Background: Patient-centered care (PCC) is known to improve experiences of chronic care medical encounters and outcomes. As Malawi strives to institutionalize PCC in its quality-of-care initiatives, documenting the extent of its practice and its correlates is an important starting point in implementation and advocacy efforts.
Aim: We sought to assess DM patients’ level of perception of PCC and its relationship to self-efficacy, adherence, and glycaemic control.
Methods: Using a locally generated tool we assessed the adequacy of PCC experienced by patients with diabetes mellitus during medical encounters in Malawi. We used regression models to assess PCC correlation with self-efficacy, adherence, and long-term glycaemic control.
Results: We report low levels of PCC perception (about half of the DM patients receiving inadequate PCC, 241 (56.3%), especially in patient participation. Female patients and those who reported having DM complications particularly reported low PCC levels. Patient-centered care was shown to mediate process outcomes in the DM management pathway and a minimum mean score of 65.9 (SD 9.6), a range of 81-112 seems to be required. The perception of PCC was negatively associated with self-efficacy (aβ=-3.11; 95% CI -5.98; -0.43), positively associated with adherence (aβ=0.98; 95% CI 0.60, 1.36), and, no statistical significance relationship with glycaemic control. Independently, self-efficacy itself was a predictor of better adherence (aβ=0.04; 95% CI 0.02, 0.05) and glycaemic control (aOR=0.03; 95% CI 0. 01, 0.04).
Conclusion: Though PCC is not an end in itself, it matters in facilitating better process outcomes in the DM management pathway; especially those with complications and, minimum required dose required. To effect better self-efficacy for long-term outcomes, PCC delivery should go beyond providing a good interactional ambiance to acknowledging and leveraging patients’ capabilities for self-care. The findings stimulate discussions on the value of PCC and how it can be optimised for better chronic care.

1.• Perceiving 9 patient centred care( PCC )adequately is associated with better adherence and fewer complications among patients with DM even in the context of poor therapeutic options, A minimum level of PCC may be required to effect change.
2. • Patient-centred care delivery seems to be discretionary for those thought to have low self-efficacy
2. • PCC efforts need to spill over beyond the interactional realm to include improvements in the organization of care
3.

Background:
Type 2 Diabetes Mellitus is a wide spread condition characterized by a long, and relatively asymptomatic phase with rapid deterioration due to end organ damage and complications. This case study presents a Filipino family dealing with crisis due to a member’s acute illness and rapid deterioration and how a patient centered, family focused and community oriented approach can help patients and their family maneuver through the treatment of a rapidly progressing disease process.

Method: Case study

Results:
The case highlights how a moderately dysfunctional low-income nuclear family care for a sick member and how adjustments in resource provision and social support help guide them through crisis and grief in the context of the Filipino health system.

Conclusion:
Family physicians must be able to provide families with knowledge about disease sequelae, facilitate timely referrals for the complex condition and recognize the available social determinants of health to provide guidance in resource mobilization. Family focused care must also be practiced through the recognition of the response of the family towards illness and offer anticipatory care to changes in the family system and introduce psychological support for families of such as crisis and grief counselling.

1) PATIENT CENTERED: Be one step ahead by having knowledge about the disease sequela, have an ability to facilitate timely referrals and be able to navigate of health resources.
2) FAMILY FOCUSED: Recognize the response of the family towards illness and offer anticipatory support to changes in the family system and introduce psychological support for families of patients such as crisis and grief counselling
3) COMMUNITY ORIENTED: Be adept in transitioning from inpatient to outpatient or primary care and be able to identify relevant social determinants of health to the family’s medical concerns.

Background: General practice nurses play an essential role in Australia’s primary health care sector by delivering effective preventive care and chronic disease management. This is not surprising given approximately 80% of Australia’s burden of disease is attributed to chronic illness, 38% of which may be prevented by addressing lifestyle-risk factors.
Aims: Identify enablers of and barriers to effective preventive care by general practice nurses and improve understanding of the factors contributing to advancements in the field.
Methods: An exploratory sequential, mixed-methods design. Quantitative data were collected via the Lifestyle Risk Factor Survey and analysed using SPSS. Qualitative data were collected via semi-structured interviews and analysed thematically using NVivo 12.
Results: From 245 survey responses, most general practice nurses indicated: patients found it acceptable to discuss lifestyle risk factors during consultations; addressing lifestyle risk factors with patients was important; and the level of priority given to addressing lifestyle risk factors at their practice was high. Most general practice nurses found it ‘easy’ to find support services for patient referrals for all risk factors excepting alcohol counselling and were confident to perform preventive care including patient assessments (excepting nicotine dependency assessments), provide lifestyle change recommendations, conduct motivational interviewing, and apply adult education principles. However, most general practice nurses perceived their behaviour change advice was only ‘somewhat effective’. Interviews with 34 general practice nurses revealed the primary enablers of effective preventive care were related to individual factors (experience, motivation, knowledge, confidence, attitude) and interpersonal factors (motivated patients, supportive work colleagues, working dynamics). The main barriers were related to organisational factors (time, organisational structure, workplace culture, consultation space) and public policy and funding factors.
Conclusion/summary: General practices nurses, general practices, and patients acknowledge the importance of effective preventive care. Training, resources, and support initiatives including funding opportunities and allocations may promote practice improvement.

1. The assessment and management of lifestyle risk factors are considered as integral aspects of the role of the general practice nurse.
2. In general, our analysis demonstrated that general practice nurses have confidence in their abilities related to lifestyle risk factor assessments.
3. Our study has identified several important enablers of, and barriers to, general practice nurses performing lifestyle risk factor assessments as part of preventive care provision in Australian general practices. The enablers and the barriers identified in this study to exist at the individual, intrapersonal, and organisational levels can help to inform opportunities to improve the professional capacity of general practice nurses in general practices to better perform lifestyle risk factor assessments of patients.

Background: To improve the quality of integrated care for patients with complicated multimorbidity, a new, research-based care model “Complex intervention for patients with complicated multimorbidity model” (CIM2) is presently being tested for feasibility and acceptance in a pilot RCT-study in two regions of Denmark. The CIM2 consist of 1) a three-hour teaching program for health professionals in GP’s practices, hospital and municipalities, 2) a 45 min. extended patient-centred overview consultation in general practice, 3) development of an individual care plan together with the patient that is shared with the hospital and municipality, 4) additional consultation(s) depending on the patients’ needs, and 5) a follow-up extended overview consultation after 12 months. The model is evaluated quantitatively as well as qualitatively, and results will contribute to further improvement of the model.

Aim: The aim of the qualitative evaluation is to investigate how the CIM2 is experienced by health professionals and patients in relation to acceptability, workability, patient-centeredness, and cross-sectorial collaboration.

Methods: An in-depth evaluation with a mix of qualitative methods carried out by a team of researchers during the spring 2023: 1) semi-structured interviews with health professionals in general practice, municipalities and hospitals, 2) semi-structured interviews with 15 patients with complex multimorbidity, 3) video recordings of extended consultations in general practice and 4) participant-observations following selected participants cross sectors. A collaborative inductive analytical approach is conducted.

Results: Results regarding patients and professionals’ experience of the CIM2 is reported with a focus on themes of importance in relation to improvement of the CIM2 toward a focused, patient centred integrated health service.

Conclusions: The findings of the qualitative evaluation, contributes to the limited knowledge on the most appropriate organisation of high quality patient-centred and integrated care services for people with complicated multimorbidity.

At the conclusion of my presentation attendees will take away
1. General practitioners' perspectives on working with a new model for integrated care for patients with complex multimorbidity
2. General practitioners' perspectives on cross-sectorial collaboration working with a new model for integrated care
3. How patients with complex multimorbidity experience the new model of integrated care

Clinical decision support (CDS) systems are known to enhance physician practice performance through improved EHR usability, clinical guideline compliance, EHR integration, and real-time prescription alerts. (Moghadam 2021). While EHRs are directly associated with clinician burnout which can inhibit performance and impair patient outcome, CDS tools aim to mitigate these negative effects (Gardner 2019). CDS systems can help reduce clinical burden if they are relevant, customized, and optimized to the provider and integrate clinician feedback (Jankovic 2020). While CDS offers many benefits to clinicians, little research has focused on the impact of CDS on preoperative assessment within primary care; most prior studies have focused on CDS within anesthesiology or on preoperative assessment of patients with specific disorders such as diabetes mellitus (Bau 2014; Chau 2012). This study examined whether an Assessment, Plan, Subjective, Objective (APSO)-style note template embedded with CDS tools can improve competence and confidence in providing preoperative assessments within primary care. The APSO note template was trialed among a group of primary care providers at a primary care clinic in Colchester, Vermont. Two group qualitative interviews were performed, transcribed, and inductive coding methods were used to determine overarching patterns within the data. Providers felt that the APSO preop note provided practical clinical decision support systems that helped guide and improve clinical decision-making. Various features of the note, such as the ease of use and clinical decision tools, were felt to improve competence in navigating the EHR and providing preoperative assessments. Despite the high frequency of low risk preoperative assessments performed in the clinic, providers felt that the APSO preop note was not excessive, although this is an area for further exploration. Findings from this study indicate the potential of this and other APSO note templates to serve as clinical decision support systems for providing preoperative care.

1. At the conclusion of the presentation attendees will be inspired to develop note templates and clinical decision support tools to improve care delivery and reduce cognitive burden in their practice.
2. At the conclusion of the presentation attendees will understand the importance of provider feedback in the development of note templates and clinical decision supports.
3. At the conclusion of the presentation attendees will be able to understand the potential increase in provider satisfaction with standardized note templates.

Non-drug interventions, such as psychological therapy, diet changes, and physical therapy, are often recommended to support prevention and management of chronic conditions. They are effective, and accessible in general practice via online clinical resources like Royal Australian College of General Practitioners’ Handbook of Non-Drug Interventions (RACGPs’ HANDI). Yet, non-drug interventions are underutilised, and their efficacy is underestimated by clinicians and patients alike. This indicates that there are barriers to using these effective interventions in primary care settings. To better understand the common barriers and enablers to using non-drug interventions for the management of chronic conditions in primary care, we are conducting an overview of reviews. The study is currently in progress, with preliminary results anticipated in early 2023. We searched five databases (PubMed, Cochrane, Embase, CINAHL and PsycInfo) for relevant articles. After deduplication, 5354 articles were screened to select scoping or systematic reviews of any study type, that reported barriers and/or enablers to using non-drug interventions for chronic disease management in primary care settings, including allied health. At present, 35 full text articles are included, however, forward and backward citation analysis to identify additional relevant studies is yet to be completed. Data on study characteristics, chronic condition, non-drug intervention, barriers and/or enablers, and evidence certainty will be extracted, and analysed for barrier or enabler factors that are common across different chronic conditions and non-drug intervention types. To better understand these factors and their role in implementing non-drug interventions in primary care settings, common barriers and enablers will be coded using the consolidated framework of implementation science (CFIR), and subsequently mapped to possible implementation strategies. By understanding and addressing common barriers and enablers, we can strategize ways to improve the implementation of non-drug interventions for management of chronic conditions in primary care.

At the conclusion of my presentation attendees will take away:
1. Why increasing the use of effective, evidence-based, non-drug interventions in primary care is important for quality, patient-centred healthcare delivery.
2. An understanding of the common barriers and enablers to using non-drug interventions for chronic disease management in primary care.
3. Theory-driven implementation strategies that can address barriers and utilise enablers to improve the use of effective non-drug interventions.

Polyarthritis has many diagnostic possibilities and identifying a cause can be difficult. We present an atypical case of an acute polyarthritis. On presentation the patient had a 2-day history of symmetrical polyarticular joint pain and swelling involving bilateral shoulders, elbows, wrists, knees and interphalangeal joints. He had high fever on admission, but otherwise had no constitutional symptoms or significant exposures. Preliminary blood culture was positive for gram positive cocci, with final culture of streptococcus pneumoniae. Joint aspiration of his left knee had mild leucocytosis with negative gram stain and no crystals. He was started on empiric antibiotics. Reactive arthritis is an uncommon sequelae following pneumococcal infection.

1. An initial approach to polyarthritis involves differentiating between inflammatory and mechanical causes, duration of symptoms, pattern of joint involvement and presence of extra-articular symptoms.
2. A presentation of arthritis accompanied by fever often invites a consideration of either septic arthritis or crystal arthropathy; however, a systematic approach should be taken to avoid prematurely reaching a diagnosis.
3. Reactive arthritis is most commonly associated with enteric and genitourinary pathogens, but a large number of other pathogens, including streptococcus, have also been less commonly reported in patients.