scholarly journals Defining culturally safe primary care for people who use substances: a participatory concept mapping study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Karen Urbanoski ◽  
Bernadette Pauly ◽  
Dakota Inglis ◽  
Fred Cameron ◽  
Troy Haddad ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Concept Mapping ◽  
Help Seeking ◽  
Hierarchical Cluster ◽  
Cultural Safety ◽  
Positive Interactions ◽  
Research Approach ◽  
Starting Point ◽  
Wide Range

Abstract Background People who use substances experience high levels of substance-related stigma, both within and outside of health care settings, which can prevent people from help-seeking and contribute further to health inequities. Recognizing and respecting how political, social, economic, and historical conditions influence health and health care, cultural safety, with origins in addressing Indigenous racism, is a potential strategy for mitigating stigma and marginalization in health care. Using a participatory research approach, we applied the concept of cultural safety to develop a model of safe primary care from the perspective of people who use substances. Methods People who use or used substances were involved in all phases of the research and led data collection. Study participants (n = 75) were 42.5 years old on average; half identified as female and one quarter as Indigenous. All were currently using or had previous experience with substances (alcohol and/or other drugs) and were recruited through two local peer-run support agencies. Concept mapping with hierarchical cluster analysis was used to develop the model of safe primary care, with data collected over three rounds of focus groups. Results Participants identified 73 unique statements to complete the focus prompt: “I would feel safe going to the doctor if …” The final model consisted of 8 clusters that cover a wide range of topics, from being treated with respect and not being red-flagged for substance use, to preserving confidentiality, advocacy for good care and systems change, and appropriate accommodations for anxiety and the effects of poverty and criminalization. Conclusions Developing a definition of safe care (from the patient perspective) is the necessary first step in creating space for positive interactions and, in turn, improve care processes. This model provides numerous concrete suggestions for providers, as well as serving as starting point for the development of interventions designed to foster system change.

scholarly journals Use of health care services in seasonal affective disorder

2002 ◽  
Vol 180 (5) ◽  
pp. 449-454 ◽  
Author(s):  
John M. Eagles ◽  
Fiona L. Howie ◽  
Isobel M. Cameron ◽  
Samantha M. Wileman ◽  
Jane E. Andrew ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Affective Disorder ◽  
Help Seeking ◽  
Health Care Services ◽  
Seasonal Affective Disorder ◽  
Care Services ◽  
Help Seeking Behaviour ◽  
And Gender ◽  
Use Of Health Care

BackgroundLittle is known about the presentation and management of seasonal affective disorder (SAD) in primary care.AimsTo determine the use of health care services by people suffering from SAD.MethodFollowing a screening of patients consulting in primary care, 123 were identified as suffering from SAD. Each was age— and gender-matched with two primary care consulters with minimal seasonal morbidity yielding 246 non-seasonal controls. From primary care records, health care usage over a 5-year period was established.ResultsPatients with SAD consulted in primary care significantly more often than controls and presented with a wider variety of symptoms. They received more prescriptions, under went more investigations and had more referrals to secondary care.ConclusionsPatients with SAD are heavy users of health care services. This may reflect the condition itself, its comorbidity or factors related to the personality or help-seeking behaviour of sufferers.

Serial concept mapping: A tool to assess the evolution of medical student learning about cancer survivorship.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 21-21
Author(s):  
Miklos C. Fogarasi ◽  
Roy P Eichengreen
Keyword(s):  
Primary Care ◽  
Critical Thinking ◽  
Concept Mapping ◽  
Primary Care Physician ◽  
Cancer Survivorship ◽  
Health Care Professionals ◽  
Care Physician ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Wide Range

21 Background: Concept mapping (CM) fosters meaningful learning yet its use in cancer education is rare. Serial CM as a learning tool may offer novel ways to promote critical thinking about complex medical issues. We introduced CM in our Cancer Survivorship (CS) elective to study the evolution of students’ conceptual learning, to offer feed-back and as a tool for inter-professional and team-based education. Methods: The study was funded by an institutional grant and received IRB exemption. Eleven 2nd year medical students and 2 pre-med students enrolled. Oncologist-lead classes were co-facilitated by a primary care physician, a survivor, caregivers or other health care professionals. Students were trained using cMAPTools on week 1 and applied domains of the Quality of Life (QoL)-CS tool by City of Hope to their CMs. Feedback given after each round of mapping assessed adequate use of CS concepts and creation of meaningful linkages. Results: Map #1 (week 1) tested baseline perceptions. These maps displayed a wide-range of complexity, a largely non-hierarchical structure with rare connections and a sense of overload by the scope of CS issues. Map #2 (week 4) explored physical and spiritual challenges of CS from a primary care physician and a cancer survivor. Here improved maps presented concepts more clearly but linear thinking with limited crosslinks was still observed. Map #3 (week 8) about social aspects of CS followed lively sessions with a social worker and family caregivers. Emerging cross-links reflected a deeper understanding of survivor issues. Final CMs will be based on interviewing a panel of survivors and should aid students in creating a thorough Survivorship Care Plan. Team-based and inter-professional maps were well received. Conclusions: Serial concept mapping exposes progressive understanding of Survivorship issues during a one-semester elective. CM facilitates the learning of relationships among complex survivorship topics. Inter-professional and team-based CM is feasible. By mapping issues to QoL domains, students practice patient-centered critical thinking. Challenges include low reproducibility due to changing concepts, and limited practicality once concepts grow too large.

scholarly journals Help-Seeking Experiences of Health Care Learners in a WebCT Online Graduate Study Program

2005 ◽  
Vol 31 (2) ◽  
Author(s):  
Sherri Melrose ◽  
Bonnie Shapiro ◽  
Carrie LaVallie
Keyword(s):  
Health Care ◽  
Help Seeking ◽  
Theoretical Perspective ◽  
Primary Source ◽  
Study Data ◽  
Research Approach ◽  
Study Program ◽  
Educational Support ◽  
Action Research Approach ◽  
Message Involvement

This article presents findings from a qualitative research project that explored health care students’ activities related to seeking help within a masters program offered exclusively through a WebCT online environment. A constructivist theoretical perspective and an action research approach framed the study. Data sources included one question on a program satisfaction questionnaire, focus groups and ten individual audio tape-recorded transcribed interviews. Content was analyzed for themes and confirmed through ongoing member checking with participants. The following four overarching themes were identified and are used to explain and describe significant features of help-seeking experiences of online health care learners: (1) Self-help included reflection and re-reading directions available within the course; (2) A primary source of help was other students in the class; (3) Involving family, friends and co-workers provided important educational support; and (4) Instructors’ first message, involvement in weekly discussions and anecdotal comments were highly valued.

A Primary Care Perspective on Prevailing Assumptions about Persistent Medically Unexplained Physical Symptoms

2002 ◽  
Vol 32 (2) ◽  
pp. 125-140 ◽  
Author(s):  
Ian M. Stanley ◽  
Sarah Peters ◽  
Peter Salmon
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Mental State ◽  
Physical Symptoms ◽  
Health Care Use ◽  
Medically Unexplained Physical Symptoms ◽  
Wide Range ◽  
Medically Unexplained ◽  
Primary Care Patients ◽  
Unexplained Physical Symptoms

Objective: To re-examine the widespread assumption that medically unexplained physical symptoms represent discrete syndromes resulting from somatization of mental illness. Method: Primary care patients ( N = 223) with medically unexplained symptoms of at least one year's duration were recruited to a study of exercise therapy. Data gathered from patients, from their general practitioners, and from medical records were used to examine relationships between self-defined disability, symptoms, mental state, and use of health care. Results: Levels of disability and health care use were both raised, but were only weakly correlated. While most patients were depressed and/or anxious, a minority (14 percent) were neither. Although mental state correlated with disability, health care use was unrelated to either. Among a wide range of recorded symptoms, few correlations were found to support the existence of discrete syndromes. Analysis of agreement between patients and their doctors in assigning symptoms to broadly defined “syndromes” appears to reflect collaboration that is largely expedient. Conclusions: In this sample of primary care patients with persistent unexplained physical symptoms, we found little evidence of discrete somatic syndromes. The level of health care use is no indication of mental state or level of disability, and the findings are equally consistent with depression or anxiety being secondary to disability and its consequences as with them being primary. The observed collaboration between patients and their doctors carries the risk of shaping, reinforcing, and legitimizing dubious syndromes.

scholarly journals EVALUATION OF NONCARDIAC CHEST PAIN

2017 ◽  
Vol 9 (3) ◽  
pp. 12-23
Author(s):  
V I Dorofeev ◽  
D N Monashenko ◽  
D A Svirido ◽  
A A Savelev
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Chest Pain ◽  
Primary Care Physicians ◽  
Diagnostic Tools ◽  
Noncardiac Chest Pain ◽  
Wide Range ◽  
Diagnostic Approaches ◽  
Care Costs ◽  
Upper Gastrointestinal

In the presented review of the current literature a lot of information about differente diagnostic approaches for patients management with a syndrome of noncardiac chest pain were system- atized and generalized.These patients have a diverse set of disease that requires the physician applying a wide range of ad- ditional surveys. In General, doctors need to exclude heart disease in patients who were treated with chest pain. If chest pain is noncardiac, then empirical treatment for gastro-intestinal reasons and the cor- responding assessment of psychogenic causes of chest pain are important for the symptomatology of pa- tients. In particular, primary care physicians should consider - besides the cardiac causes as a possible causes of thoracalgia - possible mental disorders, impaired motility of the upper gastrointestinal tract, problems with the thoracic spine - as a possible causes of thoracalgia. It would be beter to find out the rea- sons of thoracalgia with all available diagnostic tools and then - choose and assign appropriate adequate etiotropic therapy for most effectively cupping the patient's symptoms and reducing health care costs.

scholarly journals Results from Telehealth

2021 ◽  
Author(s):  
Malcolm Clarke
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Residential Care ◽  
Home Health Care ◽  
Clinical Setting ◽  
Patient Monitoring ◽  
Clinical Information ◽  
Remote Patient Monitoring ◽  
Wide Range ◽  
Remote Patient

Telemedicine and telehealth have a wide range of definitions and understanding. Telehealth has been described as taking many forms and having many terms to describe its activities such as; home health care, telecare, tele-dermatology, tele-psychiatry, tele-radiology, telemonitoring, and remote patient monitoring. In general, the purpose of telehealth is to acquire information on a patient in one location, make that information available in a separate location, usually for the convenience of the clinician, and then use that information to provide management to a patient, who may be in a further location, through the mediation of a remote clinician, or directly to the patient. Typically this has taken the form of the patient being in their own home or at a clinical establishment remote from the hospital such as the district hospital, remote clinic, and primary care, with clinical information being collected and transferred using technology between locations. This chapter focuses on results from telehealth in the form of remote patient monitoring (RPM), in which data is collected from the patient whilst they are in their own home, or other non-clinical setting such as residential care.

Bringing together child health professionals and dental experts to tackle oral health in children

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711017
Author(s):  
Vinoshini Vasikaran ◽  
Arpana Soni ◽  
Mando Watson
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Oral Health ◽  
Child Health ◽  
Healthcare Professionals ◽  
Health Concern ◽  
Wide Range ◽  
Health Advice ◽  
The Impact ◽  
Primary Care Professionals

BackgroundIn the UK, poor oral health among children continues to be a major public health concern. Primary care professionals are encouraged to take a proactive approach in engaging parents and carers to develop better oral health practices for their children. Unfortunately, research has shown that patients are often exposed to inconsistent and at worst conflicting advice.AimTo increase the confidence of primary care professionals in their knowledge surrounding preventative oral health and ensure the delivery of consistent and proactive oral health advice.MethodA local dentist and dental health educator were invited to a general practice multidisciplinary meeting to deliver an educational session on oral health advice for children. Qualitative and quantitative data in form of a questionnaire was collected to analyse the impact of the education session.ResultsThe meeting was attended by 15 healthcare professionals including GPs, paediatricians, a community mental health representative, and a school nurse. There were 78% of attendees who reported that they had never received any formal teaching on oral health care prior to this session. Qualitative data highlighted specific gaps in knowledge, while confidence ratings suggest significant improvement in confidence of attendees in their knowledge of oral health in children.ConclusionAchieving good oral health for all children requires the support of a wide range of healthcare professionals. Further education sessions such as this encourages joint learning and relationship building between professionals and influences behaviour to improve child health care as part of making every contact count. The emerging Primary Care Networks provide an excellent setting to deliver this education.

Survival analysis using primary care electronic health record data: A systematic review of the literature

2017 ◽  
Vol 47 (1) ◽  
pp. 6-16 ◽  
Author(s):  
Adam Jose Hodgkins ◽  
Andrew Bonney ◽  
Judy Mullan ◽  
Darren John Mayne ◽  
Stephen Barnett
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Survival Analysis ◽  
Median Number ◽  
Care Practice ◽  
Research Approach ◽  
Electronic Health Record Data ◽  
Wide Range ◽  
Electronic Health ◽  
The Many

Purpose: An emerging body of research involves observational studies in which survival analysis is applied to data obtained from primary care electronic health records (EHRs). This systematic review of these studies examined the utility of using this approach. Method: An electronic literature search of the Scopus, PubMed, Web of Science, CINAHL, and Cochrane databases was conducted. Search terms and exclusion criteria were chosen to select studies where survival analysis was applied to the data extracted wholly from EHRs used in primary care medical practice. Results: A total of 46 studies that met the inclusion criteria for the systematic review were examined. All were published within the past decade (2005–2014) with a majority ( n = 26, 57%) being published between 2012 and 2014. Even though citation rates varied from nil to 628, over half ( n = 27, 59%) of the studies were cited 10 times or more. The median number of subjects was 18,042 with five studies including over 1,000,000 patients. Of the included studies, 35 (76%) were published in specialty journals and 11 (24%) in general medical journals. The many conditions studied largely corresponded well with conditions important to general practice. Conclusion: Survival analysis applied to primary care electronic medical data is a research approach that has been frequently used in recent times. The utility of this approach was demonstrated by the ability to produce research with large numbers of subjects, across a wide range of conditions and with the potential of a high impact. Importantly, primary care data were thus available to inform primary care practice.

scholarly journals Attributes and generic competencies required of doctors: findings from a participatory concept mapping study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kathryn Ogden ◽  
Sue Kilpatrick ◽  
Shandell Elmer ◽  
Kim Rooney
Keyword(s):  
Health Care ◽  
Cluster Analysis ◽  
Concept Mapping ◽  
Hierarchical Cluster Analysis ◽  
Health Care Systems ◽  
Hierarchical Cluster ◽  
Junior Doctors ◽  
Generic Competencies ◽  
Care Systems ◽  
Group Concept

Abstract Background Medical education should ensure graduates are equipped for practice in modern health-care systems. Practicing effectively in complex health-care systems requires contemporary attributes and competencies, complementing core clinical competencies. These need to be made overt and opportunities to develop and practice them provided. This study explicates these attributes and generic competencies using Group Concept Mapping, aiming to inform pre-vocational medical education curriculum development. Methods Group Concept Mapping is a mixed methods consensus building methodology whereby ideas are generated using qualitative techniques, sorted and grouped using hierarchical cluster analysis, and rated to provide further quantitative confirmation of value. Health service providers from varied disciplines (including medicine, nursing, allied health), health profession educators, health managers, and service users contributed to the conceptual model’s development. They responded to the prompt ‘An attribute or non-clinical competency required of doctors for effective practice in modern health-care systems is...’ and grouped the synthesized responses according to similarity. Data were subjected to hierarchical cluster analysis. Junior doctors rated competencies according to importance to their practice and preparedness at graduation. Results Sixty-seven contributors generated 338 responses which were synthesised into 60 statements. Hierarchical cluster analysis resulted in a conceptual map of seven clusters representing: value-led professionalism; attributes for self-awareness and reflective practice; cognitive capability; active engagement; communication to build and manage relationships; patient-centredness and advocacy; and systems awareness, thinking and contribution. Logic model transformation identified three overarching meta-competencies: leadership and systems thinking; learning and cognitive processes; and interpersonal capability. Ratings indicated that junior doctors believe system-related competencies are less important than other competencies, and they feel less prepared to carry them out. Conclusion The domains that have been identified highlight the competencies necessary for effective practice for those who work within and use health-care systems. Three overarching domains relate to leadership in systems, learning, and interpersonal competencies. The model is a useful adjunct to broader competencies frameworks because of the focus on generic competencies that are crucial in modern complex adaptive health-care systems. Explicating these will allow future investigation into those that are currently well achieved, and those which are lacking, in differing contexts.

Pediatric Urology for Primary Care

2019 ◽  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Professionals ◽  
Pediatric Urology ◽  
Congenital Defects ◽  
Wide Range ◽  
Book Covers ◽  
Primary Care Pediatricians

An excellent reference for primary care pediatricians and other health care professionals who treat a wide range of urological conditions, this book covers everything from bed-wetting, congenital defects, and diaper rash to perinatal concerns. https://shop.aap.org/pediatric-urology-for-primary-care-paperback/

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