Serious welfare problems can negatively impact health and create a complex mix of physical, mental and welfare problems. These problems are often persistent, and are associated with a lower quality of life and frequent healthcare utilisation. Policymakers and researchers are increasingly looking to integrated care as a solution for patients with problems on multiple life domains. However, there is little information on how these patients experience care and whether this meets their needs.To describe the characteristics, care experiences and views on optimal care among patients with multi-domain problemsFocus groups and individual (semi-structured) interviews were conducted with ‘patients with multi-domain problems’. Participants had ≥1 chronic physical condition, ≥1 welfare issue, and frequent GP consultations.In total, 21 participated in the study. They described their situation as complex due to accumulating and interacting problems. Participants mentioned unmet basic needs, that they often felt were urgent. They mentioned trust issues, due to negative or traumatic experiences, and a tendency to withdraw from contact. They expressed that building a relationship with their care provider takes time, personal continuity and a supportive attitude. They underlined the need for coordinated and personalised care. Further issues were: need for assistance with practical issues and improving self-reliance.Participants’ description of ideal care aligns with what patients in general value: relationship, continuity, feeling acknowledged and whole person care. Their trust issues trust may complicate building a trusting relationship. Feelings of urgency may not be shared by GP’s and risk ad hoc consultations (hindering continuity). GP’s should consider referring to case management for expertise on unmet basic needs and practical support, but steps are needed to prevent withdrawal from future care.The care needs of patients with multi-domain problems are roughly similar to those of the general population. Fragile trust and feelings of urgency are distinctive characteristics that need attention of GPs.

The escalating global epidemics of obesity and type 2 diabetes (T2DM) pose a severe threat to public health, with lower-middle-income countries like Kyrgyzstan facing a disproportionately high burden. Primary care is recognized as the crucial frontline for prevention, yet significant barriers often hinder its effectiveness in resource-limited settings.This study aimed to comprehensively assess the role, barriers, and opportunities related to obesity and diabetes prevention within the primary care system of Kyrgyzstan.A qualitative, exploratory study based on grounded theory was conducted in 2025. Thirteen family physicians (12 female, 1 male) with a mix of urban and rural practices in Northern Kyrgyzstan were recruited. Data were collected via semi-structured interviews, which were transcribed, translated, and analyzed using axial coding to identify central categories and their relationships.The analysis identified a central issue: the ineffective prevention and management of obesity and diabetes. Several key themes emerged, including patient-related barriers, systemic obstacles, contextual challenges, a lack of institutional support, compensatory strategies, and negative consequences. This situation was primarily driven by several causal factors, including a critical shortage of specialists, such as endocrinologists and dietitians, financial barriers faced by patients, and low public awareness about these health issues. These challenges were further exacerbated by overwhelming physician workloads and deeply ingrained cultural dietary habits. In response to these pressures, physicians, constrained by a lack of government assistance and a patient mindset that often places health responsibility elsewhere, resorted to compensatory strategies. These included taking on extra duties and focusing health education efforts on younger, more receptive audiences. However, these measures ultimately resulted in late-stage diagnoses, physician burnout, and a continued failure of the preventive health system.Kyrgyzstan's primary care physicians are constrained by systemic and sociocultural barriers, resulting in a reactive care model unlike more integrated systems elsewhere.There is an urgent need for systemic interventions to address specialist shortages, reduce physician workload by transferring competencies and involving other health specialists in primary health care, and implement supportive policies. Strengthening the primary care system is essential to unlock its preventive potential and curb the growing epidemic of obesity and diabetes in Kyrgyzstan.

As a family physician serving a small Jaʿfari Shi’a minority community in Eastern Turkey, I work within a sociocultural setting where self-bloodletting during Ashura is a deeply meaningful expression of mourning, identity, and fraternity. Similar practices exist in other Shi’a populations globally. In our region, the ritual creates predictable periods of elevated exposure to blood-borne infections. In primary care—guided by principles of liberty, equity, and humanism—understanding such lived cultural realities is essential for equitable and culturally safe care.During the ritual, I observed frequent sharing of blades, absence of sterilization, and rapid sequential blood contact—conditions forming a potential transmission chain for hepatitis B, hepatitis C, and HIV. Cultural norms of endurance, self-sacrifice, and lack of previous outbreaks appeared to normalize risk-taking and reduce preventive behavior. These sociocultural dynamics shaped engagement with health information and primary care services.This experience prompted several practice adaptations: prioritizing hepatitis B vaccination and tetanus boosters; proactive screening of ritual participants, pregnant women, and newborns; pre-ritual counseling; and maintaining a non-judgmental environment encouraging care-seeking when complications occur. Insights from frontline physicians revealed gaps in knowledge and attitudes regarding blood exposure. A community-based KAP (Knowledge–Attitude–Practice) study, currently underway, will clarify understanding of transmission routes and guide tailored education.Identifying this group as periodically high-risk supports more equitable preventive service allocation. Harm-reduction approaches proved more culturally aligned than prohibition-oriented messaging.Our aim is not to restrict the ritual but to support safer participation by aligning cultural respect with evidence-based prevention, thereby strengthening trust, equity, and humanistic primary care.

A considerable proportion of the population (1-3%) lives with an intellectual disability (ID), based on their IQ (>70). In the Netherlands, the estimated prevalence is even higher, with around 1.1 million people (6.4% of the population) and includes borderline intellectual functioning (IQ 70-85) when combined with limitations in adaptive functioning. However, accurate numbers are lacking. General practitioners (GPs) provide important medical care for people with an ID, yet only about 20% of these patients are formally registered in GP records. No guidelines exist for this registration, although the International Classification of Primary Care (ICPC) code p85, ‘mental retardation’, is often used. While GPs are not required to register ID, doing so may facilitate better recognition of health needs and tailored care (longer consults, simplified communication). However, barriers exist: GPs may lack the knowledge to recognize ID, and stigma can discourage registration. Consequently, consultations may be too short or too complex, leaving patients without appropriate care. To develop recommendations for registration of ID in general practice, it is essential to understand perspectives and experiences of people with an ID and GPs on registration.To gain insight into the experiences and perceptions of GPs and people with an ID regarding the process of registering an ID in general practice.A qualitative study explores perceptions and experiences of GPs and people with an ID on the process of registration an ID in general practice using focus groups. We aim to conduct three focus groups with GPs and five focus groups with people with a mild ID.At the time of the 30th WONCA Europe conference 2026 the focus groups will have ended and results will be presented. We will share the essential views of GPs and people with an ID on the registration of an ID in general practice.We will share and discuss obtained views of GPs and people with an ID on the registration of an ID in general practice.Our insights will generate new knowledge and approaches to improve ID recognition and registration in primary care and contribute to improved health care and reduced health inequities for people with ID.

Loneliness and social isolation are major public health concerns among older adults and are associated with depression, cognitive decline, frailty, and loss of independence. Companion animals (and dogs in particular) might mitigate these adverse outcomes by fostering emotional support, physical activity, and social interactions.The objective of the present study aimed to evaluate the association between dog ownership and loneliness in community-dwelling older adults.C-KDOG is a multicentre, cross-sectional study conducted between September 2020 and April 2023 at seven investigating centres in France. The participants were aged 75 or over and were living at home. Loneliness was assessed on the 11-item De Jong Gierveld Loneliness Scale. The secondary outcomes included emotional and social loneliness subscores, social isolation (according to the Social Network Index), and the presence of falls and bites. Associations between dog ownership and loneliness were analyzed using multivariable linear regressions adjusted for sociodemographic, environmental and clinical characteristics.A total of 160 participants were included, of whom 47 were dog owners (mean age: 82 years; females: 116 (73%); living alone: 79 (49%)). The median overall loneliness scores did not differ significantly when comparing dog owners and non-owners. In adjusted models, however, dog ownership was independently associated with lower loneliness. This association was mainly driven by a lower emotional loneliness subscore. Living alone, frailty, depressive symptoms, and sleep problems were independently associated with a greater level of loneliness. Dog ownership was primarily motivated by companionship (81%). Adverse events (falls or bites) were rare (5%).This study had strengths: the analysis of the patients’ clinical and sociodemographic characteristics in depth; the distinction between loneliness and social isolation and the characterization of respondents motivations for owning a dog or not. The limitations were a study design that prevents the assessment of causal relationships; a relatively small sample size and the fact that the study was conducted during the COVID-19 pandemic, which may have altered how loneliness and social isolation were reported.Dog ownership was associated with a lower level of emotional loneliness among community-dwelling older adults, independently of frailty and depression. Companion dogs might contribute to emotional well-being in older adults.

Family doctors are increasingly asked to comment on a wide range of treatments—prescription medications, supplements, and natural/alternative remedies. Patients want to know: Does it work? Is it safe? Should I try it? In an environment saturated with marketing, testimonials, and conflicting opinions, both patients and clinicians need a consistent, practical way to evaluate these claims together.This presentation outlines a four-question framework developed from everyday clinical practice to guide evidence-informed, patient-centred decision-making. The framework can be applied to any health intervention—traditional or otherwise—by systematically asking: 1. What are the benefits?  2. What are the harms?  3. What are the costs?  4. How convenient is it?  Each step will be further outlined and supported by examples drawn from real-world consultations. The process integrates shared decision-making, critical thinking, and basic principles of evidence evaluation to create a repeatable approach for clinical encounters.Applying this model can lead to clearer patient understanding, greater confidence in clinical recommendations, and more collaborative decision-making. It helps clinicians do this process with confidence and clarity. Patients can then make their choice based on good information and what they value, to ensure they focus their time and money on interventions that matter to them, and that can have the most impact.Given the myriad of decisions family physicans have to make alongside their patients, it is imperative that we have a structured and practical framework with which to have those discussions. The framework outlined provides that structure to handle any conversation around treatment and medication options.These discussions can strengthen trust, improve patient autonomy, and safeguard against misinformation—without requiring extra time or complex tools.This practical four-question framework empowers clinicians and patients alike to evaluate any treatment - traditional or modern - using common sense, clarity, and compassion which are the core of family medicine.

While patient-centered care and contextual adaptation are recognized as crucial for clinical practice, they are often overlooked in randomized controlled trials. Current personalized medicine studies focus almost exclusively on biological factors, mainly because precise markers describing patients’ psychosocial and environmental factors are lacking.The objective of this study was to provide an initial set of psychosocial and contextual markers, derived from physicians’ self-reported descriptions of real-world personalization situations.An online questionnaire with one open-ended question, asking physicians to describe clinical situations in which they personalized care, was used. Physicians were recruited from March 31, 2023, to August 10, 2023, from three hospitals, five university departments of general practice and six physician organizations in France. Recruitment was conducted through email invitations, with participants encouraged to invite their colleagues via a snowball sampling method. The analysis involved both manual and AI-assisted content analysis using GPT3.5-Turbo (OpenAI). Mathematical models to assess data saturation were used to ensure that a comprehensive list of markers was identified.In total, 1340 people connected to the survey platform and 1004 (75.0%) physicians were eligible for the study (median age 39 years old, IQR 34 to 50; 60.5% women; 67.0% working in outpatient settings; 65.2% were general practitioners), among whom 290 answered the open-ended question. The participants reported 317 clinical situations during which they personalized care. Personalization was based on the consideration of 40 markers: 27 were related to patients’ psychosocial characteristics (e.g., patient capacity, psychological state, beliefs), and 13 were related to circumstances (e.g., competing activities, support network, living environment). The data saturation models showed that at least 97.0% of the potential markers were identified. Manual and AI-assisted content analysis using GPT3.5-Turbo were concordant for 89.9% of clinical situations.Afterwards, the effect of these markers on treatment engagement and effectiveness needs to be evaluated in clinical studies and integrated as tailoring variables in personalized interventions to build evidence-based personalization.To our knowledge, this is the first list of fine-grained individuals’ psychological, social, cultural, behavioral, and economic factors that may influence their response to treatment across a broad range of situations and diseases.