Family Medicine Specialists Research Articles

Clinical practice guidelines for acute and chronic thyroiditis (excluding autoimmune thyroiditis)

Острые и хронические заболевания щитовидной железы занимают второе место по выявляемости после сахарного диабета. Всемирная организация здравоохранения отмечает ежегодную тенденцию к увеличению числа заболеваний щитовидной железы. В настоящих клинических рекомендациях будут рассмотрены вопросы этиологии, клинического течения, диагностики и лечения острых и хронических (за исключением аутоиммунного) воспалительных заболеваний щитовидной железы.Клинические рекомендации — это основной рабочий инструмент практикующего врача, как специалиста, так и врача узкой практики. Лаконичность, структурированность сведений об определенной нозологии, методов ее диагностики и лечения, базирующихся на принципах доказательной медицины, позволяют в короткий срок дать тот или иной ответ на интересующий вопрос специалисту, добиваться максимальной эффективности и персонализации лечения.Клинические рекомендации составлены профессиональным сообществом узких специалистов, одобрены экспертным советом Министерства здравоохранения РФ. Представленные рекомендации содержат максимально полную информацию, которая требуется на этапе диагностики острых и хронических тиреоидитов, этапе выбора тактики ведения пациентов с тиреоидитом, а также на этапе лечения пациента.Рабочая группа представляет этот проект в профессиональном журнале, посвященном актуальным проблемам эндокринологии, с целью повышения качества оказываемой медицинской помощи, повышения эффективности лечения острых и хронических тиреоидитов путем ознакомления с полным тестом клинических рекомендаций по острым и хроническим тиреоидитам (исключая аутоиммунный тиреоидит) максимально возможного количества специалистов в области не только эндокринологии, но и медицины общей (семейной) практики.

MANAGING PULMONARY TUBERCULOSIS IN A PATIENT WITH POST OP OROPHARYNGEAL CANCER - CHALLENGES FOR FAMILY PHYSICIAN

Oropharyngeal carcinoma is uncommon cancer compared to other malignancies. It accounts for less than 3% worldwide cancer and classified under the head and neck carcinoma. Patients with locally advanced oropharyngeal malignancy are usually treated with surgery with combination of radiotherapy and chemotherapy. This later required regular follow up especially on supportive care and adaptation to swallowing. Difficulty in swallowing provided burden to the patient and may lead to underlying malnutrition and risk of infection including tuberculosis. This will end up with poor compliance to oral treatment and risk of resistance. Therefore, this case study is illustrating the challenging role of family medicine specialists in managing a case of sputum positive pulmonary tuberculosis with underlying swallowing difficulty from glossectomy and radiotherapy on top of defaulted tongue carcinoma supportive care follow up.

Bir aile hekimliği biriminde düzenlenen ilaç raporlarının değerlendirilmesi

Amaç: Bu çalışmada bir aile hekimliği biriminde dört yıldan uzun süre çalışan bir aile hekimliği uzmanının düzenlediği ilaç raporlarının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Retrospektif arşiv incelemesinin yapıldığı bu çalışma Samsun iline bağlı Asarcık ilçesinde bir aile sağlığı merkezine bağlı birimde gerçekleştirilmiştir. Ağustos 2015- Ekim 2019 tarihleri arasında ilgili birimde düzenlenen ilaç raporlarının sahipleri örneklemi oluşturmaktadır. Bulgular: İlaç raporu yenilenen veya ilk defa düzenlenen 446 kişinin 623 adet raporu incelenmiştir. Yaş ortalaması 61,81±16,24 olup, hasta başına ortalama 2,19 kez rapor düzenlenmiştir. Hastaların %79,37’ine (n=354) en az bir adet antihipertansif ilaç raporu düzenlenmiştir, %14,57’sine (n= 65) ise en az bir adet oral antidiyabetik ilaç raporu düzenlenmiştir. Antihipertansif ilaçlardan en sık diüretikler (n= 225, %50,45), oral antidiyabetik ilaçlardan en sık metformin (n= 54, %12,11) raporlanmıştır. Kalp damar sistemi kısmında değerlendirilen ilaçlar rapor başına 1,55±1,10 kez ile en sık raporlananlardır. Yaş ile kalp damar sistemi rahatsızlıklarında kullanılan ilaç sayısı pozitif yönlü ve zayıf bir korelasyon göstermiştir (p< 0,001 , r= 0,266). Sonuç: Birinci basamak uzmanının kronik hastalıklarının medikal izleminde düzenlediği raporlarla etkin rol aldığı görülmüştür. Bu yüzden, düzenlenebilen ilaç raporu çeşitliliğinin artması faydalı olabilir.

Awareness of Neural Tube Defects in Family Physicians

Objective: The aim of this study was to measure the knowledge level of physicians working in family health centers about the conditions leading to neural tube defect (NTD) and preventive measures. Material and Methods: In this cross-sectional study, 406 general practitioners and family medicine specialists made a survey consisted of 13 questions. Chi-square, Fisher’s Exact test and Pearson chi-square analysis were applied as statistical methods. Results: A total of 406 physicians (family medicine specialists: 110, general practitioners: 296) participated in the study. 81.53% of the participants were working in a city and 18.47% were working in the countryside. The number of referral to general practitioners before pregnancy was significantly higher than that of family medicine specialists. (p<0.05). 36.95% of the respondents knew that the neural tube was closed in the first month of embryological life. Folic acid initiation rate was 99.26% for patients planning pregnancy. Initiation of vit B12 with folic acid was 28.33% in patients planning pregnancy. The rate of knowing that vitamin B12 deficiency causes NTD was 39.41% (family medicine specialists: 50%, general practitioners: 35.47%), and FMSs were statistically significant (p<0.05). Discussion: While the number of pregnant women who received folic acid only was sufficient, the number of pregnant women who took vitamin B12 with folic acid was very low. Family medicine specialists and general practitioners had insufficient knowledge that using vitamin B12 in combination with folic acid prevented NTD development. By preparing and implementing algorithms that can prevent NTDs, many life-long complications can be prevented.

Evaluation for Parkinsonian Bradykinesia by deep learning modeling of kinematic parameters.

A wearable sensor system is available for monitoring of bradykinesia in patients with Parkinson's disease (PD), however, it remains unclear whether kinematic parameters would reflect clinical severity of PD, or would help clinical diagnosis of physicians. The present study investigated whether the classification model using kinematic parameters from the wearable sensor may show accordance with clinical rating and diagnosis in PD patients. Using the Inertial Measurement Units (IMU) sensor, we measured the movement of finger tapping (FT), hand movements (HM), and rapid alternating movements (RA) in 25 PD patients and 21 healthy controls. Through the analysis of the measured signal, 11 objective features were derived. In addition, a clinician who specializes in movement disorders viewed the test video and evaluated each of the Unified Parkinson's Disease Rating Scale (UPDRS) scores. In all items of FT, HM, RA, the correlation between the linear regression score obtained through objective features (angle, period, coefficient variances for angle and period, change rates of angle and period, angular velocity, total angle, frequency, magnitude, and frequency × magnitude) and the clinician's UPDRS score was analyzed, and there was a significant correlation (rho > 0.7, p < 0.001). PD patients and controls were classified by deep learning using objective features. As a result, it showed a high performance with an area under the curve (AUC) about as high as 0.9 (FT Total = 0.950, HM Total = 0.889, RA Total = 0.888, ALL Total = 0.926. This showed similar performance to the classification result of binary logistic regression and neurologist, and significantly higher than that of family medicine specialists. Our results suggest that the deep learning model using objective features from the IMU sensor can be usefully used to identify and evaluate bradykinesia, especially for general physicians not specializing in neurology.

Family Medicine Training in Lesotho: A Strategy of Decentralized Training for Rural Physician Workforce Development.

Family medicine is a relatively new but rapidly expanding medical discipline in Sub-Saharan Africa. Specialization in family medicine is an effective means for building and retaining a highly skilled rural physician workforce in low- and middle-income countries. The Lesotho Boston Health Alliance Family Medicine Specialty Training Program is the first and only postgraduate family medicine program and the only accredited postgraduate training program in the Kingdom of Lesotho. Lesotho has unique challenges as a small mountainous enclave of South Africa with one of the lowest physician-to-patient ratios in the world. Most health professionals are based in the capital city, and the kingdom faces challenging health problems such as high human immunodeficiency virus prevalence, high maternal mortality, and malnutrition, as well as increasing burdens of non-communicable diseases such as hypertension, diabetes, and obesity. In response to these health crises and the severe shortage of health professionals, Lesotho Boston Health Alliance partnered with the Lesotho Ministry of Health in 2008 to introduce family medicine as a new specialty in order to recruit home and retain Basotho doctors. Family medicine training in Lesotho uses a unique decentralized, non-university-based model with trainees posted at rural district hospitals throughout the country. While family medicine in Lesotho is still in the early stages of development, this model of decentralized training demonstrates an effective strategy to develop the rural health workforce in Lesotho, has the potential to change the physician workforce and health care system of Lesotho, and can be a model for physician training in similar environments.

Clinical outcomes in a primary-level non-communicable disease programme for Syrian refugees and the host population in Jordan: A cohort analysis using routine data.

BackgroundLittle is known about the content or quality of non-communicable disease (NCD) care in humanitarian settings. Since 2014, Médecins Sans Frontières (MSF) has provided primary-level NCD services in Irbid, Jordan, targeting Syrian refugees and vulnerable Jordanians who struggle to access NCD care through the overburdened national health system. This retrospective cohort study explored programme and patient-level patterns in achievement of blood pressure and glycaemic control, patterns in treatment interruption, and the factors associated with these patterns.Methods and findingsThe MSF multidisciplinary, primary-level NCD programme provided facility-based care for cardiovascular disease, diabetes, and chronic respiratory disease using context-adapted guidelines and generic medications. Generalist physicians managed patients with the support of family medicine specialists, nurses, health educators, pharmacists, and psychosocial and home care teams. Among the 5,045 patients enrolled between December 2014 and December 2017, 4,044 eligible adult patients were included in our analysis, of whom 72% (2,913) had hypertension and 63% (2,546) had type II diabetes. Using visits as the unit of analysis, we plotted the following on a monthly basis: mean blood pressure among hypertensive patients, mean fasting blood glucose and HbA1c among type II diabetic patients, the proportion of each group achieving control, mean days of delayed appointment attendance, and the proportion of patients experiencing a treatment interruption. Results are presented from programmatic and patient perspectives (using months since programme initiation and months since cohort entry/diagnosis, respectively). General linear mixed models explored factors associated with clinical control and with treatment interruption. Mean age was 58.5 years, and 60.1% (2,432) were women. Within the programme’s first 6 months, mean systolic blood pressure decreased by 12.4 mm Hg from 143.9 mm Hg (95% CI 140.9 to 146.9) to 131.5 mm Hg (95% CI 130.2 to 132.9) among hypertensive patients, while fasting glucose improved by 1.12 mmol/l, from 10.75 mmol/l (95% CI 10.04 to 11.47) to 9.63 mmol/l (95% CI 9.22 to 10.04), among type II diabetic patients. The probability of achieving treatment target in a visit was 63%–75% by end of 2017, improving with programme maturation but with notable seasonable variation. The probability of experiencing a treatment interruption declined as the programme matured and with patients’ length of time in the programme. Routine operational data proved useful in evaluating a humanitarian programme in a real-world setting, but were somewhat limited in terms of data quality and completeness. We used intermediate clinical outcomes proven to be strongly associated with hard clinical outcomes (such as death), since we had neither the data nor statistical power to measure hard outcomes.ConclusionsGood treatment outcomes and reasonable rates of treatment interruption were achieved in a multidisciplinary, primary-level NCD programme in Jordan. Our approach to using continuous programmatic data may be a feasible way for humanitarian organisations to account for the complex and dynamic nature of interventions in unstable humanitarian settings when undertaking routine monitoring and evaluation. We suggest that frequency of patient contact could be reduced without negatively impacting patient outcomes and that season should be taken into account in analysing programme performance.

Onsite Versus Remote Working: The Impact on Satisfaction, Productivity, and Performance of Medical Call Center Workers.

Job satisfaction is determined as the measure to know the individuals’ feelings toward their work. The working conditions that can affect satisfaction and performance of the call center agents have received particular concern. This study aimed to determine the role of remote call center working on agents’ satisfaction compared to onsite workers. A cross-section study was conducted between December 2020 and April 2021 that include 124 agents working in a governmental medical call center in Saudi Arabia. Each agent was receiving a questionnaire that investigates his/her satisfaction with the job nature, supervisor support, job autonomy, job productivity, and performance. Seventy-seven physicians working onsite were compared to forty-seven physicians remotely working in the medical call center. The mean age of the physicians included was 43.17 ± 8.4 years, and most of them were male (>70%), married (>85%), and family medicine specialists (>50%). The mean years of experience in the medical field of the physicians included was 16.87 ± 8.07 years, and the mean years of experience in the medical call center was 1.44 ± .97 years. Onsite agents were more satisfied concerning job nature, supervisor support, productivity, and performance compared to remote agents (70.82 vs 53.47%, 63.38 vs 55.05%, and 66.51 vs 56.03%, respectively). However, onsite agents were less satisfied regarding job autonomy than remote physicians (46.81 vs 53.19%, P-value = .128). Overall, general satisfaction was more seen in physicians working onsite as opposed to remote workers in the medical call center in Saudi Arabia (64.90 vs 54.25%, P-value < .01).

Can primary care physicians recognize type 1 diabetes in children on time?

Although the diagnostic criteria for diabetes in children and adolescents should be widely known to all healthcare professionals, many cases of type 1 diabetes (DM1) are still not recognized in time. The aim of this study was to compare the experiences with the diagnosis of DM1 of young doctors during training and specialists working as primary health care physicians in Poland. 50 specialists in paediatrics or family medicine (average professional experience of 14.6 years) and 50 doctors, and those without specialization (up to 4 years after graduating from medical studies, average professional experience of 1.4 years) participated in the survey. The questionnaires were conducted from November 2019 to November 2020. Most of the study participants correctly answered the questions about the diagnostic criteria of diabetes and its management at the moment of diagnosis, except for the question regarding diagnostic criteria for diabetes in oral glucose tolerance test. The correct answers varied from 96% to 72% among medical specialists and physicians during the training, respectively. What is interesting is the relatively small number of diagnosed cases of DM1 during the entire professional career of specialists (0-12 cases), compared to the doctors without specialization (0-5 cases). Medical specialists declared more frequently the use of a glucometer in their daily practice (mean 6 vs. 1, p < 0.05), but after taking into account the years of experience, the difference was insignificant. It is important to educate primary care physicians, despite their professional experience. Practical education of physicians is also necessary.

Knowledge Level of the Family Medicine Residents and Specialists about Asymptomatic Bacteriuria during Pregnancy

Knowledge Level of the Family Medicine Residents and Specialists about Asymptomatic Bacteriuria during Pregnancy

The Attitudes and Beliefs of Family Physicians Regarding the Use of Medical Cannabis, Knowledge of Side Effects, and Barriers to Use: A Comparison Between Residents and Specialists.

Israel has a regulated system with clearly defined indications for treatment with medical cannabis. The main question was whether family physicians in southern Israel face barriers/knowledge gaps in prescribing cannabis for medical indications. The secondary question was whether there was a difference between residents and specialists in family medicine. A questionnaire-based cross-sectional study. Attitudes of the participating physicians on the use of medical cannabis; comparison of attitudes of specialists in family medicine and residents on the use of medical cannabis. One hundred and fifty-two family physicians participated in the study including 48 residents. More than 78% supported the use of medical cannabis and about 63% supported it's legalization. About 84% of the physicians believed that medical cannabis helped cancer patients and 82% believed it helped in the chronic pain. Only 28.3% believed that family physicians should recommend the use of medical cannabis. The physicians were well aware of the psychiatric (82%) and the neurological (78%) adverse effects of medical cannabis. Most (68%) were not willing to prescribe medical cannabis. No socio-demographic characteristic was associated with willingness to prescribe cannabis. About 95% of the physicians believed that the main barrier to recommending treatment was its potential for abuse, 66% percent-the danger that it would leak to the general public. About 60% of the specialists were not prepared to undergoing training in the prescription of medical cannabis compared with 31% of the residents ( P = 0.004). Family physicians are concerned about recommending medical cannabis. It is encouraging that residents are motivated to undergo training to prescribe medical cannabis. There remain medical indications and adverse effects that family physicians are less aware of. Further studies should focus on effective ways to improve the level of physicians' knowledge on the issue.

Development of a PATIENT-Medication Adherence Instrument (P-MAI) and a HEALTHCARE PROFESSIONAL-Medication Adherence Instrument (H-MAI) using the nominal group technique.

To date, several medication adherence instruments have been developed and validated worldwide. However, most instruments have only assessed medication adherence from the patient’s perspective. The aim was to develop and validate the PATIENT-Medication Adherence Instrument (P-MAI) and the HEALTHCARE PROFESSIONAL-Medication Adherence Instrument (H-MAI) to assess medication adherence from the patient’s and healthcare professional (HCP)’s perspectives. The P-MAI-12 and H-MAI-12 were developed using the nominal group technique. The face and content validity was determined by an expert panel and piloted. The initial version of these instruments consisted of 12 items were validated from October-December 2018 at a primary care clinic in Malaysia. Included were patients aged ≥21 years, diagnosed with diabetes mellitus, taking at least one oral hypoglycaemic agent and who could understand English. The HCPs recruited were family medicine specialists or trainees. To assess validity, exploratory factor analysis (EFA) and concurrent validity were performed; internal consistency and test-retest were performed to assess its reliability. A total of 120/158 patients (response rate = 75.9%) and 30/33 HCPs (response rate = 90.9%) agreed to participate. EFA found three problematic items in both instruments, which was then removed. The final version of the P-MAI-9 and the HMAI-9 had 9 items each with two domains (adherence = 2 items and knowledge/belief = 7 items). For concurrent validity, the total score of the P-MAI-9 and the H-MAI-9 were not significantly different (p = 0.091), indicating that medication adherence assessed from both the patient’s and HCP’s perspectives were similar. Both instruments achieved acceptable internal consistency (Cronbach’s α: P-MAI-9 = 0.722; H-MAI-9 = 0.895). For the P-MAI-9, 7/9 items showed no significant difference between test and retest whereas 8/9 items in the H-MAI-9 showed significant difference at test and retest (p>0.05). In conclusion, the P-MAI-9 and H-MAI-9 had low sensitivity and high specificity suggesting that both instruments can be used for identifying patients more likely to be non-adherent to their medications.

Enfoque médico integral de la enfermedad trofoblástica gestacional: Reporte de un Caso Clínico

La práctica médica diaria, siempre debe ser ejecutada de una manera integral en todos los niveles de atención del Sistema Nacional de Salud. Objetivo: Análisis de caso de neoplasia trofoblástica gestacional, dándole un enfoque integral desde la visión de un Especialista en Medicina Familiar. Metodología: presentación de caso clínico, observacional descriptivo. Resultados: La enfermedad trofoblástica gestacional es una patología poco frecuente, un pequeño porcentaje de los casos diagnosticados (2%), pueden convertirse desde el punto de vista clínico e histopatológico en una enfermedad maligna, el coriocarcinoma con mayor frecuencia. Conclusiones: Éste caso clínico trata una neoplasia trofoblástica gestacional, que desarrolló en una mujer adolescente, primigesta, sin antecedentes patológicos personales, ni familiares de importancia. Sin embargo, existen consideraciones sociales, familiares y culturales que también deben ser tomadas en cuenta para el manejo hospitalario.

Доказательная база эффективности и безопасности флавоноидов и мнение врачей амбулаторной практики в фокусе выбора подходов лечения ОРВИ

Numerous publications, meta-analyzes and systematic reviews suggest different approaches to the treatment and prevention of ARI, therefore, in the practice of a doctor both in Ukraine and in other countries, there is a variety of schemes, protocols, regulations and professional recommendations for the management of these patients. Therefore, for competent, effective and safe treatment and prevention of ARI among national and world standards, a doctor needs to find the most optimal and effective algorithm for the management and treatment of viral infections of the respiratory tract, which ideally has a high level of evidence-based medicine and can be used in specific practice with the point of view of patient management and routing. Purpose — to analyze the knowledge of the existing in Ukraine and the world of the regulatory framework and national protocols for the management of patients with ARI by general practitioners — family medicine, as well as to study the opinion of family doctors about the efficacy and safety of using flavonoids in the treatment and prevention of ARI. Materials and methods. Anonymous survey of 149 family doctors in the city of Dnipro and the region was conducted in the current 2020. Among the respondents there were 55 doctors with a primary specialization in Pediatrics (37%), 37 doctors with a primary specialization in Internal Medicine (25%) and 57 with a primary specialization in Family Medicine (38%). The distribution normality was checked using the Kolmogorov+Smirnov test. Considering that 90% of the data were normally distributed, we used parametric statistics methods. To assess relationships between binary features, the ϕ-coefficient of mutual conjugation was used. The critical level of statistical significance was accepted as &lt;5% (p&lt;0.05). Results. Family physicians are aware of current trends in the strategy of therapy and prevention of ARI. According to family doctors, drugs with the active substance Proteflazid, when prescribed for the treatment and prevention of acute respiratory viral infections, are safe (no toxic effect) and effective (according to our own observations) by reducing the duration and severity of the disease, the severity of fever and manifestations of intoxication syndrome, reducing the frequency of acute respiratory diseases (frequency rate per year), and that the above effects obtained in their own practice are associated with direct antiviral action, suppression of viral reproduction and multiple mechanisms of action of Proteflazid bioflavonoids. In addition to the professional opinion of family doctors, the opinion of parents about the effectiveness of drugs with the active substance Proteflazid for the treatment and prevention of ARI (feedback from a doctor) in the form of their positive feedback and a note that they are often used for self+treatment, and their choice is associated with the fact that Proteflazid preparations shorten the period of illness and, according to parents, children are less ill with ARI. Conclusions. The presence of the proven antiviral action of flavonoids, as a class of polyphenolic compounds, and the fact that the flavonoids that make up Flavovir have a proven mechanism of antiviral activity, which is confirmed in clinical outpatient practice by the positive experience of primary care physicians (pronounced clinical efficacy) allows you to recommend Flavovir syrup for the treatment and prevention of influenza and seasonal ARI to children from birth. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the doctors was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: ARI, flavonoids, treatment, outpatient practice, evidence-based medicine.

A human resources for health analysis of registered family medicine specialists in South Africa: 2002-19.

In South Africa, there is a need to clarify the human resources for health policy on family physicians (FPs) and to ensure that the educational and health systems are well aligned in terms of the production and employment of FPs. To analyse the human resource situation with regard to family medicine in South Africa and evaluate the requirements for the future. A retrospective review of the Health Professions Council of South Africa's (HPCSA) database on registered family medicine practitioners from 2002 until 2019. Additional data were obtained from the South African Academy of Family Physicians and published research. A total of 1247 family medicine practitioners were registered with the HPCSA in 2019, including 969 specialist FPs and 278 medical practitioners on a discontinued register. Of the 969, 194 were new graduates and 775 from older programmes. The number of FPs increased from 0.04/10 000 population in 2009 to 0.16/10 000 in 2019, with only 29% in the public sector. On average, seven registrars entered each of nine training programmes per year and three graduated. New graduates and registrars reflect a growing diversity and more female FPs. The number of FPs differed significantly in terms of age, gender, provincial location and population groups. South Africa has an inadequate supply of FPs with substantial inequalities. Training programmes need to triple their output over the next 10 years. Human resources for health policy should substantially increase opportunities for training and employment of FPs.

Portugal's primary health care human resources assessment

Abstract Background Primary health care services are the cornerstone of all health systems. Having clear data on allocated human resources is essential for planning. This work intended to map and compare the primary health care human resources of the five administrative regions (ARS) of the Portuguese public health system, so that better human resources management can be implemented. Methods The chosen design was a descriptive cross sectional study. Each of the five ARS were divided into primary health care clusters, which included several primary health care units. All of these units periodically sign a “commitment letter”, where they stand their service commitments to the covered population. This includes allocated health professionals (doctors, nurses), and the information is publicly accessible at www.bicsp.min-saude.pt. Data was collected for 2017, the year for which more commitment letters were available. Several ratios were calculated: patients/health professional; patients/doctor (family medicine specialists and residents); patients/nurse and patients/family medicine specialist. Mean, standard deviation, minimum and maximum values were calculated. Results National patients/health professional ratio was 702 with the mean of the 5 ARS calculated at 674+-7.15% (min 619, max 734) whilst the national patients/doctor ratio was 1247 with the mean of the 5 ARS calculated at 1217+-7.17% (min 1074, max 1290). National patients/nurse ratio was 1607 with the mean of the 5 ARS calculated at 1529+-13.08% (min 1199, max 1701). Finally, national patients/family medicine specialist ratio was 1711 with the mean of the 5 ARS calculated at 1650+-6,36% (min 1551, max 1795). Conclusions Human resources were differently spread across Portugal, with variations between the five ARS in all ratios. The largest differences occur between nursing staff, and may translate into inequities of access, with impact on health results. A more homogeneous human resources allocation should be implemented. Key messages Human resources in the Portuguese primary health care services are not homogeneously allocated. A better and more homogeneous allocation of human resources should be implemented to reduce access health inequities.

The adaptation and validation of the satisfaction with stroke care questionnaire (Homesat) (SASC10-My\u2122) for use in public primary healthcare facilities caring for long- term stroke survivors residing at home in the community

BackgroundSatisfaction with post stroke services would assist stakeholders in addressing gaps in service delivery. Tools used to evaluate satisfaction with stroke care services need to be validated to match healthcare services provided in each country. Studies on satisfaction with post discharge stroke care delivery in low- and middle-income countries (LMIC) are scarce, despite knowledge that post stroke care delivery is fragmented and poorly coordinated. This study aims to modify and validate the HomeSat subscale of the Dutch Satisfaction with Stroke Care-19 (SASC-19) questionnaire for use in Malaysia and in countries with similar public healthcare services in the region.MethodsThe HomeSat subscale of the Dutch SASC-19 questionnaire (11 items) underwent back-to-back translation to produce a Malay language version. Content validation was done by Family Medicine Specialists involved in community post-stroke care. Community social support services in the original questionnaire were substituted with equivalent local services to ensure contextual relevance. Internal consistency reliability was determined using Cronbach alpha. Exploratory factor analysis was done to validate the factor structure of the Malay version of the questionnaire (SASC10-My™). The SASC10-My™ was then tested on 175 post-stroke patients who were recruited at ten public primary care healthcentres across Peninsular Malaysia, in a trial-within a trial study.ResultsOne item from the original Dutch SASC19 (HomeSat) was dropped. Internal consistency for remaining 10 items was high (Cronbach alpha 0.830). Exploratory factor analysis showed the SASC10-My™ had 2 factors: discharge transition and social support services after discharge. The mean total score for SASC10-My™ was 10.74 (SD 7.33). Overall, only 18.2% were satisfied with outpatient stroke care services (SASC10-My™ score ≥ 20). Detailed analysis revealed only 10.9% of respondents were satisfied with discharge transition services, while only 40.9% were satisfied with support services after discharge.ConclusionsThe SASC10-My™ questionnaire is a reliable and valid tool to measure caregiver or patient satisfaction with outpatient stroke care services in the Malaysian healthcare setting. Studies linking discharge protocol patterns and satisfaction with outpatient stroke care services should be conducted to improve care delivery and longer-term outcomes.Trial registrationNo.: ACTRN12616001322426 (Registration Date: 21st September 2016.

Knowledge, perceived barriers and facilitators of medication error reporting: a quantitative survey in Malaysian primary care clinics.

Background Medication errors are the most common types of medical errors that occur in health care organisations; however, these errors are largely underreported. Objective This study assessed knowledge on medication error reporting, perceived barriers to reporting medication errors, motivations for reporting medication errors and medication error reporting practices among various health care practitioners working at primary care clinics. Setting This study was conducted in 27 primary care clinics in Malaysia. Methods A self-administered survey was distributed to family medicine specialists, doctors, pharmacists, pharmacist assistants, nurses and assistant medical officers. Main outcome measures Health care practitioners' knowledge, perceived barriers and motivations for reporting medication errors. Results Of all respondents (N = 376), nurses represented 31.9% (n = 120), followed by doctors (n = 87, 23.1%), pharmacists (n = 63, 16.8%), assistant medical officers (n = 53, 14.1%), pharmacist assistants (n = 46, 12.2%) and family medicine specialists (n = 7, 1.9%). Of the survey respondents who had experience reporting medication errors, 56% (n = 62) had submitted medication error reports in the preceding 12months. Results showed that 41.2% (n = 155) of respondents were classified as having good knowledge on medication error and medication error reporting. The mean score of knowledge was significantly higher among prescribers and pharmacists than nurses, pharmacist assistants and assistant medical officers (p < 0.05). A heavy workload was the key barrier for both nurses and assistant medical officers, while time constraints prevented pharmacists from reporting medication errors. Family medicine specialists were mainly unsure about the reporting process. On the other hand, doctors and pharmacist assistants did not report primarily because they were unaware medication errors had occurred. Both family medicine specialists and pharmacist assistants identified patient harm as a motivation to report an error. Doctors and nurses indicated that they would report if they thought reporting could improve the current practices. Assistant medical officers reported that anonymous reporting would encourage them to submit a report. Pharmacists would report if they have enough time to do so. Conclusion Policy makers should consider using the information on identified barriers and facilitators to reporting medication errors in this study to improve the reporting system to reduce under-reported medication errors in primary care.

Awareness, attitudes, barriers, and knowledge about evidence-based medicine among family physicians in Croatia: a cross-sectional study

BackgroundEvidence-based medicine (EBM) aims to assist physicians in making medical decisions based on the integration of the current best evidence, clinical expertise, and patients’ values. Extensive research has been conducted regarding physicians’ awareness, attitudes, barriers, and knowledge about EBM. In Croatia, there is a lack of research on this topic, especially among family physicians (FP). The aim of this study was to assess the awareness, attitudes, barriers, and knowledge about EBM among FPs in Croatia after six years of educational activities organized and provided by Cochrane Croatia.MethodsIn a cross-sectional study, conducted in 2016, we offered to FPs in Croatia a printed or online validated questionnaire to assess attitudes toward and barriers when considering the use of EBM, awareness about sources of evidence, and their level of understanding of evidence-based medicine terminology. The physicians were approached during mandatory continuing medical education courses and through their professional associations. We compared results from two groups of physicians, one with family medicine specialization and the other without.Results295 (14%) of all officially registered FPs responded to the questionnaire. Respondents were very positive toward the promotion and usage of EBM. 160 (67%) indicated that they did not have access to the Cochrane Library. The majority reported lack of time available for finding evidence (80%), and patients’ unrealistic expectations that influence doctors’ choice of treatment (72%). Between the two groups of physicians, more family medicine specialists reported time restrictions for finding evidence. The highest level of EBM terminology understanding was reported for study design terms, and the lowest for statistical terms.ConclusionsThis study demonstrated that FPs in Croatia had very positive attitudes toward the use of EBM, they agreed that EBM improves patient care, and they estimated that more than two thirds of their practice is EBM-based. Compared to the results of the first assessment of physicians in 2010, there was some increase in the level of EBM awareness among FPs. However, to further increase the quality of EBM practice in Croatia better access to EBM sources and further educational activities are needed.

Knowledge about Emergency Contraception Pills among Primary Health Care Doctors in Baghdad\Al-Karkh Sector

Background: Unintended pregnancy is associated with an increased risk of problems especially when woman is not in her optimal health for childbearing. The problem of unintended pregnancy and its complication can be reduced by the use of emergency contraception. Objective: To explore the knowledge of health care doctors in Baghdad/Al Karkh, Iraq regarding emergency contraception pills. Participants and Method: A structured questionnaire was distributed to a total of 390 primary health care doctors (obstetrics and gynecology specialists, general practitioners and family physicians). The questionnaire contained two main domains: demographic characteristics and knowledge about EC. Results: The majority of the sample were females 287 (73.6%), and the general practitioner (41.8%), family medicine specialists (34.6%). about one third of them were in age 40–49 years old, 72.1% of the physicians have no training about emergency contraceptive.. Conclusion: A deficit in knowledge shown by health care physicians lead to an insufficient use of emergency contraceptive pills methods.