'Meet and greet' intake appointments in primary care: a new pattern of patient intakes?

Background: Family physicians (FPs) are expected to take on new patients fairly and equitably and to not discriminate based on medical or social history. 'Meet and greet' appointments are initial meetings between physicians and prospective patients to establish fit between patient needs and provider scope of practice. The public often views these appointments as discriminatory; however, there is no empirical evidence regarding their prevalence or outcomes. Objectives: To determine the proportion of FPs conducting 'meet and greets' and their outcomes. Methods: Study design and setting: Census telephone survey of all FP practices in Nova Scotia (NS). Participants: Person who answers the FP office telephone. Main Outcomes: Proportion of FPs holding 'meet and greets'; proportion of FPs conducting 'meet and greets' who have ever decided not to continue seeing a patient after the meeting. Results: 9.2% of FPs accept new patients unconditionally; 51.1% accept new patients under certain conditions. Of those accepting patients unconditionally or with conditions, 46.9% require a 'meet and greet'; 41.8% have a first-come, first-serve policy. Among FPs who require a 'meet and greet', 44.0% decided, at least once, not to continue seeing a patient after the first meeting. Conclusion: 'Meet and greets' are common among FPs in NS and result in some patients not being accepted into practice. More research is needed to understand the intentions, processes, and outcomes of 'meet and greets'. We recommend that practice scope be made clear to prospective patients before their first visit, which may eliminate the need for 'meet and greets'.

Hand clasping, arm folding, and handedness: relationships and strengths of preference.

We investigated via a survey the relationship between hand clasping, arm folding, and handedness. We aimed to provide new data on degree of preference for each of these lateralities. We also examined the relative importance of thumb position versus interdigitisation of the fingers in determining one's comfort in a hand-clasping position. We explored this in the context of the fact that sensory acuity is greater for the thumb than other fingers, suggesting that preference for how the fingers are intermeshed may be more influenced by thumb than finger position. Lastly we performed an exploratory analysis to determine if self-reported menstrual phase-known to influence turning bias-also influences hand clasping, arm folding or the strength of one's handedness. Our study suggests that lateral preferences for hand clasping, arm folding, and handedness are independent. However, the degrees of lateral preference for hand clasping and arm folding are correlated. Our exploration of the relative importance of thumbs versus fingers to hand clasping revealed some trends that were not statistically significant, but worth future exploration. Our data on menstrual phase showed a reduced strength of preference for arm folding in mid-luteal females versus non-mid-luteal females.

Knowledge of reproductive system cancers, their treatments and side effects.

We explored, via an online questionnaire, knowledge of breast and reproductive system cancers in patients and non-patients who access the internet for information on these diseases. We compared that knowledge to the attention the diseases have received in medical research and on the Internet. Data were collected from 690 respondents (37 % male, 63 % female) about their knowledge of prevalence, lethality, treatments and side effects of testicular, prostate, breast, uterine, cervical and ovarian cancers. Most males, but only half of the female participants, were patients themselves. Although participants showed better knowledge of cancers specific to their own sex, both sexes felt familiar with breast cancer and less aware of other cancers. Women were as aware as men of side effects of treatments for male reproductive cancers. Sex differences in awareness appear to reflect different attitudes towards illness, bias toward females as caregivers, and the disproportionate media attention given to breast cancer.

Treatment outcomes among rural and urban patients with obstructive sleep apnea: a prospective cohort study.

STUDY OBJECTIVES: To determine whether adherence to continuous positive airway pressure (CPAP) in adults with uncomplicated obstructive sleep apnea differs by rural vs urban residential address. METHODS: In this prospective cohort study, we recruited adults who initiated CPAP for uncomplicated obstructive sleep apnea that was diagnosed by a physician using sleep specialist-interpreted diagnostic testing. Participants were classified as urban (community size > 100,000) or rural (community size < 100,000) by translating residential postal code into geographic census area. The primary outcome was mean daily hours of CPAP use compared between rural and urban patients. Secondary outcomes included the proportion of patients who were adherent to CPAP, change in Epworth Sleepiness Scale score, change in EuroQOL-5D visual analog score, and Visit-Specific Satisfaction Instrument score. All outcomes were measured 3 months after CPAP initiation. RESULTS: We enrolled 242 patients (100 rural) with a mean (standard deviation) age of 51 (13) years and a respiratory event index of 24 (18) events/h. The mean (95% confidence interval) CPAP use was 3.19 (2.8-3.58) hours/night and 35% were CPAP-adherent, with no difference between urban and rural patients. Among the 65% of patients who were using CPAP at 3 months, the mean CPAP use was 4.89 (4.51-5.28) hours/night and was not different between rural and urban patients. Improvement in the Epworth Sleepiness Scale score and patient satisfaction was similar between groups, but the EuroQOL-5D score improved to a greater extent in rural patients. Urban or rural residence was not associated with CPAP adherence according to multivariable regression analysis. CONCLUSIONS: Rural vs urban residence was not associated with differences in CPAP adherence among patients with uncomplicated OSA diagnosed by a physician using specialist-interpreted sleep diagnostic testing. CITATION: Corrigan J, Tsai WH, Ip-Buting A, et al. Treatment outcomes among rural and urban patients with obstructive sleep apnea: a prospective cohort study. J Clin Sleep Med. 2022;18(4):1013-1020.

An evaluation of rural-urban disparities in treatment outcomes for obstructive sleep apnoea: study protocol for a prospective cohort study.

BACKGROUND: Obstructive sleep apnoea (OSA) is a common and treatable chronic condition that is associated with significant morbidity and economic cost. Geography is increasingly being recognised as a barrier to diagnosis and treatment of many chronic diseases; however, no study to date has investigated the impact of place of residence on health outcomes in OSA. OBJECTIVE: The purpose of this study is to determine whether treatment outcomes for patients initiating continuous positive airway pressure (CPAP) for OSA differ between those who live in urban versus rural settings. METHODS: A prospective cohort design will be used. Participants will be recruited through community-based CPAP providers and assigned to either the rural or urban cohort based on residential postal code. The primary outcome will be the difference in nightly hours of CPAP use between the two groups, measured 3 months after initiation of therapy. Secondary outcomes will include symptoms, quality of life, patient satisfaction and patient-borne costs. ANTICIPATED RESULTS: This study will determine whether there are differences in CPAP adherence or patient-reported outcomes between rural and urban patients with OSA. These results will highlight potential challenges with providing OSA care in rural populations and may inform health interventions to reduce urban-rural inequities.

Does socio-economic status or having a chronic condition affect whether family physicians accept a new patient? A Nova Scotia population study.

OBJECTIVES: To determine whether socio-economic status (SES) and presence of a chronic condition are associated with the response a prospective patient receives when seeking a family physician (FP). METHODS: Scripted telephone calls (indicating higher or lower SES and presence or absence of a chronic condition) were made to all 327 FP offices in Nova Scotia (NS) requesting an appointment. The main outcome measures were the responses to callers seeking a FP: being accepted for an appointment or being offered further assistance if not accepted (e.g., walk-in clinic, alternative provider, and telehealth), as well as the callers' perception of the experience as positive, negative, or neutral. RESULTS: Only 9.9% of offices accepted callers as new patients. There were no statistically significant differences by SES or chronic condition in the proportion of calls resulting in an appointment. Callers indicating high SES were more likely to be provided further assistance than those with low SES (p = 0.06), and callers indicating a chronic condition reported a better overall experience than those without (p = 0.03). CONCLUSION: First contact accessibility for prospective new patients was low across NS. Lower SES was associated with fewer offers of additional assistance than higher SES. This is particularly troubling since those with lower SES may need additional support as they may have less access to resources and networks that could provide support. This study signals the need to improve general and equitable accessibility to primary care providers.

How reliable are "reputable sources" for medical information on the Internet? The case of hormonal therapy to treat prostate cancer.

OBJECTIVES: Prostate cancer patients, as well as their caregivers and healthcare providers, often search the Internet for information about treatment options. We aimed to assess how accurate and up-to-date information about prostate cancer treatments is on websites owned and managed by health-related organizations that most patients and health care providers would consider to be the most trustworthy, based on the reputations of the site providers. MATERIALS AND METHODS: We reviewed 43 noncommercial and easily found websites that offered extensive information on treatment options for prostate cancer patients. To assess how comprehensive the sites were, we focused on the information they provided on alternative hormonal therapies to commonly prescribed luteinizing hormone-releasing hormone (LHRH) agonists, namely GnRH antagonists and parenteral estradiol. RESULTS: Only 14 of 43 websites presented GnRH antagonists as a therapy option for prostate cancer. Sixteen of these 43 websites presented estrogen as a possible treatment option, but only 1 of the 43 websites contained current information on parenteral estrogen treatments. Less than half of the sites provided time stamps indicating when they were last updated. Furthermore, most sites with time stamps were not in fact up-to-date based on the information posted on the site. CONCLUSIONS: Few seemingly reputable Internet sources for medical information provide viewers with the detailed and up-to-date information that they may expect from such sites when searching for alternatives to standard treatment for androgen suppression. Strategies for keeping such websites up-to-date and reliable are discussed. Sites may improve their credibility and usefulness if they (1) present all evidence-based treatment options, (2) regularly update and time stamp their information, (3) acknowledge that their recommendations on treatments may become out-of-date quickly, (4) and direct viewers to information on relevant, active clinical trials. Maintaining high quality sites may ultimately depend on users taking the initiative to inform website owners when their sites are out-of-date.