The outpatient medical care in patients with chronic diseases under dispensary supervision in the conditions of the COVID-19 pandemic. Temporary guidelines. Version 2

Guidelines were approved at the meeting of the academic council of the National Medical Research Center for Therapy and Preventive Medicine, Moscow (Protocol No. 10 of 19.10.2021).The aim of these guidelines is to provide primary care physicians with scientifically based algorithms for the implementation of dispensary monitoring in patients with chronic non-communicable diseases in the conditions of the new coronavirus infection (COVID-19) pandemic, including the use of telemedicine technologies.The organization and conduct of high-quality medical follow-up are the most important tasks aimed at both reducing the risks of developing complications of chronic non-communicable diseases and reducing overall mortality, especially in the current conditions of the COVID-19 pandemic. The guidelines contain clinical aspects of dispensary follow-up, general principles of tactics for managing patients with various chronic non-communicable diseases in COVID-19 conditions, in addition, brief checklists with options for interviewing patients with various chronic non-communicable diseases are presented, topical aspects of the interaction of drugs used in the treatment of chronic non-communicable diseases with antiviral drugs are considered.The guidelines are intended for general practitioners, district therapists, general practitioners (family doctors), as well as doctors of other specialties providing primary health care.

Validation of the revised Diabetes Self-Management Questionnaire (DSMQ-R) in the primary care setting

Background Available tools measuring self-management in diabetes are often improperly validated or do not correlate with glucose metabolism. The Diabetes Self-Management Questionnaire (DSMQ-R) is a valid tool, that showed strong relationship with glucose metabolism in tertiary care among people with mostly type 1 diabetes. Aim of the study To validate the translated DSMQ-R questionnaire in a Hungarian sample of people with predominantly type 2 diabetes in primary care. Methods We enrolled 492 adults from 38 practices in this cross-sectional cohort study, who filled out the self-administered questionnaire, consisting of DSMQ-R and the Summary of Diabetes Self-Care Activities (SDSCA) questionnaires. Family doctors provided clinical data. The translation process was performed in six steps, reaching the expert committee appraisal. The validity of the questionnaire was evaluated by assessing reliability and construct validity. Results Cronbach’s alpha showed the questionnaire to reach good reliability (α = 0.845), although subscales had lower alphas. Contrary to the SDSCA questionnaire, the DSMQ-R sum scale differed significantly between persons on target vs not on target (median (interquartile range): 7.23 (6.17–8.44) vs 6.91 (5.91–8.02), and the DSMQ-R sum scale correlated significantly with BMI, HbA1c and SDSCA sum scale. In multivariate analysis higher DSMQ-R scores were significant predictor of achieving glycemic target goal. Conclusion The Hungarian translation of the DSMQ-R is a comprehensible tool to assess self-management of persons with diabetes. The questionnaire is valid and reliable in family practice, although its association with achievement of diabetes HbA1c target is weaker in primary than in tertiary care.

Clinical Presentation of the SARS-CoV-2 Virus Infection and Predictive Validity of the PCR Test in Primary Health Care Worker Patients of the Spanish National Health System

Background: Despite the impact that the SARS-CoV-2 virus infection has presented in Spain, data on the diagnostic capacity of the symptoms associated with this infection are limited, especially among patients with mild symptoms and who are detected in the primary care field (PC). The objective of the present study was to know the associated symptoms and their predictive criterial validity in SARS-CoV-2 infection among professionals working in PC. Methods: A cross-sectional, multicenter study was carried out in the Spanish National Health System, through an epidemiological survey directed to patients who underwent the PCR test for SARS-CoV-2 in the PC setting. Results: A total of 1612 patients participated, of which 86.6% were PC healthcare professionals, and of these, 67.4% family doctors. Hyposmia, with a sensitivity of 42.69% (95% CI: 37.30–48.08) and a specificity of 95.91% (95% CI: 94.78–97.03), and ageusia with a sensitivity of 39.47% (34.15–44.80) and a specificity of 95.20% (93.98–96.41) were the symptoms with the highest criteria validity indexes. Conclusions: This study identifies the specific symptoms of loss of smell or taste as the most frequently associated with SARS-CoV-2 infection, essential in the detection of COVID-19 given its high frequency and predictive capacity.

Impact of different sources of noise exposure on hearing impairment: A cross- sectional study

Background: Mental health is integrated into PHC as a strategy of WHO to fill the gap in mental health treatment. Part of this strategy needs a level of task shifting so that mental health care is provided by different level of PHC workers and not only specialists such as psychiatrists and psychologists. Objectives: To assess the knowledge and attitudes of family doctors regarding the provision of psychological health in PHCC and if there is an association between the certificates of these family doctors and their Knowledge and attitudes to psychological health. Subjects and Methods: A cross-sectional descriptive study with analytic elements was conducted in 8 family health care centers in Baghdad city/Al-Karkh. Data was collected via questionnaire form which consists of three domains: Domain one includes sociodemographic data, domain two was about knowledge and consists of (7) questions and domain three consisted of (12) questions about the attitude of physicians regarding mental health. A convenient sample of (83) family health care physicians were included in the current study. Results: The mean age of participants was 42 years (range: 27 – 53). The results revealed that 22.9% of participants were male, 77.1% were female. The percentage of mental illness seen by the physicians daily in the health care center was (15.7%). Physicians with higher degree certificates obtained higher knowledge scores in comparison to residents or practitioners as well as the females reported a significantly higher score of knowledge in comparison to males. Moreover, higher scores of positive attitudes were found. Conclusion: Physicians with higher certificates had more knowledge and attitude than other certificates; therefore, raising the awareness among family physicians about mental health services through making workshops, symposiums, more training courses is recommended.

ДЕКОМПЕНСОВАНИЙ ВИПАДОК ГІПОТИРЕОЗА З УРАЖЕННЯМ СЕРЦЕВО-СУДИННОЇ СИСТЕМИ

We present a clinical case that demonstrates a lack of compliance in a patient with hypothyroidism, which led to severe complications of the cardiovascular system. The clinical feature of this case is the development of severe complications of hypothyroidism due to the patient’s low adherence to therapy and untimely treatment. The patient had all characteristic signs of severe hypothyroidism with heart and skin lesions (total alopecia, edema, dryness and peeling of the skin). Fully available diagnostic criteria were as follows: critical disorders of thyroid hormone levels in the blood, hyperenzymemia, hypothyroidism, fluid in the pleural cavity, increased heart shadow, fluid in the pericardial cavity, left ventricular dilatation, decreased ejection fraction, arrhythmia. The predominant lesion of the cardiovascular system is characteristic of such cases and prevailed in the clinical presentation of the disease and was the direct reason for seeking medical help. Under the influence of treatment, the patient's sinus rhythm was restored, myocardial contractility improved, there was no fluid in the pericardial cavity and pleural cavity, edema decreased, mental activity and emotional state improved. However, the patient flatly refused further observation and treatment. As a result, hypothyroidism is underdiagnosed. Initiation of treatment in the early stages of the disease and prevention of complications relies on early diagnosis through systematic screening according to the recommendations. Heart disease, associated with hypothyroidism is a condition that can be prevented if it is detected and treated by family doctors in a timely manner in an outpatient setting. Timely detection of the disease and hospitalization will allow avoiding serious complications of hypothyroidism, timely diagnosing this pathology and prescribing adequate therapy according to the stage of the disease.

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.

The algorithm for providing paliative care by general practitioners - family doctors

Background. In Ukraine, as in the rest of the world, the majority of people who face life-threatening or life-limiting illnesses and who need palliative care are at home [1]. It is estimated that palliative care is needed in 40–60 % of all deaths [2]. According to the State Statistics Service of Ukraine, 616 840 persons died in 2020 [3], respectively, approximately 250 to 370 thousand patients needed palliative care in Ukraine. The management of patients throughout the progression/development of the disease and the final phase of life is assigned to the doctors who are closest to the patient – general practitioners – family doctors. The main goal of palliative care is to ensure the most attainable quality of life for patients. At the same time, the doctor must determine in a timely manner when the volume of palliative care provided exclusively from a general practitioner – family doctor is not enough and in a timely manner to involve specialized palliative care services. Purpose of the research: to develop an algorithm for the providing of palliative care by gene­ral practitioners – family doctors with the definition of patients for whom the volume of palliative care goes beyond primary health care. Materials and methods. The current legal framework governing the provision of palliative care by general practitioners – family doctors, scientific literature, questionnaires of sociological research of patients (n = 25). Methods of system analysis, synthesis, abstraction, sociological and medical-statistical methods were used. Results. The current orders of the Ministry of Health of Ukraine and sectoral standards for the provision of medical care, which are guided by general practitioners – family doctors in the provision of palliative care, were studied and the lack of consistency in the implementation of the norms determined by different standards was revealed. It was found that the use of tools to determine the level of quality of life (QOL) as the main purpose of palliative care is not proposed. The duty of the general practitioner – family doctor is the timely involvement of specialized services in the provision of palliative care. At the same time, there is no specific indicator or criterion that may indicate an insufficient provision of palliative care at the level of primary health care. Questionnaires have been proposed for determining the QOL of patients (EORTC QLQ-C30) and self-assessment of depression (PHQ-9). It has been shown that indicators of less than 50 points on the functional scales of the EORTC QLQ-C30 questionnaire and / or 10 or more points on the PHQ-9 depression scale are evidence of the need to accompany the patient by a psychologist, clergyman and social worker, that is the basis for the involvement of a multidisciplinary team of mobile palliative care. A unified algorithm of actions for the provision of palliative care by general practitioners – family doctors has been developed. Conclusions. To ensure the implementation of the rules and regulations defined for general practitioners – family doctors by various regulatory documents, instructions and sectoral standards, it is necessary to introduce an algorithm (unified scheme) of doctor's actions in the provision of palliative care. Therefore, general practitioners – family doctors need to timely apply an algorithm for identifying patients for whom the provision of palliative care provided exclusively by general practitioners – family doctors is insufficient and to establish interaction with mobile palliative services.