Family Medicine and Primary Care

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Implementing advanced access to primary care in an academic family medicine network

Implementing advanced access to primary care in an academic family medicine network

Our findings will inform the scaling up of implementation of the advanced access model across an academic network of family medicine settings, as well as similar quality improve- ment models in other clinical teaching settings looking to enhance access to care by leveraging leadership capacity building. Further, because implementation was carried out with family medicine residents, this might help to pave the way for integration of similar models in future clinical prac- tice, further supporting primary care accessibility. Dr Hudon is Professor and Research Director in the Department of Family Medicine and Emergency Medicine at the University of Sherbrooke in Quebec. Dr Luc was a coordinator at the time of the study and is now Deputy Director of the University of Sherbrooke Practice-based Research Network. Dr Beaulieu is Professor and Deputy Director of the Family Medicine Residency Program in the Department of Family Medicine and Emergency Medicine at the University of Sherbrooke. Dr Breton is Professor in the Department of Community Health Sciences at the University of Sherbrooke. Ms Boulianne is a quality improvement expert and a manager in the Centre intégré universitaire de santé et de services sociaux du Saguenay–Lac-Saint-Jean. Dr Champagne is Professor and Deputy Director of the Family Medicine Residency Program in the Department of Family Medicine and Emergency Medicine at the University of Sherbrooke, and Director of the Hôpital Charles–Le Moyne academic setting in Quebec. Ms Conway is a partner patient in the Department of Family Medicine and Emergency Medicine at the University of Sherbrooke. Dr Côté is a family medicine resident in the Department of Family Medicine and Emergency Medicine at the University of Sherbrooke. Dr Deshaies is Professor in the Department of Family Medicine and Emergency Medicine at the University of Sherbrooke. Ms Fillion is an organizational change expert in the Department of Human Resources at the University of Sherbrooke. Dr Villemure is Director of the Alma academic setting in Quebec and Professor in the Department of Family Medicine and Emergency Medicine at the University of Sherbrooke.
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Interprofessional primary care in academic family medicine clinics

Interprofessional primary care in academic family medicine clinics

The implication of this finding, however, might be challenging. Interprofessional development requires the substantial realignment of family medicine and family physicians within collaborative, team-based clinical organizations. Generating clinic organizational leader- ship to create conditions to foster this development requires change in academic curricula (undergraduate and postgraduate) and in the stances of professional bodies accrediting them. While the evidence from our study indicates that substantial change has (and is) tak- ing place, it also reveals that much remains to be done. For example, in the United Kingdom, many univer- sity departments of general practice have reconfigured themselves as “departments of general practice and pri- mary care” and embraced interprofessionalism as a core value for teaching and research. In pursuit of academic and scientific leadership for primary care development in Canada, departments of family medicine at universi- ties in this country should consider doing the same.
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Global Health in Family Medicine Summer Primer

Global Health in Family Medicine Summer Primer

• The Global Health in Family Medicine Summer Primer is a short program specifically aimed at providing an overview of key global health issues with a focus on the existing and potential role of family medicine and primary care. • Respondents to the needs assessment were most interested in immigration and refugee health, low-income communities and populations in Canada, health in low- and middle-income countries, and indigenous and aboriginal health. Slightly more than half of respondents indicated that their primary interest was global health abroad, while 44% were most interested in global health in Canada. A desire to help others and personal interest were the most common reasons for interest in global health. • This pilot evaluation of the intensive 5-day primer developed based on this needs assessment found that participants demonstrated increased knowledge and shifting attitudes. The lessons learned included that high-quality global health courses are in demand, participant diversity is a strength of such courses, and covering the breadth of material is challenging. Participants saw value in networking and sharing, and suggested there was need for a network or virtual community that could act as an ongoing forum for practising physicians with common interests in global health.
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Physical activity counseling in primary care and family medicine residency training: a systematic review

Physical activity counseling in primary care and family medicine residency training: a systematic review

Three studies presented knowledge, attitudes, and self-efficacy as physician outcomes [23, 25, 26]. Antognoli et al. found that with formal teaching of ONPA-related di- dactics and ONPA guidelines, as well as of health-behavior change, counseling techniques were significantly associated with greater ONPA knowledge among primary care resi- dents [23]. Paradoxically, that study showed that ONPA training opportunities were associated with poorer attitudes and perceived professional norms [23]. A similar trend was found in a study by Melatsky et al., wherein 20 h of lifestyle medicine training improved residents’ knowledge and lifestyle medicine consultation self-efficacy, but did not improve attitudes for healthy lifestyle consultation [26]. Participation in elective rotations that focused on ONPA were positively associated with attitudes, self-efficacy, and professional norms [23, 25]. In contrast, offering ONPA-related fellowships had no association with know- ledge, attitudes, self-efficacy, or professional norms [23].
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In November 2014 the Pakistan Medical and Dental Council directed that Family Medicine should be taught to final year medical students. Family Medicine will be strengthened as a result. This paper considers some implications of the decision, identifying first the need for more information on primary care services, especially in the private sector, to enable planning of the curriculum and attachments to public and private units. The challenges to medical colleges in providing what will be largely experiential learning are described and the importance of training practitioners is emphasised. The urgent need to overcome the virtual absence in Pakistan of postgraduate training in Family Medicine described, and the quality standards of primary care are explored and the need for attention in the face of student learning is described. Recommendations are offered, including an advisory board on Family Medicine to audit its introduction and performance.
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Reflective Learning Experience in Primary Care Medicine Posting: A Potential Qualitative Study

Reflective Learning Experience in Primary Care Medicine Posting: A Potential Qualitative Study

Results are based on the Response rate, Percentage of students meet the objectives and Qualitative list of feedback. The qualitative analysis of the students’ reflection revealed four salient themes based on their learning experiences. They are (1) Learning and experiences at primary health care (KK) clinics, (2) Understanding the role of family medicine clinic and health care personals, (3) Benefits and drawbacks of Primary health care clinics for the patients and (4) positive attitudes and behavior towards family medicine services and staffs. The results showing that Medical students’ responses to effects of reflection on learning are “enhanced their learning process and gain knowledge”, “improved their awareness about the common medical illness”, “improved their communication skills”, “improved their practical skills”, “applied their theory knowledge”, and “motivated them to become the efficient medical doctors in future”.
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Shedding light on conditions for the successful passive dissemination of recommendations in primary care: a mixed methods study

Shedding light on conditions for the successful passive dissemination of recommendations in primary care: a mixed methods study

themes on the structure of the FMG, current interven- tions and practice for older patients with AD, barriers and facilitators to the adoption and use of the recommenda- tions, and their impact. The interview guide was piloted and refined with four experts from different domains: family medicine, nursing, public health, and geriatrics. To triangulate our data [22], we also conducted a focus group in each site following the chart review (2014–2015). All team members were invited to participate. We presented their site-specific and overall results of the chart review and asked the clinicians to discuss the results to develop a collective understanding of the barriers and facilitators in the implementation of the recommendations. These focus groups included a total of 30 participants and were con- ducted by four researchers (IV, LL, GAL, LV). Interviews and focus groups lasted 1 h on average and were recorded and transcribed. Field notes were taken during the focus groups and interviews and during informal discussion be- tween the research team and the clinicians. The data col- lection process resulted in 750 pages of transcripts. Analysis and integration of quantitative and qualitative results
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An integrated, collaborative healthcare model for the early diagnosis and management of dementia: Preliminary audit results from the first transdisciplinary service integrating family medicine and geriatric psychiatry services to the heart of patients’ ho

An integrated, collaborative healthcare model for the early diagnosis and management of dementia: Preliminary audit results from the first transdisciplinary service integrating family medicine and geriatric psychiatry services to the heart of patients’ homes

meeting the patient and caregiver needs more effectively in a timely fashion [46]. As patients with dementia often have comorbid illnesses, these patients were managed in a holistic manner in the same polyclinic instead of different providers managing their individual conditions. This inte- grated care of all the bio-psycho-social aspects allows us to address the needs of the patients simultaneously. Stud- ies have shown that the diagnosis and management of co-morbid conditions such as diabetes mellitus [47] be- comes poorer as dementia dominates clinical encounters and shifts attention away from the co-morbidity which can lead to increased morbidity and mortality [48, 49]. As a result, it becomes easy and convenient for the patients and care- givers to attend a single clinic and keep to their follow-up appointments. Studies have also shown that both specialist and primary care practitioners mutually agree that certain complex management issues such as complex BPSD symptoms and driving competency would require special- ist input [50]. Close collaboration with specialists in our model means that the family physicians may get in touch with the specialists as soon as possible, should any uncer- tainties arise in the course of the patient management. This support is paramount to ensure that all patients are managed safely within the abilities of the family physicians while freeing up specialist services to dedicate additional time to more complicated cases that require more expert- ise and attention.
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Integrative health care model for climacteric stage women: design of the intervention

Integrative health care model for climacteric stage women: design of the intervention

The characteristics of population, structure and pro- cesses of care within social security allows the imple- mentation and testing of an integrative health care model (IHCM) for climacteric stage women (Table 1). The lessons learned from this first intervention that will be implemented in social security settings will provide further elements and evidence to eventually propose a study aimed at the population with social security in other developing countries. This work aims to develop an IHCM applicable in primary care services (family medicine clinics) for climacteric stage women. The effectiveness of the model will be evaluated through the following aspects: a) improved HR-QoL; b-d) increased empowerment, self-efficacy and knowledge regarding cli- macteric stage, and health-related self-care activities; e) increased use of screening services for breast cancer, cervical cancer, diabetes and hypertension; f-g) improved lifestyles: regular leisure time physical activity and healthy diet.
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Advancing knowledge translation in primary care

Advancing knowledge translation in primary care

Mr Menear is a doctoral candidate in the Department of Social and Preventive Medicine at the University of Montreal in Quebec. Ms Grindrod is a pharmacist and Assistant Professor in the School of Pharmacy at the University of Waterloo in Ontario. Dr Clouston is a postdoctoral fellow in the Department of Family Medicine Research at the University of Manitoba in Winnipeg. Dr Norton is Emeritus Professor in the Department of Family Medicine at the University of Calgary in Alberta. Dr Légaré is a family health practitioner, Full Professor in the Department of Family Medicine and Emergency Medicine at Laval University, and Director of the Knowledge Transfer and Health Technology Assessment Research Group at the Research Centre of the Centre hospitalier universitaire de Québec.
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Driving and dementia

Driving and dementia

• There is no single office-based test that can reliably be used alone to determine whether it is safe for a patient with cognitive impairment to drive. Evidence suggests that the use of composite batteries, rather than individual cognitive tests, might be more useful. The accredited Centre for Family Medicine Primary Care Collaborative Memory Clinic training program considers specific findings on corroborated history and cognitive testing in assessing driving safety.

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A scoping review of medical education research in family medicine

A scoping review of medical education research in family medicine

We searched the electronic databases MEDLINE, So- cial Sciences Abstracts, and ERIC using the following search terms identified through input from the re- search team and in consultation with an experienced information specialist (HM): family physician, family practice, general practitioner, primary care physician, and community practice. Using the term “AND”, these were combined with the terms: medical education, cur- riculum, learning, and teaching. Both medical subject headings (MeSH) and free text terms were used. To supplement the search, we scanned the reference lists of included studies and searched the authors’ personal files. In addition, we drew on the extensive networks of our review team to contact people who are leaders in family medicine education research to vet our search and identity missing publications. The team informa- tion specialist executed all final searches, exported the results into RefWorks, and removed all duplicates from the search results.
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Teaching Minor Surgical Procedures in Internship in Primary Care: A Necessary Approach

Teaching Minor Surgical Procedures in Internship in Primary Care: A Necessary Approach

Skin and subcutaneous lesions (nevus, fibromas, lipomas), lacerations, ingrown toenails, abscesses, musculoskeletal disorders such as arthritis, bursitis, trigger points, neuropathies and tendinitis are the main causes of problems in primary care that can be resolved with minor procedures. Performing these procedures is an important part of the general practitioner's competencies. The National Medical Course Curriculum Guidelines in Brazil show that medical students should be aware of these diagnostic and therapeutic procedures, based on current literature. In addition to the financial benefits, performing minor procedures in primary care also reduce patient anxiety, has greater convenience due to the proximity and familiarity with the health facility, requires less waiting for treatment, and allows for complete patient care. This paper is an experience report, with the objective of reporting the teaching-learning process during the internship of Family and Community Medicine of the Faculdades Pequeno Príncipe, regarding the performance of outpatient procedures in the primary health care. During the internship, it was possible to perform small procedures such as skin lesion excision, Intrauterine Device (IUD) insertion and trigger point needling. Thus, it is concluded that the teaching of small procedures is an essential part of the medical curriculum and helps to form a physician who addresses the most common complaints of patients in primary care.
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Analysis of definitions of general practice, family medicine, and primary health care: a terminological analysis

Analysis of definitions of general practice, family medicine, and primary health care: a terminological analysis

There are numerous definitions of GP/FM and PHC. The governance of these concepts is related to their use in two distinct organisations: the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) and the World Health Organization (WHO). In GP/FM textbooks and bibliographic retrieval systems, there is often confu- sion between these concepts. A clear understanding of the similarities and differences between the two concepts is needed for the organisation of medical training, for the development of the

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Health Care Transition in Adolescents and Young Adults With Diabetes

Health Care Transition in Adolescents and Young Adults With Diabetes

Providers trained in family prac- tice or combined internal medicine and pediatrics and those practic- ing in rural areas may provide both primary care services and diabetes care when access to endocrinologists is limited. In such instances, health care transition is orchestrated by PCPs and occurs without transfer of care. Alternatively, PCPs may provide routine medical services and either co-manage diabetes with, or defer management to, specialists in endocrinology. In such cases, PCPs coordinate transition and communi- cate with endocrinology colleagues to ensure that transition needs are met. In this model, transfer of care may ultimately occur among both endocrinologists and PCPs. In large hospital systems and academic centers, PCPs may coordinate care within “medical homes” or compre- hensive disease management teams in collaboration with endocrinolo- gists, other subspecialists, dietitians, nurse managers, and care coordina- tors. In such systems, PCPs remain the center of patient care and should take primary responsibility for coordinating transition and facilitat- ing transfer of care to adult-oriented systems.
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Bridging the gap in genetics: a progressive model for primary to specialist care

Bridging the gap in genetics: a progressive model for primary to specialist care

To improve PCP confidence in meeting patients’ genetics needs, participants made specific recommen- dations. PCPs’ suggestion of improving undergraduate medical education in genetics through an integration across disciplines is consistent with other reports [14, 18]. Incorporation of genetics into Family Medicine residency programs was also considered important. Consistent with CME literature in general, PCPs dis- cussed the need to improve formal CME opportun- ities and to utilize a case-based approach that connects theory to practice [14, 25]. In addition, par- ticipants also emphasized the value of informal learn- ing that occurs through regular contact with other professionals, with a goal to avoid unnecessary refer- rals. For example, “just-in-time” consultations with experts or methods wherein a librarian is employed to help PCPs locate necessary diagnostic information, have been shown to improve the speed and quality of PCP decision making, subsequently having the poten- tial to improve patient access to care [36].
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Who Should Provide Primary Health Care to Children: Pediatricians or Family Medicine Physicians?

Who Should Provide Primary Health Care to Children: Pediatricians or Family Medicine Physicians?

In 1977, the distribution of physician office visits made by children less than 15 years of age in the United States was as follows: pediatricians handled 44% of those visits, general pr[r]

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A Quality Improvement Collaborative to Improve Pediatric Primary Care Genetic Services

A Quality Improvement Collaborative to Improve Pediatric Primary Care Genetic Services

management of children with genetic disorders, the expert group created a list of International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes that would help identify patients with probable genetic disorders to be entered into a practice registry, and also provided a shorter list of genetic disorders that have existing disorder-specific health supervision guidelines or require an emergency plan (Supplemental Information). These lists were only used to define the inclusion criteria for the 7 aims related to the management of children with genetic disorders. Practices were encouraged to use these complete lists but were able to create local versions more pertinent to their clinic setting. Once created, practices used these registry lists to identify patients with genetic disorders and then reported on the number of these patients who met QIC aims monthly, regardless if they were seen in the practice that month. Practices were asked to self- identify, in conjunction with RC input, patients who required palliative care discussions. Given the challenges practices faced in working on 11 aims simultaneously, they were surveyed at the conclusion of the active improvement period regarding how hard they worked to improve each of the 11 aims (“a lot,” “a little,” or “did not work on”).
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Functional Difficulties and Health Conditions Among Children With Special Health Needs

Functional Difficulties and Health Conditions Among Children With Special Health Needs

analysis of the relative strength in pre- dicting everyday outcomes and family work status also suggest that attention to functional dif fi culties is important. Although both health conditions and functional dif fi culties were useful, func- tional dif fi culties provided greater pre- dictive utility. The data merely con fi rm what clinicians know or suspect, func- tional dif fi culties play a major role in child health and family outcomes. A review of the constellation of func- tional problems also can be useful. For example, the magnitude of functional dif fi culties related to mental health issues (anxiety or depression, behavior or conduct problems, and making and keeping friends) is substantial. Speak- ing and communicating along with learning, paying attention, and con- centration reveal the serious functional problems related to educational and social activities among this population. When viewed as broad functional areas, mental health and education are major problems that should receive greater attention from clinical, public health, research, and policy sectors.
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Patient and Citizen Innovation Council in family practice

Patient and Citizen Innovation Council in family practice

patient-centredness needs to encompass more than simply medical interaction in the examination room. Decisions around initiative prioritization, clinic work flow processes, and components of care affecting the quality of the patient experience also warrant a patient- centred perspective. The site leadership dyad (clinic manager and site medical lead) of the Academic Family Medicine (AFM) Clinic at the South Health Campus (SHC) in Calgary, Alta, recognized a potential gap between health care provider assumptions and the reality of what patients perceive to be most valuable in the clinic service environment and encounters.
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