Primary Care Family Physicians Research Articles

Professional identity work of nurse practitioners and family physicians in primary care in Quebec and Ontario – a study protocol

BackgroundSolo medical practices in primary healthcare delivery have been abandoned in favor of interdisciplinary teamwork in most Western countries. Dynamics in interdisciplinary teams might however be particularly difficult when two or more autonomous health professionals develop similar roles at the practice level. This is the case of family physicians (FPs) and nurse practitioners (NPs), due to the fact that the latter might accomplish not only the traditional role proper to a nurse, but also several medical activities such as requesting diagnostic exams and prescribing medical treatments. The tensions that this overlap might generate and their implications in regard of the development of professional identities, and consequently of the quality of health care delivered, have been suggested, but rarely examined empirically. The goal of this study is to examine identity work, i.e., the processes of (re)construction of professional identities, of NPs and FPs working together in primary care interdisciplinary teams.MethodsA longitudinal, interpretive, and comparative multiple (n = 2) case study is proposed. Identity work theory in organizations is adopted as theoretical perspective. Cases are urban primary care multidisciplinary teams from two different Canadian provinces: Quebec and Ontario. Participants are NPs, FPs, managers, and patients. Data gathering involves audio-diaries, individual semi-structured and focus group interviews, observations, and archival material. Narrative and metaphor techniques are adopted for analyzing data collected. Within- and cross-case analysis will be performed.DiscussionFor practice, the results of this investigation will: (a) be instrumental for clinicians, primary care managers, and policy decision-makers responsible for the implementation of interdisciplinary teamwork in primary healthcare delivery to improve decision-making processes and primary care team performance over time; (b) inform continuing interdisciplinary professional development educational initiatives that support competency in health professionals’ identity construction in interdisciplinary primary care organizations. For research, the project will contribute to enriching theory about identity construction dynamics in health professions, both in the fields of health services and primary care education research.

Primary Care Family Physicians’ Experiences with Clinical Integration: A Scoping Review of Qualitative and Mixed Reviews

Background: Clinical (service) integration in primary care settings describes how healthcare services are coordinated over time across healthcare contexts to meet patient care needs. Promoting integrated care with interventions that lack systematic approaches can unintentionally increase the complexity and fragmentation of the healthcare system. To improve care integration and healthcare service planning, a systematic approach to understanding its many influencing factors is paramount. This phase I study aims to generate a comprehensive map of family physician (FP) perceived factors, across diseases and patient demographics, influencing how services are integrated for patients. 
 Methods: The protocol development is guided by Arksey and O’Malley’s scoping review methodology framework. Keywords and MeSH terms were contributed by a multidisciplinary team of healthcare professionals, researchers, and patient representatives through an iterative discussion. An Information Specialist with clinical research expertise tested keywords and MeSH terms to build a search strategy using MEDLINE. The strategy was then adjusted for the EMBASE and CINAHL databases. All identified articles were imported into Covidence platform, and 228 duplicates were removed. Two independent reviewers screened 1,771 studies by their titles and abstracts. Of them, 264 studies were reviewed in full text against the selection criteria and their references were hand-searched. A total of 91 articles were included, and over 2,800 factors were extracted. The factors are being or will be coded into themes the Clinical Integration Framework, a merging of two existing models identified from literature and modified. Within each theme, similar codes are clustered together as a subtheme. 
 Discussion: The identified factors will help develop a survey in Phase II study to ascertain high impact factors for intervention(s), as well as thematic and evidence gaps to guide future research. The study findings will be shared with stakeholders to promote awareness of clinical integration issues through multiple channels: publications and conferences for researchers and care providers, an executive summary for clinical leaders and policy makers, and social media for the public.

Primary care family physicians’ experiences with clinical integration in qualitative and mixed reviews: a systematic review protocol

IntroductionClinical (service) integration in primary care settings describes how comprehensive care is coordinated by family physicians (FPs) over time across healthcare contexts to meet patient care needs. To improve care...

Primary Care Family Physicians’ Experiences with Clinical Integration: A Scoping Review of Qualitative and Mixed Reviews

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 2.913 (2021 JCR, received in June 2022)The IJIC 20th Anniversary Issue was published in 2021.

Evaluation of Family Physicians’ Knowledge and Attitudes Regarding the Rational Use of Antibiotics: A Survey Based Study

Background and Objectives: Antibiotics are widely used all over the world, but the use of appropriate antibiotics in the appropriate dose and duration plays a critical role in reducing the development of resistance, and mortality in particular, as well as undesirable effects and treatment costs associated with infections. The purpose of this study was to investigate the knowledge and attitudes of primary care family physicians regarding the rational use of antibiotics (RUA) and to raise awareness about this issue. Methods: Before the "Training for the Rational Use of Antibiotics" for family physicians of primary healthcare in Antalya in 2019, a questionnaire was distributed to the physicians. The questionnaire contained 37 questions, including 27 multiple-choice questions designed to assess physicians' general attitudes toward antibiotic rationalization. The questionnaire, which consists of ten questions, also includes a test at the end, which is calculated over a total of 100 points. The purpose of the test is to assess family physicians' knowledge of rational antibiotic use. Each correct answer was worth 10 points, and the average success and standard deviations of the physicians were computed. Results: This study included 143 family physicians in total. The mean success score standard deviation (SD) was found to be 66.5 18.51 out of 100 in the test, which measures the knowledge level of physicians prior to training. The success scores of physicians aged 55 and older were found to be statistically significantly lower than the scores of those in other age groups (55.6 21.2 points (mean SD). Other variables examined within the scope of the study were found to have no effect on the physicians' success scores. It was also discovered that physicians frequently answered incorrectly questions about the use of the Modified Centor Clinical Scoring system.The relevant records showed that only 7867 (27.4%) of 28 712 Rapid Antigen tests (RATs) distributed to family physicians by the Provincial Health Directorate were used. Conclusions: Although the majority of the participants stated that they used diagnosis and treatment guidelines when prescribing antibiotics, it was discovered that the use of the Modified Centor clinical scoring system and the RADTs was not common among them, and that there were some deficiencies in the RUA.

Correlation Between Ambulatory Blood Pressure Monitoring and Office Blood Pressure Measurement in Patients with Hypertension: A Community Study

BackgroundThe current gold standard for blood pressure (BP) measurements is based on office BP measurements (OBPMs) by a sphygmomanometer or a digital device. Ambulatory BP measurement (ABPM) is a noninvasive method for continuous monitoring of BP over a period during routine activities of the patient. Thus, ABPM offers multiple BP readings during the patients’ daily routine as compared to the single reading by OBPM at rest. A good correlation exists between mean 24-hour BP readings and the prediction of cardiovascular events. The present multicenter observational study was aimed to assess the correlation between ABPM and OBPM in patients with newly diagnosed, controlled, or uncontrolled hypertension in the community setting.Our hypothesis was to test if ABPM provides any further value in those hypertensive patients in whom the office blood pressure levels are controlled. A supplementary hypothesis was whether obtaining ABPM in patients with newly diagnosed or uncontrolled hypertension yields any value over and beyond OBPM. Another objective was to find out the applicability of ABPM in the community setting where the medical care is provided by primary care family physicians and not by specialists. Materials and MethodsMaterials and Methods A total of 1000 patients were analysed for this study. Those with controlled hypertension were assigned to Group A, and those with newly diagnosed/untreated hypertension comprised Group B. Group A was followed up during Visit 2 and Group B was followed up during Visit 2 and either Visit 3 or Visit 4 to assess the BP measurements by ABPM and OBPM. ResultsThe correlation between ABPM and OBPM showed minimal variation in the BP readings of Group A subjects at Visit 2. A variation in BP readings was observed in Group B at Visit 2. Furthermore, the correlation was established between ABPM and OBPM noted for Group B subjects during Visit 3, and minimal variation was noted during Visit 4. ConclusionsConclusions A good correlation was observed between ABPM and OBPM during both visits in patients in Groups A and B. However, a notable variation was noted in the diastolic BP readings. Thus, large-scale clinical studies are required to detect the prevalence of hypertension, masked hypertension, and dipping patterns associated with hypertension and other related medical co-morbidities.

Urinary incontinence frequency and affecting factors in women 18 years and over

Introduction: Urinary incontinence(UI) is a complicated condition that affects women of all ages, is common, affects life negatively, and occurs for many reasons. It does not only have a medical problem for women but also affects the quality of life defined as physical, psychological, economic and social well-being. In our study, it was aimed to evaluate the frequency of urinary incontinence and the affecting factors in women aged 18 and over.Methods: 212 female patients aged between 18-85 who applied to Cemil Tascioglu City Hospital Family Medicine Polyclinics were included in this study. Those patients were divided into two groups: urinary incontinent and continent. General poll form, ICIQ-SF were interrogated. In general poll form, medical story about demographic data, personal history, family history, additional diseases, UI risk factors was interrogated. Dates of study were evaluated in the sense of meaningfulness by Shapiro Wilk test, Mann Whitney U test, Pearson Ki-Kare test, Fisher’s Exact Ki-Kare test.Results: Number of incontinent and continent cases was 111 and 101, respectively. So, the frequency of UI was found to be 52.4%. Average age of incontinent and continent cases was 51.07±11.80 and 43.50±12.80 respectively. 37.7% of UI cases had urgent-type, 12.3% of UI cases had stress-type and 30.2% had mixed-type UI. Increase in body mass index (p<0.001), low level of education (p<0.001), curettage (p:0.014), menopause (p<0.001), giving birth to relatively big babies (p:0.048), hypertension (p:0.001), diabetes mellitus (p:0.038), constipation (p:0.042), genital prolapsus (p:0.008) were meaningfully higher in the incontinent group.Conclusion: In our study; it was found that urinary incontinence rate increased with increasing age. The vast majority of women see this as a result of being a woman and aging and they do not consult a doctor. In our study, we found that 86.8% of women with urinary incontinence did not consult a doctor. Most of the individuals with urinary incontinence can be recognized and treated effectively by their family physicians in primary care. Therefore, family physicians should identify the problem of urinary incontinence in patients who apply to outpatient clinics, identify risk factors, define and treat them.

Dry Eye Disease: Early Recognition with Guidance on Management and Treatment for Primary Care Family Physicians.

Primary care presentations of dry eye disease (DED) are common and pose a diagnostic challenge due to the variety of symptoms and the absence of certainty for family practitioners. While there are many published articles on the topic, the 2017 Tear Film and Ocular Surface Society Dry Eye Workshop was a landmark report in distinguishing multifactorial differences. Redefined terms clarified the DED disorder. The ocular surface—the tear/air interface—is the primary refractive component of the eye, which is why DED is so significant and impacts vision. There is a high prevalence of DED in the community, ranging from 5% to 30% of people across multiple studies. Elderly patients have up to 75% increased risk of DED and receive more intensive treatment than younger age groups. DED is also more common in women than men, occurring in 9.8% of postmenopausal women. The causes of DED span defective lacrimal apparatus and systemic disorders. Despite its prevalence, up to one-half of patients with confirmed DED do not receive proper alleviating treatment. Risk factors on functional and environmental bases follow. Tools to elicit a diagnosis more confidently are outlined using the Ocular Surface Disease Index (OSDI) and the Symptom Assessment in Dry Eye questionnaires (SANDE). Lacritin, lutein, vitamin A, and balanced nutrition are essential contributors to maintaining healthy eyes with appropriate management and treatment. The authors hope that this paper will prompt a more accurate and expedient diagnosis of DED in primary care practice and an earlier recognition of specialist referrals.Electronic supplementary materialThe online version of this article (10.1007/s40123-020-00308-z) contains supplementary material, which is available to authorized users.

Challenges in Cancer Control Services Provided by Family Physicians in Primary Care: A Qualitative and Quantitative Study From Karabuk Province in Turkey.

BackgroundFamily physicians (FPs) play an important role in cancer control. The aim of this study was to understand the functions of FPs in cancer control and to explore FPs’ perceptions of their own roles and the difficulties they face in cancer control in Karabuk province, Turkey.MethodsThe study consisted of two methodological parts. The qualitative part included a descriptive study in which data were collected from 87.5% (n=56) out of all FPs in Karabuk using a questionnaire. In the quantitative part, in-depth interviews with 15 FPs were conducted and analyzed through content analysis.ResultsHalf of the FPs (50.0%) provided cancer prevention information for their registered people, focusing on especially smoking cessation. In the last three months, the proportion of FPs who had not invited anyone to screenings was 37.5% for the pap test, 26.8% for the mammography, 19.0% for the fecal occult blood test and 34.5% for the colonoscopy. Only 16.1% of them reported that they made home visits for cancer patients. In the qualitative part of study, the following themes were highlighted: the perceived responsibilities of FPs regarding cancer control; the effect of geographically undefined working area of FPs; the issues with coordination between FPs and specialists; the effect of the number of primary care team members.ConclusionsCancer control services provided by FPs have significant problems in terms of the FPs’ approach to the services and their content, continuity and coordination.

Factors associated with lost to follow-up after hepatitis C treatment delivered by primary care teams in an inner-city multi-site program, Vancouver, Canada

BackgroundTreatment of hepatitis c virus (HCV) with direct-acting-antivirals (DAAs) by family physicians in primary care and addiction settings may allow treatment expansion to inner-city populations, including people who inject drugs (PWID). Real-world data however, suggests high rates of non-attendance to SVR 12 testing. This study examines outcomes of HCV treatment delivered by family physicians working in interdisciplinary treatment programs, integrated into inner-city primary care clinics. MethodsIn this prospective cohort, participants completed baseline questionnaires, including questions on demographics and substance use. Participants were recorded as achieving a sustained virologic response (SVR 12) if HCV RNA was undetectable 12 weeks following end of therapy, and were recorded as lost to follow-up (LTFU) if they did not present for an HCV follow-up visit. SVR was calculated in intention to treat (ITT) as well as modified intention to treat (mITT) analysis, which excluded those who completed treatment but had no SVR 12 result. A logistic regression model assessed factors associated with LTFU. ResultsOf 138 individuals included in the analysis, 52% were on opioid agonist therapy (OAT), 75% reported a history of injection drug use (IDU), with 25% reporting IDU in the month prior to treatment initiation. ITT SVR across all sites and genotypes was 86% and mITT was 95%. There was a significant difference in mITT for those reporting recent IDU compared to those who did not (87% vs 99% p = 0.03). While 13% were LTFU at SVR 12, participants receiving OAT in the same clinic as HCV treatment were less likely to be LTFU (aOR 0.09(0.02–0.46)). ConclusionHCV treatment by family physicians, along with interdisciplinary teams, can be successful in inner-city populations in the era of DAAs; however, follow-up after treatment is a challenge. Integrating OAT in the same location as HCV treatment may help to improve follow-up.

The Impact of Patient's Socio-Demographic Characterictics, Comorbidities and Attitudes on Flu Vaccination Uptake in Family Practice Settings.

ObjectivesIn Slovenia, the role of family physicians in primary care and preventive procedures is very important. Influenza vaccination rates in Slovenia are low. The reasons for low vaccination rates in Slovenia were not clear. We suppose that patient’s beliefs and attitudes are important factors. We assessed patients’ opinions regarding the acceptance of flu vaccination by their family physicians and their beliefs and attitudes about flu and vaccination. The aim was to check out factors that influence the decision to take the vaccine in family physician offices.MethodsThis was a cross-sectional, multicenter, observational study in the Styria region in Slovenia. We included patients from seven family physicians during regular office visits. They filled in a questionnaire about their general demographic data and attitudes regarding influenza and vaccination. The main outcome was the decision to be vaccinated.ResultsThe logistic regression model identified five predictors for influenza vaccination, namely: heart disease, previous vaccination, an agreement with the beliefs ‘the vaccination is an efficient measure to prevent influenza’, ‘after the vaccination there are usually no important side effects’ and ‘the vaccination is also recommended for a healthy adult person’. The belief that vaccinations harm the immune system is negatively associated with vaccination.ConclusionsPatients’ beliefs are an important factor to decide for vaccination or not. Family physician teams should discuss with patients their beliefs and concerns about vaccination.

The diagnosis and treatment of lower urinary tract symptoms due to benign prostatic hyperplasia by primary care family physicians in Portugal.

The shift towards primarily pharmacological management of lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) has led to an increasing proportion of patients being treated in the primary care setting. Two related studies were undertaken in Portugal. The first was a survey of primary care family physicians regarding the management of LUTS/BPH. The second was a cross-sectional study of the records of patients with suspected or confirmed LUTS/BPH managed by the surveyed physicians. One hundred and sixty-three physicians were surveyed between 16 June 2012 and 10 February 2013 and 2,988 patients were identified (mean age 68years). While 80% of physicians would order diagnostic tests for patients reporting symptoms, only 2.5% would initiate treatment based on reported symptoms alone. Only 1% would refer patients directly to a urologist for diagnosis, and 75% would only refer patients after an inadequate response to treatment in the primary care setting. Management practices varied according to physicians' age and experience. Nocturia was both the most common and the most bothersome symptom. Erectile dysfunction was reported by 51% of patients and 81% had hypertension, hypercholesterolaemia and/or diabetes mellitus. Diagnosis and treatment of LUTS/BPH differed for older patients, those with comorbidities and those with more severe nocturia at presentation. Primary care physicians in Portugal usually diagnose and treat patients with LUTS/BPH rather than refer them to a urologist. Physicians' age and experience, and patients' age, comorbidities and symptom severity affect the management of LUTS/BPH in primary care in Portugal.

226. ‘GP Champions' in England; Family Physicians and Youth Workers Collaborate in a New Model of Youth-friendly Primary Care Practice to Address Unmet Need

To develop a national network of GP Youth Health Champions working in collaboration with the voluntary youth sector to improve young people's access to health services. General practitioners (GPs) are primary care family physicians in the UK. Everyone is expected to register with a GP as their medical home; children are registered by their parents at birth. If they move to another community, they re-register. GPs treat all ages, and can develop relationships with young people through adolescence, but research suggests that better engagement is needed.

Chronic noncancer pain management in primary care: family medicine physicians’ risk assessment of opioid misuse

Objective: The majority of patients with chronic noncancer pain (CNCP) are managed in the primary care settings. The primary care family physician (PCFP) generally has limited time, training, or access to resources to effectively evaluate and treat these patients, particularly when there is the added potential liability of prescribing opioids. The aim of this study is to make a favorable change in PCFPs’ knowledge, attitudes, and practices about opioid use in CNCP via education on assessment of the risk of opioid misuse. Materials and methods: The universe of this cross-sectional study comprised 36 family physicians working at Family Health Centers affiliated to Antalya Provincial Directorate of Health who volunteered to participate in the study. Initially, a survey on patients risk assessment was performed in both intervention and control groups; whereas the intervention group received education on assessment of the risk of opioid misuse, the control group did not. The survey was repeated after 6 months and the intervention group underwent a core examination. Data obtained were analyzed with Statistical Package for the Social Sciences 18.0 statistics program. Intervention and control groups were compared. Additionally, pre- and post-education results of the intervention group were also compared. Results: About 61.1% of family physicians reported concern and hesitation in prescribing opioids due to known risks, such as overdose, addiction, dependence, or diversion, and agreed that family physicians should apply risk assessment before opioid use in CNCP. Only 16.6% of PCFP reported that risk assessment is not so necessary, whereas 22.2% of PCFP were undecided. Although 47.2% of the family physicians expressed a willingness to apply risk assessment before starting opioids, the rate of eagerness increased markedly to 77.7% after the education, but the rate of increase in practicing was not statistically significant. Conclusion: Knowledge and competency of the family physicians in managing CNCP were improved as was expected. Although the rate of eagerness about risk assessment of opioid misuse was increased, expected increase in the rate of using risk assessment was not achieved. Further studies are needed to identify the reasons of the difficulties on changing the attitudes and practices of primary care physicians about this subject.

Pilot Testing of a Questionnaire for the Evaluation of Mental Health Services in Family Health Team Clinics in Ontario

Family health teams (FHTs), regarded today as a premier model of provision of primary care services in North America, were introduced in 2004 to improve traditionally fragmented primary healthcare in Ontario. Physicians and healthcare providers from various disciplines team up under the same roof in FHTs to provide and coordinate care and to ensure adequate access to and continuity of care. Because many Canadians with mental health problems consult family physicians in primary care, routine evaluation of the delivery of primary mental health care services in FHTs is becoming important. The authors' goal was to develop and test an evaluation tool (containing a questionnaire for patients and a questionnaire for providers) for mental health services provided in FHTs with a focus on accessibility, availability, quality, continuity of care and coordination of services. They developed and pilot tested an English-French tailored evaluation instrument in several FHTs in South East, Champlain and North East Local Health Integration Networks across Ontario. A convenience sample of English- and French-speaking healthcare providers and patients using mental health services was recruited. Provider and patient questionnaires were developed and pilot-tested with 12 providers and 10 clients. Patient reviewers rated the patient questionnaire consistently as "good" or "very good." Provider reviewers found the provider questionnaire to be important and timely and the questions to be adequate and interesting. This instrument evaluates, from both the patient and provider perspectives, whether mental health services are structured to meet expectations set for FHTs, and enables healthcare providers, administrators and policy makers to learn about the benefits and the deficiencies of mental health care delivered through these clinics. This instrument can also be used to enhance future research and evaluation of FHTs. Further validation effort will be required to establish its validity and reliability.

Attitude of Korean Primary Care Family Physicians Towards Telehealth

BackgroundRecently, a revised telehealth legislation that allows direct doctor to patient teleconsultation was proposed in Korea. However, there have been some debates. This study aimed to examine the attitude of primary care physicians towards telehealth.MethodsA questionnaire asking attitude towards telehealth and revised telehealth legislation was self-administered to 1,988 registered members of Practitioners Council of Korean Academy of Family Medicine. A total of 218 complete responses by family physicians were included in the study.ResultsLarge proportion (60.6%) of participants disagreed to the main clause of revised telehealth legislation, which allowed doctor to patient teleconsultation. Participants tended to expect that negative outcomes are more likely to occur than positive outcomes after the enforcement of the revised telehealth legislation. Around 50% of participants had an intention to adopt telehealth just as soon (4.6%) or afterwards (45.4%). The majority of participants suggested that; primary care clinic as the most appropriate telehealth facility (75.4%); patients with low accessibility to medical care (74.3%) as the best target of telehealth service; and tele-radiology (61.9%) or tele-pathology (41.3%) as the most applicable medical field for telehealh service. Around 89% of participants suggested telehealth service fee to be similar or higher than current medical consultation fee.ConclusionThe majority of family physicians participating in this study were not in favor of the revised telehealth legislation. However, the majority of the participants had an intention to adopt telehealth to their practice and held clear opinion about practical aspects of telehealth.

Shifts in expectations: Evaluating physicians' perceptions as pharmacists become integrated into family practice

The objective of this study was to measure how primary care family physicians perceived their own and pharmacists' contributions to medication processes as pharmacists become integrated into primary care group family practices. The 22- item Family Medicine Medication Use Processes Matrix was mailed to physicians in seven sites at the 3rd, 12th and 19th month of pharmacist integration. Paired sample t-tests for the third month results were conducted to compare perceptions between pharmacist and physician contributions. One way repeated measure ANOVA test was conducted to determine significant changes over time. Physicians initially perceived their own contributions to be significantly higher than pharmacists in three subscales: Diagnosis & Prescribing, Monitoring and Administration/Documentation and their own contributions to be significantly lower than the pharmacists in the Education subscale. Over time, physicians perceived increases in the pharmacists' contribution to the Diagnosis & Prescribing, Monitoring and Medication Review subscales and decreases in their own contribution to the Diagnosis & Prescribing and Education subscales. Changes in family physicians' perceptions of pharmacists' contribution demonstrate an initial underestimate of pharmacists' role in primary care family practice and a gradual recognition of expertise and competence. This may have led to increased comfort in sharing aspects of contribution to medication use processes.

Prevalence of Erectile Dysfunction and Utilization of Sexual Counseling in Community Family Medicine Clinics

Background: Sexual dysfunction such as erectile dysfunction (ED) may be a hidden agenda, but, it should be dealt with by family physicians in primary care. We investigated the prevalence of ED and utilization of sexual consultation practice among community family physicians. Methods: We analyzed the subjects who were males aged over 30 and married who visited 10 community family clinics around Seoul, Korea and completed questionnaires related to erectile function and utilization of sexual consultation service from May 9 to 28 2009. ED was designated if the 5-item version of international index of erectile dysfunction (IIEF5) scores were less than 17. Results: The average age of the responders was 45.6 years. The prevalence of ED was 43.3% and increased according to age, chronic disease, low educational history and low family income. Almost all of the mild ED patients answered that they needed sexual consultation. But, half of them had no plan to have a sexual consultation. Odds ratios (ORs) with 95% confi dence intervals (CIs) for having a sexual consultation or not according to variables were calculated with logistic regression. More severe ED (OR = 0.875; 95% CI, 0.827 to 0.926), existence of chronic disease (OR = 1.828; 95% CI, 1.026 to 3.260), inferior education (OR = 0.395; 95% CI, 0.196 to 0.796), and lower income (OR = 0.326; 95% CI, 0.124 to 0.857) were the factors which infl uenced to have a sexual consultation with a family physician. Conclusion: The prevalence of ED in family clinic was over 40%, but the utilization of sexual consultations was under 50%. We need to develop intervention strategies for more sexual counseling practice according to educational history, family incomes and status of ED in community family medicine clinics.

Colchicine in acute gout: the need for a reappraisal

Colchicine in acute gout: the need for a reappraisal

Self-reported prescribing of antibiotics for children with undifferentiated acute respiratory tract infections with cough.

Physicians are often called on to manage children with acute respiratory tract infections with cough when the clinical presentation may not allow a differentiation between viral and bacterial etiology. To develop guidelines for appropriate antibiotic use, it is necessary to understand the present prescribing patterns of physicians who manage children presenting with such an undifferentiated acute respiratory tract infection with cough (UARTIC). To determine the variability of self-reported prescribing habits for antibiotics for children with UARTIC. In this cross-sectional survey by a modified Dillman's Total Design Method, a mail-out questionnaire was administered to a random sample of 181 primary care family physicians and pediatricians (Toronto, Ontario, Canada) to assess perceptions of their own antibiotic-prescribing habit. Completed questionnaires were received from 136 (75%) eligible physicians; 32% reported that > 10% of their office visits were for UARTIC. For a 3-day history of UARTIC 24% reported prescribing antibiotics or antibiotics in reserve (i.e. a prescription to be filled if the patient's condition does not improve) always or most times. This increased to 45% when UARTIC had worsened in the 24 h before the office visit (P < 0.001). When a pediatric patient presented with UARTIC, antibiotics or antibiotics in reserve were prescribed in the absence of clear indicators of bacterial infection. Research- and evidence-based guidelines are needed to support rational antibiotic use for UARTIC.