International Journal of Family Medicine http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Knowledge, Attitude, Practice, and Perceived Barriers of Colorectal Cancer Screening among Family Physicians in National Guard Health Affairs, Riyadh Sun, 28 Sep 2014 08:10:55 +0000 http://www.hindawi.com/journals/ijfm/2014/457354/ Objectives. The objective of this study is to explore the current knowledge, attitude, and practice of family physicians working in family medicine clinics in National Guard Health Affairs (NGHA), Riyadh, toward colorectal cancer (CRC) screening and to identify the barriers of the screening. Methods. Data were collected using a validated self-administered questionnaire adopted from the National Cancer Institute in USA, customized by adding and eliminating questions to be in line with the institution (NGHA) characteristics. Results. Of the 130 physicians, 56.2% of the physicians were not practicing CRC screening although 94.6% considered CRC screening effective. Board certified physicians had higher knowledge score and were practicing CRC screening more when compared to other physicians. Physicians who reported practicing CRC screening scored more on the knowledge score than those not practicing. Male physicians scored better on attitude score than female physicians. The study found that barriers were cited in higher rates among physicians not practicing CRC screening compared with practicing physicians. Lack of patients’ awareness was the most cited barrier. Conclusion. Large percentage of family physicians in this study do not practice CRC screening, despite the knowledge level and the positive attitude. Eyad Demyati Copyright © 2014 Eyad Demyati. All rights reserved. An Evaluation of the Knowledge and Utilization of the Partogragh in Primary, Secondary, and Tertiary Care Settings in Calabar, South-South Nigeria Sun, 14 Sep 2014 09:24:30 +0000 http://www.hindawi.com/journals/ijfm/2014/105853/ The challenge to maternal well-being with associated maternal wastages especially in labor has remained unsurmountable across the three tiers of health care delivery in Nigeria. This study aimed to determine and compare the factors that influence utilization of the partograph in primary, secondary, and tertiary health care delivery levels in Calabar, Nigeria. This was a descriptive study, using a self-administered semistructured questionnaire on 290 consenting nonphysician obstetric care workers, purposively recruited. The mean age of the respondents was with a preponderance of females (92.4%). Knowledge of the partograph and previous partograph training had statistically significant relationship with its utilization among respondents from the tertiary and general hospitals. The level of knowledge was higher among workers in the general hospital than those working in the university teaching hospital. Nurses/midwives in the three levels of care were significantly more knowledgeable in partograph use than other nonphysician obstetric care workers. Lack of detailed knowledge of the partograph, its nonavailability and poor staff strength in the study centers were factors militating against its ease of utilization. The authors recommend periodic in-service training and provision of partograph in labor rooms in all maternity wards in our environment. Ita B. Okokon, Afiong O. Oku, Thomas U. Agan, Udeme E. Asibong, Ekere J. Essien, and Emmanuel Monjok Copyright © 2014 Ita B. Okokon et al. All rights reserved. A Change in Students’ Perceptions of Peer and Faculty Attitudes to Rural Medicine following the Introduction of a Rural Health Rotation Wed, 27 Aug 2014 07:49:40 +0000 http://www.hindawi.com/journals/ijfm/2014/124708/ Introduction. In 2000, the Dunedin School of Medicine (one of Otago Medical School’s 3 clinical schools) introduced 7-week rural placement. A survey of students conducted before attending the placement showed that most students did not perceive faculty to have a positive view of rural health. In 2007, we explored whether students’ perceptions had changed. Method. All 5th year medical students at Otago Medical School were surveyed using items from the original study. The perceptions of students in Dunedin were compared with those of students in the other clinical schools (no rural rotation) and with those of students in the original study. Results. In 2007, there was a significantly increased likelihood of students from Dunedin reporting perceptions of positive faculty attitudes towards rural health compared with students from the other two clinical schools and with Dunedin students from the original survey. Conclusion. The results suggest that student perceptions of faculty attitudes in the school towards rural health may be changed following the introduction of a general practice rural placement to its curriculum. Martyn Williamson Copyright © 2014 Martyn Williamson. All rights reserved. Comparing the Effects of Dietary Flaxseed and Omega-3 Fatty Acids Supplement on Cyclical Mastalgia in Iranian Women: A Randomized Clinical Trial Wed, 13 Aug 2014 07:11:55 +0000 http://www.hindawi.com/journals/ijfm/2014/174532/ Considering the negative side effects of chemical drugs, there is a great need for effective alternative treatment strategies to manage cyclical mastalgia. Therefore, this study aimed at comparing the effects of flaxseed diet and omega-3 fatty acids supplement on treatment of cyclical mastalgia. In this study, 61, 60, and 60 women, respectively, received flaxseed as bread, omega-3 fatty acids as pearl, and wheat bread as their diet for two menstrual cycles. At the baseline cycle and end of both interventional cycles, intensity of mastalgia was measured using visual analogue scale. Analysis of covariance showed a significant difference among the three groups regarding the mean intensity of cyclical mastalgia in the first and second cycles of the interventions (). Also, repeated measures analysis of covariance with adjustment of two variables of age and mastalgia intensity of the baseline cycle demonstrated that flaxseed bread was more effective compared to omega-3 and wheat bread (). The results of this study demonstrated that flaxseed bread diet was an effective approach in decreasing cyclical mastalgia and could be prescribed to women as a simple treatment with few complications. Farideh Vaziri, Mansooreh Zamani Lari, Alamtaj Samsami Dehaghani, Mousa Salehi, Hossein Sadeghpour, Marzieh Akbarzadeh, and Najaf Zare Copyright © 2014 Farideh Vaziri et al. All rights reserved. The Danish Symptom Cohort: Questionnaire and Feasibility in the Nationwide Study on Symptom Experience and Healthcare-Seeking among 100 000 Individuals Wed, 23 Jul 2014 09:30:24 +0000 http://www.hindawi.com/journals/ijfm/2014/187280/ Introduction. In order to develop strategies to prevent delay in diagnosis, it is important to gain knowledge of symptoms and healthcare-seeking processes in the population. This paper describes a combined survey and register-based study with (1) focus on development of a questionnaire concerning experience of symptoms and subsequent consequences and (2) feasibility of the study. Methods. The study is a nationwide cohort study of 100 000 individuals randomly selected from the Danish general population. A comprehensive questionnaire concerning experience of symptoms and subsequent consequences was developed. The methodological framework for the development included defining the domains to be measured, identification of previous items, scales and questionnaires in the literature, and pilot and field testing. Results. A total of five domains and 16 subdomains were defined covering the area of symptom experience, symptom characteristics, reaction in response to symptom experience, external factors, and personality characteristics with potential influence on the symptom experience. In total, 49 706 questionnaires were completed, yielding a response rate of 52.2%. Conclusion. We developed a comprehensive questionnaire used in a large combined survey and register-based study concerning experience of symptoms and subsequent consequences of symptom experiences. We succeeded in conducting a large survey providing the groundwork for The Danish Symptom Cohort. Sanne Rasmussen, Jens Søndergaard, Pia Veldt Larsen, Kirubakaran Balasubramaniam, Sandra Elnegaard, Rikke Pilsgaard Svendsen, Rikke Sand Andersen, Anette Fischer Pedersen, Peter Vedsted, and Dorte Ejg Jarbøl Copyright © 2014 Sanne Rasmussen et al. All rights reserved. Knowledge and Perception on Long Acting and Permanent Contraceptive Methods in Adigrat Town, Tigray, Northern Ethiopia: A Qualitative Study Mon, 21 Jul 2014 08:24:52 +0000 http://www.hindawi.com/journals/ijfm/2014/878639/ Background. Long acting and permanent contraceptive methods have the potential to reduce unintended pregnancies but the contraceptive choice and utilization in Ethiopia are highly dominated by short term contraceptives. Objective. To assess the knowledge and perception on long acting and permanent contraceptives of married women and men in Northern Ethiopia. Method. A qualitative method was conducted in Adigrat on January, 2012. Four focus group discussions with married women and men and six in-depth interviews with family planning providers were conducted. Content analysis was used to synthesize the data. Result. Participants’ knowledge on long acting and permanent contraceptives is limited to recognizing the name of the methods. Most of the participants are not able to identify permanent methods as a method of contraception. They lack basic information on how these methods work and how they can use it. Women had fears and rumors about each of these methods. They prefer methods which do not require any procedure. Family planning providers stated as they have weakness on counseling of all contraceptive choices. Conclusion. There are personal barriers and knowledge gaps on these contraceptive methods. Improving the counseling service program can help women to increase knowledge and avoid misconceptions of each contraceptive choice. Alem Gebremariam and Adamu Addissie Copyright © 2014 Alem Gebremariam and Adamu Addissie. All rights reserved. Lifestyle and Dietary Behaviors among Saudi Preschool Children Attending Primary Health Care Centers, Eastern Saudi Arabia Thu, 10 Jul 2014 10:37:07 +0000 http://www.hindawi.com/journals/ijfm/2014/432732/ Objective. To study life styles and dietary behaviors among Saudi preschool children (1–5 years) attending primary health care centers (PHCCs) in Dammam and Qatif areas, eastern province, Saudi Arabia. Material and Methods. Cross-sectional study. Data were collected using structured, interviewer-filled questionnaire. Children and their mothers were encountered during their well-baby clinic visits. A total number of 300 preschool children and their mothers were interviewed during study period. Results. Unsatisfactory areas include smoking fathers (32%), smoking in front of children (11.3%), overweight and obesity among mothers (60.3%), noncompliance using seat belts for both parents (56.3%) and children (68%), children watching television (T.V) more than 2 hours (50%), adherence to exclusive breast feeding (only 20.7%), and late solid food introduction (65.3%). Frequent intake of unhealthy food items was 26%, 25%, and 24% for pizza, burger, and soft drinks. Unfortunately frequent intake of the following unhealthy food items was high: biscuits, deserts/chocolates, and chips which was 78%, 67%, and 72%, respectively. Conclusion. This study provides benchmark about the current situation. It provides health care workers and decision makers with important information that may help to improve health services. Magdy A. Darwish, Ghadeer Al-Saif, Suha Albahrani, and Amr A. Sabra Copyright © 2014 Magdy A. Darwish et al. All rights reserved. Relational Coordination and Organisational Social Capital Association with Characteristics of General Practice Thu, 19 Jun 2014 11:41:17 +0000 http://www.hindawi.com/journals/ijfm/2014/618435/ Background. Relational coordination (RC) and organisational social capital (OSC) are measures of novel aspects of an organisation’s performance, which have not previously been analysed together, in general practice. Objectives. The aim of this study was to analyse the associations between RC and OSC, and characteristics of general practice. Methods. Questionnaire survey study comprising 2074 practices in Denmark. Results. General practitioners (GPs) rated both RC and OSC in their general practice higher than their secretaries and nurses. The practice form was statistically significantly associated with high RC and OSC. RC was positively associated with the number of patients listed with a practice per staff, where staff is defined as all members of a practice including both owners and employees. Conclusion. The study showed that RC and OSC were significantly associated with type of profession and practice type. RC was also found to be significantly positively associated with number of patients per staff. However, the low response rate must be taken into consideration when interpreting the self-reported results of this study. Sanne Lykke Lundstrøm, Kasper Edwards, Thomas Bøllingtoft Knudsen, Pia Veldt Larsen, Susanne Reventlow, and Jens Søndergaard Copyright © 2014 Sanne Lykke Lundstrøm et al. All rights reserved. Effectiveness of Gatekeepers in Determining the Appropriate Use of Brain MRI/MRA Tests Mon, 26 May 2014 07:23:49 +0000 http://www.hindawi.com/journals/ijfm/2014/670915/ The purpose of the study is to examine whether, among patients who visited hospitals and underwent brain MRI or MRA scan tests, there was a relationship between the existence of clinically significant abnormal findings and the relevance of primary care physicians’ referrals. A case-control study was carried out at six teaching hospitals in Japan. We identified cases with significant abnormal MRI/MRA findings from radiologists’ reports based on certain explicit criteria and controls with outpatients who underwent MRI/MRA scans but did not have stroke. We also collected clinical data independently from medical records. The findings of 156 cases and 721 controls were collected for the analysis. A multivariate analysis adjusted by age group, sex, and the number of comorbidity factors showed that those who had visited the hospitals after referral were more likely to have significant abnormal findings in their MRI/MRA scan results (odds ratio [OR] = 1.6, 95% CI: 1.1 to 2.4). The present study suggests that referral from gatekeepers such as primary care physicians is effective in determining the appropriate use of brain MRI/MRA tests for hospital outpatients. Seiji Bito, Shinji Matsumura, Kazuhiko Kotani, and Shunichi Fukuhara Copyright © 2014 Seiji Bito et al. All rights reserved. Childhood Adversities are Associated with Diabetes Management in Working Age in Finland Mon, 28 Apr 2014 00:00:00 +0000 http://www.hindawi.com/journals/ijfm/2014/864572/ Backgrounds. Research findings suggest that the mind can cause physical disease. To plan the best quality of care, general practitioner needs to understand an individual's health problems in physical, social, and psychological dimensions. This study sought to establish whether adverse life events occurring in childhood and adolescence are associated with diabetes. Methods. The cohort was collected from the health and social support (HeSSup) study—a postal follow-up survey of randomized working-aged Finns initiated in 1998. The response rate was 40.0% and the final cohort size 24057. Data on reimbursed diabetes medication during the years 1998–2006 were obtained from the Social Insurance Institute of Finland registers. Subjects were divided into insulin, tablet, combination therapy, and drug-naive groups together with a control group without diabetes. The prevalence of childhood adversities was assessed based on answers to six survey questions. Results. Childhood adversities showed predominant linkage to diabetes type 2 groups, especially to the combination therapy group requiring combined insulin and tablet treatment. No connection was found between childhood adversities and insulin use. Cumulative adversities did not markedly increase the association. Conclusions. Stressful events in childhood are associated with diabetes combination therapy in working age. The meaning of the relationship remains unsolved. Lauri Pisto, Atte Vadén, Lauri Sillanmäki, and Kari Mattila Copyright © 2014 Lauri Pisto et al. All rights reserved. Early COPD Diagnosis in Family Medicine Practice: How to Implement Spirometry? Thu, 03 Apr 2014 00:00:00 +0000 http://www.hindawi.com/journals/ijfm/2014/962901/ Introduction. COPD is often diagnosed at an advanced stage because symptoms go unrecognized. Furthermore, spirometry is often not done. Methods. Study was conducted in diverse family medicine practice settings. Patients were targeted if respiratory symptoms were present. Patients had a spirometry to confirm the presence of airflow obstruction and COPD diagnosis. An evaluation of the process was done to better understand facilitating/limiting factors to the implementation of a primary care based spirometry program. Results. 12 of 19 primary care offices participated. 196 of 246 (80%) patients targeted based on the presence of smoking and respiratory symptoms did not have COPD; 18 (7%) and 32 (13%) had COPD, respectively, GOLD I and ≥II. There was no difference in the type and number of respiratory symptoms between non-COPD and COPD patients. Most of the clinics did not have access to a trained healthcare professional to accomplish spirometry. They agreed that giving access to a trained healthcare professional was the easiest and most reliable way of doing spirometry. Conclusion. Spirometry, a simple test, is recommended in guidelines to make the diagnosis of COPD. The lack of allocated time and training of healthcare professionals makes its implementation challenging in family medicine practices. Nathalie Saad, Maria Sedeno, Katrina Metz, and Jean Bourbeau Copyright © 2014 Nathalie Saad et al. All rights reserved. Long-Term Effect of Interactive Online Dietician Weight Loss Advice in General Practice (LIVA) Protocol for a Randomized Controlled Trial Sun, 30 Mar 2014 00:00:00 +0000 http://www.hindawi.com/journals/ijfm/2014/245347/ Background. Internet-based complex interventions aiming to promote weight loss and optimize healthy behaviors have attracted much attention. However, evidence for effect is lacking. Obesity is a growing problem, resulting in an increasing demand for cost efficient weight loss programs suitable for use on a large scale, for example, as part of standard primary care. In a previous pilot project by Brandt et al. (2011) without a control group, we examined the effects of online dietician counseling and found an average weight loss of 7.0 kg (95% CI: 4.6 to 9.3 kg) after 20 months. Aims and Methods. To analyze the effects of a complex intervention using trained dieticians in a general practice setting combined with internet-based interactive and personalized weight management support compared with conventional advice with a noninteractive internet support as placebo treatment in 340 overweight patients during a 2-year period. Primary endpoints are weight loss and lowering of cholesterol (LDL). We will also explore patients’ sociodemographics and use of the intervention as well as the health professionals’ views and perceptions of the intervention (their role and the advice and support that they provide). Perspective. The project will generate knowledge on the cost-effectiveness of a complex internet-based intervention in a general practice setting and on barriers and acceptability among professionals and patients. Carl J. Brandt, Vibeke Brandt, Mathilde Pedersen, Dorte Glintborg, Søren Toubro, Jesper Bo Nielsen, Gunther Eysenbach, Kirsten Brandt, and Jens Søndergaard Copyright © 2014 Carl J. Brandt et al. All rights reserved. Clinical Utility of Cognistat in Multiprofessional Team Evaluations of Patients with Cognitive Impairment in Swedish Primary Care Sun, 23 Mar 2014 09:55:40 +0000 http://www.hindawi.com/journals/ijfm/2014/649253/ Background. Diagnostic evaluations of dementia are often performed in primary health care (PHC). Cognitive evaluation requires validated instruments. Objective. To investigate the diagnostic accuracy and clinical utility of Cognistat in a primary care population. Methods. Participants were recruited from 4 PHC centres; 52 had cognitive symptoms and 29 were presumed cognitively healthy. Participants were tested using the Mini-Mental State Examination (MMSE), the Clock Drawing Test (CDT), and Cognistat. Clinical diagnoses, based on independent neuropsychological examination and a medical consensus discussion in secondary care, were used as criteria for diagnostic accuracy analyses. Results. The sensitivity, specificity, positive predictive value, and negative predictive value were 0.85, 0.79, 0.85, and 0.79, respectively, for Cognistat; 0.59, 0.91, 0.90, and 0.61 for MMSE; 0.26, 0.88, 0.75, and 0.46 for CDT; 0.70, 0.79, 0.82, and 0.65 for MMSE and CDT combined. The area under the receiver operating characteristic curve was 0.82 for Cognistat, 0.75 for MMSE, 0.57 for CDT, and 0.74 for MMSE and CDT combined. Conclusions. The diagnostic accuracy and clinical utility of Cognistat was better than the other tests alone or combined. Cognistat is well adapted for cognitive evaluations in PHC and can help the general practitioner to decide which patients should be referred to secondary care. Maria M. Johansson, Anna S. Kvitting, Ewa Wressle, and Jan Marcusson Copyright © 2014 Maria M. Johansson et al. All rights reserved. Prescription Practice for Diabetes Management among a Female Population in Primary Health Care Thu, 20 Mar 2014 07:06:19 +0000 http://www.hindawi.com/journals/ijfm/2014/103853/ Introduction. Prescription for diabetes care is an important practice in primary care. Methods. This is a descriptive study carried out on at primary care clinics over a five-month period at Al Imam Medical Complex, Riyadh, Saudi Arabia. It was cross-sectional study of 160 female diabetic patients, who visited the services between January and May, 2012. Data were collected from the medical records on the clinical characteristics and drugs prescribed for their diabetic management. Results. The majority of the sample population (82%) was older than 40 years old. Half of them had concomitant hypertension, hyperlipidemia, and obesity. There were 500 prescriptions for diabetes management. More than 57% of participants were on two or more drugs for hyperglycemia. Metformin was the most common drug prescribed. Metformin and sulphonylurea were the most common combined medications. Most of cases ( 70%) were on a combination of antihypertensive drugs. ACE or ARBs and diuretic was the most common combined prescriptions. Statins and aspirin were used by 41% and 23.8% of the research population, respectively. Conclusion. Polypharmacy is a feature in diabetes care. Most of the prescription practice for diabetic care follows the recommended guidelines for hyperglycemia and hypertension. Management of dyslipidemia among diabetic patients, however, is an area that needs to be developed. Fouzia A. ALHreashy and Abdulelah F. Mobierek Copyright © 2014 Fouzia A. ALHreashy and Abdulelah F. Mobierek. All rights reserved. Measuring Staff Empowerment Regarding Health Care for Clients with Intellectual Disabilities Tue, 25 Feb 2014 12:08:12 +0000 http://www.hindawi.com/journals/ijfm/2014/678127/ Background. Women with intellectual disabilities (ID) contract breast cancer at the same rate as the general population but have higher breast cancer mortality and lower rates of breast cancer screening. Many women with ID live in group homes or supported residences where they are cared for by direct support workers. While direct support workers are thought to influence client health, this effect is underresearched, and we lack tools for measuring staff empowerment and perceptions regarding client health. Methods. We developed and validated an instrument, the staff empowerment tool (SET), to measure staff empowerment as related to supporting clients in preventive health. Results. The SET was found to be a reliable instrument for measuring staff activation and empowerment in helping clients access mammography screening. Discussion. Quantifying staff empowerment and perspectives is important in studying and reducing disparities among adults with ID, a vulnerable population. Further research to determine the impact of staff empowerment levels on their clients’ health and health care access is suggested. The SET is a valuable tool for measuring the construct of staff empowerment, evaluating interventions, and collecting data regarding variation in staff empowerment. Joanne Wilkinson, Nechama W. Greenwood, Claire Tienwey Wang, Laura F. White, and Larry Culpepper Copyright © 2014 Joanne Wilkinson et al. All rights reserved. Tablet-Based Screening of Depressive Symptoms in Quito, Ecuador: Efficiency in Primary Care Mon, 17 Feb 2014 13:04:14 +0000 http://www.hindawi.com/journals/ijfm/2014/845397/ Depression is a frequent yet overlooked occurrence in primary health care clinics worldwide. Depression and related health screening instruments are available but are rarely used consistently. The availability of technologically based instruments in the assessments offers novel approaches for gathering, storing, and assessing data that includes self-reported symptom severity from the patients themselves as well as clinician recorded information. In a suburban primary health care clinic in Quito, Ecuador, we tested the feasibility and utility of computer tablet-based assessments to evaluate clinic attendees for depression symptoms with the goal of developing effective screening and monitoring tools in the primary care clinics. We assessed individuals using the 9-item Patient Health Questionnaire, the Quick Inventory of Depressive Symptoms-Self-Report, the 12-item General Health Questionnaire, the Clinical Global Impression Severity, and a DSM-IV checklist of symptoms. We found that 20% of individuals had a PHQ9 of 8 or greater. There was good correlation between the symptom severity assessments. We conclude that the tablet-based PHQ9 is an excellent and efficient method of screening for depression in attendees at primary health care clinics and that one in five people should be assessed further for depressive illness and possible intervention. Michelle Grunauer, David Schrock, Eric Fabara, Gabriela Jimenez, Aimee Miller, Zongshan Lai, Amy Kilbourne, and Melvin G. McInnis Copyright © 2014 Michelle Grunauer et al. All rights reserved. Adherence to Long-Term Therapies and Beliefs about Medications Thu, 13 Feb 2014 13:07:42 +0000 http://www.hindawi.com/journals/ijfm/2014/479596/ Objectives. To assess adherence to long-term medications among patients in family medicine clinics and to evaluate relationship between adherence, beliefs about medications, medication information adequacy, and other factors. Methods. Interviewer assisted survey was conducted to assess adherence using the 8-item Morisky Medication Adherence Scale (MMAS-8), beliefs about medications using beliefs about medicine questionnaire (BMQ), and the patients’ perception of medication information adequacy. Results. Of the 408 participants, 56.9% reported low adherence. Pearson’s bivariate correlation showed positive association between MMAS-8 score and BMQ-specific necessity (  ) and the perceived information adequacy (  ), and there was negative association between adherence score and BMQ specific concerns, general overuse, and harm (, 0.466, and 0.663, resp.) (). Multivariable analysis revealed that age, number of medications, number of medical conditions, specific necessity and concerns beliefs, general harm beliefs, and perceived adequacy of medication information were independent predictor of adherence. Furthermore, specific beliefs explain 27.7% of the variance in adherence, while medication information adequacy explains 32.3% of the variance in adherence. Conclusion. The prevalence of low adherence among patients on long-term medications is high and it is related to negative beliefs about medications and to inadequate information given to patients about their medications. Abdullah AlHewiti Copyright © 2014 Abdullah AlHewiti. All rights reserved. The Impact of Insurance and a Usual Source of Care on Emergency Department Use in the United States Sun, 09 Feb 2014 11:26:52 +0000 http://www.hindawi.com/journals/ijfm/2014/842847/ Background. Finding a usual source of care (USC) is difficult for certain populations. This analysis determines how insurance type and having a USC affect the settings in which patients seek care. Methods. In this cross-sectional study of the 2000–2011 Medical Expenditure Panel Surveys, we assessed the percentage of low-income persons with half or more of their ambulatory visits to the emergency department (ED). Respondents were stratified based on insurance type and presence of a USC. Results. In 2011, among Medicaid enrollees without USCs, 21.6% had half or more of their ambulatory visits to EDs compared to 8.1% for those with USCs. Among the uninsured without USCs, 24.1% went to an ED for half or more of their ambulatory visits compared to 8.8% for those with USCs in 2011. Among the privately insured without USCs, 7.8% went to an ED for half or more of their ambulatory visits compared to 5.0% for those with USCs in 2011. These differences remained in multivariate analyses. Conclusions. Those who lack USCs, particularly the uninsured and Medicaid enrollees, are more likely to rely on EDs. Winston Liaw, Stephen Petterson, David L. Rabin, and Andrew Bazemore Copyright © 2014 Winston Liaw et al. All rights reserved. Primary Healthcare Solo Practices: Homogeneous or Heterogeneous? Sun, 12 Jan 2014 00:00:00 +0000 http://www.hindawi.com/journals/ijfm/2014/373725/ Introduction. Solo practices have generally been viewed as forming a homogeneous group. However, they may differ on many characteristics. The objective of this paper is to identify different forms of solo practice and to determine the extent to which they are associated with patient experience of care. Methods. Two surveys were carried out in two regions of Quebec in 2010: a telephone survey of 9180 respondents from the general population and a postal survey of 606 primary healthcare (PHC) practices. Data from the two surveys were linked through the respondent’s usual source of care. A taxonomy of solo practices was constructed (), using cluster analysis techniques. Bivariate and multilevel analyses were used to determine the relationship of the taxonomy with patient experience of care. Results. Four models were derived from the taxonomy. Practices in the “resourceful networked” model contrast with those of the “resourceless isolated” model to the extent that the experience of care reported by their patients is more favorable. Conclusion. Solo practice is not a homogeneous group. The four models identified have different organizational features and their patients’ experience of care also differs. Some models seem to offer a better organizational potential in the context of current reforms. Raynald Pineault, Roxane Borgès Da Silva, Sylvie Provost, Marie-Dominique Beaulieu, Antoine Boivin, Audrey Couture, and Alexandre Prud'homme Copyright © 2014 Raynald Pineault et al. All rights reserved. Everyday Living with Diabetes Described by Family Members of Adult People with Type 1 Diabetes Wed, 18 Dec 2013 10:08:27 +0000 http://www.hindawi.com/journals/ijfm/2013/967872/ The aim of this study was to explore family members’ experiences of everyday life in families with adult people living with type 1 diabetes. The grounded theory method was used to gather and analyse data from the interviews of nineteen family members. Six concepts describing the family members’ views on everyday living with diabetes were generated on the basis of the data. Everyday life with diabetes is described as being intertwined with hypoglycemia. Becoming acquainted with diabetes takes place little by little. Being involved in the management and watching self-management from the sidelines are concepts describing family members’ participation in the daily management of diabetes. The family members are also integrating diabetes into everyday life. Living on an emotional roller-coaster tells about the thoughts and feelings that family members experience. Family members of adult people with diabetes are involved in the management of the diabetes in many ways and experience many concerns. The family members’ point of view is important to take into consideration when developing education for adults with diabetes. Tuula-Maria Rintala, Eija Paavilainen, and Päivi Åstedt-Kurki Copyright © 2013 Tuula-Maria Rintala et al. All rights reserved. Ethical Diversity and the Role of Conscience in Clinical Medicine Thu, 12 Dec 2013 14:12:28 +0000 http://www.hindawi.com/journals/ijfm/2013/587541/ In a climate of plurality about the concept of what is “good,” one of the most daunting challenges facing contemporary medicine is the provision of medical care within the mosaic of ethical diversity. Juxtaposed with escalating scientific knowledge and clinical prowess has been the concomitant erosion of unity of thought in medical ethics. With innumerable technologies now available in the armamentarium of healthcare, combined with escalating realities of financial constraints, cultural differences, moral divergence, and ideological divides among stakeholders, medical professionals and their patients are increasingly faced with ethical quandaries when making medical decisions. Amidst the plurality of values, ethical collision arises when the values of individual health professionals are dissonant with the expressed requests of patients, the common practice amongst colleagues, or the directives from regulatory and political authorities. In addition, concern is increasing among some medical practitioners due to mounting attempts by certain groups to curtail freedom of independent conscience—by preventing medical professionals from doing what to them is apparently good, or by compelling practitioners to do what they, in conscience, deem to be evil. This paper and the case study presented will explore issues related to freedom of conscience and consider practical approaches to ethical collision in clinical medicine. Stephen J. Genuis and Chris Lipp Copyright © 2013 Stephen J. Genuis and Chris Lipp. All rights reserved. Sexual and Reproductive Health Care for Women with Intellectual Disabilities: A Primary Care Perspective Thu, 12 Dec 2013 08:49:02 +0000 http://www.hindawi.com/journals/ijfm/2013/642472/ Adults with intellectual disabilities (ID) face multiple health disparities and challenges to accessing health care. Little is known about sexual health care of this population and about how to optimize women’s reproductive health care for women with intellectual disabilities. Women with ID face important barriers to care, including lack of provider training and experience, hesitancy to broach the topic of sexual health, a lack of sexual knowledge and limited opportunities for sex education, disability-related barriers, higher prevalence of sexual abuse and assault, often underreported, lack of dialogue around this population’s human right to consensual sexual expression, undertreatment of menstrual disorders, and legal and systemic barriers. We conducted a limited literature review related to six aspects of sexual health care of women with ID, including barriers to sexual health care, sex education, sexual abuse and consensual sexuality, contraception, screening for sexually transmitted infections and cervical cancer, and pregnancy and parenting. After providing background information about each topic, we suggest practice recommendations for primary care clinicians, using a rights-based framework. Nechama W. Greenwood and Joanne Wilkinson Copyright © 2013 Nechama W. Greenwood and Joanne Wilkinson. All rights reserved. A Pharmacist-Led Point-of-Care INR Clinic: Optimizing Care in a Family Health Team Setting Thu, 12 Dec 2013 08:27:50 +0000 http://www.hindawi.com/journals/ijfm/2013/691454/ Purpose. Monitoring patients’ international normalized ratio (INR) within a family medicine setting can be challenging. Novel methods of doing this effectively and in a timely manner are important for patient care. The purpose of this study was to determine the effectiveness of a pharmacist-led point-of-care (POC) INR clinic. Methods. At a community-based academic Family Health Team in Toronto, Canada, charts of patients with atrial fibrillation managed by a pharmacist with usual care (bloodtesting at lab and pharmacist follow up of INR by phone) from February 2008 to April 2008 were compared with charts of patients attending a weekly POC INR clinic from February 2010 to April 2010. Time in therapeutic range (TTR) was measured for both groups. Results. 119 patient charts were reviewed and 114 had TTR calculated. After excluding patients with planned inconsistent Coumadin use (20), such as initiating Coumadin treatment or stopping for a surgical procedure, the mean TTR increased from 64.41% to 77.09% with the implementation of the POC clinic. This was a statistically significant difference of 12.68% (CI: 1.18, 24.18; ). Conclusion. A pharmacist-led POC-INR clinic improves control of anticoagulation therapy in patients receiving warfarin and should be considered for implementation in other family medicine settings. Jennifer Rossiter, Gursharan Soor, Deanna Telner, Babak Aliarzadeh, and Jennifer Lake Copyright © 2013 Jennifer Rossiter et al. All rights reserved. Assessment of Preference and Its Determinant Factors to Ward Modern Contraceptive Methods among Women of Reproductive Age Group in Shire Indaselassie Town, Northern Ethiopia, 2011 Wed, 11 Dec 2013 12:04:03 +0000 http://www.hindawi.com/journals/ijfm/2013/317609/ Background. Women’s preferences for various contraceptive methods attribute vary according to the type of relations and other aspects of their life. The discrepancy between fertility preferences and contraceptive practice is regarded as an indicator of unmet demand for family planning. Objective. To assess modern contraceptive methods preference and its determinant factors among women of reproductive age group in Shire Indaselassie town, Tigray Region, Northern Ethiopia. Method. A community based cross-sectional study design was employed on 367 sampled women. Stratified sampling technique was used to select the study subjects. Then, data was collected using structured questionnaire. Result. In this study, the most commonly preferred modern contraceptive method was injectable contraceptive 202 (55%), the second 61 (16.6%) was oral contraceptives, and the third 47 (12.8%) was Norplant. Condom 31 (8.4%), IUD 14 (3.8%), female sterilization 7 (1.9%), and others were less commonly preferred methods. Some of the reasons for preference were effectiveness of the method, reversibility, fewer side effects, convenience, long duration of use, and no need to remember daily. Conclusion. This study clearly described that women preferences of modern contraceptive methods increased after they had higher number of children and less desire to limit family size. Weyzer T. Tsehaye, Daniel Mengistu, Emebet Birhanu, and Kalayou K. Berhe Copyright © 2013 Weyzer T. Tsehaye et al. All rights reserved. Risk of Burnout in Danish GPs and Exploration of Factors Associated with Development of Burnout: A Two-Wave Panel Study Sat, 07 Dec 2013 14:20:07 +0000 http://www.hindawi.com/journals/ijfm/2013/603713/ Background. We assessed risk of burnout in GPs during a 7-year followup and examined whether (1) thoughts about changing medical specialty increased the risk of burnout and (2) burned out GPs had higher job turnover rates than burnout-free GPs. Methods. In 2004 and 2012, all GPs in the county of Aarhus, Denmark, were invited to participate in a survey. Retirement status of physicians who participated in 2004 was obtained through the Registry of Health Providers in 2012. Results. 216 GPs completed both surveys. The risk of developing burnout during the 7-year followup was 13.2% (8.2–19.6%). GPs who in 2004 were burnout-free and reported that they would not select general practice as medical specialty again had a statistically significant increased risk of burnout in 2012 (OR = 4.5; 95% CI = 1.2–16.5; ). Among GPs with burnout in 2004, 25.0% had withdrawn from general practice during followup compared to 28.8% of burnout-free GPs in 2004 (adj. OR = 0.99; 95% CI = 0.48–2.02; ). Conclusion. The 7-year incidence of burnout was 13%. Thoughts about changing medical specialty were an important predictor of burnout. Burned out GPs had not higher job turnover rates than burnout-free GPs. Anette Fischer Pedersen, Christina Maar Andersen, Frede Olesen, and Peter Vedsted Copyright © 2013 Anette Fischer Pedersen et al. All rights reserved. Psychological Distress in Women with Chronic Bronchitis in a Fishing Community in the Niger Delta Region of Nigeria Thu, 05 Dec 2013 14:57:20 +0000 http://www.hindawi.com/journals/ijfm/2013/526463/ Background. Biomass smoke exposure is a known risk factor for chronic bronchitis. Psychiatric comorbidities may have significant impact on the quality of life of patients with chronic bronchitis. Methods. Women who engage in fish preservation by drying over burning firewood in a fishing community were recruited for this survey. The British medical research questionnaire was used to determine chronic bronchitis, and psychological distress was determined using the hospital anxiety and depression scale. Results. A total of 342 women were recruited for this study and 63 of them had chronic bronchitis. 96 women had features suggestive of psychological distress: 57 (16.6%) women with anxiety, 51 (14.9%) women with depression and 12 women (3.5%) had combined features. Psychological distress was more common among women with chronic bronchitis. Anxiety was significantly associated with chronic bronchitis and the level of biomass exposure while depression was significantly associated with chronic bronchitis, level of exposure, and a history of sleeping in the fish smoking room. Conclusion. Anxiety and depression show significant association with chronic bronchitis among women with biomass smoke exposure with the level of exposure having an aggravating effect on the relationship. Victor Aniedi Umoh, Andrew Ibok, Bassey Edet, Ekpe Essien, and Festus Abasiubong Copyright © 2013 Victor Aniedi Umoh et al. All rights reserved. Danish General Practitioners' Use of Prostate-Specific Antigen in Opportunistic Screening for Prostate Cancer: A Survey Comprising 174 GPs Tue, 19 Nov 2013 10:53:54 +0000 http://www.hindawi.com/journals/ijfm/2013/540707/ Background. The use of prostate-specific antigen test has markedly increased in Danish general practice in the last decade. Despite the national guidelines advice against PSA screening, opportunistic screening is supposed to be the primary reason for this increased number of PSA tests performed. Aims. Based on the increase in the amount of PSA conducted, we aimed to analyse how GPs in Denmark use the PSA test. Methods. A self-administrated questionnaire concerning symptomatic and asymptomatic patient cases was developed based on the national and international guidelines and the extensive literature review, and an in-depth interview conducted with a GP was performed. Results. None of the GPs would do a PSA measurement for an asymptomatic 76-year-old man. For asymptomatic 55- and 42-year-old men, respectively, 21.9% and 18.6% of GPs would measure PSA. Patient request and concern could be potential reasons for measuring PSA for asymptomatic patients. Almost all GPs stated that a PSA measurement is indicated for symptomatic 49- and 78-year-old men, respectively, 98.9% and 93.8%. Conclusion. Opportunistic PC screening is being performed in general practice to a high degree. Hence, current guidelines are not followed, and intense focus should be on more effective implementation strategies in order to avoid overuse of PSA. Kasper Jessen, Jens Søndergaard, Pia Veldt Larsen, and Janus Laust Thomsen Copyright © 2013 Kasper Jessen et al. All rights reserved. From Doctor to Nurse Triage in the Danish Out-of-Hours Primary Care Service: Simulated Effects on Costs Mon, 30 Sep 2013 13:47:03 +0000 http://www.hindawi.com/journals/ijfm/2013/987834/ Introduction. General practitioners (GP) answer calls to the Danish out-of-hours primary care service (OOH) in Denmark, and this is a subject of discussions about quality and cost-effectiveness. The aim of this study was to estimate changes in fee costs if nurses substituted the GPs. Methods. We applied experiences from The Netherlands on nurse performance in the OOH triage concerning the number of calls per hour. Using the 2011 number of calls in one region, we examined three hypothetical scenarios with nurse triage and calculated the differences in fee costs. Results. A new organisation with 97 employed nurses would be needed. Fewer telephone consultations may result in an increase of face-to-face contacts, resulting in an increase of 23.6% in costs fees. Under optimal circumstances (e.g., a lower demand for OOH services, a high telephone termination rate, and unchanged GP fees) the costs could be reduced by 26.2% though excluding administrative costs of a new organisation. Conclusion. Substituting GPs with nurses in OOH primary care may increase the cost in fees compared to a model with only GPs. Further research is needed involving more influencing factors, such as costs due to nurse training and running the organisation. Grete Moth, Linda Huibers, and Peter Vedsted Copyright © 2013 Grete Moth et al. All rights reserved. Relevance of Hypersexual Disorder to Family Medicine and Primary Care as a Complex Multidimensional Chronic Disease Construct Tue, 27 Aug 2013 08:56:45 +0000 http://www.hindawi.com/journals/ijfm/2013/519265/ Hypersexual disorder (HD) is not defined in a uniform way in the psychiatric literature. In the absence of solid evidence on prevalence, causes, empirically validated diagnostic criteria, instruments for diagnosis, consistent guidelines on treatment options, medical and psychosocial consequences, and type of caregivers that need to be involved, HD remains a controversial and relatively poorly understood chronic disease construct. The role of family medicine in the detection, treatment, and followup of HD is not well studied. The purpose of this paper is to describe the complexity of HD as a multidimensional chronic disease construct and its relevance to family medicine and primary care. Liesbeth Borgermans, Bert Vrijhoef, Jan Vandevoorde, Jan De Maeseneer, Johan Vansintejan, and Dirk Devroey Copyright © 2013 Liesbeth Borgermans et al. All rights reserved. Family Doctors Seen through the Eyes of Specialists: A Qualitative Study Sun, 02 Jun 2013 11:44:28 +0000 http://www.hindawi.com/journals/ijfm/2013/729473/ Germany is facing a shortage of young family doctors. In search of possible reasons the aim of this study was to explore the perception of specialists on family doctors. Within a qualitative study 16 medical specialists from different fields in hospital and outpatient care setting were interviewed. Interviews were analysed using qualitative content analysis according to Mayring. Most of the interviewed specialists have a positive view on family doctors although a certain depreciative assumption is resonated in a number of statements. According to the specialists, family doctors enjoy a high status in public, even if social processes of change may have a negative influence on their rather old-fashioned image. Specialists find that family medicine is underrepresented in university education suffering from an upgrading of specialized disciplines. Altogether the majority of the interviewed specialists certify family doctors in Germany a positive image. Lecturer in medical education and training should be aware of their key role in the career choices of young trainees and avoid degradation or upgrading of certain medical disciplines. Interlinked measures on different levels focusing on the improvement of working conditions and representation at the universities would be needed to regain attractiveness for the family doctor's profession as a career choice for young doctors. Anna Probst, Iris Natanzon, Joachim Szecsenyi, and Stefanie Joos Copyright © 2013 Anna Probst et al. All rights reserved.