Polypsychopharmacy has been associated with increased risks of adverse drug reactions, metabolic syndrome, and higher healthcare utilization. Although its prevalence is well-documented in secondary and tertiary care, data from primary care settings remain scarce. This study investigated trends in polypsychopharmacy, associated factors, and prescribing patterns in Dutch primary care from 2012-2021. We conducted a cross-sectional analysis of a primary care database containing medical records from approximately 500 000 adult patients across 100 practices. Polypsychopharmacy was defined as concomitant use of two different psychotropic medication classes for≥90 days (chronic). Point prevalence was measured on July 1st of each year from 2012 to 2021. We performed a multivariate analyses (using 2021 data) to identify factors associated with polypsychopharmacy, including demographic characteristics, mental and physical comorbidities, analgesic use, and healthcare utilization. The prevalence of polypsychopharmacy increased from 7.6 (95% CI: 7.3-8.0) to 12.6 (95% CI: 12.3-13.1) per 1,000 patients between 2012-2021 (annual increase: 0.49 per 1,000; 95% CI: 0.40-0.57). The most common combinations were antidepressant-antipsychotic (473 per 100,000), antidepressant-anxiolytic (387 per 100,000), and antidepressant-hypnotics/sedatives (251 per 100,000). Factors associated with polypsychopharmacy included older age, female sex, multiple psychiatric diagnoses, use of analgesics, and high healthcare utilization. Polypsychopharmacy in Dutch primary care increased considerably over the past decade, increasing demands on general practice. Although certain regimens may be clinically justified, the upward trend underscores the need for further research into prescribing appropriateness, strategies to optimize psychotropic use, and the role of non-pharmacological treatments in primary care.

In 2019, a global appeal was launched by the World Organization of Family Doctors that invited GPs to take action for planetary health. In 2023, 4 years after this call, what have French GPs done to promote planetary health? To describe GPs' opinions about this subject and pro-planetary health actions in general practice and to evaluate their knowledge of planetary health. An online survey of GPs, locums, and medical interns in France. The survey was sent by email to French general practice networks. The responses were statistically analysed, and the demographic data were analysed via descriptive statistics. The 974 participants who responded placed significant importance on ecology in their personal lives (mean = 7.81/10) and were relatively aware of the environmental impact of health care. In their professional lives, they placed less importance on ecology (mean = 5.80/10). Only 23.10% (n = 225) reported being trained on planetary health during their medical education. During consultations regarding both health and environmental benefits, the most frequently given advice involved direct benefits to patients' health. A lack of time (n = 676, 69.40%) was the first barrier to integrating planetary health into practice, and the second barrier was a lack of knowledge (n = 606, 62.22%). GPs are sensitive to environmental issues, but they are more detached from these issues in their professional lives. It is crucial to strengthen prevention efforts and integrate environmental considerations into training programmes and health policies to create the conditions necessary for this change in practice.

Older adults from culturally and linguistically diverse backgrounds often face communication barriers in general practice, which compromise care quality and patient safety. Limited English Proficiency is a key determinant of these barriers, yet little is known about how older, LEP patients experience communication from general practice. To identify the experiences and preferences for communication from Australian general practice by older Greek patients with limited English proficiency. An exploratory, qualitative, descriptive research design was used. The study took place in a Greek community club in South-East Melbourne. Ten older Greek persons with limited English proficiency and two informal carers were interviewed in a mix of both English and Greek. Interviews lasted 20-45 minutes, were audio-recorded, transcribed verbatim, and translated to English. Data were analysed using reflexive thematic analysis. Participants described diverse experiences, three themes emerged: 1) The 'good doctor' and 'good clinic': being a person or place that provides them with a range of communication modalities tailored to their needs, is comfortable and accessible, and provides essential health services on-site; 2) Communication experiences with healthcare professionals, including the communication methods used and the reasons for their use; and 3) The diverse range of preferences for communication, particularly in relation to technology, which were often due to their age and English proficiency. The preferences and needs for communication from general practice clinics amongst this group was influenced by age and language related factors. It is important to consider these factors when designing, and implementing communication systems in general practice.

Social media is a pervasive part of young peoples' lives and may influence their mental health. Primary care is often the first point of care when seeking help for mental health problems. However, little is known about how young adults with mental health problems experience and perceive primary care support for managing social media. To explore young adults' views on help-seeking for social media use in primary care in relation to mental health problems. Qualitative interview study with 28 young adults aged 18-25 with self-reported mental health problems across England. Semi-structured interviews were analysed thematically to identify barriers and facilitators to help-seeking. Themes were organised using the Theory of Planned Behaviour - attitudes, social norms and perceived behavioural control. Barriers for help-seeking included attitudes that social media was a secondary issue and low expectations of meaningful support; perceived negative attitudes and limited understanding of social media by primary care clinicians, communities and families; and constrained ability to seek help due to limited consultation time and uncertainty around how to seek help. Facilitators included clinicians offering practical strategies, raising the topic non-judgmentally, receiving training to better understand young people's digital lives, longer appointment times, and clearer information about support in primary care for social media-related concerns. Young adults with mental health concerns face multiple barriers to discussing social media in primary care, shaped by attitudes and structural challenges. Addressing these through clinician training, communication, and service adaptations may enhance engagement and support.

People experiencing homelessness (PEH) are disproportionately affected by frailty, yet few interventions have targeted this syndrome in this population. To assess the feasibility, and potential impact of a combined exercise and nutritional intervention for PEH living with frailty. A single-arm feasibility trial in a GP clinic for PEH in Ireland. A two-month exercise and nutritional intervention tailored for PEH was offered to potential participants. Pre-frail and frail individuals attending a GP clinic for PEH in Ireland were invited to participate. The primary outcomes was feasibility, assessed using Bowen's framework. Secondary outcomes were based on potential impact and included frailty scores (Clinical Frailty Scale [CFS] and SHARE-Frailty Index [SHARE-FI]) and weight. A process evaluation explored participant experience. Of 124 eligible individuals, 108 (87.1%) enrolled, and 75 (69.4%) completed follow-up. Among those followed up, 70 (93.3%) engaged with at least one component of the intervention, with the majority finding the intervention easy to follow. CFS and SHARE-FI scores improved following the intervention in those followed-up. This study supports the feasibility of a primary care-based exercise and nutritional intervention for PEH living with frailty. The intervention appeared to be safe and to improve frailty status of participants and can inform the design of a definitive trial.

Rapid, cost-effective diagnosis of acute respiratory infections is now possible using multi-viral rapid-antigen point-of-care-tests (MVRA-POCTs) with high sensitivity/specificity. These offer a realistic alternative to polymerase chain reaction tests in primary care. However, evidence of acceptability and clinical utility in this setting is limited. To pilot feasibility of integrating MVRA-POCTs into routine primary care and investigate patient/clinician attitudes and behaviours. A prospective mixed-methods pilot study in seven New Zealand primary care clinics during winter 2023. Patients with acute respiratory symptoms received a MVRA-POCT (instead of COVID-19-only). Outcomes and acceptability were assessed via audits of electronic medical records, clinician/patient surveys, and interviews/focus groups with patients/clinic staff. Swab results were recorded from a demographically diverse cohort of 1754 patients; 14% tested positive for any virus (246/1754). All clinicians and most patients surveyed positively evaluated the test. All clinicians incorporated the MVRA-POCT into practice and found it useful. 66% of prescribers (27/41) reported results influenced antibiotic prescribing; 12% (5/41) avoided referrals to secondary care. All patient respondents who tested positive (n=39) and most testing negative (172/180, 96%) would like the MVRA-POCT in future. Patients testing positive self-reported as more likely to follow non-pharmaceutical interventions to reduce transmission compared to those testing negative. MVRA-POCTs were well-accepted and readily incorporated into practice. Routine integration into primary care could potentially improve management of common respiratory illnesses and promote patient behaviour change to reduce transmission.

Perinatal mental health (PMH) problems affect 10-20% of women during pregnancy and the postnatal year, costing the UK an estimated £8.1 billion annually. Underserved groups-including women from ethnic minorities, deprived areas, and those facing multiple disadvantages-experience the greatest inequalities in access and outcomes. Despite national investment, many fall between primary care (general practice, NHS Talking Therapies) and specialist PMH services, with limited guidance on bridging this gap. To co-design an experience-based intervention to address unmet PMH needs among underserved women, and to explore barriers to accessing care and gaps across PMH pathways. A mixed-methods study using the MRC framework and an adapted Accelerated Experience-Based Co-Design (AEBCD) approach. Work Package 1 will survey and interview professionals nationally across diverse roles and organisational contexts. Work Package 2 will involve focus groups and interviews with underserved women in Sheffield and Doncaster (South Yorkshire, UK), supported by bilingual community link workers. Findings will be synthesised and used in co-design workshops (Work Package 3) to develop an accessible, evidence-informed intervention tailored to the needs of an underserved group. The PRAMS study will generate clinically relevant insights into improving access to and management of PMH care for underserved women and birthing people. By working collaboratively with practitioners, women with lived experience, and community partners, PRAMS will deliver a co-designed intervention with potential to reduce inequalities. Findings will inform local service delivery and contribute national learning on user-led redesign of PMH services across primary and secondary care.

Diabetic foot ulcers (DFUs) significantly impair health-related quality of life (HRQoL). While clinical predictors are well established, the contribution of psychological factors, particularly in primary care, remains underexplored. To examine the sociodemographic, clinical, and psychological determinants of HRQoL in individuals with DFUs to inform development of psychologically informed interventions. Cross-sectional study conducted between April and October 2022 in primary care settings in Singapore. A total of 186 patients with DFUs completed validated measures, including psychological variables (for example, the Diabetes Distress Scale and Brief Illness Perception Questionnaire) and Wound-QoL, which uses a questionnaire to assess quality of life in body, psyche, and everyday life domains. Hierarchical multiple regression analyses evaluated the contribution of psychological variables to HRQoL. Psychological burden dominated, with psyche HRQoL impaired in 57% of participants (mean = 2.0), outpacing everyday life (38%; mean = 1.3) and body domains (24%; mean = 0.8). In hierarchical models, psychological variables - together with sociodemographic and clinical factors - explained 29.8% of the variance in body HRQoL, with interpersonal distress and threat perceptions emerging as significant predictors. A similar model accounted for 31.8% of the variance in psyche HRQoL, with female sex, emotional burden, and threat perceptions as key predictors. Everyday life HRQoL was significantly associated with HbA1c, independence in daily activities, emotional burden, and threat perceptions, with the full model explaining 33.7% of the variance. Psychological factors significantly contributed to reduced HRQoL in primary care patients with DFUs. Routine screening and targeted, psychologically informed support - particularly for females, those with poor glycaemic control, or limited functional independence - are essential to improve outcomes.

The COVID-19 pandemic necessitated significant adaptations for General Practitioner (GP) practices, affecting healthcare services and workload. The mixed-methods study VeCo-Praxis was designed to investigate these changes, focusing on non-COVID-related services in three German regions. This article is based on a qualitative interview study with GPs and Medical Practice Assistants (MPAs). To explore the perspectives of GPs and MPAs regarding their work and role during the pandemic and what conclusions they draw for GP care in the aftermath of the pandemic. A qualitative study with 15 GPs and 15 MPAs from three federal German states (August 2022 - September 2023). We conducted semi-structured telephone interviews and performed thematic analysis by Braun and Clarke. In this article, we focus on three key aspects: 1) the evolving role of GPs and MPAs as central healthcare coordinators, 2) frustrations stemming from inadequate collaboration with specialists, health authorities, and hospitals, and 3) conclusions and outlook for the aftermath of the pandemic. GPs reported an increased sense of responsibility but also greater exhaustion, while MPAs felt undervalued, particularly in comparison to hospital nurses. While telemedicine was helpful, both groups criticised the administrative workload, the lack of timely communication from authorities and the lack of support with pandemic-related tasks to ensure general patient care. As lessons learnt from the pandemic, GPs and MPAs must be adequately supported in their roles, interdisciplinary collaboration must be improved, and information flows and administrative processes must be more efficient to assure better pandemic-preparedness.

Health research should reflect contexts where interventions are needed to provide evidence generalisable to practice. There is concern that socioeconomically disadvantaged populations with poorer health and care outcomes are underrepresented in research, potentially exacerbating health inequalities. Evidence on the relationship between socioeconomic deprivation and general practice research involvement is limited. To explore the relationship between socioeconomic deprivation, general practice research involvement, and recruitment. Quantitative analysis of routine data and qualitative interviews with clinical and non-clinical general practice staff in the North East and North Cumbria (NENC) area of England. Analysis of general practice and National Institute for Health and Care Research (NIHR) Clinical Research Network (now the Regional Research Delivery Network [RDN]) data to understand associations between neighbourhood deprivation and research recruitment. Semi-structured interviews with GPs and practice managers or administrators explored barriers and facilitators to research involvement and patient recruitment in disadvantaged areas. Interviews were recorded, transcribed, and thematically analysed. Research recruitment was lower among practices (n = 358) with more deprived populations (χ2(4) = 7520.8, P<0.001), and significantly lower among 'Deep End' practices in areas of blanket socioeconomic disadvantage (P<0.001). Eleven GPs and four practice managers or administrators were interviewed. Barriers included greater difficulty recruiting patients, resource pressures, limited financial benefit, and awareness. Supporting factors were research designed to meet needs of socioeconomically disadvantaged populations that was accurately costed, remunerated, and resourced, with concise, practically focused communications. To support equitable general practice research participation, research should be relevant for and designed to meet the needs of socioeconomically disadvantaged populations, and be accurately costed and remunerated. Targeting additional resource at practices in socioeconomically disadvantaged areas could incentivise equitable research participation.