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2.
BMC Health Serv Res ; 19(1): 793, 2019 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-31684933

RESUMO

BACKGROUND: Health professionals in Norway are required by law to help safeguard information and follow-up with children of parents with mental or physical illness, or who have substance abuse problems, to reduce their higher risk of psychosocial problems. Knowledge is lacking regarding whether organisation and/or worker-related factors can explain the differences in health professionals' ability to support the families when patients are parents. METHODS: Employing a translated, generic version of the Family Focused Mental Health Practice Questionnaire (FFPQ), this cross-sectional study examines family focused practice (FFP) differences in relation to health professionals' background and role (N = 280) along with exploring predictors of parent, child, and family support. RESULTS: While most health professions had begun to have conversations with parents on children's needs, under one-third have had conversations with children. There were significant differences between nurses, social workers, psychologists, physicians, and others on seven of the FFP subscales, with physicians scoring lowest on five subscales and psychologists providing the least family support. Controlling for confounders, there were significant differences between child responsible personnel (CRP) and other clinicians (C), with CRP scoring significantly higher on knowledge and skills, confidence, and referrals. Predictors of FFP varied between less complex practices (talking with parents) and more complex practices (family support and referrals). CONCLUSION: The type of profession was a key predictor of delivering family support, suggesting that social workers have more undergraduate training to support families, followed by nurses; alternately, the results could suggest that that social workers and nurses have been more willing or able than physicians and psychologists to follow the new legal requirements. The findings highlight the importance of multidisciplinary teams and of tailoring training strategies to health professionals' needs in order to strengthen their ability to better support children and families when a parent is ill.


Assuntos
Filho de Pais Incapacitados , Medicina de Família e Comunidade/organização & administração , Pessoal de Saúde/estatística & dados numéricos , Transtornos Mentais , Papel Profissional , Adolescente , Adulto , Criança , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde , Pessoal de Saúde/legislação & jurisprudência , Humanos , Masculino , Pessoa de Meia-Idade , Noruega
3.
J R Soc Med ; 112(11): 462-471, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31710823

RESUMO

Locum doctors are often perceived to present greater risks of causing harm to patients than permanent doctors. After eligibility and quality assessment, eight empirical and 34 non-empirical papers were included in a narrative synthesis to establish what was known about the quality and safety of locum medical practice. Empirical literature was limited and weak methodologically. Locums enabled healthcare organisations to maintain appropriate staffing levels and allowed staffing flexibility, but they also gave rise to concerns about continuity of care, patient safety, team function and cost. There was some evidence to suggest that the way locum doctors are recruited, employed and used by organisations, may result in a higher risk of harm to patients. A better understanding of the quality and safety of locum working is needed to improve the use of locum doctors and the quality and safety of patient care that they provide.


Assuntos
Escolha da Profissão , Medicina de Família e Comunidade/organização & administração , Satisfação no Emprego , Segurança do Paciente/normas , Admissão e Escalonamento de Pessoal/organização & administração , Médicos/provisão & distribução , Humanos
4.
Health Serv Res ; 54(6): 1316-1325, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31598965

RESUMO

OBJECTIVE: To investigate whether continuity of care in family practice reduces unplanned hospital use for people with serious mental illness (SMI). DATA SOURCES: Linked administrative data on family practice and hospital utilization by people with SMI in England, 2007-2014. STUDY DESIGN: This observational cohort study used discrete-time survival analysis to investigate the relationship between continuity of care in family practice and unplanned hospital use: emergency department (ED) presentations, and unplanned admissions for SMI and ambulatory care-sensitive conditions (ACSC). The analysis distinguishes between relational continuity and management/ informational continuity (as captured by care plans) and accounts for unobserved confounding by examining deviation from long-term averages. DATA COLLECTION/EXTRACTION METHODS: Individual-level family practice administrative data linked to hospital administrative data. PRINCIPAL FINDINGS: Higher relational continuity was associated with 8-11 percent lower risk of ED presentation and 23-27 percent lower risk of ACSC admissions. Care plans were associated with 29 percent lower risk of ED presentation, 39 percent lower risk of SMI admissions, and 32 percent lower risk of ACSC admissions. CONCLUSIONS: Family practice continuity of care can reduce unplanned hospital use for physical and mental health of people with SMI.


Assuntos
Continuidade da Assistência ao Paciente/organização & administração , Medicina de Família e Comunidade/organização & administração , Hospitalização/estatística & dados numéricos , Transtornos Mentais/economia , Transtornos Mentais/terapia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Inglaterra , Medicina de Família e Comunidade/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
5.
Fam Med ; 51(8): 664-669, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31509217

RESUMO

BACKGROUND AND OBJECTIVES: Facilitation is common in the era of practice transformation. Much of the literature on practice facilitators focuses on the role of external facilitators who come into a practice to aid in practice transformation efforts. Our study sought to better understand the attributes of exemplary facilitators. METHODS: We conducted 10 structured interviews in four family medicine residencies. RESULTS: Program directors easily identified internal staff who serve informally as exemplary facilitators. Despite varying jobs, they possess seven identifiable attributes within three broad domains: task orientation, relational skills, and emotional intelligence. CONCLUSIONS: Given the increasing cost of practice transformation and the finite resources in many clinics, this study can help leaders identify current employees best suited for facilitation.


Assuntos
Comportamento Cooperativo , Medicina de Família e Comunidade/educação , Medicina de Família e Comunidade/organização & administração , Ciência da Implementação , Internato e Residência , Inovação Organizacional , Inteligência Emocional , Humanos , Entrevistas como Assunto , Pesquisa Qualitativa , Melhoria de Qualidade
6.
Niger J Clin Pract ; 22(8): 1063-1069, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31417048

RESUMO

Aim: The objective of this study was to determine the prevalence of burnout syndrome and associated factors among family physicians before and after family medicine system (FMS). Materials and Method: The first part of the study was conducted in 2008 (pre-FMS) and the second part in 2012 (post-FMS). Physician's burnout was investigated by using the Maslach Burnout Inventory (MBI). In total, 139 physicians had been participating pre-FMS and 246 physician's post-FMS. Results: The mean pre-FMS emotional exhaustion score was 15.7 ± 5.8, increasing significantly to 17.14 ± 7.5 post-FMS (P = 0.045). Mean pre-FMS and post-FMS depersonalization and reduced personal accomplishment scores were similar (P > 0.05). Age was negatively correlated with depersonalization in this study (P = 0.012) and positively correlated with personal accomplishment (P = 0.001). The primary care physicians in the post-FMS period were older, female physicians had a greater preference for primary care, and the levels of married doctors were higher. In addition, a higher level of physicians also owned their own home and cars compared to the pre-FMS period. A negative correlation has been reported between physicians' burnout levels and home or car ownership in the present study. Conclusion: Our findings suggest that physicians working under the family medicine system, a new primary care model, are at greater risk of emotional exhaustion, but that no change has occurred in terms of personal accomplishment or depersonalization, despite this new system.


Assuntos
Esgotamento Profissional/psicologia , Estresse Ocupacional/psicologia , Médicos de Família/psicologia , Carga de Trabalho , Adulto , Esgotamento Profissional/epidemiologia , Estudos Transversais , Despersonalização , Emoções , Medicina de Família e Comunidade/organização & administração , Feminino , Humanos , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Estresse Ocupacional/epidemiologia , Prevalência , Atenção Primária à Saúde/organização & administração , Inquéritos e Questionários , Turquia/epidemiologia
7.
Cien Saude Colet ; 24(6): 2221-2232, 2019 Jun 27.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31269181

RESUMO

The history of Primary Health Care (PHC) in the Federal District (DF) is as old as the history of the Federative Unit. The history of Family and Community Medicine (MFC), however, is relatively recent, both locally and nationally. This paper proposes to focus on the fundamental contribution of MFC to advances in Public Health in the Federal District, especially in the last 10 years, after the founding of the Family and Community Medicine Association of Brasília (ABMFC). In order to do so, the most relevant historical events and contexts related to Health Care, Management, Social Control and Medical Education - including Undergraduate course and Residency - were documented, which support this position, in parallel with the evolution of the specialty in the Federal District. Therefore, its organization was divided into four historical stages: until 2008, from 2008 to 2011, from 2011 to 2016, and from 2016 to 2018.


Assuntos
Assistência à Saúde/organização & administração , Atenção Primária à Saúde/organização & administração , Saúde Pública , Brasil , Medicina Comunitária/organização & administração , Medicina Comunitária/tendências , Assistência à Saúde/tendências , Educação Médica/métodos , Educação Médica/tendências , Medicina de Família e Comunidade/organização & administração , Medicina de Família e Comunidade/tendências , Humanos , Atenção Primária à Saúde/tendências
10.
Artigo em Inglês | MEDLINE | ID: mdl-31170335

RESUMO

Background: The Institute of Mental Health (IMH), the leading tertiary psychiatric hospital in Singapore, has managed patients' psychiatric issues for decades. However, these patients' existing medical conditions often require care in subspeciality outpatient clinics of restructured hospitals. Given the need to reduce follow-up appointments in subspeciality outpatient clinics for conditions that can be managed by family physicians, a novel family medicine-psychiatry collaborative initiative between Sengkang General Hospital and IMH was implemented to address this issue. Methods: Data were retrospectively collected on patients with upcoming appointments who were seen by family physicians at IMH from January 2 to May 14, 2017. Patients with upcoming appointments in the subspeciality outpatient clinics were scheduled for review by family physicians. Continuous data were summarized as median (range) and count (percentage). Results: At 4.5 months, 272 patients with 426 preexisting specialty appointments had been seen by family physicians. Of the specialty appointments, 150 (35.2%) were cancelled, as the conditions could be managed by family physicians. In 64 (15.0%) cases, a memo requesting transfer of care was given to the subspecialty consultant to ensure a consensus regarding the patient's management. Conclusions: Family physicians embedded in mental health institutions can reduce the need to transfer patients out of the hospital to receive care for nonpsychiatric conditions.


Assuntos
Agendamento de Consultas , Medicina de Família e Comunidade/organização & administração , Hospitais Psiquiátricos/estatística & dados numéricos , Colaboração Intersetorial , Psiquiatria/organização & administração , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Singapura , Adulto Jovem
11.
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
12.
BMC Health Serv Res ; 19(1): 228, 2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30987616

RESUMO

BACKGROUND: Commissioning is a term used in the English National Health Service (NHS) to refer to what most health systems call health planning or strategic purchasing. Drawing on research from a recent in-depth mixed methods study of a major integrated care initiative in North West London, we examine the role of commissioning in attempts to secure large-scale change within and between health and social care services to support the delivery of integrated care for people living with complex long-term conditions. METHODS: We analysed data collected in semi-structured interviews, surveys, workshops and non-participant observations using a thematic framework derived both deductively from the literature on commissioning and integrated care, as well as inductively from our coding and analysis of interview data. RESULTS: Our findings indicate that commissioning has significant limitations in enabling large-scale change in health services, particularly in engaging providers, supporting implementation, and attending to both its transactional and relational dimensions. CONCLUSIONS: Our study highlights the consequences of giving insufficient attention to implementation, and especially the need for commissioners to enable, support and performance manage the delivery of procured services, while working closely with providers at all times. We propose a revised version of Øvretveit's cycle of commissioning that gives greater emphasis to embedding effective implementation processes within models of commissioning large-scale change.


Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Medicina de Família e Comunidade/organização & administração , Planejamento em Saúde/organização & administração , Humanos , Londres , Programas Nacionais de Saúde/organização & administração , Avaliação de Programas e Projetos de Saúde , Seguridade Social
13.
Fam Med ; 51(4): 338-343, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30973622

RESUMO

BACKGROUND AND OBJECTIVES: Clinic First residency curricular approaches hold promise as models to successfully prepare primary care residents for future practice. The objective of our study was to estimate the prevalence of the Clinic First model in current family medicine residency training environments, and assess beliefs surrounding curricular structure and postgraduate practice. METHODS: An eight-question survey was conducted among Association of Family Medicine Residency Directors (AFMRD) members in 2017. Data were grouped and analyzed for statistical significance and correlation using analysis of variance, Kendall's τ, χ2, and Fisher exact test. RESULTS: Two hundred-eleven AFMRD members responded to the survey; 27% described their current curriculum as Clinic First; 68% stated that their ideal curriculum is Clinic First. Residents in Clinic First programs spend more half-days in continuity clinic per week compared with traditional programs during PGY1 (1.79, 1.39, P=0.001) and PGY2 (3.18, 2.90, P=0.024). In group analyses, 63% of Clinic First respondents prioritized clinic in developing resident schedules, compared with 8% of traditional respondents (P<0.001). Seventy-four percent of Clinic First respondents described their philosophy as full spectrum, compared with 93% of traditional respondents (P<0.001). Seventy-five percent of respondents listed their graduates' most common practice type as outpatient practice, and there were no differences between groups (P=0.361). Sixty-one percent of traditional respondents stated that their ideal curriculum is Clinic First (P<0.001). CONCLUSIONS: There is a high level of interest in the Clinic First model as a tool to prepare residents for future practice, but barriers to implementation need to be explored and addressed.


Assuntos
Currículo/estatística & dados numéricos , Currículo/normas , Medicina de Família e Comunidade/educação , Medicina de Família e Comunidade/organização & administração , Internato e Residência/organização & administração , Instituições de Assistência Ambulatorial , Humanos , Prevalência , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários
14.
Healthc Q ; 21(4): 21-27, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30946650

RESUMO

Five Alberta family practices achieved accreditation with Accreditation Canada in 2013-2015. This study conducted a workload and cost analysis of achieving accreditation. Human resources (HR) comprised 95% of the total cost. Document preparation constituted 76% of workload and 68% of total HR costs. Centralized content experts were tasked with document write-up. Clinics focused on survey preparation: 56% of staff participated, with the workload being the heaviest on managers. In CAD (2018 $ value), per capita cost was the highest for the 2-physician clinic ($65.78) and lower for the 11-physician ($19.44) clinic. Other cost determinants included culture, organizational structure, physician/staff engagement and pre-existing compliance to standards. A cost-benefit analysis shall provide insights into system-level benefits.


Assuntos
Acreditação/economia , Acreditação/estatística & dados numéricos , Medicina de Família e Comunidade/organização & administração , Acreditação/organização & administração , Alberta , Análise Custo-Benefício , Medicina de Família e Comunidade/economia , Humanos , Recursos Humanos/economia , Recursos Humanos/organização & administração , Carga de Trabalho/estatística & dados numéricos
15.
Rev Med Inst Mex Seguro Soc ; 56(6): 513-515, 2019 Mar 15.
Artigo em Espanhol | MEDLINE | ID: mdl-30889337
19.
Fam Med ; 51(2): 120-128, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30736037

RESUMO

BACKGROUND AND OBJECTIVES: Family medicine is continuously advanced by a reinforcing research enterprise. In the United States, each national family medicine organization contributes to the discipline's research foundations. We sought to map the unique and interorganizational roles of the eight US family medicine professional organizations participating in Family Medicine for America's Health (FMAHealth) in supporting family medicine research. METHODS: We interviewed leaders and reviewed supporting materials from organizations participating in FMAHealth. We explored existing activities, capacity, and collaboration. We identified areas of strength and opportunities for growth and synergy with respect to how the family of family medicine nurtures family medicine research. RESULTS: The FMAHealth organizations support certain aspects of the family medicine research infrastructure. Six domains were identified through this work: showcasing scholarship, communication and dissemination, workforce development, data-driven initiatives, performing primary research, and advocacy for family medicine research. Each organization's areas of emphasis differ, but we found substantial collaboration on initiatives across organizations, possibly attributable to the fact that many members belong to more than one organization. CONCLUSIONS: Deliberate contributions to each of the six domains identified herein will be important for the future success of family medicine research. Key opportunity areas described here include coordinated and strategic advocacy for increased funding for family medicine research, dedicated investment in training opportunities, protected effort to grow the next generation of family medicine researchers, pilot funding to build a research base for future high-impact research, and infrastructure to facilitate cross-institutional collaboration and data sharing.


Assuntos
Fortalecimento Institucional , Medicina de Família e Comunidade/organização & administração , Pesquisa sobre Serviços de Saúde , Sociedades Médicas/organização & administração , Comportamento Cooperativo , Humanos , Entrevistas como Assunto , Pesquisa Qualitativa , Estados Unidos , Recursos Humanos
20.
Fam Med ; 51(2): 143-148, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30736039

RESUMO

BACKGROUND AND OBJECTIVES: The Family Medicine for America's Health Workforce and Education Team aims to increase the number of medical students choosing family medicine to address the projected primary care physician shortage. This aim can be achieved by developing a well-trained primary care workforce. Our student- and resident-led FMAHealth work group aimed to identify factors that influenced fourth-year medical students' choice to become family physicians. The secondary objective compared such factors between the 10 medical schools with the highest percentage of students matching into family medicine and non-top 10 medical schools. METHODS: Fourth-year medical students nationwide participated in 90-minute virtual focus groups. Reviewers coded deidentified transcriptions and identified key themes and subthemes that were found to influence student choice. RESULTS: Fifty-five medical students participated in focus groups over a 2-year period. Three key themes were found to influence students: perspective, choice, and exposure. Subthemes included: (1) the importance of high-quality preceptors practicing full-scope family medicine, (2) the value of a rural experience, and (3) institutional support to pursue family medicine. Physician compensation and loan repayment concerns were not major factors influencing student choice. CONCLUSIONS: Many factors influence student choice of family medicine including preceptors, clinical exposures, and institutional support. These factors varied by institution and many were found to be different between top 10 and non-top 10 schools. Addressing these factors will help increase students' choice of family medicine and reduce the primary care shortage.


Assuntos
Escolha da Profissão , Medicina de Família e Comunidade/organização & administração , Preceptoria , Estudantes de Medicina/estatística & dados numéricos , Comportamento Cooperativo , Medicina de Família e Comunidade/educação , Grupos Focais , Humanos , Faculdades de Medicina , Recursos Humanos
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