Claire Collins

Background: Person-centeredness is a widely recognized key dimension of quality of care, but its implementation in primary care varies substantially. Understanding attitudes and challenges that support or hinder adoption is essential for effective integration. This paper explores general practitioners’/family physicians’ (GPs’) attitudes toward person-centered care (PCC) across 24 European countries and examines socio-demographic, professional, and work-related factors associated with these attitudes. Methods: An online self-reported survey was conducted among GPs across Europe. Attitudes were assessed with the Patient-Practitioner Orientation Scale (PPOS), a validated instrument scored from 1 to 6 where higher scores reflect a more patient-centered orientation, including the Caring and Sharing sub-scales. Because GPs were nested within countries, linear mixed-effects (multilevel) models were used with country as a random effect and practitioner- and practice-level characteristics as fixed effects. The intraclass correlation coefficient (ICC) quantified between-country variation. Analyses used cleaned data from the 24 countries available as of December 12, 2024. Results: In total, 3,691 GPs participated, and the mixed-model analysis of the PPOS total score included 3,370 respondents across 24 countries. Approximately 31% of the variance in PPOS total scores lay between countries (ICC = 0.31), indicating substantial cross-national variation. Regional grouping captured this variation better than EU integration status in descriptive comparisons; however, between-group variance was estimated from very few clusters and was therefore statistically unstable, thus exploratory. After adjustment, teaching involvement, specialist training in General Practice/Family Medicine, urban practice, an above-average share of psychiatrically vulnerable patients, and lower daily patient-contact volume were associated with higher (more patient-centered) scores, whereas higher perceived work-related stress, older age, and the least experience were associated with lower scores. Broadly similar patterns emerged for the Caring and Sharing sub-scales, with some dimensional differences. Conclusions: In this pan-European study, individual, professional, and practice-level factors were associated with GPs’ attitudes toward PCC, and a substantial share of the variation was attributable to differences between countries. Given the cross-sectional design and that PPOS measures attitudes rather than delivered care, results should be interpreted as associations at the attitudinal level. Identifying these factors may support strategies to foster person-centered attitudes across diverse European primary care settings. Trial registration: Not applicable.

Female general practitioners (GPs) often encounter diverse challenges in sustaining a career in general practice, in addition to those experienced by their male counterparts, which may have implications for workforce planning and retention in Ireland. To explore the experiences and expectations of female GPs regarding a sustainable career in general practice. Rooted in a constructivist paradigm, this qualitative study was conducted in Ireland. Thirteen online semi-structured interviews were conducted using 'Love and Breakup Letter' methodology as an elicitation prompt to facilitate discussion. Narratives were explored thematically. Participants viewed their GP role as an integral part of their identity. A career in general practice was found to be fulfilling, with a constant stream of new learning opportunities. The unique context of establishing long-term relationships with patients and having a supportive peer network was the primary motivation for pursuing and staying in this career. Yet, despite these benefits, dissatisfaction with the primary care system, competing family responsibilities and gender-driven challenges added further complexity to sustaining their careers. The incompatibility between work and family life has led many to adapt their careers, reducing clinical hours and pursuing diverse GP careers, to regain balance and manage competing demands. The career of a GP was treasured among women who chose this profession; however, system changes are needed to ensure the ideals of sustained and satisfying GP careers are upheld. Equipping GP graduates with skills to diversify their careers and promoting a strong peer-support network and mentoring opportunities are recommended.

Background: Acute Exacerbations of COPD (AECOPD) are frequently treated with antibiotics in primary care, leading to antibiotic resistance and adverse effects. Biomarkers might assist in reducing unnecessary antibiotic prescribing when used alongside clinical assessment. Aim: To evaluate the benefit in primary care of biomarkers point-of-care testing (POCT) in practices and laboratory blood tests in decreasing antibiotic prescribing for AECOPD. Design and Setting: This systematic review identified randomised controlled trials (RCTs) and non-randomised studies conducted in primary care settings, assessing POCTs for COPD. Method: The primary outcome was the rate of antibiotic prescribing or use, and secondary outcomes were biomarker thresholds for prescribing antibiotics and patient harm. We conducted searches from January 2022 until November 2025 in four medical databases, six registers and COPD academic societies, extracted data and assessed for quality and bias. Then we performed a meta-analysis whenever possible. Results: We included seven studies. For CRP POCT, there was one RCT, four non-randomised studies and for PCT in laboratories, two RCTs. The meta-analysis of CRP POCT indicated a significant reduction in antibiotic prescribing (OR=0.41; 95% CI: [0.32-0.53]; I²=36%) and low certainty of evidence. No meta-analysis for PCT was feasible. Conclusion: CRP POCT reduces antibiotic prescribing for AECOPD in primary care settings when used alongside with clinical assessment. There is insufficient data to draw conclusions about the PCT biomarker.

Background: Virtual consultations (VC) are now integral to primary care delivery, but their implementation has been hampered by technological limitations, user engagement issues, and the lack of validated implementation frameworks.Objective: This study sought to identify and validate key elements required for the successful adoption of high-quality VC and to develop recommendations for its implementation in primary care.Methods: An electronic Delphi (eDelphi) study was conducted between March and December 2024 with Primary Care Physicians (PCPs) from 24 countries who had experience using VC in routine practice. Participants assessed 25 proposed toolkit components across six domains using a 5-point Likert scale. Descriptive statistics were applied, and consensus was defined as ≥70% agreement.Results: A total of 135 PCPs participated across three Delphi rounds. Consensus was achieved for 24 of the 25 framework elements. High priority was placed on long-term strategic planning and financial sustainability, sustained investment in VC infrastructure, enhanced cybersecurity and system resilience, improved digital literacy, and clear communication strategies for end-users. The sole component failing to reach consensus related to religious factors affecting VC acceptability, with most participants favouring inclusion of religion within broader cultural considerations rather than as a separate element.Conclusion: This study validated key components of a flexible VC implementation framework for primary care. The lack of consensus on certain contextual factors highlights the importance of culturally sensitive adaptation when implementing VC. Future work should focus on real-world piloting of the framework to evaluate its effectiveness at practice, policy, and system levels.

Background: General practitioners (GPs) in the Republic of Ireland have historically faced limited access to diagnostic imaging. A new national initiative allowing GPs to refer patients to private providers for imaging studies may alter referral patterns and improve patient care. Aims: This exploratory study aimed to evaluate the perceived impact of expanded GP access to diagnostic imaging on referral patterns and patient care quality in Irish primary care. Methods: A cross-sectional analysis was conducted of 620 diagnostic imaging referrals from 45 GP clinics across all Community Health Organization (CHO) regions, spanning June 2021 to August 2022. Data included imaging modalities (X-ray, DEXA, CT, MRI), referral frequencies to emergency departments (EDs), acute medical units (AMUs), outpatient clinics, and GP perceptions of care quality. GPs also provided retrospective assessments of how they would have managed each case prior to the initiative. Results: ED and AMU referrals decreased by 89%, while outpatient clinic referrals declined by 53%. Concurrently, management of cases within GP settings rose substantially. In total, 91% of participating GPs reported improved patient care quality, citing more timely and accessible imaging as a key factor. Conclusion: Despite the study’s exploratory design and reliance on retrospective GP assessments, these findings suggest that broadening GP access to diagnostic imaging may reduce hospital-based referrals and enhance patient care. Ongoing monitoring and further research are recommended to confirm the long-term impacts and sustainability of this initiative.

Expanding access to self-management via Digital Health Technologies may supplement traditional care, mitigating pressures on primary care through self-management. Primary Care Physicians (PCP) can play a critical role in the integration of digital health technologies into patient care, but it is unclear what factors influence PCPs' recommendation of such technologies. To identify the factors associated with PCPs recommending digital health technologies to patients for self-management before and during the pandemic. PCPs across 20 countries completed an online questionnaire between June and September 2020. The outcome was a self-report of recommending patients to at least one of six listed forms of digital health technologies. Univariable logistic regression models were performed to explore factors associated with recommending digital health technologies to patients before and during the pandemic. 1,592 PCPs were included. Before the pandemic, the odds of recommending digital health technologies for self-management were lower for PCPs not involved in teaching, or practising in Turkey, Australia, Chile, Colombia, France, Italy, Poland, Portugal, Slovenia, and Spain. During the pandemic, PCPs practising in rural settings had higher odds of starting to recommend digital health technologies, as well as those from Brazil, Colombia, and Italy. There was no significant difference in recommending digital health technologies before and during the pandemic. Involvement in teaching (pre-pandemic) and practising in a rural setting (during the pandemic) positively influenced the recommendation of digital health technologies. Significant variation in recommending digital health technologies was present across countries.

Objective: A dashboard was developed with and for Irish general practitioners (GPs) to improve their understanding of practice data. The aim of this study was to design and develop interactive CARA dashboards to enable Irish GPs to visualise patient data and compare their data with other practices. Design: An interpretivist qualitative approach was taken to create a deeper understanding of how GPs view and engage with data. It included four stages: (a) problem formulation, (b) building, intervention and evaluation, (c) reflection and learning and (d) formalisation of learning. The process included interviews to explore what type of information GPs need, as well as iterative testing of the CARA dashboard prototype. Setting: General practice. Participants: GPs, design experts and domain experts (antibiotic prescribing and stewardship). Results: Key challenges identified from the interviews (context, sense-making, audits, relevance, action, engagement and ease of use) formed the basis for developing the CARA dashboard prototype. The first exemplar dashboard focused on antibiotic prescribing to develop and showcase the proposed platform, including automated audit reports, filters (within-practice) and between-practice comparisons, as well as a visual overview of practice demographics. The design thinking approach helped to capture and build an understanding of the GPs’ perspectives and identify unmet needs. This approach benefits the quality improvement methodology commonly adopted across healthcare, which aims to understand the process, not the users. Conclusions: The development of a useful dashboard is based on two key elements: users’ requirements and their continued involvement in the development of content and overall design decisions. The next step will be an incremental inclusion of GPs using the dashboard and an exploratory study on dashboard engagement. Additional dashboards, such as for chronic disease, will be developed.

Background: Virtual consultations represent a notable change in health care delivery following the COVID-19 pandemic. Understanding the dynamics of virtual consultations is critical in assessing health care system resilience and adaptability in times of crisis. Objective: This study aimed to describe the availability and hours of use of telephone, video, and human chat consultations before and during the COVID-19 pandemic period, and identify factors associated with their availability. Methods: Primary care physicians (PCPs) from 20 upper-middle– and high-income countries completed a cross-sectional web-based survey in 2020. Factors associated with availability were investigated using chi-square tests and effect size (ES) estimates calculated using Cramer V. Results: A total of 1370 PCPs were included in this study (85.4% of the total sample of 1605). Telephone consultations were the most frequently available type of virtual consultations before and during the pandemic (73.1% and 90.4%, respectively). Significant increases in availability and use were observed during the pandemic for all the types of virtual consultations. The largest absolute increase in availability was observed for video consultations (39.5%), followed by telephone (17.3%) and chat (8.6%; all P<.001). The largest increase in use was observed for telephone consultations (+11 hours per week, P<.001). Digital maturity of the practice was weakly associated with availability of video consultations both before (ES 0.2) and during (ES 0.2) the pandemic (P<.001 for both), and with chat consultations before the pandemic only (ES 0.1, P=.001). Greater availability of video and chat consultations was found in PCPs who had completed digital health training, both before and during the pandemic (P<.001 for all). There was significant country-level variation in the use and availabilities of the technologies between both time periods. The association between country and the availability of telephone consultations changed from strong (ES 0.5, P<.001) to weak (ES 0.2, P=.03), while the relationship between country and video consultations changed from moderate (ES 0.3, P<.001) to strong (ES 0.5, P<.001). Conclusions: Our study demonstrates the transformative impact of the COVID-19 pandemic on the availability of virtual consultations globally, and how practice-level factors, predominantly digital maturity, digital health training, and country, were associated with the availability of virtual consultations. Further exploration of drivers of availability, particularly at the national level, is needed to ensure sustained and effective implementation of virtual consultations. International Registered Report Identifier (IRRID): RR2-10.2196/30099

Person-centred care (PCC) is a fundamental principle in general practice, emphasising practices tailored to individual patient preferences, needs, and values. Despite the importance of PCC, general practitioners (GPs) face obstacles in effectively implementing it, with associated factors remaining unclear. The PACE GP/FP study aims to explore GPs' attitudes towards PCC and the factors facilitating or hindering its implementation in daily practice across European countries. This paper outlines the PACE GP/FP study protocol. The cross-sectional design with data collection via an online survey distribution to GPs in 24 European countries. Study instruments include two validated questionnaires (Perceived Stress Scale (PSS) and Patient Physician Orientation Scale (PPOS)) and additional items covering general information about the doctor and their practice, as well as facilitators and barriers to PCC. These additional items were specifically developed for the study, translated using the forward-backward method, evaluated through cognitive debriefing, and integrated into the REDCap platform to create language and country-specific survey links. The STROBE checklist guides the reporting of the manuscript. The PACE GP/FP study will provide a comprehensive exploration of GPs' attitudes towards PCC and the factors shaping its practice in Europe. The findings from the PACE GP/FP study will provide evidence for designing future implementation strategies and guide targeted interventions to promote PCC in primary care across Europe.

The COVID-19 pandemic posed severe challenges to delivery of services at Primary Care level and for achieving follow-up of patients with chronic diseases. We analysed data from the PRICOV-19 study to explore determinants of active follow-up for chronic disease patients in seven Central and Eastern European (CEE) countries during the pandemic. Pricov-19 was a cross-sectional study conducted within PC (Primary Care) practices in 37 European countries. We analysed data from 7 CEE countries (Bulgaria, Czech Republic, Hungary, Poland, Moldova, Romania, Ukraine) collected between November 2020 and December 2021. Practices were recruited through random or convenience sampling and participation of practices was voluntary. We performed descriptive statistics to identify the level of follow-up of chronic disease and what health system and practice-specific factors were associated with better follow-up. We used logistic regression and meta-analysis techniques to explore associations and heterogeneity between countries. 67.8% out of 978 practices reported actively following up chronic patients. Positive associations were found between active follow-up and such as having more GPs (aOR = 1.18, p-value = 0.005), an above-average chronic patient population (aOR = 3.13, p-value = 0.006), adequate government support (aOR = 2.35, p-value = 0.001), and GPs having time for guideline reading (aOR = 0.008, p-value = 1.71). Patient follow-up, was influenced by different health system and practice-specific factors. The implications suggest the need for government support to enhance PC practice organisation during crises and solutions to decrease GP workload and provide tailored care for patients with chronic disease.