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1.
Am J Forensic Med Pathol ; 41(1): 11-17, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31977347

RESUMO

Errors in death certification can directly affect the decedent's survivors and the public register. We assessed the effectiveness of an educational seminar targeting frequent and important errors identified by local death certificate (DC) evaluation. Retrospective review of 1500 DCs categorized errors and physician specialty. A 60-minute didactic/case-based seminar was subsequently designed for family medicine physician (FAM) participants, with administration of presurvey, immediate post, and 2-month postsurveys. Most DCs were completed by FAM (73%), followed by internists (18%) and surgeons (3%). Error occurrence (EO) rate ranged between 32 and 75% across all specialities. Family medicine physician experienced in palliative care had the lowest EO rate (32%), significantly lower (P < 0.001) than FAM without interest in palliative care (62%), internal medicine (62%), and surgery (75%). Common errors were use of abbreviations (26%), mechanism as underlying cause of death (23%), and no underlying cause of death recorded (22%). Presurvey participants (n = 72) had an overall EO rate of 72% (64% excluding formatting errors). Immediate postsurvey (n = 75) and 2-month postsurvey (n = 24) participants demonstrated significantly lower overall EO (34% and 24%, respectively), compared with the Pre-S (P < 0.05). A 60-minute seminar on death certification reduced EO rate with perceived long-term effects.


Assuntos
Atestado de Óbito , Documentação/normas , Capacitação em Serviço , Médicos de Família/educação , Alberta , Causas de Morte , Avaliação Educacional , Docentes de Medicina/estatística & dados numéricos , Humanos , Internato e Residência , Determinação de Necessidades de Cuidados de Saúde , Estudos Retrospectivos
2.
BMC Med Educ ; 19(1): 251, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286945

RESUMO

BACKGROUND: In South Africa it is compulsory to submit a satisfactory portfolio of learning to gain entrance to the national exit examination of the College of Family Physicians and to qualify as a family physician. A paper-based portfolio has been implemented thus far and the need for an electronic portfolio (e-portfolio) was identified. The aim of the study was to describe and evaluate the implementation of an e-portfolio for the training of family medicine registrars in the Western Cape province of South Africa. METHODS: Mixed methods were used. A quasi-experimental study evaluated paper- and e-portfolios from the same 28 registrars in 2015 compared to 2016. Semi-structured interviews were conducted with 11 registrars or supervisors to explore their experiences of using the e-portfolio. Quantitative data was analysed in the Statistical Package for Social Sciences and qualitative data in Atlas.ti. RESULTS: Most respondents found the e-portfolio easier to use and more accessible. It made progress easier to monitor and provided sufficient evidence of learning. Feedback was made easier and more explicit. There were concerns regarding face-to-face feedback being negatively affected. It was suggested to have a feedback template to further improve feedback. Several aspects were significantly better in the e-portfolio such as feedback on the registrar's general behaviour, alignment with learning outcomes, less feedback based on hearsay and acknowledgement of the feedback by the registrar. Although not statistically significant, there was an increase in the usage of the e-portfolio, compared to the paper portfolio. CONCLUSION: In general, the e-portfolio is an improvement on the paper-based portfolio. It is easier to access, more user-friendly and less cumbersome. It makes feedback and monitoring of progress and development of registrars easier and more visible and provides sufficient evidence of learning. Its implementation throughout South Africa is recommended.


Assuntos
Competência Clínica/normas , Documentação/métodos , Educação de Pós-Graduação em Medicina , Medicina de Família e Comunidade/educação , Médicos de Família/educação , Atitude do Pessoal de Saúde , Computação em Nuvem , Documentação/tendências , Avaliação Educacional , Estudos de Avaliação como Assunto , Retroalimentação , Humanos , Internet , Aprendizagem , Desenvolvimento de Programas , África do Sul
3.
Afr J Prim Health Care Fam Med ; 11(1): e1-e15, 2019 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-31038332

RESUMO

BACKGROUND:  Cardiovascular disease (CVD)-related deaths in sub-Saharan Africa (SSA) are on the rise, and primary care physicians could facilitate the reversal of this trend through treatment and prevention strategies. AIM:  The aim of this study was to determine the relationship between physician lifestyle practices, CVD prevention knowledge and patient CVD counselling practices among family physicians (FPs) and family medicine (FM) trainees affiliated to FM colleges and organisations in SSA. SETTING:  FPs and FM trainees affiliated to FM colleges and organisations in Anglophone SSA. METHODS:  A web-based cross-sectional analytical study was conducted using validated, self-administered questionnaires. Following collation of responses, the relationship between the participants' CVD prevention knowledge, lifestyle practices and CVD counselling rates was assessed. RESULTS:  Of the 174 participants (53% response rate), 83% were married, 51% were females and the mean age was 39.2 (standard deviation [SD] 7.6) years. Most of the participants responded accurately to the CVD prevention knowledge items, but few had accurate responses on prioritising care by 10-year risk. Most participants had less than optimal lifestyle practices except for smoking, vegetable or fruit ingestion and sleep habits. Most participants (65%) usually counselled patients on nutrition, but less frequently on weight management, exercise, smoking and alcohol. The region of practice and physicians with poor lifestyle were predictive of patient counselling rates. CONCLUSION:  Training on patient counselling and self-awareness for CVD prevention may influence patient counselling practice. Promoting quality training on patient counselling among FPs as well as a healthy self-awareness for CVD prevention is thus needed. The complex relationship between physician lifestyle and patient counselling warrants further study.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Aconselhamento/estatística & dados numéricos , Medicina de Família e Comunidade/estatística & dados numéricos , Corpo Clínico Hospitalar/psicologia , Médicos de Família/psicologia , Padrões de Prática Médica/estatística & dados numéricos , Adulto , África ao Sul do Saara , Doenças Cardiovasculares/psicologia , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Médicos de Família/educação , Inquéritos e Questionários
4.
GMS J Med Educ ; 36(1): Doc9, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30828609

RESUMO

Aim: Against the background of an impending shortage of family practitioners, it is important to investigate the factors influencing the choice to become one. The aim of this study was to identify factors that encourage medical students to choose to practice family medicine. Method: Using a questionnaire, students in the fourth and fifth years of their studies in the Federal State of Hesse were asked about the factors that had influenced their choice of medical specialty and their experience of courses in family medicine. Predictors of an interest in practicing family medicine were calculated using multiple logistic regression. Results: 361 questionnaires were returned, representing a response rate of 70.9%. Confirmation of personal strengths, an interest in the field, and practical experience of the subject generally turned out to be important factors influencing the choice of medical specialty. 49.3% of students expressed an interest in practicing family medicine. A link existed between an interest in working as a family doctor and the opportunity to take over an existing practice, experience of medicine in rural areas, and an appreciation of the conditions of work. With regard to education at medical school, positive experiences during a clinical traineeship in family medicine and positive role models among teachers of general practice were identified as predictors. Conclusion: Almost half the medical students were open to the idea of practicing family medicine. Experience of medicine in rural areas and positive experiences of courses in general practice were linked to an increased interest in working as a family doctor. To promote this interest, it may be a promising approach to increase opportunities to collect experience of medicine in rural areas, and to encourage highly motivated teaching practices.


Assuntos
Escolha da Profissão , Comportamento de Escolha , Medicina de Família e Comunidade/educação , Medicina , Estudantes de Medicina/psicologia , Adulto , Educação de Graduação em Medicina/normas , Feminino , Humanos , Masculino , Médicos de Família/educação , Médicos de Família/provisão & distribução , Estudantes de Medicina/estatística & dados numéricos , Inquéritos e Questionários
6.
Acad Med ; 94(6): 847-852, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30768464

RESUMO

PURPOSE: Lack of specialty board certification has been reported as a significant physician-level predictor of receiving a disciplinary action from a state medical board. This study investigated the association between family physicians receiving a disciplinary action from a state medical board and certification by the American Board of Family Medicine (ABFM). METHOD: Three datasets were merged and a series of logistic regressions were conducted examining the relationship between certification status and disciplinary actions when adjusting for covariates. Data were available from 1976 to 2017. Predictor variables were gender, age, medical training degree type, medical school location, and the severity of the action. RESULTS: Of the family physicians in this sample, 95% (114,454/120,443) had never received any disciplinary action. Having ever been certified was associated with a reduced likelihood of ever receiving an action (odds ratio [OR] = 0.35; 95% confidence interval [CI] = 0.30, 0.40; P < .001), and having held a prior but not current certification at the time of the action was associated with an increase in receiving the most severe type of action (OR = 3.71; 95% CI = 2.24, 6.13; P < .001). CONCLUSIONS: Disciplinary actions are uncommon events. Family physicians who had ever been ABFM certified were less likely to receive an action. The most severe actions were associated with decreased odds of being board certified at the time of the action. Receiving the most severe action type increased the likelihood of physicians holding a prior but not current certification.


Assuntos
Disciplina no Trabalho/estatística & dados numéricos , Médicos de Família/educação , Conselhos de Especialidade Profissional/organização & administração , Adulto , Certificação , Competência Clínica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Faculdades de Medicina , Estados Unidos
10.
J Am Board Fam Med ; 31(6): 842-843, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30413540

RESUMO

Diversification of the physician workforce has been a goal of Association of American Medical Colleges for several years and could improve access to primary care for under-served populations and address health disparities. We found that family physicians' demographics have become more diverse over time, but still do not reflect the national demographic composition. Increased collaboration with undergraduate universities to expand pipeline programs may help increase the diversity of students accepted to medical schools, which in turn should help diversify the family medicine workforce.


Assuntos
Certificação/estatística & dados numéricos , Diversidade Cultural , Mão de Obra em Saúde/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Médicos de Família/estatística & dados numéricos , Grupos de Populações Continentais/estatística & dados numéricos , Educação Médica/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Medicina de Família e Comunidade/educação , Medicina de Família e Comunidade/legislação & jurisprudência , Medicina de Família e Comunidade/estatística & dados numéricos , Acesso aos Serviços de Saúde , Humanos , Grupos Minoritários/educação , Médicos de Família/educação , Médicos de Família/legislação & jurisprudência , Faculdades de Medicina/estatística & dados numéricos , Estados Unidos
11.
J Am Board Fam Med ; 31(6): 917-923, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30413547

RESUMO

BACKGROUND: Thought leaders from family medicine and practice-based research networks (PBRNs) have put forth definitions and goals recommending future directions for PBRNs. Evidence demonstrating that PBRNs are acting in accordance with these trends supports future investment in PBRN infrastructure, funding, and training of clinician researchers. Our objective was to explore the alignment of PBRN research efforts with thought leader recommendations. METHODS: The 2017 Council of Academic Family Medicine Educational Research Alliance surveyed PBRN directors via emails to 126 respondents. This survey included 6 general background questions about PBRN characteristics. An additional 25 questions focused on current and future research directions, including the training of health care professionals about PBRN research. RESULTS: The survey response rate was 56/126 (44%). Physician faculty receive continuing medical education credit for PBRN training (reported by 12/56 of PBRN directors). PBRN provided continuing medical education for study participation (24/56), reviewing study results (7/56), attending a study results presentation (24/56), and attending study planning meetings (13/56). Practice-based research education of medical students and residents was reported at 11/56 and 14/56, respectively. Current PBRN research efforts were most frequent in the areas of community engagement, practice transformation, and quality improvement projects. CONCLUSION: PBRNs currently thrive on conducting research predominantly in quality improvement and practice transformation. However, the study findings suggest that moving forward, PBRNs should participate more in training the future generations of primary care researchers and to address health policy needs.


Assuntos
Medicina de Família e Comunidade/organização & administração , Pesquisa sobre Serviços de Saúde/tendências , Atenção Primária à Saúde/organização & administração , Melhoria de Qualidade , Educação Médica Continuada/estatística & dados numéricos , Educação Médica Continuada/tendências , Docentes/educação , Docentes/estatística & dados numéricos , Medicina de Família e Comunidade/educação , Humanos , Internato e Residência/estatística & dados numéricos , Diretores Médicos/estatística & dados numéricos , Médicos de Família/educação , Participação dos Interessados , Estudantes de Medicina/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , Estados Unidos , United States Agency for Healthcare Research and Quality/organização & administração
12.
Implement Sci ; 13(1): 120, 2018 09 05.
Artigo em Inglês | MEDLINE | ID: mdl-30185197

RESUMO

BACKGROUND: Educational outreach visits are meant to improve the practice of health professionals by promoting face-to-face visits to deliver educational contents. They have been shown to change prescription behavior, but long-term effects are still uncertain. This trial aimed to determine if they improve family physician prescribing compared with passive guideline dissemination. METHODS: Parallel, open, superiority, and cluster-randomized trial. National Health Service primary care practices (clusters) were recruited in the Lisbon region-Portugal between March 2013 and January 2014. They could enter if they had at least four family physicians willing to participate and not planning to retire in the follow-up period. Three national guidelines were chosen for dissemination: acid secretion modifiers, non-steroidal anti-inflammatory drugs, and antiplatelets. Physicians in the intervention group received one 15 to 20 min educational outreach visit at their workplace for each guideline. Physicians in the control group had access to guidelines through the Directorate-General for Health's website (passive dissemination). Primary outcomes were the proportion of COX-2 inhibitors prescribed within the NSAID class and the proportion of omeprazole within the PPI class at 18 months after the intervention. A cost-benefit analysis was performed. Practices were randomized by minimization. Data analyses were done at individual physician level using generalized mixed-effects regression models. Participants could not be blinded. RESULTS: Thirty-eight practices with 239 physicians were randomized (120 to intervention and 119 to control). Of 360 planned visits, 322 were delivered. No differences were found between physicians in the intervention and control groups regarding the proportion of omeprazole prescribed among PPIs 18 months after the visit (46.28 vs 47.15%, p = 0.971) or the proportion of COX-2 inhibitors among NSAIDs (12.07 vs 13.08%, p = 0.085). All secondary outcome comparisons showed no effect. There was no difference in cumulative drug costs at 18 months (3223.50€/1000 patients in the intervention group and 3143.92€/1000 patients in the control group, p = 0.848). CONCLUSIONS: Educational outreach visits were unsuccessful in improving compliance with guideline recommendations among Portuguese family physicians. No effects were observed at 1, 6, and 18 months after the intervention, and there were no associated cost savings. TRIAL REGISTRATION: ClinicalTrials.gov NCT01984034 . Registered 7 November 2013.


Assuntos
Médicos de Família/educação , Guias de Prática Clínica como Assunto , Padrões de Prática Médica , Prescrições/estatística & dados numéricos , Desenvolvimento de Pessoal/organização & administração , Medicina de Família e Comunidade , Feminino , Humanos , Portugal
13.
Ann Fam Med ; 16(5): 443-446, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30201642

RESUMO

Buprenorphine can be used in primary care to treat opioid use disorder, but many family physicians feel unprepared to care for patients with opioid addiction. We sought to describe preparedness to provide and current provision of buprenorphine treatment by early career family physicians using data from the 2016 National Family Medicine Graduate Survey. Of 1,979 respondents, 10.0% reported preparedness to provide buprenorphine treatment, and 7.0% reported current buprenorphine provision. Residency preparation to provide buprenorphine treatment was most highly associated with current provision (odds ratio = 13.50; 95% CI, 7.59-24.03). Efforts to increase buprenorphine training may alleviate the workforce shortage to treat opioid use disorder.


Assuntos
Buprenorfina/uso terapêutico , Medicina de Família e Comunidade/educação , Antagonistas de Entorpecentes/uso terapêutico , Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Médicos de Família/educação , Adulto , Competência Clínica , Feminino , Humanos , Internato e Residência , Masculino , Atenção Primária à Saúde/métodos
14.
BMC Health Serv Res ; 18(1): 637, 2018 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-30107799

RESUMO

BACKGROUND: Effective communication between family physicians and their patients is crucial to improving healthcare outcomes and patients' satisfaction. However, the barriers to effective communication have been weakly studied in the Gulf region with no reported studies in Dubai. This study aims to identify the main perceived barriers to effective communication between patients and their family physicians in Dubai from both the physicians' and the patients' viewpoints. METHODS: The study was conducted at 12 primary healthcare centres in Dubai between October 2016 - July 2017. Two self-administered questionnaires were used, one measuring the patients' perceived frequency of encounters with barriers to communication, while the other was for the family physicians' perceived level of risk to communication posed by the barriers. The barriers were assessed in the following four domains: personal characteristics and attitudes, organisational factors, communication of information, and linguistic and cultural factors. RESULTS: There were a total of 1122 patients and 170 family physicians, with 75% and 85% response rates, respectively. Having a time limitation was the highest ranking barrier, with 23.4% of patients encountering it half of the time-always, and 50.6% of physicians perceiving it as moderate-very high risk. This was followed by barriers in the communication of information domain, especially not checking the patient's understanding and not educating the patient (16.0-16.9%) from the patients' perception and presentation with multiple problems and not following with a treatment plan (51.2% and 35.9%, respectively), from the physicians' perception. Preoccupation with medical records ranked in the second pentile for the physicians, and in the lowest pentile for the patients. Barriers related to the failure of rapport building and linguistic/cultural factors ranked in the fourth and fifth pentiles for both patients and physicians. CONCLUSION: Time pressure is the major perceived barrier to communication between patients and family physicians. In addition, a greater focus needs to be placed on training the physicians to convey their messages to the patients clearly, checking their understanding and managing poor historians.


Assuntos
Instituições de Assistência Ambulatorial , Barreiras de Comunicação , Médicos de Família , Adolescente , Adulto , Idoso , Atitude do Pessoal de Saúde , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Relações Médico-Paciente , Médicos de Família/educação , Atenção Primária à Saúde , Inquéritos e Questionários , Emirados Árabes Unidos , Adulto Jovem
15.
Orv Hetil ; 159(32): 1310-1316, 2018 Aug.
Artigo em Húngaro | MEDLINE | ID: mdl-30078356

RESUMO

It is internationally recognized that the best method for practicing general medical care is family medicine, based on the correct relationship between the physician and the patients/families, where the principles of disease prevention and patient care meet, and the cost-benefit rates are better. In Hungary, a major part of the health reform had been the advancement of a primary care system by the international standards of modern family medicine. The Scientific Association of the Hungarian General Practitioners (SAHGP), founded in 1967, has adviced - from its onset - to introduce a new, independent medical specialty named 'general practice' which was finally realised in 1974. That was followed, according to the Welfare Ministry Order No. 6/1993, by the specific training program for general practice which prescribed, also for the in-service GP-s, to complete an individual postgraduate training, to be ended by a state specialty exam in family practice, under conduction of the regional medical schools. Furthermore, for strengthening the primary healthcare, in 1998 the government established - uniquely in Europe - the National Institute of Primary Healthcare (NIPHC). So a unique task force has gained shape which included the academic sector, the professional NGO and the governmental background institution in order to manage: 1) human resource supply in PHC, 2) to implement statewide professional and public health goals as well as 3) to manage research and development projects. This paper takes a look back at the early events of this process as well as tries to offer an insight into the results and conclusions of the performed research projects, highlighting those which can be potentially usable in further professional development of the Hungarian PHC. Orv Hetil. 2018; 159(32): 1310-1316.


Assuntos
Assistência à Saúde/organização & administração , Educação Médica/tendências , Medicina de Família e Comunidade/educação , Médicos de Família/educação , Academias e Institutos , Medicina de Família e Comunidade/tendências , Humanos , Hungria , Médicos de Família/tendências , Padrões de Prática Médica/tendências , Faculdades de Medicina/tendências
16.
Rev. cuba. endocrinol ; 29(2): 1-22, mayo.-ago. 2018. tab
Artigo em Espanhol | CUMED | ID: cum-73077

RESUMO

Introducción: en Cuba, menos de la mitad de las mujeres diabéticas que se embarazan reciben atención preconcepcional. Objetivo: describir aspectos relacionados con la atención al riesgo reproductivo de la mujer diabética, y el papel que juega el médico de familia en esta actividad en un municipio de la capital cubana. Métodos: primera etapa: estudio transversal descriptivo, que incluyó a 132 diabéticas en edad fértil (entrevista); y, segunda etapa: estudio exploratorio, que implicó a 57 médicos de familia (aplicación de cuestionario sobre cuidados preconcepcionales), realizado en el municipio Plaza de la Revolución, La Habana, durante 2012-2016. Se utilizó el porcentaje y chi cuadrado para describir y comparar respectivamente variables categóricas. Se consideró p< 0,05. Resultados: el antecedente de complicaciones gestacionales fue más frecuente en las mujeres sin atención preconcepcional. El 68,9 pre ciento (91/132) de estas utiliza anticonceptivo, mayormente métodos de barrera (51,6 por ciento), y 61,5 por ciento (16/26) de las que desean embarazo acuden a consulta de atención preconcepcional, lo que se relaciona con su nivel de educación terapéutica. Los médicos de familia tienen insuficientes conocimientos sobre cuidados preconcepcionales, y no juegan un papel preponderante en prodigarlos. Conclusiones: la mayoría de las diabéticas en edad fértil están recibiendo cuidados preconcepcionales; no obstante, los médicos de familia tener insuficientes conocimientos sobre estos y no ejercen un papel preponderante en la atención al riesgo reproductivo de estas mujeres(AU)


Introduction: in Cuba, less than half of diabetic women who get pregnant receive preconception care. Objective: to describe aspects related to the attention to the reproductive risk of the diabetic woman, and the role played by the family doctor in this activity in a municipality of the Cuban capital. Methods: first stage: descriptive cross-sectional study, which included 132 diabetic women in childbearing age (interview); and, second stage: exploratory study, which involved 57 family doctors (application of preconception care questionnaire conducted in Plaza de la Revolución municipality, Havana, from 2012 to 2016). Percentage and chi square methods were used to describe and compare categorical variables, respectively. It was considered p< 0.05. Results: the history of gestational complications was more frequent in women without preconception care. 68.9 percent (91/132) of these used contraceptives, mostly barrier methods (51.6 percent), and 61.5 percent (16/26) of those who want to get pregnant attend to a preconception care consultation, which it is related to their level of therapeutic education. Family doctors have insufficient knowledge about preconception care, and do not play a preponderant role in delivering it. Conclusions: the majority of diabetics of childbearing age are receiving preconception care; nevertheless, family doctors have insufficient knowledge about these and do not play a preponderant role in the attention to the reproductive risk of these women(AU)


Assuntos
Humanos , Fatores de Risco , Assistência Perinatal/estatística & dados numéricos , Serviços de Saúde Reprodutiva , Diabetes Mellitus/epidemiologia , Médicos de Família/educação , Inquéritos e Questionários
17.
Rev. cuba. endocrinol ; 29(2): 1-22, mayo.-ago. 2018. tab
Artigo em Espanhol | LILACS | ID: biblio-978382

RESUMO

Introducción: en Cuba, menos de la mitad de las mujeres diabéticas que se embarazan reciben atención preconcepcional. Objetivo: describir aspectos relacionados con la atención al riesgo reproductivo de la mujer diabética, y el papel que juega el médico de familia en esta actividad en un municipio de la capital cubana. Métodos: primera etapa: estudio transversal descriptivo, que incluyó a 132 diabéticas en edad fértil (entrevista); y, segunda etapa: estudio exploratorio, que implicó a 57 médicos de familia (aplicación de cuestionario sobre cuidados preconcepcionales), realizado en el municipio Plaza de la Revolución, La Habana, durante 2012-2016. Se utilizó el porcentaje y chi cuadrado para describir y comparar respectivamente variables categóricas. Se consideró p< 0,05. Resultados: el antecedente de complicaciones gestacionales fue más frecuente en las mujeres sin atención preconcepcional. El 68,9 pre ciento (91/132) de estas utiliza anticonceptivo, mayormente métodos de barrera (51,6 por ciento), y 61,5 por ciento (16/26) de las que desean embarazo acuden a consulta de atención preconcepcional, lo que se relaciona con su nivel de educación terapéutica. Los médicos de familia tienen insuficientes conocimientos sobre cuidados preconcepcionales, y no juegan un papel preponderante en prodigarlos. Conclusiones: la mayoría de las diabéticas en edad fértil están recibiendo cuidados preconcepcionales; no obstante, los médicos de familia tener insuficientes conocimientos sobre estos y no ejercen un papel preponderante en la atención al riesgo reproductivo de estas mujeres(AU)


Introduction: in Cuba, less than half of diabetic women who get pregnant receive preconception care. Objective: to describe aspects related to the attention to the reproductive risk of the diabetic woman, and the role played by the family doctor in this activity in a municipality of the Cuban capital. Methods: first stage: descriptive cross-sectional study, which included 132 diabetic women in childbearing age (interview); and, second stage: exploratory study, which involved 57 family doctors (application of preconception care questionnaire conducted in Plaza de la Revolución municipality, Havana, from 2012 to 2016). Percentage and chi square methods were used to describe and compare categorical variables, respectively. It was considered p< 0.05. Results: the history of gestational complications was more frequent in women without preconception care. 68.9 percent (91/132) of these used contraceptives, mostly barrier methods (51.6 percent), and 61.5 percent (16/26) of those who want to get pregnant attend to a preconception care consultation, which it is related to their level of therapeutic education. Family doctors have insufficient knowledge about preconception care, and do not play a preponderant role in delivering it. Conclusions: the majority of diabetics of childbearing age are receiving preconception care; nevertheless, family doctors have insufficient knowledge about these and do not play a preponderant role in the attention to the reproductive risk of these women(AU)


Assuntos
Humanos , Fatores de Risco , Assistência Perinatal/estatística & dados numéricos , Serviços de Saúde Reprodutiva , Diabetes Mellitus/epidemiologia , Médicos de Família/educação , Inquéritos e Questionários/estatística & dados numéricos
18.
J Am Board Fam Med ; 31(4): 522-528, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29986977

RESUMO

BACKGROUND: Obesity is a serious and highly prevalent health problem. Behavioral modification for weight loss is effective, and physician nutrition counseling is encouraged. Nevertheless, several studies have reported that physicians provide nutrition counseling infrequently. Time constraints and lack of patient compliance are among frequently reported barriers. AIM: In this pilot study, we aimed to examine physician weight loss nutrition counseling among family physicians in Huntington, West Virginia, an area with the highest obesity prevalence in the United States. METHODS: We administered an anonymous 13-question online survey designed for this study to all area family physicians in continuity ambulatory practice, asking about how often they provided nutrition counseling to their comorbidly obese patients, their nutrition education background, the counseling resources used, and the barriers they faced. RESULTS: Thirty-eight of the 47 invited physicians completed surveys. The 35 to 55 age group comprised 55% of the respondents. Men comprised 53% of our sample. Two-thirds of the physicians reported that they counseled at a high frequency. Twenty-six of the 38 physicians reported that their nutrition education in medical school was none to minimal. Of the rest, 47.2% viewed their education as clinically relevant. The most frequently-used specific patient education sources were those embedded in electronic health records, the US Department of Agriculture's MyPlate tool, and a variety of smartphone-based apps. Time constraints and lack of patient interest in nutrition topics were the leading barriers cited. CONCLUSION: Family physicians practicing in the most obese population in the United States tend to be high-frequency obesity nutrition counselors who frequently use specific tools, consider their education lacking and face oft-cited barriers. Studies in other highly endemic areas are needed to confirm these findings.


Assuntos
Aconselhamento/estatística & dados numéricos , Obesidade/dietoterapia , Médicos de Família/estatística & dados numéricos , Programas de Redução de Peso/estatística & dados numéricos , Adulto , Aconselhamento/métodos , Medicina de Família e Comunidade/educação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Cooperação do Paciente/psicologia , Cooperação do Paciente/estatística & dados numéricos , Educação de Pacientes como Assunto , Médicos de Família/educação , Projetos Piloto , Prevalência , Inquéritos e Questionários/estatística & dados numéricos , Fatores de Tempo , Perda de Peso/fisiologia , Programas de Redução de Peso/métodos , West Virginia/epidemiologia
19.
J Am Board Fam Med ; 31(4): 542-549, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29986980

RESUMO

BACKGROUND: The closure of obstetrics (OB) units at rural hospitals is thought to have implications for access to prenatal care (PNC) and infant mortality rate (IMR). The objective of this study was to determine whether local availability of PNC and OB services, specifically as provided by family physicians (FPs), would be associated with a lower IMR in 1 rural Alabama county. METHODS: Data from 1986 to 2013 from Pickens County was compared with data from 2 sets of control counties: Clarke/Monroe (full OB care) and Coosa/Conecuh (no local OB care). RESULTS: From 1986 to 1991 (no local OB services; period 1), Pickens County's IMR was 17.9, which fell to 7.2 from 1993 to 2001 (with local services; period 2). After the county's OB unit closed, IMR rose to 16.0 from 2005 to 2013 (period 3). In Clarke/Monroe (continuous OB service), the IMR fell from 14.5 to 9.9 from period 1 to period 3. Coosa/Conecuh (no OB service) exhibited a consistent IMR ranging from 10.9 to 14.4. CONCLUSION: OB services provided by FPs in Pickens County resulted in improvement of the county's IMR. Local PNC was associated with a lower IMR.


Assuntos
Medicina de Família e Comunidade/organização & administração , Mortalidade Infantil/tendências , Cuidado Pré-Natal/organização & administração , Serviços de Saúde Rural/organização & administração , População Rural/estatística & dados numéricos , Adolescente , Adulto , Alabama/epidemiologia , Criança , Medicina de Família e Comunidade/estatística & dados numéricos , Feminino , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Obstetrícia/educação , Médicos de Família/educação , Médicos de Família/estatística & dados numéricos , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Serviços de Saúde Rural/estatística & dados numéricos , População Rural/tendências , Adulto Jovem
20.
Rural Remote Health ; 18(3): 4514, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-30059629

RESUMO

INTRODUCTION: In Canada, rural-based family medicine residency programs were established largely in response to a shortage of rural physicians and the perception that urban-based training programs were not meeting the needs of rural populations. Examinations of practice patterns of physicians trained in rural and urban programs are lacking. The purpose of this study was to compare the scope of practice of family medicine graduates who completed a rural versus an urban residency program, by practice location. METHODS: This was a cross-sectional, mail-out, questionnaire survey of 651 graduates who had completed the family medicine residency program at the University of Alberta or the University of Calgary, Alberta, Canada during 2006-2011. Rural program graduates lived and trained in regional settings and spent a considerable amount of time in smaller rural and remote communities for their clinical experience. The training of urban program graduates was primarily based in large urban settings and family medicine clinical experience was based in the community. Practice location (rural, urban) was classified by population size of the town/city at which physicians practiced. Scope of practice was ascertained through four domains of care: types of care, clinical procedures, practice settings and specific populations. Items within each domain were rated on a five-point scale (1='not part of practice', 5='element of core practice'). Mean rating scores for items in the domains of care were compared between urban and rural program graduates using ANOVA. RESULTS: A total of 307 (47.2%) graduates responded to the survey, of whom 173 were categorized as urban program graduates and 59 as rural program graduates. Overall, rural program graduates exhibited a broader scope of practice in providing postnatal care, intrapartum care/deliveries, palliative care, office-based and in-hospital clinical procedures, emergency care, in-hospital care, home visits, long-term care, and caring for rural and Aboriginal populations. Irrespective of program completed, those in a rural practice location had a broader scope of practice than those in urban practice. Urban and rural program graduates in rural locations tended to have a similar scope of practice. In urban locations, rural program graduates were more likely to include intrapartum care/deliveries as part of their clinical practice. Rural program graduates were more likely to practice in rural locations than urban program graduates. CONCLUSION: A combination of site of training (rural or urban program) and location of practice appear to work together to influence scope of practice of family physicians. A conceptual framework that summarizes the factors that have been reported to be associated with the scope of family practice is proposed.


Assuntos
Médicos de Família/educação , Saúde da População Rural/educação , Saúde da População Urbana/educação , Adulto , Alberta , Estudos Transversais , Currículo , Feminino , Humanos , Masculino , Médicos de Família/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Inquéritos e Questionários
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