General Practitioner's Experience of Public-Private Partnerships to Develop Team-Based Care: A Qualitative Study.

Objectives: A tripartite public-private partnership was established between GPs' practices, public health authorities and a university department of family medicine, to develop multidisciplinary teams and integrate nurses into GPs' practices. The present paper describes the points of view of the GPs involved in this collaboration. Methods: We conducted a qualitative study, with data coming from eight interviews with GPs, one from each practice. We also used the facilitator's project diary to complete the discussion. Results: The principal issue discussed was the financial aspects of the collaboration. GPs are generally satisfied, but time spent coordinating with nurses and transferring activities made them fear financial losses. Secondly, the partnership with public health authorities was well appreciated, but not clear enough. Some aspects of the partnership, such as referring patient to the nurse should have been better defined et controlled. The last aspect was the academic support. It allowed reducing GPs' workload in training nurses and supporting the project implementation within the GPs' practice. Conclusion: GPs have a positive point of view of such public-private partnership and saw an opportunity to be involved in developing public health policies.

[Experience of an interprofessional family practice in a medical residency pathways]. / Expérience d'un médecin assistant dans un cabinet de médecine de famille interprofessionnel.

This article is based on an experience during family medicine residency in a family medicine practice participating in the MOCCA project (Coordination model in family medicine practices). This new model of care integrates a family medicine nurse (FMN) into the team of each practice. Three clinical vignettes and an interview with the people involved provide a better understanding of the new role that the FMN can play in medical practices. In these situations, we note an increase in the possibilities of acting in prevention and health promotion as well as a reinforcement in the continuity of care. An experience of this type during medical residency is not common in Switzerland, because Switzerland is in the early stages of development of these new models of care in international comparison.

Cet article est né d'une expérience d'un médecin assistant au sein d'un cabinet de médecine de famille participant au projet MOCCA (modèle de coordination dans les cabinets de médecine de famille). Ce nouveau modèle de soins intègre dans l'équipe de chaque cabinet un-e infirmier-ère en médecine de famille (IMF). Trois vignettes cliniques et une interview des personnes concernées permettent de mieux comprendre le rôle nouveau que peut prendre l'IMF dans les cabinets médicaux. Dans ces situations, on constate l'augmentation des possibilités d'agir dans les domaines de la prévention et de la promotion de la santé ainsi qu'un renforcement dans la continuité des soins. Une expérience de ce type lors du parcours de médecin assistant-e n'est pas fréquente car la Suisse est au stade initial du développement de ces nouveaux modèles de soins en comparaison internationale.

The role of general practitioners in managing the COVID-19 pandemic in a private healthcare system.

BACKGROUND: The canton of Vaud's public health authorities, in Switzerland, invited general practitioners (GPs) to participate in managing suspected COVID-19 patients and continue caring for their non-COVID-19 patients. However, this course of action was not mandatory. The present study's objective was to describe and understand how involved GPs were in dealing with the COVID-19 pandemic's first wave. METHODS: This mixed-methods study combined a retrospective quantitative survey and a qualitative explanatory investigation. All of the canton's GPs were invited to participate in the quantitative survey via an online questionnaire including sections on: specific organization regarding COVID-19 activities and suspected COVID-19 patients, activities relating to non-COVID-19 patients, consequences on the practice's professional staff, and opinions about the public health authorities' pandemic crisis management. The qualitative investigation involved interviews with 10 volunteer GPs. RESULTS: The participation rate was 41%. One third of GPs chose not to reorganize their practice for the specific management of suspected COVID-19 patients. The number of weekly activities and interventions decreased by over 50% at 44% of practices, mostly due to a lack of patients. Even in an extraordinary crisis, GPs maintained their choice of whether to become involved, as their private and independent status allowed them to do. However, those who chose to be involved felt frustrated that the public health authorities did not recognize them as major health providers in the management of the pandemic. CONCLUSION: This study illustrated the complexity and limitations of a primary care system based completely on private healthcare providers.

Influence of reconstruction parameters during filtered backprojection and ordered-subset expectation maximization in the measurement of the left-ventricular volumes and function during gated SPECT.

UNLABELLED: A crucial method for investigating patients with coronary artery disease (CAD) is the calculation of the left ventricular ejection fraction (LVEF). It is, consequently, imperative to precisely estimate the value of LVEF--a process that can be done with myocardial perfusion scintigraphy. Therefore, the present study aimed to establish and compare the estimation performance of the quantitative parameters of the reconstruction methods filtered backprojection (FBP) and ordered-subset expectation maximization (OSEM). METHODS: A beating-heart phantom with known values of end-diastolic volume, end-systolic volume, and LVEF was used. Quantitative gated SPECT/quantitative perfusion SPECT software was used to obtain these quantitative parameters in a semiautomatic mode. The Butterworth filter was used in FBP, with the cutoff frequencies between 0.2 and 0.8 cycles per pixel combined with the orders of 5, 10, 15, and 20. Sixty-three reconstructions were performed using 2, 4, 6, 8, 10, 12, and 16 OSEM subsets, combined with several iterations: 2, 4, 6, 8, 10, 12, 16, 32, and 64. RESULTS: With FBP, the values of end-diastolic, end-systolic, and the stroke volumes rise as the cutoff frequency increases, whereas the value of LVEF diminishes. This same pattern is verified with the OSEM reconstruction. However, with OSEM there is a more precise estimation of the quantitative parameters, especially with the combinations 2 iterations × 10 subsets and 2 iterations × 12 subsets. CONCLUSION: The OSEM reconstruction presents better estimations of the quantitative parameters than does FBP. This study recommends the use of 2 iterations with 10 or 12 subsets for OSEM and a cutoff frequency of 0.5 cycles per pixel with the orders 5, 10, or 15 for FBP as the best estimations for the left ventricular volumes and ejection fraction quantification in myocardial perfusion scintigraphy.