General Practitioners In Primary Health Care Research Articles

Modern organization aspects of the prevention of ischemic stroke in patients with extracranial carotid stenosis

Stroke is the second leading cause of death and the third leading cause of disability globally. This literature review described risk factors and diagnostic aspects of ischemic stroke prevention. Carotid stenosis and occlusion is a treatable cause of ischemic stroke, which can be diagnosed by duplex scanning of the brachiocephalic arteries. The reasons for the low effectiveness of preventive measures for ischemic stroke are the incomplete collection of anamnesis for risk factors that affect the clinical prognosis, the low use of modern diagnostic methods by primary health care general practitioners in the screening of patients.

Adaptación y validación de un instrumento de evaluación de la competencia del consejo breve para dejar de fumar. BTI-Prof©

ObjectiveAdaptation and validation of the BTI-St© to assess the level of competence in brief tobacco intervention in general practitioners and nurses in Primary Health Care. DesignCross-sectional study of adaptation and psychometric validation of a criterion-referenced test. SettingPrimary Health Care. ParticipantsOne hundred fifty-five general practitioners and nurses working at Primary Health Care. InterventionsThree clinical scenarios were designed. Using an online platform, participants first viewed each scenario in which brief tobacco intervention was given. Health professional had to assess whether or not the scenarios were carried out in accordance with the 5A+5R model. Main measuresCompetence in brief tobacco intervention measured by the BTI-Prof©. ResultsResults related to reliability were obtained through Kuder-Richardson coefficient, being for scenario 1, 0.880, for scenario 2, 0.829, and for scenario 3, 0.826. The test–retest shows adequate temporal stability: intraclass correlation coefficient for scenario 1 0.857 (95% CI 0.734–0.923), p<0.0001, for scenario 2 0.829 (95% CI 0.676–0.909), p<0.001, and for scenario 3 0.869 (95% CI 0.76–0.928), p<0.0001. ConclusionsThe BTI-Prof© is a robust tool with adequate psychometric properties to assess competence in brief tobacco intervention in Primary Health Care general practitioners and nurses.

Association Between Characteristics of Danish Chiropractors and Number of Referred Patients From General Practitioners: A Cross-sectional Study

ObjectiveThe purposes of this study were to quantify the number of patients referred weekly from primary health care general practitioners (GPs) to chiropractors and to identify chiropractor characteristics associated with the number of referrals. MethodsAn online, cross-sectional survey was sent to the 600 active members of the Danish Chiropractic Association. Of those, 364 completed the survey and 286 met our inclusion criteria. We used bivariable analyses and negative binomial multivariable regression to evaluate the association between predetermined characteristics and the weekly number of patients referred by GPs. ResultsOn average, chiropractors reported that they received 2.5 (standard deviation, 2.2) referrals from GPs per week, representing 31% of all new patients received by chiropractors. Clinics with more than 1 chiropractor and access to diagnostic ultrasound received more GP referrals. Chiropractors reporting expertise in geriatrics and a higher number of new patients per week reported more referrals. Chiropractors who reported referring more patients to GPs also reported receiving more referrals from them. ConclusionVariables related to access to chiropractic care, the type of care provided, and interprofessional communication were positively associated with the number of GP referrals that chiropractors self-reported. This is the first study to report on factors associated with GP referrals to Danish chiropractors.

Development of a scale for measuring collaboration between physicians and nurses in primary health-care teams

ABSTRACTDuring past decades the science of collaboration in health care has progressed significantly worldwide, although in some regions (e.g.: Central and Eastern Europe) these processes are slower. The aim of this study was to develop a new, multidimensional measurement tool of the developing collaboration in primary health care (PHC). This study included both qualitative (thematic analysis of the data from focus group discussions) and quantitative (a 36-item cross-sectional questionnaire) methods in order to develop and test a new measurement scale. The collaboration scale between community nurses (CNs) and general practitioners (GPs) in primary health-care teams (COPAN scale) was created. It initially revealed five determining factors: “Goal Oriented Team Synergy”, “Team Structure and Leadership”, “Organizational Background for Teamwork”, “Competence” and “Diffusion of Functions.” Two and three-factor scales (COPAN-2 and COPAN-3) were developed after confirmatory factor analysis with sufficient psychometric characteristics to be applied in practice. This study reports the reliability of a novel tool that can be used to measure collaboration of CNs and GPs in PHC. The newly developed scale has the potential to become an easy-to-use tool in the monitoring of teamwork situations within PHC settings of low integration or newly evolving teams.

Clinical skills of Chilean general practitioners for the management of depressive disorders

Diverse and sustained efforts have been developed to improve the management of depression by general practitioners (GPs), but they have not improved treatment coverage and quality of services. To explore the level of knowledge and clinical skills to diagnose and treat depression by GPs in Primary Health Care (PHC) in the Metropolitan Area of Santiago de Chile (RM). Theoretical knowledge (TK), diagnostic skills (DS) and treatment skills (TS) were evaluated in 56 GPs of the RM with a battery of specially designed instruments. In TK there were significant differences between GPs aged 31 years or less and their older counterparts and between Chilean and foreign doctors. Five percent of observed differences in TK were explained by age and nationality, respectively. Chilean GPs achieved higher scores in recognition of symptoms (RS), one of the dimensions of DS. No significant differences by age or nationality were observed for DS and TS. Achievement of GPs on tests measuring TK, DS, and TS was generally below 50%. This deficiency should be improved.

Diagnostic interaction: The patient as a source of knowledge?

Objective. To explore diagnostic interaction to understand more about why some problems appear medically unexplained. Design. A qualitative discourse analysis case study. Setting. Encounters between women patients and general practitioners in primary healthcare. Subjects. Microanalysis of two audiotaped consultations without a clear-cut diagnosis and opposing levels of mutuality between doctor and patient. Main outcome measures. Descriptions of linguistic patterns in diagnostic interaction. Results. Two patterns were identified demonstrating how different ways of speech acts contribute or obstruct diagnostic interaction and common ground for understanding. To invite or reject the patient into/from the diagnostic process, and to recognize or stereotype the patient may impose on how illness stories are perceived as medically unexplained. Conclusion. Making sense of illness can be enhanced by inviting and recognizing the patient's story.

Validación de un cuestionario para el diagnóstico de la epilepsia en servicios de atención primaria

To evaluate the usefulness of a questionnaire in primary health care services for establishing the diagnosis of epilepsy in children from 1 to 10 years old and for classifying their epileptic seizures. This cross-sectional observational study was conducted in 2004. There were 204 children in the study (102 diagnosed with epilepsy and 102 without epilepsy). The children were randomly selected at the Regional Center of Epilepsies and the Vincent Corral Moscoso Hospital, which are both in the city of Cuenca, Ecuador. For the study, each child with epilepsy was matched with a child without epilepsy, in two age groups: 1 to 5 years old and 6 to 10 years old. Four students who were in their last academic year in the School of Medicine of Cuenca and who did not know the child's diagnosis utilized the questionnaire with a family member or other guardian of the child. The validity, sensitivity, specificity, positive predictive value, and negative predictive value of the questionnaire were calculated, with 95% confidence intervals (95% CIs). The clinical diagnosis carried out by specialists was used as the gold standard. The assessment showed that the questionnaire had good sensitivity (95.10%; 95% CI: 94.58%-95.61%) and good specificity (97.06%; 95% CI: 96.58%-97.59%). Validity was 96.08% (95% CI: 95.84%-96.36%), with a positive predictive value of 97.00% (95% CI: 96.48%-97.52%) and a negative predictive value of 95.19% (95% CI: 94.74%-95.74%). The level of agreement in the classification of the epileptic seizures carried out by the neurologists and by the medical students who used the questionnaire was satisfactory for the generalized seizures (kappa = 0.67). Upon testing for interobserver agreement among the specialists, the kappa value for the diagnoses was 0.80 among the neurologists and 0.89 among the pediatricians. The diagnostic questionnaire that was assessed has good sensitivity and adequate specificity, and, after brief training, primary health care general practitioners can use it to help them diagnose epileptic seizures.

Shifts in B12 opinions in primary health care of Sweden

The diagnosis and management of vitamin B12 deficiency varies between countries and within countries. The aim of the study was to map current attitudes and values behind clinical decision-making in Swedish primary health care, which has a unique B12 tradition: two patients out of three are treated with oral high-dose cyanocobalamin. Most patients with B12-associated problems are managed in primary health care by general practitioners (GPs). The study was designed to elucidate possible opinion shifts among GPs during the period 1996-1998. GPs (n=499), stratified and randomized, received a questionnaire with 24 statements on B12-associated clinical and laboratory problems, to be evaluated by a visuo-analogue scale. The majority of GPs in primary health care in Sweden accepted homocysteine and methylmalonic acid (MMA) as markers for functional deficiency of vitamin B12. The evaluation of classical markers of B12 deficiency was wary and balanced. There was a consensus of the need for B12 therapy to risk groups such as patients with atrophic gastritis or previous gastric surgery. The answers also appeared to reflect an improvement of professional knowledge and competence concerning B12-associated problems among Swedish GPs between 1996 and 1998. The overriding conclusion was that B12-associated opinions of Swedish GPs were stable within the period studied, with marginal improvements of knowledge and competence.

Original Paper: Cumulative incidence of asthma diagnosis at the age of seven in a birth cohort

Objectives: The aim of this study was to follow a cohort of children in a defined region from birth up to the age of seven for the occurrence of a doctor's diagnosis of asthma in the medical records in primary healthcare and hospital.Methods: In a defined region in Sweden with a population of about 150,000 inhabitants, all children (n=2104) born in the University Hospital in 1990 were recorded. Seven years later, 82% (n=1752) were still living in the region; their medical files at the Department of Paediatrics and all primary healthcare centres in the region were checked for an asthma diagnosis (ICD 9).Results: The results gave a total cumulative asthma incidence of 10.9% among seven-year-old children in the studied region. A significantly (p<0.01) higher number of boys (13.1%) than girls (8.5%) had this diagnosis. The incidence of asthma was highest (p<0.005) among boys living in urban areas at the age of seven. Increased relative risks for asthma were also found among children born in the autumn (p<0.05) and children born of young mothers (p<0.0001).Conclusions: These results indicate a higher childhood asthma incidence than previously presented figures for Sweden and illustrate the importance of collaboration between general practitioners in primary healthcare and paediatricians in hospitals in order to cope with the disease in diagnostic, curative and preventive respects.

The developments of general practice/family medicine in Turkey

The current healthcare system of Turkey has failed to meet the health needs of the people. Neither the people who use the healthcare services nor the providers are satisfied with current healthcare delivery. Transition from this system of hospital-based health services towards a general practice-based health care system is the core content of the reform process in Turkey. However, although a period of ten years has elapsed, this process has made little progress and the draft laws from 1994 have not yet been enacted. Retraining general practitioners in primary healthcare (PHC) towards general practice/family medicine (GP/FM) and vocational training in GP/FM are challenging issues for the reform process and for academic general practice departments. Following the decision of the Higher Educational Council (HEC) in 1993, departments of general practice have been established in 21 of the 45 medical schools. Despite many substantial problems, there are promising developments in GP/FM in Turkey.