The study examines perspectives of patients in home hospice care; their informal caregivers; palliative health-care providers (HCPs); and family physicians, all regarding patients’ unmet needs and quality of life (QoL)-related concerns.

Participants from all 4 groups were approached within 2 months after the patient’s admission to the home hospice care unit. Participants completed Edmonton Symptom Assessment Scale (ESAS) and Measure Yourself Concerns and Wellbeing (MYCAW) questionnaires, for patient’s QoL-related concerns. Qualitative analysis of short narratives was conducted using ATLAS.ti software for systematic coding.

In total, 78 participants completed the study questionnaires: 24 patients, 22 informal caregivers, 22 palliative HCPs, and 11 family physicians. Informal caregivers gave higher scores (i.e., greater severity) than patients for fatigue on ESAS (p = 0.009); and family physicians lower scores than patients for ESAS drowsiness (p = 0.046). Compared with patients, palliative HCPs gave higher scores for patient emotional-spiritual concerns (77.2% vs. 41.7%, p = 0.02); lower scores for gastrointestinal concerns (p = 0.048); and higher scores for overall function (p = 0.049). Qualitative assessment identified a gap between how patients/informal caregivers vs. palliative HCPs/family physicians regard emotional-spiritual themes, including discussing issues related to death and dying.

The findings of the present study suggest that exploring a multifaceted cohort of home hospice patients, informal caregivers, palliative HCPs, and family physicians may provide insight on how to reduce communication gaps and address unmet needs of patients, particularly regarding emotional and spiritual concerns.

While the 4 groups were similar in their scoring of patient QoL-related concerns, there were discrepancies for some concerns (e.g., patient fatigue) and expectations regarding the need to discuss emotional and spiritual concerns, including on death and dying. Educational initiatives with programs providing training to all 4 groups may help bridge this gap, creating a more open and collaborative hospice care environment.

To assess the opinions of physicians working in family physician teams regarding COVID-19 (threat perception, overall work satisfaction, patient satisfaction with services provided, patient access to services, and the need for new tools for service provision).

An anonymous survey of physicians (N = 191) working in family physician teams. Questionnaires were distributed among family physicians with the permission of the managers of their institutions and were collected by the lead researcher within 1–8 weeks. The quantitative study was conducted from 21 June 2021 to 17 September 2021. In total, 398 questionnaires were distributed, yielding a response rate of 48%, or 9% of the total population. Thirty-nine primary health care institutions (PHCIs) were randomly selected for the study: 11 public and 28 private.

Older respondents and those with more years of work experience strongly agreed that the COVID-19 pandemic threatened their lives and safety, as well as that of their colleagues. Work satisfaction decreased during the pandemic among older respondents, those with more years of work experience, and those who had been employed at their current institution for longer. Respondents with more work experience believed that patient satisfaction with the services provided by their family medical institution decreased. Older respondents with more work experience asserted that patient access to services decreased during the pandemic. Physicians working further away from urban centers indicated a greater need for new tools in the effort to provide consultations compared to city-based physicians.

The current health care crisis prompted by the COVID-19 pandemic is defined by the perception of threats to life and safety among physicians, an overall drop in their work satisfaction, decreased patient satisfaction with services provided, reduced patient access to services, and a greater need for new tools for providing consultations.

A physicians work is closely related to patients and the understanding of their problems. The use of psychotherapeutic methods is a factor for successful care (Swanson, 1994). At the same time burnout is a syndrome that can affect the health of doctors themselves thus reflecting on the quality of care they can provide (Lloyd et al, 2002).

To investigate the use of psychotherapeutic methods in family physicians work in Latvia and the association between burnout rates and the use of these methods in practice as well as different demographic and work-related factors.

A cross sectional study was carried out. An anonymous online form that contained questions about the demographic data, psychotherapeutic methods/techniques mastering and usage and questions from the Maslach Burnout Inventory was sent out to the publicly available email addresses of family physicians in Latvia. The collected data was analyzed using Microsoft Excel and IBM SPSS software.

Together 54 responses were received from all regions of Latvia. The analysis found association between work hours per week, patients seen per week, usage of psychotherapeutic methods and burnout. More hours per week was associated with higher rates of depersonalization (p=0,014) and burnout (p=0,010). More patients per week was associated with higher rates of burnout (p=0,024). Being unsure if they were using any psychotherapeutic methods was associated with higher rates of depersonalization (p=0,028).

The data obtained allows a better insight in to the usage of psychotherapeutic methods, everyday work and the association with burnout rates in family physicians.

Family medicine practitioners (FMP) take care of a varied range of patients with undifferentiated conditions over a lifetime. Although it was incepted in Saudi Arabia in 1980, limited data exists on FMP. This paper explores what family physicians deem relevant.

A cross-sectional survey was conducted among FMP in Saudi Arabia in 2018–2019 who responded to an online questionnaire that listed 20 activities usually done by FMP asking them to rate their meaningfulness on a 5-point Likert Scale, and select the top 3 they would like to spend the most and the least time on. Chi-square statistics were used to compare preference for time spent on these six activities by participant characteristics

Of the 415 survey participants, the majority were male (246) and had a Bachelor’s degree (176). The management of risk conditions, follow-up of chronic illnesses and running preventive health clinics were listed as most meaningful. The majority wished to spend more time on managing health risks, handling daily common complaints and follow-up of chronic illnesses and less time on terminal care activities (46.8%), emergency care (32.3%) and addiction medicine (23.4%). Bachelor’s degree holders wished to spend more time on emergency care compared to Diploma, Board-certified and Fellowship holders (63%, 21%, 10% and 5%, respectively; P = 0.01).

The activities preferred by FMP align with prevailing disease epidemiology. Variations in preferences of ‘managing emergencies’ reflect the varied format of training. Training of FMP should be standardized and further studies investigate reasons for specific preferences.

In our study, we intended to observe the impact of recommending the pneumococcal vaccine to individuals who were called on the phone or interviewed face-to-face by their doctors on vaccination rates.

Two hundred individuals who were 65 years old and older were included in our study. They were questioned about their awareness regarding adult immunisation, and their knowledge level and vaccination statuses were determined regarding the tetanus, influenza, hepatitis, and pneumococcal vaccines. After they were given information about the pneumococcal vaccine, they were asked about their interest in being vaccinated. Those who agreed to be vaccinated were invited and vaccinated.

According to the questionnaire, 150 people (75%) knew of the influenza vaccine, 130 people (65%) knew of the tetanus vaccine, 53 people (26.5%) knew of the hepatitis B vaccine, and 49 people (24.5%) knew of the pneumococcal vaccine. A total of five people (2.5%) had received the pneumococcal vaccine. Fifty-eight of 97 patients (59.8%) who completed the questionnaire during a phone call and 84 of 103 patients (81.6%) who completed the questionnaire during a face-to-face interview received the pneumococcal vaccine. As a result, the rates of pneumococcal vaccination increased from 2.5% before the study to 73.5% after the study.

The findings show that the vaccination rates for pneumococcus were very low among our participants. The immunisation rates increased when doctors provided consultation to participants about adult immunisation.

The Alma-Ata Declaration was a big step in the development of primary care, defining the main tasks and populations’ expectation. Celebrating the 40th year’s anniversary is a good opportunity to make an analysis. Development of primary care was not parallel in the Eastern and Western part of Europe.

To provide an overview on the societal and economic situation, structural and financial changes of healthcare systems in the former ‘Soviet bloc’ countries, to present an analysis of the primary healthcare (PHC) provision and to find relationships between economic development and epidemiological changes of the respective countries.

Epidemiological data, healthcare expenditures and structure, and financing schemes were compared; systematic literature search was performed.

Visible improvements in population health, in the national economic condition, structural changes in healthcare and more focus to primary care were experienced everywhere. Higher life expectancies with high inter-country variation were observed in the former ‘Soviet bloc’ countries, although it could not be clearly linked to the development of healthcare system. PHC provision improved while structural changes were rarely initiated, often only as a project or model initiation. Single-handed practices are yet predominant. The gate-keeping system is usually weak; there were no effective initiatives to improve the education of nurses and to widen their competences. Migrations of workforce to Western countries become a real threat for the Central-East European countries.

Lack of coordination between practices and interdisciplinary cooperation were recognized as the main barriers for further improvement in the structure.

Family practice aims to recognize the health problems and needs expressed by the person rather than only focusing on the disease. Documenting person-related information will facilitate both the understanding and delivery of person-focused care.

To explore if the patients’ ideas, concerns and expectations (ICE) behind the reason for encounter (RFE) can be coded with the International Classification of Primary Care, version 2 (ICPC-2) and what kinds of codes are missing to be able to do so.

In total, 613 consultations were observed, and patients’ expressions of ICE were narratively recorded. These descriptions were consequently translated to ICPC codes by two researchers. Descriptions that could not be translated were qualitatively analysed in order to identify gaps in ICPC-2.

In all, 613 consultations yielded 672 ICE expressions. Within the 123 that could not be coded with ICPC-2, eight categories could be defined: concern about the duration/time frame; concern about the evolution/severity; concern of being contagious or a danger to others; patient has no concern, but others do; expects a confirmation of something; expects a solution for the symptoms without specification of what it should be; expects a specific procedure; and expects that something is not done.

Although many ICE can be registered with ICPC-2, adding eight new categories would capture almost all ICE.

To explore the current status of academic primary care research in Arab countries and investigate the barriers to its adequate implementation.

Research is an essential building block that ensures the advancement of the discipline of Family Medicine (FM). FM research thus ought to be contributed to by all family physicians; nevertheless, its development is being hindered worldwide by several challenges. The amount of research conducted by academic academic family physicians and general practitioners is scant. This phenomenon is more pronounced in the Arab countries.

An online questionnaire was emailed to all academic family physicians practicing in member Arab countries of the World Organization of Family Doctors WONCA-East Mediterranean Region.

Seventy-six out of 139 academic family physicians from eight Arab countries completed the questionnaire. Around 75% reported that they are required to conduct research studies, yet only 46% contributed to at least one publication. While 75% and 52.6% disclosed their interest in participating in a research team and in leading a research team respectively, 64.5% reported being currently involved in research activities. Of all, 56% have attended a research ethics course. Lack of training in research, the unavailability of a healthcare system that is supportive of research, insufficient financial resources, and the unavailability of electronic health records were perceived as major barriers in conducting FM research.

Although many physicians in Arab academic institutions expressed enthusiasm to conduct research projects, FM research infrastructure remains to be weak. This demonstrates the need for immense efforts from different parties particularly governments and academic institutions.

We explored potential barriers to adoption of recommended screening for autism by family physicians at 18- and 24-month well-child visits.

The American Academy of Pediatrics recommends early detection and intervention of autism through the use of a standardized autism-specific screening tool on all children at the 18- and 24-month well-child visits. However, not all family physicians screen for autism.

Three focus groups and six semi-structured interviews were conducted with 15 family physicians in the Kansas City metropolitan area. Verbatim transcripts were inductively coded; data were analyzed using standard text analysis.

Participants had differing views on the increased incidence of autism. Most participants attributed the increase to changes in diagnostic criteria. There was no consensus on the benefit of implementing universal screening for autism during the 18- or 24-month visit. Many preferred to identify potential problems through general developmental assessments and observations. No participants used specific screening tools for autism, and only one participant was aware of such a tool (M-CHAT). Lack of adequate training on child development and screening methods as well as limited availability of community-based resources to manage children with autism was seen as major barriers to routine screening. Suggested solutions included working toward a stronger evidence base, improving physician training and continuing education, and making systemic changes in healthcare. In conclusion, universal screening for autism at the 18- and 24-month visits is not widely accepted, nor is it implemented by family physicians.

To introduce systems biology as a conceptual framework for research in family medicine, based on empirical data from a case study on the prediction of influenza vaccination outcomes. This concept is primarily oriented towards planning preventive interventions and includes systematic data recording, a multi-step research protocol and predictive modelling.

Factors known to affect responses to influenza vaccination include older age, past exposure to influenza viruses, and chronic diseases; however, constructing useful prediction models remains a challenge, because of the need to identify health parameters that are appropriate for general use in modelling patients’ responses.

The sample consisted of 93 patients aged 50–89 years (median 69), with multiple medical conditions, who were vaccinated against influenza. Literature searches identified potentially predictive health-related parameters, including age, gender, diagnoses of the main chronic ageing diseases, anthropometric measures, and haematological and biochemical tests. By applying data mining algorithms, patterns were identified in the data set. Candidate health parameters, selected in this way, were then combined with information on past influenza virus exposure to build the prediction model using logistic regression.

A highly significant prediction model was obtained, indicating that by using a systems biology approach it is possible to answer unresolved complex medical uncertainties. Adopting this systems biology approach can be expected to be useful in identifying the most appropriate target groups for other preventive programmes.

Kosovo is a post-conflict nation with an extensively damaged infrastructure, a weak primary care base, and poor maternal-child health outcomes. The Kosovo-Dartmouth Alliance for Healthy Newborns (the Alliance) sought to improve maternal and neonatal health in Kosovo by providing family medicine-based antenatal care (ANC).

The ANC Program used a modification of the World Health Organization's four-visit, prenatal care model. The program is based in family medicine and requires minimal medical equipment, such as a blood pressure cuff, fetal doppler, measuring tape, urine dipstick, and charting materials. Patient education and counseling are stressed. Women are taught about danger signs in pregnancy and establishing an emergency plan, so that they can respond promptly if complications occur. Antenatal care doctors and nurses are trained to refer women to obstetricians for deviations from normal pregnancy. The providers are taught using a “Training of Trainers” approach, building on an existing system of family medicine trainers. In order to address challenges in implementation and sustainability, microsystems methodology is used to focus on implementing change and assuring quality improvement through shared decision-making and the study of outcomes.

Based on chart reviews and direct observation, ANC providers showed mastery of the components of ANC, including physical examination, recognition and referral of high-risk pregnancies, and patient education. After an initial pilot project, Kosovo's Ministry of Health recommended this program for dissemination throughout the country. During the next year, ANC was implemented at 27 Family Medicine Centers in nine municipalities; 1,671 women were seen for a total of 3,399 visits. Currently, the Alliance's model of ANC is offered in 30% of Kosovo's municipalities.

International aid projects often lack attention to long-term sustainability. Microsystems training gives participants the tools and framework to implement and sustain change, even after international support is withdrawn.

The Alliance's model of family medicine-based ANC is simple to teach and emphasizes sustainability. It may be modified for use in different cultures and healthcare systems and offers the opportunity to improve maternal and infant health by providing low cost antenatal care, available in a woman's own community.

Health care systems are changing around the world; family doctors need to adapt and prepare for future challenges.

To consider the present status of family doctors, anticipated changes in health care systems, the challenges these will bring and possible solutions.

Collaborative enquiry amongst members of the International Federation for Primary Care Research Networks (IFPCRN). Six strategic questions were addressed by 37 contributors from 23 countries. Responses were collated and contributors invited to further comment on the interim report.

Present status: Despite wide variability, common problems relate to delivery systems, funding and policy, lack of evidence-based medical practice, education and research. Role of family doctors: There is wide variability in roles and often poor interaction with other caregivers. Anticipated changes: An expansion of the family physician model is anticipated, alongside shortages of family doctors in the face of increased health care needs, increased complexity of problems and the shift to ambulatory care. Advances in information technology may be useful. Anticipated challenges and proposed actions: Address quality issues. This requires audit and quality assurance, promoting adaptability, promoting group practices and teamwork, coordinating care, incorporating information technology and ensuring ethical relationships with industry. Improve education and continuing professional development: Improved education and continuing professional development are needed, as are measures to prevent burnout and retain the workforce. Develop a robust research enterprise: Research in primary care is needed to develop relevant guidelines. Improve support for family doctors: Providing excellent patient care is essential for improved status and support. Achieving this requires engagement with policy makers, academic institutions and the public.

While there is great variability across different countries, common themes relate to present status, anticipated changes in health systems and the responses needed from family medicine.