ABSTRACT
Introducción: La atención a pacientes nefrogeriátricos requiere de nuevas acciones que propicien mejores resultados de forma armónica e integrada. Objetivo: Caracterizar el estado actual del desempeño profesional del médico de familia en nefrogeriatría en la Atención Primaria de Salud. Métodos: Estudio observacional, descriptivo y transversal, desde mayo de 2014 a mayo de 2015, dirigido a 39 médicos de familia del área 5 de septiembre. Se emplearon métodos teóricos, empíricos y estadísticos para evaluar el desempeño profesional del médico de familia en nefrogeriatría. Se tuvo en cuenta el consentimiento informado. Resultados: Se identificó el estado actual de la variable estudiada, con la identificación de problemas relacionados con la dimensión cognitiva, asistencial, educativa e investigativa en la atención al paciente nefrogeriátrico en la Atención Primaria de Salud. Conclusiones: El desempeño profesional del médico de familia en nefrogeriatría carece de integración en la atención integral a los pacientes, la familia y la comunidad(AU)
Introduction: The care for nephrogeriatric patients requires new actions with better outcomes in a harmonic and integrated way. Objective: To characterize the current state of professional performance of family physicians in nephrogeriatrics in primary healthcare. Methods: Observational, descriptive and cross-sectional study carried out from May 2014 to May 2015, targeted at 39 family physicians belonging to 5 de Septiembre health area. Theoretical, empirical and statistical methods were used to evaluate the professional performance of the family physician in nephrogeriatrics. Informed consent was taken into account. Results: The current state of the studied variable was identified, with the identification of problems related to the cognitive, assistance, educational and investigative dimensions in the care of nephrogeriatric patients in primary healthcare. Conclusions: The professional performance of the family physician in nephrogeriatrics lacks integration regarding the comprehensive care of patients, family and the community(AU)
Subject(s)
Humans , Male , Female , Physicians, Family , Professional Practice , Work Performance , Epidemiology, Descriptive , Cross-Sectional Studies , Observational StudyABSTRACT
German family physicians practice independently in clinics, and provide primary health care services. General practitioners are a type of specialists. The basis for the self-management of German doctors is the homogeneous medical education in Germany. The new round of medical education reform emphasizes the theory and practical training throughout the entire process of medical education. All medical students in Germany need to go to the clinic for internship and be familiar with primary health care models. Post-graduation education sets rotation plans and assessment standards according to the characteristics of general practice specialties, emphasizes the clinical practice time in the clinics, and urges doctors to continue medical education through the payment of medical insurance. This article draws on the German general practitioner training model, proposes to strengthen the enlightenment of general practice education during the education of undergraduate medical colleges, and strengthen the clinical practice of general practitioners and the construction of general practice training bases, as well as improve the ability of the community physician faculties, in order to provide a reference for the training of general practitioners in China.
ABSTRACT
Objective @#To explore the effect of a community family doctor model on caries management for children aged 1 to 3 years in Wuhan, and to provide basis for community prevention and control of children’s caries.@*Methods@#Using stratified randomization and paired sampling, 1 000 children aged 1 to 3 years were selected from the core community of the Wuhan Donghu High-tech Zone. The trial group was followed up 4 times a year at home or in the clinic, and the control group was followed up only at the baseline and the endpoint (2 years later). Caries and caries status were examined at baseline and 2 years later, and brushing behavior was investigated by questionnaire. @* Results @#The prevalence/dmft in the test group and control group after two years were 15.8%/1.41 and 46.6%/3.25, respectively, and the difference was statistically significant. The frequency with which parents helped their children to brush in the test group improved significantly compared to that of the control group.@* Conclusion @#For children aged 1 to 3 years, the dental family doctor model of caries prevention is economical and effective, and its application and promotion are recommended.
ABSTRACT
Background: Metabolic syndrome includes atherogenic dyslipidemia, obesity, hypertension, hyperglycemia, andinsulin resistance. This complex of metabolic abnormalities is a risk factor for DM2, stroke, adverse cardiacevents, and hepatic necrosis. In the last few years, studies showed a significant high prevalence of this syndromeamong Saudi males. Central visceral adiposity is thought to be the primary trigger of most pathogenic eventsinvolved in the advent of the syndrome. Objectives: In this paper, our aim is to discuss metabolic syndrome, itsdefinitions, pathophysiology, diagnosis, screening, and the management done for such patients in general withspecial focus to primary healthcare. Methodology: PubMed database was used for articles selection. Conclusion:The syndrome is linked with significant impacts on the patient health; as a result, the health care providers shallbe alarmed on how to screen, diagnose and manage such disease. Prevention of childhood obesity is criticalthrough screening and early diagnosis to save major burden and prevent future complications. Thus, nowadays,the new trend is towards incorporating screening of this syndrome in primary health care centers.
ABSTRACT
Background: Hypertension is a prevalent disease in many countries, either developing alone as essentialhypertension or passing as co-morbid in atherosclerotic diseases and fibrodysplasia. Hypertension has a variablepresentation, with most patients being asymptomatic; clinical signs do occur, such as headaches, and should alertthe physician to the possibility of advanced disease or uncontrolled blood pressure. Methods: PubMed databasewas used for articles selection, and the following keywords were used in the mesh; "Hypertension"[Mesh] and“Evaluation"[Mesh] or "Management"[Mesh] or "Treatment"[Mesh] and “Family Physician” [Mesh]. Manyarticles on the topic were found, with further restriction by PubMed filters, and with reviewing the titles andabstracts of the articles, the final results were included in this paper. Conclusion: Family physicians should focuson maintaining blood pressure to appropriate levels by combining updated guidelines and clinical judgment.Beta-blockers, thiazides, and angiotensin-converting enzyme inhibitors continue to be the mainstay of treatmentin hypertensive diseases; newer novel drugs are being tested with promising results.
ABSTRACT
Background: Obstructive sleep apnea (OSA) despite being the most common type of sleep disorder, may presenta myriad of clinical features, ranging from simple fatigue and lack of concentration to per-sonality changes andheart diseases. The association between the genetic, physiological built, so-cial status, and behaviour plays themajor role in disease risk factors diagnosis and management plans. The most often used treatment method of OSAis Continuous Positive Airway Pressure (CPAP) aimed at monitoring respiratory effort and Apnea-HypopneaIndex (AHI) measuring the number of apnea and hypopnea events per hour of sleep or the RespiratoryDisturbance Index (RDI). Objective: The focus of this paper is providing a review on obstructive sleep apnea,different treatment ap-proaches and the recent perspectives with regard to family physicians’ enrolment inmanagement and modulation of pain in OSA patients. Methodology: PubMed database was used for articlesselection using the keywords obstructive sleep apnea, its evaluation, management, and diagnosis. Conclusion: Insummary, family doctors and primary care providers play a major role in controlling OSA and are involved indealing with CPAP, AHI measurement and RDI. Obstructive sleep apnea re-quires a high cost which may furthercontribute to late detection, complications deterioration, and increasing in the drop of follow-ups. Increasingawareness of the primary care providers especial-ly family physicians would help to avoid such outcomes. OSAremains a common condition that requires attention, identification, and more directed research.
ABSTRACT
@#Background: The number of house calls made by physicians has been declining over the years, while the number of people requiring house calls, especially the elderly, is growing. Aim: To consolidate the literature regarding the barriers faced by primary care physicians in making house calls. Design of the study: Literature review. Method: Studies were sourced from PubMed and Embase. Results: 7 studies were selected to be in the literature review. Barriers to making house calls by primary care physicians include inadequate remuneration, lack of time and training, unconducive home environment, concerns with professional liability and safety, and perceived low value-added in the patient’s quality of care. Conclusion: While primary care physicians do recognize the value of house calls in patient care, the perceived limited standard of care that can be achieved in the home setting, busy clinic practice (large patient loads), coupled with inadequate remuneration make house calls unrealistic for many doctors. These barriers must be addressed to ensure accessibility to primary health care services for the immobile, frail, and sick is not being compromised. One of the solutions may be to expose medical students and residents to house calls early through mentorship.
ABSTRACT
@#Objective: This study was conducted to investigate the challenges faced in the implementation of the pay-for-performance system in Iran’s family physician program. Study design: Qualitative. Place and duration of study: The study was conducted with 32 key informants at the family physician program at the Tabriz University of Medical Sciences between May 2018 and June 2018. Method: This is a qualitative study. A purposeful sampling method was used with only one inclusion criterion for participants: five years of experience in the family physician program. The researchers conducted 17 individual and group non-structured interviews and examined participants’ perspectives on the challenges faced in the implementation of the pay-for-performance system in the family physician program. Content analysis was conducted on the obtained data. Results: This study identified 7 themes, 14 sub-themes, and 46 items related to the challenges in the implementation of pay-for-performance systems in Iran’s family physician program. The main themes are: workload, training, program cultivation, payment, assessment and monitoring, information management, and level of authority. Other sub-challenges were also identified. Conclusion: The study results demonstrate some notable challenges faced in the implementation of the pay-for-performance system. This information can be helpful to managers and policymakers.
ABSTRACT
Objectives: Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality. The American College of Cardiology/American Heart Association (ACC/AHA) atherosclerotic cardiovascular disease (ASCVD) risk estimator is a recently developed online calculator tool for primary prevention. Family physicians, as first-line soldiers, have close contact with local community patients making preventive care management an integral part of their routine work. Therefore, we would like to assess primary health care providers’ knowledge, attitude and barriers for using ASCVD risk estimator in a family health care facility. Methods: This was a quantitative, cross-sectional, single-center study which took place at a tertiary health care facility between December 2018 and January 2019. An English-paper-based self-administered questionnaire was distributed to all primary health care physicians (n=172). Results: Most of the participants were using a different type of cardiovascular risk score calculator 128 (97.7%). Among these scores, ASCVD risk assessment calculator was the highest frequently used calculator 67 (51.1%) and Framingham risk score 43 (32.8%). Study participant preferred to use mobile application 102 (77.9%) as a technical method of risk score calculation. ASCVD knowledge was significantly related to participants’ clinical attitude (r=0.3, p-value=0.003) however, they have moderate knowledge about ASCVD risk calculator (61.7%), and only 37.3% have a positive attitude towards it. Conclusion: Health promotion implementation needs using powerful primary prevention of cardiovascular risk calculators. Therefore, enhancing family physician knowledge and eliminate obstacles will gradually improve their attitude towards disease prediction and prevention.
ABSTRACT
La prescripción social permite al médico de familia orientar, indicar, prescribir al paciente servicios y ayudas no médicas disponibles en la comunidad, que podrían proporcionarles bienestar y remediar problemas que tradicionalmente se van de la típica solución ofrecida por el profesional de la atención primaria. La prescripción social está relacionada con la prescripción de activos de salud, estilos de vida, intersectorialidad y determinantes sociales de la salud en la localidad que trabaja el médico de familia, y puede ser un componente de un nuevo modelo de salud en la atención primaria. En este trabajo se ofrecen ejemplos de servicios de prescripción social y se sugiere ampliar la lista con facilitadores/pacientes/usuarios en la comunidad(AU)
Social prescription allows the family physician to guide, indicate, prescribe the patient services and non-medical aids available in the community, which could provide welfare and solve problems that traditionally go away from the typical solution offered by the primary care professional. Social prescription is related to the prescription of health assets, lifestyles, intersectoriality and social determinants of health in the community where the family physicians works and can be a component of a new health model in primary care. This paper offers examples of social prescription services, while it is suggested to expand the list with facilitators, patients and users in the community(AU)
Subject(s)
Humans , Male , Female , Physicians, Family , Primary Health Care , Prescriptions , Health PromotionABSTRACT
Objective: To clarify the involvement of Japanese family physicians with patients and their families in their daily practice.Methods: Participants were Japanese family physicians with over one year of experience of full-time work in their clinics, and who were able to join the focus group discussions (FGD) and member checks. The study employed a qualitative research design with semi-structured FGD. Two analysts examined video recordings of the FGD, and the results were verified through member checks and external checks.Results: Eight physicians participated at first, but five of them dropped out because of job commitments or death. The involvement by Japanese family physicians consisted of three stages. The first stage was "the approach of repeated hypothesis testing and normalizing" as safety interventions. The second stage was "reevaluation of the family" utilizing family genograms, family conferences, and others. After exhausting all other efforts, they engaged in "accepting the one who comes to them" in collaboration with the patient and families. The outcomes included awareness of patients, their smiles due to feeling accepted, and their expressed emotions. They did not explicitly boast that they were able to engage with family members. In addition, they also needed case studies of instances of "failure." Conclusion: Japanese family physicians engaged in three-stage involvement with families.
ABSTRACT
The paper analyzed the dilemma of rural family physician signing model. Then established the evolutionary game model of residents' and the rural family physician's strategy. The Matlab simulation software were used to analyze the influencing factors of residents and family physician strategy-making system. We proposed the advice enhancing the enthusiasm of signing the family physician, increasing the proportion of residents signing the personalized service package, reduction of utility loss caused by family physician's "lazy" strategy, the cost reduction of basic medical service provided by family physician, improving the award of effective signing and the punishment mechanism of not ideal health management to make result develop towards the residents' signing the family physician and an integrated basic medical service system.
ABSTRACT
This paper systematically reviews the latest and relevant literatures and policy documents on the in-tegrated health services in Canada in recent years. Therefore, it summarizes the practice and mode of integrated serv-ice delivery in Ontario, Alberta and Quebec wherein the integration among health organization, health service team, and a series of health services are included. The contributing factors and impeding factors ( the barriers) of organiza-tional integration and specific integration strategy were summarized. Finally, according to the actual practical situa-tion, it is proposed that China should adhere to the government-led approach in promoting the integration of health services, and give a full play to the positive role of the market mechanism. Through strengthening the network man-agement and group service of primary health services, emphasis will be put on health services of population groups and specific diseases. Therefore, integration will be regarded as a strategic priority, increasing incentives and boos-ting promotion of nursing personnel on the process of Integrated Service Delivery, building the health information sys-tem that is conducive to integration in order to continuously advance Hierarchical Diagnosis and bridge the fragmented service system. This will help in providing residents with personalized, convenient, comprehensive, and continuous health services.
ABSTRACT
Every year, we tour a leading country for family medicine with new trainees and staff who join the Department of Community and Family Medicine at Fukushima Medical University. This time we visited Denmark. In Denmark, General Practitioners (GPs) see their patients by a list system. GPs work as a gatekeeper and solve many kinds of health problems. GP training is a 5-year program, and the training system is well established. It is usual for both GP trainees and their partners to work and raise their children during the training.
ABSTRACT
This article is a short report on the third Japan-UK Primary Care Exchange Programme. Japanese delegates visited Scotland in September of 2015. They watched GP surgeries and attended the Royal College of General Practitioners (RCGP) Annual Primary Care Conference. The following topics are covered as some of the most insightful experiences: NHS Cancer screening programmes, support for people with cancer and their families, working conditions for GPs, and the Half-Day Release Programme for GP specialist training. In addition, the delegates reflected on their experiences.
ABSTRACT
Introduction: Worries and concerns about taking medicine, and related factors in older patients undergoing polypharmacy were investigated.Methods: Participants (N = 9) aged 65 years or older with chronic diseases who were prescribed more than six types of medicine were selected for this survey. Qualitative data obtained by semi-structured interviews were analyzed by Steps Coding and Theorization (SCAT). Components and concepts are indicated by "" and ' ', respectively.Results: Worries about taking medicine were affected by "lack of support from medical staff providing polypharmacy", and by "negative experiences and lack of understanding about medicine". "Behaviors for coping with worries", which were composed of "self-control in taking medicine" and "asking advice from the prescribing physician", dispelled worries. Participants that had never been worried had "received adequate support from staff involved in polypharmacy" and had "positive attitudes about polypharmacy".Conclusion: Worries about taking medicine among older patients undergoing polypharmacy were solved through self-control. Moreover, medical staff involved in polypharmacy should conduct activities to initiate communication with such patients.
ABSTRACT
Introdução: O cirurgião-dentista é o profissional mais capacitado para trabalhar assuntos relativos à situação de saúde bucal. No entanto, algumas equipes de ESF ainda não possuem o profissional cirurgião-dentista presente. Muitas vezes, o profissional médico passa a ser o principal contato da equipe de saúde com a população. Assim, observa-se a necessidade do mesmo ter o conhecimento de práticas preventivas em relação à saúde bucal. Objetivos: Verificar o conhecimento em saúde bucal da criança dos médicos de família. Material e Métodos: Foi realizada uma entrevista semiestruturada com oito Médicos de Família do Serviço de Saúde Comunitária (SSC) do Grupo Hospitalar Conceição (GHC) Resultados: Apenas 37,5% da amostra citaram que a dentição decídua deveria estar completa abaixo de 4 anos. Quanto à transmissibilidade da doença cárie, 50% dos médicos consideraram que esta não é transmissível de uma pessoa para outra. Todos os médicos entrevistados consideraram que o fator bacteriano não é o único capaz de desencadear o processo carioso, necessitando de outras variáveis associadas. O período mais recomendado pelos médicos para a 1ª consulta odontológica da criança seria quando da erupção dos primeiros dentes (37,50%). Em relação à utilização de mamadeiras, 50% dos entrevistados orientam a higienização bucal após a mamada e 62,50% orientam mínima ou não utilização de açúcar nas mamadeiras. Conclusão: Diante do número reduzido de dentistas em atenção primária no Brasil, e das necessidades odontológicas apresentadas pela população, vê-se a necessidade de capacitação de profissionais médicos para atuação direcionada à prevenção em saúde bucal.
Introduction: The dentist is the most skilled professional for work on matters relating to oral health. However, some FHS (Family Health Strategy) teams still do not include a professional dental surgeon. Often, the medical professional will be the main health team contact with the population. Thus, it is the necessary that this professional has an understanding of preventive practices in relation to oral health. Objectives: verify the knowledge of family physicians regarding children's oral health. Material and Methods: a semistructured interview was conducted with eight family physicians from the Community Health Service (CHS) of the Grupo Hospitalar Conceição (GHC). Results: Only 37.5% of the sample stated that complete deciduous dentition should occur by 4 years of age. As to the transmissibility of the caries disease, 50% of the doctors felt that this is not transferable from one person to another. All the doctors interviewed considered that the bacterial factor is not solely capable of triggering the caries process, requiring other associated variables. Most doctors recommended that the first dental appointment of the child would be when the first tooth erupted (37.5%). In relation to the use of baby bottles, 50% of respondents recommended oral hygiene after feeding and 62.5% recommended little or no use of sugar in baby bottles. Conclusion: Considering the limited number of dentists participating in primary health care in Brazil, and the dental requirements of the population, there is a need to train medical professionals to act in preventative measures in oral health.
Subject(s)
Oral Health , Primary Prevention , Child Health , Health ServicesABSTRACT
BACKGROUND: The main aim of this study was to evaluate the achievements of some important goals of Iran's urban family physician plan. This plan was implemented when the country experienced economic instability. We examine whether an economic crisis affects the efficacy of a healthcare program. METHODS: We used the household income and expenditures survey data for 2011 (before program implementation) and 2012 (after program implementation). Changes in out-of-pocket payments and healthcare utilization were investigated using the propensity score matching estimator. Furthermore, changes in inequality in these two dimensions were examined. RESULTS: No changes in out-of-pocket payments and healthcare utilization were found after the implementation of this program; however, inequality in out-of-pocket payments increased during the reform. CONCLUSION: The urban family physician program was not implemented completely and many of its fundamental settings were not conducted because of lack of necessary healthcare infrastructure and budget limitations. Family physician programs should be implemented under a strong healthcare infrastructure and favorable economic conditions.
Subject(s)
Humans , Budgets , Delivery of Health Care , Family Characteristics , Health Expenditures , Iran , Physicians, Family , Propensity Score , Socioeconomic FactorsABSTRACT
Objective To explore the effect of online health education by family physician using the wearable devices, and provide the basis in theory and practice to improve the level of primary health care in community. Methods A total of 132 community residents (78 for male and 36 for female, all of them are WeChat user) with hypertension in one residential area who had regularly participated in the activity of volunteer blood pressure measurement organized by community health service center in wujiaochang street from November 2015 to February were chosen as the participants. The residents who wore the wearable device given by the community hospital uniformly were set as the study group (60 people), while the remaining 72 residents were set as the control group. Both groups received the daily online health education provided by the family physicians through their smartphone. We compared the diversity of health cognition, controlling behavior and controlling results to blood pressure of both groups before and after the studyrelatively, then we comprehensively analyzed the effect of use of wearable devices in family physicians ' online health education. SPSS 18.0 was used for data analysis. The categorical data of two groups were compared with chi-square test and the comparison of continuous data was performed with t test. Results Totally 114 community residents were qualified in the study, and the initial backgrounds of study group and control group had no significant difference. After receiving the online health education information for three months, both groups achieved improvement on the cognition and related self-control behavior of hypertension except for several items, and the study group did better than control group in most items. The physical examination showed that the systolic blood pressure of the study group after the intervention [(131.46 ± 12.89) mmHg] (1 mmHg=0.133 kPa) was lower than before [(137.24 ± 12.27) mmHg] and the difference was significant (t=9.2, P<0.01); the diastolic blood pressure of the study group after the intervention [(78.29±8.91) mmHg] was lower than that of before intervention [(80.75±10.25) mmHg] and the difference was significant (t=2.3, P<0.05). Meanwhile, after intervention the systolic blood pressure of study group [(131.46 ± 12.89) mmHg] was lower than that of control group [(133.27 ± 12.7) mmHg] and the intervention was significant (t=2.1, P<0.05). Conclusion Long-term use of wearable devices help family physicians improve the effect of health education, consequently the community hospitals are responsible to enhance the input and management of the informatization of family physicians' service, and assist them to broaden the form and content of health education.