Family practice最新文献

Objective: This study aimed to explore the perceptions and experiences of individuals that currently smoke and healthcare professionals on using real-time video counseling in the Smoking Cessation and Counselling Program in General Out-patient Clinics in Hong Kong.

Design: This was a qualitative study using face-to-face semi-structured interviews based on the extended technology acceptance model. All interviews were audiotaped and transcribed verbatim. Two investigators coded the transcripts independently. Thematic analysis was adopted.

Participants: Individuals that currently smoke and healthcare professionals who had experience using real-time video counseling in the Smoking Cessation and Counselling Program in General Out-patient Clinics in Hong Kong were recruited. Purposive sampling was adopted. 18 participants were interviewed to reach data saturation.

Main outcome measures: Themes that emerged from thematic analysis of data were the main outcome measures. The emerged themes were refined and verified via inductive and then deductive processes until data saturation was reached.

Results: Two core themes, which were in coherence with the extended technology acceptance model, namely (i) perceived ease of use and (ii) perceived usefulness, were identified. Under perceived ease of use, we identified 2 subthemes: (i) convenience and (ii) measures to facilitate the use of real-time video counseling. Three subthemes were identified under perceived usefulness: (i) empathy and rapport, (ii) measures for pandemics, and (iii) service outcome.

Conclusion: Our study provided a culture-specific perspective of users towards real-time video counseling. It identified users' opinions on the easiness and usefulness of the service. Those could provide clues for future improvement and development of using real-time video counseling in healthcare services.

Background: Acne vulgaris is one of the most frequent visits to primary care physicians and dermatologists alike. Isotretinoin is the backbone of acne treatment. In most countries, depending on the health care system, isotretinoin is prescribed by dermatologists but primary care physicians are a part of the follow-up and interpreting analysis. Adverse effects of isotretinoin on the kidney and urinary system are mostly limited to sparse case reports. Specifically, gross and microscopic haematuria is not mentioned to be associated with isotretinoin. Lack of data regarding these adverse effects can lead to doubt regarding further patient management not only with dermatologists but also primary care physicians.

Objective: We report a 16-year-old male patient with isotretinoin-induced haematuria with multiple episodes and subsequent challenge and de-challenge. No personal or familial history of nephrological disease was present. Ultrasound imaging and nephrology workup was within normal limits. Other aetiologies were excluded. Nephrology consult stated there was no contraindication for isotretinoin use and was reinstated at 0.6 m/kg/day. More frequent observation was indicated until completion of isotretinoin.

Conclusion: Our case raises awareness to other dermatologists and primary care physicians that haematuria can be secondary to isotretinoin but not a contraindication for further use if asymptomatic and microscopic. More extensive evaluation and monitoring should be done if the patient is symptomatic with other abnormalities and symptoms. Urinalysis should be a part of routine follow-up monitoring in patients on isotretinoin. Furthermore, delineating and differentiating when to refer to a nephrologist is essential for physicians, patients, and the health care system overall.

Introduction: Health system disruptions, caused by unexpected emergencies such as disease outbreaks, natural disasters, and cybercrimes, impact the delivery of routine preventative care. As comprehensive care providers, family physicians (FPs) devote significant time to prevention. However, without emergency and pandemic plans in place in primary care, FPs face added barriers to prioritizing and sustaining preventative care when health systems are strained, which was evident during the COVID-19 pandemic. This study aims to describe FPs' experiences providing preventative care during the COVID-19 pandemic and their perceptions of the impacts of disrupted preventative care in primary care settings.

Methods: Using a qualitative descriptive approach, we conducted semistructured interviews with FPs across 4 provinces in Canada (i.e. Newfoundland and Labrador, Nova Scotia, Ontario, British Columbia) between October 2020 and June 2021 as part of a larger multiple case study. These interviews broadly explored the roles and responsibilities of FPs during the COVID-19 pandemic. Interviews were coded thematically and codes from the larger study were analysed further using an iterative, phased process of thematic analysis.

Results: Interviews averaged 58 min in length (range 17-97 min) and FPs had a mean of 16.9 years of experience. We identified 4 major themes from interviews with FPs (n = 68): (i) lack of capacity and coordination across health systems, (ii) patient fear, (iii) impacts on patient care, and (iv) negative impacts on FPs. Physicians voiced concerns with managing patients' prevention needs when testing availability and coordination of services was limited. Early in the pandemic, patients were also missing or postponing their own primary care appointments. Change in the provision and coordination of routine preventative care had negative impacts on both patients and physicians, affecting disease incidence/progression, physician workload, and psychological wellbeing.

Conclusion: During the COVID-19 pandemic, upstream care efforts were impacted, and FPs were forced to reduce their provision of preventative care. FPs contribute direct insight to primary care delivery that can support pandemic planning to ensure preventative care is sustained during future emergencies.

Background: Associated with both socioeconomic position and health outcomes, health literacy (HL) may be a mechanism contributing to social disparities. However, it is often difficult for general practitioners (GPs) to assess their patients' HL level.

Objective: To analyse disagreements about patient HL between GPs and their patients according to the patient's socioeconomic position.

Methods: For each of the 15 participating GPs (from the Paris-Saclay University network), every adult consulting at the practice on a single day was recruited. Patients completed the European HL Survey questionnaire and provided socio-demographic information. For each patient, doctors answered 4 questions from the HL questionnaire with their opinion of the patient's HL. The doctor-patient disagreement about each patient's HL was analysed with mixed logistic models to study its associations with patients' occupational, educational, and financial characteristics.

Results: The analysis covered the 292 patients (88.2% of the 331 included patients) for whom both patients and GPs responded. The overall disagreement was 23.9%. In all, 71.8% of patients estimated their own HL as higher than their doctors did, and the gap between doctors' answers and those of their patients widened from the top to the bottom of the social ladder. The odd ratio for the 'synthetic disagreement' variable for workers versus managers was 3.48 (95% CI: 1.46-8.26).

Conclusions: The lower the patient's place on the social ladder, the greater the gap between the patient's and doctor's opinion of the patient's HL. This greater gap may contribute to the reproduction or maintenance of social disparities in care and health.

Background: In France, general practitioners (GPs) prescribe benzodiazepines and Z-drugs (BZD/ZDs) widely, and especially to older adults. Several characteristics of patients and/or GPs linked to BZD/ZD overprescription have been described in the general population but not among older patients in primary care.

Objectives: To estimate the proportion of GP consultations by patients aged 65 and over that resulted in a BZD/ZD prescription, and determine whether any GP-related factors predicted BZD/ZD overprescription in this setting.

Methods: We analyzed sociodemographic and practice-related GP characteristics, and aggregated data on consultations recorded prospectively by 117 GPs in a database between 2000 and 2010. Next, we used logistic regression models to look for factors potentially associated with BZD/ZD overprescription (defined as an above-median prescription rate).

Results: The GPs' mean age at inclusion was 47.4 (7.1), and 87.9% were male. During the study period, the median (95% confidence interval) proportion of consultations with patients aged 65 and over resulting in a BZD/ZD prescription was 21.8% (18.1-26.1) (range per GP: 5-34.1%). In a multivariable analysis, a greater number of chronic disease (OR [95% CI] = 2.10 [1.22-3.64]), a greater number of drugs prescribed per consultation (5.29 [2.72-10.28]), and shorter study participation were independently associated with BZD/ZD overprescription.

Conclusions: BZD/ZD overprescription was associated with a greater chronic disease burden and the number of drugs prescribed per consultation but not with any sociodemographic or practice-related GP characteristics. Targeted actions are needed to help GPs limit their prescription of BZD/ZDs to older patients with multiple comorbidities and polypharmacy.

Background: Population-based expanded carrier screening (ECS) involves screening for multiple recessive diseases offered to all couples considering a pregnancy or during pregnancy. Previous research indicates that in some countries primary care professionals are perceived as suitable providers for ECS. However, little is known about their perspectives. We therefore aimed to explore primary care professionals' views on population-based ECS.

Methods: Four online focus groups with 14 general practitioners (GPs) and 16 community midwives were conducted in the Netherlands.

Results: Our findings highlight various perspectives on the desirability of population-based ECS. Participants agreed that ECS could enhance reproductive autonomy and thereby prevent suffering of the child and/or parents. However, they also raised several ethical, societal, and psychological concerns, including a tendency towards a perfect society, stigmatization, unequal access to screening and negative psychosocial consequences. Participants believed that provision of population-based ECS would be feasible if prerequisites regarding training and reimbursement for providers would be fulfilled. most GPs considered themselves less suitable or capable of providing ECS, in contrast to midwives who did consider themselves suitable. Nevertheless, participants believed that, if implemented, ECS should be offered in primary care or by public health services rather than as hospital-based specialized care, because they believed a primary care ECS offer increases access in terms of time and location.

Conclusions: While participants believed that an ECS offer would be feasible, they questioned its desirability and priority. Studies on the desirability and feasibility of population-based ECS offered in primary care or public health settings are needed.

Background: In the United Kingdom, 15-min appointments with the general practitioner (GP) are recommended for people with complex health conditions, including intellectual disabilities and health needs, but we do not know whether this happens.

Aims: We compared number and length of primary care consultations (GP, nurse, other allied health, other) for people with and without intellectual disabilities and health needs.

Methods: Linked primary care data from the Clinical Practice Research Datalink (CPRD) in England were used to investigate face-to-face and telephone primary care consultations in 2017-2019. Health needs investigated were: epilepsy; incontinence; severe visual/hearing impairments; severe mobility difficulties; cerebral palsy; and percutaneous endoscopic gastrostomy feeding. Age and gender-standardized consultation rates per year (Poisson), duration of consultations, and the proportion of "long consultations" (≥15 min) were reported.

Results: People with intellectual disabilities (n = 7,794) had 1.9 times as many GP consultations per year as those without (n = 176,807; consultation rate ratio = 1.87 [95% confidence interval 1.86-1.89]). Consultation rates with nurses and allied healthcare professionals were also twice as high. Mean GP consultation time was 9-10 min regardless of intellectual disability/health need status. Long GP consultations were less common in people with intellectual disabilities (18.2% [17.8-18.7] vs. 20.9% [20.8-21.0]). Long consultations with practice nurses were more common in people with health needs, particularly severe visual loss.

Conclusions: People with intellectual disabilities and/or health needs tend to have more, rather than longer, GP consultations compared with the rest of the population. We recommend further investigation into the role of practice nurses to support people with intellectual disabilities and health needs.

Background: Primary care providers (PCPs) are relevant stakeholders for primary care research (PCR).

Objective: We report the perceived importance and interest in PCR of a national sample of Chilean PCPs.

Methods: We conducted a cross-sectional study targeting Chilean PCPs. An electronic survey assessing perceived relevance of PCR, research training and experience, training interests, and demographics was disseminated through emails and WhatsApp messages. Descriptive statistics were used to summarize data. Logistic regression models were used to estimate adjusted probabilities and 95% confidence intervals for high interest in PCR, high interest in using research methods, and high interest in receiving research training, and predictors of these outcomes.

Results: A total of 387 providers completed the online survey. Only 26.4% of PCPs had research experience as a principal or co-investigator. However, most clinicians perceived PCR as very important (92.5%) and were interested in using research methods (90.7%) and receiving training (94.3%). There were no statistically significant differences in these perceptions between provider's discipline, role, sex, age, and geographical location after adjusting for covariates.

Conclusions: Despite few Chilean PCPs have research training, a large majority perceive it as important, are interested in using it in their practice and would like to receive training.

Background: The Family Caregiver Medication Administration Hassles Scale (FCMAHS) was developed to evaluate the hassles and concerns experienced by family caregivers in medication administration.

Objective: This study aimed to evaluate the reliability and validity of the Turkish version of the Family Caregiver Medication Administration Hassles Scale (FCMAHS-TR).

Methods: The FCMAHS-TR was developed after translation, cultural adaptation, and a pilot study. The cross-sectional study was conducted among family caregivers (≥18 years) in community pharmacies. Test-retest reliability analysis, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA) were performed. Hypothesis testing was used for the assessment of construct validity.

Results: The majority (68.7%) of the family caregivers were female (n = 470). In the test-retest reliability analysis (n = 30), the ICC value was 0.917 (P < 0.001). In EFA analysis (n = 251), the Kaiser‒Meyer‒Olkin (KMO) measure was 0.799, 62.6% of the total variance was explained by five factors including eighteen items, and Cronbach's alpha was 0.836. According to CFA (n = 219), the root mean square error of approximation (RMSEA) was 0.0654, and the comparative fit index (CFI) was 0.918. In construct validity, family caregivers with low reading ability of health-related materials and with high care burden had significantly higher median scores for all the factors of the FCMAHS-TR (P < 0.05 for all).

Conclusions: The FCMAHS-TR can be used to evaluate the hassle and concerns experienced by family caregivers in medication administration. This scale can be used by healthcare professionals to identify family caregivers who need individualized interventions for medication administration hassles.