Perspectives Of Family Physicians Research Articles

Impact of COVID-19 on perinatal care: Perceptions of family physicians in the United States.

BackgroundPatient‐centered care is the best practice in the care of pregnant and postpartum patients. The COVID‐19 pandemic prompted changes in perinatal care policies, which were often reactive, resulting in unintended consequences, many of which made the delivery of patient‐centered care more difficult. This study aimed to understand the impact of the COVID‐19 pandemic on perinatal health care delivery from the perspective of family physicians in the United States.MethodsFrom October 5 to November 4, 2020, we surveyed mid‐ to late‐career family physicians who provide perinatal care. We conducted descriptive analyses to measure the impact of COVID‐19 on prenatal care, labor and delivery, postpartum care, patient experience, and patient volume. An immersion‐crystallization approach was used to analyze qualitative data provided as open‐text comments.ResultsOf the 1518 survey respondents, 1062 (69.8%) stated that they currently attend births; 595 of those elaborated about the impact of COVID‐19 on perinatal care in free‐text comments. Eight themes emerged related to the impact of COVID‐19 on perinatal care: visitation, patient decisions, testing, personal protective equipment, care continuity, changes in care delivery, reassignment, and volume. The greatest perceived impact of COVID‐19 was on patient experience.ConclusionsFamily physicians who provided perinatal care during the COVID‐19 pandemic noted a considerable impact on patient experience, which particularly affected the ability to deliver patient‐centered and family‐centered care. Continued research is needed to understand the long‐term impact of policies affecting the delivery of patient‐centered perinatal care and to inform more evidence‐based, proactive policies to be implemented in future pandemic or disaster situations.

Barriers to care for perinatal patients with opioid use disorder: family physician perspectives

While barriers to care for pregnant patients with opioid use disorder (OUD) have been described, the experiences and challenges of the physicians providing care to these patients are poorly understood. To describe the experiences of family physicians providing comprehensive care to pregnant people with OUD and the challenges they face in providing such care. Qualitative thematic analysis of 17 semistructured interviews conducted from July 2019 to September 2020 with family physicians who possess a Drug Enforcement Administration "X" waiver and provide care to pregnant patients. Seventeen family physicians practicing in the United States who care for pregnant people with OUD were interviewed. They described physician-, patient-, and systems-level barriers to providing and accessing care for this patient population. Of the 12 interrelated themes regarding challenges to delivering and accessing this care, 3 were particularly salient: the pervasive effects of social determinants of health, a lack of adequately trained providers, and social stigma associated with pregnant people with OUD. A comprehensive, multilevel, and multidisciplinary approach is necessary to address these barriers and move towards health equity for this vulnerable patient population.

Assessing the Quantitative and Qualitative Status of the Family Physician Plan from the Perspective of Family Physicians, Health Team Members and Staff Experts

Assessing the Quantitative and Qualitative Status of the Family Physician Plan from the Perspective of Family Physicians, Health Team Members and Staff Experts

Antibiotic prescription in primary care from the perspective of family physicians: a qualitative study.

Antibiotic consumption increases worldwide steadily. Turkey is now top on the list of global consumption and became a prototype of excessive use of antibiotics. In the last two decades, family physicians (FPs) have become key figures in the healthcare system. This study aims to understand the reasons for inappropriate antibiotic prescribing and elicit suggestions for improving antibiotic use in primary care from doctors themselves. This is a qualitative semi-structured interview study with research dialogues guided by the Vancouver School of interpretive phenomenology. Fourteen FPs from different parts of Turkey were questioned on inappropriate antibiotic prescriptions and their suggestions for improving antibiotic use. The most important reasons for prescribing antibiotics without acceptable indications were patient expectations, defensive medical decision making, constraints due to workload, and limited access to laboratories. The most remarkable inference was the personal feeling of an insecure job environment of the FPs. The most potent suggestions for improving the quality of antibiotic prescription were public campaigns, improvements in the diagnostic infrastructures of primary care centers, and enhancing the social status of FPs. The FPs expressed strong concerns related to the complaints that patients make to administrative bodies. Primary care physicians work under immense pressure, stemming mainly from workload, patient expectations, and obstacles related to diagnostic processes. Improving the social status of physicians, increasing public awareness, and the facilitation of diagnostic procedures was the methods suggested for increasing antibiotic prescription accuracy.

Rural family physician perspectives on communication with urban specialists: a qualitative study

ObjectiveCommunication is a key competency for medical education and comprehensive patient care. In rural environments, communication between rural family physicians and urban specialists is an essential pathway for clinical decision...

Family physician perspectives on primary care reform priorities: a cross-sectional survey.

Background:The province of British Columbia is facing a family physician shortage despite consistent increases in the number of physicians per capita and ongoing reforms to address the shortage. We identify physicians’ priorities for structural reform, describe the alignment of those priorities with BC’s suite of reforms and compare responses between established physicians and those new to practice; we also assessed rates of burnout.Methods:All family physicians credentialed within Vancouver Coastal Health in 2018 were invited to participate in a cross-sectional survey. Respondents were asked about their practice model and characteristics, demographics, level of burnout and reform priorities. We used χ2 tests and multivariable logistic regression to investigate associations between personal and practice characteristics, burnout and reform priorities.Results:Of the 1017 family physicians invited to participate, 525 (51.6%) responded. Of these, 399 (76.0%) indicated a need for fundamental change to how primary care is delivered; 244 (46.4%) would prefer to be a clinic employee rather than a small business owner. Other reform priorities included options to practise in a team (stated as very important by 69.6% of respondents), direct funding for team roles (66.7%), direct clinic funding (59.8%), part-time work options (64.7%), and ability to take planned vacations and parental leave (81.1%). The importance of individual reform priorities varied based on the participants’ model of practice, location and years in practice. Of respondents, 108 (21.1%) had experienced a high level of burnout.Interpretation:Almost half of family physicians would prefer to be employees rather than small business owners and over 20% reported a high level of burnout. Practice models offering direct employment model have very limited availability and are not included in the current suite of reforms in BC, potentially pulling physicians away from community-based family medicine and into other models or specialties.

Perspectives of family physicians towards access to lung cancer screening for individuals living with low income \u2013 a qualitative study

BackgroundIndividuals living with low income are less likely to participate in lung cancer screening (LCS) with low-dose computed tomography. Family physicians (FPs) are typically responsible for referring eligible patients to LCS; therefore, we sought to understand their perspectives on access to lung cancer screening for individuals living with low income in order to improve equity in access to LCS.MethodsA theory-informed thematic analysis was conducted using data collected from 11 semi-structured interviews with FPs recruited from three primary care sites in downtown Toronto. Data was coded using the Systems Model of Clinical Preventative Care as a framework and interpretation was guided by the synergies of oppression analytical lens.ResultsFour overarching themes describe FP perspectives on access to LCS for individuals living with low income: the degree of social disadvantage that influences lung cancer risk and opportunities to access care; the clinical encounter, where there is often a mismatch between the complex health needs of low income individuals and structure of health care appointments; the need for equity-oriented health care, illustrated by the neglect of structural origins of health risk and the benefits of a trauma-informed approach; and finally, the multiprong strategies that will be needed in order to improve equity in health outcomes.ConclusionAn equity-oriented and interdisciplinary team based approach to care will be needed in order to improve access to LCS, and attention must be given to the upstream determinants of lung cancer in order to reduce lung cancer risk.

Traditional and Complementary Medicine Methods Which Have Become Widespread from The Perspective of Family Physicians and self-Employed Pharmacists; Approaches, Thoughts

Traditional and Complementary Medicine Methods Which Have Become Widespread from The Perspective of Family Physicians and self-Employed Pharmacists; Approaches, Thoughts

Caring for Children and Youth with Ongoing Mental Health Problems: Perspectives of Family Physicians, Nurse Practitioners, Social Workers and Psychologists in Primary Health Care

Few studies have examined a diversity of professionals’ perspectives in providing children’s mental health (CMH) care, particularly for ongoing-complex problems. Based on interviews with 16 primary healthcare (PHC) providers, care for ongoing-complex CMH problems depended on provider interest and scope of practice. Most providers felt PHC is where ongoing-complex CMH problems should be cared for, where providers can emphasize advocacy, coordination, and ongoing monitoring; few felt able to provide this type of care. A comprehensive approach for incorporating PHC with specialized MH services is needed. Defining a care coordinator would be a clear step toward improving collaboration and care.

Recommendations for a national Coronavirus disease 2019 response guideline for the care of older persons in Nigeria during and post-pandemic: A family physician's perspective.

The older persons in our society are a special group of people in need of additional measures of care and protection. They have medical, financial, emotional and social needs. The novel Coronavirus disease 2019 (COVID-19) only exacerbates those needs. COVID-19 is a new disease, and there is limited information regarding the disease. Based on currently available information, older persons and people of any age who have serious underlying medical conditions may be at higher risk of severe illness from COVID-19. Family physicians provide care for individuals across their lifespan. Because geriatricians are internists or family physicians with post-residency training in geriatric medicine, they are major stakeholders in geriatric care. The authors are concerned about the absence of a COVID-19 response guideline/special advisory targeting the vulnerable population of older adults. The management and response to COVID-19 will be implemented in part based on the local context of available resources. Nigeria has been described as a resource-constrained nation. Infection prevention in older persons in Nigeria will far outweigh the possibilities of treatment given limited resources. The aim was to recommend actionable strategies to prevent COVID-19-related morbidity or mortality among older persons in Nigeria and to promote their overall well-being during and after the pandemic. These recommendations cut across the geriatric medicine domains of physical health, mental health, functioning ability and socio-environmental situation.

Barriers and opportunities for the treatment of mild-to-moderate depression with a watchful waiting approach

ObjectiveThe aim of this study is to explore barriers and opportunities in non-pharmacological treatment of depression in primary care (PC) from the perspective of family physicians (FPs). MethodsQualitative analysis was used to explore a sample of 36 FPs treating patients with depressive symptoms. Criteria to maximize variability were followed. Participants were identified by key informants. Six group interviews were developed following a semi-structured thematic script. All interviews were transcribed, analyzed and triangulated. Information was saturated. Principals of reflexivity and circularity were implemented. ResultsThe results obtained followed 3 main theoretical axes: the FP, the patient, the healthcare system, and the interaction between them. Barriers included poor alignment with clinical practice guidelines, inadequate FP training, patients’ preferences and structural challenges in PC. Among opportunities were good FP clinical interview skills, the beneficial bond of trust between patients and FPs and improved communication with mental healthcare services. ConclusionBased on FPs’ perceptions, non-pharmacological treatment of depression in PC is particularly limited by lack of structured training; patients’ preferences and treatment expectations; structural challenges in PC; and insufficient support from specialized mental health professionals. Practice implicationsResources for education, structural support in PC and modified back up from mental healthcare services are needed.

Barriers and Facilitators to Using Statins: A Qualitative Study With Patients and Family Physicians

BackgroundDespite their proven efficacy to reduce cardiovascular disease, statin medication use remains low in individuals at high risk of cardiovascular disease considering their widespread availability and safety. Our objective was to explore the perspectives of patients and family physicians with regard to the barriers and facilitators of statin use in primary care. MethodsIn this qualitative descriptive study, we conducted 2 focus groups with patients (number, n = 8/6) and individual semistructured interviews with family physicians (n = 17) from community settings. Interviewers asked participants about barriers to and facilitators of statin use. Focus groups and interviews were digitally recorded, transcribed, and analyzed in duplicate using conventional content analysis. ResultsPatients were averse to taking statins for a variety of reasons: medication avoidance and burden; inadequate buy-in for statin therapy; and difficulty remembering to take statins regularly. Family physicians perceived similar barriers and reported other barriers: lack of resources such as inadequate tracking systems; specialist-primary care provider guideline discordance; and lack of continuity and relationship. Patients expressed that key facilitators were patient education and support; splitting tablets to increase cost-effectiveness; and changing to a different statin or lower dose in those with side effects. Family physicians described several similar strategies to facilitate therapy as well as shared decision making and clinical decision support tools as enablers for improvement. ConclusionsWe identified several important barriers to and facilitators of statin use at the patient and prescriber level. This information offers insight into strategies to improve statin use and the development of innovative programs and interventions.

Doctors’ professional identity and socialisation from medical students to staff doctors in Japan: narrative analysis in qualitative research from a family physician perspective

ObjectiveBecoming a doctor involves transforming a lay person into a medical professional, which is known as professional socialisation. However, few studies have clarified differences in the professional socialisation process in...

Obstetrical Care in Rural Minnesota: Family Physician Perspectives on Factors Affecting the Ability to Provide Prenatal, Labor, and Delivery Care.

With decreasing access to rural obstetrical care, this study aimed to identify factors that contribute to the ability of Minnesota's rural communities to continue to offer obstetrical services locally. The study also sought to characterize attributes that differentiate rural communities that continue to offer obstetrical care from those that do not. Family medicine physicians practicing in communities of fewer than 20,000 people were interviewed through a phone survey that included multiple choice and open-ended questions. Quantitative and qualitative analyses were performed on data collected from the responses. Within the Minnesota communities represented (N = 25), prenatal care was provided broadly, regardless of whether labor and delivery services were available. For the communities providing local labor and delivery (N = 17), several factors seemed to be key to sustaining these services: having a sufficient cohort of delivering providers, having surgical backup, having accessible confident nurses and nurse anesthetists, sustaining a sufficient annual birth volume at the hospital, and having organizational and administrative support. In addition, supporting anesthesia and analgesic services, access to specialist consultation, having resources for managing and referring both newborn and maternal complications, and sustaining proper equipment were also requisite. Rural Minnesota family medicine physicians practicing in communities providing local labor and delivery care emphasized several essential components for sustainable provision of these services. With awareness of these essential components, rural health care providers, administrators, and policy makers can focus resources and initiatives on efforts that are most likely to support a sustainable and coordinated rural labor and delivery program.

Perspectives of specialists and family physicians in interprofessional teams in caring for patients with multimorbidity: a qualitative study.

Patients with multimorbidity often require services across different health care settings, yet team processes among settings are rarely implemented. We explored perceptions of specialists and family physicians collaborating in a telemedicine interprofessional consultation for patients with multimorbidity to better understand the value of bringing physicians together across the boundaries of health care settings. This was a descriptive qualitative, interview-based study. Physicians who had previously participated in the Telemedicine Interprofessional Model of Practice for Aging and Complex Treatments (Telemedicine IMPACT Plus [TIP] Program) were invited to participate and asked to describe their experience of being a member of the program. Interviews were conducted from March to May 2016. We conducted an iterative and interpretive process using both individual and team analysis to identify themes. There were 15 participants, 9 specialists and 6 family physicians. Three themes emerged in the analysis: creating new perspectives on care for patients with multimorbidity by sharing knowledge, skills and attitudes; the shift from a consultant model to an interprofessional team model (allowing a window into the community, extending discussions beyond the medical model and focusing on the patient's health in context); and opportunities for learners, including learning about interprofessional collaboration and gaining exposure to a real-world model for caring for people with multimorbidity in outpatient settings. Family physicians and specialists participating in a TIP Program believed the program improved their knowledge and skills, while also serving as an effective care delivery strategy. The findings also support that learners require more exposure to nontraditional consultant models in order to care for patients with multimorbidity effectively.

Support for family caregivers: A scoping review of family physician's perspectives on their role in supporting family caregivers.

Support for family caregivers: A scoping review of family physician's perspectives on their role in supporting family caregivers.

Barriers to accessing weight-loss interventions for patients with class II or III obesity in primary care: a qualitative study.

Over 1 million Canadians have class II or III obesity; however, access to weight-loss interventions for these patients remains limited. The purpose of our study was to identify the barriers to accessing medical and surgical weight-loss interventions from the perspectives of 3 groups: family physicians, patients who were referred for weight-loss intervention and patients who were not referred for weight-loss intervention. Between November 2017 and May 2018, we conducted a qualitative exploratory research study using focus groups with family physicians and interviews with patients with class II or III obesity from 1 region in southern Ontario. We conducted a thematic analysis to identify emergent themes and used the barriers to change theory to classify the similarities and differences between the perspectives of family physicians, referred patients and nonreferred patients in first- and second-order barriers. Seventeen family physicians participated in 7 focus groups (1-4 participants/group), and we interviewed 8 referred patients and 7 nonreferred patients. We identified lack of resource supports, logistics and lack of knowledge about weight-loss interventions as first-order barriers to change, and lack of knowledge about root causes of obesity, lack of patient readiness for change and family physicians' perceptions about surgical weight loss as second-order barriers to change. Family physicians and patients had similar perceptions regarding lack of resource supports in the community, logistical issues, family physicians' lack of knowledge regarding weight-loss interventions, patients' lack of motivation and family physicians' perceptions of bariatric surgery as being high risk. They differed regarding the root cause of obesity, with family physicians attributing obesity to multiple extrinsic and intrinsic causes, whereas patients believed obesity was largely due to intrinsic causes alone. It is important to address first- and second-order barriers to accessing weight-loss interventions through continuing professional development activities for family physicians to help ensure effective and timely treatment for patients with class II or III obesity and related comorbidities.

83 - Patient and Family Physician Perspectives on Facilitated Relay to Enhance Use of Statins

Statin use remains suboptimal among individuals with indicated conditions. Facilitated relay (FR) is a quality improvement strategy where clinical information is collected from patients and transmitted to providers by a means other than the existing medical record. It has been shown to enhance guideline concordant care in some contexts. Our objective was to explore the perspectives of patients and family physicians regarding interventions to increase statin use, including receiving feedback on a proposed FR intervention.

75 - Exploring Patient and Family Physician Perspectives on Initiation and Adherence to Statin Therapy

Despite their proven efficacy to reduce cardiovascular disease, statin medication use remains suboptimal. Less than 50% of individuals at high risk for cardiovascular disease take statin therapy despite their widespread availability and safety. Our objectives were to explore the perspectives of family physicians and patients with regards to the barriers to initiating and adhering to statins, as well as the facilitators and strategies to increase statin use.

Potential for Integrating Mental Health Specialist Video Consultations in Office-Based Routine Primary Care: Cross-Sectional Qualitative Study Among Family Physicians.

BackgroundAlthough real-time mental health specialist video consultations have been proposed as an effective care model for treating patients with mental health conditions in primary care, little is known about their integration into routine practice from the perspective of family physicians.ObjectiveThis study aimed to determine the degree to which family physicians advocate that mental health specialist video consultations can be integrated into routine primary care, where most patients with mental health conditions receive treatment.MethodsIn a cross-sectional qualitative study, we conducted 4 semistructured focus groups and 3 telephonic interviews in a sample of 19 family physicians from urban and rural districts. We conducted a qualitative content analysis applying the Tailored Implementation in Chronic Diseases framework in a combined bottom-up (data-driven) and top-down strategy for deriving key domains.ResultsFamily physicians indicated that mental health specialist video consultations are a promising and practical way to address the most pressing challenges in current practice, that is, to increase the accessibility and co-ordination of specialized care. Individual health professional factors were the most frequently discussed topics. Specifically, family physicians valued the anticipated clinical outcomes for patients and the anticipated resources set for the primary care practice as major facilitators (16/19, 84%). However, family physicians raised a concern regarding a lack of facial expressions and physical interaction (19/19, 100%), especially in emergency situations. Therefore, most family physicians considered a viable emergency plan for mental health specialist video consultations that clearly delineates the responsibilities and tasks of both family physicians and mental health specialists to be essential (11/19, 58%). Social, political, and legal factors, as well as guideline factors, were hardly discussed as prerequisites for individual family physicians to integrate mental health specialist video consultations into routine care. To facilitate the implementation of future mental health specialist video consultation models, we compiled a checklist of recommendations that covers (1) buy-in from practices (eg, emphasizing logistical and psychological relief for the practice), (2) the engagement of patients (eg, establishing a trusted patient-provider relationship), (3) the setup and conduct of consultations (eg, reliable emergency plans), and (4) the fostering of collaboration between family physicians and mental health specialists (eg, kick-off meetings to build trust).ConclusionsBy leveraging the primary care practice as a familiar environment for patients, mental health specialist video consultations provide timely specialist support and potentially lead to benefits for patients and more efficient processes of care. Integration should account for the determinants of practice as described by the family physicians.Trial RegistrationGerman Clinical Trials Register DRKS00012487; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00012487