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J., Tobih, Oyewole A., Tobih D., Olajide A., and Esan T. "The Practice of Patient Education by Attending Physicians in Southwest Nigeria." African Journal of Biology and Medical Research 6, no. 1 (January 3, 2023): 9–23. http://dx.doi.org/10.52589/ajbmr-kalbt5ij.
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Background: The value of patient education involves an improved understanding of their medical conditions, diagnosis, disease, or disability. However, the challenge of educating patients is multi-faceted, considering the complexity of many diseases, limited health literacy and a limited number of available doctors to tend to the long awaiting patient queue. Objective: This study aimed to assess the practice of patients’ education of their illnesses by the treating physician in different practice settings, specialties, contact, duration of admission, the eventuality of death and post-mortem. Method: The study was a cross-sectional descriptive design conducted among 449 medical doctors. A self-administered semi-structured pretested questionnaire was administered to all cadres of physicians in four health centres selected randomly in the southwest, Nigeria. The data collected were analysed using SPSS version 25 and results were presented in descriptive statistics and inferential statistics with the level of significance set at p = < 0.05. Result: The majority (57.0%) of the respondents were within the age range of 25-40. The highest respondent cadres were registrars and medical officers 224 (49.9%). Of the total participants, 140 reported seeing over 40 patients per week. It was observed that 95.9% did explain to the patients the impressions of their symptoms at first contact. However, the percentage of respondents reduced markedly when giving the next appointment, 58.8%. Also, 86.6% always explain the need for hospital admission, 76.4% explained options of surgery while only 28.3% discussed mistakes/complications from the procedures. Conclusion: There were a lot of gaps in the patient’s understanding of their illnesses as imparted by the attending physicians. The gap increases after the first contact both in knowledge and understanding on the part of the patient which may be one of the major factors responsible for poor compliance and cooperation on the part of the patient which ultimately hinders the optimum delivery of effective and efficient health care. This in effect affects the overall health status of the community and society.
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Hallinan, Christine Mary, Jane Maree Gunn, and Yvonne Ann Bonomo. "Implementation of medicinal cannabis in Australia: innovation or upheaval? Perspectives from physicians as key informants, a qualitative analysis." BMJ Open 11, no. 10 (October 2021): e054044. http://dx.doi.org/10.1136/bmjopen-2021-054044.
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Objective We sought to explore physician perspectives on the prescribing of cannabinoids to patients to gain a deeper understanding of the issues faced by prescriber and public health advisors in the rollout of medicinal cannabis. Design A thematic qualitative analysis of 21 in-depth interviews was undertaken to explore the narrative on the policy and practice of medicinal cannabis prescribing. The analysis used the Diffusion of Innovations (DoI) theoretical framework to model the conceptualisation of the rollout of medicinal cannabis in the Australian context. Setting Informants from the states and territories of Victoria, New South Wales, Tasmania, Australian Capital Territory, and Queensland in Australia were invited to participate in interviews to explore the policy and practice of medicinal cannabis prescribing. Participants Participants included 21 prescribing and non-prescribing key informants working in the area of neurology, rheumatology, oncology, pain medicine, psychiatry, public health, and general practice. Results There was an agreement among many informants that medicinal cannabis is, indeed, a pharmaceutical innovation. From the analysis of the informant interviews, the factors that facilitate the diffusion of medicinal cannabis into clincal practice include the adoption of appropriate regulation, the use of data to evaluate safety and efficacy, improved prescriber education, and the continuous monitoring of product quality and cost. Most informants asserted the widespread assimilation of medicinal cannabis into practice is impeded by a lack of health system antecedents that are required to facilitate safe, effective, and equitable access to medicinal cannabis as a therapeutic. Conclusions This research highlights the tensions that arise and the factors that influence the rollout of cannabis as an unregistered medicine. Addressing these factors is essential for the safe and effective prescribing in contemporary medical practice. The findings from this research provides important evidence on medicinal cannabis as a therapeutic, and also informs the rollout of potential novel therapeutics in the future.
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Schultz, Susan E., Chris Vinden, and Linda Rabeneck. "Colonoscopy and Flexible Sigmoidoscopy Practice Patterns in Ontario: A Population-Based Study." Canadian Journal of Gastroenterology 21, no. 7 (2007): 431–34. http://dx.doi.org/10.1155/2007/817810.
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OBJECTIVE: To conduct a population-based study on the provision of large bowel endoscopic services in Ontario.METHODS: Data from the following databases were analyzed: the Ontario Health Insurance Plan, the Institute for Clinical Evaluative Sciences Physicians Database and Statistics Canada. The flexible sigmoidoscopy and colonoscopy rates per 10,000 persons (50 to 74 years of age) by region between April 1, 2001, and March 31, 2002, were calculated, as well as the numbers and types of physicians who performed each procedure.RESULTS: In 2001/2002, a total of 172,108 colonoscopies and 43,400 flexible sigmoidoscopies were performed in Ontario for all age groups. The colonoscopy rate was approximately five times that of flexible sigmoidoscopy; rates varied from 463.1 colonoscopies per 10,000 people in the north to 286.8 colonoscopies per 10,000 people in the east. Gastroenterologists in all regions tended to perform more procedures per physician, but because of the large number of general surgeons, the total number of procedures performed by each group was almost the same.CONCLUSION: Population-based rates of colonoscopies and flexible sigmoidoscopies are low in Ontario, as are the procedure volumes of approximately one-quarter of physicians.
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Willging, Abbygale M., Elvis Castro, and Jun Xu. "Physician–patient communication in vascular surgery: Analysis of encounters in academic practice." SAGE Open Medicine 10 (January 2022): 205031212211224. http://dx.doi.org/10.1177/20503121221122414.
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Objective: To assess physician–patient communication in vascular consults with the aim of identifying areas for improvement. Introduction: Shared decision-making in clinical consults can enhance patient outcomes. Its potential benefits are significant in vascular surgery, where decisions are dependent on the patient’s definition of quality of life and outcomes are influenced by significant lifestyle changes. Methods: In this qualitative cross-sectional study, encounters between five vascular surgeons and their patients with two asymptomatic vascular diseases were audio recorded, transcribed, and analyzed for validated sociolinguistic statistics. The nine-item shared decision-making questionnaire was used to gauge subjective patient perspective. Results: Physicians spent an average of 19 min and 28 s (±8:55) per consult and an average of 12 min and 7 s talking to the patient (±6:33). Physicians used formalized language about 10.3 times an encounter (±8.39), checked for understanding 6.4 times (±4.84), and asked more close-ended than open-ended questions (10.5 ± 6.15 versus 4.6 ± 2.37). Physicians accounted for 46.34% of utterances (±6%) and averaged 5.8 interruptions per encounter (±4). Patients and company accounted for 53.66% of total utterances (±6%) and averaged 10.1 clarification questions (±9.78). The average nine-item shared decision-making questionnaire Likert-type score per patient was 2.82 on a range of −3 to +3 (±0.33), with positive numbers indicating agreement. On average, patients strongly (+2) or completely (+3) agreed that physicians covered the nine criteria. Conclusion: The 9-item shared decision-making questionnaire data showed that patients mostly felt their physician was adequate in exhibiting shared decision-making behaviors. However, physicians asked closed-ended questions that elicited “yes/no” or brief responses, continuously interrupted patient narratives, and rarely checked for understanding from their patients. These subliminal behaviors restrict patient participation in shared decision-making and may be corrected via longitudinal intervention.
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Lahham, Aroub, Angela T. Burge, Christine F. McDonald, and Anne E. Holland. "How do healthcare professionals perceive physical activity prescription for community-dwelling people with COPD in Australia? A qualitative study." BMJ Open 10, no. 8 (August 2020): e035524. http://dx.doi.org/10.1136/bmjopen-2019-035524.
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ObjectivesClinical practice guidelines recommend that people with chronic obstructive pulmonary disease (COPD) should be encouraged to increase their physical activity levels. However, it is not clear how these guidelines are applied in clinical practice. This study aimed to understand the perspectives of respiratory healthcare professionals on the provision of physical activity advice to people with COPD. These perspectives may shed light on the translation of physical activity recommendations into clinical practice.DesignA qualitative study using thematic analysis.SettingHealthcare professionals who provided care for people with COPD at two major tertiary referral hospitals in Victoria, Australia.Participants30 respiratory healthcare professionals including 12 physicians, 10 physical therapists, 4 nurses and 4 exercise physiologists.InterventionsSemistructured voice-recorded interviews were conducted, transcribed verbatim and analysed by two independent researchers using an inductive thematic analysis approach.ResultsHealthcare professionals acknowledged the importance of physical activity for people with COPD. They were conscious of low physical activity levels among such patients; however, few specifically addressed this in consultations. Physicians described limitations including time constraints, treatment prioritisation and perceived lack of expertise; they often preferred that physical therapists provide more comprehensive assessment and advice regarding physical activity. Healthcare professionals perceived that there were few evidence-based strategies to enhance physical activity. Physical activity was poorly differentiated from the prescription of structured exercise training. Although healthcare professionals were aware of physical activity guidelines, few were able to recall specific recommendations for people with COPD.ConclusionPractical strategies to enhance physical activity prescription may be required to encourage physical activity promotion in COPD care.
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Abdulrahman Hadi Almutiri, Abdul Bari Mohd, and Tahani Mohammad Al Rahbeni. "Antimicrobial-stewardship Knowledge, attitude, and practice among professional physicians in Saudi hospitals." International Journal of Research in Pharmaceutical Sciences 11, no. 4 (September 28, 2020): 5665–73. http://dx.doi.org/10.26452/ijrps.v11i4.3208.
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Antimicrobial stewardship (AMS) is of vital significance to tackle the antibiotic resistance. Insights of physicians is important for implementation of AMS. Therefore, present study was conducted to assess the knowledge, attitude and practices regarding antibiotic stewardship among professional physicians in Riyadh, Saudi Arabia. A cross-sectional questionnaire-based survey was conducted among professional physicians between January 2020 to April 2020 in clusters of Saudi hospitals. The self-administered and closed ended questionnaire encompassed of informed consent, demographics information and questionnaire which included 7 items for knowledge, 10 for attitude and 8 for practices. Chi-square test and Fisher’s exact test was performed to assess the relationship of knowledge, attitude and practices with gender and medical specialty of the study participants along with descriptive statistics. A p value below (p<0.05) was considered significant for all the statistical purposes. A total of 413 medical practitioners participated in this study. Most of the participants were male 280 (67.8%), aged 31-40 years 163(39.4%). The term antimicrobial stewardship was known to 55.9% of participants and 65% of participants knew the difference between and bactericidal antimicrobial agents (). 71.9% participants opined that can be prevented by using specific . 89% of participants do not prescribe on demand of patients. Health professionals should be adequately trained regarding usage of and their consequences to curb the menace of quickly developing AMA resistance.
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Mastarone, Ginnifer L., Jessica J. Wyse, Eileen R. Wilbur, Benjamin J. Morasco, Somnath Saha, and Kathleen F. Carlson. "Barriers to Utilization of Prescription Drug Monitoring Programs Among Prescribing Physicians and Advanced Practice Registered Nurses at Veterans Health Administration Facilities in Oregon." Pain Medicine 21, no. 4 (November 13, 2019): 695–703. http://dx.doi.org/10.1093/pm/pnz289.
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Abstract Objective To identify barriers to using state prescription drug monitoring programs (PDMPs) among prescribing physicians and advanced practice registered nurses across a variety of Veterans Health Administration (VA) settings in Oregon. Design In-person and telephone-based qualitative interviews and user experience assessments conducted with 25 VA prescribers in 2018 probed barriers to use of state PDMPs. Setting VA health care facilities in Oregon. Subjects Physicians (N = 11) and advanced practice registered nurses (N = 14) who prescribed scheduled medications, provided care to patients receiving opioids, and used PDMPs in their clinical practice. Prescribers were stationed at VA medical centers (N = 10) and community-based outpatient clinics (N = 15); medical specialties included primary care (N = 10), mental health (N = 9), and emergency medicine (N = 6). Methods User experience was analyzed using descriptive statistics. Qualitative interviews were analyzed using conventional content analysis methodology. Results The majority of physicians (64%) and advanced practice registered nurses (79%) rated PDMPs as “useful.” However, participants identified both organizational and software design issues as barriers to their efficient use of PDMPs. Organizational barriers included time constraints, clinical team members without access, and lack of clarity regarding the priority of querying PDMPs relative to other pressing clinical tasks. Design barriers included difficulties entering or remembering passwords, unreadable data formats, time-consuming program navigation, and inability to access patient information across state lines. Conclusions Physicians and advanced practice registered nurses across diverse VA settings reported that PDMPs are an important tool and contribute to patient safety. However, issues regarding organizational processes and software design impede optimal use of these resources.
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Ospel, Johanna Maria, Nima Kashani, Alexis T. Wilson, Urs Fischer, Bruce C. V. Campbell, Pillai N. Sylaja, Shinichi Yoshimura, et al. "Endovascular treatment decision in acute stroke: does physician gender matter? Insights from UNMASK EVT, an international, multidisciplinary survey." Journal of NeuroInterventional Surgery 12, no. 3 (July 30, 2019): 256–59. http://dx.doi.org/10.1136/neurintsurg-2019-015003.
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Background and purposeDifferences in the treatment practice of female and male physicians have been shown in several medical subspecialties. It is currently not known whether this also applies to endovascular stroke treatment. The purpose of this study was to explore whether there are differences in endovascular treatment decisions made by female and male stroke physicians and neurointerventionalists.MethodsIn an international survey, stroke physicians and neurointerventionalists were randomly assigned 10 case scenarios and asked how they would treat the patient: (A) assuming there were no external constraints and (B) given their local working conditions. Descriptive statistics were used to describe baseline demographics, and the adjusted OR for physician gender as a predictor of endovascular treatment decision was calculated using logistic regression.Results607 physicians (97 women, 508 men, 2 who did not wish to declare) participated in this survey. Physician gender was neither a significant predictor for endovascular treatment decision under assumed ideal conditions (endovascular therapy was favored by 77.0% of female and 79.3% of male physicians, adjusted OR 1.03, P=0.806) nor under current local resources (endovascular therapy was favored by 69.1% of female and 76.9% of male physicians, adjusted OR 1.03, P=0.814).ConclusionEndovascular therapy decision making between male and female physicians did not differ under assumed ideal conditions or under current local resources.
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Arada, Mary Joeline D., John Armand E. Aquino, Redmond Benigno S. Aquino, Miguel Luis O. Arkoncel, Belisarius Arandia, and Ida Marie Tabangay-Lim. "Self-efficacy of Filipino Physicians Towards Research and Research Utilization: A Single-Center Quantitative Descriptive Survey." Journal of Medicine, University of Santo Tomas 6, no. 1 (April 30, 2022): 929–38. http://dx.doi.org/10.35460/2546-1621.2020-0056.
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Research Question: What is the current status of self-efficacy beliefs towards research and research utilization (RU) of University of Santo Tomas Faculty of Medicine and Surgery (UST-FMS) graduates who had Clinical Epidemiology in their basic medical education curriculum? Significance of the Study: There is an increase in research and RU trends globally as adherence to practice based on evidence results in improved patient outcomes. Limited studies are available in describing research and RU of Filipino physicians and there is no study available specific for UST-FMS graduates. Objectives: The study aims to describe self-efficacy beliefs towards research and RU of UST-FMS graduates’ batches 2012-2016 who had Clinical Epidemiology in their basic medical education. Study Design: A single-center, quantitative descriptive survey design was used. Methodology: Participants were graduates of UST-FMS batches 2012-2016, currently working at the University of Santo Tomas Hospital. Evidence-based Practice Confidence Scale (EPIC scale) and Edmonton Research Orientation Survey (EROS) were used to assess the research and RU of the participants gathered through snowball sampling. Statistical Analysis: Descriptive statistics such as means and standard deviations were used to analyze the EPIC and EROS scores. Results: The UST-FMS graduates value research and are generally confident in their ability to participate in evidence-based medicine. However, they rarely conduct research and have a low understanding of statistics. Conclusion: The self-efficacy beliefs of UST-FMS graduates towards research and RU may be attributed to several factors. Clinical epidemiology as a subject may be improved by adding more lectures on statistics while hospitals should create avenues to support the conduct of research. Keywords: self-efficacy belief, research and research utilization, Clinical Epidemiology, medical education curriculum
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Nazarian, Lawrence F. "The Pediatrician As Wage Earner." Pediatrics In Review 9, no. 1 (July 1, 1987): 3–4. http://dx.doi.org/10.1542/pir.9.1.3a.
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When the statistics on physicians' earnings come out each year, the pediatricians are close to the cellar. Our colleagues in general practice make a little less; everyone else makes more. We were ahead of the psychiatrists, but they passed us a few years ago. Many of our colleagues have incomes that are multiples of ours. I doubt whether the general public is aware of these figures. When the newspaper prints the median income for physicians, I wager that many readers would estimate ours even higher. They see our busy offices and decide, "He's rolling in it!" They are right, of course, except for what it is we are rolling in.
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Azizi, Shajeda, Khursheda Akhtar, Shahidullah Azizi, M. Kariul Islam, Sajidul Huq, Raziur Rahman, and Sayeda M. Chowdhury. "Assessment of knowledge regarding Nipah virus infection among physicians in a selected tertiary hospital, Rangpur, Bangladesh." International Journal Of Community Medicine And Public Health 8, no. 12 (November 24, 2021): 5771. http://dx.doi.org/10.18203/2394-6040.ijcmph20214565.
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Background: Human Nipah virus (NiV) infection is an emerging zoonotic disease caused by the NiV resulting in severe illness in humans. The physicians can represent a lead role in disease prevention if they have the right knowledge regarding disease. This study aimed to state the assessment of knowledge regarding NiV infection among physicians in a selected tertiary hospital, Rangpur, Bangladesh.Methods: A cross-sectional study was conducted among 211 physicians in Rangpur Medical College and Hospital by pretested structured questionnaire, from January 2020 to December 2020, using a convenient sampling method. Data were collected through face-to-face interviews.Results: The majority of the respondents (69%) were within the 21 to 25 years of age group, mean age was 25±2.9 years where 54% of respondents were female. A questionnaire was comprised of 87 questions regarding knowledge on NiV infection. The findings revealed that 19% had good knowledge, 50% had fair and about 31% had poor level of knowledge regarding NiV infection. Among the respondents, 83% mentioned lack of awareness as a barrier regarding the prevention of NiV infection. Inferential statistics were done at a 95% confidence interval and 5% level of significance. Those who were aged between 21 to 25 years had significantly good knowledge than those who were more than 26 years of age (p=0.002).Conclusions: This study concludes that knowledge of the physicians on NiV infection was at a fair or average level. There is a dire need for the routine integration of the awareness and safety precaution practice among the physicians.
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Suryanto, S. "(P2-28) Collaboration Between Nurses and Physicians in the Emergency Department: An Indonesian Study." Prehospital and Disaster Medicine 26, S1 (May 2011): s144—s149. http://dx.doi.org/10.1017/s1049023x11004729.
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BackgroundPositive collaboration between nurses and physicians is essential in all areas of care especially in emergency practice. This is because it has a significant relationship with the quality, safety, accountability, and responsibility of care. Three areas are positively related to collaborative interaction between nurses and physicians: provider outcomes, patient outcomes, and organizational outcomes.AimTo examine nurses' and physicians' attitudes towards nurse-physician collaboration in the Emergency Department of Dr Saiful Anwar General Hospital, Malang, Indonesia.MethodsThe study was a comparative descriptive quantitative study using a modified Jefferson Scale of Attitude towards Physician-Nurse Collaboration. Data were collected from 47 nurses and 24 physicians who participated in the study. Descriptive statistics, parametric and non-parametric inferential statistics were used to determine group scores and to examine differences between groups, as well as to determine the relationship between demographic characteristics and participants attitudes.ResultsEmergency nurses had significantly more positive attitudes toward collaboration than emergency physicians (p < 0.001). Emergency nurses had significantly higher scores in three of four underlying factors of the instrument: “physician dominance”, “nurse autonomy”, and “caring as opposed to curing”. The effects of gender, age, education, and experience in other hospitals on nurses' and physicians' attitude towards collaboration were not statistically significant. However, experience in the Emergency Department of Dr Saiful Anwar General Hospital was significantly related to participants' attitudes towards collaboration (p = 0.023).ConclusionsThe findings of this study indicate that both organizational and individual strategies should be developed to enhance the nurse-physician collaborative relationship. Inter-professional education may enhance health care professionals' attitudes towards collaboration. A larger and more representative sample is needed for future research, especially examining relationships such as between collaboration of these health professionals and patient outcomes and work place satisfaction.
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Cerasa, Antonio, Gennaro Tartarisco, Roberta Bruschetta, Irene Ciancarelli, Giovanni Morone, Rocco Salvatore Calabrò, Giovanni Pioggia, Paolo Tonin, and Marco Iosa. "Predicting Outcome in Patients with Brain Injury: Differences between Machine Learning versus Conventional Statistics." Biomedicines 10, no. 9 (September 13, 2022): 2267. http://dx.doi.org/10.3390/biomedicines10092267.
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Defining reliable tools for early prediction of outcome is the main target for physicians to guide care decisions in patients with brain injury. The application of machine learning (ML) is rapidly increasing in this field of study, but with a poor translation to clinical practice. This is basically dependent on the uncertainty about the advantages of this novel technique with respect to traditional approaches. In this review we address the main differences between ML techniques and traditional statistics (such as logistic regression, LR) applied for predicting outcome in patients with stroke and traumatic brain injury (TBI). Thirteen papers directly addressing the different performance among ML and LR methods were included in this review. Basically, ML algorithms do not outperform traditional regression approaches for outcome prediction in brain injury. Better performance of specific ML algorithms (such as Artificial neural networks) was mainly described in the stroke domain, but the high heterogeneity in features extracted from low-dimensional clinical data reduces the enthusiasm for applying this powerful method in clinical practice. To better capture and predict the dynamic changes in patients with brain injury during intensive care courses ML algorithms should be extended to high-dimensional data extracted from neuroimaging (structural and fMRI), EEG and genetics.
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Le, Dan, Amanda Brain, Tamara Nina Shenkier, and Paris-Ann Ingledew. "Virtual health in cancer care: Results from a semi-structured interview-survey of oncology health care providers." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): e13618-e13618. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e13618.
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e13618 Background: The COVID-19 pandemic has compelled an increased use of virtual care delivery models in oncology. This study sought to examine the views of oncology health care providers (HCP) in British Columbia on the value and impact of virtual care models in clinical practice. Methods: A semi-structured interview-survey was developed to compare provider practice patterns between May 2019 and May 2020. Questions were designed to determine provider-perceived value and impact of virtual visits on clinical interactions with patients. HCP (including physicians, dentists, and nurse practitioners) at BC Cancer were invited to participate. Responses to the interview questions were de-identified and HCP names were replaced with a study code. Quantitative questions were interpreted with descriptive statistics. Qualitative results were analyzed and iteratively coded by multiple reviewers for emerging themes. Results: Among 531 invited participants, 61 completed the interview-survey and 60 were included in the final analysis. Of those interviewed, 47% were radiation oncologists and 33% were medical oncologists. The remainder of HCP interviewed (n = 12) included functional imaging physicians, general practitioners in oncology, hereditary cancer physicians, nurse practitioners, palliative care physicians, psychiatrists, and surgical oncologists. Most oncology providers (87%) desired the continuation of virtual visits as part of their clinical practice so long as barriers to integration were addressed. Barriers identified included limited access to physical resources, such as hardware (70% responses) and quiet spaces (54% responses), insufficient logistic support such as information technology services (84% responses) and operational workflows (46% responses), the absence of guidelines to select patients for this delivery model (38% responses), and concerns regarding HCP liability, security and privacy (30% responses). Conclusions: Oncology HCP value delivering patient care through virtual means, however, barriers to implementation must be better understood. These data may inform continued use and implementation of virtual care at other oncology centers.
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Caldwell, Bryan D., Robert D. Katz, and Eugene M. Pascarella. "The Use of Focused Electronic Medical Record Forms to Improve Health-care Outcomes." Journal of the American Podiatric Medical Association 101, no. 4 (July 1, 2011): 331–34. http://dx.doi.org/10.7547/1010331.
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Background: We tested the use of specifically designed electronic medical record forms, thereby demonstrating the ability to electronically capture, report, and compare clinical data. To that end, podiatric physicians can determine what constitutes the most effective program or treatment for specific conditions by documenting their treatment outcomes. Methods: A prospective case series was initiated to determine the value of using focused electronic medical record forms to track walking programs in the practices of podiatric physicians. Three patients were observed for 48 weeks using focused electronic medical record forms to input data (body mass index, cholesterol level, hemoglobin A1c level, blood pressure, and other vital information). Patients were given pedometers so that they could log their mileage and their podiatric physicians could enter it into the medical record. Information was collected using an electronic medical record system with the ability to link multiple templates together and assign logic to create flexible entry completion requirements. The clinical data generated are captured in a common database, where the data offer future opportunity to compare statistics among a multitude of practices in various demographic regions. Results: Focused electronic medical record forms were effectively used to track improvements and overall health benefits in a walking program supervised by podiatric physicians. Conclusions: Valuable information can be ascertained with focused electronic medical record forms to help determine treatment effectiveness. This information can later be compared with practices across many different demographics to ascertain the best evidence-based practice. (J Am Podiatr Med Assoc 101(4): 331–334, 2011)
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Bathory, David S. "Relational Dynamics and Health Economics." International Journal of Applied Behavioral Economics 3, no. 1 (January 2014): 36–50. http://dx.doi.org/10.4018/ijabe.2014010103.
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Primary care physicians' and allied healing professionals are overwhelmed with greater demands to provide complex care within business structures that either mandate high volume or exorbitant fees for service in order to support healthcare needs or sustain their livelihood. Statistics within the USA note that 40 to 50 percent of primary care physicians practice consists of complicated care. There are continued decreases within the USA of medical doctors who enter general practice and most choose to enter specialties where they are able to dictate their hours of availability and are reimbursed at a higher rate for services. The exception lies in psychiatry and pediatrics, where there is a shortage of providers and low fees for service. Models that have been proposed to alleviate issues related to these shortages include models of integrated health care, where physicians provide holistic care or partner seamlessly with others to provide total care at a single location. Physician extenders have been developed as an alternative where Master's Level Nurses and Physician Assistants are allowed to practice in the same setting and under the supervision of the licensed physician to deliver care. The intent of the physician extender is to allow the physician to spend greater time with more complicated cases and for the assistants to provide routine care. The issue becomes differentiating when a patient presents with a routine issue but actually requires complex interventions. When traditional physical medicine is combined with a need for psychological counseling the needs are complex, and medical doctors or physician extenders are provided with only a three month rotation in psychological diagnosis and interventions. Both socialized non-socialized medicine do not have a practice model in which they provide adequate care and holistic healing. This paper proposes a new model of providing holistic healthcare based upon relational dynamics in an economically sound manner.
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Grzybicki, Dana Marie, Thomas Gross, Kim R. Geisinger, and Stephen S. Raab. "Estimation of Performance and Sequential Selection of Diagnostic Tests in Patients With Lung Lesions Suspicious for Cancer." Archives of Pathology & Laboratory Medicine 126, no. 1 (January 1, 2002): 19–27. http://dx.doi.org/10.5858/2002-126-0019-eopass.
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Abstract Context.—Measuring variation in clinician test ordering behavior for patients with similar indications is an important focus for quality management and cost containment. Objective.—To obtain information from physicians and nonphysicians regarding their test-ordering behavior and their knowledge of test performance characteristics for diagnostic tests used to work up patients with lung lesions suspicious for cancer. Design.—A self-administered, voluntary, anonymous questionnaire was distributed to 452 multiple-specialty physicians and 500 nonphysicians in academic and private practice in Pennsylvania, Iowa, and North Carolina. Respondents indicated their estimates of test sensitivities for multiple tests used in the diagnosis of lung lesions and provided their test selection strategy for case simulations of patients with solitary lung lesions. Data were analyzed using descriptive statistics and the χ2 test. Results.—The response rate was 11.2%. Both physicians and nonphysicians tended to underestimate the sensitivities of all minimally invasive tests, with the greatest underestimations reported for sputum cytology and transthoracic fine-needle aspiration biopsy. There was marked variation in sequential test selection for all the case simulations and no association between respondent perception of test sensitivity and their selection of first diagnostic test. Overall, the most frequently chosen first diagnostic test was bronchoscopy. Conclusions.—Physicians and nonphysicians tend to underestimate the performance of diagnostic tests used to evaluate solitary lung lesions. However, their misperceptions do not appear to explain the wide variation in test-ordering behavior for patients with lung lesions suspicious for cancer.
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Kostic, Milena, Marina Fisekovic-Kremic, and Mira Kis-Veljkovic. "Recognition and treatment of mild cognitive impairment in Serbian general practice." Srpski arhiv za celokupno lekarstvo, no. 00 (2023): 7. http://dx.doi.org/10.2298/sarh210620007k.
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Introduction/Objective. Mild cognitive impairment (MCI) is a state of progressive cognitive decline, rarely recognized by general practitioners (GPs), which is a reason of late treatment and fast progression towards more serious conditions. The main obstacles for the timely treatment of MCI are lack of diagnostic protocols and clinical guidelines as well as lack of knowledge and disbelief in the pharmacological therapeutic possibilities. The aim of this investigation was to assess level of recognition of MCI symptoms by general practitioners (GPs), and to estimate their perception of distinct risk factors significance for MCI development. Methods. Participants (general practitioners) of the ?Days of General Medicine? Conference (Serbia, March 2018), n = 340, completed 12 items questionnaire about recognition and treatment of the MCI patients. We have used descriptive statistics, Chi-square, Mann-Whitney U tests, binary logistic regression analysis for results presentation, sub-groups comparison, to assess predictors of drug therapy selection, respectively. Results. Study showed GPs recognize diabetes as most important factor for MCI, then hypercholesterolemia, smoking and sedentary behavior, while hypertension and obesity are perceived as less important. Those GPs who estimated diabetes and hypercholesterolemia as more important for all patients are significantly more prone to prescribe symptomatic therapy (pentoxifylline and vinpocetine), p < 0.05 according to Chi-square test. Logistic regression analysis regarding therapy predictions showed that years of GP experience is the most important predictor of drug therapy selection (p < 0.01). Conclusion. Results of this investigation pointed a need for MCI education for young physicians, in order to improve diagnosis and treatment of these patients.
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Chatterjee, Kaushik, and Mandovi Nath. "Physician understanding and preferences on the current management and treatment approaches for chronic constipation: a cross-sectional survey-based study." International Journal of Research in Medical Sciences 10, no. 11 (October 28, 2022): 2434. http://dx.doi.org/10.18203/2320-6012.ijrms20222838.
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Background: Chronic constipation is a prevalent gastrointestinal (GI) motility disorder. To date, there is a lack of real-world evidence on the current treatment approaches and patterns in the management of chronic constipation in India.Methods: We administered a cross-sectional, physical and digital-based survey between May 2021 and November 2021 to experienced gastroenterologists from different zones of India whose practices encompass direct care of patients with chronic constipation. The questionnaire included 30 close-ended questions on qualitative aspects of constipation management, with specific focus on physicians’ experience with efficacy, tolerability and compliance of Duphalac bulk, a combination of soluble fibers and lactulose. Responses of survey participants were summarized and analyzed using descriptive statistics. All analyses were performed using SPSS 25.0.Results: The survey was completed by 195 respondents, of which, 81.5% of physicians preferred osmotic laxatives plus fibers for the management of chronic constipation. Soluble fibers are the preferred choice of physicians (84.6%) over insoluble fibers and lactulose plus soluble fibers was the most preferred in the management of constipation symptoms. The efficacy, tolerability and compliance of Duphalac® bulk were found to be highly satisfactory.Conclusions: In this survey, key practice-relevant information on the current treatment approaches related to the management of chronic constipation from Indian were garnered. The use of soluble fibers was found to be preferred over insoluble fibers, and the clinical profile of a combination formulation of soluble fibers and lactulose was found to be extremely satisfactory among the survey population.
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Vanderhout, Shelley M., Clara Juando-Prats, Catherine S. Birken, Kevin E. Thorpe, and Jonathon L. Maguire. "A qualitative study to understand parent and physician perspectives about cow’s milk fat for children." Public Health Nutrition 22, no. 16 (September 2, 2019): 3017–24. http://dx.doi.org/10.1017/s136898001900243x.
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AbstractObjective:Consensus guidelines recommend that children consume reduced-fat (0·1–2 %) cow’s milk at age 2 years to reduce the risk of obesity. Behaviours and perspectives of parents and physicians about cow’s milk fat for children are unknown. Objectives were to: (i) understand what cow’s milk fat recommendations physicians provide to 2-year-old children; (ii) assess the acceptability of reduced-fat v. whole cow’s milk in children’s diets by parents and physicians; and (iii) explore attitudes and perceptions about cow’s milk fat for children.Design:Online questionnaires and individual interviews were conducted. Questionnaire data were analysed using descriptive statistics. Interview transcripts were analysed using a general inductive approach and thematic analysis.Setting:The TARGet Kids! practice-based research network in Toronto, Canada.Participants:Questionnaire respondents included fifty parents and fifteen physicians; individual interviews were conducted with with fourteen parents and twelve physicians.Results:Physicians provided various milk fat recommendations for 2-year-old children. Parents also provided different cow’s milks: eighteen (36 %) provided whole milk and twenty-nine (58 %) provided reduced-fat milk. Analysis of qualitative interviews revealed three themes: (i) healthy eating behaviours, (ii) trustworthy nutrition information and (iii) importance of dietary fat for children.Conclusions:Parents provide, and physicians recommend, a variety of cow’s milks for children and hold mixed interpretations of the role of cow’s milk fat in children’s diets. Clarity about its effect on child adiposity is needed to help make informed decisions about cow’s milk fat for children.
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Cloutier, Justin M., Clarence Khoo, Brett Hiebert, Anthony Wassef, and Colette M. Seifer. "Physician decision making in anticoagulating atrial fibrillation: a prospective survey of a physician notification system for atrial fibrillation detected on cardiac implantable electronic devices of patients at increased risk of stroke." Therapeutic Advances in Cardiovascular Disease 12, no. 4 (March 11, 2018): 113–22. http://dx.doi.org/10.1177/1753944717749739.
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Objectives: The objectives of this study were to evaluate the effectiveness of a physician notification system for atrial fibrillation (AF) detected on cardiac devices, and to assess predictors of anticoagulation in patients with device-detected AF. Methods: In 2013, a physician notification system for AF detected on a patient’s CIED [including pacemakers, implantable cardioverter defibrillators (ICD) or cardiac resynchronization therapy (CRT) devices] was implemented, with a recommendation to consider oral anticoagulation in high-risk patients. We prospectively investigated the effectiveness of this system, and evaluated both patient and physician predictors of anticoagulation, as well as factors influencing physician decision making in prescribing anticoagulation. Both uni- and multivariable analysis as well as descriptive statistics were used in the analysis. Results: We identified 177 patients with device-detected AF, 126 with a CHADS2 ⩾2. Only 41% were prescribed anticoagulation at any point within 12 months. On multivariable analysis, stroke risk as predicted by CHADS2 was not a predictor of anticoagulation. ASA use predicted a lower rate of anticoagulation (OR 0.39, 95% CI 0.16–0.97, p = 0.04); physicians in practice for <20 years were more likely to prescribe anticoagulation (OR 3.39, 95% CI 1.28–8.93, p = 0.01); and physicians who believed both cardiologist and family doctor should be involved in managing anticoagulation were more likely to prescribe anticoagulation (OR 3.28, 95% CI 1.02–10.5, p = 0.05). Conclusions: Patients on aspirin were less likely to be anticoagulated. Physicians in practice for <20 years and who believed that both the general practitioner and cardiologist should be involved in managing anticoagulants were more likely to prescribe anticoagulation.
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Allan, Beverly, Kalysha Closson, Alexandra B. Collins, Mia Kibel, Shenyi Pan, Zishan Cui, Taylor McLinden, et al. "Physicians’ patient base composition and mortality among people living with HIV who initiated antiretroviral therapy in a universal care setting." BMJ Open 9, no. 3 (March 2019): e023957. http://dx.doi.org/10.1136/bmjopen-2018-023957.
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ObjectivesTo assess the impact of physicians’ patient base composition on all-cause mortality among people living with HIV (PLHIV) who initiated highly active antiretroviral therapy (HAART) in British Columbia (BC), Canada.DesignObservational cohort study from 1 January 2000 to 31 December 2013.SettingBC Centre for Excellence in HIV/AIDS’ (BC-CfE) Drug Treatment Program, where HAART is available at no cost.ParticipantsPLHIV aged ≥ 19 who initiated HAART in BC in the HAART Observational Medical Evaluation and Research (HOMER) Study.Outcome measuresAll-cause mortality as determined through monthly linkages to the BC Vital Statistics Agency.Statistical analysisWe examined the relationships between patient characteristics, physicians’ patient base composition, the location of the practice, and physicians’ experience with PLHIV and all-cause mortality using unadjusted and adjusted Cox proportional hazards models.ResultsA total of 4 445 PLHIV (median age = 42, Q1, Q3 = 34–49; 80% male) were eligible for our study. Patients were seen by 683 prescribing physicians with a median experience of 77 previously treated PLHIV in the past 2 years (Q1, Q3 = 23–170). A multivariable Cox model indicated that the following factors were associated with all-cause mortality: age (aHR = 1.05 per 1-year increase, 95% CI = 1.04 to 1.06), year of HAART initiation (2004–2007: aHR = 0.65, 95% CI = 0.53 to 0.81, 2008-2011: aHR = 0.46, 95% CI = 0.35 to 0.61, Ref: 2000–2003), CD4 cell count at baseline (aHR = 0.88 per 100-unit increase in cells/mm3, 95% CI = 0.82 to 0.94), and < 95% adherence in first year on HAART (aHR = 2.28, 95% CI = 1.88 to 2.76). In addition, physicians’ patient base composition, specifically, the proportion of patients who have a history of injection drug use (aHR = 1.11 per 10% increase in the proportion of patients, 95% CI = 1.07 to 1.15) or Indigenous ancestry (aHR = 1.07 per 10% increase , 95% CI = 1.03–1.11) and being a patient of a physician who primarily serves individuals outside of the Vancouver Coastal Health Authority region (aHR = 1.22, 95% CI = 1.01 to 1.47) were associated with mortality.ConclusionsOur findings suggest that physicians with a higher proportion of individuals who face potential barriers to care may need additional supports to decrease mortality among their patients. Future research is required to examine these relationships in other settings and to determine strategies that may mitigate the associations between the composition of physicians’ patient bases and survival.
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Huynh, L., S. Hass, B. E. Sands, M. S. Duh, H. Sipsma, M. Cheng, A. Lax, and A. NAG. "P621 Physician preferences for biologics (originator vs. biosimilar) for the treatment of ulcerative colitis in France, Germany and the UK." Journal of Crohn's and Colitis 14, Supplement_1 (January 2020): S515—S516. http://dx.doi.org/10.1093/ecco-jcc/jjz203.749.
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Abstract Background Although originator biologics are effective therapies for patients with ulcerative colitis (UC), they can be costly and may not be widely available. Therefore, less expensive biosimilars have been developed and approved to treat and manage symptoms. In this new treatment landscape, UC-treatment preferences are unknown. Thus, this interim analysis aimed to characterise physician preferences for biologics for the treatment of UC in France, Germany and the UK. Methods As part of a broader chart review study, treatment preferences were also collected from participating gastroenterologists and general practitioners (GPs) in France, Germany and the UK who had treated patients (≥ 18 years) with moderate-to-severe UC who had received ≥ 1 UC-related biologic any time from 2014 to 25 October 2019. Descriptive statistics were used to describe the sample overall, and by physician speciality and treatment preference. Results Physicians (161 gastroenterologists; 57 GPs) were from different clinical settings in France (39.9%), Germany (28.4%) and the UK (31.7%). Overall, infliximab (33.0%) and adalimumab (32.1%) were selected more often as first treatment options than their biosimilars (17.0% and 9.6%, respectively). Gastroenterologists preferred biosimilars more frequently than GPs did (35.4% vs. 1.8%). More physicians who preferred biosimilars were from France (48.3%) than Germany (17.2%) or the UK (34.5%). In France and the UK, 93.8% of physicians who selected biosimilars worked in hospital settings; in Germany, 50.0% worked in clinics and 50.0% worked in practice settings with statutory and private patients. Physicians who preferred biosimilars treated more patients with UC in the preceding 12 months than those who preferred originators did (mean ± SD: 110.3 ± 113.9 vs. 94.0 ± 93.2). Although most physicians reported efficacy as a reason for biologic preference (93.6%), physicians who preferred originators were more likely to report good tolerability (73.8%) and patient preference (20.6%) and less likely to report affordability or availability (11.9%) than physicians who preferred biosimilars (63.8%, 10.3% and 44.8%, respectively). In patients who failed anti-TNF therapy, vedolizumab was the preferred treatment (78.9%), although this preference differed by speciality (gastroenterologists: 83.2%; GPs: 66.7%). Conclusion Originator biologics for treating patients with moderate-to-severe UC dominate the treatment landscape in Europe, driven primarily by efficacy, tolerability and patient preference. However, variations and differences in preferences by speciality and clinical setting may suggest a need to explore additional treatment options to manage disease symptoms among patients with UC.
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Kennedy, W., D. Andruchow, S. Dowling, K. Lonergan, T. Rich, and C. Patocka. "MP23: Mixed methods analysis of an automated e-mail audit and feedback intervention for fostering emergency physician reflection." CJEM 22, S1 (May 2020): S50. http://dx.doi.org/10.1017/cem.2020.171.
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Innovation Concept: Emergency physicians (EP) rarely receive timely, iterative feedback on clinical performance that aids their reflective practice. The Calgary zone ED recently implemented a novel email-based alert system wherein an EP is notified when a patient whose ED care they were involved in is admitted to hospital within 72-hours of discharge from an index ED visit. Our study sought to evaluate the general acceptability of this form of audit and feedback and determine whether it encourages practice reflection. Methods: This mixed methods realist evaluation consisted of two sequential phases. An initial quantitative phase used data from our electronic health record and a survey to examine the general features and acceptability of 72-hour readmission alerts sent from May 2017-2018. A subsequent qualitative phase involved semi-structured interviews exploring the alert's role in greater depth. Quantitative data were summarized using descriptive statistics and qualitative data were analyzed using thematic and template analysis techniques. Results of both phases were used to guide construction of context-mechanism-outcome statements to refine our program theory. Curriculum, Tool, or Material: 4024 alerts were sent over a 1-year period, with each physician receiving approximately 17 alerts per year (Q1: 7, Q3: 25, IQR: 18). The top five CEDIS complaints on index presentations were abdominal pain, flank pain, shortness of breath, vomiting and/or nausea, and chest pain (cardiac features). The majority of re-admissions (78.6%) occurred within 48 hours after discharge. Immediate alert survey feedback provided by EP's noted that 52.65% (N = 471) of alerts were helpful. Thematic analysis of 17 semi-structured interviews suggests that the alert was generally acceptable to physicians, However, certain EPs were concerned that the alert impacted hire/fire decisions even when leadership didn't endorse this sentiment. Physicians who didn't believe alerts were involved in hire/fire decisions, described greater engagement in the reflective process. Conversely, physicians, who believed alerts were involved in hire/fire decisions, were more likely to defensively change their practice. Conclusion: Most EPs noted that timely notification of 72-hour readmissions made them more mindful of documenting discharge instructions. Our implementation of a 72- hour readmission alert was an acceptable format for audit and feedback and appeared to facilitate physician reflection under certain conditions.
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Schnapp, Benjamin, Emily Fleming, Aaron Kraut, Mary Westergaard, Robert Batt, and Brian Patterson. "Maggots, Mucous and Monkey Meat: Does Disgust Sensitivity Affect Case Mix Seen During Residency?" Western Journal of Emergency Medicine 21, no. 1 (December 9, 2019): 87–90. http://dx.doi.org/10.5811/westjem.2019.9.44309.
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Introduction: Emergency physicians encounter scenarios daily that many would consider “disgusting,” including exposure to blood, pus, and stool. Physicians in procedural specialties such as surgery and emergency medicine (EM) have lower disgust sensitivity overall, but the role this plays in clinical practice is unclear. The objective of this study was to determine whether emergency physicians with higher disgust sensitivity see fewer “disgusting” cases during training. Methods: All EM residents at a midsize urban EM program were eligible to complete the Disgust Scale Revised (DS-R). We preidentified cases as “disgust elicitors” based on diagnoses likely to induce disgust due to physician exposure to bodily fluids, anogenital anatomy, or gross deformity. The “disgust elicitor” case percent was determined by “disgust elicitor” cases seen as the primary resident divided by the number of cases seen thus far in residency. We calculated Pearson’s r, t-tests and descriptive statistics on resident and population DS-R scores and “disgust elicitor” cases per month. Results: Mean DS-R for EM residents (n = 40) was 1.20 (standard deviation [SD] 1.24), significantly less than the population mean of 1.67 (SD 0.61, p<0.05). There was no correlation (r = -0.04) between “disgust elicitor” case (n = 2191) percent and DS-R scores. There was no significant difference between DS-R scores for junior residents (31.1, 95% confidence interval [CI], 26.8-35.4) and for senior residents (29.0, 95%CI, 23.4-34.6). Conclusion: Higher disgust sensitivity does not appear to be correlated with a lower percentage of “disgust elicitor” cases seen during EM residency.
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Zhu, Xiaoying, Lynn R. Kohan, Joshua D. Morris, and Robin J. Hamill-Ruth. "Sympathetic blocks for complex regional pain syndrome: a survey of pain physicians." Regional Anesthesia & Pain Medicine 44, no. 7 (May 3, 2019): 736–41. http://dx.doi.org/10.1136/rapm-2019-100418.
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BackgroundSympathetic blocks (SB) are commonly used to treat pain from complex regional pain syndrome (CRPS). However, there are currently no guidelines to assist pain physicians in determining the best practices when using and performing these procedures.MethodsA 32-question survey was developed on how SBs are used and performed to treat CRPS. The survey was conducted online via SurveyMonkey. The responses were statistically analyzed using descriptive statistics, and comparing academic versus non-academic, and fellowship versus non-fellowship-trained physicians.ResultsA total of 248 pain physicians responded with a response rate of 37%. Forty-four percent of respondents schedule the first SB at the first clinic visit; 73% perform one to three consecutive blocks; over 50% will repeat the block if a patient receives at least 50% pain relief from the previous one lasting 1–7 days.Fifty-four percent of respondents perform stellate ganglion blocks (SGB) at the C6 vertebral level, 41% at C7; 53% perform lumbar sympathetic blocks (LSB) at L3 level, 39% at L2; 50% use fluoroscopy to guide SGB, 47% use ultrasound. More respondents from academic than non-academic centers use ultrasound for SGB. About 75% of respondents use a total volume of 5–10 mL for SGB and 10–20 mL for LSB. The most commonly used local anesthetic is 0.25% bupivacaine. About 50% of respondents add other medications, mostly steroids, for these blocks.ConclusionOur study showed a wide variation in current practice among pain physicians in treating CRPS with SBs. There is a clear need for evidence-based guidelines on when and how to perform SBs for CRPS.
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Hochgatterer, Karl, H. Moshammer, M. Nikl, G. Orsolits, and Stephan Letzel. "Ärztliches Meldeverhalten von Berufskrankheiten in Österreich am Beispiel Mesotheliom." ASU Arbeitsmedizin Sozialmedizin Umweltmedizin 2020, no. 01 (December 23, 2019): 34–37. http://dx.doi.org/10.17147/asu-2001-8316.
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Reporting of occupational diseases by physicians in Austria based on the example of mesothelioma Background: Physicians and employers in Austria have a duty to report the well-founded suspicion of the existence of an occupational disease to the responsible accident insurance institution. In particular, an occupational disease report must be made as a matter of principle in the case of mesothelioma, which is highly likely to be caused by job-related exposure to asbestos. Methods: In the pilot study, the available data on mesothelioma cases from Statistics Austria (StatAT) were compared with the corresponding cases of the General Accident Insurance Institution (AUVA) that were recognised as an occupational disease during the period from 2004 to 2016. Results: The results show that during the period under observation only about 40% of the mesothelioma cases registered by StatAT were recognised by AUVA as an occupational disease. There are some significant differences in the recognition rate if the cases of disease are differentiated according to the individual federal states of Austria where the enterprises are located in which the mesothelioma cases have occurred. Conclusions: The reasons for the relatively low recognition rate of mesothelioma cases in Austria can be complex. It is most likely that the relatively low recognition rate is related to poor reporting practice on the part of physicians. In order to improve this situation, appropriate information campaigns should be carried out among physicians in Austria. Keywords: occupational disease – cancer – mesothelioma – occupational disease report
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Najmabadi, Shahpar, Trenton J. Honda, and Roderick S. Hooker. "Collaborative practice trends in US physician office visits: an analysis of the National Ambulatory Medical Care Survey (NAMCS), 2007–2016." BMJ Open 10, no. 6 (June 2020): e035414. http://dx.doi.org/10.1136/bmjopen-2019-035414.
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ObjectivePractice arrangements in physician offices were characterised by examining the share of visits that involved physician assistants (PAs) and nurse practitioners (NPs). The hypothesis was that collaborative practice (ie, care delivered by a dyad of physician-PA and/or physician-NP) was increasing.DesignTemporal ecological study.SettingNon-federal physician offices.ParticipantsPatient visits to a physician, PA or NP, spanning years 2007–2016.MethodsA stratified random sample of visits to office-based physicians was pooled through the National Ambulatory Medical Care Survey public use linkage file. Among 317 674 visits to physicians, PAs or NPs, solo and collaborative practices were described and compared over two timespans of 2007–2011 and 2012–2016. Weighted patient visits were aggregated in bivariate analyses to achieve nationally representative estimates. Survey statistics assessed patient demographic characteristics, reason for visit and visit specialty by provider type.ResultsWithin years 2007–2011 and 2012–2016, there were 4.4 billion and 4.1 billion physician office visits (POVs), respectively. Comparing the two timespans, the rate of POVs with a solo PA (0.43% vs 0.21%) or NP (0.31% vs 0.17%) decreased. Rate of POVs with a collaborative physician-PA increased non-significantly. Rate of POVs with a collaborative physician-NP (0.49% vs 0.97%, p<0.01) increased. Overall, collaborative practice, in particular physician-NP, has increased in recent years (p<0.01), while visits handled by a solo PA or NP decreased (p<0.01). In models adjusted for patient age and chronic conditions, the odds of collaborative practice in years 2012–2016 compared with years 2007–2011 was 35% higher (95% CI 1.01 to 1.79). Furthermore, in 2012–2016, NPs provided more independent primary care, and PAs provided more independent care in a non-primary care medical specialty. Preventive visits declined among all providers.ConclusionsIn non-federal physician offices, collaborative care with a physician-PA or physician-NP appears to be a growing part of office-based healthcare delivery.
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Melton, PharmD, MPH, BCPS, Tyler C., Nicholas E. Hagemeier, PharmD, PhD, Fred G. Tudiver, MD, Kelly N. Foster, PhD, Jessie Arnold, MA, Bill Brooks, DrPH, MPH, Arsham Alamian, PhD, MSc, FACE, and Robert P. Pack, PhD, MPH. "Primary care physicians’ opioid-related prevention behaviors and intentions: A descriptive analysis." Journal of Opioid Management 18, no. 1 (January 1, 2022): 75–83. http://dx.doi.org/10.5055/jom.2022.0697.
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Objective: Primary care physicians (PCPs) are positioned to mitigate opioid morbidity and mortality, but their engagement in primary, secondary, and tertiary opioid-related prevention behaviors is unclear. The objective of this study was to evaluate Tennessee PCPs’ engagement in and intention to engage in multiple opioid-related prevention behaviors.Methods: A survey instrument was developed, pretested, and pilot tested with practicing PCPs. Thereafter, a census of eligible Tennessee PCPs was conducted using a modified, four-wave tailored design method approach. Three patient scenarios were employed to assess physician intention to engage in 10 primary, secondary, and tertiary prevention behaviors. Respondents were asked to report, given 10 similar scenarios, the number of times (0-10) they would engage in prevention behaviors. Descriptive statistics were calculated using SPSS version 25.Results: A total of 296 usable responses were received. Physician intention to engage in prevention behaviors varied across the 10 behaviors studied. Physicians reported frequently communicating risks associated with prescription opioids to patients (8.9 ± 2.8 out of 10 patients), infrequently utilizing brief questionnaires to assess for risk of opioid misuse (1.7 ± 3.3 out of 10 patients), and screening for current opioid misuse (3.1 ± 4.3 out of 10 patients). Physicians reported seldomly co-prescribing naloxone for overdose reversal and frequently discharging from practice patients presenting with an opioid use disorder.Conclusions: This study noted strengths and opportunities to increase engagement in prevention behaviors. Understanding PCPs’ engagement in opioid-related prevention behaviors is important to effectively target and implement morbidity and mortality reducing interventions.
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Peng, Xueqing, Zhiguang Li, Chi Zhang, Rui Liu, Yongzhi Jiang, Jiayu Chen, Zixin Qi, et al. "Determinants of physicians’ online medical services uptake: a cross-sectional study applying social ecosystem theory." BMJ Open 11, no. 9 (September 2021): e048851. http://dx.doi.org/10.1136/bmjopen-2021-048851.
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ObjectiveTo investigate the determinants of willingness and practice of physicians’ online medical services (OMS) uptake based on social ecosystem theory, so as to formulate OMS development strategies.DesignCross-sectional survey.SettingResearch was conducted in two comprehensive hospitals and two community hospitals in Jiangsu, China, and the data were gathered from 1 June to 31 June 2020.ParticipantsWith multistage sampling, 707 physicians were enrolled in this study.Outcome measureDescriptive statistics were reported for the basic characteristics. χ2 test, Mann-Whitney U test and Spearman’s correlation analysis were used to perform univariate analysis. Linear regression and logistic regression were employed to examine the determinants of physicians’ OMS uptake willingness and actual uptake, respectively.ResultsThe mean score of the physicians’ OMS uptake willingness was 17.33 (range 5–25), with an SD of 4.39, and 53.3% of them reported having conducted OMS. In the micro system, factors positively associated with willingness included holding administrative positions (b=1.03, p<0.05), OMS-related awareness (b=1.32, p<0.001) and OMS-related skills (b=4.88, p<0.001); the determinants of actual uptake included holding administrative positions (OR=2.89, 95% CI 1.59 to 5.28, p<0.01), OMS-related awareness (OR=1.90, 95% CI 1.22 to 2.96, p<0.01), OMS-related skills (OR=2.25, 95% CI 1.35 to 3.74, p<0.01) and working years (OR=2.44, 95% CI 1.66 to 3.59, p<0.001). In the meso system, the hospital’s incentive mechanisms (b=0.78, p<0.05) were correlated with willingness; hospital advocated for OMS (OR=2.34, 95% CI 1.21 to 4.52, p<0.05), colleagues’ experiences (OR=3.81, 95% CI 2.25 to 6.45, p<0.001) and patients’ consultations (OR=2.93, 95% CI 2.02 to 4.25, p<0.001) were determinants of actual uptake. In the macro system, laws and policies were correlated with willingness (b=0.73, p<0.05) and actual uptake (OR=1.98, 95% CI 1.31 to 2.99, p<0.01); media orientation was also associated with willingness (b=0.74, p<0.05).ConclusionMultiple determinants influence physicians’ OMS application. Comprehensive OMS promotion strategies should be put forward from multidimensional perspectives including the micro, meso and macro levels.
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Gidey, Kidu, Mohammedamin Seifu, Berhane Yohannes Hailu, Solomon Weldegebreal Asgedom, and Yirga Legesse Niriayo. "Healthcare professionals knowledge, attitude and practice of adverse drug reactions reporting in Ethiopia: a cross-sectional study." BMJ Open 10, no. 2 (February 2020): e034553. http://dx.doi.org/10.1136/bmjopen-2019-034553.
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ObjectiveThis study aimed to assess the knowledge, attitude and practice of adverse drug reactions (ADRs) reporting and identify factors associated with ADRs reporting among healthcare professionals (HCPs) working in Tigray region, Ethiopia.Materials and methodsA cross-sectional study was conducted between January and March of 2019 in a tertiary care hospital in Tigray region, Ethiopia. A self-administered, pretested questionnaire was administered to HCPs. Data were summarised using descriptive statistics. Logistic regression analysis was used to identify factors associated with poor ADRs reporting practices.ResultsIn total, 362 questionnaires were distributed, and the response rate was 84.8% (n=307). Of all respondents, 190 (61.9%) were nurses, 63 (20.5%) were pharmacist and 54 (17.6%) were physicians. About 58.3% of HCPs had poor knowledge of ADRs reporting. The majority of the respondents had a positive attitude (59.9%), and only a few (32.1%) respondents have good ADRs reporting practices. Poor knowledge (adjusted OR (AOR)=2.63, 95% CI: 1.26 to 5.45) and lack of training on ADRs reporting (AOR=7.31, 95% CI: 3.42 to 15.62) were both negatively associated with ADRs reporting practice, whereas higher work experience (≥10 years) (AOR=0.36, 95% CI: 0.13 to 0.97) was positively associated with ADRs reporting practice.ConclusionsThe majority of HCPs had poor knowledge and practice, but a positive attitude towards ADRs reporting. Poor knowledge, less work experience and lack of training were associated with poor ADRs reporting practice. Hence, strategies to improve the knowledge and practice of ADRs reporting should be implemented, particularly for untrained and less experienced HCPs.
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Burzyńska, Joanna, Anna Bartosiewicz, and Paweł Januszewicz. "Dr. Google: Physicians—The Web—Patients Triangle: Digital Skills and Attitudes towards e-Health Solutions among Physicians in South Eastern Poland—A Cross-Sectional Study in a Pre-COVID-19 Era." International Journal of Environmental Research and Public Health 20, no. 2 (January 5, 2023): 978. http://dx.doi.org/10.3390/ijerph20020978.
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The investment in digital e-health services is a priority direction in the development of global healthcare systems. While people are increasingly using the Web for health information, it is not entirely clear what physicians’ attitudes are towards digital transformation, as well as the acceptance of new technologies in healthcare. The aim of this cross-sectional survey study was to investigate physicians’ self-digital skills and their opinions on obtaining online health knowledge by patients, as well as the recognition of physicians’ attitudes towards e-health solutions. Principal component analysis (PCA) was performed to emerge the variables from self-designed questionnaire and cross-sectional analysis, comparing descriptive statistics and correlations for dependent variables using the one-way ANOVA (F-test). A total of 307 physicians participated in the study, reported as using the internet mainly several times a day (66.8%). Most participants (70.4%) were familiar with new technologies and rated their e-health literacy high, although 84.0% reported the need for additional training in this field and reported a need to introduce a larger number of subjects shaping digital skills (75.9%). 53.4% of physicians perceived Internet-sourced information as sometimes reliable and, in general, assessed the effects of its use by their patients negatively (41.7%). Digital skills increased significantly with frequency of internet use (F = 13.167; p = 0.0001) and decreased with physicians’ age and the need for training. Those who claimed that patients often experienced health benefits from online health showed higher digital skills (−1.06). Physicians most often recommended their patients to obtain laboratory test results online (32.2%) and to arrange medical appointments via the Internet (27.0%). Along with the deterioration of physicians’ digital skills, the recommendation of e-health solutions decreased (r = 0.413) and lowered the assessment of e-health solutions for the patient (r = 0.449). Physicians perceive digitization as a sign of the times and frequently use its tools in daily practice. The evaluation of Dr. Google’s phenomenon and online health is directly related to their own e-health literacy skills, but there is still a need for practical training to deal with the digital revolution.
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Carek, Peter J., Lisa Mims, Stacey Kirkpatrick, Maribeth P. Williams, Runzhi Zhang, Benjamin Rooks, Susmita Datta, Lars E. Peterson, and Arch G. Mainous. "Does Community- or University-Based Residency Sponsorship Affect Graduate Perceived Preparation or Performance?" Journal of Graduate Medical Education 12, no. 5 (October 1, 2020): 583–90. http://dx.doi.org/10.4300/jgme-d-19-00907.1.
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ABSTRACT Background Residency training occurs in varied settings. Whether there are differences in the training received by graduates of community- or medical school–based programs has been the subject of debate. Objective This study examined the perceived preparation for practice, scope of practice, and American Board of Family Medicine (ABFM) board examination pass rates of family physicians in relation to the type of residency program (community, medical school, or partnership) in which they trained. Methods Predetermined survey responses were abstracted from the 2016 and 2017 National Family Medicine Graduate Survey of ABFM and linked to data about residency programs obtained from the websites of national organizations. Descriptive statistics were used to summarize the data and logistic regression to examine differences between survey results based on type of residency training: community, medical school, or partnership. Results Differences in the perception of preparation as well as current scope of practice were noted for the 3 residency types. The differences in perception were mainly noted in hospital-based skills, such as intubation and ventilator management, and in women's health and family planning services, with different program types increasing preparedness perception in different domains. Conclusions In general, graduates of family medicine community-based, non-affiliated, and partnership programs perceived they were prepared for and were providing more of the services queried in the survey than graduates of medical school–based programs.
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Luchinin, Alexander Sergeevich. "Artificial Intelligence in Hematology." Clinical oncohematology 15, no. 1 (2022): 16–27. http://dx.doi.org/10.21320/2500-2139-2022-15-1-16-27.
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‘Artificial Intelligence’ is a general term to designate computer technologies for solving the problems that require implementation of human intelligence, for example, human voice or image recognition. Most artificial intelligence products with application in healthcare are associated with machine learning, i.e., a field of informatics and statistics dealing with the generation of predictive or descriptive models through data-based learning, rather than programming of strict rules. Machine learning has been widely used in pathomorphology, radiology, genomics, and electronic medical record data analysis. In line with the current trend, artificial intelligence technologies will most likely become increasingly integrated into health research and practice, including hematology. Thus, artificial intelligence and machine learning call for attention and understanding on the part of researchers and clinical physicians. The present review covers important terms and basic concepts of these technologies, as well as offers examples of their actual use in hematological research and practice.
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Carney, Patricia A., M. Patrice Eiff, John W. Saultz, Erik Lindbloom, Elaine Waller, Samuel Jones, Jamie Osborn, and Larry Green. "Assessing the Impact of Innovative Training of Family Physicians for the Patient-Centered Medical Home." Journal of Graduate Medical Education 4, no. 1 (March 1, 2012): 16–22. http://dx.doi.org/10.4300/jgme-d-11-00035.1.
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Abstract Background New approaches to enhance access in primary care necessitate change in the model for residency education. Purpose To describe instrument design, development and testing, and data collection strategies for residency programs, continuity clinics, residents, and program graduates participating in the Preparing the Personal Physician for Practice (P4) project. Methods We developed and pilot-tested surveys to assess demographic characteristics of residents, clinical and operational features of the continuity clinics and educational programs, and attitudes about and implementation status of Patient Centered Medical Home (PCMH) characteristics. Surveys were administered annually to P4 residency programs since the project started in 2007. Descriptive statistics were used to profile data from the P4 baseline year. Results Most P4 residents were non-Hispanic white women (60.7%), married or partnered, attended medical school in the United States and were the first physicians in their families to attend medical school. Nearly 85% of residency continuity clinics were family health centers, and about 8% were federally qualified health centers. The most likely PCMH features in continuity clinics were having an electronic health record and having fully secure remote access available; both of which were found in more than 50% of continuity clinics. Approximately one-half of continuity clinics used the electronic health record for safety projects, and nearly 60% used it for quality-improvement projects. Conclusions We created a collaborative evaluation model in all 14 P4 residencies. Successful implementation of new surveys revealed important baseline features of residencies and residents that are pertinent to studying the effects of new training models for the PCMH.
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Abel, Gregory A., Christopher R. Friese, Bridget A. Neville, B. Taylor Hastings, Craig C. Earle, and Lisa C. Richardson. "The Anemia Workup in Current Clinical Practice: Results From a Survey of Primary Care Physicians." Blood 118, no. 21 (November 18, 2011): 2084. http://dx.doi.org/10.1182/blood.v118.21.2084.2084.
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Abstract Abstract 2084 BACKGROUND: Although the primary care physician (PCP) is often the first provider to diagnose anemia, little is known about the anemia workup in current clinical practice. Knowledge of current practices can inform efforts to improve anemia management in older adults, which has been recognized as a public health crisis by a combined ASH/National Institute of Aging blue ribbon panel. METHODS: From April to August 2010, we administered a 34-item questionnaire to a random sample of 190 Massachusetts physicians identified as PCPs (family practice, general practice, or internal medicine) in the American Medical Association's physician file. PCPs were given a vignette about a hypothetical patient asking “If you were to see a previously healthy patient during a routine physical with mild anemia (Hg 80% of normal) and no other symptoms, which of the following would you do?” PCPs were given 13 choices, but could also write in answers. In the next section, they were told “The patient with mild anemia presents two weeks later. The anemia is unchanged, but the patient has one new sign/symptom in the following list. For each of these as an isolated new finding, what would you do next?” and asked which of 11 signs/symptoms would prompt (1) imaging (2) referral to a hematologist (3) further follow-up. More than one choice was allowed. Results were analyzed descriptively, and significant differences in the second workup stage were identified using Wald chi-square statistics obtained from logistic regression models controlling for correlations of individual PCP responses. RESULTS: 134 PCPs responded (70.5%). 62.4% identified as internists; 58.7% were male. PCPs were evenly distributed with respect to level of academic affiliation. The median reported patient panel size during the prior 12 months was 1800; median percentage of patients ≥ 65 years was 30.0%; median percentage of patients in managed care 55.0%; and median year of graduation from residency, 1996. For the first stage of the workup, most PCPs reported they would send iron studies (93.2%), a differential (85.7%), and B12/folate (85.0%). Fewer would obtain a stool guaiac (69.2%), reticulocyte count (66.2%), or a serum protein electrophoresis (SPEP; 17.3%). At this first stage, 30.8% reported they would require a 2-week follow-up visit, 26.3% a colonoscopy, and 8.3% an EGD. Almost none would refer to a hematologist (3.8%) or obtain imaging (1.5%), and 12.0% wrote in “work-up depends on patient's age.” Reported subsequent actions with persistent anemia and one new sign or symptom were as follows: Among those patients mostly likely to be referred to a hematologist (those with pancytopenia, thrombocytopenia and leukopenia), PCPs reported recommending low levels of 2-week follow-up in addition to the referral (10.6%, 16.7% and 15.6% respectively). CONCLUSIONS: Use of the reticulocyte count, stool guaiac and SPEP were less frequent than might be expected in the first steps of the anemia work-up; in contrast, more than one-quarter of PCPs reported they would obtain a relatively expensive procedure (colonoscopy) as a first step. Signs and symptoms suggesting bone marrow failure most often prompted referral to a hematologist, while those suggesting lymphoma were generally followed by imaging. Interestingly, an insistent family member could influence hematology referral in the setting of persistent anemia, even more so than night sweats, leukocytosis, or weight loss. These data suggest that several lower-cost diagnostic tools may be underutilized in the PCP's anemia workup, that the workup varies with associated clinical factors, and that patients and families influence the ultimate decision to refer to a hematologist. Disclosures: No relevant conflicts of interest to declare.
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Aruasa, Wilson Kipkirui, Linus Kipkorir Chirchir, and Stanley Kulei Chebon. "Implications of physicians and nurses’ professional satisfaction on patient care." International Journal of Public Health Science (IJPHS) 8, no. 3 (September 1, 2019): 300. http://dx.doi.org/10.11591/ijphs.v8i3.20238.
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<p><span lang="EN-GB">The patient outcomes of a health organization depend on the knowledge, skills and motivation of its individual employees. Therefore, it is important for health care employers to motivate their workers in order to meet the desired outcomes. It is widely acknowledged that health workers who are motivated facilitate the desired patient outcomes. This illustrates how the levels of physicians’ and nurses’ professional satisfaction influences the health care outcomes for patients based on a study of the Moi Teaching and Referral Hospital (MTRH). Descriptive quantitative research design was used. Data was collected using a structured questionnaire issued to <br /> a stratified group of 82 Physicians and 220 Nurses. <br /> All the completed questionnaires were entered into IBM SPSS 21.0 statistical software and data analysed for descriptive statistics. The results were presented in tables and figures. The study was powered to 95% confidence interval. With regards to effects of general practitioners’ and nurses’ work satisfaction on patient services, the study revealed that work associated with the respondents’ position allows contributions to be made to the hospital, <br /> the profession and to own sense of achievement. Furthermore, the study findings showed that praise received for work well done translates to improved job productivity and that the medicine/nursing practice allows autonomous professional decisions to be made which in turn promotes high levels of clinical competence. Based on these findings, the study concludes that health care practitioners’ work satisfaction has implications on <br /> patient care.</span></p>
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Maqsood, Muhammad, Faizan Maqsood, M. Zahid Bashir, Muhammad Dawood, M. Kashif Butt, and Umaima Manzoor Khattak. "Physician’s Knowledge and Skill to Complete the Certificate of Cause of Death According to who Guidelines A Survey Among the Doctors of A Tertiary Care Hospital at Lahore\." Pakistan Journal of Medical and Health Sciences 16, no. 11 (November 30, 2022): 377–80. http://dx.doi.org/10.53350/pjmhs20221611377.
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Background: The medical document certifying the cause of death provides vital data to develop health policies. In spite of very comprehensive guidelines issued by the WHO for thecompletion of death certificates; very few certificate arefound errorfree which might be due to lack of knowledge and practice on the part of physicians issuing that certificate.Purpose of this study is to assess the knowledge and competencies of a doctor in completing a death certificate. Methods: This study was cross-sectional. The population of this study was physicians of a tertiary care hospital of Lahore. A structured questionnaire along with a case scenario was given to 137 physicians having variable working experiences, performing in different clinical departments of a tertiary care hospital of Lahore.The participants were asked to complete the component of cause of death of the certificateonly. The percentage of omissions done by the doctors during the completion of said section was analyzed using the chi square test to establish the association between participant’s characteristics and their relevant responses. Results: Among 137participants working in different clinical departments of a Tertiary Care Hospital at Lahore, 89% were having less than 5 years’ experience and 11% having more than 5 years’ experience. 53% were qualified from public sector, 24% from private sector and 23% from foreign institutes. 77% doctors identified immediate cause of death incorrectly, 83 % did not identify and interpret underlying cause of death correctly; 90 % did notidentify contributory cause of death correctly. In46 % cases mechanism/mode of death was confused with the cause of death. Practical Implication: The correct completion of death certificates would provide an accurate and genuine mortality index essential for framing a national health policy. Conclusion: Physician’s knowledge and skill of completing the death certificates is very deficient and alarming which necessitate periodical and regular training of the physicians on completing the death certificates as per guidelines of the WHO to get an appropriate and valid health statistics effective for future public national health policies and strategies. Keywords (MeSH): Death certificate completion, Medical certification of cause of death, Physician’s knowledge, skill to complete death certificate, Mortality index
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Lord, Bill, Emily Andrew, Karen Smith, Amanda Henderson, David J. Anderson, and Stephen Bernard. "OP7 Palliative care in paramedic practice: a retrospective cohort study." Emergency Medicine Journal 36, no. 10 (September 24, 2019): e4.3-e5. http://dx.doi.org/10.1136/emermed-2019-999abs.7.
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IntroductionParamedics may be involved in the care of patients experiencing a health crisis associated with palliative care. However, little is known about the paramedic’s role in the care of these patients. This study therefore aimed to describe the incidence and nature of cases attended by paramedics, the treatment provided, and the transport destination if transported, where the reason for attendance was associated with a history of palliative care.MethodsThis retrospective cohort study included all adult patients (aged > 17 years) attended by paramedics in the Australian state of Victoria between 1 July 2015 and 30 June 2016 where terms associated with palliative care, dying or end of life were recorded in the patient care record. Secondary transfers were excluded. Descriptive statistics were used to analyse the sample. Categorical data are presented as frequencies and proportions, with comparisons made using the χ2 test.Results4,348 cases met inclusion criteria. Most patients were aged between 61–80 years (47.9%). The most common assessments recorded by paramedics were ‘respiratory’ (20.1%), ‘pain’ (15.8%), and ‘deceased’ (7.9%). 54.0% (n=2,346) received treatment from the paramedics, and 74.4% (n=3,237) were transported, with the most common destination a hospital (99.5%, n=3,221). Of those with pain as the primary impression, 359 (53.9%) received an analgesic. Nausea and/or vomiting was documented in 15.6% (n=680) of cases attended. Antiemetics administered in these cases included metoclopramide (n=71, 10.4%), prochlorperazine (n=21, 3.1%), and ondansetron (n=9, 1.3%). Resuscitation was attempted in 98 (29.1%) of the 337 cases coded as cardiac arrest. Among non-transported cases, there were 105 (9.6%) cases where paramedics re-attended the patient within 24 hours of the previous attendance.Discussion and conclusionParamedics may become involved in the care of patients receiving palliative care due to exacerbation of symptoms or a new health emergency. As such, the paramedic has a key role in managing symptoms or liaising with other members of the patient’s palliative care team to provide appropriate care. The results should inform integrated systems of care that involve ambulance services in the planning and delivery of community-based palliative care.
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Tenn-Lyn, N., S. Verma, and R. Zulla. "68. The resident experience in a large urban teaching setting: Results of the 2005-2006 resident exit survey, University of Torontos." Clinical & Investigative Medicine 30, no. 4 (August 1, 2007): 66. http://dx.doi.org/10.25011/cim.v30i4.2829.
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We developed and implemented an annual online survey to administer to residents exiting residency training in order to (1) assess the quality of the residency experience and (2) identify areas of strength and areas requiring improvement. Long-term goals include program planning, policy-making and maintenance of quality control. Survey content was developed from an environmental scan, pre-existing survey instruments, examination of training criteria established by the CFPC and the CanMEDS criteria established by the RCPSC. The survey included evaluation benchmarks and satisfaction ratings of program director and faculty, preparation for certification and practice, quality of life, quality of education, and work environment.
The response rate was 28%. Seventy-five percent of respondents were exiting from Royal College training programs. Results of descriptive statistics determined that the overall educational experience was rated highly, with 98.9% of respondents satisfied or very satisfied with their overall patient care experience. Ninety-six percent of respondents were satisfied or very satisfied with the overall quality of teaching. Preparation for practice was identified as needing improvement, with 26% and 34% of respondents giving an unsatisfactory rating to career guidance and assistance with finding employment, respectively. Although 80% of respondents reported receiving ongoing feedback and 84% discussed their evaluations with their supervisors, only 38% of evaluations were completed by the end of the rotation.
The results indicate that residents are generally satisfied with their experiences during residency training, especially with their overall educational experience. Areas of improvement include preparation for practice and timeliness of evaluations. Further iterations of this survey are needed to refine the instrument, identify data trends and maintain quality control in residency training programs.
Frank JR (ed.). The CanMEDS competency framework: better standards, better physicians, better care. Ottawa: The Royal College of Physicians and Surgeons of Canada, 2005.
Merritt, Hawkins and Associates. Summary Report: 2003 Survey of final-year medical residents. http://www.merritthawkins.com/pdf/MHA2003residentsurv.pdf. Accessed May 1, 2006.
Regnier K, Kopelow M, Lane D, Alden A. Accreditation for learning and change: Quality and improvement as the outcome. The Journal of Continuing Education in the Health Professions 2005; 25:174-182.
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Chum, MC, T. Gofton, and C. Shoesmith. "E.11 Non-invasive ventilation in patients with amyotrophic lateral sclerosis: practice patterns amongst Canadian care providers." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 43, S2 (June 2016): S18. http://dx.doi.org/10.1017/cjn.2016.95.
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Background: The purpose of this study was to: 1) describe current non-invasive ventilation (NIV) usage patterns amongst Canadian ALS healthcare providers; 2) compare/contrast with previous practice patterns; and 3) explore barriers to NIV access encountered by current practitioners. Methods: Healthcare professionals (including physicians, respiratory therapists, and nurses) at major Canadian ALS care centres were sent a web-based survey. Participants were asked to provide input on practice demographics, access and initiation of NIV, and follow-up of NIV. Quantitative data were analyzed with descriptive and comparative statistics, while qualitative data were analyzed using interpretative phenomenological analysis method to identify emergent themes. Results: 26 participants responded. Median NIV usage was 39% (range 10-100%), about double of what was previously reported (18%). Mean times from referral to routine and urgent NIV initiation were 13 (95% CI 9-17) and 5 (95% CI 3-7) days respectively. NIV was most commonly initiated in clinic (68%), while 38% report having access to home-NIV initiation. Lack of social support (62%) and cognitive impairment (46%) were the most common deterrents to initiating NIV. Similar to what is previously reported, barriers to access can be stratified to patient, clinical, institutional, and regional levels. Conclusions: Despite increased usage and improved access, there remain considerable barriers for ALS patients to receive NIV.
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Agyapong, V. O. I., C. Conway, F. Jabber, A. Guerandel, and F. O’Connell. "Shared care between specialized psychiatric services and primary care - the experiences and expectation of primary care physicians in Ireland." European Psychiatry 26, S2 (March 2011): 1695. http://dx.doi.org/10.1016/s0924-9338(11)73399-5.
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ObjectiveThe study aims to explore the views of primary care physicians in Ireland on shared care of psychiatric patients between primary and secondary services.MethodsA self-administered questionnaire was posted to a random cross-section primary care physicians working in Ireland. Data were compiled and analyzed using descriptive statistics and analysis of variance.Results145 out of 300 questionnaires were returned giving a response rate of 48%. Overall, 77.9% of respondents reported that they completed a psychiatric rotation as part of their general practice training. Most General Practitioners expressed confidence in their ability to recognize and manage psychiatric disorders in primary care (on a confidence scale of 1 to 5, mean was 3.97, SD 0.699). There was a statistically, significant difference in confidence scores between those who had took a rotation in psychiatry as part of their GP training and those who did not, with the former reporting higher scores (4.04 vs. 3.72, F = 1.801, t = 2.363, p = 0.02)Regarding shared care, 95.8% of GPs were in favour of a formal shared care policy; however 42.8% expressed reservations regarding the implications of implementing such a policy. The most frequently expressed concerns related to the lack of resources in primary care for psychiatric patients (55.9%), financial implications for some patients (48.3%), and concern over communication with psychiatric services (42%).ConclusionThe majority of Primary Care physicians in Ireland would support a policy of shared care of psychiatric patients’; however they raise some concerns regarding practical implications of such a policy.
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Zafirovski, Aleksandar, Marija Zafirovska, Danica Rotar-Pavlić, Ljubin Sukriev, and Nino Zajc. "The Frequency and Form of Controls by HIIS over Primary Health Care Physicians in Slovenia." Acta Medica Academica 50, no. 2 (November 21, 2021): 329. http://dx.doi.org/10.5644/ama2006-124.350.
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<p><strong>Objective</strong>. The aim of this study was to evaluate the pattern of controls and sanctions by the Health Insurance Institute (HIIS) over primary healthcare practitioners (PHCPs) in Slovenia, the reasons for sanctions and the violence against PHCPs if they followed the HIIS rules.</p><p><strong>Materials and Methods</strong>. We performed analyses using survey data from a cross-sectional study, across public health centres and individual contractors in which 1,458 PHCPs were invited to answer a questionnaire anonymously via an online system used to collect data for the Slovenian Medical Chamber and the Association of General Practice/Family Medicine of South-East Europe. Quantitative data were presented by descriptive statistics and analysed using Pearson’s chisquared test. Results. Responses were obtained from 462 female and 138 male PHCPs. Of the total number of 600 participants, 430 were family medicine specialists. 263 (43.8%) responded that they have been sanctioned for various reasons. PHCPs that are more likely to be sanctioned include family medicine specialists and individual contractors. PHCPs working in areas smaller than 20 000 inhabitants were sanctioned in a bigger proportion than their counterparts. Monetary penalties levied against those working at health centres were usually covered by the health centre. Family medicine specialists, more often than other PHCPs experienced violence from patients or patients’ relatives if they followed HIIS rules. Conclusion. Family medicine specialists are sanctioned more frequently than other PHCPs, individual contractors are sanctioned more frequently than public healthcare PHCPs and PHCPs in working area with a population less than 20.000 are more frequently sanctioned than those working in an area with a bigger population count.</p>
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Song, Kaoru H., Dana R. Nguyen, Erich J. Dietrich, John E. Powers, and John P. Barrett. "Career Satisfaction of Military Medical Officers." Military Medicine 185, no. 3-4 (October 28, 2019): e438-e447. http://dx.doi.org/10.1093/milmed/usz327.
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Abstract Introduction Having a mentor is associated with higher job satisfaction among U.S. physicians. The objective of this study was to assess satisfaction among military medical officers and to assess if mentorship and job satisfaction are associated with intention to continue military service. Materials and Methods This is a cross-sectional study using voluntary, anonymous data from 2018 Uniformed Services Academy of Family Physicians Annual Meeting registered attendees who completed an online Omnibus Survey. Outcome measures: satisfaction with work hours and workload; voice in organizational decision-making; amount of teaching, research, and other administrative tasks; being and having a mentor; and likelihood of remaining in the military beyond current service obligation. Statistical analysis: descriptive statistics, chi-square, and logistic regression. Results There was a 66% response rate (310/568) among registered attendees. Respondents reported being satisfied with work hours-workload (53.3%), voice in organizational decision-making (47.4%), and amount of teaching-research-other administrative tasks (55.7%). About 64.6% of respondents reported being a mentor, and 80.7% reported having a mentor. About 53.4% reported being likely/very likely to continue military service beyond their current service obligation. Adjustment for demographic and occupational factors, with significance defined as P ≤ 0.05, revealed that higher percent time in clinical care was negatively associated with satisfaction with voice in organizational decision-making; being a mentor and working in an academic practice setting were positively associated with satisfaction in amount of time with teaching, research, and administrative tasks; and having a mentor was the only factor associated with being likely/very likely to continue military service beyond current service obligation (odd ratio 3.9, 95% confidence interval 1.2–12.1). Conclusions Having a mentor was the only factor associated with intention to remain in the military among 2018 Uniformed Services Academy of Family Physicians Omnibus Survey respondents. These results support enhancing mentorship among military medical officers.
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Rodrigues Mendonça, Renata, Drielly Lima Valle Folha Salvador, Trindade Cristina Furlan da Mata, Pedro Augusto Masashiro Nakasima, Neide Derenzo, Eduardo Rocha Covre, and Maria Antonia Ramos Costa. "INFORMATION AND COMMUNICATION TECHNOLOGIES: THE PERSPECTIVE OF THE URGENCY AND EMERGENCY MOBILE CARE SERVICE PROFESSIONALS." Cogitare Enfermagem, no. 27 (November 18, 2022): 1–11. http://dx.doi.org/10.5380/ce.v27i0.87756.
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Objective: to assess the interest, access and knowledge of the Urgency and Emergency Mobile Care Service professionals in relation to Information and Communication Technologies in such service. Method: a descriptive and cross-sectional study conducted with Urgency and Emergency Mobile Care Service professionals (physicians, nurses, nursing technicians and drivers) in September and October 2020 in the Northwest region of the state of Paraná, Brazil. The data were collected through a structured instrument and analyzed by means of descriptive statistics. Results: of the 30 participants, 80% reported access only to a simple cell phone, and 86.7% believed in the viability of a computerized system to assist in care provision and in the improvement of the response time for the event. Conclusion: despite the technological deficit in the service researched and dissatisfaction of its professionals, they wish for technologies to streamline care, thus reducing the response time for the event. Thus, the results can support management of the services and bring about positive contributions to the SAMU team professional practice.
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Moak, Teri N., Phaedra E. Cress, Marissa Tenenbaum, and Laurie A. Casas. "The Leaky Pipeline of Women in Plastic Surgery: Embracing Diversity to Close the Gender Disparity Gap." Aesthetic Surgery Journal 40, no. 11 (October 30, 2019): 1241–48. http://dx.doi.org/10.1093/asj/sjz299.
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Abstract The Balance for Better campaign theme of the 2019 International Women’s Day prompted a closer look at diversity within the plastic surgery specialty. Gender balance in the United States has improved through many organizational efforts and enactment of laws. Unfortunately, despite these endeavors, statistics show that men still enjoy greater financial and career success. Within the field of medicine, a similar trend has been observed. Although women constitute 50% of medical school graduates, the majority still enter fields outside of surgical subspecialties. In comparison to other surgical subspecialties, women are most represented in plastic surgery. Unfortunately, significant gender discrepancies remain in postgraduate practice including academic practice rank, societal board membership, invited speaker opportunities, and compensation, to name a few. The “leaky pipeline” of women describes the precipitous decline in the numbers of women at each step up the professional ladder. We explore the multifaceted nature of this phenomenon and highlight factors that contribute to limiting female growth within the plastic surgery profession. We also emphasize the continued growth of female plastic surgeon presence in all sectors despite these existing obstacles. We submit that continued leadership, mentorship, and sponsorship provided by both male and female physicians in the field will facilitate future leadership, advance gender parity, and cultivate a sense of belonging within the plastic surgery community, allowing brilliant minds to flourish and the profession to thrive.
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Lennon, Robert P., Karl T. Clebak, Jonathan B. Stepanian, and Timothy D. Riley. "Mock Trial as a Learning Tool in a Family Medicine Residency." Family Medicine 52, no. 10 (November 5, 2020): 741–44. http://dx.doi.org/10.22454/fammed.2020.405328.
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Background and Objectives: Mock trials have been used to teach medical learners about malpractice litigation, ethics, legal concepts, and evidence-based practice. Although 5.2% of family physicians are sued for malpractice annually, there is no formal requirement nor curriculum for educating our residents about malpractice, and mock trial has not been reported as an education modality in a family medicine residency. We developed a mock trial experience to educate family medicine residents about malpractice litigation and evaluated the resident experience over 3 years. Methods: This is a retrospective, single-site study evaluating resident experience in our mock trials. We assessed perceived value using a 5-point Likert scale; and we assessed knowledge with free-text answers to both open and closed questions. We used descriptive statistics to describe data. Results: Residents found the mock trial effective and engaging, giving the experience an overall evaluation of 4.9/5±0.3; 86.4% identified the importance of documentation as a learning outcome; 72.7% of residents identified negligence as necessary to justify a lawsuit, but they demonstrated limited mastery of the four elements of negligence, with 45.5% correctly listing harm, 40.9% causation, 13.6% breach of duty, and 0% duty owed. Conclusions: Mock trial is an enjoyable and effective tool to engage residents and provide a general understanding of malpractice litigation. It is less effective in conveying nuanced details of negligence. It may also be effective in teaching practice management techniques.
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Hamlin, Lynette, Lindsay Grunwald, Rodney X. Sturdivant, and Tracey P. Koehlmoos. "Comparison of Nurse-Midwife and Physician Birth Outcomes in the Military Health System." Policy, Politics, & Nursing Practice 22, no. 2 (February 20, 2021): 105–13. http://dx.doi.org/10.1177/1527154421994071.
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The purpose of this study is to identify the socioeconomic and demographic characteristics of women cared for by Certified Nurse-Midwives (CNMs) versus physicians in the Military Health System (MHS) and compare birth outcomes between provider types. The MHS is one of America’s largest and most complex health care systems. Using the Military Health System Data Repository, this retrospective study examined TRICARE beneficiaries who gave birth during 2012–2014. Analysis included frequency of patients by perinatal services, descriptive statistics, and logistic regression analysis by provider type. To account for differences in patient and pregnancy risk, odds ratios were calculated for both high-risk and general risk population. There were 136,848 births from 2012 to 2014, and 30.8% were delivered by CNMs. Low-risk women whose births were attended by CNMs had lower odds of a cesarean birth, induction/augmentation of labor, complications of birth, postpartum hemorrhage, endometritis, and preterm birth and higher odds of a vaginal birth, vaginal birth after cesarean, and breastfeeding than women whose births were attended by physicians. These results have implications for the composition of the women’s health workforce. In the MHS, where CNMs work to the fullest scope of their authority, CNMs attended almost 4 times more births than our national average. An example to other U.S. systems and high-income countries, this study adds to the growing body of evidence demonstrating that when CNMs practice to the fullest extent of their education, they provide quality health outcomes to more women.
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Schrewe, Brett, Rikin Patel, and Anne Rowan-Legg. "Growth curves: The experiences of Canadian paediatricians in their first 5 years of independent practice." Paediatrics & Child Health 25, no. 4 (March 5, 2019): 235–40. http://dx.doi.org/10.1093/pch/pxz014.
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Abstract Objectives Completing training is a rite of passage common to all physicians, yet our knowledge of the components in postgraduate paediatric education that equip learners for successful transition to practice is limited. In order to optimally design training programs, it is critical to develop a better sense of what early career paediatricians (ECPs) experience as they navigate this time of transition. Methods We created and distributed a 23-question survey via e-mail to 481 Canadian ECPs in September 2017, specifically to those who received Royal College certification in 2011 or later. Survey responses were obtained confidentially through an online platform (Survey Monkey). Descriptive statistics and thematic analysis were used to analyze responses to closed-ended and free text questions, respectively. Results Response rate was 42% with nearly 70% of the respondents self-identifying as general paediatricians. Factors facilitating transition to practice included: dedicated mentorship; supportive new colleagues and workplace environment; and ease of finding work. Identified challenges included: billing, finances, and practice management; adjusting to a different scope of practice and learning local resources; managing comfort level; and achieving work–life balance. Nearly half of the respondents expressed interest in mentoring new ECP colleagues. Conclusions Our findings suggest that ECPs find clear value in mentorship, but desire further support to adapt to new practice contexts and activities. As a result, we must consider strategies in both individual programs and nationally that effectively prepare learners prior to transition and align with needs in the first years of independent practice.
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Winkelmann, Zachary K., Lindsey E. Eberman, and Kenneth E. Games. "Telemedicine Experiences of Athletic Trainers and Orthopaedic Physicians for Patients With Musculoskeletal Conditions." Journal of Athletic Training 55, no. 8 (July 21, 2020): 768–79. http://dx.doi.org/10.4085/1062-6050-388-19.
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Context Telemedicine is the delivery of medical care from a distance using technology. The integration of telemedicine as a supplement to musculoskeletal-based patient encounters may be feasible in sports medicine. Objective To investigate health care professionals' perceptions of and experiences with telemedicine. Design Cross-sectional explanatory sequential mixed-methods study. Patients or Other Participants A purposeful sample of 17 athletic trainers from a National Collegiate Athletic Association Division I institution and 5 orthopaedic physicians from a sports medicine clinic located 92 miles from the campus. Intervention(s) Participants were trained on the telemedicine platform and used it over 5 months for initial, follow-up, and discharge patient encounters. Main Outcome Measure(s) Participants completed a preintervention survey containing the Theory of Planned Behavior and Technology Acceptance Model tool. Responses were analyzed using descriptive statistics and an independent-samples t test. After the intervention period, participants completed individual semistructured interviews that we coded using the consensual qualitative research tradition. Results From the interviews, the clinicians were characterized as telemedicine adopters (n = 14) or nonadopters (n = 8). The adopters reported higher levels of agreement on the Theory of Planned Behavior and Technology Acceptance Model tool as compared with nonadopters for all constructs. When comparing adoption status, we identified a difference (P < .01), with nonadopters reporting a low level of agreement for the subjective norm construct. The interviews revealed 5 domains: integration challenges, integration opportunities, collaborative practice, anticipatory socialization to future use, and benefits of integration. The participants indicated that integration challenges centered on “buy in,” whereas opportunities aligned with the patient's condition and technology ease of use. They reflected that the telemedicine encounters required more preparation and yet allowed for cooperative behaviors between clinicians. The benefits of telemedicine included convenience and scheduling preferences that encouraged future use. Conclusions The integration of telemedicine in sports medicine brought about both challenges and opportunities for collaboration among athletic trainers and physicians that were heavily predetermined by the social pressures of colleagues.