Family Medicine

Hybrid telecare for type 2 diabetes matches usual care for HbA1c and improves blood pressure

In this single-blind non-inferiority RCT of 786 adults with type 2 diabetes, hybrid telecare maintained HbA1c comparable to in-person care over 84 weeks. The hybrid group alternated telecare and in-person visits and had consistently lower blood pressure than the in-person group. Medication adherence remained stable in the hybrid group but declined mid-trial in usual care, suggesting better treatment persistence. All seven clinics continued the telecare model post-trial, indicating real-world feasibility and comparable costs within a public system. 1

Frequent home BP readings plus dedicated nurses improve short-term hypertension control in RPM

Among 1464 RPM participants with hypertension, adequate home BP readings were associated with 10%–15% higher control at 4–12 weeks. Monitoring by dedicated Brook nurses, versus clinic staff, yielded up to 16% higher prevalence of BP control early in the program. Combining adequate readings with Brook nurse monitoring improved control by 17%–27% versus inadequate readings without Brook monitoring. Benefits emerged within four weeks, supporting intensive early engagement and dedicated staffing in primary care RPM programs. 2

Tiered non-specialist iCBT reduces perinatal depression and is highly cost-effective

This pragmatic primary care trial enrolled 428 pregnant women with EPDS ≥9, comparing tiered iCBT plus usual care with usual care alone. The iCBT group had greater EPDS reductions to six months postpartum and lower postpartum depression risk (aOR 0.46, 95% CI 0.27–0.79). Response rates improved (aOR 1.70, 95% CI 1.05–2.76), with similar favorable trends for anxiety and life satisfaction. Benefits were larger in moderate to severe depression, with minimal effect in mild cases, supporting symptom-stratified intensity. The program was highly cost-effective, with very low incremental cost per 1% increase in response, and used trained non-specialist providers. 3

Potentially inappropriate prescribing strongly linked to adverse outcomes in nearly 3 million older adults

This retrospective cohort followed 2,937,927 Ontario residents aged ≥65 years with at least one prescription over 14 years. STOPP-START–defined potentially inappropriate prescriptions were associated with higher odds of mortality (aOR 3.68) and hospitalization (aOR 4.86). Beers-defined inappropriate prescriptions similarly increased odds of mortality, hospitalization, ED visits, and a composite adverse outcome. Risk rose with each additional inappropriate prescription, with five or more STOPP-START triggers linked to nearly 15-fold higher mortality odds. Findings support routine use of STOPP-START and Beers criteria to prioritize medication review and deprescribing in primary care. 4