Adaptation to Brazilian Portuguese and Latin-American Spanish and psychometric properties of the Mental Illness Clinicians' Attitudes Scale (MICA v4)

Abstract Objective To describe translation to Spanish and Portuguese and adaptation of the Mental Illness Clinicians' Attitudes Scale version 4 (MICA v4). Methods The questionnaire was administered to primary care physicians (PCPs) from four Latin-American countries, Brazil, Bolivia, Chile, and Cuba. The validation process included four phases: 1) translation of the questionnaire to Spanish and Portuguese; 2) assessment of face validity; 3) assessment of reliability; and 4) evaluation of construct validity with confirmatory factor analysis (CFA). Results The study sample comprised 427 PCPs. The mean age of the Spanish-speaking sample (n = 252) was 40.1 (S.D = 9.7) years and the mean age of the Portuguese-speaking sample (n = 150) was 40.2 (S.D = 10.9) years. Both models demonstrated "appropriate" internal reliability. Total omega was 0.91 for the Spanish-speaking sample and 0.89 for the Portuguese-speaking sample. The CFA of both questionnaires showed an appropriate fit for a three-factor model (Portuguese: CFI = 0.927; TLI = 0.913; RMSEA = 0.066; Spanish: CFI = 0.945; TLI = 0.935; RMSEA = 0.068). Conclusion The Latin-American versions of the MICA v4 in Spanish and Brazilian Portuguese have appropriate psychometric properties, good internal consistency, and are applicable to and acceptable in the Latin-American context. The instrument proved its validity for collecting data on stigmatizing attitudes among health professionals in different contexts and cultures.

Exposure to indoor air pollution/outdoor air pollution: the silent killers ­ A pilot study / Exposição à poluição do ar interno/poluição do ar externo: os assassinos silenciosos ­ Estudo piloto

Objective: To identify possible risks factors of exposure to indoor air pollution (IAP)/outdoor air pollution (OAP) and their relationship with noncommunicable diseases in men and women treated by primary care physicians. Method: In total, 551 patients (382 women) attended three basic health units in Uruguaiana, Brazil, for various complaints, and completed a questionnaire about risk factors for exposure to IAP/OAP. Results: Women were significantly more exposed to wood-burning pollutants (79.6% vs. 52.7%, p < 0.0001) for having more housework-related activities; men had more outdoor activities and spent extended periods in traffic (47.3% vs. 18.8%, p < 0.0001). Arterial hypertension (AH)/ chronic respiratory disease (CRD) were more frequent among women. Patients with AH/CRD were more exposed to OAP because of their work (18.1% vs. 11%, p = 0.02) or for living near a source of air pollution (45.6% vs. 29.6%, p = 0.0002) or on a street with heavy traffic (41.7% vs. 33%, p = 0.04). Passive smoking, active smoking, using wood, charcoal, or firewood for cooking, heating, or drying, or burning charcoal indoors were not associated with a higher prevalence of AH/CRD. Conclusion: Exposure to OAP was associated with AH/CRD. Women were more exposed to IAP from burning firewood, and men were more exposed to fossil fuel burning. Knowledge of these behaviors should be directed to primary care physicians and all health professionals so that preventive and educational measures can be implemented.

Objetivo: Identificar possíveis fatores de risco da exposição à poluição intradomiciliar (PID) e extradomiciliar (PED) e sua relação com doenças não transmissíveis (DNT) em homens e mulheres tratados por médicos de atenção primária. Método: Quinhentos e cinquenta e um pacientes (382 mulheres) atendidos em três unidades básicas de saúde em Uruguaiana, Brasil, por queixas diversas, responderam a um questionário sobre os fatores de risco para exposição à PID/PED. Resultados: As mulheres foram significantemente mais expostas aos poluentes da queima de lenha (79,6% vs. 52,7%, p < 0,0001) por terem mais atividades domésticas; os homens praticaram mais atividades ao ar livre e passaram longos períodos no trânsito (47,3% vs. 18,8%, p < 0,0001). Hipertensão arterial (HA) / Doença respiratória crônica (DRC) foram mais frequentes entre as mulheres. Pacientes com HA/DRC foram mais expostos à PED devido ao trabalho (18,1% vs. 11%, p = 0,02), ou por viver perto de uma fonte de poluição do ar (45,6% vs. 29,6%, p = 0,0002), ou em uma rua com trânsito intenso (41,7% vs. 33%, p = 0,04). O fumo passivo, o fumo ativo, o uso de lenha ou carvão para cozinhar, aquecer ou secar ou queimar carvão em ambientes fechados não foram associados a maior prevalência de HA/DRC. Conclusão: A exposição à PED foi associada a HA/CRD. As mulheres foram mais expostas à PID pela queima de lenha, e os homens foram mais expostos à queima de combustíveis fósseis. O conhecimento destes comportamentos deve ser direcionado aos médicos da atenção básica e a todos os profissionais da saúde, para que medidas preventivas e educacionais possam ser implementadas.

Knowledge, attitude, and practice regarding atrial fibrillation among primary care physicians: the potential role of postgraduate training

@#Introduction: Atrial fibrillation (AF) is known to lead to stroke and thromboembolism, causing a five-fold increase in the risk of stroke and almost doubling the mortality rate. Optimal anticoagulant therapy is effective in reducing AF-related death. However, prescription of anticoagulants in AF in East Asian countries has been low, ranging from 0.5% to 28%. This study aimed to determine whether vocational training in family medicine improves primary care physicians’ knowledge, attitude, and practice in the management of AF. Method: This investigation was a cross-sectional study carried out during centralized workshops for two groups of trainees using a validated questionnaire: (i) junior trainees were newly enrolled postgraduate trainees in the Graduate Certificate in Family Medicine (GCFM) program, and (ii) senior trainees were postgraduate trainees in Advance Training in Family Medicine (ATFM) programs of the Academy of Family Physicians of Malaysia (AFPM). Results: A total of 223 trainees (127 junior and 96 senior) participated in this study. Only 55.2% of the trainees passed the knowledge test; senior trainees were more likely to pass the knowledge test compared to junior trainees (69.8% vs. 44.1%, p <0.001). Female trainees were significantly more likely to pass the knowledge test than male trainees. While the attitude of senior and junior trainees was similar, more of the latter group worked in public clinic that provide better support where there is better support for outpatient anticoagulation treatment (e.g., same-day INR test, direct access echocardiogram, and warfarin in in-house pharmacy). Conclusion: Vocational training in family medicine appears to improve primary care physicians’ knowledge regarding the management of AF. Better knowledge will help vocationally trained primary care physicians to provide anticoagulation treatment for AF within primary care clinics. More optimal AF management within primary care can take place if the identified barriers are addressed and a shared care plan can be implemented.

Misconceptions about Insulin and Barriers to Insulin Initiation in Type 2 Diabetes among General Physicians in Southeast Nigeria

Aims: The aim of this study was to evaluate the perceptions of general physicians (GPs) regarding insulin and determine the barriers to its initiation in patients with type 2 diabetes mellitus (T2DM).Study Design:A cross-sectional, quantitative research.Place and Duration:Enugu metropolis, Southeast Nigeria, between March and November 2018.Methodology:We used structured self administered questionnaire to evaluate the perceptions of 64 GPs (45 males and 19 females) regarding insulin, and to elicit barriers to insulin initiation in subjects with T2DM.Results:The mean (SD) age of the participants was 45.5 (11.7) years and their duration of general practice ranged from 3 –38 years. Majority were private practitioners predominantly in the rural areas. Only 15 (23.4%) respondents had ever initiated insulin for outpatient with T2DM Fear of hypoglycemia, anticipated patients’ refusal of insulin, physician’s lack of confidence, and concerns about needle pains were among the commonly reported barriers to insulin initiation. Others were socio-economic factors including concerns about affordability of insulin and frequent glycemic monitoring, and availability of insulin storage facilities.There was a general consensus among the GPs on a number of misconceptions including that patients’ adherence to oral glucose lowering drugs eliminates the need for insulin; that insulin should be reserved as a last resort; and that once initiated, insulin therapy is lifelong.Conclusion:This study revealed that there are several physician-related barriers and misconceptions regarding insulin therapy for T2DM among GPs in Southeast Nigeria. Periodic training to improve GPs’ attitude to insulin and optimize insulin utilization in T2DM is required

Understanding and Navigating Mental Health Resources in the Community through a Case Study

@#This article shows how Primary Care Physicians can manage stable chronic schizophrenia with complex psycho-social issues in the community. This is made possible through improved access to mental healthcare services. The case study highlights the utilisation of the Mental Health-GP Partnership Programme and Community Mental Health Team to facilitate a smooth transition and maintenance of mental well-being in the community. Resources like Aged Psychiatry Community Assessment and Treatment Service, Assessment and Shared Care Teams, Community Intervention Teams are discussed as well as future directions to strengthen care in the community.

Do primary care physicians require training in core clinical dermatology? A cross sectional needs assessment study from Western India

Background: Primary care physicians play a crucial role in managing patients with common skin disorders who form around one-third of outpatient attendees. Aim: This study aimed to assess the need for dermatology training among primary care physicians by assessing their knowledge, self-perception of ability to diagnose and manage skin disorders, and their difficulties in managing these patients. Methods: A descriptive, cross-sectional, needs assessment study was done among primary care physicians (n = 61) of rural (n = 34) and urban (n = 27) areas of Vadodara district. A pre-validated semi-structured questionnaire (for self-rating of the ability to diagnose/manage skin disorders and difficulties faced in managing patients) was used along with a photo-quiz (for knowledge assessment) while approaching primary care physicians during their monthly review meeting with prior permission. Data were analyzed by Epi InfoTM software and manual content analysis. Results: The mean score on the photo-quiz was 4.1/10. Forty-three (70.5%) participants rated their ability to diagnose/manage skin disorders as 'average' on a five-point Likert scale. Various difficulties (n = 89) narrated by participants were related to their knowledge/skill, disease factors, patients and administrative aspects. Three-fourths of the participants managed difficulties by referring patients to dermatologists. One-third suggested conducting training in common skin disorders. Limitations: The study population included primary care physicians from the government healthcare setup only. Knowledge assessment was done using a short ten-item photo-quiz instead of actual patients. Conclusions: Primary care physicians had poor knowledge of skin disorders, and a majority overrated their own ability for clinical management of these disorders. Most common difficulties faced were related to clinical management. There is a need for training on common skin disorders.

Knowledge and practice of colorectal cancer screening in an urban setting: cross-sectional survey of primary care physicians in government clinics in Malaysia

INTRODUCTION@#Colorectal cancer (CRC) was the third most commonly diagnosed cancer worldwide in 2008 (1.23 million cases, 9.7%). CRC screening was shown to be effective in reducing 70% of CRC mortality. However, the screening rate for CRC remains poor.@*METHODS@#A cross-sectional survey was conducted among primary care physicians (PCPs) in public primary care clinics in Kuala Lumpur, Malaysia. A 30-item self-administered questionnaire was used to assess the knowledge and practice of CRC screening.@*RESULTS@#The response rate was 86.4% (n = 197/228). Less than half (39.1%) of the respondents answered correctly for all risk stratification scenarios. Mean knowledge score on CRC screening modalities was 48.7% ± 17.7%. The knowledge score was positively associated with having postgraduate educational qualification and usage of screening guidelines. Overall, 69.9% of PCPs reported that they practised screening. However, of these, only 25.9% of PCPs screened over 50% of all eligible patients. PCPs who agreed that screening was cost-effective (odds ratio [OR] 3.34, 95% confidence interval [CI] 1.69‒6.59) and those who agreed that they had adequate resources in their locality (OR 1.92, 95% CI 1.01‒3.68) were more likely to practise screening. Knowledge score was not associated with the practice of screening (p = 0.185).@*CONCLUSION@#Knowledge and practice of CRC screening was inadequate among PCPs. Knowledge of screening did not translate into its practice. PCPs' perceptions about cost-effectiveness of screening and adequate resources were important determinants of the practice of screening.

Nivel de conocimientos sobre demencia frontotemporal en una muestra de médicos que evalúan regularmente a pacientes con demencia en Lima-Perú / Knowledge level of fronto-temporal dementia in a sample of physicians that regularly assessing patients with dementia in Lima-Peru

Resumen Médicos especialistas en geriatría, psiquiatría y neurología no han recibido entrenamiento respecto al diagnóstico diferencial de demencia, en particular acerca de demencia frontotemporal (DFT). Objetivo: Evaluar el nivel de conocimiento de los médicos sobre DFT. Material y Método: La encuesta se llevó a cabo durante simposios y congresos científicos desde enero de 2016 hasta julio de 2017. Los criterios de inclusión fueron: ser médico general o especialista en Geriatría, Neurología y Psiquiatría cuyo proceso de formación como médico y especialista haya sido realizado en universidades peruanas. Se analizaron 217 encuestas de las cuales 13 fueron eliminadas. La encuesta estuvo dividida en tres partes: la primera sobre datos generales de los médicos, la segunda parte fue acerca del diagnóstico de demencia y la tercera sobre datos específicos de DFT. Para el análisis estadístico se utilizó STATA versión 12. Resultados: El 90% de los médicos encuestados fueron médicos especialistas en: Psiquiatría (41,3%), Geriatría (31,3%) y Neurología (15,4%). El 98,5% de médicos encuestados afirmó diagnosticar demencia. Los médicos especialistas tuvieron un mejor desempeño al momento de identificar las pruebas empleadas. El 72,1% de médicos encuestados no pudo reconocer ningún tipo de DFT, mientras que el 27,9% reconoció al menos 1 tipo de DFT. El 43,8% de médicos encuestados identificó correctamente 5 o más de los síntomas presentados en DFT. Conclusiones: El nivel de conocimientos entre médicos especialistas encuestados acerca del diagnóstico de demencia es aceptable, sin embargo es deficiente cuando se trata específicamente acerca del diagnóstico de DFT.

Physicians with specialty in geriatrics, psychiatry and neurology have not received training about the differential diagnosis of dementia, particularly regarding fronto-temporal dementia (FTD). Objective: To assess the level of knowledge of physicians about FTD. Material and Method: The survey was carried out during symposiums and scientific congresses from January 2016 to July 2017. Inclusion criteria: being a general practitioner or specialist in Geriatrics, Neurology and psychiatry whose training process as a physician and specialist has been carried out in Peruvian universities. We analyzed 217 surveys of which 13 were eliminated. The survey was divided into three parts, the first about general data of doctors, the second part was about the diagnosis of dementia; and the third on specific data of FTD. STATA version 12 was used for the statistical analysis. Results: 90% of the doctors surveyed were specialists in: Psychiatry (41.3%), Geriatrics (31.3%) and Neurology (15.4%). The 98.5% of physicians surveyed claimed to diagnose dementia. The medical specialists performed better when identifying the tests used. 72.1% of the doctors surveyed could not recognize any type of FTD, while 27.9% recognized at least 1 type of FTD. 43.8% of physicians surveyed identified 5 or more of the symptoms presented in FTD. Conclusions: The level of knowledge among medical specialists surveyed about the diagnosis of dementia is acceptable, however it is deficient when it is specifically about the diagnosis of FTD.

Nivel de conocimiento sobre Trastorno por Déficit de Atención con Hiperactividad en médicos del Servicio Rural y Urbano Marginal de Salud en Lima, Perú / Knowledge level of Attention Deficit Hyperactivity Disorder among general physicians in Lima, Peru

Introducción: El trastorno por déficit de atención con hiperactividad (TDAH), exhibe una prevalencia mundial del 5% y la mayoría de las consultas médicas tienen lugar en clínicas de Atención Primaria. En tal contexto, se plantea la necesidad de que los médicos del Servicio Rural y Urbano Marginal de Salud (SERUM) conozcan suficientemente aspectos del diagnóstico y manejo de este trastorno, para su oportuna derivación al especialista. Objetivos: Determinar el nivel de conocimiento que tienen los médicos serumistas en relación al diagnóstico, manejo y pronóstico del TDAH. Material y Métodos: Estudio descriptivo, observacional y transversal basado en la aplicación de una encuesta a médicos serumistas, revisada por la Asociación de Profesionales Peruanos para el estudio del Trastorno por Déficit de Atención e Hiperactividad. Resultados. De un total de 550 encuestas, 63,5% (349) cumplieron los criterios de inclusión. Se encontró que el 80,5 % de estos probandos tenían un alto nivel de conocimiento general sobre el TDAH. Sin embargo, sólo el 16,9% mostró un nivel similar en relación al diagnóstico y el 73,1% alcanzó un nivel de conocimiento medio. En relación al tratamiento, 56,2 % de la muestra tuvo un nivel alto y 39,8 %, un nivel medio de conocimiento. Conclusiones: Los médicos serumistas encuestados en Lima muestran un alto nivel de conocimiento global en relación al TDAH, consideran apropiadamente el tratamiento mixto de elección y dan importancia al pronóstico del paciente no tratado. La mayoría, sin embargo, no basa su diagnóstico en los criterios del DSM5 o CIE 10 y no identifican fármacos de primera línea para el manejo del trastorno. Se postula la necesidad de mejorar estos aspectos

Introduction: Attention deficit hyperactivity disorder (ADHD) has a worldwide prevalence of 5%, and most of medical consultations to children with the diagnosis take place in Primary Care settings. It would be necessary for physicians of the Rural and Urban-Marginal Health Service (SERUM) in Peru to have sufficient knowledge about the diagnosis and management of this disorder for its timely referral to the specialist. Objectives: To determine the knowledge level that SERUM primary care physicians have regarding diagnosis, management and prognosis of ADHD. Material and Methods: This is a descriptive, observational and transversal study, based on the application of a survey instrument, specifically designed for the study of ADHD, and revised by the Peruvian Association of Professionals. Results: From a total of 550 surveys applied, 63.5% (349) met the inclusion criteria. It was found that 80.5% of these probands had a high level of general knowledge about ADHD, but only a 16.9% has a similar knowledge level regarding diagnosis, and 73.1%, an intermediate level. Regarding treatment, 56.2% of the sample had a high and 39.8%, an average knowledge level.Conclusions: SERUM-associatedprimary care physicians in Lima have a high knowledge level about general aspects of ADHD as they consider a combined treatment as the management of choice, and give importance to the prognosis of the non-treated patient. However, most of them do not base their diagnosis on DSM-5 or ICD-10 criteria, and do not identify first-line pharmacological agents for the management of the disorder. The need to improve this aspects is emphasized.

O desafio do Programa Mais Médicos para o provimento e a garantia da atenção integral à saúde em áreas rurais na região amazônica, Brasil / The challenges faced by the More Doctors Program in providing and ensuring comprehensive health care in rural areas in the Amazon region, Brazil / El desafío del Programa Más Médicos para la provisión y garantía de la atención integral de la salud en áreas rurales en la región amazónica, Brasil

A pesquisa objetivou avaliar como o Programa Mais Médicos vem sendo implementado em áreas rurais e a contribuição do provimento de médicos para garantir atenção integral à saúde. Realizou-se estudo em município predominantemente rural no estado do Pará, conduzindo-se 42 entrevistas com: profissionais, gestores de saúde, conselheiros e usuários; submeteram-se as entrevistas à análise de conteúdo. Os resultados sugerem melhorias na atenção primária à saúde ­ como aumento de consultas e ampliação do acesso aos serviços de atenção básica ofertados ­ atribuídas à presença do médico e às estratégias mais equitativas adotadas. No entanto, ainda persistem desafios a enfrentar para garantir atenção integral à saúde nas zonas rurais, como a manutenção do programa e a superação de problemas recorrentes, como: falta de medicamentos e exames, limitações no retorno dos pacientes referidos a outros serviços e fragilidades na rede de atenção à saúde.(AU)

The objective of this research was to assess how the More Doctors Program has been implemented in rural areas and the contributions made by providing physicians to ensure comprehensive health care. A study was conducted in a predominantly rural city in the state of Pará, involving 42 interviews with health professionals and managers, council members and users. The interviews then underwent content analysis. The results suggest that there have been improvements in primary health care ­ such as a higher number of consultations and expanded access to the primary care services offered ­ that can be attributed to the presence of the physicians and the use of more equitable strategies. However, there are still challenges to be confronted in order to ensure comprehensive health care in rural areas, such as maintenance of the program and overcoming recurrent problems, such as: lack of drugs and tests; limitations in follow-up on patients referred to other services; and weaknesses in the health care network.(AU)

El objetivo de la encuesta fue evaluar cómo se ha implementado el Programa Más Médicos en áreas rurales y la contribución de la provisión de médicos para asegurar atención integral de la salud. Se realizó un estudio en un municipio predominantemente rural en el Estado de Pará, por medio de 42 entrevistas con profesionales, gestores de salud, consejeros y usuarios y las mismas pasaron por análisis de contenido. Los resultados sugieren mejoras en la atención primaria de la salud, como aumento de consultas y ampliación de acceso a los servicios de atención básica ofrecidos, atribuidas a la presencia del médico y a las estrategias más equitativas adoptadas. No obstante, todavía persisten desafíos que hay que enfrentar para asegurar la atención integral de la salud en las zonas rurales y también el mantenimiento del programa y la superación de problemas recurrentes, tales como falta de medicamentos y exámenes, limitaciones en el retorno de los pacientes referidos a otros servicios y fragilidad en la red de atención de la salud.(AU)

HANDLING DIFFERENT PERSONALITIES IN ACP CONVERSATIONS

Documented advance care planning (ACP) discussions with patients enable doctors to have continuity and collaboration across all settings as patients move from one setting to another. These shared decision-making discussions generally consist of 3 steps: giving information; assisting patients to understand the options in the context of their situations; and helping these patients make informed decisions based on their individual preferences. Primary care physicians should take advantage of their position as healthcare providers to continue the care of the patient and the relationship they have with the patient by initiating ACP discussions. The National Medical Ethics Committees recommendation in 2010 is that such discussions should be started as part of routine care in primary care and outpatient settings before individuals become acutely unwell. Important barriers that need to be overcome are negative encounters with different personalities who can present themselves as difficult - the angry patient, the anxious patient, the patient in collusion, and the patient in denial. In this paper are some guiding principles on how to carry out ACP discussions with such patients. There is also a need for doctors to recognise that as caregivers, they may be exhibiting blocking behaviours to ACP discussions that patients are trying to initiate. These should be avoided.

Burnout in Primary Care Physicians and Interventions - An Evidence-Based Review

Family practice, like other fields of medicine involving daily direct contact with patients, is rewarding but can lead to burnout. Ideas about burnout have evolved through time and the concepts and terms used have become more refined, and more commonly agreed. Earlier publications were mostly descriptive but later ones have begun to look into possible interventions to combat burnout. Validated scales are increasingly being used as outcome measures of the intervention strategies, some in randomised control trials which have contributed to the evidence base. This paper is an evidence-based review of the definition, causes, and interventions published in current literature indexed in PUBMED.

Management of long-term colorectal cancer survivors in Korea

Colorectal cancer (CRC) is the third most common cancer in Korea. Its average growth rate has been 3.7% annually from 1999 to 2013. The 5-year relative survival rate is 75.6%. The number of CRC survivors is expected to increase steadily because of its high incidence and survival rate. Because CRC survivors are at risk for recurrence, metachronous cancer, and other cancers, they should be checked regularly. Recommended surveillance includes history-taking and physical examination, colonoscopy, carcinoembryonic antigen testing, and computed tomography. Routine complete blood counts, liver function test, and positron emission tomography are not recommended. CRC survival, which is associated with Lynch syndrome and familial adenomatous polyposis, is also related to a higher risk of other cancers such as gastrointestinal and gynecologic cancers. Additional surveillance should be taken. CRC survivors could complain of general health problems such as cancer-related fatigue and psychosocial/cognitive dysfunction, in addition to treatment-related problems including bowel/urologic/sexual dysfunction, peripheral neuropathy, and ostomy care. They are also at greater risk of cardiovascular diseases. The primary care physician should counsel CRC survivors about their health problems and make an effort to address these concerns. Primary care physicians should try to communicate with CRC survivors and all specialists for clinical follow-up care.

The learning characteristics of primary care physicians / 한국의학교육

PURPOSE: This study analyzed the learning characteristics of primary care physicians that are necessary to develop proper educational support systems in continuing medical education. METHODS: The research participants were 15 physicians with an average of 8 years of experience in primary care clinics. The data were collected through in-person interviews with each participant and analyzed by keyword coding, expert review, and content elaboration. RESULTS: The learning styles of primary care physicians were classified as "reactive," "organized," and "exploratory," according to their problem-solving approaches in clinics. The types of learning interaction were "unilateral acquisition," "mutual exchange," and "organization participation." The primary motives of learning in clinics were the primary care physicians' recognition of accountability and the intrinsic enjoyment of learning itself. CONCLUSION: For continuous professional development-i.e., the self-directed learning of primary care physicians with problemsolving approaches-learning interactions in professional communities should be considered in continuing educational support systems.

Adesão às listas de medicamentos essenciais por médicos brasileiros em atuação no sistema único de saúde / Adherence to the essential medicines lists by brazilian physicians in the unified health system

OBJETIVO: Investigou-se a adesão de médicos brasileiros em atuação no SUS a listas de medicamentos essenciais (LME), buscando conhecer o papel das LME na prática prescritiva e identificar a aceitação e barreiras para sua utilização no Brasil. MÉTODOS: O estudo, de âmbito nacional, entrevistou médicos da Atenção Primária e da hospitalar de 30 unidades públicas de saúde de municípios com e sem LME definida. Na análise dos dados foram utilizadas técnicas da pesquisa qualitativa em saúde. As categorias finais de análise foram: (i) contato com diferentes LME; (ii) utilização das LME na prática clínica; (iii) percepção do conceito de medicamentos essenciais. RESULTADOS: Foram ouvidos 58 médicos, sendo 11 do Nordeste e do Centro-Oeste e 12 do Sudeste, Norte e Sul. Apenas 17 dos 58 médicos entrevistados informaram contato anterior com uma LME, a maior parte referindo-se à lista municipal. Quando perguntados se utilizavam a Rename em sua prática clínica, todos os entrevistados responderam que não. Dentre os motivos citados, estão (i) a indisponibilidade dos medicamentos (da lista) no momento requerido; (ii) a falta de orientação necessária para o uso; (iii) a impressão de que a composição da lista é inadequada à demanda clínica. CONCLUSÕES: Os resultados das falas expõem desconhecimento e baixa adesão a LME. Ainda que tenham tido algum contato prévio com uma LME, esta não é valorizada como fonte de informações para a prescrição baseada em evidências.

OBJECTIVE: To investigate the adherence to the essential medicines lists (EML) by Brazilian physicians practicing in the public health system and the role of the EML in prescribing practices, identifying barriers to their use in Brazil. METHODS: A nationwide study interviewed physicians from diverse public healthcare settings in 30 facilities, in municipalities with different statuses in regard to the existence of EMLs. Research data was analyzed through content analysis and perception analysis techniques. The final analytical categories were (i) physician's contact with different EMLs, (ii) use of EMLs in clinical practice and (iii) physician's perceptions regarding the essential medicines concept. RESULTS: A total of 58 physicians were interviewed, from all five Brazilian regions: eleven from the Northeast, eleven from the Mid-West, and twelve each from the Southeast, the North and the South. Seventeen of the 58 physicians reported previous contact with an EML, most of which had occurred with municipal lists. All physicians informed that they did not use the Brazilian Essential Medicines List (RENAME) in their clinical practices. Among the main reasons for this were: (i) unavailability of listed medicines at required moment, (ii) the lack of necessary information and training for adequate use of EML, and (iii) the perception that the composition of the EML is inadequate for clinical demands. CONCLUSIONS: Results from content analysis exposed low awareness regarding EMLs and the essential medicines concept, in addition to a low level of adherence to EMLs. Even though some physicians reported having previous contact with an EML, this tool is not valued as an evidence-based information source for writing prescriptions.

How can Japanese University-based Primary Care Physicians Attend International Conferences? / General Medicine

<b>Background: </b>Activity in international conferences is essential for the academic progress of primary care in Japan. We aimed to clarify the obstacles Japanese university-based primary care physicians face in attending and presenting at international conferences.<br><b>Methods: </b>We conducted a questionnaire of 10 residents and 22 physicians in the Department of General Medicine and Primary Care at the University of Tsukuba.<br><b>Results: </b>The primary obstacle preventing conference attendance was English language skills. A secondary obstacle was insufficient time off work.<br><b>Conclusions: </b>Additional support in English language skills and time off work is necessary to promote attendance at international conferences.

Health-Promotion and Disease-Prevention Behaviors of Primary-Care Practitioners / 가정의학회지

BACKGROUND: In the 1990s the primary focus of medicine was shifted to disease prevention. Accordingly, it became the responsibility of primary-care physicians to educate and counsel the general population not only on disease prevention specifically but health promotion generally as well. Moreover, it was, and is still today, considered important that physicians provide positive examples of health-promotion behaviors to patients. The purpose of this study was to investigate physicians' health-promotion behaviors and to identify the factors that influence them. METHODS: We conducted a postal and e-mail survey of the 371 members of the Physician Association of Cheonan City between May 16th and June 25th, 2011. The questionnaire consisted of 18 items, including questions relating to sociodemographic factors, screening tests for adult diseases and cancer, and health habits. RESULTS: There were 127 respondents. The gender breakdown was 112 men (88.2%) and 15 women (11.8%), and the mean age was 47.8 years. Fifty-nine (46.4%) were family physicians or interns, and 68 (53.6%) were surgeons. Twenty-six percent (26%) were smokers, and 74.8% were drinkers; 53.5% did exercise; 37% had chronic diseases; 44.9% took periodic cancer screening tests, and 72.4% took periodic screening tests for adult diseases. CONCLUSION: It was found that general characteristics and other health-promotion behaviors of physicians do not affect physicians' practice of undergoing periodic health examination.

Prevalence of burnout amongst physicians working in primary care in Riyadh military hospital, Saudi Arabia.

Background: Burnout is associated with decreased job performance and low career satisfaction. It has a special significance in health care, where staff experience both psychological–emotional and physical stress. Aims & Objective: This study was conducted to determine the prevalence of burnout, and its associated factors, amongst primary care doctors (PHC) in Riyadh Military Hospital RMH. Material and Methods: A cross-sectional survey of PHC was conducted using a custom-designed and validated questionnaire which incorporated the Maslach Burnout Inventory Human Services Survey (MBI-HSS) as well as questions about demographic factors, working experience, health, lifestyle and job satisfaction. MBI-HSS scores were analyzed in the three dimensions of emotional exhaustion (EE), depersonalization (DP) and personal accomplishment (PA). Results: Almost 200 questionnaires were distributed, and 144 were returned to give a response rate of 72%. In terms of burnout, 53.5% of respondents scored high for EE burnout, 38.9% for DP and 28.5% for PA, with 2.78% scoring high burnout in all three dimensions. Just over one-quarter of doctors did not score high for burnout in any dimension. High burnout was found to be strongly associated with several of the variables under study, especially low job satisfaction, expressed intention to change job, tobacco consumption and use of psychotropic medication, younger age, recent graduation, married and board qualified doctors. Conclusion: Burnout seems to be a common problem in PHC doctors in RMH and is associated with personal and workload indicators. Recommendations for improving employment conditions of PHC physicians and future research is needed to explore the problem in depth, develop models to describe the phenomenon and to identify causative factors and effective intervention strategies.

Burnout entre médicos da Saúde da Família: os desafios da transformação do trabalho / Burnout among Family Healthcare physicians: the challenge of transformation in the workplace

Compreender como os conflitos com a instituição e desacordos quanto às atribuições de membros da equipe, são apreendidos e reconstruídos pelos médicos da Saúde da Família, sob a perspectiva do "burnout". Métodos: Pesquisa qualitativa desenvolvida no Recife, entre agosto de 2005 e novembro de 2006, com 24 médicos. Foram selecionadas quatro equipes a partir de avaliação da gerência (acesso geográfico, conflitos na equipe, entre equipe e Distrito, entre equipe e comunidade e violência pública na área), em cada um dos seis Distritos Sanitários. Foram realizadas entrevistas semiestruturadas. Resultados: Os médicos revelam enorme discrepância entre expectativas e realidade do trabalho. Rejeitam a priorização institucional da consulta e cobrança de produtividade. Sofrem diante do que consideram à perda da identidade profissional: atribuições da enfermeira questionam o núcleo histórico da sua prática -o diagnóstico e o tratamento da doença. Sobretudo entre aqueles com maiores expectativas na conversão do modelo, existe descrédito quanto às mudanças e há o desejo de desistir. Observa-se amplo conjunto de elementos que favorecem o desenvolvimento simultâneo de esgotamento e ineficácia profissional, e que provocam atitudes negativas, reforçando a necessidade da promoção da saúde no trabalho.

The scope of this paper is to understand how conflicts with the institution and disagreements regarding team members'attributions are interpreted by Family Healthcare physicians from the burnout perspective. Qualitative research was conducted with 24 doctors in Recife between August 2005 and November 2006 based on management evaluation (geographic access, conflicts within the team, between teams and the District, between the team and the community and public violence in the area), and four teams were selected in each of the six Health Districts. Semi-structured interviews were then conducted. An enormous discrepancy between the expectations of physicians and the reality of the workplace was detected. They reject the institutional consultation priority and demands for productivity. They suffer from what they consider loss of professional identity, with nurses attributions questioning the historic essence of their practice. There is discredit concerning change and a desire to abandon the profession, especially amongst those with the highest expectations concerning conversion of the model. A broad set of elements was detected that favor simultaneous exhaustion and professional inefficiency and provoke negative attitudes, stressing the need for promoting health in the workplace.

Non-participation bias in health services reseach using data from an integrated electronic prescribing project: the role of informed consent / Sego por falta de participación en la investigación de los servicios de salud al usar datos de un proyecto integrado de prescripción electrónica: el papel del consentimiento informado / Sesgo pela falta de participação na pesquisa dos serviços de saúde ao usar dados de um projeto integrado de prescrição eletrônica: o papel do consentimento informado

Electronic prescribing potentially reduces adverse outcomes and provides critical information for drug safety research but studies may be distorted by non-participation bias. 52,507 patients and 28 physicians were evaluated to determine characteristics associated with consent status in an electronic prescribing project. Physicians with less technology proficiency, seeing more patients, and having patients with higher fragmentation of care were less likely to obtain consent. Older patients with complex health status, higher income, and more visits to the study physician were more likely to consent. These systematic differences could result in significant non-participation bias for research conducted only with consenting patients.

La prescripción electrónica reduce, potencialmente, los resultados adversos. y proporciona información crítica para una investigación segura en drogas, pero los estudios pueden ser distorsionados por un sesgo por falta de participación. Se evaluó a 52.505 pacientes y a 28 médicos para determinar características asociadas con el estatus del consentimiento en un proyecto de prescripción electrónica. Los médicos con menor eficiencia tecnológica, con más cantidad de pacientes que, además, mostraban mayor fragmentación en su atención, presentaban menor opción de obtener consentimiento. Los pacientes de más edad, con estatus de salud complejo, mayor ingreso y con más visitas al médico a cargo, manifestaban mayor disposición a consentir. Estas diferencias sistemáticas podrían desembocar en un sesgo significativo por falta de participación en la investigación llevada a cabo sólo con pacientes con consentimiento.

A prescrição eletrônica reduz potencialmente os resultados adversos e proporciona informação crítica para uma pesquisa segura em drogas, porém os estudos podem ser destorcidos por um sesgo por falta de participação. Avaliou-se 52.505 pacientes e a 28 médicos para determinar características associadas com o estatus do consentimento num projeto de prescrição eletrônica. Os médicos com menor eficiência tecnológica, com mais quantidade de pacientes que os outros, mostravam maior fragmentação em sua atenção, apresentavam menos opção para conseguir o consentimento. Os pacientes mais idosos, com estudos de saúde maiôs complexos, maiores salários e com mais visitas ao médico, manifestavam maior disposição de consentir. Estas diferenças sistemáticas poderiam desembocar num erro significativo por falta de participação na pesquisa levada a cabo somente com pacientes que consentiram.