safety errors are complied:

  • Béatrice Marianne Ewalds-Kvist added an answer:
    Is there any research done on the assessment of self-medication practices among students in Nepal?

    Thanks in advance for your replies.?

    Béatrice Marianne Ewalds-Kvist

    This was what I found.

  • Rejina Kamrul added an answer:
    What are the most reliable measures (indicators) of treatment adherence in metabolic syndrome?
    We are looking at predicting adherence to medical and behavioral health care recommendations among individuals with metabolic syndrome. I'm curious if anyone might be able to provide personal insight into specific indicators (behavioral or otherwise) that have been effective/reliable in quantifying the construct of treatment adherence?
    Rejina Kamrul

    Successful management requires identification and addressing both root cause, barrier. Patient vary considerably in their readiness and capacity. Success can be defied as better quality of life. greater self esteem. higher energy level etc. There is an approach for obesity management from Canadian obesity network:

  • Jennifer M. Giddens added an answer:
    According to the American Association of Suicidology, a person commits suicide every 13.7 minutes. How can we reduce these statistics?

    Hi everyone! My name is Mandy. At the moment, I'm currently involved with a research study at UCSF, where we're doing a survey on how we can reduce suicide rates in primary care settings. According to the CDC, suicide rates in America are steadily increasing, becoming even higher than the rates of homicide. In fact, suicide is now the 10th leading cause of death, surpassing chronic liver disease.

    If you are a physician, nurse practitioner, or a physician assistant in the United States, it'll be great if you can help us fill out this 5-10 min survey! We already have about 120 responses for this study, but we're hoping to get more participants for a more extensive study. Here is the link!

    Jennifer M. Giddens

    I believe the best way to reduce the statistics of completed suicide (and even suicide attempts) is to completely revolutionize the way we understand suicidality.  The current models being followed are largely based on the works of Durkheim and Shneidman.  I do not believe these these models are correct for all of the cases of suicidality.  We need to start looking at suicidality in the same way we look at other disorders - based on phenomenology.  Doing so may lead to creating a classification system for suicidality disorders which may allow specific anti-suicidality treatments (not just anti-depressants or other treatments like CBT or DBT) to be found to help the people experiencing suicidality.  Without a classification system for different types of suicidality the results of any research will be muddled (just as the results would be muddled if you tested a treatment on a group of people with 'mood disorders' without specifically targeting those with Major Depressive Disorder).  Until then, researchers are kind of stuck because the likelihood of one treatment being effective for all types of suicidality is not very high (just as one treatment isn't effective for all mood disorders).

  • Yogarabindranath Swarna Nantha added an answer:
    How Do I Validate Yale Food Addiction Scale (YFAS) In Another Language?

    In validating the YFAS in another language (Malay), I am curious to know if I would need to run factor analysis to see if the questions match the 8 domains (withdrawal, tolerance etc.) seen in the English version of YFAS? Or should I just run a Cronbach's alpha and determine the internal consistency of each domain and assume that it fits the model? If this is done, I would like to determine the validity through the test-retest method. Does this sound correct?

    Yogarabindranath Swarna Nantha

    Hi Evelyne,

     Thanks for your feedback and it is never too late for any form of suggestion. In fact your advice came in at the right time. We are about to perform another round of pilot testing. I will consider running a confirmatory factor analysis once this is done. Take care and a tout a l'heure.


  • Yogarabindranath Swarna Nantha added an answer:
    Is there a way of specifically testing the intrinsic motivation of physicians in primary care/tertiary care using a psychological framework?

    Intrinsic and extrinsic motivation are almost inseparable. At times they work dynamically. However, there are many examples of testing out the intrinsic motivation component in other fields, less so in healthcare. So is it possible to specifically isolate factors to measure intrinsic motivation amongst physicians?

    Yogarabindranath Swarna Nantha

    Thanks for your feedback Eswaran. Unfortunately, there are not fixed or validated questionnaire for 'intrinsic' motivation. There are lots of those for general motivation assessments.

    I have already designed one and I am on the verge of testing it out but need to confirm if it is sound more a psychological point of view.

  • Dharma N Bhatta added an answer:
    Is there any evidence of link between banned cosmetics use and maternal mortality?
    The world is struggling with MDG 5. In developing countries like Tanzania, a comprehensive strategy has been put in place during the last 20 years involving many aspects such as family planning, education to prevent teenage pregnancies, focused antenatal care (where up to 95% of pregnant mothers attend antenatal care), increasing skilled labour attendance (over 51% of all deliveries now attended by trained midwife), addressing PPH (use of misoprostol) and even training on post abortion care. Despite the efforts, the reduction in maternal mortality does not seem to match achievements in the implementation of these interventions and overall improvement on the services. Furthermore, in urban settings, we still see a number of unexplainable maternal mortalities despite readily availability of the services provides through these national interventions. Thre is political will and even our President is now tasking Regional and District Administrative Officers to investigate the maternal deaths. Obviously, it is time to think beyond the box. Is there any evidence that exposure to dangerous chemicals such as mercury compunds, triclosan, lead acetate, phthalates, oxybenzene, etc via persistent use of banned prodiucts e.g. food, cosmetics etc contribute to maternal mortality? Would a survey to attempt to establish the relationship (if it exists) be useful?
    Dharma N Bhatta

    Concern is interesting but this can be the confounding factor for maternal mortality and other moralities also. ANC coverage can help to aware and educate the risk of mortality. ANC neither predict nor prevent the maternal mortality at all in rural and poor settings. You did not mention about BEOC and CEOC serivices, increment of these services can help to reduce MMR. If the exposure of those chemical is in higher level, it could be the possible risk factors.

  • Jenni Moore added an answer:
    What should integrated care look like in the General Practice?

    We're looking at mapping out processes of care in the primary care setting. What should integrated care look like in General Practice? And how can we measure the extent of integration?

    Jenni Moore

    Interesting discussion and aligned with my work. In searching for measures of integration i have come across a paper form NZ by Sue Pullon et al: Developing Indicators of Service Integration for child health: Perception of service providers and families of young children in an area of high need in New Zealand, published in the Journal of Child Health care 12 august 2013.

  • Michael F Weaver added an answer:
    What are the best indicators to use when assessing safe opioid prescribing in a primary care chart review?

    I would like to start some research on whether primary care opioid prescribing for chronic non-cancer pain meets current guidelines, especially for patient safety. There are too many recommendations in our guidelines to use all of them, some are more/less important, and some are difficult to operationalize for a chart review or ongoing quality improvement.  I have seen some initial work on quality/safety indicators for opioid prescribing by others in unpublished and grey literature.  Does anyone know which would be the best to use, and where/how this is being measured?

    Michael F Weaver

    In terms of identifying indicators to help determine more safe versus less safe opioid prescribing practices for quality improvement (and potential research), I recommend to look at frequency of certain physician behaviors that can be verified through more than one source during chart review.  Frequency of office visits, frequency of urine drug testing (that takes into account the frequency of office visits), frequency of prescription refill requests without an office visit, documentation of use of risk assessment tools (such as the ORT mentioned by Vahid Mohabbati), use of a pain medication agreement, documentation of at least one discrete and specific pain diagnosis, and co-prescription of riskier medications such as benzodiazepines (as mentioned by Yacov Fogelman).  These can be identified in the chart and verified by cross-referencing with lab results, pharmacy records, charges billed, etc. For some general examples of how this has been done, you may want to see the following articles:

    Yanni LM, Weaver MF, Johnson BA, et al: Management of chronic nonmalignant pain: A needs assessment in an Internal Medicine Resident Continuity Clinic. J Opioid Manage 2008;4:201-211.

    Chelminski PR, Ives TJ, Felix KM, et al: A primary care, multi-disciplinary disease management program for opioid treated patients with chronic non-cancer pain and a high burden of psychiatric comorbidity. BMC Health Serv Res. 2005;5:3.

    Adams NJ, Plane MB, Fleming MF, et al: Opioids and the treatment of chronic pain in a primary care sample. J Pain Symptom Manage. 2001;22:791-796.

  • Chai Eng Tan added an answer:
    How does nursing home care to elderly patients living in their own homes work?
    I´m a spanish primary care nurse and I'm interested in how nursing home care to elderly patients living in their own homes works in different countries.
    I appreciate your information.
    Chai Eng Tan

    For the first question:

    The plan for domiciliary care under the Ministry of Health Malaysia is to be executed by the primary care team (currently being piloted in several states before nationwide implementation).  Postnatal home visits have been long established by the maternal and child health section of the public primary care clinics.  I am also a family medicine specialist who happens to have an interest in home care, and thus, am working together with the nurses to develop the service further.  In Singapore, it is also run by the Family Medicine / primary care unit. 

    For the second question:

    For the home care service offered by the teaching hospital I'm working in, patients referred to us are patients who have reasonable logistic difficulty to come to the hospital / clinic for nursing procedures, staying within the catchment area, and agreeable to the terms of service.  These include stroke patients, patients with spinal cord injuries, cerebral palsy, diabetic foot ulcers, post-amputation etc. 

    For the third question:

    Services offered are nursing procedures such as changing Ryle's tube, changing urinary catheters and suprapubic catheters, wound dressing, caregiver education and monitoring of blood pressure and capillary blood glucose.  We are working to extend our services and now we include doctors doing house calls for complex cases, and in future may coordinate with rehabilitation or dietetic services.  However, due to logistics, it is still very challenging to coordinate services from various other departments.  Our services are partially subsidized as our teaching hospital is under the purvey of the Ministry of Education, whereas clinics under teh Ministry of Health offer their services at an even more highly subsidized rates.  We don't have the facility for telemonitoring at the moment.  So I do envy the Australians as described by Ms Franks above. 

  • William R Hazzard added an answer:
    Who should treat elderly patients in a community? Their primary care physician or a specialist in geriatrics?
    Geriatric medicine is a distinct medical specialty with vast specific knowledge accumulated over the last 30 years. On the other side most present primary care community physicians have not been exposed to systematic geriatric education. How could this gap be bridged?
    William R Hazzard

    To Jenice in particular (but all who may read this): Thanks for your efforts within the hard-working, futuristic (but currently much maligned) VA, where I worked as director of Geriatrics & Extended Care ar VA Puget Sound from 2000-2010): I could not agree more. I would only suggest substitution of  "gerontologize" for "geriatricize". Gerontologize rolls off the tongue more easliy, plus it encompasses all we do and know as a scientific discipline that studies and values life from conception through death as well as caring for those nearing the end of their lives. Good luck! Bill

  • Terry Richmond added an answer:
    Do you have any information on successful implementations of fall-prevention strategies in your country?
    We will be looking at the implementation of the fall-prevention strategies in the acute sector, primary care and nursing homes.
    Terry Richmond

    Daily mobility assessments and falls risk assessments by nursing staff .Identification of falls risk patients with use of falling star logos.Daily walking program by 2 personal care assistants on all patients over 65yrs admitted to medicine program that come from home,retirement home or rehab.Frequent audits.Daily discussuins of mobility status and falls risk at board rounds. 

  • Pandi-Perumal Seithikurippu Ratnas added an answer:
    Are there any review articles on integration of sleep medicine in a primary care setting?
    There are several studies on integrating mental health services in primary care. I am interested in integrating sleep medicine services in a primary care setting.
    Pandi-Perumal Seithikurippu Ratnas
    Here is the first edition of Primary Care Sleep Medicine:

    Second edition will be released in few months!
  • Aoife Lawton added an answer:
    What are the visual, clinical and verbal barriers and facilitators to disclosure of domestic violence in a primary care setting?
    I'm looking for research around patient engagement in primary care - GP setting. Specifically around domestic violence discovery and disclosure.
    Aoife Lawton
    Dear Daniel and Jeanettte, the author has now published her Thesis.
    I thought you might be interested in it. It is openly accessible in our repository, available at

About Primary Care

The primary research focus is on the prevention, early diagnosis and management of common illness in general practice - particularly childhood infection, cancer, cardiovascular disease and stroke. Primary care has recently developed a new stream of clinical research which seeks to improve the conceptual understanding and effectiveness of early and more reliable diagnosis and monitoring in a number of chronic diseases. The primary aim is that Primary care has an international reputation for developing innovative methods of research synthesis and research use to ensure that research findings change clinical practice.

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