Responsabilidad profesional médica en la asistencia urgente de especialistas en medicina familiar y comunitaria / Professional liability in primary care emergencies of specialists of family and community medicine

Introducción: La atención urgente en atención primaria es un ámbito clave del sistema sanitario, señalándose como un estresor importante el estar expuestos a recibir reclamaciones por responsabilidad profesional. El objetivo fue analizar las reclamaciones por responsabilidad profesional en la asistencia urgente de especialistas en medicina familiar y comunitaria y sus principales características en nuestro entorno.MétodosAnálisis descriptivo/retrospectivo de las reclamaciones contra especialistas de medicina familiar y comunitaria entre 1986 y 2015.ResultadosSe analizaron 224 reclamaciones, todas ellas resueltas, motivadas por error o retraso diagnóstico (122-54,5%), problemas de accesibilidad en la atención médica (48-21,4%), errores en el tratamiento (29-12,9%) y errores en la emisión de documentos (25-11,1%). En 147 (65,6%) se trataba de asistencia urgente y en 77 (34,3%) programada. La vía de interposición fue judicial en el 71,4%. En 6 casos (2,6%) la resolución implicó una indemnización, tratándose de 3 casos de asistencia urgente y 3 de programada.ConclusiónSe confirma el riesgo muy bajo de reclamación y de indemnización, no habiéndose hallado diferencias entre asistencia urgente y programada. Debe insistirse en aspectos de seguridad clínica, enfatizando en el error diagnóstico. (AU)

Introduction: Urgent assistance in primary care is a key area of the health system, being as an important stressor to be claimed for professional liability. The objective was to analyze the professional liability in primary care emergencies of specialists of family and community medicine and their main characteristics in our environment.MethodsRetrospective descriptive analysis of claims against General Practitioners between 1986 to 2015 was performed.Results224 claims, all resolved, were analyzed, due to error or diagnostic delay (122-54.5%), accessibility problems in medical care (48-21.4%), treatment errors (29-12.9%) and errors in the issuance of documents (25-11.1%). In 147 (65.6%) it was urgent assistance and in 77 (34.3%) scheduled. The way of interposition was judicial in 71.4%. In 6 cases (2.6%) the resolution involved compensation in 3 cases of urgent assistance and 3 of scheduled.ConclusionThe very low risk of claim and compensation payment is confirmed, with no differences found between urgent and scheduled assistance. Clinical safety aspects should be emphasized, especially in the diagnostic error. (AU)

Analysis of lawsuits related to diagnostic errors from point-of-care ultrasound in internal medicine, paediatrics, family medicine and critical care in the USA.

PURPOSE: The purpose of this study is to identify the extent of diagnostic error lawsuits related to point-of-care ultrasound (POCUS) in internal medicine, paediatrics, family medicine and critical care, of which little is known. METHODS: We conducted a retrospective review of the Westlaw legal database for indexed state and federal lawsuits involving the diagnostic use of POCUS in internal medicine, paediatrics, family medicine and critical care. Retrieved cases were reviewed independently by three physicians to identify cases relevant to our study objective. A lawyer secondarily reviewed any cases with discrepancies between the three reviewers. RESULTS: Our search criteria returned 131 total cases. Ultrasound was mentioned in relation to the lawsuit claim in 70 of the cases returned. In these cases, the majority were formal ultrasounds performed and reviewed by the radiology department, echocardiography studies performed by cardiologists or obstetrical ultrasounds. There were no cases of internal medicine, paediatrics, family medicine or critical care physicians being subjected to adverse legal action for their diagnostic use of POCUS. CONCLUSION: Our results suggest that concerns regarding the potential for lawsuits related to POCUS in the fields of internal medicine, paediatrics, family medicine and critical care are not substantiated by indexed state and federal filed lawsuits.

No estamos solos. Motivos de consulta al gabinete médico-jurídico del sindicato médico de Murcia / We are not alone. Reasons for consulting the medical-legal cabinet of the medical union of Murcia

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Medicina de Familia, una especialidad amenazada / Family Medicine, a threatened specialty

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Family medicine in Tanzania: Seize the moment.

In the context of addressing the pressing health needs for the global population, the World Health Organization has repeatedly called for universal health coverage (UHC) to be prioritised by its member countries. This is to be achieved through a high-quality primary health care (PHC) approach that provides comprehensive and integrated generalist care as close to where people live as well as links the clinical care to health promotion and disease prevention. In this paper, we argue for the introduction of family medicines as a critical player in the healthcare system of Tanzania to strengthen the strategies towards UHC. The paper reviews how PHC is understood, the context of family medicine in sub-Saharan Africa and makes a case for how family medicine can assist in addressing the current burden of disease in Tanzania.

Validating the Test Plan Specifications for the American Board of Family Medicine's Certification Examination.

PURPOSE: To demonstrate the degree to which the American Board of Family Medicine's certification examination is representative of family physician practice with regard to frequency of diagnoses encounter and the criticality of the diagnoses. METHODS: Data from 2012 National Ambulatory Medical Care Survey was used to assess the frequency of diagnoses encountered by family physicians nationally. These diagnoses were also rated by a panel of content experts for how critical it was to diagnose and treat the condition correctly and then assign the condition to 1 of the 16 content categories used on the American Board of Family Medicine examination. These ratings of frequency and criticality were used to create 7 different new schemas to compute percentages for the content categories. RESULTS: The content category percentages for the 7 different schemas correlated with the 2006 to 2016 test plan percentages from 0.50 to 0.90 with the frequency conditions being more highly correlated and the criticality conditions being less correlated. CONCLUSIONS: This study supports the continued use of the current Family Medicine Certification Examination content specifications as being representative of current family medicine practice; however, small adjustments might be warranted to permit better representation of the criticality of the topics.

Promoting access to family medicine in Québec, Canada: Analysis of bill 20, enacted in November 2015.

Primary care can potentially make an important contribution to improving health system performance. However, Canada does not fare as well as other developed countries in terms of timely access to primary health care services. In November 2015, Bill 20 was introduced in the province of Québec. The goal of Bill 20 was to optimize the utilisation of medical and financial resources to improve access to primary care. Bill 20 states the obligations of general practitioners to register a minimum number of patients, ensure the continuity of care of that population, and practice a minimum number of hours in hospitals. Many actors agreed that access to primary care had to be improved in Québec, but disagreed with Bill 20. In particular, family physicians strongly opposed the financial penalties that were introduced for physicians failing to meet the specified targets. In January 2018, 3 years after Bill 20, indicators for patient registration and continuity of care have considerably improved. However, the attractiveness of general practice seems to have decreased among medical graduates, which creates uncertainty regarding the sustainability of the achievements brought on by Bill 20.

Referral and consultation process between family medicine and continuous medical attention / Proceso de interconsulta entre medicina familiar y atención médica continua

The process of sending patients between the outpatient service of family medicine and the continuous medical care service at the IMSS is well established in the various internal systems as well as in the applicable mexican official standards, but it is necessary for the personnel involved to know it well in order to avoid setbacks during the reference and counter-reference process within the unit.

El proceso de envío de pacientes entre el servicio de consulta externa de medicina familiar y el servicio de atención médica continua en el IMSS se encuentra bien establecido en los diversos ordenamientos internos así como en las normas oficiales mexicanas aplicables, pero es necesario que el personal involucrado lo conozca bien con el fin de evitar contratiempos durante el proceso de referencia-contrareferencia dentro de la unidad.

Abogacía de salud, la partaqe olvidada de la promoción de salud en medicina familiar / Health Advocacy, the forgotten part of health promotion in family medicine

Introducción: La abogacía de salud es una estrategia de la promoción de salud y un componente esencial y fundamental de ella, mas no siempre se ve así, a veces se confunde o se intercambia con la promoción de salud misma. Objetivo: Realizar una revisión bibliográfica sobre el término abogacía de salud y su relación con la promoción de salud y la medicina familiar. Métodos: Análisis documental de la literatura encontrada en bases de datos y análisis y síntesis de estos documentos desde un enfoque socio-histórico y lógico. Conclusiones: A pesar de que es un tema sugerido para su inclusión en los programas de formación de medicina familiar según los estándares globales de la Organización Mundial de Médicos de Familia y Generales (2013), existen muy escasas referencias en la literatura hispana y latinoamericana de medicina familiar. La abogacía de salud es habitualmente subestimada y obviada como parte de la promoción de salud en medicina familiar, es una actitud, una competencia y una responsabilidad social del médico en general(AU)

Introduction: Health advocacy is a health promotion strategy and an essential and fundamental component of it, but it does not always looks like this, sometimes it is confused or exchanged with the promotion of health itself. Objective: To carry out a bibliographical review on the term health advocacy and its relationship with the promotion of health and family medicine. Methods: Documentary analysis of the literature found in data and analysis bases, and summary of these documents from a socio-historical and logical approach. Conclusions: Although it is a suggested topic for inclusion in family medicine training programs according to global standards of the World Organization of Family and General Physicians (2013), there are very few references in the Hispanic and Latin American literature on Family Medicine. Health advocacy is usually underestimated and ignored as part of health promotion in family medicine, it is an attitude, a competence and a social responsibility of the general practitioners(AU)

General practice location and malpractice litigation.

INTRODUCTION: Healthcare systems in many countries struggle to recruit general practitioners (GPs) for clinics in rural areas leading to less GPs for an increasing number of patients. As a result, fewer resources are available for individual patients, potentially influencing patient satisfaction and the likelihood of malpractice litigation. The aim of this study was to investigate the association between malpractice litigation and local setting characteristics in a Danish national sample of GPs considering rurality, number of patients listed with the GP, as well as levels of local unemployment, education, income and healthcare expenditure. METHOD: This is a register study on Danish complaint files and administrative register data using multivariate logistic regression. RESULTS: No statistical significant association could be established between litigation figures and rurality, occupation with respect to education, and municipality level of healthcare expenditures. However, larger patient list size was associated with higher rates of malpractice litigation (odds ratio (OR) 1.05 per 100 patients). Litigation was less frequent in settings with higher income patient populations (OR 0.65), although where it did occur the criticism seemed much more likely to be justified (OR 6.03). CONCLUSION: Many GPs face an increasing workload in terms of patient lists. This can cause drawbacks in terms of patient dissatisfaction and malpractice litigation even though local factors such as economic wealth apparently interfere. Further research is needed about the role of geographic variations, workload and socioeconomic inequality in malpractice litigation.

Board Certified Family Physician Workforce: Progress in Racial and Ethnic Diversity.

Diversification of the physician workforce has been a goal of Association of American Medical Colleges for several years and could improve access to primary care for under-served populations and address health disparities. We found that family physicians' demographics have become more diverse over time, but still do not reflect the national demographic composition. Increased collaboration with undergraduate universities to expand pipeline programs may help increase the diversity of students accepted to medical schools, which in turn should help diversify the family medicine workforce.

¿Tiene futuro la troncalidad? / Does the core subjects have a future?

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Strategies for Increasing the Role of Family Medicine in Mexican Health Care Reform.

There is little or no role for primary care and family medicine in current health reforms in Mexico. However, robust evidence shows that primary care helps prevent morbidity and mortality and increases health equity. Mexico has participated in several international meetings sponsored by the World Organization of National Colleges, Academies and Academic Associations and the North American Primary Care Research Group that are aimed at increased understanding of national health systems and the need to strengthen primary care for improved health outcomes. From 1 of these meetings the Cancún Manifesto emerged, with a strategic plan to increase the stature and impact of the Mexican College of Family Physicians (COLMEXAC) in strengthening primary care in Mexico. We aim to describe this strategic plan and discuss its early implementation, and for this account to serve as a possible formula for other countries. The 5 specific strategies discussed are 1) the need for consensus on the leading role of the Mexican family physician in the national health system; 2) health ecology research; 3) to improve the perception of patients about the benefits of primary care and family medicine; 4) to organize meetings of health providers, users, and other stakeholders; and 5) to promote the professionalization of COLMEXAC as a legal entity.

Vaccination policies of Utah family practice clinics.

BACKGROUND AND PURPOSE: The purpose of this study was to collect information regarding healthcare worker (HCW) vaccination policies in Utah family practice clinics. METHODS: The study was conducted in Utah family practice clinics in the most densely populated counties in the state and was a cross-sectional descriptive design. Data were collected from 91 family practice clinic managers. Descriptive statistics were performed, as well as a content analysis for open-ended items. CONCLUSIONS: HCWs are employed in environments where infectious diseases can be easily spread from person to person, thus, vaccinations can be instrumental in protecting the health of HCWs and patients alike. In Utah, 56.8% of family practice clinics had either no vaccination policy for HCWs or had a policy with no consequences for noncompliance. Utah family practice clinics need to implement changes to create and maintain HCW vaccination policies. IMPLICATIONS FOR PRACTICE: Nurse practitioners can be leaders and change agents by working with their county and state health departments to create state-wide policies that mirror the position statements from the American Nurses Association and the American Association of Nurse Practitioners.

[Legal Analysis of the Implementation Rules of Delegation of Home Visits by Family Doctors to Non-Physician Health Professionals: Is the Implementation in Accordance with the Intention of the Law?] / Juristische Analyse der Umsetzungsregelungen der Delegation vertragsärztlicher Hausbesuche an nicht-ärztliche Gesundheitsberufe ­ ist die Umsetzung in Einklang mit dem Willen des Gesetzgebers?

Objective: Triggered by the AGnES model project of the University Medicine Greifswald, the Code of Social Law V was changed by the German Lower and Upper House of Parliament (Bundestag and Bundesrat) in 2008 so that the delegation of GP's activities to non-physician colleagues was allowed under highly restricted preconditions. Delegated home visits should become an integral part of the standard care in Germany. In this study, the implementation of § 87 para 2b clause 5 SGB V, established in Annex 8 of the Federal Collective Agreement, was checked for its legality in terms of qualification. Methods: The problem was checked with the legal methods of interpretation in pursuance of the norm and the methods of systematic, historic and teleologic interpretation. Results: Even though the Parliament clearly required orientation to the AGnES model project (in order to assure safety and effective care of delegated home visits), self-management in the implementation of the law remained far behind these guidelines. The main outcome of the legal analysis was that the implementation arrangements of the Code of Social Law V are predominantly illegal. Conclusions: The parties of the Federal Collective Agreement have to change the arrangements to meet the requirements of the Parliament and to avoid risks of liability for delegating GPs.