Detection and follow-up of chronic health conditions in Rio de Janeiro – the impact of residency training in family medicine

Abstract Background There is a need for evidence that residency training in family medicine can benefit the care of patients in primary care in low- and middle-income countries. We tested the hypothesis that two years of residency training in family medicine enables doctors to better detect chronic health conditions while requesting fewer laboratory tests and providing more follow-up visits. Methods We performed a retrospective longitudinal observational analysis of medical consultations from 2013 to 2018 in primary care in Rio de Janeiro, comparing doctors without residency training in family medicine (Generalists) versus family physicians (FPs). Multivariate multilevel binomial regression models estimated the risks of patients being diagnosed for a list of 31 chronic health conditions, having a follow-up visit for these conditions, and having laboratory tests ordered from a list of 30 exams. Results 569.289 patients had 2.908.864 medical consultations performed by 734 generalists and 231 FPs. Patients seen by FPs were at a higher risk of being detected for most of the chronic health conditions, at a lower risk of having any of the 30 laboratory tests requested, and at a higher risk of having a follow-up visit in primary care. Conclusions Residency training in family medicine can make physicians more skilled to work in primary care. Policymakers must prioritize investments in capacity building of healthcare workforce to make primary care truly comprehensive.

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Detection and follow-up of chronic health conditions in Rio de Janeiro – the impact of residency training in family medicine

10.21203/rs.3.rs-143052/v1 ◽

2021 ◽

Author(s):

Adelson Jantsch ◽

Bo Burström ◽

Gunnar Nilsson ◽

Antônio de Leon

Keyword(s):

Primary Care ◽

Family Medicine ◽

Residency Training ◽

Rio De Janeiro ◽

Chronic Health Conditions ◽

Health Conditions ◽

Chronic Health ◽

Medical Consultations ◽

The Impact

Abstract There is a need for evidence that residency training in family medicine (RTFM) can benefit the care of patients in primary care in low- and middle-income countries. We tested the hypothesis that two years of RTFM enables doctors to better detect chronic health conditions (CHC) while requesting fewer laboratory exams and providing more follow-up visits. We performed a retrospective longitudinal observational analysis of medical consultations from 2013 to 2018 in primary care in Rio de Janeiro, comparing doctors without RTFM (Generalists) versus family physicians (FPs). Multivariate multilevel binomial regression models estimated the risks of patients being diagnosed for a list of 31 CHCs, having a follow-up visit for these CHCs, and having laboratory tests ordered from a list of 30 exams. 569.289 patients had 2.908.864 medical consultations performed by 734 generalists and 231 FPs. Patients seen by FPs were at a higher risk of being detected for most of the CHCs, at a lower risk of having any of the 30 LTs requested, and at higher risk of having a follow-up visit in primary care. RTFM can make physicians more skilled to work in primary care. Policymakers must prioritize investments in RTFM to make primary care truly comprehensive.

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Residency training in family medicine and its impact on coordination and continuity of care: an analysis of referrals to secondary care in Rio de Janeiro

10.21203/rs.3.rs-350593/v1 ◽

2021 ◽

Author(s):

Adelson Guaraci Jantsch ◽

Bo Burström ◽

Gunnar Nilsson ◽

Antônio Ponce de Leon

Keyword(s):

Primary Care ◽

Family Medicine ◽

Residency Training ◽

Continuity Of Care ◽

Secondary Care ◽

Rio De Janeiro ◽

Family Physicians ◽

Health Conditions ◽

Medical Consultations

Abstract Objective: To measure the effect that Residency Training in Family Medicine (RTFM) has on continuity and coordination of care. Design: Observational cohort study using electronic health records.Setting: Rio de Janeiro, Brazil, public primary care system.Participants: 504940 patients, 633 generalists (physicians without RTFM) and 204 Family physicians (FP – doctors with two years of RTFM) from one health district between January 2015 and December 2018.Intervention: Two years of Residency Training in Family Medicine (RTFM)Main outcome measures: risk of patients being referred to secondary care for outpatient consultations and diagnostics tests; and having a follow-up medical consultation in primary care within three and six months after being referred.Results: We examined 2414508 medical consultations and 284754 referrals to secondary care. Family physicians (FPs) were less likely to request ambulatory care services (including surgical specialties), but were more likely to request Ophthalmology, Physiotherapy, Rehabilitation, and Surgical evaluations for their patients. Patients referred to secondary care by FPs were at a higher risk of having a follow-up visit in primary care for almost every service requested. If all medical consultations were performed by FPs, a 37.6% (95% CI 32.4% - 42.4%) increased demand for Rehabilitation services would be noticed. Oppositely, 1532 (95%CI 1458; 1602) fewer requests for Dermatology would happen every year. Conclusions: RTFM improves coordination and continuity of care by making FPs more competent to retain those health conditions that can be properly managed in primary care and making FPs more competent to detect health conditions that require specific biomedical technologies and skills, increasing the demand for those services. Besides, it increases the chances of patients having follow-up visits in primary care. Policymakers in low- and middle-income countries must consider investing in RTFM to make primary care systems more comprehensive, with better coordination and continuity of care.

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A Worksite Self-management Program for Workers with Chronic Health Conditions Improves Worker Engagement and Retention, but not Workplace Function

Journal of Occupational Rehabilitation ◽

10.1007/s10926-021-09983-6 ◽

2021 ◽

Author(s):

William S. Shaw ◽

Robert K. McLellan ◽

Elyssa Besen ◽

Sara Namazi ◽

Michael K. Nicholas ◽

...

Keyword(s):

Job Satisfaction ◽

Work Engagement ◽

Self Efficacy ◽

Management Program ◽

Chronic Health Conditions ◽

Health Conditions ◽

Self Management ◽

Chronic Health ◽

Work Limitation

AbstractPurpose An increasing number of workers in the US have chronic health conditions that limit their ability to work, and few worksite interventions have been tested to improve worker coping and problem solving at work. The purpose of this study was to evaluate a worksite-based health self-management program designed to improve workplace function among workers with chronic health conditions. Methods We conducted a randomized, controlled trial of a worksite self-management program (“Manage at Work”) (clinicaltrials.gov #NCT01978392) for workers with chronic health conditions (N = 119; 82% female, ages 20–69). Most workers were recruited from the health care or light manufacturing industry sectors. Workers attended a 5-session, facilitated psychoeducational program using concepts of health self-management, self-efficacy, ergonomics, and communication. Changes on outcomes of work engagement, work limitation, job satisfaction, work fatigue, work self-efficacy, days absent, and turnover intention at 6-month follow-up were compared to wait-list controls. Results The most prevalent chronic health conditions were musculoskeletal pain, headaches, vision problems, gastrointestinal disorders, respiratory disorders, and mental health disorders. The self-management program showed greater improvement in work engagement and turnover intent at 6-month follow-up, but there was no evidence of a parallel reduction in perceived work limitation. Trends for improved outcomes of work self-efficacy, job satisfaction, and work fatigue in the intervention group did not reach statistical significance in a group x time interaction test. Conclusions Offering a worksite self-management program to workers with chronic health conditions may be a feasible and beneficial strategy to engage and retain skilled workers who are risking disability.Clinical trial registration: Clinicaltrials.gov #NCT01978392.

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An integrated motivational interviewing and cognitive-behavioural intervention promoting physical activity maintenance for adults with chronic health conditions: A feasibility study

Chronic Illness ◽

10.1177/1742395318769370 ◽

2018 ◽

Vol 15 (4) ◽

pp. 276-292

Author(s):

Sarah E Scott ◽

Jeff D Breckon ◽

Robert J Copeland

Keyword(s):

Physical Activity ◽

Motivational Interviewing ◽

Chronic Health Conditions ◽

Health Conditions ◽

Behavioural Intervention ◽

Chronic Health ◽

Cognitive Behavioural ◽

Cognitive Behavioural Intervention ◽

Physical Activity Maintenance

Objectives Physical activity is recommended for managing chronic health conditions but is rarely maintained. This feasibility study aimed to evaluate the preliminary efficacy of a motivational interviewing and cognitive-behavioural intervention for long-term physical activity for adults with chronic health conditions. Methods Participants ( N = 37) with stable conditions (e.g. diabetes) were randomized into a three-month motivational interviewing and cognitive-behavioural group ( N = 20) or usual care ( N = 17) after completing a physical activity referral scheme. Participants completed physical activity (e.g. average steps per day and kilocalorie expenditure), psychological (e.g. self-efficacy) and epidemiological (e.g. body mass index) standardized measures at baseline, three- and six-month follow-up. Treatment fidelity and feasibility were assessed. Results Thirty-five participants completed the study (96% retention). The motivational interviewing and cognitive-behavioural group maintained kilocalorie expenditure at three ( p = 0.009) and six months ( p = 0.009). Exercise barrier self-efficacy ( p = 0.03), physical ( p = 0.02) and psychological ( p = 0.01) physical activity experiences were increased at three months only. No difference was found for average steps/day, social support, coping skills and epidemiological factors. Discussion This is the first study to demonstrate the feasibility and preliminary efficacy of motivational interviewing and cognitive-behavioural interventions for promoting physical activity maintenance in a clinical population. A large-scale trial with a longer follow-up (≥6 months) is warranted with treatment fidelity assessment.

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63. A Pain in the Neck: The Association Between Chronic Health Conditions and Frequent Consultation in Primary Care

Rheumatology ◽

10.1093/rheumatology/keu099.003 ◽

2014 ◽

Vol 53 (suppl_1) ◽

pp. i79-i79

Author(s):

Jonathan Broad ◽

Ross Wilkie ◽

Jo Protheroe

Keyword(s):

Primary Care ◽

Chronic Health Conditions ◽

Health Conditions ◽

Chronic Health

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Psychology and primary care: New collaborations for providing effective care for adults with chronic health conditions.

American Psychologist ◽

10.1037/a0036101 ◽

2014 ◽

Vol 69 (4) ◽

pp. 355-363 ◽

Cited By ~ 25

Author(s):

Lawrence Fisher ◽

W. Perry Dickinson

Keyword(s):

Primary Care ◽

Chronic Health Conditions ◽

Health Conditions ◽

Chronic Health ◽

Effective Care

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Filling the GAPS: Description and Evaluation of a Primary Care Intervention for Children With Chronic Health Conditions

Ambulatory Pediatrics ◽

10.1367/a03-082r.1 ◽

2004 ◽

Vol 4 (3) ◽

pp. 249-256 ◽

Cited By ~ 5

Author(s):

Jannette M. McMenamy ◽

Ellen C. Perrin

Keyword(s):

Primary Care ◽

Chronic Health Conditions ◽

Health Conditions ◽

Chronic Health ◽

Care Intervention

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Hospitalization rates among survivors of childhood and adolescent cancer: A report from the Childhood Cancer Survivor Study (CCSS)

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.9556 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 9556-9556

Author(s):

B. A. Kurt ◽

V. G. Nolan ◽

K. K. Ness ◽

J. P. Neglia ◽

J. M. Tersak ◽

...

Keyword(s):

Childhood Cancer ◽

Cancer Diagnosis ◽

Chronic Health Conditions ◽

Health Conditions ◽

Severe Toxicity ◽

Chronic Health ◽

Adolescent Cancer ◽

Hospitalization Rates ◽

Survivors Of Childhood Cancer

9556 Background: Survivors of childhood cancer have a high burden of chronic health conditions following cancer therapy, but the risk for subsequent hospitalization has not been reported. Methods: Hospitalizations during 1996–2000 among a cohort of 10,367 5-yr survivors of childhood cancer (diagnosed 1970–1986) and 2,540 siblings were ascertained. Age-and gender-stratified standardized incidence ratios (SIRs) for hospitalization were calculated using the sibling cohort and U.S. population from the National Hospital Discharge Survey (NHDS). Associations between demographic, cancer/treatment-related risk factors and non-obstetrical hospitalization among survivors were evaluated in multiple variable logistic regression models. Results: At follow-up, survivors were a mean of 20.9 yrs. from diagnosis (SD: 4.6, range: 13.3–32.2) and mean age of 28.6 yrs. (SD: 7.7, range: 13–51). Overall hospitalization rates among survivors were 1.5 times (95% CI 1.44–1.52) that of siblings and 1.2 times (95% CI 1.16–1.22) that of the U.S. general population. Increased risk of hospitalization was noted irrespective of gender, age at follow-up, or cancer diagnosis, with highest SIRs noted for male (SIR=12.7, 95% CI 9.5–15.8) and female (SIR=72.1, 95% CI 58.8–85.5) survivors aged 45–54. Females (OR=1.2, 95% CI 1.04–1.3) and survivors with a chronic health condition (OR=1.6, 95% CI 1.5–1.8) were more likely to have been hospitalized for non-obstetrical causes after adjusting for age at diagnosis, age at follow-up, cancer diagnosis, household income, insurance, and history of relapse/second malignancy. Among survivors, those with Hodgkin's lymphoma had the highest hospitalization rates for neoplastic, infectious, endocrine, pulmonary and cardiovascular causes. CNS malignancy survivors had the highest hospitalization rates for neurologic, psychological and external (e.g. traumatic) causes. Conclusions: Therapy for childhood and adolescent cancer is associated with a significant increase in subsequent hospitalization rates. Regular medical follow-up and early intervention for chronic health conditions may help to limit severe toxicity that would require hospitalization. No significant financial relationships to disclose.

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Time Effects of Supportive Interaction and Facilitator Input Variety on Treatment Adherence of Young People with Chronic Health Conditions: A Dynamic Mechanism in Mutual Aid Groups

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18063061 ◽

2021 ◽

Vol 18 (6) ◽

pp. 3061

Author(s):

Steven Sek-yum Ngai ◽

Chau-kiu Cheung ◽

Yuen-hang Ng ◽

Liang Shang ◽

Hon-yin Tang ◽

...

Keyword(s):

Young People ◽

Treatment Adherence ◽

Dynamic Mechanism ◽

Chronic Health Conditions ◽

Health Conditions ◽

Equation Modeling ◽

Mutual Aid ◽

Time Effects ◽

Chronic Health

This study aims to examine the mechanism of how supportive interaction and facilitator input variety in mutual aid groups impact treatment adherence of young people with chronic health conditions, with consideration of time effects, which have been rarely studied in the existing literature. A stratified random sample of 391 individuals aged 12–45 years with chronic health conditions were recruited from mutual aid groups in Hong Kong and completed both the baseline and 12-month follow-up surveys. The results of the structural equation modeling indicated that supportive interaction and facilitator input variety positively predicted treatment adherence in a delayed condition, whereas members’ treatment adherence in the baseline survey had reversed effects on members’ supportive interaction in the follow-up survey. The findings of this study shed light on the dynamic mechanism of the mutual aid groups and provide important implications to promote better rehabilitation outcomes of young people with chronic health conditions.

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