Primary Care Epidemiology Research Articles

An online dynamic knowledge base in multiple languages on general medicine and primary care

IntroductionLa classification internationale des soins primaires, deuxième version (CISP-2) alignée sur la classification internationale des maladies dixième révision (CIM-10) est un standard pour le recueil épidémiologique en soins primaires. La CISP-2 convient aussi pour identifier les thèmes cliniques dont discutent les médecins de famille. Les domaines contextuels de connaissances spécifiques à la médecine de famille et aux soins primaires comme les structures, la gestion, les catégories de patients, les méthodes de recherche, les aspects éthiques ou environnementaux ne sont pas standardisés et reflètent le plus souvent des vues d'experts.MéthodesUne méthode de recherche qualitative, appliquée à l'analyse de plusieurs congrès de médecine de famille a permis d'identifier, en plus des items cliniques, un ensemble de concepts contextuels abordés par les médecins de famille lors de leurs échanges pendant les congrès. Assemblés sous forme hiérarchique, ces concepts ont trouvé leur place au côté de la CISP-2, sous le nom de Q-codes version 2.5, sur le serveur sémantique multilingue multi-terminologique du Département d'Information et d'Informatique médicale (D2IM) de l'Université de Rouen, France. Les deux classifications sont éditées sous le sigle 3CGP pour Core Content Classification of General Practice. Ce serveur d'accès libre permet de consulter la CISP-2 en 22 langues et les Q-codes en dix languesRésultatsLe résultat de l'utilisation conjointe de ces deux classifications, comme descripteurs dans des congrès, pour identifier des concepts dans des textes, ou indexer la littérature grise en médecine de famille et soins primaires est présenté ici dans différentes utilisations pilotes. La validité et la généralisabilité de 3CGP semble bonne au vu des traductions déjà réalisées par des collègues du monde entier et de l'applicabilité de la méthode des deux côtés de l'Atlantique. Toute fois la reproductibilité et la variation inter-codeurs restent encore à tester pour les Q-codes. La question de la maintenance reste posée.ConclusionGrâce à cette méthode, on peut mettre en évidence l'extension conceptuelle, la complexité et la dynamique du métier de médecin généraliste et de famille et de médecin de soins primaires.

The dire need for primary care specialization in India: Concerns and challenges.

Primary health care is an evidence-based priority, but it is still inadequately supported in many countries. Ironically, on one hand, India is a popular destination for medical tourism due to the affordability of high quality of health care and, on the other hand, ill health and health care are the main reasons for becoming poor through medical poverty traps. Surprisingly, this is despite the fact that India was committed to 'Health for All by 2000’ in the past, and is committed to 'Universal Health Coverage’ by 2022! Clearly, these commitments are destined to fail unless something is done to improve the present state of affairs. This study argues for the need to develop primary care as a specialization in India as a remedial measure to reform its health care in order to truly commit to the commitments. Three critical issues for this specialization are discussed in this review: (1) The dynamic and distinct nature of primary care as opposed to other medical specializations, (2) the intersection of primary care and public health which can be facilitated by such a specialization, and (3) research in primary care including the development of screening and referral tools for early diagnosis of cancers, researches for evidence-based interventions via health programs, and primary care epidemiology. Despite the potential challenges and difficulties, India is a country in dire need for primary care specialization. India's experience in providing low-cost and high quality healthcare for medical tourism presages a more cost-effective and efficient primary care with due attention and specialization.

Family Practice is seeking excellent manuscript submissions

Family Practice: The International Journal for Research in Primary Care is an international journal aimed at clinicians and researchers in the fields of primary care, family medicine and general practice. The journal’s range and content include primary care epidemiology, health care delivery, clinical care, health promotion and disease prevention, systematic reviews and primary care research methods. Articles should have broad applicability to other settings and countries. We would particularly like to encourage the reporting of randomized controlled trials from primary care.

Achieving vocational training goals during six months in an Italian general practice

Background: General practice training in Europe is still an unresolved issue. Italy has developed a formation course similar to specialty schools, awarding a certificate of attendance at the end of a 3-year period. Its training goals are defined mainly as work hours in medical facilities, including two semesters at two general practices.Objectives: To evaluate if a registrar, during a semester in a general practice, has access to a case spectrum consistent enough to achieve the training goals, both ‘methodological’ (work organization targets) and ‘specific’ (targets of opportunity).Methods: During a six-month period, every patient contact qualified for tutoring was recorded. For each visit, access mode and priority, patient name, age, patient reason for encounter (RFE), diagnosis, referrals, prescribed laboratory tests and treatment were recorded. Data was evaluated as in other Italian medical specialties; i.e. compared to target numbers.Results: A total of 1 828 contacts and 2 437 RFE in 122 work days were recorded. There were 1 007 and 613 contacts with and without appointment respectively, 88 ‘family contacts,’ 44 scheduled check-ups, 11 phone contacts, and 65 nurse interventions. Of all contacts, 9.8% were indirect. In six months, we had at least one contact with 792 patients out of 1 500 (52.8%). Main RFE resulted from respiratory and musculoskeletal symptoms while most frequent diagnoses belonged to musculoskeletal, cardiovascular and respiratory fields.Conclusions: A six months training period can be sufficient for representing a general practitioner's work organization and primary care epidemiology. However, deficiencies were observed.

Building a Pan-Canadian Primary Care Sentinel Surveillance Network: Initial Development and Moving Forward

The development of a pan-Canadian network of primary care research networks for studying issues in primary care has been the vision of Canadian primary care researchers for many years. With the opportunity for funding from the Public Health Agency of Canada and the support of the College of Family Physicians of Canada, we have planned and developed a project to assess the feasibility of a network of networks of family medicine practices that exclusively use electronic medical records. The Canadian Primary Care Sentinel Surveillance Network will collect longitudinal data from practices across Canada to assess the primary care epidemiology and management of 5 chronic diseases: hypertension, diabetes, depression, chronic obstructive lung disease, and osteoarthritis. This article reports on the 7-month first phase of the feasibility project of 7 regional networks in Canada to develop a business plan, including governance, mission, and vision; develop memorandum of agreements with the regional networks and their respective universities; develop and obtain approval of research ethics board applications; develop methods for data extraction, a Canadian Primary Care Sentinel Surveillance Network database, and initial assessment of the types of data that can be extracted; and recruitment of 10 practices at each network that use electronic medical records. The project will continue in phase 2 of the feasibility testing until April 2010.

Is there a place for mental health research in general practice?

Is there a place for mental health research in general practice?

Primary care epidemiology: its scope and purpose

Clinical epidemiology is a basic science of medical practice; informing, among other things, diagnostic, prognostic and therapeutic decisions relating to individuals. In the 1980s, Mullan coined the term ‘primary care epidemiology’ to describe the application of clinical epidemiology to primary care practice. Calls for a new discipline derived from the desire of Mullan, and others, to see an increased use of epidemiological principles to shape the development of community orientated primary care. To a large extent, these ambitions echoed those of Tudor Hart, who, a decade earlier, had called for a marriage between primary care and epidemiology so that programmes of organised, whole-population anticipatory care could be developed. They also built upon the work of other GP researchers who used epidemiological principles to describe clinical events in their practices. The emphasis on affecting the dynamics of health care within defined (usually single practice) communities required short intervals between the seeking and using of information, with an acknowledged consequence that primary care epidemiology might only be able to answer relatively basic questions. We believe, however, that this focus is too narrow for the sector that provides ‘integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practising in the context of family and community’. Primary care epidemiology can contribute to wider improvements in health and health care services, through better understanding of disease aetiology, use of health care services and the role of different health care interventions. Primary care is delivered by a wide range of health professionals, including nurses, doctors, care assistants, social workers, mental health specialists, dieticians, pharmacists, dentists, optometrists and other health care professionals, administrators and clerical staff. The practice of each of these professional groups can contribute to, and needs to be informed by, primary care epidemiology.