Family Practice Units Research Articles

Evaluation of Clinical Follow-Up of The Patients Monitored at Home Due To COVID-19 Pandemic

Aim: The most valuable approach to prevent the spread of the novel COVID-19, which is a pandemic today, is to detect, isolate, and treat patients. The majority of patients are mild or asymptomatic cases. These cases are followed up and isolated at home in many countries. With a governmental decision issued in Turkey, it has been deemed appropriate to follow up the suspected, contact or definitive diagnosis patients who do not indicate inpatient treatment, have a mild clinical course, or do not have a risk factor that may lead to a severe course of COVID-19, at home by the family practice units. In this study, we aimed to investigate the characteristics of the patients with COVID-19 who were being monitored at home. Methods: The study was designed as a retrospective cross-sectional observational study. In this study, 321 people who were registered at the Education and Family Health Centers of our hospital and followed up as COVID-19 suspects, contacts, or definitive cases were identified. Home follow-up data of these patients between April 1-30 were obtained retrospectively from the records of family health centers. Data, such as the presence and course of symptoms of people followed at home, their isolation status, medicine usage status, and test results were recorded electronically for further analysis. Results: In this study, 321 patients, 163 (50.28%) males, and 158 (49.22%) females were included. Among 321 patients, 287 (89.41%) were contact patients, 54 (16.82%) were suspected patients, and 28 (8.72%) had a definitive diagnosis. The mean age of the patients was 40.00±20.68. Among the patients included in this study, 27 (8.41%) were hospitalized, symptoms worsened in 8 (2.49%), 5 (1.56%) were re-applied to the hospital, 5 (1.56%) were re-hospitalized, and 28 people (8.72%) were administered medication. Conclusion: The mean age of patients who complied with the measures of isolation was higher than patients who did not. The mean age of hospitalized patients was higher than in non-hospitalized patients. The frequency of observed symptoms was consistent with the previous studies in the literature. Keywords: cough, fever, pandemics, quarantine, SARS-CoV-2

Bir aile hekimliği biriminde düzenlenen ilaç raporlarının değerlendirilmesi

Amaç: Bu çalışmada bir aile hekimliği biriminde dört yıldan uzun süre çalışan bir aile hekimliği uzmanının düzenlediği ilaç raporlarının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Retrospektif arşiv incelemesinin yapıldığı bu çalışma Samsun iline bağlı Asarcık ilçesinde bir aile sağlığı merkezine bağlı birimde gerçekleştirilmiştir. Ağustos 2015- Ekim 2019 tarihleri arasında ilgili birimde düzenlenen ilaç raporlarının sahipleri örneklemi oluşturmaktadır. Bulgular: İlaç raporu yenilenen veya ilk defa düzenlenen 446 kişinin 623 adet raporu incelenmiştir. Yaş ortalaması 61,81±16,24 olup, hasta başına ortalama 2,19 kez rapor düzenlenmiştir. Hastaların %79,37’ine (n=354) en az bir adet antihipertansif ilaç raporu düzenlenmiştir, %14,57’sine (n= 65) ise en az bir adet oral antidiyabetik ilaç raporu düzenlenmiştir. Antihipertansif ilaçlardan en sık diüretikler (n= 225, %50,45), oral antidiyabetik ilaçlardan en sık metformin (n= 54, %12,11) raporlanmıştır. Kalp damar sistemi kısmında değerlendirilen ilaçlar rapor başına 1,55±1,10 kez ile en sık raporlananlardır. Yaş ile kalp damar sistemi rahatsızlıklarında kullanılan ilaç sayısı pozitif yönlü ve zayıf bir korelasyon göstermiştir (p< 0,001 , r= 0,266). Sonuç: Birinci basamak uzmanının kronik hastalıklarının medikal izleminde düzenlediği raporlarla etkin rol aldığı görülmüştür. Bu yüzden, düzenlenebilen ilaç raporu çeşitliliğinin artması faydalı olabilir.

Effect of BATHE interview technique on patient satisfaction in an ambulatory family medicine centre in South India

ObjectiveThe objective of the study is to determine the effect of background, affect, trouble, handling and empathy (BATHE) versus usual interview technique on patient satisfaction during regular consultation with family...

Assessing the Impact of Early Identification of Patients Appropriate for Palliative Care on Resource Use and Costs in the Final Month of Life.

This study evaluates whether an intervention to identify Canadian patients eligible for a palliative approach changes the use of health care resources and costs within the final month of life. Between 2014 and 2017, physicians identified 1,187 patients in family practice units and cancer centers who were likely to die within 1 year based on diagnosis, symptom assessment, and performance status. A multidisciplinary intervention that included activation of community resources and initiation of palliative planning was started. By using propensity-score matching, patients in the intervention group were matched 1:1 with nonintervention controls selected from provincial administrative data. We compared health care use and costs (using 2017 Canadian dollars) for 30 days before death between patients who died within the 1-year follow-up and matched controls. Groups (n = 629 in each group) were well-balanced in sociodemographic characteristics, comorbidities, and previous health care use. In the last 30 days, there was no differences in proportions between the two groups of patients regarding emergency department visits, intensive care unit admissions, or inpatient hospitalizations. However, patients in the intervention group had greater use of palliative physician encounters, community home care visits, and/or physician home visits (92.8% v 88.4%; P = .007). In the 507 pairs with cancer, more patients in the intervention group underwent chemotherapy (44% v 33%; P < .001) and radiation (18.7% v 3.2%; P = .043) in the last 30 days. Mean cost per patient was similar for the intervention group (mean, $17,231; 95% CI, $16,027 to $18,436) and for the control group (mean, $16,951; 95% CI, $15,899 to $18,004). Even with the limitations in our observational study design, identification of palliative patients did not significantly change overall costs but may shift resources toward palliative services.

Türkiye’de iller arası yerleştirmeye açılan birimlerin boş kalma durumları ve etkileyen faktörler

Türkiye’de iller arası yerleştirmeye açılan birimlerin boş kalma durumları ve etkileyen faktörler

Reducing Unnecessary Coagulation Testing in Outpatients (REDUCTION): A Quality Improvement Project

Introduction: The prothrombin time (PT) and partial thromboplastin time (PTT) are often considered ‘routine’ tests in the outpatient setting. They are frequently used as screening tests for bleeding disorders in unselected patients despite sensitivities ranging of 1-2 %. For the most common bleeding disorder, a negative score on a bleeding assessment tool (BAT), in the presence of a negative family history, has a NPV of 1. A recent quality improvement study conducted in the emergency department at our institution resulted in a greater than 2-fold reduction in coagulation test ordering rates and more than $6000 CAN direct cost-savings per month.Objectives: We developed a multimodal sequential quality improvement study in the outpatient family practice unit with the primary aim of minimizing unnecessary coagulation testing and maximizing the appropriate use of a BAT.Materials and Methods: We have developed four interventions using plan-do-study-act (PDSA) cycles to achieve our goal. Cycle (1) baseline assessment of ordering rates, involved stakeholder engagement, development of educational tools and addition of the BAT onto the electronic medical record (EMR). Cycle (2) involved assessment of EMR-available BAT. Cycle (3) involved an audit to determine appropriateness of coagulation testing for patients on oral anticoagulants and a subsequent targeted intervention. Cycle (4) involved alteration of the laboratory requisition and facilitating access to decision support and educational materials. Rates were calculated per 100 patient visits per month. Data were analyzed on Strata 13 using an interrupted time series analysis.Results: After Cycle 1, we saw a significant decrease in rates of PT and PTT ordering from 1.9 tests per 100 patient visits per month (for both tests) to 1.5 and 1.4 respectively; (p< 0.001 for both). However, the rate of creatinine (control) testing rate also decreased significantly (8.9 to 8; p=0.006). With Cycle 2, we found that all referrals for bleeding from the family practice unit were appropriate and only 19% of patients who had a BAT completed were referred. In Cycle 3, we identified an inappropriate PT and PTT ordering rate of 11% and 36% respectively for patients on oral anticoagulants. We also identified that PT and PTT were being tested together despite being ordered individually; further investigation revealed that they were being erroneously coupled by laboratory technicians. Finally, results of Cycle 4 showed no significant change in INR (increase by 0.05; p=0.64) or PTT (increase by 0.01; p=0.95) testing rates but a significant increase in control testing rates (0.68; p=0.016) in the first 4 months after the intervention.Conclusions: From our previous quality improvement project in the emergency department, we learned that educational interventions alone are often not sufficient and that a process change is required to achieve meaningful change in coagulation test utilization. Through EMR integration of the BAT we successfully guided hematology referrals for bleeding. We were unable to alter rates of PTT testing despite physically removing the PTT from the lab requisition. This likely reflects the strength of the cultural link between INR and PTT. Planning is underway for PDSA Cycle 5 which will consist of a lab audit of PTT testing and subsequent targeted intervention. DisclosuresJames:Shire: Research Funding; Bayer: Research Funding; CSL Behring: Research Funding.

Evaluation of Prescribing Appropriateness and Initiatives to Improve Prescribing of Proton Pump Inhibitors at Vancouver General Hospital

Proton pump inhibitors (PPIs) have proven clinical efficacy for a variety of indications. However, there is emerging evidence of adverse events associated with their long-term use. The emergence of these adverse events has reinforced the need to regularly evaluate the appropriateness of continuing PPI therapy, and to use only the lowest effective dose for the minimally indicated duration. To characterize the appropriateness of PPI orders continued or initiated in the internal medicine and family practice units of Vancouver General Hospital, to detect adverse events associated with PPI use, and to explore the impact of multidisciplinary teaching and provision of educational resources on health care practitioners' views about PPI use. A chart review was conducted for patients admitted (for at least 24 hours) between January 1 and December 31, 2015, for whom a hospital formulary PPI was prescribed. An educational initiative, which included interprofessional in-service sessions, a PPI prescribing infographic, a PPI prescribing card, and a patient counselling sheet, was implemented. The impact of these interventions was assessed using a qualitative survey of health care practitioners. Of the 258 patients whose charts were reviewed, 175 had a PPI prescription before hospital admission, and 83 were initiated on PPI therapy during their hospital stay. Overall, 94 (36%) of the patients were receiving PPIs without an appropriate indication. Community-acquired pneumonia and Clostridium difficile infections were the most common adverse events potentially associated with PPI use. In-service sessions and educational resources on PPI prescribing were reported to affect the clinical practice of 24 (52%) of the 46 survey respondents. The results of this study emphasize the need for ongoing re-evaluation of long-term PPI therapy at the time of admission, during the hospital stay, and upon discharge. Implementing multidisciplinary teaching and providing educational resources may encourage more appropriate prescribing.

Yaşlılarda yeti yitimi ve aleksitimi

Amaç: Yaşlılık döneminde yeti yitimi ve aleksitimi kişilerin sağlık ve sosyal durumlarına etkili olabilen önemli kavramlardır. Bu çalışmada, Gümüşhane İl Merkezinde evde yaşayan yaşlılarınyeti yitimi ve aleksitimi özelliklerinin değerlendirilmesi amaçlanmıştır. Yöntem: Kesitsel tipte olan araştırma, Gümüşhane İl Merkezinde bulunan 14 aile hekimliği birimine kayıtlı nüfustan sistematik örnekleme ile seçilen 65 yaş ve üzeri 437 kişi ile yürütülmüştür. Örnekleme alınan yaşlılara, içerisinde Kısa Yeti Yitimi Anketi ve Toronto Aleksitimi Ölçeği-20 (TAÖ-20)’nin de yeraldığı bir anket yüz yüze görüşme ile uygulanmıştır. Tanımlayıcı veriler sayı, yüzde, ortanca ve min-max olarak gösterilmiştir. İstatistiksel analizlerde, p&amp;lt;0.05 değerleri anlamlı olarak kabuledilmiştir. Bulgular: Araştırma kapsamına alınan yaşlıların yaş ortalaması 74.3±7.15 yıl (min:65, max:100) olup, %63.4’ü kadın, %36.6’sı erkektir. Yaşlıların Kısa Yeti Yitimi puan ortalaması 10.25±5.03 (min:0, max:22), TAÖ-20 puan ortalaması ise 49.28±9.58 (min:25, max:85)’dir. Yaşlıların %86’sında çeşitli derecelerde yeti yitimi saptanmıştır. Kadın olmanın, dul/boşanmış olmanın, düşük eğitim düzeyine sahip olmanın, herhangi bir ruhsal sorun yaşamanın, mobilizasyonda kısıtlılık artışının, egzersiz yapmamanın, genel-fiziksel-zihinselduygusal ve sosyal sağlık düzeylerinde kötü sağlık algısına sahip olmanın TAÖ-20 puan ortalamasını arttırdığı saptanmıştır (p&amp;lt;0.05). Hayatı boyunca herhangi bir şiddet türüne maruz kalmış olanların şiddet görmeyenlere, aile içinde kendini ifade edemeyenlerin ya da kısmen ifade edenlerin böyle bir sorun yaşamayanlara göre aleksitimi toplam puanları daha yüksek bulunmuştur (p&amp;lt;0.05). Sonuç: Bu araştırmada, yaklaşık olarak her beş yaşlıdan dördünde yeti yitimi bulunmuştur. Ortalama aleksitimi puanı ise ölçeğin maksimum puanın yarısının altındabulunmuştur. Yaşlılarda yeti yitimi ve aleksitimiyi etkileyen faktörlere yönelik iyileştirici yönde çalışmalar planlanmalı ve uygulanmalıdır.

Two BRM promoter polymorphisms predict poor survival in patients with hepatocellular carcinoma

Polymorphisms in the promoter of the BRM gene, a critical subunit of the chromatin remodeling SWI/SNF complex, have previously been implicated in risk and prognosis in Caucasian-predominant lung, head and neck, esophageal, and pancreatic cancers, and in hepatocellular cancers in Asians. We investigated the role of these polymorphisms in hepatocellular carcinoma (HCC) risk and prognosis. HCC cases were recruited in a comprehensive cancer center while the matched controls were recruited from family practice units from the same catchment area. For risk analyses, unconditional logistic regression analyses were performed in HCC patients and matched healthy controls. Overall survival analyses were performed using Cox proportional hazard models, Kaplan-Meier curves, and log-rank tests. In 266 HCC cases and 536 controls, no association between either BRM promoter polymorphism (BRM-741 or BRM-1321) and risk of HCC was identified (P > 0.10 for all comparisons). There was significant worsening of overall survival as the number of variant alleles increased: BRM-741 per variant allele adjusted hazards ratio (aHR) 5.77, 95% confidence interval (CI) 2.89-11.54 and BRM-1321 per variant allele aHR 4.09, 95%CI 2.22-7.51. The effects of these two polymorphisms were at least additive, where individuals who were double homozygotes for the variant alleles had a 45-fold increase in risk of death when compared to those who were double wild-type for the two polymorphisms. Two BRM promoter polymorphisms were strongly associated with HCC prognosis but were not associated with increased HCC susceptibility. The association was strongest in double homozygotes for the allele variants.

A multicenter family practitioners' research on Chronic Obstructive Pulmonary Disease screening using the COPD Assessment Test.

Spirometry is known to be a gold standard for the diagnosis of chronic obstructive pulmonary disease (COPD). COPD Assessment Test (CAT) is an eight-item questionnaire currently in use to evaluate patients with COPD. In the present study, we aimed to evaluate if CAT is an adequate tool for screening COPD. In total, 600 persons aging ⩾40 years old were randomly selected from three different family practice units located in the city center. CAT was asked to the participants and a spirometry was used to assess pulmonary obstruction. Pulmonary obstruction was defined as forced expiratory volume in first second/forced vital capacity (FEV1/FVC)<70% and then COPD diagnosis was confirmed with the reversibility test. The relationship between CAT results and pulmonary function test values was evaluated. In this sampling, the prevalence of COPD was 4.2%. Reliability of the CAT in the study group was acceptable (Cronbach's α: 0.84). The CAT scores was significantly higher in patients with COPD (P<0.001). There was a significant negative correlation between CAT score and FEV1, FVC and FEV1/FVC ratio (r=-0.31, P<0.001; r=-0.26, P<0.001; r=0.18, P=0.001). Among smokers, phlegm was the predominating symptom (P=0.01). Sensitivity of CAT was 66.67% and its specificity was 75.15% to determine COPD. CAT is a reliable questionnaire and there is an apparent relationship between the total CAT scores and COPD. However, CAT's ability to screen COPD is limited since it may miss the symptom-free cases.

P138: The Family Medicine Obstetrical Ultrasound (FaMOUS) course: a model for training office-based family physicians in first trimester point of care ultrasound

Introduction / Innovation Concept: In Canada, family physicians (FPs) provide the majority of 1st trimester pregnancy care and are often first to evaluate complications, including threatened and spontaneous abortion and ectopic pregnancy. To receive a same day urgent US, most patients will be sent to the emergency department (ED). With increasing availability and affordability of point of care ultrasound (PoCUS), FPs are starting to use US in their offices, potentially diverting some ED visits for patients with reassuring US findings. To date, no formal certification process exists for FPs who wish to use PoCUS for 1st trimester indications. Methods: The objective of this educational initiative was to implement and evaluate a novel, 2-day didactic and hands-on certification process for FPs utilizing office-based PoCUS to identify intrauterine pregnancy and fetal cardiac activity. The FaMOUS course was modeled after the Canadian Emergency Ultrasound Society Emergency Department Echo (CEUS EDE) curriculum and adapted with permission for FPs. Curriculum, Tool, or Material: The curriculum consisted of a deliberate practice mastery model utilizing on-line materials, seminars and hands-on training. Prior to the 2-day course, FPs completed an e-learning module comprised of core competency material specific to obstetrical practice. Learners were required to score 100% on a post-module exam to participate in the 2-day course. Attendees participated in a 4-hour training session to learn US image generation and interpretation. This was followed by 10 hours of hands-on training with CEUS instructor supervision to complete the certification process (50 determinate scans). Thirteen FPs from 3 family practice units successfully completed the certification process. Cumulative knowledge and skill levels were assessed throughout the 2-day workshop through feedback from CEUS supervisors to confirm key concepts were learned. All 13 participants agreed to utilize PoCUS in their clinical assessments of patients with 1st trimester complaints using handheld PoCUS equipment provided to the sites. FPs will be surveyed at 3 month intervals for 12 months following the FaMOUS course to assess provider confidence, satisfaction and perceived impact on clinical decision-making. Conclusion: The FaMOUS certification course is a standardized curriculum by which FPs can learn PoCUS safely to improve quality and timeliness of care for patients experiencing 1st trimester complaints. If PoCUS is adopted by FPs, lengthy ED visits may be decreased for this patient population.

Aile sağlığı merkezine başvuran kadınlarda idrar kaçırma sıklığı

Summary Objective: The studies which investigate urinary incontinence (UI) are fairly few in our country. To contribute scientific data in this subject, we planned this study to evaluate women between 40-65 ages who are in the list of 41.08.040 numbered family practice unit of Izmit Kurucesme Family Health Center.

Profile of elderly attending a general practice clinic in a poor urban area: A cross-sectional study from South India.

Introduction:In India, the number of elderly is steadily increasing and is likely to reach 301 million by 2051. The increasing number and proportion of elderly will have a direct impact on the demand for health and pension services. As per the Demography of Indian Aging (Rajan et al.), information on morbidity profile of this population is essential to plan health-care facilities.Methods:A descriptive cross-sectional study was designed to study the morbidity profile of 100 elderly persons reporting to the outpatient clinic of a family practice unit of a tertiary care center in South India between June 2008 and May 2010. This was done with a view to plan better services for the elderly in that area.Results:In this study, 88% of the participants were on a follow-up while new ailment(s) were diagnosed in 11 participants. A majority of participants were illiterate (62%), unemployed (83%), and financially dependent (54%). Forty-four participants screened had depression that required intervention such as counseling and follow-up; in ten participants, the screening score was sufficient to warrant therapy. In nearly half of the participants, the musculoskeletal system was involved, and a significant number had the involvement of cardiorespiratory system and urinary incontinence.Conclusion:A large number of elderly are affected by a constellation of conditions including mental as well social issues. A family practice unit may be a good setup to provide the first-contact care for the diagnosis and management of common problems in the elderly and help to improve their quality of life.

Patients' willingness to utilize a SMS-based appointment scheduling system at a family practice unit in a developing country.

Aim The investigators aimed to assess the willingness of patients to utilize and pay for a proposed short message service- (SMS) based appointment scheduling service. Telecommunication applications have been introduced to improve the delivery of healthcare services in developed countries; however, public-funded healthcare systems in developing countries like Nigeria are mostly unfamiliar with the use of such technologies for improving healthcare access. We proposed a SMS-based (text message) appointment scheduling system to consenting subjects at an outpatients' clinic and explored their willingness to utilize and pay for the service. Using semi-structured interview schedules, we collected information on: estimated arrival time, most important worry when seeking for healthcare services at public hospitals in the study setting, ownership of a mobile phone, willingness to utilize a SMS-based appointment for clinic visits and willingness to pay for the service. In addition, respondents were asked to suggest a tariff for the proposed system. Findings A total of 500 consecutively recruited patients aged 16-86 (42.1±15.4) years participated; 54% (n=270) were females. Waiting time ranged from 1-7.5 h (3.9±1.1). Two overlapping themes emerged as most important worries: crowded waiting rooms and long waiting time. Ownership of mobile phones was reported by 96.4% (n=482) of subjects. Nearly all favoured the proposed appointment scheduling system (n=486, 97.2%). Majority of patients who favoured the system were willing to pay for the service (n=484, 99.6%). Suggested tariff ranged from 0.03 to 20.83 (1.53±2.11) US dollars; 89.8% (n=349) of the subjects suggested tariffs that were greater than the prevailing retail cost of the proposed service. In sum, our findings indicate that patients in this study were willing to utilize and pay for a proposed SMS-based appointment scheduling system. The findings have implications for policies aimed at improving healthcare access and delivery of healthcare services at the primary care level in developing countries like Nigeria.

Abstract 351: The Family Study: Assessment of the Risk for Sudden Cardiac Arrest in Family Members of Cardiac Arrest Patients

Background: Sudden cardiac arrest (SCA) is devastating for the patient’s family, friends, and community. There is limited information on its identifiable familial predisposition. Objectives: To evaluate the familial risk pattern for SCA in family members of cases compared to age-and-sex matched control groups. Incidence of prior symptoms and SCA triggers were also compared. Methods: We used a prospectively collected, population-based registry of all out-of-hospital cardiac arrests (OHCAs) in the Greater Toronto Area, to identify cases from 2010-2012. Cases were defined as SCA patients aged 18-65 who arrested from a cardiac cause and were treated by Emergency Medical Services. Two relatives per patient were interviewed regarding symptoms prior to the arrest, cardiac history and family history of SCA. Control patients with known coronary heart disease (CHD) and healthy participants were recruited from PCI procedures and the Family Practice Units at St. Michael’s Hospital. Results: Complete family and medical history was obtained for 66 SCA cases, 56 heart disease patients and 27 healthy controls. Underlying diseases were CHD in 77%, non-CHD structural heart disease in 9%, primary arrhythmic in 3% and presumed cardiac of unknown etiology in 11%. A higher proportion of SCA individuals had a family history of SCA in 1st degree relatives (19/66; 28.8%) than 1st degree relatives of healthy controls (2/27; 7%; p=0.006) and 1st degree relatives of patients with heart disease (14/56; 25%) (Table 1). Among families with SCA, 3/66 (4.5%) had a history of &gt;1 relative with SCA, vs. none in either control group. Most SCA patients experienced one or more warning symptoms in the hour preceding an arrest (40/66; 61%); 24/66 (36%) experienced a cardiac arrest during or following exercise. Conclusion: Family members of SCA patients have a higher SCA prevalence than family members of healthy controls. A high proportion of SCA patients experienced symptoms in the hour preceding their arrest.

Teaching Medical Students About Disability: The Use of Standardized Patients

Standardized patients (SPs), now a mainstay of the undergraduate medical education experience, are beginning to play larger roles in helping students build competencies to better serve patients who have disabilities, in educating students about the lived experiences of persons with disabilities, and in testing students' understanding of disability-related issues. In this article, the authors discuss several U.S. training programs that involve SPs who have disabilities or SPs who do not have disabilities but who portray patients who do. The authors review the goals of each program (e.g., to provide students with opportunities to gain experience with patients with disabilities), describe their commonalities (enhancing students' interview skills) and differences (some programs are educational; some are evaluative), and summarize the evaluative data of each. The authors also explore the benefits and challenges of working with SPs with disabilities and of working with SPs without disabilities. Finally, they consider the practical issues (e.g., recruiting SPs) of developing and implementing such programs.

Manisa merkez yarı kentsel bölgede bir aile sağlığı birimine kayıtlı kadınlarda bazı birinci basamak sağlık hizmet özelliklerinin değerlendirilmesi

Ozet Amac: Birinci basamak saglik hizmet ozellikleri kaynakca dogrultusunda bilimsel olarak olculebilir niteliktedir ve ilk basvuru, sureklilik, kapsayicilik ve koordinasyon gibi temel hizmet ozellikleri uzerinden degerlendirilir. Yontem: Ornek seciminde cok asamali kume ornekleme yontemi kullanilmis, veriler yuz yuze gorusme teknigine gore yapilandirilmis anketle toplanmistir. Arastirma bolgesindeki toplam hane sayisi 870’tir. Kume ornekleme yontemi ile 376 haneden 318 kadina ulasilmistir. Arastirmanin ulasilabilirlik orani % 84.6’dir. Arastirmanin bagimli degiskenleri; Ilk basvuru, Sureklilik, Kapsayicilik ve OHS (Olagan Hizmet Surekliligi) gibi hizmet ozellikleridir. Bagimsiz degiskenler ise kadinin ve esinin yasi, kadin ve esinin egitimi, medeni hal, kadinin calisma durumu, sosyal sinif (esin isine gore), gelir algisi, bolgede yasama yili, goc edilen bolge, saglik guvencesi, aile tipi, bes yasindan kucuk cocuk varligi ve hanedeki cocuk sayisi kullanilmistir. Bulgular: Katilimcilarin yas ortalamasi 38.3±15.3’tur. Bir saglik sorunu nedeniyle aile hekimine basvurma % 61.0, ondan bir onceki saglik sorununda AH’ne (Aile Hekimi) basvuru %55,2 oranindadir. Bu sorularin her ikisine de “ayni aile hekimine basvururum” cevabini verenlerin (OHS) orani %40.1 olmustur. Aile Sagligi Birimini yakin, normal mesafe bulanlarin orani %93.1’dir. Aile hekiminin ismini bilme %84, ebenin ismini bilme %36.2, her turlu sorununuzla surekli ilgilenen bir hekim veya saglik kurulusuna kayitli oldugunu soyleyenlerin %74.5’tir. Son bir yilda evime ebe ziyareti aldim diyenler %40.6 oranindadir. Sonuc: Arastirmanin yapildigi ASB’de gecen bir yillik ilk AH uygulama doneminde sosyallestirme donemiyle karsilastirildiginda, tedavi edici hizmet oruntusunun degismedigi buna karsin gezici ebe hizmetlerinin azaldigi gorulmustur. Anahtar Kelimeler: Aile sagligi birimi, ilk basvuru, sureklilik, kapsayicilik, olagan hizmet sunucu surekliligi Abstract Aim: The capability of primary care services can be scientifically measured and assessed via basic elements of these services such as accessibility, longitidunality, comprehensiveness and coordination. Methods: A multistage cluster sampling method was used and the data were collected by face to face interviews with a structured questionnaire. An overall 870 households which were recorded in a Family Practice Unit (FPU) consisted of the universe of this study and 318 women were identified from a sample of 376 households by cluster sampling method. The response rate was of 84.6%. The dependent variables in the study were, the First contact care, Continuity (Usual provider continuity), Comprehensiveness; whereas independent variables were, the women’s and husband's age, the women's and husband's education, marital status, women's occupational status, family social class, perception of income, years of residency in the region, the area of emigration, health insurance status, family type, existence of children under five years of age. Results: The average age of participants was 38.3 ± 15.3. The percentage of women who preferred FPU services for their most recent health problem was 61.0%, whereas this percentage was 55.2% for the previous experienced health problem. The Usual Provider Continuity (UPC) rate was 40.1%. 93.1 percent of women stated that FPU is quite close to their house. The proportion of the women who knew the name of their family physician was 84.0% and 36.2% them knew the name of their midwife. Of the respondents, 74.5% had been registered with a PHC facility or a primary care physician. Midwives visited 40.6% of the respondents at least once during the last year. Conclusion: This research indicates that, the pattern of therapeutic services was not changed in the new FPU system, compared to the previous socialized health organization in the Primary Care services. Besides this fact, mobile midwife services might be said to have decreased in the new FPU system. Key Words: Family health unit, the first contact, continuity, comprehensiveness, usual provider continuity.

Perceptions of the Role of the Registered Nurse in an Urban Interprofessional Academic Family Practice Setting

Registered nurses (RNs) in Ontario have been asked to work collaboratively with family physicians (FPs) and other healthcare professionals in the family practice setting to improve the efficiency and effectiveness of healthcare delivery (OFPN 2005). Yet, little is known about the optimal utilization of the RN's role in family practice. This study builds on recent conversations regarding utilization of the nursing workforce (Oelke et al. 2008) and the nursing role (White et al. 2008) in the acute care setting by presenting perceptions of the role of the RN in an urban academic family practice setting. Interviews were conducted with 23 healthcare professionals of varying disciplines across three interprofessional academic family practice units in a Canadian city. Interviewees were asked about their perception of the RN's role as it relates to interprofessional collaboration (IPC). Our findings suggest that ambiguity surrounds the RN's role in family practice in general and in IPC in particular. Also, an FP's level of trust in an RN was found to be a central theme and an important variable in determining FP-RN collaboration, with higher levels of RN trustworthiness associated with higher levels of FP-RN collaboration. Optimal utilization of the family practice RN requires leadership in clarifying the RN's role in IPC, and why and how trust among IPC members is cultivated and nurtured.

Does monitoring change in function in community-dwelling older adults alter outcome? A randomized controlled trial

Objective: To determine whether information about an older person's physical functioning provided to the patient and his or her physician delays functional decline and improves health outcomes. Design: A randomized controlled trial was undertaken; the assessors were not blinded to the group allocation. Setting: The study took place in a clinic within a hospital setting. Participants: Two hundred and sixty-five community-dwelling people over 65 years were recruited from family practice units. Interventions: The intervention group received assessments of physical function with feedback to the participant and the participant's family physician or functional assessments alone over 18 months. Self-report measures for health status using the Short Form-36 (SF-36) and preclinical disability were used together with performance measures which included the lower extremity performance test and muscle strength. Results: There were small, statistically significant group/time interactions which included disability scores, F=4.78, P ≤0.05), and the vitality subscale of the SF-36, F=7.47, P ≤0.01). Conclusion: Providing information about the results of detailed assessment of physical functioning to older adults and their physicians did not show significant differences in function scores between the intervention and control groups.

Librarian office hours in a family practice unit

Objective – To determine if the implementation of well-advertised "librarian office hours" in a busy clinical department of a teaching hospital would increase utilization of library services. Setting – The open-concept office of the Department of Family and Community Medicine at the Toronto Western Hospital site of the University Health Network. Program – As of June 2004, a librarian provided monthly office hours during the lunch hour in the Department of Family and Community Medicine. Staff were encouraged to e-mail any specific issues or questions to the librarian in advance of consultation, if possible, but all consultations were otherwise provided on a first-come, first-served basis. Results – In the 7-month period since the librarian office hours were initiated, 21 separate training sessions or consultations were provided to this department. This constitutes 15 sessions more than the number of sessions provided to this group in the same 7-month period in the previous year. Concurrently, the number of literature search requests made by this department has doubled compared with the same 7-month period in the previous year. Conclusion – User-centered information services for primary care professionals need to be mindful of clients' information-seeking preferences and lack of time. While providing librarian visits to individual hospital departments may not be the best use of a librarian's limited time and resources, in the drive to meet the unique needs of general practice, such an approach may be an advantageous way of librarians meeting client needs in the context of their own environment. Further examination of the benefits of approaches similar to this concept, for both librarians and hospital staff, is warranted.