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1.
GMS J Med Educ ; 38(2): Doc36, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33763521

RESUMEN

Aim: The seminar program of the KWBW Verbundweiterbildungplus® is offered by the Competence Center for Postgraduate Medical Education in Baden-Württemberg (KWBW) for physicians specializing in general practice (GP trainees). Attendance is a voluntary one comprised of 48 curricular units of 45 minutes each per GP trainee. This seminar program is meant to be attended in parallel to the postgraduate medical education in clinic or practice. The intention behind this project was to develop objectives, topics and a feasible structure for a seminar curriculum while taking time and financial constraints into account. Method: The Kern cycle was applied in an open, modified nominal group consensus technique in the form of an iterative process. Participating were 17 experts from the departments of general practice at the universities in Freiburg, Heidelberg, Tuebingen and Ulm, plus a pediatrician. Results: The main objective was defined as empowering GP trainees to independently provide high-quality primary care, including in rural areas. A basic curriculum was defined based on relevant frameworks, such as the 2018 Model Regulation for Postgraduate Medical Training (Musterweiterbildungsordnung/MWBO) and the Competency-based Curriculum General Practice (KCA). Overall, the seminar curriculum has 62 basic modules with 2 curricular units each (e.g. Basic Principles of General Practice, Chest Pain, Billing) and another 58 two-unit modules on variable topics (e.g. digitalization, travel medicine) adding up to 240 (124+116) curricular units. A blueprint with a rotation schedule for all of the teaching sites in Baden-Württemberg allows regular attendance by n=400 GP trainees over a period of five years, with individual variability in terms of program length. Conclusion: The model entails a five-year, flexible program to accompany the postgraduate medical education in general practice which can also be implemented in multicenter programs and those with high enrollments. The model's focus is on acquisition of core competencies for general practice. Despite the current shift to eLearning seminars due to SARS-CoV, the program's implementation is being continued, constantly evaluated, and used to further develop the KWBW Verbundweiterbildungplus® program.


Asunto(s)
Competencia Clínica , Curriculum , Educación de Postgrado en Medicina , Medicina General/educación , Médicos Generales/educación , Universidades , Alemania , Humanos , Informe de Investigación
2.
Medicine (Baltimore) ; 100(5): e23680, 2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-33592827

RESUMEN

BACKGROUND: Healthcare professionals have negative implicit biases toward minority and poor patients. Few communication skills interventions target implicit bias as a factor contributing to disparities in health outcomes. We report the protocol from the COmmuNity-engaged SimULation Training for Blood Pressure Control (CONSULT-BP), a trial evaluating a novel educational and training intervention targeting graduate medical and nursing trainees that is designed to mitigate the effects of implicit bias in clinical encounters. The CONSULT-BP intervention combines knowledge acquisition, bias awareness, and practice of bias mitigating skills in simulation-based communication encounters with racially/ethnically diverse standardized patients. The trial evaluates the effect of this 3-part program on patient BP outcomes, self-reported patient medication adherence, patient-reported quality of provider communication, and trainee bias awareness. METHODS: We are conducting a cluster randomized trial of the intervention among cohorts of internal medicine (IM), family medicine (FM), and nurse practitioner (NP) trainees at a single academic medical center. We are enrolling entire specialty cohorts of IM, FM, and NP trainees over a 3-year period, with each academic year constituting an intervention cycle. There are 3 cycles of implementation corresponding to 3 sequential academic years. Within each academic year, we randomize training times to 1 of 5 start dates using a stepped wedge design. The stepped wedge design compares outcomes within training clusters before and after the intervention, as well as across exposed and unexposed clusters. Primary outcome of blood pressure control is measured at the patient-level for patients clustered within trainees. Eligible patients for outcomes analysis are: English-speaking; non-White racial/ethnic minority; Medicaid recipient (regardless of race/ethnicity); hypertension; not have pregnancy, dementia, schizophrenia, bipolar illness, or other serious comorbidities that would interfere with hypertension self-control; not enrolled in hospice. Secondary outcomes include trainee bias awareness. A unique feature of this trial is the engagement of academic and community stakeholders to design, pilot test and implement a training program addressing healthcare. DISCUSSION: Equipping clinicians with skills to mitigate implicit bias in clinical encounters is crucial to addressing persistent disparities in healthcare outcomes. Our novel, integrated approach may improve patient outcomes. TRIAL REGISTRATION: NCT03375918. PROTOCOL VERSION: 1.0 (November 10, 2020).


Asunto(s)
Educación de Postgrado en Medicina/organización & administración , Educación en Enfermería/organización & administración , Hipertensión/etnología , Grupos Minoritarios , Enfermeras Practicantes , Simulación de Paciente , Presión Sanguínea , Competencia Cultural , Medicina General/educación , Conocimientos, Actitudes y Práctica en Salud , Humanos , Medicina Interna/educación , Medicaid , Enfermeras Practicantes/educación , Estados Unidos
3.
N Z Med J ; 134(1529): 57-68, 2021 02 05.
Artículo en Inglés | MEDLINE | ID: mdl-33582708

RESUMEN

AIMS: The Rural Hospital Medicine Training Programme (RHMTP) was established in 2008 to develop New Zealand's rural hospital medical workforce. This study evaluates the RHMTP's first 10-year outcomes. METHODS: A mixed-methods descriptive study. Database interrogation of: the Royal New Zealand College of General Practitioners records; University of Otago's e-Vision; the Medical Council of New Zealand's register of doctors. A survey of trainees who had graduated or withdrew from the programme. Survey questions included: current scope and place of employment; undergraduate rural experience; and trainee experiences. RESULTS: From 2009-2018, 98 doctors entered the RHMTP: 29 graduated, 20 withdrew and 49 are active registrars. Of the graduates, more than half (17/29) also completed GP training. Overall survey response rate: 80% (39/49). Graduate response rate: 97% (28/29). 92% (24/26) of currently practising graduates are working in rural New Zealand, mostly (22/24) in rural hospitals. Trainees value the RHMTP's flexibility and breadth of clinical exposure. The main challenges relate to a lack of alignment of training requirements and funding. CONCLUSIONS: In its first decade, the RHMTP has been successful in generating a rural hospital workforce and the programme is steadily growing. Attention to existing barriers is needed to ensure the RHMTP can reach its potential to benefit all of New Zealand's rural communities.


Asunto(s)
Actitud del Personal de Salud , Medicina General/educación , Médicos Generales/provisión & distribución , Hospitales Rurales , Adulto , Selección de Profesión , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nueva Zelanda , Evaluación de Programas y Proyectos de Salud , Salud Rural , Encuestas y Cuestionarios , Recursos Humanos
4.
Front Public Health ; 9: 623904, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33614587

RESUMEN

Since February 2020, when coronavirus disease began to spread in Italy, general practitioners (GPs) were called to manage a growing number of health situations. The challenges experienced by Italian GPs remained unrevealed. This study aimed at exploring Italian GPs' care experiences and practices associated with critical incidents during the first wave of the pandemic. A qualitative study design involving the critical incident technique through an online survey was applied. Sociodemographic data and open-ended responses were collected. While participants' characteristics were analyzed through descriptive statistics, qualitative data were thematically analyzed employing the framework method. 149 GPs responded to the survey and 99 participants completed the survey (dropout rate = 33%). Eight themes emerged indicating factors related to the organization of the healthcare system and factors related to the clinical management of patients, that were perceived as impacting on the GPs' care provision. The analysis revealed difficulties in communicating with other local services. This, together with the lack of coordination among services, was reported as a major challenge. Primary care was perceived as having been undervalued and criticalities in the organization of GP courses, led in a bureaucratic fashion, posed at risk some trainees to be infected. The digital technologies adopted for remote patient consultations were seen as useful tools for daily practice helping the GPs to stay emotionally connected with their patients. Besides, the improvement in the GP-patient relationship in terms of solidarity between patients and doctors and compliance to rules, had a positive impact. Moreover, many respondents addressed the importance of professional collaboration and teamwork, in terms of both support in practical issues (to find PPE, diagnostics and guidelines) and emotional support. At the same time, the lack of resources (e.g., PPE, swabs) and of specific guidelines and protocols impacted on the care provision. Our findings suggest that GPs in Italy are at risk of being left behind within the epidemic management. Communication and coordination among services are essential and should be substantially improved, and primary care research should be initiated to collect the context-specific evidence necessary to enhance the system's preparedness to public health emergencies and the quality of primary care services.


Asunto(s)
Médicos Generales , Atención Primaria de Salud/organización & administración , Adulto , Anciano , Actitud del Personal de Salud , Conducta Cooperativa , Educación Médica/organización & administración , Femenino , Medicina General/educación , Medicina General/organización & administración , Humanos , Italia , Masculino , Persona de Mediana Edad , Relaciones Médico-Paciente , Análisis y Desempeño de Tareas
5.
BMC Fam Pract ; 22(1): 18, 2021 01 11.
Artículo en Inglés | MEDLINE | ID: mdl-33430776

RESUMEN

BACKGROUND: The coronavirus disease 2019 (COVID-19) has been a worldwide public health emergency that has put great pressure on medical workers and the medical system. General Practitioners (GPs) played an important role in controlling the epidemic, and GP trainees also took an active part in this approach. This study was to explore Chinese GP trainees' career perspectives after COVID-19. METHODS: We conducted a qualitative research study which included 12 GP trainees from three teaching hospitals in China. Semi-structured telephone interviews were conducted. Grounded theory and thematic analysis were used to code the data and identify categories and factors. RESULTS: Eleven participants chose to continue a GP career after COVID-19, and nearly half of the participants strengthened their determination to dedicate themselves to this career. Only one participant decided to change the career choice because of interest in another specialty. Four main themes influencing GP trainees' perceptions of career development after COVID-19 emerged from the interviews: changes of GPs' work content in COVID-19, challenges of being a GP, psychological changes of the career, how to provide better primary care. Although some negative psychological changes existed, most of participants were inspired by role models and medical colleagues. They had more in-depth understanding of GPs' role and responsibility during COVID-19, and exhibited intensions for self-improvement in career development, especially in public health education and self-protection in preventing infectious diseases. In addition, the wide use of telemedicine provided a new work way for GP trainees. However, challenges, such as increased workloads, low income, lack of resources in primary medical institutions, and distrust of GPs are faced by trainees during the outbreak. CONCLUSIONS: Overall, no substantial changes were seen in the career choice of GP trainees after COVID-19 outbreak. However, they were inspired and had an in-depth understanding about the GP's work and responsibility during an epidemic. Owing to the challenges faced by the GPs, measures are needed to improve the GP education and work environment in the training phase.


Asunto(s)
/epidemiología , Selección de Profesión , Educación Médica/métodos , Medicina General/educación , Médicos Generales/psicología , Investigación Cualitativa , Adulto , China , Femenino , Humanos , Masculino , Pandemias , Carga de Trabajo/estadística & datos numéricos , Adulto Joven
7.
Eur J Gen Pract ; 26(1): 182-188, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33337939

RESUMEN

COVID-19 outbreak has significantly changed all aspects of general practice in Europe. This article focuses on the academic challenges for the discipline, mainly in the field of education, research, and quality assurance. The efforts of the European Region of the World Organisation of National Colleges, Academies, and Academic Associations of General Practitioners/Family Physicians (WONCA Europe) to support academic sustainability of the discipline in the time of pandemic are presented. Medical education was affected by the pandemic, threatening both its productivity and quality. Emerging new educational methods might be promising, but the results of their rapid implementation remain uncertain. A relatively small number of publications related to COVID-19 and general practice is available in the medical literature. There is a shortage of original data from general practice settings. This contrasts with the crucial role of GPs in fighting a pandemic. COVID-19 outbreak has opened widely new research areas, which should be explored by GPs. Maintaining the quality of care and safety of all patients during the COVID-19 pandemic is the utmost priority. Many of them suffer from poor access or inadequate management of their problems. Rapid implementation of telemedicine brought both threats and opportunities. The COVID-19 pandemic also challenged doctors' safety and well-being. These aspects will require discussion and remedy to prevent deterioration of the quality of primary care. WONCA Europe is making a multi-faceted effort to support GPs in difficult times of the pandemic. It is ready to support future efforts to uphold the integrity of family medicine as an academic discipline.


Asunto(s)
Investigación Biomédica , Educación Médica , Medicina Familiar y Comunitaria/métodos , Educación a Distancia , Europa (Continente) , Medicina Familiar y Comunitaria/educación , Medicina Familiar y Comunitaria/normas , Medicina General/educación , Medicina General/métodos , Medicina General/normas , Humanos , Calidad de la Atención de Salud , Telemedicina
8.
GMS J Med Educ ; 37(7): Doc97, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33364376

RESUMEN

Background: The task of the Competence Centers for vocational training (KW) is to increase the attractiveness and quality of vocational (=post-graduate) training in general practice. For this purpose, they offer, among other things, a structured seminar program for post-graduate trainees in general practice (GP-trainees). During the Covid-19 pandemic the seminar program of the KWBW-Verbundweiterbildungplus® in Baden-Württemberg was converted to digital formats. The goal of the paper is to evaluate the acceptance by the GP-trainees and lecturers, to describe experiences with the conversion to e-learning and to derive recommendations with regard to the future orientation of seminar programs in post-graduate as well as continuing medical education. The implementation was based on a modified Kern-cycle and aimed at offering eight teaching units of 45 minutes each to a large number of GP-trainees. It tried to maintain the high quality of content and education as well as the interactive character of the previous seminars. For this purpose, the events were designed as synchronous webinars (six units) with asynchronous preparation and post-processing (two units) according to the flipped classroom method. The evaluation by the participating GP-trainees and lecturers was performed online using a multi-center developed and pre-piloted questionnaire. Results and discussion: N=101 GP-trainees participated in the evaluation of five individual seminar days in the second quarter of 2020 (response rate 97%). 58% (N=59) of the trainees were satisfied or very satisfied with the implementation. 82% (n=83) rated pre-tasks as helpful. 99% (n=100) would participate in an online seminar again. For 52% (n=53) of the trainees, the attitude towards e-learning had changed positively. The main advantages mentioned were no travel, save in time and costs as well as increased flexibility. The main disadvantages mentioned were less personal interaction and technical obstacles. The high acceptance of the new digital format showed the fundamental potential of e-learning in continuing medical education. The experiences can be a source of inspiration for other departments and KW. However, it also shows that important goals of KW, such as the personal interaction of the peer group, could not be achieved. In the future, it is important to develop a suitable mix of presence and digital formats with the aim to improve the attractiveness as well as sustainability of continuing medical education.


Asunto(s)
/epidemiología , Instrucción por Computador/métodos , Educación a Distancia/organización & administración , Educación de Postgrado en Medicina/organización & administración , Medicina General/educación , Adulto , Competencia Clínica , Docentes Médicos/psicología , Femenino , Humanos , Masculino , Motivación , Pandemias , Estudiantes de Medicina/psicología
9.
GMS J Med Educ ; 37(7): Doc98, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33364377

RESUMEN

Background: The SARS-CoV-2 pandemic had a strong impact on academic teaching and could change it sustainably. Ad hoc digitization of teaching had to be carried out. General practice teaching situation: Education in general practice at the Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) offers, in addition to the main lecture, various elective courses, clinical traineeships, internship as well as the elective part in the final practical year. The main lecture and one clinical elective course were offered digitally in the summer term 2020. Digital methods: In the main lecture, an adapted inverted-classroom concept was used. Podcasts and audio annotated videos were provided. Teaching materials were reflected via a weekly, 1hr video consultation and in a forum. An asynchronous learning module was developed for the elective course "Smart Decision-making in Clinical Practice". Each module consisted of course preparation, podcasts and follow-ups as well as a supervised forum. Results: The main lecture (response rate n=115/170; 67.6%) was rated "very good" on average. The same applies to the commented videos. The forum, reflective video consultation and teaching materials were rated "good" on average. The predominantly desired forms of presence were "Focus on virtual with in-depth presence phases" (n=54) and "Focus on presence phases, virtual support only" (n=37). Discussion and implications: The digital restructuring enables students to work on the course contents independently. This requires self-regulation strategies, which in future shall be taught through portfolio work. The teaching focus shifts from a passive teaching format to an interactive one. First evaluation results showed a very good acceptance by the students.


Asunto(s)
/epidemiología , Instrucción por Computador/métodos , Educación a Distancia/organización & administración , Educación Médica/organización & administración , Medicina General/educación , Humanos , Pandemias , Comunicación por Videocoferencia
11.
BMC Infect Dis ; 20(1): 586, 2020 Aug 07.
Artículo en Inglés | MEDLINE | ID: mdl-32767968

RESUMEN

BACKGROUND: Inappropriate and excessive antimicrobial prescribing can lead to antimicrobial resistance. Antimicrobial Stewardship (AMS) principles are not well established in general practice in Australia despite the relatively high rate of community antimicrobial prescribing. Few interventions have been implemented that have resulted in a significant reduction or improvement in antimicrobial prescribing by General Practitioners (GPs). This study was therefore conducted to assess the impact of a novel GP educational intervention on the appropriateness of antimicrobial prescriptions as well as GP compliance with antimicrobial prescription guidelines. METHODS: In 2018, a simple GP educational intervention was rolled out in a large clinic with the aim of improving antimicrobial prescribing. It included face-to-face education sessions with GPs on AMS principles, antimicrobial resistance, current prescribing guidelines and microbiological testing. An antibiotic appropriateness audit on prescribing practice before and after the educational intervention was conducted. Data were summarised using percentages and compared across time points using Chi-squared tests and Poisson regression (results reported as risk ratios (RR) with 95% confidence intervals (CI)). RESULTS: Data from 376 and 369 prescriptions in July 2016 and July 2018, respectively, were extracted. There were significant improvements in appropriate antimicrobial selection (73.9% vs 92.8%, RR = 1.26; 95% CI = 1.18-1.34), appropriate duration (53.1% vs 87.7%, RR = 1.65; 95% CI = 1.49-1.83) and compliance with guidelines (42.2% vs 58.5%, RR = 1.39, 95% CI = 1.19-1.61) post- intervention. Documentation of antimicrobial duration directions, patient follow-up as well as patient weight significantly increased after the intervention (p < 0.001). There was significant reduction in; prescriptions without a listed indication for antimicrobial therapy, prescriptions without appropriate accompanying microbiological tests and the provision of unnecessary repeat prescriptions (p < 0.001). Inappropriate antimicrobial prescriptions observed pre-intervention for medical termination of pregnancy ceased post-intervention. CONCLUSIONS: Auditing GP antimicrobial prescriptions identified prescribing practices inconsistent with Australian guidelines. However, implementation of a simple education program led to significantly improved antimicrobial prescribing by GPs. These findings indicate the important role of AMS and continued antimicrobial education within general practice.


Asunto(s)
Antiinfecciosos/uso terapéutico , Programas de Optimización del Uso de los Antimicrobianos , Medicina General/educación , Médicos Generales/psicología , Australia , Humanos , Prescripción Inadecuada/prevención & control , Proyectos Piloto , Guías de Práctica Clínica como Asunto , Prescripciones
12.
Med Educ Online ; 25(1): 1760466, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-32379582

RESUMEN

Background: Musculoskeletal (MSK) problems are common, yet many primary care (PC) providers feel inadequately trained to manage these conditions. Previous studies describe successful MSK educational innovations at single sites, but none have reported on subsequent attempts to replicate or adapt these innovations to new contexts. This article presents a study of a national Veterans Affairs MSK training program modified to fit an existing PC educational program.Objectives: (1) To evaluate the effectiveness and feasibility of an adapted MSK curriculum in a new context. (2) To provide a model for adaptation studies in health professions education.Design: A national MSK shoulder and knee curriculum was adapted for San Francisco VA PC trainees, which included a small-group workshop and workplace learning within a newly-created MSK clinic. Effectiveness was evaluated by assessments of trainee confidence in exam and injection skills (via 5-point Likert scale) and faculty-observed performance of knee and shoulder exams (reported as percent of maximum possible score). Feasibility was evaluated by determining acceptability of the program to PC trainees (via 5-point Likert scale) and ability to implement the curriculum using local resources.Results: 52 trainees completed the training during a 2-year period. Trainees' confidence in MSK exam skills improved from 3.3 to 4.5 for shoulder, and from 3.5 to 4.6 for knee. Confidence performing joint injections improved from 2.6 to 4.2 (shoulder) and 2.5 to 4.5 (knee) (p < 0.001 for all). Observed performance improved markedly - from 50% to 92% for shoulder, and 57% to 90% for knee. Feasibility was evident in high acceptability (5.0 for MSK clinic, and 4.9 for workshops), and successful and sustained implementation.Conclusions: Adapting an established MSK curriculum to a new context was effective and feasible. This may serve as a more efficient model for improving trainee education than de novo curriculum design at individual sites.


Asunto(s)
Educación Médica/organización & administración , Medicina General/educación , Enfermedades Musculoesqueléticas/fisiopatología , Competencia Clínica , Curriculum , Estudios de Factibilidad , Humanos , Atención Primaria de Salud , San Francisco , Estados Unidos , United States Department of Veterans Affairs
13.
Aust J Gen Pract ; 49(5): 280-287, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32416655

RESUMEN

BACKGROUND AND OBJECTIVES: Currently when undergoing Australian general practice training, a registrar must determine when clinical supervision is needed. The aim of this study was to identify situations in early Australian general practice training requiring closer supervision and consider how this can be achieved. METHOD: The study used a qualitative approach involving 75 registrars, supervisors and medical educators from seven focus groups in Victoria and Tasmania. RESULTS: Eighty circumstances in which a registrar should call their general practice supervisor were identified. Participants indicated the 'call for help' list should be modified early in the term after considering the registrar's prior experience, and through the term as supervision and teaching identifies readiness for independent practice. DISCUSSION: The size of the list developed by the focus groups reflects the breadth of general practice. It is a 'call for help' list rather than a safety checklist as it is not exclusively concerned with high-risk scenarios and includes broad triggers to call for help. The 'call for help' list is an aid to patient safety and the supervisor-registrar alliance.


Asunto(s)
Medicina General/educación , Cuerpo Médico de Hospitales/educación , Adulto , Femenino , Grupos Focales/métodos , Medicina General/tendencias , Humanos , Masculino , Cuerpo Médico de Hospitales/tendencias , Investigación Cualitativa , Tasmania , Victoria
14.
Educ Prim Care ; 31(4): 247-254, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32469632

RESUMEN

Senior medical students at the University of Auckland, New Zealand spend most of their learning time in clinical attachments. Experiential apprentice-style training is traditionally recognised as an important aspect of obtaining competency. In March 2020 they were stood down from their general practice placements in the context of a national response to the COVID-19 pandemic. Acute conversion of their general practice education from experiential clinical exposure to online and offsite learning was required. This paper describes the steps taken and the underlying theoretical foundations for our expediently developed online course. Our online learning programme has three online components, reflecting the domains of educational environment theory: asynchronous discussion forums; a symposium facilitating social interactions and teacher presence, and a portfolio facilitating personal goal aspects. The latter is underpinned by a multi-theories model of adult learning, built upon the scaffolding framework that supports our entire medical curriculum. Within this theory, we propose a five-stage model of learning. Learning from this experience contributes to the body of knowledge around online education, particularly in meeting the needs of a clinical attachment traditionally grounded in experiential learning. It is hoped that the mechanisms described here might be useful to other educators facing similar challenges.


Asunto(s)
Educación a Distancia , Educación de Pregrado en Medicina/métodos , Medicina General/educación , Estudiantes de Medicina , Betacoronavirus , Competencia Clínica , Infecciones por Coronavirus , Curriculum , Humanos , Nueva Zelanda , Pandemias , Neumonía Viral
16.
JAMA Netw Open ; 3(4): e201903, 2020 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-32236530

RESUMEN

Importance: Immigrant women have lower participation in cervical cancer screening (CCS) programs. At the same time, some groups of immigrants have higher prevalence of cervical cancer. Targeted interventions are therefore necessary. Objective: To determine whether an intervention among general practitioners (GPs) could influence immigrant women's participation in the Norwegian CCS program. Design, Setting, and Participants: Cluster-randomized clinical trial using the 20 subdistricts of the Bergen, Norway, municipality as clusters. The clusters were matched in 10 pairs according to the number of immigrant women living in them and randomized thereafter. The intervention was implemented between January and June 2017 among urban, primary care, general practices in Bergen. Follow-up ended in January 2018. General practices belonging to the control areas continued treatment as usual. A total of 10 360 women who attended 73 general practices in the 20 subdistricts were included as participants. Intervention: The intervention consisted of 3 elements: an educational session for GPs at lunch describing the importance of CCS among immigrants and giving advice about how to invite them to participate, a mouse pad as a reminder, and a poster placed in waiting rooms. In the educational session, we elaborated the need for GPs to ask every immigrant woman about CCS, regardless of their reason for contacting their GP. Main Outcomes and Measures: The main outcome, screening status of immigrant women by January 1, 2018, was obtained from the Norwegian Cancer Registry. The effect of the intervention was measured as odds ratio (OR) for CCS status as of January 1, 2018, for the intervention group vs the control group, with 3 levels of adjustments: baseline CCS status at January 1, 2017 (model 1), additional adjustment for women's age, marital status, income level, and region of origin (model 2), and further adjustment for the GP's sex, age, and region of origin (model 3). Two subgroup analyses, screening status at baseline and women's country of origin, were conducted to assess whether these factors had any influence on the effect of the intervention. Data were analyzed as intention to treat. Results: A total of 10 360 immigrant women, 5227 (50.4%; mean [SD] age, 44.0 [12.0] years) in the intervention group and 5133 (49.6%; mean [SD] age, 44.5 [11.6] years) in the control group, belonging to 39 general practices in the intervention area and 34 in the control area, were included in the study. The proportion of immigrant women screened increased by 2.6% in the intervention group and 0.6% in the control group. After adjustment for screening status at baseline, women in the intervention group were more likely to have participated in CCS (OR, 1.24 [95% CI, 1.11-1.38]). This statistically significant effect remained unchanged after adjustment for women's characteristics (OR, 1.24 [95% CI, 1.11-1.38]) and was reduced, but still significant, after further adjustment for GP characteristics (OR, 1.19 [95% CI, 1.06-1.34]). In subgroup analyses, the intervention particularly increased participation among women who were not previously screened at baseline (OR, 1.35 [95% CI, 1.16-1.56]), and those from Poland, Pakistan, and Somalia (OR, 1.74 [95% CI, 1.17-2.61]) when adjusting for baseline screening status. Conclusions and Relevance: Our intervention targeting general practices significantly increased CCS participation among immigrants, although the absolute effect size of 2% in the fully adjusted model was small. Engaging other primary health professionals such as midwives to perform CCS could further contribute to increasing participation. Trial Registration: ClinicalTrials.gov Identifier: NCT03155581.


Asunto(s)
Emigrantes e Inmigrantes/psicología , Medicina General/educación , Tamizaje Masivo/métodos , Neoplasias del Cuello Uterino/diagnóstico , Adulto , Estudios de Casos y Controles , Detección Precoz del Cáncer/estadística & datos numéricos , Intervención Médica Temprana/métodos , Emigrantes e Inmigrantes/estadística & datos numéricos , Femenino , Humanos , Persona de Mediana Edad , Noruega/epidemiología , Prevalencia , Sistema de Registros , Neoplasias del Cuello Uterino/epidemiología
17.
Ciênc. Saúde Colet ; 25(4): 1475-1482, abr. 2020.
Artículo en Portugués | LILACS | ID: biblio-1089511

RESUMEN

Resumo O artigo analisa políticas recentes no campo da Atenção Primária à Saúde (APS) e suas possíveis implicações para o modelo assistencial no Sistema Único de Saúde (SUS). Inicialmente resgatam-se algumas das concepções que influenciaram os modelos de atenção no sistema público brasileiro e argumenta-se que a Estratégia Saúde da Família (ESF) apresenta as bases para reorientação das práticas assistenciais na atenção básica coerentes com os princípios do SUS. A seguir, analisam-se elementos centrais de políticas federais recentes para a APS. Demonstra-se que as mudanças no modelo assistencial da APS com ameaças à multiprofissionalidade das equipes, prioridade ao pronto atendimento, centralidade no cuidado individual, enfraquecimento do enfoque territorial comunitário e cobertura por cadastramento, evidenciam redirecionamento da política de saúde, ferindo os princípios da universalidade, integralidade e equidade no SUS.


Abstract This paper analyzes recent policies in the field of Primary Health Care (PHC) and their possible implications for the care model in the Unified Health System (SUS). Initially, some of the concepts that influenced the models of care in the Brazilian public system are revived, and we argue that the Family Health Strategy (ESF) bases for reorienting care practices in primary care are consistent with the principles of the SUS. Below, we analyze the central elements of new federal policies for PHC. We show that changes in the PHC care model threaten the teams' multidisciplinarity, prioritize acute illness care, focus in individual care, weaken the community territorial approach and establish coverage by registration, which evidence redirection of the health policy, harming the principles of universality, integrality, and equity in the SUS.


Asunto(s)
Humanos , Atención Primaria de Salud/tendencias , Salud de la Familia/tendencias , Política de Salud/tendencias , Programas Nacionales de Salud/tendencias , Grupo de Atención al Paciente , Brasil , Servicios de Salud Comunitaria , Disparidades en Atención de Salud/tendencias , Medicina General/educación
18.
Geriatr Psychol Neuropsychiatr Vieil ; 18(1): 53-62, 2020 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-32160984

RESUMEN

Screening and management of frail elderly patients is essential in general practice. OBJECTIVE: This study aims to describe and evaluate the knowledge about frailty, its screening tests and management in a population of general practice interns. METHOD: A prospective, descriptive and mono-centric study using an online survey was conducted. The 2018's promotion of general practice interns in Rouen's University participated. Evaluation of the general knowledge (e.g diagnostic criteria) and specific knowledge (e.g ranking different conditions such as: undernourishment leading to asthenia) and management algorithm (e.g to address the patient for geriatric evaluation) Results: 90 questionnaires were analyzed. Ten interns (11%) stated to know at least one screening test or to know a set of 4 major frailty criteria. Thirty four interns knew at least 4 frailty criteria (major or minor) and 46 interns had partial knowledge. Fried's phenotype was the most known. Seventy-five interns (83%) stated to know the frailty syndrome. However, 88% of the interns had little knowledge about its pathophysiology. Concerning frailty management, 78% (70 interns) stated to know how to screen frailty and prescribe first line treatments. Thirty-one among them knew how to reassess initial treatment if failure. In 59 interns (65%), identifying frailty would have led to a geriatric consultation. Seventy-nine interns (87%) were favorable to go through further training on frailty. CONCLUSION: These general practice interns were able to identify frailty criterion but, in contrast, global understanding of the syndrome was missing. Further training about this topic seems to be necessary.


Asunto(s)
Anciano Frágil , Fragilidad/diagnóstico , Medicina General/educación , Evaluación Geriátrica/métodos , Internado y Residencia , Tamizaje Masivo/métodos , Anciano , Competencia Clínica , Humanos , Estudios Prospectivos , Encuestas y Cuestionarios
19.
BMC Fam Pract ; 21(1): 28, 2020 02 07.
Artículo en Inglés | MEDLINE | ID: mdl-32033540

RESUMEN

BACKGROUND: 'Ad hoc' help-seeking by trainees from their supervisors during trainee consultations is important for patient safety, and trainee professional development. We explored trainee objectives and activities in seeking supervisor assistance, and trainee perceptions of the outcomes of this help-seeking (including the utility of supervisor responses). METHODS: Focus groups with Australian general practice trainees were undertaken. All data was audio-recorded and transcribed, coded using in-vivo and descriptive codes, and analysed by the constant comparison of provisional interpretations and themes with the data. Findings are reported under the over-arching categories of help-seeking objectives, activities and outcomes. RESULTS: Early in their general practice placements trainees needed information about practice facilities, and the "complex maze" of local patient resources and referral preferences: some clinical presentations were also unfamiliar, and many trainees were unaccustomed to making patient management decisions. Subsequent help-seeking was often characterised informally as "having a chat" or "getting a second opinion" so as not to "miss anything" when trainees were "not 100% sure". Trainees emphasised the importance of being (and demonstrating that they were) clinically safe. Workflow constraints, and supervisory and doctor-patient relationships, had a powerful influence on trainee help-seeking activities. An etiquette for providing help in front of patients was described. Trainees assessed the credibility of supervisors based on their approach to risk and their clinical expertise in the relevant area. Several trainees reported reservations about their supervisor's advice on occasions. CONCLUSION: A trainee's subsequent help-seeking is strongly influenced by how their supervisor responds when their help is sought. Trainees prefer to seek help from credible supervisors who respond promptly and maintain trainee 'face' in front of patients. Trainees learn through help-seeking to make their own clinical decisions but may remain uncertain about professional and societal expectations, and curious about how other general practitioners practise. Trainees value opportunities throughout their training to observe expert general practice.


Asunto(s)
Actitud del Personal de Salud , Competencia Clínica , Medicina General/educación , Conducta de Búsqueda de Ayuda , Seguridad del Paciente , Adulto , Australia , Toma de Decisiones , Educación de Postgrado en Medicina , Femenino , Grupos Focales , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa
20.
BMC Fam Pract ; 21(1): 5, 2020 01 08.
Artículo en Inglés | MEDLINE | ID: mdl-31914934

RESUMEN

BACKGROUND: Evidence-based medicine (EBM) in general practice involves applying a complex combination of best-available evidence, the patient's preferences and the general practitioner's (GP) clinical expertise in decision-making. GPs and GP trainees learn how to apply EBM informally by observing each other's consultations, as well as through more deliberative forms of workplace-based learning. This study aims to gain insight into workplace-based EBM learning by investigating the extent to which GP supervisors and trainees recognise each other's EBM behaviour through observation, and by identifying aspects that influence their recognition. METHODS: We conducted a qualitative multicentre study based on video-stimulated recall interviews (VSI) of paired GP supervisors and GP trainees affiliated with GP training institutes in Belgium and the Netherlands. The GP pairs (n = 22) were shown fragments of their own and their partner's consultations and were asked to elucidate their own EBM considerations and the ones they recognised in their partner's actions. The interview recordings were transcribed verbatim and analysed with NVivo. By comparing pairs who recognised each other's considerations well with those who did not, we developed a model describing the aspects that influence the observer's recognition of an actor's EBM behaviour. RESULTS: Overall, there was moderate similarity between an actor's EBM behaviour and the observer's recognition of it. Aspects that negatively influence recognition are often observer-related. Observers tend to be judgemental, give unsolicited comments on how they would act themselves and are more concerned with the trainee-supervisor relationship than objective observation. There was less recognition when actors used implicit reasoning, such as mindlines (internalised, collectively reinforced tacit guidelines). Pair-related aspects also played a role: previous discussion of a specific topic or EBM decision-making generally enhanced recognition. Consultation-specific aspects played only a marginal role. CONCLUSIONS: GP trainees and supervisors do not fully recognise EBM behaviour through observing each other's consultations. To improve recognition of EBM behaviour and thus benefit from informal observational learning, observers need to be aware of automatic judgements that they make. Creating explicit learning moments in which EBM decision-making is discussed, can improve shared knowledge and can also be useful to unveil tacit knowledge derived from mindlines.


Asunto(s)
Toma de Decisiones Clínicas , Medicina Basada en la Evidencia , Medicina General/educación , Aprendizaje , Observación , Adulto , Anciano , Bélgica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Países Bajos , Prioridad del Paciente , Investigación Cualitativa , Grabación en Video
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