Family practice最新文献_第3页

The long-term impacts of opioid use before and after joint arthroplasty: matched cohort analysis of New Zealand linked register data. 关节置换术前后阿片类药物使用的长期影响：新西兰关联登记数据的匹配队列分析。

IF 2.4 4区医学

Family practice Pub Date : 2024-12-02 DOI: 10.1093/fampra/cmad112

Yana Pryymachenko, Ross Wilson, John Haxby Abbott, Michelle Dowsey, Peter Choong

{"title":"The long-term impacts of opioid use before and after joint arthroplasty: matched cohort analysis of New Zealand linked register data.","authors":"Yana Pryymachenko, Ross Wilson, John Haxby Abbott, Michelle Dowsey, Peter Choong","doi":"10.1093/fampra/cmad112","DOIUrl":"10.1093/fampra/cmad112","url":null,"abstract":"Background: Opioids are commonly used both before and after total joint arthroplasty (TJA).Objective: The objective of this study was to estimate the long-term effects of pre- and perioperative opioid use in patients undergoing TJA.Methods: We used linked population datasets to identify all (n =18,666) patients who had a publicly funded TJA in New Zealand between 2011 and 2013. We used propensity score matching to match individuals who used opioids either before surgery, during hospital stay, or immediately post-discharge with individuals who did not based on a comprehensive set of covariates. Regression analysis was used to estimate the effect of opioid use on health and socio-economic outcomes over 5 years.Results: Opioid use in the 3 months prior to surgery was associated with significant increases in healthcare utilization and costs (number of hospitalizations 6%, days spent in hospital 14.4%, opioid scripts dispensed 181%, and total healthcare costs 11%). Also increased were the rate of receiving social benefits (2 percentage points) and the rates of opioid overdose (0.5 percentage points) and mortality (3 percentage points). Opioid use during hospital stay or post-discharge was associated with increased long-term opioid use, but there was little evidence of other adverse effects.Conclusions: Opioid use before TJA is associated with significant negative health and economic consequences and should be limited. This has implications for opioid prescribing in primary care. There is little evidence that peri- or post-operative opioid use is associated with significant long-term detriments.","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":"916-924"},"PeriodicalIF":2.4,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11636625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138487036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Association of primary care visit length with outpatient utilization, continuity, and care processes. 初级保健就诊时间与门诊利用率、连续性和护理流程的关系。

IF 2.4 4区医学

Family practice Pub Date : 2024-12-02 DOI: 10.1093/fampra/cmad116

David T Liss, Andrew J Cooper, Manisha Cherupally, Tiffany Brown, Marilyn G Pearson

{"title":"Association of primary care visit length with outpatient utilization, continuity, and care processes.","authors":"David T Liss, Andrew J Cooper, Manisha Cherupally, Tiffany Brown, Marilyn G Pearson","doi":"10.1093/fampra/cmad116","DOIUrl":"10.1093/fampra/cmad116","url":null,"abstract":"Background: Little is known about how variation in the scheduled length of primary care visits can impact patients' patterns of health care utilization.Objective: To evaluate how the scheduled length of in-person visits with primary care physicians (PCPs) was associated with PCP and patient characteristics, outpatient utilization, and preventive care receipt.Methods: This retrospective cohort study examined data from a large American academic health system. PCP visit length template was defined as either 15- and 30-min scheduled appointments (i.e. 15/30), or 20- and 40-min scheduled appointments (i.e. 20/40).Results: Of 222 included PCPs, 85 (38.3%) used the 15/30 template and 137 (61.7%) used the 20/40 template. The 15/30 group had higher proportions of male (49.4%, vs. 35.8% in the 20/40 group) and family medicine (37.6% vs. 21.2%) physicians. In adjusted patient-level analysis (N = 238,806), having a 15/30 PCP was associated with 9% more primary care visits (incidence rate ratio [IRR], 1.09; 95% confidence interval [CI], 1.03-1.14), and 8% fewer specialty care visits (IRR, 0.92; 95% CI, 0.86-0.98). PCP visit length template was not associated with significant differences in obstetrics/gynaecology visits, continuity of care, or preventive care receipt. In interaction analyses, having a 15/30 PCP was associated with additional primary care visits among non-Hispanic White patients (IRR, 1.10; 95% CI, 1.04-1.16) but not among non-Hispanic Black patients.Conclusion: PCPs' choices about the scheduled length of in-person visits may impact their patients' specialty care use, and have varying impacts across different racial/ethnic groups.","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":"1002-1009"},"PeriodicalIF":2.4,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138829007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Preferences for training needs of village doctors in China: a systematic review. 中国乡村医生培训需求偏好的系统评价

IF 2.4 4区医学

Family practice Pub Date : 2024-12-02 DOI: 10.1093/fampra/cmad063

Liying Zhou, Xuefeng Wei, Yanan Wu, Xinxin Deng, Meng Xu, Xue Shang, E Fenfen, Guihang Song, Yiliang Zhu, Kehu Yang, Xiuxia Li

{"title":"Preferences for training needs of village doctors in China: a systematic review.","authors":"Liying Zhou, Xuefeng Wei, Yanan Wu, Xinxin Deng, Meng Xu, Xue Shang, E Fenfen, Guihang Song, Yiliang Zhu, Kehu Yang, Xiuxia Li","doi":"10.1093/fampra/cmad063","DOIUrl":"10.1093/fampra/cmad063","url":null,"abstract":"Background: Village doctors, as gatekeepers of the health system for rural residents in China, are often confronted with adversity in providing the basic public healthcare services.Objective: We sought to summarize the training contents, training method, training location, and training costs most preferred by village doctors in China and hope to provide evidence and support for the government to deliver better training in the future.Methods: Eight databases were searched to include studies that reported on the training needs of village doctors in China. We undertook a systematic review and a narrative synthesis of data.Results: A total of 38 cross-sectional studies including 35,545 participants were included. In China, village doctors have extensive training needs. \"Clinical knowledge and skill\" and \"diagnosis and treatment of common disease\" were the most preferred training content; \"continuing medical education\" was the most preferred delivery method; above county- and county-level hospitals were the most desirable training locations, and the training costs were expected to be low or even free.Conclusion: Village doctors in various regions of China have similar preferences for training. Thus, future training should focus more on the training needs and preferences of village doctors.","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":"874-882"},"PeriodicalIF":2.4,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9593014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Patients treated with vitamin K oral anticoagulants in family practice: a new approach to bleeding risk assessment. An ancillary study by the CACAO prospective general practice cohort. 家庭医生中接受维生素 K 口服抗凝剂治疗的患者：出血风险评估的新方法。CACAO前瞻性全科队列的辅助研究。

IF 2.4 4区医学

Family practice Pub Date : 2024-12-02 DOI: 10.1093/fampra/cmae052

Yoann Gaboreau, Paul Frappé, Celine Vermorel, Alison Foote, Jean-Luc Bosson, Gilles Pernod

{"title":"Patients treated with vitamin K oral anticoagulants in family practice: a new approach to bleeding risk assessment. An ancillary study by the CACAO prospective general practice cohort.","authors":"Yoann Gaboreau, Paul Frappé, Celine Vermorel, Alison Foote, Jean-Luc Bosson, Gilles Pernod","doi":"10.1093/fampra/cmae052","DOIUrl":"10.1093/fampra/cmae052","url":null,"abstract":"Background: The ability of bleeding risk scores to predict major bleeding (MB) or clinically relevant nonmajor bleeding (CRNMB) remains a topic of contention, particularly in nonselected patients in family practice. In addition, the capacity to predict bleeding risk using simple variables has yet to be established.Objectives: The main objective was to confirm that severe anemia was the most predictive factor for the estimation of bleeding risk in patients treated with vitamin K antagonists (VKAs). Secondary objectives were to test the capacity of different bleeding scores to detect high-risk patients. Subsequently, the impact of functional decline on bleeding incidence was explored.Methods: The CACAO study was a multicenter prospective cohort study of patients who, due to nonvalvular atrial fibrillation (NVAF) and/or venous thromboembolism (VTE), had been prescribed an oral anticoagulant by their general practitioner (GP) as a prophylactic measure. Patient characteristics were collected at the time of inclusion by GPs, who then monitored them in accordance with standard practice for one year. MB and CRNMB were the main outcomes for one year. By applying this approach, a total of 13 scores were analyzed.Results: Aaemia was found to be strongly associated with MB (HR: 2.77, 95% CI: 1.2-6.36), with a particularly pronounced association observed in cases of severe anemia (HR: 12.9, 95% CI: 2.76-60.35). Twelve out of 27 MB cases were not identified by at least half of the scores. By contrast, functional decline was identified as a novel factor associated with MB (HR: 2.45, 95% CI: 1.13-5.31).Conclusions: Preexisting anemia is a major prognostic factor associated with the occurrence of bleeding. It seems relevant to suggest that functional decline should be considered by GPs when assessing bleeding risk.","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":"932-940"},"PeriodicalIF":2.4,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Outcomes of antenatal depression in women and the new-born: a retrospective cohort study. 产前抑郁症对妇女和新生儿的影响：一项回顾性队列研究。

IF 2.4 4区医学

Family practice Pub Date : 2024-12-02 DOI: 10.1093/fampra/cmae041

Daniel Perejón López, Laura Gascó Serna, María Catalina Serna Arnáiz, Miriam Orós Ruiz, Júlia Siscart Viladegut, Joaquim Sol, Blanca Salinas-Roca

引用次数: 0

"We're trained to trust our patients": a qualitative study on the general practitioners' trust in patients for colorectal cancer shared care. “我们被训练来信任我们的患者”：一项关于全科医生对癌症患者共同护理的信任的定性研究。

IF 2.4 4区医学

Family practice Pub Date : 2024-12-02 DOI: 10.1093/fampra/cmad095

Faith R Yong, Sundresan Naicker, Kerry Uebel, Maria Agaliotis, Christopher Chan, John D T Nguyen, Thanya Pathirana, Alexandra Hawkey, Kylie Vuong

{"title":"\"We're trained to trust our patients\": a qualitative study on the general practitioners' trust in patients for colorectal cancer shared care.","authors":"Faith R Yong, Sundresan Naicker, Kerry Uebel, Maria Agaliotis, Christopher Chan, John D T Nguyen, Thanya Pathirana, Alexandra Hawkey, Kylie Vuong","doi":"10.1093/fampra/cmad095","DOIUrl":"10.1093/fampra/cmad095","url":null,"abstract":"Background: In a therapeutic partnership, physicians rely on patients to describe their health conditions, join in shared decision-making, and engage with supported self-management activities. In shared care, the patient, primary care, and specialist services partner together using agreed processes and outputs for the patient to be placed at the centre of their care. However, few empirical studies have explored physicians' trust in patients and its implications for shared care models.Aim: To explore trust in patients amongst general practitioners (GPs), and the impacts of trust on GPs' willingness to engage in new models of care, such as colorectal cancer shared care.Methods: GP participants were recruited through professional networks for semi-structured interviews. Transcripts were integrity checked, coded inductively, and themes developed iteratively.Results: Twenty-five interviews were analysed. Some GPs view trust as a responsibility of the physician and have a high propensity for trusting patients. For other GPs, trust in patients is developed over successive consultations based on patient characteristics such as honesty, reliability, and proactivity in self-care. GPs were more willing to engage in colorectal cancer shared care with patients with whom they have a developed, trusting relationship.Conclusions: Trust plays a significant role in the patient's access to shared care. The implementation of shared care should consider the relational dynamics between the patient and health care providers.","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":"1032-1038"},"PeriodicalIF":2.4,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11636565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41096977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Decrease in antibiotic prescription. 抗生素处方减少。

IF 2.4 4区医学

Family practice Pub Date : 2024-12-02 DOI: 10.1093/fampra/cmad053

Hilal Aksoy

引用次数: 0

Anaemia and its causes at the Brazilian Longitudinal Study of Adult Health: a cross-sectional analysis of baseline data. 巴西成人健康纵向研究中的贫血及其原因:基线数据的横断面分析。

IF 2.4 4区医学

Family practice Pub Date : 2024-12-02 DOI: 10.1093/fampra/cmad102

Cássia S S Silva, Isabela M Bensenor, Alessandra C Goulart, Paulo A Lotufo, Itamar S Santos

{"title":"Anaemia and its causes at the Brazilian Longitudinal Study of Adult Health: a cross-sectional analysis of baseline data.","authors":"Cássia S S Silva, Isabela M Bensenor, Alessandra C Goulart, Paulo A Lotufo, Itamar S Santos","doi":"10.1093/fampra/cmad102","DOIUrl":"10.1093/fampra/cmad102","url":null,"abstract":"Background: Most anaemia studies focus on children and women of childbearing age. We assessed the frequency and main aetiologies of anaemia according to sociodemographic characteristics at the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a cohort of middle-aged adults.Methods: The primary analyses included 15,051 participants aged 35-74 years with a valid blood cell count. We built logistic models to analyse the association between socioeconomic characteristics and anaemia diagnosis. We also described the main aetiologies in a subset (n = 209) of participants with anaemia.Results: Anaemia was present in 3.0% (95% confidence interval [95%CI]: 2.6-3.4%) of men and 7.4% (95%CI: 6.9-8.0%) of women. The frequency of anaemia diagnosis was higher in women in all subgroups except for the oldest age stratum (65-74 years). The frequency of anaemia was particularly high in Blacks (6.0% and 15.5% in men and women, respectively). The most common causes of anaemia were iron deficiency (in women), chronic kidney disease, and chronic inflammation (in men). The frequency of unexplained anaemia was respectively 33.3% and 34.2% for men and women, and this condition was more frequent among participants of Black or Mixed races.Conclusions: Anaemia was associated with age, female sex, Black race, and low socioeconomic status. Unexplained anaemia was common and more frequent in individuals of Black and Mixed races. ELSA-Brasil follow-up data may provide further insight into the relevance of unexplained anaemia in this setting.","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":"892-900"},"PeriodicalIF":2.4,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89717580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Use of Mindex and Demiquet for assessing nutritional status in older adults. 使用Mindex和Demiquet评估老年人的营养状况。

IF 2.4 4区医学

Family practice Pub Date : 2024-12-02 DOI: 10.1093/fampra/cmad057

Yanisa Thuayngam, Narucha Komolsuradej, Napakkawat Buathong, Siwaluk Srikrajang

{"title":"Use of Mindex and Demiquet for assessing nutritional status in older adults.","authors":"Yanisa Thuayngam, Narucha Komolsuradej, Napakkawat Buathong, Siwaluk Srikrajang","doi":"10.1093/fampra/cmad057","DOIUrl":"10.1093/fampra/cmad057","url":null,"abstract":"Background: The Mini Nutritional Assessment (MNA) is a validated questionnaire that estimates nutritional status. Given that this questionnaire uses stature measurement, which are unreliable in older adults, Mindex and Demiquet are alternatives to BMI for assessing malnutrition risk. However, the correlation of Mindex and Demiquet values with MNA scores has not been investigated.Objectives: This cross-sectional study examined the correlation of Mindex and Demiquet with nutritional status and blood parameters in older adults in Thailand.Methods: The correlation of Mindex and Demiquet with MNA scores and body mass index (BMI), as well as blood parameters, was evaluated. Sociodemographic characteristics, anthropometric measurements, and blood test results were collected from 347 participants aged 60 years and older (mean ± SD, 66.4 ± 5.3 years). Spearman's rank correlation coefficient and multiple logistic regression analyses were used in statistical analyses.Results: MNA scores were significantly correlated with Mindex (P < 0.001) and Demiquet (P = 0.001), and BMI was related to Mindex and Demiquet (P < 0.001). Low-density lipoprotein cholesterol (LDL-C) predicted MNA scores (P = 0.048) in males but not females.Conclusions: Mindex and Demiquet values were positively correlated with MNA scores and BMI. In addition, LDL-C predicted MNA scores in male older adults.","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":"941-948"},"PeriodicalIF":2.4,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9844375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Impact of implementing primary care-based medication for opioid use disorder on provider and staff perceptions. 对阿片类药物使用障碍实施以初级保健为基础的药物治疗对提供者和员工看法的影响。

IF 2.4 4区医学

Family practice Pub Date : 2024-12-02 DOI: 10.1093/fampra/cmae044

Sara Mazzarelli, Audrey L Blewer, Truls Østbye, Katherine Rhodes, Gabriela Plasencia, Lauren Hart, Gregory Sawin

{"title":"Impact of implementing primary care-based medication for opioid use disorder on provider and staff perceptions.","authors":"Sara Mazzarelli, Audrey L Blewer, Truls Østbye, Katherine Rhodes, Gabriela Plasencia, Lauren Hart, Gregory Sawin","doi":"10.1093/fampra/cmae044","DOIUrl":"10.1093/fampra/cmae044","url":null,"abstract":"Medication for opioid use disorder (MOUD) is the management of opioid use disorder (OUD) on an outpatient basis with buprenorphine or buprenorphine/naloxone (or methadone, which is limited to federally certified opioid treatment programs). Primary care practices are well poised to provide comprehensive care for patients with OUD, including provision of MOUD. The aim of this study was to assess provider and staff OUD attitudes and role perceptions before and after implementation of a MOUD clinical service line. A survey was distributed to evaluate attitudes and perceptions of patients with OUD and provision of MOUD among providers and staff in an academic family medicine clinic. Surveys were distributed in December 2020 (73% response rate), prior to a substance use disorder educational training and MOUD service line implementation, which provided patients with OUD both primary care services and management with buprenorphine/naloxone. A follow-up survey was distributed in February 2022 (69% response rate).Training and implementation of the MOUD service line demonstrated improvements in the domains of motivation (+0.63), attitudes (+0.32), satisfaction (+0.38), role support (+0.48), role adequacy (+0.39), and safety (+0.79) among surveyed participants. The change in satisfaction and safety domains was statistically significant (P < .05). There was no change in the role legitimacy domain.Implementation of a primary care-based MOUD service line positively affected provider and staff motivation, attitudes, satisfaction, sense of safety, role support, and adequacy when working with patients with OUD. This highlights the benefits of MOUD-specific clinical support to optimize care delivery within primary care.","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":"1018-1024"},"PeriodicalIF":2.4,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11638083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142282637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0