Family practice最新文献

Background: Decarbonization in general practice is a critical step toward achieving a net zero healthcare system. Understanding the factors that facilitate or hinder the implementation of environmentally sustainable practices is essential for effective and equitable action. Hence, the overarching aim of this study is to advance understanding of the factors influencing decarbonization in general practice. This study's objective is to map and compare the application of the Normalization Process Theory (NPT) and Theoretical Domains Framework (TDF) in understanding the key factors and sub-factors related to decarbonization in general practice.

Methods: Factors derived from a systematic review and narrative synthesis were mapped to NPT constructs and TDF domains by a multidisciplinary team of 10 coders, including academic general practitioners (GPs), researchers, and patient representatives. The mapping was conducted independently, and coder agreement was evaluated for consistency and reliability in categorization.

Results: The study identifies key NPT ('Coherence', 'Collective Action', and 'Cognitive Participation') and TDF domains ('Environmental Context and Resources', 'Knowledge', and 'Social/professional role and identity') associated with factors identified in previous research as being associated with achieving decarbonization in general practice. A high intercoder reliability rate (73% for NPT, 84% for TDF) supports the consistency of the analysis, particularly for structured drivers such as financial incentives and policy support.

Conclusions: The findings demonstrate that the NPT and TDF frameworks provide useful, though incomplete, insights into factors influencing decarbonization in general practice. Such factors require more attention when developing evidence-based strategies for promoting decarbonization, something that future research could evaluate.

Background: The current war in Gaza has created a thick cloud over the surrounding region: a cloud of anger, frustration, and despair. Palestinians make up a large portion of the population in Jordan with 2.39 million registered refugees alone, not including non-registered refugees. Many have relatives living in Gaza, making them particularly invested in the conflict.

Discussion: The ongoing suffering of loved ones preoccupies them, making it difficult to focus on anything else. I also sometimes fall into despair even though I am a foreigner living in Jordan.

Conclusion: A bright spot between the thick clouds occurred during my time with Ali at "Camp for All," a camp for students with disabilities in Jordan.

Background: Unintended pregnancies and short interpregnancy intervals (IPIs) are common and can be associated with adverse neonatal and maternal outcomes. Effective postpartum contraception could provide women with more control over their reproductive outcomes. Lactational amenorrhoea can be effective contraception; however, early breastfeeding discontinuation is common. This study aimed to explore and understand the experiences, practices, and perspectives of Australian general practitioners (GPs) in relation to postpartum care, contraception, and breastfeeding.

Methods: Twenty-one qualitative, semi-structured interviews were conducted with GPs working in Sydney, Australia. Interviews were audio-recorded and transcribed for directed content analysis and thematic analysis.

Results: Directed content analysis identified a diverse range of issues that constitute postpartum care. Thematic analysis identified four themes:(1) GPs have a holistic view of the postpartum period and play a coordinator role in postpartum care.(2) GPs identify opportunities for empowering postpartum women in their healthcare.(3) GPs perceive that women deprioritize their postpartum care and contraception.(4) GPs identify barriers and facilitators for postpartum care delivery.Subthemes provided further detail about how GPs consult with postpartum patients and opportunities to improve care. They noted areas of professional development needs and discussed the system, professional and patient factors impacting care.

Conclusions: We identified several areas for improving postpartum care, including routine antenatal contraception counselling, revisiting the timing of postpartum visits, improving GP education in IPIs and breastfeeding, and improving engagement in postpartum care services through patient education.

Background: The COVID@Home Clinical Care Pathway (the Pathway) was developed and implemented as an evidence-based remote monitoring clinical care pathway for the integrated management of coronavirus disease 2019 (COVID-19) in the province of Ontario, Canada. We examine its effectiveness and rapid large-scale implementation.

Methods: Using a prospective longitudinal study design, we used electronic medical record clinical data, provider and patient surveys, web analytics, healthcare and provincial utilization, and government holdings data to evaluate reach, effectiveness, adoption, implementation, and maintenance outcomes, including patient mortality and health equity.

Results: The Pathway was widely accessed (19 474 Ontario unique users), contributed 28 816 oxygen saturation monitors, and achieved coverage across income levels and geography. Two-thirds of patients had > 1 encounter, monitored for a median of 4 days (Range: 1-57). Fifty percent of patients had > 1 chronic condition. Patients receiving Pathway care were less likely to die by 0.44% (20/4556), two times lower compared to the total mortality of a population-based representative patient cohort over a parallel time period in Ontario of 0.86% (1820/212 326, P = .0023). Patients were very satisfied with their care, and felt care was accessible, safe, and clear. Providers were very satisfied with the Pathway resources and reported strengthened relationships across the health system.

Conclusions: Primary care (PC) rapidly implemented a clinical care pathway during the COVID-19 crisis. The Pathway demonstrated the beneficial role and effectiveness of PC when patients are provided with timely, accessible, and comprehensive care. Public health responses should explicitly collaborate with PC to address population health.

Background: Hospital family physicians are recognized for their excellence in managing complex issues. This study aimed to reveal the level of complexities of patients referred to hospital family physicians by community centers, and the degree of change in these complexities following care provided by a health care team that includes hospital family physicians.

Methods: A retrospective cohort analysis. Patients introduced by community centers between 2020 and 2023 were identified. The patients received team-based comprehensive care. Complexity was calculated before and after the care, using the patient-centered assessment method (PCAM), which evaluates 12 items across four domains. Each item is rated from 1 to 4, yielding a total score range of 12 to 48. Pre- and post-intervention scores were compared using paired-sample t-tests, with standardized mean difference calculated using Hedges' g.

Results: Of 41 referred patients, three died shortly after the initial consultation. Among the 38 remaining patients, 24 were admitted, and 14 were treated as outpatients. The mean PCAM score significantly decreased from 36.9 to 23.7 after interventions (P < .001, Hedges' g = 2.54). Scores improved significantly across all domains: health and well-being (2.96 vs 1.95; P < .001, g = 2.00), social environment (3.09 vs 1.96; P < .001, g = 2.38), health literacy and communication (2.78 vs 2.46; P < .001, g = 0.67), and service coordination (3.61 vs 1.57; P < .001, g = 4.68).

Conclusion: Hospital family physicians in Japan often manage patients with exceptionally complex problems and improve patient outcomes across multiple domains.

Introduction: Given high levels of student debt and a desire for high income, we hypothesize that the mean salary of a medical specialty is correlated with how desirable that specialty is for graduating US medical students.

Methods: We used salary data from a 2024 survey of 33,000 US physicians. As a proxy for desirability or competitiveness, we used the percentage of year 1 positions filled with US allopathic seniors based on data from the National Residency Match Program. Scatter plots were created and Pearson correlation coefficients were calculated.

Results: There was a strong positive correlation between salary and competitiveness for US allopathic seniors (r = + 0.65). A negative correlation was seen for US osteopathic seniors (r = -0.53) and international medical graduates (r = -0.58).

Conclusions: A specialty's salary is strongly associated with its competitiveness for US allopathic seniors. Data for osteopathic seniors and international graduates shows the opposite association, suggesting a channeling bias of these students into lower-paying specialties or more successful efforts to encourage primary care careers.