Participation Of Primary Care Physicians Research Articles

Hausärztliche Perspektiven auf eine multimodale Intervention zum adäquaten Einsatz von Antibiotika beim Harnwegsinfekt – eine qualitative Interviewstudie

IntroductionContrary to current guideline recommendations, second-line antibiotics are still frequently used in the ambulatory treatment of uncomplicated urinary tract infections (UTI), which are associated with a high risk of antibiotic resistance development. The REDARES project (REDuction of Antibiotic RESistance in uncomplicated urinary tract infections by treatment according to national guidelines in ambulatory care), funded by the Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA)/Innovation Fund is developing a multimodal intervention for primary care physicians to support them in a guideline-based approach. The intervention consists of the following components: (1) provision of local resistance data of pathogens of uncomplicated UTI (Robert Koch Institute), (2) concise guideline content on the therapy of uncomplicated UTI for patients (paper and online), and (3) prescription feedback on practice level and benchmarking among the study participants (anonymized). In a participatory approach and as part of the process evaluation, representatives of the intended target group were interviewed in advance about the acceptance and feasibility of the intervention. MethodsUsing guided individual interviews, Thuringian GPs were interviewed before the start of the intervention phase. Following a description of the study concept and the planned components of the intervention, the interviewees were asked about their assessment regarding acceptance and feasibility. The individual interviews were recorded, transcribed verbatim and qualitatively analyzed according to Mayring. ResultsA total of ten interviews with an average duration of 29minutes were conducted and evaluated. 40 per cent of the interviewed GPs were female and, on average, 45 years old. The interviewees described the uncomplicated UTI as an easily manageable condition. The practical nature of the research question was described as a reason to potentially participate in the intervention phase; lack of time or human resources were cited as potential barriers. Regarding the intervention elements, the provision of local resistance data of UTI pathogens was considered beneficial to their own work. The extraction of their own antibiotic prescription data from the practice software was basically assessed as feasible. The interviewees differed in their assessment of whether they would take account of the feedback on their prescribing behavior in their daily work. DiscussionThe interviews generated a detailed picture of the different diagnostic and therapeutic pathways used by respondents for uncomplicated UTI. Overall, they predominantly regarded both the study concept and the intervention components as feasible. Although the study population is small and not representative, some of the results seem to be transferable to other regions in Germany. ConclusionA research question relating to their daily routine can increase participation of primary care physicians in (intervention) studies. Starting the process evaluation before the intervention seems to be reasonable since the results will be integrated into the design of the intervention. The method of data extraction from practice software by practice teams seems to be promising.

Control médico en migraña y variables relacionadas. Resultados de la encuesta europea Trabajo y Migraña

ObjectiveThis purpose of this work is to determine the care preferences and the required use of medical care by migraine patients in the different countries of Europe, and the observed differences depending on their social and demographic conditions. Material and methodsCross-sectional observational study by anonymous web survey of 3,342 patients from Spain, Italy, France, Portugal, Ireland, United Kingdom, Germany, and a mixed group of countries not included in the initial design. Variables: age, gender, country, type of location, level of studies and rural or urban area. The demand for care is collected by neurologist, primary care doctors/family/general practitioners, by occupational health doctors, nurses, by other doctors/other specialists, non-medical control/self-control. ResultsThe patients more seen by a neurologist were about 21-60years old and with a high cultural level. Primary care/family doctor care is higher in urban areas. Occupational medicine, nursing, and other specialties predominate in large cities. Self-control is greater in patients aged 21-40years and in women. Spain and Germany are the countries with the greatest demand for care in Neurology and Primary Care. ConclusionsThe medical demand for migraine care in Europe shows irregular results according to countries, with it being a priority in neurology and with less participation of Primary Care physicians, work doctors, nurses, or other specialties. Differences are observed by age, gender, and cultural level both in the demand for care and in the choice of specialist. It is important to take into account the percentage of patients who have no medical control.

Needs of Women with Osteoporosis in Disease Self-Management: A Qualitative Study

Background: Osteoporosis is a major chronic health condition that affects women more than men. A few qualitative studies have been conducted to investigate what women with osteoporosis need to manage their disease. Objectives: The aim of the study was to determine the needs of women with osteoporosis in disease self-management. Methods: This qualitative study was conducted at the osteoporosis screening units of three private and governmental centers in Sanandaj, the West of Iran. A purposive sample was recruited from among all eligible women who attended the osteoporosis screening units from November 2015 to June 2016. The inclusion criteria were osteoporosis diagnosis by the woman’s attending physician for at least six months and prescribed osteoporosis medication. The exclusion criterion was a T-score of above -2.5. Data were collected by individual semi-structured interviews, focus group discussion, and drawings. The data were analyzed by conventional content analysis. To confirm the accuracy and strength of the data, credibility, confirmability, and transferability components were taken into account. Results: Four themes emerged from the data analysis, including “social support”, “cultural-economic factors”, “improved implementation of health education”, and “having a normal living”. Conclusions: The results of the study showed that women with osteoporosis are in need of engagement and active participation of primary care physicians, regular review of patient’s care plan, planned care visits, improving the quality of care and patient outcomes, patient education and self-management education, the cooperation of the public media and relevant organizations, and emotional and informational support to improve their osteoporosis self-management.

Associations Between the Patient Protection and Affordable Care Act Medicaid Primary Care Payment Increase and Physician Participation in Medicaid

The Patient Protection and Affordable Care Act (ACA) increased 2013 to 2014 Medicaid payment rates for qualifying primary care physicians (PCPs) and services to higher Medicare payment levels, with the goal of improving primary care access for Medicaid enrollees. To evaluate the payment increase policy and to assess whether it was associated with changes in Medicaid participation rates or Medicaid service volume among PCPs. This study used 2012 to 2015 IMS Health aggregated medical claims and encounter data from PCPs eligible for the payment increase practicing in all states except Alaska and Hawaii and included 20 723 PCPs with observations in each month from January 1, 2012, to December 31, 2015. Data are for professional services performed in ambulatory settings, including office, hospital outpatient department, and emergency department. Regression models were used to test whether outcomes differed in months subject to higher payment rates relative to months before the increase and after the expiration of the increase in some states. The models controlled for time-invariant physician characteristics and time-varying characteristics, such as Medicaid enrollment. Interaction terms were included to estimate differential associations in subgroups of states (eg, by Medicaid managed care penetration) and physicians (eg, by specialty). Physician-month records subject to higher Medicaid payment rates were flagged using state-specific implementation and end dates for the payment increase. Five outcomes were measured for each physician-month observation, including (1) an indicator for seeing any patients enrolled in Medicaid, (2) an indicator for seeing more than 5 patients enrolled in Medicaid, (3) the Medicaid share of total patients, (4) a count of new patient evaluation and management visits furnished to patients enrolled in Medicaid, and (5) a count of existing patient evaluation and management visits furnished to patients enrolled in Medicaid. Among 20 723 PCPs, the payment increase had no association with PCP participation in Medicaid or Medicaid service volume. The estimated average marginal effects for all 5 outcomes were not statistically distinguishable from 0. This null result was robust to sensitivity analyses, including different time trend specifications and analyses focusing on the payment increase implementation and expiration time frames. Descriptively, the Medicaid share of patients increased by about 25% from 2012 to 2015, although the share did not increase differentially in states and months subject to higher payment rates. The limited duration and design of the payment increase may have dampened its effectiveness. Future efforts to improve access through payment changes or other means can benefit from better understanding of the outcomes of this policy.

The European Society of Cardiology Heart Failure Association Annual Congress.

The European Society of Cardiology Heart Failure Association Annual Congress.

Primary care physicians' role perception and self-reported performance in glaucoma care: a survey study.

BackgroundGlaucoma is a leading cause of blindness. The participation of primary care physicians (PCPs) in glaucoma care may improve health outcomes for glaucoma patients.ObjectivesTo investigate PCPs’ attitudes towards their role in glaucoma care, perceived barriers, and self-reported performance in glaucoma management.MethodsPCPs working in the Haifa and Western Galilee District of Clalit Health Services, Israel’s largest Health Maintenance Organization (HMO) were asked to complete a self-administered structured questionnaire. Physicians were asked to rate their agreement with statements describing the PCP’s role in glaucoma care, and to state how often they behave accordingly in their practice. In addition, physicians were asked to rate the extent that factors such as time constraints and knowledge gaps impede their performance in glaucoma care.ResultsEighty-two physicians completed the questionnaire. The majority thought that PCPs have a major role in early detection of glaucoma (99 %), discussing the importance of adherence to treatment (93 %), and encouraging patients to make regular visits to their ophthalmologist (99 %). However, only 30 % reported asking patients about family history of glaucoma, 64 % reported discussing adherence to treatment, and only 35 % stated that they explain how to use eye drops, while most of respondents (87 %) regularly provide refill prescriptions for glaucoma medications. Sixty percent claimed that during their residency they had not acquired adequate knowledge and competence to allow them to take proper care of glaucoma patients. The main barriers reported were lack of time (43 %), lack of knowledge regarding treatment options and recommended follow-up (46 %), and not being familiar with glaucoma medications’ side effects (54 %).ConclusionsThere is a gap between PCPs’ perceptions of their role in glaucoma care and their report on actual performance in early detection and management of glaucoma. Further research is needed to develop and assess interventions that aim at closing this gap.

Patient, Primary Care Physician and Specialist Expectations of Primary Care Physician Involvement in Cancer Care

In Canada, many health authorities recommend that primary care physicians (PCP) stay involved throughout their patients' cancer journey to increase continuity of care. Few studies have focused on patient and physician expectations regarding PCP involvement in cancer care. To compare lung cancer patient, PCP and specialist expectations regarding PCP involvement in coordination of care, emotional support, information transmission and symptom relief at the different phases of cancer. Canadian survey of lung cancer patients, PCPs and cancer specialists A total of 395 patients completed questionnaires on their expectations regarding their PCP participation in several aspects of care, at different phases of their cancer. Also, 45 specialists and 232 community-based PCP involved in these patients' care responded to a mail survey on the same aspects of cancer care. Most specialists did not expect participation of the PCP in coordination of care in the diagnosis and treatment phases (65% and 78% respectively), in contrast with patients (83% and 85%) and PCPs (80% and 59%) (p < 0.0001). At these same phases, the best agreement among the 3 groups was around PCP role in emotional support: 84% and more of all groups had this expectation. PCP participation in symptom relief was another shared expectation, but more unanimously at the treatment phase (p = 0.85). In the advanced phase, most specialists expect a major role of PCP in all aspects of care (from 81% to 97%). Patients and PCP agree with them mainly for emotional support and information transmission. Lung cancer patient, PCP and specialist expectations regarding PCP role differ with the phase of cancer and the specific aspect of cancer care. There is a need to reach a better agreement among them and to better define PCP role, in order to achieve more collaborative and integrated cancer care.

プライマリ・ケア医の外来診療教育への参加 米国・家庭医療学教師会プリセプター教育プロジェクトの方略

プライマリ・ケア医の外来診療教育への参加 米国・家庭医療学教師会プリセプター教育プロジェクトの方略

Violations of medical confidentiality: opinions of primary care physicians.

Physicians should be able to distinguish situations where they need to protect confidentiality from those where they could be obligated to reveal information. Data are scarce concerning physician's attitudes in daily situations where violations of confidentiality are avoidable. Physicians should be aware of situations where patients are identifiable. To solicit participation of primary care physicians in a teaching intervention and to explore participants' opinions on violations of confidentiality. A questionnaire presented seven vignettes describing avoidable violations of confidentiality (for example, without patient consent a physician mentions a politician's illness their spouse). Participants answered on a scale of 0-3 (0=no violation and 3=serious violation). All contacted physicians were invited to a teaching session during which the study results were discussed. Three-hundred and seventy-eight members of the Association of Physicians in Geneva (community physicians) working in primary care medicine, and 130 GPs and internists working at the University Hospital of Geneva (hospital physicians) took part. Physicians' answers were compared to responses from Swiss, UK, and other European law professors, and from 311 medical and law students in Geneva. Between 4% (case 6) and 57% (case 2), of physicians thought that no violation occurred. Law professors attributed the scores to each case as 3, 3, 2, 3, 2, 3, 3; the means of physicians were: 1.9, 1.4, 0.7, 1.4 (hospital physicians)/1.9 (community physicians), 0.4, 1.6, 2.6. In most cases, physicians' and students' answers were similar. A significantly higher percentage of community physicians than hospital physicians and students thought that a physician violates confidentiality if they provide the list of their patients to the police for the investigation of the theft of a purse in the waiting room. Physicians need to be fully aware of their obligations towards patient confidentiality. Avoidable breaches of confidentiality occur when colleagues and authorities (such as police and those in a judicial context) ask for information.

Candidiasis secondary to antibiotic treatment in primary care

At the Pharmacological Vigilance Center of Navarra a prospective observational study was designed and promoted aimed at estimating the incidence of candidiasis and its relation with the consumption of a wide spectrum of antibiotics. The field work, which lasted for one week, was carried out with the participation of Primary Care physicians, and included all of the previously selected antibiotic treatments prescribed during that time for any pathology, a search for determinate clinical manifestations, and an evaluation of the existence of a series of predisposing factors. Of the 1,430 patients treated (by 158 family doctors in 1,098 cases adn by 29 paediatricians in 332 cases) there were 49 cases of localised candidiasis, which gives an incidence of 3.435 (IC 2.61-4.53) The most frequently involved antibiotic group was that of penicillins, with a relative risk of two with respect to the rest of the antibiotics (1.1<RR<3.78) IC95% and, amongst these, the association of clavulanic-amoxycillin showed a relative risk of 3.34 (1.54<RR<7.26) IC95% against the rest of the penicillins. It is worth noting the scarce incidence of candidiasis in the paediatric population with just six cases (1.6%), four of them with an oropharyngeal localisation. Bearing in mind that the classical manifestation of this infection in the infant population takes the form of acute pseudomembranous candidiasis, it would not be an exaggeration to think that in this age group, besides the clinical form that has been mentioned, there is a second manifestation in the form of oropharyngeal candidiasis as a secondary effect of antibiotic treatment as an independent entity. Its poor representation is perhaps due to the scarce presence of risk factors in this age group.

Verbal communication among Alzheimer's disease patients, their caregivers, and primary care physicians during primary care office visits

ObjectivePrimary care visits of patients with Alzheimer's disease (AD) often involve communication among patients, family caregivers, and primary care physicians (PCPs). The objective of this study was to understand the nature of each individual's verbal participation in these triadic interactions. MethodsTo define the verbal communication dynamics of AD care triads, we compared verbal participation (percent of total visit speech) by each participant in patient/caregiver/PCP triads. Twenty-three triads were audio taped during a routine primary care visit. Rates of verbal participation were described and effects of patient cognitive status (MMSE score, verbal fluency) on verbal participation were assessed. ResultsPCP verbal participation was highest at 53% of total visit speech, followed by caregivers (31%) and patients (16%). Patient cognitive measures were related to patient and caregiver verbal participation, but not to PCP participation. Caregiver satisfaction with interpersonal treatment by PCP was positively related to caregiver's own verbal participation. ConclusionCaregivers of AD patients and PCPs maintain active, coordinated verbal participation in primary care visits while patients participate less. Practice implicationsEncouraging verbal participation by AD patients and their caregivers may increase the AD patient's active role and caregiver satisfaction with primary care visits.

Forschungsinteresse bei praktizierenden Ärzten: Eine Umfrage

For doing research on topics in primary care medicine participation of primary care physicians is necessary. Research in this field of medicine is only marginally established in Switzerland. In a postal survey we evaluate the general attitudes of physicians towards research in the field of primary care. In particular we were interested in their willingness to participate in research projects and the facilitating and impeding factors to take part in such projects. A purpose designed questionnaire was sent by post to 3044 primary care physicians in the central and eastern parts of Switzerland. The return rate was 52%. A majority of 94% of the responding physicians revealed interest in primary care research and 60% of all responders are willing to participate actively in such projects. They are prepared to spend about 15 min a day for data acquisition. Their willingness to participate depends on the conditions that, first, the research topic is relevant for daily practice and, second, boards odder Continuous Medical Education credits for time spent for research. Time constraints, additional administrative work and lack of relevance of research topics to daily practice are the main barriers. This survey demonstrates the general interest of primary care physicians to participate in relevant research projects. Therefore the structure to set up such research should be established.

Long-Term Therapy to Prevent Stroke

Cerebrovascular disease is the third leading cause of mortality and the leading cause of long-term neurological disability in the United States. Most strokes are of ischemic origin and, other than cardioembolic or small vessel strokes, are caused by the development of platelet-fibrin thrombi on an atherosclerotic plaque. This underlying disease mechanism shares important features with coronary artery disease and peripheral artery disease, highlighting the systemic nature of atherothrombosis and the elevated cross risk in stroke patients for ischemic events in other vascular beds. It has been estimated that up to 80% of ischemic strokes could be prevented with application of currently available treatments for blood pressure, cholesterol, and antithrombotic therapies. Stroke is not, like cancer, waiting for a scientific breakthrough; stroke preventive treatments are well understood and widely available. It is only the application of these treatments to patients, many of whom do not visit physicians, that is lacking. Clearly, better education of the public and active participation of primary care physicians is essential to get the message out to all those at risk.

Use of cancer susceptibility testing among primary care physicians.

Primary care physicians (PCPs) are assuming greater roles in cancer risk assessment and susceptibility testing of patients. The objective of this study was to assess the beliefs and practices of PCPs relative to genetic susceptibility testing for cancer. A cross-sectional survey was mailed to 726 PCPs in community-based practices in southeastern Pennsylvania and southern New Jersey. Data were collected on physician background, cognitive and psychosocial factors, practice environment, and patient factors. The main outcome measure was physician self-reported recommendation or referral of patients for cancer genetic susceptibility testing in a 12-month period prior to the survey. Of those surveyed, 475 (65%) PCPs responded. Complete survey data were available for 433 PCPs. Multivariable analyses show that factors positively associated with PCP recommendation/referral included: patient inquiry about their need for genetic testing for cancer (p < 0.001); PCP belief that patient age is the best predictor of cancer risk (p = 0.01); PCP self-reported frequency of collecting patient diet information (p = 0.01) and medical history information (p = 0.01); and PCP participation in an integrated health system (p = 0.01). PCP use of cancer genetic susceptibility testing may be influenced by patient inquiry, provider beliefs about factors that affect cancer risk, provider collection of risk-assessment data, and provider practice environment.