scholarly journals Suicide and Suicidal Tendency in Primary Care Setting; Review Article

2021 ◽  
pp. 60-73
Author(s):  
Faisal Suliman Algaows ◽  
Sarah Salman Alhussain ◽  
Joud Bandar Damanhori ◽  
Alzahrani Amjad Ahmed H. ◽  
Alghamdi, Ahmed Hamed A ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Care Setting ◽  
Primary Care Setting ◽  
Public Health Problem ◽  
Care Physician ◽  
Precipitating Factors ◽  
Suicidal Tendency ◽  
Medical Teams ◽  
Critical Public Health

Suicide is critical public health problem that primary care physicians potentially can help address given that concerned patients frequently visit them in the weeks and months preceding the successful suicide. This article contemplates issues placing the patient at high risk for successful suicide and clinical valuation techniques available to the primary care physician. Patients identified as being at risk of attractive suicidal or those who have a equal of suicidal ideation or behavior judged apposite for management in the primary care setting should be monitored for risk at regular intervals. It is extremely significant to learn about and try to contextualize the patients' emotions that triggered the present crisis. Nurses can make sure that they have a thorough understanding of the present acuity, and all of the precipitating factors, and can exactly and collaboratively communicate with the caregivers and other involved medical teams.

scholarly journals Childhood chronic cough made easy: a simplified approach for the primary care setting

2021 ◽  
Vol 49 (2) ◽  
pp. 170-177
Author(s):  
Grigorios Chatziparasidis ◽  
Sotirios Fouzas ◽  
Ahmad Kantar
Keyword(s):  
Primary Care ◽  
Chronic Cough ◽  
Primary Care Physicians ◽  
Care Setting ◽  
Primary Care Setting ◽  
Defense Mechanism ◽  
Negative Impact ◽  
Care Physician ◽  
Simplified Approach ◽  
Clinical Scenarios

Cough is a defense mechanism, but when it becomes persistent and troublesome, it must be carefully assessed. Chronic cough, that is, cough persisting for more than 4 weeks, has a proven negative impact on a child’s quality of life; it interferes with daily activities, sleep, and schooling and may involve frequent health care visits and long-lasting treatments. Currently, there is a plethora of algorithms in the literature aiming to assist in the assessment of chronic cough in children; however, referring to complex flowcharts may be impractical for the usually busy primary care physician. Herein, we provide a simplified tool for the assessment of children with chronic cough in the primary care setting, presenting a basic approach to the most common causes along with hints to avoid common pitfalls in everyday practice. Finally, the most common clinical scenarios are analyzed, aiming to assist primary care physicians in providing the appropriate care to these patients.

scholarly journals Prospective Analysis of Scrotal Pathology Referrals – Are Referrals Appropriate and Accurate?

2006 ◽  
Vol 88 (4) ◽  
pp. 363-366 ◽  
Author(s):  
Paul W Foster ◽  
Alastair WS Ritchie ◽  
David J Jones
Keyword(s):  
Primary Care ◽  
Testicular Cancer ◽  
Care Setting ◽  
Primary Care Setting ◽  
Care Physician ◽  
Accurate Diagnosis ◽  
Benign Pathology ◽  
Clinical Diagnoses ◽  
Treatable Condition ◽  
Referral Practice

INTRODUCTION Testicular cancer is a relatively uncommon, treatable condition. A general practitioner would expect to see, on average, one case of testicular cancer in the whole of their career. Benign scrotal conditions are extremely common and the source of many primary care consultations. The main patient expectations of these attendances are accurate diagnosis and adequate re-assurance as often they are the source of much anxiety and perceived embarrassment. The aim of this study was to examine the content and referral practice of primary care referral of testicular pathology and the resultant findings of the specialist practitioner. PATIENTS AND METHODS A total of 201 patients referred with scrotal pathology were prospectively analysed at the time of specialist practitioner assessment by means of data recording in a urological surgery unit and regional peripheral community clinics. RESULTS In the study group, 53 patients were referred under the 2-week rule. Of these, 9 (17%) were found to have testicular cancer. Five (36%) cancers were referred outside the 2-week rule referrals; 1 cancer was missed and 2 diagnoses delayed. In total, 44% of final clinical diagnoses differed between the referring primary care physician and the specialist practitioner. Of the 71 (35%) patients referred with a suspicion of cancer, 62 (87%) were subsequently found to be of clinically benign pathology. Overall, 80% of patients were referred more urgently than the opinion of the specialist practitioner. CONCLUSIONS Scrotal examination in the primary care setting appears to be of variable accuracy. Many patients referred with a high suspicion of cancer are found to have benign pathology. Two-week rule referrals have an acceptable positive predictive value for testicular cancer (17%). Disagreements exist in the referral priority of patients.

An Examination of the Prescription Renewal Process and Implications for Primary Care Physicians and Community Pharmacists

2018 ◽  
Vol 33 (2) ◽  
pp. 187-191
Author(s):  
Anthony J. Pattin ◽  
Nathan Devore ◽  
Jonathan Fowler ◽  
David Weldy
Keyword(s):  
Primary Care ◽  
Renewal Process ◽  
Primary Care Physicians ◽  
Care Setting ◽  
Primary Care Setting ◽  
Community Pharmacists ◽  
Effective Management ◽  
Physician Practices ◽  
Staff Members ◽  
Inappropriate Medications

In physician practices and pharmacies, staff members work to process prescription renewals so that patients receive a steady supply of medications. These functions are essential to ensure patients have continuous access to medications and remain adherent to prescribed therapies. Despite the incorporation of e-prescribing software programs to ease management of these processes, barriers to effective management of the prescription renewal process exist. Mismanagement of pharmacy adherence programs can ultimately lead to patients receiving inappropriate medications and excessive use of staff resources. The objective of this article is to examine the prescription renewal process in both the primary care setting and the pharmacy and report challenges associated with the process. A literature review was conducted to find studies that describe pharmacists’ and physicians’ handlings of prescription renewals, use of e-prescribing software, and benefits and barriers to using these technologies. Although studies report e-prescribing software improves efficiency in the prescription renewal process, there is a need to reduce technological problems that create challenges in use. It is recommended that staff within physician practices and pharmacies standardize prescription renewal processes and educate patients about the prescription renewal process.

scholarly journals Barriers to End-of-life Discussions in the Primary Care Setting

2020 ◽  
pp. 12-15
Author(s):  
Devon Boydstun ◽  
Shandra Basil ◽  
JIll Porter ◽  
Anand Gupta
Keyword(s):  
Primary Care ◽  
End Of Life ◽  
Primary Care Physicians ◽  
Care Setting ◽  
Primary Care Setting ◽  
Age Difference ◽  
Advanced Directives ◽  
Healthcare Facilities ◽  
Number Of Patients ◽  
Study Population

Background: The Patient Self Determination Act was passed in 1991 and requires healthcare facilities to present patients with information regarding advanced directives. Since that time, there has been no improvement in the number of patients reported to have had such discussions. Numerous barriers to these discussions exist both on the patient and provider side. This study aims to identify barriers to end of life discussions among providers in the primary care setting. Methods: The study population included practicing primary care physicians in the OhioHealth system. They were administered an anonymous questionnaire addressing demographic information and questions specific to end of life discussions and what barriers exist. Results: A majority of primary care physicians reported engaging in end of life discussions with their patients. A majority of physicians cited lack of time as a barrier to having these discussions. There was a statistically significant age difference among primary care physicians who reported they have end of life discussions with their patients and among these physicians there was a statistically significant increase in their level of comfort having these discussions. Conclusion: Primary care physicians further into their career reported having end of life discussions more frequently and felt more comfortable doing so. Additionally, physicians cite lack of time as the most common barrier to holding end of life discussions.

scholarly journals Pitfalls in diagnosis and management of suspected urinary tract infection in an urban tropical primary care setting

2019 ◽  
Vol 13 (03) ◽  
pp. 219-226
Author(s):  
Alison A Jackson ◽  
Pauline Siew Mei Lai ◽  
Aqtab Mazhar Alias ◽  
Nadia Atiya ◽  
Siti Nurkamilla Ramdzan ◽  
...  
Keyword(s):  
Primary Care ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Primary Care Physicians ◽  
Care Setting ◽  
Primary Care Setting ◽  
Diagnosis And Management ◽  
Prostatic Enlargement ◽  
Suboptimal Adherence

Introduction: Diagnosis and management of urinary tract infection (UTI) are complex, and do not always follow guidelines. The aim of this study was to determine adherence to the 2014 Malaysian Ministry of Health guidelines for managing suspected UTI in a Malaysian primary care setting. Methodology: We retrospectively reviewed computerized medical records of adults with suspected UTI between July-December 2016. Excluded were consultations misclassified by the search engine, duplicated records of the same patient, consultations for follow-up of suspected UTI, patients who were pregnant, catheterised, or who had a renal transplant. Records were reviewed by two primary care physicians and a clinical microbiologist. Results: From 852 records, 366 consultations were a fresh episode of possible UTI. Most subjects were female (78.2%) with median age of 61.5 years. The major co-morbidities were hypertension (37.1%), prostatic enlargement in males (35.5%) and impaired renal function (31.1%). Symptoms were reported in 349 (95.4%) consultations. Antibiotics were prescribed in 307 (83.9%) consultations, which was appropriate in 227/307 (73.9%), where the subject had at least one symptom, and leucocytes were raised in urine full examination and microscopic examination (UFEME). In 73 (23.8%) consultations antibiotics were prescribed inappropriately, as the subjects were asymptomatic (14,4.6%), urine was clear (17,5.5%), or UFEME did not show raised leucocytes (42,13.7%). In 7 (2.3%) consultations appropriateness of antibiotics could not be determined as UFEME was not available. Conclusion: Several pitfalls contributed to suboptimal adherence to guidelines for diagnosis and management of suspected UTI. This illustrates the complexity of managing suspected UTI in older subjects with multiple co-morbidities.

Consultation-Liaison Psychiatry Fellowship in Primary Care

1996 ◽  
Vol 26 (2) ◽  
pp. 135-143 ◽  
Author(s):  
Maurice D. Steinberg ◽  
Steven A. Cole ◽  
Stephen M. Saravay
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Care Setting ◽  
Primary Care Setting ◽  
Liaison Psychiatry ◽  
Service Staff ◽  
Consultation Liaison Psychiatry ◽  
Primary Care Practitioners ◽  
Primary Care Medicine ◽  
Selection Of

Objective: This article describes the need for and development of an outpatient primary care psychiatry fellowship program. Method: The Department of Psychiatry at Hillside Hospital established a primary care fellowship for psychiatrists in 1994, through its consultation-liaison (C-L) service. Staff alliances established by the C-L service with primary care physicians provided the basis for identifying appropriate outpatient practices in the community. Knowledge and skills objectives were adapted from a traditional C-L fellowship to outpatient primary care medicine. Results: The selection of a psychologically minded primary care practitioners was crucial. Practitioners used an inclusive model in which fellows would see all patients with them, not just those with mental disorders. Fellows have felt comfortable working in the primary care setting and have been well received by practitioners, staff, and patients. The practitioners were clearly more interested in psychosocial aspects of their patient than were primary care residents. Conclusions: The gap in preparing U.S. psychiatrists to function in integrated primary care programs requires establishing a presence in the primary care setting. Skills and relationships from traditional C-L settings can be productively used to accomplish this goal.

scholarly journals Domestic Violence Against Men in Primary Care in Nigeria

2008 ◽  
Vol 3 (4) ◽  
pp. 333-339 ◽  
Author(s):  
Paul O. Dienye ◽  
Precious K. Gbeneol
Keyword(s):  
Primary Care ◽  
Domestic Violence ◽  
Medical Records ◽  
Care Setting ◽  
Primary Care Setting ◽  
Care Physician ◽  
Male Victims ◽  
Pattern Of Injury ◽  
High Index Of Suspicion ◽  
Married Male

Domestic violence against men is rare in Nigeria. This study was aimed at assessing the prevalence of domestic violence against men, the sociodemographic characteristics of victims, and the pattern of injury sustained in a primary care setting. This was a retrospective study over a period of 5 years in which all the medical records of patients were retrieved and information on domestic violence extracted from them and transferred to a data sheet. Those whose records were grossly deficient were excluded from the study. A total of 220,000 patients were seen of which 48 (22 per 100,000) were victims of domestic violence. There were only five married male victims with a prevalence of 0.0023%. The injuries observed were scratches, bruises, welts, and scalds. The primary care physician needs a high index of suspicion to be able to detect it.

scholarly journals A qualitative study documenting unmet needs in the management of diabetic kidney disease (DKD) in the primary care setting

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Manasi Datar ◽  
Saranya Ramakrishnan ◽  
Elizabeth Montgomery ◽  
Steven G. Coca ◽  
Joseph A. Vassalotti ◽  
...  
Keyword(s):  
Primary Care ◽  
Kidney Disease ◽  
Risk Stratification ◽  
Primary Care Physicians ◽  
Diabetic Kidney Disease ◽  
Care Setting ◽  
Unmet Needs ◽  
Primary Care Setting ◽  
Diabetic Kidney ◽  
Early Stages

Abstract Background A majority of diabetic kidney disease (DKD) patients receive medical care in the primary care setting, making it an important opportunity to improve patient management. There is limited evidence evaluating whether primary care physicians (PCPs) are equipped to effectively manage these patients in routine clinical practice. The present study was undertaken to identify gaps in primary care and unmet needs in the diagnosis and monitoring of DKD in type 2 diabetes (T2D) patients among PCPs. Methods This was a qualitative analysis based on 30–45-min interviews with PCPs treating T2D patients. PCPs were recruited via email and were board-certified, in practice for more than 3 years, spent most of their time in direct clinical care, and provided care for more than three T2D patients in a week. Descriptive data analysis was conducted to identify and examine themes that were generated by interviews. Two reviewers evaluated interview data to identify themes and developed consensus on the priority themes identified. Results A total of 16 PCPs satisfying the inclusion criteria were recruited for qualitative interviews. Although the PCPs recognized kidney disease as an important comorbidity in T2D patients, testing for kidney disease was not consistently top of mind, with 56% reportedly performing kidney function testing in their T2D patients. PCPs most frequently reported using estimated glomerular filtration rate (eGFR) alone to monitor and stage DKD; only 25% PCPs reported testing for albuminuria. Most PCPs incorrectly believed that a majority of DKD patients are diagnosed in early stages. Also, early stages of DKD emerged as ambiguous areas of decision-making, wherein treatments prescribed greatly varied among PCPs. Lastly, early and accurate risk stratification of DKD patients emerged as the most important unmet need; which, if it could be overcome, was consistently identified by PCPs as a key to monitoring, appropriate nephrologist referrals, and intervening to improve outcomes in patients with DKD. Conclusions Our study highlights important unmet needs in T2D DKD testing, staging, and stratification in the PCP setting that limit effective patient care. Health systems and insurers in the U.S. should prioritize the review and approval of new strategies that can improve DKD staging and risk stratification.

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