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1.
J Am Board Fam Med ; 34(Suppl): S61-S70, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33622820

RESUMO

BACKGROUND: Primary care practices rapidly adopted telemedicine visits because of the COVID-19 pandemic, but information on physician perspectives about these visits is lacking. METHODS: Fifteen semistructured interviews with practicing primary care physicians and physicians-in-training from a Southern California academic health system and group-model health maintenance organization were conducted to assess physician perspectives regarding the benefits and challenges of telemedicine. RESULTS: Physicians indicated that telemedicine improved patient access to care by providing greater convenience, although some expressed concern that certain groups of vulnerable patients were unable to navigate or did not possess the technology required to participate in telemedicine visits. Physicians noted that telemedicine visits offered more time for patient counseling, opportunities for better medication reconciliations, and the ability to see and evaluate patient home environments and connect with patient families. Challenges existed when visits required a physical examination. Physicians were very concerned about the loss of personal connections and touch, which they believed diminished expected rituals that typically strengthen physician-patient relationships. Physicians also observed that careful consideration to physician workflows may be needed to avoid physician burnout. CONCLUSIONS: Physicians reported that telemedicine visits offer new opportunities to improve the quality of patient care but noted changes to their interactions with patients. Many of these changes are positive, but it remains to be seen whether others such as lack of physical examination and loss of physical presence and touch adversely influence provider-patient communication, patient willingness to disclose concerns that may affect their care, and, ultimately, patient health outcomes.


Assuntos
Atitude do Pessoal de Saúde , Relações Médico-Paciente , Médicos de Atenção Primária/psicologia , Telemedicina/organização & administração , Adulto , Feminino , Acesso aos Serviços de Saúde/organização & administração , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Exame Físico/psicologia , Pesquisa Qualitativa
2.
Support Care Cancer ; 29(1): 223-230, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32338315

RESUMO

PURPOSE: To examine primary care physician's (PCPs) internal (confidence, training) and external (communication, receipt of survivorship care plans (SCPs)) regarding their provision of survivorship care to older breast cancer survivors METHOD: A web-based questionnaire was completed individually by PCPs about their training and areas of survivorship they address under their care. A subset of survey participants was interviewed about survivorship care for older breast cancer survivors, care coordination, and areas of improvement regarding SCPs. RESULTS: PCPs (n = 29) had an average 13.5 years in family practice. Forty-five percent surveyed as "somewhat confident" or "not confident" evaluating and managing the late effects of cancer treatment, and 25% surveyed as "somewhat confident" or "not confident" addressing the chronic comorbidities of older breast cancer survivors. More than half of PCPs surveyed that they reach out to their patients' oncologist "a little" or "none of the time" and that they receive SCPs "a little" or "none of the time." Semi-structured interviews also indicated that many PCPs did not receive a SCP from their patients' oncologists and that communication between the two providers regarding survivorship care was poor. CONCLUSION: Participants indicated that PCP confidence in providing survivorship care is lacking and that lack of training, infrequent communication with oncologists, and underutilization of SCPs may contribute to this lack of confidence. These findings provide insight into the possible need for a well-defined shared care model, which has been encouraged but not always a routine part of survivorship care in various practice settings.


Assuntos
Neoplasias da Mama/terapia , Sobreviventes de Câncer/estatística & dados numéricos , Médicos de Atenção Primária/psicologia , Atenção Primária à Saúde/métodos , Autoimagem , Adulto , Mama/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Sobrevida , Sobrevivência
3.
Rev Med Suisse ; 16(707): 1767-1770, 2020 Sep 23.
Artigo em Francês | MEDLINE | ID: mdl-32969615

RESUMO

Since the creation of Balint groups in the 1950s, the concept of meeting among doctors to discuss difficult clinical situations has spread widely, whether or not in line with Michael Balint's initial model. While the latter had thought of these groups as training, their therapeutic role was quickly questioned in the medical literature. At a time when we are seeing and concerned about the poor mental health of primary care doctors, we wanted to show that the added value provided by participation in a practice exchange group is both formative and therapeutic. In this sense, the participation of GP in such a group is part of the recommendations to improve the quality of care, prevent caregivers from burnout, and improve their professional satisfaction.


Assuntos
Esgotamento Profissional/prevenção & controle , Processos Grupais , Médicos de Atenção Primária/educação , Médicos de Atenção Primária/psicologia , Humanos , Satisfação no Emprego
4.
PLoS One ; 15(9): e0239035, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32915906

RESUMO

BACKGROUND: Trust in healthcare providers has been shown to improve several clinical and patient-reported outcomes. However, its relationship with depression and anxiety has not been investigated among patients with chronic health conditions, such as diabetes. Therefore, the aim of this study was to examine whether trust in primary care physicians among patients with diabetes is associated with their levels of depression and/or anxiety. METHOD: Adult patients (≥18 years) with a diagnosis of diabetes, confirmed through their electronic health records, were recruited and interviewed from the primary care clinics of three public hospitals. Patient trust in primary care physicians was assessed using the Health Care Relationship (HCR) Trust scale. Depression and anxiety were assessed using the Patient Health Questionnaire 9-item (PHQ-9) and Generalized Anxiety Disorder 7-item (GAD-7), respectively. Two multiple linear regression analyses were conducted to examine the association of HCR-Trust scores with PHQ-9 and GAD-7 scores controlling for age, sex, Charlson comorbidity index score, education, health literacy, annual income, nationality, duration of illness, and research site. RESULTS: The number of patients who agreed to be interviewed was 367. Most of the participants were female (61.54%) and Saudi (92.86%). High HCR-Trust scores were negatively associated with PHQ-9 scores (ß = -0.18; 95% CI: -0.23 --0.13; P = < .0001), and GAD-7 scores (ß = -0.17; 95% CI: -0.22- -0.12; P = < .0001). CONCLUSIONS: Trust in primary care physicians among patients with diabetes was associated with lower levels of depression and anxiety. Therefore, healthcare providers should adopt a patient-centered care approach that fosters trust in the relationship between their patients and themselves. Further research should explore whether interventions that foster shared decision-making and trust in healthcare providers might also improve the health outcomes of patients with diabetes.


Assuntos
Ansiedade/epidemiologia , Depressão/epidemiologia , Diabetes Mellitus/psicologia , Médicos de Atenção Primária/psicologia , Relações Profissional-Paciente , Adulto , Idoso , Estudos Transversais , Feminino , Pessoal de Saúde/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Questionário de Saúde do Paciente , Arábia Saudita/epidemiologia , Confiança
5.
JAMA Netw Open ; 3(6): e206772, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32511720

RESUMO

Importance: Despite clinical practice guidelines recommending against routine cancer screening in older adults with limited life expectancy, older adults are still frequently screened for breast, colorectal, and prostate cancers. Objective: To examine primary care clinicians' decision-making on stopping breast, colorectal, or prostate cancer screening in older adults with limited life expectancy. Design, Setting, and Participants: In qualitative interviews coupled with medical record-stimulated recall, clinicians from 17 academic and community clinics affiliated with a large health system were asked how they came to specific cancer screening decisions in 2 or 3 of their older patients with less than 10-year of estimated life expectancy, including patients with and without recent screening. Patients were surveyed by telephone. Data collection occurred between October 2018 and May 2019. Main Outcomes and Measures: Clinician interviews were audio-recorded and transcribed verbatim. Transcripts were analyzed with qualitative content analysis to identify major themes. Patient surveys assessed perception of cancer screening decisions, importance of clinician recommendation, and willingness to stop screening. Results: Twenty-five primary care clinicians (mean [SD] age, 47.1 [9.7] years; 14 female [56%]) discussed 53 patients during medical record-stimulated recall, ranging from 2 to 3 patients per clinician; 46 patients and 1 caregiver (mean [SD] age 74.9 [5.4]; 31 female [66%]) participated in the survey. Clinician interviews revealed 5 major themes: (1) cancer screening decisions were not always conscious, deliberate decisions; (2) electronic medical record alerts were connected with less deliberate decision-making; (3) cancer screening was not binary and clinicians often considered other options to scale back screening without actually stopping; (4) in addition to patient characteristics, clinicians were influenced by patient request and anecdotal experiences; and (5) influences outside of the primary care clinician-patient dyad were important, such as from specialists and patients' family or friends. Patient surveys asked approximately 64 cancer screening decisions of 47 patients. Patients did not recall approximately half (31 of 64) of their cancer screening decisions. Among those with recent screening, the mean score for willingness to stop screening was 3.2 (95% CI 2.5-3.9) on a 5-point Likert scale (with 1 indicating "extremely unlikely" and 5 indicating "extremely likely"). In most screening decisions that involved specialists (13 of 16), patients valued specialists' recommendations over those of primary care clinicians. Conclusions and Relevance: Cancer screening decision-making is complex. Study findings suggest that strategies that facilitate more deliberate decision-making may be important in cancer screening of older adults with limited life expectancy.


Assuntos
Tomada de Decisão Clínica/ética , Detecção Precoce de Câncer/ética , Expectativa de Vida/tendências , Programas de Rastreamento/ética , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Avaliação como Assunto , Feminino , Humanos , Entrevistas como Assunto , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Médicos de Atenção Primária/psicologia , Médicos de Atenção Primária/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Inquéritos e Questionários
6.
AIDS Care ; 32(8): 994-1000, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32539453

RESUMO

Recently, research has shifted from investigating the effectiveness of HIV pre-exposure prophylaxis (PrEP) to strategizing its implementation. Several European studies have explored physicians' perspectives on implementing PrEP in diverse settings, yet there are no data on the situation in Germany. The purpose of this study was to explore physicians' perspectives on current PrEP care in Germany. From April to July 2018, we conducted 16 semi-structured interviews with HIV providers (HIVPs) and primary care physicians (PCPs). Transcripts were analyzed using thematic content analysis. Physicians showed varying levels of PrEP expertise. Many PCPs lacked knowledge about PrEP. Some PCPs did not support the idea of PrEP as a prophylactic option. Opinions about PCPs' role in PrEP care were diverging, yet most PCPs favored referring PrEP clients to an HIVP or opted for a shared-care arrangement. Perceived problems included stigma and lack of privacy for PrEP care in rural areas. Our findings highlight the need for tailored physician training, which should be addressed in PrEP implementation in Germany.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Médicos de Atenção Primária/psicologia , Padrões de Prática Médica/estatística & dados numéricos , Profilaxia Pré-Exposição , Adulto , Idoso , Feminino , Alemanha , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa
7.
Saudi Med J ; 41(6): 645-651, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32518933

RESUMO

OBJECTIVES: To determine the knowledge of primary healthcare (PHC) physicians and factors influencing implementation of the catch-up vaccination program in PHC clinics in Dammam, Saudi Arabia. Methods: A cross-sectional study was conducted with a sample of 136 general and family physicians between October 2018 and August 2019 in PHC clinics. A self-administered questionnaire related to knowledge, practices, and factors affecting their practices regarding vaccination was given to participants. Their responses were assessed for level of knowledge, practices regarding the vaccination program, and factors affecting their practices, and then compared between family and general physicians. Results: The majority of physicians (60%) surveyed had good knowledge of the catch-up vaccination program and no significant difference was observed between family and general physicians. Most physicians (60%) demonstrated correct knowledge of vaccination schedules and gaps between vaccines; no significant differences were observed between family and general physicians, except for the next scheduled child visit after 3 months, for the 18-month vaccination. A statistically significant difference was observed between family and general physicians related to attending educational lectures and seeing children younger than 5 years. General physicians were more involved in the vaccination program. Conclusion: The overall knowledge and practices of the catch-up vaccination program was satisfactory among PHC physicians. However, a lack of family physicians' involvement in the vaccination program was observed that needs to be addressed in their training program.


Assuntos
Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Programas de Imunização , Médicos de Atenção Primária/psicologia , Padrões de Prática Médica , Atenção Primária à Saúde , Vacinação , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Arábia Saudita , Inquéritos e Questionários
11.
Int J Med Inform ; 137: 104072, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32200295

RESUMO

BACKGROUND: To explore attitudes about artificial intelligence (AI) among staff who utilized AI-based clinical decision support (CDS). METHODS: A survey was designed to assess staff attitudes about AI-based CDS tools. The survey was anonymously and voluntarily completed by clinical staff in three primary care outpatient clinics before and after implementation of an AI-based CDS system aimed to improve glycemic control in patients with diabetes as part of a quality improvement project. The CDS identified patients at risk for poor glycemic control and generated intervention recommendations intended to reduce patients' risk. RESULTS: Staff completed 45 surveys pre-intervention and 38 post-intervention. Following implementation, staff felt that care was better coordinated (11 favorable responses, 14 unfavorable responses pre-intervention; 21 favorable responses, 3 unfavorable responses post-intervention; p < 0.01). However, only 14 % of users would recommend the AI-based CDS. Staff feedback revealed that the most favorable aspect of the CDS was that it promoted team dialog about patient needs (N = 14, 52 %), and the least favorable aspect was inadequacy of the interventions recommended by the CDS. CONCLUSIONS: AI-based CDS tools that are perceived negatively by staff may reduce staff excitement about AI technology, and hands-on experience with AI may lead to more realistic expectations about the technology's capabilities. In our setting, although AI-based CDS prompted an interdisciplinary discussion about the needs of patients at high risk for poor glycemic control, the interventions recommended by the CDS were often perceived to be poorly tailored, inappropriate, or not useful. Developers should carefully consider tasks that are best performed by AI and those best performed by the patient's care team.


Assuntos
Inteligência Artificial/estatística & dados numéricos , Sistemas de Apoio a Decisões Clínicas/organização & administração , Diabetes Mellitus/prevenção & controle , Pessoal de Saúde/estatística & dados numéricos , Implementação de Plano de Saúde , Médicos de Atenção Primária/psicologia , Atenção Primária à Saúde/organização & administração , Instituições de Assistência Ambulatorial , Inteligência Artificial/tendências , Índice Glicêmico , Humanos , Melhoria de Qualidade , Software , Inquéritos e Questionários
12.
Nutr Metab Cardiovasc Dis ; 30(4): 608-615, 2020 04 12.
Artigo em Inglês | MEDLINE | ID: mdl-32131986

RESUMO

BACKGROUND AND AIMS: Engaging healthcare providers (HCPs) is critical for early identification of overweight and obesity. The aim of this study is to describe the trend in clinicians' adherence to clinical recommendations to discuss body weight status with adults with overweight and obesity. METHODS AND RESULTS: We analyzed the data of adults aged 20 and older with overweight or obesity from the National Health and Nutrition Examination Surveys, 1999 to 2016 with a 2-year data-release cycle. The question of interest was "Has a doctor or other health professionals ever told you that you were overweight?" Adjusted biennial percentage ratio (abPR) of being notified was estimated. We observed a significant increasing trend of notification in adults with overweight [abPR = 1.04 (95% confidence interval: 1.03, 1.06), about 4% increase for every two-years] and obesity [1.01 (1.00, 1.02)]. The highest increase occurred in adults with overweight aged 20-34 [1.12 (1.08, 1.16)], however, young adults with overweight remained the group with the lowest percentage (24%, 2015-2016 survey) of notification compared to others in recent survey. Notification in adults with obesity demonstrated similar trends. In 2015-2016, among adults with obesity who visited HCPs last year, 80% of these aged 50-64 and 78% of these aged 65 and older were notified. More than 80% of adults with overweight or obesity visited HCPs at least once last year. CONCLUSIONS: There was an improvement in informing patients of overweight/obesity status. However, less than a quarter of young adults with overweight were notified in recent surveys, compromising the opportunities of preventing overweight from becoming obesity in early adulthood.


Assuntos
Atitude do Pessoal de Saúde , Peso Corporal , Comunicação em Saúde , Conhecimentos, Atitudes e Prática em Saúde , Obesidade/diagnóstico , Médicos de Atenção Primária/psicologia , Padrões de Prática Médica , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Obesidade/epidemiologia , Obesidade/fisiopatologia , Relações Médico-Paciente , Atenção Primária à Saúde , Fatores de Tempo , Estados Unidos/epidemiologia , Adulto Jovem
13.
Support Care Cancer ; 28(10): 4923-4931, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32016600

RESUMO

BACKGROUND: Primary care providers (PCPs) are critical to the provision of comprehensive care for cancer survivors, yet there is very little data on the practices and quality of survivorship care occurring in safety net primary care settings. This study aimed to assess the knowledge and attitudes of PCPs and preferences for care models for breast and colon cancer survivors in a safety net health network. METHODS: A modified National Cancer Institute Survey of Physician Attitudes Regarding the Care of Cancer Survivors was sent electronically to 220 PCPs in 12 primary care clinics in the San Francisco Health Network affiliated with Zuckerberg San Francisco General Hospital and Trauma Center. RESULTS: The response rate was 50% (110/220). About half of PCPs strongly/somewhat agreed (vs. strongly/somewhat disagreed) that PCPs have the knowledge needed to provide follow-up care related to breast (50%) and colon cancer (54%). Most providers (93%) correctly reported recommended frequency of mammography, however, frequency of blood tests and other imaging surveillance were not as well recognized for breast or colon cancer. Recognition of long-term side effects of chemotherapy drugs ranged from 12% for oxaliplatin to 44% for doxorubicin. Only 33% of providers reported receiving any survivorship training. The most preferred model for survivorship care was shared care model (40%). CONCLUSIONS: Safety net PCPs prefer a shared care model for care of cancer survivors but are limited by lack of training, poor communication, and poor delineation of roles. Patient-centered survivorship care can be improved through effective oncologist-PCP-patient partnerships and coordination.


Assuntos
Neoplasias da Mama/reabilitação , Sobreviventes de Câncer , Neoplasias do Colo/reabilitação , Assistência ao Convalescente , Atitude do Pessoal de Saúde , Neoplasias da Mama/diagnóstico , Neoplasias do Colo/diagnóstico , Continuidade da Assistência ao Paciente , Feminino , Humanos , Conhecimento , Masculino , Pessoa de Meia-Idade , Médicos de Atenção Primária/psicologia , Médicos de Atenção Primária/normas , Médicos de Atenção Primária/estatística & dados numéricos , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/normas , Atenção Primária à Saúde/estatística & dados numéricos , São Francisco , Autoeficácia , Inquéritos e Questionários
14.
J Nerv Ment Dis ; 208(3): 238-244, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31904669

RESUMO

Latinos in the United States are less likely to take antidepressants than non-Latino whites, and more likely to prefer depression treatment in primary care. This preliminary study comprised focus groups (2) with primary care providers (12) serving uninsured immigrant Latinos regarding their experiences prescribing and counseling patients about antidepressants. Barriers and challenges included health literacy, language barriers, and illiteracy; perceived stigma; patients' concerns about addiction, polypharmacy, and adverse effects; time constraints of office visits; and difficulty discussing comorbid posttraumatic stress disorder. Messages providers try to share with patients included allowing time for medications to work, taking medications daily as prescribed, mechanisms of action, weighing risks versus benefits, and flexible options for treatment. Providers' recommendations for improving this process included better low-literacy, culturally appropriate written materials with pictures or videos discussing depression. More research is needed to understand patients' and providers' needs in optimizing counseling about antidepressants, particularly regarding underserved and at-risk US populations.


Assuntos
Antidepressivos/uso terapêutico , Atitude do Pessoal de Saúde , Emigrantes e Imigrantes/psicologia , Hispano-Americanos/psicologia , Médicos de Atenção Primária/psicologia , Feminino , Grupos Focais , Letramento em Saúde , Humanos , Proficiência Limitada em Inglês , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Estigma Social
15.
PLoS One ; 15(1): e0227890, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31935271

RESUMO

BACKGROUND: Norovirus is a leading cause of acute gastroenteritis (AGE) across the age spectrum; candidate vaccines are in clinical trials. While norovirus diagnostic testing is increasingly available, stool testing may not be performed routinely, which can hamper surveillance and burden of disease estimates. Additionally, lack of knowledge of the burden of disease may inhibit provider vaccine recommendations, which could affect coverage rates and ultimately the impact of the vaccine. Our objectives were to understand physicians' stool testing practices in outpatients with AGE, and physician knowledge of norovirus, in order to improve surveillance and prepare for vaccine introduction. METHODS: Internet and mail survey on AGE, norovirus, and future norovirus vaccines conducted January to March 2018 among national networks of primary care pediatricians, family practice and general internal medicine physicians. RESULTS: The response rate was 59% (820/1383). During peak AGE season, physicians estimated they ordered stool tests for a median of 15% (interquartile range: 5-33%) of their outpatients with AGE. Stool tests were reported as more often available for ova and parasites, Clostridioides difficile, and bacterial culture (>95% for all specialties) than for norovirus (6-33% across specialties); even when available, norovirus-specific tests were infrequently ordered. Most providers were unaware that norovirus is a leading cause of AGE across all age groups (Pediatricians 80%, Family Practice 86%, General Internal Medicine 89%) or that alcohol-based hand sanitizers are ineffective against norovirus (Pediatricians 51%, Family Practice 66%, General Internal Medicine 62%). Concerns cited as major barriers to implementing a future norovirus vaccine included if the vaccine is not covered by insurance (General Internal Medicine 64%, Pediatricians 67%, Family Practice 74%) and lack of adequate reimbursement for vaccination (Pediatricians 43%, General Internal Medicine 46%, Family Practice 50%). Factors that providers believed were 'not at all a barrier' or 'minor barrier' to new vaccine introduction included the belief that "my patients won't need this vaccine" (General Internal Medicine 78%, Family Practice 86%, Pediatricians 90%) and "my patients already get too many vaccines" (Family Practice 89%, General Internal Medicine 92%, Pediatricians 95%). CONCLUSIONS: Primary care physicians had few concerns regarding future norovirus vaccine introduction, but have knowledge gaps on norovirus prevalence and hand hygiene for prevention. Also, physicians infrequently order stool tests for outpatients with AGE, which limits surveillance estimates that rely on physician-ordered stool diagnostics. Closing physician knowledge gaps on norovirus burden and transmission can help support norovirus vaccine introduction.


Assuntos
Atitude do Pessoal de Saúde , Gastroenterite/epidemiologia , Norovirus/isolamento & purificação , Médicos de Atenção Primária/psicologia , Feminino , Gastroenterite/diagnóstico , Gastroenterite/patologia , Gastroenterite/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Norovirus/patogenicidade , Médicos/psicologia , Vacinas/uso terapêutico
16.
BMC Fam Pract ; 21(1): 12, 2020 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-31941455

RESUMO

BACKGROUND: Low job satisfaction, severe burnout and high turnover intention are found to be prevalent among the primary care providers (PCPs) in township health centers (THCs), but their associations have received scant attention in the literature. In light of this, this study aims to examine the relationships between job satisfaction, burnout and turnover intention, and explore the predictors of turnover intention with a view to retaining PCPs in rural China. METHODS: Using the multistage cluster sampling method, a cross-sectional survey was conducted in Shandong Province, China. 1148 PCPs from 47 THCs participated in this study. Job satisfaction, burnout and turnover intention were measured with a multifaceted instrument developed based on the existing literature, the Maslach Burnout Inventory and the participants' responses to a Likert item drawn from the literature, respectively. The relationships of the three factors were examined using Pearson correlation and structural equation modeling, while the predictors of turnover intention were investigated using multivariate logistic regression. RESULTS: The subscale that the PCPs were most dissatisfied with was job rewards (95.12%), followed by working environment (49.65%) and organizational management (47.98%). The percentages of the PCPs reporting high-levels of emotional exhaustion, depersonalization and reduced personal accomplishment were 27.66, 6.06, and 38.74%, respectively. About 14.06% of the respondents had high turnover intention. There was a significant direct effect of job satisfaction on burnout (γ = - 0.52) and turnover intention (γ = - 0.29), a significant direct effect of burnout on turnover intention (γ = 0.28), and a significant indirect effect (γ = - 0.14) of job satisfaction on turnover intention through burnout as a mediator. Work environment satisfaction, medical practicing environment satisfaction, and organizational management satisfaction proved to be negative predictors of turnover intention (p < 0.05), whereas reduced personal accomplishment was identified as a positive predictor (p < 0.05). CONCLUSIONS: Plagued by low job satisfaction and severe burnout, the PCPs in rural China may have high turnover intentions. Job satisfaction had not only negative direct effects on burnout and turnover intention, but also an indirect effect on turnover intention through burnout as a mediator. Targeted strategies should be taken to motivate and retain the PCPs.


Assuntos
Esgotamento Profissional/epidemiologia , Pessoal de Saúde/estatística & dados numéricos , Intenção , Satisfação no Emprego , Reorganização de Recursos Humanos , Médicos de Atenção Primária/estatística & dados numéricos , População Rural/estatística & dados numéricos , Adulto , Esgotamento Profissional/psicologia , China/epidemiologia , Estudos Transversais , Feminino , Pessoal de Saúde/psicologia , Humanos , Análise de Classes Latentes , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros , Médicos de Atenção Primária/psicologia , Recompensa , Salários e Benefícios , Local de Trabalho
17.
J Womens Health (Larchmt) ; 29(3): 406-411, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31895647

RESUMO

Background: Women who occasionally or regularly have sex with other women (WSW) are rarely identified in primary care. Although we know about their specific health needs, health care professionals still find it difficult to ask questions about sexual orientation (SO) and behaviors, and sometimes, patients may find them difficult to answer. The presumption of heterosexuality still remains a widespread attitude in health care. This study took place in a primary care setting, and aimed to identify differences in gynecological health care and clinical practice for women, according to what their presumed SO and behaviors were. Methods: We conducted a cross-sectional observational, descriptive, and comparative study from October 2018 to February 2019. Three hundred thirty-eight general practitioners (GPs) from Rhône-Alpes area (France) received an anonymous questionnaire with clinical case vignettes. The main outcome was the percentage of GPs who perform a different gynecological follow-up for WSW and non-WSW. Results: In total, 165 questionnaires were analyzed. Ninety percent of respondents performed a different gynecological follow-up for WSW, compared with other women. They less often addressed topics such as contraception needs, use of barrier protections, and screening of sexually transmitted infections. Ninety-two percent of respondents were aware that they have WSW among their patients, but 2/3 of them never or rarely asked about SO. Conclusion: Most GPs know that they manage WSW but may misidentify these patients and their real care needs. Therefore, WSW receive a different and poorer follow-up than non-WSW. Clinical guidelines would be useful to improve and standardize quality and experience of health care for WSW.


Assuntos
Atitude do Pessoal de Saúde , Ginecologia/estatística & dados numéricos , Homossexualidade Feminina/estatística & dados numéricos , Médicos de Atenção Primária/psicologia , Bissexualidade/estatística & dados numéricos , Estudos Transversais , Feminino , França , Humanos , Masculino , Médicos de Atenção Primária/estatística & dados numéricos , Comportamento Sexual , Parceiros Sexuais , Doenças Sexualmente Transmissíveis/prevenção & controle , Inquéritos e Questionários
18.
J Genet Couns ; 29(1): 122-130, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31729099

RESUMO

BRCA1 and BRCA2 (BRCA1/2) testing is standard for individuals with personal and/or family history suggestive of hereditary breast and ovarian cancer syndrome. The indications for testing have been expanding. To accommodate the need, incorporation of cancer genetic services into the practice of non-genetic healthcare providers should be considered. We carried out a survey to evaluate the knowledge and opinions regarding BRCA1/2 testing among primary care providers. The survey was sent to 245 Obstetrics/Gynecology and 97 Family Medicine physicians in the UPMC network. Eighty-six completed the survey between July 2015 and September 2015. The average correct responses to knowledge questions was 73%. A few respondents reported being completely confident, and ~50% reported being somewhat confident, in providing BRCA1/2-related information. Respondents selected genetic specialists and oncologists as the most qualified to provide cancer genetic services. Several perceived barriers and motivating factors to the implementation of BRCA1/2 testing in primary care were identified. The findings from this study suggested that primary care providers were not uniformly ready to provide BRCA1/2 genetic testing. Availability of professional society guidelines and evidence of testing's usefulness might motivate the incorporation of BRCA1/2 genetic testing into primary care practices. These findings would help guide future educational efforts to promote provision of cancer genetic services by non-genetic professionals.


Assuntos
Atitude do Pessoal de Saúde , Neoplasias da Mama/genética , Genes BRCA1 , Genes BRCA2 , Testes Genéticos , Médicos de Atenção Primária/psicologia , Adulto , Feminino , Predisposição Genética para Doença , Humanos , Pessoa de Meia-Idade , Inquéritos e Questionários
19.
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
20.
Prev Med ; 130: 105875, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31678174

RESUMO

HIV disproportionately affects persons in Southeast United States. Primary care providers (PCPs) are vital for HIV prevention. Data are limited about their prescribing of antiretrovirals (ARVs) for prevention, including non-occupational post-exposure prophylaxis (nPEP), pre-exposure prophylaxis (PrEP), and antiretroviral therapy (ART). We examined these practices to assess gaps. During April-August 2017, we conducted an online survey of PCPs in Atlanta, Baltimore, Baton Rouge, Miami, New Orleans, and Washington, DC to assess HIV-related knowledge, attitudes and practices. Adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) were used to estimate correlates of nPEP, PrEP and ART prescribing practices. Adjusting for MSA and specialty, the weighted sample (n = 820, 29.6% adjusted response rate) comprised 60.2% white and 59.4% females. PCPs reported ever prescribing nPEP (31.0%), PrEP (18.1%), and ART (27.2%). Prescribing nPEP was associated with nPEP familiarity (aPR = 2.63, 95% CI 1.59, 4.35) and prescribing PrEP (aPR = 3.57, 95% CI 2.78, 4.55). Prescribing PrEP was associated with PrEP familiarity (aPR = 4.35, 95% CI 2.63, 7.14), prescribing nPEP (aPR = 5.00, 95% CI 2.00, 12.50), and providing care for persons with HIV (aPR = 1.56, 95% CI 1.06, 2.27). Prescribing ART was associated with nPEP familiarity (aPR = 1.89, 95% CI 1.27, 2.78) and practicing in outpatient public practice versus hospital-based facilities (aPR = 2.14 95% CI 1.51, 3.04), and inversely associated with collaborations involving specialists (aPR = 0.60, 95% CI 0.42, 0.86). A minority of PCPs surveyed from the Southeast report ever prescribing ARVs for prevention. Future efforts should include enhancing HIV care coordination and developing strategies to increase use of biomedical tools.


Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Médicos de Atenção Primária/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Adulto , Feminino , Infecções por HIV/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Médicos de Atenção Primária/psicologia , Sudeste dos Estados Unidos , Inquéritos e Questionários
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