The true complexities of "standard" family practice visits unmasked: an observational cross-sectional study in Regina.

BACKGROUND: Many patients present to their family medicine clinic with more than one health concern, placing an increased demand on family physicians. Research into the average number of concerns per regular family medicine visit is limited. Recognition of the frequency that family physicians address more than one concern per visit and adapting practices accordingly is important for improving patient care. OBJECTIVE: To examine whether family physicians routinely address multiple different patient concerns during a single visit and if this is influenced by patient demographics. METHODS: This study was conducted at a multi-physician family medicine clinic in Regina, Saskatchewan, Canada. Five physicians contributed their 500 most recent charts, extending retrospectively from 1 June 2023, from in-person visits by patients over 18 years of age and billed as regular appointments without billed procedures. Each chart was reviewed for the number of concerns addressed in the visit. RESULTS: Fifty percent of visits addressed more than 1 concern (range = 1-8). A generalized linear mixed model using Poisson distribution showed certain physicians (incident rate ratio [IRR]: 1.192, 95% CI: 1.087-1.307, P < 0.001) and adults older than 65 years compared to adults less than 40 years (IRR 1.151, 95% CI: 1.069-1.239, P < 0.001) were more likely to present with multiple concerns, but patient sex was not a significant predictor. CONCLUSIONS: Family physicians routinely address more than one concern per visit. Standard visit length and billing practices should be adapted to reflect this complexity.

Early detection of neurodevelopmental disorders in paediatric primary care: A scoping review.

BACKGROUND: Earlier detection of children at risk for neurodevelopmental disorders is critical and has longstanding repercussions if not addressed early enough. OBJECTIVES: To explore the supporting or facilitating characteristics of paediatric primary care models of care for early detection in infants and toddlers at risk for neurodevelopmental disorders, identify practitioners involved, and describe how they align with occupational therapy's scope of practice. METHODS: A scoping review following the Joanna Briggs Institute framework was used. PubMed Central, Cumulative Index to Nursing & Allied Health Literature, and Scopus databases were searched. The search was conducted between January and February 2022. Inclusion criteria were: children aged 0-3 years old; neurodevelopmental disorders including cerebral palsy (CP) and autism spectrum disorder (ASD); models of care used in the paediatric primary care setting and addressing concepts of timing and plasticity; peer-reviewed literature written in English; published between 2010 and 2022. Study protocol registered at https://doi.org/10.17605/OSF.IO/MD4K5. RESULTS: We identified 1,434 publications, yielding 22 studies that met inclusion criteria. Models of care characteristics included the use of technology, education to parents and staff, funding to utilize innovative models of care, assessment variability, organizational management changes, increased visit length, earlier timeline for neurodevelopmental screening, and collaboration with current office staff or nonphysician practitioners. The top 4 providers were paediatricians, general or family practitioners, nurse/nurse practitioners, and office staff. All studies aligned with occupational therapy health promotion scope of practice and intervention approach yet did not include occupational therapy within the paediatric primary care setting. CONCLUSIONS: No studies included occupational therapy as a healthcare provider that could be used within the paediatric primary care setting. However, all studies demonstrated models of care facilitating characteristics aligning with occupational therapy practice. Models of care facilitating characteristics identified interdisciplinary staff as a major contributor, which can include occupational therapy, to improve early detection within paediatric primary care.

There is a predicted shortage of primary care doctors in the next decade,1­4 and there are infants and toddlers at risk for cerebral palsy (CP) and autism spectrum disorder (ASD) that typically do not get diagnosed until after the 6­18-month time period where the brain has more plasticity to change its trajectory with how these neurodevelopmental disorders manifest.5­15 This scoping review investigated facilitating characteristics of the models of care (MOC) that improve early detection of neurodevelopmental disorders, such as CP and ASD, in the paediatric primary care setting since primary care practitioners are typically the first to see infants and toddlers for health care check-ups.16,17 In addition, since the United States Patient Protection and Affordable Care Act18 was enacted in 2010, this legislation has allowed nonphysician practitioners to participate in primary care to facilitate more efficient healthcare delivery. Therefore, this scoping review examined if non-physician practitioners, such as occupational therapists, have been used since 2010 within MOC, and demonstrated if the facilitating characteristics align with the occupational therapy scope of practice. Results demonstrated that interdisciplinary staff in the paediatric primary care setting contributed to improved early detection of neurodevelopmental disorders.