International journal of family medicine最新文献

{"title":"Care for patients with type 2 diabetes in a random sample of community family practices in ontario, Canada.","authors":"Gina Agarwal, Janusz Kaczorowski, Steve Hanna","doi":"10.1155/2012/734202","DOIUrl":"10.1155/2012/734202","url":null,"abstract":"<p><p>Objective. Diabetes care is an important part of family practice. Previous work indicates that diabetes management is variable. This study aimed to examine diabetes care according to best practices in one part of Ontario. Design and Participants. A retrospective chart audit of 96 charts from 18 physicians was conducted to examine charts regarding diabetes care during a one-year period. Setting. Grimsby, Ontario. Main Outcome Measures. Glycemic screening, control and management strategies, documentation and counselling for lifestyle habits, prevalence of comorbidities, screening for hypertension, hyperlipidemia, and use of appropriate recommended preventive medications in the charts were examined. Results. Mean A1c was within target (less than or equal to 7.00) in 76% of patients (ICC = -0.02), at least 4 readings per annum were taken in 75% of patients (ICC = 0.006). Nearly 2/3 of patients had been counselled about diet, more than 1/2 on exercise, and nearly all (90%) were on medication. Nearly all patients had a documented blood pressure reading and lipid profile. Over half (60%) had a record of their weight and/or BMI. Conclusion. Although room for improvement exists, diabetes targets were mainly reached according to recognized best practices, in keeping with international data on attainment of diabetes targets.</p>","PeriodicalId":89569,"journal":{"name":"International journal of family medicine","volume":"2012 ","pages":"734202"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3407621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30804769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental health problems in family medicine/general practice.","authors":"Jan De Lepeleire,&nbsp;Marian Oud,&nbsp;Marta Buszewicz","doi":"10.1155/2012/794845","DOIUrl":"https://doi.org/10.1155/2012/794845","url":null,"abstract":"Mental health disorders represent a large proportion of the world's disease burden, mostly due to depression and anxiety disorders, alcohol and drug abuse, and psychoses [1, 2]. \u0000 \u0000In terms of disability-adjusted life years, depression ranks number one among noncommunicable diseases and is projected to become the most important overall contributor to the global disease burden by 2030 [3]. \u0000 \u0000People with mental problems usually seek help from their general practitioner (GP), sometimes in combination with a psychiatrist [4]. In this current period of economic recession, delivering health care in an efficient and cost-effective way is particularly important. Primary health care teams are being asked to take on increased responsibilities in the implementation of strategies to help in the prevention and treatment of mild and moderate mental health problems and effective coordination with secondary care for more severe conditions. \u0000 \u0000Mental health disorders are very often comorbid with physical health disorders [5]. They can play an important role in the development of somatic diseases and vice versa. The burden of mental disorders is likely to be underestimated as a consequence of the inadequate recognition of the connection between mental and physical health. Indeed, as mental and physical health are correlated, there can be no health without mental health [2]. \u0000 \u0000In this special mental health edition of the International Journal of Family Medicine we are pleased to present a selection of papers from 5 different European countries, looking in more depth at some of these important issues. \u0000 \u0000E. M. McMahon et al. investigated the functional impairment, service use, and costs of patients with chronic and recurrent depression recruited from UK primary care. These patients visited their GP more often than other patients and were also high users of hospital-based services (including both physical and mental health care), especially those patients with chronic major depression. This was a patient group with very significant morbidity and high costs, highlighting the need for effective interventions. A. Wallerblad et al. found that forty-seven percent of those affected by mild depression and/or anxiety had been seeking care for psychological symptoms within the last year. Those who had consulted their GP about their psychological problem and those who had also seen a psychiatrist, psychologist, or alternative health provider were more likely to have both depression and anxiety, and disability due to their psychological symptoms and so likely to be more severely affected. Among those not seeking care for their psychological symptoms, two-thirds had sought care for somatic symptoms, which might be linked with them, focusing on the physical symptoms which often accompany depression and anxiety and highlight the importance of GPs actively, also considering mental health problems in patients who present with physical symptoms [6]. \u0000 \u0000How these and other determina","PeriodicalId":89569,"journal":{"name":"International journal of family medicine","volume":"2012 ","pages":"794845"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2012/794845","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31387185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"To Drive or Not to Drive: Assessment Dilemmas for GPs.","authors":"J Sims,&nbsp;S Rouse-Watson,&nbsp;P Schattner,&nbsp;A Beveridge,&nbsp;K M Jones","doi":"10.1155/2012/417512","DOIUrl":"https://doi.org/10.1155/2012/417512","url":null,"abstract":"<p><p>Introduction. Most Australians are dependent on their cars for mobility, thus relinquishing driving licences for medical reasons poses challenges. Aims. To investigate how general practitioners (GPs) recognise and manage patients' fitness to drive, GPs' attitudes and beliefs about their role as assessors, and GPs' experiences in assessing and reporting to driving authorities and identify GPs' educational needs. Methods. Mixed methods: questionnaire mailed to GPs from three rural and two metropolitan Divisons of General Practice in Victoria, Australia. Results. 217/1028 completed questionnaires were returned: 85% recognised a patients' fitness to drive, 54% felt confident in their assessment ability, 21% felt the GP should have primary responsibility for declaring patients' fitness to drive, 79% felt that reporting a patient would negatively impact on the doctor-patient relationship, 74% expressed concern about legal liability, and 74% favoured further education. Discussion. This study provides considerable information including recommendations about GP education, the assessment forms, and legal clarification.</p>","PeriodicalId":89569,"journal":{"name":"International journal of family medicine","volume":"2012 ","pages":"417512"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2012/417512","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30427955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Responding to domestic violence in general practice: a qualitative study on perceptions and experiences.","authors":"Howa Yeung, Nubaha Chowdhury, Alice Malpass, Gene S Feder","doi":"10.1155/2012/960523","DOIUrl":"10.1155/2012/960523","url":null,"abstract":"<p><p>The perceptions and experiences among general practitioners (GPs) and nurses in identifying female patients experiencing domestic violence and referring patients to specialist agencies need to be clarified. Eleven GPs and six nurses participating in a multidisciplinary domestic violence training and support programme in east London and Bristol were interviewed. All participants recognised that identification of women experiencing domestic violence and offering support were part of their clinical roles. Perceived differences between GPs and nurses, including time constraints, level of patient interaction, awareness of patients' social history, scope of clinical interview, and patient expectations were used to explain their levels of domestic violence inquiry. Barriers to inquiry included lack of time, experience, awareness of community resources, and availability of effective interventions postdisclosure. Longstanding relationships with patients were cited both as barrier and facilitator to domestic violence disclosure. Some nurses reported discomfort with direct inquiry due to the lack of clinical experience in responding to domestic violence despite satisfaction with training. Future domestic violence training programmes should take into account potential differences between GPs and nurses, in terms of their clinical roles and the unique barriers encountered, in order to improve self-efficacy and to facilitate collaborative and effective responses.</p>","PeriodicalId":89569,"journal":{"name":"International journal of family medicine","volume":"2012 ","pages":"960523"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3502852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31138979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-related factors influencing satisfaction in the patient-doctor encounters at the general outpatient clinic of the university of calabar teaching hospital, calabar, Nigeria.","authors":"Ndifreke E Udonwa,&nbsp;Udoezuo K Ogbonna","doi":"10.1155/2012/517027","DOIUrl":"https://doi.org/10.1155/2012/517027","url":null,"abstract":"<p><p>Medical consultation is at the centre of clinical practice. Satisfaction of a patient with this process is a major determinant of the clinical outcome. This study sought to determine the proportion of patients who were satisfied with their doctor-patient encounter and the patient-related factors that affected patients' satisfaction with the consultation process. A clinic-based, cross-sectional study using a modified version of the General Practice Assessment Questionnaire (GPAQ), which employed a systematic sampling technique, was used. The questionnaires were administered on 430 patients within the ages of 18 years and 65 years. Among the 430 subjects within the ages of 18 years and 65 years studied, 200 (46.5%) were males and 230 (53.5%) were females. Only 59.3% were satisfied with their patient-doctor encounter. The patient's perception of time spent in the consultation, illness understanding after the visit, ability to cope with the illness after the visit, and ability to maintain health after visit were the only factors that affected patient's satisfaction with the consultation. In our environment, nonsatisfaction with the patient-doctor encounter is high. Only few factors considered to encourage a patients satisfaction at primary care consultation contributed to end-of-consultation satisfaction. This calls for refocusing so as to improve the overall patient care in our cultural context and meet the patient needs in our environment.</p>","PeriodicalId":89569,"journal":{"name":"International journal of family medicine","volume":"2012 ","pages":"517027"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2012/517027","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30674634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physician cross-cultural nonverbal communication skills, patient satisfaction and health outcomes in the physician-patient relationship.","authors":"Ken Russell Coelho,&nbsp;Chardee Galan","doi":"10.1155/2012/376907","DOIUrl":"https://doi.org/10.1155/2012/376907","url":null,"abstract":"<p><p>Recent empirical findings document the role of nonverbal communication in cross-cultural interactions. As ethnic minority health disparities in the United States continue to persist, physician competence in this area is important. We examine physicians' abilities to decode nonverbal emotions across cultures, our hypothesis being that there is a relationship between physicians' skill in this area and their patients' satisfaction and outcomes. First part tested Caucasian and South Asian physicians' cross-cultural emotional recognition ability. Physicians completed a fully balanced forced multiple-choice test of decoding accuracy judging emotions based on facial expressions and vocal tones. In the second part, patients reported on satisfaction and health outcomes with their physicians using a survey. Scores from the patient survey were correlated with scores from the physician decoding accuracy test. Physicians, regardless of their ethnicity, were more accurate at rating Caucasian faces and vocal tones. South Asian physicians were no better at decoding the facial expressions or vocal tones of South Asian patients, who were also less likely to be satisfied with the quality of care provided by their physicians and to adhere to their physicians' recommendations. Implications include the development of cultural sensitivity training programs in medical schools, continuing medical education and public health programs.</p>","PeriodicalId":89569,"journal":{"name":"International journal of family medicine","volume":"2012 ","pages":"376907"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2012/376907","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30759749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Gaze in Risk-Factor Haze: Swedish GPs' Perceptions of Prescribing Cardiovascular Preventive Drugs.","authors":"Josabeth Hultberg,&nbsp;Carl Edvard Rudebeck","doi":"10.1155/2012/612572","DOIUrl":"https://doi.org/10.1155/2012/612572","url":null,"abstract":"<p><p>Aims. To explore general practitioners' (GPs') descriptions of their thoughts and action when prescribing cardiovascular preventive drugs. Methods. Qualitative content analysis of transcribed group interviews with 14 participants from two primary health care centres in the southeast of Sweden. Results. GPs' prescribing of cardiovascular preventive drugs, from their own descriptions, involved \"the patient as calculated\" and \"the inclination to prescribe,\" which were negotiated in the interaction with \"the patient in front of me.\" In situations with high cardiovascular risk, the GPs reported a tendency to adopt a directive consultation style. In situations with low cardiovascular risk and great uncertainty about the net benefit of preventive drugs, the GPs described a preference for an informed patient choice. Conclusions. Our findings suggest that GPs mainly involve patients at low and uncertain risk of cardiovascular disease in treatment decisions, whereas patient involvement tends to decrease when GPs judge the cardiovascular risk as high. Our findings may serve as a memento for clinicians, and we suggest them to be considered in training in communication skills.</p>","PeriodicalId":89569,"journal":{"name":"International journal of family medicine","volume":"2012 ","pages":"612572"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2012/612572","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31099632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Attitudes and Practices of General Practitioners about the Use of Chaperones in Melbourne, Australia.","authors":"Oliver van Hecke, Kay M Jones","doi":"10.1155/2012/768461","DOIUrl":"10.1155/2012/768461","url":null,"abstract":"<p><p>Introduction. To consider the use of medical chaperones during certain clinical examinations is important whether one practises as a specialist, nurse, medical student, or generalist. Chaperones have been used by doctors conducting intimate examinations for many years but their true extent remains largely unknown. Until recently, there was no national guidance in Australia. Aim. To explore the attitudes and practices of general practitioners (GP) regarding their use of chaperones in urban Melbourne, Australia. Method. Qualitative two focus groups involving seventeen GPs from two locations. Discussions were audio-taped, transcribed verbatim and analysed. Results. Common themes and subthemes emerged which were grouped into three main areas: (a) practitioner-related, (b) patient-related and (c) practice related. Discussion. This is the first study from an Australian primary care perspective to gauge the attitudes and experiences of GPs on their use of chaperones. It will provide vital information to inform the next step of extending this research to a national GP audience. From an international perspective, this study provides an excellent template for other primary care clinicians to conduct research in this important field of doctor-patient relationship.</p>","PeriodicalId":89569,"journal":{"name":"International journal of family medicine","volume":"2012 ","pages":"768461"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3431125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30888606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic and recurrent depression in primary care: socio-demographic features, morbidity, and costs.","authors":"Elaine M McMahon, Marta Buszewicz, Mark Griffin, Jennifer Beecham, Eva-Maria Bonin, Felicitas Rost, Kate Walters, Michael King","doi":"10.1155/2012/316409","DOIUrl":"10.1155/2012/316409","url":null,"abstract":"<p><p>Background. Major depression is often chronic or recurrent and is usually treated within primary care. Little is known about the associated morbidity and costs. Objectives. To determine socio-demographic characteristics of people with chronic or recurrent depression in primary care and associated morbidity, service use, and costs. Method. 558 participants were recruited from 42 GP practices in the UK. All participants had a history of chronic major depression, recurrent major depression, or dysthymia. Participants completed questionnaires including the BDI-II, Work and Social Adjustment Scale, Euroquol, and Client Service Receipt Inventory documenting use of primary care, mental health, and other services. Results. The sample was characterised by high levels of depression, functional impairment, and high service use and costs. The majority (74%) had been treated with an anti-depressant, while few had seen a counsellor (15%) or a psychologist (3%) in the preceding three months. The group with chronic major depression was most depressed and impaired with highest service use, whilst those with dysthymia were least depressed, impaired, and costly to support but still had high morbidity and associated costs. Conclusion. This is a patient group with very significant morbidity and high costs. Effective interventions to reduce both are required.</p>","PeriodicalId":89569,"journal":{"name":"International journal of family medicine","volume":"2012 ","pages":"316409"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3375145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30708294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integration between Primary Care and Mental Health Services in Italy: Determinants of Referral and Stepped Care.","authors":"Paola Rucci,&nbsp;Antonella Piazza,&nbsp;Marco Menchetti,&nbsp;Domenico Berardi,&nbsp;Angelo Fioritti,&nbsp;Stefano Mimmi,&nbsp;Maria Pia Fantini","doi":"10.1155/2012/507464","DOIUrl":"https://doi.org/10.1155/2012/507464","url":null,"abstract":"<p><p>This study, carried out in the context of a collaborative care program for common mental disorders, is aimed at identifying the predictors of Primary Care Physician (PCP) referral to Community Mental Health Center (CMHC) and patterns of care. Patients with depression or anxiety disorders who had a first contact with CMHCs between January 1, 2007-December 31, 2009 were extracted from Bologna Local Health Authority database. A classification and regression tree procedure was used to determine which combination of demographic and diagnostic variables best distinguished patients referred by PCPs and to identify predictors of patterns of care (consultation, shared care, and treatment at the CMHC) for patients referred by PCPs. Of the 8570 patients, 57.4% were referred by PCPs. Those less likely to be referred by PCPs were living in the urban area, suffered from depressive disorder, and were young. As to the pattern of care, patients living in the urban area were more likely to receive shared care compared with those living in the nonurban area, while the reverse was true for consultation. Predictors of CMHC treatment were depression and young age. Prospective studies are needed to assess length, quantity, and quality of collaborative treatment for common mental disorder delivered at any step of care.</p>","PeriodicalId":89569,"journal":{"name":"International journal of family medicine","volume":"2012 ","pages":"507464"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2012/507464","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30674633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}