Willingness Of Physicians Research Articles

Family Medicine Preceptorships for First Year Medical Students: Durable Educational Value Amid Healthcare Transformation

In existence for decades, the first year required Family Medicine Preceptorship at the Duluth regional campus of the University of Minnesota Medical School has provided students with opportunities to work with regional family physicians. Exposing medical students to excellent primary care of patients early in the curriculum remains an educational priority. This time series analysis for the years 1992, 2002 and 2012 examines the physician’s practice structure (physician-owner versus employed physician) along with physician willingness to participate. As anticipated, the data demonstrate a transition from independent practice to larger health systems; physicians in large health systems at 22.9% (1992); 28.8% (2002); and 64.3% (2012). In addition, a downward trend in the percentage of physicians agreeing to serve as preceptors is reported (1992 at 83.61%; 2002 at 70.97%; and 2012 at 61.22%). This time series analysis also provides comparative data summarizing student opinion and evaluation of these experiences from the years 1992, 2012 and 2015. Despite changes in practice structure and fewer physicians agreeing to precept, the data demonstrate consistently high ratings by medical students over time.

LO85: Knowledge, attitudes, and practices regarding opioid use in the pediatric emergency department

Introduction: Inadequate pain management in children is ubiquitous in the emergency department (ED). As the current national opioid crisis has highlighted, physicians are caught between balancing pain management and the risk of long term opioid dependence. This study aimed to describe pediatric emergency physicians (PEPs) willingness to prescribe opioids to children in the ED and at discharge. Methods: A unique survey tool was created using published methodology guidelines. Information regarding practices, knowledge, attitudes, perceived barriers, facilitators and demographics were collected. The survey was distributed to all physician members of Pediatric Emergency Research Canada (PERC), using a modified Dillmans Tailored Design method, from October to December 2017. Results: The response rate was 49.7% (124/242); 53% (57/107) were female, mean age was 43.6 years (+/− 8.7), and 58% (72/124) had pediatric emergency subspecialty training. The most common first line ED pain medication was ibuprofen for mild, moderate and severe musculoskeletal injury (MSK-I)-related pain (94.4% (117/124), 89.5% (111/124), and 62.9% (78/124), respectively). For moderate and severe MSK-I, intranasal fentanyl was the most common opioid for first (35.5% (44/124) and 61.3% (76/124), respectively) and second line pain management (41.1% (51/124) and 20.2% (25/124), respectively). 74.8% (89/119) of PEPs reported that an opioid protocol would be helpful, specifically for morphine, fentanyl, and hydromorphone. Using a 0-100 scale, physicians minimally worried about physical dependence (13.3 +/−19.3), addiction (16.6 +/−19.8), and diversion of opioids (32.8+/−26.4) when prescribing short-term opioids to children. They reported that the current opioid crisis minimally influenced their willingness to prescribe opioids (30.0 +/−26.2). Physicians reported rarely (36%; 45/125) or never (28%; 35/125) completing a screening risk assessment prior to prescribing opioids. Conclusion: Ibuprofen remains the most common medication recommended for MSK-I pain in the ED and at discharge. Intranasal fentanyl was the top opioid for all pain intensities. PEPs are minimally concerned regarding dependence, addiction, and the current opioid crisis when prescribing short-term opioids to children. There is an urgent need for robust evidence regarding the dependence and addiction risk for children receiving short term opioids in order to create knowledge translation tools for ED physicians. Opioid specific protocols for both in the ED and at discharge would likely improve physician comfort in responsible and adequate pain management for children.

An Investigation of Prescription Indicators and Trends Among General Practitioners and Specialists From 2005 to 2015 in Kerman, Iran.

Background: The World Health Organization (WHO) aims to promote strategies that ensure efficacy, safety, suitability, and cost-effectiveness of medicine prescription. Health systems should design effective mechanisms to monitor prescription and rational use of medicines at all healthcare settings. This study aimed to determine and analyze prescription patterns of general practitioners and specialists in Kerman/Iran from 2005 to 2015. Methods: This is an explanatory mixed method study. Data were gathered during two phases. At the first phase, prescriptions issued by physicians during 2005-2015 were reviewed to extract information required to develop eight main prescription indicators. In the second phase, the indicators trends were presented to experts participating in expert panel to have their opinions and analyses on the data obtained in the first phase. Experts were selected based on their experience and expertise in medicine and/or health policy and/or experience in implementation of polices to promote rational use of medicines. Some experts attending the panel were a sample of physicians whose prescriptions were included in the first phase. Results: Findings revealed that two indicators of the average price of prescriptions and the maximum number of medicines in each prescription had an increasing trend over the study period. Reasons including unprecedented devaluation of the Iranian Rial and willingness of young physicians to prescribe more medications were proposed as the primary contributors to the observed increasing trends. However, other indicators including types of prescribed medicines, average number of medicines per prescription, the percentage of prescriptions with more than four medications, a percentage of encounters with a corticosteroid prescribed, a percentage of encounters with an antibiotic prescribed, and a percentage of encounters with an injection prescribed decreased in the study period. Reasons of controlling initiatives adopted by the Ministry of Health, the higher responsibility of physicians, adoption of continued medical education (CME) programs, and improved knowledge of pharmacists, physicians, and patients about irrational use of medicines were proposed by participants as the main reasons for the decreasing trend. Conclusion: Findings indicated that prescription indicators were better in Kerman than those of country average over the study period based on comparing the results of this study and others in Iran. However, they were non-desirable when compared to the international average. The number of factors contributes to the irrational use of medicines, including lack of knowledge among healthcare providers and patients, patients’ misunderstanding about the efficacy of some particular medicines, the high cost of drug development and manufacturing, and unavailability of effective medicines.

Women in rural family medicine: a qualitative exploration of practice attributes that promote physician satisfaction.

The USA needs more rural physicians. Although women represent half of all US trained medical students, the rural physician workforce has remained predominantly male. Insight is needed into what makes rural practice attractive for women and which practice characteristics allow women physicians to practice successfully in rural areas. This study's purpose was to examine aspects of the practice environment that impact women physicians' professional satisfaction and commitment to rural medicine. Twenty-five women family physicians practicing in rural areas of the USA were interviewed by phone using a semi-structured format. Transcribed interviews were analyzed using an immersion and crystallization approach. Emergent themes were identified, coded, and discussed until team consensus was attained. Interviews continued until saturation of themes was reached. Three themes emerged from the data, in relationship to practice and employment attributes that contribute to US women physicians' professional satisfaction and willingness to remain in a rural setting: professional relationships, practice characteristics, and support during times of transition. Participants placed high importance on professional relationships, both within and outside of their rural practice. Rural women physicians enjoyed practicing an expanded scope of care, valued loan repayment opportunities, and appreciated supportive practice partners. Importantly, women physicians who found themselves struggling to maintain rural careers often had experienced difficulty during times of practice transition, including maternity leaves. Understanding practice attributes valued by successful rural women family physicians in the USA will help rural health systems, practices, and physicians-in-training to develop and evaluate opportunities that will best contribute to successful rural practice. Supporting women physicians during periods of practice transition may improve retention.

Physicians' experiences of SBIRT training and implementation for SUD management in primary care in the UAE: a qualitative study.

Substance misuse in the UAE is an increasing problem. However religious beliefs and fear of legal consequences have prevented this topic from being openly discussed, risk levels identified through screening and treatment options offered. A controlled trial was undertaken which included a qualitative process study which is reported here. Qualitative interviews with primary care physicians from two intervention clinics were undertaken to explore their views, experiences and attitudes towards substance misuse management in their clinic. Physicians were trained on SBIRT and on the research project process and documentation. At completion of the project, 10 months after the training, physicians (n=17) were invited to participate in an interview to explore their experiences of training and implementation of SBIRT. Interviews were recorded and transcribed. Inductive thematic coding was applied.FindingsIn total, 11 physicians were interviewed and three main themes emerged: (1) The SBIRT screening project, (2) cultural issues and (3) patient follow-up. Findings revealed a general willingness toward the concept of screening and delivering brief interventions in primary care although increased workload and uncertainties about remuneration for the service may be a barrier to future implementation. There was a perceived problem of substance misuse that was not currently being met and a strong perception that patients were not willing to reveal substance use due cultural barriers and fear of police involvement. In conclusion this qualitative process evaluation provided essential insight into implementing SBIRT in the Middle East. In conclusion, despite physician willingness and a clinical need for a substance misuse care pathway, the reluctance among patients to admit to substance use in this culture needs to be addressed to enable successful implementation.

Readiness and willingness of Bulgarian physicians and nurses to face the challenges of eHealth

Readiness and willingness of Bulgarian physicians and nurses to face the challenges of eHealth

Interprofessional learning: learning gain and change of attitude in first semester medical students / Interprofessionelles Lernen: Lernzuwachs und Einstellungsänderung bei Medizinstudierenden im 1. Semester

Abstract Background The competence and willingness of physicians to work in interprofessional teams is important for the quality of patient care. To train this competence, the integration of interprofessional learning into undergraduate medical curricula is recommended by experts. This study analyses how a single interprofessional teaching course impacts on medical students’ learning gain and change of attitude towards interprofessional collaboration. Method With a questionnaire study in a pre/post design, the learning gain of five learning goals were analyzed. For analyzing change of attitude towards interprofessional collaboration, the “Readiness for interprofessional learning scale” was used in a German translation (RIPLS-D). 71 interprofessionally taught medical students were compared to 227 monoprofessionally taught medical students. In addition, the subjective impressions of the course were analyzed qualitatively by free text answers. Results Four out of five learning goals show no differences in the extent of learning gain between inter- and monoprofessionally taught groups. The group comparison shows a change of attitude towards interprofessional collaboration for the interprofessionally taught group. The free text responses show positive feedback on the course and suggest good acceptance of interprofessional learning. Discussion The present study is evidence of a positive impact of interprofessional teaching on medical students’ willingness towards interprofessional collaboration. In addition, medical students express a good acceptance for interprofessional learning. In order to detect long-term effects on health care practice, conditions for long-term testing of interprofessional teaching should be established in undergraduate medical curricula.

The Role of Municipalities in Lower Saxony for Future Physician's Care - A Survey of Mayors and District Administrators

Comprehensive outpatient medical care is being increasingly threatened due to the decreasing willingness of physicians to establish their practices in rural areas. Partly, municipalities feel impelled to support doctors setting up their practices with their own resources. The aim of this study was to get the community perspective on the ambulatory care situation and to examine the role and influence of the local authorities. The mayors (n=411) and district administrators (n=38) in Lower Saxony received a self-developed written questionnaire in September 2015 (comprehensive survey). The response rate was 72%. Availability of general practitioners was considered as inadequate by 30% of those surveyed and 71% described specialist care as being insufficient. Two-thirds of respondents saw local problems with filling vacant doctors' offices. 42% of mayors and 65% of district administrators said they had already supported outpatient doctors. The most frequent measures carried out so far included financial support, consulting services and the development of cooperation and networks. The majority considered the model of medical care centers being operated under municipal sponsorship to be unsuitable in principle. Local governments prevalently see problems with filling vacant doctors' offices as well as a need for local support. A significant proportion of municipalities has already implemented various support measures. Community participation in the outpatient care with medical care centers under municipal sponsorship is assessed rather critically.

Dying From Cancer

Medical oncologists and patients with advanced cancer struggle to discuss prognosis, goals, options, and values in a timely fashion. As a consequence, many patients die receiving aggressive treatment potentially inconsistent with their fully informed preferences and experience increased symptom burden and distress. The goals of patient - oncologist communication include exchanging information, building relationship, and engaging in shared decisions. Empathy is perhaps especially essential to effective patient - oncologist communication when the end of life is approaching. We speculate that, in addition to being a skilled response to a patient’s negative emotions, empathy is an emergent property of the relationship that allows the patient and oncologist to imagine what it will be like to navigate the transition from living with to dying from cancer; and to prepare for the transition. We propose that effective empathy: 1) requires an attentive, curious and imaginative physician; 2) acknowledges the complex and shifting goals as the end of life approaches; and 3) begins with a willingness of physicians to check in and find out what she may have misunderstood or misperceived. Empathy in end of life conversations cultivates the shared experiences necessary to co-create the new goals of care that underlie excellent end of life care.

Standardized Treatment of Pulmonary Exacerbations (STOP) study: Observations at the initiation of intravenous antibiotics for cystic fibrosis pulmonary exacerbations

BackgroundThe Standardized Treatment of Pulmonary Exacerbations (STOP) program has the intent of defining best practices in the treatment of pulmonary exacerbations (PEx) in patients with cystic fibrosis (CF). The objective of this analysis was to describe the clinical presentations of patients admitted for intravenous (IV) antibiotics and enrolled in a prospective observational PEx study as well as to understand physician treatment goals at the start of the intervention. MethodsWe enrolled adolescents and adults admitted to the hospital for a PEx treated with IV antibiotics. We recorded patient and PEx characteristics at the time of enrollment. We surveyed treating physicians on treatment goals as well as their willingness to enroll patients in various study designs. Additional demographic and clinical data were obtained from the CF Foundation Patient Registry. ResultsOf 220 patients enrolled, 56% were female, 19% were adolescents, and 71% were infected with P. aeruginosa. The mean (SD) FEV1 at enrollment was 51.1 (21.6)% predicted. Most patients (85%) experienced symptoms for ≥7days before admission, 43% had received IV antibiotics within the previous 6months, and 48% received oral and/or inhaled antibiotics prior to IV antibiotic initiation. Forty percent had ≥10% FEV1 decrease from their best value recorded in the previous 6months, but for 20% of patients, their enrollment FEV1 was their best FEV1 recorded within the previous 6months. Physicians reported that their primary treatment objectives were lung function recovery (53%) and improvement of symptoms (47%) of PEx. Most physicians stated they would enroll patients in studies involving 10-day (72%) or 14-day (87%), but not 7-day (29%), treatment regimens. ConclusionsBased on the results of this study, prospective studies are feasible and physician willingness for interventional studies of PEx exists. Results of this observational study will help design future PEx trials.

The International NERSH Data Pool—A Methodological Description of a Data Pool of Religious and Spiritual Values of Health Professionals from Six Continents

Collaboration within the recently established Network for Research on Spirituality and Health (NERSH) has made it possible to pool data from 14 different surveys from six continents. All surveys are largely based on the questionnaire by Curlin “Religion and Spirituality in Medicine, Perspectives of Physicians” (RSMPP). This article is a methodological description of the process of building the International NERSH Data Pool. The larger contours of the data are described using frequency statistics. Five subscales in the data pool (including the already established DUREL scale) were tested using Cronbach’s alpha and Principal Component Analysis (PCA) in an Exploratory Factor Analysis (EFA). 5724 individuals were included, of which 57% were female and the mean age was 41.5 years with a 95% confidence interval (CI) ranging from 41.2 to 41.8. Most respondents were physicians (n = 3883), nurses (n = 1189), and midwives (n = 286); but also psychologists (n = 50), therapists (n = 44), chaplains (n = 5), and students (n = 10) were included. The DUREL scale was assessed with Cronbach’s alpha (α = 0.92) and PCA confirmed its reliability and unidimensionality. The new scales covering the dimensions of “Religiosity of Health Professionals (HPs)” (α = 0.89), “Willingness of Physicians to Interact with Patients Regarding R/S Issues” (α = 0.79), “Religious Objections to Controversial Issues in Medicine” (α = 0.78), and “R/S as a Calling” (α = 0.82), also proved unidimensional in the PCAs. We argue that the proposed scales are relevant and reliable measures of religious dimensions within the data pool. Finally, we outline future studies already planned based on the data pool, and invite interested researchers to join the NERSH collaboration.

Physician Satisfaction With Clinical Laboratory Services: A College of American Pathologists Q-Probes Study of 81 Institutions.

-Assessment of customer satisfaction is a vital component of the laboratory quality improvement program. -To survey the level of physician satisfaction with hospital clinical laboratory services. -Participating institutions provided demographic information and survey results of physician satisfaction, with specific features of clinical laboratory services individually rated on a scale of 5 (excellent) to 1 (poor). -Eighty-one institutions submitted 2425 surveys. The median overall satisfaction score was 4.2 (10th percentile, 3.6; 90th percentile, 4.6). Of the 16 surveyed areas receiving the highest percentage of excellent/good ratings (combined scores of 4 and 5), quality of results was highest along with test menu adequacy, staff courtesy, and overall satisfaction. Of the 4 categories receiving the lowest percentage values of excellent/good ratings, 3 were related to turnaround time for inpatient "STAT" (tests performed immediately), outpatient STAT, and esoteric tests. The fourth was a new category presented in this survey: ease of electronic order entry. Here, 11.4% (241 of 2121) of physicians assigned below-average (2) or poor (1) scores. The 5 categories deemed most important to physicians included quality of results, turnaround times for inpatient STAT, routine, and outpatient STAT tests, and clinical report format. Overall satisfaction as measured by physician willingness to recommend their laboratory to another physician remains high at 94.5% (2160 of 2286 respondents). -There is a continued trend of high physician satisfaction and loyalty with clinical laboratory services. Physician dissatisfaction with ease of electronic order entry represents a new challenge. Test turnaround times are persistent areas of dissatisfaction, representing areas for improvement.

Continuity of clinical management and information across care levels: perceptions of users of different healthcare areas in the Catalan national health system.

BackgroundThe integration of health care has become a priority in most health systems, as patients increasingly receive care from several professionals in various different settings and institutions, particularly those with chronic conditions and multi-morbidities. Continuity of care is defined as one patient experiencing care over time as connected and coherent with his or her health needs and personal circumstances. The objective is to analyse perceptions of continuity of clinical management and information across care levels and the factors influencing it, from the viewpoint of users of the Catalan national health system.MethodsA descriptive-interpretative qualitative study was conducted using a phenomenological approach. A two-stage theoretical sample was selected: (i) the study contexts: healthcare areas in Catalonia with different services management models; (ii) users ≥ 18 years of age who were attended to at both care levels for the same health problem. Data were collected by means of individual semi-structured interviews with patients (n = 49). All interviews were recorded and transcribed. A thematic content analysis was conducted segmented by study area, with a mixed generation of categories and triangulation of analysts.ResultsPatients in all three areas generally perceived that continuity of clinical management across levels existed, on referring to consistent care (same diagnosis and treatment by doctors of both care levels, no incompatibilities of prescribed medications, referrals across levels when needed) and accessibility across levels (timeliness of appointments). In terms of continuity of information, patients in most areas mentioned the existence of information sharing via computer and its adequate usage. Only a few discontinuity elements were reported such as long waiting times for specific tests performed in secondary care or insufficient use of electronic medical records by locum doctors. Different factors influencing continuity were identified by patients, relating to the health system itself (clear distribution of roles between primary and secondary care), health services organizations (care coordination mechanisms, co-location, insufficient resources) and physicians (willingness to collaborate, commitment to patient care, the primary care physician’s technical competence).ConclusionsCare continuity across care levels is experienced by patients in the areas studied, with certain exceptions that highlight where there is room for improvement. Influencing factors offer valuable insights on where to direct coordination efforts.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1696-8) contains supplementary material, which is available to authorized users.

Primary Care Physicians' Characteristics and Attitudes on Smoking Cessation.

Primary care physicians are uniquely positioned to initiate and promote smoking cessation. However, their attitude towards smoking cessation is influenced by many factors, including their own smoking habits and knowledge. The aim of the study was to assess the impact of smoking habits, knowledge, and personal characteristics of primary care physicians on their attitude towards smoking cessation in comparison to a previous study conducted a decade ago. Overall, 302 primary care physicians filled out a questionnaire designed specifically to evaluate knowledge, smoking habits, and smoking cessation interventions they use. More never-smoking physicians initiate conversations about smoking cessation, recommend smoking cessation groups, and set quit date to their smoking patients. They also invest greater efforts in patients with smoking complications. More current-smoking physicians advise Nicotine Replacement Therapy and joining Internet forums and telephone consultations. Keeping good relations with the patients plays an important role in the willingness of physicians to initiate a talk. A large proportion of physicians state they would prescribe smoking cessation medications to patients even when contraindicated. The various approaches of primary care physicians emphasize the importance of physician education according to their own smoking habits.

The Economic Impact of the Introduction of Biosimilars in Inflammatory Bowel Disease

Inflammatory bowel disease [IBD] entails a high economic burden to society. We aimed to estimate the current and future impact of the introduction of biosimilars for infliximab on IBD-related health care costs. We designed a stochastic economic model to simulate the introduction of biosimilars in IBD, using a 5-year time horizon, based on the Dutch situation. Prevalence data on ulcerative colitis [UC] and Crohn's disease [CD] and IBD-related health care costs data were used as input. Assumptions were made on price reductions of anti-tumour necrosis factor [TNF] therapy, increase of anti-TNF prescription rate, and development of hospitalization costs. The base case scenario included a gradual decrease in prices of biosimilars up to 60%, a gradual decrease in prices of original anti-TNF compounds up to 50%, and an annual increase of anti-TNF prescription rate of 1%, and this was compared with no introduction of biosimilars. Sensitivity analyses were performed. For the base case, cost savings over the total of 5 years were on average €9,850 per CD patient and €2,250 per UC patient, yielding in €493 million total cost savings [a reduction of 28%] for The Netherlands. Results were predominantly determined by price reduction of anti-TNF therapy, threshold price reduction at which physicians switch patients towards biosimilars and the extent to which switching will take place. The introduction of biosimilars for infliximab can be expected to have a major impact on the cost profile of IBD. The economic impact will depend on local pricing, procurement policies and the physician's willingness to switch patients to biosimilars.

Factors influencing physicians' knowledge sharing on web medical forums.

Web medical forums are relatively unique as knowledge-sharing platforms because physicians participate exclusively as knowledge contributors and not as knowledge recipients. Using the perspective of social exchange theory and considering both extrinsic and intrinsic motivations, this study aims to elicit the factors that significantly influence the willingness of physicians to share professional knowledge on web medical forums and develops a research model to explore the motivations that underlie physicians' knowledge-sharing attitudes. This model hypothesizes that constructs, including shared vision, reputation, altruism, and self-efficacy, positively influence these attitudes and, by extension, positively impact knowledge-sharing intention. A conventional sampling method and the direct recruitment of physicians at their outpatient clinic gathered valid data from a total of 164 physicians for analysis in the model. The empirical results support the validity of the proposed model and identified shared vision as the most significant factor of influence on knowledge-sharing attitudes, followed in descending order by knowledge-sharing self-efficacy, reputation, and altruism.

Physician-facilitated designation of proxy decision maker.

With vast improvements in healthcare in recent decades, people are living longer but often with higher rates of morbidity and chronic illnesses. This has resulted in a higher proportion of the population who may benefit from early end-of-life ‘conversation and planning’, but also gives healthcare professionals more time during which these discussions are relevant, as people live longer with their chronic diseases. A survey conducted by Lifshitz et al (Isr J Health Policy Res 5:6, 2016) sought to assess physician awareness and willingness to discuss designating a proxy decision-maker with patients, in order to aid end-of-life care in the event that the patient is rendered unable to make or communicate these decisions later in life.Their article suggests that proxy decision-maker designation is only one aspect of end-of-life care; a challenging area littered with ethical and moral dilemmas. Without early, open and frank discussions with patients regarding their wishes at the end of life, proxy decision-makers may be in no better position than physicians or a court appointed proxy to make decisions in the patients’ best interests/benefits. This commentary also touches upon the use of health and care passports being developed or in early phases in the United Kingdom, and whether these may be utilised in the field of palliative care in Israel.

A cross-sectional observation study regarding patients and their physician willingness to wait for driver mutation report in nonsmall-cell lung cancer.

Background:Palliative chemotherapy +/− targeted therapy in accordance with mutation profile is the norm in nonsmall-cell lung cancer (NSCLC). The objective of this audit was to determine the proportion of patients and physicians, who are unwilling to wait for the mutation report and the reasons thereof.Materials and Methods:All newly diagnosed NSCLC patients, post biopsy, seen at our center between November 2014 and January 2015 were included. The relationship between patient and physician decision and objective factors was explored by Fisher's exact test. The factors considered were Eastern Cooperative Oncology Group performance status (ECOG PS), the presence of a cough, hemoptysis, fatigue, and breathlessness. The agreement between patients and physician decision was tested by contingency table.Results:Out of 168 patients, 57 were unwilling to wait for driver mutation report (33.9% 95% confidence interval [CI] 27.2-41.4%). The most common reason provided by patients was symptomatic status (23, 40.1%). No other objective factor except PS (P = 0.00) was associated with patient's decision. In 56 patients (33.4% 95% CI 26.6-40.7%), physicians were unwilling to wait. Among the tested factors ECOG PS (P = 0.000), breathlessness (P = 0.00) and fatigue (P = 0.00) were associated with the decision of not waiting for the report. The percentage corrected value of contingency between patients and physician decision was 78.74%.Conclusion:At present, in our setup, nearly one-third of our NSCLC patients opt for immediate chemotherapy treatment and are unwilling to wait for mutation analysis report. The major reasons for such attitude is poor symptom control and deteriorating general condition.

Emergency Department-based Opioid Harm Reduction: Moving Physicians From Willing to Doing.

Develop and internally validate a survey tool to assess emergency department (ED) physician attitudes, clinical practice, and willingness to perform opiate harm reduction (OHR) interventions and to identify barriers and facilitators in translating willingness to action. This study was an anonymous, Web-based survey based on the Theory of Planned Behavior of ED physicians at three tertiary referral centers. Construction and internal validation of scaled questions was assessed through principal component and Cronbach's alpha analyses. Stepwise linear regression was conducted to measure impact of physician knowledge, attitudes, confidence, and self-efficacy on willingness to perform OHR interventions including opioid overdose education; naloxone prescribing; and referral to naloxone, methadone, and syringe access programs. A total of 200 of 278 (71.9%) physicians completed the survey. Principal component analysis yielded five components: attitude, confidence, self-efficacy, professional impact factors, and personal impact factors. Overall, respondents were willing to perform OHR interventions, but few actually do. Willingness was correlated with attitude, confidence, and self-efficacy (R(2) =0.50); however, overall physicians lacked confidence (mean=3.06 of 5, 95% confidence interval [CI]=2.94 to 3.18]). Knowledge, time, training, and institutional support were all prohibitive barriers. Physicians reported that research evidence, professional organization recommendations, and opinions of ED leaders would strongly influence a change in their clinical practice to incorporate OHR interventions (mean=4.25 of 5, 95% CI=4.18 to 4.32). Compared to prior studies, emergency medicine physicians had increased willingness to perform OHR interventions, but there remains a disparity between willingness and clinical practice. Influential factors that may move physicians from "willing" to "doing" include dissemination of supportive research evidence; professional organization endorsement; ED leadership opinion; and addressing time, knowledge, and institutional barriers.

EHealth and the need for education in biomedical and health informatics for the physicians in Bulgaria

Introduction . eHealth applications are numerous: electronic health records, evidence-based practice, delivering care from a distance, patient self-care, epidemiological research, healthcare management activities etc. However, the effective provision of healthcare as appropriate to the eHealth environment, needs not only suitable buildings and modern medical equipment, it needs adequately trained healthcare staff. The aim of this study is to assess the readiness and the willingness of the Bulgarian physicians to work in eHealth environment and to give reason for their still actual necessity of education in biomedical and health informatics. Material and methods . An enquiry was carried out in 2013 among the physicians in Bulgaria aiming at the assessment of their knowledge of using computers in their daily medical practice, their attitude to eHealth and their readiness to work in eHealth environment. Results. The results of the study showed the positive attitude of the Bulgarian physicians to information technologies (97%) and their recognized need of using computers in medicine (91.9%). Although 77.49% declared that they have the necessary skills and knowledge to use computers, the study proved that this is just a basic computer literacy (word-processing and Internet). About half of the respondents recognize the need of additional education: databases and medical information systems (37.64%), graphical software (40.59%), statistical software (47.98%), specialized medical software (48.34%). The majority of the participants (86%) wish to personally use computers in their daily medical practice, yet only 38.4% of them wish to enter patient data in a computer by themselves. In fact, only 17.7% are aware of the principles of eHealth. Conclusions . Тhe adequate education in biomedical and health informatics is one of the most important prerequisites for the successful implementation of eHealth in Bulgaria. Keywords : Biomedical and health Informatics, eHealth, computer literacy, ICT