9.7 Accessing Child and Youth Psychiatry: Perspectives of Primary Care Practitioners (PCPs) in Southeastern Ontario, Canada

This chapter comprises a focused review of the best available evidence for psychological and pharmacological treatments of choice for anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other specified and unspecified feeding and eating disorders (OSFED and UFED), discusses the role of primary care and online therapies, and presents treatment algorithms. In AN, although there is consensus on the need for specialist care that includes nutritional rehabilitation in addition to psychological therapy, no single approach has yet been found to offer a distinct advantage. In contrast, manualized cognitive behavior therapy (CBT) for BN has attained “first-line” treatment status with a stronger evidence base than other psychotherapies. Similarly, CBT has a good evidence base in treatment of BED and for BN, and BED has been successfully adapted into less intensive and non-specialist forms. Behavioral and pharmacological weight loss management in treatment of co-morbid obesity/overweight and BED may be helpful in the short term, but long-term maintenance of effects is unclear. Primary care practitioners are in a key role, both with regard to providing care and with coordination and initiation of specialist care. There is an emerging evidence base for online therapies in BN and BED where access to care is delayed or problematic.

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Evidence-Based Treatment for the Eating Disorders

10.1093/oxfordhb/9780195373622.013.0025 ◽

2012 ◽

Cited By ~ 1

Author(s):

Phillipa J. Hay ◽

Angélica de M. Claudino

Keyword(s):

Primary Care ◽

Eating Disorders ◽

Evidence Base ◽

Good Evidence ◽

Distinct Advantage ◽

Specialist Care ◽

Feeding And Eating Disorders ◽

Online Therapies ◽

Primary Care Practitioners

This chapter comprises a focused review of the best available evidence for psychological and pharmacological treatments of choice for anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other specified and unspecified feeding and eating disorders (OSFED and UFED), discusses the role of primary care and online therapies, and presents treatment algorithms. In AN, although there is consensus on the need for specialist care that includes nutritional rehabilitation in addition to psychological therapy, no single approach has yet been found to offer a distinct advantage. In contrast, manualized cognitive behavior therapy (CBT) for BN has attained “first-line” treatment status with a stronger evidence base than other psychotherapies. Similarly, CBT has a good evidence base in treatment of BED and for BN, and BED has been successfully adapted into less intensive and non-specialist forms. Behavioral and pharmacological weight loss management in treatment of co-morbid obesity/overweight and BED may be helpful in the short term, but long-term maintenance of effects is unclear. Primary care practitioners are in a key role, both with regard to providing care and with coordination and initiation of specialist care. There is an emerging evidence base for online therapies in BN and BED where access to care is delayed or problematic.

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An analysis of directly observed weight communication processes between primary care practitioners and overweight patients

Patient Education and Counseling ◽

10.1016/j.pec.2019.07.010 ◽

2019 ◽

Vol 102 (12) ◽

pp. 2214-2222 ◽

Cited By ~ 1

Author(s):

Calum T McHale ◽

Joanne E Cecil ◽

Anita H Laidlaw

Keyword(s):

Primary Care ◽

Communication Processes ◽

Primary Care Practitioners

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Knowledge, attitude and practice of evidence-based medicine among primary care practitioners in Malaysia: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2020-044372 ◽

2021 ◽

Vol 11 (6) ◽

pp. e044372

Author(s):

Mat Nawi Zanaridah ◽

Mohd Noor Norhayati ◽

Zakaria Rosnani

Keyword(s):

Primary Care ◽

Evidence Based Medicine ◽

Primary Care Physicians ◽

Cross Sectional Study ◽

Evidence Based ◽

Sectional Study ◽

Primary Care Practitioner ◽

Cross Sectional ◽

Primary Care Practitioners ◽

Based Medicine

ObjectivesTo determine the level of knowledge and practice of evidence-based medicine (EBM) and the attitudes towards it and to identify the factors associated with its practice among primary care practitioners in Selangor, Malaysia.SettingThis cross-sectional study was conducted in randomly selected health clinics in Selangor. Data were collected from primary care physicians using self-administered questionnaires on knowledge, practice and attitudes regarding EBM.ParticipantsThe study included 225 respondents working in either government or private clinics. It excluded house officers and those working in public and private universities or who were retired from practice.ResultsA total of 32.9% had a high level of EBM knowledge, 12% had a positive attitude towards EBM and 0.4% had a good level of its practice. The factors significantly associated with EBM practice were ethnicity, attitude, length of work experience as a primary care practitioner and quick access to online reference applications on mobile phones.ConclusionsAlthough many physicians have suboptimal knowledge of EBM and low levels of practising it, majority of them have a neutral attitude towards EBM practice. Extensive experience as a primary care practitioner, quick access to online references on a mobile phone and good attitude towards EBM were associated with its practice.

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Primary care practitioners’ diagnostic action when the patient may have cancer: an exploratory vignette study in 20 European countries

BMJ Open ◽

10.1136/bmjopen-2019-035678 ◽

2020 ◽

Vol 10 (10) ◽

pp. e035678

Author(s):

Michael Harris ◽

Mette Brekke ◽

Geert-Jan Dinant ◽

Magdalena Esteva ◽

Robert Hoffman ◽

...

Keyword(s):

Primary Care ◽

Diagnostic Test ◽

Cancer Survival ◽

Survival Rates ◽

European Countries ◽

Survey Question ◽

Referral Decisions ◽

Physician Characteristics ◽

Care Survey ◽

Primary Care Practitioners

ObjectivesCancer survival rates vary widely between European countries, with differences in timeliness of diagnosis thought to be one key reason. There is little evidence on the way in which different healthcare systems influence primary care practitioners’ (PCPs) referral decisions in patients who could have cancer.This study aimed to explore PCPs’ diagnostic actions (whether or not they perform a key diagnostic test and/or refer to a specialist) in patients with symptoms that could be due to cancer and how they vary across European countries.DesignA primary care survey. PCPs were given vignettes describing patients with symptoms that could indicate cancer and asked how they would manage these patients. The likelihood of taking immediate diagnostic action (a diagnostic test and/or referral) in the different participating countries was analysed. Comparisons between the likelihood of taking immediate diagnostic action and physician characteristics were calculated.SettingCentres in 20 European countries with widely varying cancer survival rates.ParticipantsA total of 2086 PCPs answered the survey question, with a median of 72 PCPs per country.ResultsPCPs’ likelihood of immediate diagnostic action at the first consultation varied from 50% to 82% between countries. PCPs who were more experienced were more likely to take immediate diagnostic action than their peers.ConclusionWhen given vignettes of patients with a low but significant possibility of cancer, more than half of PCPs across Europe would take diagnostic action, most often by ordering diagnostic tests. However, there are substantial between-country variations.

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Engaging family caregivers and health system partners in exploring how multi-level contexts in primary care practices affect case management functions and outcomes of patients and family caregivers at end of life: a realist synthesis

BMC Palliative Care ◽

10.1186/s12904-021-00781-8 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Grace Warner ◽

Lisa Garland Baird ◽

Brendan McCormack ◽

Robin Urquhart ◽

Beverley Lawson ◽

...

Keyword(s):

Primary Care ◽

Case Management ◽

End Of Life ◽

End Of Life Care ◽

Realist Synthesis ◽

Multi Level ◽

Care Practices ◽

Primary Care Practitioners ◽

Management Functions ◽

Primary Care Practices

Abstract Background An upstream approach to palliative care in the last 12 months of life delivered by primary care practices is often referred to as Primary Palliative Care (PPC). Implementing case management functions can support delivery of PPC and help patients and their families navigate health, social and fiscal environments that become more complex at end-of-life. A realist synthesis was conducted to understand how multi-level contexts affect case management functions related to initiating end-of-life conversations, assessing patient and caregiver needs, and patient/family centred planning in primary care practices to improve outcomes. The synthesis also explored how these functions aligned with critical community resources identified by patients/families dealing with end-of-life. Methods A realist synthesis is theory driven and iterative, involving the investigation of proposed program theories of how particular contexts catalyze mechanisms (program resources and individual reactions to resources) to generate improved outcomes. To assess whether program theories were supported and plausible, two librarian-assisted and several researcher-initiated purposive searches of the literature were conducted, then extracted data were analyzed and synthesized. To assess relevancy, health system partners and family advisors informed the review process. Results Twenty-eight articles were identified as being relevant and evidence was consolidated into two final program theories: 1) Making end-of-life discussions comfortable, and 2) Creating plans that reflect needs and values. Theories were explored in depth to assess the effect of multi-level contexts on primary care practices implementing tools or frameworks, strategies for improving end-of-life communications, or facilitators that could improve advance care planning by primary care practitioners. Conclusions Primary care practitioners’ use of tools to assess patients/families’ needs facilitated discussions and planning for end-of-life issues without specifically discussing death. Also, receiving training on how to better communicate increased practitioner confidence for initiating end-of-life discussions. Practitioner attitudes toward death and prior education or training in end-of-life care affected their ability to initiate end-of-life conversations and plan with patients/families. Recognizing and seizing opportunities when patients are aware of the need to plan for their end-of-life care, such as in contexts when patients experience transitions can increase readiness for end-of-life discussions and planning. Ultimately conversations and planning can improve patients/families’ outcomes.

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