"Three Good Things" Digital Intervention Among Health Care Workers: A Randomized Controlled Trial.

PURPOSE: Positive psychology shows promise in improving positive affect and happiness. We tested a digital version of a positive psychology intervention called Three Good Things (3GT) among health care workers to assess whether gratitude practice improved well-being. METHODS: All members of a large academic medicine department were invited. Participants were randomized to an immediate intervention group or control group (delayed intervention). Participants completed outcome measures surveys (demographics, depression, positive affect, gratitude, and life satisfaction) at baseline, and at 1 month and 3 months post-intervention. Controls completed additional surveys at 4 and 6 months (completion of the delayed intervention). During the intervention, we sent 3 text messages per week asking for 3GT that occurred that day. We used linear mixed models to compare the groups and to look at the effects of department role, sex, age, and time on outcomes. RESULTS: Of 468 eligible individuals, 223 (48%) enrolled and were randomized with high retention through the end of the study. Most (87%) identified as female. For the intervention group, positive affect improved slightly at 1 month, then declined slightly but remained significantly improved at 3 months. Depression, gratitude, and life satisfaction scores showed a similar trend but were not statistically different between groups. CONCLUSIONS: Our research showed adherence to a positive psychology intervention for health care workers created small positive improvements immediately post-intervention but were not sustained. Further work should evaluate whether utilizing different duration or intensity of the intervention improves benefits.

The prevalence and associations of Australian early-career general practitioners' provision of after-hours care.

INTRODUCTION: Access to after-hours care (AHC) is an important aspect of general practice service provision. OBJECTIVE: To establish the prevalence and associations of early-career GPs' provision of AHC. DESIGN: An analysis of data from the New alumni Experiences of Training and independent Unsupervised Practice (NEXT-UP) cross-sectional questionnaire-based study. Participants were early-career GPs (6-month to 2-year post-Fellowship) following the completion of GP vocational training in NSW, the ACT, Victoria or Tasmania. The outcome factor was 'current provision of after-hours care'. Associations of the outcome were established using multivariable logistic regression. FINDINGS: Three hundred and fifty-four early-career GPs participated (response rate 28%). Of these, 322 had responses available for analysis of currently performing AHC. Of these observations, 128 (40%) reported current provision of AHC (55% of rural participants and 32% of urban participants). On multivariable analysis, participants who provided any AHC during training were more likely to be providing AHC (odds ratio (OR) 5.51, [95% confidence interval (CI) 2.80-10.80], p < 0.001). Current rural location and in-training rural experience were strongly associated with currently providing AHC in univariable but not multivariable analysis. DISCUSSION: Early-career GPs who provided AHC during training, compared with those who did not, were more than five times more likely to provide after-hours care in their first 2 years after gaining Fellowship, suggesting participation in AHC during training may have a role in preparing registrars to provide AHC as independent practitioners. CONCLUSION: These findings may inform future GP vocational training policy and practice concerning registrars' provision of AHC during training.

Rates and estimated cost of primary care consultations in people diagnosed with type 2 diabetes and comorbidities: A retrospective analysis of 8.9 million consultations.

AIMS: To determine whether telephone and face-to-face primary care consultation rates, costs, and temporal trends during 2000 to 2018 differed by the number of comorbidities in people with type 2 diabetes (T2DM). METHODS: A total of 120 409 adults with newly diagnosed T2DM between 2000 and 2018 were classified by the number of prevalent and incident comorbidities. Data on face-to-face and telephone primary care consultations with a nurse or physician were obtained. Crude and sex- and age-adjusted annual consultation rates and associated costs were calculated based on the number of comorbidities at the time of consultation. RESULTS: The crude rate of face-to-face primary care consultations for patients without comorbidities was 10.3 (95% confidence interval [CI] 10.3-10.4) per person-year, 12.7 (95% CI 12.7-12.7) for patients with one comorbidity, 15.1 (95% CI 15.1-15.2) for those with two comorbidities, and 18.7 (95% CI 18.7-18.8) for those with three or more comorbidities. The mean annual inflation-adjusted cost for face-to-face consultations was £412.70 per patient without comorbidities, £516.80 for one comorbidity, £620.75 for two comorbidities, and £778.83 for three or more comorbidities. The age- and sex-adjusted face-to-face consultation rate changed by an average of -3.3% (95% CI -4.4 to -2.3) per year from 2000 to 2018 for patients without comorbidities, -2.7% (95% CI -4.0 to -1.3) for those with one comorbidity, -2.2% (95% CI -3.3 to -1.2) for those with two comorbidities, and -4.3% (95% CI -8.7 to +0.3) for those with three or more comorbidities. CONCLUSIONS: Although consultation rates for all patients decreased from 2000 to 2018, there was a significant disparity between the rate for patients with and without comorbidities. Patients with T2DM and comorbidities may require different models of service delivery.

Palpitation referrals from primary care to a secondary care cardiology outpatient clinic: assessing adherence to guidelines.

BACKGROUND AND AIMS: Palpitations are a common presentation in primary care. Guidelines have been developed to identify patients with palpitations who require further assessment by a cardiologist in secondary care. However, patients that do not meet guideline thresholds for referrals are still referred to secondary care services. This audit evaluated the adherence to referral guidelines at our trust and assessed the characteristics of patients who were referred appropriately versus those referred without meeting guideline referral thresholds (inappropriate referral). RESULTS: Palpitation referrals to a single cardiology outpatient clinic were assessed (n = 66). Half the patients referred for palpitations were referred inappropriately (n = 34, 51.5%). Patients referred inappropriately were more likely to have a benign diagnosis after assessment (91.2%). These patients also had significantly fewer investigations [mean difference of 1.1 (confidence interval: 0.6-1.6)]. Specialist investigations, such as cardiac event recorders (P < 0.05) and cardiac magnetic resonance imaging (P < 0.05) were less likely to be used in inappropriately referred patients. CONCLUSIONS: The results from this audit provide early evidence that there are a significant number of patients who are being referred that could be managed in primary care. Further studies are needed to confirm our findings in larger cohorts and to establish the underlying reasons for inappropriate referrals.

The Strengths and Difficulties Questionnaire is a usable way to address mental health at well-child visits in general practice - a qualitative study of feasibility.

BACKGROUND: Mental health problems is frequent among children and psychopathology in early childhood seems to predict mental disorders in adulthood. All Danish children are offered seven free well-child visits at their General Practitioner (GP) during their first 5 years of life. GPs have a unique position to address mental health problems at the well-child visits, but they lack a systematic approach when assessing children's mental health. The purpose of this study was to investigate if the Strengths and Difficulties Questionnaire (SDQ) is a usable way to address preschool children's mental health in general practice. METHODS: A qualitative study of feasibility. Parents completed an online version of the SDQ at home. At the well-child visit, the GP used the SDQ results as a basis for a talk about the child's mental health. Afterwards the author JS conducted semistructured interviews with both the parent and the GP over the phone. The interviews were descriptively analyzed using the Framework Approach. RESULTS: Five primary care centres with 22 general practitioners in both Copenhagen and Region Zealand participated. Twenty four parents completed the SDQ and were interviewed. Participating parents and GPs agreed, that the SDQ introduced mental health as a natural and important part of the well-child visit. Online access had clear advantages: time for reflection at home and preparation, plus a clear result summary for the GP. Some of the GPs were worried that the questionnaire would be too time consuming, and might compromise the individualistic style of general practice. Some parents were worried if children with minor problems would be diagnosed. CONCLUSIONS: The online SDQ was well-accepted and feasible in daily practice. Implementing the SDQ into the well-child visit could strengthen the focus on the child's mental health. However, before the SDQ can be generally implemented a guideline on how to utilize it in the well-child visit is needed, as well as studies of efficacy in this setting. TRIAL REGISTRATION: Not relevant.

Development of Primary Care Research in North America, Europe, and Australia From 1974 to 2017.

Research is a necessity for high-quality medicine. We used the MEDLINE database to conduct a bibliometric analysis of research output with respect to primary care by 21 countries. For the period 1974 to 2017, the United States and the United Kingdom stood out in terms of publication volume, and the UK, Canada, and Australia had the greatest percentage of publications in primary care. As of 2017, publications in primary care represented a small proportion of total publications. The countries with the greatest publication productivity possess factors that should be considered with respect to strengthening research in primary care.

Area deprivation and attachment to a general practitioner through centralized waiting lists: a cross-sectional study in Quebec, Canada.

BACKGROUND: Access to primary healthcare is an important social determinant of health and having a regular general practitioner (GP) has been shown to improve access. In Canada, socio-economically disadvantaged patients are more likely to be unattached (i.e. not have a regular GP). In the province of Quebec, where over 30% of the population is unattached, centralized waiting lists were implemented to help patients find a GP. Our objectives were to examine the association between social and material deprivation and 1) likelihood of attachment, and 2) wait time for attachment to a GP through centralized waiting lists. METHODS: A cross-sectional study was conducted in five local health networks in Quebec, Canada, using clinical administrative data of patients attached to a GP between June 2013 and May 2015 (n = 24, 958 patients) and patients remaining on the waiting list as of May 2015 (n = 49, 901), using clinical administrative data. Social and material area deprivation indexes were used as proxies for patients' socio-economic status. Multiple regressions were carried out to assess the association between deprivation indexes and 1) likelihood of attachment to a GP and 2) wait time for attachment. Analyses controlled for sex, age, local health network and variables related to health needs. RESULTS: Patients from materially medium, disadvantaged and very disadvantaged areas were underrepresented on the centralized waiting lists, while patients from socially disadvantaged and very disadvantaged areas were overrepresented. Patients from very materially advantaged and advantaged areas were less likely to be attached to a GP than patients from very disadvantaged areas. With the exception of patients from socially disadvantaged areas, all other categories of social deprivation were more likely to be attached to a GP compared to patients from very disadvantaged areas. We found a pro-rich gradient in wait time for attachment to a GP, with patients from more materially advantaged areas waiting less than those from disadvantaged areas. CONCLUSION: Our findings suggest that there are socio-economic inequities in attachment to a GP through centralized waiting lists. Policy makers should take these findings into consideration to adjust centralized waiting list processes to avoid further exacerbation of health inequities.

Effects of Educational Interventions for Chronic Airway Disease on Primary Care.

Education has been known to essential for management of chronic airway diseases. However the real benefits remain unclear. We evaluated the effectiveness of an organized educational intervention for chronic airway diseases directed at primary care physicians and patients. The intervention was a 1-month education program of three visits, during which subjects were taught about their disease, an action plan in acute exacerbation and inhaler technique. Asthma control tests (ACT) for asthma and, chronic obstructive pulmonary disease (COPD) assessment tests (CAT) for COPD subjects were compared before and after education as an index of quality of life. Educational effectiveness was also measured associated with improvement of their knowledge for chronic airway disease itself, proper use of inhaler technique, and satisfaction of the subjects and clinicians before and after education. Among the 285 participants, 60.7% (n = 173) were men and the mean age was 62.2 ± 14.7. ACT for asthma and CAT in COPD patients were significantly improved by 49.7% (n = 79) and 51.2% (n = 65) more than MCID respectively after education (P < 0.05). In all individual items, knowledge about their disease, inhaler use and satisfaction of the patients and clinicians were also improved after education (P < 0.05). This study demonstrates the well-organized education program for primary care physicians and patients is a crucial process for management of chronic airway diseases.

Individual and geospatial factors associated with receipt of colorectal cancer screening: a state-wide mixed-level analysis.

BACKGROUND: Colorectal cancer (CRC) is the second leading cause of cancer death in US adults but can be reduced by screening. The roles of individual and contextual factors, and especially physician supply, in attaining universal CRC screening remains uncertain. METHODS: We used data from adults 50-75 years old participating in the 2018 New York (NY) Behavioural Risk Factor Surveillance System linked to county-level covariates, including primary care physician (PCP) density and gastroenterologist (GI) density. Data were analysed in 2023-2024. Our analyses included (1) ecological and geospatial analyses of county-level CRC screening prevalence and (2) individual-level Poisson regression models of receipt of screening, adjusted for socioeconomic and county-level contextual variables. RESULTS: Mean prevalence of up-to-date CRC screening was 71% (95% CI 70% to 73%) across NY's 62 counties. County-level CRC screening demonstrated significant spatial patterning (Global Moran's I=0.14, p=0.04), consistent with the existence of county-level contextual factors. In both county-level and individual-level analyses, lack of health insurance was associated with lower likelihood of up-to-date screening (ß=-1.09 (95% CI -2.00 to -0.19); adjusted prevalence ratio 0.68 (95% CI 0.60 to 0.77)), even accounting for age, race/ethnicity and education. In contrast, county-level densities of both PCPs and GIs were completely unassociated with screening at either the county or individual level. As expected, other determinants at the individual level included education status and age. CONCLUSION: In this state-wide representative analysis, physician density was completely unassociated with CRC screening, although health insurance status remains strongly related. In similar screening environments, broadened insurance coverage for CRC screening is likely to improve screening far more effectively than increased physician supply.

Storylines of family medicine I: framing family medicine - history, values and perspectives.

Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'I: framing family medicine-history, values, and perspectives', the authors address the following themes: 'Notes on Storylines of Family Medicine', 'Family medicine-the generalist specialty', 'Family medicine's achievements-a glass half full assessment', 'Family medicine's next 50 years-toward filling our glasses', 'Four enduring truths of family medicine', 'Names matter', 'Family medicine at its core' and 'The ecology of medical care.' May readers find much food for thought in these essays.

General practice-related MeSH terms in main journals: a bibliometric analysis from 2011 to 2021.

BACKGROUND: There are various Medical Subject Headings (MeSH) terms used to index general practice research, without consistency. AIM: To understand how general practice-related research is indexed in the main general practice journals between 2011 and 2021, and to analyse the factors that influenced the choice of the general practice-related MeSH. DESIGN AND SETTING: This was a quantitative bibliometric study conducted on MEDLINE. METHOD: MeSH were selected according to the international definition of General Practice/Family Medicine: 'General Practice', 'Primary Health Care', 'Family Practice', 'General Practitioners', 'Physicians, Primary Care', and 'Physicians, Family'. Their use was studied from 2011 to 2021 on MEDLINE, reviewing the 20 general practice journals with the highest impact factors. A descriptive and analytical approach was used; the association of the country, journal, and year with the choice of general practice-related MeSH terms was analysed. RESULTS: A total of 8514 of 150 286 articles (5.7%) were using one of the general practice-related MeSH terms. The most used were 'Primary Health Care' (4648/9984, 46.6%) and 'General Practice' (2841/9984, 28.5%). A total of 80.0% (6172/7723) of the articles were related to the UK or US and 71.0% (6055/8514) of the articles came from four journals (BJGP, BMJ, Journal of General Internal Medicine, and Annals of Family Medicine). Two main country clusters emerged from the use of general practice-related MeSH: a British cluster mainly using 'General Practice' and an American cluster using 'Primary Health Care'. The journals also mainly differed in their used of these two MeSH terms. CONCLUSION: Important variations in the indexation of general practice research were found. Researchers should consider combining 'Primary Health Care' and 'General Practice' in their PubMed searches to access all the general practice research, regardless of their country of origin.

Utility of the New Early Warning Score (NEWS) in combination with the neutrophil-lymphocyte ratio for the prediction of prognosis in older patients with pneumonia.

OBJECTIVE: Predictors of prognosis are necessary for use in routine clinical practice for older patients with pneumonia, given the ageing of the population. Recently, the National Early Warning Score (NEWS), a comprehensive predictor of severity that consists solely of physiological indicators, has been proposed to predict the prognosis of pneumonia. The neutrophil/lymphocyte ratio (NLR) is a simple index of inflammation that may also be predictive of pneumonia. In the present study, we aimed to determine whether NEWS or a combination of NEWS and NLR predicts mortality in older patients with pneumonia. DESIGN: A retrospective cohort study. SETTING: A general hospital in Japan. PARTICIPANTS: We collected data from patients aged ≥65 years with pneumonia who were admitted between 2018 and 2020 (n=282; age=85.3 (7.9)). Data regarding vital signs, demographics and the length of hospital stay, in addition to the NEWS and NLR, were extracted from the participants' electronic medical records. INTERVENTION: The utility of the combination of NEWS and NLR was assessed using NEWS×NLR and NEWS+NLR. MAIN OUTCOME MEASURES: Their predictive ability for 30-day mortality as the primary outcome was assessed using receiver operating characteristic (ROC) curve analysis. RESULTS: According to the NEWS classification, 80 (28.3%), 64 (22.7%) and 138 (48.9%) of the participants were at low, medium and high risk of mortality, respectively. The 30-day mortality for the entire cohort was 9.2% (n=26), and the mortality rate increased with the NEWS classification: low, 1.3%; medium, 7.8%; and high, 14.5%. The NLRs were 6.0 (4.2-9.8), 6.8 (4.8-10.4) and 14.6 (9.4-22.2), respectively (p<0.001). The areas under the ROC curves for 30-day mortality were 0.73 for the NEWS score, 0.84 for NEWS×NLR and 0.83 for NEWS+NLR, indicating that the combinations represent superior predictors of mortality to the NEWS alone. NEWS×NLR and NEWS+NLR tended to have better sensitivity, accuracy, positive predictive value and negative predictive value than NEWS alone (p=0.06). CONCLUSIONS: A combination of the NEWS and NLR (NEWS×NLR or NEWS+NLR) may be superior to the NEWS alone for the prediction of 30-day mortality in older patients with pneumonia. However, further validation of these combinations for use in the prediction of prognosis is required.

Exploring why European primary care physicians sometimes do not think of, or act on, a possible cancer diagnosis. A qualitative study.

BACKGROUND: While primary care physicians (PCPs) play a key role in cancer detection, they can find cancer diagnosis challenging, and some patients have considerable delays between presentation and onward referral. AIM: To explore European PCPs' experiences and views on cases where they considered that they had been slow to think of, or act on, a possible cancer diagnosis. DESIGN & SETTING: A multicentre European qualitative study, based on an online survey with open-ended questions, asking PCPs for their narratives about cases when they had missed a diagnosis of cancer. METHOD: Using maximum variation sampling, PCPs in 23 European countries were asked to describe what happened in a case where they were slow to think of a cancer diagnosis, and for their views on why it happened. Thematic analysis was used to analyse the data. RESULTS: A total of 158 PCPs completed the questionnaire. The main themes were as follows: patients' descriptions did not suggest cancer; distracting factors reduced PCPs' cancer suspicions; patients' hesitancy delayed the diagnosis; system factors not facilitating timely diagnosis; PCPs felt that they had acted wrongly; and problems with communicating adequately. CONCLUSION: The study identified six overarching themes that need to be addressed. Doing so should reduce morbidity and mortality in the small proportion of patients who have a significant, avoidable delay in their cancer diagnosis. The 'Swiss cheese' model of accident causation showed how the themes related to each other.

Interdisciplinary collaboration in the diagnosis and management of chronic cough: the role and importance of primary care providers.

Chronic cough (CC) is associated with many conditions, so identifying contributing causes poses a diagnostic challenge. However, guidelines written for US physicians do not explicitly outline suggested roles for primary care providers (PCPs) in the approach to patients with CC, including refractory or unexplained CC. The objective of this review is to describe the role of PCPs in the diagnosis and treatment of CC in adults. This narrative review draws upon literature (identified via a PubMed search performed January 9, 2023, using primary care/disease state-related terms) and expertise from specialist physicians to provide recommendations for CC management in primary care. Cough is one of the top reasons patients seek care from PCPs; accordingly, PCPs are often the first physicians to conduct workup and initiate treatment. Patients with CC often experience a burdensome cough that lasts for years, have high healthcare resource utilization (HCRU), undergo multiple or failed treatment trials, and have limited success finding an etiology. Although specialist referral may be needed for many diagnostic tests, initial aspects of CC workup and management should be completed in primary care. Often more accessible than specialists, real-world evidence on HCRU suggests PCPs are important stakeholders in diagnosing and managing CC, including during initial workup and treatment for the most common causes of CC (i.e. upper-airway cough syndrome, asthma, noneosinophilic asthmatic bronchitis, and gastroesophageal reflux disease). Thorough workup at the primary care level may facilitate earlier identification of CC cause(s), improving patient journey to diagnosis and management.

Perspectives of patients, care partners, and primary care physicians on management of mild cognitive impairment and mild Alzheimer's disease dementia.

OBJECTIVES: Early diagnosis of mild cognitive impairment (MCI) and mild Alzheimer's disease (AD) dementia is crucial for effective disease management and optimizing patient outcomes. We sought to better understand the MCI and mild AD dementia medical journey from the perspective of patients, care partners, and physicians. METHODS: We conducted online surveys in the United States among patients/care partners and physicians in 2021. RESULTS: 103 patients with all-cause MCI or mild AD dementia aged 46-90 years, 150 care partners for someone with all-cause MCI or mild AD dementia, and 301 physicians (101 of which were primary care physicians, [PCPs]) completed surveys. Most patient/care partners reported that experiencing forgetfulness (71%) and short-term memory loss (68%) occurred before talking to a healthcare professional. Most patients (73%) followed a common medical journey, in which the initial discussion with a PCP took place 15 months after symptom onset. However, only 33% and 39% were diagnosed and treated by a PCP, respectively. Most (74%) PCPs viewed themselves as coordinators of care for their patients with MCI and mild AD dementia. Over one-third (37%) of patients/care partners viewed PCPs as the care coordinator. CONCLUSIONS: PCPs play a vital role in the timely diagnosis and treatment of MCI and mild AD dementia but often are not considered the care coordinator. For the majority of patients, the initial discussion with a PCP took place 15 months after symptom onset; therefore, it is important to educate patients/care partners and PCPs on MCI and AD risk factors, early symptom recognition, and the need for early diagnosis and treatment. PCPs could improve patient care and outcomes by building their understanding of the need for early AD diagnosis and treatment and improving the efficiency of the patient medical journey by serving as coordinators of care.

Alzheimer's disease (AD) is not a normal part of aging, but many people develop AD as they age, and it is the seventh leading cause of death in the US. AD is a neurological condition that begins as mild cognitive impairment (MCI) or mild AD dementia. To understand the medical journey of patients with MCI or mild AD dementia, we surveyed 103 patients with MCI or mild AD dementia, 150 care partners, and 301 doctors. Patients had several symptoms before talking to a doctor, including forgetfulness and short-term memory loss; most patients (64%) first discussed these symptoms with a primary care physician (PCP) on average 15 months later. However, most patients were not diagnosed or treated by a PCP for MCI or mild AD dementia. We asked patients/care partners who they believe is the coordinator of their care for MCI and mild AD dementia. Thirty-seven percent felt the PCP was the coordinator of care. Most surveyed PCPs (74%) considered themselves to be the coordinator of care for their patients with MCI or mild AD dementia. In conclusion, PCPs play a key role in the care of patients with MCI and mild AD dementia. It is important for patients and care partners to understand the symptoms of MCI and mild AD dementia, and the need to get a diagnosis and treatment soon after symptoms appear. PCPs can play an important role in early diagnosis and treatment and serve as coordinators of care for their patients with MCI and mild AD dementia.[Figure: see text].

[Communicative competence in family physicians in a family medicine unit]. / Competencia comunicativa de médicos familiares en una unidad de medicina familiar.

Background: Communication in the health field is essential, since it depends on it that the physician has complete and accurate information to carry out the fulfillment of his functions. The relationship with the medical staff leads the patient to feel listened to and cared for, in order to understand their state of health. Objective: To know the perception of patients about the communicative competence of family physicians during the consult at the Family Medicine Unit No. 27. Material and methods: Descriptive and cross-sectional study that identifies patients who attended Family Medicine Unit No. 27 in Tijuana in September 2021. The Communication Assessment Tool was applied to participants to measure the perception of communicative competence of doctors. The responses obtained were collected and analyzed with descriptive statistics. Results: 200 patients who met selection criteria were studied, made up of patients on morning and afternoon shifts equally. 54.6% of the studied population considers the communicative competence of family doctors to be excellent. Conclusions: The communicative competence in the family physicians of the studied unit had a better result than others studies of several countries; however, it has areas of opportunity to optimize this competence, since medical knowledge must include the area of communication and interpersonal relationships.

Introducción: la comunicación en el ámbito de la salud es fundamental, pues de ella depende que el médico cuente con información completa y precisa para realizar el cumplimiento de sus funciones. La vinculación con el personal médico conlleva al paciente a sentirse escuchado y atendido, a fin de que se comprenda su estado de salud. Objetivo: conocer la percepción de los pacientes acerca de la competencia comunicativa de los médicos familiares durante la consulta en la Unidad de Medicina Familiar No. 27. Material y métodos: estudio descriptivo y transversal en el que se identifica a pacientes que acudieron a la Unidad de Medicina Familiar No. 27 de Tijuana en septiembre de 2021. Se aplicó el instrumento Communication Assessment Tool a participantes para medir la percepción de la competencia comunicativa de los médicos. Se recolectaron las respuestas obtenidas y se analizaron con estadística descriptiva. Resultados: se estudiaron 200 pacientes que cumplieron criterios de selección, conformados por pacientes de turno matutino y vespertino equitativamente. El 54.6% de la población estudiada considera excelente la competencia comunicativa de los médicos familiares. Conclusiones: la competencia comunicativa en los médicos familiares de la unidad estudiada tuvo un mejor resultado que el de varios países; sin embargo, cuenta con áreas de oportunidad para optimizarla, ya que el conocimiento médico debe incluir el rubro de de comunicación y relaciones interpersonales.

Efficacy of journaling in the management of mental illness: a systematic review and meta-analysis.

OBJECTIVES: Journaling is a common non-pharmacological tool in the management of mental illness, however, no clear evidence-based guideline exists informing primary care providers on its use. We seek here to present this synthesis that may begin to inform future research and eventual evidence-based guideline development. DESIGN: Of the 3797 articles retrieved from MEDLINE, EMBASE, PsycINFO, 20 peer-reviewed randomised control trials (31 outcomes) met inclusion criteria. These studies addressed the impact of a journaling intervention on PTSD, other anxiety disorders, depression or a combination of the aforementioned. ELIGIBILITY CRITERIA: Peer reviewed, randomised control trials on the impact of journaling on mental illness were included. INFORMATION SOURCES: MEDLINE, EMBASE and PsycINFO. RESULTS: The data are highly heterogeneous (control arm=I2 of 71.2%, intervention arm=I2 of 83.8%) combined with a B-level Strength of Recommendation Taxonomy recommendation. It was additionally found that there is a significant pre-post psychometric scale difference between control (-0.01, 95% CI -0.03 to 0.00) and intervention arms (-0.06, 95% CI -0.09 to -0.03). This 5% difference between groups indicates that a journaling intervention resulted in a greater reduction in scores on patient health measures. Cohen's d effect size analysis of studies suggests a small to moderate benefit. CONCLUSION: Further studies are needed to better define the outcomes. Our review suggests that while there is some randomised control data to support the benefit of journaling, high degrees of heterogeneity and methodological flaws limit our ability to definitively draw conclusions about the benefit and effect size of journaling in a wide array of mental illnesses. Given the low risk of adverse effects, low resource requirement and emphasis on self-efficacy, primary care providers should consider this as an adjunct therapy to complement current evidence-based management.

COVID-19 vaccine hesitancy and related factors among primary healthcare workers in a district of Istanbul: a cross-sectional study from Turkey.

OBJECTIVES: This study aimed to determine the COVID-19 risk perceptions, vaccination intentions and predictive factors of family physicians and family healthcare staff working in primary care in Üsküdar. DESIGN: A cross-sectional study was performed using an online questionnaire to determine the demographic and general characteristics of the participants and their willingness to be vaccinated. SETTING: An online questionnaire was applied to family physicians and family health workers working in primary care family health centres in Üsküdar between 25 and 29 December 2020. Multivariate analysis was performed to identify independent predictors of the willingness of individuals to be vaccinated. PARTICIPANTS: Out of 323 health workers working in 44 family health centres in the district, a total of 276 health workers were reached, including 126 physicians (n=158, 79.7%) and 150 midwives/nurses (n=165, 90.9%) (response rate 85.4%). RESULTS: 50.4% (n=139) of the healthcare workers were willing to have the COVID-19 vaccine, 29% (n=80) were undecided and 20.7% (n=57) refused the vaccine. The rate of acceptance to be vaccinated was higher in physicians, in men and in those who had not received a seasonal influenza vaccination regularly each year. CONCLUSIONS: Half of the primary healthcare workers, one of the high-risk groups in the pandemic, were hesitant or refused to be vaccinated for COVID-19. Knowing the factors affecting the vaccine acceptance rates of healthcare professionals can be considered one of the most strategic moves in reaching the target of high community vaccination rates. For evidence-based planning in vaccination studies, there is a need to investigate the reasons for COVID-19 vaccine acceptance by healthcare workers at all levels.

Finding Primary Care-Repurposing Physician Registration Data to Generate a Regionally Accurate List of Primary Care Clinics: Development and Validation of an Open-Source Algorithm.

BACKGROUND: Some Canadians have limited access to longitudinal primary care, despite its known advantages for population health. Current initiatives to transform primary care aim to increase access to team-based primary care clinics. However, many regions lack a reliable method to enumerate clinics, limiting estimates of clinical capacity and ongoing access gaps. A region-based complete clinic list is needed to effectively describe clinic characteristics and to compare primary care outcomes at the clinic level. OBJECTIVE: The objective of this study is to show how publicly available data sources, including the provincial physician license registry, can be used to generate a verifiable, region-wide list of primary care clinics in British Columbia, Canada, using a process named the Clinic List Algorithm (CLA). METHODS: The CLA has 10 steps: (1) collect data sets, (2) develop clinic inclusion and exclusion criteria, (3) process data sets, (4) consolidate data sets, (5) transform from list of physicians to initial list of clinics, (6) add additional metadata, (7) create working lists, (8) verify working lists, (9) consolidate working lists, and (10) adjust processing steps based on learnings. RESULTS: The College of Physicians and Surgeons of British Columbia Registry contained 13,726 physicians, at 2915 unique addresses, 6942 (50.58%) of whom were family physicians (FPs) licensed to practice in British Columbia. The CLA identified 1239 addresses where primary care was delivered by 4262 (61.39%) FPs. Of the included addresses, 84.50% (n=1047) were in urban locations, and there was a median of 2 (IQR 2-4, range 1-23) FPs at each unique address. CONCLUSIONS: The CLA provides a region-wide description of primary care clinics that improves on simple counts of primary care providers or self-report lists. It identifies the number and location of primary care clinics and excludes primary care providers who are likely not providing community-based primary care. Such information may be useful for estimates of capacity of primary care, as well as for policy planning and research in regions engaged in primary care evaluation or transformation.