Training Of Primary Care Physicians Research Articles

The role of the primary care physician in identifying patients at high risk of fractures in real clinical practice

BACKGROUND: The FRAX calculator is an accessible method for identifying patients at high risk of fracture. However, data on its practical use in primary health care settings are limited.
 AIM: To evaluate the correctness of calculating the 10-year fracture probability according to FRAX by primary care physicians and then analyze the impact of the results on patient routing.
 MATERIALS AND METHODS: The base of the study was the city polyclinic No. 25 of the Nevsky district of Saint Petersburg. The study included men and women aged 40 years and older.
 During 2017–2020, polyclinic doctors assessed the risk of fracture using the FRAX calculator for 11,013 people. A group of patients with significant differences (30% or more) in the obtained value of the risk of major osteoporotic fractures from the average was identified. A 10-year probability of fractures was recalculated for these patients.
 RESULTS: Major osteoporotic fracture risk scores were compared before and after recalculation. In most cases of patients (83%), the risk category did not change after recalculation. In 15% of patients changed to a higher risk. In the total group (11,013 people), errors in FRAX calculation led to an underestimation of high fracture risk in 41 patients (0.4%).
 CONCLUSIONS: The study showed that primary care physicians use the FRAX calculator correctly. The proportion of incorrect fracture risk calculations was low. Nevertheless, training of primary care physicians in the calculation and interpretation of the FRAX score is essential.

Training program for primary care physicians in medical rehabilitation at the Pacifi c Medical University

This article describes the experience of training primary care physicians in the field of medical rehabilitation. The existing procedure for the arrangement of medical rehabilitation prescribes its rules and order of implementation in medical primary health care organizations both in outpatient and day patient settings. The Pacific State Medical University (PSMU) runs training programs for primary care physicians within the 31.05.01 educational program “General Medicine”, direction “02 Healthcare”. In accordance with the curriculum, a training program “Medical Rehabilitation” that includes both lectures and training sessions was developed. This program is aimed at forming the necessary competencies of future primary care physicians in implementing and monitoring the effectiveness of the patient’s medical rehabilitation. Training is carried out at the facilities of the PSMU Institute of Clinical Neurology and Rehabilitation Medicine by specialists having experience in medical rehabilitation and having completed the program “Modern aspects of specialist training in the field of physical and rehabilitation medicine”.

Comparative Analysis of the Impact of Training through Simulation Using the Crisis Resource Management Tool for Primary Care Professionals.

This was a prospective observational study based on clinical simulation courses taught in 2017 at the IDEhA Simulation Center of Alcorcón Foundation University Hospital. Two courses in metabolic emergencies (MEs) and respiratory emergencies (REs) were offered to primary care physicians all over Spain. The main objective was to teach nontechnical skills (crisis resource management). Using a modified five-level Kirkpatrick-Phillips education evaluation model, level I (reaction, K1), level II (learning, K2) and level III (behavioral change, K3) changes were evaluated through surveys at the end of the courses and one year later. Thirty courses were held (15 ME courses and 15 RE courses) with 283 primary care physicians. The overall satisfaction (K1) was high: ME courses, 9.5/10; RE courses, 9.6/10. More than 80% of the participants rated the organization, resources, content, debriefing and scenarios as excellent, with no significant differences between the two courses. After one year (156 responses), the respondents for both courses reported that they would repeat the training annually (K2), encourage debriefing with colleagues (K3) and have modified some aspects of their workplace (K3), citing improvements in procedures and in the organization of the health team as the most important. After the ME course, few participants, i.e., 5 (6%), reported providing improved care to patients; after the RE course, 15 (19%) participants reported providing improved care; the difference between groups was significant (p < 0.05). Compared with the ME course, the RE course imparted greater knowledge about patient safety (K2) (38 (49%) vs. 24 (31%) (p < 0.05)) and more useful tools for daily clinical practice (K3) (67% vs. 56.4%) and resulted in participants paying more attention to personal performance and to colleagues when working as a team (K2) (64% vs. 50%). Clinical simulation courses are highly valued and potentially effective for training primary care physicians in patient safety and CRM tools. Future studies with objective measures of long-term impact, behavior in the workplace (K3) and benefits to patients (K4) are needed. Based on the results of our study, the areas that are important are those aimed at improving procedures and the organization of health teams.

Functional vesico-sphincteric disorders in children: clinical, urodynamic and evolutionary profile

Childhood vesico-sphincteric disorders are the cause of functional and psychological disability. They are also responsible for serious uronephrologic complications akin to neuro-bladder complications. In this study, we looked for the clinical manifestations linked to these disorders as well as the paraclinical and urodynamic anomalies and their therapeutic management. We carried out a retrospective and descriptive study of patients with vesico-sphincteric disorders, followed in the pediatrics department of Charles Nicolle hospital in Tunis. In total 26 patients were included in our study. The median age at the first consultation in a pediatric nephrology department was 9 years (IQR 25 = 6 years; IQR 75 = 11 years). There was a predominance of girls: 19 boys and 43 girls. The filling phase and the voiding phase were dominated by the combination of three or more symptoms. Bladder tenderness was reduced in 12% of cases. Nineteen percent of patients reported post micturition dribble in the post-voiding phase. The flow rate curve was polyphasic in 36% of cases and flat in 11% of cases. The median of the post void residual was 62, 2 mL (IQR 25 = 25 mL; IQR 75 = 102 mL). Cystometry showed reduced bladder sensation in 14% of cases, detrusor overactivity in 65% of cases, bladder hypocontractility in 8% of cases, hypocompliant bladder in 42% of cases and small capacity in 88% of cases. Sphincter dysynergia was noted in 34% of patients. Anticholinergics were the most used in the treatment of disorders (53%). Renal failure was noted in 45% of the patients of which 11% had end-renal stage failure. During follow-up 16% of our patients required kidney replacement therapy. Given the seriousness of vesico-sphincteric disorders in children and the late discovery in the majority of cases at the complication stage, targeted primary prevention must be carried out based on continuous training of primary care physicians to minimize the appearance of complications involving the functional and vital prognosis of these children.

Histopathologic Spectrum and Clinicopathologic Concordance of Pediatric Skin Biopsies: 18-Year Experience in a Tertiary Hospital in Southeast Nigeria

ABSTRACT Background: Many studies have evaluated the spectrum of pediatric skin disorders in outpatient, inpatient, and emergency settings in different regions of Nigeria. However, literature analyzing histopathological data of dermatologic diseases in children undergoing biopsy or excision of skin lesions in Nigeria is lacking. The present study was aimed at determining the spectrum, frequency, and clinicopathologic diagnostic concordance of pediatric dermatopathological lesions at a tertiary care hospital in southeast Nigeria. Materials and Methods: This is a retrospective cross-sectional study undertaken at the department of Histopathology, Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi. All pediatric (up to 18 years old) skin biopsies received at the department of Histopathology, NAUTH, Nnewi over an 18-year period from January 2004 to December 2021 were included in the study. Relevant clinical and demographic data had been collected from the request forms. For ease of analysis and comparison with other skin studies, the skin lesions were classified according to the International Classification of Diseases, Tenth revision (ICD-10) (2019), for disorders of the skin and subcutaneous tissue. Results: Pediatric skin biopsies constituted 20.2% of all the skin biopsies received at our laboratory during the study period, with a male to female ratio of 1:1. The initial clinical diagnosis was concordant with histopathologic diagnosis in 88 out of 189 cases (46.6%). Forty-nine percent of biopsies/excisions were performed in the head and neck area. The most common diagnostic categories, in decreasing order of size, were neoplasms, disorders of skin appendages, papulosquamous disorders, and infections. Only about a quarter of neoplasms were malignant. Conclusion: Our study has documented the importance of histopathology as a gold standard in the diagnosis and management of skin lesions. Improved training of primary care physicians and closer cooperation between pediatricians, dermatologists, and pediatric surgeons will increase the chances of accurate diagnosis.

Barriers, facilitators, and strategies for improving breast cancer screening in Ukraine.

e18769 Background: Because of Russia’s invasion of Ukraine, many cancers are diagnosed at later stages, resulting in renewed emphasis on preventive medicine. To this end, we explored barriers and facilitators of breast cancer screening in Ukraine. Methods: A survey exploring factors that may influence breast cancer screening was distributed through the Primary Care Physician Facebook group in Ukraine. Chi-Squared and Student’s t-tests tested association between discrete and continuous variables, respectively. Linear and logistic regression were used to test independent association. Results: 150 surveys were completed. Respondents’ mean age was 36.6 years (SD 11.6); 127 (84%) were female. 124 (83%) worked in public primary care clinics. Respondents were from 25 (92%) of 27 regions of Ukraine. 110 (73%) were familiar with Ministry of Health (MOH) Order 504 guidelines for breast cancer screening. 103 (64%) had a clinical breast exam (CBE) and 34 (21%) a screening mammography. Breast cancer screening was done via mammography by 134 (84%), via CBE by 93 (58%), and via CBE referral by 86 (57%). Fifty-six (36%) referred 1-3 patients per month to mammography, 46 (30%) referred 4-10, 25 (16%) 11-20. CBE screening was done for 1-10 patients per month by 86 (56%), 11-20 patients by 27 (18%), and 21-40 by 18 (12%). Factors independently associated with patient number having CBE screening per month included daily patient volume, having had a CBE, mammography availability; awareness of MOH 504 and patient pathways, and United States/Europe screening recommendations (latter three p &lt; 0.1). In addition to the above, factors independently associated with performing CBE screening also included participation in seminars about breast cancer screening and comfort with performing a CBE. Factors independently associated with number of patients referred to mammography per month included daily patient volume, having undergone a mammography, and mammography availability. In addition to the above, factors independently associated with mammography referral also included awareness of MOH 504 and patient family history. (All p &lt; 0.05) Barriers to screening included insufficient knowledge among patients (81, 54%), fear of cancer treatment (71, 47%), lack of money for cancer treatment (50, 33%), insufficient training for primary care physicians (84, 56%), insufficient mammography equipment (39, 26%), and insufficient screening recommendation in primary care (38, 25%). Breast cancer screening could be expanded via collaboration with oncologists (64, 42%), training about breast cancer screening (60, 40%), breast cancer educational materials for patients (56, 37%), and automating screening referrals via electronic health records (50, 33%). Conclusions: Factors associated with breast cancer screening included knowledge, personally undergoing screening, and resource availability. Results are limited by online convenience sampling.

Modelling the Clinical and Economic Impacts of Foundation-Funded versus Staff-Driven Quality Improvement Mental Health Strategies

BACKGROUND Employing a valid and reliable clinical measurement system established in 2002 within our regional Child and Adolescent, Addictions, Mental Health, and Psychiatry Program, we have been able to measure the effect of the general service system, a novel pre-admission initial family group session to orient families to treatment, and an acute at home care service deigned to divert admissions from emergency to in-home support rather than inpatient admission. Additionally, the modelled clinical effect and economic impact of two community programs; one school-based mental health literacy program and one primary care physician training and education program focusing on the management of children's mental health problems. In this paper, we present an established clinical measurement system combined with standardized cost evaluation strategy to assess the respective cost/benefit impacts of four service innovations. METHODS The clinical measurement system has been described in detail, as has its role in measuring the impact of community-level training on the quality of referrals. Our financial department developed standardized per diem cost references for levels of care within our system. The cost references permitted comparison of groups that were exposed and unexposed to the system innovations before and after the initiation of service and community innovations. The school-based mental health literacy program was a regional implementation of a national program (https://mentalhealthliteracy.org/). The primary care physician education was an internationally develop program from the United States (https://thereachinstitute.org). The other two projects were accomplished on a somewhat smaller local scale and at lower overall cost. The pre-admission initial family group session was a bottom-up, staff-designed and developed quality improvement project. The acute at home project, while funded by the children’s hospital foundation as were the two national and international projects. the acute at home project was a top-down director-designed project with one manager and a coordinator. RESULTS The four innovations were evaluated employing the same model. In each case the clinical space created by each innovation was measured in terms of the cost saved comparing the same outcomes (re-admission rates and lengths of stay) over comparable time intervals between and within pre/post exposed and unexposed groups, whilst controlling for clinical effects of exposure and time. The clinical measurement system helped determine group effects to ensure that the target groups were comparable within each initiative’s exposed and unexposed groups and were appropriately distinct between initiatives (eg, appropriate clinical groups were served by each initiative). While four projects were different and served somewhat different patient groups, the pre-admission initial family group session was the most cost effective. The physician training program was both effective and cost neutral. The school-based mental health literacy program was the least evaluable due to the direction of implementation and tended to increase referrals rather than create clinical space for more affected youth, as might be expected. The acute at home project successfully diverted less suicidal patients away from inpatient readmission over the evaluation period. DISCUSSION The main implications for mental health policy derives from linking standardized cost and clinical measurement models permitting economic evaluation of system and community level innovations. Pre and post clinical and cost measurements within and between exposed and unexposed groups for each innovation or project permitted estimation of benefits and cost. CONCLUSIONS The projects varied in focus together with the evaluability of each project, yet this provided important information for health system innovation and renewal within the context of fiscal constraint. The ranking of the projects in terms of their overall benefits and costs may guide decision-making where maximum return on investment makes the most sense.

Influence of prior internist encounter on glycaemic control among patients with type 2 diabetes mellitus at a family practice setting in Nigeria.

The huge global diabetes burden and the paucity of diabetes specialists make primary care physicians important stakeholders in controlling diabetes. Hence, we examined the predictors of glycaemic control among primary care patients with type 2 diabetes mellitus (T2DM), highlighting the influence of prior internist encounters during the preceding year on glycaemic control. This questionnaire-based cross-sectional study involved 276 T2DM patients systematically recruited from attendees of a general outpatient clinic (GOPC) in Kano, Nigeria. Data regarding their sociodemographic, clinical and internist encounter and GOPC visit characteristics were collected. Data were subjected to descriptive and inferential statistical analysis. Most participants (56.5%) were females; their mean age was 57.7 ± 9.6 years, mean glycated haemoglobin level was 7.3 ± 1.9%. Age, educational level, ethnicity, insurance status, current blood pressure (BP), treatment type, medication adherence, awareness of the importance of diet in DM control, specialist diabetic clinic visited, number of GOPC visits and prior encounter with an internist in the preceding year were associated with glycaemic control after bivariate analysis (P < 0.05). On multivariate regression, low education, retirees, being self-employed, uninsured, overweight, having optimal BP, using metformin alone, sulphonylurea-metformin and insulin-based treatments and prior encounter with the internist in the preceding year were predictors of optimal glycaemic control. There are multiple predictors of glycaemic control in this setting. These predictors should be considered in glycaemic control risk stratification towards quality individualised care, which includes establishing referral protocols to available specialists. Regular training of primary care physicians on diabetes care is also required.

Smart Brain Care – A novel approach to health care of mild cognitive impairment and mild dementia

Abstract Background Dementia is a huge burden. Trends for the aging European nations indicate a significant increase of people with dementia. Prevention and early detection are the key elements to reduce risk factors and to treat reversible causes. In addition, identifying people at the beginning of the disease process is crucial when disease-modifying therapy becomes available. Methods We aim to develop a complex intervention to improve the identification, diagnosis, and treatment of people with mild cognitive impairment (MCI) and mild dementia syndromes. Our goal is to reduce the time to diagnosis, raising awareness for MCI and increase patient involvement. First, barriers in pathways of care are determined in a systematic review and refined by conducting focus groups and interviews with primary care physicians (PCPs), specialists and experts in the field. A first theory about intervention components and how they interact are developed and will be further tested and adapted through development phase, feasibility and piloting. Results The first blueprint of Smart Brain Care addresses three identified key barriers for an improved care of MCI and mild dementia syndromes (communication, skills and awareness) by three interventions (1-3), all linked and accessible through an e-database: An online platform (1) for exchange between PCPs, specialists and experts, (2) a screening tool, diagnosis-algorithm and training for PCPs as well as (3) information materials (e.g., fact sheets, short videos) separately accessible for patients. Conclusions There is still low awareness about MCI under health care providers and the general population. A lack of knowledge, cooperation strategies and guidance seem to play an important role for the management of MCI and mild dementia syndromes. Key messages • We need to increase focusing on the identification of people with MCI and mild dementia syndromes. • Call for a structured diagnosis and treatment regimen to support primary care physicians as key players in the management of MCI and mild dementia syndromes.

1.116 Training Primary Care Physicians (PCPs) in the Delivery of Child and Youth Mental Health Care: Outcomes From the Project ECHO Model and Associations With Clinic Duration

Project Extension for Community Healthcare Outcomes (ECHO) for Child/Youth Mental Health (CYMH) aims to improve mental health care delivered by primary care providers (PCPs), but no studies have tested whether the program is associated with positive learning outcomes. In addition, the ECHO model is frequently criticized as infeasible for PCPs because of weekly 90-minute learning sessions. We studied whether: 1) ECHO CYMH improved knowledge and care; and 2) improvements in learning outcomes differed between cycles using 90- and 60-minute clinics.

The Benefits and Barriers of Using Point-of-Care Ultrasound in Primary Healthcare in the United States.

An effective healthcare system should embrace practices that enhance overall quality and productivity. Training primary care physicians in Point-of-Care Ultrasound (POCUS) has become part of the processes that improve the quality of patient care and serve to guide the diagnostic impression quickly and effectively. With the purpose of highlighting the applications and challenges of POCUS use in US primary health care, we conducted a narrative review based on PubMed-indexed and Cochrane Library English text publications searched in May-July 2022 using a combination of key terms including point of care ultrasound, primary care, and US healthcare. Many studies have shown that POCUS has a positive impact on fostering medical attention and reducing morbidity, mortality, and healthcare costs. Besides assisting in procedures, POCUS has a head-to-toe application in evaluating inflammatory and infectious conditions, acute abdomen, cardiopulmonary function, musculoskeletal and vascular pathologies. However, its uniform implementation is limited across the US healthcare system due to multitudes of barriers such as lack of training, resource scarcity, and low reimbursement. Training primary care physicians in general and emergency care providers, in particular, is key to scaleup POCUS use. Large size studies are paramount to further explore the effectiveness of POCUS and identify key challenges to its implementation.

Practical approach lung health-global alliance against chronic respiratory diseases (PAL-GARD) initiative in Brazil.

BackgroundTo evaluate the impact of training primary care physicians (PCPs) in the use of the practical approach lung health-global alliance against chronic respiratory diseases (PAL-GARD) upon their diagnostic skills.MethodsIn this real-life three-phase study, PCPs were allocated to a PAL-GARD training or control group. Patients who sought a primary care health facility due to cough, dyspnea and/or wheezing were eligible. The clinical diagnoses made by PCPs during the baseline and post-intervention phase were audited by a panel of pulmonologists. Kappa inter-rater statistics was used to compare agreement between PCPs and pulmonologists.ResultsThirty PCPs evaluated 536 patients, 358 in the intervention and 178 in the control group. According to Kappa, there was an increase in the agreement in the diagnosis of asthma (from 0.546 to 0.638), tuberculosis (from 0.393 to 0.655) and acute respiratory infections (ARI) (from 0.577 to 0.584) was observed in the PAL-GARD group, but there was a reduction in chronic obstructive pulmonary disease (COPD) (from 0.430 to 0.284).ConclusionsIn this setting, PAL-GARD-based guide and training improved the clinical diagnosis of common respiratory diseases with the exception of COPD.

Effects of early preventive dental visits and its associations with dental caries experience: a cross-sectional study

ObjectivesLimited information is known about preventive dental visits (PDVs) before seven years of age among children in China. This study aimed to examine the early PDV rate, identify the impact of PDV on dental caries and untreated dental caries, and explore the factors related to PDV among Chinese sampled children under seven years old.MethodsA cross-sectional survey was conducted in five selected primary health care facilities in Chengdu, China, from May to August 2021. Parent–child dyads during regular systematic medical management were recruited to participate. Children's dental caries were identified through dental examinations and documented as decayed, missing and filled teeth index (dmft) by trained primary care physicians. Dental-related information was collected through a questionnaire. Zero-inflated negative binomial (ZINB) regression was used to test the effect of early PDV on the dmft value, and logistic regression was used to analyse impact factors on the early PDV.ResultsA total of 2028 out of 2377 parent–child dyads were qualified for analysis. Half of the children (50.4%) were male, with a mean age of 4.8 years. Among all the children, 12.1% had their first dental visit for preventive purposes, 34.4% had their first dental visit for symptomatic purposes, and more than half had never visited a dentist. The results showed that a lower dmft value (adjusted OR: 0.69, 95% CI: 0.48–0.84), a higher rate of caries-free (aOR: 6.5, 95% CI: 3.93–10.58), and a lower rate of untreated dental caries (aOR: 0.40, 95% CI: 0.21–0.76) were associated with early PDV utilization. Children who had a higher rate of PDV were positively associated with living in a family with better parental behaviours (aOR: 2.30, 95% CI: 1.71–3.08), better parental oral health perception (aOR: 1.23, 95% CI: 1.06–1.32), fathers who had no untreated caries (aOR: 0.68, 95% CI: 0.47–0.97), families with higher socioeconomic status (aOR: 1.09, 95% CI: 1.04–1.16), and dental health advice received from well-child care physicians (aOR: 1.47, 95% CI: 1.08–2.00).ConclusionsEarly PDV was associated with a lower rate of dental caries prevalence and untreated dental caries among sampled children younger than seven in Western China. Underutilization and social inequities existed in PDV utilization. Public health strategies should be developed to increase preventive dental visits and eliminate social disparities that prevent dental care utilization.

Healthcare professionals\u2019 perspectives on facilitators of and barriers to CKD management in primary care: a qualitative study in Singapore clinics

IntroductionThe burden of chronic kidney disease (CKD) is rising globally including in Singapore. Primary care is the first point of contact for most patients with early stages of CKD. However, several barriers to optimal CKD management exist. Knowing healthcare professionals’ (HCPs) perspectives is important to understand how best to strengthen CKD services in the primary care setting. Integrating a theory-based framework, we explored HCPs’ perspectives on the facilitators of and barriers to CKD management in primary care clinics in Singapore.MethodsIn-depth interviews were conducted on a purposive sample of 20 HCPs including 13 physicians, 2 nurses and 1 pharmacist from three public primary care polyclinics, and 4 nephrologists from one referral hospital. Interviews were audio recorded, transcribed verbatim and thematically analyzed underpinned by the Theoretical Domains Framework (TDF) version 2.ResultsNumerous facilitators of and barriers to CKD management identified. HCPs perceived insufficient attention is given to CKD in primary care and highlighted several barriers including knowledge and practice gaps, ineffective CKD diagnosis disclosure, limitations in decision-making for nephrology referrals, consultation time, suboptimal care coordination, and lack of CKD awareness and self-management skills among patients. Nevertheless, intensive CKD training of primary care physicians, structured CKD-care pathways, multidisciplinary team-based care, and prioritizing nephrology referrals with risk-based assessment were key facilitators. Participants underscored the importance of improving awareness and self-management skills among patients. Primary care providers expressed willingness to manage early-stage CKD as a collaborative care model with nephrologists. Our findings provide valuable insights to design targeted interventions to enhance CKD management in primary care in Singapore that may be relevant to other countries.ConclusionsThe are several roadblocks to improving CKD management in primary care settings warranting urgent attention. Foremost, CKD deserves greater priority from HCPs and health planners. Multipronged approaches should urgently address gaps in care coordination, patient-physician communication, and knowledge. Strategies could focus on intensive CKD-oriented training for primary care physicians and building novel team-based care models integrating structured CKD management, risk-based nephrology referrals coupled with education and motivational counseling for patients. Such concerted efforts are likely to improve outcomes of patients with CKD and reduce the ESKD burden.

Effectiveness of training primary care physicians about the principles of smoking treatment

Aim. To evaluate the impact of training primary care physicians about the principles of smoking treatment on the rate of successful quitting among their patients.Material and methods. Within the regional program on cardiovascular prevention among men aged 45-55 years, a study was made on the effectiveness of an educational seminar for primary care physicians (clustered quasi-experimental study). The main group consisted of 70 physicians (subjects of intervention) who underwent face-to-face training at a 3-hour interactive seminar on the principles of behavioral and drug treatment of smoking patients. In the following year, they consulted 423 smokers (subjects of analysis). The comparison group was represented by 174 doctors trained with extramural program who consulted 654 smokers. The doctors of both groups were provided with methodological and informational support in the form of short guides and brochures for patients. The main outcome studied was smoking cessation in patients one year after physician training. The comparison of outcomes was carried out taking into account the cluster structure of data using hierarchical regression. The initial imbalance of comparison groups in history of smoking, quit attempts, as well as level of alcohol consumption was corrected at the analysis stage.Results. In total, 12,6% of patients in the observed cohort quit smoking after one year, which was significantly higher than the common successful self-quit rate (3-5%). The likelihood of quitting smoking was strongly influenced by a particular doctor (ICC=0,326). Face-to-face interactive training of physicians significantly increased the probability of successful refusal in patients compared with distance learning (adjusted hazard ratio (HR) =4,8; odds ratio (OR) =5,3, 95% confidence interval (CI), 2,7-10,6, p&lt;0,001). The likelihood of successful withdrawals among patients among primary care physicians was much higher than among health center patients (adjusted HR=4,5; adjusted OR, 5, 95% CI, 1,2-20,6, p=0,027).Conclusion. Education of primary care physicians in the principles of smoking treatment, combined with the provision of information materials for patients, significantly increases the success rate among motivated smokers. At the same time, a face-to-face interactive seminar is much more effective than distance learning. General practitioners demonstrate the best professional productivity, regardless of the training form.

Impact of multimodal dermatoscopy training on skin biopsies by primary care providers

Primary care providers (PCPs) play a pivotal role in skin cancer detection. With training, dermatoscopy improves skin cancer identification. Yet, access to dermatoscopy training remains a barrier for many PCPs.1Fee J.A. McGrady F.P. Rosendahl C. Hart N.D. Training primary care physicians in dermoscopy for skin cancer detection: a scoping review.J Cancer Educ. 2020; 35: 643-650https://doi.org/10.1007/s13187-019-01647-7Crossref PubMed Scopus (9) Google Scholar In this study, a multimodal dermatoscopy training intervention for novice dermatoscopist PCPs was implemented. We present the impact of the training intervention on the proportion of benign-to-malignant biopsies performed and on the number needed to biopsy (NNB) to detect a melanoma across the MaineHealth system. A needs assessment at our institution found that <10% of PCPs were trained to use dermatoscopy. To address this training gap, a multimodal dermatoscopy curriculum was created and implemented over a 1-year period. The curriculum provided foundational dermatoscopy training using a 90-minute dermatoscopy workshop, followed by monthly telementoring online review sessions.2Seiverling E.V. Li D. Stevens K. Cyr P. Dorr G. Ahrns H. Distance learning and spaced review to complement dermoscopy training for primary care.Dermatol Pract Concept. 2021; 11e2021030https://doi.org/10.5826/dpc.1102a30Crossref PubMed Scopus (5) Google Scholar A total of 267 PCPs participated in the training. A skin biopsy database was developed to analyze the impact of the intervention on the proportion of benign-to-malignant neoplasms being removed in the primary care setting. Here we present data comparing 5 years before the intervention (from November 5, 2013, to November 5, 2018) to almost 2 years after the intervention (from November 6, 2018, to October 1, 2020). Using the Current Procedural Terminology codes, skin biopsy data were extracted from electronic medical records using the Business Intelligence Portal (Epic). Pathology reports were manually reviewed by 2 reviewers (KS and MP) and entered into Research Electronic Data Capture. The inclusion criteria for PCPs were providers at MaineHealth in internal medicine, family medicine, internal medicine/pediatrics, and pediatrics. Skin biopsy reports were excluded in the following situations: rash, re-excision, pathology absent, and duplicate record. Biopsies were categorized by results (benign, malignant, and premalignant) and further into subtypes (benign: seborrheic keratosis, angioma, dermatofibroma, nevi, etc; malignant: basal cell carcinoma, squamous cell carcinoma, and melanoma). A total of 4565 biopsies were included in the preintervention group, whereas 2969 biopsies were included in the postintervention group. Two years following multimodal dermatoscopy training, significant shifts in biopsy percentages were demonstrated. There was a 10% shift from benign to malignant biopsy results found using binomial probability (P < .0001, Fig 1). The NNB for melanoma decreased from 119 before the intervention to 53 after the intervention (P < .001, Fig 2). Although there was a notable increase in the overall number of biopsies after the intervention, the NNB to detect melanoma was reduced by >50%. Our multimodal dermatoscopy curriculum included training on how to perform skin biopsies. The training may have led to increased confidence in performing skin biopsies and fewer external referrals for skin biopsies. As PCPs gain additional dermatoscopy skills, streamlined management and even “watchful waiting” of some skin cancers might be possible.3Wu X. Elkin E.B. Jason Chen C.S. Marghoob A. Traditional versus streamlined management of basal cell carcinoma (BCC): a cost analysis.J Am Acad Dermatol. 2015; 73: 791-798https://doi.org/10.1016/j.jaad.2015.07.021Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar,4van Winden M.E.C. Hetterschijt C.R.M. Bronkhorst E.M. van de Kerkhof P.C.M. de Jong E.M.G.J. Lubeek S.F.K. Evaluation of watchful waiting and tumor behavior in patients with basal cell carcinoma: an observational cohort study of 280 basal cell carcinomas in 89 patients.JAMA Dermatol. 2021; 157: 1174-1181https://doi.org/10.1001/jamadermatol.2021.3020Crossref PubMed Scopus (9) Google Scholar These strategies might help reduce health care costs and overdiagnosis. As we shift toward value-based care models, dermatoscopy has the potential to hit on all aspects of the quadruple aim.5Sikka R. Morath J.M. Leape L. The Quadruple Aim: care, health, cost and meaning in work.BMJ Qual Saf. 2015; 24: 608-610https://doi.org/10.1136/bmjqs-2015-004160Crossref PubMed Scopus (298) Google ScholarFig 2Impact of multimodal dermatoscopy training on number needed to biopsy to detect 1 melanoma by year. The training intervention duration is indicated by the time between the 2 vertical lines.View Large Image Figure ViewerDownload Hi-res image Download (PPT) The limitations of this study are that the postintervention data were limited to 23 months and the sample size for melanomas was small. Without a control group, we were unable to determine how much of the improvement in biopsy ratios and NNB was due to additional clinical experience. We also have not accounted for changes in skin cancer incidence in our patient population. None disclosed.

P281 TELEIBD: A telematic fast-track pathway for patients with high suspicion of Inflammatory Bowel Disease in primary care

Abstract Background The incidence and prevalence of Inflammatory bowel disease (IBD) are increasing in the last years. In primary care (PC) patients often present with confusing and non-specific symptoms which can often be a delay in referring and diagnosing suspected IBD. The average time from symptom onset to diagnosis of IBD is longer than five years in up to 18% of cases and 64% of patients presenting to emergency care with symptoms of IBD prior to the diagnosis. Shared care protocols and closer working with integrated care teams can bridge the gap between primary and specialized care, improving their assistance Methods This is a retrospective study that evaluates the results of TELEIBD (telematic circuit care) in patients with high diagnostic suspicion of IBD between PC and IBD Unit of our health area since its implementation in August 2019 to October 2020. The number of telematic consultations, average resolution time, adaptation to referral criteria, complementary tests requested and diagnostic confirmation were evaluated. TELEIBD establishes the issuance of a telematic consultation through the electronic clinical history when a patient meets previously established criteria. Specialized IBD physician who evaluates the case, can advise a diagnostic or therapeutic attitude either by electronic means or face-to-face with the patient. Results A total number of 77 care consultations from 77 patients (58,4% females) have been made. The average age was 49,2 years and the average reponse time were 7,5 days. After teleconsultation, 46 patients (59.7%) were not requested medical test. Lower gastrointestinal endoscopy (LGE) was performed in 25 patients, blood and faecal calprotectin testing in 7 patients, magnetic resonance (MR) or computer tomographic (CT) enterography in 6 patients. Taking into account the criteria for referral to a specialist, a total of 15 patients (19,5%) fully met the criteria, 13 patients (16,9%) partially met the criteria and 49 patients (63,6%) did not meet it. The main reason fot not meeting the criteria were the inadequated use of TELEIBD (53,1%). Of the 25 LGE requested, 3 were suggestive of Ulcerative Colitis (UC) and 1 of Crohn’s Disease (CD). Diagnosis of CD was confirmed in 2 patients, using MR or CT enterography. Diagnoses were reached in 4 patients, 3 of the group that met referral criteria (20%) and 1 of the group that partially met it (7.7%). The diagnosis was not achieved in any patient who did not partially and/or fully meet the referral criteria. Conclusion TELEIBD can be a useful tool for the quick assessment of patients who meet the criteria for high suspicion of IBD. Training primary care physicians in the referral criteria of the pathway is essential to improve the functioning of the circuit.

Implementing Cancer Screening Programs by Training Primary Care Physicians in India—Findings from the National Institute of Cancer Prevention Research Project ECHO for Cancer Prevention

In 2016, the Government of India launched a national program for screening and prevention of oral, breast, and cervical cancer. In support, the National Institute for Cancer Prevention Research (NICPR) adopted the Project ECHO (Extension for Community Healthcare Outcomes) model for training health care providers in cancer screening. We assess change in knowledge and skills among physicians attending hybrid (i.e., online and in person) NICPR-ECHO trainings and impact on implementation of cancer screening services. Prior to the start of the online phase and upon completion of 14 weeks, trainees answered a 23-item online questionnaire, including visual vignettes. We conducted descriptive and bivariate analysis of pre-post assessments from trainees participating in the online phase and wherever available report on the weekly quizzes and the hands-on workshop assessments. A total of 641 medical officers participated in the trainings from May 2019 to February 2020. Across nine cohorts of trainees, only 116 primary care physicians completed both the pre- and post-assessments. Almost two-thirds completed medical training (69.7%) and 85% were working in government healthcare facilities. Trainees reported statistically significant improvements before and after the online phase, when queried specifically on knowledge and skills using visual vignettes about oral (p < 0.001), breast (p = 0.35), and cervical cancer screening (p < 0.001). Study findings support the effectiveness of Project ECHO in reaching primary care physicians across the country and improving their knowledge and skills related to screening for breast, oral, and cervical cancer, with additional support needed for implementation of clinical cancer screening services.

A public health approach to suicide prevention in the Indian setting

Suicide prevention should be one of the top global priorities. A public health approach is the one which is likely to produce the best results. Suicide prevention cannot be achieved in isolation – addressing the social determinants of health and mental health is integral to this. Identifying collaborators, situation analysis, assessing the availability of resources, advocacy, gaining commitment of the political leadership, and tackling stigma are integral components. Suicide prevention should be aimed at all levels – primary, secondary, and tertiary. Increasing awareness, identification of risk and protective factors, training of primary care physicians and other health personnel, helplines, restriction of the means, responsible media reporting, and multisectoral collaboration are important strategies.

General medical practice in educational programs of the Ural State Medical University. Place and role in the training of primary care physicians

<h3></h3> В статье обсуждаются место и роль дисциплины «Общая врачебная практика» в образовательных программах Уральского государственного медицинского университета как фактор повышения качества подготовки специалистов для первичного звена здравоохранения на этапах специалитета, ординатуры, программ дополнительного образования врачей. Показан опыт кафедры профилактической и семейной медицины в разработке учебных программ, системообразующим вектором которых является научно обоснованная профилактика, базирующаяся на биопсихосоциальной концепции. Такой подход способствует приобретению обучающимися компетенций, требуемых Федеральными государственными образовательными стандартами высшего образования, формирует навыки, необходимые для успешного выполнения трудовых функций действующих профессиональных стандартов.