RESUMO
OBJECTIVE: The University of California (UC) leadership sought to develop a robust educational response to the epidemic of opioid-related deaths. Because the contributors to this current crisis are multifactorial, a comprehensive response requires educating future physicians about safe and effective management of pain, safer opioid prescribing, and identification and treatment of substance use disorder (SUD). METHODS: The six UC medical schools appointed an opioid crisis workgroup to develop educational strategies and a coordinated response to the opioid epidemic. The workgroup had diverse specialty and disciplinary representation. This workgroup focused on developing a foundational set of educational competencies for adoption across all UC medical schools that address pain, SUD, and public health concerns related to the opioid crisis. RESULTS: The UC pain and SUD competencies were either newly created or adapted from existing competencies that addressed pain, SUD, and opioid and other prescription drug misuse. The final competencies covered three domains: pain, SUD, and public health issues related to the opioid crisis. CONCLUSIONS: The authors present a novel set of educational competencies as a response to the opioid crisis. These competencies emphasize the subject areas that are fundamental to the opioid crisis: pain management, the safe use of opioids, and understanding and treating SUD.
Assuntos
Epidemias , Transtornos Relacionados ao Uso de Opioides , Transtornos Relacionados ao Uso de Substâncias , Analgésicos Opioides/efeitos adversos , Humanos , Epidemia de Opioides , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Dor/tratamento farmacológico , Padrões de Prática Médica , Faculdades de Medicina , Transtornos Relacionados ao Uso de Substâncias/epidemiologiaRESUMO
BACKGROUND AND OBJECTIVES: One-third of all medical students attend a community college (CC) on their path to medical school. The objective of this study was to examine the association between CC participation and initial specialty of interest among US allopathic medical students. METHODS: We performed a national cross-sectional study of allopathic medical students who completed the 2012 Association of American Medical Colleges' Matriculating Student Questionnaire. Bivariate and logistic regression analyses were conducted. RESULTS: A total of 9,885 medical student respondents were included in the study sample, consisting of 7,035 (71%) non-CC pathway, and 2,850 (29%) CC pathway participants. CC pathway participants were more likely to express intent to specialize in family medicine (272/2,850 [10%] vs 463/7,035 [7%], P<.001), compared to those on the non-CC path. CC pathway participants had higher odds of intent to specialize in family medicine (adjusted odds ratio [AOR]=1.32; 95% CI 1.13-1.56, P<0.001), compared to those on the non-CC path. Women, independent of college pathway, were nearly two times more likely to express an intention to specialize in family medicine, and three times more likely to express an intention to specialize in pediatrics than men. CONCLUSIONS: Medical students who used a CC pathway are more likely to have intentions to specialize in family medicine, compared to those on the non-CC path.
Assuntos
Escolha da Profissão , Educação/estatística & dados numéricos , Medicina de Família e Comunidade , Intenção , Estudantes de Medicina/estatística & dados numéricos , Universidades , Adulto , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Razão de Chances , Fatores Sexuais , Inquéritos e Questionários , Estados Unidos , Adulto JovemRESUMO
PURPOSE: The authors conducted a systematic review of the medical literature to determine the factors most strongly associated with localizing primary care physicians (PCPs) in underserved urban or rural areas of the United States. METHOD: In November 2015, the authors searched databases (MEDLINE, ERIC, SCOPUS) and Google Scholar to identify published peer-reviewed studies that focused on PCPs and reported practice location outcomes that included U.S. underserved urban or rural areas. Studies focusing on practice intentions, nonphysicians, patient panel composition, or retention/turnover were excluded. They screened 4,130 titles and reviewed 284 full-text articles. RESULTS: Seventy-two observational or case-control studies met inclusion criteria. These were categorized into four broad themes aligned with prior literature: 19 studies focused on physician characteristics, 13 on financial factors, 20 on medical school curricula/programs, and 20 on graduate medical education (GME) programs. Studies found significant relationships between physician race/ethnicity and language and practice in underserved areas. Multiple studies demonstrated significant associations between financial factors (e.g., debt or incentives) and underserved or rural practice, independent of preexisting trainee characteristics. There was also evidence that medical school and GME programs were effective in training PCPs who locate in underserved areas. CONCLUSIONS: Both financial incentives and special training programs could be used to support trainees with the personal characteristics associated with practicing in underserved or rural areas. Expanding and replicating medical school curricula and programs proven to produce clinicians who practice in underserved urban or rural areas should be a strategic investment for medical education and future research.
Assuntos
Área Carente de Assistência Médica , Médicos de Atenção Primária/estatística & dados numéricos , Médicos de Atenção Primária/tendências , Área de Atuação Profissional/estatística & dados numéricos , Área de Atuação Profissional/tendências , Serviços de Saúde Rural/estatística & dados numéricos , Serviços de Saúde Rural/tendências , Previsões , Humanos , População Rural/estatística & dados numéricos , Estados Unidos , População Urbana/estatística & dados numéricosRESUMO
BACKGROUND AND OBJECTIVES: The United States is in an unprecedented era of health care reform that is pushing medical professionals and medical educators to evaluate the future of their patients, careers, and the field of medicine. Our objectives were to describe physician familiarity and knowledge with the Patient Protection and Affordable Care Act (ACA) and to determine if knowledge is associated with support and endorsement of the ACA. METHODS: We used a cross-sectional Internet-based survey of 559 physicians practicing in California. Primary outcomes were physician support and endorsement of ACA: (1) overall impact on the country (one item) and (2) perceived impact on physician's medical practice (one item). The primary predictor was knowledge of the ACA as measured with 10 questions. Other measures included age, gender, race-ethnicity, specialty, political views, provision of direct care, satisfaction with the practice of medicine, and compensation type. Descriptive statistics and multiple variable regression models were calculated. RESULTS: Respondents were 65% females, and the mean age was 54 years (+/- 9.7). Seventy-seven percent of physicians understood the ACA somewhat well/very well, and 59% endorsed the ACA, but 36% of physicians believed that health care reform will most likely hurt their practice. Primary care physicians were more likely to perceive that the new law will help their practice, compared to procedural specialties. Satisfaction with the practice of medicine, political affiliation, compensation type, and more knowledge of the health care law were independently associated with endorsement of the ACA. CONCLUSIONS: Endorsement of the ACA varied by specialty, knowledge, and satisfaction with the practice of medicine.
Assuntos
Atitude do Pessoal de Saúde , Conhecimento , Medicina/estatística & dados numéricos , Patient Protection and Affordable Care Act/legislação & jurisprudência , Adulto , Fatores Etários , Idoso , California , Estudos Transversais , Feminino , Humanos , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Política , Grupos Raciais , Salários e Benefícios , Fatores Sexuais , Estados UnidosRESUMO
After identifying many unlicensed Hispanic international medical graduates (IMGs) legally residing in southern California, University of California, Los Angeles developed an innovative program to prepare these sidelined physicians to enter family medicine residency programs and become licensed physicians. On completion of a 3-year family medicine residency-training program, these IMGs have an obligation to practice in a federally designated underserved community in the state for 2 to 3 years. As the US health care system moves from physician-centered practices to patient-focused teams, with primary care serving as the foundation for building patient-centered medical homes, attention to educating IMGs in these concepts is crucial.
Assuntos
Médicos Graduados Estrangeiros/provisão & distribuição , Medicina Geral , Acessibilidade aos Serviços de Saúde , Hispânico ou Latino , Internato e Residência/organização & administração , Licenciamento em Medicina , Barreiras de Comunicação , Emigração e Imigração/legislação & jurisprudência , Médicos Graduados Estrangeiros/legislação & jurisprudência , Medicina Geral/educação , Disparidades em Assistência à Saúde , Humanos , Los Angeles , Multilinguismo , Patient Protection and Affordable Care Act , Recursos HumanosRESUMO
AIMS: To evaluate the efficacy and safety of the PROMETA™ Protocol for treating methamphetamine dependence. DESIGN: A double-blind, placebo-controlled 108-day study with random assignment to one of two study conditions: active medication with flumazenil (2 mg infusions on days 1, 2, 3, 22, 23), gabapentin (1200 mg to day 40) and hydroxazine (50 mg to day 10) versus placebo medication (with active hydroxazine only). SETTING: Three substance abuse treatment clinics: two in-patient, one out-patient. PARTICIPANTS: Treatment-seeking, methamphetamine-dependent adults (n = 120). MEASUREMENTS: Primary outcome was percentage of urine samples testing negative for methamphetamine during the trial. FINDINGS: No statistically significant between-group differences were detected in urine drug test results, craving, treatment retention or adverse events. CONCLUSIONS: The PROMETA protocol, consisting of flumazenil, gabapentin and hydroxyzine, appears to be no more effective than placebo in reducing methamphetamine use, retaining patients in treatment or reducing methamphetamine craving.
Assuntos
Transtornos Relacionados ao Uso de Anfetaminas/reabilitação , Moduladores GABAérgicos/administração & dosagem , Agonistas dos Receptores Histamínicos/administração & dosagem , Metanfetamina , Adulto , Aminas/administração & dosagem , Aminas/efeitos adversos , Ácidos Cicloexanocarboxílicos/administração & dosagem , Ácidos Cicloexanocarboxílicos/efeitos adversos , Método Duplo-Cego , Combinação de Medicamentos , Feminino , Flumazenil/administração & dosagem , Flumazenil/efeitos adversos , Moduladores GABAérgicos/efeitos adversos , Gabapentina , Agonistas dos Receptores Histamínicos/efeitos adversos , Humanos , Hidroxizina/administração & dosagem , Hidroxizina/efeitos adversos , Infusões Intravenosas , Masculino , Adesão à Medicação , Autorrelato , Ácido gama-Aminobutírico/administração & dosagem , Ácido gama-Aminobutírico/efeitos adversosAssuntos
Doença Celíaca , Erros de Diagnóstico/prevenção & controle , Dieta Livre de Glúten/métodos , Comportamento Alimentar/fisiologia , Glutens/metabolismo , Antígenos HLA-DQ , Adulto , Idade de Início , Doenças Assintomáticas/epidemiologia , Doença Celíaca/diagnóstico , Doença Celíaca/dietoterapia , Doença Celíaca/epidemiologia , Doença Celíaca/etiologia , Doença Celíaca/imunologia , Doença Celíaca/fisiopatologia , Criança , Interação Gene-Ambiente , Antígenos HLA-DQ/análise , Antígenos HLA-DQ/genética , Humanos , Intestino Delgado/imunologia , Intestino Delgado/patologia , Prevalência , Medição de Risco , Fatores de Risco , Testes Sorológicos/métodos , Fatores Sexuais , Avaliação de Sintomas/métodosRESUMO
Acknowledging the growing disparities in health and health care that exist among immigrant families and minority populations in large urban communities, the UCLA Department of Family Medicine (DFM) sought a leadership role in the development of family medicine training and community-based participatory research (CBPR). Performing CBPR requires that academic medicine departments build sustainable and long-term community partnerships. The authors describe the eight-year (2000-2008) process of building sustainable community partnerships and trust between the UCLA DFM and the Sun Valley community, located in Los Angeles County.The authors used case studies of three research areas of concentration (asthma, diabetes prevention, and establishing access to primary care) to describe how they established community trust and sustained long-term community research partnerships. In preparing each case study, they used an iterative process to review qualitative data.Many lessons were common across their research concentration areas. They included the importance of (1) having clear and concrete community benefits, (2) supporting an academic-community champion, (3) political advocacy, (4) partnering with diverse organizations, (5) long-term academic commitment, and (6) medical student involvement. The authors found that establishing a long-term relationship and trust was a prerequisite to successfully initiate CBPR activities that included an asthma school-based screening program, community walking groups, and one of the largest school-based primary care clinics in the United States.Their eight-year experience in the Sun Valley community underscores how academic-community research partnerships can result in benefits of high value to communities and academic departments.
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Pesquisa Participativa Baseada na Comunidade/organização & administração , Relações Comunidade-Instituição , Medicina de Família e Comunidade/educação , Atenção Primária à Saúde/organização & administração , Faculdades de Medicina/organização & administração , Adulto , Asma/prevenção & controle , Criança , Diabetes Mellitus/prevenção & controle , Acessibilidade aos Serviços de Saúde , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde , Humanos , Desenvolvimento de ProgramasRESUMO
OBJECTIVES: Little is known about how the public uses formerly prescription medications that are available over-the-counter (OTC). This study examines whether consumers inappropriately use and substitute a recently widely distributed OTC urinary analgesic, phenazopyridine, for provider care. DESIGN/SETTING: We conducted a cross-sectional survey of a stratified cluster random sample of OTC phenazopyridine purchasers (N = 434) in 31 Los Angeles retail pharmacies over 5 months. Recruited by shelf advertisements, participants were 18 years or older who purchased a phenazopyridine product. Each completed a 25-item self-administered anonymous questionnaire. Inappropriate use was defined as 1) having medical contraindications to phenazopyridine, or 2) not having concurrent antibiotic and/or provider evaluation for the urinary symptoms. RESULTS: The survey response rate was 58%. Fifty-one percent of the respondents used OTC phenazopyridine inappropriately, and 38% substituted it for medical care. Multiple logistic regression analyses revealed that inappropriate use was correlated with having little time to see a provider (odds ratio [OR], 1.57; 95% confidence interval [95% CI], 1.26 to 1.96), receiving friend's or family's advice (OR, 1.25; 95% CI, 1.05 to 1.47), having prior urinary tract infections (OR, 0.49; 95% CI, 0.30 to 0.80), having used prescription phenazopyridine, (OR, 0.40; 95% CI, 0.25 to 0.63), and having back pain (OR, 0.34; 95% CI, 0.16 to 0.74). Similar correlates were found in those who substituted OTC phenazopyridine for provider care. Respondents with incorrect knowledge about phenazopyridine's mode of action had 1.9 times greater odds of inappropriate use and 2.2 times greater odds of substitution than those who had correct knowledge about this drug. CONCLUSION: Inappropriate use of OTC phenazopyridine appears common. Increasing the public's knowledge about reclassified drugs may help to mitigate this problem.