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1.
Postgrad Med ; 132(1): 7-16, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31570072

RESUMO

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


Assuntos
Esgotamento Profissional/etiologia , Estresse Ocupacional/etiologia , Médicos de Atenção Primária/psicologia , Esgotamento Profissional/epidemiologia , Humanos , Estresse Ocupacional/complicações , Estresse Ocupacional/epidemiologia , Médicos de Atenção Primária/educação , Médicos de Atenção Primária/estatística & dados numéricos , Prevalência , Fatores de Risco
2.
J Opioid Manag ; 15(6): 455-468, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31850507

RESUMO

OBJECTIVE: The goal of the study was to assess knowledge gaps and practice patterns of US-based addiction specialists, primary care physicians (PCPs), nurse practitioners (NPs), and physician assistants (PAs) who treat patients with opioid use disorder (OUD). DESIGN: As part of a prospective study, the authors developed a survey tool consisting of case-vignettes and questions designed to reveal practice patterns and highlight gaps in clinician knowledge. SETTING: The primary study setting included clinicians practicing in outpatient care. PARTICIPANTS: The surveys were distributed via email between August and September 2017 to a national sample of addiction specialists, PCPs, and NPs/PAs that see at least one patient per week and at least 1 percent of their patient population had to be diagnosed with OUD. RESULTS: The knowledge assessment results varied among the clinicians surveyed. Addiction specialists saw more patients with OUD than PCPs, NPs, or PAs. They also demonstrated a higher level of understanding and knowledge of the various domains assessed. CONCLUSIONS: There are multiple educational intervention strategies that can support the clinicians; including reducing restrictions to access treatment for OUD, care coordination programs for patients to improve early access to treatment and education, and frequent chart audit and feedback programs to support clinician decision making and education.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides , Humanos , Profissionais de Enfermagem/psicologia , Transtornos Relacionados ao Uso de Opioides/terapia , Assistentes Médicos/psicologia , Médicos de Atenção Primária/psicologia , Padrões de Prática Médica , Estudos Prospectivos
3.
BMC Public Health ; 19(1): 1335, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640625

RESUMO

BACKGROUND: Australia is committed to eliminating the hepatitis C virus (HCV) by 2030. Despite regulations in Australia that enable the prescription of subsidised direct acting antiviral (DAA) by primary health care providers, the number of providers who treat patients for HCV remains low and this limits the prospect of HCV elimination. The Prince Charles Hospital, Brisbane, Australia, implemented an innovative program called Cure-It aimed at engaging primary care providers in community-based HCV treatment. This paper aims to describe initial experiences and short-term patient outcomes of this program. METHODS: A formative evaluation was conducted using program data for the period March 2016 to April 2018. Descriptive statistics were used to report the number of engaged primary care providers, patients' baseline characteristics, treatment plans, and treatment outcomes. RESULTS: Thirty primary care providers from different settings were engaged in HCV treatment. Among 331 patients eligible for community-based treatment, 315 (95.2%) commenced treatment, the completion rate was 92.4 and 66.5% achieved sustained virological response at 12 weeks (SVR12). The SVR12 had not been documented for 26.8% of patients. Among patients whose SVR12 was documented, 98.2% achieved SVR12. Only 1.3% of patients experienced treatment failure. CONCLUSION: A flexible tertiary-led model can improve primary care providers and patients' engagement with provision of HCV treatment. Tertiary centres need to play their role to improve the accessibility of HCV treatment through providing training and on-going support for primary care providers while enabling those providers to become more confident in providing treatment independently.


Assuntos
Antivirais/uso terapêutico , Difusão de Inovações , Hepatite C/tratamento farmacológico , Médicos de Atenção Primária/psicologia , Atenção Terciária à Saúde/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
4.
BMC Health Serv Res ; 19(1): 753, 2019 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-31653211

RESUMO

BACKGROUND: The aim of this nationwide study was to investigate barriers to adequate professional interpreter use and to describe existing initiatives and identify key factors for successful interpreter policies in primary care, using Switzerland as a case study. METHODS: Adult and paediatric primary care providers were invited to participate in an online cross-sectional questionnaire-based study. All accredited regional interpreter agencies were contacted first by email and, in the absence of a reply, by mail and then by phone. Local as well as the national health authorities were asked about existing policies. RESULTS: 599 primary care physicians participated. Among other reasons, physicians identified cumbersome organization (58.7%), absent financial coverage (53.7%) and lack of knowledge on how to arrange interpreter interventions (44%) as main barriers. The odds of organising professional interpreters were 6.6-times higher with full financial coverage. Some agencies confirmed difficulties providing professional interpreters for certain languages at a timely manner. Degrees of coverage of professional interpreter costs (full coverage to none) and organization varied between regions resulting in different levels of unmet needs. CONCLUSIONS: Professional interpreter use can be improved through the following points: increase awareness and knowledge of primary care providers on interpreter use and organization, ensure financial coverage, as well as address organizational aspects. Examples of successful interventions exist.


Assuntos
Pessoal Técnico de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde , Médicos de Atenção Primária/psicologia , Atenção Primária à Saúde/organização & administração , Tradução , Adulto , Pessoal Técnico de Saúde/economia , Criança , Estudos Transversais , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Médicos de Atenção Primária/estatística & dados numéricos , Inquéritos e Questionários , Suíça
5.
J Stroke Cerebrovasc Dis ; 28(12): 104323, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31562040

RESUMO

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


Assuntos
Serviços de Saúde Comunitária , Educação Médica Continuada/métodos , Conhecimentos, Atitudes e Prática em Saúde , Capacitação em Serviço/métodos , Médicos de Família/economia , Médicos de Atenção Primária/educação , Acidente Vascular Cerebral , Adulto , Atitude do Pessoal de Saúde , Conscientização , China , Competência Clínica , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Médicos de Família/psicologia , Médicos de Atenção Primária/psicologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Terapia Trombolítica , Tempo para o Tratamento , Adulto Jovem
6.
BMC Emerg Med ; 19(1): 48, 2019 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-31477062

RESUMO

BACKGROUND: No known data in the literature assessing practice of kidney stone prevention in the emergency department (ED) is available. OBJECTIVES: Assess patient perception and compliance to kidney stone prevention given within the emergency department. It also indirectly detects the attitude and practice patterns of primary care providers in kidney stone prevention. MATERIALS AND METHODS: This is a qualitative study done in a single institution from January 2018 to January 2019 that includes 99 patients that were diagnosed with kidney or ureteral stone in ED and were discharged home, all of them where stone formers. They were asked to fill a self- administered questionnaire when they are able to read, or interviewed by the resident within the ED when they are unable to read. RESULTS: The majority of patients (68%) did not receive any instructions about kidney stones prevention within the ED. Most of patients who follow instructions if it was given were educated (90%), had an insurance coverage (85%), and had an income higher than $1000 per month (76%), (p < 0.05). Seventy one percents of patients believe in the effectiveness of stone prevention if it was provided and most of them are interested in learning about these preventive strategies (82%). Reasons for not following the instructions about kidney stones prevention measures were the cost (53.1%) following by the lack of explanation by ED physicians (18.8%). The majority of patients (62.6%) prefer to receive kidney stones prevention measures from urologists. CONCLUSION: Most of patients in our institute did not receive kidney stones prevention measures in ED despite that they declared their interest in following these measures. Most of the time they did not adhere to those measures due to socioeconomic factors and lack of clarifications. If these instructions were given within the ED, it could lead to an acceptable compliance rate.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Cálculos Renais/prevenção & controle , Cálculos Renais/psicologia , Relações Médico-Paciente , Adolescente , Adulto , Atitude do Pessoal de Saúde , Criança , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Sumários de Alta do Paciente Hospitalar/estatística & dados numéricos , Educação de Pacientes como Assunto , Médicos de Atenção Primária/psicologia , Inquéritos e Questionários , Adulto Jovem
7.
Diabetes Metab Syndr ; 13(4): 2689-2697, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31405695

RESUMO

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.


Assuntos
Biomarcadores/análise , Conhecimentos, Atitudes e Prática em Saúde , Programas de Rastreamento , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/prevenção & controle , Médicos de Atenção Primária/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Adulto , Atitude do Pessoal de Saúde , Estudos Transversais , Gerenciamento Clínico , Feminino , Seguimentos , Humanos , Masculino , Médicos de Atenção Primária/psicologia , Médicos de Atenção Primária/normas , Projetos Piloto , Prognóstico , Arábia Saudita , Inquéritos e Questionários
8.
BMC Health Serv Res ; 19(1): 534, 2019 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-31366355

RESUMO

BACKGROUND: In the United States, primary care providers (PCPs) routinely balance acute, chronic, and preventive patient care delivery, including cancer prevention and screening, in time-limited visits. Clinical decision support (CDS) may help PCPs prioritize cancer prevention and screening with other patient needs. In a three-arm, pragmatic, clinic-randomized control trial, we are studying cancer prevention CDS in a large, upper Midwestern healthcare system. The web-based, electronic health record (EHR)-linked CDS integrates evidence-based primary and secondary cancer prevention and screening recommendations into an existing cardiovascular risk management CDS system. Our objective with this study was to identify adoption barriers and facilitators before implementation in primary care. METHODS: We conducted semi-structured interviews guided by the Consolidated Framework for Implementation Research (CFIR) with 28 key informants employed by the healthcare organization in either leadership roles or the direct provision of clinical care. Transcribed interviews were analyzed using qualitative content analysis. RESULTS: EHR, CDS workflow, CDS users (providers and patients), training, and organizational barriers and facilitators were identified related to Intervention Characteristics, Outer Setting, Inner Setting, and Characteristics of Individuals CFIR domains. CONCLUSION: Identifying and addressing key informant-identified barriers and facilitators before implementing cancer prevention CDS in primary care may support a successful implementation and sustained use. The CFIR is a useful framework for understanding pre-implementation barriers and facilitators. Based on our findings, the research team developed and instituted specialized training, pilot testing, implementation plans, and post-implementation efforts to maximize identified facilitators and address barriers. TRIAL REGISTRATION: clinicaltrials.gov , NCT02986230 , December 6, 2016.


Assuntos
Sistemas de Apoio a Decisões Clínicas/organização & administração , Neoplasias/prevenção & controle , Atenção Primária à Saúde/organização & administração , Humanos , Médicos de Atenção Primária/psicologia , Pesquisa Qualitativa , Estados Unidos
9.
BMC Health Serv Res ; 19(1): 475, 2019 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-31296211

RESUMO

BACKGROUND: Measuring and reporting outcome data is fundamental for health care systems to drive improvement. Our electronic health record built a dashboard that allows each primary care provider (PCP) to view real-time population health quality data of their patient panel and use that information to identify care gaps. We hypothesized that the number of dashboard views would be positively associated with clinical quality improvement. METHODS: We performed a retrospective analysis of change in quality scores compared to number of dashboard views for each PCP over a five-month period (2017-18). Using the manager dashboard, we recorded the number of views for each provider. The quality scores analyzed were: colorectal cancer (CRC) screening rates and diabetic patients with an A1c greater than 9% or no A1c in the past year. RESULTS: Data from 120 PCPs were included. The number of dashboard views by each PCP ranged from 0 to 222. Thirty-one PCPs (25.8%) did not view their dashboard. We found no significant correlation between views and change in quality scores (correlation coefficient = 0.06, 95% CI [- 0.13, 0.25] and - 0.05, 95% CI [- 0.25, 0.14] for CRC and diabetes, respectively). CONCLUSION: Clinical dashboards provide feedback to PCPs and are likely to become more available as healthcare systems continue to focus on improving population health. However, dashboards on their own may not be sufficient to impact clinical quality improvement. Dashboard viewership did not appear to impact clinician performance on quality metrics.


Assuntos
Neoplasias Colorretais/prevenção & controle , Diabetes Mellitus/prevenção & controle , Registros Eletrônicos de Saúde/estatística & dados numéricos , Médicos de Atenção Primária/psicologia , Melhoria de Qualidade/estatística & dados numéricos , Detecção Precoce de Câncer/estatística & dados numéricos , Hemoglobina A Glicada/metabolismo , Humanos , Estudos Retrospectivos
10.
Artigo em Inglês | MEDLINE | ID: mdl-31284381

RESUMO

The aim of this paper is to measure the knowledge and attitudes of primary care physicians toward antibiotic prescriptions and their impacts on antibiotic prescribing. A questionnaire survey was conducted on 625 physicians from 67 primary care facilities in Hubei, China. Structural equation modelling (SEM) was applied to test the theoretical framework derived from the Knowledge, Attitudes, and Practices (KAP) theory. Physicians' knowledge, five sub-types of attitudes, and three sub-types of behavioral intentions towards antibiotic use were measured. Physicians had limited knowledge about antibiotic prescriptions (average 54.55% correct answers to 11 questions). Although they were generally concerned about antibiotic resistance (mean = 1.28, SD = 0.43), and were reluctant to be submissive to pressures from consumer demands for antibiotics (mean = 1.29, SD = 0.65) and the requirements of defensive practice (mean = 1.11, SD = 0.63), there was a lack of motivation to change prescribing practices (mean = -0.29, SD = 0.70) and strong agreement that other stakeholders should take the responsibility (mean = -1.15, SD = 0.45). The SEM results showed that poor knowledge, unawareness of antibiotic resistance, and limited motivation to change contributed to physicians' high antibiotics prescriptions (p < 0.001). To curb antibiotic over-prescriptions, improving knowledge itself is not enough. The lack of motivation of physicians to change needs to be addressed through a systematic approach.


Assuntos
Antibacterianos/uso terapêutico , Atitude , Competência Clínica , Intenção , Médicos de Atenção Primária/psicologia , Padrões de Prática Médica/estatística & dados numéricos , China , Análise de Classes Latentes
12.
J Opioid Manag ; 15(3): 183-191, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31343720

RESUMO

OBJECTIVE: To characterize primary care physicians' (PCPs') perceptions of the reasons patients receive opioid medications from both VA and non-VA healthcare systems. DESIGN: Qualitative. SETTING: Department of Veterans Affairs (VA). PARTICIPANTS: Forty-two VA PCPs who prescribed opioids to at least 15 patients and who practiced in Massachusetts, Illinois, or Pennsylvania. METHODS: Thirty-minute, semistructured telephone interviews were conducted in 2016, addressing topics regarding PCPs' experiences and perspectives on patients who use both VA and non-VA healthcare systems to obtain prescription opioids. The analysis focused on two questions: attributes that PCPs believe characterize dual-use patients and reasons that PCPs believe patients obtain opioids from both VA and non-VA sources. RESULTS: PCPs identified multiple attributes of, and reasons for, patients obtaining opioid medications from both VA and non-VA healthcare systems, including pain issues, opioid misuse, having healthcare managed through multiple healthcare systems, and transferring care between systems. More than half of the PCPs identified addiction and diversion as key attributes and reasons why patients obtain prescription opioids from multiple sources. PCPs also identified several behavioral and psychological factors as attributes of these patients. CONCLUSIONS: PCPs within the VA have varying perceptions of patients obtaining opioid medications from multiple healthcare systems, with pain complaints and opioid misuse as the primary themes. This knowledge about PCPs' perceptions can be incorporated into interventions to better manage pain and prescription opioid use by VA patients.


Assuntos
Analgésicos Opioides/administração & dosagem , Transtornos Relacionados ao Uso de Opioides , Médicos de Atenção Primária/psicologia , Veteranos , Humanos , Massachusetts , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Percepção , Veteranos/estatística & dados numéricos
13.
BMC Public Health ; 19(1): 1003, 2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31349786

RESUMO

BACKGROUND: This study explored primary healthcare provider and HIV/contraception expert stakeholder perspectives on South Africa's public sector provision of contraceptive implants to women living with HIV. We investigated the contraceptive service-impact of official advice against provision of implants to women using the HIV antiretroviral drug, efavirenz, issued by the South African National Department of Health (NDoH) in 2014. METHODS: Qualitative data was collected in Cape Town in 2017 from primary healthcare contraceptive providers in four clinics that provide implants, as well as from other expert stakeholders selected for expertise in HIV and/or contraception. In-depth interviews and a group discussion explored South Africa's implant introduction and implant provision to women living with HIV. Data was analysed using an inductive thematic analysis approach. RESULTS: Interviews were conducted with 10 providers and 10 stakeholders. None of the four clinics where the providers worked currently offered the implant to women living with HIV. Stakeholders confirmed that this was consistent with patterns of implant provision at primary healthcare facilities across Cape Town. Factors contributing to providers' decisions to suspend provision of the implant to women living with HIV included: inadequate initial and ongoing provider training; interpretation of NDoH communications about implant use with efavirenz; provider unwillingness to risk harming clients and concerns about professional liability; and other pressures related to provider capacity. CONCLUSIONS: All South African women, including those living with HIV, should have access to the full range of contraceptive options for which they are medically eligible. Changing guidance should be initiated and communicated in consultation with primary-level providers and service beneficiaries. Guidance issued to providers needs to be clear and fully evidence-informed, and its correct interpretation and implementation facilitated and monitored. Guidance should be accompanied by provider training, as well as counselling messages and tools to support providers. Generalized retraining of providers in rights-based, client-centred family planning, and in particular implant provision for women with HIV, is needed. These recommendations accord with the right of women living with HIV to access the highest possible standard of sexual and reproductive healthcare, including informed contraceptive choice and access to the contraceptive implant.


Assuntos
Atitude do Pessoal de Saúde , Anticoncepcionais Femininos , Implantes de Medicamento , Infecções por HIV/epidemiologia , Médicos de Atenção Primária/psicologia , Benzoxazinas/uso terapêutico , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Médicos de Atenção Primária/estatística & dados numéricos , Pesquisa Qualitativa , África do Sul/epidemiologia , Participação dos Interessados
14.
Surgery ; 166(5): 744-751, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31303324

RESUMO

BACKGROUND: Persistent opioid use is common after surgical procedures, and postoperative opioid prescribing often transitions from surgeons to primary care physicians in the months after surgery. It is unknown how surgeons currently transition these patients or the preferred approach to successful coordination of care. This qualitative study aimed to describe transitions of care for postoperative opioid prescribing and identify barriers and facilitators of ideal transitions for potential intervention targets. METHODS: We conducted a qualitative study of surgeons and primary care physicians at a large academic healthcare system using a semi-structured interview guide. Transcripts were independently coded using the Theoretical Domains Framework to identify underlying determinants of physician behaviors. We mapped dominant themes to the Behavior Change Wheel to propose potential interventions targeting these behaiors. RESULTS: Physicians were interviewed between July 2017 and December 2017 beyond thematic saturation (n = 20). Surgeons report passive transitions to primary care physicians after ruling out surgical complications, and these patients often bounce back to the surgeon when primary care physicians are uncertain of the cause of ongoing pain. Ideal practices were identified as setting preoperative expectations and engaging in active transition for postoperative opioid prescribing. We identified 3 behavioral targets for multidisciplinary intervention: knowledge (guidelines for coordination of care), barriers (utilizing support staff for active transition), and professional role (incentive for multidisciplinary collaboration). CONCLUSION: This qualitative study identifies potential interventions aimed at changing physician behaviors regarding transitions of care for postoperative opioid prescribing. Implementation of these interventions could improve coordination of care for patients with persistent postoperative opioid use.


Assuntos
Analgésicos Opioides/uso terapêutico , Atitude do Pessoal de Saúde , Dor Pós-Operatória/tratamento farmacológico , Transferência de Pacientes/organização & administração , Papel Profissional , Adulto , Prescrições de Medicamentos , Feminino , Humanos , Masculino , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Médicos de Atenção Primária/organização & administração , Médicos de Atenção Primária/psicologia , Padrões de Prática Médica/organização & administração , Pesquisa Qualitativa , Cirurgiões/organização & administração , Cirurgiões/psicologia
15.
GMS J Med Educ ; 36(3): Doc28, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31211223

RESUMO

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


Assuntos
Meio Ambiente , Médicos de Atenção Primária/educação , Atenção Primária à Saúde/métodos , Estudantes de Medicina/psicologia , Adulto , Currículo/normas , Feminino , Alemanha , Humanos , Entrevistas como Assunto/métodos , Masculino , Médicos de Atenção Primária/psicologia , Médicos de Atenção Primária/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Pesquisa Qualitativa , Estudantes de Medicina/estatística & dados numéricos
16.
Helicobacter ; 24(4): e12593, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31111627

RESUMO

INTRODUCTION: Dyspepsia and Helicobacter pylori are two of the most relevant digestive conditions in primary care. Several consensuses on the subject have been published, but the assimilation/implementation of these guidelines is uncertain. AIMS AND METHODS: To evaluate the attitudes, perceptions, limitations, and adherence to recommendations of Spanish primary care physicians using an open online survey. Responses were anonymously codified. Estimated margin of error was 3.4%. Responses were weighted by province, gender, age, and type of practice. Survey was performed using the AEG-REDCap platform. RESULTS: A total of 1445 responses, received between December 2017 and April 2018, were analyzed. Women represented 54%, and the average age was 48 years; 59% were from urban context, 20% from semi-urban, and 21% from rural; 93% provided public practice. Over 40% had read at least one Maastricht consensus (24% Maastricht V), and 34% had attended a course related to H. pylori. 16% reported no direct access to any validated diagnostic method, only 44% to urea breath test, and 33% did not systematically refer to eradication confirmation test. The first-line treatment of choice was standard triple therapy in 56%, followed by concomitant therapy (28%). Only 20% of physicians had optimal adherence to recommendations. CONCLUSION: Even though some improvements from guidelines have been partially incorporated, the level of penetration of recommendations is still poor and delayed. To provide optimal primary care, the barriers for implementation, access to diagnostic tests and to continuous medical education, should be removed. Rigorous dissemination, implementation, and evaluation programs are desired in future consensuses.


Assuntos
Atitude Frente a Saúde , Dispepsia/psicologia , Infecções por Helicobacter/psicologia , Médicos de Atenção Primária/psicologia , Adulto , Idoso , Tomada de Decisões , Dispepsia/etnologia , Dispepsia/terapia , Feminino , Infecções por Helicobacter/etnologia , Infecções por Helicobacter/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Percepção , Atenção Primária à Saúde/estatística & dados numéricos , Espanha , Inquéritos e Questionários
17.
PLoS One ; 14(5): e0215148, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31042733

RESUMO

BACKGROUND: This study reports on physicians' experiences with chronic pain management. For over a decade prescription opioids have been a primary treatment for chronic pain in North America. However, the current opioid epidemic has complicated long-standing practices for chronic pain management which historically involved prescribing pain medication. Caring for patients with chronic pain occurs within a context in which a growing proportion of patients suffer from chronic rather than acute conditions alongside rising social inequities. METHODS: Our team undertook an ethnographic approach known as institutional ethnography in the province of Ontario, Canada in order to explore the social organization of chronic pain management from the standpoint of primary care physicians. This paper reports on a subset of this study data, specifically interviews with 19 primary care clinicians and 8 nurses supplemented by 40 hours of observations. The clinicians in our sample were largely primary care physicians and nurses working in urban, rural and Northern settings. FINDINGS: In their reflections on providing care for patients with chronic pain, many providers describe being most challenged by the work involved in helping patients who also struggled with poverty, mental health and addiction. These frustrations were often complicated by concerns that they could lose their license for inappropriate prescribing, thus shifting their work from providing treatment and care to policing their patients for malingering and opioid abuse. INTERPRETATION: Our findings show that care providers find the treatment of patients with chronic pain-especially those patients also experiencing poverty-to be challenging at best, and at worst frustrating and overwhelming. In many instances, their narratives suggested experiences of depersonalization, loss of job satisfaction and emotional exhaustion in relation to providing care for these patients, key dimensions of burnout. In essence, the work that they performed in relation to their patients' social rather than medical needs seems to contribute to these experiences. Their experiences were further exacerbated by the fact that restricting and reducing opioid dosing in patients with chronic pain has become a major focus of care provision.


Assuntos
Dor Crônica/tratamento farmacológico , Enfermeiras e Enfermeiros/psicologia , Estresse Ocupacional/psicologia , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Médicos de Atenção Primária/psicologia , Antropologia Cultural , Feminino , Humanos , Satisfação no Emprego , Masculino , Estresse Ocupacional/epidemiologia , Ontário/epidemiologia , Manejo da Dor , Guias de Prática Clínica como Assunto , Padrões de Prática em Enfermagem , Padrões de Prática Médica , Fatores Socioeconômicos
18.
BMC Health Serv Res ; 19(1): 290, 2019 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-31068209

RESUMO

BACKGROUND: In 2014, Indonesia launched a mandatory national health insurance system called Jaminan Kesehatan Nasional (JKN). The reform introduced new conditions for primary care physicians (PCPs) that could influence their job satisfaction. This study assessed PCPs' satisfaction and its predictors in two cities in Central Java, Indonesia, following the reform. METHODS: In this exploratory, cross-sectional study, we recruited 276 PCPs from the selected area. The data were all collected in 2016 using self-report questionnaires and interviews. PCPs' satisfaction was measured using a modified version of the Warr-Cook-Wall Job Satisfaction Scale which contains 19 items and uses a Likert-type response scale. Analysis of variance, the Kruskal-Wallis H test, both with Bonferroni corrections for post hoc testing, and Cochran-Mantel-Haenszel tests were used to compare overall job satisfaction between participant groups. We used simple and multiple linear regression analyses to identify the predictors of PCP satisfaction. Furthermore, a logistic regression analysis for binary outcome was applied to model the PCPs intention to leave practice. RESULTS: PCPs' mean overall satisfaction level was 3.19 out of 5. They tended to be very satisfied with their relationship with colleagues, working hours, and physical working conditions. However, the PCPs were dissatisfied with the new referral system, the JKN health services standards, and JKN policy. The factors significantly associated with job satisfaction (p <  0.001) included type of practice, performance of managerial tasks, and PCPs' perceptions of and experiences with patients. PCP satisfaction was negatively associated (p = 0.004) with PCPs' intention to leave their practice. CONCLUSIONS: The PCPs investigated in these two cities in Central Java had moderate satisfaction after the Indonesian health care reform. PCPs who worked in solo practices, performed managerial tasks, and had good experiences with patients tended to have higher satisfaction scores, which in turn prevented them from developing an intention to leave their practice. The three aspects that PCPs with which most dissatisfied were related with the JKN reform. Because of that, the government and BPJS for Health should aim to improve the JKN system in order to increase PCPs' satisfaction.


Assuntos
Reforma dos Serviços de Saúde , Satisfação no Emprego , Médicos de Atenção Primária/psicologia , Adulto , Estudos Transversais , Feminino , Humanos , Indonésia , Masculino , Satisfação Pessoal , Médicos de Atenção Primária/estatística & dados numéricos , Inquéritos e Questionários
19.
Public Health ; 171: 15-23, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31075546

RESUMO

OBJECTIVES: Rheumatic heart disease (RHD) is a preventable disease frequently recognized in urban slums. Disease rates in Brazilian slums are incommensurate with the country's economic status and the existence of its universal healthcare system. Our study aimed to investigate what system issues may allow for disease persistence, focusing on issues surrounding access and utilization of primary and specialized healthcare services. STUDY DESIGN: This was a two-part (formative phase followed by implementation phase) qualitative study based on interviews and focus groups and analyzed via content analysis. METHODS: One focus group and 17 in-depth interviews with community health workers, primary care providers, and cardiologists who serve slum residents in Brazil and six interviews with key informants (community health researchers and cardiologists) were performed. Interviews with community health workers and primary care providers were from a single heath post in the neighborhood of Liberdade, a populous and previously unstudied slum in Salvador. Cardiologists were recruited from tertiary care referral hospitals in Salvador. RESULTS: Our findings revealed six major chronological categories/themes of issues and twenty subthemes that patients must overcome to avoid developing RHD or to have it successfully medically managed. Major themes include the effects of living in a slum (1), barriers to access and utilization of primary healthcare services (2), treatment in primary healthcare services (3), access/utilization of specialized healthcare services (4), treatment in specialized healthcare services (5), and certain systemic issues (6). CONCLUSION: Slums make residents sick in a manner of ways, and various bottlenecks impeding medical access to both primary care and specialty care exist, requiring multifaceted interventions. We detail major themes and finally suggest interventions that can allow for the health system to successfully eliminate RHD as a public health concern for slum residents.


Assuntos
Pessoal de Saúde/psicologia , Acesso aos Serviços de Saúde , Áreas de Pobreza , Cardiopatia Reumática/prevenção & controle , Cobertura Universal do Seguro de Saúde , Brasil/epidemiologia , Cardiologistas/psicologia , Agentes Comunitários de Saúde/psicologia , Grupos Focais , Humanos , Médicos de Atenção Primária/psicologia , Pesquisa Qualitativa , Cardiopatia Reumática/epidemiologia , Determinantes Sociais da Saúde
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