Buprenorphine Maintenance Treatment in Primary Care: An Overview of the French Experience and Insight Into the Prison Setting

Infants, children, and adolescents with inguinoscrotal pathology comprise a significant proportion of emergency department and outpatient visits. Visits to the emergency department primarily comprise individuals presenting with scrotal pain due to testicular torsion or torsion of the testicular appendages. At such time, immediate urological consultation is sought. Outpatient visits comprise those individuals with undescended testes, hydroceles, and varicoceles. Rare, but important problems, such as pediatric testicular tumours, may also present in the office setting. Many of these outpatient visits are to primary care physicians, who should have an appreciation of the timing and need for referral.The purpose of this review is to familiarize the general urologist and primary care physician with these varied pathologies and give insight into their assessment and management. Some of these same conditions are seen in adult patients, but there are some significant differences in their management in the pediatric group. In addition, the utility of imaging studies, such as ultrasound, are discussed within each pathological entity. It is hoped that this overview will assist our general urology and primary care colleagues in patient management for diverse inguinoscrotal pathologies.

Download Full-text

Becoming a lead nurse in a primary care network

Practice Nursing ◽

10.12968/pnur.2020.31.1.42 ◽

2020 ◽

Vol 31 (1) ◽

pp. 42-42

Author(s):

Clare Blackwell

Keyword(s):

Primary Care ◽

General Practice ◽

Care Network ◽

Insight Into

The new primary care networks provide opportunities for nurses working in general practice. Clare Blackwell provides an insight into the role of lead nurse in a primary care network

Download Full-text

Multimorbidity in Patients Enrolled in a Community-Based Methadone Maintenance Treatment Programme Delivered through Primary Care

Journal of Comorbidity ◽

10.15256/joc.2014.4.42 ◽

2014 ◽

Vol 4 (1) ◽

pp. 46-54 ◽

Cited By ~ 2

Author(s):

Diane E. Arnold-Reed ◽

Tom Brett ◽

Lakkhina Troeung ◽

Jasmine O'Neill ◽

Rupert Backhouse ◽

...

Keyword(s):

Primary Care ◽

Disease Severity ◽

Methadone Maintenance Treatment ◽

Maintenance Treatment ◽

Rating Scale ◽

Methadone Maintenance ◽

Drug Abusers ◽

Age Group ◽

Community Based ◽

Long Term Conditions

Background Multimorbidity, the co-existence of two or more (2+) long-term conditions in an individual, is common among problem drug abusers. Objective To delineate the patterns, multimorbidity prevalence, and disease severity in patients enrolled in a community-based primary care methadone maintenance treatment (MMT) programme. Design This was a retrospective cohort study ( n=274). The comparator group consisted of mainstream primary care patients. Electronic medical record assessment was performed using the Cumulative Illness Rating Scale. Results Prevalence of multimorbidity across 2+ domains was significantly higher within the MMT sample at 88.7% (243/274) than the comparator sample at 51.8% (142/274), p<0.001. MMT patients were seven times more likely to have multimorbidity across 2+ domains compared with mainstream patients (OR 7.29, 95% confidence interval 4.68–11.34; p<0.001). Prevalence of multimorbidity was consistently high across all age groups in the MMT cohort (range 87.8–100%), while there was a positive correlation with age in the comparator cohort ( r=0.29, p<0.001). Respiratory, psychiatric, and hepatic–pancreatic domains were the three most common domains with multimorbidity. Overall, MMT patients (mean±SD, 1.97±0.43) demonstrated significantly higher disease severity than mainstream patients (mean±SD, 1.18±0.78), p<0.001. Prevalence of moderate disease severity observed in the <45-year MMT age group was 50% higher than the ≥45-year comparator age group. Conclusions Prevalence of multimorbidity and disease severity in MMT patients was greater than in the age- and sex-matched comparators. Patients with a history of drug abuse require co-ordinated care for treatment of their addiction, and to manage and prevent chronic illnesses. Community-based programmes delivered through primary care help fulfil this need.

Download Full-text

Evaluation of an electronic consultation service for transgender care

BMC Family Practice ◽

10.1186/s12875-021-01401-3 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Jatinderpreet Singh ◽

Allison Lou ◽

Michael Green ◽

Erin Keely ◽

Mary Greenaway ◽

...

Keyword(s):

Primary Care ◽

Response Time ◽

Access To Care ◽

Hormone Therapy ◽

Primary Care Providers ◽

Care Providers ◽

Face To Face ◽

Electronic Consultation ◽

Clinical Questions ◽

Insight Into

Abstract Background Access to transgender care in Canada is poor. Although primary care providers are ideally positioned to initiate care, many feel uncomfortable providing transgender care. This study aimed to explore the impact of an electronic consultation (eConsult) service between primary care providers and transgender care specialists on access to care and to explore the content of clinical questions that were asked. Methods This was a retrospective mixed methods analysis of 62 eConsults submitted between January 2017 and December 2018 by primary care providers to specialists in transgender care in a health region in eastern Ontario, Canada. A descriptive analysis was conducted to assess the average response time and the total time spent by the specialist for the eConsults. An inductive and deductive content analysis was carried out to identify common themes of clinical questions being asked to transgender specialists. A post-eConsult survey completed by primary care providers was assessed to gain insight into avoided face-to-face referrals and overall provider satisfaction. Results The median specialist response time was 1.2 days (range: 1 h to 5 days) and the average time spent by specialists per eConsult was 18 min (range: 10 to 40 min). The qualitative analysis identified six major themes: 1) interpretation/management of abnormal bloodwork, 2) change in management due to lack of desired effect/hormone levels not a target, 3) initiation of hormone therapy/initial work up, 4) management of adverse effects of hormone therapy, 5) transition related surgery counseling and post-op complications, and 6) management of patients with comorbidities. Approximately one-third of eConsults resulted in an avoided face-to-face referral and 95% of primary care providers rated the value of their eConsult as a 5 (excellent value) or 4. Conclusions This study demonstrated that a transgender eConsult service has potential to significantly improve access to care for transgender patients. Given the importance that timely access has on improving mental health and reducing suicide attempts, eConsult has the potential to make a substantial clinical impact on this population. Identified themes of eConsult questions provides insight into potential gaps in knowledge amongst primary care providers that could help inform future continuing education events.

Download Full-text