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1.
Evid. actual. práct. ambul ; 22(2)sept. 2019. tab.
Artículo en Español | LILACS | ID: biblio-1046776

RESUMEN

Antecedentes: Más allá del pago por cápita, desde 2009 el Plan de Salud del Hospital Italiano de Buenos Aires reconoció a los médicos de familia el pago por prestación de intervenciones psicosociales de cuarenta minutos de duración realizadas para promover el bienestar y la autonomía de sus pacientes. Objetivos: Describir los problemas que motivaron estas intervenciones y las redefiniciones diagnósticas que realizaron estos profesionales. Métodos: Fueron revisadas las fichas estructuradas de registro de 482 intervenciones psicosociales realizadas durante 2011 y codificadas mediante la Clasificación Internacional de la Atención Primaria (CIAP-2). Resultados: Los motivos de consulta más frecuentes fueron los sentimientos depresivos y/o de ansiedad (33,25 %), problemas familiares y/o vinculados a crisis vitales (16 %), dolor (9,56 %) y cansancio (2,91 %). Entre las redefiniciones diagnósticas predominaron las crisis vitales (15,45 %), los problemas de la relación conyugal o con hijos (14,61 %), y los trastornos depresivos y/o de ansiedad (27 %). Conclusiones: nuestro modelo de trabajo contribuyó a que en una gran proporción de pacientes que había consultado por dolor u otros síntomas generales, detectáramos, abordáramos y documentáramos el proceso de atención de problemas de la esfera psicosocial, que suele ser subregistrado con el abordaje biomédico clásico. (AU)


Background: Beyond capitation payment, since 2009 Hospital Italiano de Buenos Aires Health Maintenance Organization incorporated "structured primary care psychosocial interventions" as a fee for service practice. They last 40 minutes and are undertaken by family physicians with the aim of improving the wellbeing of their patients and helping them to strengtheningtheir autonomy. Objectives: To identify chief complaints and problems (re)definitions carried out by family physicians. Methodology: 482 medical records written during 2011 were reviewed and coded according to the International Classification of Primary Care (ICPC-2). Results: Most frequent chief complaints were depressive and/or anxious feelings (33.25 %), family problems and/or phasesof adult life problems (16 %), pain (9.56 %) and fatigue (2.91 %). Most common problem (re)definitions were life events(15.45 %), followed by marital or childrelated problems (14.61 %), and depressive and/or anxiety disorders (27 %). Conclusions: Our working model enabled us to identify, address and document psychosocial problems which are often underreported within the classical biomedical approach in a large proportion of patients whose chief complaint were painor other general symptoms. (AU)


Asunto(s)
Médicos de Familia/tendencias , Atención Primaria de Salud/métodos , Sistemas de Apoyo Psicosocial , Ansiedad , Dolor , Médicos de Familia/economía , Atención Primaria de Salud/organización & administración , Atención Primaria de Salud/estadística & datos numéricos , Planes de Aranceles por Servicios/organización & administración , Impacto Psicosocial , Depresión , Conflicto Familiar , Fatiga , Promoción de la Salud/provisión & distribución
2.
Fam Med ; 51(5): 424-429, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-31081914

RESUMEN

BACKGROUND AND OBJECTIVES: In Ethiopia, family medicine began in 2013. The objective of this study was to compare family medicine residents' attitudes about training in Ethiopia with those at a program in the United States. METHODS: Family medicine residents at Addis Ababa University in Addis Ababa, Ethiopia and the University of Maryland in Baltimore, Maryland completed a 43-item Likert scale survey in 2017. The survey assessed residents' attitudes about residency education, patient care, independence as family physicians, finances, impact of residency on personal life, and women's issues. We calculated descriptive statistics on the demographics data and analyzed survey responses using a two-sample t-test. RESULTS: A total of 18 (75%) Ethiopian residents and 18 (60%) US residents completed the survey (n=36). The Ethiopian residents had a wider age distribution (25-50 years) than the US residents (25-34 years). More US residents were female (72%) compared to the Ethiopian cohort (50%), while more Ethiopian residents were married (72%) compared to the US cohort (47%). There were statistically significant differences in attitudes toward patient care (P=0.005) and finances (P<0.001), differences approaching significance in attitudes toward residency education, and no significant differences in independence as family physicians, the impact of residency on personal life, and women's issues in family medicine. CONCLUSIONS: Across two very different cultures, resident attitudes about independence as family physicians, the impact of residency on personal life and women's issues, were largely similar, while cross-national differences in attitudes were found relative to residency education, patient care, and finances.


Asunto(s)
Actitud del Personal de Salud , Comparación Transcultural , Medicina Familiar y Comunitaria/educación , Internado y Residencia , Médicos de Familia/estadística & datos numéricos , Adulto , Estudios Transversales , Educación de Postgrado en Medicina , Etiopía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Médicos de Familia/tendencias , Estados Unidos
3.
BMC Musculoskelet Disord ; 20(1): 50, 2019 Feb 02.
Artículo en Inglés | MEDLINE | ID: mdl-30711002

RESUMEN

BACKGROUND: At any one time, one in every five Canadians has low back pain (LBP), and LBP is one of the most common health problems in primary care. Guidelines recommend that imaging not be routinely performed in patients presenting with LBP without signs or symptoms indicating a potential pathological cause. Yet imaging rates remain high for many patients who present without such indications. Inappropriate imaging can lead to inappropriate treatments, results in worse health outcomes and causes harm from unnecessary radiation. There is a need to understand the extent of, and factors contributing to, inappropriate imaging for LBP, and to develop effective strategies that target modifiable barriers and facilitators. The primary study objectives are to determine: 1) The rate of, and factors associated with, inappropriate lumbar spine imaging (x-ray, CT scan and MRI) for people with non-specific LBP presenting to primary care clinicians in Ontario; 2) The barriers and facilitators to reduce inappropriate imaging for LBP in primary care settings. METHODS: The project will comprise an inception cohort study and a concurrent qualitative study. For the cohort study, we will recruit 175 primary care clinicians (50 each from physiotherapy and chiropractic; 75 from family medicine), and 3750 patients with a new episode of LBP who present to these clinicians. Clinicians will collect data in the clinic, and each participant will be tracked for 12 months using Ontario health administrative and self-reported data to measure diagnostic imaging use and other health outcomes. We will assess characteristics of the clinicians, patients and encounters to identify variables associated with inappropriate imaging. In the qualitative study we will conduct in-depth interviews with primary care clinicians and patients. DISCUSSION: This will be the first Canadian study to accurately document the extent of the overuse of imaging for LBP, and the first worldwide to include data from the main healthcare professions offering primary care for people with LBP. This study will provide robust information about rates of inappropriate imaging for LBP, along with factors associated with, and an understanding of, potential reasons for inappropriate imaging.


Asunto(s)
Dolor de la Región Lumbar/diagnóstico por imagen , Vértebras Lumbares/diagnóstico por imagen , Imagen por Resonancia Magnética/tendencias , Pautas de la Práctica en Medicina/tendencias , Atención Primaria de Salud/tendencias , Proyectos de Investigación , Tomografía Computarizada por Rayos X/tendencias , Quiropráctica/tendencias , Toma de Decisiones Clínicas , Investigación sobre Servicios de Salud , Humanos , Uso Excesivo de los Servicios de Salud/prevención & control , Uso Excesivo de los Servicios de Salud/tendencias , Ontario , Fisioterapeutas/tendencias , Médicos de Familia/tendencias , Valor Predictivo de las Pruebas , Investigación Cualitativa
4.
Evid. actual. práct. ambul ; 22(4): e002027, 2019. tab.
Artículo en Español | LILACS | ID: biblio-1052886

RESUMEN

Antecedentes. El modelo biopsicosocial propone que la atención de la salud se centre en las necesidades de las personas.Sin embargo, no siempre los profesionales de la salud conocen adecuadamente lo que esperan de los encuentros clínicos sus pacientes. Objetivo. Explorar las expectativas respecto de sus encuentros clínicos de los/as pacientes atendidos por médicos de familia en un Centro de Salud de Atención Primaria del Conurbano Bonaerense (Buenos Aires, Argentina). Métodos. Estudio observacional descriptivo de corte transversal llevado a cabo sobre una muestra consecutiva de pacientes que acudieron a las consultas médicas de un centro de salud. Se les pidió a los pacientes que de un listado de diez potenciales expectativas, valoraran y priorizaran las más importantes para esa consulta. Resultados. Fueron entrevistadas 146 personas (91 % mujeres) con una mediana de edad de 30 años.Las expectativas más mencionadas (94 % de las personas encuestadas) fueron que el médico demuestre interés y escuche a sus pacientes, y que les brinde explicaciones sobre sus problemas y dudas. Conclusiones. Hemos podido documentar que las expectativas de nuestros pacientes respecto de sus entrevistas clínicas están muy vinculadas a su componente actitudinal (predisposición a escuchar con interés sus problemas) y al de las habilidades comunicacionales del profesional de la salud (explicaciones). (AU)


Background. The biopsychosocial model proposes that health care focus on the needs of people. However, health profes-sionals do not always know what their patients expect from clinical meetings. Objective. To explore the expectations regarding their clinical meetings of the patients attended by family doctors in aPrimary Health Care Center of Buenos Aires, Argentina. Methods. Descriptive cross-sectional observational study carried out on a consecutive sample of patients who attendedthe medical consultations of a health center. Patients were asked to rate and prioritize the most important ones for thatconsultation from a list of ten potential expectations. Results. 146 people (91 % women) with a median age of 30 years were interviewed.The most mentioned expectations (94 % of the people surveyed) were for the doctor to show interest and listen to theirpatients, and to give them explanations about their problems and doubts. Conclusions. We have been able to document that our patients' expectations regarding their clinical interviews are closelylinked to their attitudinal component (predisposition to listen with interest to their problems) and to the communication skillsof the healthcare professional (explanations). (AU)


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Adulto Joven , Satisfacción del Paciente , Medicina Familiar y Comunitaria/tendencias , Argentina , Relaciones Médico-Paciente , Médicos de Familia/tendencias , Atención Primaria de Salud/tendencias , Garantía de la Calidad de Atención de Salud/tendencias , Calidad de la Atención de Salud/tendencias , Estudios Transversales/estadística & datos numéricos , Competencia Clínica , Atención Dirigida al Paciente/tendencias , Empatía , Prioridad del Paciente/psicología , Comunicación en Salud/métodos
6.
8.
Ann Fam Med ; 16(5): 436-439, 2018 09.
Artículo en Inglés | MEDLINE | ID: mdl-30201640

RESUMEN

POEMs (patient-oriented evidence that matters) are studies that address a relevant clinical question, demonstrate improved patient-oriented outcomes, and have the potential to change practice. For 20 years the authors of this article have reviewed more than 100 English language clinical journals monthly to identify POEMs in the medical literature relevant to primary care practice. This article identifies the POEMs in each of the last 20 years that were highest ranked for having recommended a major and persistent change in practice that year. They include POEMs that recommend a novel, effective intervention, a second group that recommends abandoning an ineffective practice, and a third group that recommends abandoning a potentially harmful practice. The top POEMs of the past 20 years illustrate the breadth of practice change in primary care and the need for family physicians to have a systematic approach to keeping up with the medical literature, such as that in POEMs, especially because many of these important articles did not appear in the primary care literature.


Asunto(s)
Investigación Biomédica/tendencias , Medicina Basada en la Evidencia/tendencias , Medicina Familiar y Comunitaria/tendencias , Médicos de Familia/tendencias , Atención Primaria de Salud/tendencias , Investigación Biomédica/historia , Medicina Basada en la Evidencia/historia , Medicina Familiar y Comunitaria/historia , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Médicos de Familia/historia , Atención Primaria de Salud/historia
9.
Orv Hetil ; 159(32): 1310-1316, 2018 Aug.
Artículo en Húngaro | MEDLINE | ID: mdl-30078356

RESUMEN

It is internationally recognized that the best method for practicing general medical care is family medicine, based on the correct relationship between the physician and the patients/families, where the principles of disease prevention and patient care meet, and the cost-benefit rates are better. In Hungary, a major part of the health reform had been the advancement of a primary care system by the international standards of modern family medicine. The Scientific Association of the Hungarian General Practitioners (SAHGP), founded in 1967, has adviced - from its onset - to introduce a new, independent medical specialty named 'general practice' which was finally realised in 1974. That was followed, according to the Welfare Ministry Order No. 6/1993, by the specific training program for general practice which prescribed, also for the in-service GP-s, to complete an individual postgraduate training, to be ended by a state specialty exam in family practice, under conduction of the regional medical schools. Furthermore, for strengthening the primary healthcare, in 1998 the government established - uniquely in Europe - the National Institute of Primary Healthcare (NIPHC). So a unique task force has gained shape which included the academic sector, the professional NGO and the governmental background institution in order to manage: 1) human resource supply in PHC, 2) to implement statewide professional and public health goals as well as 3) to manage research and development projects. This paper takes a look back at the early events of this process as well as tries to offer an insight into the results and conclusions of the performed research projects, highlighting those which can be potentially usable in further professional development of the Hungarian PHC. Orv Hetil. 2018; 159(32): 1310-1316.


Asunto(s)
Prestación de Atención de Salud/organización & administración , Educación Médica/tendencias , Medicina Familiar y Comunitaria/educación , Médicos de Familia/educación , Academias e Institutos , Medicina Familiar y Comunitaria/tendencias , Humanos , Hungría , Médicos de Familia/tendencias , Pautas de la Práctica en Medicina/tendencias , Facultades de Medicina/tendencias
10.
SEMERGEN, Soc. Esp. Med. Rural Gen. (Ed. Impr.) ; 44(4): 243-248, mayo-jun. 2018. tab
Artículo en Español | IBECS | ID: ibc-179987

RESUMEN

Objetivo: Determinar cuál es el volumen idóneo de actividad que deben llevar a cabo los residentes de Medicina Familiar y Comunitaria para adquirir las competencias propias de su desempeño profesional. Material y método: Se recogió la opinión consensuada de un grupo de expertos en formación de residentes en Medicina Familiar y Comunitaria mediante una encuesta realizada con el método Delphi vía online en la que participaron 152 tutores. Resultados: La mediana total obtenida en las diferentes actividades a desarrollar por los residentes de Medicina Familiar y Comunitaria son: intervenciones individuales diagnósticas/terapéuticas: retinografías 60, espirometrías 40, anticoagulación 45, crio/electrocoagulación 35, infiltraciones 45, teledermatología 60, otras 45; salud mujer: embarazo 45, ecografía ginecológica/DIU 41, citologías 32,5, planificación 19,5, educación maternal 17; intervenciones estilo vida y cuidados: geriatría 30, enfermería 45, tabaco individual 30, grupal 15, problemas salud 15, consejo dietético 15; intervención comunitaria: sesiones con jóvenes 15, riesgo social 15; formación: sesiones 40, continuada 40


Objective: To determine the ideal volume of activity to be carried out by residents in Family and Community Medicine in order to acquire the competencies of their professional activity. Material and method: The consensus opinion of a group of experts in the training of residents in Family and Community Medicine was collected from 152 tutors using an online Delphi-type questionnaire. Results: The overall medians obtained in the different activities that should be developed by residents of Family and Community Medicine were: individual diagnostic/therapeutic interventions: retinography 60, spirometry 40, anticoagulation 45, cryo/electrocoagulation 35, infiltrations 45, tele-dermatology 60, and others 45; women's health: pregnancy 45, gynaecological ultrasound/IUD 41, cytology 32.5, family planning 19.5, and maternal education 17; lifestyle and care interventions: geriatrics 30, nursing 45, individual tobacco advice 30, group advice 15, health problems 15, and dietary advice 15; community intervention: sessions with youth 15, and social risk 15; training: sessions 40, continuing education 40. Conclusions: This information has defined the activity volumes that should be developed by the residents in order to acquire an adequate level of competence in the areas of individual diagnostic and therapeutic interventions, women's health, interventions to change lifestyles, community intervention, and clinical and training sessions. The consensus obtained could serve as a basis for the creation of a road map in the training of residents as a complementary tool to the Resident's Book, which is obligatory in all specialties


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Internado y Residencia/tendencias , Medicina Comunitaria/tendencias , Medicina Familiar y Comunitaria/tendencias , Competencia Profesional/normas , Médicos de Familia/tendencias , Médicos de Atención Primaria/tendencias , Pautas de la Práctica en Medicina/normas , Evaluación Educacional
12.
J Am Board Fam Med ; 31(1): 126-138, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29330247

RESUMEN

BACKGROUND: Family medicine is a specialty of breadth, providing comprehensive health care for the individual and the family that integrates the broad scope of clinical, social, and behavioral sciences. As such, the scope of practice (SOP) for family medicine is extensive; however, over time many family physicians narrow their SOP. We sought to provide a nationally representative description of the most common and the most critical diagnoses that family physicians see in their practice. METHODS: Data were extracted from the 2012 National Ambulatory Medical Care Survey (NAMCS) to select all ICD-9 codes reported by family physicians. A panel of family physicians then reviewed 1893 ICD-9 codes to place each code into an American Board of Family Medicine Family Medicine Certification Examination test plan specifications (TPS) category and provide a rating for an Index of Harm (IoH). RESULTS: An analysis of all 1893 ICD-9 codes seen by family physicians in the 2012 NAMCS found that 198 ICD-9 codes could not be assigned a TPS category, leaving 1695 ICD-9 codes in the dataset. Top 10 lists of ICD-9 codes by TPS category were created for both frequency and IoH. CONCLUSIONS: This study provides a nationally representative description of the most common diagnoses that family physicians are seeing in their practice and the criticality of these diagnoses. These results provide insight into the domain of the specialty of family medicine. Medical educators may use these results to better tailor education and training to practice.


Asunto(s)
Medicina Familiar y Comunitaria/estadística & datos numéricos , Encuestas de Atención de la Salud/estadística & datos numéricos , Médicos de Familia/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Enfermedad Crítica , Análisis de Datos , Medicina Familiar y Comunitaria/tendencias , Humanos , Clasificación Internacional de Enfermedades , Médicos de Familia/tendencias , Pautas de la Práctica en Medicina/tendencias , Estados Unidos
13.
Eur J Gen Pract ; 24(1): 74-83, 2018 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-29243549

RESUMEN

BACKGROUND: Turkish health reforms began in 2003 and brought some significant changes in primary care services. Few studies in Turkey compare the shift from health centres (HC) to family physicians (FP) approach, which was initiated by reforms. OBJECTIVES: This study compares health status indicators during the HC period before reforms (2003-2007) and the FP period after reforms (2008-2012) in Turkey. METHODS: This study encompasses time series data consisting of the results of a 10-year assessment (2003-2012) in Manisa district. All the data were obtained electronically and by month. The intersection points of the regression curves of these two periods and the beta coefficients were compared using segmented linear regression analysis. RESULTS: The mean number of follow-up per person/year during the HC period in infants (10.5), pregnant women (6.6) and women (1.8) was significantly higher than the mean number of follow-up during the FP period in infants (6.7), pregnant women (5.6) and women (0.9). Rates of BCG and measles vaccinations were significantly higher during the FP period; however, rates of HBV and DPT were same. The mean number of outpatient services per person/year during the FP period (3.3) was significantly higher than HC period (2.8). Within non-communicable diseases, no difference was detected for hypertension prevalence. Within communicable diseases, there was no difference for rabies suspected bites but acute haemorrhagic gastroenteritis significantly decreased. The infant mortality rate and under five-year child mortality rate significantly increased during the FP period. CONCLUSION: Primary care services should be reorganized and integrated with public health services.


Asunto(s)
Médicos Generales/organización & administración , Reforma de la Atención de Salud , Indicadores de Salud , Atención Primaria de Salud/organización & administración , Niño , Prestación de Atención de Salud/organización & administración , Prestación de Atención de Salud/tendencias , Femenino , Estudios de Seguimiento , Humanos , Lactante , Análisis de Series de Tiempo Interrumpido , Modelos Lineales , Masculino , Médicos de Familia/organización & administración , Médicos de Familia/tendencias , Embarazo , Atención Primaria de Salud/tendencias , Turquia
15.
J Am Board Fam Med ; 30(6): 838-842, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-29180562

RESUMEN

BACKGROUND: Due to the Accreditation Council for Graduate Medical Education (ACGME)/American Osteopathic Association (AOA) single-accreditation model, the specialty of family medicine may see as many as 150 programs and 500 trainees in AOA-accredited programs seek ACGME accreditation. This analysis serves to better understand the composition of physicians completing family medicine residency training and their subsequent certification by the American Board of Family Medicine. METHODS: We identified residents who completed an ACGME-accredited or dual-accredited family medicine residency program between 2006 and 2016 and cross-tabulated the data by graduation year and by educational background (US Medical Graduate-MD [USMG-MD], USMG-DO, or International Medical Graduate-MD [IMG-MD]) to examine the cohort composition trend over time. RESULTS: The number and proportion of osteopaths completing family medicine residency training continues to rise concurrent with a decline in the number and proportion of IMGs. Take Rates for USMG-MDs and USMG-IMGs seem stable; however, the Take Rate for the USMG-DOs has generally been rising since 2011. CONCLUSIONS: There is a clear change in the composition of graduating trainees entering the family medicine workforce. As the transition to a single accreditation system for graduate medical education progresses, further shifts in the composition of this workforce should be expected.


Asunto(s)
Acreditación/legislación & jurisprudencia , Educación de Postgrado en Medicina/legislación & jurisprudencia , Medicina Familiar y Comunitaria/educación , Medicina Osteopática/educación , Médicos de Familia/educación , Acreditación/tendencias , Educación de Postgrado en Medicina/métodos , Educación de Postgrado en Medicina/tendencias , Humanos , Internado y Residencia/legislación & jurisprudencia , Internado y Residencia/tendencias , Medicina Osteopática/legislación & jurisprudencia , Medicina Osteopática/tendencias , Médicos de Familia/legislación & jurisprudencia , Médicos de Familia/tendencias , Sociedades Médicas/legislación & jurisprudencia , Estados Unidos
19.
Can Fam Physician ; 63(3): 221-227, 2017 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-28292802

RESUMEN

OBJECTIVE: To investigate changes in family doctors' attitudes about and participation in hospital activities and inpatient care in an urban hospital family medicine department from 1977 to 1997 and 2014. DESIGN: Cross-sectional survey design. SETTING: The Department of Family Medicine at St Joseph's Healthcare Hamilton in Ontario. PARTICIPANTS: Family physicians affiliated with the Department of Family Medicine at St Joseph's Healthcare Hamilton were surveyed in 2014. Data were compared with findings from similar surveys administered at this institution in 1977 and 1997. MAIN OUTCOME MEASURES: Family physicians' roles in hospital activities, attitudes toward the role of the family physician in the hospital setting, and the barriers to and facilitators of maintaining this role. RESULTS: A total of 93 physicians returned completed surveys (37.3% response rate). In 2014, half of the respondents provided some inpatient care. This patient care was largely supportive and newborn care (71.7% and 67.4%, respectively). In 2014, 47.3% believed the quality of care would suffer (compared with 92.1% in 1977 and 87.5% in 1997) if they were not involved in patient care in the hospital. There was also a considerable shift away from the 1977 and 1997 perception that the family physician had a role as patient advocate: 92.0% and 95.3%, respectively, compared with only 49.5% in the 2014 survey. CONCLUSION: Family physicians' hospital activities and attitudes continued to change from 1977 to 1997 and 2014 in this urban hospital setting. Most of the respondents had stopped providing direct inpatient care, with a few continuing to provide supportive care. Despite this, most respondents still see a role for the Department of Family Medicine within the hospital as a focus for identifying with their family physician community, a place to interact with other specialist colleagues, and a source of some continuing medical education.


Asunto(s)
Actitud del Personal de Salud , Hospitales Urbanos , Atención al Paciente , Rol del Médico , Médicos de Familia/tendencias , Estudios Transversales , Educación Médica Continua , Femenino , Relaciones Médico-Hospital , Humanos , Cuidado del Lactante , Recién Nacido , Relaciones Interprofesionales , Masculino , Defensa del Paciente , Percepción , Médicos de Familia/psicología , Encuestas y Cuestionarios
20.
Pain Pract ; 17(3): 366-370, 2017 03.
Artículo en Inglés | MEDLINE | ID: mdl-27160386

RESUMEN

PURPOSE: Following discharge, patients requiring high opioid doses may be at risk for both under- and overdosing, posing a major challenge to community physicians. The aim of this study was to examine the effectiveness and degree of satisfaction with a personalized taper schedule and physician letter through interviews of patients and physicians. METHODS: This was a 1-year prospective study. Following ethics approval and informed written consent, patients admitted for elective surgery, 18 to 60 years of age, receiving opioid analgesics, were recruited. Prior to discharge, the acute pain service team provided patients with a taper schedule explained in detail. Individualized physician letters were faxed to treating family physicians. Patients were contacted by phone 2, 4, and 6 weeks after discharge. Physicians were contacted once, a month after discharge. Patients and physicians were asked to grade the taper schedule on a 1- to 5-point Likert scale. Questions pertained to clarity, usefulness, ability to follow the instructions, and general satisfaction. RESULTS: Twenty-six patients and 21 physicians completed the study. Physicians were generally satisfied with both the taper schedule and letter and rated all aspects between 3.76 and 4.38 of 5. Similarly, patients were satisfied with the taper schedule and rated all aspects between 4.08 and 4.5. CONCLUSIONS: Both physicians and patients generally found the taper schedule and letter helpful in assisting them to taper off their opioid use. This is one way of bridging the gap in continuity of care between the acute and primary care providers while reducing the risk to patients during the transition period.


Asunto(s)
Dolor Agudo/tratamiento farmacológico , Analgésicos Opioides/administración & dosificación , Correspondencia como Asunto , Clínicas de Dolor/tendencias , Alta del Paciente/tendencias , Médicos de Familia/tendencias , Dolor Agudo/diagnóstico , Dolor Agudo/psicología , Anciano , Esquema de Medicación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Manejo del Dolor/métodos , Manejo del Dolor/psicología , Manejo del Dolor/tendencias , Médicos de Familia/psicología , Estudios Prospectivos , Encuestas y Cuestionarios
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