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

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

BMC Family Practice ◽

10.1186/s12875-021-01542-5 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Adelson Guaraci Jantsch ◽

Bo Burström ◽

Gunnar Nilsson ◽

Antônio Ponce de Leon

Keyword(s):

Primary Care ◽

Family Medicine ◽

Residency Training ◽

Rio De Janeiro ◽

Laboratory Tests ◽

Chronic Health Conditions ◽

Health Conditions ◽

Chronic Health ◽

Medical Consultations

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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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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Psychosocial Risks of Chronic Health Conditions in Childhood and Adolescence

PEDIATRICS ◽

10.1542/peds.92.6.876 ◽

1993 ◽

Vol 92 (6) ◽

pp. 876-878 ◽

Cited By ~ 1

Author(s):

Keyword(s):

Children And Adolescents ◽

Health Condition ◽

Work And Family ◽

Chronic Health Conditions ◽

Health Conditions ◽

Medical Attention ◽

Childhood And Adolescence ◽

Chronic Health ◽

Persistent Symptoms ◽

The Impact

Chronic health conditions affect many children and adolescents. These conditions are illnesses or impairments that are expected to last for an extended period of time and require medical attention and care that is above and beyond what would normally be expected for a child or adolescent of the same age, extensive hospitalization, or in-home health services.1 These conditions include, among others, juvenile rheumatoid arthritis, asthma, cystic fibrosis, diabetes, spina bifida, hemophilia, seizure disorders, neuromuscular disease, acquired immunodeficiency syndrome, and congenital heart diseases. Although each specific condition may be relatively or extremely rare, when they are considered together, many children and adolescents are affected. Health conditions may be characterized by their duration and their severity. Although these terms are often linked, they refer to different aspects of a health condition. A chronic condition is generally one that has lasted or is expected to last more than a defined period of time, usually 3 months or longer. Conditions vary widely in their onset, course, and duration.2 Severity refers to the impact a condition has on a child's physical, intellectual, psychological, or social functioning.3 This impact may occur as a result of persistent symptoms, required treatments, limitations of activity or mobility, or interference with school, recreation, work, and family activities. Current estimates are that between 10 and 20 million American children and adolescents have some type of chronic health condition or impairment. Most of these conditions are relatively mild and interfere little with the children's ability to participate in usual childhood activities.4 However.

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Children and Adolescents with Chronic Health Conditions

The Power of Positive Parenting ◽

10.1093/med-psych/9780190629069.003.0011 ◽

2017 ◽

pp. 145-155

Author(s):

Alina Morawska

Keyword(s):

Well Being ◽

Health Condition ◽

Chronic Health Conditions ◽

Health Conditions ◽

Triple P ◽

Childhood Health ◽

Chronic Health ◽

Parenting Support ◽

The Family ◽

The Impact

Chronic childhood health conditions are common and significantly affect the child and family. This chapter begins by describing the central role parents play in children’s health outcomes and illness management and the impact the child’s health condition has on parents and the family. Few parenting interventions have been evaluated, and most focus on medical aspects rather than psychosocial factors related to child and family well-being. Existing approaches to parenting support are described, followed by an exploration of the evidence for Triple P interventions. Recent research using Positive Parenting for Healthy Living, a brief parenting intervention for parents with children with chronic health conditions, is showing promising outcomes. Policy and service implications of recent research are summarized.

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