Family practice最新文献

{"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":"<p><strong>Background: </strong>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.</p><p><strong>Objectives: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","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}

{"title":"Outcomes of antenatal depression in women and the new-born: a retrospective cohort study.","authors":"Daniel Perejón López, Laura Gascó Serna, María Catalina Serna Arnáiz, Miriam Orós Ruiz, Júlia Siscart Viladegut, Joaquim Sol, Blanca Salinas-Roca","doi":"10.1093/fampra/cmae041","DOIUrl":"10.1093/fampra/cmae041","url":null,"abstract":"<p><strong>Objective: </strong>To determine what effect maternal antenatal depression has on pregnancy and infant outcomes in the Lleida health region.</p><p><strong>Methods: </strong>Retrospective observational cohort study in pregnant women between 2012 and 2018 in the Lleida health region. Variables included age, body mass index, caesarean section, pre-eclampsia, birth weight, and Apgar score. We performed multivariate analysis, with linear regression coefficients and 95% confidence interval (CI).</p><p><strong>Results: </strong>Antenatal depression was diagnosed in 2.54% pregnant women from a total sample of 17 177. Depression is significantly associated with a higher risk pregnancy and low birth weight. Pre-eclampsia, 1-minute Apgar score, and caesarean section were not significantly associated with depression.</p><p><strong>Conclusions: </strong>Antenatal depression increases the risk of pregnancy complications. In addition, depression in the mother increases the probability of low birth weight.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":"925-931"},"PeriodicalIF":2.4,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461445","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}

{"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":"<p><strong>Background: </strong>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.</p><p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","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}

{"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":"<p><strong>Background: </strong>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.</p><p><strong>Aim: </strong>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.</p><p><strong>Methods: </strong>GP participants were recruited through professional networks for semi-structured interviews. Transcripts were integrity checked, coded inductively, and themes developed iteratively.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","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}

{"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":"<p><p>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.</p>","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}

{"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":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","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}

{"title":"Decrease in antibiotic prescription.","authors":"Hilal Aksoy","doi":"10.1093/fampra/cmad053","DOIUrl":"10.1093/fampra/cmad053","url":null,"abstract":"","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":"873"},"PeriodicalIF":2.4,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9470984","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}

{"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":"<p><strong>Background: </strong>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.</p><p><strong>Objectives: </strong>This cross-sectional study examined the correlation of Mindex and Demiquet with nutritional status and blood parameters in older adults in Thailand.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>Mindex and Demiquet values were positively correlated with MNA scores and BMI. In addition, LDL-C predicted MNA scores in male older adults.</p>","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}

{"title":"A short tool to screen self-care preparedness: cross-sectional study in general practice.","authors":"Ulla Mikkonen, Nina Tusa, Sanna Sinikallio, Hannu Kautiainen, Pekka Mäntyselkä","doi":"10.1093/fampra/cmad107","DOIUrl":"10.1093/fampra/cmad107","url":null,"abstract":"<p><strong>Background: </strong>Self-care is crucial in the prevention and treatment of chronic diseases. It is important to identify patients who need support with self-care.</p><p><strong>Objectives: </strong>This study introduces a self-care preparedness index (SCPI) and examines its associations with health-related quality of life (HRQoL) and other outcomes.</p><p><strong>Methods: </strong>A cross-sectional study of adults (n = 301) with hypertension, coronary artery disease, or diabetes in primary health care. Based on the self-care questionnaire, SCPI was formed. A higher SCPI value indicated better self-care preparedness. We examined correlations and a hypothesis of linearity between SCPI and HRQoL (15D), depressive symptoms (BDI), patient activation (PAM), and health-related outcomes (self-rated health, life satisfaction, physical activity, body mass index [BMI], waist, low-density lipoprotein). Exploratory factor analysis was used to test the construct validity of SCPI.</p><p><strong>Results: </strong>A total of 293 patients with a mean age of 68 (54.3% women) were included in the analysis. BDI, BMI, and waist had a negative linear trend with SCPI. Self-rated health, physical activity, patient activity, and life satisfaction had a positive linear trend with SCPI. SCPI correlated with HRQoL (r = 0.31 [95% CI: 0.20 to 0.41]). Exploratory factor analysis of the SCPI scores revealed 3 factors explaining 82% of the total variance.</p><p><strong>Conclusions: </strong>SCPI seems to identify individuals with different levels of preparedness in self-care. This provides means for health care providers to individualize the levels of support and counselling. SCPI seems to be a promising tool in primary health care but needs further validation before use in large scale trials or clinical practice.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":"970-976"},"PeriodicalIF":2.4,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11636555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136397072","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}

{"title":"Early detection of neurodevelopmental disorders in paediatric primary care: A scoping review.","authors":"Paulette T O'Hara, Pamela Talero Cabrejo, Tracey V Earland","doi":"10.1093/fampra/cmad072","DOIUrl":"10.1093/fampra/cmad072","url":null,"abstract":"<p><strong>Background: </strong>Earlier detection of children at risk for neurodevelopmental disorders is critical and has longstanding repercussions if not addressed early enough.</p><p><strong>Objectives: </strong>To explore the supporting or facilitating characteristics of paediatric primary care models of care for early detection in infants and toddlers at risk for neurodevelopmental disorders, identify practitioners involved, and describe how they align with occupational therapy's scope of practice.</p><p><strong>Methods: </strong>A scoping review following the Joanna Briggs Institute framework was used. PubMed Central, Cumulative Index to Nursing & Allied Health Literature, and Scopus databases were searched. The search was conducted between January and February 2022. Inclusion criteria were: children aged 0-3 years old; neurodevelopmental disorders including cerebral palsy (CP) and autism spectrum disorder (ASD); models of care used in the paediatric primary care setting and addressing concepts of timing and plasticity; peer-reviewed literature written in English; published between 2010 and 2022. Study protocol registered at https://doi.org/10.17605/OSF.IO/MD4K5.</p><p><strong>Results: </strong>We identified 1,434 publications, yielding 22 studies that met inclusion criteria. Models of care characteristics included the use of technology, education to parents and staff, funding to utilize innovative models of care, assessment variability, organizational management changes, increased visit length, earlier timeline for neurodevelopmental screening, and collaboration with current office staff or nonphysician practitioners. The top 4 providers were paediatricians, general or family practitioners, nurse/nurse practitioners, and office staff. All studies aligned with occupational therapy health promotion scope of practice and intervention approach yet did not include occupational therapy within the paediatric primary care setting.</p><p><strong>Conclusions: </strong>No studies included occupational therapy as a healthcare provider that could be used within the paediatric primary care setting. However, all studies demonstrated models of care facilitating characteristics aligning with occupational therapy practice. Models of care facilitating characteristics identified interdisciplinary staff as a major contributor, which can include occupational therapy, to improve early detection within paediatric primary care.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":"883-891"},"PeriodicalIF":2.4,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10228665","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}