Scarcity of Primary Care Positions May Divert Physician Assistants Into Specialty Practice

2016 ◽  
Vol 74 (1) ◽  
pp. 109-122 ◽  
Author(s):  
Perri Morgan ◽  
Kristine A. Himmerick ◽  
Brandi Leach ◽  
Patricia Dieter ◽  
Christine Everett
Keyword(s):  
Primary Care ◽  
Physician Assistants ◽  
Partial Solution ◽  
Cross Sectional Study ◽  
Care Practice ◽  
Market Demand ◽  
Cross Sectional ◽  
Primary Care Workforce ◽  
Specialty Practice ◽  
Job Postings

Background: Physician assistants (PAs) are often suggested as a partial solution to predicted primary care workforce shortages, but a declining proportion of PAs are entering primary care practice. Policy efforts have focused on increasing primary care PA supply, but low labor market demand might be constricting the primary care PA pipeline. Method: In this descriptive, cross-sectional study, we compare primary care and specialty job postings to each other and to occupied PA positions. Job posting data for 2014 are from a leading labor analytics firm. Results: Only 18% of job postings were in primary care, compared with 27% of occupied PA positions. The proportion of postings that were for primary care varied widely by state (9% to 40%) and were highest in the West. Discussion: Job availability is a potential barrier to PAs practicing in primary care, especially in some locations. Other job factors are examined and policy solutions are suggested.

scholarly journals SEXUAL DYSFUNCTION AMONG WOMEN AT FOUR TO SIX MONTHS POSTPARTUM: A STUDY IN A PRIMARY CARE SETTING

2020 ◽  
Vol 20 (1) ◽  
pp. 235-243
Author(s):  
Norafini Salamon ◽  
Syahnaz Mohd Hashim ◽  
Norfazilah Ahmad ◽  
Suzaily Wahab
Keyword(s):  
Primary Care ◽  
Sexual Dysfunction ◽  
Care Setting ◽  
Primary Care Setting ◽  
Cross Sectional Study ◽  
Care Practice ◽  
Cross Sectional ◽  
Maternal Characteristics ◽  
Local Setting ◽  
Arousal Disorder

Sexual dysfunction in women is a significant health problem that harms marriage stability. Women in the Western countries were reportedly being affected by this condition after childbirth but the magnitude of the problem in our local setting is still unknown. The aim of this cross-sectional study was to determine the prevalence of women with sexual dysfunction at four to six months postpartum and its possible risk factors in an urban primary care setting. The participants were given a set of questionnaire, consisting of three parts; i) sociodemographic and maternal characteristics ii) Malay version of Female Sexual Function Index and iii) Malay DASS-21 questionnaire. Responses from 249 women were analyzed. More than half (57.0%,n=142) were found to have sexual dysfunction. The most prevalent types of sexual dysfunction reported by the affected women were sexual satisfaction disorder (98.6%), followed by arousal disorder (58.5%) and lubrication disorder (28.9%). Three factors were found to be significantly associated with sexual dysfunction; household income of less than RM2000 (adj OR = 0.31, 95% CI 0.14, 0.70), Malay ethnic group (adj OR = 1.93,95% CI 1.02, 3.66) and breastfeeding (adj OR = 2.24,95% CI 1.03, 4.85). In conclusion, the prevalence of sexual dysfunction in the postpartum period was considerably high. Efforts should be made to incorporate sexual health as part of the routine postnatal assessment in primary care practice.

Nursing Care Systematization: Applicability to Primary Care

2020 ◽  
Vol 42 ◽  
pp. e48465
Author(s):  
Emilli Karine Marcomini ◽  
Nanci Verginia Kuster de Paula ◽  
Daiane Cortez Raimondi
Keyword(s):  
Primary Care ◽  
Nursing Care ◽  
Cross Sectional Study ◽  
Health Centers ◽  
Care Practice ◽  
Cross Sectional ◽  
Primary Care Teams ◽  
Time Availability ◽  
Health Zone ◽  
Nursing Professionals

Nursing Care Systematization (NCS) is an organized and systematized process that concerns nursing professionals who provide quality assistance, being a mandatory tool in all health centers. Despite this factor, there is a visible resistance from nursing to the operationalization of a systematized care. Thus, the present study aims to analyze the applicability of nursing care systematization and the knowledge that primary care nurses have of this process. This is a descriptive, cross-sectional study with quanti-qualitative approach, conducted with nurses working in primary care teams from a regional health zone in the state of Paraná, Brazil. Out of the 44 participant nurses, only 20.5% claimed to take all steps in the nursing process during their care practice, and 43.2% do not know about the Resolution of the Federal Nursing Council that addresses NCS application. This low NCS applicability is worrisome, since it is related to the quality, resolution and security of care provision. The applicability of the systematization within the assessed teams is quite fragmented and small; besides, their NCS knowledge is insufficient considering that this is such a relevant tool to a nurse’s professional practice. It is possible to notice numerous fragilities and difficulties in the application of NCS to primary care, with highlight to time availability, overworked nurses, and need for training.

scholarly journals Socioeconomic status and benzodiazepine and Z-drug prescribing: a cross-sectional study of practice-level data in England

2019 ◽  
Author(s):  
Stephanie Soyombo ◽  
Rhian Stanbrook ◽  
Harpal Aujla ◽  
David Capewell ◽  
Mary Shantikumar ◽  
...  
Keyword(s):  
Primary Care ◽  
Socioeconomic Status ◽  
Cross Sectional Study ◽  
Care Practice ◽  
Drug Prescribing ◽  
Sectional Study ◽  
Cross Sectional ◽  
Data Set ◽  
Practice Level ◽  
Age And Sex

Abstract Background Benzodiazepines and Z-drugs (such as zopiclone) are widely prescribed in primary care. Given their association with addiction and dependence, understanding where and for whom these medications are being prescribed is a necessary step in addressing potentially harmful prescribing. Objective To determine whether there is an association between primary care practice benzodiazepine and Z-drug prescribing and practice population socioeconomic status in England. Methods This was a cross-sectional study. An aggregated data set was created to include primary care prescribing data for 2017, practice age and sex profiles and practice Index of Multiple Deprivation (IMD) scores—a marker of socioeconomic status. Drug doses were converted to their milligram-equivalent of diazepam to allow comparison. Multiple linear regression was used to examine the association between IMD and prescribing (for all benzodiazepines and Z-drugs in total, and individually), adjusting for practice sex (% male) and older age (>65 years) distribution (%). Results Benzodiazepine and Z-drug prescribing overall was positively associated with practice-level IMD score, with more prescribing in practices with more underserved patients, after adjusting for age and sex (P < 0.001), although the strength of the association varied by individual drug. Overall, however, IMD score, age and sex only explained a small proportion of the overall variation in prescribing across GP practices. Conclusion Our findings may, in part, be a reflection of an underlying association between the indications for benzodiazepine and Z-drug prescribing and socioeconomic status. Further work is required to more accurately define the major contributors of prescribing variation.

scholarly journals Self-Care for Common Colds by Primary Care Patients: A European Multicenter Survey on the Prevalence and Patterns of Practices—The COCO Study

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Anika Thielmann ◽  
Biljana Gerasimovska-Kitanovska ◽  
Krzysztof Buczkowski ◽  
Tuomas H. Koskela ◽  
Vildan Mevsim ◽  
...  
Keyword(s):  
Primary Care ◽  
Self Care ◽  
Cross Sectional Study ◽  
National Study ◽  
Care Practice ◽  
Cross Sectional ◽  
Multicenter Survey ◽  
Primary Care Patients ◽  
Primary Care Practices ◽  
Cross National Study

Background.Patients use self-care to relieve symptoms of common colds, yet little is known about the prevalence and patterns across Europe.Methods/Design.In a cross-sectional study 27 primary care practices from 14 countries distributed 120 questionnaires to consecutive patients (≥18 years, any reason for consultation). A 27-item questionnaire asked for patients’ self-care for their last common cold.Results.3,074 patients from 27 European sites participated. Their mean age was 46.7 years, and 62.5% were females. 99% of the participants used ≥1 self-care practice. In total, 527 different practices were reported; the age-standardized mean was 11.5 (±SD 6.0) per participant. The most frequent self-care categories were foodstuffs (95%), extras at home (81%), preparations for intestinal absorption (81%), and intranasal applications (53%). Patterns were similar across all sites, while the number of practices varied between and within countries. The most frequent single practices were water (43%), honey (42%), paracetamol (38%), oranges/orange juice (38%), and staying in bed (38%). Participants used 9 times more nonpharmaceutical items than pharmaceutical items. The majority (69%) combined self-care with and without proof of evidence, while ≤1% used only evidence-based items.Discussion.This first cross-national study on self-care for common colds showed a similar pattern across sites but quantitative differences.

scholarly journals Prevalence and practice for rare diseases in primary care: a national cross-sectional study in the USA

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e027248 ◽  
Author(s):  
Ara Jo ◽  
Samantha Larson ◽  
Peter Carek ◽  
Michael R Peabody ◽  
Lars E Peterson ◽  
...  
Keyword(s):  
Primary Care ◽  
Rare Diseases ◽  
Primary Care Physicians ◽  
Primary Outcome ◽  
Primary Care Practice ◽  
Cross Sectional Study ◽  
Care Practice ◽  
Sectional Study ◽  
Cross Sectional ◽  
The Usa

ObjectivesThere are more than 7000 rare diseases in the USA, and they are prevalent in 8% of the population. Due to life-threatening risk and limited therapies, early detection and treatment are critical. The purpose of this study was to explore characteristics of visits for patients with rare diseases seen by primary care physicians (PCPs).DesignThe study used a cross sectional study using a national representative dataset, the National Ambulatory Medical Care Survey for the years 2012–2014.SettingPrimary care setting.ParticipantsVisits to PCPs (n=22 306 representing 354 507 772 office visits to PCPs).Primary outcome measuresPrevalence of rare diseases in visits of PCPs was the primary outcome. Bivariate analyses and logistic regression analyses were used to compare patients with rare diseases and those without rare diseases and examined characteristics of PCP visits for rare diseases and practice pattern.ResultsAmong outpatient visits to PCPs, rare diseases account for 1.6% of the visits. The majority of patients with rare diseases were established patients (93.0%) and almost half (49.0%) were enrolled in public insurance programmes. The time spent in visits for rare diseases (22.4 min) and visits for more common diseases (21.3 min) was not significantly different (p=0.09). In an adjusted model controlling for patient characteristics (age, sex, types of insurance, reason for this visit, total number of chronic disease, having a rare disease and established or new patient), patients with rare diseases were 52% more likely to be referred to another provider (OR 1.52, 95% CI, 1.01 to 2.28).ConclusionsVisits for rare diseases are uncommon in primary care practice. Future research may help to explain whether this low level of management of rare diseases in primary care practice is consistent with a goal of a broad scope of care.

Portuguese Patient Dignity Question: A cross-sectional study of palliative patients cared for in primary care

2020 ◽  
Vol 18 (6) ◽  
pp. 658-661
Author(s):  
Mafalda Lemos Caldas ◽  
Miguel Julião ◽  
Ana João Santos ◽  
Harvey Max Chochinov
Keyword(s):  
Primary Care ◽  
Health Care Providers ◽  
Cross Sectional Study ◽  
Care Providers ◽  
Sectional Study ◽  
Clinical Tool ◽  
Cross Sectional ◽  
Old Patients ◽  
Promising Tool ◽  
Palliative Patients

AbstractIntroductionThe Patient Dignity Question (PDQ) is a clinical tool developed with the aim of reinforcing the sense of personhood and dignity, enabling health care providers (HCPs) to see patients as people and not solely based on their illness.ObjectiveTo study the acceptability and feasibility of the Portuguese version of the PDQ (PDQ-PT) in a sample of palliative care patients cared for in primary care (PC).MethodA cross-sectional study using 20 palliative patients cared for in a PC unit. A post-PDQ satisfaction questionnaire was developed.ResultsTwenty participants were included, 75% were male; average age was 70 years old. Patients found the summary accurate, precise, and complete; all said that they would recommend the PDQ to others and want a copy of the summary placed on their family physician's medical chart. They felt the summary heightened their sense of dignity, considered it important that HCPs have access to the summary and indicated that this information could affect the way HCPs see and care for them. The PDQ-PT's took 7 min on average to answer, and 10 min to complete the summary.Significance of resultsThe PDQ-PT is well accepted and feasible to use with palliative patients in the context of PC and seems to be a promising tool to be implemented. Future trials are now warranted.

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