Bakgrund: Övervikt och fetma ökar i Sverige i dag. Ett BMI över 30 ökar markant risken för följdsjukdomar och för tidig död. Inom primärvården är det ofta distriktssköterskan som möter och initierar behandling av denna patientgrupp. Forskning visar att patienter som har övervikt eller fetma upplever diskriminering, skam och brist på värdighet och empati i kontakten med hälso- och sjukvården. Syfte: Syftet med detta examensarbete var att belysa distriktssköterskors attityder till vuxna patienter som har övervikt eller fetma inom primärvården.Metod: I examensarbetet användes en kvalitativ innehållsanalys med induktiv ansats. Intervjuer genomfördes med nio distriktssköterskor som arbetade inom primärvården. Resultat: I resultatet framkom tre teman: Att skapa en vårdande relation, att se kroppen och att förändra. Under dessa tre teman beskrevs den vårdande relationen som en förutsättning för förändring. Genom att se kroppen kunde distriktssköterskorna få information angående patienternas levnadsvanor. Det visade sig även finnas hinder för viktnedgång. Konklusion: Detta examensarbete beskriver komplexiteten i att som distriktssköterska vårda patienter som har övervikt eller fetma. Detta utifrån att övervikt och fetma är ett känsligt ämne att samtala om. En fungerande vårdande relation är förutsättningen för ett framgångsrikt hälsofrämjande arbete. Utifrån denna kunskap finns möjligheten att utveckla vården och mötet med denna patientgrupp. / Background: Overweight and obesity are on the rise in Sweden today. A BMI over 30 significantly increases the risk of consequential diseases and premature death. It is often the primary care nurse who meets and initiates treatment of this patient group in the primary care. Research shows that patients who are overweight or obese experience discrimination, shame and lack of dignity and empathy in contact with the health care system.Aim: The aim of this thesis was to highlight primary care nurses' attitudes towards adult patients who are overweight or obese in the primary care.Method: The degree project used a qualitative content analysis with an inductive approach. Interviews were conducted with nine primary care nurses who worked in primary care.Results: The results revealed three themes: Creating a caring relationship, looking at the body and to changing. Under these three themes, the caring relationship was described as a prerequisite for change. By seeing the body, the informants were able to obtain information about the patients' living habits. There were also obstacles to patients losing weight. Conclusion: This thesis describes the complexity of caring for patients who are overweight or obese as primary care nurse. This is on the basis that overweight and obesity is a sensitive topic to talk about. A functioning caring relationship is the prerequisite for successful health promotion work. Based on this knowledge, there is anopportunity to develop care and the meeting with this patient group.

The nation is facing a physician shortage, specifically in relation to primary care and in rural underserved areas. The most basic function of a medical school is to educate physicians to care for the national population. The purpose of this study was to examine the physician practicing characteristics of the graduates of East Tennessee State University Quillen College of Medicine including factors that influence graduates’ specialty choices and practice locations, especially those related to primary care. Secondary data for this study were collected from the college’s student database system and the American Medical Association Physician Masterfile. The study population included all living graduates with Doctor of Medicine (MD) degrees who graduated from 1998 through 2009 (n=678). Statistical procedures included Pearson Chi-square, logistic regression, independent t tests, ANOVA, and multiple linear regression. Data analyses revealed that the majority of graduates were between 24 and 29 years of age, male, white, non-Hispanic, and from metropolitan hometowns. Most had completed the generalist track and initially entered a primary care residency training program. The majority passed USMLE Step 1 and Step 2 on the first attempt. The USMLE Step 2-CK average was 212.50. The average cumulative GPA was 3.44. Graduates were nearly evenly divided between primary care and nonprimary care practice, with the majority practicing in metropolitan areas. Graduates who initially entered primary care residency training were more likely to practice primary care medicine than those who entered nonprimary care programs; however, fewer graduates were practicing primary care than had entered primary care residency training. Graduates who attended internal medicine residency training were less likely to be practicing primary care medicine than those who attended family medicine, pediatrics, or OB/GYN programs. Women and Rural Primary Care Track graduates were significantly more likely to practice primary care than were men and generalist track graduates, respectively. Nonprimary care physicians had significantly higher USMLE Step 2-CK scores than did primary care physicians (PCPs). PCPs practiced in more rural locales than non-PCPs. Family physician graduates tended to practice in more rural locales than OB/GYNs or pediatricians. Hometown location predicted practice location over and above medical school track.

Yes / The Primary Care Patient Measure of Safety (PC PMOS) is designed to capture patient feedback about the contributing factors to patient safety incidents in primary care. It required further reliability and validity testing to produce a robust tool intended to improve safety in practice. Method 490 adult patients in nine primary care practices in Greater Manchester, UK, completed the PC PMOS. Practice staff (n = 81) completed a survey on patient safety culture to assess convergent validity. Confirmatory factor analysis (CFA) assessed the construct validity and internal reliability of the PC PMOS domains and items. A multivariate analysis of variance was conducted to assess discriminant validity, and Spearman correlation was conducted to establish test–retest reliability. Results Initial CFA results showed data did not fit the model well (a chi-square to df ratio (CMIN/DF) = 5.68; goodness-of-fit index (GFI) = 0.61, CFI = 0.57, SRMR = 0.13  and root mean square error of approximation (RMSEA) = 0.10). On the basis of large modification indices (>10), standardised residuals >± 2.58 and assessment of item content; 22 items were removed. This revised nine-factor model (28 items) was found to fit the data satisfactorily (CMIN/DF = 2.51; GFI = 0.87, CFI = 0.91, SRMR = 0.04  and RMSEA = 0.05). New factors demonstrated good internal reliability with average inter-item correlations ranging from 0.20 to 0.70. The PC PMOS demonstrated good discriminant validity between primary care practices (F = 2.64, df = 72, p < 0.001) and showed some association with practice staff safety score (convergent validity) but failed to reach statistical significance (r = −0.64, k = 9, p = 0.06). Conclusion This study led to a reliable and valid 28-item PC PMOS. It could enhance or complement current data collection methods used in primary care to identify and prevent error. / NIHR Greater Manchester Patient Safety Translational Research Centre.

Thesis (PhD)--Stellenbosch University, 2002.

The purpose of this study was to examine the practicing characteristics of graduates of a college of medicine with a rural primary care mission, including influences on graduates' specialty choices and practice locations. Secondary data analyses were conducted on student records and AMA Physician Masterfile data. Fewer graduates were practicing primary care than had entered primary care training. Graduates who attended internal medicine residency training were less likely to be practicing primary care medicine than those who attended other primary care programs. Women and rural track graduates were significantly more likely to practice primary care than were men and generalist track graduates, respectively. Primary care physicians (PCPs) were practicing in more rural locales than non-PCPs. Family physicians tended to practice in the most rural locales. FMDRL_ID: 4822

This dissertation examines the factors that have the most significant impact on the pace of change in the primary care (PC) sector in Ontario. In Canada, there have been many attempts to improve the PC system through the introduction of a variety of primary care reform (PCR) models. Some say that there is insufficient movement in the PC sector and that it is in a policy gridlock. Others assert that substantial progress has been made and that transformational change is proceeding. This dissertation demonstrates that PCR – the movement from PC to some form of primary health care (PHC) – is multi-dimensional and complex. It identifies the multiple dimensions of PHC and demonstrates that each dimension has implications for the structural relationships between the state and the medical association in the PC sector in Ontario. The framework for this dissertation was derived from three bodies of literature: PC/PHC, neo-institutionalism and professional autonomy. The research design used involves qualitative and quantitative methods, including historical analysis, document analysis, key informant interviews and qualitative data. The case study of PCR in Ontario demonstrates that while there have been some changes in the methods of physician payment and in the organization and delivery of PC, the majority of PCR models have not fundamentally altered the underlying institutional and structural relationships that characterize the sector. This includes the profession’s ability to control the political, economic and clinical aspects of care. Thus, the PCR models that propose the greatest amount of reform – those that alter structural relationships between the state and the medical association in a manner that results in a significant impact on the balance of power in the PC sector- are less likely to be adopted by physicians. This dissertation corroborates that the PCR models that have the greatest impact on professional autonomy are those that remain at the margins of the health care system, whereas the models that have little or no impact on autonomy have been more readily adopted.

This dissertation examines the factors that have the most significant impact on the pace of change in the primary care (PC) sector in Ontario. In Canada, there have been many attempts to improve the PC system through the introduction of a variety of primary care reform (PCR) models. Some say that there is insufficient movement in the PC sector and that it is in a policy gridlock. Others assert that substantial progress has been made and that transformational change is proceeding. This dissertation demonstrates that PCR – the movement from PC to some form of primary health care (PHC) – is multi-dimensional and complex. It identifies the multiple dimensions of PHC and demonstrates that each dimension has implications for the structural relationships between the state and the medical association in the PC sector in Ontario. The framework for this dissertation was derived from three bodies of literature: PC/PHC, neo-institutionalism and professional autonomy. The research design used involves qualitative and quantitative methods, including historical analysis, document analysis, key informant interviews and qualitative data. The case study of PCR in Ontario demonstrates that while there have been some changes in the methods of physician payment and in the organization and delivery of PC, the majority of PCR models have not fundamentally altered the underlying institutional and structural relationships that characterize the sector. This includes the profession’s ability to control the political, economic and clinical aspects of care. Thus, the PCR models that propose the greatest amount of reform – those that alter structural relationships between the state and the medical association in a manner that results in a significant impact on the balance of power in the PC sector- are less likely to be adopted by physicians. This dissertation corroborates that the PCR models that have the greatest impact on professional autonomy are those that remain at the margins of the health care system, whereas the models that have little or no impact on autonomy have been more readily adopted.

PURPOSE The purpose of this study was to explore how primary care registered nurses address unmet social needs in patients. SPECIFIC AIMS Explore how RNs in a safety-net, primary care setting develop an awareness of and address patient's unmet social needs. Describe how information about unmet social needs are integrated into nursing assessment and intervention activities, and are shared with other members of the health care team. Describe the challenges primary care RNs face when addressing unmet social needs. FRAMEWORK Critical caring theory provided the framework for this study. DESIGN This study used a descriptive, qualitative design. Semi-structured interviews were conducted with seventeen nurses working in 11 different safety-net primary care clinics within a hospital-based system. RESULTS Three major themes emerged. Key findings included the importance of the nurse-patient relationship, the establishment of trust, and a caring, nonjudgmental approach to patients with unmet social needs. Nurses used knowledge of unmet needs to coordinate patient care, provide social support, and work collaboratively with care team members to refer patients to resources within the health care system and in the community. CONCLUSION Unmet social needs contribute to adverse health outcomes, and addressing social and medical needs is critical to eliminating health inequities and reducing health care costs. In this study, primary care nurses described relationships with patients that allowed for the sharing of sensitive information, leading the nurse to identify and address unmet social needs that could impact patient health.

No description available.

Patients who have chronic diseases are often readmitted to the hospital within 30 days of being discharged. In the United States preventable hospital readmissions cost approximately $12-$17.4 billion annually. The Institute of Healthcare Improvement [IHI] has identified one key measure for reducing preventable readmissions and that is a timely post hospital follow-up visit. Although this seems to be a simple task, studies have revealed that as many as one-third of patients discharged from the hospital are not following up with their primary care provider. In North Dakota the percentages of patients with chronic diseases such as heart failure, chronic obstructive pulmonary disease, type 2 diabetes, and pneumonia have steadily increased over the last several years. A North Dakota critical access hospital report revealed a high percentage of patients with a chronic disease are being readmitted within 30 days. Identifying barriers to care in North Dakota can help to reduce the rate of readmission within the state. This study seeks to identify perceived barriers as observed by primary care nurse practitioners to improve patient outcomes and reduce hospital readmission rates.