Sexually transmissible infection management practices among primary care physicians in Singapore

Background: Primary care physicians manage a significant number of sexually transmissible infections (STI); however, there has not been a survey to assess the standard of medical care, completeness of notifications, provision of counselling and contact tracing by primary care physicians in Singapore. Methods: An anonymous postal survey was conducted in which 1557 questionnaires were mailed out to general practitioners (GP), and government primary care and emergency department doctors. Results: In all, 736 questionnaires (47.3%) were returned, and the majority of respondents were graduates from the local medical school, worked in solo or group practices and were males. One hundred and thirty doctors (17.7%) indicated they had received training attachments or postings in dermato-venereology departments. Almost one-third (30.8%) had been working as doctors for fewer than 10 years and 87.8% reported that they managed STI in their practice. Almost half did not investigate genital discharge patients, and one-third would still use ciprofloxacin to treat discharges. In the management of ulcers, over half indicated that they would order syphilis serology, and a significant minority would use parenteral penicillin. Most doctors provided history taking, screening for other STI, testing for HIV infection and STI counselling. A small minority of doctors undertook contact tracing, and there was incomplete notification of many STI. Conclusions: Overall medical management of STI by primary care physicians was acceptable. Skills in contact tracing and reminders on disease notification are areas that need particular attention.

Download Full-text

Potentials and current shortcomings in the cooperation between German centers for rare diseases and primary care physicians: results from the project TRANSLATE-NAMSE

Orphanet Journal of Rare Diseases ◽

10.1186/s13023-021-02106-7 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

D. Druschke ◽

F. Krause ◽

G. Müller ◽

J. Scharfe ◽

G. F. Hoffmann ◽

...

Keyword(s):

Primary Care ◽

Rare Disease ◽

Rare Diseases ◽

Primary Care Physicians ◽

Postal Survey ◽

National Plan ◽

Major Step ◽

Interface Management ◽

Telephone Interviews ◽

Center For Rare Diseases

Abstract Background The TRANSLATE-NAMSE project with the strengthening of the centers for rare diseases with their affiliation to the European Reference Networks was a major step towards the implementation of the German National Plan of Action for People with Rare Diseases establishing better care structures. As primary care physicians, general practitioners and pediatricians play a central role in the diagnosis of patients with rare disease, as it is usually them referring to specialists and rare disease centers. Therefore, the interface management between primary care physicians and the centers for rare diseases is of particular importance. Methods In a mixed-method-approach an anonymous postal survey of 1,500 randomly selected primary care physicians in Germany was conducted with focus on (1) knowledge about a center for rare diseases and how it works, (2) in case of cooperation, satisfaction with the services provided by centers, and (3) expectations and needs they have with regard to the centers. In addition, in-depth telephone interviews were conducted with physicians who had already referred patients to a center. Results In total, 248 physicians responded to the survey, and 15 primary care physicians were interviewed. We observed a wide lack of knowledge about the existence of (45.6% confirmed to know at least one center) about how to access rare disease centers (50.4% of those who know a center confirmed knowledge) and what the center specializes in. In case of cooperation the evaluation was mostly positive. Conclusion To improve medical care, the interplay between primary care physicians and rare disease centers needs to be strengthened. (1) To improve the communication, the objectives and functioning of the rare disease centers should become more visible. (2) Other projects dealing with the analysis and improvement of interface management between centers and primary care physicians, as described in the National Plan of Action for People with Rare Diseases, need to be implemented immediately. (3) If the project is evaluated positively, the structures of TRANSLATE-NAMSE should be introduced nationwide into the German health care system to ensure comprehensive, quality-assured care for people with rare diseases with special consideration of the key role of primary care physicians—also taking into account the financial expenditures of this new care model.

Download Full-text

Screening and management of cardiovascular disease in Australian adults with HIV infection

Sexual Health ◽

10.1071/sh13009 ◽

2013 ◽

Vol 10 (6) ◽

pp. 495 ◽

Cited By ~ 7

Author(s):

Derek Chan ◽

David Gracey ◽

Michael Bailey ◽

Deborah Richards ◽

Brad Dalton

Keyword(s):

Cardiovascular Disease ◽

Primary Care ◽

Clinical Practice ◽

Hiv Infection ◽

Primary Care Physicians ◽

Management Practices ◽

Cvd Risk ◽

Online Forms ◽

Current Screening

Background Cardiovascular disease (CVD) is common in HIV infection. With no specific Australian guidelines for the screening and management of CVD in HIV-infected patients, best clinical practice is based on data from the general population. We evaluated adherence to these recommendations by primary care physicians who treat HIV-infected patients. Methods: Primary care physicians with a special interest in HIV infection were asked to complete details for at least 10 consecutive patient encounters using structured online forms. This included management practices pertaining to blood pressure (BP), blood glucose, electrocardiogram, lipid profile and CVD risk calculations. We assessed overall adherence to screening and follow-up recommendations as suggested by national and international guidelines. Results: Between May 2009 and March 2010, 43 physicians from 25 centres completed reporting for 530 HIV-infected patients, of whom 93% were male, 25% were aged 41–50 years and 83% were treated with antiretrovirals. Risk factors for CVD were common and included smoking (38%), hyperlipidaemia (16%) and hypertension (28%). In men aged >40 years and women aged >50 years without evidence of ischaemic heart disease, only 14% received a CVD risk assessment. Lipid and BP assessments were performed in 87% and 88% of patients, respectively. Conclusions: This Australian audit provides unique information on the characteristics and management of HIV and CVD in clinical practice. We have found a high burden of risk for CVD in HIV-infected Australians, but current screening and management practices in these patients fall short of contemporary guidelines.

Download Full-text

Chlamydia Screening and Management Practices of Primary Care Physicians and Nurse Practitioners in California

Journal of General Internal Medicine ◽

10.1111/j.1525-1497.2005.02012001_1.x ◽

2005 ◽

Vol 20 (12) ◽

pp. A-6-A-6

Keyword(s):

Primary Care ◽

Nurse Practitioners ◽

Primary Care Physicians ◽

Management Practices ◽

Chlamydia Screening

Download Full-text

Chlamydia Screening and Management Practices of Primary Care Physicians and Nurse Practitioners in California

Journal of General Internal Medicine ◽

10.1111/j.1525-1497.2005.0240_1.x ◽

2005 ◽

Vol 0 (0) ◽

pp. 050920120805001-???

Author(s):

Sarah L. Guerry ◽

Heidi M. Bauer ◽

Laura Packel ◽

Michael Samuel ◽

Joan Chow ◽

...

Keyword(s):

Primary Care ◽

Nurse Practitioners ◽

Primary Care Physicians ◽

Management Practices ◽

Chlamydia Screening

Download Full-text

Primary care physicians' attitudes towards cognitive screening: findings from a national postal survey

International Journal of Geriatric Psychiatry ◽

10.1002/gps.2293 ◽

2009 ◽

pp. n/a-n/a ◽

Cited By ~ 3

Author(s):

Panayiotis Iracleous ◽

Jason Xin Nie ◽

C. Shawn Tracy ◽

Rahim Moineddin ◽

Zahinoor Ismail ◽

...

Keyword(s):

Primary Care ◽

Primary Care Physicians ◽

Postal Survey ◽

Cognitive Screening

Download Full-text

North East London coronavirus disease 2019 protocol for diagnostics in two-week wait head and neck cancer patients

The Journal of Laryngology & Otology ◽

10.1017/s0022215120001267 ◽

2020 ◽

Vol 134 (8) ◽

pp. 680-683 ◽

Cited By ~ 1

Author(s):

E Warner ◽

D W Scholfield ◽

A Adams ◽

P Richards ◽

S Ali ◽

...

Keyword(s):

Primary Care ◽

Head And Neck Cancer ◽

High Risk ◽

Head And Neck ◽

Neck Cancer ◽

Primary Care Physicians ◽

Management Practices ◽

Diagnostic Delay ◽

Low Risk ◽

Risk Patients

AbstractBackgroundThe coronavirus disease 2019 pandemic requires urgent modification to existing head and neck cancer diagnosis and management practices. A protocol was established that utilises risk stratification, early investigation prior to clinical review and a reduction in aerosol generating procedures to lessen the risk of coronavirus disease 2019 spread.MethodsTwo-week wait referrals were stratified into low, intermediate and high risk. Low risk patients were referred back to primary care with advice; intermediate and high risk patients underwent investigation. Clinical encounters and aerosol generating procedures were minimised. A combined diagnostic and therapeutic surgical approach was undertaken where possible.ResultsForty-one patients were used to assess feasibility. Thirty-one per cent were low risk, 35 per cent were intermediate and 33 per cent were high risk. Thirty-three per cent were discharged with no imaging.ConclusionImplementing this protocol reduces the future burden on tertiary services, by empowering primary care physicians to re-refer low risk patients. The protocol is applicable across the UK and avoids diagnostic delay.

Download Full-text

Pandemic response in pluralistic health systems: a cross-sectional study of COVID-19 knowledge and practices among informal and formal primary care providers in Bihar, India

BMJ Open ◽

10.1136/bmjopen-2020-047334 ◽

2021 ◽

Vol 11 (4) ◽

pp. e047334

Author(s):

Krishna D Rao ◽

Japneet Kaur ◽

Michael A Peters ◽

Navneet Kumar ◽

Priya Nanda

Keyword(s):

Primary Care ◽

Health Systems ◽

Management Practices ◽

Primary Care Providers ◽

Cross Sectional Study ◽

Contact Tracing ◽

Care Seeking ◽

Care Providers ◽

Sectional Study ◽

Cross Sectional

ObjectivesResponding to pandemics is challenging in pluralistic health systems. This study assesses COVID-19 knowledge and case management of informal providers (IPs), trained practitioners of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy (AYUSH) and Bachelor of Medicine, Bachelor of Surgery (MBBS) medical doctors providing primary care services in rural Bihar, India.DesignThis was a cross-sectional study of primary care providers conducted via telephone between 1 and 15 July 2020.SettingPrimary care providers from 224 villages in 34 districts across Bihar, India.Participants452 IPs, 57 AYUSH practitioners and 38 doctors (including 23 government doctors) were interviewed from a census of 1138 primary care providers used by community members that could be reached by telephone.Primary outcome measure(s)Providers were interviewed using a structured questionnaire with choice-based answers to gather information on (1) change in patient care seeking, (2) source of COVID-19 information, (3) knowledge on COVID-19 spread, symptoms and methods for prevention and (4) clinical management of COVID-19.ResultsDuring the early days of the COVID-19 pandemic, 72% of providers reported a decrease in patient visits. Most IPs and other private primary care providers reported receiving no COVID-19 related engagement with government or civil society agencies. For them, the principal source of COVID-19 information was television and newspapers. IPs had reasonably good knowledge of typical COVID-19 symptoms and prevention, and at levels similar to doctors. However, there was low stated compliance among IPs (16%) and qualified primary care providers (15% of MBBS doctors and 12% of AYUSH practitioners) with all WHO recommended management practices for suspect COVID-19 cases. Nearly half of IPs and other providers intended to treat COVID-19 suspects without referral.ConclusionsPoor management practices of COVID-19 suspects by rural primary care providers weakens government pandemic control efforts. Government action of providing information to IPs, as well as engaging them in contact tracing or public health messaging can strengthen pandemic control efforts.

Download Full-text

Chlamydia screening and management practices of primary care physicians and nurse practitioners in California

Journal of General Internal Medicine ◽

10.1111/j.1525-1497.2005.00240.x ◽

2005 ◽

Vol 20 (12) ◽

pp. 1102-1107 ◽

Cited By ~ 20

Author(s):

Sarah L. Guerry ◽

Heidi M. Bauer ◽

Laura Packel ◽

Michael Samuel ◽

Joan Chow ◽

...

Keyword(s):

Primary Care ◽

Nurse Practitioners ◽

Primary Care Physicians ◽

Management Practices ◽

Chlamydia Screening

Download Full-text

Managing Antidepressants in Primary Care: Physicians' Treatment Modifications

Psychological Reports ◽

10.2466/02.13.15.pr0.108.3.799-804 ◽

2011 ◽

Vol 108 (3) ◽

pp. 799-804 ◽

Cited By ~ 2

Author(s):

Marijo B. Tamburrino ◽

Rollin W. Nagel ◽

Denis J. Lynch

Keyword(s):

Primary Care ◽

Major Depressive Disorder ◽

Depressive Disorder ◽

Primary Care Physicians ◽

Management Practices ◽

Dysthymic Disorder ◽

Major Depressive ◽

Medication Change ◽

Depression Status ◽

Patient Health

To examine antidepressant management practices in primary care, patients ( N = 148) given an antidepressant for at least one month completed the Beck Depression Inventory (BDI–II), the Patient Health Questionnaire–9 (PHQ–9), and a demographic survey. Participants' mean age was 50.7 yr. and 80% were women. Patients' charts indicated whether physicians had made changes to prescribed antidepressants or dose either 6 wk. before or 6 wk. after study entry. For the 87% of participants whose depression status could be determined, 10% met dysthymic disorder criteria and only 33% had had a medication change in the previous month. Major depressive disorder occurred in 37% but only 18% had had a medication change. Co-existing dysthymic disorder and major depressive disorder were diagnosed in 34%, with 24% receiving a medication change. Participants not receiving a medication change had mean BDI-II scores indicating moderate depression. Lack of antidepressant adjustment suggests physicians may need to monitor depressive symptoms closely using protocols and prompts.

Download Full-text