Using ChatGPT in family medicine and primary health care.

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Development of entrustable professional activities for family medicine in South Africa.

South Africa is undergoing a significant shift towards implementing enhanced workplace-based assessment methodologies across various specialist training programmes, including family medicine. This paradigm involves the evaluation of Entrustable Professional Activities (EPAs) through comprehensive portfolios of evidence, which a local and national clinical competency committee then assesses. The initial phase of this transformative journey entails the meticulous development of EPAs rooted in discrete units of work. Each EPA delineates the registrar's level of entrustment for autonomous practice, along with the specific supervision requirements. This concise report details the collaborative effort within the discipline of family medicine in South Africa, culminating in the consensus formation of 22 meticulously crafted EPAs for postgraduate family medicine training. The article intricately outlines the systematic structuring and rationale behind the EPAs, elucidating the iterative process employed in their development. Notably, this marks a groundbreaking milestone as the first comprehensive documentation of EPAs nationally for family medicine training in Africa.

Effect of Motivational Interviewing on Lifestyle Modification among Patients with Hypertension Attending the Family Medicine Clinics of ISTH, Irrua, Nigeria (Milmaph Study) - A Randomised Control Trial Study Protocol.

BACKGROUND: Hypertension is a leading cause of morbidity and mortality globally. Over a quarter of patients with hypertension have uncontrolled hypertension. Lifestyle modification has been shown to improve blood pressure control, thus measures that would help patients with hypertension achieve positive lifestyle modification would improve BP control. The study aims to determine the effect of motivational interviews on lifestyle modification and blood pressure control among patients with hypertension attending the Family Medicine Clinics of Irrua Specialist Teaching Hospital (ISTH), Irrua, Nigeria. METHODS: The proposed study will be a randomised control trial (PACTR202301917477205). About 212 adults between 18 and 65 years with hypertension presenting to the Family Medicine Clinics of ISTH will be randomised into intervention and control groups. The intervention group will be given a motivational interview (MI) on lifestyle modification at the start of the study and monthly for 6 months in addition to standard care for the management of hypertension. The control group will be given standard care for the management of hypertension only without MI and seen monthly for 6 months. Both groups will be assessed at baseline and 6 months. At baseline, a qualitative technique will be used to determine the reason for not adopting lifestyle modification. STUDY OUTCOME: The primary outcome shall be lifestyle modification at 6 months while the secondary outcome shall be blood pressure control at 6 months. CONCLUSION: Findings from the study will provide cost-effective ways of blood pressure control and reduction in the disease burden of hypertension in Nigeria.

CONTEXTE: L'hypertension est l'une des principales causes de morbidité et de mortalité à l'échelle mondiale. Plus d'un quart des patients hypertendus ont une hypertension non contrôlée. La modification du mode de vie a été démontrée pour améliorer le contrôle de la pression artérielle, ainsi les mesures qui aideraient les patients hypertendus à réaliser une modification positive de leur mode de vie amélioreraient le contrôle de la PA. L'étude vise à déterminer l'effet des entretiens motivationnels sur la modification du mode de vie et le contrôle de la pression artérielle chez les patients hypertendus fréquentant les cliniques de médecine familiale de l'hôpital spécialisé d'enseignement d'Irrua (ISTH), Irrua, Nigeria. MÉTHODES: L'étude proposée sera un essai contrôlé randomisé (PACTR202301917477205). Environ 212 adultes âgés de 18 à 65 ans atteints d'hypertension se présentant aux cliniques de médecine familiale de l'ISTH seront randomisés en groupes d'intervention et de contrôle. Le groupe d'intervention recevra un entretien motivationnel (EM) sur la modification du mode de vie au début de l'étude et mensuellement pendant 6 mois en plus des soins standard pour la prise en charge de l'hypertension. Le groupe témoin recevra uniquement les soins standard pour la prise en charge de l'hypertension sans EM et sera vu mensuellement pendant 6 mois. Les deux groupes seront évalués au départ et à 6 mois. Au début, une technique qualitative sera utilisée pour déterminer la raison de la non-adoption de la modification du mode de vie. RÉSULTAT DE L'ÉTUDE: Le critère de jugement principal sera la modification du mode de vie à 6 mois, tandis que le critère de jugement secondaire sera le contrôle de la pression artérielle à 6 mois. CONCLUSION: Les résultats de l'étude fourniront des moyens rentables de contrôle de la pression artérielle et de réduction de la charge de morbidité de l'hypertension au Nigeria. MOTS-CLÉS: hypertension, entretien motivationnel, modification du mode de vie, contrôle de la pression artérielle, médecine familiale.

Adapting care provision in family practice during the COVID-19 pandemic: a qualitative study exploring the impact of primary care reforms in four Canadian regions.

BACKGROUND: Over the past two decades, Canadian provinces and territories have introduced a series of primary care reforms in an attempt to improve access to and quality of primary care services, resulting in diverse organizational structures and practice models. We examine the impact of these reforms on family physicians' (FPs) ability to adapt their roles during the COVID-19 pandemic, including the provision of routine primary care. METHODS: As part of a larger case study, we conducted semi-structured qualitative interviews with FPs in four Canadian regions: British Columbia, Newfoundland and Labrador, Nova Scotia, and Ontario. During the interviews, participants were asked about their personal and practice characteristics, the pandemic-related roles they performed over different stages of the pandemic, the facilitators and barriers they experienced in performing these roles, and potential roles FPs could have filled. Interviews were transcribed and a thematic analysis approach was applied to identify recurring themes in the data. RESULTS: Sixty-eight FPs completed an interview across the four regions. Participants described five areas of primary care reform that impacted their ability to operate and provide care during the pandemic: funding models, electronic medical records (EMRs), integration with regional entities, interdisciplinary teams, and practice size. FPs in alternate funding models experienced fewer financial constraints than those in fee-for-service practices. EMR access enhanced FPs' ability to deliver virtual care, integration with regional entities improved access to personal protective equipment and technological support, and team-based models facilitated the implementation of infection prevention and control protocols. Lastly, larger group practices had capacity to ensure adequate staffing and cover additional costs, allowing FPs more time to devote to patient care. CONCLUSIONS: Recent primary care system reforms implemented in Canada enhanced FPs' ability to adapt to the uncertain and evolving environment of providing primary care during the pandemic. Our study highlights the importance of ongoing primary care reforms to enhance pandemic preparedness and advocates for further expansion of these reforms.

Diagnosis and Management of Common Pediatric Cutaneous Infections.

Dermatologic concerns are common in the general pediatrician's practice. Herein, we review the most commonly encountered cutaneous bacterial, viral, and superficial fungal infections in the pediatric population. We describe clinical presentation, pathogenesis, and current treatments. The goal of this guide is to increase pediatricians' comfort in diagnosing and managing common skin infections, as well as determining when a dermatology referral may be necessary. [Pediatr Ann. 2024;53(4):e138-e145.].

Mastering your fellowship: Part 2, 2024.

The 'Mastering your Fellowship' series provides examples of the question format encountered in the written and clinical examinations, Part A of the Fellowship of the College of Family Physicians of South Africa (FCFP [SA]) examination. The series is aimed at helping family medicine registrars prepare for this examination.

Mastering your fellowship: Part 3, 2024.

The series 'Mastering your Fellowship' provides examples of the question formats encountered in the written and clinical examinations, Part A of the Fellowship of the College of Family Physicians of South Africa (FCFP [SA]) examination. The series aims to help family medicine registrars (and supervisors) prepare for this examination.

Malnutrition, nutritional deficiency and alcohol: A guide for general practice.

BACKGROUND: Alcohol use has an effect on nutritional status, with nutritional deficiencies being a major contributor to morbidity, for example Wernicke's encephalopathy. Currently, there is an absence of best-practice guidelines to support general practitioners (GPs) in the identification and management of malnutrition and nutritional risk factors in patients who drink at risky levels. OBJECTIVE: This article reviews some of the nutritional considerations in patients who drink at risky levels or who have alcohol dependence, with the aim of enhancing GPs' awareness of the nutritional considerations in this patient group. DISCUSSION: Nutritional risk factors extend beyond body mass index (BMI), and patients might present with a healthy BMI and be malnourished. Screening for risk of malnutrition and other nutritional deficiencies followed by supplementation and consideration of referral to multidisciplinary services, including a dietitian, is likely to improve patient outcomes.

Cancer in general practice research priorities in Australia.

BACKGROUND AND OBJECTIVES: The Primary Care Collaborative Cancer Clinical Trials Group (PC4) is funded by Cancer Australia to support the development of new cancer in primary care research. We undertook a research prioritisation exercise to identify cancer research priorities in Australian general practice. METHOD: We adapted the nominal group technique, including a literature search and stakeholder survey. An expert group from the Primary Care Collaborative Cancer Clinical Trials Group consolidated and ranked priorities. A second stakeholder survey reviewing the top 50 priorities informed a final prioritisation workshop. RESULTS: Overall, 311 priorities were identified across the cancer continuum. Nearly one-third of priorities were related to cancer survivorship and included strategies to detect recurrence, behavioural interventions and tools to assess physical and psychosocial aspects of survivorship. Prevention/early detection comprised 43.4% of priorities. Palliative care produced the least priorities (9.6%). Cross cutting research priorities (15.1%) included quality and models of care. DISCUSSION: This is the first study to identify cancer research priorities for general practice in Australia. It could be used to inform the development of targeted research and funding to improve the care and outcomes for Australians affected by cancer.

Checklist como herramienta para los padres ante la fiebre en el paciente pediátrico / Facing fever in the pediatric patient: Checklist as a tool for parents

Introducción: En Europa occidental el 20-40% de los niños con fiebre solicitan asistencia sanitaria. La mayoría presentan infecciones virales banales, sin embargo, es esencial en pediatría distinguir los pacientes que presentan una infección severa. Este proceso se inicia con el reconocimiento de la gravedad y la posterior búsqueda de atención médica por parte de los padres. Metodología: Estudio observacional analítico y transversal. Se seleccionaron 100 pacientes en 2 centros de salud. Se recogieron los datos sociodemográficos, junto con las respuestas de un checklist que contenía los signos y los síntomas ante los que solicitar asistencia sanitaria en caso de fiebre. Posteriormente se rellenó el checklist por parte del pediatra. Resultados: La edad media de los pacientes fue de 5,41 años. El 50% consultó en las primeras 48h de evolución de la fiebre. En el 42% la respuesta a todos los ítems del checklist fue exactamente la misma entre acompañante y pediatra. No existieron diferencias significativas según variables: primer episodio de fiebre (p=0,262), edad del paciente (p=0,859), tener hermano/as (p=0,880), parentesco familiar del acompañante (p=0,648) o grado de estudios del acompañante (p=0,828). Conclusiones: Las consultas médicas por fiebre en pediatría se realizan muy precozmente. Un alto porcentaje no presentan signos de alarma cuando consultan. Se plantea la necesidad ampliar la formación sobre los signos de alarma de la fiebre en todos los padres, independientemente del número de hijos, de la edad o del nivel educacional. El checklist como herramienta para la valoración en el domicilio de la fiebre ha recibido una alta puntuación en su utilidad.(AU)

Introduction: In Western Europe, 20%-40% of children with fever request health care. Most of them present trivial viral infections, however, it is essential in pediatrics to distinguish patients who present a severe infection. This process begins with the recognition of the seriousness and the subsequent search for medical attention by the parents. Methodology: Analytical and cross-sectional observational study. One hundred patients were selected in two health centers. Sociodemographic data were collected, together with the responses to a checklist containing the signs and symptoms to request health care in case of fever. Subsequently, the checklist was filled out by the pediatrician. Results: The mean age of the patients was 5.41 years. 50% consulted in the first 48h of fever evolution. In 42%, the response to all the items on the checklist was exactly the same between the companion and the pediatrician. There were no significant differences according to variables: first episode of fever (P=.262), age of the patient (P=.859), having a sibling (P=.880), family relationship of the companion (P=.648) or educational level of the companion (P=.828). Conclusions: Medical consultations for fever in pediatrics are carried out very early. A high percentage do not present alarm signs when they consult. There is a need to expand training on the alarm signs of fever in all parents, regardless of the number of children, age or educational level. The checklist as a tool for home assessment of fever has received high marks for its usefulness.(AU)

Evaluación de la interconsulta virtual por los profesionales de atención primaria: dimensiones de la calidad y oportunidades de mejora / Evaluation of virtual consultation by primary care professionals: quality dimensions and opportunities for improvement

Objetivo: Conocer la opinión de los médicos de Atención Primaria de Aragón, sobre la interconsulta virtual y su repercusión sobre las distintas dimensiones de la calidad asistencial. Diseño: Estudio transversal, mediante encuesta, de elaboración propia. Se habilitó la recogida de respuestas entre el 14 de abril y el 31 de mayo de 2023. Emplazamiento: Médicos con labor asistencial en atención primaria de Aragón. Participantes: Médicos especialistas e internos residentes en Medicina Familiar y Comunitaria. Mediciones: Características del puesto de trabajo, variables Likert valorando la interconsulta virtual como herramienta y su repercusión en dimensiones de la calidad asistencial, detección de ventajas e inconvenientes y preguntas de respuesta libre planteando líneas de mejora. Resultados: Total de 202 respuestas. El 90,1% de los participantes consideran útil la interconsulta virtual, el 67,8% cree que mejora la calidad de la derivación. Las principales ventajas identificadas son su contribución al enriquecimiento profesional y la visión integral del paciente, y la mejora de la comunicación entre primer y segundo nivel asistencial; el principal inconveniente el papel de Atención Primaria como intermediario en la información al paciente. Las dimensiones de la calidad mejor valoradas fueron eficiencia y equidad, siendo la seguridad la menos valorada. Conclusiones: La interconsulta virtual puede favorecer la comunicación y coordinación asistencial y potenciar la capacidad de resolución de atención primaria. Su éxito radica en formación y tiempo para su uso, consensuar protocolos y homogeneizar la distribución de recursos; no obstante, existen todavía oportunidades de mejora, principalmente en el ámbito de la seguridad.(AU)

Objective: To know the opinion of Aragon primary care physicians about virtual consultation and its impact on the different healthcare quality domains. Design: Cross-sectional study through a self-developed survey. Data collection was enabled from April 14th to May 31st, 2023. Site: Physicians with healthcare duties in primary care in Aragon. Participants: Specialist physicians and resident interns in Family and Community Medicine. Meansurements: Job characteristics, Likert variables assessing virtual consultation as a tool and its impact on healthcare quality domains, identification of advantages and disadvantages, and free answer questions proposing improvement strategies. Results: 202 responses. 90.1% of participants consider virtual consultation useful, while 67.8% believe that it improves the quality of referrals. The main advantages identified are its contribution to professional enrichment and the integral visión of the patient, and the improvement of communication between the primary and secondary levels of care; the main drawback is the role of Primary Care as an intermediary in patient information. Efficiency and equity were the most highly rated quality domains, with safety being the least valued. Conclusions: Virtual consultation can promote communication and coordination of care, and enhance the primary care resolution capacity. Its success relies on training and time for its use, as well as on reaching a consensus on protocols and to homogenize resource distribution. Nevertheless, there are still opportunities for improvement, mainly in the realm of safety.(AU)

Ten-Year Outcomes: Community Health Center/Academic Medicine Partnership for Rural Family Medicine Training.

BACKGROUND AND OBJECTIVES: The widening gap between urban and rural health outcomes is exacerbated by physician shortages that disproportionately affect rural communities. Rural residencies are an effective mechanism to increase physician placement in rural and medically underserved areas yet are limited in number due to funding. Community health center/academic medicine partnerships (CHAMPs) can serve as a collaborative framework for expansion of academic primary care residencies outside of traditional funding models. This report describes 10-year outcomes of a rural training pathway developed as part of a CHAMP collaboration. METHODS: Using data from internal registries and public sources, our retrospective study examined demographic and postgraduation practice characteristics for rural pathway graduates. We identified the rates of postgraduation placement in rural (Federal Office of Rural Health Policy grant-eligible) and federally designated Medically Underserved Areas/Populations (MUA/Ps). We assessed current placement for graduates >3 years from program completion. RESULTS: Over a 10-year period, 25 trainees graduated from the two residency expansion sites. Immediately postgraduation, 84% (21) were in primary care Health Professional Shortage Areas (HPSAs), 80% (20) in MUA/Ps, and 60% (15) in rural locations. Sixteen graduates were >3 years from program completion, including 69% (11) in primary care HPSAs, 69% (11) in MUA/Ps, and 50% (5) in rural locations. CONCLUSIONS: This CHAMP collaboration supported development of a rural pathway that embedded family medicine residents in community health centers and effectively increased placement in rural and MUA/Ps. This report adds to national research on rural workforce development, highlighting the role of academic-community partnerships in expanding rural residency training outside of traditional funding models.

COVID-19 Impact on Family Medicine Residents Exam Performance.

BACKGROUND AND OBJECTIVES: The COVID-19 pandemic began interrupting family medicine residency training in spring 2020. While a decline in scores on the American Board of Family Medicine In-Training Examination (ITE) has been observed, whether this decline has translated into the high-stakes Family Medicine Certification Examination (FMCE) is unclear. The goal of this study was to systematically assess the magnitude of COVID-19 impact on medical knowledge acquisition during residency, as measured by the ITE and FMCE. METHODS: A total of 19,101 initial certification candidates from 2017 to 2022 were included in this study. Annual ITE scores and FMCE scores were reported on the same scale (200-800) and served as the outcome measure. We conducted multilevel regression analysis to determine ITE score growth and FMCE scores compared to cohorts prior to COVID-19. RESULTS: During COVID-19, the increase in ITE scores from postgraduate year 2 (PGY-2) to PGY-3 was 25.5 points less, representing a 57.6% relative decrease; and from PGY-3 ITE to FMCE, it was 8.6 points less, a 12.7% relative decrease, compared with cohorts prior to COVID-19. FMCE scores were 6.6 points less during COVID-19, representing a 1.2% relative decline from the average FMCE score prior to COVID-19. CONCLUSIONS: This study found nonsubstantive COVID-19 impact on FMCE scores, but a considerable knowledge acquisition decline during residency, especially during the PGY-2 to PGY-3 period. While COVID-19 impacted learning, our findings indicated that residencies were largely able to remediate knowledge deficits before residents took the FMCE.