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Improving Access to Psychological Therapies (IAPT) services address anxiety and depression in primary care, with psychotic disorders typically excluded. Our previous research found 1 in 4 patients report distressing psychotic experiences (PE) alongside common mental disorders, yet little is known about their clinical presentation and impact on recovery. We used the Community Assessment of Psychic Experiences — Positive Scale (CAPE-P15) to assess the clinical presentation and symptomatic profile of PE within IAPT settings across three National Health Service (NHS) trusts, serving a diverse population in Southern England. We identified different classes based on the reported PE frequencies using latent class analysis. A total of 2042 IAPT patients completed the CAPE-P15. The mean age was 39.8 (±15.3) years. We identified five distinct classes of symptom profiles, findings that PE were common, especially self-referential and persecutory ideas. Prevalence and intensity increased across classes, extending to bizarre experiences and perceptual abnormalities in the fifth and least common class. Perceptual abnormalities were a strong indicator of symptom severity, with patients being the least likely to achieve recovery by the end of treatment. Data were collected during a service evaluation. Replication of these findings across other IAPT services could prove beneficial. We did not collect information on negative PE. Patients seeking treatment for anxiety and depression in primary care commonly experience a wide range of positive PE. Self-referential and persecutory ideation were prevalent; perceptual abnormalities were infrequent. Providing information about prevalence and tailoring therapy may help reduce patient distress. • Persecutory ideation are common in patients with anxiety and depression. • As psychotic experiences increase, more severe symptoms emerge. • Perceptual abnormalities are rare but act as a marker of severity. • Recovery from anxiety/depression decreases with severity of psychotic experiences. [ABSTRACT FROM AUTHOR]

Antiretroviral therapy (ART) adherence during and after pregnancy is essential to reduce perinatal transmission of HIV. However, little is known about adherence during the intrapartum and early postpartum inpatient hospital stay. Using secondary data from a hospital-based cohort study focused on the relationship between birthweight and engagement in HIV care, we examined the magnitude of, reasons for, and factors associated with incomplete intrapartum and early postpartum ART adherence among adult women (18 years or older) living with HIV who delivered within the previous two weeks at one of five hospitals in Accra, Ghana. Of the 142 enrolled participants who had complete adherence data and reported being on ART at the time of hospital admission, 43% (61/142) reported missing at least one ART dose during labor, delivery, and postpartum, including almost 20% (28/142) missing 2 or more consecutive doses. Women who reported frequently missing ART doses during pregnancy had higher odds of reporting missed doses during their intrapartum and postpartum hospital stays. Among those with inpatient ART interruption, the most frequently cited reasons were: forgetting medication at home (42%) and challenges of being in or recovering from labor (29%). Maternal perception of infant health at birth, hospital level of care, and frequency of missing HIV medications during pregnancy were associated with incomplete ART adherence during the intrapartum and early postpartum inpatient stay. An enabling clinical environment to facilitate access to ART during inpatient stays may have positive implications for ART adherence. [ABSTRACT FROM AUTHOR]

Women with cerebral palsy have the same sexual and reproductive healthcare (SRH) needs and rights as non-disabled women across the life course. Multi-level barriers prevent their SRH needs from being met in a timely way. Grouped according to Bronfenbrenner's socio-ecological model, these include physical and psychosocial determinants. The aim of this scoping review was to collate global literature of access to, and utilisation of, SRH for women with cerebral palsy across the life course. We screened five databases for international empirical studies published in English between 2000–2019. Twelve studies met the inclusion criteria. The review highlights that women with cerebral palsy face challenges to receiving good quality healthcare, including limited practitioner knowledge and training on the effects of cerebral palsy in adulthood and how it interacts with women's SRH needs. Much more research is needed to inform the provision of appropriate SRH treatment for women with cerebral palsy across the life course. This article blends together the findings of 12 international studies on healthcare of girls and adult women with cerebral palsy, particularly focusing on sexual and reproductive health and healthcare. The review indicates a significant gap in evidence about the experiences of healthcare transitions for women with cerebral palsy as they move from childhood to adulthood and children's to adult healthcare The review highlights large gaps in the global literature, in relation to sexual and reproductive healthcare across the lifecourse of disabled women in general, but women with cerebral palsy in particular. The studies found that General Practitioners (GPs) (family doctors) did not consider how prescribed contraceptives relate to impairment effects for girls and women with cerebral palsy. Barriers to good quality sexual and reproductive healthcare for women with cerebral palsy include: inaccessible physical environment and procedures (cervical smear and breast scans), and limited practitioner knowledge about the effects of cerebral palsy in adulthood for women and its interaction with sexual and reproductive health needs. [ABSTRACT FROM AUTHOR]

Copyright of Revista Ciência & Saúde Coletiva is the property of Associacao Brasileira de Pos-Graduacao em Saude Coletiva and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The use of electronic health records (EHR) in primary healthcare (PHC) aims for better integration of services and care quality. One of most the critical points of Brazilian PHC is access. This article aims to analyze, through data from the third evaluation cycle of the Brazilian Program for Improving Access and Quality of Primary Care (PMAQ-AB), the relationship between the use of electronic health records and the parameters of access of the participant teams. Crosssectional analytical study with secondary data. Data from 38,865 primary care teams, 30,346 health units and 140,444 interviewed users were evaluated. The use of EHR was associated with greater care for non-programmed demands (OR 1.664; 95%CI 1.485-1.866), risk and vulnerability assessment (OR 1.329; 95%CI 1.122-1.574) and use of protocols for clinical conducts (OR 1.656; 95%CI 1.530-1.793), in addition to a greater possibility of scheduling consultation by telephone (OR 3.179; 95%CI 3.030-3.335). Services using EHR are more likely to be the patients first contact (OR 1.226; 95%CI 1.171-1.283) and to be sought when facing urgent health problem (OR 1.198; 95%CI 1.161-1.236). The results point to a concrete possibility of improving access through computerization. [ABSTRACT FROM AUTHOR]

Copyright of Revista Família, Ciclos de Vida e Saúde no Contexto Social (REFACS) is the property of Universidade Federal do Triangulo Mineiro, Instituto de Ciencias da Saude and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Saberes Plurais is the property of Saberes Plurais and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Rural healthcare is an integral part of the Ukrainian healthcare system. However, access to healthcare for the rural population is uneven due to poor development of medical infrastructure and staffing. The problem of access to medical care in rural areas has been exacerbated by the full-scale war. The objective: to study and analyze the current state of accessibility of primary health care in rural areas in Ukraine, followed by a discussion of promising areas for the introduction of mobile health units as a tool for implementing the “Medical Guarantees” program in hard-to-reach regions of Ukraine. Materials and methods. The study included data from official statistical reports, regulatory documents and scientific sources. The methodology includes bibliosemantic, medical and statistical methods and the method of structural logical analysis. Results. It has been established that the low level of access to primary health care for the rural population of Ukraine has been significantly exacerbated by the devastating impact of the war on medical and transport infrastructure, especially in the frontline and recently de-occupied rural areas, and by migration processes. The situation is complicated by the fact that most patients in rural areas are elderly people who are physically unable to use public transportation, even if it is available. The analysis of international practice has shown that mobile health units can be introduced into the public healthcare system as a temporary measure to meet the urgent needs of the Ukrainian population, especially in rural areas. Integration of mobile health units into the state program “Medical Guarantees” can effectively address the urgent health care needs to increase access to health care for the rural population of Ukraine. State regulation of the division of these units will eliminate problems such as duplication and uneven service delivery and will create a transparent system of remuneration for the staff included in these units. Conclusions. The results of the study suggest that the practice of mobile medical units should be introduced as a tool for implementing the “Medical Guarantees” program for regions/locations of Ukraine with low access to medical infrastructure, namely remote rural areas and areas that have been devastated by the war. Mobile medical units will ensure the stability of access to primary health care services and contribute to improving the health of the population. [ABSTRACT FROM AUTHOR]

A limited number of healthcare workers and cost constraints encumber primary care access in the Philippines. To test telehealth as a low-cost and effective solution, a large-scale digital health clinic was implemented in the selected urban and rural communities. In collaboration with local authorities, our pilot telemedicine clinic was implemented for 3 days in January 2023. Patients were registered, and their vitals were assessed before they were seen by a remote US-based licensed physician who provided treatment recommendations. Medical devices with real-time streaming capabilities, such as electronic stethoscopes, were utilized to enhance remote examinations. A total of 322 patients were treated at the telehealth clinic; of which, 218 completed a population health survey. A large proportion of patients had a doctor visit more than 12 months prior (39.2%) and had not received a dental examination (86.3%) or an eye examination within the past year (84.4%). Most patients had access to a smartphone (69.7%). A lower proportion had access to an internet connection sufficient for video calls (57.9%) or a laptop (8.5%). Our clinic demonstrated that telehealth is a feasible solution to improve primary care access for disadvantaged communities in the Philippines. [ABSTRACT FROM AUTHOR]

The article focuses on the events and developments during the Mississippi 2024 Legislative session. Topics including the election of new leadership, security concerns; legislative priorities such as healthcare access and streamlining prior authorization processes; the challenges and potential impact of Medicare Advantage plans on patient care and hospital finances; and the importance of physician involvement in legislative advocacy.

Background: The COVID-19 pandemic in 2020 led to the rapid adoption of telemedicine, including virtual visits, to minimize face-to-face contact between clinicians and patients. Family medicine clinics across the nation had to transform how they provided primary care while maintaining the core values of family medicine. The objective of this study was to analyze how family medicine faculty perceived the impact of virtual visits on patient access to care. Methods: This qualitative study took place in an academic primary care setting. We interviewed clinical faculty who utilized virtual visits about their experiences from June to December 2020. We used qualitative content analysis to evaluate the results of the interviews. Results: The study included a total of 20 participants. The mean age was 43.4 years, and 85% of participants were female. Researchers developed 3 themes, "Logistics of virtual visits," "reigniting the concept of home visits," and "barriers and benefits that affect specific patient populations" that describe how virtual visits have impacted patients' access to care. The results highlight how virtual visits improve access to care by increasing flexibility for patients and providers and provide a new perspective into a patient's home life. Challenges of virtual visits include language barriers, technological issues, and issues unique to vulnerable patient populations. Conclusion: Virtual visits can enhance family medicine's ability to provide accessible care, but there are concerns it may worsen health disparities. Further research and quality improvement projects are needed to examine ways to implement innovative care delivery solutions to avoid further exacerbating these disparities. [ABSTRACT FROM AUTHOR]

Introduction: Inspired by examples in low- and middle-income countries, 50 community health workers (CHWs) were introduced in Belgium to improve access to primary care for people living in socio-economically vulnerable circumstances. This article aims to explore the ways in which CHWs support people living in socio-economically vulnerable circumstances in their access to primary care. Methods: The qualitative research focuses on the first year of implementation of this pioneer nationwide CHW programme in Belgium. To respond to the research aim, thirteen semi-structured in-depth interviews were held with people living in socio-economically vulnerable circumstances. In addition, a photovoice study was conducted with fifteen CHWs comprising four phases: (1) photovoice training; (2) participatory observation with each CHW individually; (3) an individual semi-structured in-depth interview; and (4) three focus group discussions. The transcripts and the observation notes were analysed in accordance with the abductive analysis procedures described by Timmermans and Tavory. Results: The qualitative results show that the CHWs' outreaching way of working allows them to reach people living at the crossroads of different vulnerabilities that are intertwined and reinforce each other. They experience complex care needs, while at the same time they face several barriers that interrupt the continuum of access to primary care – as conceptualised in the theoretical access-to-care framework of (Levesque et al. Int J Equity Health. 12:18, 2013). Building on the theoretical access-to-care framework described by (Levesque et al. Int J Equity Health. 12:18, 2013), the conceptual model outlines first the underlying mechanisms of CHW-facilitated access to primary care: (I) outreaching and pro-active way of working; (II) building trust; (III) providing unbiased support and guidance in a culturally sensitive manner; and (IV) tailoring the CHWs' approach to the unique interplay of barriers at the individual and health system level along the access-to-care continuum as experienced by the individual. Further disentangling how CHWs provide support to the barriers in access to care across the continuum and at each step is outlined further in the process characteristics of this conceptual model. Furthermore, the qualitative results show that the way in which CHWs support people is also impacted by the broader health system, such as long waiting times and unwelcoming healthcare professionals after referral from a CHW. Discussion: The conceptual model of CHW-facilitated access to primary care developed in this article explores the way in which CHWs support people living in socio-economically vulnerable circumstances in their access to primary care in Belgium. Through their outreaching method, they play a valuable bridging role between the Belgian healthcare system and people living in socio-economically vulnerable circumstances. Highlights: - Community health workers (CHWs) reach people who live at the crossroads of different vulnerabilities. - CHWs adjust their support to the unique interplay of barriers at the individual and health system level across the access-to-care continuum. - Through their outreaching method, they play a valuable bridging role between the Belgian healthcare system and people living in socio-economically vulnerable circumstances. - The conceptual model of CHW-facilitated access to primary care explores the ways in which CHWs support people living in socio-economically vulnerable circumstances in their access to primary care in Belgium. [ABSTRACT FROM AUTHOR]

This article explores the impact of leadership and diplomacy on good governance and sustainable economic development in Nigeria and Rwanda. It highlights the importance of effective leadership and diplomatic approaches in achieving these goals, while also acknowledging challenges such as corruption and inadequate governance. The study reveals divergent opinions among participants from both countries, with some expressing uncertainty or disagreement on certain initiatives. Overall, the article emphasizes the significance of prioritizing capacity-building, social welfare, and poverty alleviation to achieve effective governance and economic well-being. [Extracted from the article]

Health disparities exist across different linguistic groups. Language barriers in primary care can negatively affect access to healthcare services and the quality and safety of care at the end-of-life. This study will take a novel, in-depth look at the experience of language- and/or cultural-discordant care for adults from linguistic minority groups through the eyes of primary care physicians providing palliative and/or end-of-life care. Language and cultural discordance means that the physician and patient do not speak the same language or are not from the same cultural background. Qualitative data from primary care physicians (n = 12–24) providing language-discordant end-of-life care to Francophone and/or Allophone older adults across different care models and diverse geographies in Ontario will be collected through semi-structured interviews. Reflexive thematic analysis will be used to report themes within the data and consider the influence of the social locations of the researcher and research participants, geographic considerations impacting service provision, and barriers imposed by differing primary care funding structures on the provision of palliative and end-of-life care for linguistic and cultural minority groups in Ontario. Findings from this study will identify the interconnections among language and cultural discordance, care model, geographic region, and physician perceptions of their combined effects on access to, and quality of, palliative and end-of-life care. This evidence will be key to informing clinical practice guidelines and mobilizing change to improve primary care access and quality for adults at the end-of-life from linguistic and cultural minority populations across Ontario. [ABSTRACT FROM AUTHOR]

Background: The pre-conception period is an unmissable opportunity to introduce preventive measures before pregnancy to improve maternal and fetal outcomes. Despite the global pre-conception initiatives and the 2030 Saudi national vision to promote maternal, fetal health and safety, various barriers still exist. This study focuses on exploring pre-conception care extensively from the patients' perspectives and their experience in accessing this type of care in the primary care setting. Methods: A qualitative study using interpretive thematic analysis was used to explore patients' perspectives, and experiences in accessing pre-conception care in the city of Riyadh from January 2019 to January 2020. A semi-structured interview guide and field notes were used to collect data. A step wise interpretive and iterative process was used for data analysis and thematic extraction. Theme saturation was achieved by the eleventh interview. Results: The participants' perspectives were influenced by their cultural beliefs, understanding of pre-conception, and their prevised barriers to approaching physicians. Three main themes emerged: A) Acceptance of pre-conception care; was heavily influenced by how they understood and defined per-conception care. B) Pre-conception health seeking behavior; demonstrated a clear disconnect between the patient and the physician. C) Expectation from health services; to raise awareness about pre-conception care and push physicians to initiate the conversation with their patients. Conclusions: An appreciable gap in the patient-physician relationship was revealed as a source of inconsistency in accessing pre-conception care. Physicians are encouraged to take the first step in demonstrating to their patients both the importance of pre-conception care and their intent to offer respectful, empathetic, and culturally appropriate care. [ABSTRACT FROM AUTHOR]

Background: First Contact Practice Physiotherapists (FCPPs) offer expert care for patients with musculoskeletal (MSK) conditions in Primary Care, usually within GP practices. This is a rapidly expanding area of practice endorsed by NHS England, the Chartered Society of Physiotherapy (CSP) and the British Medical Association (BMA). Efficient and appropriate access is important for optimising FCPP practice, but there is little published information about how patients currently access FCPP appointments. Objective: To investigate how patients access FCPP appointments in General Practice. Design: Cross‐sectional online survey of FCPPs in the UK. Methods: FCPPs were surveyed about patient access to appointments. The survey instrument was designed using Jisc Online Surveys, piloted, and then distributed via social media and professional groups to FCPPs nationwide. Descriptive statistics were used to analyse demographic and multiple‐choice questions, and free text responses were analysed using quantitative content analysis. Results: 193 participants completed the survey. Booking via GP Reception (n = 179) was reported as the most common route into an FCPP appointment, closely followed by booking after seeing another clinician for the problem (n = 172). Conclusion: This research has provided clarity regarding how patients access the rapidly growing speciality of FCPP within GP practices in the UK. The role of GP Reception staff in facilitating access to FCPPs, the application of triage and the use of digital or online systems were highlighted as important elements for enabling efficient access to FCPPs by patients with MSK conditions. [ABSTRACT FROM AUTHOR]

Despite our successful tobacco control campaign and the rapid increase in the number of smokers who have quit in recent years, smoking remains the most important public health problem in our country. All physicians should strongly advise every patient who smokes to quit because evidence shows that quitting with physician advice increases long-term success. Family physicians, who are the first point of access to health as primary care physicians and provide continuous and biopsychosocial comprehensive care to the patient, have a great role in the fight against smoking. The 5A-5R approach is a structured method that can be used by physicians in all smoking cessation interventions from brief physician intervention to more intensive clinical interviews. The withdrawal symptoms encountered during cessation can be overcome by adopting a healthy lifestyle, sharing these problems with the physician and seeking solutions, and adding pharmacological treatment when necessary. [ABSTRACT FROM AUTHOR]

Objectives: Early in the COVID-19 pandemic, outpatient visits were adapted for the virtual setting, forcing laryngologists to presume certain diagnoses without the aid of laryngoscopy, solely based on history and the limited physical exam available via video visit. This study aims to examine the accuracy of presumptive diagnoses made via telemedicine, compared to subsequent in-person follow up, where endoscopic examination could confirm or refute suspected diagnoses. Methods: A retrospective chart review was conducted of 38 patients evaluated for voice-related issues at NYU Langone Health and the University of California-San Francisco. Presumptive diagnoses at the initial telemedicine encounter were noted, along with diagnostic cues used for clinical reasoning and recommended treatment plans. These presumptive diagnoses were compared to diagnoses and plans established following laryngoscopy at follow-up in-person visits. Results: After laryngoscopy at the first in-person visit, 38% of presumptive diagnoses changed, as did 37% of treatment plans. The accuracy varied among conditions. Muscle tension dysphonia and Reinke's edema were accurately diagnosed without laryngoscopy, but other conditions, including vocal fold paralysis and subglottic stenosis, were not initially suspected, relying on laryngoscopy for diagnosis. Conclusions: While some laryngologic conditions may be reasonably identified without in-person examination, laryngoscopy remains central to definitive diagnosis and treatment. Telemedicine can increase access to care, but it may provide more utility as a screening tool, triaging which patients should present more urgently for in-person laryngoscopy. Level of Evidence: 4 [ABSTRACT FROM AUTHOR]

Background: Access to primary health care is a fundamental right for all. However, persons with disabilities are experiencing difficulties when accessing healthcare because of various environmental and personal barriers which may lead to nonuse of such services. Objectives: This study aimed to identify the challenges leading to non-use of healthcare services among persons with mobility impairments in Cofimvaba. Method: A descriptive qualitative design using snowball sampling was implemented. Semistructured interviews were conducted in isiXhosa with five participants who stopped accessing healthcare, using a self-developed interview guide. Inductive thematic analysis was used to develop codes and themes from the data. Results: Study findings revealed major challenges experienced by persons with mobility impairments in accessing healthcare. These included inaccessible roads, geographic inaccessibility, financial accessibility and indirect cost of care, having little or not many health problems, physical infrastructure difficulties within facilities, and attitudinal barriers. Conclusion: The findings indicated that persons with disabilities are experiencing a combination of structural and environmental challenges which make them stop accessing healthcare. Contribution: The article shares insights on access challenges that influence non-use of the often-needed healthcare services within the context of rural areas. [ABSTRACT FROM AUTHOR]

Access to quality healthcare is an essential component of health policy. This cross-sectional study describes the actions performed by Brazilian Oral Health Teams (OHTs) analyzed in the National Program for Improving Access and Quality of Primary Care and the relationship of contextual aspects. A total of 22,993 OHTs that participated in the third cycle of the referred program were evaluated using a structured questionnaire. Thirteen procedures (items) related to spontaneous dental care and preventive, surgical, restorative, prosthetic, and oral cancer prevention or diagnosis were assessed. Item response theory was used to estimate the performance scores of OHTs, based on 13 items. The relationship between performance scores and contextual variables in Brazilian regions was analyzed by thematic maps and Spearman correlation (p < 0.05). The highest difficulty parameters were for questions related to prosthetics (b = 0.879) and actions for oral cancer (b = 2.922). The 13 items were more appropriate to discriminate the teams with lower performance and relatively ineffective in differentiating those with better performance. A direct relationship with the Human Development Index (rs = 0.249; p = 0.004) and an indirect relationship with the Gini Index (rs = −0.482; p < 0.001) were found. Contextual aspects presented a relationship with the performance of the Brazilian OHTs. The evaluated items showed some potential to discriminate the performance of OHTs since many of the evaluated dental procedures are performed by most of the teams. [ABSTRACT FROM AUTHOR]

U.S. HIV diagnoses disproportionately affect Non-Hispanic Black (NHB) and Hispanic gay and bisexual men. Using data from the National Health Interview Survey (2013-2018), we examined race and ethnicity and primary care access, an HIV prevention resource, among gay and bisexual men. The explanatory variable was NHB, Hispanic or Non-Hispanic White (NHW). Outcomes were primary care-specific usual place of care (potential access) and saw general doctor <12 months (realized access). We used multivariable logistic regression, adjusting for individual sociodemographic characteristics, health status, and care barriers. In sensitivity analysis, we examined general access (any place/doctor) and subgroups (1) NHB (2) has usual place of care. The sample included 1,858 adult, gay and bisexual men (unweighted). Nearly one-third self-identified as NHB or Hispanic. Compared to NHW men, NHB and Hispanic men were younger, with lower household income, and more care barriers (p < 0.05). NHB and Hispanic men had lower realized access (aOR 0.7058, p = 0.030) than NHW men. Potential access was lower for NHB only (versus NHW) and, among those with any usual place of care, NHB and Hispanic men versus NHW men. Lower primary care access for NHB or Hispanic, rather than NHW, gay and bisexual men, may reduce HIV prevention access. [ABSTRACT FROM AUTHOR]

We aimed to access the burden of primary health issues in two refugee camps in Cox's Bazar. We compared the burden of disease between different age groups and gender. Data on primary health issues, referrals, maternal and child services, and family planning services were collected from November 2017 to May 2018. The sample population was 20,769 Rohingya refugees who had sought medical care; 38.2% (7,935) were males and 61.8% (12,834) were females. Those younger than five years of age constituted 28.1% (5,831), and those five years old and older constituted 71.9% (14,938). The findings revealed that 48% of the sample population sought medical care due to infectious diseases. Acute respiratory infection (29.3%) was the most frequent primary health problem encountered by refugees, followed by diarrhea (9.2%), skin problems (4.6%), injuries/wounds (2.0%) and unexplained fever causes (1.4%). There was a significant difference in the infection rate (p<0.001) between those younger than five years of age (71.7%) and those five years of age or older (38.6%). For communicable diseases, we recommended regular health awareness programs to reduce and prevent outbreaks. For noncommunicable diseases (NCDs), regular treatment and monitoring were essential. Improving the health and social status of refugees will definitely benefit the host country. [ABSTRACT FROM AUTHOR]

Access to primary care has been a long-standing priority for improving population health. Asian Americans, who often settle in ethnic enclaves, have been found to underutilize health care. Understanding geographic primary care accessibility within Asian American enclaves can help to ensure the long-term health of this fast-growing population. U.S. Census data from five states (California, Florida, New Jersey, New York, and Texas) were used to develop and describe census-tract level measures of Asian American enclaves and social and built environment characteristics for years 2000 and 2010. The 2-step floating catchment area method was applied to National Provider Identifier data to develop a tract-level measure of geographic primary care accessibility. Analyses were conducted in 2022–2023, and associations between enclaves (versus nonenclaves) and geographic primary care accessibility were evaluated using multivariable Poisson regression with robust variance estimation, adjusting for potential area-level confounders. Of 24,482 census tracts, 26.1% were classified as Asian American enclaves. Asian American enclaves were more likely to be metropolitan and have less poverty, lower crime, and lower proportions of uninsured individuals than nonenclaves. Asian American enclaves had higher primary care accessibility than nonenclaves (adjusted prevalence ratio=1.23, 95% CI=1.17, 1.29). Asian American enclaves in five of the most diverse and populous states in the U.S. had fewer markers of disadvantage and greater geographic primary care accessibility. This study contributes to the growing body of research elucidating the constellation of social and built environment features within Asian American enclaves and provides evidence of health-promoting characteristics of these neighborhoods. [ABSTRACT FROM AUTHOR]

Equity of access to primary health services is critical for the most vulnerable and marginalized people in our societies. Despite global efforts to establish universal health care systems, women continue to be among society's most underserved citizens in both poor urban and rural settings. The main barriers may include economic, geographic, cultural, or institutional factors. Monitoring access inequalities to primary health care services is critical in providing policymakers with an evidence-based solutions more equity-oriented policies, programmes, and practices towards improving long and healthy life for all people in the society. The main purpose of the study was to explore what factors influence women's access to health services provided through government and civil society health programmes. It also examines the evolution of nutritional programs under government and civil society organizations in Bangladesh to provide insights on their design considerations to inform future design, deliver, and access of health care programmes by women in Bangladesh. Findings indicated that only 50% of rural women had access to health programmes. In addition, young and education women with high exposure to public awareness opportunities had more access health programmes. Further, health programme delivered through government and civil society design and delivery mechanisms reached out to more women. The study concludes that understanding women's circumstances and taking institutional design into account for operational effectiveness are crucial for the design and delivery of health services to rural areas, given these challenges. [ABSTRACT FROM AUTHOR]

Aims: We aim to monitor and improve the quality of the heart failure (HF) integrated assistance model defined by national and regional guidelines and implemented in the province of Reggio Emilia, Italy. Specific aims of the audit were to estimate the prevalence of HF, describe the characteristics of patients with HF and the rate of patients enrolled in the integrated care treated in primary care, and identify socioeconomic and geographic determinants of the 4‐year survival of these patients. Methods and results: Retrospective analysis of a cohort of prevalent cases of HF, diagnosed before 31 December 2015 in Reggio Emilia, Italy, alive on 1 January 2016, and residing at the time of diagnosis on the provincial territory. Age and sex‐adjusted prevalence of HF by area of residence were calculated according to the standard European population 2013. Patients were followed until death or 31 December 2019, whatever came first. The outcome measure of the study was four‐year case fatality. Cox proportional hazards models, adjusted for age, sex, and duration of disease were used to determine the association between socio‐geographic factors and death. The 4‐year case‐fatality rate was 36.7%, and it was the highest in the mountains (50.8%) compared with hills (34.6%), lowland (35.4%) and city (37.7%). The prevalence of HF was the lowest in the mountain [149.9, 95% confidence interval (CI) 112.1–187.7] and the highest in the lowland (340.8, 95% CI 308.7–372.9) and city (308, 95% CI 276.0–321.2). Patients living in the mountains had a lower deprivation index, and fewer hospitalizations prior to official diagnosis, although these characteristics were not statistically significant determinants of HF death in multivariate analysis. Behavioural (smoking and obesity) and socio‐geographic characteristics (educational level, deprivation index and area of residence) were not significantly associated with mortality in both univariable and multivariable analysis; however, patients who live in mountains (hazard ratio 1.10, 95% CI 0.73–1.66) or hills (hazard ratio 1.11, 95% CI 0.90–1.37) had a slightly higher risk of death than those living in the city. Only 197 (12.1%) of patients in the cohort were enrolled in the integrated care pathway over the course of 4 years. Conclusions: Although clinical determinants outweigh the geographic and behavioural disparities in the survival of patients with CHF treated in primary care, effective prevention strategies are needed to address environmental and socio‐geographic inequalities in access to primary care and to hasten equitable linkage to integrated care. [ABSTRACT FROM AUTHOR]

Background: The Canadian healthcare system bares a long legacy of colonisation and assimilation of Indigenous values and approaches to health and wellness. This system often perpetuates social and health inequities through systemic racism, underfunding, lack of culturally appropriate care and barriers to access care. Current funding legislation policies enacted across federal, provincialand territorial governments do not necessarily uphold Indigenous Peoples' rights to self-determination, health and wellness. We summarise literature on promising Indigenous health systems and practices that prioritise and/or improve rural Indigenous Peoples' health and wellness. Objective: The impetus for this review was to provide information on promising health systems, while Dehcho First Nations developed a health and wellness vision. Methods: Documents were gathered from indexed and non-indexed databases to obtain literature from peer-reviewed and non-peer reviewed sources. Two reviewers independently 1) screened titles, abstracts and full texts to ensure they met the inclusion criteria, 2) gathered relevant data from all included documents and 3) identified major themes and sub-themes. Reviewers then discussed and reached consensus on the themes. Results: Thematic analysis revealed six themes for effective health systems for rural and remote Indigenous communities: 1) access to primary care, 2) multi-directional knowledge exchange, 3) culturally appropriate care, 4) training and building community capacity, 5) integrated care and 6) health system funding. Conclusion: Effective health and wellness systems must support Indigenous ways of knowing and doing in healthcare models based on collaborative partnerships with community members, health providers and government agencies. Sustainable health and wellness funding plans must be provided through federal, provincial, territorial and state partnerships. Indigenous core values, culture and knowledge must be integrated within mainstream health systems. Indigenous Rightsholders must inform all plans for altering or implementing Indigenous health systems. Non-Indigenous cultural safety and competency training can improve care. [ABSTRACT FROM AUTHOR]

Introduction: Growing recognition of the role of vitamin D augmented the demand for a point‐of‐care testing (POCT) framework, unveiling a niche for development of a novel service. Objectives: Review available vitamin D POCT devices and validate vitamin D POCT; Develop and validate framework for vitamin D POCT; Conduct pilot study for pharmacist‐led vitamin D POCT framework in community pharmacy. Methods: Vitamin D POCT devices were appraised by considering specifications and the identified vitamin D POCT kit was validated by comparing results with gold standard method in 20 participants, employing Cohen's Kappa coefficient. A framework consisting of a Data Collection Sheet, a standard operating procedure and Action Plan record for pharmacist‐led vitamin D POCT was developed and validated. The framework was piloted in a community pharmacy with 80 participants and patient data was correlated with POCT result. Data was analyzed using the chi‐square test. Results: The appraisal identified a semi‐quantitative POCT which conforms with European Union (EU) regulations. Concordance between POCT and gold standard was observed (κ = 0.84, p < 0.001). Of the 80 participants, 49 had insufficient; 8 had deficient vitamin D levels. The framework developed was practical to be applied in the community pharmacy setting. Participants suffering from chronic conditions are more likely to have their vitamin D levels tested (p = 0.042), those suffering from metabolic disorders being more likely to have deficient/insufficient vitamin D levels (p = 0.026). Conclusion: The study identified a POCT device for use within a framework for community pharmacist‐led assessment of vitamin D in the context of collaborative care. A high incidence of vitamin D insufficiency was observed, indicating the value of providing access to this service at primary care level. An accessible vitamin D testing service to participants, supported by community pharmacist professional advice, facilitates early detection of vitamin D insufficiency and management. [ABSTRACT FROM AUTHOR]

The use of insulin for patients with diabetes mellitus in Indonesia appears to be under expectation; moreover, there are gaps in knowledge regarding the proper injection technique and pen needle reuse by both healthcare professionals (HCPs) and patients. To address these issues, a scientific expert meeting was held with the participation of endocrinologists and public health specialist from many different organizations in Indonesia to identify the challenges and problem related to injection technique, high pen needle reuse rate, and the need of all stakeholders. The experts agreed that it is necessary to ensure physicians to start the initiation phase as early as indicated, continue optimizing its dosage to reach targeted blood sugar based on guideline, and involve all relevant stakeholders to improve insulin distribution and patient access in every primary care facility in order to optimize the use of insulin or other injectable diabetes medications in Indonesia. Additionally, the experts believed that education on proper injection technique and improved reuse rate of pen needle is necessary. To date, Indonesian Diabetes Educators Association (IDEA/PEDI) has established guideline on injection technique. There are also recommendations on injection technique and needle reuse from Indonesian Society of Endocrinology (PERKENI) and Forum for Injection Technique & Therapy: Expert Recommendations (FITTER); however, this guideline/recommendation should be disseminated more widely among HCPs. In addition, cost-effectiveness studies based on local data are needed to propose and convince the Payors and other stakeholders. This article can be used as a guidance for HCPs and policymakers to improve current practice on injection technique, pen needle reuse, needle prescription and reimbursement policy in Indonesia and elsewhere. [ABSTRACT FROM AUTHOR]

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Background: GPs aim to provide patient-centred care combining clinical evidence, clinical judgement, and patient priorities. Despite a recognition of the need to translate evidence to support patient care, barriers exist to the use of evidence in practice. Aim: To ascertain the needs and preferences of GPs regarding evidence-based guidance to support patient care. The study also aimed to prioritise content and optimise structure and dissemination of future evidence-based guidance. Design & setting: This was a convergent parallel mixed-methods study in collaboration with the national GP professional body in the Republic of Ireland (Irish College of General Practitioners [ICGP]). Quantitative and qualitative findings were integrated at the interpretive level. Method: A national GP survey was administered via the ICGP (December 2020) and seven GP focus groups were undertaken (April-May 2021). Results: Of 3496 GPs, a total of 509 responders (14.6%) completed the survey and 40 GP participants took part in focus groups. Prescribing updates, interpretation of test results, chronic disease management, and older person care were the preferred topics for future evidence-based guidance. GPs reported that they required rapid access to up-to-date and relevant evidence summaries online for use in clinical practice. Access to more comprehensive reviews for the purposes of continuing education and teaching was also a priority. Multimodal forms of dissemination were preferred to increase uptake of evidence in practice. Conclusion: GPs indicated that rapid access to up-to-date, summarised evidence-based resources, available from their professional organisation, is preferred. Evidence should reflect the disease burden of the population and involve multifaceted dissemination approaches. [ABSTRACT FROM AUTHOR]

Background: Hospitalization for ambulatory care sensitive conditions (ACSCs) is potentially preventable with timely and effective primary care but may increase owing to poor access. Spatial access inequalities exist between Japan and other countries. This retrospective cohort study examined the association between admission for ACSC and spatial accessibility to primary care. Methods: We used claims data and spatial data of 50–74 years-old beneficiaries of the National Health Insurance program in a large city in Japan from April 2013–March 2014 and followed them until March 2015. We used a multilevel Poisson regression model to assess the association between the number of ACSC admissions, the distance to the nearest clinic, and the number of physicians in a given area, adjusting for age, gender, comorbidities, number of visits, and household income. Results: Among 126,666 eligible beneficiaries (mean age 65.8 years, 54% were women), 1,793 (1.4%) were hospitalized for ACSCs. The ACSC admission rate was significantly higher in those with a distance to the nearest clinic of >1 km than in those with 1 km: IRR 1.98, 95% CI 1.29–3.03, respectively) and those aged ≥65 years (≥0.3 km and 1 km: IRR 1.48, 95% CI 1.10–1.98). Conclusion: Unfavorable spatial access was associated with ACSC admissions, particularly among women and older adults.

Indigenous students from reserves, rural, and Northern communities are underrepresented in Canadian medical schools, which contributes to health inequities in these communities. Factors such as socioeconomic disadvantage, geographic barriers to education, and limited exposure to healthcare careers contribute to this problem. To address this issue, medical schools should adopt a distinctions-based approach to recruiting Indigenous students and implement upstream interventions to support students throughout the process of preparing for medical school. Partnerships between key players in medical education are crucial to supporting successful applications from Indigenous students. It is important to recognize and rectify the underrepresentation of Indigenous students in order to improve access to medical education and address the needs of Indigenous communities. [Extracted from the article]

This article discusses the challenges faced by the stateless community in Semporna, Malaysia, particularly in accessing primary healthcare services. The Bajau Laut community, who live a semi-nomadic maritime lifestyle, are considered stateless by the Malaysian government. They lack access to healthcare, education, and employment opportunities, leading to intergenerational poverty and poor health outcomes. To address this issue, a voluntary medical outreach program called "Sunset Clinic" has been established to provide healthcare services to the stateless population. The program focuses on treating communicable and non-communicable diseases and also provides dental services and health education. The article emphasizes the need for systemic change and collaboration among policymakers and healthcare professionals to improve the health and well-being of the stateless population. [Extracted from the article]

The article discusses a study which showed that a same-day access initiative could be feasibly implemented and streamlined in the context of integrated workflow. Topics include the proposition for same-day visits as a means of increasing convenience and patient access to care, benefits of integrating same-day access into everyday physician workflow without the creation of new patient slots, and the most critical element of the same-day access initiative.

A study published in the European Heart Journal analyzed trends in cardiovascular hospitalizations and in-hospital mortality among young and middle-aged adults in the USA between 2008 and 2019. The study found that hospitalizations for acute myocardial infarction, heart failure, and ischemic stroke increased during this period, while in-hospital mortality rates for these conditions slightly declined. The burden of comorbidities, particularly diabetes, kidney disease, and obesity, also increased among hospitalized patients. The study highlighted disparities in hospitalization rates and mortality based on income and insurance status, with low-income individuals and people identifying as Black or Hispanic being disproportionately affected. The authors suggested that a multifaceted approach is needed to address the increasing rates of hospitalizations and disparities in cardiovascular health, including raising awareness of disparities, improving access to care, and implementing interventions that address social determinants of health. [Extracted from the article]

This article discusses the importance of accurate blood pressure (BP) measurement in diagnosing and treating hypertension. It highlights the use of oscillometric devices and the need for validated devices recommended by the British and Irish Hypertension Society. The article explores different techniques for measuring BP, including office BP, unattended automated oscillometric BP, ambulatory BP monitoring, and home BP monitoring. It also addresses specific challenges in BP measurement, such as in pregnant women, patients with obesity, and patients with irregular heart rhythm. The article concludes by emphasizing the need for quality control and standardized protocols in BP measurement. [Extracted from the article]

AbstractObjective To compare consultations with pregnant undocumented migrants at emergency primary health care to consultations with pregnant residents of Norway.Design A cross-sectional study of consultations at several time points.Setting The study was conducted at the Oslo Accident and Emergency Outpatient Clinic (OAEOC), the main emergency primary care service in Oslo, Norway.Subjects Consultations with pregnant patients without a Norwegian identity number seeking care at the Department of Emergency General Practice at the OAEOC were identified through a manual search of registration lists from 2009 to 2019. The consultations were categorized by women’s residency status as ‘probably documented migrant’, ‘uncertain migrant status’, or ‘probably undocumented migrant’. We also extracted aggregated data for women with a Norwegian identity number (i.e. residents) presenting in consultations with pregnancy-related (ICPC-2 chapter W) conditions.Main outcome measures Manchester Triage System urgency level at presentation, and hospitalization.Results Among 829 consultations with female patients categorized as probably undocumented migrants, we found 27.1% (225/829) with pregnant women. About half of the pregnant women (54.6% (123/225)) presented with a pregnancy-related condition. Pregnant women that were probably undocumented migrants had an increased risk of being triaged with a high level of urgency at presentation (relative risk (RR) 1.86, 95% CI 1.14–3.04) and being hospitalized (RR 1.68, 95% CI 1.21–2.34), compared to pregnant residents.Conclusion Pregnant undocumented migrants were more severely sick when presenting to emergency primary care services than pregnant residents. Increased access to primary care and emergency primary care services for pregnant undocumented migrants is urgently needed.

Background: In January 2010, the choice reform was instituted in Swedish primary health care establishing free entry for private primary health care providers and enabling patients to choose freely among primary health care centers. The motivation behind the reform was to improve access to primary care and responsiveness to patient expectations. Reform effects on health care utilization have previously been investigated by using subgroup analyses assuming a pattern of homogeneous subgroups of the population. By using a different methodological approach, the aim of this study was to, from an equity perspective, investigate long term trends of primary health care utilization following the choice reform. Method: A closed cohort was created based on register data from Region Skåne, the third most populated region in Sweden, describing individuals' health care utilization between 2007–2017. Using a novel approach, utilization data, measured as primary health care visits, was matched with socioeconomic and geographic determinants, and analyzed using logistic regression models. Results: A total of 659,298 individuals were included in the cohort. Sex differences in utilization were recorded to decrease in the older age group and to increase in the younger age group. Multivariable logistic regression showed increasing utilization in older men to be associated with higher socioeconomic position, while in women it was associated with lower socioeconomic position. Furthermore, groups of becoming high utilizers were all associated with lower socioeconomic position and with residence in urban areas. Conclusion: The impact of demographic, socioeconomic and geographic determinants on primary health care utilization varies in magnitude and direction between groups of the population. As a result, the increase in utilization as observed in the general population following the choice reform is unevenly distributed between different population groups. [ABSTRACT FROM AUTHOR]

Background: Social risks contribute to poor health outcomes, especially for patients with complex medical needs. These same risks may impact access to primary care services. Objective: To study associations between social risks and primary care utilization among patients with medical complexity. Design: Prospective cohort study of respondents to a 2018 mailed survey, followed up to 2 years after survey completion. Participants: Nationally representative sample of 10,000 primary care patients in the Veterans Affairs (VA) health care system, with high (≥ 75th percentile) 1-year risk of hospitalization or death. Main Measures: Survey-based exposures were low social support, no family member/friend involved in health care, unemployment, transportation problem, food insecurity, medication insecurity, financial strain, low medical literacy, and less than high school graduate. Electronic health record–based outcomes were number of primary care provider (PCP) encounters, number of primary care team encounters (PCP, nurse, clinical pharmacist, and social worker), and having ≥ 1 social work encounter. Key Results: Among 4680 respondents, mean age was 70.3, 93.7% were male, 71.8% White non-Hispanic, and 15.8% Black non-Hispanic. Unemployment was associated with fewer PCP and primary care team encounters (incident rate ratio 0.77, 95% CI 0.65–0.91; p = 0.002 and 0.75, 0.59–0.95; p = 0.02, respectively), and low medical literacy was associated with more primary care team encounters (1.17, 1.05–1.32; p = 0.006). Among those with one or more social risks, 18.4% had ≥ 1 social work encounter. Low medical literacy (OR 1.95, 95% CI 1.45–2.61; p < 0.001), transportation problem (1.42, 1.10–1.83; p = 0.007), and low social support (1.31, 1.06–1.63; p = 0.01) were associated with higher odds of ≥ 1 social work encounter. Conclusions: We found few differences in PCP and primary care team utilization among medically complex VA patients by social risk. However, social work use was low, despite its central role in addressing social risks. More work is needed to understand barriers to social work utilization. [ABSTRACT FROM AUTHOR]

Background: Efforts to reduce emergency department (ED) volumes often target frequent users. We examined transitions in care across ED, hospital, and community settings, and in-hospital death, for high system users (HSUs) compared to controls. Methods: Population-based databases provided ED visits and hospitalizations in Alberta and Ontario, Canada. The retrospective cohort included the top 10% of all the ED users during 2015/2016 (termed HSUs) and a random sample of controls (4 per each HSU) from the bottom 90% per province. Rates of transitions among ED, hospitalization, community settings, and in-hospital mortality were adjusted for sociodemographic and ED variables in a multistate statistical model. Results: There were 2,684,924 patients and 579,230 (21.6%) were HSUs. Patient characteristics associated with shorter community to ED transition times for HSUs included Alberta residence (ratio of hazard ratio [RHR] = 1.11, 95% confidence interval [CI] 1.11,1.12), living in areas in the lower income quintile (RHR = 1.06, 95%CI 1.06,1.06), and Ontario residents without a primary health care provider (RHR = 1.13, 95%CI 1.13,1.14). Once at the ED, characteristics associated with shorter ED to hospital transition times for HSUs included higher acuity (e.g., RHR = 1.70, 95% CI 1.61, 1.81 for emergent), and for many diagnoses including chest pain (RHR = 1.71, 95%CI 1.65,1.76) and gastrointestinal (RHR = 1.66, 95%CI 1.62,1.71). Once admitted to hospital, HSUs did not necessarily have longer stays except for conditions such as chest pain (RHR = 0.90, 95% CI 0.86, 0.95). HSUs had shorter times to death in the ED if they presented for cancer (RHR = 2.51), congestive heart failure (RHR = 1.93), myocardial infarction (RHR = 1.53), and stroke (RHR = 1.84), and shorter times to death in-hospital if they presented with cancer (RHR = 1.29). Conclusions: Differences between HSUs and controls in predictors of transitions among care settings were identified. Co-morbidities and limitations in access to primary care are associated with more rapid transitions from community to ED and hospital among HSUs. Interventions targeting these challenges may better serve patients across health systems.. Trial registration: Not applicable. [ABSTRACT FROM AUTHOR]

Background: Supported asthma self-management, incorporating an asthma action plan and annual clinical review, has been recommended by UK/global guidelines for over three decades. However, implementation remains poor, as only around a third of individuals receive basic asthma care, according to the UKs leading respiratory charity Asthma and Lung UK. A systematic review of implementation studies recommended that a whole systems approach targeting patients, healthcare professional education, and organisations is needed to improve implementation of supported asthma self-management in primary care. The IMPlementing IMProved Asthma self-management as RouTine (IMP2ART) is a national Hybrid-II implementation cluster randomised controlled trial that aims to evaluate such an approach. This paper describes the development of the implementation strategy for IMP2ART with particular focus on the integration of multiple level theories. Methods: The Medical Research Council design and evaluation of complex interventions framework and the Person-Based Approach to intervention development were used as guidance for stages of strategy development. Specifically, we (i) set up a multidisciplinary team (including practicing and academic clinicians, health psychologists, public health and patient colleagues), (ii) reviewed and integrated evidence and theory, (iii) developed guiding principles, (iv) developed prototype materials, and (v) conducted a pre-pilot study before final refinement. Results: The implementation strategy included resources for patients, team-based and individual healthcare professional education, practice audit and feedback, and an asthma review template, as well as a facilitator role accessible to primary care practices for 12 months. The synthesis of the integrated Promoting Action on Research Implementation in Health Services (iPARIHS) and Capability, Opportunity, Motivation and Behaviour (COM-B) frameworks led to an evolved framework bringing together important implementation and behaviour change elements which will be used as a basis for the study process evaluation. Conclusions: A description of rigorous implementation strategy development for the IMP2ART study is provided along with newly theorised integration of implementation and behaviour change science which may be of benefit to others targeting implementation in primary care. Trial registration: ISRCTN15448074. Registered on 2nd December 2019. [ABSTRACT FROM AUTHOR]

Background: In France, rural general practitioner (GP) numbers could reduce by 20% between 2006 and 2030 if no measures are taken to address primary care access difficulties. In countries such as Australia, the USA and Canada, intrinsic and extrinsic factors associated with GPs practising in rural areas include rural upbringing and rural training placements. However, the health systems and rural area definition differ between these countries and France making result extrapolation difficult. These factors must be studied in the context of the French heath system, to design strategies to improve rural GP recruitment and retention. This study aims to identify the intrinsic and extrinsic factors associated with GPs practising in rural areas in France. Methods: This case–control study was conducted between May and September 2020. Included GPs practised in Brittany, France, and completed a self-administered questionnaire. The cases were rural GPs and controls were urban GPs. National references defined rural and urban areas. Comparisons between rural and urban groups were conducted using univariate and multivariate analyses to identify factors associated with practising in a rural area. Results: The study included 341 GPs, of which 146 were in the rural group and 195 in the urban group. Working as a rural GP was significantly associated with having a rural upbringing (OR = 2.35; 95% CI [1.07–5.15]; p = 0.032), completing at least one undergraduate general medicine training placement in a rural area (OR = 3.44; 95% CI [1.18–9.98]; p < 0.023), and having worked as a locum in a rural area for at least three months (OR = 3.76; 95% CI [2.28–6.18]; p < 0.001). Choosing to work in a rural area was also associated with the place of residence at the end of postgraduate training (OR = 5.13; 95% CI [1.38–19.06]; p = 0.015) and with the spouse or partner having a rural upbringing (OR = 2.36; 95% CI [1.12–4.96]; p = 0.023) or working in a rural area (OR = 5.29; 95% CI [2,02–13.87]; p < 0.001). Conclusions: French rural GPs were more likely to have grown up, trained, or worked as a locum in a rural area. Strategies to improve rural GP retention and recruitment in France could therefore include making rural areas a more attractive place to live and work, encouraging rural locum placements and compulsory rural training, and possibly enrolling more medical students with a rural background. [ABSTRACT FROM AUTHOR]