Family practice
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Cancer is a major global cause of death, and primary care is crucial for cancer prevention and early detection. However, there is conflicting information on the effectiveness, implementation, and sustainability of cancer control interventions in primary care. ⋯ While numerous interventions are effective for cancer prevention and detection in primary care, literature on implementation and sustainability strategies is lacking. Focusing on continuous resources and funding for cancer strategies in primary care may aid sustainability. Future research should prioritize reporting on implementation and sustainability factors to enhance cancer prevention and control in primary care settings.
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Collectively, rare diseases are common, affecting approximately 8% of the population in Canada and the USA. Therefore, the majority of primary care (PC) clinicians will care for patients who are affected or at risk for a genetic disease. Considering the increasing ways in which genetics is being implemented into all areas of healthcare, one way to address these needs and expand the capacity of the PC workforce is through the integration of genetic counselors (GCs) into PC multidisciplinary teams. ⋯ Complex tasks related to genetics, such as pre- and post-test counseling, genetic test selection, and results interpretation, are conducted by GCs, which, in turn, allows physicians, nurse practitioners, and other PC providers to work at the top of their scope of practice. Quality genetics services provided by GCs improve clinical outcomes for patients and their families; the simultaneous provision of genetic education and psychological support by a GC is associated with an increase in patient knowledge, perceived personal control, decrease in distress, and can lead to positive health behavior changes, all of which are aligned with the goals of primary healthcare. With their extensive training in clinical care, medical communication, and psychotherapeutic counseling, integrating GCs into PC care teams will improve the care patients receive and allow PC clinicians to ensure their patients are at the forefront of the personalized medicine revolution.
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Randomized Controlled Trial
Case control study of access to medications during COVID-19 and longitudinal impact on health outcomes for primary care patients managing multiple chronic conditions.
During coronavirus disease 2019 (COVID-19), people managing multiple chronic conditions (MCCs) experienced barriers to obtaining needed medications. The purposes of this paper are to (i) determine risk factors for difficulty obtaining medications during COVID-19, (ii) document reasons for the difficulty, and (iii) evaluate the impact on later physical and mental health outcomes. ⋯ People with socioeconomic disadvantages experienced a disproportionate impact of difficulty obtaining medications and poorer health outcomes due to COVID-19. They may be at greater risk in the event of future pandemics and other societal disruptions.
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Randomized Controlled Trial
Using an SMS to improve bowel cancer screening: the acceptability and feasibility of a multifaceted intervention.
The Australian National Bowel Cancer Screening Program sends an immunochemical faecal occult blood test to Australians aged 50-74 years to screen for bowel cancer, but uptake is low (40.9%). The SMARTscreen trial demonstrated that sending a short messaging services (SMS) prompt from the participant's general practitioner (GP) increased the proportion of kit returns by 16.5%. This research aimed to determine the acceptability and feasibility of implementing SMARTscreen. ⋯ The SMS-based intervention was widely accepted by GP staff and participants. Future research should test the SMS with and without the weblink, and send the SMS at a more convenient time of the day/week.
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Observational Study
Recent life events and adverse childhood experiences in predicting antenatal depression and anxiety: cross-sectional study.
Antenatal depression and anxiety are associated with preterm labour, low birth weight, and postpartum depression, and can impact the emotional and mental development of the child. Both adverse childhood experiences and recent stressful events are linked to negative health outcomes. However, certain events may be more impactful than others. ⋯ Recent stressful life events have a stronger association with postnatal mental health than adverse childhood events, implying that it might be useful for clinicians providing routine antenatal care to gather information on recent stressors.