Characteristics of family physicians with additional training or focused practices in caring for older adults: Population-based retrospective cohort study.

OBJECTIVE: To identify FPs with additional training and focused practice activities relevant to the needs of older patients within health administrative data and to describe their medical practices and service provision in community-based primary care settings. DESIGN: Retrospective cohort study. SETTING: Ontario. PARTICIPANTS: Family physicians with Certificates of Added Competence in care of the elderly from the College of Family Physicians of Canada or focused practice billing designations in care of the elderly. MAIN OUTCOME MEASURES: Evidence of additional training or certification in care of the elderly or practice activities relevant to the care of older adults. RESULTS: Of 14,123 FPs, 242 had evidence of additional scope to better support older adults. These FPs mainly practised in team-based care models, tended to provide comprehensive care, and billed for core primary care services. In an unadjusted analysis, factors statistically significantly associated with greater likelihood of having additional training or focused practices relevant to the care of older patients included physician demographic characteristics (eg, female sex, having completed medical school in Canada, residential instability at the community level), primary care practice model (ie, focused practice type), primary care activities (eg, more likely to provide consultations, practise in long-term care, refer patients to psychiatry and geriatrics, bill for complex house call assessments, bill for home care applications, and bill for long-term care health report forms), and patient characteristics (ie, older average age of patients). CONCLUSION: The FP workforce with additional training or focused practices in caring for older patients represents a small but specialized group of providers who contribute a portion of the total primary care activities for older adults. Health human resource planning should consider the contributions of all FPs who care for older adults, and enhancing geriatric competence across the family medicine workforce should be emphasized.

Top 10 Signs and Symptoms of Psychotropic Adverse Drug Events to Monitor in Residents of Long-Term Care Facilities.

OBJECTIVES: To produce a consensus list of the top 10 signs and symptoms suggestive of adverse drug events (ADEs) for monitoring in residents of long-term care facilities (LTCFs) who use antipsychotics, benzodiazepines, or antidepressants. DESIGN: A 3-round Delphi study. SETTING AND PARTICIPANTS: Geriatricians, psychiatrists, pharmacologists, general practitioners, pharmacists, nurses, and caregivers from 13 Asia Pacific, European, and North American countries. METHODS: Three survey rounds were completed between April and June 2023. In Round 1, participants indicated their level of agreement on a 9-point Likert scale on whether 41 signs or symptoms identified in a systematic review should be routinely monitored. Participants considered signs and symptoms that reduce quality of life or cause significant harm, are observable or measurable by nurses or care workers, and can be assessed at a single time point. Round 1 statements were included in a list for prioritization in Round 3 if ≥ 70% of participants responded ≥7 on the Likert scale. Statements were excluded if ≤ 30% of participants responded ≥7. In Round 2, participants indicated their level of agreement with statements that did not reach initial consensus, plus amended statements based on Round 1 participant feedback. Round 2 statements were included in Round 3 if ≥ 50% of the participants responded ≥7 on the Likert scale. In Round 3, participants prioritized the signs and symptoms. RESULTS: Forty-four participants (93.6%) completed all 3 rounds. Four of 41 signs and symptoms reached consensus for inclusion after Round 1, and 9 after Round 2. The top 10 signs and symptoms prioritized in Round 3 were recent falls, daytime drowsiness or sleepiness, abnormal movements (eg, shaking or stiffness), confusion or disorientation, balance problems, dizziness, postural hypotension, reduced self-care, restlessness, and dry mouth. CONCLUSIONS AND IMPLICATIONS: The top 10 signs and symptoms provide a basis for proactive monitoring for psychotropic ADEs.

Parkinson disease primer, part 2: management of motor and nonmotor symptoms.

OBJECTIVE: To provide family physicians with an approach to the management of motor and nonmotor symptoms of Parkinson disease (PD). SOURCES OF INFORMATION: Published guidelines on the management of PD were reviewed. Database searches were conducted to retrieve relevant research articles published between 2011 and 2021. Evidence levels ranged from I to III. MAIN MESSAGE: Family physicians can play an important role in identifying and treating motor and nonmotor symptoms of PD. Family physicians should initiate levodopa treatment for motor symptoms if they affect function and if specialist wait times are long, and they should be aware of basic titration approaches and possible side effects of dopaminergic therapies. Abrupt withdrawal of dopaminergic agents should be avoided. Nonmotor symptoms are common and underrecognized and are a major factor in disability, quality of life, and risk of hospitalization and poor outcomes for patients. Family physicians can manage common autonomic symptoms such as orthostatic hypotension and constipation. Family physicians can treat common neuropsychiatric symptoms such as depression and sleep disorders, and they can help recognize and treat psychosis and PD dementia. Referrals to physiotherapy, occupational therapy, speech language therapy, and exercise groups are recommended to help preserve function. CONCLUSION: Patients with PD present with complex combinations of motor and nonmotor symptoms. Family physicians should have basic knowledge of dopaminergic treatments and their side effects. Family physicians can play important roles in management of motor symptoms and particularly nonmotor symptoms and can have a positive impact on patients' quality of life. An interdisciplinary approach involving specialty clinics and allied health experts is an important part of management.

Abécédaire de la maladie de Parkinson, partie 2 : prise en charge des symptômes moteurs et non moteurs.

OBJECTIF: Présenter aux médecins de famille une approche pour la prise en charge des symptômes moteurs et non moteurs de la maladie de Parkinson (MP). SOURCES DE L'INFORMATION: Les lignes directrices sur la prise en charge de la MP ont été passées en revue. Des recensions dans les bases de données ont été effectuées pour en extraire les articles de recherche publiés entre 2011 et 2021. Le niveau des données probantes varie entre I et III. MESSAGE PRINCIPAL: Les médecins de famille peuvent jouer un rôle important dans la détection et le traitement des symptômes moteurs et non moteurs de la MP. Les médecins de famille devraient amorcer un traitement à la lévodopa pour les symptômes moteurs s'ils nuisent au fonctionnement et si les temps d'attente pour voir un spécialiste sont longs. Ils devraient être au courant des approches de base du titrage, de même que les effets secondaires possibles des thérapies dopaminergiques. Il faudrait éviter une cessation abrupte des agents dopaminergiques. Les symptômes non moteurs sont fréquents et peu reconnus, et ils influent grandement sur l'incapacité, la qualité de vie, le risque d'hospitalisation et les mauvais résultats chez les patients. Les médecins de famille peuvent prendre en charge les symptômes courants du fonctionnement autonome, comme l'hypotension orthostatique et la constipation. Ils peuvent traiter les symptômes neuropsychiatriques communs, comme la dépression et les troubles du sommeil, et aider à reconnaître et à traiter la psychose et la démence de la MP. Il est recommandé de demander des consultations en physiothérapie, en ergothérapie et en orthophonie, et de conseiller les groupes d'activité physique pour aider à préserver le fonctionnement. CONCLUSION: Les patients atteints de la MP présentent des combinaisons complexes de symptômes moteurs et non moteurs. Les médecins de famille devraient avoir des connaissances de base sur les traitements dopaminergiques et leurs effets secondaires. Les médecins de famille peuvent jouer des rôles importants dans la prise en charge des symptômes moteurs, et surtout des symptômes non moteurs, et ils peuvent exercer une influence positive sur la qualité de vie des patients. Une approche interdisciplinaire impliquant des cliniques et d'autres professionnels de la santé spécialisés est une importante composante de la prise en charge.

Parkinson disease primer, part 1: diagnosis.

OBJECTIVE: To provide family physicians an updated approach to the diagnosis of Parkinson disease (PD). SOURCES OF INFORMATION: Published guidelines on the diagnosis and management of PD were reviewed. Database searches were conducted to retrieve relevant research articles published between 2011 and 2021. Evidence levels ranged from I to III. MAIN MESSAGE: Diagnosis of PD is predominantly clinical. Family physicians should evaluate patients for specific features of parkinsonism, then determine whether symptoms are attributable to PD. Levodopa trials can be used to help confirm the diagnosis and alleviate motor symptoms of PD. "Red flag" features and absence of response to levodopa may point to other causes of parkinsonism and prompt more urgent referral. CONCLUSION: Access to neurologists and specialized clinics varies, and Canadian family physicians can be important players in facilitating early and accurate diagnosis of PD. Applying an organized approach to diagnosis and considering motor and nonmotor symptoms can greatly benefit patients with PD. Part 2 in this series will review management of PD.