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2.
Postgrad Med ; 132(1): 7-16, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31570072

RESUMEN

Primary care physicians (general practitioners (GPs)) are burdened for various reasons and are particularly affected by stress-related complaints and an increasing prevalence of burnout. Thus, the prevention of physician burnout has become a major interest for health care services. Although many studies have addressed this issue in recent years, little seems to be known about the work strain and burnout rates in GP trainees. Therefore the objective of this article is to review the psychosocial burden and relevant prevention strategies for GPs with a special emphasis on GP trainees. Regardless of the specialty, burnout is more prevalent among medical trainees and so-called 'early career' physicians than among the age-matched population. Accordingly, burnout seems to be frequent among GP trainees, although there is some evidence that there are fewer doctors working in general medicine who were already heavily burdened at the time of choosing their career. The sudden assumption of responsibility in patient care as well as the fear of showing imperfection in front of their supervisors, or lack of recognition from senior doctors, the medical team, or patients might be stressors typical to this career stage. GP trainees might also feel burdened by the new level of personal involvement and thus have to develop or increase their individual level of professionality to deal with the patients' medical and personal problems. In conclusion, interventions to promote physical and mental health of GP trainees are a necessity to ensure passionate GPs in the future and should therefore be integrated into any postgraduate training curriculum in general practice.


Asunto(s)
Agotamiento Profesional/etiología , Estrés Laboral/etiología , Médicos de Atención Primaria/psicología , Agotamiento Profesional/epidemiología , Humanos , Estrés Laboral/complicaciones , Estrés Laboral/epidemiología , Médicos de Atención Primaria/educación , Médicos de Atención Primaria/estadística & datos numéricos , Prevalencia , Factores de Riesgo
3.
BMC Health Serv Res ; 19(1): 728, 2019 Oct 22.
Artículo en Inglés | MEDLINE | ID: mdl-31640695

RESUMEN

BACKGROUND: User understanding of information technology systems (IT-Systems) is a prerequisite for their use. This study aimed to explore how primary care physician trainees learn, understand and use IT-Systems. METHODS: A paper-based survey study among 301 primary care physician trainees in Baden-Wuerttemberg, Germany, was performed. The questionnaire included measures of understanding and use of nine specific system features, five possible learning strategies, a validated scale for affinity for technology interaction, and five individual and three practice characteristics. RESULTS: The sample comprised 94 respondents (31.6% response rate). Between 3.2 and 59.6% said to know specific systems features well; between 13.8 and 42.6% expressed a wish to know more about specific system features. The predominant strategy for learning system features was explanation by others: 51.7 to 66.7% had applied this strategy to learn the features. Between 18.6 and 41.4% had learned the features by trial and error. A better understanding of system features was associated with the use of a trial and error strategy for learning system features (beta = 0.260, p = 0.012). The use of a greater variety of learning strategies was associated with higher affinity for technology interaction (beta = 0.215, p = 0.037). CONCLUSION: The study suggests that many physicians need a better understanding of IT-Systems. The role of manuals, online resources and courses in learning IT-Systems seems limited. The new generation of primary care physicians seem to learn features of IT-Systems through explanation by others and trying in their ambulatory practices. The relevance of IT-Systems in healthcare is high, but physicians need more support in learning to use system features.


Asunto(s)
Tecnología Biomédica/educación , Sistemas de Información en Salud , Médicos de Atención Primaria/educación , Estudios Transversales , Conocimientos, Actitudes y Práctica en Salud , Humanos , Aprendizaje , Apoyo a la Formación Profesional , Interfaz Usuario-Computador
4.
J Stroke Cerebrovasc Dis ; 28(12): 104323, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31562040

RESUMEN

BACKGROUND AND PURPOSE: In the existing model of community health service in China, community general practitioners play important roles in health promotion as well as prehospital stroke recognition and management. We recently engineered Stroke 120 based on FAST for China. This investigation aimed to investigate its acceptance in community physicians and promote their stroke related knowledge. METHODS: We conducted an stroke education session to community physicians or family doctors (total of 435 participants), teaching both FAST and Stroke 120. Online survey was distributed to the participants before and after the education session to evaluate the awareness of stroke and the acceptance of the stroke recognition tool. RESULTS: Significant stroke knowledge deficiencies were found in community physicians. After the education session, percent of the participants knew that the thrombolytic therapeutic window (<4.5 hours) was improved from 54.0% to 91.6% (P < .001). A total of 88.5% of them would send their patients who had stroke to the nearest hospital with stroke center by emergency medical service, compared to baseline (64.4%, P < .001). In total, 95.2% of them would recommend thrombolytic therapy in the treatment of acute ischemic stroke compared to 82.7% (baseline P < .001). Although majority mastered both FAST (95.5%) and Stroke 120 (98.0%) through our education session, 96.3% of them believe that Stroke 120 is the most suitable for Chinese in stroke education. CONCLUSIONS: Stroke 120 strategy was well accepted by the community physicians in China and in the meantime improved knowledge regarding stroke was observed.


Asunto(s)
Servicios de Salud Comunitaria , Educación Médica Continua/métodos , Conocimientos, Actitudes y Práctica en Salud , Capacitación en Servicio/métodos , Médicos de Familia/economía , Médicos de Atención Primaria/educación , Accidente Cerebrovascular , Adulto , Actitud del Personal de Salud , Concienciación , China , Competencia Clínica , Servicio de Urgencia en Hospital , Femenino , Humanos , Masculino , Persona de Mediana Edad , Médicos de Familia/psicología , Médicos de Atención Primaria/psicología , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/fisiopatología , Accidente Cerebrovascular/terapia , Terapia Trombolítica , Tiempo de Tratamiento , Adulto Joven
5.
Artículo en Inglés | MEDLINE | ID: mdl-31408282

RESUMEN

Objective: Patients with severe mental illness often lack care coordination between primary care and mental health providers. Siloed patient care across separate health care systems can negatively impact quality and safety of patient care. The purpose of the project discussed in this article is to effectively engage stakeholders from separate primary care and mental health organizations to develop an ideal cross-organization communication system to improve metabolic monitoring for their comanaged patients prescribed second-generation antipsychotics (SGAs). Methods: The mixed method approach of group concept mapping was used to engage stakeholders across a nonaffiliated primary care clinic and a community mental health organization over the time period of March 2018 through May 2018. Results: Three important domains in communication were identified: (1) process/workflow, (2) advocacy, and (3) a patient-centered focus. Seven high priority/easier to implement brainstormed items were identified and resulted in practice changes across both organizations, including developing a standard release of information, identifying a point person from each clinic focused on cross-organization care coordination, endorsing an SGA monitoring protocol across organizations, agreeing that metabolic monitoring of SGAs will be the responsibility of the primary care clinicians, beginning monthly medication reconciliation and cross-organization care conferences, developing standard electronic health record documentation, and providing education. Conclusions: Care coordination across all health systems is critical to optimize patient care for chronic medical and psychiatric conditions. Group concept mapping provides a strategic process to allow shared decision-making among stakeholders to take steps toward solving more complex systematic problems such as poor electronic health record interoperability across health systems.


Asunto(s)
Antipsicóticos/uso terapéutico , Servicios Comunitarios de Salud Mental/métodos , Monitoreo de Drogas/métodos , Trastornos Mentales/tratamiento farmacológico , Atención Primaria de Salud/métodos , Comunicación , Servicios Comunitarios de Salud Mental/organización & administración , Registros Electrónicos de Salud/normas , Humanos , Trastornos Mentales/metabolismo , Defensa del Paciente , Atención Dirigida al Paciente/métodos , Rol del Médico , Médicos de Atención Primaria/educación , Atención Primaria de Salud/organización & administración , Mejoramiento de la Calidad , Flujo de Trabajo
6.
Fam Med ; 51(7): 567-573, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31287902

RESUMEN

BACKGROUND AND OBJECTIVES: Patients in many countries face poor access to specialist care. Electronic consultation (eConsult) improves access by allowing primary care providers (PCPs) and specialists to communicate electronically. As more countries adopt eConsult services, there has been growing interest in leveraging them as educational tools. Our study aimed to assess PCPs' perspectives on eConsult's ability to improve collegiality between providers and serve as an educational tool. METHODS: We conducted a qualitative content analysis of free-text comments left by PCPs using the Champlain BASE eConsult service based in Eastern Ontario, Canada. All responses provided between January 1, 2015 and January 31, 2017 that mentioned education or collegiality were included. RESULTS: PCPs completed 16,712 closeout surveys during the study period, of which 3,601 (22%) included free-text comments. Of these, 223 (6%) included references to education or collegiality. Three prominent themes emerged from the data: building provider relationships, teaching incorporated into answer, and prompting further learning. CONCLUSIONS: PCPs described eConsult's ability to foster stronger relationships with specialists, deliver responses that provided teaching in multiple areas of their practice, and support further learning that extended beyond the case at hand and into their overall practice. The Champlain BASE eConsult service has educational value for providers. Further study is underway to explore how questions and replies submitted through eConsult can be used to facilitate reflective learning and promote feedback to providers.


Asunto(s)
Conducta Cooperativa , Aprendizaje , Médicos de Atención Primaria/educación , Consulta Remota , Especialización , Actitud del Personal de Salud , Humanos , Ontario , Encuestas y Cuestionarios
8.
BMC Med Educ ; 19(1): 195, 2019 Jun 11.
Artículo en Inglés | MEDLINE | ID: mdl-31185964

RESUMEN

BACKGROUND: The rapid expansion of genetic knowledge, and the implications for healthcare has resulted in an increased role for Primary Care Providers (PCPs) to incorporate genetics into their daily practice. The objective of this study was to explore the self-identified needs, including educational needs, of both urban and rural Primary Care Providers (PCPs) in order to provide genetic care to their patients. METHODS: Using a qualitative grounded theory approach, ten key informant interviews, and one urban and two rural PCP focus groups (FGs) (n = 19) were conducted. All PCPs practiced in Southeastern Ontario. Data was analyzed using a constant comparative method and thematic design. The data reported here represent a subset of a larger study. RESULTS: Participants reported that PCPs have a responsibility to ensure patients receive genetic care. However, specific roles and responsibilities for that care were poorly defined. PCPs identified a need for further education and resources to enable them to provide care for individuals with genetic conditions. Based on the findings, a progressive stepped model that bridges primary and specialty genetic care was developed; the model ranged from PCPs identifying patients with genetic conditions that they could manage alone, to patients who they could manage with informal or electronic consultation to those who clearly required specialist referral. CONCLUSIONS: PCPs identified a need to integrate genetics into primary care practice but they perceived barriers including a lack of knowledge and confidence, access to timely formal and informal consultation and clearly defined roles for themselves and specialists. To address gaps in PCP confidence in providing genetic care, interventions that are directed at accessible just-in-time support and consultation have the potential to empower PCPs to manage patients' genetic conditions. Specific attention to content, timing, and accessibility of educational interventions is critical to address the needs of both urban and rural PCPs. A progressive framework for bridging primary to specialty care through a 'stepped' model for providing continuing medical education, and genetic care can was developed and can be used to guide future design and delivery of educational interventions and resources.


Asunto(s)
Genética Médica , Evaluación de Necesidades , Médicos de Atención Primaria , Adulto , Femenino , Grupos Focales , Genética Médica/educación , Teoría Fundamentada , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Ontario , Médicos de Atención Primaria/educación
9.
AIDS Behav ; 23(11): 2926-2935, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31172333

RESUMEN

The Southeast accounted for most HIV diagnoses (52%) in the United States in 2015. Primary care providers (PCPs) play a vital role in HIV prevention for at-risk persons and treatment of persons living with HIV. We studied HIV-related training, knowledge, and clinical practices among PCPs in the Southeast to address knowledge gaps to inform HIV prevention strategies. Between April and August 2017, we conducted an on-line survey of a representative sample of PCPs in six Southeast jurisdictions with high rates of HIV diagnoses (Atlanta; Baltimore; Baton Rouge; District of Columbia; Miami; New Orleans). We defined HIV-related training as self-reported completion of any certified HIV/STD course or continuing education in past 24 months (prior to survey completion). We assessed associations between training and HIV testing practices, familiarity with nonoccupational post-exposure prophylaxis (nPEP) and pre-exposure prophylaxis (PrEP), and ever prescribing nPEP or PrEP. There were 820 participants after fielding 4595 surveys (29.6% adjusted response rate). In weighted analyses, 36.3% reported HIV-related training. Using adjusted prevalence ratio (aPR) and confidence intervals (CI), we found that PCPs with HIV-related training (compared to those with no training) were more likely to be familiar with nPEP (aPR = 1.32, 95% CI 1.05, 1.67) and PrEP (aPR = 1.67, 95% CI 1.19, 2.38); and to have ever prescribed PrEP to patients (aPR = 1.75, 95% CI 1.10, 2.78). Increased HIV-related trainings among PCPs in high HIV prevalence Southeast jurisdictions may be warranted. Strengthening nPEP and PrEP familiarity among PCPs in Southeast may advance national HIV prevention goals.


Asunto(s)
Fármacos Anti-VIH/administración & dosificación , Infecciones por VIH/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Médicos de Atención Primaria/educación , Profilaxis Posexposición , Pautas de la Práctica en Medicina/estadística & datos numéricos , Profilaxis Pre-Exposición , Adulto , Anciano , Competencia Clínica , Prescripciones de Medicamentos/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Atención Primaria de Salud/estadística & datos numéricos , Pruebas Serológicas , Sudeste de Estados Unidos , Encuestas y Cuestionarios
10.
PLoS Med ; 16(6): e1002825, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-31173597

RESUMEN

BACKGROUND: Primary care antimicrobial stewardship interventions can improve antimicrobial prescribing, but there is less evidence that they reduce rates of resistant infection. This study examined changes in broad-spectrum antimicrobial prescribing in the community and resistance in people admitted to hospital with community-associated coliform bacteraemia associated with a primary care stewardship intervention. METHODS AND FINDINGS: Segmented regression analysis of data on all patients registered with a general practitioner in the National Health Service (NHS) Tayside region in the east of Scotland, UK, from 1 January 2005 to 31 December 2015 was performed, examining associations between a primary care antimicrobial stewardship intervention in 2009 and primary care prescribing of fluoroquinolones, cephalosporins, and co-amoxiclav and resistance to the same three antimicrobials/classes among community-associated coliform bacteraemia. Prescribing outcomes were the rate per 1,000 population prescribed each antimicrobial/class per quarter. Resistance outcomes were proportion of community-associated (first 2 days of hospital admission) coliform (Escherichia coli, Proteus spp., or Klebsiella spp.) bacteraemia among adult (18+ years) patients resistant to each antimicrobial/class. 11.4% of 3,442,205 oral antimicrobial prescriptions dispensed in primary care over the study period were for targeted antimicrobials. There were large, statistically significant reductions in prescribing at 1 year postintervention that were larger by 3 years postintervention when the relative reduction was -68.8% (95% CI -76.3 to -62.1) and the absolute reduction -6.3 (-7.6 to -5.2) people exposed per 1,000 population per quarter for fluoroquinolones; relative -74.0% (-80.3 to -67.9) and absolute reduction -6.1 (-7.2 to -5.2) for cephalosporins; and relative -62.3% (-66.9 to -58.1) and absolute reduction -6.8 (-7.7 to -6.0) for co-amoxiclav, all compared to their prior trends. There were 2,143 eligible bacteraemia episodes involving 2,004 patients over the study period (mean age 73.7 [SD 14.8] years; 51.4% women). There was no increase in community-associated coliform bacteraemia admissions associated with reduced community broad-spectrum antimicrobial use. Resistance to targeted antimicrobials reduced by 3.5 years postintervention compared to prior trends, but this was not statistically significant for co-amoxiclav. Relative and absolute changes were -34.7% (95% CI -52.3 to -10.6) and -63.5 (-131.8 to -12.8) resistant bacteraemia per 1,000 bacteraemia per quarter for fluoroquinolones; -48.3% (-62.7 to -32.3) and -153.1 (-255.7 to -77.0) for cephalosporins; and -17.8% (-47.1 to 20.8) and -63.6 (-206.4 to 42.4) for co-amoxiclav, respectively. Overall, there was reversal of a previously rising rate of fluoroquinolone resistance and flattening of previously rising rates of cephalosporin and co-amoxiclav resistance. The limitations of this study include that associations are not definitive evidence of causation and that potential effects of underlying secular trends in the postintervention period and/or of other interventions occurring simultaneously cannot be definitively excluded. CONCLUSIONS: In this population-based study in Scotland, compared to prior trends, there were very large reductions in community broad-spectrum antimicrobial use associated with the stewardship intervention. In contrast, changes in resistance among coliform bacteraemia were more modest. Prevention of resistance through judicious use of new antimicrobials may be more effective than trying to reverse resistance that has become established.


Asunto(s)
Antibacterianos/uso terapéutico , Programas de Optimización del Uso de los Antimicrobianos/normas , Farmacorresistencia Bacteriana/efectos de los fármacos , Enterobacteriaceae/efectos de los fármacos , Análisis de Series de Tiempo Interrumpido/normas , Médicos de Atención Primaria/normas , Antibacterianos/farmacología , Programas de Optimización del Uso de los Antimicrobianos/métodos , Prescripciones de Medicamentos/normas , Farmacorresistencia Bacteriana/fisiología , Enterobacteriaceae/fisiología , Infecciones por Enterobacteriaceae/tratamiento farmacológico , Infecciones por Enterobacteriaceae/epidemiología , Humanos , Análisis de Series de Tiempo Interrumpido/métodos , Médicos de Atención Primaria/educación , Vigilancia de la Población , Atención Primaria de Salud/métodos , Atención Primaria de Salud/normas , Escocia/epidemiología
11.
J Clin Pharm Ther ; 44(4): 579-587, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31152684

RESUMEN

WHAT IS KNOWN AND OBJECTIVE: The use of generic oral contraceptives (OCPs) can improve adherence and reduce healthcare costs, yet scepticism of generic drugs remains a barrier to generic OCP discussion and prescription. An educational web module was developed to reduce generic scepticism related to OCPs, improve knowledge of generic drugs and increase physician willingness to discuss and prescribe generic OCPs. METHODS: A needs assessment was completed using in-person focus groups at American College of Physicians (ACP) Annual Meeting and a survey targeting baseline generic scepticism. Insights gained were used to build an educational web module detailing barriers and benefits of generic OCP prescription. The module was disseminated via email to an ACP research panel who completed our baseline survey. Post-module evaluation measured learner reaction, knowledge and intention to change behaviour along with generic scepticism. RESULTS AND DISCUSSION: The module had a response rate of 56% (n = 208/369). Individuals defined as generic sceptics at baseline were significantly less likely to complete our module compared to non-sceptics (responders 9.6% vs non-responders 16.8%, P = 0.04). The majority (85%, n = 17/20) of baseline sceptics were converted to non-sceptics (P < 0.01) following completion of the module. Compared to non-sceptics, post-module generic sceptics reported less willingness to discuss (sceptic 33.3% vs non-sceptic 71.5%, P < 0.01), but not less willingness to prescribe generic OCPs (sceptic 53.3% vs non-sceptic 67.9%, P = 0.25). Non-white physicians and international medical graduates (IMG) were more likely to be generic sceptics at baseline (non-white 86.9% vs white 69.9%, P = 0.01, IMG 13.0% vs USMG 5.0% vs unknown 18.2%, P = 0.03) but were also more likely to report intention to prescribe generic OCPs as a result of the module (non-white 78.7% vs white 57.3%, P < 0.01, IMG 76.1% vs USMG 50.3% vs unknown 77.3%, P = 0.03). WHAT IS NEW AND CONCLUSION: A brief educational web module can be used to promote prescribing of generic OCPs and reduce generic scepticism.


Asunto(s)
Anticonceptivos Orales/economía , Medicamentos Genéricos/economía , Médicos de Atención Primaria/economía , Médicos de Atención Primaria/educación , Pautas de la Práctica en Medicina/economía , Adulto , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Internet , Masculino , Persona de Mediana Edad
12.
GMS J Med Educ ; 36(3): Doc28, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31211223

RESUMEN

Aim: Following changes in licensing regulations for doctors ("Approbationsordnung") in 2012, a 4-week clinical attachment ("Famulatur") in primary care is now mandatory for all medical students in Germany. To date, it has not been studied how the Famulatur in primary care is perceived by the learner or the teacher. The aim of this study was to explore the experiences of both medical students and primary care physicians (PCPs) with regard to the teaching and learning situation in the Famulatur in primary care. Methods: A qualitative analysis of semi-structured interviews with 12 students from the medical faculty in Tübingen, Germany, and 17 PCPs from this region, was performed. Interview material was analyzed following content analysis according to Mayring. Results: In addition to considering the variety of tasks expected of the students and the optimal time for the Famulatur during the medical curriculum, the main themes of the interviews were the strengths, weaknesses and suggestions for improvement of the Famulatur. The Famulatur was predominantly perceived positively, although it being obligatory was criticized. In particular, the 1:1 supervision and the extended duration (compared to the first curricular primary care placement ("Blockpraktikum")) were positively evaluated. PCPs and students were critical of the lack of a learning and educational Famulatur framework, which would have enabled earlier orientation and alignment of each party. Conclusion: The Famulatur offers good learning opportunities for medical students and provides an insight into primary care, which is typically seen positively; it appears to heighten enthusiasm for primary care within budding doctors. Even if the obligation should cease in "The Master Plan for Medical Studies 2020" (Masterplan Medizinstudium 2020), it would be beneficial to optimize the primary care Famulatur; the development of a student logbook and learning objectives could be helpful, for example in the form of portfolios.


Asunto(s)
Ambiente , Médicos de Atención Primaria/educación , Atención Primaria de Salud/métodos , Estudiantes de Medicina/psicología , Adulto , Curriculum/normas , Femenino , Alemania , Humanos , Entrevistas como Asunto/métodos , Masculino , Médicos de Atención Primaria/psicología , Médicos de Atención Primaria/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Investigación Cualitativa , Estudiantes de Medicina/estadística & datos numéricos
15.
Rev. medica electron ; 41(2): 496-507, mar.-abr. 2019.
Artículo en Español | LILACS, CUMED | ID: biblio-1043122

RESUMEN

RESUMEN La evolución favorable de los pacientes afectados con dermatitis atópica está muy relacionada con un diagnóstico y orientación precoz en la atención primaria, para un seguimiento más especializado en las consultas de dermatología y alergología, por ser una entidad que ofrece dificultades en su identificación. Es necesario incrementar el nivel de información en los médicos de las áreas de salud, por ser estos escenarios donde ocurre el primer contacto con el paciente. El objetivo es ofrecer una visión actualizada sobre el diagnóstico y tratamiento de la dermatitis atópica que contribuya a la formación de los médicos en la atención primaria. Se realiza una revisión bibliográfica de los últimos 5 años, principalmente en las bases de datos PubMed y Scielo sobre el tema. Se abordan aspectos de interés relacionados con las manifestaciones clínicas, criterios diagnósticos y tratamiento. Los resultados que se ofrecen en este trabajo contribuirán a la formación profesional para una mejor promoción, prevención, diagnóstico precoz y tratamiento de esta enfermedad, cuya prevalencia es mayor en la infancia.


ABSTRACT The favorable evolution of the patients affected with Atopic Dermatitis is quite related with a diagnosis and precocious orientation in the primary attention, for a more specialized follow up in the dermatology and alergology consultations, as it is an entity that offers difficulties in its identification. It is necessary to increase the level of knowledge of doctors in these medical areas as these are the scenarios where it occurs the first contact patient doctor. Offering an updated vision about Atopic Dermatitis that contributes to the continuous formation of the professionals of the health sector in the primary attention. A revision of articles in the PubMed and Scielo database is carried out principally during the last 5 years. Aspects of interest related with the clinical manifestations, diagnoses criteria and treatment are considered. The results that are offered in this work will contribute to the professional formation for a better promotion, prevention, precocious diagnosis and treatment of this illness that is more likely to be found in the childhood.


Asunto(s)
Humanos , Dermatitis Atópica/diagnóstico , Dermatitis Atópica/etiología , Dermatitis Atópica/tratamiento farmacológico , Dermatitis Atópica/epidemiología , Médicos de Atención Primaria/educación , Capacitación Profesional
16.
Medisan ; 23(2)mar.-abr. 2019. tab
Artículo en Español | LILACS | ID: biblio-1002632

RESUMEN

Introducción: el conocimiento sobre reperfusión coronaria en el infarto agudo del miocardio con elevación del segmento ST en el nivel primario de atención es de extraordinaria importancia para disminuir las complicaciones y la mortalidad. Objetivo: determinar las necesidades de aprendizaje de médicos de atención primaria sobre reperfusión coronaria en el infarto agudo del miocardio. Método: se realizó un estudio descriptivo de 65 galenos que laboraban en 5 policlínicos principales de urgencias de Santiago de Cuba en noviembre del 2017, para lo cual se aplicó una encuesta con variables de interés, que se calificó según metodología de evaluación y estándar previamente establecida por el equipo de trabajo. Resultados: del total de preguntas, solo una (5,9 por ciento) cumplió con el estándar de más de 70 por ciento de médicos con respuestas adecuadas; los años de experiencia y haber recibido adiestramiento influyeron positivamente en el número de dichas respuestas. La falta de capacitación fue la causa por la cual no se aplicó el tratamiento, y la planificación de esta, así como la creación de algoritmos de trabajo resultaron las medidas más propuestas por los galenos. Ninguno de ellos refirió sentirse adiestrado correctamente. Conclusiones: los médicos que laboraban en los 5 policlínicos principales de urgencias mostraron necesidades de aprendizaje y capacitación sobre el proceso de reperfusión coronaria.


Introduction: the knowledge on coronary reperfusion in the acute myocardial infarction with elevation of the ST segment in the primary care level is of extraordinary importance to decrease complications and mortality. Objective: to determine the necessities of doctors from primary care on coronary reperfusion in the acute myocardial infarction. Method: a descriptive study of 65 physicians who worked in 5 main polyclinics for emergencies of Santiago de Cuba was carried out in November, 2017 for which a survey with variables of interest was applied which was qualified according to evaluation methodology and previously established standard by the working team. Results: of all questions, only one (5.9 percent) fulfilled the standard of more than 70 percent of doctors with appropriate responses; the years of experience and receiving a previous training influenced positively in the number of these responses. The lack of training was the cause for which the treatment was not applied, and its planning, as well as the creation of working algorithms were the measures mostly proposed by the physicians. None of them referred to be correctly trained. Conclusions: doctors who worked in the 5 main emergency polyclinics showed learning necessities and training on the management for coronary reperfusion.


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Reperfusión Miocárdica , Médicos de Atención Primaria/educación , Infarto del Miocardio , Enseñanza , Epidemiología Descriptiva , Evaluación de Necesidades , Aprendizaje
18.
Trials ; 20(1): 103, 2019 Feb 06.
Artículo en Inglés | MEDLINE | ID: mdl-30728043

RESUMEN

BACKGROUND: The overuse of antibiotics is a major cause for the worldwide rise of antibiotic resistance. Although it is well known that acute respiratory tract infections (ARTI) are mainly caused by viruses and are often self limiting, antibiotics are too frequently prescribed in primary care. CHANGE-3 examines whether a complex intervention focusing on improving communication and provision of prescribing feedback reduces antibiotic use in patients suffering from ARTI. METHODS/DESIGN: The CHANGE-3 trial is a cluster-randomized controlled trial nested within a web-based public campaign conducted in two regions in Germany. A total of 114 medical practices will be included. Practices randomized to the intervention will receive a practice-specific antibiotic-prescription feedback and an educational outreach visit. During the visit the whole practice team will receive an introduction to e-learning modules addressing patient-centered communication on antibiotics. Furthermore, the practices will receive tablet PCs with information on antibiotics and the treatment of ARTI to be presented to patients. Practices randomized to the control will provide care as usual. The primary outcome measure is the antibiotic prescribing rate for patients with a history of ARTI. Data collected before the intervention, during the intervention and after the intervention will be compared. The use of narrow- vs. broad-spectrum antibiotics will be analyzed as a secondary outcome. A process evaluation is also part of the trial. DISCUSSION: This study should contribute to the growing body of research on reducing antibiotic prescription. TRIAL REGISTRATION: ISRCTN, ISRCTN15061174 . Registered retrospectively on 13 July 2018.


Asunto(s)
Antibacterianos/uso terapéutico , Educación Médica Continua/métodos , Retroalimentación Psicológica , Hábitos , Capacitación en Servicio/métodos , Médicos de Atención Primaria/educación , Pautas de la Práctica en Medicina , Atención Primaria de Salud , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Antibacterianos/efectos adversos , Actitud del Personal de Salud , Comunicación , Prescripciones de Medicamentos , Alemania , Conocimientos, Actitudes y Práctica en Salud , Humanos , Estudios Multicéntricos como Asunto , Relaciones Médico-Paciente , Médicos de Atención Primaria/tendencias , Pautas de la Práctica en Medicina/tendencias , Atención Primaria de Salud/tendencias , Ensayos Clínicos Controlados Aleatorios como Asunto , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/microbiología , Infecciones del Sistema Respiratorio/virología , Resultado del Tratamiento , Procedimientos Innecesarios
19.
BMC Fam Pract ; 20(1): 31, 2019 02 21.
Artículo en Inglés | MEDLINE | ID: mdl-30791879

RESUMEN

BACKGROUND: Personal convictions in referral to pain cause misbeliefs in health professionals, which can influence patients who suffer from non-specific chronic low back pain. Likewise, health professionals' beliefs affect their advice and attitudes towards patients' treatment, becoming a possible cause of greater disability. The development of educational interventions based on the best scientific evidence in neurophysiology of pain could be a way to provide information and advice to primary care health professionals to change their cognition towards chronic non-specific low back pain. The use of Information and Communication Technologies allows the development of web sites, which might be one of the effective resources to modify misbeliefs and attitudes, in relation to the origin and meaning of non-specific chronic low back pain, of primary care professionals and that may modify their attitudes in patients' treatment. METHODS: The aim of this project is to identify misbeliefs and attitudes of primary care physicians and nurses about chronic non-specific low back pain to develop a web-based educational tool using different educational formats and gamification techniques. This study has a mixed-method sequential exploratory design. The participants are medical and nursing staff working in primary care centers in the city of Lleida, Spain. For the qualitative phase of this study, the authors will use personal semi-structured interviews. For the quantitative phase the authors will use an experimental study design. Subjects will be randomly allocated using a simple random sample technique. The intervention group will have access to the web site where they will find information related to non-specific chronic low back pain, based on the information obtained in the qualitative phase. The control group will have access to a video explaining the clinical practice guidelines on low back pain. DISCUSSION: This study has been designed to explore and modify the beliefs and attitudes about chronic low back pain of physicians and nurses working in primary care settings, using a web-based educational tool with different educational formats and gamification techniques. The aim of the educational intervention is to change their knowledge about the origin and meaning of pain, with the result of reducing their misbeliefs and attitudes of fear avoidance. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02962817 . Date of registration: 11/09/2016.


Asunto(s)
Actitud del Personal de Salud , Dolor de Espalda , Dolor Crónico , Competencia Clínica , Educación en Enfermería , Médicos de Atención Primaria/educación , Medicina Basada en la Evidencia , Humanos , Enfermeras y Enfermeros , Enfermería de Atención Primaria , Atención Primaria de Salud
20.
Intern Med ; 58(11): 1645-1647, 2019 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-30713320

RESUMEN

An 81-year-old Japanese man with no history of diabetes mellitus was admitted to our hospital for a fever with a new ulcerative lesion on the left heel. Blood cultures on admission grew Arcanobacterium haemolyticum in aerobic bottles. He was therefore diagnosed with A. haemolyticum bacteremia and osteomyelitis complicated with foot decubitus ulcer. He was successfully treated with intravenous antibiotic therapy and debridement of the left heel. Our case and literature review show that it is important to recognize that A. haemolyticum is a systemic causative pathogen in immunocompetent patients in primary care practice.


Asunto(s)
Infecciones por Actinomycetales/complicaciones , Arcanobacterium , Úlcera del Pie/microbiología , Úlcera por Presión/microbiología , Infecciones por Actinomycetales/diagnóstico , Infecciones por Actinomycetales/terapia , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Bacteriemia/complicaciones , Terapia Combinada , Desbridamiento , Educación Médica Continua , Fiebre/microbiología , Úlcera del Pie/terapia , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Osteomielitis/microbiología , Médicos de Atención Primaria/educación , Úlcera por Presión/terapia
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