Family Practice Physicians Research Articles

Controlled trial of the impact of a BC adult mental health practice support program (AMHPSP) on primary health care professionals\u2019 management of depression

BackgroundDepression affects over 400 million people globally. The majority are seen in primary care. Barriers in providing adequate care are not solely related to physicians’ knowledge/skills deficits, but also time constraints, lack of confidence/avoidance, which need to be addressed in mental health-care redesign. We hypothesized that family physician (FP) training in the Adult Mental Health Practice Support Program (AMHPSP) would lead to greater improvements in patient depressive symptom ratings (a priori primary outcome) compared to treatment as usual.MethodsFrom October 2013 to May 2015, in a controlled trial 77 FP practices were stratified on the total number of physicians/practice as well as urban/rural setting, and randomized to the British Columbia AMHPSP⎯a multi-component contact-based training to enhance FPs’ comfort/skills in treating mild-moderate depression (intervention), or no training (control) by an investigator not operationally involved in the trial. FPs with a valid license to practice in NS were eligible. FPs from both groups were asked to identify 3–4 consecutive patients > 18 years old, diagnosis of depression, Patient Health Questionnaire (PHQ-9) score ≥ 10, able to read English, intact cognitive functioning. Exclusion criteria: antidepressants within 5 weeks and psychotherapy within 3 months of enrollment, and clinically judged urgent/emergent medical/psychiatric condition. Patients were assigned to the same arm as their physician. Thirty-six practices recruited patients (intervention n = 23; control n = 13). The study was prematurely terminated at 6 months of enrollment start-date due to concomitant primary health-care transformation by health-system leaders which resulted in increased in-office demands, and recruitment failure. We used the PHQ-9 to assess between-group differences at baseline, 1, 2, 3, and 6 months follow-up. Outcome collectors and assessors were blind to group assignment.ResultsOne hundred-and-twenty-nine patients (intervention n = 72; control n = 57) were analysed. A significant improvement in depression scores among intervention group patients emerged between 3 and 6 months, time by treatment interaction, likelihood ratio test (LR) chi2(3) = 7.96, p = .047.ConclusionsThis novel skill-based program shows promise in translating increased FP comfort and skills managing depressed patients into improved patient clinical outcomes⎯even in absence of mental health specialists availability.Trial registration#NCT01975948.

The Assessment of Knowledge Levels and Practices of Family Physicians Practicing in Family Health Centers in Ankara with Regard to Well Child Follow-up

Objectives: The purpose of our study is to call attention to responsibilities of family physicians regarding well child follow‐up, which is very important to improve and support pediatric health, to refresh family physicians’ knowledge, and to emphasize the significance and vitality of well child follow-up. Materials and Methods: The study was planned as an observational and cross‐sectional survey study. The survey questions were prepared based on the guideline titled “Periodical Health Examinations and Screening Tests Recommended in Family Medicine Practice”, which was produced by the Turkish Ministry of Health and distributed to all family physicians. All family physicians practicing in Family Health Centers (FHC) located in Ankara were sent 4 e‐mails containing the link to the survey between December 1st, 2016 and February 2nd, 2017, and invited to participate in the study. Among the family physicians who agreed to participate in the study, 191 physicians who answered the section measuring their knowledge levels in full were included in the study. The overall knowledge level was calculated by scoring each correct answer as 1 point. The maximum score possible was 19 points. Results: The average total score of family physicians was found to be 9.73 ± 2.94 which was relatively low. A positive, weak, and significant correlation was found between knowledge level score and total months worked in FHC. Also, a positive and significant correlation was found between frequency of reading the guideline on well child follow‐up and knowledge level score. Further, it was revealed that family physicians mostly performed their daily practices related to well child follow‐up. However, it was seen that some non‐mandatory follow‐up practices were not sufficiently performed. Conclusion: This study showed that it was necessary to provide trainings for family physicians and to encourage them to use guidelines on the subject in order to ensure well child follow‐up is at the desired level in primary health care to raise a healthy generation.

Rural-urban disparities in family physician practice patterns: A nationwide survey in Taiwan.

In a world with increasing urbanization, rural-urban disparities in health care utilization have been a long-term concern. However, the details regarding the practice patterns of family physicians in Taiwan have not received sufficient attention thus far. The National Health Insurance Research Database of Taiwan offered 0.2% of the total ambulatory visit records for Taiwan in 2013. Records from community clinics of family medicine were collected, with the clinics categorized as rural, suburban, or urban area clinics according to their locations. Among 100334 visits to family medicine clinics, the median patient age was 50years for urban clinics, 51 for suburban clinics, and 58 for rural clinics. The distributions of patient ages differed in the three areas (P<0.001). Four types of chronic diseases (cardiovascular diseases, diabetes, chronic respiratory diseases, and cancers) accounted for 10.8%, 11.3%, and 13.6%, of the visits to urban, suburban, and rural clinics, respectively. The most common procedure was wound treatment, and the pattern of the top 10 procedures was similar in the three areas. Although rural patients in Taiwan were older and had more chronic diseases than urban and suburban patients, the pattern of procedures undertaken by rural family physicians did not differ from those of urban and suburban family physicians.

Association of Medical Scribes in Primary Care With Physician Workflow and Patient Experience

Widespread adoption of electronic health records (EHRs) in medical care has resulted in increased physician documentation workload and decreased interaction with patients. Despite the increasing use of medical scribes for EHR documentation assistance, few methodologically rigorous studies have examined the use of medical scribes in primary care. To evaluate the association of use of medical scribes with primary care physician (PCP) workflow and patient experience. This 12-month crossover study with 2 sequences and 4 periods was conducted from July 1, 2016, to June 30, 2017, in 2 medical center facilities within an integrated health care system and included 18 of 24 eligible PCPs. The PCPs were randomly assigned to start the first 3-month period with or without scribes and then alternated exposure status every 3 months for 1 year, thereby serving as their own controls. The PCPs completed a 6-question survey at the end of each study period. Patients of participating PCPs were surveyed after scribed clinic visits. PCP-reported perceptions of documentation burden and visit interactions, objective measures of time spent on EHR activity and required for closing encounters, and patient-reported perceptions of visit quality. Of the 18 participating PCPs, 10 were women, 12 were internal medicine physicians, and 6 were family practice physicians. The PCPs graduated from medical school a mean (SD) of 13.7 (6.5) years before the study start date. Compared with nonscribed periods, scribed periods were associated with less self-reported after-hours EHR documentation (<1 hour daily during week: adjusted odds ratio [aOR], 18.0 [95% CI, 4.7-69.0]; <1 hour daily during weekend: aOR, 8.7; 95% CI, 2.7-28.7). Scribed periods were also associated with higher likelihood of PCP-reported spending more than 75% of the visit interacting with the patient (aOR, 295.0; 95% CI, 19.7 to >900) and less than 25% of the visit on a computer (aOR, 31.5; 95% CI, 7.3-136.4). Encounter documentation was more likely to be completed by the end of the next business day during scribed periods (aOR, 2.8; 95% CI, 1.2-7.1). A total of 450 of 735 patients (61.2%) reported that scribes had a positive bearing on their visits; only 2.4% reported a negative bearing. Medical scribes were associated with decreased physician EHR documentation burden, improved work efficiency, and improved visit interactions. Our results support the use of medical scribes as one strategy for improving physician workflow and visit quality in primary care.

Providers' Reports of Environmental Conditions and Resources at Births in the United States.

Environmental conditions and resources that may influence provider's behaviors have been investigated in birth environments focusing on location rather than conditions and available resources. Using a descriptive, cross sectional design, we surveyed a random sample of certified nurse-midwives (CNMs), obstetricians, family practice physicians, and certified professional midwives (CPMs) to describe conditions, resources, and workforce present during U.S. births. In all, 1,243 midwives and physicians reported most environmental resources were present at almost 100% of births they attended. Conditions varied: room noise acceptability restriction of phone calls/texts from any source and lighting kept to a minimum. Trainees were present at most births regardless of setting and provider type. The impact of room noise, phone calls/texting, and lighting on outcomes should be determined. The roles and impact of personnel, including trainees, should be described. The extent to which clusters of resources are associated with outcomes might provide new directions for interventions that improve care.

Response: Re: Wide Gap between Preparation and Scope of Practice of Early Career Family Physicians

To the Editor: I read with interest Dr. Frey's comments spurred by my recent article[1][1] on differences between preparation for and provision of different clinical activities seemingly central to the core of family medicine. Like many people, my refrigerator door has many magnets, among my

The knowledge of low back pain management between physical therapists and family practice physicians

ABSTRACTObjectives: The purpose of this study was to compare knowledge in managing patients with low back pain (LBP) between physical therapists and family practice physicians.Methods: Seventy-three physical therapists and 30 family practice physicians completed standardized examinations assessing knowledge, attitudes, the usefulness of clinical practice guidelines, and management strategies for patients with LBP. Beliefs of physical therapists and family practice physicians about LBP were compared using relative risks and independent t-tests.Results: Scores related to knowledge, attitudes, and the usefulness of clinical practice guidelines were generally similar between the groups. In addition, there was no difference between the groups for knowledge regarding optimal management strategies for patients with LBP. However, physical therapists were less likely to have difficulty assessing motivation levels of patients with LBP compared to family practice physicians (64.6% vs 26.7%; relative risk: 2.41 [95% confidence interval: 1.30–4.48] and physical therapists were less likely to agree that interventions by health care providers have little positive effect on the natural history of acute LBP (17.8% vs. 50.0%; relative risk: 0.36 [95% confidence interval: 0.19–0.66]).Discussion: The results of this study may have implications for third-party payers and health care administrators regarding the utilization of physical therapists in the management of patients with LBP in expanded scopes of practice, including direct access and potential placement in primary care clinics.

Standards and risk factors for reducing the amount of lactobacillus and bifidobacterium in bronchoalveolar lavage in young patients with recurrent bronchitis

The role of normal microflora of the respiratory tract in maintaining the homeostasis of an organism is extremely important. The upper respiratory tract have a high microbial burden, since their mucus membrane is the first to resist the actions of various environmental factors.The objective: to study parameters of lactobacillus and bifidobacterium in bronchoalveolar lavage, in young people without respiratory diseases, and to identify the risk factors for decreasing the normal flora in patients with recurrent bronchitis.Materials and methods. For the period from November, 2015 to May 2017, a survey of 108 patients aged 18 to 35 years old was conducted. Of these, men – 61% (56,5±4,8), women – 47% (43,5±4,8) with recurrent bronchitis (ICD-10 J40). In addition, 20 patients in the control group with a diagnosis were examined «Third-party respiratory tract» were examined, among which 35,0% (7/20) were males and 65,0% (13/20) women.Results. The norm for lactobacillus and bifidobacterium in bronchoalveolar lavage in individuals from 18 to 35 years old was first established. The positive result of this study allows us to recommend this rate norm for use in the practice of family physician and pulmonologist. The revealed risk factors for reducing the number of lactobacillus and bifidobacterium in recurrent bronchitis in young patients.Conclusions. The presence of lactobacillus and bifidobacterium in degree 105 and above can be considered as a variant of the norm among the population aged 18 to 35 years, without diseases of the lower respiratory tract. Overweight is a risk factor for reducing lactobacillus and bifidobacterium by 1.3 times. The fact of smoking, like the fact of antibiotic therapy, increases the risk of lactobacillus reduction in patients with recurrent bronchitis by 1,5 times.

Discrepancies Between US Food and Drug Administration Vaccine Licensure Indications and Advisory Committee on Immunization Practices Recommendations: Provider Knowledge and Attitudes

PurposeIn the United States, the Center for Biologics Evaluation and Research at the US Food and Drug Administration (FDA) is responsible for licensure of vaccines. The Advisory Committee on Immunization Practices (ACIP) is a federal advisory committee that provides guidance to the Centers for Disease Control and Prevention (CDC) on use of vaccines. Discrepancies between FDA licensure indications and ACIP/CDC vaccine recommendations exist, challenging health care providers. The objectives of this study were: (1) to categorize differences between FDA vaccine licensure indications and ACIP/CDC vaccine recommendations for vaccines; and (2) to assess knowledge, attitudes, and practices of pediatricians, family physicians, and obstetrician-gynecologists regarding their understanding of differences. MethodsInformation was extracted from FDAvaccine package inserts, and corresponding information was collected for ACIP/CDC vaccine recommendations (2000–2014) for vaccines in the childhood and adult immunization schedules. Surveys regarding knowledge of discrepancies were distributed electronically to members of the Georgia chapters of the American Academy of Pediatrics (GA-AAP) and the American Academy of Family Physicians (GA-AAFP), and the national American College of Obstetricians and Gynecologists (ACOG) in 2014. FindingsDifferences were identified in 20 instances: differences in age group indications were identified in 6, in dosing administration schedules in 4, and in immunocompromised hosts and pregnant women in 10. We received 145 (8.5%) responses from GA-AAP, 237 (9.5%) from GA-AAFP, and 869 (1.5%) from national ACOG members. A total of 105 (72%) GA-AAP respondents reported that they follow AAP recommendations and 168 (71%) GA-AAFP respondents follow ACIP recommendations. GA-AAP and GA-AAFP respondents generally were not aware of data the FDA considers for vaccine licensure or data that pharmaceutical company representatives are permitted to discuss. Respondents remain current with vaccine recommendations through review of materials from professional organizations, the CDC, and package inserts; Continuing Medical Education; and information from pharmaceutical representatives. A total of 780 (90%) ACOG respondents had no concerns regarding routinely recommended reduced diphtheria toxoid and acellular pertussis vaccines (n = 730 [84%]) and influenza during pregnancy vaccines (n = 852 [98%]) to pregnant patients. However, these findings must be interpreted within the context of a low overall ACOG survey response rate. ImplicationsEducation regarding existence of and reasons for discrepancies between FDA licensure of and ACIP/CDC recommendations for vaccines and reasons for these differences could optimize immunization delivery.

AACN TeleICU Nursing Practice: An Expert Consensus Statement Supporting High Acuity, Progressive, and Critical Care

The recently updated expert consensus statement on tele-intensive care unit (tele-ICU) nursing, AACN TeleICU Nursing Practice, conveys the essential elements for implementing, evaluating, and improving tele-ICU nursing practice. AACN TeleICU Nursing Practice includes revised practice definitions, a refined practice model, and vignettes that demonstrate the impact of tele-ICU.Practice definitions have been updated and expanded to reflect the current state of tele-ICU nursing practice, which reaches 18% of all ICU patients. In addition, this updated document more clearly describes the roles of the tele-ICU nurse, the nurse leader, and the health care organization. The individual responsibilities of these roles are no longer combined. Revised recommendations (previously labeled practice guidelines) are presented by role, with each role individually defined and responsibilities described. The focus of the revised recommendations is on the application of a healthy work environment, the development of proficiency in tele-ICU knowledge, skills and abilities, and the need to support and engage in research.New vignettes provide powerful testimony to the impact of tele-ICU nursing. Each vignette is written as a demonstration of how tele-ICU nursing can fulfill the 3 consensus recommendations. Vignettes include help provided by a tele-ICU nurse to a family practice physician managing a cardiac arrest at a remote Alaska critical access hospital, support provided during recent natural disasters to hospitals requiring evacuation, and coaching the staff of a small rural hospital in the application of a hypothermia protocol for a patient resuscitated after cardiac arrest.The AACN TeleICU Nursing Practice Model was also given a new look in AACN TeleICU Nursing Practice. This model is supported by both the AACN Synergy Model for Patient Care and AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence, 2nd edition. The updated TeleICU Nursing Practice Model demonstrates how the key concepts of true collaboration, practice excellence, and skilled communication enhance patient care when combined with the optimized use of technology and the application of authentic leadership.AACN TeleICU Nursing Practice also includes a name change. This updated document has been classified as an expert consensus statement instead of a guide-line to reflect that the body of evidence to support tele-ICU nursing is still developing. The task force recommended the name change and included an acknowledgment that further research, both quantitative and qualitative, are needed to support tele-ICU nursing and to ensure optimal patient outcomes for the future. Among the task force’s recommendations for future research are inquiry into appropriate staffing models, optimal communication methods, nursing interventions, mentoring, retention, moral distress, return on investment, and the impact of the Tele-ICU Nursing Practice Model on patients and families.

Depression and its Associated Factors among Patients with Chronic Obstructive Pulmonary Disease in Karachi, Pakistan.

IntroductionDepression in patients with chronic obstructive pulmonary disease (COPD) can be an incapacitating health problem that negatively affects the quality of life. If the depression is not treated, it is associated with increased morbidity and mortality. The goal of this study was to determine the frequency of depression in patients with COPD and examine the factors contributing to depression in these patients.MethodsThis cross-sectional study was conducted using a sample of 556 patients with COPD visiting the Pulmonology Clinic of the Aga Khan University Hospital in Karachi, Pakistan, from March 2010 to March 2011. A pretested structured questionnaire was used for data collection. The Hospital Anxiety and Depression Scale (HADS) was used to screen for depression. SPSS Statistics for Windows, Version 19.0. (IBM Corp, Armonk, NY) was used to enter and analyze data.ResultsOut of the total 556 participants, majority 62.9% were between 60 and 79 years of age and 70.1% of the participants were males. The frequency of depression in COPD patients was 57.2%, and multiple logistic regression analyses indicated being over 59 years (Adjusted odds ratio (ORadj), 2.750; 95% confidence interval [CI]: 1.25 to 6.05, p = 0.039), being male (ORadj, 2.28; 95% CI: 0.89 to 5.14), being retired or unemployed (ORadj, 1.041; 95% CI: 0.41 to 2.62, p = 0.000), using inhaled steroids (ORadj, 3.929; 95% CI: 2.59 to 5.97, p = 0.000), and living alone were significantly associated with depression in COPD patients.ConclusionSeveral risk factors for depression in patients with COPD were identified. Patients with COPD who are elderly, male, retired or unemployed, use inhaled steroids, and patients who live alone have characteristics significantly associated with depression. These factors should be considered by practicing family physicians, pulmonologists, and healthcare workers.

Family Physicians' Perspectives on Their Weight Loss Nutrition Counseling in a High Obesity Prevalence Area.

Obesity is a serious and highly prevalent health problem. Behavioral modification for weight loss is effective, and physician nutrition counseling is encouraged. Nevertheless, several studies have reported that physicians provide nutrition counseling infrequently. Time constraints and lack of patient compliance are among frequently reported barriers. In this pilot study, we aimed to examine physician weight loss nutrition counseling among family physicians in Huntington, West Virginia, an area with the highest obesity prevalence in the United States. We administered an anonymous 13-question online survey designed for this study to all area family physicians in continuity ambulatory practice, asking about how often they provided nutrition counseling to their comorbidly obese patients, their nutrition education background, the counseling resources used, and the barriers they faced. Thirty-eight of the 47 invited physicians completed surveys. The 35 to 55 age group comprised 55% of the respondents. Men comprised 53% of our sample. Two-thirds of the physicians reported that they counseled at a high frequency. Twenty-six of the 38 physicians reported that their nutrition education in medical school was none to minimal. Of the rest, 47.2% viewed their education as clinically relevant. The most frequently-used specific patient education sources were those embedded in electronic health records, the US Department of Agriculture's MyPlate tool, and a variety of smartphone-based apps. Time constraints and lack of patient interest in nutrition topics were the leading barriers cited. Family physicians practicing in the most obese population in the United States tend to be high-frequency obesity nutrition counselors who frequently use specific tools, consider their education lacking and face oft-cited barriers. Studies in other highly endemic areas are needed to confirm these findings.

BARRIERS TO IMPLEMENTATION OF EARLY PEANUT INTRODUCTION AMONG PEDIATRICIANS, FAMILY PHYSICIANS, AND ALLERGISTS

Abstract BACKGROUND The approach to peanut allergy prevention has shifted with publication of the Learning Early About Peanut (LEAP) trial and recently released NIAID guideline recommending early peanut introduction in high risk infants. OBJECTIVES Our objective was to determine whether current practice patterns at both the allergist and primary care level are in keeping with the LEAP recommendations and NIAID guideline. DESIGN/METHODS A 17-question survey was distributed in 2016 to Canadian allergists through the Canadian Society of Allergy and Clinical Immunology, paediatricians through the Canadian Paediatric Society, and a sample of practicing family physicians. RESULTS There was variability in the definition of infants at high risk for peanut allergy and recommendations for age of introduction of allergenic solids. There was also variability in how often allergist evaluation was recommended for infants with egg allergy or severe eczema prior to peanut introduction, with allergists 9 times more likely to recommend pre-emptive peanut testing in infants with severe eczema prior to peanut introduction. The majority of family physicians (77.1%), paediatricians (91.4%) and allergists (89.1%) did not believe there was harm to introduction of solids between 4–6 months of age, or that breastfeeding rates would be affected with earlier solid introduction. CONCLUSION Further education about the implications of LEAP is required. There are broad issues (such as the definition of a high risk infant) that require international consensus. Most primary care physicians and allergists do not believe there are harms to introduction of allergenic solids prior to 6 months of age, or that breastfeeding rates will be affected.

Family Presence During Resuscitation: Physicians' Perceptions of Risk, Benefit, and Self-Confidence.

Families often desire proximity to loved ones during life-threatening resuscitations and perceive clear benefits to being present. However, critical care nurses and physicians perceive risks and benefits. Whereas research is accumulating on nurses' perceptions of family presence, physicians' perspectives have not been clearly explicated. Psychometrically sound measures of physicians' perceptions are needed to create new knowledge and enhance collaboration among critical care nurses and physicians during resuscitation events. This study tests 2 new instruments that measure physicians' perceived risks, benefits, and self-confidence related to family presence during resuscitation. By a correlational design, a convenience sample of physicians (N = 195) from diverse clinical specialties in 1 hospital in the United States completed the Physicians' Family Presence Risk-Benefit Scale and Physicians' Family Presence Self-confidence Scale. Findings supported the internal consistency reliability and construct validity of both new scales. Mean scale scores indicated that physicians perceived more risk than benefit and were confident in managing resuscitations with families present, although more than two-thirds reported feeling anxious. Higher self-confidence was significantly related to more perceived benefit and less perceived risk (P = .001). Younger physicians, family practice physicians, and physicians who previously had invited family presence expressed more positive perceptions (P = .05-.001). These 2 new scales offer a means to assess key perceptions of physicians related to family presence. Further testing in diverse physician populations may further validate the scales and yield knowledge that can strengthen collaboration among critical care nurses and physicians and improve patient and family outcomes.

Injuries to Cyclists due to a Dog-Bicycle Interaction.

Both dogs and bicycles are common in our society and thus a dog-bicycle interaction resulting in an injury to a cyclist is possible. It was the purpose of this study to investigate such injuries. The National Electronic Injury Surveillance System (NEISS) data for the 10-year period from 2006 through 2015 associated with bicycles were accessed. Injuries involving dogs were identified and the mechanism of injury determined. Due to the stratified and weighted nature of the NEISS data, statistical analyses were performed with SUDAAN 10 software (RTI International, Research Triangle Park, North Carolina, United States). A p < 0.05 was considered statistically significant. There were 5,184,057 emergency department visits for bicycle-associated injuries; dogs were involved in 35,254 (0.67%) cases. The average age for those involved with a dog was 33.2 years and it was 25.5 years for those in which dogs were not involved. There were more females in the dog group (34.1 vs. 27.6%). Dog involvement increased from ages 0 to 14 years, then decreased until the age of 20 years and then progressively increased. Dog-associated injuries most frequently occurred away from home, involved the knee and distal lower extremity, 49.1% sustaining dog bites. Dog bites were more common in younger individuals. Four injury mechanisms (chased by a dog, hit/collided with a dog, swerved/tried to avoid a dog or riding with a dog) accounted for 97.5% of the injuries. Those chased by a dog were younger, more commonly released from the emergency department, had an injury involving the lower extremity and frequently sustained a bite. The most severe injuries were in those who swerved/tried to avoid a dog or hit a dog. Approximately 1% of injuries to bicyclists are associated with dogs; one-half sustained a bite. Potential/proposed prevention strategies could be educational materials regarding bicycles and dogs to owners, dog restraint, student/parent education and educational materials in waiting rooms of veterinarians, paediatricians, family practice physicians and emergency rooms.

Nutrition and obesity care in multidisciplinary primary care settings in Ontario, Canada: Short duration of visits and complex health problems perceived as barriers.

Nutrition care in the primary care setting is integral in obesity management, but there is a substantial gap between patients who would benefit from this service and those receiving it. This study provides an in-depth understanding of how relatively new multidisciplinary primary care settings may be affecting nutrition care practices of family physicians and nurse practitioners. This qualitative comparative case study sought to assess nutrition care practices in three different types of multidisciplinary clinics (2 Family Health Teams, 3 Community Health Centers, 1 Nurse Practitioner-Led Clinic) in Ontario, Canada. Individual semi-structured interviews were conducted with nurse practitioners (n = 13) and family physicians (n = 7) in fall 2017. Data analysis was conducted using NVivo Software. The integrated approach was used for elucidating codes and themes. Findings suggest that suboptimal duration of medical visits and increasing prevalence of complex patients were reported by most participants and were perceived as barriers for addressing nutrition and obesity. However, improved nutrition care was fostered through Electronic Medical Records, primary care providers' positive attitude towards nutrition and cost-free dietitian services at point of access. Site-specific challenges, such as duration of medical visits, incentive programs, access to dietitians on site, and continued professional development could enhance nutritional care for weight management in these multidisciplinary primary care settings.

Wide Gap between Preparation and Scope of Practice of Early Career Family Physicians.

We found substantial gaps between preparation for, and practice of, early career family physicians in nearly all clinical practice areas. With reported intentions of graduates for a broad scope of practice, gaps between practice and preparation suggest family physicians early in their careers may not be finding opportunities to provide comprehensive care.

Potentially Alarming Trends in the Scope of Practice for Family Physicians

Potentially Alarming Trends in the Scope of Practice for Family Physicians

The perceived impact of family physicians on the district health system in South Africa: a cross-sectional survey

BackgroundEvidence from first world contexts support the notion that strong primary health care teams contain family physicians (FPs). African leaders are looking for evidence from their own context. The roles and scope of practice of FPs are also contextually defined. The South African family medicine discipline has agreed on six roles. These roles were incorporated into a family physician impact assessment tool, previously validated in the Western Cape Province.MethodsA cross-sectional study design was used to assess the perceived impact of family physicians across seven South African provinces. All FPs working in the district health system (DHS) of these seven provinces were invited to participate. Sixteen respondents (including the FP) per enrolled FP were asked to complete the validated 360-degree assessment tool.ResultsA total number of 52 FPs enrolled for the survey (a response rate of 56.5%) with a total number of 542 respondents. The mean number of respondents per FP was 10.4 (SD = 3.9). The perceived impact made by FPs was high for five of the six roles. Co-workers rated their FP’s impact across all six roles as higher, compared to the other doctors at the same facility. The perceived beneficial impact was experienced equally across the whole study setting, with no significant differences when comparing location (rural vs. metropolitan), facility type or training model (graduation before and ≥ 2011).ConclusionsThe findings support the need to increase the deployment of family physicians in the DHS and to increase the number being trained as per the national position paper.

Osteoporosis guideline awareness among Iranian family physicians: results of a knowledge, attitudes, and practices survey.

Osteoporosis is a relatively preventable, chronic and progressive disease. Family physicians play a crucial role in relieving the burden of care. This cross-sectional study was addressed at all qualified family physicians who registered at urban family physicians and referral system program. Data collection included demographics, professional experience, and knowledge of guidelines based on a standardized KAP questionnaire. Student's t-test was used to measure the associations between KAP scores and demographic, professional experience variables.FindingsThe response rate was 72% (540/750). Based on Bloom's cut off scale, family physicians knowledge and practice scores were in moderate level, and only 14 and 38.5% of them had good knowledge and practice, respectively. Attitude score was in good level, and 64.1% of participants had positive attitude. Mean score of knowledge and practice were higher significantly among family physicians that practice in public settings. Family physicians, who completed osteoporosis training courses, had higher attitude score (P=0.03). Only 23.5% of family physicians were aware of the existence of national osteoporosis guideline. Although most family physicians believed in the importance of preventive measures, however, limited number of them had good knowledge and practice regarding osteoporosis and less than a quarter were aware of national guideline. This is a clear need to disseminate the guideline more effectively, make greater use of efficient training methods.