This study examined the location decisions of family physicians in Saskatchewan by determining the factors that influence family physicians’ location decisions, and identifying the major themes from the factors. The research employed a rational choice model as a basis to design the methodology and explain how Saskatchewan family physicians make their practice location and re-location decisions. A mixed method approach, including an on-line questionnaire survey and interviews with key health agencies, was used to collect and analyse data. Data from the survey were summarised using summary statistics and cross tabulation. Responses from stakeholder interviews were transcribed and analyzed using interpretive description method. The mixed method approach elicited a rich and detailed description of family physicians’ location decisions. Participants of the study ranked family concern, work-life balance and community influence as the most influential factors of family physicians’ location decisions. The fourth factor of locations decisions according the study was compensation. Although compensation was mentioned as a factor, it was recorded as the least influential factor among the participants of this research. Other factors that were identified as having some influence on practice location choices were respect and appreciation, and scope of practice. To conclude, the study found that location decisions are not only about identifying the major influential factors of practice location choices, but also involve finding a good match between family physicians and potential practice locations and communities. That is, family physicians’ preferences must match the characteristics of the potential communities. Based on the conclusion, the study made two policy recommendations regarding the matching between family physicians and communities. The first policy recommendation is strategic matching between family physicians and communities for more efficient and effective recruitment and retention. The second recommendation is providing strategic incentives to ensure access to family physician services for the population in communities that do not meet the requirements of the strategic matching.

Physicians are usually the first contact in the health care system for persons with dementia and their family caregivers. Although specialists typically make the diagnosis, it is the family physician who is key to confirming the diagnosis for dementia, explaining what it means physically, emotionally, and describing what to expect as the disease progresses. Our knowledge about interaction between persons with dementia and their physicians is based largely on the caregiver's view while few studies have investigated the physician's perspective. Persons with dementia have been underrepresented in research pertaining to the issue of diagnosis disclosure. The aim of this exploratory study was to examine the attitudes of family physicians and individuals with early stage dementia about the diagnostic process. The effects of a companion on a medical encounter were also investigated. Data were compiled from responses of 14 family physicians to a structured questionnaire containing highly selective questions, as well as in-depth interviews with 9 individuals with dementia. Using a conflict theoretical framework, the results show that family physicians do inform patients of a diagnosis for dementia. Although the majority of individuals with dementia are satisfied with their family physicians' communication, they were dissatisfied in terms of referral to community resources. Persons with dementia also felt that they received less than ideal care, particularly from specialists, in terms of how the diagnosis was disclosed. Overall, physicians and persons with dementia rated the influence of a third person in the medical encounter as positive. Physicians in this study continued to use an illness-centered approach rather than a patient-centered approach that acknowledges the patient as a person with unique needs and a life-story. Future research thus needs to address the development of a patient-centered model in which the understanding of the subjective experience of the person with dementia is essential. / Thesis / Master of Arts (MA)

The safe and successful performance of office procedures, surgical procedures, and emergency procedures as well as radiological imaging procedures demand a working and yet specific knowledge of anatomy. This study focuses on the competency to perform clinical procedures, especially the underlying anatomical knowledge base necessary to perform a safe and successful procedure. No study reports on the assessment of clinical anatomy as part of the competency of family physicians to perform clinical procedures. The aim of this study was to determine a) which clinical procedures are performed in hospital practices in South Africa; b) the frequency of performance; c) the importance rating of clinical procedures; d) the comfort of performance; e) difficulties and anatomically related complications encountered; f) the role of clinical anatomy competency in reducing difficulties and complications; g) the role of clinical anatomy in improving confidence of performance; h) a selection of 15 problem procedures; i) the relevant clinical anatomy necessary to perform these procedures and j) to develop a clinical anatomy training program for these procedures. A list of 57 procedures relevant to family practice in South Africa was compiled and a questionnaire completed by doctors at various hospitals, which were randomly selected in three provinces in South Africa. A total of 102 questionnaires were obtained and analyzed. The following procedures were selected which were performed often (>50%), ranked important, encountered most difficulties and complications, where more doctors were uncomfortable than comfortable and where the influence of clinical anatomy knowledge on the safe and successful performance of the procedure, was ranked highest: Central venous catheterization, cricothyroidotomy, pericardiocentesis, great saphenous vein cutdown, oro/naso tracheal intubation, lumbar puncture, appendectomy, cesarean section, reduction of uncomplicated forearm fractures, ectopic pregnancy surgery, epistaxis and nasal packing, rectal examination, proctoscopy and sigmoidoscopy, knee joint aspiration, wrist and digital nerve block and obstetric ultrasound. A referenced knowledge base was developed by an extensive literature search of the selected procedures under the following headings: Indications, contraindications/ precautions, step by step procedure, anatomical pitfalls and anatomically relevant complications. This was expanded to develop a Virtual Procedures Clinic, an interactive multimedia package. / Thesis (PhD)--University of Pretoria, 2009. / Anatomy / unrestricted

No description available.

Sexual health affects many aspects of patient health; however, it is often not addressed with patients, and research shows that sexual health is not emphasized in medical education. Primary care providers ought to be on the front lines of the integration of sexual health into patient centered care. In rural areas, this responsibility often falls to family medicine physicians as patients do not have access to Ob/Gyns (obstetrician and gynecologist). The objective of this study was to assess the types and prevalence of sexual health concerns among patients in rural Appalachia and also to assess the comfort level of family medicine physicians in addressing and managing sexual health concerns. Sexual health was defined to include sexual wellness, infections, contraception, and sexual dysfunction. Participants included East Tennessee State University (ETSU) family medicine attending physicians (faculty physicians) and resident physicians at three designated ETSU residency clinic sites. We designed and distributed an eighteen-question survey to residents and faculty physicians in order to evaluate how the recently emerging sexual health emphasis has translated to the practice of family medicine in East Tennessee. Of note in the data analysis, the majority of providers reported they feel at least moderately comfortable discussing sexual health with patients. However, when asked how frequency they address sexual health with patients, most providers reported that they do not frequently ask patients about sexual health concerns. Even though the American College of Obstetrics and Gynecology (ACOG) recommends long-acting reversible contraceptives (LARCs) as first-line contraceptives, less than half of providers recommend LARCs to patients. Additional exploration is needed to address why most family medicine physicians do not ask patients about sexual health as well as to determine if any regional barriers exist. This data also suggests that family medicine providers often do not have the means to recommend first-line contraception, likely due to lack of access and/or lack of knowledge regarding current recommendations. This study suggests that more emphasis should be placed on addressing sexual health and there is a need for additional training perhaps through educational workshops, or the distribution of educational brochures, or training in LARC placement.

No description available.

Introduction The U.S. South has higher rates of unintended pregnancy than other regions of the nation. Rurality and limited supply of medical providers and reproductive health services contribute to these disparities. Layered on this are restrictive reproductive health policies that are changing rapidly. Many rural areas in the South are "maternity care deserts” with no OB/GYNs, midwives, or obstetric care. In these areas, family physicians are often the only providers of reproductive health services. While family physicians commonly counsel about and prescribe oral contraceptives, little is known about their counseling practices for long-acting reversible contraception (LARC), including intrauterine devices (IUDs) and contraceptive implants. This study examines attitudes and practices of family physicians in two Southern states related to counseling for IUDs and implants. Methods Statewide representative surveys of family physicians (FPs) were administered in South Carolina and Alabama in 2018. The survey questionnaire, informed by in-depth interviews with providers and a systematic literature review, collected data about providers’ knowledge, attitudes and practices related to contraceptive counseling and provision. The questionnaire was pilot tested, revised and finalized. Random samples of FPs from each state were selected, with oversampling of rural providers. Sampled providers were web traced and phone screened to verify eligibility and contact information. The IRB-approved survey protocol involved mixed-mode administration (electronic and mail surveys), participation incentives for providers and office managers, and extensive follow-up with non-respondents. Survey data were weighted to account for the sampling design and to generate robust estimates. Data were cleaned and analyzed in STATA using t-tests and chi-square tests for independence. Results Five hundred and ten (510) FPs responded to the survey. The majority of FPs (70%) were in private medical practice and one-fourth in rural areas. Among FPs in Alabama, 39.3% reported not counseling any of their reproductive-aged female patients in the past year about IUDs, and 53.1% reported not counseling about the implant. Prevalence of counseling did not differ significantly between AL and SC providers. While a majority of FPs in both states (88.7%) reported general training in contraceptive counseling during their formal education, fewer reported training specific to IUDs (61.7%) and implants (43.9%), and only 28% had received recent training in contraceptive counseling in the past 2 years. Risk perceptions of providers varied. Contrary to medical eligibility criteria, the majority of FPs considered IUDs unsafe for women who had an STI (sexually transmitted infection) in the past 2 years (62.4%) and unsafe immediately post-partum (69.4%). Contraceptive training was positively associated with counseling provision, whereas risk perceptions were negatively associated with counseling provision. Conclusion Substantial training gaps and needs were noted among FPs. While the scope of practice of FPs is broad and demanding, their engagement in comprehensive contraceptive counseling is essential for their patients’ health and well-being. This is particularly true in the U.S. south where contraceptive services are not always available or accessible. FPs must be supported through evidence-based training programs and clinic-level interventions that facilitate their contraceptive counseling and, ultimately, their patients’ contraceptive choices and outcomes.

The purpose of this study was to explore the extent that family physicians believe their patients could benefit from marriage and family therapy-related care, the extent of their experiences of collaborating with family therapists, and their interest in future collaboration with family therapists. Limitations family physicians face when providing psychosocial care as well as roadblocks they face when making mental health referrals and collaborating with family therapists were also explored. Sixty-four percent of the 240 family physicians surveyed responded to the mailed questionnaire. Descriptive statistics are provided for the quantitative analysis, while content analysis was used to evaluate the qualitative data. Quantitative results revealed that family physicians do detect psychosocial concerns in patient encounters, even when those concerns are not the presenting complaint, but face limitations and roadblocks to adequately addressing these concerns. The most common form of collaboration that the respondents expressed interest in was referring out with collaborative communication continuing with the family therapist, but other forms were also identified. / Master of Science

The adherence to published guidelines for diagnosis and treatment of Attention-Deficit Hyperactivity Disorder (ADHD) by primary care pediatricians (PDs) and family practice physicians (FPs), particularly those in rural areas, has not been well documented. This study examined survey responses from PDs and FPs who serve southern Appalachia (northeast Tennessee, southwest Virginia and Kentucky, and western North Carolina) regarding key practice parameters in line with the current American Academy of Pediatrics guidelines. Results showed that both PDs and FPs reported adhering to most of the diagnosis and treatment guidelines. PDs were more likely than FPs to report using both parent and teacher input in diagnosis and reported prescribing different medications for ADHD to some degree. Both practice areas reported ongoing access to continuing medical education, which is a means to enhancing care of ADHD patients. Implications for primary care are given with attention to the limited availability of PDs in rural areas and future areas of research in rural mental healthcare are suggested.

Darbo tikslas. Įvertinti šeimos gydytojų požiūrį į akušerinės – ginekologinės pagalbos paslaugas, teikiamas pirminėje sveikatos priežiūros grandyje. Uždaviniai. 1. Įvertinti šeimos gydytojų požiūrį į akušerinės – ginekologinės pagalbos organizavimo pokyčius. 2. Nustatyti šeimos gydytojų teikiamų akušerinės – ginekologinės pagalbos paslaugų apimtį pirminėje sveikatos priežiūros grandyje. 3. Nustatyti problemas, su kuriomis susiduria šeimos gydytojai, teikdami akušerinės – ginekologinės pagalbos paslaugas savo bendruomenės moterims. Tyrimo metodika. Tyrimo objektas: Kauno mieste dirbančių šeimos gydytojų požiūris į jų teikiamas akušerinės – ginekologinės pagalbos paslaugas. Tyrimo metodai: Anoniminė anketinė šeimos gydytojų apklausa. Anketa išplatinta visiems Kauno miesto šeimos gydytojams (n = 220). Atsakas – 90,9 proc. Statistinė duomenų analizė atlikta SPSS – 13 programa. Rezultatai. Moterų piktybinių navikų prevencijos vykdymo ir moterų raštingumo lytinės higienos ir šeimos planavimo klausimais priskyrimą šeimos medicinos institucijai teigiamai vertino 96 proc. visų respondentų, nėščiųjų stebėsenos - 58 proc., ginekologinių paslaugų - 64 proc. Privačiose pirminės sveikatos priežiūros įstaigose ( PSPĮ) dirbančių šeimos gydytojų teikiamų akušerinių – ginekologinių paslaugų apimtis (išskyrus klimakterinių simptomų diagnostiką) yra didesnė nei VŠĮ dirbančių šeimos gydytojų. Statistiškai reikšmingi skirtumai nustatyti teikiant šias paslaugas: tepinėlio iš gimdos kaklelio... [toliau žr. visą tekstą] / Aim of the study. To evaluate family physicians’ attitudes towards obstetric-gynecological services provided in primary health care settings. Objectives. 1. To evaluate family physicians’ attitudes towards changes in the organization of obstetric-gynecological servises. 2. To determine the extent of obstetric-gynecological services provided by family physicians in primary health care level. 3. To identify the problems family physicians encounter when providing obstetric-gynecological services . Methods. Anonymous questionnaire-based survey of family physicians was carried out in Kaunas city (n = 220). The response rate was 90.9%. Statistical data analysis was performed using SPSS v.13 software package. Results. The attribution of cancer prevention among women and women’s literacy in sexual hygiene- and family planning-related issues to the institution of family medicine was positively evaluated by 96% of respondents, the attribution of the monitoring of pregnant women – by 58% and the attribution of gynecological services – by 64% of respondents. The extent of obstetric-gynecological services (except for the diagnostics of menopausal symptoms) provided by family physicians working in private primary health care institutions (PHCI) exceeded that provided by family physicians working in public PHCI. Statistically significant differences were detected in the provision of the following services: cervical smear (a service provided by 82.2% of family physicians in private... [to full text]