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INTRODUCTION Artificial intelligence (AI) has increasingly become part of our society, including in health care. The use of AI in primary care, in particular, has the potential for widespread impact [...], PURPOSE Information about social determinants of health (SDOH) is essential for primary care clinicians in the delivery of equitable, comprehensive care, as well as for program planning and resource allocation. SDOH are rarely captured consistently in clinical settings, however. Artificial intelligence (AI) could potentially fill these data gaps, but it needs to be designed collaboratively and thoughtfully. We report on a codesign process with primary care clinicians to understand how an AI tool could be developed, implemented, and used in practice. METHODS We conducted semistructured, 50-minute workshops with a large urban family health team in Toronto, Ontario, Canada asking their feedback on a proposed AI- based tool used to derive patient SDOH from electronic health record data. An inductive thematic analysis was used to describe participants' perspectives regarding the implementation and use of the proposed tool. RESULTS Fifteen participants contributed across 4 workshops. Most patient SDOH information was not available or was difficult to find in their electronic health record. Discussions focused on 3 areas related to the implementation and use of an AI tool to derive social data: people, process, and technology. Participants recommended starting with 1 or 2 social determinants (income and housing were suggested as priorities) and emphasized the need for adequate resources, staff, and training materials. They noted many challenges, including how to discuss the use of AI with patients and how to confirm their social needs identified by the AI tool. CONCLUSIONS Our codesign experience provides guidance from end users on the appropriate and meaningful design and implementation of an AI-based tool for social data in primary care. Key words: primary care; artificial intelligence; codesign; qualitative methods; social factors in health and health care; practice-based research; vulnerable populations https://doi.org/10.1370/afm.3117

The study aims to evaluate whether a collaborative intervention can help improve chronic pain-related outcomes in a primary care setting. The results indicate that pain treatment collaborative intervention resulted in modest and significant improvements in chronic pain.

Summary Graduate primary care mental health workers are part of the NHS strategy for improving the mental health of the primary care population This article describes the role and potential [...]

Purpose: For depressed older primary care patients, this study aimed to examine (a) characteristics associated with depression treatment preferences; (b) predictors of receiving preferred treatment; and (c) whether receiving preferred treatment predicted satisfaction and depression outcomes. Design and Methods: Data are from 1,602 depressed older primary care patients who participated in a multi-site, randomized clinical trial comparing usual care to collaborative care, which offered medication and counseling for up to 12 months. Baseline assessment included demographics, depression, health information, prior depression treatment, potential barriers, and treatment preferences (medication, counseling). At 12 months, services received, satisfaction, and depression outcomes were assessed. Results' More patients preferred counseling (57%) than medication (43%). Previous experience with a treatment type was the strongest predictor of preference. In addition, medication preference was predicted by male gender and diagnosis of major depression (vs dysthymia). The collaborative care model greatly improved access to preferred treatment, especially for counseling (74% vs 33% in usual care). Receipt of preferred treatment did not predict satisfaction of depression outcomes; these outcomes were most strongly impacted by treatment condition. Implications: Many depressed older primary care patients desire counseling, which is infrequently available in usual primary care. Discussion of treatment preferences should include an assessment of prior treatment experiences. A collaborative care model that increases collaboration between primary care and mental health professionals can increase access to preferred treatment. If preferred treatment is not available, collaborative care still results in good satisfaction and depression outcomes. Key Words: Treatment preferences, Depression, Primary care, Collaborative care, Counseling

This article analyzes the interactions through which primary-care nurses and patients accomplish patient weighing. The analysis is based on videotaped nurse adult patient interactions in clinics in the area of Southern California. Detailed examination of co-participants' naturally situated weighing conduct shows that parties recurrently deliver utterances that go beyond that required to accomplish weight measurement-precisely 'where' they 'are' within the weighing process shaping how they produce and understand these utterances. Using weighing as a locus of epistemic negotiation and potential affiliation, co-participants interactionally achieve the distribution of weight/weighing knowledge and the character of their social relationship. Confronting their numerical weight results in a social/medical setting, patients can use expansive weighing utterances to claim or demonstrate that they possess pre-existing knowledge regarding weight, asserting independent expertise vis-a-vis nurses and claiming result co-recipiency and co-ownership. Speakers can also use expansive utterances to proffer an interactional opportunity for affiliation, inviting recipients to collaborate in producing a more personalized encounter. Through the acceptance or declination of these invitations, the parties work out 'who' they 'are' to and for one another. Keywords: USA; Conversation analysis; Weight; Nurse-patient; Epistemic; Affiliation

In this cross-sectional qualitative study, researchers performed in-depth, semistructured interviews with 30 pairs of patients and their primary care providers in an outpatient clinic of a large, urban Veterans Affairs (VA) medical center in the United States. During audiotaped interviews to assess their understanding of advance directive concepts, participants were asked what 'life-sustaining treatment' means to them and why they think of it in the way they do. The findings indicate that patients and providers in the United States tend to view and discuss life-sustaining treatment in terms of four goals for end-of-life care: (1) extending the length of life, (2) improving the quality of life, (3) maintaining or improving specific biological functions, and (4) assisting the body for a temporary period of time. Patients thought providers were more concerned with extending the length of life than with quality-based outcomes, and patients often discussed life-sustaining treatment as acceptable means for short-term but not long-term use. Many providers indicated that they struggle with conflicting quality-based and physiologic care goals. The findings highlight the importance of eliciting patient preferences not only for specific types of treatment, such as cardiopulmonary resuscitation, but also for end-of-life care goals or desired health-related outcomes, such as maximizing the quantity of life. The findings also suggest that advance directives and patient-provider discussions that focus on acceptable health states and valued life activities may be better suited to patients' end-of-life care goals than those that focus on specific medical interventions. Keywords: USA; End-of-life care; Life-sustaining treatment; Advance care planning; Healthcare preferences; Qualitative research; Veterans

Numerous studies examine inequalities in health by gender, age, class and race, but few address the actions of primary care doctors. This factorial experiment examined how four patient characteristics impact on primary care doctors' decisions regarding coronary heart disease (CHD). Primary care doctors viewed a video-vignette of a scripted consultation where the patient presented with standardised symptoms of CHD. Videotapes were identical apart from varying patients' gender, age (55 versus 75), class and race, thereby removing any confounding factors from the social context of the consultation or other aspects of patients' symptomatology or behaviour. A probability sample of 256 primary care doctors in the UK and US viewed these video-vignettes in a randomised experimental design. Gender of patient significantly influenced doctors' diagnostic and management activities. However, there was no influence of social class or race, and no evidence of ageism in doctors' behaviour. Women were asked fewer questions, received fewer examinations and had fewer diagnostic tests ordered for CHD. 'Gendered ageism' was suggested, since midlife women were asked fewest questions and prescribed least medication appropriate for CHD. Primary care doctors' behaviour differed significantly by patients' gender, suggesting doctors' actions may contribute to gender inequalities in health. Keywords: Gender; Ageism; Health inequalities; Primary care; Decision-making; UK/US; Randomised experiment

Since the publication of A Vision for the Future (Department of Health (DH) 1993) there has been a range of initiatives aimed at introducing models of clinical supervision into the [...]

Talking to patients during consultations can often seem confusing, complex and a daunting experience for novice nurse practitioners. Theories and models have analysed the structure, process and outcomes that occurred [...]

In December 2002, Blackburn with Darwen primary care trust (PCT) appointed a community infection control nurse to work proactively with practice staff and provide expert advice and guidance on infection [...]

This survey covers the primary care management of a group of adults with epilepsy, in a geographical area with clear epilepsy management guidelines. Suggestions of methods to improve management of [...]

Depression in primary care is common and a major public health problem. It has been estimated that depressive disorders affect 1 5 per cent of the population at some level [...]

SUMMARY A systematic approach to helping patients quit smoking is being rolled out across primary health care, following a trial in Yorkshire and Humberside. Keywords Smoking cessation * Primary care [...]

The development of palliative care services, and the need to provide a patient-centred service, is a priority for primary care trusts (Department of Health (DH) 2003a). However, delivering such a [...]