impact of virtual care on relationship centered care: Observations of a family physician

The COVID-19 pandemic propelled many physicians and their patients into an unfamiliar world of virtual care. This presentation is based on the perceptions of a family physician/ teacher/ researcher with 43 years of interest in, and promotion of, a strong doctor-patient relationship. It will describe a protocol that governed how tele-medicine and video-conferencing took place over nearly 18 months in his practice. It will then describe observed positive and negative impacts for the patients, their family members, the physician, and members of the family medicine health care team. Interpretation will be made about what such observations mean for the doctor-patient relationship.

A qualitative study of resident and early-career family physicians’ focused practice choices in Canada

Background: Although focused practice within family medicine may be increasing globally, there is limited research on the factors contributing to decisions to focus practice. Aim: We aimed to examine the factors influencing resident and early-career family physician choices of focused practice across three Canadian provinces. Design and Setting: We analyzed a subset of qualitative interview data from a study across British Columbia, Ontario, and Nova Scotia. Method: A total of 22 resident family physicians and 38 early-career family physicians in their first 10 years of practice who intend to or currently practice in a focused area were included in our analysis. We compared participant types, provinces, and the degree of focused practice while identifying themes related to factors influencing the pursuit of focused practice. Results: We identified three key themes of factors contributing to choices of focused practice: self-preservation within the current health care system, support from colleagues, and experiences in medical school and/or residency. Minor themes included alignment of practice with skills, personal values, or ability to derive professional satisfaction; personal lived experiences; and having many attractive opportunities for focused practice. Conclusion: Both groups of participants unanimously viewed focused practice as a way to circumvent the burnout or exhaustion they associated with comprehensive practice in the current structure of the health care system. This finding, in addition to other influential factors, was consistent across the three provinces. More research is needed to understand the implications of resident and early-career family physician choices of focused practice within the physician workforce.

The Impact of Linguistic Concordance and the Active Offer of French Language Services on Patient Satisfaction

Communication is essential to providing quality primary care. Linguistic concordance between patients and physicians has been linked to improved health outcomes and greater patient satisfaction. Although Canadian Francophones often struggle to access linguistics concordant health services, the concept of the active offer of French Language Services (FLS) has emerged as a means of ensuring the availability of such services and improving the francophone patient experience. However, the impact of language concordance and the active offer of FLS on patient satisfaction among Ontario Francophones remain largely unknown. Patient satisfaction surveys were collected as part of a continuing education program targeted at family physicians in Northeastern Ontario. Participating physicians distributed patient surveys consisting of select patient satisfaction questions from the Physicians Achievement Review (PAR) and select questions from the Active Offer of French Language Services in Minority Context Measure. Valid surveys were received from 235 patients. Just under half of these (44%) identified as Francophones, 62.6% had a French-speaking family physician; however, only 17.2% reported regularly speaking in French with their family physician. As hypothesized, there was a consistent tendency for Francophones who experience stronger linguistic concordance with their family physician to report higher satisfaction scores. Francophones who regularly speak French with their family physicians were more satisfied ( = 4.63) than those who rarely/never speak French ( = 4.29, F(1; 83) = 4.852; p < 0.05). There was also a statistically significant interaction between the patients' language of preference and the service language. Francophones who prefer French and regularly speak it with their family physician (linguistic concordance; adj= 4.82) were significantly more satisfied than those who prefer French yet rarely/never speak it (linguistic discordance; adj= 4.06, F(1; 75) = 11.950; p < 0.001). Furthermore, a positive correlation between patient satisfaction and the active offer was observed in Francophones (r = 0.49, p<0.001). The present findings provide evidence of the impact of linguistically adapted health care services on the satisfaction of Ontario Francophones and suggest that patient satisfaction may be improved through the active offer of FLS. A larger and more diverse sample is required to confirm these findings.

Trends in Family Physician Usage among Canadians from 2001 to 2016: An Age-Period-Cohort Analysis

As primary health care providers, family physicians play a critical role in Canada’s health care system by providing first-level contact for patients and acting as advocates for preventative medicine. Due to their essential role in population health, public health practitioners are concerned about temporal trends surrounding family physician visits. This study uses eight cycles of the Canadian Community Health Survey, a nationally representative survey, to conducing an age-period-cohort analysis with the bounding method, while controlling for sex and race. Most notably, we discover a declining cohort trend indicating that later cohorts are less likely to visit a family doctor over a 12-month period. These results suggest that health promotion policies surrounding family physician use should not only be targeted towards middle and older-aged adults who experience declining health, as the cohort effect implies that a portion of health care avoidance behaviour is molded in youth and young adulthood.

Keeping doors open: A cross-sectional survey of family physician practice patterns during COVID-19, needs, and intentions

Objective: To determine the extent to which family physicians closed their doors altogether or for in-person visits during the pandemic, their future practice intentions, and related factors. Methods: Between March and June 2021, we conducted a cross-sectional survey using email, fax, and phone of 1,186 family doctors practicing comprehensive family medicine in Toronto, Ontario. We asked about practice patterns in January 2021, use of virtual care, and practice intentions. Results: Of the 1,016 (86%) that responded to the survey, 99.7% (1001/1004) indicated their practice was open in January 2021 with 94.8% (928/979) seeing patients in-person and 30.8% (264/856) providing in-person care to patients reporting COVID-19 symptoms. Respondents estimated spending 58.2% of clinical care time on phone visits and an additional 5.8% on video and 7.5% on email. 17.2% (77/447) were planning to close their current practice in the next five years. There was a higher proportion of physicians who worked alone in a clinic among those who did not see patients in-person (27.6% no vs 12.4% yes, p<0.05), did not see symptomatic patients (15.6% no vs 6.5 % yes, p<0.001), and those who planned to close their practice in the next 5 years (28.9% yes vs 13.9% no, p<0.01). Interpretation: The vast majority of family physicians in Toronto were open to in-person care in January 2021 but almost one-fifth are considering closing their practice in the next five years. Policy-makers need to prepare for a growing family physician shortage and better understand factors that support recruitment and retention.

Palliative care physicians’ motivations for models of practicing in the community: A qualitative descriptive study

Background: Internationally, both primary care providers and palliative care specialists are required to address palliative care needs of our communities. Clarity on the roles of primary and specialist-level palliative care providers is needed in order to improve access to care. This study examines how community-based palliative care physicians apply their roles as palliative care specialists, what motivates them, and the impact that has on how they practice. Design: A qualitative descriptive study using semi-structured virtual interviews of community-based palliative care specialists. We asked participants to describe their care processes and the factors that influence how they work. Setting/participants: A qualitative descriptive study using semi-structured virtual interviews of community-based palliative care physicians in Ontario, Canada was undertaken between March and June 2020. At interview end, participants indicated whether their practice approaches aligned with one or more models depicted in a conceptual framework that includes consultation (specialist provides recommendations to the family physician) and takeover (palliative care physician takes over all care responsibility from the family physician) models. Results: Of the 14 participants, 4 worked in a consultation model, 8 in a takeover model, and 2 were transitioning to a consultation model. Different motivators were found for the two practice models. In the takeover model, palliative care physicians were primarily motivated by their relationships with patients. In the consultation model, palliative care physicians were primarily motivated by their relationships with primary care. These differing motivations corresponded to differences in the day-to-day processes and outcomes of care. Conclusions: The physician’s personal or internal motivators were drivers in their practice style of takeover versus consultative palliative care models. Awareness of these motivations can aid our understanding of current models of care and help inform strategies to enhance consultative palliative care models.

Role of Family Physician in Periodic Health Assessment Screening: A Review

A family physician is considered the first line of healthcare with patients. In the public sector, a medical officer is a generalist with no postgraduate training. The periodic health assessment has its roots at least as far back as the industrial revolution, employers paid for annual medical fitness examinations and tests to assess the state of their workers with intention of keeping their workforce healthy and safe. The technique is now included into the work of primary care physicians and is still practiced across multiple countries but it may be named with a different name such as Periodic health examination (PHE). The PHE allows for the implementation of evidence-based preventative measures, the education of patients on lifestyle issues, the updating of vaccines, and, most importantly, the detection of risk factors and diagnoses by updating the patient's cumulative profile. In low-risk individuals, however, treatment may not be essential every year. There’s serious question about the value of Periodic health assessment/examination. In this article we’ll be reviewing the PHE, its value and the role of family physician in it.

Underlying factors and challenges of implementing the urban family physician program in Iran

Background The family physician program was launched in 2005 in rural areas of Iran and then piloted in 2012 in the cities of Fars and Mazandaran provinces due to insufficient health coverage in these cities. However, despite its pivotal role in the health system, this program has not progressed according to the policies. This study aimed to explain the underlying factors and challenges of implementing the urban family physician program in Iran. Methods This qualitative study was conducted on 44 policy-makers and managers at national and provincial levels selected via snowball and purposive sampling with maximum variation. The data were managed in MAXQDA 2020 and analyzed by directed content analysis. A triangulation method was adopted for this purpose. Results A total of 10 categories, 18 sub-categories, and 29 codes were formed. Most challenges related to underlying factors included precipitancy, economic sanctions, belief in traditional medicine, belief in the expertise of previous physicians, and global ranking of countries. For program implementation, most challenges included a diversity of insurance organizations, budget allocation, referral system, electronic file, educational system, and culture building. Conclusions The major challenges pertaining to underlying factors included international pressure for reforms and precipitancy in program implementation due to management changes. The challenges associated with program implementation included budget provision and interaction with insurance organizations. Therefore, to expand this program to other provinces in Iran, the identified factors should be carefully considered so that sufficient confidence and commitment can be guaranteed for all stakeholders.

Does the white coat influence satisfaction, trust and empathy in the doctor–patient relationship in the General and Family Medicine consultation? Interventional study

ObjectivesTo understand the influence of the white coat on patient satisfaction, opinions about medical clothing, perception about confidence, empathy and medical knowledge and the satisfaction and comfort level of physicians in consultation.SettingAn interventional study was conducted with a representative sample of the population attending primary care in central Portugal.ParticipantsThe sample was composed by 286 patients divided into two groups exposed or not to a doctor wearing a white coat. The first and last patients in consultation every day for 10 consecutive days were included.InterventionsEvery other day the volunteer physicians consulted with or without the use of a white coat. At the end of the consultation, a questionnaire was distributed to the patient with simple questions with a Likert scale response, the Portuguese version of the ‘Trust in physician’ scale and the Jefferson Scale of Patient Perceptions of Physician Empathy - Portuguese Version (JSPPPE-VP scale). A questionnaire was also distributed to the physician.OutcomesPlanned and measured primary outcomes were patient satisfaction, trust and perception about empathy and secondary outcomes were opinion about medical clothing, satisfaction and comfort level of physicians in consultation.ResultsThe sample was homogeneous in terms of sociodemographic variables. There were no statistically significant differences between the groups in terms of satisfaction, trust, empathy and knowledge perceived by the patients. There were differences in the opinion of the patients about the white coat, and when the physician was wearing the white coat this group of patients tended to think that this was the only acceptable attire for the physician (p<0.001). But when the family physician was in consultation without the white coat, this group of patients tended to agree that communication was easier (p=0.001).ConclusionsThere was no significant impact of the white coat in patient satisfaction, empathy and confidence in the family physician.Trial registration numberClinicalTrials.gov ID number: NCT03965416.