Darbo tikslas – įvertinti Marijampolės apskrities šeimos gydytojų nuomonę apie imunoprofilaktiką bei jos organizavimą pirminėje sveikatos priežiūroje. Metodika. Tyrimo metu apklausėme visus Marijampolės apskrities šeimos gydytojus, dirbančius viešosiose ir privačiose pirminės sveikatos priežiūros įstaigose. Respondentams buvo išdalintos 109 anketos, iš kurių teisingai užpildytos ir grąžintos buvo 86 (atsako dažnis 79,0 proc.). Duomenų analizę atlikome naudojant statistinį programinį paketą SPSS (17.0 versija). Hipotezės apie požymių priklausomybę buvo tikrinamos naudojant chi kvadrato (χ2) ir z kriterijus bei Spearmano koreliacijos koeficientą (r). Rezultatai. Šeimos gydytojai, teikiantys paslaugas vaikams, gana aktyviai vykdo jų imunoprofilaktiką pagal Lietuvos Respublikos vaikų profilaktinių skiepijimų kalendorių. Didžioji dalis respondentų (87,2 proc.) tėvus (globėjus) apie vaiko skiepijimą informuoja žodžiu, šiems atvykus į sveikatos priežiūros įstaigą, ir (ar) lankydami savo pacientus namuose (70,9 proc.). Skiepijimo mokamomis vakcinomis srityje apklaustieji dalyvauja gana pasyviai: kiek daugiau nei pusė tirtųjų (53,5 proc.) teigė visada informuojantys pacientus apie galimybę pasiskiepyti šiomis vakcinomis, mažiau nei trečdalis tyrimo dalyvių (31,4 proc.) nurodė tai darantys kartais, o likusioji dalis (15,1 proc.) – retai. Informaciją apie mokamas vakcinas savo pacientams teikiantys telefonu ir (ar) lankstinukuose, stenduose, esančiuose sveikatos priežiūros įstaigoje... [toliau žr. visą tekstą] / Aim of the study - to evaluate the attitude of the family physicians working in Marijampolė County towards the immunoprophylaxis and its organization in the primary health care settings. Methods. All the family physicians working in the public and private primary health care institutions of Marijampolė County took part in the survey. 109 questionnaires were delivered to the respondents. 86 of them were filled-in and returned (the response 79.0%). The data analysis was performed by the application of statistical program package SPSS (version 17.0). The hypotheses about the dependence of the variables were checked using the Chi square (χ2), z criteria and Spearman correlation coefficient (r). Results. The family physicians providing services to the children were actively performing the immunoprophylaxis activities according to the Calendar of the Preventive Vaccination of the Children of the Republic of Lithuania. The major part of the respondents (87.2%) were informing the parents (guardians) about the need to vaccinate their children upon their arrival to the health care institutions and (or) while visiting the patients at home (70.9%). The respondents were passively participating in the vaccination with chargeable vaccines activities. Little more than a half of the respondents (53.5%) told that they were always informing their patients about the possibilities to vaccinate their children with the chargeable vaccines, less than one third (31.4%) indicated that they were... [to full text]

Rationale: Prescription drug abuse and misuse (PDA/M) is a significant problem in Central Appalachia and continues to grow. Since 2000, Tennessee has seen a 250% increase in prescription overdose deaths. Nationally, most prescription painkillers are prescribed by primary care doctors and dentists, rather than specialists. Objective: To develop and test a survey instrument aimed at understanding family physician knowledge, attitudes, and beliefs about opioid therapy prescribing. Design: Survey development. Setting: Survey questions were developed based on results of five focus groups held in primary care clinics in Northeast Tennessee and Southwest Virginia. Surveys were validated and tested by faculty and residents in three family medicine residency clinics in Northeast Tennessee. Participants: Survey questions were face validated for clarity and relevance by family physician attendings and third year residents (N=29). All faculty attendings and residents (N≈85) at the same family medicine residency clinics will be invited to complete the survey for psychometric testing. Main and Secondary Outcome Measures: Survey questions have been face validated for clarity and relevance. Data from the psychometric testing phase will be analyzed for internal consistency and inter-item correlations. Exploratory factor analysis will be used to identify underlying constructs. Results: Based on the results of the focus groups and physician expertise, a 51-item instrument was developed. Following face validation, wording was clarified on 25 questions, 3 questions were removed, and 5 questions were added, resulting in a 53-item instrument. Psychometric testing has not been completed at this time, but will be completed at the time of presentation. Conclusions: Researchers intend to use the findings to improve policies and practice guidelines for primary care clinics in the Appalachian region. Results will be used to design CME activities to decrease PDA/M and to help foster more effective and responsible prescribing of pain medication.

No description available.

Background: Rural maternity care in Canada is in crisis, with many communities losing local services. This forces rural women and families to travel for care, leading to heightened stress, expenses, and adverse outcomes. Family physicians, often the primary providers of rural maternity care, are decreasing in numbers, exacerbating the problem. Without enough providers, rural communities struggle to offer safe and accessible maternity services, risking the health of expectant mothers and families. Objective: This research aims to gain a comprehensive understanding of the socio-ecological influences that shape the commitment of family physicians and residents to practice rural maternity care. Methods: A scoping review was conducted, and database searching occurred in Ovid Medline, Ovid Embase, Ovid Emcare, and Web of Science. Primary studies and literature reviews in English were included if they discussed family physicians' and residents' experiences and perspectives in practicing and training for rural maternity care. Articles were restricted to the past 30 years. Thematic analysis was applied to analyze the data, and results were reported in tabular format. Results: Influencing factors were categorized into themes and contextualized across the socio-ecological model: 1) individual factors (i.e. interests, attitudes, motivation, burnout, risk), 2) interpersonal factors (i.e. lifestyle, interprofessional relationships, mentors), 3) organizational factors (i.e. training and professional development, work environment and practice characteristics, resources, regulation and privileging), 4) community-level factors (i.e. practice setting and location, job availability, community context), and 5) systematic factors (healthcare system structure, public policy, legal and regulatory framework). Conclusion: The most salient influencing factors included challenges with Family Medicine residency training and role models, call schedule sustainability and interprofessional collaboration, as well as preserving clinical skills and financial stability with low procedural volume in rural communities. There is a need to implement evidence-based interventions targeting training, recruiting role models, interprofessional collaboration and call, and effective rural remuneration. / Thesis / Master of Science (MSc) / Family physicians (FP) are often the sole care providers of maternity care (MC) in rural communities. Unfortunately, there is a declining number of FPs choosing to provide comprehensive maternity care (CMC). In addition, centralization has resulted in rural maternity center closures across the country. Rural women and families that must travel to access MC experience increased levels of stress, personal costs, and increased rates of adverse outcomes. With fewer FPs available to provide CMC alongside maternity centre closures, rural communities face challenges in ensuring safe and accessible care for expectant mothers. Addressing this issue is vital to protecting the health and well-being of rural families. Although research exists regarding the challenges FPs encounter when providing CMC in rural areas and what influences resident practice intentions, there has yet to be a synthesis of the literature over the last 30 years. To address this, a scoping review was conducted to explore the research on the influences on FPs’ and residents’ commitment to practicing rural MC. This scoping review can help understand what factors have been most influential over time, emerging challenges, and what socio-ecological levels to target for intervention.

This thesis applies the econometric projection approach to forecast the numbers of general practitioners (GPs) in Saskatchewan for the next 15 years at both provincial and the Regional Health Authorities (RHAs) levels. The projection results will provide the estimated level of GPs up to 2021 for policy makers to adjust their decision on health professionals planning.<p> Three hypothesized scenarios, which include the changes in population proportion, average income for GPs and a combination of both, are used for projections based on the regression results. The projections suggest a 4.34% expected annual increase of GPs if the proportions of children and seniors increase or decrease according to prediction for the next 15 years for Saskatchewan. At the RHAs level, 4.5% to 10.7% expected annual rate of increase for numbers of GPs is projected for the northern RHAs and Saskatoon RHA, while the expected increase for other urban RHAs will experience less than 1.5% increases.<p> The predicted changes in average income for GPs show insignificant effect for the expected changes in numbers of GPs. However, the second and third scenarios are not extended to the RHAs level due to lack of information, which requires additional data for both Saskatchewan physicians and population for further projection analysis.

This thesis applies the econometric projection approach to forecast the numbers of general practitioners (GPs) in Saskatchewan for the next 15 years at both provincial and the Regional Health Authorities (RHAs) levels. The projection results will provide the estimated level of GPs up to 2021 for policy makers to adjust their decision on health professionals planning.<p> Three hypothesized scenarios, which include the changes in population proportion, average income for GPs and a combination of both, are used for projections based on the regression results. The projections suggest a 4.34% expected annual increase of GPs if the proportions of children and seniors increase or decrease according to prediction for the next 15 years for Saskatchewan. At the RHAs level, 4.5% to 10.7% expected annual rate of increase for numbers of GPs is projected for the northern RHAs and Saskatoon RHA, while the expected increase for other urban RHAs will experience less than 1.5% increases.<p> The predicted changes in average income for GPs show insignificant effect for the expected changes in numbers of GPs. However, the second and third scenarios are not extended to the RHAs level due to lack of information, which requires additional data for both Saskatchewan physicians and population for further projection analysis.

Įvadas. Pertvarkant pirminės sveikatos priežiūros (PSP) įstaigų tinklą, siekiama gerinti sveikatos priežiūros paslaugų prieinamumą, priimtinumą ir kokybę. Todėl, aktualu periodiskai tirti pacientų požiūrį į sveikatos priežiūros paslaugų prieinamumą bei priimtinumą įvairioms socialinėms grupėms. Darbo tikslas: nustatyti ir įvertinti pacientų požiurį į sveikatos paslaugų prieinamumą bei priimtinumą Varėnos pirminės sveikatos priežiūros įstaigoje ir jų ryšius su socialiniais demografiniais veiksniais. Tyrimo metodika. 2006.03.01 – 2006.03.10 laikotarpiu VšĮ Varėnos PSP centre buvo atliekama anoniminė anketinė pacientų apklausa. Apklausoje dalyvavo VšĮ Varėnos PSP centre(miesto gyventojai) ir jo filialuose (kaimo gyventojai) besilankantys pacientai. Buvo išdalinta 280 anketų, atsakė – 208 respondentai (atsakas – 74 proc.). Statistinė duomenų analizė atlikta SPSS 9 versijos programiniu paketu. Rezultatai. Pagrindinis šeimos gydytojo pasirinkimo motyvas yra gydytojo profesionalumas, žinios ir patirtis (72,6 proc.).Centre sveikatos priežiūros paslaugų teritorinis, finansinis, organizacinis ir informacinis prieinamumas buvo geresnis negu jo filialuose.Visi centro pacientai per vieną valandą pasiekdavo PSP įstaigą, tuo tarpu filialų – tik 54,1 proc. respondentų (p<0,05). 32,3 proc. centro respondentų buvo finansiškai pajėgūs įsigyti vaistus, o filialų – tik 15,6 proc. (p<0,05). Prie registratūros langelio ilgiau negu 15 min. laukė 11,1 proc. centro respondentų, o filialų – 26... [toliau žr. visą tekstą] / Introduction. The reorganization of the network of primary healthcare (PHC) institutions is aimed at the improvement of the accessibility, acceptability, and quality of healthcare services. For this reason, periodical investigations of the patients’ attitude towards the accessibility and acceptability of healthcare services to various social groups are relevant. The aim of the study was to determine and evaluate patients’ attitudes towards the accessibility and acceptability of healthcare services in Varėna district primary healthcare unit, and to evaluate the relationships of these attitudes with socio-demographic factors. The methods of the study. During the period of March 1, 2003 to March 10, 2006, we performed an anonymous questionnaire-based inquiry of patients at Public institution Varėna PHC center. The participants of the inquiry were patients who visited Public institution Varėna PHC center (patients living in the city) and its branch offices (patients living in the countryside). In total, 280 questionnaires were distributed, 208 of which were returned (the response rate was 74%). Statistical analysis of the obtained data was performed using the SPSS v. 9 software package. Results. The main motive for the choice of the family physician was the physician’s professionalism, knowledge, and experience (72.6% of answers). The territorial, financial, organizational, and informational accessibility of services at the PHC center was better than in its branch offices... [to full text]

Darbo tikslas - Išanalizuoti šeimos gydytojų ir bendros praktikos slaugytojų darbo krūvio pasiskirstymą darbo metu. Uždaviniai: 1. Įvertinti šeimos gydytojo darbo krūvį pacientų priėmimo metu. 2. Įvertinti bendros praktikos slaugytojo darbo krūvį. 3. Palyginti privačiose ir valstybinėse PSPC dirbančių šeimos gydytojų ir bendros praktikos slaugytojų darbo krūvį. Tyrimo metodika: anoniminė anketinė apklausa. Šeimos gydytojams ir bendros praktikos slaugytojams atsitiktine tvarka buvo pateiktos anketos, į kurias jie atsakydavo ir grąžindavo apklausėjui. Anketos buvo dalinamos darbo vietose, konferencijų, mokymų metu. Dėmesys buvo kreipiamas į apklausiamojo specialybę ( šeimos gydytojas ar bendros praktikos slaugytojas ), o ne į tai, kokioje PSPĮ jis dirba. Anketos buvo pateiktos 145 šeimos gydytojams ir 139 bendros praktikos slaugytojams. Į anketas respondentai atsakė 100%. Naudoti statistinės analizės metodai: SPSS Statistics 20.0 programa, Kolmogorovo ir Smirnovo testas, Spearman koreliacijos koeficientas, nepriklausomų imčių Stjudento t testas, blokuotų duomenų dispersinė analizė (ANOVA) su post hoc analizės Bonferonni kriterijumi, tiesinės regresijos metodas. Tyrimo rezultatai: Pastebėta, kad dubliuojasi dauguma šeimos gydytojų ir slaugytojų atliekamų manipuliacijų, kai kurių dokumentų pildymas, visos pateiktos apklausos metu funkcijos. Šeimos gydytojai daugiausiai priima lėtinėmis neinfekcinėmis ligomis sergančių pacientų. Tarp privačiose ir valstybinėse gydymo... [toliau žr. visą tekstą] / Purpose: To analyse the distribution of workload of family physicians and general practice nurses during the working hours. Tasks: 1. To assess the workload of family physician during the working hours. 2. To assess the workload of general practice nurses during the working hours. 3. To compare the workload of family physicians and general practice nurses employed in the private and public health care centers. Methods: Anonymous questionnaires were presented to the family physicians and general practice nurses in randomised order. The questionnaires were distributed at working places during conferences and training courses. The attention was drawn to the professional qualification of the interviewed person (family physician or general practice nurse) rather than to a primary health care institution where the person was employed. The questionnaires were presented to 145 family physicians and 139 general practice nurses. 100 % of the respondents presented completed questionnaires. SPSS Statistics 20.0 software was used for statistical analysis. Kolmogorov's and Smirnov's test, Spearman's correlation coefficient, Student's T-test for the independent samples, dispersive analysis of blocked data (ANOVA) with Benferonni criterion for the post hoc analysis and method of linear regression were calculated Results: The data showed that many manipulations all functions listed in the questionnaires and completion of some documents duplicated between nurses and physicians. Patients... [to full text]

Abstract Background The National Health and Medical Research Council and the Royal Australian College of General Practitioners recommend exclusive breastfeeding for the first six months of an infant’s life and continued breastfeeding with the addition of appropriate complementary food until at least 12 months. While most Australian women initiate breastfeeding, many wean earlier than recommended due to breastfeeding difficulties. As most women consult their GP frequently in the first six months postpartum, GPs are in an ideal position to provide encouragement, evidence-based information and advice that breastfeeding women need. In addition, women are more likely to initiate and continue to breastfeed if their doctor supports and encourages them to do so. The limited Australian data available question whether GPs have the skills to be able to effectively assist breastfeeding women, although no research has specifically addressed the breastfeeding knowledge or attitudes of Australian GPs. Additionally, there are no data detailing the breastfeeding training available to medical students, GP registrars or GPs. Aim This study aimed to identify the breastfeeding educational needs of Australian GP registrars and to develop a relevant and applicable breastfeeding educational resource within the context of these identified needs. Research design Triangulation methodology, using more than one data source and qualitative and quantitative data-collection methods, was chosen for this study to give a richer, more inclusive and wider reaching understanding of the issues involved than could be obtained by using one method alone. Therefore, to meet the aims of the study, a three phase mixed-method project with triangulation of data was designed. Phase 1 had three distinct data-collection arms: a quantitative survey of medical school curricula; focus groups with medical students from two Queensland medical schools; and interviews with eight GP registrars. Data from Phase 1 provided information about breastfeeding attitudes, knowledge needs and learning opportunities, and informed the development of a questionnaire sent to final-year GP registrars Australia-wide (Phase 2). The aim of this phase was to ascertain the GP registrars’ breastfeeding attitudes and knowledge gaps. Phase 3 used the outcomes of Phases 1 and 2 to design an educational resource that would meet the needs of GP registrars. Results Breastfeeding was included in the curricula of most of the Australian medical schools surveyed (n = 10). Many medical schools relied on contact between the student and patients to provide clinical experience and practical knowledge. Medical students and GP registrars reported marked variability in breastfeeding learning opportunities. Although both groups had positive breastfeeding attitudes, participants had differing opinions regarding doctors’ involvement in infant feeding decisions and the type of support and information offered to women. Overall, the breastfeeding attitudes of the 161 GP registrars who returned the questionnaire were positive (mean 3.99, 1 = least positive, 5 = most positive). However, while the mean breastfeeding knowledge score was 3.40, (1 = minimum score, 5 = maximum score) 40 percent of the knowledge items were incorrectly answered by more than half the cohort. Approximately 40 percent of the registrars were confident and thought they were effective assisting breastfeeding women. Nevertheless, only 23 percent thought they had had sufficient breastfeeding training. Registrars who thought their previous training was inadequate had lower knowledge scores, were less confident and perceived that they were less effective than the remainder of the cohort. A new finding from this study was that Australian-born registrars had more positive breastfeeding attitudes and higher knowledge scores than their overseas-born counterparts. In addition, while parents with more than 26 weeks’ personal breastfeeding experience (self or partner) had more positive breastfeeding attitudes and higher breastfeeding knowledge, confidence and perceived effectiveness scores, parents with less experience had less positive attitudes and poorer knowledge than non-parent participants. Similar to previous studies, gender had no effect on breastfeeding knowledge or attitudes. Using adult learning principles, a five-session, case-based breastfeeding educational resource addressing the knowledge deficits identified in the previous phases of the study was developed. Evaluation activities before and after each session, as well as exercises designed for reflection and critical thinking, were an integral part of the resource. Conclusion This study found that the breastfeeding training of Australian medical students and GP registrars was inadequate and, regardless of their positive breastfeeding attitudes, resulted in registrars being ill-prepared to assist breastfeeding women. Based on the training needs identified in the study and in the literature, an educational resource was developed that presented information within real-life case-based scenarios. Additional background information provided logic and rationale for diagnosis, management and treatment. While the implementation of the resource is outside the scope of this thesis (but will be the focus of post-doctoral work), it is believed that the resource has the potential to provide GP registrars with training opportunities to improve their breastfeeding knowledge and skills, thus better meeting the needs of breastfeeding women.

<p><strong>Background and Objectives: </strong>Previous research has examined the effect of family physician continuity of care within end-of-life care cancer patients and its association with reduced use of acute care services. However, such research has not been examined in the end of life homecare cancer population.<strong> Objectives: </strong>To investigate the association of family physician continuity with location of death, hospital and emergency room (ER) visits in the last 2 weeks of life in end of life homecare cancer patients.<strong> Research Design: </strong>Retrospective study involving secondary data analysis of 7 linked databases<strong>. Subjects: </strong>All those who died of cancer between January 1, 2006 to December 31, 2006 in Ontario who had at least 1 visit to a family physician and enrolled in homecare for at least 2 weeks.<strong> Methods: </strong>The relationship of family physician continuity of care and location of death, and hospital and ER visits in the last 2 weeks of life was examined using logistic regression.<strong> Results: </strong>The Usual Provider of Care (UPC) measure demonstrated a dose response relationship with increasing continuity resulting in decreased odds of dying in the hospital and visiting the hospital and ER in the last 2 weeks of life. The Family Physician visits per week measure demonstrated a threshold effect relationship with location of death and hospital visits and dose response relationship with ER visits in the last 2 weeks of life. <strong>Conclusions:</strong> These results demonstrate an association between family physician continuity of care and location of death and visits to the hospital and ER in the last 2 weeks of life. This indicates the need for more involvement of family physicians in end of life cancer care.</p> / Master of Science (MSc)