Results of the study of the attitude of women of reproductive age to the integrated gynecological care provision by family physicians.

OBJECTIVE: Aim: To study and analyze the attitude of women of reproductive age to the integrated gynecological care provision by family physicians, their readiness to receive some gynecological services from family physicians, as well as to analyze the level of women's support and readiness for the integrated provision of gynecological care depending on age and level of education. PATIENTS AND METHODS: Materials and Methods: For the survey, anonymous questionnaires containing questions on the attitude of women of reproductive age to the integrated provision of certain types of gynecological care by family physicians were developed. 181 women from the Kyiv region took part in the survey. RESULTS: Results: Support of more than 80% of respondents regarding the integrated gynecological care provision by family physicians received the following questions: counseling on the prevention of sexually transmitted infections and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) (92,3%); counseling on family planning and prevention of unwanted pregnancy (83,4%); counseling on the use of various methods of contraception (82,3%); examination and palpation of mammary glands (80,1%); referral of women to a higher level of obstetric and gynecological care (if necessary (86,2%). CONCLUSION: Conclusions: The majority of respondents (67,4%) are ready or better ready than not ready to receive certain types of gynecological care services from family physicians. Almost the same percentage ratio (more than 60%) of women of each age group and all levels of education are ready or better ready than not ready to receive gynecological care services, which they supported, from family physicians.

How family physicians in Singapore recognise complexity during consultations: a qualitative study.

BACKGROUND: The prevalence of persons with complex needs in Singapore is rising. Poor understanding of what constitutes complexity impedes the identification of care gaps and development of interventions to improve care for these individuals. We aim to identify the characteristics contributing to complexity in primary care, from the Family Physicians' (FP) perspectives. METHODS: Focus group discussions (FGDs) were conducted from January to September 2021 with experienced FPs across 14 study sites, employing a qualitative descriptive approach based on a complexity framework. Data were coded independently and categorised using thematic analysis by two independent investigators. RESULTS: Five FGDs were conducted with 18 FPs aged 32 to 57 years old working in different primary care settings, with a mean of 13.5 years of primary care experience. Participants emphasised the need for a unified definition of complexity. Complexity is characterised by the presence of issues spanning across two or more domains (medical, psychological, social or behavioural) that adversely impact medical care and outcomes. Persons with complex needs contrast with persons with medically difficult issues. Medical domain issues include the number of active medical problems, poor chronic disease control, treatment interactions, ill-defined symptoms, management of end-of-life conditions and functional impairment. Psychological domain issues include the presence of mental health conditions or cognitive impairment. Social domain issues include the lack of social support, competing social responsibilities and financial issues, while behavioural domain issues include a lack of trust in healthcare workers, fixed health beliefs and poor health literacy. CONCLUSION: Recognising the medical, psychological, social and behavioural factors that contribute to complexity aids in discerning the diverse needs of individuals with complex needs. This underscores the need for additional support in these pertinent areas.

The relationship between relational continuity and family physician follow-up after an antidepressant prescription in older adults: a retrospective cohort study.

BACKGROUND: Side effects can occur within hours to days of starting antidepressant medications, whereas full therapeutic benefit for mood typically takes up to four weeks. This mismatch between time to harm and lag to benefit often leads to premature discontinuation of antidepressants, a phenomenon that can be partially reversed through early doctor-patient communication and follow-up. We investigated the relationship between relational continuity of care - the number of years family physicians have cared for older adult patients - and early follow-up care for patients prescribed antidepressants. METHODS: A retrospective cohort study was conducted on residents of Ontario, Canada aged 66 years or older who were dispensed their first antidepressant prescription through the provincial drug insurance program between April 1, 2016, and March 31, 2019. The study utilized multivariable regression to estimate the relationship between relational continuity and 30-day follow-up with the prescribing family physician. Separate estimates were generated for older adults living in urban, non-major urban, and rural communities. RESULTS: The study found a small positive relationship between relational continuity of care and follow-up care by the prescribing family physician for patients dispensed a first antidepressant prescription (RRR = 1.005; 95% CI = 1.004, 1.006). The relationship was moderated by the patients' location of dwelling, where the effect was stronger for older adults residing in non-major urban (RRR = 1.009; 95% CI = 1.007, 1.012) and rural communities (RRR = 1.006; 95% CI = 1.002, 1.011). CONCLUSIONS: Our findings do not provide strong evidence of a relationship between relational continuity of care and higher quality management of antidepressant prescriptions. However, the relationship is slightly more pronounced in rural communities where access to continuous primary care and specialized mental health services is more limited. This may support the ongoing need for the recruitment and retention of primary care providers in rural communities.

Virtual Care: Perspectives From Family Physicians.

BACKGROUND: During the COVID-19 pandemic, virtual care expanded rapidly at Michigan Medicine and other health systems. From family physicians' perspectives, this shift to virtual care has the potential to affect workflow, job satisfaction, and patient communication. As clinics reopened and care delivery models shifted to a combination of in-person and virtual care, the need to understand physician experiences with virtual care arose in order to improve both patient and provider experiences. This study investigated Michigan Medicine family medicine physicians' perceptions of virtual care through qualitative interviews to better understand how to improve the quality and effectiveness of virtual care for both patients and physicians. METHODS: We employed a qualitative descriptive design to examine physician perspectives through semistructured interviews. We coded and analyzed transcripts using thematic analysis, facilitated by MAXQDA (VERBI) software. RESULTS: The results of the analysis identified four major themes: (a) chief concerns that are appropriate for virtual evaluation, (b) physician perceptions of patient benefits, (c) focused but contextually enriched patient-physician communication, and (d) structural support needed for high-quality virtual care. CONCLUSIONS: These findings can help further direct the discussion of how to make use of resources to improve the quality and effectiveness of virtual care.

Influences of early diagnostic suggestions on clinical reasoning.

Previous research has highlighted the importance of physicians' early hypotheses for their subsequent diagnostic decisions. It has also been shown that diagnostic accuracy improves when physicians are presented with a list of diagnostic suggestions to consider at the start of the clinical encounter. The psychological mechanisms underlying this improvement in accuracy are hypothesised. It is possible that the provision of diagnostic suggestions disrupts physicians' intuitive thinking and reduces their certainty in their initial diagnostic hypotheses. This may encourage them to seek more information before reaching a diagnostic conclusion, evaluate this information more objectively, and be more open to changing their initial hypotheses. Three online experiments explored the effects of early diagnostic suggestions, provided by a hypothetical decision aid, on different aspects of the diagnostic reasoning process. Family physicians assessed up to two patient scenarios with and without suggestions. We measured effects on certainty about the initial diagnosis, information search and evaluation, and frequency of diagnostic changes. We did not find a clear and consistent effect of suggestions and detected mainly non-significant trends, some in the expected direction. We also detected a potential biasing effect: when the most likely diagnosis was included in the list of suggestions (vs. not included), physicians who gave that diagnosis initially, tended to request less information, evaluate it as more supportive of their diagnosis, become more certain about it, and change it less frequently when encountering new but ambiguous information; in other words, they seemed to validate rather than question their initial hypothesis. We conclude that further research using different methodologies and more realistic experimental situations is required to uncover both the beneficial and biasing effects of early diagnostic suggestions.

Mental health impact of COVID-19 on family doctors in Canada: one year after.

Context: A year after the pandemic outbreak, primary care providers continue to face extreme psychological pressure. This study gauges the mental health and burnout levels of family physicians during the third wave of the COVID-19 pandemic in Canada. Objective: Assess the levels of personal, professional and patient-related burnout of family physicians (FPs) in the response to the pandemic and explore demographic and work-related factors that may influence burnout levels. Study Design: Online, self-report survey administered between April 7 and May 10, 2021. Setting or Dataset: The College of Family Physicians of Canada's (CFPC) list of all active members was used to reach family physicians in diverse practice settings in all Canadian provinces and territories. Population studied: All active CFPC family physician (FP) members were included. Family medicine trainees and members with primary addresses outside Canada were excluded. Most FPs in Canada are CFPC members; 39,991 FPs received survey invitations; 3,409 replied, for an overall response rate of 9%. Outcome Measures: The study used the Copenhagen Burnout Inventory (CBI) which measures the level of personal, work-related and patient-related burnout. As well, question asking about FP's overall sense of well being and personal wellness which were asked in a previous survey, a year prior, were incorporated to allow for longitudinal comparison. Results: 15% of FPs reported feeling burned out and thinking of, or have taken, a break from work, three times more than last year. More than one-fifth of FPs currently experience high or severe personal (22%) and work-related (21%) burnout, while 13% report the same levels of patient-related burnout. Female FPs report higher levels of personal burnout (26%, 17%) and work-related burnout (23%, 16%) than male FPs. Generations Y (30%) and X (25%) are experiencing higher levels of personal burnout than Baby Boomers (14%) and Traditionalists (2%). Conclusions: Roughly 1-in-4 FPs in Canada are currently experiencing high or severe personal and work-related burnout. Compared with the survey results a year prior, the numbers are climbing rapidly, reflecting the serious challenges FPs facing during the pandemic. This study was designed to contribute to a better understanding of the extent of the problem, contributing factors and to assist in considering approaches to build effective support systems to improve the mental health of FPs.

Emotional distress, occupational stress and burnout among Family Doctors in Europe: Monitoring and testing of interventions is required.

In recent years, the medical literature from a wide range of medical specialities has exploded with publications on the theme of emotional distress, stress and burnout in the practice of medicine. Improving the work-life of health care providers is necessary to optimise health system performance. COVID-19 has caused considerable additional pressure on health services across Europe and there have been calls for interventions to address the psychological and occupational stress caused by the pandemic. Although there is an ongoing need to monitor these factors among family physicians, and other staff working in primary care across Europe, we must also identify supports and promote them. Further research is needed to explore causative factors and provide convincing evidence in relation to effective interventions.

Knowledge, attitude and management of hearing screening in children among family physicians in the Kingdom of Saudi Arabia.

BACKGROUND: Early detection and management of hearing loss are important to develop ordinary speaking language and academic skills during childhood. Lack of knowledge by either parents or health care providers could hinder the process of hearing loss diagnosis, such that the intervention will be less effective. There is little evidence about the knowledge and practice of family physicians regarding hearing screening in Saudi Arabia and worldwide. OBJECTIVES: This study aimed to assess family physicians' knowledge, attitudes, and practices related to hearing loss in children. This in turn will help policy makers and educational institutions to establish and promote a program concerned with screening, diagnosis and intervention of paediatric hearing loss. METHODS: A cross-sectional descriptive study enrolled 133 family physicians working at primary health centres in Saudi Arabia from March 2020 to September 2020. A self-reported questionnaire was used to assess the knowledge, attitudes, and practices of family physicians concerning hearing loss in children. RESULTS: The majority of the participants were working under the umbrella of the Ministry of Health and around half of them did not screen any child for hearing loss. Despite that, 91.7% indicated the importance of neonatal hearing screening, 70.7% indicate infant candidacy for cochlear implant and only 33.1% know about the existence of the early hearing detection and intervention (EHDI) governmental program in kingdom of Saudi Arabia (KSA). Participants were able to identify factors associated with hearing loss such as a family history of hearing loss (85.6%), meningitis (75%) and craniofacial anomalies (51.5%). The most frequent specialists for patient referrals were ear nose and throat ENT (75.2%) and audiologists (67.7%). CONCLUSION: This study shows that family physicians have good general background about the benefits of EHDI programs and the management of hearing loss in the paediatric population. However, it also indicated insufficient knowledge in other domains of hearing loss, including assessments and the presence of the EHDI governmental program in KSA. Further actions on the involvement of family physicians in the process of neonatal hearing screening, diagnosis and intervention for hearing impairment are needed.

Lower Likelihood of Burnout Among Family Physicians From Underrepresented Racial-Ethnic Groups.

PURPOSE: We investigated whether physician race and ethnicity were associated with burnout among a nationally representative sample of family physicians. METHODS: We undertook a cross-sectional observational study using survey data from 1,510 American Board of Family Medicine recertification applicants in 2017 and 1,586 respondents to the 2017 National Graduate Survey. Of the 3,096 total family physicians, 450 (15%) were from racial and ethnic groups underrepresented in medicine. We used structural equation models to test the effects of underrepresented status on single-item measures of emotional exhaustion and depersonalization. RESULTS: Family physicians underrepresented in medicine were significantly less likely than their non-underrepresented counterparts to report emotional exhaustion (adjusted odds ratio = 0.82; 95% CI, 0.69-0.99; total effect) and depersonalization (adjusted odds ratio = 0.54; 95% CI, 0.41-0.71; total effect). The underrepresented physicians were more likely than non-underrepresented peers to practice in more racially and ethnically diverse counties and less likely to practice obstetrics, both of which partly mediated the protective effect of underrepresented status on depersonalization. CONCLUSIONS: Although factors such as racism might be expected to adversely affect the well-being of underrepresented clinicians, underrepresented family physicians reported a lower frequency of emotional exhaustion and depersonalization. The mediating protective effect of working in more racially and ethnically diverse counties is consistent with evidence of the beneficial effect of cultural diversity on health outcomes for minorities. Because physician burnout is a known predictor of job turnover and may also be associated with poorer quality of care, the lower burnout observed among underrepresented family physicians may be an asset for the health care system as a whole.

Psychological outcomes amongst family medicine healthcare professionals during COVID-19 outbreak: A cross-sectional study in Croatia.

BACKGROUND: Healthcare professionals (HCPs) in family medicine (FM) in Croatia work in a demanding environment caused by the SARS-CoV-2 pandemic. Besides particular circumstances in healthcare, an unknown virus, social distancing, and homeschooling, the capital was hit with the earthquake during the lockdown. OBJECTIVES: To assess the prevalence of stress, anxiety, depression, posttraumatic stress disorder (PTSD) and the influence of demographic characteristics, professional differences, medical history, and specific stressors on the psychological outcomes. METHODS: A cross-sectional study with the online questionnaire containing the Depression, Anxiety and Stress Scale (DASS-21) and the Impact of Event Scale-Revised (IES-R) was conducted from 1st to 15 May 2020 in FM. RESULTS: HCPs (534, 35% response rate), predominantly female (84.5%), participated in the research. High prevalence of stress (30.9%), anxiety (33.1%), depression (30.7%), and PTSD (33.0%) were found. Female participants had higher results in the anxiety subscale of DASS-21 and IES-R scores. Pre-existing conditions were associated with higher levels of stress, anxiety, depression, and PTSD. The IES-R score for PTSD showed borderline correlation (p = 0.053) with working in regions with the highest incidence of COVID-19. Having schoolchildren made a difference on a stress subscale in DASS-21 (p < 0.043), but the earthquake did not have an impact. CONCLUSION: Family physicians and nurses in FM in Croatia are under a great mental load during the COVID-19 outbreak. Results suggest that HCPs of the female sex, with pre-existing chronic conditions, work in regions with a high incidence of SARS-CoV-2 or have schoolchildren at greater risk of the poor psychological outcome.

Burnout, Depression, Anxiety, and Stress Among Family Physicians in Kansas Responding to the COVID-19 Pandemic.

INTRODUCTION: COVID-19 has spread rapidly, with vast global implications. This study assessed how family physicians in Kansas were responding to COVID-19 and the effects of the pandemic on their well-being. METHODS: The authors conducted a cross-sectional survey of 113 family physicians in Kansas between May 22, 2020 and June 25, 2020. The study participants completed an anonymous, 36-item survey assessing their concerns about being exposed to COVID-19 and levels of personal depression, anxiety, stress, and burnout in addition to demographic information. RESULTS: There was a 45.6% response rate, with 50.4% (n = 57) of the respondents reporting manifestations of burnout. The physicians who personally treated any presumptive or confirmed COVID-19 patient, compared with those who did not, were more likely to report at least 1 manifestation of burnout, experience emotional exhaustion, and feel a higher level of personal stress. CONCLUSION: Our findings demonstrate that the COVID-19 pandemic may be taking an emotional toll on family physicians in Kansas. This study provides a baseline from which to continue further monitoring of outcomes. Data can help drive initiatives at local, state, and national levels to help diminish the negative impact of the COVID-19 pandemic on physicians.

Attitudes toward medical cannabis among family physicians practising in Ontario, Canada: a qualitative research study.

BACKGROUND: Medical cannabis has been legally available in Canada since 2001, but its benefits and harms remain uncertain. We explored attitudes toward medical cannabis among family physicians practising in Ontario. METHODS: Between January and October 2019, we conducted a qualitative study of Ontario family physicians using semistructured telephone interviews. We applied thematic analysis to interview transcripts and identified representative quotes. RESULTS: Eleven physicians agreed to be interviewed, and 3 themes regarding medical cannabis emerged: reluctance to authorize use, concern over harms and lack of practical knowledge. Participants raised concerns about the limited evidence for, and their lack of education regarding, the therapeutic use of cannabis, particularly the harms associated with neurocognitive development, exacerbation of mental illness and drug interactions in older adults. Some participants thought medical cannabis was overly accessible and questioned their role following legalization of recreational cannabis. INTERPRETATION: Despite the increasing availability of medical cannabis, family physicians expressed reluctance to authorize its use because of lack of knowledge and concerns regarding harms. Family physicians may benefit from guidance and education that address concerns they have surrounding medical cannabis.

[Examination of the health status and health behaviors of Hungarian family physicians]. / Magyar családorvosok egészségi állapotának, életmódjának vizsgálata.

Összefoglaló. Bevezetés: A családorvosok testi, lelki egészségi állapota hatással van a munkavégzésükre, a betegellátás minoségére, ezáltal a társadalom egészségmutatóira is. Az életmód pedig az egyik legjelentosebb, egészségi állapotot befolyásoló tényezo. Célkituzés: A vizsgálat célja a magyar háziorvosok egészségi állapotának és az azt befolyásoló életmódtényezoknek a felmérése. Módszer: Keresztmetszeti vizsgálat. Kvantitatív, papíralapú felmérés családorvosok körében (n = 569, életkor 54 ± 10 év, nok 42%). Eredmények: A háziorvosok 61%-a túlsúlyos vagy elhízott, 88%-ának a vércukorszintje ≤5,5 mmol/l. A résztvevok 50%-a legalább heti rendszerességgel végez testmozgást, 20%-uk egyáltalán nem. A háziorvosok 13%-a dohányzik jelenleg, 5%-a tekintheto nagyivónak. Enyhe fokú depressziós tünetegyüttes 19%-uknál, közepes fokú 6%-uknál, súlyos fokú 5%-uknál fordult elo. A súlyos fokú kiégés mindkét nemben, mindhárom dimenzióban 18­39% volt. Következtetés: A magyar háziorvosok általános egészségi állapota nem mondható jobbnak sem a hazai nem orvos populációénál, sem a külföldi orvoskollégákénál. A magyar háziorvosok dohányzási mutatói kedvezobbek a lakossági adatoknál, míg az alkoholfogyasztás terén kedvezotlenebb eredményeket kaptunk. Nemzetközi összehasonlításban, a káros szenvedélyek terén a hazai kollégák eredményei jónak tekinthetok. A depresszió és a kiégés gyakori elofordulása jelentos probléma a háziorvosok körében. Mentális egészségük monitorozása és gondozása a hatékony egészségügyi ellátórendszer kulcskérdése. Orv Hetil. 2021; 162(12): 449­457. Summary. Introduction: General practitioners' somatic and mental health status have an impact on their work and the quality of care they provide and thus influence the health indicators of the society. Lifestyle is one of the most important influencing factors of health. Objective: The study aims to assess the health status of Hungarian general practitioners and the lifestyle factors influencing it. Method: Cross-sectional study. Quantitative, paper-based questionnaire among general practitioners (n = 569, age 54 ± 10 years, female 42%). Results: 61% of family physicians are overweight or obese, 88% of them have blood glucose level ≤5.5 mmol/l. 50% of the participants do exercise at least once a week, 20% do not take any exercise at all. 13% currently smoke, 7% are considered heavy drinkers. Mild, moderate and severe depression symptoms occurred in 19%, 6% and 5% of them, respectively. A severe level of burnout syndrome was reported in 18­39% in both sexes, in all three dimensions. Conclusion: The health status of Hungarian general practitioners is not better than that of the non-medical Hungarian population or than that of foreign colleagues. The smoking indicators of Hungarian doctors are more favorable than the Hungarian population data, while we obtained worse results in the field of alcohol consumption. In international comparison, the results of Hungarian colleagues in the field of smoking and alcohol consumption are good. The frequent occurrence of depression and burnout is a significant problem among family physicians. Monitoring and caring for their mental health is a key factor in the effective health care system. Orv Hetil. 2021; 162(12): 449­457.

Continuity of Cancer Care and Collaboration Between Family Physicians and Oncologists: Results of a Randomized Clinical Trial.

PURPOSE: Collaboration between family physicians (FPs) and oncologists can be challenging. We present the results of a randomized clinical trial of an intervention designed to improve continuity of care and interprofessional collaboration, as perceived by patients with lung cancer and their FPs. METHODS: The intervention included (1) supplying FPs with standardized summaries related to each patient, (2) recommending that patients see their FP after receiving the cancer diagnosis, (3) supplying the oncology team with patient information resulting from FP visits, and (4) providing patients with priority access to FPs as needed. A total of 206 patients with newly diagnosed lung cancer were randomly assigned to the intervention (n = 104) or control group (n = 102), and 86.4% of involved FPs participated. Perceptions of continuity of care and interprofessional collaboration were assessed every 3 months for patients and at baseline and at the end of the study for FPs. Patient distress and health service utilization were also assessed. RESULTS: Patients and FPs in the intervention group perceived better interprofessional collaboration (patients: P <.0001; FPs: P = .0006) than those in the control group. Patients reported better informational continuity (P = .001) and management continuity (P = .05) compared to the control group, but no differences were found for FPs (information: P = .22; management: P = .13). No effect was found with regard to patient distress or health service utilization. CONCLUSIONS: This intervention improved patient and FP perception of interprofessional collaboration, but its effectiveness on continuity of care was less clear for FPs than for patients. Additional strategies should be considered to sustainably improve continuity of care and interprofessional collaboration.

Video Visits: Family Physician Experiences With Uptake During the COVID-19 Pandemic.

BACKGROUND AND OBJECTIVES: With the emergence of COVID-19, telemedicine use has increased dramatically as clinicians and patients have looked for alternatives to face-to-face care. Prior research has shown high levels of patient satisfaction and comparable quality of care. Video visits have been hypothesized to be one way to reduce burnout among clinicians, but there has been minimal research on physician views of virtual care. We sought to measure family physician experience with video visits at the start of the COVID-19 pandemic. METHODS: We identified all faculty and resident physicians at a large academic department of family medicine who had conducted a video visit in the prior month and conducted an anonymous online 12-question survey about their experiences, satisfaction, and barriers with care. RESULTS: Most eligible physicians responded (102/109, 94%), of whom half (52%) reported this was their first month trying a video visit. There was very high satisfaction (91% very or somewhat satisfied). The majority of respondents felt that video visits were shorter (54%) or took the same amount of time (38%) as in-person visits. There was concern that many physicians had experienced a visit in which they felt video was not the appropriate platform given patient concerns. CONCLUSIONS: This study is among the first to assess physician experience with video visits. As the visits are perceived as shorter, they may offer a unique opportunity to address clinician burnout. There was a high level of satisfaction at our institution despite multiple technical challenges.

Family Physicians' Standpoint and Mental Health Assessment in the Light of COVID-19 Pandemic-A Nationwide Survey Study.

During the coronavirus disease 2019 (COVID-19) outbreak, family physicians (FPs) are the backbone of the healthcare system with considerable impact on the general population, and their well-being is of great importance. The aim of this investigation was to assess FPs mental health, as well as knowledge, attitudes and practices (KAPs) regarding the pandemic, and opinions on non-communicable disease (NCD) health care provided to patients. A cross-sectional study was carried out with a sample of 613 FPs. Anxiety and depression levels were estimated with the Hospital Anxiety and Depression Scale, subjective perceived stress with the Perceived Stress Scale, while trauma-related symptoms were assessed using the Impact on Event Scale-COVID19. KAPs toward the pandemic and opinions regarding NCD patients were evaluated with questionnaires accordingly. Results have shown that age (ß = -0.02, p = 0.013) and personal risk of COVID­19 (ß = 1.05, p < 0.001) were significant independent correlates of the knowledge score. A total of 87.7% FPs expressed moderate/high perceived stress, 45.2% moderate/severe trauma-related symptoms, 60.4% borderline/abnormal anxiety levels, and 52.4% borderline/abnormal depression levels. Knowledge score was an independent predictor of perceived stress (ß = -0.33, p = 0.023) and anxiety (ß = -0.31, p = 0.006) levels. Limited accessibility to healthcare services and decreased number of newly-diagnosed NCD cases were mostly agreed on. The pandemic puts a considerable strain on FPs mental health, as well as on public health measures, due to the decreased overall quality of NCD patient health care. Educational programs may bridge the gaps between FPs' knowledge. Thus lowering anxiety and improving patient care.