A Cross-Sectional Study about Knowledge, Attitude, and Practices among Primary Health Care Physicians in Jazan Province, Saudi Arabia, Regarding Rome IV Criteria for Diagnosis of Irritable Bowel Syndrome.

Background and objectives: Most individuals with irritable bowel syndrome (IBS) are diagnosed by primary health care (PHC) physicians. However, a significant percentage of patients remain undiagnosed or misdiagnosed owing to the lack of knowledge or a systematic strategy regarding the use of ROME IV criteria for the diagnosis of IBS. Thus, in this study, we aimed to assess the knowledge, attitude, and practices among primary health care physicians in Jazan Province, Saudi Arabia, regarding ROME IV criteria for the diagnosis of IBS. Methods: A cross-sectional study was conducted using a pretested self-administered questionnaire that determines participants' sociodemographic data and measures knowledge about ROME IV criteria, targeting PHC physicians in Jazan Province, Saudi Arabia. Data were analyzed using the Statistical Package for Social Sciences (SPSS) v.23. Results: We included 200 participants, and the majority of participants in our study (approximately 78%) were aware of the ROME IV diagnostic criteria for IBS; this awareness was associated with age, nationality, specialty, and classification. The participants' mean level of knowledge was 4.30 (out of 6). However, knowledge was higher among Saudi and family medicine doctors in this study, as compared to non-Saudi and doctors of other specialties. More than two-thirds of participants who were aware of ROME IV criteria thought that they are sufficient to diagnose IBS; however, only 47.5% of physicians reported using ROME IV frequently in their daily practice. Conclusions: Most of the participants of this study are aware of ROME IV criteria, and better knowledge was noted among Saudi and family medicine physicians. About 70% thought that ROME IV criteria are effective enough to diagnose IBS, and only about half of the participants use ROME IV criteria in their practice. Therefore, due to its high prevalence in the region, further efforts are required to disseminate basic knowledge and improve attitudes and practices related to ROME IV criteria among PHC physicians of all specialties.

Assessing research self-efficacy among primary health care physicians: a snapshot from Qatar.

BACKGROUND: Research self-efficacy is one of the crucial predictors of productively engaging in research activities emphasized by the Qatar National Vision 2030. Nevertheless, studies typically focus on research self-efficacy among students, neglecting physicians, despite the importance of research as competency in continuous professional development. Therefore, the objective of our study is to understand the level of research self-efficacy among physicians and its determinants.  METHODS: An analytical cross-sectional design was employed. We utilized an open survey through DACIMA Software that included questions related to Self-Efficacy in Research Measure (SERM) and possible determinants. One-hundred-twenty-two completed answers, and the response rate was 19.2%. Following descriptive analyses, a chi-square test was used to uncover the associations among variables, with significance set to p ≤ 0.05. Next, a logistic regression model was conducted to identify the predictors of a low research self-efficacy level. Finally, reliability and principal component analysis were applied on the SERM scale. RESULTS: Three-quarters of the sample reported insufficient research self-efficacy. The sociodemographic and professional factors did not significantly associate with insufficient research self-efficacy. However, participation in clinical guidelines proved to be a determinant of sufficient research self-efficacy. CONCLUSIONS: Physicians must be encouraged to participate in clinical guidelines to improve their research self-efficacy level.

Análise da produção científica sobre a síndrome de burnout em médicos da atenção primária: uma revisão narrativa com busca sistematizada / Analysis of the scientific production on burnout syndrome in primary care physicians: A narrative review with systematic search / Análisis de la producción científica sobre el síndrome de burnout en médicos de atención primaria: una revisión narrativa con búsqueda sistemática

Introdução: A síndrome de burnout é um transtorno adaptativo ao estresse crônico no ambiente laboral, com consequências tanto na saúde e na qualidade de vida do profissional quanto em sua organização e desempenho no trabalho. Médicos de todas as especialidades estão vulneráveis ao desenvolvimento da síndrome de burnout. Aqueles que atuam na atenção primária à saúde ­ generalistas e médicos de família e comunidade ­ parecem apresentar maior risco, visto que estão expostos a diversos estressores no trabalho. As pesquisas sobre a síndrome de burnout em médicos da atenção primária à saúde vêm ganhando destaque nos últimos 20 anos, e a escassez de estudos no Brasil dificulta a caracterização do real impacto dessa síndrome nesses profissionais. Objetivo: Revisar a literatura na busca por publicações relacionadas à síndrome de burnout em médicos da atenção primária à saúde e analisá-las, sistematizando as áreas de interesse. Métodos: Revisão narrativa da literatura sobre a síndrome de burnout em médicos da atenção primária à saúde, por meio de busca sistematizada nas bases eletrônicas PubMed e Scientific Electronic Library Online (SciELO), utilizando os seguintes descritores: "burnout, professional", "physicians, primary care" e "physicians, family". A busca foi realizada em outubro de 2018 e possibilitou a identificação de 192 publicações, das quais 55 foram incluídas na análise e categorizadas quanto a ano de publicação, país de origem, desenho do estudo e áreas de interesse. Resultados: A maior parte dos estudos era do tipo observacional descritivo transversal, metodologia utilizada em 40 trabalhos. Também foram identificadas duas revisões sistemáticas de estudos observacionais, dois estudos descritivos qualitativos, dois estudos longitudinais de coorte, dois ensaios clínicos randomizados, dois artigos de opinião, dois editoriais, um ensaio temporal, uma série temporal e um estudo de caso. Identificamos uma variedade de temas investigados sobre a síndrome de burnout em médicos da atenção primária à saúde, mas são frequentes estudos observacionais que descrevem a prevalência da síndrome nesses profissionais e as diversas variáveis de associação. As mais frequentemente estudadas são as sociodemográficas e as relacionadas ao ambiente laboral ou ao profissional. Percebe-se escassez de estudos que levantem dados epidemiológicos em médicos da atenção primária à saúde no Brasil, passo importante para o conhecimento de como essa síndrome se comporta em nosso meio. Conclusões: Fazem-se necessárias pesquisas de prevalência e sobre o impacto da síndrome de burnout nos médicos da atenção primária à saúde, que investiguem principalmente fatores relacionados ao ambiente e ao processo laboral. Ensaios clínicos podem prover evidências no combate eficaz ao burnout. Estudos qualitativos podem levantar dados sobre as motivações dos profissionais, além de comportamentos, opiniões e expectativas, direcionando estratégias para o enfrentamento dessa síndrome.

Introduction: Burnout syndrome is an adjustment disorder related to chronic stress in the work environment, with consequences both to the professional's health and quality of life and to their work organization and performance. Physicians from all specialties are vulnerable to the development of burnout syndrome. Those who work in primary health care ­ general practitioners and family physicians ­ seem to be at higher risk since they are exposed to several stressors in their practice. Research on burnout syndrome in primary care physicians has been gaining prominence in the past 20 years, but the scarcity of studies in Brazil makes it difficult to characterize the real impact of this syndrome on these professionals. Objective: To review the literature searching for publications related to burnout syndrome in primary care physicians and analyze them, systematizing the areas of interest. Methods: This is a narrative literature review on the burnout syndrome in primary care physicians based on a systematic search in the electronic databases PubMed and Scientific Electronic Library Online (SciELO), using the following descriptors: "burnout, professional", "physicians, primary care", and "physicians, family". The search was conducted in October 2018 and allowed the identification of 192 publications, of which 55 were included in the analysis and categorized according to the year of publication, country of origin, study design, and areas of interest. Results: Most studies (40) adopted an observational descriptive cross-sectional design. We also found two systematic reviews of observational studies, two qualitative descriptive studies, two longitudinal cohort studies, two randomized clinical trials, two opinion papers, two editorials, one time trial, one time series, and one case study. We foundmany topics investigating burnout syndrome in primary care physicians, but the studies are often observational and describe the prevalence of the syndrome in these professionals and the various associated variables. The most frequently studied variables are sociodemographic aspects and those related to the work environment or to the professional. Studies collecting epidemiological data about primary care physicians in Brazil are scarce, but this is an important step toward understanding how this syndrome behaves in our context. Conclusions: We need studies on the prevalence and impact of burnout syndrome on primary care physicians that can particularly investigate factors related to the environment and the work process. Clinical trials can provide evidence to combat burnout effectively. Qualitative studies can collect data on the motivations of professionals, as well as their behaviors, opinions, and expectations, guiding strategies for coping with this syndrome.

Introducción: el Síndrome de Burnout es un trastorno adaptativo al estrés crónico en el entorno laboral, con consecuencias tanto en la salud y calidad de vida del profesional, como en la organización y desempeño en el trabajo. Médicos de todas las especialidades son vulnerables al desarrollo de Síndrome de Burnout. Los que trabajan en la atención primaria de salud (APS) ­ médicos generales y los médicos de familia y de la comunidad ­ parecen correr un mayor riesgo, ya que están expuestos a diversos estresores en el trabajo. La investigación sobre Síndrome de Burnout en médicos de atención primaria de salud ha ido ganando protagonismo en los últimos veinte años y la escasez de estudios en Brasil dificulta la caracterización del impacto real de este síndrome en estos profesionales. Objetivo: revisar la literatura en la búsqueda de publicaciones relacionadas con la Síndrome de Burnout en médicos de la atención primaria de salud y analizarlas, sistematizando las áreas de interés. Métodos: revisión narrativa de la literatura sobre Síndrome de Burnout en médicos de atención primaria de salud, mediante búsqueda sistemática en las bases de datos electrónicas PubMed y SciELO, utilizando los siguientes descriptores: "Burnout, Professional", "Physicians, Primary Care" y "Physicians, Family". La búsqueda se realizó en octubre de 2018 y permitió identificar 192 publicaciones, de las cuales 55 fueron incluidas para análisis y categorizadas según año de publicación, país de origen, diseño del estudio y áreas de interés. Resultados: la mayoría de los estudios fueron de tipo observacional transversal, siendo esta metodología utilizada en 40 estudios. También se identificaron dos revisiones sistemáticas de estudios observacionales, dos estudios descriptivos cualitativos, dos estudios de cohortes longitudinales, dos ensayos clínicos aleatorizados, dos artículos de opinión, dos editoriales, una contrarreloj, una serie temporal y un estudio de caso. Identificamos una variedad de temas investigados sobre Síndrome de Burnout en médicos de atención primaria de salud, pero son frecuentes los estudios observacionales que describen la prevalencia del síndrome en estos profesionales y las distintas variables de asociación. Las más estudiadas son las sociodemográficas y las relacionadas con el entorno laboral o con el profesional. Faltan estudios que levanten datos epidemiológicos en médicos de atención primaria de salud en Brasil, un paso importante para comprender cómo se comporta este síndrome en nuestro país. Conclusiones: es necesaria una investigación sobre la prevalencia y el impacto de la Síndrome de Burnout en los médicos de atención primaria de salud, investigando principalmente factores relacionados con el entorno y el proceso de trabajo. Los ensayos clínicos pueden proporcionar evidencia en la lucha eficaz contra el burnout. Los estudios cualitativos pueden levantar datos sobre las motivaciones de los profesionales, además de comportamientos, opiniones y expectativas, orientando estrategias para afrontar este síndrome.

Primary health care and family physicians provide frontline care to the dermatology patients during the era of COVID-19: Recommendations and future directions.

COVID-19 has affected those disciplines where close contact is required and where there is no need for urgent care such as the field of dermatology. Due to the contagious nature of the virus, front line health care workers such as family health care physicians and primary health care doctors are using personal protective measures (PPE), which might result in skin disorders. In addition, social distancing has also resulted in the compromise of teaching and learning mainly bedside teaching in the dermatology wards. Moreover, there is also uncertainty about the guidelines different to be followed by primary health care and family physicians while assessing patients of dermatology. We aim to provide an overview of how COVID-19 has affected the primary health care workers and physicians. We have highlighted the challenges faced by the family health care physicians from the perspective of dermatology along with recommendations and future directions for family health care physicians. Results reveal that wearing PPE measures might be challenging for primary health care workers and family physicians as it can cause facial inflammatory papules, acne rosacea, seborrheic dermatitis, and facial itching. They cannot escape encounter with the patients, and they need to be careful by undertaking some precautionary measures while taking care of the patients in general with a specific focus on COVID-19. COVID-19 has also affected all teaching and learning in the field of dermatology. However, academic institutions can use digital tools such as zoom or skype to continue learning dermatology during the crisis of COVID-19.

Provimento médico na atenção primária à saúde no estado da Paraíba por meio do Programa Mais Médicos / Provision of physicians in primary health care in the state of Paraíba, Brazil, according to the More Doctors Program / Proveimiento de médicos en la atención primaria de salud en el estado de Paraíba, Brasil, según el Programa Más Médicos

Resumo A provisão médica tem sido fruto de debates internacionais há décadas, inclusive no Brasil, onde há um cenário de déficit e má distribuição de médicos. Esta pesquisa objetivou descrever o perfil dos médicos inseridos no Programa Mais Médicos a fim de avaliar a qualidade do provimento médico. Trata-se de um estudo quantitativo do tipo transversal, descritivo, seguido de estudo de caso baseado em informações de 272 questionários, no período de 2015 e 2016.Os dados foram analisados com o programa estatístico IBM SPSS v.22.0. A idade média dos entrevistados foi de 38,2 anos, sendo 50,7% do sexo feminino, 11% estavam no primeiro emprego, 51,1% tinham entre 1 e 5 anos de formado e 85% disseram ter experiência de trabalho na Atenção Primária à Saúde. Observou-se que, com a implantação do Programa na Paraíba, houve uma mudança não apenas no quantitativo de médicos, como também no número de postos de trabalho, na interiorização e redistribuição desses profissionais. Todavia, há 22 municípios paraibanos sem médico, e 85,3% dos médicos inseridos no Programa sem título de especialista. Denota-se que as condições de acesso e a qualidade dos serviços prestados constituem um grande desafio a ser superado, com fundamental participação reguladora do Estado.

Abstract The provision of physicians has been the object of international discussions for decades, and the same is true for Brazil, where there is a situation of shortage and bad distribution of physicians. The present research had the aim of describing the profile of the physicians included in the 'More Doctors' Program (Programa Mais Médicos, in Portuguese). It is a quantitative, cross-sectional, descriptive study, followed by a case study with information from 272 questionnaires. The data were analyzed using the SPSS statistical software, version 22.0. The average age of the interviewees was 38.2 years, and 50.7% of them were female, 11% were in their first jobs, 51.1% had graduated between 1 and 5 years prior to the study, and 85% reported having experience working in primary health care. We observed that, with the implementation of the 'More Doctors' Program in the state of Paraíba, Northeastern Brazil, there was a change not only in the amount of doctors, but also in the number of job posts, in the number of physicians who go work on the countryside, and in the redistribution of these professionals. However, the results indicate that there still are 22 municipalities in Paraíba without physicians, and that 85.3% of the physicians included in the Program still did not have a specialist title. The conditions of access and the quality of the services provided still constitute a great challenge yet to be overcome.

Resumen Hace décadas que se discute internacionalmente el proveimiento de médicos, y la situación no es distinta en Brasil, donde hay un escenario de déficit y mala distribución de médicos. Esta investigación tuvo el objetivo de describir el perfil de los médicos integrantes del Programa "Más Médicos". Se trata de un estudio cuantitativo del tipo transversal, descriptivo, seguido de estudio de caso con informaciones de 272 cuestionarios. Los datos fueron analizados con el programa estadístico SPSS, versión 22.0. La edad media de los entrevistados fue de 38,2 años, y 50,7% era del sexo femenino, 11% estaban en su primer empleo, 51,1% tenían entre 1 y 5 años de egresados, y 85% afirmaron tener experiencia de trabajo en la atención primaria. Se observó que, con la implantación del Programa en Paraíba, hubo un cambio no sólo en la cantidad de médicos, sino que también en el número de puestos de trabajo, en la interiorización, y en la redistribución de estos profesionales. Sin embargo, los resultados indican que todavía hay 22 municipios de Paraíba sin médico, y 85,3% de los médicos integrantes del Programa aún no tenían el título de especialista. Las condiciones de acceso y la calidad de los servicios prestados aún son un gran reto por superar.

Primary care physicians' knowledge, attitudes and practices related to metabolic syndrome screening and management in Alahsa, Saudi Arabia.

BACKGROUND: The metabolic syndrome (Metabolic syndrome) is a cluster of the most dangerous risk factors for type 2 diabetes mellitus and cardiovascular diseases (CVD), two of the main causes of morbidity and mortality worldwide, which include hyperglycemia, abdominal obesity, lipid abnormalities and high blood pressure. STUDY DESIGN: a cross-sectional descriptive study. RESULTS: A predominant number (94.1%) knew what constitutes MS. However, merely more than a quarter of the participant (28%) knew correctly the serum LDL cutoff value for the diagnosis of MS according to IDF criteria. The aim of lipid lowering treatment was known by slightly more than three fourth (78%) of the participants. Two third also knew the target of antihypertensive therapy. More than two third (69.5%) were also aware that waist circumference is one of the criteria for diagnosis of Metabolic syndrome. CONCLUSION: There is a need to increase the awareness of MS among the PHC Physicians. More training programs need to be planned. A better awareness among primary care physician is warranted for an early diagnosis and effective management of MS in Saudi Arabia.

Perspectives on the Training of Chinese Primary Health Care Physicians to Reduce Chronic Illnesses and Their Burden.

This paper is a commentary on the training of Chinese Primary Health Care Doctors to reduce chronic illness and its burden. First, we will consider the policy position of the Chinese government concerning the development of a competent and enlarged primary physician workforce to deliver the proposed primary health care system reforms. We then turn to a review of the drivers of the high burden of chronic illnesses especially in older people in China. We argue that the curriculum for the training of primary health care medical practitioners should match the demonstrated high prevalence chronic illnesses and their risk factors and that there needs to specific competencies in prevention and mitigation of the diseases and their risk factors.

Avaliação quantitativa da cobertura assistencial médica básica e especializada no município de Caratinga ­ MG / Quantitative assessment of basic and specialized medical assistance coverage in the city of Caratinga -MG

Avaliou-se o quantitativo inerente à cobertura assistencial médica, básica e especializada do município de Caratinga-MG, no período de setembro de 2014 a agosto de 2015. Estudo observacional transversal. Os elementos referenciados foram avaliados por meio de dados secundários do sistema de informação ambulatorial SIA/SUS, referente às 23 equipes da Estratégia Saúde da Família, agregados no seguinte perfil de pacientes: menores de 01 ano, 01 a 04, 05 a 14, 15 a 44, 45 a 59 anos e de 60 anos ou mais. Posteriormente foram avaliados os encaminhamentos aos atendimentos especializados, sendo submetidos a uma análise de parâmetros, de acordo com a Portaria 1101/02 do Ministério da Saúde. Os dados foram calculados através das frequências absolutas e relativas, média e desvio-padrão. Na avaliação para a média e desvio-padrão os resultados apontaram para um superávit nas consultas médicas básicas para os pacientes acima de 60 anos (m=905,4 e dp=347,4), e um déficit no cumprimento dos parâmetros nas consultas médicas básicas das demais faixas etárias: menores de 01 ano (m=101,4 e dp=50,4), 01 a 04 anos (m=191,4 e dp=54,3), 05 a 14 anos (m=375,8 e dp=93,7) e 15 a 59 anos (m=2.200 e dp=533,7). Os encaminhamentos aos atendimentos especializados também apresentaram déficit (m=380,2 e dp=234,2). A cobertura assistencial de consulta médica básica e de encaminhamento ao atendimento especializado no município de Caratinga-MG apresentou um percentual inferior aos parâmetros preconizados pelo Ministério da Saúde, com atendimento em apenas uma faixa etária.

The quantitative of medical, basic and specialized health care coverage was evaluated in the city of Caratinga-MG from September 2014 to August 2015. It is an observational research. The referenced elements were evaluated through secondary data from the outpatient information system - SIA / SUS referring to the 23 teams of the Family Health Strategy, aggregated in the following patients profile: under 1 year, from 01 to 04 years, from 05 to 14 years, 15 to 44 years, 45 to 59 years and 60 years or more. Subsequently, the referrals to the specialized services were evaluated, being submitted to a parameter analysis, in accordance with Ministry of Health Ordinance 1101/02. Data were calculated through the absolute and relative frequencies, mean and standard deviation. In the evaluation for the mean and standard deviation the results pointed to a surplus in basic medical appointments for patients over 60 years (m = 905.4 and dp = 347.4), and a deficit in compliance with the parameters in the basic medical visits (M = 101.4 and dp = 50.4), 01 to 04 years (m = 191.4 and dp = 54.3), 05 to 14 years (m = 375, 8 and dp = 93.7) and 15 to 59 years (m = 2,200 and dp = 533.7). Referrals to specialized care also presented a deficit of (m = 380.2 and dp = 234.2). The assistance coverage of basic medical consultation and referral to specialized care in the city of Caratinga-MG presented a percentage lower than the parameters recommended by the Ministry of Health.

GPs' and dentists' experiences and expectations of interprofessional collaboration: findings from a qualitative study in Germany.

BACKGROUND: Against the background of well-described associations between oral and general health, collaboration between dentists and general practitioners (GP) is crucial to provide therapeutic and preventive patient care. However, in the German health system, GPs and dentists are organizationally separated, implying that interprofessional collaboration can only occur informally and on a voluntary basis. Given the scarce evidence of interprofessional collaboration between dentists and GPs, an explorative study was conducted. This paper outlines the findings of this study with regard to GPs' and dentists' experiences and expectations of interprofessional collaboration. METHODS: Semi-structured interviews were conducted with GPs (n = 15) and dentists (n = 13) from three structurally different regions in Baden-Wurttemberg, Germany. The interview guide included questions on occasions, expectations and experiences of interprofessional collaboration. The interviews were transcribed verbatim and analysed using qualitative content analysis according to Mayring. RESULTS: Both GPs and dentists reported perceived knowledge deficits of the other profession with regard to medication, particularly anticoagulants and bisphosphonates, as well as systemic and general respectively dental diseases. Expectations regarding the scope of collaboration diverge: whereas dentists were interested in extending collaboration, most GPs saw no need for collaboration. CONCLUSIONS: The perceived medical knowledge deficits of the other profession as well as divergent expectations concerning the scope of collaboration hinder profound and regular interprofessional collaboration between GPs and dentists. These perceived knowledge deficits may be rooted in the separate education of dentists and GPs in Germany. Fostering interprofessional education is a promising way to improve cooperation between GPs and dentists in the long term.

Percepções de gestores municipais de Saúde sobre o provimento e a atuação dos médicos do Programa Mais Médicos / Perceptions of city health managers about the provision and activity of physicians from the More Doctors Program / Percepciones de gestores municipales de Salud sobre la provisión y actuación de lós médicos del Programa Más Médicos

No Brasil, o desafio da redistribuição de médicos foi alvo de diversas intervenções governamentais. Objetivou-se analisar o provimento de médicos do Programa Mais Médicos, segundo as percepções de gestores municipais de Saúde. Trata-se de um estudo qualitativo realizado com 63 gestores em 32 municípios do Brasil. As entrevistas foram submetidas à análise de conteúdo com a ajuda do software ATLAS.ti. Destacam-se as contribuições dos médicos do programa na melhoria da Atenção à Saúde, nas práticas clínicas humanizadas e diferenciadas e nas mudanças na rede de Atenção à Saúde, após a implementação do programa. Os gestores reafirmam a importância da implementação, no que concerne ao provimento e à fixação de médicos na Atenção Básica, em municípios vulneráveis e de difícil acesso.

In Brazil, the challenge of redistributing physicians has been the subject of several government interventions. The objective of this paper was to analyze the provision of physicians through the More Doctors Program, according to city health managers. This was a qualitative study carried out with 63 managers in 32 Brazilian cities. The interviews were submitted to content analysis using Atlas.it software. It is noteworthy to highlight the contributions of the program physicians to improvements in health care, humanized and differentiated clinical practices, and changes to health care networks after implementation of the program. The managers reiterated the importance of the program in providing and securing physicians in primary health care in vulnerable and hard-to-access cities.

En Brasil, el desafío de la redistribución de médicos fue objeto de diversas intervenciones gubernamentales. El objetivo fue analizar la provisión de médicos del Programa Más Médicos, según las percepciones de gestores municipales de Salud. Se trata de un estudio cualitativo realizado con 63 gestores en 32 municipios de Brasil. Las entrevistas se sometieron a análisis de contenido con la ayuda del software Atlas.ti. Se subrayan las contribuciones de los médicos del programa en la mejora de la atención a la salud, en las prácticas clínicas humanizadas y diferenciadas y en los cambios en la red de atención a la salud, después de la implementación del Programa. Los gestores reafirman la importancia de la implementación del programa en lo que se refiere a la provisión y a la fijación de médicos en la atención básica en municipios vulnerables y de difícil acceso.

Perspectives of primary health care physicians on diagnosing and referring patients with apparent osteolytic lesions on plain X-ray films: a cross-sectional study.

BACKGROUND AND OBJECTIVES: The identification and diagnosis of musculoskeletal symptoms are major challenges for primary care physicians. A lack of clinical suspicion, limited exposure, and referral of patients to nonspecialized centers can delay the management of cases, which in turn can increase morbidity and mortality. SUBJECTS AND METHODS: Four different sets of X-ray films were shown to 91 primary health care physicians. The first two were normal, whereas the third and fourth showed bone lesions. Participants were asked to indicate the presence of an abnormality, the diagnosis, and the approach to referral if required. RESULTS: There was a variation in the results for the first two sets of normal X-ray films. Most participants (73.6%) were able to diagnose the first case correctly. However, 73.6% of participants were unable to diagnose the second case correctly. A high percentage of participants (90.1%) were able to detect abnormalities in Cases 3 and 4, with nearly all participants indicating that they would refer patients to centers other than bone oncology centers in the western region of Saudi Arabia if they suspected bone tumors. Only 25.8% of participants were aware of these bone oncology centers. CONCLUSION: Physicians in many primary health care centers need practice in reading normal X-ray films to avoid unnecessary referral of patients to specialized medical centers. We recommend the development of a new system for referring patients suspected to have bone tumors to avoid a delay in the management of cases and to decrease morbidity and mortality.

A Cross-sectional Study on the Prevalence of Physical Activity Among Primary Health Care Physicians in Aljouf Region of Saudi Arabia.

BACKGROUND: Sedentary life style and consequent obesity prevail in both developed and developing nations; gender- and age-independently. Physical inactivity in a population in a life style transition-like Saudi Arabia-causes metabolic syndrome with its immediate and long-term complications. Healthcare workers are in a better position for role modeling and counseling of appropriate health behaviors. Personal physical activity and body built among physicians influences to some degree their exercise counseling. Realizing such principle necessitates gauging the extent of physical activity among physicians and assessing the likelihood of counseling the patients on physical activities. METHODS: A cross-sectional study enrolled primary health care physicians (PHCPs) from primary health care centers and general hospitals of two cities (Sakaka and Dumat Al-Jandal) of Aljouf region, Saudi Arabia. Both genders were included. English version of step-wise questionnaire of World Health Organization was used for data collection. RESULTS: The response rate was 64.2%. 65.2% of respondent PHCPs were doing moderate to vigorous physical exercise and 34.8% of them were physically inactive. Majority of physically inactive PHCPs had intention to increase their physical activity. Neither gender, nationality nor city-wise significant differences were recorded. However, physically active PHCPs significantly impart advice and role modeling on physical activity to their patients compared to physically inactive PHCPs (p<0.01). CONCLUSION: Most PHCPs in Sakaka and Dumat Al-Jandal cities were physically active and were able to impart the healthy behavior counseling to their patients. A strong intention prevailed to increase physical activity among physically inactive Primary Health care Physicians (PHCPs).

Primary health care physicians' approach toward domestic violence in Tehran, Iran.

BACKGROUND: Primary health care physicians (PHCPs) are the first in the clinic to detect and help victims of intimate partner violence (IPV). Therefore, their attitude and practice toward domestic violence (DV) are important to manage this problem. The aim of current study was to compare the behavior and attitude of PHCPs about DV versus other health risk factors in Tehran, Iran. METHODS: A convenience sample of 220 PHCPs was evaluated. The study was carried out in April 2012. Two self-administered questionnaires were used to identify physicians' beliefs and behaviors on screening and intervention of DV and other health risk factors. All analyses were performed using SPSS version 18.0 (SPSS, Inc. Chicago, IL). RESULTS: One hundred and ninety eight questionnaires were analyzed. PHCPs' mean age was 39.06 (±7.5) years. Participants were just reported 10% screening of regular patients for DV compared with 29% to 48% for other health risk factors. Mean age of PHCPs was not associated with their approach toward the DV. Compared to male physicians, females spared more time for DV victims. Major of physicians (96%) believed that DV is not a private problem and is something that needs to be addressed cautiously. CONCLUSION: The results of this study indicated that DV screening occurs less than that of other health risk factors. Attitude of majority of PHCPs was positive for addressing this problem.

[Family doctor-centred care in Baden-Wuerttemberg: concept and results of a controlled evaluation study]. / Hausarztzentrierte Versorgung in Baden-Württemberg - Konzept und Ergebnisse der kontrollierten Begleitevaluation.

BACKGROUND AND RESEARCH QUESTION: Pursuant to Section 73b, volume V of the German Social Security Code (SGB V), the agreement on family doctor-centred care (HzV), which went into effect in Baden-Wuerttemberg on July 1, 2008, provides for spatially inclusive and comprehensive medical coverage. The most important elements of the agreement are: the voluntary registration of family practices and patients, the strengthening of the coordinative function of family practices, the fulfilment of certain training, quality and qualification requirements, the standardised remuneration system and the use of specified practice software for billing and the prescription of drugs. The aim of this complex intervention is to strengthen family medicine, improve health care, in particular for patients with chronic disease, and to limit primary health care costs while improving its quality wherever possible. This first controlled nationwide evaluation examines the question whether these objectives were met in the early phase (2008 to 2011) and, if so, to what extent. METHOD: Four work packages were defined: 1. differences in health care processes (utilisation, contact to specialists, hospitalisations, drug prescriptions); 2. developments in practice teams and of patient satisfaction; 3. deployment of specially trained health care assistants in family practices (VERAH); 4. implementation of the DEGAM (German Society of General Practice and Family Medicine) heart failure guideline. To the extent that it was possible to use the statutory health insurance company AOK Baden-Wuerttemberg's routine data, an adjusted comparison of the target variables was made for HzV- and non-HzV-insured patients between the first and second or between the third and fourth quarters of 2008, and between the first and second or third and fourth quarters of 2010. RESULTS: HzV participants were older, had a higher disease burden (Charlson Index 1.45 vs. 1.19), and were attended to more intensively than patients receiving routine care (1.7 more contacts with the family doctor per half-year). The number of non-referred contacts to specialists fell by 12.5 %. An increase in the number of referrals and hospitalisations was not observed. Participation in structured treatment programmes was substantially higher, e.g. 15 % vs. 7.5 % (non-HzV) in DMP diabetes mellitus Type 2. In the HzV, the rise in medication costs due to family physician prescriptions (ignoring the effect of discount agreements) was lower by 2.5 %, and the me-too rate was significantly lower. Higher remuneration contributed to greater satisfaction among HzV physicians despite the perceived increase in the workload. In a survey of 2,535 patients HzV participants showed a high rate of patient satisfaction overall, and physical examinations and services aimed at preventing illness were regarded particularly favourably. A survey of 294 VERAH showed that they more often accepted patient-related tasks such as home visits, geriatric assessments, patient training, and vaccination and preventive management. Family physicians were prepared to delegate responsibilities and, as a result, felt disburdened. In accordance with the latest DEGAM guideline patients with heart failure enjoyed an improvement to an overall high level in their drug therapies with ACE inhibitors, AT1 antagonists and beta blockers. Further improvement resulting from medical quality circles and training was not observed. DISCUSSION AND CONCLUSIONS: The results confirm the findings of international studies: in particular, HzV benefits patients with chronic disease, and patients receive improved health care when they participate in the Baden-Wuerttemberg HzV. All four evaluation modules reveal that changes towards the intended direction are taking place. Family doctors assumed more responsibility for coordination. These findings reflect the early start-up phase and the development phase of HzV in Baden-Wuerttemberg. These effects, together with those of other prioritised topics, will be continuously monitored as part of an accompanying evaluation process.

Primary care physicians' knowledge and perceived barriers in the management of overweight and obesity.

OBJECTIVES: To determine the level of knowledge of primary health care physicians and the barriers perceived in the management of overweight and obesity in the Eastern Province of Saudi Arabia. SETTING: Primary health care centers in Dammam and Al-Khobar cities, Saudi Arabia. DESIGN: A cross-sectional study. MATERIALS AND METHODS: One hundred and forty-nine physicians were surveyed. Data were collected with a specially made anonymous, self-administrated, structured questionnaire with a Cronbach alpha reliability of 0.85, and content validity by five experts was used to measure the knowledge and barriers from several different aspects of care provided by primary health care centers to the overweight and obese. RESULTS: One hundred and thirty (87%) physicians responded. More than two-thirds of the respondents considered themselves as key players in the management of obesity. However, only one-third believed that they were well prepared to treat obesity. Eighty-three per cent of the respondents had a negative attitude toward the concept of overweight and obesity. It was noted that 76.9% of physicians advised patients to control their weight with sport and exercise together with low calorie diet. Sixty percent of the respondents used body mass index to diagnose obesity. Seventy-two percent of respondents did not use weight reduction medications to treat obesity. Lack of training, poor administrative support, and time constraints were identified as barriers in managing overweight and obesity. CONCLUSION: Respondents were aware of the magnitude of overweight and obesity as a major public health problem in Saudi Arabia, and they were also aware of the correct definition of overweight and obesity, as well as its effect in increasing mortality. Better training is required to improve some areas of awareness and management of the conditions.