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Family Practice

Marcela Ewing, Peter Naredi, Chenyang Zhang, Jörgen Månsson
Background: Many patients with common cancers are late diagnosed. Objectives: Identify consultation profiles and clinical features in patients with the seven most common cancers, who had consulted a general practitioner (GP) frequently before their cancer diagnosis. Methods: A case-control study was conducted in Region Västra Götaland, Sweden. A total of 2570 patients, diagnosed in 2011 with prostate, breast, colorectal, lung, gynaecological and skin cancers including malignant melanoma, and 9424 controls were selected from the Swedish Cancer Register and a regional health care database...
March 13, 2018: Family Practice
Nicola Thomas
No abstract text is available yet for this article.
March 13, 2018: Family Practice
Devesh Vashishtha, William Sieber, Brittany Hailey, Kristen Guirguis, Alexander Gershunov, Wael K Al-Delaimy
Introduction: The purpose of this study was to determine whether heat waves are associated with increased frequency of clinic visits for ICD-9 codes of illnesses traditionally associated with heat waves. Methods: During 4 years of family medicine clinic data between 2012 and 2016, we identified six heat wave events in San Diego County. For each heat wave event, we selected a control period in the same season that was twice as long. Scheduling a visit on a heat wave day (versus a non-heat wave day) was the primary predictor, and receiving a primary ICD-9 disease code related to heat waves was the outcome...
March 10, 2018: Family Practice
Filipe Prazeres, Luiz Santiago
Background: The presence of multimorbidity in the family practice setting is as evident as it is hard to measure. Objective: The objective of this study was to describe the differences in the prevalence of multimorbidity in a single primary care population, through the use of the only two available lists of chronic conditions based on the International Classification for Primary Care coding system. Methods: This is a cross-sectional, analytical study...
March 10, 2018: Family Practice
Isabel Lane, Ashley Bryce, Suzanne M Ingle, Alastair D Hay
Purpose: Antimicrobial resistance is a significant threat to public health. Diagnostic uncertainty is a key driver of antimicrobial prescribing. We sought to determine whether locally relevant, real-time syndromic or microbiological infection epidemiology can improve prescribing by reducing diagnostic uncertainty. Methods: Eligible studies investigated effects on primary care prescribing for common infections in Organisation For Economic Co-Operation And Development countries...
February 26, 2018: Family Practice
Minke S Nieuwboer, Marieke Perry, Rob van der Sande, Irma T H M Maassen, Marcel G M Olde Rikkert, Marjolein A van der Marck
Background: As the number of patients with complex healthcare needs grows, inter-professional collaboration between primary care professionals must be constantly optimized. General practitioners (GPs) and community nurses (CNs) are key professions in primary care; however, poor GP-CN communication is common, and research into the factors influencing its quality is limited. Objective: To explore patient-related GP-CN communication and facilitating and hindering factors, and to identify strategies to enhance this communication...
February 26, 2018: Family Practice
Janelle Guirguis-Blake, Gina A Keppel, John Holmes, Rex W Force, William Kriegsman, Laura-Mae Baldwin
Background: Patients with chronic kidney disease (CKD) are at high risk for adverse drug events related to medication dosing errors and prescriptions for relatively contraindicated medications, such as non-steroidal anti-inflammatory drugs (NSAIDs). Objectives: To examine the scope of and variation in prescribing relatively contraindicated medications and medications above the recommended dose levels among patients with stage III/IV CKD in primary care practice...
February 26, 2018: Family Practice
Yee Wei Lim, Joanna Ling, Zoe Lim, Audrey Chia
Background: Singapore's health care system is strained by the health care needs of a rapidly aging population. The unprecedented collaboration between a public hospital and a private family practice to set up the Family Medicine Clinic (FMC) to co-manage patients with chronic disease is an example of efforts to shift care to the community. Objective: To explore patients' initial experience of shared chronic disease care in a private family practice setting. Methods: In this exploratory case study, we surveyed 330 patients with stable chronic diseases and interviewed 10 complex care patients and their caregivers...
February 17, 2018: Family Practice
Esther J Bakker-van Gijssel, Peter L B J Lucassen, Tim C Olde Hartman, Willem J J Assendelft, Henny M J van Schrojenstein Lantman-de Valk
Background: People with intellectual disabilities (IDs) experience health inequalities. Applying health assessments is one way of diminishing these inequalities. A health assessment instrument can support general practitioners (GPs) in providing better medical care to people with ID. Objectives: The aim of this study was to determine which items should be part of a health assessment instrument for people with ID to be used in primary care. Methods: This Delphi consensus study was conducted among 24 GP experts and 21 ID physicians...
February 17, 2018: Family Practice
Keith D Gordon, Tina Felfeli
Background: Charles Bonnet syndrome is characterized by formed visual hallucinations in individuals with vision loss. It is reported that one in five older adults with vision loss suffer from Charles Bonnet syndrome and the suspected lack of awareness amongst family physicians may lead to misdiagnosis and inappropriate treatment. Objective: To assess Canadian family physicians' awareness of Charles Bonnet syndrome. Methods: We conducted a national perception and practices survey of family physicians across Canada to assess (i) the level of awareness of Charles Bonnet syndrome amongst family physicians; (ii) the frequency of family physicians' encounters with patients with visual hallucinations and (iii) management strategies and referral patterns for patients with Charles Bonnet syndrome presenting to family physicians...
February 17, 2018: Family Practice
Amanda L Terry, Bridget L Ryan, Scott McKay, Michael Oates, Jill Strong, Kate McRobert, Amardeep Thind
Background: While primary health care electronic medical record (EMR) adoption has increased in Canada, the use of advanced EMR features is limited. Realizing the potential benefits of primary health care EMR use is dependent not only on EMR acquisition, but also on its comprehensive use and integration into practice; yet, little is known about the advanced use of EMRs in primary health care. Objective: To explore the views of advanced primary health care EMR users practising in a team-based environment...
February 10, 2018: Family Practice
Karen Cardwell, Susan M Smith
No abstract text is available yet for this article.
February 6, 2018: Family Practice
Mio Ozawa, Paul M Brennan, Karolis Zienius, Kathreena M Kurian, William Hollingworth, David Weller, Willie Hamilton, Robin Grant, Yoav Ben-Shlomo
Background: Brain tumours often present with varied, non-specific features with other diagnoses usually being more likely. Objective: To examine how different symptoms and patient demographics predict variations in time to brain tumour diagnosis. Methods: We conducted a secondary analysis of brain tumour cases from National Audit of Cancer Diagnosis in Primary Care. We grouped neurological symptoms into six domains (headache, behavioural/cognitive change, focal neurology, 'fits, faints or falls', non-specific neurological, and other/non-specific) and calculated times for patient presentation, GP referral, specialist consultation and total pathway interval...
February 6, 2018: Family Practice
Femke de Jong, Monique H Frings-Dresen, Nynke van Dijk, Faridi S van Etten-Jamaludin, Kristel M van Asselt, Angela G E M de Boer
Background: The number of cancer patients and survivors of working age is increasing. General Practitioners (GPs) may have a significant role in psychosocial cancer care, including work-related concerns. Therefore, we performed a systematic literature review to identify the role of the GP in work-related concerns and integration/reintegration into work of cancer patients and/or survivors. Methods: We searched PubMed, Embase, Cinahl, PsycINFO and Cochrane Library, irrespective of study design...
February 6, 2018: Family Practice
Ninna Nielsen, Peter Vedsted, Henry Jensen
Introduction: Many countries have implemented cancer patient pathways (CPPs) for organ-specific cancers. However, due to high symptom diversity, it can be difficult for the General Practitioner (GP) to decide on the appropriate CPP. Objective: The aim of this study was to estimate the proportion of patients who were referred to a second CPP, were diagnosed with cancer or died within 6 months after receiving a negative result from clinical investigation through an initial CPP...
February 6, 2018: Family Practice
Meera Sreedhara, Valerie J Silfee, Milagros C Rosal, Molly E Waring, Stephenie C Lemon
Background: Regular physical activity (PA) lowers the risk of cardiovascular disease (CVD), but few US adults meet PA guidelines. The United States Preventive Services Task Force (USPSTF) recommends primary care providers offer PA counselling for CVD prevention. We examined the association between adherence to PA guidelines and reported provider advice to increase PA among US adults with overweight/obesity and ≥1 additional CVD risk factor. Methods: Cross-sectional data from the National Health and Nutrition Examination Survey (2011-2014) on PA and provider advice to increase PA were analysed for 4158 adults (≥20 years old) with overweight/obesity who reported ≥1 of hypertension, high cholesterol or impaired fasting glucose...
January 30, 2018: Family Practice
Per E Wändell, Anne-Karien M de Waard, Martin J Holzmann, Carl Gornitzki, Christos Lionis, Niek de Wit, Jens Søndergaard, Anders L Sønderlund, Norbert Kral, Bohumil Seifert, Joke C Korevaar, François G Schellevis, Axel C Carlsson
The aim of this study is to identify potential facilitators and barriers for health care professionals to undertake selective prevention of cardiometabolic diseases (CMD) in primary health care. We developed a search string for Medline, Embase, Cinahl and PubMed. We also screened reference lists of relevant articles to retain barriers and facilitators for prevention of CMD. We found 19 qualitative studies, 7 quantitative studies and 2 mixed qualitative and quantitative studies. In terms of five overarching categories, the most frequently reported barriers and facilitators were as follows: Structural (barriers: time restraints, ineffective counselling and interventions, insufficient reimbursement and problems with guidelines; facilitators: feasible and effective counselling and interventions, sufficient assistance and support, adequate referral, and identification of obstacles), Organizational (barriers: general organizational problems, role of practice, insufficient IT support, communication problems within health teams and lack of support services, role of staff, lack of suitable appointment times; facilitators: structured practice, IT support, flexibility of counselling, sufficient logistic/practical support and cooperation with allied health staff/community resources, responsibility to offer and importance of prevention), Professional (barriers: insufficient counselling skills, lack of knowledge and of experience; facilitators: sufficient training, effective in motivating patients), Patient-related factors (barriers: low adherence, causes problems for patients; facilitators: strong GP-patient relationship, appreciation from patients), and Attitudinal (barriers: negative attitudes to prevention; facilitators: positive attitudes of importance of prevention)...
January 29, 2018: Family Practice
Angel M R Schols, Geert-Jan Dinant, Rogier Hopstaken, Christopher P Price, Ron Kusters, Jochen W L Cals
Background: The use of point-of-care tests (POCTs) in family practice is increasing, and the term POCT is often used in medical literature and clinical practice. Yet, no widely supported definition by several professional fields exists. Objective: To reach consensus on an international definition of a POCT in family practice. Methods: We performed a modified international e-Delphi procedure of four rounds among expert panel members from different professional backgrounds-family practitioners, laboratory specialists, policymakers, researchers and manufacturers...
January 29, 2018: Family Practice
Casanova Ludovic, Ringa Virginie, Chatelard Sophia, Paquet Sylvain, Pendola-Luchel Isabelle, Panjo Henri, Bideau Camille, Deflesselle Eric, Delpech Raphaëlle, Bloy Géraldine, Rigal Laurent
Background: GPs need to consider assorted relevant non-medical factors, such as family or work situations or health insurance coverage, to determine appropriate patient care. If GPs' knowledge of these factors varies according to patients' social position, less advantaged patients might receive poorer care, resulting in the perpetuation of social inequalities in health. Objective: To assess social disparities in GPs' knowledge of non-medical factors relevant to patient care...
January 29, 2018: Family Practice
Marion Eisele, Winfried Adam, Anja Rakebrandt, Sigrid Boczor, Eva Blozik, Jens-Martin Träder, Stefan Störk, Christoph Herrmann-Lingen, Martin Scherer
Background: Both non-cardiac and cardiac comorbidities are related to the prognosis of chronic heart failure (HF), but so far little is known about the impact of comorbidities on treatment difficulties in routine care. Objectives: To investigate which comorbidities are associated with treatment difficulties in primary care. We hypothesized that somatic comorbidities as well as psychosocial distress are associated with treatment difficulties. Methods: In this baseline analysis of data of the observational RECODE-HF study, HF patients were recruited via primary care practices in two German sites...
January 29, 2018: Family Practice
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