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Al-Sharydah AM, Katbi FA, AlHarbi RE, Al-Ghamdi F, AlShreadah S, AlDhafery BF. Trends of primary health care practitioners toward bleeding management in Saudi Arabia: a cross-sectional analysis. Postgrad Med 2025; 137:189-200. [PMID: 39783964 DOI: 10.1080/00325481.2025.2452146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Revised: 12/19/2024] [Accepted: 01/06/2025] [Indexed: 01/12/2025]
Abstract
OBJECTIVES High rates of morbidity and mortality are a result of trauma being a significant health burden in Saudi Arabia. We evaluated the current trends of primary healthcare (PHC) physicians in Saudi Arabia toward patients with bleeding and their referral awareness for percutaneous endovascular arterial embolization (EAE). METHODS We formulated a 13-question survey to assess PHC physicians' knowledge regarding decision-making and appropriate approaches to manage patients with traumatic and non-traumatic abdominopelvic and lower limb bleeding. We conducted in-person surveys with various specialists with varying levels of clinical experience in Saudi Arabia. RESULTS Overall, 112 PHC physicians were assessed. Of them, 43.75% had ≥ 5 years of independent practice experience, and 72.3% and 27.7% encountered bleeding patients rarely and routinely, respectively. General practitioners scored lower across all questions than other PHC physicians. Physicians with > 10 years of practice had higher median scores in decision-making questions (p = 0.159). Internists and gynecologists (p = 0.046) and physicians (p = 0.050) in tertiary-care settings had significantly higher median scores on decision-making questions. Pediatricians (p = 0.091) and PHC physicians (p = 0.440) at private institutions had higher median scores on approach appropriateness questions. CONCLUSIONS PHC physicians in Saudi Arabia require a better understanding of the indications of EAE to avoid referral and triage errors, inefficient use of healthcare resources, and suboptimal patient outcomes.
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Affiliation(s)
- Abdulaziz Mohammad Al-Sharydah
- Diagnostic and Interventional Radiology Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, AlKhobar, Eastern Province, Saudi Arabia
| | - Faisal Ahmad Katbi
- Emergency Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, AlKhobar, Eastern Province, Saudi Arabia
- Critical Care Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, AlKhobar, Eastern Province, Saudi Arabia
| | - Razan Essam AlHarbi
- Diagnostic and Interventional Radiology Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, AlKhobar, Eastern Province, Saudi Arabia
| | - Faisal Al-Ghamdi
- Emergency Department, Alnairiyah General Hospital, Ministry of Health, AlKhobar City, Eastern Province, Saudi Arabia
| | - Saleh AlShreadah
- Radiodiagnostics and Medical Imaging Department, King Fahd Military Medical Complex, Dhahran, Eastern Province, Saudi Arabia
| | - Bander Fuhaid AlDhafery
- Diagnostic and Interventional Radiology Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, AlKhobar, Eastern Province, Saudi Arabia
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Szczepek AJ, Wrzosek M, Makowska M. Attributes Desired in a General Practitioner by Adults: Implications for Humanization in Medicine and Enhancement of the Patient Experience. Healthcare (Basel) 2024; 12:2589. [PMID: 39766016 PMCID: PMC11727714 DOI: 10.3390/healthcare12242589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Revised: 12/10/2024] [Accepted: 12/18/2024] [Indexed: 01/15/2025] Open
Abstract
BACKGROUND Progress in medical education is reflected in healthcare quality and patient satisfaction. However, there are still gaps in knowledge regarding the patients' expectations of general practitioners (GPs), even though patients' interactions with GPs are among the most frequent in healthcare. Accordingly, this study investigated the qualities desired by adults in GPs, intending to include them in future medical humanization education to enhance the patients' experience. METHODS Using an online survey, 1057 respondents (52.8% female; mean age, 46.55 years old, SD 16.03) were asked to rate 15 statements on a scale of 1 to 10 regarding desirable characteristics of general practitioners. In addition to the respondents' high regard for their GP's ongoing education and sincerity in conveying both positive and negative information, the findings suggest that the socio-demographic attributes of the respondents influence their expectations of GPs. RESULTS Women had higher overall expectations than men. In addition, those who reported higher satisfaction with their lives and recent healthcare users had higher expectations of GPs than those who were dissatisfied. The youngest group of respondents exhibited the lowest expectations of the GPs' attributes, except for their greater willingness to engage in discussions with GPs regarding personal or professional issues, compared with the older groups. CONCLUSIONS The information presented in this work can be utilized during medical students' humanization training and physicians' continuing education. The knowledge gained should enhance GPs' awareness of the distinctions in patients' expectations, enabling them to adapt their approach and services to align with their patients' unique needs, expectations, and experiences.
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Affiliation(s)
- Agnieszka J. Szczepek
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Faculty of Medicine and Health Sciences, University of Zielona Góra, 65-046 Zielona Góra, Poland
| | - Malgorzata Wrzosek
- Faculty of Psychology and Cognitive Science, Adam Mickiewicz University, 60-568 Poznań, Poland;
| | - Marta Makowska
- Department of Economic Psychology, Kozminski University, 03-301 Warszawa, Poland;
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Wang W, Zhang J, Lu J, Wei X. Patient views of the good doctor in primary care: a qualitative study in six provinces in China. Glob Health Res Policy 2023; 8:24. [PMID: 37434267 DOI: 10.1186/s41256-023-00309-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 06/07/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND China has been striving to train primary care doctors capable of delivering high-quality service through general practitioner training programs and family doctor team reforms, but these initiatives have not adequately met patient needs and expectations. In order to guide further reform efforts to better meet patient expectations, this study generates a profile of the good doctor in primary care from the patient perspective. METHODS Semi-structured interviews were conducted in six provinces (Shandong, Zhejiang, Henan, Shaanxi, Shanxi, Heilongjiang) in China. A total of 58 interviewees completed the recorded interviews. Tape-based analysis was used to produce narrative summaries. Trained research assistants listened to the recordings of the interviews and summarized them by 30-s segments. Thematic analysis was performed on narrative summaries to identify thematic families. RESULTS Five domains and 18 attributes were generated from the analysis of the interview data. The domains of the good doctor in primary care from the patient perspective were: strong Clinical Competency (mentioned by 97% of participants) and Professionalism & Humanism (mentioned by 93% of participants) during service delivery, followed by Service Provision and Information Communication (mentioned by 74% and 62% of participants, respectively). Moreover, Chinese patients expect that primary care doctors have high educational attainment and a good personality (mentioned by 41% of participants). CONCLUSIONS This five-domain profile of the good doctor in primary care constitutes a foundation for further primary care workforce capacity building. Further primary care reform efforts should reflect the patient views and expectations, especially in the family physician competency framework and primary care performance assessment system development. Meanwhile, frontline primary care organizations also need to create supportive environments to assist competent doctors practice in primary care, especially through facilitating the learning of primary care doctors and improving their well-being.
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Affiliation(s)
- Wenhua Wang
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 West Xianning Road, Xi'an, People's Republic of China
| | - Jinnan Zhang
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 West Xianning Road, Xi'an, People's Republic of China
| | - Jiao Lu
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 West Xianning Road, Xi'an, People's Republic of China
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
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Sun AY, Wright SM, Miller L. Clinical excellence in child and adolescent psychiatry: examples from the published literature. Int J Psychiatry Clin Pract 2022:1-7. [PMID: 36369875 DOI: 10.1080/13651501.2022.2144748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There has been growing interest in the past century in improving understanding of the development and treatment of psychopathology of children, with increasing government funding of research in the past two decades. However, child and adolescent psychiatry excellence in clinical care has not been well-documented in the existing literature. This article provides examples of clinical excellence in paediatric mental health to supplement existing guidelines for the clinical practice of paediatric psychiatry. A review of the literature identified 204 unique peer-reviewed articles that were then further evaluated for applicability and relevance to the definition of clinical excellence as outlined by the Miller-Coulson Academy of Clinical Excellence (MCACE). Cases were then identified and selected for each domain of clinical excellence as they apply to child and adolescent psychiatry and to provide a model for patient care.KEYPOINTSClinical excellence in child and adolescent psychiatry has not previously been defined or extensively documented.The Miller-Coulson Academy of Clinical Excellence (MCACE) has developed a systematic method to measuring excellence in clinical care and created a definition of clinical excellence.The MCACE defined the domains of clinical excellence as communication and interpersonal skills, professionalism and humanism, diagnostic acumen, skilful negotiation of the healthcare system, knowledge, scholarly approach to clinical practice, exhibiting a passion for patient care and modelling clinical excellence, and collaborating with investigators to advance science and discovery.There are numerous case examples in the literature that represent mastery in paediatric psychiatry in these areas.Clinicians in paediatric mental health will likely benefit from future research on evidence-based approaches to training and education in these domains of clinical excellence.
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Affiliation(s)
- Amanda Y Sun
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Scott M Wright
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Leslie Miller
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Khan S, Llinas EJ, Danoff SK, Llinas RH, Marsh EB. The telemedicine experience: using principles of clinical excellence to identify disparities and optimize care. Medicine (Baltimore) 2022; 101:e29017. [PMID: 35451400 PMCID: PMC8913094 DOI: 10.1097/md.0000000000029017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/17/2022] [Indexed: 01/04/2023] Open
Abstract
The use of telemedicine has increased significantly during the Corona virus disease 2019 pandemic. This manuscript serves to identify the underlying principles of clinical excellence in telemedicine and to determine whether effective care practices can be generalized as a one-size-fits-all model or must instead be tailored to individual patient populations.A survey assessing care quality and patient satisfaction for patients using telemedicine was created and administered via email to 2 urban cohorts of varying demographics and socioeconomic backgrounds: a population of patients with prior stroke and cerebrovascular disease, and a cohort of patients followed for interstitial lung disease. Results were compared across groups to determine the generalizability of effective practices across populations.Individuals taking part in telemedicine were more likely to be White, more affluent, and woman, regardless of clinical diagnosis compared with a similar cohort of patients seen in-person the year prior. A lower-than-expected number of patients who were Black and of lower socioeconomic status followed up virtually, indicating potential barriers to access. Overall, patients who participated in televisits were satisfied with the experience and felt that the care met their medical needs; however, those who were older were more likely to experience technical difficulties and prefer in-person visits, while those with less education were less likely to feel that their questions were addressed in an understandable way.When thoughtfully designed, telemedicine practices can be an effective model for patient care, though implementation must consider population characteristics including age, education, and socioeconomic status, and strategies such as ease of access versus optimization of communication strategies should be tailored to meet individual patient needs.
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Affiliation(s)
- Sheena Khan
- Department of Neurology, The Johns Hopkins School of Medicine, Baltimore, MD
| | - Edward J. Llinas
- Department of Neurology, The Johns Hopkins School of Medicine, Baltimore, MD
| | - Sonye K. Danoff
- Division of Pulmonary and Critical Care Medicine, The Johns Hopkins School of Medicine, Baltimore, MD
| | - Rafael H. Llinas
- Department of Neurology, The Johns Hopkins School of Medicine, Baltimore, MD
| | - Elisabeth B. Marsh
- Department of Neurology, The Johns Hopkins School of Medicine, Baltimore, MD
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Apers H, Vuylsteke B, Loos J, Smekens T, Deblonde J, Van Beckhoven D, Nöstlinger C. Development and Evaluation of an HIV-Testing Intervention for Primary Care: Protocol for a Mixed Methods Study. JMIR Res Protoc 2020; 9:e16486. [PMID: 32497016 PMCID: PMC7459432 DOI: 10.2196/16486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Late diagnosis of HIV fosters HIV transmission and may lead to hidden HIV epidemics. In Belgium, mathematical modeling indicates a high prevalence of undiagnosed HIV infections among men who have sex with men of non-Belgian origin and among sub-Saharan African migrants. Promotion of HIV testing facilitates early diagnosis, but diagnostic opportunities are missed in primary care. OBJECTIVE The intervention study aims to enhance provider-initiated HIV testing by GPs. This protocol presents the conceptual development, implementation, and evaluation of an HIV-testing intervention for Flemish general practitioners (GPs). METHODS A mixed methods evaluation design is used. Guided by a simplified intervention mapping approach, an evidence-based intervention was developed in collaboration, guided by an interdisciplinary advisory board. The intervention consisted of an evidence-based tool (ie, "HIV-testing advice for primary care") to support GPs in provider-initiated HIV testing. A modified stepped-wedge design compare two different intervention levels: (1) online dissemination of the HIV-testing advice and (2) dissemination with additional group-level training. Both conditions were compared against a control condition with no intervention. The effect of the intervention was measured using Poisson regression for national surveillance data. The primary outcome was the number of HIV diagnoses made by GPs. Secondary outcomes were HIV diagnoses among groups at risk for undiagnosed HIV, distribution of new diagnoses by CD4 cell count, number of HIV tests prescribed by GPs, and rate of new diagnoses by tests. To evaluate the intervention's implementation, the GPs' fidelity to the intervention and the intervention's feasibility and acceptability by GPs were assessed through (web-based) surveys and in-depth telephone interviews. RESULTS The study was funded in 2016 and ethically approved in January 2017. The implementation of the intervention started in January 2017 and ended in December 2018. Data was completed in October 2019 and was the starting point for the ongoing data analysis. The results are expected to be published in the second half of 2020. CONCLUSIONS Results of the intervention study will provide useful information on the intervention's effectiveness among Flemish GPs and can inform further development of official testing guidelines. Limitations of this real-life intervention approach are potential spill-over effects, delay in access to surveillance data, and little detailed information on HIV-testing practices among GPs. TRIAL REGISTRATION ClinicalTrials.gov NCT04056156; https://clinicaltrials.gov/ct2/show/NCT04056156. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/16486.
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Affiliation(s)
- Hanne Apers
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Centre for Migration and Intercultural Studies, University of Antwerp, Antwerp, Belgium
| | - Bea Vuylsteke
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jasna Loos
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Domus Medica, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Tom Smekens
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jessika Deblonde
- Epidemiology of Infectious Diseases Unit, Department of Public Health and Surveillance, Belgian Scientific Institute of Public Health (Sciensano), Brussels, Belgium
| | - Dominique Van Beckhoven
- Epidemiology of Infectious Diseases Unit, Department of Public Health and Surveillance, Belgian Scientific Institute of Public Health (Sciensano), Brussels, Belgium
| | - Christiana Nöstlinger
- Epidemiology of Infectious Diseases Unit, Department of Public Health and Surveillance, Belgian Scientific Institute of Public Health (Sciensano), Brussels, Belgium
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Wells BM, Salsbury SA, Nightingale LM, Derby DC, Lawrence DJ, Goertz CM. Improper Communication Makes for Squat: A Qualitative Study of the Health-Care Processes Experienced By Older Adults in a Clinical Trial for Back Pain. J Patient Exp 2020; 7:507-515. [PMID: 33062871 PMCID: PMC7534140 DOI: 10.1177/2374373519860347] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The study focused on perceptions of older adults toward the healthcare processes they experienced during a clinical trial for back pain that involved family medicine residents and licensed chiropractors. METHODS Individual semi-structured interviews were conducted with 115 older adults after a 12-week, 3-arm, randomized controlled trial. Two researchers conducted thematic analysis with inductive coding using qualitative software to identify participants' salient experiences of the doctor-patient relationship, healthcare process, and collaboration between study providers. Investigators categorized thematic codes within an existing framework of clinical excellence in primary care. RESULTS Participants emphasized provider communication and interpersonal relationships, professionalism and passion for patient care, clinical and diagnostic acumen, and skillful negotiation of the health-care system. Older adults also described the importance of interdisciplinary collaboration and their preferences for receiving hands-on treatments for musculoskeletal conditions. CONCLUSION These older adults valued doctors who communicated clearly and spent time listening to their concerns. Many participants appreciated clinicians who supported an active role for patients in their health-care and who provided touch-based care for musculoskeletal conditions.
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Affiliation(s)
- Breanne M Wells
- Technique Department, Palmer College of Chiropractic, Davenport, IA, USA
| | - Stacie A Salsbury
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA, USA
| | - Lia M Nightingale
- Life Sciences Department, Palmer College of Chiropractic, Davenport, IA, USA
| | - Dustin C Derby
- College Administration, Palmer College of Chiropractic, Davenport, IA, USA
| | - Dana J Lawrence
- Parker Research Institute, Parker University, Dallas, TX, USA
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Figueras-Roca M, Figueroa MS, Calvo P, Garay-Aramburu G, García-Martínez JR, Fernández AM, Pou A, Adán A. Optimization of Diabetic Macular Edema Management in the Real World: A Model of Excellence in Retina Units: The EMUREX Initiative. Ophthalmologica 2020; 243:379-390. [PMID: 32015240 DOI: 10.1159/000506311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 02/03/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE To define and develop a model of excellence for the clinical management of diabetic macular edema (DME) patients in a real-world setting. METHODS A multidisciplinary joint commission (5 ophthalmologists, 1 nurse, and 1 pharmaceutic) established a series of preliminary recommendations based on clinical guidelines and DME activity results from 8 Pilot Hospitals (PH). These were validated by members of each PH and a group of DME patients in discussion workshops. Thus, the validated guideline (VG) took into consideration different aspects, namely, main core points (ranging 0-100), criteria, and indicators. Finally, each PH own setting was compared to the VG in order to settle down a starting point to clinical excellence. RESULTS Mean PH score was 51.5 (range 30-65). As compared to their maximum, main points that showed best scores were Clinical Guidelines and Protocols (78%) and Portfolio of Services (73%). Topics reaching close to 50% scoring included Resources (55%), Innovation (54%), Care Process (53%), Organization (52%), and Leadership (50%). Lowest scores were observed in the Strategic Alliances (46%) and Staff (37%) points. CONCLUSIONS Analysis of each PH by the VG delivered a global vision of the starting situation, especially focused in the identification of the different improvement areas. In order to further extend this model into the Public Health System, the effect of implementing it in different hospitals should be assessed to analyze its impact on daily clinical practice and health economics.
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Affiliation(s)
- Marc Figueras-Roca
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Barcelona, Spain,
| | | | - Pilar Calvo
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | | | | | - Aránzazu Pou
- Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Alfredo Adán
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Barcelona, Spain
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Deblonde J, Van Beckhoven D, Loos J, Boffin N, Sasse A, Nöstlinger C, Supervie V. HIV testing within general practices in Europe: a mixed-methods systematic review. BMC Public Health 2018; 18:1191. [PMID: 30348140 PMCID: PMC6196459 DOI: 10.1186/s12889-018-6107-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 10/10/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Late diagnosis of HIV infection remains a key challenge in Europe. It is acknowledged that general practitioners (GPs) may contribute greatly to early case finding, yet there is evidence that many diagnostic opportunities are being missed. To further promote HIV testing in primary care and to increase the utility of available research, the existing evidence has been synthesised in a systematic review adhering to the PRISMA guidelines. METHODS The databases PubMed, Scopus and Embase were searched for the period 2006-2017. Two authors judged independently on the eligibility of studies. Through a mixed-methods systematic review of 29 studies, we provide a description of HIV testing in general practices in Europe, including barriers and facilitators. RESULTS The findings of the study show that although various approaches to target patients are used by GPs, most tests are still carried out based on the patient's request. Several barriers obstruct HIV testing in general practice. Included are a lack of communication skills on sexual health, lack of knowledge about HIV testing recommendations and epidemic specificities, difficulties with using the complete list of clinical HIV indicator diseases and lack of experience in delivering and communicating test results. The findings also suggest that the provision of specific training, practical tools and promotion programmes has an impact on the testing performance of GPs. CONCLUSIONS GPs could have an increased role in provider-initiated HIV-testing for early case finding. To achieve this objective, solutions to the reported barriers should be identified and testing criteria adapted to primary healthcare defined. Providing guidance and training to better identify priority groups for HIV testing, as well as information on the HIV epidemic's characteristics, will be fundamental to increasing awareness and testing by GPs.
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Affiliation(s)
- Jessika Deblonde
- Sciensano, Health Services Research, Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | | | - Jasna Loos
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| | - Nicole Boffin
- Sciensano, Health Services Research, Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | - André Sasse
- Sciensano, Health Services Research, Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | - Christiana Nöstlinger
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
- Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Virginie Supervie
- Institut Pierre Louis d’Epidémiologie et de Santé Publique, INSERM, Sorbonne Université, 56 Bd. Vincent Auriol, CS 81393, 75646 Paris Cedex 13, France
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Christoffels R, Mash B. How well do public sector primary care providers function as medical generalists in Cape Town: a descriptive survey. BMC FAMILY PRACTICE 2018; 19:122. [PMID: 30025537 PMCID: PMC6053747 DOI: 10.1186/s12875-018-0802-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 06/21/2018] [Indexed: 11/13/2022]
Abstract
BACKGROUND Effective primary health care requires a workforce of competent medical generalists. In South Africa nurses are the main primary care providers, supported by doctors. Medical generalists should practice person-centred care for patients of all ages, with a wide variety of undifferentiated conditions and should support continuity and co-ordination of care. The aim of this study was to assess the ability of primary care providers to function as medical generalists in the Tygerberg sub-district of the Cape Town Metropole. METHODS A randomly selected adult consultation was audio-recorded from each primary care provider in the sub-district. A validated local assessment tool based on the Calgary-Cambridge guide was used to score 16 skills from each consultation. Consultations were also coded for reasons for encounter, diagnoses and complexity. The coders inter- and intra-rater reliability was evaluated. Analysis described the consultation skills and compared doctors with nurses. RESULTS 45 practitioners participated (response rate 85%) with 20 nurses and 25 doctors. Nurses were older and more experienced than the doctors. Doctors saw more complicated patients. Good inter- and intra-rater reliability was shown for the coder with an intra-class correlation coefficient of 0.84 (95% CI 0.045-0.996) and 0.99 (95% CI 0.984-0.998) respectively. The overall median consultation score was 25.0% (IQR 18.8-34.4). The median consultation score for nurses was 21.6% (95% CL 16.7-28.1) and for doctors was 26.7% (95% CL 23.3-34.4) (p = 0.17). There was no difference in score with the complexity of the consultation. Ten of the 16 skills were not performed in more than half of the consultations. Six of the 16 skills were partly or fully performed in more than half of the consultations and these included the more biomedical skills. CONCLUSION Practitioners did not demonstrate a person-centred approach to the consultation and lacked many of the skills required of a medical generalist. Doctors and nurses were not significantly different. Improving medical generalism may require attention to how access to care is organised as well as to training programmes.
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Affiliation(s)
- Renaldo Christoffels
- Division of Family Medicine and Primary Care, Stellenbosch University, Box 241, Cape Town, 8000 South Africa
| | - Bob Mash
- Division of Family Medicine and Primary Care, Stellenbosch University, Box 241, Cape Town, 8000 South Africa
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11
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von Pressentin KB, Mash RJ, Baldwin-Ragaven L, Botha RPG, Govender I, Steinberg WJ, Esterhuizen TM. The Influence of Family Physicians Within the South African District Health System: A Cross-Sectional Study. Ann Fam Med 2018; 16:28-36. [PMID: 29311172 PMCID: PMC5758317 DOI: 10.1370/afm.2133] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 06/03/2017] [Accepted: 06/22/2017] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Evidence of the influence of family physicians on health care is required to assist managers and policy makers with human resource planning in Africa. The international argument for family physicians derives mainly from research in high-income countries, so this study aimed to evaluate the influence of family physicians on the South African district health system. METHODS We conducted a cross-sectional observational study in 7 South African provinces, comparing 15 district hospitals and 15 community health centers (primary care facilities) with family physicians and the same numbers without family physicians. Facilities with and without family physicians were matched on factors such as province, setting, and size. RESULTS Among district hospitals, those with family physicians generally scored better on indicators of health system performance and clinical processes, and they had significantly fewer modifiable factors associated with pediatric mortality (mean, 2.2 vs 4.7, P =.049). In contrast, among community health centers, those with family physicians generally scored more poorly on indicators of health system performance and clinical processes, with significantly poorer mean scores for continuity of care (2.79 vs 3.03; P =.03) and coordination of care (3.05 vs 3.51; P =.02). CONCLUSIONS In this study, having family physicians on staff was associated with better indicators of performance and processes in district hospitals but not in community health centers. The latter was surprising and is inconsistent with the global literature, suggesting that further research is needed on the influence of family physicians at the primary care level.
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Affiliation(s)
- Klaus B von Pressentin
- Division of Family Medicine and Primary Care, Stellenbosch University, Cape Town, South Africa
| | - Robert J Mash
- Division of Family Medicine and Primary Care, Stellenbosch University, Cape Town, South Africa
| | - Laurel Baldwin-Ragaven
- Department of Family Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Indiran Govender
- Family Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | | | - Tonya M Esterhuizen
- Biostatistics Unit, Centre for Evidence-based Health Care, Department of Global Health, Stellenbosch University, Cape Town, South Africa
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Wu DS, Wright SM. Clinical Excellence in Palliative Care: Examples From the Published Literature. Am J Hosp Palliat Care 2017; 35:1037-1042. [DOI: 10.1177/1049909117748882] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: With the expansion of palliative care, the concept of clinical excellence is worthy of study and has not been described well in the literature. Objective: To apply the domains of clinical excellence, as proposed and published by the Miller Coulson Academy of Clinical Excellence, to the field of palliative care. Design: Review of the literature to identify episodes of superb palliative care delivered by individuals and teams. Measurement and Main Results: In reviewing 821 publications, we found multiple palliative care case reports to serve as exemplars for each of the distinct domains of clinical excellence. Conclusions: The domains of excellence are relevant and applicable to the field of palliative care. This article aims to inspire clinicians—and advance the field—by promoting thoughtful reflection on what clinical excellence in palliative care entails.
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Affiliation(s)
- David Shih Wu
- Palliative Care Program, Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Scott M. Wright
- Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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