The funding of primary care is subject to intense debate internationally. Three main funding models predominate: capitation, pay-for-performance, and fee-for-service. A number of systematic reviews regarding the effect of primary care funding structures have been published, but not synthesized through an equity lens. Given the urgent need for evaluating funding models and addressing inequalities, a reliable, synthesized evidence base concerning the effects of funding on inequalities is imperative.

This umbrella review aims to systematically evaluate all systematic reviews available on the effect of different primary care funding models in high-income countries on inequalities in funding, access, outcomes, or experience from inception until 2024.

Three databases (MEDLINE, EMBASE, Cochrane) and a machine learning living evidence map were searched. Abstracts and titles were double screened, before two authors independently screened full texts, extracted data, and performed quality assessments utilizing the AMSTAR2 tool.

The search identified 2480 unique articles, of which 14 were included in the final review. Only one review compared reimbursement systems; capitation systems were more equitable between ethnic groups compared to pay-for-performance in terms of primary care access, continuity, and quality. Twelve reviews reviewed the impact of the introduction of pay-for-performance models, predominantly focusing on the Quality and Outcomes Framework (QOF) in the UK. Synthesized findings suggest that QOF’s introduction coincided with reduced socioeconomic health inequalities in the UK overall, but not in Scotland. Overall, inequalities in age narrowed, but inequalities measured by sex widened. One review found evidence that targeting funding for minority groups, with poorer health, was effective. A further review found that introducing privately provided general practices in Sweden and allowing patients to choose these over public-owned options generally benefitted those with higher income and lower health needs. We identify a range of gaps in the literature, which should inform future research.

Childhood morbidity is a precursor and contributor to under-five child mortality. Community-based primary healthcare programs are culturally responsive and low-cost strategies for delivering maternal and child health services in rural communities.

To evaluate the equity effect of the Ghana Essential Health Intervention Program (GEHIP) – a five-year community-based primary healthcare program – on childhood morbidity.

GEHIP was implemented in the Upper East region of Northern Ghana. Household baseline and end line surveys conducted in 2010/2011 and 2014/2015, respectively, from both intervention and comparison districts were used to assess three childhood morbidity conditions: maternal recall of neonatal illness, the incidence of diarrhoea, and fever. Difference-in-differences analysis, mean comparison test, and multivariate logistic regressions are used to assess the effect of GEHIP exposure on these three childhood morbidity conditions.

Baseline sample data of 2,911 women and end line sample of 2,829 women were included in this analysis. There was generally more reduction in all three childhood morbidity conditions in intervention communities relative to comparison communities. Diarrhoea and fever had a statistically significant treatment effect (AOR = 0.95, p-value<0.01 and AOR = 0.94, p-value<0.001). Results of equity analysis indicate significant mean reductions for both the poor and non-poor for neonatal illness and diarrhea, while only the intervention group had a significant reduction for both poor and non-poor for fever. Regression analysis shows no significant equity/inequity effects of GEHIP on the incidence of diarrhoea and fever. Neonatal illness, however, shows significant effects of wealth within the intervention group.

This study shows that GEHIP contributed significantly to childhood morbidity reduction. This implies that community-based strategies have the potential to improve child health and contribute to the attainment of the United Nations sustainable development goal related to child health. Specific targeted measures are recommended to ensure both the poor and relatively better-off benefit from interventions.

To report on the design and results of an innovative nurse practitioner (NP)-led specialist primary care service for children facing housing instability.

During 2017–2018, children aged 0–14 years represented 23% of the total population receiving support from specialist homeless services in Australia. The impact of housing instability on Australian children is considerable, resulting in disengagement from social institutions including health and education, and poorer physical and mental health outcomes across the lifespan. Current services fail to adequately address health and educational needs of children facing housing insecurity. Research identifies similar circumstances for children in other high-income countries. This paper outlines the design, and reports on results of, an innovative NP-led primary care service for children facing housing instability introduced into three not-for-profit faith-based services in one Australian state.

Between 2019 and 2021, 66 children of parents experiencing housing instability received standardized health assessment and referral where appropriate by a NP. Data from the standardized tool, such as condition and severity, were recorded to determine common conditions. In addition, comprehensive case notes recorded by the NP were used to understand potential causes of conditions, and referral needs, including potential barriers.

The 66 children assessed were aged between 7 weeks to 16 years. Developmental delay, low immunization rates, and dental caries were the most common conditions identified. Access to appropriate services was inhibited by cost, disengagement, and COVID-19.

Given their advanced skills and knowledge, embedding NPs in specialist homeless services is advantageous to help vulnerable children.

The aim of this study was to perform a systematic literature review of the purpose, design, and use of family trees by family physicians (FPs).

Family trees offer a valuable contribution to understanding the relevance of the patient’s family history in comprehensive primary healthcare provision. There is little research on the role of family trees in the everyday practice of FPs. Studies often focus on specific diseases and their context: however, a comprehensive exploration of the usefulness of family trees is crucial for FPs.

A systematic literature review was conducted through a keyword search in the PubMed and Cochrane databases. Based on the inclusion and exclusion criteria selected, 24 studies were identified and a qualitative analysis was performed.

A total of 369 publications were identified across 32 fields. Twenty-four studies were included in the final analysis according to the QUOROM statement. The results underscore the role of family trees and highlight the value of this tool’s multidimensionality. The use of this tool directs FPs to consider a genetic cause and a possible referral to a geneticist. The value of a family tree lies in the personalized patient-oriented treatment in connection with hereditary risks for chronic diseases. For FPs, the greatest challenge in treating patients is determining their risk of developing a chronic disease or cancer. Using a family tree can improve the quality of their healthcare.

Cardiovascular disease (CVD) poses a substantial global health burden, necessitating effective and scalable interventions for primary prevention. Despite the increasing recognition of peer-based interventions in managing chronic diseases, their application in CVD prevention still needs to be explored.

We describe the protocol of a quasi-experiment to evaluate the effectiveness of a peer-led digital health lifestyle intervention, MYCardio-PEER, for a low-income community at risk for CVD. This study aims to assess the effectiveness of MYCardio-PEER in improving the participants’ knowledge, lifestyle behaviours and biomarkers related to CVD. Secondarily, we aim to assess the adherence and satisfaction of participants towards MYCardio-PEER.

A minimum total sample of 68 low-income community members at risk for CVD will be recruited and allocated either to the control group or the intervention group. Participants in the control group will receive standard lifestyle advice and printed materials for CVD prevention, while the intervention group will participate in the 8-week MYCardio-PEER intervention program. The participants will be assessed at Week 0 (baseline), Week 8 (post-intervention) and Week 20 (post-follow-up).

We anticipate a net improvement in CVD risk score, besides investigating the effectiveness of the intervention program on CVD-related knowledge, biomarkers, and diet and lifestyle behaviours. The successful outcome of this study is essential for various healthcare professionals and stakeholders to implement population-based, cost-effective, and accessible interventions in reducing CVD prevalence in the country.

Trial registration: ClinicalTrials.gov (NCT06408493)

The use of technology including digital decision support tools has become more ubiquitous in general practice. Australian GPs’ use of digital decision support tools, the sentiments, and associations with practitioner and practice characteristics. Positive and negative sentiments were considered facilitators and barriers to the uptake of digital decision support tools.

Secondary analysis of a cross-sectional study was undertaken with data from the Medicine in Australia: Balancing Employment and Life (MABEL) survey was analysed. 3,126 GPs responded from a total of 27,829 participants representing all types of physicians, surveyed in September 2018. Descriptive statistics was used to examine facilitators and barriers to GP uptake of digital decision support tools, and multivariable logistic regression was used to examine its associations with practitioner and practice characteristics.

2240 GPs in this study (83.8%) reported using digital decision support tools with largely positive sentiments regarding technology use in consultations. Reservations include privacy concerns, system incompatibility, and lack of support. Those using digital decision support tools were more likely to be female, younger and bulk-billing.

Perceived facilitators of digital decision support tools in Australian general practice include improvements in patient outcomes, satisfaction, care processes, and saving time. Barriers include concerns about data privacy, lack of support, incompatibility, and being time-consuming. There was higher uptake amongst bulk-billing and female practitioners. Further research on the clinical usefulness of digital decision support tools and its impact on decision-making in general practice would be of value.

Diabetes is a global health concern, and early identification of high-risk individuals is crucial for preventive interventions. Finnish Diabetes Risk Score (FINDRISC) is a widely accepted non-invasive tool that estimates the 10-year diabetes risk. This study aims to validate the FINDRISC in the Turkish population and develop a specific model using data from a nationwide cohort.

The study used data of 12249 participants from the Türkiye Chronic Diseases and Risk Factors Survey. Data included sociodemographic variables, lifestyle factors, and anthropometric measurements. Multivariable logistic regression was employed using FINDRISC variables to predict incident type 2 diabetes mellitus (T2DM). Two country-specific models, one incorporating the waist-to-hip ratio (WHR model) and the other waist circumference (WC model), were developed. The least absolute shrinkage and selection operator (LASSO) algorithm was used for variable selection in the final models, and model discrimination indexes were compared.

The optimal FINDRISC cut-off was 8.5, with an area under the curve (AUC) of 0.76, demonstrating good predictive performance in identifying T2DM cases in the Turkish population. Both WHR and WC models showed similar predictive accuracy (AUC: 0.77). Marital status and education were associated with increased diabetes risk in both country-specific models.

The study found that the FINDRISC tool is effective in predicting the risk of type 2 diabetes in the Turkish population. Models using WHR and WC showed similar predictive performance to FINDRISC. Sociodemographic factors may play a role in diabetes risk. These findings highlight the need to consider population-specific characteristics when evaluating diabetes risk.

To assess the impact of a person-centred culturally sensitive approach in primary care on the recognition and discussion of mental distress in refugee youth.

Refugee minors are at risk for mental health problems. Timely recognition and treatment prevent deterioration. Primary care is the first point of contact where these problems could be discussed. However, primary care staff struggle to discuss mental health with refugees.

Guided by the needs of refugees and professionals we developed and implemented the Empowerment intervention, consisting of a training, guidance and interprofessional collaboration in four general practices in the Netherlands.

This mixed-method study consisted of a quantitative cohort study and semi-structured interviews. The intervention was implemented in a stepped wedge design. Patient records of refugee youth and controls were analysed descriptively regarding number of contacts, mental health conversations, and diagnosis, before and after the start of the intervention.

Semi-structured interviews on experiences were held with refugee parents, general practitioners, primary care mental health nurses, and other participants in the local collaboration groups.

Findings:

A total of 152 refugees were included. Discussions about mental health were significantly less often held with refugees than with controls (16 versus 38 discussions/1000 patient-years) but increased substantially, and relatively more than in the control group, to 47 discussions/1000 patient-years (compared to 71 in the controls) after the implementation of the programme.

The intervention was much appreciated by all involved, and professionals in GP felt more able to provide person-centred culturally sensitive care.

Person-centred culturally sensitive care in general practice, including an introductory meeting with refugees, in combination with interprofessional collaboration, indeed results in more discussions of mental health problems with refugee minors in general practice. Such an approach is assessed positively by all involved and is therefore recommended for broader implementation and assessment.

The implementation of South Africa’s maternal care guidelines is still subpar, especially during the postnatal periods, despite midwives playing a key part in postnatal care for women and their newborns. This article aimed to pinpoint the obstacles to and enablers of midwives’ roles in putting South Africa’s maternal care recommendations for postnatal health into practice.

A scoping review was conducted following Arksey and O’Malley method. Systematic searches were conducted using the PsycINFO, Nursing and Allied Health (CINAHL), PubMed, EBSCOhost web, and Google Scholar. The screening was guided by the inclusion and exclusion criteria. Data were analyzed using the Braun and Clarke method for thematic content analysis and included 22 articles. The quality of included studies was determined by Mixed Method Appraisal Tool and these were reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analysis for Scoping Review.

There is a gap between inadequate postnatal care services provision and suboptimal implementation of maternal recommendations. Owing to a lack of basic knowledge about the guidelines, an absence of midwives in the maternity units, inadequate facilities and resources, a lack of drive and support, inadequate training of midwives in critical competencies, and poor information sharing and communication. Maintaining qualified midwives in the maternity units and providing them with training to increase their capacity, knowledge, and competencies on the guidelines’ critical information for managing postnatal complications and providing high-quality care to women and their babies is necessary to effectively implement the recommendations.

The relative success in implementing maternal care guidelines in South Africa lies in the contextual consideration of these factors for the development of intersectoral healthcare packages, strengthening health system collaborations, and stakeholder partnerships to ameliorate maternal and newborn morbidity and mortality.

This study aimed to explore health professionals’ use, barriers, confidence, and preferences for technology and smartphone apps to assist clients with self-managing low back pain (LBP).

Prospective observational cross-sectional survey of registered Australian health professionals that managed clients with LBP.

In total, 52 survey responses were included (mean age 43 ±13.8 years). Most did not personally use healthy lifestyle apps (60%) and did not recommend apps due to a lack of knowledge of app effectiveness (93%). The largest barrier to recommending apps was the potential for apps to be misused as a substitute to health professional diagnosis. Fifteen recommended smartphone apps (mean age 36 ±10.6 years) and were at least moderately confident in choosing/recommending apps (94%) and assessing app quality (80%). Those more likely to recommend apps personally used apps for healthy lifestyle behaviours (odds ratio (OR) 5.1 (p = 0.009)) were physiotherapists (OR 0.13 (p = 0.035) c/f chiropractors in their profession for <10 years (OR 8.6 (p = 0.015)) c/f >30 years. Increasing age decreased the odds (OR 0.94 (p = 0.013)) of recommending apps.

Health professionals do not recommend LBP self-management apps due to a lack of knowledge of their effectiveness. Those that do recommend apps are confident with app choice, recommendation, and app quality assessment. Physiotherapists with <10 years’ experience were most likely to recommend apps.

Food hygiene practices are crucial to avoid foodborne illness and improve human well-being. Millions of people get sick, and many of them pass away due to eating unhealthy food. Foodborne diseases are still a public health problem in developing countries.

This study aimed to determine the prevalence and factors associated with food hygiene practices among food handlers in sub-Saharan Africa.

An extensive search was conducted using various databases including PubMed, Science Direct, African Journal Online, and Google Scholar. The search results were then extracted using Microsoft Excel. The data analysis was conducted using STATA version 14. Publication bias was checked by funnel plot, and more objectively through Begg and Egger regression test, with P < 0.05 considered to indicate potential publication bias. A random effect model was used to calculate the pooled prevalence of hygienic food handling practices. Sub-group analysis was done by country and study site.

To estimate the pooled prevalence of food hygiene practices in sub-Saharan Africa, 42 reviewed studies and 12,367 study participants were included. The pooled prevalence of food hygiene practices among food handlers in sub-Saharan Africa was found to be 50.68% (95% CI: 45.35, 56.02) in this study. Factors associated with food hygiene practices included lack of food safety training (OR = 2.14 95% CI: 0.68, 6.76), negative attitude (OR: 2.36, 95% CI: 1.36, 4.09), and lack of regular medical checkups (OR: 2.66, 95% CI: 1.52, 4.65) among food handlers.

This research found that only half of sub-Saharan Africa’s food handlers had good food hygiene practices. Lack of food safety training, a lack of regular medical checkups, and unfavorable attitudes toward food hygiene practices were factors contributing to food hygiene practices. Thus, the authors recommended that food workers receive food safety training about food hygiene and safety procedures.

Migraine is a prevalent and debilitating neurological disorder that significantly affects quality of life. While pharmacological treatments exist, they can have limitations such as side effects, contraindications, and incomplete relief, prompting interest in non-pharmacological approaches for better symptom management.

This study aimed to assess the effectiveness of alternate nostril breathing (ANB) as a non-pharmacological intervention to reduce the frequency and severity of migraine attacks and associated disability in adult patients.

A single-center, open-label, two-arm, parallel-group randomized controlled trial was conducted at six Family Health Centers (FHCs) of Dokuz Eylul University, Izmir, Turkey. A total of 86 migraine patients aged 18–50 years, diagnosed with migraine based on ICD-10 criteria, were randomized into control (n = 43) and intervention (n = 43) groups. The intervention group practiced ANB three times daily for three months, while the control group continued their usual care. The primary outcomes were changes in migraine frequency and severity. Secondary outcomes included changes in migraine-related disability, both outcomes measured using the Migraine Disability Assessment Scale (MIDAS).

The intervention group showed a significant reduction in migraine attack frequency (P = 0.002) and MIDAS scores (P = 0.003) compared to the control group. Both groups experienced a reduction in attack severity (P = 0.001), though no significant difference was observed between the groups (P = 0.074). Within-group comparisons showed significant improvements in attack frequency, severity, and MIDAS scores in the intervention group (P = 0.001 for all).

ANB significantly reduced migraine frequency and disability, making it a promising non-invasive and accessible treatment option for migraine management. Further research with longer follow-up periods is needed to explore its long-term effects and broader applicability.

Poor diet is a major contributing factor to the increasing prevalence of non-communicable diseases. There is a need for effective nutrition care in primary care that manages the bulk of such diseases. This study aimed to describe the self-perceived nutrition competence of primary care physicians (PCPs) in Singapore and to evaluate the associated factors.

A cross-sectional study utilizing an anonymous online survey platform was conducted among PCPs from a public primary care institution in Singapore. We collected data on PCPs’ sociodemographic information, previous nutrition education and personal dietary habits, and measured self-perceived nutrition competence using the NUTrition COMPetence (NUTCOMP) questionnaire. Multivariable linear regression was conducted to examine the association between PCPs’ characteristics with their self-perceived nutrition competence.

Totally, 153 PCPs (45.9%) completed the survey in full. Among the four NUTCOMP constructs, ‘nutrition knowledge’ (2.8 ± 0.6) and ‘nutrition skills’ (2.9 ± 0.6) had the lowest mean scores followed by ‘nutrition communication and counselling’ (3.1 ± 0.6) and ‘attitudes towards providing nutrition care’ (4.3 ± 0.5). PCPs with formal nutrition training had significantly higher NUTCOMP scores compared with those without (β = 10.76, 95%CI:4.57–16.94), and those with 5 to 9 years and more than 10 years of work experience had significantly higher scores than those with less than 5 years (β = 7.62, 95%CI:0.44–14.81, and β = 9.44, 95%CI:2.85–16.04, respectively).

PCPs had lowest self-perceived confidence in nutrition knowledge and skills. Previous formal nutrition education and a longer primary care work experience were associated with better self-perceived nutrition competence. Future research to better integrate nutrition competencies into formal education programmes may be useful to improve PCPs’ self-perceived nutrition competence.

Test educational interventions to increase the quality of care in telemedicine.

Telemedicine (TM) has become an essential tool to practise medicine around the world. However, education to address clinical skills in TM remains an area of need globally across the health professions. We aim to evaluate the impact of a pilot online learning platform (OLP) and standardized coaching programme on the quality of medical student TM clinical skills.

A randomized pilot study was conducted with fourth-year medical students (n = 12). All participants engaged in video-recorded standardized patient (SP) simulated encounters to assess TM clinical skills before and after the intervention. Participants were randomized to either the OLP or OLP + Virtual Coaching Institute (VCI) intervention cohort. Quantitative and qualitative data were collected to address self-reported skills, attitudes, and self-efficacy before the 1st SP encounter and after the 2nd SP encounter. SP encounter recordings were scored by two blinded non-investigator raters based on a standardized rubric to measure the change in TM care delivered pre- and post-intervention. Statistical analysis of quantitative data included descriptive statistics and mixed effects ANOVA.

Recruitment and retention of participants exceeded expectations, pointing to significant enthusiasm for this educational opportunity. Self-reported skills and scored simulation skills demonstrated significant improvements for all participants receiving the interventions. Both OLP and VCI interventions were well received, feasible, and demonstrated statistically significant efficacy in improving TM clinical skills. Participants who received coaching described more improvements in self-efficacy, confidence, and overall virtual clinical skills. This study provides evidence that virtualized clinical learning environments can positively impact the development of TM clinical skills among medical students. As TM continues to evolve, the implementation of innovative training approaches will be crucial in preparing the next generation of healthcare professionals for the demands of modern healthcare delivery.

The Peruvian public healthcare system is characterized by various shortcomings that adversely affect healthcare quality as perceived by the general and minority populations, including the Afro-Peruvian community. This population has demonstrated reduced healthcare access due to discrimination and differential treatment, reflecting broader societal inequities.

This study explores the experiences and perceptions of Afro-Peruvian individuals regarding the treatment they receive from public primary healthcare providers in metropolitan Lima.

In-depth qualitative interviews were conducted with Afro-Peruvian individuals recruited from Lima. They were selected based on their responses to a survey conducted in a previous study, which indicated a high or low perception of intercultural adaptation in healthcare. The interviews explored their experiences with healthcare services and their perceptions about their interactions with health providers. The qualitative analysis involved topic coding to interpret the data.

We interviewed 19 Afro-Peruvians, including 15 women and 4 men, ages 26 to 70. The findings reveal that Afro-Peruvians generally experience mistreatment in the healthcare system. In their opinion, this is associated with systemic issues such as poor infrastructure, low salaries, and insufficient time allocated for patient care. Furthermore, participants perceive receiving poor quality and inefficient service not only from providers but also from the system presents difficulties in other processes, such as getting the appointment.

This study highlights significant areas for improvement in the public healthcare system, specifically enhancing the quality of patient care, improving communication, and upgrading healthcare infrastructure to serve the Afro-Peruvian community better. These insights could guide the development of targeted policy recommendations and practical interventions to address healthcare disparities and improve access to quality healthcare services for minority populations.

The aim of this study was to explore the role of managers and employees with an assigned responsibility (i.e. inspirers) when integrating recovery-enhancing activities into everyday work in a primary health care setting.

The possibility of recovery during the workday is essential for employee wellbeing. However, the literature on workplace interventions focusing on recovery is scarce. Especially with regard to the importance of local driving forces, like managers and inspirers.

Two focus groups and two individual interviews were conducted in this qualitative interview study. In total, ten managers and inspirers from different primary health care centres were interviewed about their experiences of brief recovery interventions at their workplaces. A semi-structured interview guide was used, and the qualitative analysis was conducted by using systematic text condensation.

From a leadership perspective, two themes with promoting factors for recovery interventions were identified. These were structural promoting factors (including authorisation, communication, and integration) and cultural promoting factors (including attitude, support, and open-mindedness). This knowledge can contribute to future workplace environment development with the focus on recovery during the workday. The results also showed several positive effects of integrated recovery, both on an individual and group level. Hence, this study is a valuable addition to the work recovery research, in terms of understanding the importance of investing in recovery at work.

Community pharmacists should provide qualified drug information services for the rational use of medicine in community. However, there is no standard professional incentive for the service in Indonesia. This study aimed to assess drug information services with incentives and its associated factors among community pharmacists in Indonesia.

A multi-centre cross-sectional study was conducted among community pharmacists in Medan City, Bandung City, Bandung Regency, and Makassar City. A validated online self-administered questionnaire was used to collect data on pharmacists’ demographics, pharmacy characteristics, and drug information provision practices. Multivariate logistic regression was applied to identify factors associated with incentivized drug information services.

A total of 639 community pharmacists participated, with representation from Medan (21.9%), Bandung City (20.8%), Bandung Regency (26%), and Makassar (31.3%). Most respondents were female (79%) with a median age of 31 years (IQR: 9). Only 12% of pharmacists reported receiving incentives for providing drug information services. Factors significantly associated with receiving incentives included being male (OR: 2.04, 95% CI: 1.16–3.58), aged 20–30 years (OR: 3.25, 95% CI: 1.10–9.58), working over 40 hours per week (OR: 2.30, 95% CI: 1.16–4.58), working in a chain pharmacy (OR: 2.08, 95% CI: 1.18–3.67), and having an onsite physician practice (OR: 1.72, 95% CI: 1.04–2.85).

Limited number of community pharmacists received an incentive for drug information services. The development of a remuneration system for drug information services can be considered to enhance the quality of pharmaceutical care services in the community setting.

The aim of this study was to evaluate district nurses’ perceived and factual knowledge about nutritional care after an updated and expanded educational intervention. Furthermore, we aimed to compare the outcomes of the revised and the original educational intervention.

In-depth knowledge of nutritional care is a prerequisite to supporting older adults’ well-being and health. District nurses’ actual knowledge of the nutrition care process, older adults’ need for food, and palliative care in diverse phases of disease is therefore of utmost importance. An updated and expanded educational intervention meeting these needs was evaluated.

A study-specific questionnaire about nutritional care was used before and after the educational intervention. Participants (n = 118) were district nurses working in primary health care in Region Stockholm. Additionally, a pre- and post-test quasi-experimental design was used to assess differences in learning outcomes of the revised intervention compared with the original intervention.

District nurses who completed the questionnaire had worked in health care for about 18 years and as district nurses for 5 years after their specialist examination. After the revised educational intervention, significant improvements were found in all statements concerning perceived challenges and actions related to nutritional care, while questions about factual knowledge showed significant improvements in three of the four questions.

Comparison between the revised and the original intervention revealed no differences in most areas of perceived challenges and actions related to nutritional care. Additionally, in half of the areas assessed, factual knowledge improved more after the revision than after the original educational intervention, including the maximum length of overnight fast and the type of oral nutritional supplements (ONS) that should be prescribed.

The intervention was successful in increasing knowledge about nutritional care, nutritional counselling, food adaptation, and prescribing ONS in an individually tailored way. In-depth knowledge supports usability in clinical practice. Nevertheless, we need to follow-up and understand how increased knowledge about undernutrition and ONS prescription are implemented in primary health care when caring for older adults’ desires and needs.

We describe activity, outcomes, and benefits after streaming low urgency attenders to General practice services at Door of Accident and Emergency departments (GDAE).

Many attendances to A&Es are for non-urgent health problems that could be better met by primary care rather than urgent care clinicians. It is valuable to monitor service activity, outcomes, service user demographics, and potential benefits when primary care is co-located with A&E departments.

As a service evaluation, we describe and analyse GDAE users, reasons for presentation, wait times, outcomes, and co-located A&E wait times at two hospitals in eastern England. Distributions of outcomes, wait times, reasons for attendance, deprivation, and age groups were compared for GDAE and usual A&E attenders at each site using Pearson chi-square tests and accelerated time failure modelling. Performance in a four-hour key performance indicator was descriptively compared for co-located and similar emergency departments.

Each GDAE saw about 1025 patients per month. Wait times for usual accident and emergency (A&E) care are relatively short at only one site. Reattendances were common (about 11% of unique patients), 75% of GDAE attenders were seen within 1 hour of arrival, 7% of patients initially allocated to GDAE were referred back to A&E for further investigations, and 59% of GDAE patients were treated and discharged with no further treatment or referral required. Pain, injury, infection, or feeling generally unwell each comprised > 10% of primary reasons for attendance. At James Paget University Hospital, 4.3%, and at Queen Elizabeth Hospital, 16.1% of GDAE attendances led to referral to specialist health services. GDAE attenders were younger and more socially deprived than attenders to co-located A&Es. Patients were seen quickly at both GDAE sites, but there were differences in counts of specialist referrals and wait times. Process evaluation could illuminate reasons for differences between study sites.