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2.
S D Med ; 72(8): 354-360, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31465640

RESUMO

INTRODUCTION: The Centers for Disease Control and Prevention updated recommendations for human papillomavirus (HPV) vaccine in 2016. National and statewide statistics indicate that HPV vaccination in the adolescent population is well below the administration rates for other vaccines. Because cancers associated with HPV infection are vaccine preventable, low administration rates are a cause for concern. METHODS: Through a two-year project funded by the South Dakota Department of Health, Sanford Health implemented a quality improvement project to address the low rate of HPV vaccine administration in their clinics in South Dakota. Evidence-based interventions included: implementation of a client reminder and recall system, vaccine education for providers and staff, a provider assessment and feedback system, and re-education on protocol (standing) orders. RESULTS: Implementation of this quality improvement project resulted in the following: 104,571 client reminders distributed, re-education on standing orders for vaccine administration, as well as feedback on missed opportunities for vaccination, and increased awareness for all providers and staff. In patients ages 11-26, HPV vaccine series completion rates increased by 13 percent in the two-year period. Zero-dose HPV vaccination dropped 22 percent in the seven pilot clinics over the two-year grant period, and by 10 percent overall when the additional clinics (n=32) were added in the second year. DISCUSSION: Implementation of the above practices provided a significant increase in awareness of the need to assess and administer HPV vaccine. The methods used are easily adaptable to any clinic system. These practices can increase HPV vaccination rates and ultimately decrease the number of HPV associated cancers.


Assuntos
Infecções por Papillomavirus , Vacinas contra Papillomavirus/administração & dosagem , Vacinação/estatística & dados numéricos , Adolescente , Adulto , Criança , Medicina de Família e Comunidade , Humanos , Infecções por Papillomavirus/prevenção & controle , Melhoria de Qualidade , South Dakota , Adulto Jovem
3.
S D Med ; 72(4): 164-167, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31436929

RESUMO

BACKGROUND: The Sioux Falls Family Medicine Residency serves a large non-English speaking and low socioeconomic status population. We designed a quality initiative to increase influenza and pneumonia vaccination rates in our elderly patients. METHODS: The main components of the project included improved clinic workflow, physician and staff education, and heightened patient awareness of vaccination importance. For the latter, we employed posters with key points about why patients should receive the vaccines, and personalized handouts with a photo of their provider discussing the importance of receiving these vaccines. The handouts were translated into the four most common non-English languages served by our clinics. RESULTS: Following implementation of the initiative, influenza vaccination rates increased from 35 to 53 percent, PPSV23 vaccination rates increased from 62.5 to 64 percent, and most impressively, PCV13 vaccination rates increased from 40 to 60 percent. CONCLUSION: This quality improvement project demonstrated meaningful change with minimal financial and logistical investment and should be sustainable in the long-term.


Assuntos
Programas de Imunização/organização & administração , Vacinas contra Influenza , Influenza Humana/prevenção & controle , Pneumonia/prevenção & controle , Idoso , Medicina de Família e Comunidade , Humanos , Vacinas contra Influenza/administração & dosagem , South Dakota , Vacinação
4.
Stud Health Technol Inform ; 264: 1423-1424, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438162

RESUMO

To describe information content in an automatically generated patient summary worksheet (PS) comparatively to electronic health records (EHRs) for 90 patients. The PS was more focused on the cure than person-centred care. Ergonomic solutions based on the users' needs should enhance shared decision-making and improve the healthcare professional-patient relationship.


Assuntos
Registros Eletrônicos de Saúde , Medicina Geral , Tomada de Decisões , Medicina de Família e Comunidade , Humanos
8.
Fam Med ; 51(7): 549-550, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31287898
11.
Sante Publique ; Vol. 31(1): 7-17, 2019 January February.
Artigo em Francês | MEDLINE | ID: mdl-31210519

RESUMO

BACKGROUND: Overweight patients feel stigmatized and are reluctant to talk about weight. Physicians question the efficiency of weight management. This work explored how the weight topic was initiated in GP consultations and the experience of patients about this action, whatever their weight or reason for consultation. METHODS: Mixed method study conducted in parallel with direct observation of GPs' consultations by trainees (with a standardized observation grid) and semi directive interview (with guide) after the consultation. Analyses were descriptive on quantitative data, and thematic on verbatim (double blind coding). RESULTS: 187 consultations were observed and 81 patients interviewed. In consultation, GPs initiated the majority of the weight discussions, with three types of approach: discussion alone, discussion and/or weighing, and weighing alone. GP's demands of weighing were very directive and sometimes seemed to make patients feel uncomfortable. The discussion about weight without weighing seemed to enhance a reflection on a possible change of patient's behavior.The joint analysis questions the scale's role in consultation since the discussion approach to the weight debate led to more patient mobilization and, according to them, "the weight is seen". For the patient, the eye appeared as a tool to measure weight, especially since the doctor could see variations. CONCLUSION: Comparing the results of the two exploratory studies, in order to better understand this little studied phenomenon, allowed for the emergence of hypotheses and questions the role of the scale in consultations.


Assuntos
Medicina Geral , Clínicos Gerais , Obesidade/psicologia , Relações Médico-Paciente , Adulto , Medicina de Família e Comunidade , Humanos , Encaminhamento e Consulta
12.
Stud Health Technol Inform ; 261: 205-210, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31156117

RESUMO

The magnitude and seriousness of the challenge posed by heterogeneous multimorbidity in most health services is now unquestioned. Equally well-acknowledged is the fact that existing guidelines essentially set out the principles of best practice in an idealised setting, concentrating on information gathering and not providing any personalisable decision support for the general practitioner aiming to share decision making with a person with multiple morbidities in the reality of routine practice. Existing decision aids have been developed largely within the single condition context and can draw on a body of robust research largely absent in the multimorbidity context. The need for a more flexible and generic approach which draws more on the clinician's expertise-based judgments has been called for, and we introduce a Decision Support Tool, GREST CLIN, in response to this call. Based on Multi-Criteria Decision Analysis it reflects the quantitative calculation approach to decision support rather than the deliberative reasoning of mainstream decision aids. It is emphasised that any evaluation should use the current decision making process as empirical comparator, rather than idealised normative standards, and that the primary outcome measure should be decision quality at the point of care, not downstream outcomes. A demonstration version of the tool is available online as proof of method.


Assuntos
Técnicas de Apoio para a Decisão , Medicina Geral , Multimorbidade , Tomada de Decisões , Medicina de Família e Comunidade , Humanos
13.
BMC Health Serv Res ; 19(1): 388, 2019 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-31200709

RESUMO

BACKGROUND: There is an increasing number of pediatric urgent care centers that are largely staffed by pediatric residency graduates. It is unclear if pediatric residency adequately prepares a physician to fully and successfully provide care in an urgent care setting. The goal of this study is to conduct an assessment of urgent care directors' perceptions of recent pediatric residency graduates' preparedness to successfully provide pediatric urgent care after graduation. METHODS: This is a 2018 cross-sectional survey of all pediatric emergency medicine division chiefs in the United States and all pediatric urgent care directors who are members of the Society for Pediatric Urgent Care. An electronic survey was distributed consisting of eight multiple choice questions regarding perceived preparedness and knowledge gaps of recent pediatric residency graduates for independent practice in urgent care. Descriptive statistics were used to analyze results and qualitative data were analyzed via an inductive thematic approach. RESULTS: Forty-two percent (65/154) of surveys were completed. No respondents believed that a recent pediatric residency graduate would be adequately prepared to independently practice in a pediatric urgent care and 81% of respondents recommended some additional training. Most respondents described this training as important (46%) or very important (35%). Most respondents recommended between 6 months and 1 year as the appropriate amount of time to achieve competency. CONCLUSIONS: Despite the growing number pediatric residency graduates staffing pediatric urgent care centers, the majority of surveyed pediatric emergency medicine division chiefs and pediatric urgent care directors do not think that pediatric residency adequately prepares graduates to successfully provide urgent care to pediatric patients. We recommend further exploration of gaps in knowledge of recent pediatric residency graduates as a next step towards developing systems for further training for pediatric residency graduates to gain competency in urgent care management.


Assuntos
Medicina de Emergência/educação , Internato e Residência/normas , Pediatria/educação , Assistência Ambulatorial/normas , Atitude do Pessoal de Saúde , Criança , Competência Clínica/normas , Estudos Transversais , Assistência à Saúde/normas , Medicina de Família e Comunidade , Bolsas de Estudo , Humanos , Internato e Residência/estatística & dados numéricos , Determinação de Necessidades de Cuidados de Saúde , Diretores Médicos/psicologia , Médicos , Inquéritos e Questionários , Estados Unidos
14.
Wiad Lek ; 72(5 cz 1): 938-941, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31175800

RESUMO

OBJECTIVE: Introduction: In today's realities of health care reform in Ukraine family doctors play a leading role. The aim of our work was to analyze the medical cards of patients who applied for medical care to the family medicine clinic. PATIENTS AND METHODS: Materials and methods: It was analyzed outpatient medical cards of 87 patients who applied to the family medicine clinic in the Khotov village, Kyiv region. The study included people aged 18 to 60 years, which corresponded to the groups of young and middle ages according to the WHO classification. RESULTS: Review: Our findings indicate the prevalence of functional changes among young people: somatoform dysfunction of the autonomic nervous system - 9 (37,5%) and the development of organic manifestations at middle-aged patients: arterial hypertension - 32 (62,7%) and coronary artery disease - 17 (33,3%). CONCLUSION: Conclusions: This study is important for determining the risk groups, early diagnosis and prevention of diseases.


Assuntos
Medicina de Família e Comunidade , Reforma dos Serviços de Saúde , Adolescente , Adulto , Documentação , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Ucrânia , Adulto Jovem
15.
Croat Med J ; 60(3): 255-264, 2019 06 13.
Artigo em Inglês | MEDLINE | ID: mdl-31187954

RESUMO

AIM: To investigate the prevalence of burnout syndrome among physicians of all specialties, including residents and non-specialists, on a national level in Croatia. METHODS: This cross-sectional study, conducted in October 2017, used anonymous online survey based on the Maslach Burnout Inventory Human Services Survey. The Croatian version of the inventory was assessed for acceptability, factorial validity, and reliability. Key dimensions of burnout - emotional exhaustion, depersonalization, and lack of personal accomplishment were assessed. Respondents scoring high for emotional exhaustion or depersonalization were defined as burned-out. RESULTS: The response rate was 18% (2557/14 427). Respondents' median age was 41 years (range 25-80), and 68% (1737/2557) were women. Good sampling adequacy and scale reliability were confirmed. Factorial validity suggested the presence of three overall factors, and no items were eliminated. Sixty-three percent of physicians were burned-out. High score on emotional exhaustion, depersonalization, and reduced personal accomplishment were found in 58%, 29%, and 52% of respondents, respectively. As many as 16% of the respondents simultaneously experienced high levels of all three burnout dimensions. Multivariate logistic regression analysis revealed that residents and physicians in tertiary or primary care were at an increased risk of burnout, while physicians working in institutes were at a decreased risk. CONCLUSION: Active national measures are needed to reduce the high prevalence of burnout among Croatian physicians.


Assuntos
Esgotamento Profissional/epidemiologia , Médicos/psicologia , Médicos/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Croácia/epidemiologia , Estudos Transversais , Despersonalização , Emoções , Medicina de Família e Comunidade/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação Pessoal , Prevalência , Inquéritos e Questionários , Atenção Terciária à Saúde/estatística & dados numéricos
16.
Rev. urug. enferm ; 14(1): 38-48, jun 2019.
Artigo em Português | LILACS, InstitutionalDB, RHS | ID: biblio-1009337

RESUMO

ntrodução:O Programa Mais Médicos criado pela Lei nº 12.871, de 2013, surgiu estruturado em três frentes estratégicas: a primeira foi o provimento emergencial de médicos para Atenção Básica, a segunda, o investimento em infraestrutura neste nível de atenção e a última, medidas relacionadas à formação de médicos no país. O acesso da população aos cuidados médicos é essen-cial para promoção de um cuidado integral aos usuários do Sistema Único de Saúde. No Brasil há uma concentração desses profi ssionais nos grandes centros urbanos, e escassez nas regiões norte e nordeste do país, especialmente na Atenção Básica. As cidades situadas em região de fronteira também sofrem de escassez dos profi ssionais médicos, pois são consideradas áreas longínquas das grandes centros urbanos e capitais.Objetivo: descrever a percepção de seis gestores municipais sobre as potencialidades do Programa Mais Médicos na reorientação da Atenção Básica, em cidades gêmeas entre o Brasil e o Uruguai. Metodologia: Estudo de abordagem qualitativa. A coleta dos dados foi realizada de janeiro a março de 2016 mediante a entrevista semiestruturada. A análise dos dados foi embasada na análise de conteúdo prosposta por Bardin e referencial teórico do Planejamento Estratégico descrito por Matus e Testa. Resultados: Os municípios fronteiriços descentralizaram e planifi caram a atenção em saúde ao alocarem os profi ssionais médicos na Atenção Básica. O provimento e maior permanência do mé-dico nas equipes mobilizou o trabalho multiprofi ssional e ampliou o acesso dos usuários aos servi-ços e ações de saúde. Conclusão: A gestão em saúde aufere maior poder de planejamento ao dispor do profi ssional medico em seu quadro de trabalhadores. Portanto, o Programa Mais Médicos pro-piciou mudanças no modelo de atenção e enfrentamento das desigualdades sociais em saúde nos municípios fronteiriços.


Introducción: El Programa Más Médicos creado por la Ley nº 12.871, de 2013, surgió estructurado en tres frentes estratégicos: la primera fue la provisión de emergencia de médicos para Atención Básica, la segunda, la inversión en infraestructura en este nivel de atención y la última, medidas re-lacionadas con la formación de médicos en el país. El acceso de la población a la atención médica es esencial para promover un cuidado integral a los usuarios del Sistema Único de Salud. En Brasil hay una concentración de estos profesionales en los grandes centros urbanos, y escasez en las regiones norte y noreste del país, especialmente en la Atención Básica. Las ciudades situadas en región de frontera también sufren de escasez del profesional médico , pues son consideradas áreas lejanas de los grandes centros urbanos y capitales. Objetivo: describir la percepción de seis gestores municipales sobre las potencialidades del Pro-grama Más Médicos en la reorientación de la Atención Básica, en ciudades gemelas entre Brasil y Uruguay. Metodología: Estudio de enfoque cualitativo. La recolección de los datos fue realizada de enero a marzo de 2016 mediante la entrevista semiestructurada. El análisis de los datos se basó en el análisis de contenido propuesto por Bardin y referencial teórico de la Planifi cación Estratégica descrito por Matus y Testa. Resultados: Los municipios fronterizos descentralizaron y planifi caron la atención en salud al asignar a los profesionales médicos en la Atención Básica. La provisión y mayor permanencia del médico en los equipos movilizó el trabajo multiprofesional y amplió el acceso de los usuarios a los servicios y acciones de salud. Conclusión: La gestión en salud aporta mayor poder de planifi cación al disponer del profesional médico en su cuadro de trabajadores. Por lo tanto, el Programa Más Médicos propició cambios en el modelo de atención y enfrentamiento de las desigualdades sociales en salud en los municipios fronterizos


Introduction: More Doctors Program, in accordance with Law No. 12,871 of 2013, was structured on three strategic fronts: the fi rst one deal with the emergency of medical care for Basic Care, the second, an investment in infrastructure for Basic Care and the last one, these are measures related to the training of doctors in the country. Access to medical care is essential for the comprehensive health care for users of the Unifi ed Health System (called SUS in Brazil). Health professionals are concentrated in large urban centers and are lacking in the north and northeast regions of Brazil, especially in relation to Basic Care. Cities located in the border region also suff er from a shortage of doctors; as such places are considered remote areas of urban centers and capitals. Objective: " is study aims to describe the perception of six municipal managers about the poten-tial of the More Doctors Program in relation to the reorientation of Basic Care in twin cities betwe-en Brazil and Uruguay. Methodology: " is is a qualitative study with a semi-structured interview. Data collection was performed from January to March in 2016. " e analysis of the data was based on the analysis of content proposed by Bardin and the theoretical reference of Strategic Planning was described by Matus and Testa. Results: Border cities decentralized and planned health care by allocating doctors to Basic Care. " e provision of doctors and their permanence in the teams mobilized the multiprofessional work and extended the access of the users to actions and health services. Conclusion: Health manage-ment has greater planning power by having a medical professional in its workforce. " erefore, the More Doctors Program provided both changes in the care model and confrontation of social ine-qualities in health in border cities


Assuntos
Humanos , Gestão em Saúde , Planejamento em Saúde , Política de Saúde , Atenção Primária à Saúde , Uruguai , Brasil , Medicina de Família e Comunidade
17.
Rev Med Suisse ; 15(650): 947-950, 2019 May 08.
Artigo em Francês | MEDLINE | ID: mdl-31066525

RESUMO

Ecodesign is relatively new to the family medicine practice. It consists of a pro-active approach in order to reduce harmful environmental impacts from an organization or a product. These environmental impacts, such as climate change, clearly represent major public health concerns. It seems legitimate for the medical community to question its role in «â€…preventing ¼ rather than «â€…curing ¼ through its contribution to the protection of the environment. This review lays some definitions and explains the current situation. It tries to gather the existing ecodesign initiatives in the outpatient area. At last, some lines of thought and of progress are presented, with a focus on the Swiss context.


Assuntos
Meio Ambiente , Medicina de Família e Comunidade , Medicina Geral , Mudança Climática , Saúde Pública
18.
Rev Med Suisse ; 15(650): 951-955, 2019 May 08.
Artigo em Francês | MEDLINE | ID: mdl-31066526

RESUMO

The health sector is one of the most stressed occupational sectors. In family medicine, the risk is especially high: the prevalence of burnout increased. This article explores four facets of the problem : 1) the elements influencing physicians' satisfaction and well-being at work ; 2) prevention and detection of burnout in doctors ; 3) the impact of the doctors' stress on patient care and 4) the organization of the practice to improve the practitioners' well-being. The elements presented here are a summary of a meeting of physicians engaged in training and practice in family medicine, the objective being to identify ways to promote sustainable doctors in their practice !


Assuntos
Esgotamento Profissional , Médicos , Esgotamento Profissional/prevenção & controle , Medicina de Família e Comunidade , Humanos , Satisfação Pessoal , Prevalência
19.
Rev Med Suisse ; 15(650): 958-964, 2019 May 08.
Artigo em Francês | MEDLINE | ID: mdl-31066527

RESUMO

Family medicine is now an integral part of the curriculum of medical schools in Switzerland. The current challenge is to convey information about the attractive aspects of family medicine to medical students to address the growing shortage of primary care physicians. This article describes the implementation of a research program to promote career choice in family medicine, which leads to the development of a conceptual framework as a theoretical basis for teaching and research. Innovations from three medical schools in French-speaking Switzerland are presented. The authors describe the implication for family physicians in private practice, who are key partners of academic family medicine.


Assuntos
Currículo , Medicina de Família e Comunidade , Universidades , Escolha da Profissão , Medicina de Família e Comunidade/educação , Faculdades de Medicina , Suíça
20.
Rev Med Suisse ; 15(650): 971-974, 2019 May 08.
Artigo em Francês | MEDLINE | ID: mdl-31066529

RESUMO

This is selection of some important studies published in 2018 dealing with several key organization and functioning features of family medicine. In 1978, the Declaration of Alma Ata emphasised the central role of primary care to guarantee health equity. Today, if some objectives of the Declaration seem to be on the way, others remain unrealistic. The article on the second study demonstrates how financial crises can lead to the strengthening of primary care services by describing the positive evolution of access between 2007 and 2012. The third paper uses medico-administrative data to characterize continuity of care and show its association with cost reduction. Finally, the choice to provide a care manager for certain patients should be based not only on medical criteria but also on personal criteria such as patient's social support and motivation.


Assuntos
Medicina de Família e Comunidade , Atenção Primária à Saúde , Medicina de Família e Comunidade/organização & administração , Medicina de Família e Comunidade/tendências , Humanos
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