scholarly journals Retaining interest in caring for underserved patients among future medicine subspecialists: Underserved Medicine and Public Health (UMPH) program

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jillian S. Catalanotti ◽  
David K. Popiel ◽  
April Barbour
Keyword(s):  
Public Health ◽  
Internal Medicine ◽  
Primary Care ◽  
Primary Care Physicians ◽  
Underserved Populations ◽  
Lessons Learned ◽  
University Hospital ◽  
Subspecialty Training ◽  
Internal Medicine Residents ◽  
Underserved Patients

Abstract Background Accessing subspecialty care is hard for underserved patients in the U.S. Published curricula in underserved medicine for Internal Medicine residents target future-primary care physicians, with unknown impact on future medicine subspecialists. Methods The aim was to retain interest in caring for underserved patients among Internal Medicine residents who plan for subspecialist careers at an urban university hospital. The two-year Underserved Medicine and Public Health (UMPH) program features community-based clinics, evening seminars, reflection assignments and practicum projects for 3–7 Internal Medicine residents per year. All may apply regardless of anticipated career plans after residency. Seven years of graduates were surveyed. Data were analyzed using descriptive statistics. Results According to respondents, UMPH provided a meaningful forum to discuss important issues in underserved medicine, fostered interest in treating underserved populations and provided a sense of belonging to a community of providers committed to underserved medicine. After residency, 48% of UMPH graduates pursued subspecialty training and 34% practiced hospitalist medicine. 65% of respondents disagreed that “UMPH made me more likely to practice primary care” and 59% agreed “UMPH should target residents pursuing subpecialty careers.” Conclusions A curriculum in underserved medicine can retain interest in caring for underserved patients among future-medicine subspecialists. Lessons learned include [1] building relationships with local community health centers and community-practicing physicians was important for success and [2] thoughtful scheduling promoted high resident attendance at program events and avoided detracting from other activities required during residency for subspecialist career paths. We hope Internal Medicine residency programs consider training in underserved medicine for all trainees. Future work should investigate sustainability, whether training results in improved subspecialty access, and whether subspecialists face unique barriers caring for underserved patients. Future curricula should include advocacy skills to target systemic barriers.

Virtual Primary Care Implementation during COVID-19 in High-Income Countries: A Scoping Review (Preprint)

2021 ◽  
Author(s):  
Kristina De Vera ◽  
Priyanka Challa ◽  
Rebecca H Liu ◽  
Kaitlin Fuller ◽  
Anam Shahil Feroz ◽  
...  
Keyword(s):  
Primary Care ◽  
Scoping Review ◽  
Primary Care Physicians ◽  
Underserved Populations ◽  
High Income ◽  
Lessons Learned ◽  
Regulatory Policies ◽  
Care Services ◽  
Virtual Care ◽  
Primary Care Services

BACKGROUND Primary care physicians across the world are grappling with adopting virtual services to provide appropriate patient care during the COVID-19 pandemic. As the crisis continues, it is imperative to recognize the wide-scale barriers and seek strategies to mitigate the challenges of rapid adoption to virtual care felt by patients and physicians alike. OBJECTIVE The purpose of this scoping review was to map the challenges, strategies, and lessons learned from high-income countries that can be mobilized to inform decision-makers on how to best implement virtual primary care services during and after the COVID-19 pandemic. Moreover, the findings of our scoping review identified the barriers and strategies within the Quadruple Aim components, which may prove to be an effective implementation strategy for virtual care adoption in primary care settings. METHODS The two concepts of virtual care and COVID-19 were searched in MEDLINE, EMBASE, and CINAHL on Aug 10, 2020, and Scopus was searched on Aug 15, 2020. The database searches returned 10,549 citations and an additional 766 citations were retrieved from searching the citations from the reference lists of articles that met all inclusion criteria. After deduplication, 6,580 unique citations remained. Following title and abstract screening, 1,260 full-text articles were reviewed, of which 49 articles were included for data extraction, and 38 articles met the eligibility criteria for inclusion in the review. RESULTS Seven factors were identified as major barriers to the implementation of virtual primary care. Of the 38 articles included in this scoping review, 20 (53%) articles focused on challenges to equitable access to care, specifically regarding the lack of access to internet, smartphones, and Internet bandwidth for rural, seniors, and underserved populations. The second most common factor discussed in the articles was the lack of funding for virtual care (n= 14; 37%), such as inadequate reimbursement policies for virtual care. Other factors included negative patient and clinician perceptions of virtual care (n=11; 29%), lack of appropriate regulatory policies (n= 10, 26%), inappropriate clinical workflows (n= 9, 24%), lack of virtual care infrastructure (n= 8; 21%), and lastly, a need for appropriate virtual care training and education for clinicians (n=5;13%). CONCLUSIONS This review identified several barriers and strategies to mitigate those barriers that address the challenges of virtual primary care implementation related to equity, regulatory policies, technology and infrastructure, education, clinician and patient experience, clinical workflows, and funding for virtual care. These strategies included providing equitable alternatives to access care for patients with limited technical literacy and English proficiency and altering clinical workflows to integrate virtual care services. As many countries enter potential subsequent waves of the COVID-19 pandemic, applying early lessons learned to mitigate implementation barriers can help with the transition to equitable and appropriate virtual primary care services.

scholarly journals Career Choice and Primary Care in the United Arab Emirates

2015 ◽  
Vol 7 (4) ◽  
pp. 663-666 ◽  
Author(s):  
Nicoline Schiess ◽  
Halah Ibrahim ◽  
Sami Shaban ◽  
Maria Nichole Perez ◽  
Satish Chandrasekhar Nair
Keyword(s):  
Internal Medicine ◽  
Primary Care ◽  
Career Choice ◽  
United Arab Emirates ◽  
Primary Care Physicians ◽  
Career Choices ◽  
Calculated Data ◽  
Subspecialty Training ◽  
Limited Information ◽  
Cross Sectional Survey

ABSTRACT Background  The low number of medical trainees entering primary care is contributing to the lack of access to primary care services in many countries. Despite the need for primary care physicians in the Middle East, there is limited information regarding trainees' career choices, a critical determinant in the supply of primary care physicians. Objective  We analyzed the career choices of medical students in the United Arab Emirates (UAE), with a larger goal of reforming postgraduate training in the region and enhancing the focus on primary care. Methods  We conducted a cross-sectional survey of applicants to a large established internal medicine residency program in the UAE. We calculated data for demographics, subspecialty choice, and factors affecting subspecialty choice, and we also reported descriptive statistics. Results  Our response rate was 86% (183 of 212). Only 25% of applicants (n = 46) were interested in general internal medicine. The majority of respondents (n = 126, 69%) indicated a desire to pursue subspecialty training, and the remainder chose careers in research or administration. A majority of respondents (73%) were women, unmarried, and childless. Educational debt or lifestyle were not indicated as important factors in career choice. Conclusions  Low interest in primary care was similar to that in many Western countries, despite a much higher percentage of female applicants and a reduced emphasis on lifestyle or income factors in career decisions. Reasons for the reduced interest in primary care deserve further exploration, as do tests of interventions to increase interest, such as improving the primary care clerkship experience.

scholarly journals Comparing Hospital and Primary Care Physicians’ Attitudes and Knowledge Regarding Antibiotic Prescribing: A Survey within the Centre Region of Portugal

Antibiotics ◽  
2021 ◽  
Vol 10 (6) ◽  
pp. 629
Author(s):  
António Teixeira Rodrigues ◽  
João C. F. Nunes ◽  
Marta Estrela ◽  
Adolfo Figueiras ◽  
Fátima Roque ◽  
...  
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Health Problem ◽  
Primary Care Physicians ◽  
Negative Impact ◽  
Public Health Problem ◽  
Antibiotic Prescribing ◽  
Self Medication ◽  
Centre Region ◽  
Attitudes And Knowledge

Background: Antibiotic resistance is a worldwide public health problem, leading to longer hospital stays, raising medical costs and mortality levels. As physicians’ attitudes are key factors to antibiotic prescribing, this study sought to explore their differences between primary care and hospital settings. Methods: A survey was conducted between September 2011 and February 2012 in the center region of Portugal in the form of a questionnaire to compare hospital (n = 154) and primary care (n = 421) physicians’ attitudes and knowledge regarding antibiotic prescribing. Results: More than 70% of the attitudes were statistically different (p < 0.05) between hospital physicians (HPs) and primary care physicians (PCPs). When compared to PCPs, HPs showed higher agreement with antibiotic resistances being a public health problem and ascribed more importance to microbiological tests and to the influence of prescription on the development of resistances. On the other hand, PCPs tended to agree more regarding the negative impact of self-medication with antibiotics dispensed without medical prescription and the need for rapid diagnostic tests. Seven out of nine sources of knowledge’s usefulness were statistically different between both settings, with HPs considering most of the knowledge sources to be more useful than PCPs. Conclusions: Besides the efforts made to improve both antibiotic prescribing and use, there are differences in the opinions between physicians working in different settings that might impact the quality of antibiotic prescribing. In the future, these differences must be considered to develop more appropriate interventions.

scholarly journals Boan and Joint Disease Internal Medicine Specialist Provide Medical Care; New Evolutiion of the Treatment. Expectations of Primary Care Physicians

2008 ◽  
Vol 97 (10) ◽  
pp. 2484-2506
Author(s):  
Yoshiya Tanaka ◽  
Masataka Shiraki ◽  
Mitsumasa Kishimoto ◽  
Shingo Nakayamada ◽  
Tsutomu Takeuchi
Keyword(s):  
Internal Medicine ◽  
Primary Care ◽  
Medical Care ◽  
Primary Care Physicians ◽  
Joint Disease ◽  
Treatment Expectations

scholarly journals The 4-Level Approach: Prevention of Suicidal Behaviour Through Community-Based Intervention

2021 ◽  
Vol 12 ◽  
Author(s):  
Ulrich Hegerl ◽  
Ines Heinz ◽  
Ainslie O'Connor ◽  
Hannah Reich
Keyword(s):  
Public Health ◽  
Primary Care ◽  
High Risk ◽  
Suicidal Behaviour ◽  
Lessons Learned ◽  
Community Based Interventions ◽  
Community Based ◽  
Four Levels ◽  
The Many ◽  
Different Levels

Due to the many different factors contributing to diagnostic and therapeutic deficits concerning depression and the risk of suicidal behaviour, community-based interventions combining different measures are considered the most efficient way to address these important areas of public health. The network of the European Alliance Against Depression has implemented in more than 120 regions within and outside of Europe community-based 4-level-interventions that combine activities at four levels: (i) primary care, (ii) general public, (iii) community facilitators and gatekeepers (e.g., police, journalists, caregivers, pharmacists, and teachers), and (iv) patients, individuals at high risk and their relatives. This review will discuss lessons learned from these broad implementation activities. These include targeting depression and suicidal behaviour within one approach; being simultaneously active on the four different levels; promoting bottom-up initiatives; and avoiding any cooperation with the pharmaceutical industry for reasons of credibility.

A retrospective analysis and quality improvement education initiative to increase HPV vaccination rates in an inner city primary care clinic.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 213-213
Author(s):  
Jasmin Hundal ◽  
Matthew J Hadfield ◽  
Alifaiz Saiyed ◽  
William Rabitaille
Keyword(s):  
Internal Medicine ◽  
Primary Care ◽  
Hpv Vaccine ◽  
Current Practice ◽  
Insurance Coverage ◽  
Hpv Vaccination ◽  
Shared Decision ◽  
Resident Physicians ◽  
Internal Medicine Residents ◽  
Attending Physicians

213 Background: Human papillomavirus (HPV) is the most commonly spread sexually transmitted infection and is implicated in the oncogenesis of several cancers, including cervical, anal,vaginal and oropharyngeal cancers. HPV vaccinations have a high efficacy, and recent data demonstrated adults aged 18-26 years old are not adequately fully vaccinated. Our objective was to assess the current practice regarding HPV vaccination among persons 9-45 years of age, knowledge about the HPV guidelines, and recommendation practice. Methods: A retrospective review was conducted of Internal Medicine residents acting as primary care physicians at an urban clinic based in Hartford, Connecticut, USA. The survey was administered to internal medicine residents and attending physicians to assess the current practice regarding the HPV vaccination for adults and knowledge of the updated guidelines. The key drivers identified were resident knowledge, communication, insurance coverage, and availability of HPV vaccination in the clinic. An educational handout and lecture was provided with a follow-up survey. Results: A total of 347 charts were reviewed. Of those eligible to receive the HPV vaccine, it was found that only 5.2% received the total dosage. The response rate to our initial survey was 60%. 47.83% did not inquire about the HPV vaccination or recommended it to patients compared to 71.43% of attending physicians (AP) who inquired, but only 28.47% discussed it during precepting sessions. 27.7% of the residents and 71.43% AP correctly identified the updated guidelines. The biggest three barriers were unfamiliarity with the availability of HPV vaccination, insurance coverage, and current guidelines. A short educational review and summary were provided to close the gaps identified with the questionnaire.100% of residents correctly identified the updated guidelines, risks, benefits, importance of shared decision-making, and more likely recommend the HPV vaccination. However, 69.2% were unaware that HPV vaccination does not prevent the progression of HPV-related cancers. Conclusions: Adherence to CDC guidelines regarding vaccinating against HPV amongst resident physicians is poor. The percentage of patients, who received the complete Gardasil-9 vaccination series, was significantly below the national average. Our study highlights a large practice gap that exists amongst resident physicians regarding the HPV vaccine. There was minimal documentation amongst resident physicians regarding shared decision-making conversations with patients. We addressed the knowledge and resource deficit with an educational handout and information session. Our intervention demonstrated improved confidence in discussing the vaccine with the patients and resolved the concern of insurance coverage and availability of vaccines in the clinic and pharmacy.

scholarly journals Inter-hospital comparison of working time allocation among internal medicine residents using time-motion observations: an innovative benchmarking tool

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e033021
Author(s):  
Simon Martin Frey ◽  
Marie Méan ◽  
Antoine Garnier ◽  
Julien Castioni ◽  
Nathalie Wenger ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Time Allocation ◽  
Postgraduate Training ◽  
Working Time ◽  
University Hospital ◽  
Direct Patient Care ◽  
Time Motion ◽  
Internal Medicine Residents ◽  
Working Day ◽  
Hospital Comparison

ObjectivesThe vast majority of residents’ working time is spent away from patients. In hospital practice, many factors may influence the resident’s working day structure.Using an innovative method, we aimed to compare working time allocation among internal medicine residents using time-motion observations. The first study goal was to describe how the method could be used for inter-hospital comparison. The secondary goal was to learn about specific differences in the resident’s working day structure in university and non-university hospital settings.DesignTwo separate time-motion studies. Trained peer-observers followed the residents during weekday day shifts with a tablet, able to record 22 different activities and corresponding context (with patient, phone, colleague or computer).SettingInternal medicine residencies at a university (May–July 2015) and a non-university (September–October 2016) community hospital.Participants28 residents (mean age: 29 years, average postgraduate training: 30 months) at university hospital, 21 residents (mean age: 30 years, average postgraduate training: 17 months) at non-university hospital.OutcomesTime spent with patients and time dedicated to activities directly related to patients; description of main differences of time allocation between hospitals.ResultsCumulatively 1051 hours of observation (566 (university hospital)+486 (non-university hospital)) and 92 day shifts (49+43) were evaluated. Daily working time was 11.5 versus 11.3 hours. A median daily period of 195 min (IQR 179–211, 27.9%) and 116 min (IQR 98–134, 17.2%) (p<0.001) was dedicated to direct patient care, respectively.ConclusionsWe successfully identified differences potentially related to each hospital structure and organisation. Inter-hospital comparisons could help set up interventions aiming to improve workday structure and experience of residents.

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