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Objectives To evaluate the effect of training primary care health professionals in behaviour change counselling on the proportion of patients self reporting change in four risk behaviours (smoking, alcohol use, exercise, and healthy eating).Design Cluster randomised trial with general practices as the unit of randomisation.Setting General practices in Wales.Participants 53 general practitioners and practice nurses from 27 general practices (one each at all but one practice) recruited 1827 patients who screened positive for at least one risky behaviour.Intervention Behaviour change counselling was developed from motivational interviewing to enable clinicians to enhance patients’ motivation to change health related behaviour. Clinicians were trained using a blended learning programme called Talking Lifestyles.Main outcome measures Proportion of patients who reported making beneficial changes in at least one of the four risky behaviours at three months.Results 1308 patients from 13 intervention and 1496 from 14 control practices were approached: 76% and 72% respectively agreed to participate, with 831 (84%) and 996 (92%) respectively screening eligible for an intervention. There was no effect on the primary outcome (beneficial change in behaviour) at three months (362 (44%) v 404 (41%), odds ratio 1.12 (95% CI 0.90 to 1.39)) or on biochemical or biometric measures at 12 months. More patients who had consulted with trained clinicians recalled consultation discussion about a health behaviour (724/795 (91%) v 531/966 (55%), odds ratio 12.44 (5.85 to 26.46)) and intended to change (599/831 (72%) v 491/996 (49%), odds ratio 2.88 (2.05 to 4.05)). More intervention practice patients reported making an attempt to change (328 (39%) v 317 (32%), odds ratio 1.40 (1.15 to 1.70)), a sustained behaviour change at three months (288 (35%) v 280 (28%), odds ratio 1.36 (1.11 to 1.65)), and reported slightly greater improvements in healthy eating at three and 12 months, plus improved activity at 12 months. Training cost £1597 per practice.Discussion Training primary care clinicians in behaviour change counselling using a brief blended learning programme did not increase patients reported beneficial behaviour change at three months or improve biometric and a biochemical measure at 12 months, but it did increase patients’ recollection of discussing behaviour change with their clinicians, intentions to change, attempts to change, and perceptions of having made a lasting change at three months. Enduring behaviour change and improvements in biometric measures are unlikely after a single routine consultation with a clinician trained in behaviour change counselling without additional intervention.Trial registration ISRCTN 22495456

Colorectal cancer (CRC) is a significant contributor to cancer-related burden, ranking second in cancer mortality in France. Despite the proven survival benefits of systematic CRC screening, uptake remains suboptimal, particularly among people with limited health literacy (HL) and lower socioeconomic position. This study aimed to assess the acceptability of an e-learning training programme on HL and CRC screening among general practitioners (GPs) in deprived areas while also exploring strategies for its promotion and scale-up. A qualitative study nested within the DECODE cluster-randomised controlled trial (NCT04631692) across four French regions was conducted. Semi-structured interviews (phone or online) were carried out to capture opinions, experiences, and recommendations of GPs in the intervention arm. Thematic analysis, employing manual and NVivo coding, was performed. The majority of 22 GPs (16/22) found the training acceptable, informative, tailored to their knowledge needs and offering great flexibility of use. The module on HL garnered more interest than the one on CRC screening, as it addressed a relatively new area for many GPs. It facilitated reflection on patient communication techniques and identified areas for improvement in physician-patient interaction. A perceived gap in the training was the insufficient interactivity in both didactic and virtual group sessions. The findings of this study show high acceptability of the e-learning training by participants, indicating a potential for implementation, if kept concise, self-paced, asynchronous, and with a stronger focus on HL. The training helped GPs reflect on their practices, enhance HL knowledge, and improve patient communication strategies, leading some to adopt new techniques in daily interactions with low HL patients, beyond just screening.

Eating disorders (EDs) are a significant public health concern, yet men remain underrepresented in research and care, partly due to stigmatization. This stigmatization contributes to reduced help-seeking and recognition of ED symptoms in men. To address this, targeted interventions for healthcare professionals are needed. The iSMEsH intervention aims to sensitize general practitioners (GPs) in Germany to EDs in men, impart relevant knowledge and skills, and counter the perception of EDs as \"women's diseases\". We will evaluate the iSMEsH intervention regarding its effects on biased attitudes, knowledge, and self-efficacy among GPs. A sequential explanatory mixed-methods design (QUAN → qual) will be applied in three steps: (1) pre-implementation focus groups and a panel discussion with individuals with lived ED experience and GPs to design the intervention, (2) conduction of a randomized, wait-list controlled trial of the online training trial with GPs and medical students, and (3) post-implementation qualitative interviews with GPs. Quantitative data (step 2) will be analyzed using mixed-measures ANOVAs and contrast analyses (per-protocol) as well as corresponding 2 × 3 linear mixed models with fixed and random effects (intention-to-treat). Qualitative data from step 3 will be analyzed using thematic analysis as outlined by Braun and Clarke (2006). Ethical approval was granted by the Ruhr-University Bochum Ethics Committee (AZ 2023-1106). Participants will provide written or digital informed consent. The intervention seeks to reduce stigma against men with EDs in primary care by improving GPs' and medical students' knowledge, attitudes, and self-efficacy. Strengths include the comprehensive mixed-methods approach and involvement of people with lived experience. Limitations are reliance on self-report and short-/intermediate-term outcomes. If effective, iSMEsH may offer a foundation for future stigma-reduction strategies in healthcare.

Background Patients with advanced chronic non-malignant conditions often experience significant symptom burden. Therefore, overcoming barriers to interprofessional collaboration between general practitioners (GPs) and specialist palliative home care (SPHC) teams is essential to facilitate the timely integration of palliative care elements. The KOPAL trial aimed to examine the impact of case conferences between GPs and SPHC teams on symptom burden and pain in patients with advanced chronic heart failure, chronic obstructive pulmonary disease, and dementia. Methods The cluster-randomised controlled trial compared a structured palliative care nurse visit followed by an interprofessional case conference to usual care. Data were collected from GPs at baseline and 48 weeks, while standardised patient interviews were conducted at baseline, 6, 12, 24, and 48 weeks. Results We analysed 172 patients from 49 German GP practices. Both groups showed marginal improvement in symptom burden; however, no statistically significant between-group difference was found ( =-0.561, 95% CI: -3.201–2.079, p  = .68). Patients with dementia experienced a significant pain reduction ( =2.187, 95% CI: 0.563–3.812, p  = .009). Conversely, the intervention did not have a significant effect on pain severity ( =-0.711, 95% CI: -1.430 − 0.008, p =.053) or pain interference ( =-0.036, 95% CI:-0.797 − 0.725, p =.926) in other patient groups. Conclusions The intervention showed promise in the timely introduction of palliative care elements to address pain management in patients with dementia. Further studies are needed to identify and effectively address symptom burden and pain in other patient groups. Trial registration German Clinical Trials Register: https://www.drks.de/DRKS00017795 (Registration date: 9th January 2020).

Nurse practitioners and physician assistants are providing an increasing share of health care services, and education programs have proliferated. These dynamics will have lasting effects on the health care workforce and on relationships among health professionals.

Social media is increasingly utilized as a resource in healthcare. We sought to identify perceptions of using social media as an educational tool among healthcare practitioners. An electronic survey was distributed to healthcare administrators, nurses, nurse practitioners, pharmacists, physicians, and physician assistants f hospital systems and affiliated health science schools in Georgia, Maryland, South Carolina, and Wisconsin. Survey questions evaluated respondents' use and views of social media for educational purposes and workplace accessibility using a Likert scale (1 = strongly disagree, 5 = strongly agree). Nurses (75%), pharmacists (11%), and administrators (7%) were the most frequent respondents. Facebook® (27%), Pinterest® (17%), and Instagram® (17%) were the most frequently accessed social media platforms. Nearly 85% agreed or strongly agreed that social media can be an effective tool for educational purposes. Among those who had social media platforms, 43.0% use them for educational purposes. Pinterest® (30%), Facebook® (22%), LinkedIn® (16%), and Twitter® (14%) were most frequently used for education. About 50% of respondents had limited or no access to social media at work. Administrators, those with unlimited and limited work access, and respondents aged 20-29 and 30-39 years were more likely to agree that social media is an educational tool (OR: 3.41 (95% CI 1.31 to 8.84), 4.18 (95% CI 2.30 to 7.60), 1.66 (95% CI 1.22 to 2.25), 4.40 (95% CI 2.80 to 6.92), 2.14 (95% CI 1.53 to 3.01) respectively). Residents, physicians, and those with unlimited access were less likely to agree with allowing social media access at work for educational purposes only. Healthcare practitioners frequently utilize social media, and many believe it can be an effective educational tool in healthcare.

Few patients with opioid use disorder receive medication for addiction treatment. In 2017 the Comprehensive Addiction and Recovery Act enabled nurse practitioners (NPs) and physician assistants (PAs) to obtain federal waivers allowing them to prescribe buprenorphine, a key medication for opioid use disorder. The waiver expansion was intended to increase patients' access to opioid use treatment, which was particularly important for rural areas with few physicians. However, little is known about the adoption of these waivers by NPs or PAs in rural areas. Using federal data, we examined waiver adoption in rural areas and its association with scope-of-practice regulations, which set the extent to which NPs or PAs can prescribe medication. From 2016 to 2019 the number of waivered clinicians per 100,000 population in rural areas increased by 111 percent. NPs and PAs accounted for more than half of this increase and were the first waivered clinicians in 165 [corrected] rural counties with 5.7 million residents. In rural areas, broad scope-of-practice regulations were associated with twice as many waivered NPs per 100,000 population as restricted scopes of practice were. The rapid growth in the numbers of NPs and PAs with buprenorphine waivers is a promising development in improving access to addiction treatment in rural areas.

Unnecessary antibiotic prescribing contributes to antimicrobial resistance. In this trial, we aimed to reduce unnecessary prescriptions of antibiotics by general practitioners (GPs) in England. In this randomised, 2 × 2 factorial trial, publicly available databases were used to identify GP practices whose prescribing rate for antibiotics was in the top 20% for their National Health Service (NHS) Local Area Team. Eligible practices were randomly assigned (1:1) into two groups by computer-generated allocation sequence, stratified by NHS Local Area Team. Participants, but not investigators, were blinded to group assignment. On Sept 29, 2014, every GP in the feedback intervention group was sent a letter from England's Chief Medical Officer and a leaflet on antibiotics for use with patients. The letter stated that the practice was prescribing antibiotics at a higher rate than 80% of practices in its NHS Local Area Team. GPs in the control group received no communication. The sample was re-randomised into two groups, and in December, 2014, GP practices were either sent patient-focused information that promoted reduced use of antibiotics or received no communication. The primary outcome measure was the rate of antibiotic items dispensed per 1000 weighted population, controlling for past prescribing. Analysis was by intention to treat. This trial is registered with the ISRCTN registry, number ISRCTN32349954, and has been completed. Between Sept 8 and Sept 26, 2014, we recruited and assigned 1581 GP practices to feedback intervention (n=791) or control (n=790) groups. Letters were sent to 3227 GPs in the intervention group. Between October, 2014, and March, 2015, the rate of antibiotic items dispensed per 1000 population was 126·98 (95% CI 125·68–128·27) in the feedback intervention group and 131·25 (130·33–132·16) in the control group, a difference of 4·27 (3·3%; incidence rate ratio [IRR] 0·967 [95% CI 0·957–0·977]; p<0·0001), representing an estimated 73 406 fewer antibiotic items dispensed. In December, 2014, GP practices were re-assigned to patient-focused intervention (n=777) or control (n=804) groups. The patient-focused intervention did not significantly affect the primary outcome measure between December, 2014, and March, 2015 (antibiotic items dispensed per 1000 population: 135·00 [95% CI 133·77–136·22] in the patient-focused intervention group and 133·98 [133·06–134·90] in the control group; IRR for difference between groups 1·01, 95% CI 1·00–1·02; p=0·105). Social norm feedback from a high-profile messenger can substantially reduce antibiotic prescribing at low cost and at national scale; this outcome makes it a worthwhile addition to antimicrobial stewardship programmes. Public Health England.

The increasing prevalence of dermatological diseases will pose a growing challenge to the health care system and, in particular, to general practitioners (GPs) as the first point of contact for these patients. In many countries, primary care physicians are supported by teledermatology services. The aim of this study was to detect learning effects and gains among GPs through teledermatology consultations (TCs) in daily practice. As part of a mixed methods study embedded in a cluster-randomized controlled trial (TeleDerm), a full survey and semiguided face-to-face interviews were conducted among GPs of participating intervention practices using the telemedicine approach. A TC assessment tool (TC-AT) was developed to evaluate the quality of clinical data and images of TCs conducted during the run-in and intervention phases, with a score ranging from 0 (lowest quality) to 10 (highest quality). Mixed methods analysis triangulated qualitative content analysis, survey data with a growth curve model calculated from TC-AT data, comparing subjective experiences of GPs with objective process data. A total of 487 TCs of 33 practices were analyzed. Questionnaires from n=46 GPs (practice-level response rate: 69.9%) were included in the quantitative analysis. Two-thirds of the GPs (n=31; 67.4%) in the written survey rated the TCs as helpful for differential diagnosis and treatment management. Improved self-reported confidence in diagnosing skin diseases due to the timely clinical feedback from dermatologists was reported by more than half of the responding GPs (n=25; 54.3%). In the interviews (n=13), teleconsultations were mainly seen as a learning opportunity by the GPs. Regarding the quality of TCs, a mean TC-AT score of 7.4 (SD 1.7, range 0-10) was observed. In the growth curve model, a simple linear time trend provided the best fit to the TC-AT score trajectory across the observed study period. A significant time * TC-AT start score interaction was found (F452=30.66, P<.001). While regardless of the initial TC-AT score, repeated TCs lead to process quality improvements over time, post hoc probing of the TC-AT start score as a moderator of the learning effect over time revealed the highest improvements among GP practices with a lower initial TC-AT score (-1 SD: standardized slope=0.59, P<.001; mean: standardized slope=0.38, P<.001; +1 SD: standardized slope=0.18, P<.001). TCs have been shown to be an effective method of education for GPs in terms of \"learning on the job\" in daily practice. The telemedicine approach seems to be an easily implementable and effective tool to support continuing medical education in the field of dermatology. Strategies could be developed to train GPs and medical students in the use of TC to adequately prepare them for the increasing technological demands of their future profession in primary care.

The use of nurse practitioners (NPs) in primary care is one way to address growing patient demand and improve care delivery. However, little is known about trends in NP presence in primary care practices, or about how state policies such as scope-of-practice laws and expansion of eligibility for Medicaid may encourage or inhibit the use of NPs. We found increasing NP presence in both rural and nonrural primary care practices in the period 2008-16. At the end of the period, NPs constituted 25.2 percent of providers in rural and 23.0 percent in nonrural practices, compared to 17.6 percent and 15.9 percent, respectively, in 2008. States with full scope-of-practice laws had the highest NP presence, but the fastest growth occurred in states with reduced and restricted scopes of practice. State Medicaid expansion status was not associated with greater NP presence. Overall, primary care practices are embracing interdisciplinary provider configurations, and including NPs as providers can strengthen health care delivery.