Since 2018, to strengthen general practitioner training and promote two-way referral, general hospitals have begun to establish departments of general practice. On this basis, the rational division of labor between tertiary hospitals and community health service centers is key to optimizing medical resources, yet systematic comparison of their general practice outpatients’ disease characteristics is lacking.To compare these characteristics and inform inter-institutional cooperation and differentiated general practice development.Retrospective analysis of 2022–2023 outpatient data (gender, age, diseases) from a Beijing tertiary hospital (A) and a community health service center (B). Chi-square test was used to compare the difference between A and B in disease characteristics.A total of 79,889 and 91,800 visits were recorded in A and B, respectively. Chi-square test showed significant gender (44% vs 47.8% males; p<0.001) and age differences (predominant age: 40–59 years in A [39.14%] vs 60–79 years in B [55.74%]; p<0.001). Stratified analysis of 5 common diseases revealed no gender difference in hypertension. Females with hyperlipidemia/upper respiratory tract infection preferred A, while males with diabetes/coronary heart disease (CHD) preferred B (all p<0.001). Age differences existed in all 5 diseases: 60–79-year-olds with hypertension/hyperlipidemia/diabetes preferred B vs <60 preferred A; 60–79-year-old CHD patients preferred A vs <60 preferred B; respiratory tract infection patients aged ≤19/≥60 preferred B vs 20–59 preferred A (all p<0.001).The significant gender and age differences in general practice outpatient visits between tertiary hospitals (Institution A) and community health service centers (Institution B) reflect the inherent connection between institutional functional positioning and population health needs. In terms of age distribution, the predominance of 60–79-year-old outpatients in Institution B is consistent with the core function of community health service centers in chronic disease management and elderly health care. In contrast, Institution A may be related to the middle-aged population’s higher demand for accurate diagnosis and standardized treatment of potential chronic diseases or early-stage complex symptoms.General practice outpatients in both institutions are mainly chronic disease patients but with gender and age differences. Tailored service models should be explored to achieve differentiated development and strengthen inter-institutional connection.

Taiwan’s National Health Insurance achieves high accessibility but faces challenges in establishing continuity of care. Despite government initiatives like the "Family Practice Integrated Care Project (FPICP)", a significant portion of the population still lacks a fixed family doctor.This study utilized the Theory of Planned Behavior to investigate the public's understanding of family physicians, focusing on cognition, attitudes, subjective norms, and behavioral barriers.The study was conducted in two phases. Phase 1 involved a cross-sectional survey of 507 citizens to delineate the determinants of having a family doctor. Phase 2 was a quasi-experimental intervention study (N=96) with or without involving help seeking family doctor via 5 health education animation youtube video.Phase 1 revealed that the primary barriers without their own family doctor were an "Information Gap"—70% were unaware of the government project—and a "Convenience Myth," where non-users significantly underestimated the efficiency of having a fixed health care provider (p<0.0001). Phase 2 results showed that the intervention significantly improved cognition (p<0.0001) and behavioral intention (p=0.003). However, a "Time Lag" in identity formation was observed; despite high satisfaction (71.4%), the self-perceived status of "having a family doctor" did not immediately change.The barrier to continuity of care in Taiwan is cognitive and behavioral. First is the "Information Gap", 70% without a family doctor, were completely unaware that the government even has a FPICP.  Second is the "Convenience Myth". Citizens without a family doctor significantly believe that finding a fixed doctor is inconvenient (p<0.0001). Essentially, non-users are deterred by a 'perceived cost' of time that does not actually exist. Based on these findings, we propose three policy shifts for Taiwan: Digital Wayfinding: We need an official 'Family Doctor Map' App showing specific 'Family Doctor' tags. Rituals of Registration: We suggest a system where patients sign a 'Care Agreement' via an app. Family-Centric Marketing:  We need to start marketing to households—such as "Every family, a family doctor".Future policies for finding a family doctor must shift from passive enrollment to active "relationship management" utilizing tools like Digital Wayfinding (apps), Rituals of Registration (formal care agreements), and Family-Centric Marketing to solidify the patient-physician bond.

In 2022, cardiovascular diseases (CVD) accounted for 32.7% of all deaths in the EU, with associated costs of €282 billion annually. In Germany, coronary heart disease (CHD) remains the leading cause of mortality and reported reductions in life expectancy gains over the last decade have been attributed to excess CVD mortality. In addition, high rates of avoidable hospital admissions suggest shortcomings in ambulatory and preventative care. In 2004, Germany introduced the general practitioner-centred care (GPCC) programme with the aim of delivering structured, coordinated and strengthened primary care.This study describes the long-term effects of the GPCC programme on healthcare utilization and all-cause mortality for patients with CHD over a 12-year observation period (2011–22).A longitudinal, observational cohort study was conducted based on German health insurance claims data, covering 2011–22. Patients with CHD at the beginning of the observation period were included. Multivariate models were calculated, adjusting for key confounders to reduce selection bias, comparing usual care with GPCC.In 2011, 125,758 patients with CHD were enrolled; increasing to 169,101 patients in 2022. Over the 12-year observation period, GPCC participants had consistently lower rates of all-cause hospitalisation (OR 0.988, 95%CI, p<0.001), hospitalisation due to CVD (OR 0.989, 95% CI, p<0,001) and ambulatory care sensitive condition hospitalisation (OR 0.989, 95% CI, p<0,001) in comparison to usual care. Statin prescription rates were lower in the GPCC group at the start of the study but increased over the 12-year period, showing significantly higher rates (OR 1.003, 95%CI, p<0.0046) at the end of the study. All-cause mortality reduced over the 12-year period and was significantly lower in the GPCC group at the end of the study period (OR 0.987, 95% CI, p<0.001).Participation in structured and coordinated primary care programmes results in reduced health care utilisation and all-cause mortality in patients with CHD, offering sustained benefits for these patients over a 12-year period.Given the high prevalence of CVD in Europe and associated costs, these findings emphasise the role of structured, coordinated primary care in strengthening care for patients with CVD and support the broader implementation of GPCC models.

Although there are as many general practitioners (GPs) as ways of practicing general medicine, comprehensive data on GP practice are lacking. To date, no descriptive scientific study of general practice has been conducted. The main objective was to describe the medical practice of GPs in XXX according to five dimensions: practice mode, GP office, office organization, schedule organization and patient panel management. This is an ancillary study investigating the description and influence of educational and professional pathways – according to their temporality of completion and typology – on medical practice.We conducted a regional, cross-sectional, descriptive and observational study, using a mixed-methods design (quantitative: Excel® ; qualitative analysis: data standardization, thematic analysis of free-text responses). A self-administered questionnaire, distributed over three months to GPs, explored their professional activity.GPs had practised for an average of 16.2 years, under Sector 1 contracts, without additional fees, and were fully established in group practices. Their main supplementary activity was supervising medical trainees. Hospital-based work most frequently involved emergency medicine. Hypnosis predominated in alternative medicine, while medical regulation was the main activity in other modes of practice. Professional practice remained uncoordinated, included home visits, care in long-term care facilities, out-of-hours duties, technical procedures and tele-expertise. GP offices were located on average 10.45 km from the GP’s residence, in urban areas, most often in health centres, without background music in waiting rooms. Office organisation included a physical secretary, and GPs were replaced during leave. GPs worked an average of 8,1 half-days per week, combining scheduled appointments with urgent-care sessions. Consultations lasted 16–20 minutes. GPs followed between 1001 and 1500 patients, while continuing to accept new ones. Patient panels, primarily composed of adult and elderly patients, were perceived as similar to the GP.Strengths of this study include originality, a comprehensive questionnaire, high participation, multi-level analysis and external validity. Limitations involve potential recall bias and geographic constraints.This research provides a unique and enriched model of general practice. Future perspectives include interregional and national extension, relevant for defining GP practice in XXX, updating professional standards and refining data in the Medical Demography Atlas.

General practice is the cornerstone of healthcare in many countries, providing comprehensive and continuous care for people with a wide range of health problems. Understanding the diversity of health problems managed in general practice is crucial for maintaining the broad expertise that defines general practice.To quantify the diversity and frequency of health problems managed in Dutch general practiceWe analysed 2024 data from the Nivel Primary Care Database, comprising data on patient contacts and health problems from 426 GP practices and 1,921,614 registered patients. Health problems were classified using the International Classification of Primary Care (ICPC-1). We calculated how many different health problems were registered by an average GP practice (2.095 patients) on a weekly basis. Besides, we calculated whether health problems were registered weekly, monthly, or less than monthly, and what proportion of all patient contacts each group of problems represented.An average Dutch GP practice has 175 patient contacts per week, in which they see 157 different patients and manage 123 different health problems. Of the 653 ICPC-1 codes, 55 problems are registered weekly, 162 monthly, and 464 less than monthly. The 55 frequent problems account for 50% of all patient contacts, whereas the 464 infrequent problems account for only 14%. The most frequent health problems were cystitis,  hypertension, cough, diabetes and fatigue.Our findings highlight that a limited set of health problems dominate daily practice. These frequent problems may be candidates for further task delegation within or outside the GP practice. In the Netherlands, Care for CVRM and diabetes have already (partially) been delegated to a practice nurse, but this could be organised on a regional level.Dutch GPs see a wide variety of health problems. Although a limited set of health problems dominate daily practice, GPs also need to be prepared for a large number of infrequent health problems.

Despite often lacking the prestige and remuneration of hospital-based sub-specialties, family medicine is hypothesized to be the critical driver of overall health system performance.This review had the objective to empirically evaluate the assertion that General Practitioners (GPs) are the "actual stars of medicine" by synthesizing evidence on their impact on population health, equity, and health economy.A pragmatic literature review of relevant peer-reviewed publications on primary care effectiveness was performed across several databases. The review focused on identifying key associations between primary care strength and outcomes such as mortality rates, healthcare costs, continuity of care, and disease management efficiency.The synthesis identifies eight distinct evidence-based mechanisms, here summarized within five topics, demonstrating the superior value of primary care: 1) System Effectiveness: Countries with strong primary care orientations consistently exhibit lower health inequalities and reduced premature mortality. 2) Mortality Reduction: Increased GP density correlates directly with higher life expectancy; US-based data indicates that adding one GP per 10,000 inhabitants is associated with significant reductions in deaths and hospitalizations. 3) Continuity of Care: Long-term GP-patient relationships show a dose-dependent benefit; relationships spanning 15+ years are associated with a 28% decrease in acute hospital admissions and a 25% reduction in mortality risk. 4) Prevention and Cost: Primary care-centric systems demonstrate superior chronic disease management and higher delivery of preventive services (e.g., higher vaccination rates) while simultaneously reducing overall healthcare spending by avoiding unnecessary specialist interventions. 5) Health Equity: Stronger primary care orientation and higher GP densities are associated with lower health disparities.The evidence unequivocally positions family physicians as the backbone of effective healthcare systems. By prioritizing prevention, ensuring continuity, and mitigating social determinants of health, GPs deliver superior outcomes at lower costs compared to specialist-centric models.These findings reinforce that shifting political and educational focus to primary care is the most effective, evidence-based strategy for securing a sustainable and healthy future.

The emergence of new psychoactive substances and shifting patterns of illicit drug use pose increasing challenges for public health and for family medicine, which often serves as the first point of contact for affected individuals. Traditional epidemiological surveillance systems frequently experience delays in detection and response. Several countries have developed sentinel networks to enable earlier monitoring, using models based on hospital emergency departments, community pharmacies, or even drug users themselves. Spain currently lacks a sentinel system tailored to its healthcare and social context.To identify the key elements required for the design and implementation of a sentinel network for the surveillance of illicit drug use in Spain, drawing specifically on the perspectives of key informants.A qualitative study was conducted using focus groups with key informants from sectors involved in the detection, care, and analysis of substance use: hospital emergency professionals, family physicians, toxicologists, community pharmacists, harm-reduction workers, and epidemiologists.Participants identified common challenges: lack of standardised data collection, high clinical workload, concerns regarding the reliability of information obtained from drug users, and limited feedback mechanisms for participating professionals. They highlighted the need for a flexible model that integrates clinical detection, community-level information, and real-time epidemiological analysis. Key components identified included more training in toxicology and digital tools, the incorporation of primary care as a central node, and incentives or feedback systems to maintain professional engagement.Findings indicate that developing an effective sentinel network requires strong intersectoral coordination. The perspectives of family physicians underscore their strategic position for early detection and the need for improved tools and communication channels. Integrating clinical and community information streams would enhance the system’s responsiveness.A sentinel network tailored to the Spanish context should be multidisciplinary, flexible, and supported by adequate training and digital tools. Primary care should play a central role, given its proximity to patients and its capacity for early identification of emerging consumption patterns.