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1.
S D Med ; 72(7): 306-308, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31461585

RESUMO

PURPOSE: Physician burnout is prevalent in family physicians. Burnout has been associated with an intent to leave practice location. This is especially concerning in many rural areas, which already have physician shortages. While other demographic characteristics of burnout have been assessed, no previously published studies were found that have specifically compared family physician burnout rates in rural versus metropolitan areas. We hypothesized that rural family physicians have higher burnout rates due to increased practice demands and lack of resources. METHODS: Three hundred and two graduates of a Midwest family medicine residency program were surveyed to assess burnout rates in rural (practicing in towns less than 10,000 people) versus medium-sized towns (10,000- 50,000 people) and metropolitan areas (greater than 50,000 people). Burnout was determined by a one question assessment tool that has been validated with the Maslach Burnout Inventory Emotional Exhaustion Index. FINDINGS: Ninety-nine surveys were completed. Twenty-five percent of rural respondents reported burnout, compared to 37.5 percent of respondents in medium-sized towns, and 51.4 percent of respondents practicing in metropolitan areas. These results were statistically significant (p value=0.0183). CONCLUSION: These results were unexpected and may indicate that a rural practice location has a positive effect on physician well-being, which could encourage physicians to pursue rural practice. A larger study of this issue would be beneficial.


Assuntos
Esgotamento Profissional , Médicos de Família , Esgotamento Psicológico , Humanos , Médicos de Família/psicologia , Projetos Piloto , Saúde da População Rural , População Rural
3.
Pan Afr Med J ; 32: 66, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31223358

RESUMO

Introduction: The International Classification of Primary Care, Second version (ICPC-2) aligned with the 10th Revision of the International Classification of Disease (ICD-10) is a standard for primary care epidemiology compendium. ICPC-2 has been also intended to identify the clinical topics in family medicine. Contextual field-specific knowledge in family medicine and primary care such as health structures, management, categories of patients, research methods, ethical or environmental features are not standardized and reflect, more often, the views of experts. Methods: A qualitative research method, applied to the analysis of several Family Medicine congresses, has helped identify, in addition to clinical items, a spectrum of contextual concepts addressed by family doctors during their exchanges at the congresses. Assembled in a hierarchical manner, these concepts were given expression, together with ICPC-2, under the name of Q-codes Version 2.5, in the multilingual multi-terminology semantic server of the Department of Information and medical informatics (D2Im) at the University of Rouen, France. The two classifications are edited under the acronym 3 CGP for Core Content classification of General Practice. This free access server allows you to consult the ICPC-2 in 22 languages and the Q-codes in ten languages. Results: The result of the joint use of these two classifications, as descriptors in congress to identify the concepts in texts or index the gray literature for family medicine and primary care is presented here in its various pilot uses. The validity and generalizability of 3CGP appears to be good in the light of the translations already carried out by colleagues around the world and of the applicability of the method in the two sides of the Atlantic. However the reproducibility and the inter-coder variations still remain to be tested for Q-codes. Maintenance remains an issue. Conclusion: This method highlights the conceptual extension, the complexity and the dynamics of the role of general practitioner and family doctor as well as of primary care physician.


Assuntos
Medicina Geral , Classificação Internacional de Doenças/normas , Bases de Conhecimento , Atenção Primária à Saúde , Clínicos Gerais/organização & administração , Humanos , Internet , Linguagem , Papel do Médico , Médicos de Família/organização & administração , Reprodutibilidade dos Testes , Terminologia como Assunto
4.
Wiad Lek ; 72(4): 631-634, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31055546

RESUMO

OBJECTIVE: Introduction: Obesity rates have continued to increase recently, what is connected to the reduction of physical activity of population. The aim: To determine the peculiarities of treatment of patients with obesity, who sustained a severe concomitant body trauma on an outpatient basis by family physicians. PATIENTS AND METHODS: Materials and methods: Clinical material composed of 67 patients who sustained severe concomitant body trauma. RESULTS: Results: On the grounds of the long-term outcomes assessment cards developed by us, treatment of the severe concomitant trauma in persons with obesity, we found typical complications of the traumatic disease, which family physicians faced on an ambulatory stage. These cards contained by system analysis of consequences of the sustained polytrauma on the systems and organs respectively to the body mass index meaning. In general, treatment of such patients was complex and included applying of the diet therapy (a low-calorie diet with enough protein, vitamins and low levels of animal fats and carbohydrates, especially easily digestible), pharmacological therapy (antibiotics, mucolytics, solvents) as well as therapeutic exercise, which played almost dominant role. In particular, therapeutic massage was prescribed for improvement of general body tone, activation of peripheral circulation and lymph flow, oxidation-reduction and metabolic processes, retroaction to the impaired motor-evacuation function of the large intestine, eliminating fatigue and increasing muscle tone and functioning. CONCLUSION: Conclusions: Role of the family physician in the process of traumatic disease treatment is especially important and lies in the organization of medical treatment of patients on an ambulatory stage.


Assuntos
Traumatismo Múltiplo/terapia , Obesidade/complicações , Papel do Médico , Médicos de Família , Índice de Massa Corporal , Humanos
5.
Wiad Lek ; 72(3): 489-492, 2019.
Artigo em Polonês | MEDLINE | ID: mdl-31051003

RESUMO

O. anthropi, formerly known as Achromobacter, is an aerobic, Gram-negative bacillus, widespread in the environment, in various ecological niches. Currently, it is an emerging opportunistic microorganism associated with health care, as well as infections in people with immunodeficiency, mainly in children and newborns. The authors of the presented work present a case of a 13-year-old female patient with a neurodegenerative disorder in which O. anthropi was isolated from blood cultures. She was hospitalized in the Social Society of the Cordis Hospice in Katowice, and after discharge from the hospice she was covered by long-term home care under the supervision of a family doctor. Clinical picture O. anthropi can be very different, causes serious infections, such as blood infections. Due to difficulties in identification, Ochrobactrum anthropi can be a diagnostic and therapeutic challenge. The difficulty in differentiating Ochrobactrum spp. Is also related to the lack of a clear clinical picture of infection with bactera O.anthropi. In addition, this microorganism is difficult to treat due to the natural broad spectrum of antibiotic resistance.


Assuntos
Bacteriemia , Infecções por Bactérias Gram-Negativas , Ochrobactrum anthropi , Adolescente , Criança , Feminino , Humanos , Recém-Nascido , Assistência de Longa Duração/normas , Médicos de Família
7.
J Med Life ; 12(1): 34-42, 2019 Jan-Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31123523

RESUMO

Walk-in patients who do not require urgent treatment at an emergency department (ED) are a known and long-standing problem. This study aims to investigate the characteristics of walk-in patients visiting the ED over time. During four days in June 2012, all walk-in patients attending the ED of the University Hospital Brussels between 8 AM and 11 PM were recorded. A similar registration took place in the same ED in June 2001. Patients completed a questionnaire about their characteristics and the reason for the encounter. Data of both study periods were compared. The mean age of the patients attending the ED was significantly lower in 2001 (40.9 years) than in 2012 (43.9 years) (p=0,02). In 2001, 81% of the participants had Belgian nationality, but in 2012 this proportion increased to 90% (p=0.008). In 2001 as well as in 2012, 21% of the participants had a referral from their family physician (FP) (p=0.9). The proportion of patients that were aware that FP could also handle some emergencies increased from 17% in 2001 to 29% in 2012 (p=0.003). More patients had complaints that begun less than 24h before they attended the ED (48% in 2001 and 58% in 2012) (p=0.03). The walk-in patients at the ED are getting slightly older and are attending the ED faster after the onset of the complaints. More patients judge their complaints as urgent. However, more patients are getting aware that FP also could handle some emergencies.


Assuntos
Serviço Hospitalar de Emergência , Hospitais Universitários , Adulto , Bélgica , Emergências , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Médicos de Família , Encaminhamento e Consulta , Fatores de Tempo
10.
Fam Med ; 51(4): 311-318, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30973618

RESUMO

BACKGROUND AND OBJECTIVES: Little is known about how the presence of nurse practitioners (NPs) and physician assistants (PAs) in a practice impacts family physicians' (FPs') scope of practice. This study sought to examine variations in FPs' practice associated with NPs and PAs. METHODS: We obtained data from American Board of Family Medicine practice demographic questionnaires completed by FPs who registered for the Family Medicine Certification Examination during 2013-2016. Scope of practice score was calculated for each FP, ranging from 0-30 with higher numbers equating to broader scope of practice. FPs self-reported patient panel size. Primary care teams were classified into NP only, PA only, both NP and PA, or no NP or PA. We estimated variation in scope and panel size with different team configurations in regression models. RESULTS: Of 27,836 FPs, nearly 70% had NPs or PAs in their practice but less than half (42.5%) estimated a panel size. Accounting for physician and practice characteristics, the presence of NPs and/or PAs was associated with significant increases in panel sizes (by 410 with PA only, 259 with NP only and 245 with both; all P<0.05) and in scope score (by 0.53 with PA only, 0.10 with NP only and 0.51 with both; all P<0.05). CONCLUSIONS: We found evidence that team-based care involving NPs and PAs was associated with higher practice capacity of FPs. Working with PAs seemed to allow FPs to see a greater number of patients and provide more services than working with NPs. Delineation of primary care team roles, responsibilities and boundaries may explain these findings.


Assuntos
Profissionais de Enfermagem/estatística & dados numéricos , Assistentes Médicos/estatística & dados numéricos , Médicos de Família/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica , Inquéritos e Questionários , Estados Unidos
11.
Fam Med ; 51(4): 331-337, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30973621

RESUMO

BACKGROUND AND OBJECTIVES: In 2010, the College of Family Physicians of Canada (CFPC) launched its competency-based medical education (CBME) approach to residency curriculum and assessment. Named Triple C, this innovation was developed to ensure graduates of family medicine training programs are competent to begin unsupervised practice. Further, Triple C was intended to promote interest in practicing comprehensive family medicine. A program evaluation plan was launched by the CFPC alongside the implementation of Triple C to explore if intended outcomes were achieved. METHODS: We conducted retrospective secondary data analysis of survey findings from graduating family medicine residents from two sources: National Physician Survey (NPS 2007 and 2010); and the Family Medicine Longitudinal Survey (FMLS 2015). Demographics and practice intentions reported by residents in the NPS 2007, NPS 2010, and FMLS 2015 were included in the analyses and a comparison between years was undertaken using a series of Pearson χ2 test. RESULTS: Findings indicate that in comparison to pre-Triple C (NPS 2007 and NPS 2010), significantly more residents reported the intention to include palliative care, intrapartum care, in-patient hospital care, care in the home, and practicing in rural settings after the implementation of Triple C (FMLS 2015; P<0.01). CONCLUSIONS: Family medicine graduates report an increase in intention to include a broader range of clinical domains after implementation of Triple C. While a causal relationship cannot be determined, using a historical control in the form of survey data that predates Triple C implementation could support future approaches to evaluation of education reform.


Assuntos
Educação Baseada em Competências/normas , Currículo , Medicina de Família e Comunidade/educação , Internato e Residência , Médicos de Família/normas , Canadá , Feminino , Humanos , Estudos Longitudinais , Masculino , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Inquéritos e Questionários
12.
Artigo em Inglês | MEDLINE | ID: mdl-31013799

RESUMO

Health literacy (HL) has become an important area of research. The aim of this study was to evaluate the HL of primary healthcare patients in the Republic of Srpska (RS), Bosnia and Herzegovina (B&H) and to identify socioeconomic and health factors associated with HL. This cross-sectional study among 768 patients was conducted in two healthcare centres between March and May 2017, using the Short Test of Functional Health Literacy in Adults (S-TOFHLA). Analysis was done using descriptive and inferential statistics (a chi-squared test and logistic regression). Inadequate and marginal HL was found in 34,6% of respondents. Socioeconomic and self-reported health factors were significantly related to HL. An age of 55 years and over (OR 1.02), living in a rural environment (OR 2.25), being divorced (OR 3.32), being insufficiently physically active (OR 1.29), having poor income (OR 1.96), having more than three chronic diseases (OR 1.94), and poor health (OR 1.59) were significantly corelated with inadequate and marginal HL. The results of our study indicate that a low level of HL is related to the elderly, having a divorce, having a rural residence, poor income, having more than three chronic diseases, poor health, and insufficient physical activity. Further evaluation, monitoring, and activities to improve HL are of great importance for patients' health outcomes.


Assuntos
Alfabetização em Saúde/estatística & dados numéricos , Médicos de Família , Adulto , Idoso , Bósnia e Herzegóvina , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , População Rural/estatística & dados numéricos , Autorrelato , Fatores Socioeconômicos
13.
Inquiry ; 56: 46958019834830, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30947595

RESUMO

Family physicians serve as personal doctors for individuals and their families and also act as gatekeepers of the health care system. If no special status is accorded to family physicians, however, then the rates at which health care recipients utilize their service might be affected. In the present cross-sectional study, representative claims data sets for 2010 from Taiwan's National Health Insurance program, a health care system in which beneficiaries are not required to register with a family physician, were used to investigate the provision of health care to the population by family physicians. Among 919 206 beneficiaries with a total of 13 713 199 ambulatory visits, 49.1% had visited family physicians, 34.1% had visited internists, 24.3% had visited pediatricians, and 38.9% had visited otolaryngologists. Women (χ2(1) = 538, P < .001) and patients aged 65 and above (χ2(1) = 16 000, P < .001) had a higher proportion of visiting family physicians rather than visiting other specialties. The onion-shaped population pyramid with family medicine visits was compatible with the general population, and the proportion of visiting family physicians increased with increasing age. Among 112 289 patients with essential hypertension, 63 379 patients with diabetes mellitus, and 80 090 patients with hyperlipidemia, only 35.3%, 32.0%, and 31.1%, respectively, had visited family physicians. The age and sex distributions of these patients were illustrated with population pyramids for data visualization and direct comparisons. Taken together, the results of this study indicate that the utilization of family physicians in Taiwan and the effectiveness of their associated role in chronic disease management still have room for improvement.


Assuntos
Assistência Ambulatorial , Medicina , Programas Nacionais de Saúde , Médicos de Família/provisão & distribução , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Doença Crônica/psicologia , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Taiwan , Adulto Jovem
17.
Br J Gen Pract ; 69(682): 229, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31023672
20.
Singapore Med J ; 60(1): 12-16, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30840991

RESUMO

Infantile colic is a common self-limiting condition that causes significant distress to parents and caregivers. There is no clear cause, gold standard remedy or preventative action. The role of the family physician is to rule out sinister causes while providing counselling and reassurance for parents. The mainstay of management is parental support and reassurance while looking out for red flags in the baby such as fever, lethargy, distended abdomen and failure to thrive. This article provides a framework to approaching infantile colic and practical pointers to share with parents.


Assuntos
Cólica/diagnóstico , Cólica/terapia , Pediatria/métodos , Atenção Primária à Saúde/métodos , Cuidadores , Choro , Medicina Baseada em Evidências , Humanos , Lactente , Fórmulas Infantis , Recém-Nascido , Hipertonia Muscular/diagnóstico , Poder Familiar , Pais , Médicos de Família , Relações Profissional-Paciente
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