To analyze the sociodemographic characteristics and trends in clinical and analytical parameters among individuals with chronic kidney disease (CKD) in Aragon (Spain), who remain uninfected with COVID-19 during the first year of pandemic. The secondary objectives were to identify the associated comorbidities and their evolution throughout the pandemic, as well as to determine the cases that got worse and their possible relationship with the control of the main risk factors.

CKD is a major public health problem worldwide. Studies encompassing national, European, and global contexts, show a rise in the prevalence of CKD, with a significant decrease in life quality, high morbidity and mortality, and increased healthcare costs. In this scenario, primary care is a cornerstone for the early detection of CKD and for the management of progression factors. To date, there are few publications regarding the evolution of the CKD population throughout the pandemic that are not related to hospitalizations or complications due to COVID-19.

We conducted a retrospective longitudinal study with real-world data from the population over 16 years of age registered in Aragon (Spain), collecting data from electronic health records. The variables included were sociodemographic, analytical and clinical (glomerular filtration rate, cholesterol, triglycerides, glycated haemoglobin, and blood pressure) and comorbidities (hypertension, dyslipidemia, obesity, diabetes, and smoking). The data were archived and processed using the SPSS v22.0 software package.

During the first six months of COVID-19 pandemic, the clinical parameters of people with CKD were poorly controlled, although there was a later improvement which could be related to the progressive recovery of health services. The glycated haemoglobin value found was low, which makes us suspect possible overtreatment. There is a high prevalence of high blood pressure, diabetes, dyslipidemia, obesity and smoking. Interventions targeting these factors could help reduce the burden of CKD.

The funding of primary care is subject to intense debate internationally. Three main funding models predominate: capitation, pay-for-performance, and fee-for-service. A number of systematic reviews regarding the effect of primary care funding structures have been published, but not synthesized through an equity lens. Given the urgent need for evaluating funding models and addressing inequalities, a reliable, synthesized evidence base concerning the effects of funding on inequalities is imperative.

This umbrella review aims to systematically evaluate all systematic reviews available on the effect of different primary care funding models in high-income countries on inequalities in funding, access, outcomes, or experience from inception until 2024.

Three databases (MEDLINE, EMBASE, Cochrane) and a machine learning living evidence map were searched. Abstracts and titles were double screened, before two authors independently screened full texts, extracted data, and performed quality assessments utilizing the AMSTAR2 tool.

The search identified 2480 unique articles, of which 14 were included in the final review. Only one review compared reimbursement systems; capitation systems were more equitable between ethnic groups compared to pay-for-performance in terms of primary care access, continuity, and quality. Twelve reviews reviewed the impact of the introduction of pay-for-performance models, predominantly focusing on the Quality and Outcomes Framework (QOF) in the UK. Synthesized findings suggest that QOF’s introduction coincided with reduced socioeconomic health inequalities in the UK overall, but not in Scotland. Overall, inequalities in age narrowed, but inequalities measured by sex widened. One review found evidence that targeting funding for minority groups, with poorer health, was effective. A further review found that introducing privately provided general practices in Sweden and allowing patients to choose these over public-owned options generally benefitted those with higher income and lower health needs. We identify a range of gaps in the literature, which should inform future research.

To report on the design and results of an innovative nurse practitioner (NP)-led specialist primary care service for children facing housing instability.

During 2017–2018, children aged 0–14 years represented 23% of the total population receiving support from specialist homeless services in Australia. The impact of housing instability on Australian children is considerable, resulting in disengagement from social institutions including health and education, and poorer physical and mental health outcomes across the lifespan. Current services fail to adequately address health and educational needs of children facing housing insecurity. Research identifies similar circumstances for children in other high-income countries. This paper outlines the design, and reports on results of, an innovative NP-led primary care service for children facing housing instability introduced into three not-for-profit faith-based services in one Australian state.

Between 2019 and 2021, 66 children of parents experiencing housing instability received standardized health assessment and referral where appropriate by a NP. Data from the standardized tool, such as condition and severity, were recorded to determine common conditions. In addition, comprehensive case notes recorded by the NP were used to understand potential causes of conditions, and referral needs, including potential barriers.

The 66 children assessed were aged between 7 weeks to 16 years. Developmental delay, low immunization rates, and dental caries were the most common conditions identified. Access to appropriate services was inhibited by cost, disengagement, and COVID-19.

Given their advanced skills and knowledge, embedding NPs in specialist homeless services is advantageous to help vulnerable children.

To assess the impact of a person-centred culturally sensitive approach in primary care on the recognition and discussion of mental distress in refugee youth.

Refugee minors are at risk for mental health problems. Timely recognition and treatment prevent deterioration. Primary care is the first point of contact where these problems could be discussed. However, primary care staff struggle to discuss mental health with refugees.

Guided by the needs of refugees and professionals we developed and implemented the Empowerment intervention, consisting of a training, guidance and interprofessional collaboration in four general practices in the Netherlands.

This mixed-method study consisted of a quantitative cohort study and semi-structured interviews. The intervention was implemented in a stepped wedge design. Patient records of refugee youth and controls were analysed descriptively regarding number of contacts, mental health conversations, and diagnosis, before and after the start of the intervention.

Semi-structured interviews on experiences were held with refugee parents, general practitioners, primary care mental health nurses, and other participants in the local collaboration groups.

Findings:

A total of 152 refugees were included. Discussions about mental health were significantly less often held with refugees than with controls (16 versus 38 discussions/1000 patient-years) but increased substantially, and relatively more than in the control group, to 47 discussions/1000 patient-years (compared to 71 in the controls) after the implementation of the programme.

The intervention was much appreciated by all involved, and professionals in GP felt more able to provide person-centred culturally sensitive care.

Person-centred culturally sensitive care in general practice, including an introductory meeting with refugees, in combination with interprofessional collaboration, indeed results in more discussions of mental health problems with refugee minors in general practice. Such an approach is assessed positively by all involved and is therefore recommended for broader implementation and assessment.

Research indicates that treatment outcomes are poorer for people with long-term physical health conditions (LTCs) in Talking Therapies services (formerly known as Improving Access to Psychological Therapies). However, the impact of having an LTC on attendance at assessment and treatment appointments within Talking Therapies remains unclear. Internet-enabled therapies may be one way to overcome barriers to treatment engagement in Talking Therapies. However, their effect on engagement and the influence of LTC status on receipt of internet-enabled therapies is unknown.

To explore the association between LTC status and assessment attendance, treatment engagement and internet-enabled therapy receipt within Talking Therapies services, and whether receipt of internet-enabled treatment bolsters engagement.

We used anonymous patient-level data from two inner London Talking Therapies services during January to December 2022 (n = 17 095 referrals). Binary logistic regression models were constructed to compare differences between LTC and non-LTC groups on (a) assessment attendance, (b) engagement and (c) internet-enabled therapy receipt. In our regression models, we controlled for key clinical and demographic covariates.

There were no differences between patients with or without an LTC in assessment attendance or treatment engagement, after controlling for covariates. Across the whole sample, receiving internet-enabled treatment increased engagement. People with an LTC were less likely to receive an internet-enabled treatment.

Having an LTC does not negatively affect assessment attendance and engagement with talking therapies. However, receiving an internet-enabled treatment bolstered engagement in our regression models. People with an LTC were less likely to receive internet-enabled treatment.

The course of depression is heterogeneous. The employed treatment is a key element in the impact of the course of depression over the time. However, there is currently a gap of knowledge about the trajectories per treatment and related baseline factors. We aimed to identify trajectories of depressive symptoms and associated baseline characteristics for two treatment arms in a randomized clinical trial: treatment as usual (TAU) or TAU plus transdiagnostic group cognitive behavioral therapy (TAU + TDG-CBT).

Growth mixture modeling (GMM) was used to identify trajectories of depressive symptoms over 12 months post-treatment. Logistic regression models were used to examine associations between baseline characteristics and trajectory class membership in 483 patients (TAU: 231; TAU + TDG-CBT: 251).

We identified different patterns of symptom change in the randomized groups: two trajectories in TAU (‘improvement’ (71.4%) and ‘no improvement’ (28.6%)), and four trajectories in TAU + TDG-CBT (‘recovery’ (69.8%), ‘late recovery’ (5.95%), ‘chronicity’ (4.77%), and ‘relapse’ (19.44%)). Higher baseline symptom severity and comorbidity were associated with poorer treatment outcomes in both treatment groups and worse emotional regulation strategies were linked to the ‘no improvement trajectory’ in TAU. The TAU + TDG-CBT group demonstrated greater symptom reduction compared to TAU alone.

There is heterogeneity in treatment outcomes. Integration of TDG-CBT with TAU significantly improves symptom reduction compared to TAU alone. Patients with higher baseline severity and comorbidities show poorer outcomes. Identification of trajectories and related factors could assist clinicians in tailoring treatment strategies to optimize outcomes, particularly for patients with a worse prognosis.

Although individuals with lower socio-economic position (SEP) have a higher prevalence of mental health problems than others, there is no conclusive evidence on whether mental healthcare (MHC) is provided equitably. We investigated inequalities in MHC use among adults in Stockholm County (Sweden), and whether inequalities were moderated by self-reported psychological distress.

MHC use was examined in 31,433 individuals aged 18–64 years over a 6-month follow-up period, after responding to the General Health Questionnaire-12 (GHQ-12) in 2014 or the Kessler Six (K6) in 2021. Information on their MHC use and SEP indicators, education, and household income, were sourced from administrative registries. Logistic and negative binomial regression analyses were used to estimate inequalities in gained MHC access and frequency of outpatient visits, with psychological distress as a moderating variable.

Individuals with lower education or income levels were more likely to gain access to MHC than those with high SEP, irrespective of distress levels. Education-related differences in gained MHC access diminished with increasing distress, from a 74% higher likelihood when reporting no distress (odds ratio, OR = 1.74 [95% confidence interval, 95% CI: 1.43–2.12]) to 30% when reporting severe distress (OR = 1.30 [0.98–1.72]). Comparable results were found for secondary care but not primary care i.e., lower education predicted reduced access to primary care in moderate-to-severe distress groups (e.g., OR = 0.63 [0.45–0.90]), and for physical but not digital services. Income-related differences in gained MHC access remained stable or increased with distress, especially for secondary care and physical services.

Among MHC users, we found marginal socio-economic differences in the frequency of outpatient visits, and these differences decreased with increasing distress. Yet, having only primary education with severe distress was associated with fewer outpatient visits compared with having post-secondary education (rate ratio, RR = 0.82; 95% CI: 0.67–1.00). These inequities were especially evident among women and for visits to psychologists, counsellors, or psychotherapists.

Although lower-income groups used services more than others, they still had higher odds of not using services when reporting distress (i.e., those not in contact with services despite scoring ≥3 on the GHQ-12 or ≥8 on the K6; OR = 1.27; 95% CI: 1.15–1.40).

Overall, individuals with lower education and income used MHC services more than their counterparts with higher socio-economic status; however, low-educated individuals faced inequities in primary care and underutilized non-physician services such as visits to psychologists.

Nearly 3% of adults have attention-deficit and hyperactivity disorder (ADHD), although in the UK, most are undiagnosed. Adults with ADHD on average experience poorer educational and employment outcomes, worse physical and mental health and are more likely to die prematurely. No studies have yet used mortality data to examine the life expectancy deficit experienced by adults with diagnosed ADHD in the UK or worldwide.

This study used the life-table method to calculate the life-expectancy deficit for people with diagnosed ADHD using data from UK primary care.

A matched cohort study using prospectively collected primary care data (792 general practices, 9 561 450 people contributing eligible person-time from 2000–2019). We identified 30 039 people aged 18+ with diagnosed ADHD, plus a comparison group of 300 390 participants matched (1:10) by age, sex and primary care practice. We used Poisson regression to estimate age-specific mortality rates, and life tables to estimate life expectancy for people aged 18+ with diagnosed ADHD.

Around 0.32% of adults in the cohort had an ADHD diagnosis, ~1 in 9 of all adults with ADHD. Diagnoses of common physical and mental health conditions were more common in adults with diagnosed ADHD than the comparison group. The apparent reduction in life expectancy for adults with diagnosed ADHD relative to the general population was 6.78 years (95% CI: 4.50 to 9.11) for males, and 8.64 years (95% CI: 6.55 to 10.91) for females.

Adults with diagnosed ADHD are living shorter lives than they should. We believe that this is likely caused by modifiable risk factors and unmet support and treatment needs in terms of both ADHD and co-occurring mental and physical health conditions. This study included data from adults with diagnosed ADHD; the results may not generalise to the entire population of adults with ADHD, the vast majority of whom are undiagnosed.

The ‘Associate Psychological Practitioner’ (APP) is an innovative new role that expands the psychological workforce and addresses the rising demand for mental health services in England, yet the impact of this role on NHS workforce capacity has yet to be modelled.

We modelled the impact of the APP role in Primary Care in terms of additional capacity to provide mental health care and the impact on General Practitioner (GP) capacity within the sector.

Workforce experts of the NHS Workforce Repository and Planning Tool (WRaPT) team used a modelling tool to determine future state scenarios of APPs working across all Primary Care Networks (PCNs) within a region and the associated change on the baseline workforce. Modelling was based on Lancashire and South Cumbria, a large geographical area in North-West England that includes 41 PCNs. Assumptions used in the modelling included identifying the patient population and workforce in scope, documenting the activity undertaken by APPs, and considering the future state scenarios for modelling.

With regard to generating additional capacity, having 1 APP in each of the 41 PCNs in Lancashire and South Cumbria could provide 53 000 brief intervention appointments of 45 min each, thereby diverting these appointments away from the GP, and up to 48 people could benefit from attending Group and Well-being sessions over a year with 1 APP working with another Primary Care colleague, that is, 384 group intervention sessions delivered. In relation to GP capacity, 1 APP (if placed across a PCN, or within multiple practices) could free up at least 1,665 GP appointments within one year, which could lead to potential cost savings. These findings can be used to underpin decision-making with respect to training future cohorts of APPs and contribute to wider workforce planning in primary care.

This study aimed to explore healthcare experiences of rural-living patients both with (attached) and without (unattached) a local primary care provider.

Primary care providers serve a gatekeeping role in the Canadian healthcare system as the first contact for receiving many health services. With the shortage of primary care providers, especially in rural areas, there is a need to explore attached and unattached patient experiences when accessing healthcare.

A cross-sectional survey of rural patients both with (attached) and without (unattached) a primary care provider was conducted July–September 2022. An open-ended question gathered participants’ thoughts and experiences with provider shortages.

Overall, 523 (Mean age = 51 years, 75% female) rural British Columbia community members (306 attached; 217 unattached) completed the survey. Despite similar overall health, unattached patients received care less frequently overall compared to attached patients, including less frequent non-urgent and preventive care. The vast majority of attached patients sought care from a regular provider whereas unattached patients were more likely to use walk-in, emergency department, and urgent care and 29% did not seek care at all. Overall, 460 (88.0%) provided a response to the open-ended doctor shortage question. Similar themes were found among both attached and unattached participants and included: i) the ubiquity of the doctor shortage, ii) the precariousness or fluidity of attachment status, and iii) solutions and recommendations. Greater attention is needed on the negative and cyclical impacts provider shortages have for both attached and unattached patients alike.

We aimed to explore participant perspectives on social prescribing (SP) for mental health and well-being and the acceptability of community pharmacists (CP) as members of SP pathways that support people with mild to moderate depression and anxiety.

SP aims to support people with poor health related to socio-demographic determinants. Positive effects of SP on self-belief, mood, well-being, and health are well documented, including a return to work for long-term unemployed.

The study was set in a city in southwest England with diverse cultural and socio-demographics. We recruited SP stakeholders, including CP, to either one of 17 interviews or a focus group with nine members of the public.

An inductive iterative approach to thematic analysis produced four superordinate themes: (1) offering choice a non-pharmacological option, (2) supporting pharmacy communities – ‘it is an extension of what we do’, (3) stakeholder perspectives – pharmacists are very busy and their expertise unknown by some, and (4) potential for pharmacy in primary care.

Stakeholders viewed CP as local to and accessible by their community. Pharmacists perceived referral to SP services as part of their current role. General practitioner participants considered pharmacy involvement could reduce their workload and expand the primary healthcare team. Importantly, general practitioners and CP viewed SP as a non-pharmacological alternative to prescribing unnecessary antidepressants and reduce associated adverse effects. All participants voiced concerns about pharmacy dispensing busyness as a potential barrier to involvement and pharmacists requesting mental health training updates.

Key findings suggest CP offer a potential alternative to the general practitioner for people with mild to moderate depression and anxiety seeking access to support and health information. However, CP need appropriately commissioned and funded involvement in SP, including backfill for ongoing dispensing, medicines optimization, and mental health first aid training.

Contemporary data relating to antipsychotic prescribing in UK primary care for patients diagnosed with severe mental illness (SMI) are lacking.

To describe contemporary patterns of antipsychotic prescribing in UK primary care for patients diagnosed with SMI.

Cohort study of patients with an SMI diagnosis (i.e. schizophrenia, bipolar disorder, other non-organic psychoses) first recorded in primary care between 2000 and 2017 derived from Clinical Practice Research Datalink. Patients were considered exposed to antipsychotics if prescribed at least one antipsychotic in primary care between 2000 and 2019. We compared characteristics of patients prescribed and not prescribed antipsychotics; calculated annual prevalence rates for antipsychotic prescribing; and computed average daily antipsychotic doses stratified by patient characteristics.

Of 309 378 patients first diagnosed with an SMI in primary care between 2000 and 2017, 212,618 (68.7%) were prescribed an antipsychotic between 2000 and 2019. Antipsychotic prescribing prevalence was 426 (95% CI, 420–433) per 1000 patients in the year 2000, reaching a peak of 550 (547–553) in 2016, decreasing to 470 (468–473) in 2019. The proportion prescribed antipsychotics was higher among patients diagnosed with schizophrenia (81.0%) than with bipolar disorder (64.6%) and other non-organic psychoses (65.7%). Olanzapine, quetiapine, risperidone and aripiprazole accounted for 78.8% of all antipsychotic prescriptions. Higher mean olanzapine equivalent total daily doses were prescribed to patients with the following characteristics: schizophrenia diagnosis, ethnic minority status, male gender, younger age and greater relative deprivation.

Antipsychotic prescribing is dominated by olanzapine, quetiapine, risperidone and aripiprazole. We identified potential disparities in both the receipt and prescribed doses of antipsychotics across subgroups. To inform efforts to optimise prescribing and ensure equity of care, further research is needed to understand why certain groups are prescribed higher doses and are more likely to be treated with long-acting injectable antipsychotics compared with others.

The prevalence of mental health disorders has significantly increased in recent years, posing substantial challenges to healthcare systems worldwide, particularly primary care (PC) settings. This study examines trends in mental health diagnoses in PC settings in Catalonia from 2010 to 2019 and identifies associated sociodemographic, clinical characteristics, psychopharmacological treatments, and resource utilization patterns.

Data from 947,698 individuals without prior severe mental illness, derived from the Data Analytics Program for Health Research and Innovation (PADRIS), were analyzed for this study. Sociodemographic data, diagnoses, and resource utilization were extracted from electronic health records. Descriptive statistics, chi-square tests, Mann–Whitney tests, and a multivariate binary logistic regression were employed to analyze the data.

Over the study period, 172,112 individuals (18.2%) received at least one mental health diagnosis in PC, with unspecified anxiety disorder (40.5%), insomnia (15.7%) and unspecified depressive disorder (10.2%) being the most prevalent. The prevalence of these diagnoses increased steadily until 2015 and stabilized thereafter. Significant associations were found between mental health diagnoses, female sex, lower socioeconomic status, higher BMI, and smoking status in a multivariate binary logistic regression.

This study highlights a growing burden of stress-related mental health diagnoses in PC in Catalonia, driven by demographic and socioeconomic factors. These findings may be indicative of broader trends across Europe and globally. Addressing this rising prevalence requires innovative approaches and collaborative strategies that extend beyond traditional healthcare resources. Engaging stakeholders is essential for implementing effective, sustainable solutions that promote mental health in Catalonia and potentially inform similar initiatives worldwide.

Mental disorders and physical-health conditions frequently co-occur, impacting treatment outcomes. While most prior research has focused on single pairs of mental disorders and physical-health conditions, this study explores broader associations between multiple mental disorders and physical-health conditions.

Using the Norwegian primary-care register, this population-based cohort study encompassed all 2 203 553 patients born in Norway from January 1945 through December 1984, who were full-time residents from January 2006 until December 2019 (14 years; 363 million person-months). Associations between seven mental disorders (sleep disturbance, anxiety, depression, acute stress reaction, substance-use disorders, phobia/compulsive disorder, psychosis) and 16 physical-health conditions were examined, diagnosed according to the International Classification of Primary Care.

Of 112 mental-disorder/physical-health condition pairs, 96% of associations yielded positive and significant ORs, averaging 1.41 and ranging from 1.05 (99.99% CI 1.00–1.09) to 2.38 (99.99% CI 2.30–2.46). Across 14 years, every mental disorder was associated with multiple different physical-health conditions. Across 363 million person-months, having any mental disorder was associated with increased subsequent risk of all physical-health conditions (HRs:1.40 [99.99% CI 1.35–1.45] to 2.85 [99.99% CI 2.81–2.89]) and vice versa (HRs:1.56 [99.99% CI 1.54–1.59] to 3.56 [99.99% CI 3.54–3.58]). Associations were observed in both sexes, across age groups, and among patients with and without university education.

The breadth of associations between virtually every mental disorder and physical-health condition among patients treated in primary care underscores a need for integrated mental and physical healthcare policy and practice. This remarkable breadth also calls for research into etiological factors and underlying mechanisms that can explain it.