scholarly journals Self-management perspectives of elderly patients with multimorbidity and practitioners - status, challenges and further support needed?

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Amanda Breckner ◽  
Catharina Roth ◽  
Katharina Glassen ◽  
Michel Wensing
Keyword(s):  
Primary Care ◽  
Elderly Patients ◽  
Primary Care Physicians ◽  
Qualitative Content Analysis ◽  
Social Contact ◽  
Self Management ◽  
Current Status ◽  
Community Initiatives ◽  
Emotional Management ◽  
Primary Care Practitioners

Abstract Background Patients with multimorbidity (here defined as three or more chronic conditions) require constant treatment and care. Furthermore, they have to manage their health and diseases in daily life. Offering support to patients’ medical self-management is an important task of primary care. The aim of this study was to explore, what further support is needed from the perspective of patients’ and primary care practitioners. Methods A qualitative study using individual semi-structed interviews with 17 patients with multimorbidity and 7 practitioners (4 primary care physicians and 3 practice assistants) was conducted in Germany. Data were audio-recorded, pseudonymised and transcribed verbatim. Data analysis was performed using qualitative content analysis to structure data into themes and subthemes. All data were managed and organised in MAXQDA. Results The three broad themes: current status, challenges and further support emerged. Patients reported on unfulfilled needs regarding role or emotional management, like coping with loneliness, loss of independence and, changing habits. The importance of social contact was highlighted by patients and practitioners. Patients articulated further support from their primary care practitioners on coping with the disease. Practitioners’ wished for further support in aspects of social participation, public transport, and community resources. Conclusion Challenges regarding self-management of elderly patients with multimorbidity may be addressed by harnessing social support and community initiatives.

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

BMJ Open ◽  
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.

scholarly journals EVALUATION OF DIABETES SELF-MANAGEMENT EDUCATION IN PATIENTS WITH CONCOMITANT CHRONIC KIDNEY DISEASE

2020 ◽  
Vol 73 (10) ◽  
pp. 2170-2174
Author(s):  
Oleksii M. Korzh
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Management Training ◽  
Cross Sectional Study ◽  
Self Management ◽  
Average Score ◽  
Cross Sectional ◽  
Self Monitoring ◽  
Diabetes Educators

The aim: Was to evaluate the quality of DSME provided by primary care physicians to people with diabetes mellitus. Materials and methods: A descriptive cross-sectional study was conducted among 120 primary care physicians. The quality of diabetes self-management training provided by physicians was assessed on a personal scale of 39 Likert questions obtained from the American Association of Diabetes Educators in seven areas of diabetes self-monitoring. The Cronbach’s reliability coefficient for each domain / subscale was ≥ 0.7. The data were analyzed using an independent selective t-test and one-way ANOVA. Results: More than half of the doctors provided “inadequate quality” of diabetes self-management in all areas. Doctors had the highest average score in the domain of “drug intake” (4.46 ± 0.61). Average scores in the “problem-solving domain” (3.52 ± 0.63) and “ being active domain” (3.46 ± 0.75) were low. The quality of DSME provided by physicians was not related to any of the characteristics of the physician. Conclusions: The quality of doctors’ communication on DSME in this study was suboptimal. Most adequately informed cases of diabetic behavior associated with self-management have been associated with reduced risk factors and an orientation towards disease. Thus, training of primary care physicians in diabetic self-management is recommended because of the key role that these doctors play in managing diabetes.

Abstract 3892: Brooklyn AWAReness of StrokE in Diabetes Mellitus

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Kessarin Panichpisal ◽  
Benedict Tan ◽  
Yogesh Moradiya ◽  
Hasan Memon ◽  
Volodymyr Vulkanov ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Primary Care ◽  
Risk Factor ◽  
High Risk ◽  
Primary Care Physicians ◽  
Current Status ◽  
Medical Complications ◽  
High Risk Population ◽  
Diabetic Patients ◽  
Stroke Risk Factor

OBJECTIVE: Diabetes mellitus (DM) is a common risk factor for stroke. Hence stroke awareness is very critical in diabetic patients. In order to design effective educational strategies for stroke intervention and prevention in this high risk group, we assessed the current status of knowledge about stroke symptoms, risk factors and activation of emergency medical services in individuals with DM. METHOD: A hospital-based survey was conducted between February and August 2011. Subjects who have DM were interviewed at 2 sites by trained Internal medicine, Neurology residents and medical students using a structured, closed-ended questionnaire. RESULTS: Two hundred and thirty subjects were interviewed, 64% female and 71% Caribbean-American and African-American. Seventy five percent of subjects had hypertension. Only sixty percent of subjects knew that they were high risk of stroke and only 46% had been informed by their primary care physician about this risk. More than 75% did not know their hemoglobin a1c and cholesterol levels. Stroke and diabetic ketoacidosis were the least recognized medical complications of DM (29%) while diabetic foot ulcer and diabetic nephropathy were the most recognized complications (54%). Hypertension was the most identified stroke risk factor (66%). Eighty-nine percent of respondents identified two or more stroke symptoms. Only 58% of respondents would call 911 for a stroke scenario. Subjects having DM > 10 years (p=0.02) and graduating from high school (p=0.002) were more likely to call 911, while people who had a history of kidney disease were less likely to call 911 (p=0.024). The two most common sources of information about stroke that DM patients received were from their primary care physicians (43%) and family and friends (35%). CONCLUSION: Stroke is one of the least recognized medical complications in DM patients. Primary care physicians play a very important role of stroke education in this high risk population.

scholarly journals An Overview of Diabetes Management in Schizophrenia Patients: Office Based Strategies for Primary Care Practitioners and Endocrinologists

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Aniyizhai Annamalai ◽  
Cenk Tek
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Behavioral Interventions ◽  
Diabetes Management ◽  
Psychotropic Medications ◽  
Antipsychotic Medications ◽  
Multiple Factors ◽  
Metabolic Conditions ◽  
Treatment Of Diabetes ◽  
Primary Care Practitioners

Diabetes is common and seen in one in five patients with schizophrenia. It is more prevalent than in the general population and contributes to the increased morbidity and shortened lifespan seen in this population. However, screening and treatment for diabetes and other metabolic conditions remain poor for these patients. Multiple factors including genetic risk, neurobiologic mechanisms, psychotropic medications, and environmental factors contribute to the increased prevalence of diabetes. Primary care physicians should be aware of adverse effects of psychotropic medications that can cause or exacerbate diabetes and its complications. Management of diabetes requires physicians to tailor treatment recommendations to address special needs of this population. In addition to behavioral interventions, medications such as metformin have shown promise in attenuating weight loss and preventing hyperglycemia in those patients being treated with antipsychotic medications. Targeted diabetes prevention and treatment is critical in patients with schizophrenia and evidence-based interventions should be considered early in the course of treatment. This paper reviews the prevalence, etiology, and treatment of diabetes in schizophrenia and outlines office based interventions for physicians treating this vulnerable population.

A Refresher on Herpes Zoster, Current Status on Vaccination, and the Role of the Dermatologist

2011 ◽  
Vol 15 (4) ◽  
pp. 185-191 ◽  
Author(s):  
Lyn C. Guenther ◽  
Charles W. Lynde
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Herpes Zoster ◽  
Preventive Medicine ◽  
Primary Care Physicians ◽  
Current Status ◽  
Age Group ◽  
Increased Risk

Background: Herpes zoster (HZ) and postherpetic neuralgia (PHN) have a significant impact on quality of life. PHN is often chronic and difficult to treat. Dermatologists have always been involved in making the diagnosis of these conditions and, most recently, teaching the need for early antiviral therapy. Objective: With the introduction of a new vaccine, HZ and its difficult-to-treat complication PHN can be prevented or minimized. Preventive medicine is important and has been supported by dermatologists with sun safety programs. Patients receiving biologics are at increased risk of developing zoster. Conclusion: Dermatologists should embrace zoster vaccination and recommend routine vaccination of immunocompetent individuals > age 60 years, as well as patients of any age who are starting immunosuppressants, including biologics. Given that individuals over age 50 years are at risk for PHN and studies have shown that the vaccine's immunogenicity and safety are maintained in individuals age 50 to 59 years, vaccination in this age group may be considered. Some dermatologists may consider vaccinating their own patients, but most will likely recommend that vaccination be performed by their patients' primary care physicians.

scholarly journals Exploring perception and usage of narrative medicine by physician specialty: a qualitative analysis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Daniel A. Fox ◽  
Joshua M. Hauser
Keyword(s):  
Primary Care ◽  
Time Management ◽  
Primary Care Physicians ◽  
Qualitative Content Analysis ◽  
Narrative Medicine ◽  
Primary Care Providers ◽  
Negative Consequences ◽  
Care Providers ◽  
Medical Specialties ◽  
General Internists

Abstract Background Narrative medicine is a well-recognized and respected approach to care. It is now found in medical school curricula and widely implemented in practice. However, there has been no analysis of the perception and usage of narrative medicine across different medical specialties and whether there may be unique recommendations for implementation based upon specialty. The aims of this study were to explore these gaps in research. Methods Fifteen senior physicians who specialize in internal medicine, pediatrics, or surgery (5 physicians from each specialty) were interviewed in a semi-structured format about the utilization, benefits, drawbacks (i.e., negative consequences), and roles pertaining to narrative medicine. Qualitative content analysis of each interview was then performed. Results Three themes emerged from our analysis: roles, practice, and outcomes. Through these themes we examined the importance, utilization, barriers, benefits, and drawbacks of narrative medicine. There was consensus that narrative medicine is an important tool in primary care. Primary care physicians (general internists and general pediatricians) also believed that narrative medicine is not as important for non-primary care providers. However, non-primary care providers (surgeons) generally believed narrative medicine is valuable in their practice as well. Within specialties, providers’ choice of language varied when trying to obtain patients’ narratives, but choice in when to practice narrative medicine did not differ greatly. Among specialties, there was more variability regarding when to practice narrative medicine and what barriers were present. Primary care physicians primarily described barriers to eliciting a patient’s narrative to involve trust and emotional readiness, while surgeons primarily described factors involving logistics and patient data as barriers to obtaining patients’ narratives. There was broad agreement among specialties regarding the benefits and drawbacks of narrative medicine. Conclusions This study sheds light on the shared and unique beliefs in different specialties about narrative medicine. It prompts important discussion around topics such as the stereotypes physicians may hold about their peers and concerns about time management. These data provide some possible ideas for crafting narrative medicine education specific to specialties as well as future directions of study.

scholarly journals Diabetes-Related Behavior Change Knowledge Transfer to Primary Care Practitioners and Patients: Implementation and Evaluation of a Digital Health Platform (Preprint)

2017 ◽  
Author(s):  
Samina Abidi ◽  
Michael Vallis ◽  
Helena Piccinini-Vallis ◽  
Syed Ali Imran ◽  
Syed Sibte Raza Abidi
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Clinical Practice ◽  
Behavior Change ◽  
Self Management ◽  
Change Strategies ◽  
Educational Support ◽  
Behavior Change Interventions ◽  
Patients With Diabetes ◽  
Primary Care Practitioners

BACKGROUND Behavioral science is now being integrated into diabetes self-management interventions. However, the challenge that presents itself is how to translate these knowledge resources during care so that primary care practitioners can use them to offer evidence-informed behavior change support and diabetes management recommendations to patients with diabetes. OBJECTIVE The aim of this study was to develop and evaluate a computerized decision support platform called “Diabetes Web-Centric Information and Support Environment” (DWISE) that assists primary care practitioners in applying standardized behavior change strategies and clinical practice guidelines–based recommendations to an individual patient and empower the patient with the skills and knowledge required to self-manage their diabetes through planned, personalized, and pervasive behavior change strategies. METHODS A health care knowledge management approach is used to implement DWISE so that it features the following functionalities: (1) assessment of primary care practitioners’ readiness to administer validated behavior change interventions to patients with diabetes; (2) educational support for primary care practitioners to help them offer behavior change interventions to patients; (3) access to evidence-based material, such as the Canadian Diabetes Association’s (CDA) clinical practice guidelines, to primary care practitioners; (4) development of personalized patient self-management programs to help patients with diabetes achieve healthy behaviors to meet CDA targets for managing type 2 diabetes; (5) educational support for patients to help them achieve behavior change; and (6) monitoring of the patients’ progress to assess their adherence to the behavior change program and motivating them to ensure compliance with their program. DWISE offers these functionalities through an interactive Web-based interface to primary care practitioners, whereas the patient’s self-management program and associated behavior interventions are delivered through a mobile patient diary via mobile phones and tablets. DWISE has been tested for its usability, functionality, usefulness, and acceptance through a series of qualitative studies. RESULTS For the primary care practitioner tool, most usability problems were associated with the navigation of the tool and the presentation, formatting, understandability, and suitability of the content. For the patient tool, most issues were related to the tool’s screen layout, design features, understandability of the content, clarity of the labels used, and navigation across the tool. Facilitators and barriers to DWISE use in a shared decision-making environment have also been identified. CONCLUSIONS This work has provided a unique electronic health solution to translate complex health care knowledge in terms of easy-to-use, evidence-informed, point-of-care decision aids for primary care practitioners. Patients’ feedback is now being used to make necessary modification to DWISE.

Telemedicine for Patient Consultation: Factors affecting Use by Rural Primary-Care Physicians in Kansas

1995 ◽  
Vol 1 (3) ◽  
pp. 139-144 ◽  
Author(s):  
P Whitten ◽  
E A Franken
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Health Care Facilities ◽  
Telemedicine Service ◽  
Factors Affecting ◽  
Rural Primary Care ◽  
Referral Practices ◽  
Patient Consultation ◽  
Primary Care Practitioners ◽  
User Friendly

The purpose of our study was to investigate knowledge of, attitudes to, and use of interactive telemedicine for specialist consultation among rural practitioners in Kansas. We interviewed 28 rural primary-care practitioners at seven remote health-care facilities in six locations. Content analyses of the interviews showed universal but superficial knowledge of telemedicine, appreciation of the value of the technology, but relatively low usage of the telemedicine service available (32% of subjects). Physicians did not appear to be afraid of change. Telemedicine usage was not related to the professional characteristics of the physicians. Our findings suggest that further growth in the use of telemedicine will depend on efforts directed towards physicians which are aimed at creating a more user-friendly environment and at accommodating the referral practices of potential users.

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