Health systems are increasingly strained by ageing populations and rising chronic disease. At the same time, older patients now purchase commercial smartwatches and present their data to their GPs, who often face these requests without clear guidance on how such metrics should be interpreted or used. Although smartwatches hold real potential for monitoring and self-management, their value in primary care for older adults remains uncertain, leaving clinicians to navigate growing patient expectations with limited evidence.1) Synthesize findings about commercial Smartwatch applications in outpatient setting 2) Map the health outcomes associated with Smartwatch use in this population 3) Identify facilitators, barriers, and contextual factors that shape adoption and implementation of Smartwatches into clinical practice.A scoping review was conducted following established guidelines. Comprehensive searches of PubMed, Embase, and CINAHL (2013–2024) identified over five thousand records, of which forty-four met inclusion criteria. Data were extracted on device types, health metrics, populations, study designs, clinical applications, outcomes, and barriers and facilitators. Title/abstract and full-text screening were performed independently and in a blinded manner by two reviewers, with duplicate data extraction to minimize bias. Disagreements were resolved by a third reviewer.Among 44 studies, cardiology led (14), then primary care (8) and pulmonology (7), with smaller numbers elsewhere. Sixteen smartwatch brands were used, mainly Fitbit (17) and Apple (11). Devices mostly captured steps/activity and heart rate or ECG, often combined. Applications spanned feasibility monitoring, correlation with clinical tests, active interventions for rehabilitation, chronic disease self-management and behavior change, and diagnostic AF screening. Barriers included comfort/usability, accuracy, interoperability, and low digital literacy; facilitators were motivating feedback, perceived value, and social support.Commercial smartwatches hold promise for enhancing outpatient care for older adults, but their success depends on inclusive design, meaningful integration into primary care, and strategies that address global health equity. Evidence for long-term impacts on morbidity, mortality, or implementation into healthcare utilization remained limited.By mapping the understanding of current evidence of Smartwatch use in outpatient setting, this study lies the groundwork for a follow up qualitative study on the integration of Smartwatch use into primary care consultations.

Homeopathy is currently widely used in general practice worldwide, notably in Brazil, India, and Switzerland, despite the lack of evidence demonstrating efficacy beyond placebo. However, from its very inception in early nineteenth-century Germany, homeopathy was met with substantial skepticism, and as early as 1835 it was subjected to a rigorous evaluation in what is now recognized as the first randomized, double-blind, controlled trial in the history of medicine. Unfortunately, the original report of this experiment, published in a German newspaper, has never been fully translated, and is only briefly mentioned in a small number of secondary sources. As a result, this foundational event in the history of medical science remains largely unknown to contemporary clinicians and researchers.This work aims to translate and analyze this historical trial through the modern lens of general practice, with methodological, historical, and clinical perspectives.The complete text, "Die homöopathischen Kochsalzversuche zu Nürnberg", was fully translated, first using a literal approach supported by historical dictionaries, followed by a fluent translation into contemporary French. Specific translation challenges were identified and discussed. The methodological aspects of the experiment were analyzed in relation to current gold standards in general practice research.Remarkably, the Nuremberg homeopathic table salt experiment aligns closely with these standards, demonstrating careful attention to randomization and blinding, overseen by independent supervisory bodies. Measurement procedures are precisely described, and results are reported accurately and neutrally. The primary methodological limitation identified is participant self-selection through voluntary enrollment.This document constitutes the earliest known report of a randomized, double-blind, controlled trial, conducted at a time when scientific methodology was still in its infancy. Making this text accessible through translation allows this pivotal moment in medical history to be reconsidered and contextualized, and provides valuable perspective on the subsequent body of research failing to demonstrate the clinical efficacy of homeopathy.Homeopathy was subjected to rigorous evaluation as early as 1835 in a randomized, double-blind, controlled trial of remarkable methodological quality for its time, closely anticipating modern standards of clinical research. The findings demonstrate the absence of any specific effect of homeopathic dilutions, through a good level of scientific rigor.

Research indicates that lifestyle interventions can be effective for individuals experiencing symptoms of depression in primary care, with some demonstrating effects comparable to medication and cognitive behavioral therapy. However, a structured approach to providing lifestyle advice and evaluating its effects remains lacking.To investigate whether a personalized lifestyle intervention (PLI) delivered via a smartphone application is a (cost-)effective addition to current depression treatment in general practice.First, through a qualitative study with both interviews and focus groups, we developed the smartphone application in collaboration with patient representatives, general practitioners (GPs), GP mental health practice nurses (GP-MHNs) and a software developer. Second, a short pilot was performed to test its feasibility. Finally, the PLI will be tested in a cluster randomized controlled multicenter clinical trial (RCT), in which we will compare usual care with usual care plus the PLI. The PLI includes: 1) a short lifestyle questionnaire based on six pillars (mental wellbeing, harmful substances, social relationships, eating, sleep and physical activity), 2) a visualization of the results of the questionnaire, leading to formulation of two personal lifestyle goals 3), information and advices on these personal goals and 4) integration of depression symptomatology measurements over time. GPs and GP-MHNs can track the progress of the patient through their own account. Adults with mild to severe depression symptomatology are being included. The primary study parameter is change in severity of depression symptoms, assessed by the PHQ-9. Secondary outcome measures include cost-effectiveness, quality of life, functioning, relationship with the healthcare provider, and patient satisfaction.During the interviews and focusgroups, three main topics were found: 1) perspectives on lifestyle, 2) recovery process, 3) practical usability and app implementation. For the RCT, we have currently included 53 patients, and are able to present the first results during WONCA Paris.Our results thus far identified obstacles and facilitators for the effective use and implementation of a personalized lifestyle intervention aimed at reducing depressive symptoms in patients in general practice.Overall, we hypothesize that in patients with depression symptomatology, the PLI as addition to usual care will help reduce symptoms in a (cost-)effective way.

Primary care faces high demand from patients with long-term conditions, anxiety, insomnia, low mood and lifestyle-related concerns. These issues often require sustained support beyond routine clinical contacts. To address these issues we implemented a personalised digital self-management tool to support wellbeing, reduce avoidable appointments, and empower patient self-care.To evaluate the impact of digital self-management support on: 1. Wellbeing and self-efficacy 2. Lifestyle behaviours 3. Appointment utilisation 4. Suitability for patients with multimorbidity or mental health needsThe retrospective evaluation covered multiple primary care sites serving approximately 500,000 patients. Eligible patients included frequent attenders, individuals with multimorbidity, and those reporting low wellbeing. Uptake, wellbeing scores, behavioural indicators and appointment utilisation were monitored using real-world operational data. Patient feedback was analysed qualitatively.Among 25,000 invited patients, uptake was high across diverse demographic groups, including older adults and people with low digital confidence. Users reported substantial improvements in wellbeing: - 82% felt more in control of their health - 68% reported improved mental wellbeing - Significant improvement in ONS-4 wellbeing scores Behavioural outcomes included improved sleep, increased activity levels and sustained motivation. Users tracking health indicators reported a mean 4.7 kg weight reduction over eight weeks. Appointment utilisation decreased by 15% among the highest-need frequent attenders, releasing capacity for complex care and urgent demand. No additional clinical or administrative workload was generated. Patient feedback highlighted reduced anxiety, improved symptom management and enhanced confidence in self-care.A personalised digital self-management tool significantly improved wellbeing and supported behaviour change while reducing non-urgent appointment demand. Simplicity of access, personalised nudges and non-clinical guidance were key to equitable engagement. Importantly, the model required no additional clinical or administrative workload, enhancing its scalability.Digital self-management tools can strengthen prevention, reduce pressure on primary care and improve patient outcomes when delivered with strong governance and behavioural design. This model demonstrates a scalable approach to strengthening primary care delivery and may inform international efforts to modernise primary care.

Chronic obstructive pulmonary disease (COPD) increasingly burdens European healthcare systems due to aging populations and rising prevalence, causing significant morbidity, mortality, and economic costs. Digital health interventions (DHIs) can improve self-management and reduce hospitalizations. However, adoption among older adults remains limited.This study aims to identify distinct clusters of COPD patients based on their intention to use DHIs.A cross-sectional survey of 232 adults with COPD (mean age 64.87 ± 11.39, 61.21% female) was conducted across seven European countries (July 2024–February 2025). Data included sociodemographic, UTAUT constructs, digital literacy, prior DHI experience, and intention to use DHIs. Cluster analysis using Gower's dissimilarity and Partitioning Around Medoids identified two clusters.Cluster 1 (n=104, "hesitant") exhibited lower education, limited computer use, and balanced intention distribution (38.5% positive, 40.4% neutral, 21.2% negative), with intention associated with social influence, performance expectancy, and digital literacy. Cluster 2 (n=128, "enthusiastic") featured higher education, prior positive DHI experience, and 83.6% positive intention, driven by lower effort expectancy, prior experience, and lower disease complexity. Significant cross-country variations were noted.Two distinct participant clusters emerged, reflecting different psychosocial and behavioral patterns toward digital health adoption. While cluster 1 showed a balanced-hesitant stance toward digital health, cluster 2 demonstrated strong enthusiasm and readiness to engage. Digital health adoption varies by psychosocial and skill profiles. Targeted literacy training and improved usability may enhance engagement.Digital health adoption among patients with COPD and related chronic respiratory diseases is influenced more by psychosocial factors and digital skills than by demographic characteristics alone. Modifiable factors such as digital literacy, effort expectancy, performance expectancy, and social support can be leveraged to design targeted interventions for hesitant users. Although adoption patterns were broadly consistent across countries, subtle differences suggest that local context and healthcare system factors should be considered when implementing interventions, ensuring they are culturally and operationally appropriate. We highlighted the need for tailored strategies: interventions that build digital skills and social support for hesitant users, and usability-focused enhancements for motivated adopters. Applying cluster-informed approaches can improve engagement, promote equity, and maximize the effectiveness of digital health programs for older adults across diverse healthcare settings.

General practitioners play a central role in managing chronic insomnia, yet many patients experience long and complex therapeutic pathways. Light therapy is increasingly promoted as a non-pharmacological option. The INSOLUX randomized controlled trial assessed its efficacy in 239 primary care patients with insomnia, though its practical implementation in clinical settings remains to be clarified.This qualitative study was embedded within the INSOLUX trial. Its primary objective was to explore how patients with chronic insomnia experienced light therapy during their participation. A secondary aim was to identify factors influencing adherence, expectations, and perceived benefits.Forty-two adults with chronic insomnia were interviewed after completing either active or placebo light therapy. Semi-structured interviews were conducted in person or by telephone, recorded and transcribed verbatim. An inductive thematic analysis was performed by multiple researchers, with regular meetings to reach consensus. The COREQ criteria guided the conduct and reporting of the study.Most participants were particularly motivated by the non-pharmacological aspect of the study, having previously tried several treatments. Light therapy was well tolerated and easily integrated into daily routines. Reported effects varied widely, independent of whether patients received active or placebo light therapy: some described easier sleep onset or fewer night awakenings, while others saw little change. Expectations, emotions, and personal beliefs played a key role in perceived effectiveness. Many participants felt improvement related to the study context itself—feeling listened to, increased attention to sleep habits, and dedicated time to discuss insomnia. Some wanted clearer information about their sleep disorder and wished for more personalized guidance.Only a subset of participants were interviewed, but sampling ensured maximal diversity of age, gender, and prior treatments. Patient accounts suggest that light therapy offers modest subjective benefits, yet is valued for being non-drug based. The interplay of emotions, expectation, and contextual factors underscores the complexity of evaluating treatments for chronic insomnia. The noted improvements also point to a Hawthorne effect. Overall, these results highlight the importance of individualized, holistic management for insomnia.This study offers practitioners insights on using light therapy in patients with chronic insomnia, emphasizing both practical challenges and its integration alongside other recommended treatments.