Factors influencing skin cancer excision rates in Scottish primary care

BackgroundIn Australia, melanoma is managed in primary and secondary care settings. An individual concerned about a suspicious lesion typically presents first to their GP.AimTo identify factors influencing GPs’ decisions to diagnose, treat, or refer patients with suspected melanoma.Design & settingSemi-structured interviews were undertaken with 23 GPs working in general practice or skin cancer clinics in Australia.MethodThe semi-structured interviews were audio-recorded, de-identified, and professionally transcribed. Thematic analysis was used to analyse the data.ResultsConsiderable variation existed in GPs’ self-reported confidence and involvement in melanoma management. Multiple factors were identified as influencing GPs’ decisions to diagnose, treat, or refer patients with suspected or confirmed melanoma. Health system level factors included the overlapping roles of GPs and specialists, and access to and/or availability of specialists. Practice level factors included opportunities for formal and informal training, and having a GP with a special interest in skin cancer within their practice. GP and patient level factors included the GP’s clinical interests, the clinical features (for example, site and size) and histopathology of the suspected melanoma, eligibility for possible sentinel lymph node biopsy, and patient preferences. For some GPs, concerns over misdiagnosis and the option of referring patients at any stage in the melanoma management continuum appeared to affect their interest and confidence in melanoma management.ConclusionGP involvement in melanoma patient care can extend well beyond cancer screening, prevention and supportive care roles to include provision of definitive melanoma patient management. GPs with an interest in being involved in melanoma management should be encouraged and supported to develop the skills needed to manage these patients, and to refer when appropriate.

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Assessment of the factors influencing primary care physicians’ approach to vaccination of adult risk groups in Istanbul, Turkey

PeerJ ◽

10.7717/peerj.7516 ◽

2019 ◽

Vol 7 ◽

pp. e7516

Author(s):

Fatma Yılmaz Karadağ ◽

Zuhal Aydan Sağlam

Keyword(s):

Primary Care ◽

Primary Care Physicians ◽

Medical Training ◽

Risk Group ◽

Risk Groups ◽

Cross Sectional Study ◽

Cross Sectional ◽

Factors Influencing ◽

Demographical Data ◽

Adult Immunization

Background We aimed to assess the factors influencing primary care physicians’ (PCPs) approach to adult vaccination in specific risk groups and evaluate the compliance to adult immunization guidelines. Methods This cross-sectional study performed between January 2016 and April 2016 in İstanbul, Turkey. A questionnaire designed to obtain physicians’ demographical data, experience, immunization status, and attitude on prescribing or recommending vaccines for adults in the risk group. Healthy individuals older than 65 and patients suffer from chronic diseases or had splenectomy before are considered as a risk group. The questionnaire was sent via email to a randomly selected group of 1,500 PCPs. The data of 221 physicians who responded emails were recorded for statistical analysis. Results Of the 221 participants (123 women, 98 men), the majority were aged 31–40 years. Their vaccination rates were 74.2% for hepatitis B, 54.3% for seasonal influenza, and 47.1% for tetanus. Among participants, the highest recommendation and prescription rate of adult vaccines was recorded in PCPs aged 31–40 years. In addition, PCPs with <10 years occupational experience were found to prescribe adult vaccines more frequently than PCPs with longer occupational experience. Conclusions Primary care physicians with lower age and relatively less experience are more intent to prescribe adult vaccines to patients that are in risk groups. This result may be due to increased awareness of adult immunization among PCPs who had more recent medical training. However, many other factors could have caused this difference, including physicians’ approach to primary medical care.

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Teaching Skin Cancer Detection to Medical Students Using a Dermoscopic Algorithm

PRiMER ◽

10.22454/primer.2021.304379 ◽

2021 ◽

Vol 5 ◽

Author(s):

Peggy R. Cyr ◽

Wendy Craig ◽

Hadjh Ahrns ◽

Kathryn Stevens ◽

Caroline Wight ◽

...

Keyword(s):

Primary Care ◽

Medical Students ◽

Skin Cancer ◽

Primary Care Physicians ◽

Survival Rates ◽

Family Physicians ◽

Skin Lesions ◽

Posttest Score ◽

Malignant Skin ◽

Attending Physicians

Introduction: Early detection of melanoma skin cancer improves survival rates. Training family physicians in dermoscopy with the triage amalgamated dermoscopic algorithm (TADA) has high sensitivity and specificity for identifying malignant skin neoplasms. In this study we evaluated the effectiveness of TADA training among medical students, compared with practicing clinicians. Methods: We incorporated the TADA framework into 90-minute workshops that taught dermoscopy to family physicians, primary care residents, and first- and second-year medical students. The workshop reviewed the clinical and dermoscopic features of benign and malignant skin lesions and included a hands-on interactive session using a dermatoscope. All participants took a 30-image pretest and a different 30-image posttest. Results: Forty-six attending physicians, 25 residents, and 48 medical students participated in the workshop. Mean pretest scores were 20.1, 20.3, and 15.8 for attending physicians, resident physicians and students, respectively (P<.001); mean posttest scores were 24.5, 25.9, and 24.1, respectively (P=.11). Pre/posttest score differences were significant (P<.001) for all groups. The medical students showed the most gain in their pretest and posttest scores. Conclusion: After short dermoscopy workshop, medical students perform as well as trained physicians in identifying images of malignant skin lesions. Dermoscopy training may be a valuable addition to the medical school curriculum as this skill can be used by primary care physicians as well as multiple specialists including dermatologists, gynecologists, otolaryngologists, plastic surgeons, and ophthalmologists, who often encounter patients with concerning skin lesions.

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Perceived factors influencing the development of primary care-based pharmaceutical care in Scotland

International Journal of Pharmacy Practice ◽

10.1111/j.2042-7174.2001.tb01055.x ◽

2001 ◽

Vol 9 (4) ◽

pp. 243-252 ◽

Cited By ~ 13

Author(s):

J. KRSKA ◽

G. B. A. VEITCH

Keyword(s):

Primary Care ◽

Pharmaceutical Care ◽

Factors Influencing

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Adult health problems

Oxford Handbook of Primary Care and Community Nursing ◽

10.1093/med/9780198831822.003.0012 ◽

2020 ◽

pp. 677-790

Keyword(s):

Primary Care ◽

Skin Cancer ◽

Connective Tissue ◽

Sexual Health ◽

Health Problems ◽

Adult Health ◽

Sexually Transmitted ◽

Food Borne ◽

Musculoskeletal Problems ◽

Intestinal Obstructions

This chapter covers primary care and nursing of various conditions that adults may present with including frailty, skin infections (bacterial, fungal, and viral), skin cancer, eczema, psoriasis, pigmentation and hair problems, and allergies. It also covers deafness, mouth and throat problems, adrenal disorders, anal conditions, gastro-oesophageal reflux and disorders of the bowels, viral infection, and food-borne disease. It also covers bowel disease, coeliac disease, appendicitis, hernias, intestinal obstructions, problems of the liver, gallbladder, and pancreas, as well as common musculoskeletal problems, and bone and connective tissue disorders. Sexual health problems are extensively described, including how to conduct a consultation, sexually transmitted infections, sexual problems, and sexual health in the context of adults with learning difficulties. Breast and gynaecological cancers are covered, alongside problems with menstruation, the ovaries, uterus, and vagina. The final section covers issues relating to termination of pregnancy.

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