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1.
BMC Prim Care ; 23(1): 240, 2022 09 16.
Artigo em Inglês | MEDLINE | ID: mdl-36114462

RESUMO

BACKGROUND: Guidelines worldwide recommend that physicians should not treat their family members. However, studies in the U.S. have shown that approximately 74-83% of physicians have experience of treating family members. Primary care physicians were more likely to have such experiences than other specialists. In Japan, physicians do not have any guidelines regarding treating family members, and little is known about the experiences of primary care physicians. Therefore, we investigated the experience of treating family members or relatives among primary care physicians in Japan. METHODS: This cross-sectional study used an online questionnaire. We recruited 2,000 physicians who were members of the Japan Primary Care Association using random sampling. Data were collected from February 10 to March 10, 2021. We compare the experiences of treating family members between clinic-based doctors and hospital-based doctors using the chi-square test. We performed logistic regression analysis to adjust for gender, age, presence of a doctor in family, and physician's geographic location (rural or not rural). RESULTS: A total of 466 physicians (response rate = 23.3%) completed the survey. Of the sample, 79.8% had experience of treating family members or relatives. In the univariate analysis, being a clinic-based physician was associated with experience in treating family members compared to hospital-based physicians (87.6% vs. 74.9%, p = 0.001). Multivariable analysis showed that being a clinic-based physician (odds ratio 2.30, 95% confidence interval 1.31-4.04) and age of 45-64 years (odds ratio 2.93, 95% confidence interval 1.74-4.93) were significantly related to experience treating family. Gender and geographic location were not statistically significant factors. CONCLUSIONS: A high percentage of Japanese primary care physicians, especially those who worked in clinics, reported experience treating family members or relatives. These findings will serve as basic data for future studies regarding the care of families and relatives of physicians in Japan.


Assuntos
Médicos de Atenção Primária , Estudos Transversais , Família , Humanos , Japão , Pessoa de Meia-Idade , Inquéritos e Questionários
2.
JAMA Netw Open ; 5(9): e2229521, 2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-36048444

RESUMO

Importance: Inappropriate variations in clinical practice are a known cause of poor quality and safety, with variations often associated with nonclinical factors, such as individual differences in cognitive processing. The differential response of physicians to uncertainty may explain some of the variations in resource use and patient experience. Objective: To examine the association of physician tolerance for uncertainty with variations in resource use and patient experience. Design, Setting, and Participants: This survey study linked physician survey data (May to June 2019), patient experience survey data (January 2016 to December 2019), and billing data (January 2019 to December 2019) among primary care physicians (PCPs) at Massachusetts General Hospital with at least 10 visits in 2019. The statistical analysis was performed in 2021. Main Outcomes and Measures: The analysis examined associations of PCP tolerance for uncertainty with the tendency to order diagnostic tests, the frequency of outpatient visits, hospital admissions, emergency department visits, and patient experience data (focused on physician communication and overall rating). A 2-stage hierarchical framework was used to account for clustering of patients under PCPs. Binary outcomes were modeled using a hierarchical logistic model, and count outcomes were modeled using hierarchical Poisson or negative binomial models. The analysis was adjusted for patient demographic variables (age, sex, and race and ethnicity), socioeconomic factors (payer and neighborhood income), and clinical comorbidities. Results: Of 217 included physicians, 137 (63.1%) were women, and 174 (80.2%) were adult PCPs. A total of 62 physicians (28.6%) reported low tolerance, 59 (27.2%) reported medium tolerance, and 96 (44.2%) reported high tolerance for uncertainty. Physicians with a low tolerance for uncertainty were less likely to order complete blood cell counts (odds ratio [OR], 0.66; 95% CI, 0.50-0.88), thyroid tests (OR, 0.67; 95% CI, 0.52-0.88), a basic metabolic profile (OR, 0.78; 95% CI, 0.60-1.00), and liver function tests (OR, 0.72; 95% CI, 0.53-0.99) than physicians with a high tolerance for uncertainty. Physicians who reported higher tolerance for uncertainty were more likely to receive higher patient experience scores for listening to patients carefully (OR, 0.65; 95% CI, 0.50-0.83) and higher overall ratings (OR, 0.80; 95% CI, 0.66-0.98) than physicians with medium tolerance. Conversely, no association was found between physician tolerance for uncertainty and patient outpatient visits, hospital admissions, or emergency department visits. Conclusions and Relevance: In clinical practice, identifying and effectively managing inappropriate variations and improving patient experience have proven to be difficult, despite increased attention to these issues. This study supports the hypothesis that physicians' tolerance for uncertainty is associated with differences in resource use and patient experience. Whether enhancing physicians' tolerance for uncertainty could help reduce unwarranted practice variations, improve quality and patient safety, and improve patient's experience remains to be established.


Assuntos
Médicos de Atenção Primária , Adulto , Feminino , Hospitalização , Humanos , Masculino , Avaliação de Resultados da Assistência ao Paciente , Autorrelato , Incerteza
3.
Artigo em Inglês | MEDLINE | ID: mdl-36078444

RESUMO

Nurses are key players in primary care in Israel and in the efforts to improve its quality, yet a survey conducted among primary care physicians (PCPs) in 2010 indicated that 40% perceived the contribution of nurses to primary care quality as moderate to very small. In 2020, we conducted a cross-sectional survey using self-report questionnaires among PCPs employed by health plans to examine the change in PCPs' perceptions on nurses' responsibility and contributions to quality of primary care between 2010 and 2020. Four-hundred-and-fifty respondents completed the questionnaire in 2020, as compared to 605 respondents in 2010. The proportion of PCPs who perceive that nurses share the responsibility for improving the quality of medical care increased from 74% in 2010 to 83% in 2020 (p < 0.01). Older age, males, self-employment status, and board certification in family medicine independently predicted reduced PCP perception regarding nurses' responsibility for quality-of-care. PCPs who believed that nurses contribute to quality of practice were 7.2 times more likely to perceive that nurses share the responsibility for quality-of-care. The study showed that over the past decade there was an increase in the extent to which PCPs perceive nurses as significant partners in improving quality of primary care.


Assuntos
Enfermeiras e Enfermeiros , Médicos de Atenção Primária , Atitude do Pessoal de Saúde , Estudos Transversais , Humanos , Masculino , Assistência ao Paciente , Inquéritos e Questionários
5.
Isr J Health Policy Res ; 11(1): 34, 2022 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-36127744

RESUMO

BACKGROUND: The COVID-19 pandemic had a major impact on primary care and primary care physicians (PCPs) in Israel and around the world. There is paucity of information regarding treatment of patients with COVID-19 in the community, since most research was performed in hospitals. The aim of this study was to describe the Israeli PCPs' experience. METHODS: This study is a part of an international cross-sectional study, the PRICOV-19. A translated version of the questionnaire was distributed among Israeli PCPs from December 2020 to July 2021. In this study, we describe the Israeli results and compare them to the international results. RESULTS: 5,961 respondents from 29 countries answered the questionnaire, 94 from Israel, with an Israeli response rate of 16%. Israeli PCPs reported an increase in use of telemedicine from 11 to 49% during the COVID epidemic. PCPs also reported a decline in their wellbeing; absence of secured time slots for keeping updated; perception that the Ministry of Health guidelines were a threat to the staff wellbeing and organization of practice and delays in the examination of non-COVID urgent cases. CONCLUSIONS: The findings of this study raise concerns regarding the PCPs experience and may form the basis for an improved process of care. Guidelines for proper usage of telemedicine, substitutes for the physical examination and procedures for minimizing delayed patient examination for urgent conditions should be developed. Government directives and clinical guidelines should be communicated in a timely manner, with secured timeslots for physicians' self-learning or updating. Ensuring physicians' well-being in general should be an organization priority.


Assuntos
COVID-19 , Médicos de Atenção Primária , COVID-19/epidemiologia , Estudos Transversais , Humanos , Israel/epidemiologia , Pandemias/prevenção & controle
6.
Mo Med ; 119(3): 243-249, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36035575

RESUMO

Eating disorder is a term to describe a wide variety of maladaptive eating patterns and becoming more prominent in today's culture. The primary care provider (PCP) plays a key role in detection of eating disorders. Medical management by an informed provider is an essential part of the treatment team and focuses on preventing acute and chronic physical sequela of the disease. There are various levels of care offered, with family-based approaches showing the best outcomes.


Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos , Médicos de Atenção Primária , Humanos
7.
BMC Prim Care ; 23(1): 206, 2022 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-35964001

RESUMO

BACKGROUND: The postpartum period is a critical time for women to optimise their physical and mental health. Primary care physicians (PCP) often manage postpartum women in the community setting after uneventful births. However, women encounter difficulties accessing care before and after their conventional 6-week physical review. Telehealth-based interventional studies have demonstrated their successful applications in several areas of postpartum care but is not widely adopted. The study aimed to explore the PCPs' views on their acceptability and perceived barriers of telehealth in delivering postpartum care to women in primary care. METHODS: Twenty-nine PCPs participated in eleven in-depth interviews and four focus group discussions for this qualitative study conducted in Singapore. The purposively sampled PCPs had varied demographic background and medical training. Two investigators independently coded the audited transcripts. Thematic content analysis was performed using the codes to identify issues in the pertaining to the perceived usefulness, ease of use and attitudes towards telehealth in postpartum care as described in the "Telehealth Acceptance Model" framework. RESULTS: Most PCPs perceived usefulness and ease of use of video consultation in delivering postpartum care. They recognised telehealth service to complement and support the current face-to-face postpartum care amidst the pandemic. However, training, leadership support, organizational infrastructure, healthcare financial policy and personal demographic profile influence their acceptance of a new care model for postnatal mothers. CONCLUSION: Addressing the barriers and strengthening the facilitators will enhance PCPs' acceptance and utilisation of the proposed hybrid (telehealth and in-person) postnatal care model for mothers.


Assuntos
Médicos de Atenção Primária , Telemedicina , Feminino , Grupos Focais , Humanos , Cuidado Pós-Natal , Gravidez , Pesquisa Qualitativa
8.
BMC Prim Care ; 23(1): 208, 2022 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-35971075

RESUMO

BACKGROUND: Obesity is a chronic disease with increasing prevalence. We aimed to explore primary care physicians' knowledge and attitudes about obesity and how knowledge and attitudes are associated with confidence and adherence to obesity guidelines and barriers to obesity treatment. METHODS: A questionnaire survey was sent by e-mail to 1642 primary care physicians in four regions in Sweden. The survey focused on the physicians' knowledge, attitudes towards obesity, confidence in obesity management, adherence to obesity guidelines and barriers to optimal care. We created different statistical indices for knowledge, attitudes and adherence. To analyse the correlation between these indices, we used linear regression analyses. RESULTS: Replies from 235 primary care physicians yielded a response rate of 14.3%. Most physicians answered correctly that obesity is a disease (91%), that obesity regulation sits in the hypothalamus (70%) and that obesity is due to disorders of appetite regulation (69%). However, 44% of the physicians thought that the most effective weight reduction method for severe obesity was lifestyle changes; 47% believed that obesity is due to lack of self-control, 14% mentioned lack of motivation and 22% stated laziness. Although 97% believed that physicians can help individuals with obesity and 56% suggested that obesity treatment should be prioritised, 87% of the physicians expressed that losing weight is the patients' responsibility. There was a positive association between higher knowledge and better adherence to obesity guidelines (B = 0.07, CI 0.02-0.12, p-value = 0.005) and feeling confident to suggest medication (p < 0.001) or bariatric surgery (p = 0.002). While 99% of the physicians felt confident to discuss lifestyle changes, 67% and 81% were confident to suggest medication or bariatric surgery, respectively. Respondents perceived that the greatest barrier in obesity management was lack of time (69%) and resources (49%). CONCLUSION: There was a positive association between Swedish primary care physicians' knowledge and adherence to obesity guidelines and being more confident to suggest obesity treatment. Yet, many physicians had an ambivalent attitude towards obesity management.


Assuntos
Médicos de Atenção Primária , Atitude do Pessoal de Saúde , Estudos Transversais , Humanos , Obesidade/epidemiologia , Inquéritos e Questionários , Suécia/epidemiologia
9.
JAMA Netw Open ; 5(8): e2227662, 2022 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-35984659

RESUMO

Importance: Maintaining a healthy physician workforce includes the routine use of primary care physician (PCP) services; however, physicians may face barriers to attaining formal care. Objective: To analyze access to and frequency of visits to PCPs among physicians compared with nonphysicians. Design, Setting, and Participants: This population-based, retrospective cohort study used registration data from the College of Physicians and Surgeons of Ontario, Canada, from January 1, 1990, to March 31, 2018. Data for all newly practicing physicians as of March 31, 2018, were linked to Ontario health administrative databases. Data were analyzed from August 25, 2020, to August 6, 2021. Main Outcomes and Measures: The main outcomes were enrollment in a PCP practice and visits with a PCP. Generalized estimating equations compared primary care visits between physicians and nonphysicians, matched 1:5 based on age, sex, neighborhood income quintile, and health region. Results: Among 19 581 physicians (mean [SD] age, 43.99 [8.94] years; 53.27% male) matched to 97 905 nonphysicians, physicians were less likely to be enrolled with a PCP than were nonphysicians (81.8% vs 86.4%; absolute difference, 4.6%; adjusted odds ratio [OR], 0.75; 95% CI, 0.72-0.79) and had fewer primary care visits during the preceding 2 years (median [IQR], 2 [0-4] vs 4 [1-7]; adjusted relative rate ratio [RRR], 0.59; 95% CI, 0.58-0.60). Physicians aged 40 years or older and male physicians were less likely to be rostered (ages 40-44 years: OR, 0.70 [95% CI, 0.64-0.77]; male: OR, 0.60 [95% CI, 0.57-0.63]) and more likely to have a lower frequency of PCP visits (ages 40-44 years: RRR, 0.53 [95% CI, 0.51-0.56]; male: RRR, 0.50 [95% CI, 0.50-0.51]) compared with nonphysicians. Conclusions and Relevance: In this retrospective cohort study, enrollment with a PCP practice and frequency of visits were lower among physicians compared with a matched general population of nonphysicians. Individual, system, and medical cultural factors associated with these results need to be better understood so that physicians can take better care of themselves and their patients.


Assuntos
Médicos de Atenção Primária , Adulto , Estudos de Coortes , Feminino , Humanos , Renda , Masculino , Ontário/epidemiologia , Estudos Retrospectivos
10.
Int J Clin Pract ; 2022: 6450641, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35989865

RESUMO

Background: Medication nonadherence in patients with chronic diseases is common, costly, and often underdiagnosed. In the United States, approximately 40-50% of patients with cardiometabolic conditions are not adherent to long-term medications. Drug-drug interactions (DDI) are also underrecognized and may lead to medication nonadherence in this patient population. Treatment complexity associated with cardiometabolic conditions contributes to increased risk for adverse drug events and DDIs. Methods: We recruited a nationally representative sample of 246 board-certified family and internal medicine physicians to evaluate how they assessed, identified, and treated medication nonadherence, DDIs, and worsening disease. Participating physicians were asked to care for three online simulated patients, each with at least one chronic cardiometabolic disease, including atrial fibrillation, heart failure, diabetes mellitus, or hypertension, and who were taking prescription medications for their disease. Physicians' scores were based on evidence-based care recommendation criteria, including overall care quality and treatment for medication nonadherence and DDIs. Results: Overall, quality-of-care scores across all cases ranged from 13% to 87% with an average of 50.8% ± 12.1%. The average overall diagnostic plus treatment score was 21.9% ± 13.6%. Participants identified nonadherence in just 3.6% of cases, DDIs in 8.9% of cases, and disease progression in 30.3% of cases. Conclusions: Based on these study results, primary care physicians were unable to adequately diagnose and treat patients with chronic cardiometabolic diseases who either suffered from medication nonadherence, DDIs, or progression of the disease. Improved standardization and technique in identifying these diagnoses is needed in primary care. Trial Registration. This trial is registered with clinicaltrials.gov, NCT05192590.


Assuntos
Hipertensão , Médicos de Atenção Primária , Doença Crônica , Estudos Transversais , Progressão da Doença , Interações Medicamentosas , Humanos , Hipertensão/tratamento farmacológico , Adesão à Medicação , Simulação de Paciente , Estados Unidos
11.
P R Health Sci J ; 41(3): 135-141, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-36018741

RESUMO

OBJECTIVE: Advance directives (ADs) are legal documents designed to guarantee a patient's preference of care for the future. Primary care physicians (PCPs) have long been identified as key to promoting AD completion among patients. Furthermore, PCPs' levels of awareness of and attitudes toward ADs have been related to positive completion rates in patients. In this project, we sought to identify the levels of awareness and attitudes towards ADs in Puerto Rican PCPs. METHODS: Self-administered questionnaires were distributed at primary care medical conferences in Puerto Rico (PR) to explore the levels of awareness and attitudes of PCPs on ADs. RESULTS: A total of 332 surveys were collected. Overall, PCPs in PR had high selfrated knowledge of ADs, with the highest being reported among internal medicine physicians (8.63 ± 1.51). However, this self-rating was in stark contrast with the lower than 60% level of awareness of and commitment to reading the applicable laws on ADs in PR across all specialties. Puerto Rican PCPs showed strongly positive attitudes towards ADs and recognized them as useful tools for patients, healthcare workers, and families, enabling them to make healthcare decisions. Internal medicine practitioners showed the strongest positive attitudes of all PCPs. Despite the perceived usefulness of ADs, Puerto Rican PCPs had a low predisposition to complete their own ADs in the short term. CONCLUSION: Our results suggest that improvements in the education of health professionals with regard to ADs are needed to increase in physicians both their knowledge of the legal standards governing ADs and their commitment to ensuring that patients complete such directives.


Assuntos
Médicos de Atenção Primária , Diretivas Antecipadas , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Porto Rico , Inquéritos e Questionários
12.
NPJ Prim Care Respir Med ; 32(1): 28, 2022 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-35986011

RESUMO

China has a huge population with respiratory diseases, these diseases should be managed well in primary care, however, primary care physicians' knowledge level of these diseases were unknown. The aim of the study was to assess primary care physicians' knowledge of asthma, CAP, COPD, and influenza in China. An e-questionnaire was distributed to attendees of respiratory diseases academic conferences in China from July, 2017 to December, 2018. 7391 questionnaires were returned and 4815 valid questionnaires were analyzed, 3802 (79.0%) from community health service centers and 1013 (21.0%) from township hospitals. The average score of the questionnaire was 83.3 (±20.397) and 72.1 (±20.898) in township and community hospitals, respectively (P < 0.05). 61.4%, 48.7%, and 42.5% of the primary care physicians were aware of clinical manifestations of COPD, asthma, and simple influenza. 85.7%, 8.1%, 16.1%, and 1.0% knew how to diagnose COPD, asthma, CAP and influenza, respectively. 94.4% of the physicians lacked the knowledge of treating COPD with bronchodilators; 53.7% knew non-pharmacological treatments for COPD. 73.6% were unable to deal with asthma attacks. 65.1% did not know what the most essential and important treatment for influenza was. 92% of physicians did not know the management for stable COPD; 3.0% knew all prevention and management measures for asthma. 37.9% knew all the preventive measures for CAP. 44.9% did not know the important role of influenza vaccine in preventing influenza and its complications. Primary care physicians in China had a poor knowledge of CAP, asthma, Influenza, COPD. There is a need for improved training of common respiratory diseases.


Assuntos
Asma , Influenza Humana , Médicos de Atenção Primária , Doença Pulmonar Obstrutiva Crônica , Asma/tratamento farmacológico , Asma/terapia , China/epidemiologia , Humanos , Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/terapia , Inquéritos e Questionários
13.
BMC Med Inform Decis Mak ; 22(1): 208, 2022 08 04.
Artigo em Inglês | MEDLINE | ID: mdl-35927732

RESUMO

BACKGROUND: Chemoprevention with anti-estrogens, such as tamoxifen, raloxifene or aromatase inhibitors, have been shown to reduce breast cancer risk in randomized controlled trials; however, uptake among women at high-risk for developing breast cancer remains low. The aim of this study is to identify provider-related barriers to shared decision-making (SDM) for chemoprevention in the primary care setting. METHODS: Primary care providers (PCPs) and high-risk women eligible for chemoprevention were enrolled in a pilot study and a randomized clinical trial of web-based decision support tools to increase chemoprevention uptake. PCPs included internists, family practitioners, and gynecologists, whereas patients were high-risk women, age 35-75 years, who had a 5-year invasive breast cancer risk ≥ 1.67%, according to the Gail model. Seven clinical encounters of high-risk women and their PCPs who were given access to these decision support tools were included in this study. Audio-recordings of the clinical encounters were transcribed verbatim and analyzed using grounded theory methodology. RESULTS: Six primary care providers, of which four were males (mean age 36 [SD 6.5]) and two were females (mean age 39, [SD 11.5]) and seven racially/ethnically diverse high-risk female patients participated in this study. Qualitative analysis revealed three themes: (1) Competing demands during clinical encounters; (2) lack of knowledge among providers about chemoprevention; and (3) limited risk communication during clinical encounters. CONCLUSIONS: Critical barriers to SDM about chemoprevention were identified among PCPs. Providers need education and resources through decision support tools to engage in risk communication and SDM with their high-risk patients, and to gain confidence in prescribing chemoprevention in the primary care setting.


Assuntos
Neoplasias da Mama , Quimioprevenção , Tomada de Decisão Compartilhada , Adulto , Idoso , Neoplasias da Mama/prevenção & controle , Técnicas de Apoio para a Decisão , Feminino , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Médicos de Atenção Primária , Projetos Piloto , Atenção Primária à Saúde , Medição de Risco
14.
BMC Prim Care ; 23(1): 203, 2022 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-35948965

RESUMO

BACKGROUND: Primary care is a relevant pillar in managing not only individual, but also societal medical crises. The COVID-19 pandemic has demanded a rapid response from primary care with interventions in the health care system. The aim of this paper was to explore the responses of primary care practitioners (PCP) during the early COVID-19 pandemic and to analyze these with a view on the resilience of the primary health care system from the PCPs perspective. METHODS: Shortly after the first COVID-19 wave (July-October 2020) n = 39, semi-structured telephone interviews were conducted with PCP in practices and at Corona contact points (CCP) in Baden-Wuerttemberg (Germany). Qualitative content analysis was applied, and the evolved categories were related to in a framework for resilience. RESULTS: Primary care had an overall strong ability to adapt and show resilience, albeit with wide variance in speed and scope of the responses. When coping with uncertainty, the reasons given by PCPs in favor of opening a CCP mainly involved intrinsic motivation and self-initiative; the reasons against doing so were i.e. the lack of personal protective equipment, problems with space, and worries about organizational burden. A strong association existed between the establishment of a CCP and the use of resources (i.e. existing networks, personal protective equipment, exercising an office of professional political function). Our study predominantly found adaptive aspects for measures taken at medical practices and transformative aspects for setting up outpatient infection centers. PCPs played an important role in the coordination process (i.e. actively transferring knowledge, integration in crisis management teams, inclusion in regional strategic efforts) reaching a high level in the dimensions knowledge and legitimacy. The dimension interdependence repeatedly came into focus (i.e. working with stakeholders to open CCP, interacting among different types of primary care facilities, intersectoral interfaces). A need for regional capacity planning was visible at the time of the interviews. CONCLUSIONS: The results can be used for practical and research-based institutional and capacity planning, for developing resilience in primary care and for augmentation by perspectives from other stakeholders in the primary health care system.


Assuntos
COVID-19 , Médicos de Atenção Primária , Atenção Primária à Saúde , Atenção à Saúde , Alemanha , Humanos , Pandemias
15.
Crit Care ; 26(1): 248, 2022 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-35971153

RESUMO

AIM: We sought to explore unmet needs in transitions of care for critical illness survivors that concern primary care physicians. FINDINGS: Semi-structured interviews with primary care physicians identified three categories of concerns about unmet transition needs after patients' ICU stays: patients' understanding of their ICU stay and potential complications, treatments or support needs not covered by insurance, and starting and maintaining needed rehabilitation and assistance across transitions of care. CONCLUSION: Given current constraints of access to coordinated post-ICU care, efforts to identify and address the post-hospitalization needs of critical illness survivors may be improved through coordinated work across the health system.


Assuntos
Estado Terminal , Médicos de Atenção Primária , Estado Terminal/reabilitação , Hospitalização , Humanos , Unidades de Terapia Intensiva , Sobreviventes
16.
J Prim Care Community Health ; 13: 21501319221110418, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35795898

RESUMO

INTRODUCTION: Prior to the COVID-19 pandemic, telehealth utilization was growing slowly and steadily, although differentially across medical specialties in the United States. The pandemic dramatically expanded physician use of telehealth, but our understanding of how much telehealth use has changed in primary care in the United States, the correlates of physician telehealth uptake, and the frequency with which primary care physicians intend to use telehealth after the pandemic are unknown. This paper is designed to assess these important questions. METHODS: Using data from an original national survey of 625 primary care physicians conducted from May 14 to May 25, 2021, we investigate the frequency of physician telehealth use before and during the pandemic and intended use after the pandemic. We also assess the correlates of changes in telehealth use by physicians, comparing telehealth use before the pandemic to use during and after the pandemic. RESULTS: The proportion of primary care physicians using telehealth often, jumped from 5.3% (95% CI 3.5, 7.0) before the pandemic to 46.2% (95% CI 42.3, 50.2) during the pandemic. More importantly, over 70% of physicians intended to use telehealth at least occasionally after the pandemic compared to just 18.7% before, with younger physicians, physicians without telehealth training in medical school, and Asian physicians most likely to increase their telehealth use long-term. DISCUSSION: The COVID-19 pandemic has spurred expansion in telehealth use by primary care physicians that will continue to shape care delivery well beyond the pandemic. Policy change could be needed to facilitate this growth of telehealth long-term.


Assuntos
COVID-19 , Médicos de Atenção Primária , Telemedicina , COVID-19/epidemiologia , Humanos , Pandemias , Políticas , Estados Unidos
17.
J Am Board Fam Med ; 35(4): 708-715, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35896466

RESUMO

BACKGROUND: A rising population of cancer survivors is accompanied by a shortage of oncologists for continuity of care. This study examined the physicians who provided most of the care for cancer survivors, along with written information provided to the survivors before transfer of care. METHODS: Data were collected through the CDC-sponsored Behavioral Risk Factor Surveillance System. Our analysis involved states whose respondents completed a cancer survivorship module from 2016 to 2020. Primary measures were the proportions of physician specialists who provided most of their subsequent health care and the proportions of survivors who received written summaries of their care and instructions. RESULTS: The 36,737 cancer survivor respondents came from 33 states. Most of their health care came from primary care physicians [family physicians (42.3%, 95% CI: 41.3-43.2%) and general internists (26.0%, 95% CI: 25.2-26.9%)]. When seen by primary care physicians rather than subspecialists, a lower proportion of patients recalled receiving summaries of either their cancer treatments (44.3%, 95% CI: 42.5 to 46.2 vs 50.5%, 95% CI: 49.4 to 51.7%) or follow-up instructions (69.9%, 95% CI: 68.8 to 71.0% vs 78.7%, 95%CI 77.1 to 80.2%), regardless of their cancer type. CONCLUSIONS: Regardless of their cancer type, two-thirds of survivors received most of their health care from primary care physicians. Collaborative community-based care within a shared decision-making framework is essential to prioritize and individualize patients' understandings and needs in this growing population.


Assuntos
Sobreviventes de Câncer , Neoplasias , Médicos de Atenção Primária , Continuidade da Assistência ao Paciente , Atenção à Saúde , Humanos , Neoplasias/epidemiologia , Neoplasias/terapia , Inquéritos e Questionários , Sobreviventes
18.
Health Serv Res ; 57(5): 1182-1190, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35808929

RESUMO

OBJECTIVE: To evaluate whether primary care physicians' participation in the Medicare Shared Savings Program (MSSP) is associated with changes in their preventive services delivery. DATA SOURCES: Medicare Provider Utilization and Payment Physician and Other Supplier Public Use File and MSSP Accountable Care Organizations (ACO) Provider-Level Research Identifiable File from 2012 to 2018. STUDY DESIGN: The design was a two-way fixed effects model estimating within-provider changes in preventive services delivery over time controlling for provider time-invariant characteristics, national time trends, and characteristics of served patients. The following preventive services were evaluated: influenza vaccination, pneumococcal vaccination, clinical depression screening, colorectal cancer screening, breast cancer screening, Body Mass Index (BMI) screening and follow-up, tobacco use assessment, and annual wellness visits. Both the likelihood of providing services and the volume of services delivered were evaluated. DATA COLLECTION/EXTRACTION METHODS: Secondary data linked at the provider level. PRINCIPAL FINDINGS: MSSP participation was associated with an increase in the likelihood of providing influenza vaccination (0.7 percentage-points), pneumococcal vaccination (2.0 percentage-points), clinical depression screening (2.1 percentage-points), tobacco use assessment (0.3 percentage-points), and annual wellness visits (4.1 percentage-points). A similar increase was found for the volume of services delivered per 100 patients for several preventive services: influenza vaccination (0.18), pneumococcal vaccination (0.56), clinical depression screening (0.46), and annual wellness visits (1.52). MSSP participation was associated with a decrease in the likelihood (-0.4 percentage-points) and the volume of colorectal cancer screening (-0.03). CONCLUSIONS: Primary care physicians' participation in MSSP was associated with an increase in the likelihood and the volume of several preventive services.


Assuntos
Organizações de Assistência Responsáveis , Neoplasias Colorretais , Influenza Humana , Médicos de Atenção Primária , Idoso , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/prevenção & controle , Redução de Custos , Humanos , Medicare , Estados Unidos
19.
Ann Intern Med ; 175(8): 1135-1142, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35849829

RESUMO

BACKGROUND: The physician gender wage gap may be due, in part, to productivity-based compensation models that undervalue female practice patterns. OBJECTIVE: To determine how primary care physician (PCP) compensation by gender differs when applying existing productivity-based and alternative compensation models. DESIGN: Microsimulation. SETTING: 2016 to 2019 national clinical registry of 1222 primary care practices. PARTICIPANTS: Male and female PCPs matched on specialty, years since medical school graduation, practice site, and sessions worked. MEASUREMENTS: Net annual, full-time-equivalent compensation for male versus female PCPs, under productivity-based fee-for-service, panel size-based capitation without or with risk adjustment, and hybrid payment models. Microsimulation inputs included patient and visit characteristics and overhead expenses. RESULTS: Among 1435 matched male (n = 881) and female (n = 554) PCPs, female PCP panels included patients who were, on average, younger, had lower diagnosis-based risk scores, were more often female, and were more often uninsured or insured by Medicaid rather than by Medicare. Under productivity-based payment, female PCPs earned a median of $58 829 (interquartile range [IQR], $39 553 to $120 353; 21%) less than male PCPs. This gap was similar under capitation ($58 723 [IQR, $42 141 to $140 192]). It was larger under capitation risk-adjusted for age alone ($74 695 [IQR, $42 884 to $152 423]), for diagnosis-based scores alone ($114 792 [IQR, $49 080 to $215 326] and $89 974 [IQR, $26 175 to $173 760]), and for age-, sex-, and diagnosis-based scores ($83 438 [IQR, $28 927 to $129 414] and $66 195 [IQR, $11 899 to $96 566]). The gap was smaller and nonsignificant under capitation risk-adjusted for age and sex ($36 631 [IQR, $12 743 to $73 898]). LIMITATION: Panel attribution based on office visits. CONCLUSION: The gender wage gap varied by compensation model, with capitation risk-adjusted for patient age and sex resulting in a smaller gap. Future models might better align with primary care effort and outcomes. PRIMARY FUNDING SOURCE: None.


Assuntos
Capitação , Médicos de Atenção Primária , Idoso , Feminino , Humanos , Masculino , Medicare , Atenção Primária à Saúde , Salários e Benefícios , Estados Unidos
20.
Am Fam Physician ; 106(1): 61-69, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35839363

RESUMO

This article summarizes the top 20 research studies of 2021 identified as POEMs (patient-oriented evidence that matters) that did not address the COVID-19 pandemic. Sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists prevent adverse cardiovascular and renal outcomes in patients with type 2 diabetes mellitus and also reduce all-cause and cardiovascular mortality. Most older adults (mean age, 75 years) with prediabetes do not progress to diabetes. Among patients in this age group with type 2 diabetes treated with medication, an A1C level of less than 7% is associated with increased risk of hospitalization for hypoglycemia, especially when using a sulfonylurea or insulin. For patients with chronic low back pain, exercise, nonsteroidal anti-inflammatory drugs, duloxetine, and opioids were shown to be more effective than control in achieving a 30% reduction in pain, but self-discontinuation of duloxetine and opioids was common. There is no clinically important difference between muscle relaxants and placebo in the treatment of nonspecific low back pain. In patients with chronic pain, low- to moderate-quality evidence supports exercise, yoga, massage, and mindfulness-based stress reduction. For acute musculoskeletal pain, acetaminophen, 1,000 mg, plus ibuprofen, 400 mg, without an opioid is a good option. Regarding screening for colorectal cancer, trial evidence supports performing fecal immunochemical testing every other year. For chronic constipation, evidence supports polyethylene glycol, senna, fiber supplements, magnesium-based products, and fruit-based products. The following abdominal symptoms carry a greater than 3% risk of cancer or inflammatory bowel disease: dysphagia or change in bowel habits in men; rectal bleeding in women; and abdominal pain, change in bowel habits, or dyspepsia in men and women older than 60 years. For secondary prevention in those with established arteriosclerotic cardiovascular disease, 81 mg of aspirin daily appears to be effective. The Framingham Risk Score and the Pooled Cohort Equations both overestimate the risk of cardiovascular events. Over 12 years, no association between egg consumption and cardiovascular events was demonstrated. Gabapentin, pregabalin, duloxetine, and venlafaxine provide clinically meaningful improvements in chronic neuropathic pain. In patients with moderate to severe depression, initial titration above the minimum starting dose of antidepressants in the first eight weeks of treatment is not more likely to increase response. In adults with iron deficiency anemia, adding vitamin C to oral iron has no effect. In children with pharyngitis, rhinosinusitis, acute bronchitis, or acute otitis media, providing education combined with a take-and-hold antibiotic prescription results in 1 in 4 of those children eventually taking an antibiotic.


Assuntos
COVID-19 , Doenças Cardiovasculares , Diabetes Mellitus Tipo 2 , Dor Lombar , Médicos de Atenção Primária , Inibidores do Transportador 2 de Sódio-Glicose , Idoso , Analgésicos Opioides , Antibacterianos , COVID-19/complicações , Criança , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Cloridrato de Duloxetina , Feminino , Humanos , Masculino , Pandemias , Médicos de Atenção Primária/educação
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