A Questionnaire Survey of Primary Care Physicians on Dialects in the Hokushinetsu Region -A Quantitative and Qualitative Study of Dialects and Physicians' Perceptions- / 日本プライマリ・ケア連合学会誌

Introduction: Primary care (PC) physicians often struggle with the local dialects of patients, especially when they work away from their hometowns.Method: We conducted a questionnaire survey of PC physicians in the Hokushinetsu region, the northcentral part of Honshu island of Japan, to understand how doctors recognize and deal with local dialects in their daily clinical practice.We also analyzed their comments qualitatively using the Steps for Coding and Theorization (SCAT) method.Results: Thirty-one physicians (21 men and 10 women) completed the questionnaire. Of the total, 71% of respondents worked away from their hometowns.Moreover, 81.8% of these respondents stated they had difficulties understanding the dialect spoken in the region of their workplaces and 36.3% misunderstood the meanings of the dialect spoken by their local patients as a result. Respondents often heard "ui" or "tekinai" as the chief complaints of local patients, and interpreted these words as physical symptoms such as fatigue, dyspnea, and abdominal distension. SCAT analysis suggested that these words can have different meanings depending on the context. PC physicians translate them into medical terms using paraphrasing techniques based on each patient's medical history. Furthermore, PC physicians use dialects according to their relationship with the patient.Conclusion: Understanding the characteristics of these dialects and using them appropriately may improve the doctor-patient relationship.

Review of Physician Referrals to Orthopedic Spine versus Neurosurgery

BACKGROUND: Previous studies have reported what patients value while choosing their surgeon, but there are no studies exploring the patterns of referral to spine surgeons among primary care physicians (PCPs). This study aims to identify any trends in PCPs' referral to orthopedic surgery versus neurosurgery for spinal pathology.METHODS: In total, 450 internal medicine, family medicine, emergency medicine, neurology, and pain management physicians who practice at one of three locations (suburban community hospital, urban academic university hospital, and urban private practice) were asked to participate in the study. Consenting physicians completed our 24-question survey addressing their beliefs according to pathologies, locations of pathologies, and surgical interventions.RESULTS: Overall, 108 physicians (24%) completed our survey. Fifty-seven physicians (52.8%) felt that neurosurgeons would provide better long-term comprehensive spinal care. Overall, 66.7% of physicians would refer to neurosurgery for cervical spine radiculopathy; 52.8%, to neurosurgery for thoracic spine radiculopathy; and 56.5%, to orthopedics for lumbar spine radiculopathy. Most physicians would refer all spine fractures to orthopedics for treatment except cervical spine fractures (56.5% to neurosurgeons). Most physicians would refer to neurosurgery for extradural tumors (91.7%) and intradural tumors (96.3%). Most would refer to orthopedic surgeons for chronic pain. Finally, physicians would refer to orthopedics for spine fusion (61.1%) and discectomy (58.3%) and to neurosurgery for minimally invasive surgery (59.3%).CONCLUSIONS: Even though both orthopedic surgeons and neurosurgeons are intensively trained to treat a similar breath of spinal pathology, physicians vary in their referring patterns according to spinal pathology, location of pathology, and intended surgery. Education on the role of spine surgeons among PCPs is essential in ensuring unbiased referral patterns.

Using Of Hypertonic Saline And Mannitol In Patients With Aneurysmal Subarachnoid Hemorrhage

Urinaryincontinence(UI)inwomenisanawkward,oftenundiscussedsubject,associatedwithanxiety,depression,socialisolationandaffectingqualityoflife.Thisstudyaimedtoassessprimaryhealthcarephysicians'knowledgeandpracticeinSaudiArabia'sEasternProvince.Thiscross-sectional study was conducted in primary healthcare centers of three main sectors (Dammam, Khobar and Qatif) in the Eastern Province by a self-administeredsurvey.Thesamplesizewas120physicianswhocompletedthequestionnaire.MostprimaryhealthcarephysiciansclearlyunderstoodUI,one-thirdofthemroutinelyaskedpatientsaboutUI,andabout55%ofthemcommonlyencounteredUIintheirpractice.Lackofscreeningtools,unfamiliaritywithavailabletreatmentalgorithms,andlackoftimewerethemostcommonbarriers.Almostallprimarycareproviders(95.8%)referredUIpatientstosecondarycare.Sixtypercentphysicianshadgoodoverallknowledge,and52.5%hadgoodattitudesandpracticesaboutUI.Therewasnostatisticallysignificantrelationshipexceptforjoblevelinrelationtoknowledgeandpracticescores.ImprovededucationandbasicscreeningprogramsandtreatmentinprimarycarecenterswouldimproveUIdetectionandmanagementattheprimarycarelevel

An Insight about the Referral System in Health Care Network: Flaws with Recommendations for Improvement

Healthcare network is composed of primary, secondary and tertiary care centers. Purpose of each unit in this sophisticated zone is to allow steady and smooth delivery of healthcare to optimum level without wasting essential resources or time. If, primary care centers are not able to fulfill the needs of any health issues then, patients are referred to more advanced setup where their health issues can be timely addressed in a proficient way. Referral system forms an important component of healthcare network and it should be formulated in such a way that it can bring fruitful results with the proper use of time, energy, man force as well as technical resources without compromising patient’s health. In this paper, we discussed the core of healthcare network in the city, working with primary as well as referral health care centers, flaws affecting the referral system and recommendations to improve them.

Diagnostic utility and impact of ultrasonography by primary health care physician: an observational study

Background: Ultrasound appears to be a suitable diagnostic technology for use in primary care and community settings. It plays a pivotal role in evaluation of patients and helps in making timely diagnosis and more widely on referral pathways into secondary care.Methods: The study was conducted at the primary health centre Hazratbal, which is one of the primary health centre of field practice area of the Department of community medicine, Government Medical College, Srinagar. This observational study was conducted over a period of three months where 255 patients were scanned by a primary care physician (sonologist). For each patient scanned, the ultrasound performing physician completed a standardized data collection form including patient demographics, clinical details, indications for ultrasound and ultrasound findings.Results: A total of 255 patients were scanned during the study period. Males were 43 (17%) and females were 212 (83%). Maximum number of patients were in the age range of 25-34 years, n=96 (38%). Among the patients scanned 66 (24.44%) were obstetric cases. Acute diffuse abdominal pain n=32 (11.85%) was the most common clinical presentation followed by pain upper abdomen n=28 (10.37%) among non-obstetric patients. Ovarian cyst was the most common finding, followed by fatty liver and bilateral nephrolithiasis.Conclusions: The utility of ultrasonography in the hands of primary care physician is of great value. It is cost effective option, especially in this part of the world. We need to give expertise to primary care physicians in order to provide better health care at primary health care settings, which will lessen the burden of referrals.

Practice and reflection of short-term orthopedics training in primary hospitals / 中华医学教育探索杂志

In order to provide more practicable and convenient continuing medical education for orthopedic surgeons in primary hospitals and expand the academic influence of expert lecturers and host hospitals in the region, our department hosted nine short-term training courses of orthopedic surgery jointly with primary hospitals, which lasted for 1 to 1.5 days on weekends from June 2001 to October 2017, with expert lectures as the main form. Traumatic orthopedics was the main topic, and most expert lecturers were orthopedic experts from famous hospitals within the province and the whole country, as well as the experts from the host hospital. More than 1200 orthopedic and surgical physicians in local districts and counties participated in the training, and excellent social effect has been achieved. For short-term orthopedic training jointly held with hospitals in prefecture-level cities, the topic of training should be carefully selected, and duration of the training and number of lecturers should be controlled, so as to achieve satisfactory social effects under the premise of low cost of administrative resources.

Nivel de conocimientos sobre depresión mayor en médicos de atención primaria en Lambayeque, Perú, 2014 / Knowledge level about major depression in primary care physicians from Lambayeque, Peru, 2014

Objetivos: Evaluar los conocimientos sobre diagnóstico y tratamiento del trastorno depresivo mayor en médicos de atención primaria de la provincia de Chiclayo y determinar su asociación con características sociodemográficas. Material y métodos: Estudio descriptivo transversal con análisis exploratorio de datos. Se realizó un muestreo tipo censal. Se evaluaron a 111 médicos de atención primaria, mediante un instrumento validado, unidimensional, basado en los criterios diagnósticos del DSM-IV para el trastorno depresivo mayor. El análisis univariado y bivariado se realizó con el programa estadístico STATA v. 11.1. Resultados: El nivel de conocimientos fue medio en 18 (16,2%) médicos de atención primaria; y bajo, en 93 (83,8%). Ninguno tuvo un nivel de conocimientos alto. Solo 23 (20,7%) recibieron actualización en salud mental en los últimos 4 años. No se encontró asociación entre el nivel de conocimientos y las variables sociodemográficas. Conclusiones: El nivel de conocimientos en depresión mayor de los médicos de atención primaria de la provincia de Chiclayo fue deficiente. Este hallazgo, sin embargo, no parece estar asociado con las características sociodemográficas de la muestra utilizada.

Objectives: To measure the level of knowledge about the diagnosis and treatment of major depressive disorder among primary care physicians in the province of Chiclayo, and to assess its association with sociodemographic characteristics. Material and Methods: Cross-sectional study with exploratory data analysis. A census-type sampling was performed. One-hundred eleven primary care physicians were evaluated through a unidimensional validated questionnaire, based on DSM-IV diagnostic criteria for major depressive disorder. An univariate and bivariate analysis was performed using STATA statistical software v. 11.1. Results: The knowledge reached a medium level of 18 (16.2%) primary care physicians, and low in 93 (83.8%). None had a high level of knowledge. Only 23 probands (20.7%) had received a mental health update in the last 4 years. No association was found between the level of knowledge and sociodemographic characteristics. Conclusions: The level of knowledge in major depression among primary care physicians from the province of Chiclayo was poor. This finding, however, showed no association with sociodemographic features of the study sample.

Behavioural Strategies for Sleep and Burnout Amongst Primary Care Physicians

The prevalence of burnout amongst primary care physicians (PCPs) in Singapore is likely to be high. Burnout has a negative impact on sleep quality, and poor sleep quality in turn feeds into burnout resulting in a vicious perpetuating cycle. Evidenced-based behavioural strategies can be useful to help improve sleep quality, which in turn contributes to the amelioration of burnout. This article details some of the evidence-based behavioural strategies that PCPs can use to improve their own sleep quality if used consistently.

Emotion Regulation Skills for Primary Care Phyhsicians

Given the stressful demands of their work, primary care physicians are susceptible to experiencing burnout. Evidence-based strategies to effectively manage emotions at work are essential to preventing physician burnout. This article details the role of emotional regulation in a physician’s workplace, a model for understanding the processes underlying emotion regulation, and the theorised pathways to emotion dysregulation. Finally, this article provides strategies to assist the physician in practicing regular adaptive emotion regulation so as to reduce burnout.

Survey of “Rural type solitary death” through Postmortem Examination / 日本プライマリ・ケア連合学会誌

<b>Purpose</b>: To analyze “solitary deaths” in Hitachiomiya city through postmortem examination results, and contribute to formulation of preventative measures.<br><b>Methods</b>: The author surveyed 149 cases of elderly individuals found deceased in their house during the period between January 2008 and December 2014. All had lived alone or almost alone in social isolated conditions.<br><b>Results</b>: There were more males than females. Men were in a wide range of ages, while women were predominantly in their 80's and 90's. Nearly all cases were found within 2 days following death and deaths occurred more frequently in the winter and spring. Cardinal causes of death, were acute cardiac disorders and cerebrovascular diseases. Malignancy and pneumonia were less frequent. More than 90% of the corpses were found by their family members or relatives, and others by nursing service providers or neighbors.<br><b>Conclusion</b>: This analysis of “solitary deaths” in Hitachiomiya city showed predominance of men and shorter intervals between death and being found than those of metropolis after death.

Comprehensive medication management services influence medication adherence among Japanese older people / Journal of Rural Medicine

<b>Objective:</b> Assistance from health professionals is very important to ensure medication adherence among older people. The present study aimed to assess the relationship between receipt of comprehensive medication management services by primary care physicians and medication adherence among community-dwelling older people in rural Japan.<b>Methods:</b> Data including medication adherence and whether or not a doctor knew all the kinds of medicines being taken were obtained from individuals aged 65 years or older who underwent an annual health checkup between February 2013 and March 2014 at a public clinic in Asakura. The subjects were divided into 2 groups: adherent (always) and non-adherent (not always). A logistic regression analysis was performed to assess the association between the presence of a doctor who was fully responsible for medication adherence and self-reported adherence. Predictors that exhibited significant association (<i>p-</i>value < 0.05) with medication adherence in a univariate analysis were entered in the model as possible confounding factors. The results were presented as odds ratios (OR) and 95% confidence intervals (CI).<b>Results:</b> Among four-hundred ninety-seven subjects in total, the adherent group included 430 subjects (86.5%), and its members were older than those of the non-adherent group. Significant predictors of good medication adherence included older age, no discomforting symptoms, eating regularly, diabetes mellitus and having a doctor who knew all the kinds of medicines being taken. After being adjusted for confounding variables, the subjects with a doctor who knew all the kinds of medicines they were taking were three times more likely to be adherent to medication (OR 3.01, 95% CI 1.44-6.99).<b>Conclusion:</b> Receipt of comprehensive medication management services for older people was associated with medication adherence.

Concept, values, current status and prospect of primary care in Korea

Primary care is an essential part of a whole health system. It is the first contact point for medical care in the community, where many people are likely to obtain their own impression of the health system. Primary care has its own attributes, such as first contact, continuity, comprehensiveness, and coordination, which are yardsticks for measuring its excellence. Regarding the value of primary care, many studies have reported extensive evidence of the advantages of primary care at individual and societal levels. Health systems with strong bases of primary care are better than those with weak ones in terms of cost, health outcomes, and quality of care. However, primary care in South Korea has continuously shrunk or been weakened for several decades. As people age and chronic illnesses become prevalent, more attention is being paid to primary care than ever before, and several policy options have been proposed. Therefore, if the medical community wishes to invigorate primary care, it should play a pivotal role in formulating and implementing primary care policies by envisioning primary care, establishing related data infrastructure, and continuing the discussion on long term goals like training primary care physicians.

Emergency department visits: Why adults choose the emergency room over a primary care physician visit during regular office hours? / 世界急诊医学杂志（英文）

BACKGROUND: It has been estimated that up to one third of all emergency department (ED) visits may be "inappropriate" or non-emergent. Factors that have been speculated to be associated with non-emergent use have been noted to include low socioeconomic status, lack of access to primary care, lack of insurance, convenience of "on demand care" and the patient's individual perception of their complaint urgency. The objective of this study is to identify the reasons contributing to self-perceived non-emergent adult emergency department visits during primary care physician office hours of operation.METHODS: This study was a single-center, descriptive study with questionnaire. The questionnaire was collected from patients meeting exclusion/inclusion criteria who were triaged into an acute or fast track part of the emergency department during regular business hours on Monday through Friday, 8:00 am-5:00 pm during the months of July 2011 and August 2011. Questionnaire data were categorical and summarized using counts and percentages. Data collected included patient demographics, information about the patient's primary care provider, and information about the emergency department visit in question. All responses were compared among patients with visits considered to be non-emergent to those considered to be emergent by using individual chi-square tests.RESULTS: There were 262 patients available for the study. The patients were grouped according to their perception of the severity of their complaints. Roughly half of the patients placed themselves into the non-emergent category (n=129), whereas the other half of the patients categorized themselves into the emergent group (n=131). There were statistically significant differences in marital status and employment status between the two groups. It was found that 61.5％ of the non-emergent patients were single, while 58.3％ of the emergent patients were married. In the non-emergent group, 59.7％were unemployed, but in the emergent group 60.3％ were employed (P<0.05). However, no other factors were significantly different.CONCLUSIONS: Our study did not identify a statistically significant factor to the reasoning behind why patients choose the emergency department over a primary care physician during regular office hours. The only significant demographic indicating who was more likely to make this choice during the specified time frame was being single and employed with perceived non-emergent complaint. Patients without insurance and/or without a primary care physician were no more likely to visit the emergency department with a self-perceived non-emergent issue than patients with insurance and/or with an established primary care physician.

Clinical Analysis of Characteristics of Patients Who Visit Otorhinolaryngology Clinic in Secondary General Hospital / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Common cold is an upper airway viral infection and can be managed by conservative treatment. According to the hospital referral system, mild diseases like common cold should be treated first at a primary physician clinic. However, now in Korea, visiting high-level hospitals for mild diseases is not impossible officially and even the rate of visiting high-level general hospital has increased in spite of the current hospital referral system. This study aimed to provide data of characteristics of patients who choose high-level hospitals for mild diseases like common cold. SUBJECTS AND METHOD: We conducted a survey targeting those who visit general hospitals for common cold. The questionnaire comprised of asking first choice of contact hospital, sex, age, awareness and use of antibiotics when visiting primary physician, medical examinations and duration of treatment, and reasons for thinking that general hospitals are superior to primary hospitals. Subjects were categorized according to their choice of first contact hospital with common cold, primary physician or general hospital. For each group, independent sample t-test and chi-square test were applied to variables. RESULTS: Among the variables for the two groups, statistical significances were found in age, duration of treatment and whether medical examinations were performed or not. CONCLUSION: Underestimation for primary physician and vague faith in medical examinations were most influential factors that lead patients with mild diseases to visit general hospitals. This study finds that programs for educating the public are necessary to make them understand that primary physician clinics are enough to treat common cold and that an institutional framework will be needed to support the hospital referral system.

Collaboration between Hepatologists and Primary Care Physicians in Treating Patients with Chronic Hepatitis C / Journal of Rural Medicine

<b>Objective:</b> The purpose of this study was to assess the treatment outcome in patients with chronic hepatitis C (CHC) using the current standard antiviral therapy when patient were treated in collaboration between hepatologists and primary care physicians (PCPs).<b>Patients and Methods:</b> One hundred and ten patients with CHC were treated with a combination therapy of peginterferon-alpha 2b and ribavirin. Among them, 25 patients were treated by a collaboration between hepatologists and PCPs (collaboration group), whereas 85 patients were treated with exclusively by hepatologists (noncollaboration group). The duration of the therapy was 48 weeks for 58 'difficult- to-treat' patients (genotype 1 with a high load of HCV-RNA; 1H patients) and 24 weeks for the remaining 52 patients (non-1H patients). In the collaboration group, antiviral therapy was initiated and adjusted, if needed, by hepatologists (visits every four weeks), whereas the weekly administration of peginterferon-alpha 2b was performed by PCPs. Clinical characteristics and the treatment outcome were compared between these two groups.<b>Results:</b> The two groups had similar baseline characteristics. By intention to treat, the two groups showed similar rates of treatment-related serious adverse effects (0% vs. 1%, respectively) and dropout rates for adverse effects (8% vs. 13%, respectively). Sustained virologic response rates were also similar between the two groups, being 42% vs. 39% in the 58 1H patients (NS) and 62% vs. 64% in the 52 non-1H patients (NS), respectively.<b>Conclusions:</b> Collaboration between hepatologists and PCPs may be a valid treatment alternative to treat patients with CHC using the current standard antiviral therapy.

Manifestaciones clínicas tempranas de LES / Early clinical manifestations of SLE

El estudio de formas tempranas de presentación del lupus eritematoso sistémico (LES) permite optimizar su diagnóstico y tratamiento. Se revisaron las historias clínicas de pacientes con edad ≥12 años que cumplían con ≥4criterios del Colegio Americano de Reumatología (ACR). El término “presentación temprana del LES” se asignó al primer año de evolución de la enfermedad, comenzando con la fecha cuando el(los) primer(os) criterio(os) fue(ron) reportado(s) en la historia clínica. Los pacientes fueron agrupados si satisfacían cualquier combinación de ≥4, 2-3 ó 1 criterio(s) para la clasificación del LES a través del primer año de la enfermedad. El impacto sobre el diagnóstico temprano del LES fue estimado de acuerdo a la actitud del médico de atención primaria para descartar tempranamente la enfermedad. 115 pacientes fueron admitidos al estudio. Al final del primer año de evolución de la enfermedad, 68 (59,13%) reunieron <4 criterios vs. 47 (40,86%) que reunieron ≥4 criterios del CAR (p=0,05). Los pacientes que reunieron <4 criterios alcanzaron el mínimo número de criterios para LES (≥4) dentro de los siguientes 10 años (promedio 4,9 años). De los 68 pacientes que alcanzaron <4 criterios, 31 (45,58%) reunieron dos o tres criterios y 37 (54,41%) tan sólo un criterio (p=0,46). El más frecuente de los criterios solitarios fue el síndrome inflamatorio poliarticular, 26 (70,20%) comparado con un conjunto de manifestaciones cutáneas, hematológicas, neurológicas, cardiopulmonares, renales y falso VDRL positivo, 11 (29,72%) (p=0,01). Los pacientes con un número insuficiente de criterios para LES son más frecuentes que aquellos con ≥4 criterios positivos al final del primer año de presentación de la enfermedad. La manifestación de un solo criterio (comparado con los que tenían ≥2) se asoció con un retardo en el diagnóstico temprano del LES de por lo menos 1 año

The study of early systemic lupus erythematosus (SLE) presentation can optimize its diagnosis and treatment. The clinical charts of those patients ≥12 years old complied with ≥ 4 criteria for SLE of the American College of Rheumatology (ACR) were reviewed. The term “early presentation of SLE” corresponded to the first year of evolution of the disease, starting with the date when the first(s) criterion/criteria were reported in the chart. The patients were grouped if they complied with a combination of ≥4, 2-3 or 1 ACR criteria for the classification of SLE through the first year of disease. The impact over the early diagnosis of SLE was estimated according to the early performance of the primary care doctor in ruling out the disease. 115 patients were included. At the end of the first year, 68 patients (59.13%) met <4 ACR criteria vs. 47 (40.86%) who met ≥4 (p=0.05). Patients who met <4 criteria fulfilled ≥4 criteria within the next 10 years (mean= 4.9 years). Of the 68 cases with <4 ACR criteria, 31 (45.58%) met two or three criteria and 37 (54.41%) met one solitary criterion (p=0.46). The most frequent early single onset ACR criterion for SLE was the polyarticular inflammatory syndrome, 26 (70.20%) followed by a group of other single criterion that included cutaneous, hematologic, neurologic, cardiopulmonary, renal, and false-positive VDRL, 11 cases (29.72%) (p=0.01). An early solitary criterion-compared with those patients with ≥2- was associated with a lack of documentation in the medical chart- of constitutional symptoms, indication of serum antibodies and referral to specialist. Patients with an insufficient quota of ACR criteria for SLE exceeded those with ≥4 positive criteria at the end of the first year of the disease. Patients with a single criterion of presentation compared with those patients who started with ≥2 early criteria-were associated with a delay in the early diagnosis of SLE by at least one year

Training in male sexual and reproductive health for a primary care physician

In 2006, I was awarded a scholarship from Universiti Sains Malaysia for Fellowship training at Monash University (MU) for one year. The objective of the training programme was to develop knowledge and skills in several areas, including androgen deficiency, male infertility, prostate disease, testicular tumours, sexual dysfunction and sexually transmitted diseases. The training programme consisted of attachments with clinical specialists, completion of a course work module and a research project. After completion of the training programme, I believe that Primary Care Physicians (PCPs) will benefit from undertaking the training programme that I had completed. It will enable PCPs to assume leadership roles in this multidisciplinary area. The ability of PCPs in handling sexual and reproductive health issues in men will definitely be a more cost effective form of care for patients, particularly as the number of specialists is limited, and even more importantly, it will be satisfying for the patient and the physician.

A Survey on the Conception and Cognition about Enuresis of Primary Care Physicians in Daegu City

PURPOSE: Recently, the conception and cognition that enuresis was resolved spontaneously, have changed. We reviewed the attitudes of the primary care physicians who make diagnose and treat nocturnal enuresis. METHODS: From January 2006 to February 2007, a total of 293 primary care physicians in Daegu city participated in this survey. Questionnaires included questions about physicians' opinions on the appropriated age for diagnosis of enuresis, the likely causes of enuresis, etc. Physicians are grouped in two according to whether enuresis is major field of their subspecialty; the pediatrician & urologist group and the other physician group. RESULTS: 59.2% of pediatricians and urologists thought that enuresis is defined as the nightly involuntary release of urine by children of the age of 5 to 6, while 49.6% of other physicians did. For the causes of enuresis, most of clinicians checked "yes" to the question that "Under- developed bladder and nerve" and "Emotional problems". In the patient's behavioral reactions related to enuresis, "Lack of concentration in home and school" and "Frequent urination" were most responded. Attendance to the education program of enuresis in last five years and willing to participate in education program was statistically different among pediatricians-urologists and other physicians. Regarding the treatment of enuresis, most physicians used imipramin widely, but pediatricians and urologists preferred desmopressin. Alarm was the last one in treatment modality. CONCLUSIONS: This study revealed that pediatricians and urologists are attending more to the educational places and knowing much about the recent information on enuresis when compared to other primary care physicians, regarding the diagnostic age and treatment modality of enuresis. The education of enuresis for primary physicians is more needed.

Antibiotic Prescription by Primary Care Physicians for Upper Respiratory Infections / 감염과화학요법

BACKGROUND: Upper respiratory infections (URIs) are common benign illnesses that are associated with significant economic burden, adverse effects of medications, and antimicrobial resistance. These effects have been evaluated chiefly at the tertiary health care centers. The purpose of this study was to investigate the prescribing habits, including antibiotic use, for the management of URIs among the primary care physicians. METHODS: Between July and August 2006, 23 medical students visited 122 clinics of primary care physicians for the management of simulated common cold. They were instructed to present symptoms that simulated common cold; clear rhinorrhea and nasal stuffiness that lasted for 3 days, and neither was accompanied with fever nor myalgia. RESULTS: The physicians' specialties were as follows: 43 were general internists; 40, otolaryngologists; 23, general practitioners; 15, family practitioners; and 1, pediatrician. The mean number of prescribed oral medications was 4.71 (S.D.+/-0.951). Glucocorticoids were prescribed in 10 (8.2%) clinics. Antibiotics were prescribed in 50 (41.0%) clinics - cephalosporins in 17, amoxicillin-clavulanate in 16, amoxicillin in 8, fluoroquinolones in 5, macrolides in 3, and trimethoprim-sulfamethoxazole in 1 clinic. There was no difference in the rates of antibiotic prescription among the specialties. Injections were recommended in 32 (26.4%) clinics. With the exception of chest X-ray recommended in 1 clinic, no laboratory or radiologic evaluation was performed. CONCLUSION: The antibiotic prescription rate observed in this study is lower than those of the previous studies. Since diagnostic tests are seldom performed, diagnostic ambiguity might be a key cause for the overuse of antibiotics in the management of URI. The reasons for the high rates of prescription of parenteral medications need to be evaluated.

Antibiotic Prescription by Primary Care Physicians for Upper Respiratory Infections / 감염과화학요법

BACKGROUND: Upper respiratory infections (URIs) are common benign illnesses that are associated with significant economic burden, adverse effects of medications, and antimicrobial resistance. These effects have been evaluated chiefly at the tertiary health care centers. The purpose of this study was to investigate the prescribing habits, including antibiotic use, for the management of URIs among the primary care physicians. METHODS: Between July and August 2006, 23 medical students visited 122 clinics of primary care physicians for the management of simulated common cold. They were instructed to present symptoms that simulated common cold; clear rhinorrhea and nasal stuffiness that lasted for 3 days, and neither was accompanied with fever nor myalgia. RESULTS: The physicians' specialties were as follows: 43 were general internists; 40, otolaryngologists; 23, general practitioners; 15, family practitioners; and 1, pediatrician. The mean number of prescribed oral medications was 4.71 (S.D.+/-0.951). Glucocorticoids were prescribed in 10 (8.2%) clinics. Antibiotics were prescribed in 50 (41.0%) clinics - cephalosporins in 17, amoxicillin-clavulanate in 16, amoxicillin in 8, fluoroquinolones in 5, macrolides in 3, and trimethoprim-sulfamethoxazole in 1 clinic. There was no difference in the rates of antibiotic prescription among the specialties. Injections were recommended in 32 (26.4%) clinics. With the exception of chest X-ray recommended in 1 clinic, no laboratory or radiologic evaluation was performed. CONCLUSION: The antibiotic prescription rate observed in this study is lower than those of the previous studies. Since diagnostic tests are seldom performed, diagnostic ambiguity might be a key cause for the overuse of antibiotics in the management of URI. The reasons for the high rates of prescription of parenteral medications need to be evaluated.