International Journal of Family Medicine The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Exploring Self-Efficacy in Australian General Practitioners Managing Patient Obesity: A Qualitative Survey Study Wed, 04 May 2016 16:34:42 +0000 Background. Obesity is a leading cause of morbidity and mortality in the Australian community, and general practitioners (GPs) are commonly approached by patients for assistance in losing weight. Previous studies have shown that GPs have low self-efficacy and low outcome expectation when it comes to managing overweight and obese patients, which affects their willingness to initiate and continue with weight counselling. This qualitative survey study aimed to explore the factors influencing confidence and behaviour in obesity management in GPs. Method. Twelve GPs recruited to deliver a pilot of an obesity management program participated in semistructured interviews, and interpretive analysis underpinned by social cognitive theory was performed on the transcripts. Results. Analysis identified five main themes: (1) perceived knowledge and skills, (2) structure to management approach, (3) the GP-patient relationship, (4) acknowledged barriers to weight loss and lifestyle change, and (5) prior experience and outcome expectation. Conclusions. GPs are likely to welcome tools which provide a more structured approach to obesity management. Shifting away from weight and BMI as sole yardsticks for success or failure and emphasising positive lifestyle changes for their own sake may improve GP self-efficacy and allow for a more authentic GP-patient interaction. Freya Ashman, Elizabeth Sturgiss, and Emily Haesler Copyright © 2016 Freya Ashman et al. All rights reserved. “Negotiorum Gestio” in Family Medicine, Informed Consent Obtainment, and Disciplinary Responsibility Thu, 24 Mar 2016 11:42:59 +0000 Introduction. Negotiorum gestio (NG) denotes an action where a person well intendedly acts on behalf of another without obtaining the latter’s prior consent. In broad terms, NG-like actions have played a considerable role in health care provision. In some settings, health care delivery with only little or presumed patients’ consent has been the rule rather than the exception. However, bioethical principles regarding patient autonomy and obtainment of the patient’s informed consent (IC) before intervention are now increasingly materialized in the law of many countries. Aim. To study legal consequences of NG in family medicine and IC handling options. Methods. Case law examination. Results. A disciplinary board case is described concerning a family doctor conducting unlawful NG by not coming up to legal IC requirements. Discussion and Conclusion. The practical and legal implications of IC and possible role of novel Shared Decision-Making approaches in coming up to regulation and bioethical demands are discussed. It is concluded that a doctor may run an unnecessary legal risk when conducting NG in decision-competent patients and furthermore it is suggested that novel Shared Decision-Making approaches could help in obtaining a rightful and practicable IC. Søren Birkeland Copyright © 2016 Søren Birkeland. All rights reserved. General Practitioners’ Participation in a Large, Multicountry Combined General Practitioner-Patient Survey: Recruitment Procedures and Participation Rate Mon, 07 Mar 2016 11:27:28 +0000 Background. The participation of general practitioners (GPs) is essential in research on the performance of primary care. This paper describes the implementation of a large, multicountry study in primary care that combines a survey among GPs and a linked survey among patients that visited their practice (the QUALICOPC study). The aim is to describe the recruitment procedure and explore differences between countries in the participation rate of the GPs. Methods. Descriptive analyses were used to document recruitment procedures and to assess hypotheses potentially explaining variation in participation rates between countries. Results. The survey was implemented in 31 European countries. GPs were mainly selected through random sampling. The actual implementation of the study differed between countries. The median participation rate was 30%. Both material (such as the payment system of GPs in a country) and immaterial influences (such as estimated survey pressure) are related to differences between countries. Conclusion. This study shows that the participation of GPs may indeed be influenced by the context of the country. The implementation of complex data collection is difficult to realize in a completely uniform way. Procedures have to be tuned to the context of the country. Peter P. Groenewegen, Stefan Greß, and Willemijn Schäfer Copyright © 2016 Peter P. Groenewegen et al. All rights reserved. Trajectories of Change in Obesity among Tehranian Families: Multilevel Latent Growth Curve Modeling Thu, 03 Mar 2016 06:30:58 +0000 Objectives. To evaluate the trajectories of change in obesity within and between Tehranian families, who participated in the Tehran Lipid and Glucose Study (TLGS). Methods. This study is a family-based longitudinal design, in four waves. A total of 14761 individuals, within 3980 families, were selected. Three anthropometric measurements, body mass index (BMI), waist circumference (WC), and a body shape index (ABSI), were recorded. Multilevel latent growth curve modeling (MLGCM) approach was used for evaluating the change trajectories in obesity within and between the families. Results. The mean age of the subjects in the present study was (range 3–89 years) and 50.1% were male. Obesity was significantly increased (). Individuals with more fat become obese slower, whereas families with more fat become obese faster (). The initial value and growth rate of WC and ABSI were greater in men than in women, while this result is contrary to BMI (). Conclusions. Our findings demonstrated that there is an alarming increase in the obesity trend in Tehranian families. The important role of the family in the prevention of obesity is highlighted, underlining the need for public health programs, as family centered educations to lifestyle modification, which can address this emerging crisis. Mahdi Akbarzadeh, Abbas Moghimbeigi, Hossein Mahjub, Ali Reza Soltanian, Maryam Daneshpour, and Nathan Morris Copyright © 2016 Mahdi Akbarzadeh et al. All rights reserved. Impacts of Québec Primary Healthcare Reforms on Patients’ Experience of Care, Unmet Needs, and Use of Services Wed, 10 Feb 2016 09:05:36 +0000 Introduction. Healthcare reforms launched in the early 2000s in Québec, Canada, involved the implementation of new forms of primary healthcare (PHC) organizations: Family Medicine Groups (FMGs) and Network Clinics (NCs). The objective of this paper is to assess how the organizational changes associated with these reforms have impact on patients’ experience of care, use of services, and unmet needs. Methods. We conducted population and organization surveys in 2005 and 2010 in two regions of the province of Québec. The design was a before-and-after natural experiment. Changes over time between new models and other practices were assessed using difference-in-differences statistical procedures. Results. Accessibility decreased between 2003 and 2010, but less so in the treatment than in the comparison group. Continuity of care generally improved, but the increase was less for patients in the treatment group. Responsiveness also increased during the period and more so in the treatment group. There was no other significant difference between the two groups. Conclusion. PHC reform in Québec has brought about major organizational changes that have translated into slight improvements in accessibility of care and responsiveness. However, the reform does not seem to have had an impact on continuity, comprehensiveness, perceived care outcomes, use of services, and unmet needs. Raynald Pineault, Roxane Borgès Da Silva, Sylvie Provost, Mylaine Breton, Pierre Tousignant, Michel Fournier, Alexandre Prud’homme, and Jean-Frédéric Levesque Copyright © 2016 Raynald Pineault et al. All rights reserved. Improving System Integration: The Art and Science of Engaging Small Community Practices in Health System Innovation Sun, 24 Jan 2016 14:11:03 +0000 This paper focuses on successful engagement strategies in recruiting and retaining primary care physicians (PCPs) in a quality improvement project, as perceived by family physicians in small practices. Sustained physician engagement is critical for quality improvement (QI) aiming to enhance health system integration. Although there is ample literature on engaging physicians in hospital or team-based practice, few reports describe factors influencing engagement of community-based providers practicing with limited administrative support. The PCPs we describe participated in SCOPE: Seamless Care Optimizing the Patient Experience, a QI project designed to support their care of complex patients and reduce both emergency department (ED) visits and inpatient admissions. SCOPE outcome measures will inform subsequent papers. All the 30 participating PCPs completed surveys assessing perceptions regarding the importance of specific engagement strategies. Project team acknowledgement that primary care is challenging and new access to patient resources were the most important factors in generating initial interest in SCOPE. The opportunity to improve patient care via integration with other providers was most important in their commitment to participate, and a positive experience with project personnel was most important in their continued engagement. Our experience suggests that such providers respond well to personalized, repeated, and targeted engagement strategies. Pauline Pariser, Laura Pus, Ian Stanaitis, Howard Abrams, Noah Ivers, G. Ross Baker, Elizabeth Lockhart, and Gillian Hawker Copyright © 2016 Pauline Pariser et al. All rights reserved. Differences between Groups of Family Physicians with Different Attitudes towards At-Risk Drinkers: A Post Hoc Study of the ODHIN Survey in Portugal Sun, 17 Jan 2016 16:26:11 +0000 Introduction. We have recently shown that family physicians can be classified into two groups based on their attitudes towards at-risk drinkers: one with better and the other with worse attitudes. Objective. To compare the two groups regarding demographics, alcohol-related clinical practice, knowledge of sensible drinking limits, and barriers and facilitators to working with at-risk drinkers. Methods. A random sample of 234 Portuguese family physicians who answered the Optimizing Delivery of Health Care Interventions survey was included. The questionnaire asked questions on demographics, alcohol-related clinical practice, knowledge of sensible drinking limits, and barriers and facilitators to working with at-risk drinkers. Results. Family physicians with better attitudes were younger () and less experienced () and with higher male proportion (). This group had more hours of postgraduate training (), felt more prepared to counsel risky drinkers (), and considered themselves to have better counselling efficacy (). More family physicians in the group with worse attitudes considered that doctors cannot identify risky drinkers without symptoms () and believed counselling is difficult (). Conclusions. Family physicians with better attitudes had more education on alcohol and fewer barriers to work with at-risk drinkers. These differences should be taken into account when designing implementation programs seeking to increase alcohol screening and brief advice. Frederico Rosário, Marcin Wojnar, and Cristina Ribeiro Copyright © 2016 Frederico Rosário et al. All rights reserved. Telemedicine and E-Learning in a Primary Care Setting in Sudan: The Experience of the Gezira Family Medicine Project Tue, 29 Dec 2015 12:39:50 +0000 Information and communication technology (ICT) is progressively used in the health sector (e-health), to provide health care in a distance (telemedicine), facilitate medical education (e-learning), and manage patients’ information (electronic medical records, EMRs). Gezira Family Medicine Project (GFMP) in Sudan provides a 2-year master’s degree in family medicine, with ICT fully integrated in the project. This cross-sectional study describes ICT implementation and utilization at the GFMP for the years 2011-2012. Administrative data was used to describe ICT implementation, while questionnaire-based data was used to assess candidates’ perceptions and satisfaction. In the period from April 2011 to December 2012, 3808 telemedicine online consultations were recorded and over 165000 new patients’ EMRs were established by the study subjects (125 candidates enrolled in the program). Almost all respondents confirmed the importance of telemedicine. The majority appreciated also the importance of using EMRs. Online lectures were highly rated by candidates in spite of the few challenges encountered by combining service provision with learning activity. Physicians highlighted some patients’ concerns about the use of telemedicine and EMRs during clinical consultations. Results from this study confirmed the suitability of ICT use in postgraduate training in family medicine and in service provision. K. G. Mohamed, S. Hunskaar, S. H. Abdelrahman, and E. M. Malik Copyright © 2015 K. G. Mohamed et al. All rights reserved. Geographic, Racial/Ethnic, and Sociodemographic Disparities in Parent-Reported Receipt of Family-Centered Care among US Children Thu, 17 Dec 2015 08:43:08 +0000 This study examined geographic, racial/ethnic, and sociodemographic disparities in parental reporting of receipt of family-centered care (FCC) and its components among US children aged 0–17 years. We used the 2011-2012 National Survey of Children’s Health to estimate the prevalence and odds of not receiving FCC by covariates. Based on parent report, 33.4% of US children did not receive FCC. Children in Arizona, Mississippi, Nevada, California, New Jersey, Virginia, Florida, and New York had at least 1.51 times higher adjusted odds of not receiving FCC than children in Vermont. Non-Hispanic Black and Hispanic children had 2.11 and 1.58 times higher odds, respectively, of not receiving FCC than non-Hispanic White children. Children from non-English-speaking households had 2.23 and 2.35 times higher adjusted odds of not receiving FCC overall and their doctors not spending enough time in their care than children from English-speaking households, respectively. Children from low-education and low-income households had a higher likelihood of not receiving FCC. The clustering of children who did not receive FCC and its components in several Southern and Western US states, as well as children from poor, uninsured, and publicly insured and of minority background, is a cause for concern in the face of federal policies to reduce health care disparities. Romuladus E. Azuine, Gopal K. Singh, Reem M. Ghandour, and Michael D. Kogan Copyright © 2015 Romuladus E. Azuine et al. All rights reserved. Knowledge and Perceptions of Latent Tuberculosis Infection among Chinese Immigrants in a Canadian Urban Centre Tue, 24 Nov 2015 09:27:18 +0000 Background. Since most tuberculosis (TB) cases in immigrants to British Columbia (BC), Canada, develop from latent TB infection (LTBI), treating immigrants for LTBI can contribute to the eradication of TB. However, adherence to LTBI treatment is a challenge that is influenced by knowledge and perceptions. This research explores Chinese immigrants’ knowledge and perceptions towards LTBI in Greater Vancouver. Methods. This mixed methods study included a cross-sectional patient survey at BC’s Provincial TB clinics and two focus group discussions (FGDs) with Chinese immigrants. Data from FGDs were coded and analyzed in Simplified Chinese. Codes, themes, and selected quotes were then translated into English. Results. The survey identified a mean basic knowledge score: 40.0% (95% CI: 38.3%, 41.7%). FGDs confirmed that Chinese immigrants’ knowledge of LTBI was low, and they confused it with TB disease to the extent of experiencing LTBI associated stigma. Participants also expressed difficulties navigating the health system which impeded testing and treatment of LTBI. Online videos were the preferred format for receiving health information. Conclusion. We identified striking gaps in knowledge surrounding an LTBI diagnosis. Concerns of stigma may influence acceptance and adherence of LTBI treatment in Chinese immigrants. Integrating these findings into routine health care is recommended. Jie Gao, Nicole S. Berry, Darlene Taylor, Scott A. Venners, Victoria J. Cook, and Maureen Mayhew Copyright © 2015 Jie Gao et al. All rights reserved. Why Do Parents Bring Their Children to the Emergency Department? A Systematic Inventory of Motives Wed, 04 Nov 2015 12:42:00 +0000 Parents frequently bring their children to general or pediatric emergency departments (EDs), even though many of these visits are judged by others to be “nonurgent” and inappropriate. This study examined the motives behind parents’ decisions to take their children to a pediatric emergency department (PED). At a PED in Toulouse, France, 497 parents rated their level of agreement with each of 69 possible motives—representing all categories of human motivation—for coming to the PED that day. Exploratory and confirmatory factor analyses found evidence for six separable motives, called (in order of importance) (a) Seeking Quick Diagnosis, Treatment, and Reassurance; (b) PED as the Best Place to Go; (c) Empathic Concern for Child’s Suffering; (d) Being Considered by Others as Responsible Parents; (e) External Factors; and (f) Dissatisfaction with Previous Consultation. Conclusions. Parents’ motives in bringing their children to the PED are primarily serious and goal-oriented. They are also often emotion based, as would be expected in parents of ill children. The parents would be unlikely to agree that these visits were inappropriate. Anne Costet Wong, Isabelle Claudet, Paul Sorum, and Etienne Mullet Copyright © 2015 Anne Costet Wong et al. All rights reserved. Does the Primary Care Experience Influence the Cancer Diagnostic Process? Sun, 04 Oct 2015 13:05:11 +0000 Objective. To analyze the impact of patients’ experience of care at their usual source of primary care on their choice of point of entry into cancer investigation process, time to diagnosis, and presence of metastatic cancer at time of diagnosis. Method. A questionnaire was administered to 438 patients with cancer (breast, lung, and colorectal) between 2011 and 2013 in four oncology clinics of Quebec (Canada). Multiple regression analyses (logistic and Cox models) were conducted. Results. Among patients with symptoms leading to investigation of cancer (), 47% used their usual source of primary care as the point of entry for investigation. Greater comprehensiveness of care was associated with the decision to use this source as point of entry (OR = 1.25; CI 90% = 1.06–1.46), as well as with shorter times between first symptoms and investigation (HR = 1.11; ), while greater accessibility was associated with shorter times between investigation and diagnosis (HR = 1.13; ).  Conclusion. Experience of care at the usual source of primary care has a slight influence on the choice of point of entry for cancer investigation and on time to diagnosis. This influence appears to be more related to patients’ perceptions of the accessibility and comprehensiveness of their usual source of primary care. Sylvie Provost, Raynald Pineault, Pierre Tousignant, Danièle Roberge, Dominique Tremblay, Mylaine Breton, Lynda Benhadj, Mamadou Diop, Michel Fournier, and Astrid Brousselle Copyright © 2015 Sylvie Provost et al. All rights reserved. GPs’ Perceptions of Cardiovascular Risk and Views on Patient Compliance: A Qualitative Interview Study Thu, 01 Oct 2015 12:13:10 +0000 Objective. General practitioners’ (GPs’) perception of risk is a cornerstone of preventive care. The aims of this interview study were to explore GPs’ professional and personal attitudes and experiences regarding treatment with lipid-lowering drugs and their views on patient compliance. Methods. The material was drawn from semistructured qualitative interviews. We sampled GPs purposively from ten selected practices, ensuring diversity of demographic, professional, and personal characteristics. The GPs were encouraged to describe examples from their own practices and reflect on them and were informed that the focus was their personal attitudes and experiences. Systematic text condensation was applied for analysis in order to uncover the concepts and themes. Results. The analysis revealed the following 3 main themes: (1) use of cardiovascular guidelines and risk assessment tools, (2) strategies for managing patient compliance, and (3) GPs’ own risk management. There were substantial differences in the attitudes concerning all three themes. Conclusions. The substantial differences in the GPs’ personal and professional risk perceptions may be a key to understanding why GPs do not always follow cardiovascular guidelines. The impact on daily clinical practice, personal consultation style, and patient behaviour with regard to prevention is worth studying further. Benedicte Lind Barfoed, Dorte Ejg Jarbøl, Maja Skov Paulsen, Palle Mark Christensen, Peder Andreas Halvorsen, Jesper Bo Nielsen, and Jens Søndergaard Copyright © 2015 Benedicte Lind Barfoed et al. All rights reserved. Training Family Medicine Residents in Effective Communication Skills While Utilizing Promotoras as Standardized Patients in OSCEs: A Health Literacy Curriculum Tue, 29 Sep 2015 09:19:08 +0000 Introduction. Future health care providers need to be trained in the knowledge and skills to effectively communicate with their patients with limited health literacy. The purpose of this study is to develop and evaluate a curriculum designed to increase residents’ health literacy knowledge, improve communication skills, and work with an interpreter. Materials and Methods. Family Medicine residents participated in a health literacy training which included didactic lectures and an objective structured clinical examination (OSCE). Community promotoras acted as standardized patients and evaluated the residents’ ability to measure their patients’ health literacy, communicate effectively using the teach-back and Ask Me 3 methods, and appropriately use an interpreter. Pre- and postknowledge, attitudes, and postdidactic feedback were obtained. We compared OSCE scores from the group that received training (didactic group) and previous graduates. Residents reported the skills they used in practice three months later. Results. Family Medicine residents showed an increase in health literacy knowledge and scored in the adequately to expertly performed range in the OSCE. Residents reported using the teach-back method (77.8%) and a translator more effectively (77.8%) three months later. Conclusions. Our innovative health literacy OSCE can be replicated for medical learners at all levels of training. Patti Pagels, Tiffany Kindratt, Danielle Arnold, Jeffrey Brandt, Grant Woodfin, and Nora Gimpel Copyright © 2015 Patti Pagels et al. All rights reserved. Corrigendum to “Development of a Tool to Identify Poverty in a Family Practice Setting: A Pilot Study” Mon, 21 Sep 2015 11:36:48 +0000 Vanessa Brcic, Caroline Eberdt, and Janusz Kaczorowski Copyright © 2015 Vanessa Brcic et al. All rights reserved. Are Cancer Patients’ Socioeconomic and Cultural Factors Associated with Contact to General Practitioners in the Last Phase of Life? Thu, 27 Aug 2015 15:49:05 +0000 Introduction. General practitioners (GPs) play an important role in end of life care, which should be offered regardless of socioeconomic position and cultural factors. The aim was to analyse associations between GP contacts at the end of life and socioeconomic and cultural characteristics of Danish cancer patients. Method. Population-based study identifying 599 adults who died of cancer from March to November 2006, in Aarhus County, Denmark. Associations between health register-based data on “total GP face-to-face contacts” and “GP home visits” during the last 90 days of life and patients’ socioeconomic and cultural characteristics were calculated. Results. Having low income (RR: 1.18 (95% CI: 1.03; 1.35)) and being immigrants or descendants of immigrants (RR: 1.17 (95% CI: 1.02; 1.35)) were associated with GP face-to-face contacts. However, patients living in large municipalities had lower likelihood of having both GP face-to-face contacts in general (RR: 0.85 (95% CI: 0.77;0.95)) and GP home visits (RR: 0.89 (95% CI: 0.80; 0.99)). Conclusion. This study indicates higher proportion of GP contacts to economically deprived patients and immigrants/descendants of immigrants. These subgroups were, however, small and results should be looked upon with caution. Furthermore, palliative needs were not included and together with urban/rural the underlying causes need further investigation. M. A. Neergaard, F. Olesen, J. Sondergaard, P. Vedsted, and A. B. Jensen Copyright © 2015 M. A. Neergaard et al. All rights reserved. An Algorithm Using Administrative Data to Identify Patient Attachment to a Family Physician Thu, 27 Aug 2015 12:48:16 +0000 Background. Commonly self-reported questions in population health surveys, such as “do you have a family physician?”, represent one of the best-known sources of information about patients’ attachment to family physicians. Is it possible to find a proxy for this information in administrative data? Objective. To identify the type of patient attachment to a family physician using administrative data. Methods. Using physician fee-for-service database and patients enrolment registries (Quebec, Canada, 2008–2010), we developed a step-by-step algorithm including three dimensions of the physician-patient relationship: patient enrolment with a physician, complete annual medical examinations (CME), and concentration of visits to a physician. Results. 68.1% of users were attached to a family physician; for 34.4% of them, attachment was defined by enrolment with a physician, for 31.5%, by CME without enrolment, and, for 34.1%, by concentration of visits to a physician without enrolment or CME. Eight types of patient attachment were described. Conclusion. When compared to findings with survey data, our measure comes out as a solid conceptual framework to identify patient attachment to a family physician in administrative databases. This measure could be of great value for physician/patient-based cohort development and impact assessment of different types of patient attachment on health services utilization. Sylvie Provost, José Pérez, Raynald Pineault, Roxane Borgès Da Silva, and Pierre Tousignant Copyright © 2015 Sylvie Provost et al. All rights reserved. The Role of Obesity Training in Medical School and Residency on Bariatric Surgery Knowledge in Primary Care Physicians Mon, 03 Aug 2015 15:46:22 +0000 Objective. US primary care physicians are inadequately educated on how to provide obesity treatment. We sought to assess physician training in obesity and to characterize the perceptions, beliefs, knowledge, and treatment patterns of primary care physicians. Methods. We administered a cross-sectional web-based survey from July to October 2014 to adult primary care physicians in practices affiliated with the Massachusetts General Hospital (MGH). We evaluated survey respondent demographics, personal health habits, obesity training, knowledge of bariatric surgery care, perceptions, attitudes, and beliefs regarding the etiology of obesity and treatment strategies. Results. Younger primary care physicians (age 20–39) were more likely to have received some obesity training than those aged 40–49 (OR: 0.08, 95% CI: 0.008–0.822) or those 50+ (OR: 0.03, 95% CI: 0.004–0.321). Physicians who were young, had obesity, or received obesity education in medical school or postgraduate training were more likely to answer bariatric surgery knowledge questions correctly. Conclusions. There is a need for educational programs to improve physician knowledge and competency in treating patients with obesity. Obesity is a complex chronic disease, and it is important for clinicians to be equipped with the knowledge of the multiple treatment modalities that may be considered to help their patients achieve a healthy weight. Fatima Cody Stanford, Erica D. Johnson, Mechelle D. Claridy, Rebecca L. Earle, and Lee M. Kaplan Copyright © 2015 Fatima Cody Stanford et al. All rights reserved. Less Than One-Third of Caretakers Sought Formal Health Care Facilities for Common Childhood Illnesses in Ethiopia: Evidence from the 2011 Ethiopian Demographic Health Survey Sun, 26 Jul 2015 14:13:14 +0000 Background. Most of the childhood illnesses can be proven with effective interventions. However, countless children die needlessly in developing countries due to the failure of their guardians to seek care timely. The aim of this study was to assess health care seeking behavior of caretakers of children under the age of five years for treatment of common childhood illnesses. Methods. Further analysis of the Ethiopian 2011 demographic and health survey was done. All children under the age of five reported to have been ill from the three common childhood illnesses and their caretakers were included in the analysis. A complex sample logistic regression model was employed to determine factors associated with the health care seeking behavior of caretakers. Result. A total of 2,842 caregivers who reported that their index child had at least one of the three common childhood illnesses in the two weeks preceding the survey were captured, of which 849 (29.87%; 95% CI: 28, 32%) sought formal health care facilities. Conclusion and Recommendation. In Ethiopia health care seeking behavior of caretakers for common childhood illnesses is low. Increasing mass media exposure can possibly improve the health seeking behavior of caretakers. Achamyelesh Gebretsadik, Alemayehu Worku, and Yemane Berhane Copyright © 2015 Achamyelesh Gebretsadik et al. All rights reserved. Placebo-Controlled Discontinuation of Long-Term Acid-Suppressant Therapy: A Randomised Trial in General Practice Sun, 12 Jul 2015 11:26:03 +0000 Objective. To investigate whether patients on long-term antisecretory medication need to continue treatment to control symptoms. Methods. A double-blinded randomised placebo-controlled trial in general practices in Denmark. Patients aged 18–90 who were treated with antisecretory drugs on a long-term basis were randomized to esomeprazole 40 mg or identical placebo. Outcome measures were time to discontinuation with trial medication due to failed symptom control analysed as survival data. The proportion of patients stopping trial medication during the one-year follow-up was estimated. Results. A total of 171 patients were included with a median prior duration of antisecretory treatment of four years (range: 0.5 to 14.6 years). 86 patients received esomeprazole 40 mg and 85 patients received placebo. At 12 months, statistically significantly more patients in the placebo group had discontinued (73% (62/85)) compared with the esomeprazole group (21% (18/86); < 0.001). Conclusions. Long-term users of antisecretory drugs showed a preference for the active drug compared to placebo. However, 27% of patients continued on placebo throughout the study and did not need to reinstitute usual treatment. One in five patients treated with esomeprazole discontinued trial medication due to unsatisfactory symptom control. Discontinuation of antisecretory treatment should be considered in long-term users of antisecretory drugs. This trial is registered with Trial registration ID: NCT00120315. Jon Eik Zwisler, Dorte Ejg Jarbøl, Annmarie Touborg Lassen, Jakob Kragstrup, Niels Thorsgaard, and Ove B. Schaffalitzky de Muckadell Copyright © 2015 Jon Eik Zwisler et al. All rights reserved. Management of Overweight during Childhood: A Focus Group Study on Health Professionals’ Experiences in General Practice Mon, 06 Jul 2015 12:31:41 +0000 Background. Because of the increasing prevalence of overweight and obesity in childhood in the Western world, focus on the management in general practice has also increased. Objective. To explore the experiences of general practitioners (GPs) and practice nurses participating in a randomised controlled trial (RCT) comparing two management programmes in general practice for children who are overweight or obese. Methods. Three focus groups with GPs and nurses participating in the RCT. Transcribed data were analysed using systematic text condensation followed by thematic analysis. Results. Health professionals considered it their responsibility to offer a management programme to overweight children. They recognised that management of overweight during childhood was a complex task that required an evidence-based strategy with the possibility of supervision. Health professionals experienced a barrier to addressing overweight in children. However, increasing awareness of obesity in childhood and its consequences in society was considered helpful to reach an understanding of the articulations concerning how best to address the issue. Conclusions. Health professionals in general practice recognised that they have a special obligation, capacity, and role in the management of obesity in childhood. Implementation of future management programmes must address existing barriers beyond an evidence-based standardised strategy. Lone Marie Larsen, Loni Ledderer, and Dorte Ejg Jarbøl Copyright © 2015 Lone Marie Larsen et al. All rights reserved. Improving Preclinic Preparation for Patients with Chronic Conditions in Quito, Ecuador: A Randomized Controlled Trial Wed, 25 Mar 2015 12:28:41 +0000 Objectives. As in many settings, patients in community health centers in Ecuador do not complete previsit forms or receive assistance to identify questions and concerns they would like to address in brief clinic visits with physicians. We examined the comparative effectiveness of providing (1) a previsit form to complete; (2) a previsit form along with assistance in completing the form; and (3) usual care. Methods. Parallel, three-arm randomized controlled trial in two health centers serving indigent to low-income communities in Quito, Ecuador, among 199 adult patients who took medications for at least one chronic condition. Outcome measures were self-reported satisfaction with the visit, confidence in asking questions, and extent to which patients’ objectives were met. Results. Patients who received assistance in completing a previsit form were more than twice as likely as participants in usual care to report achieving everything they wanted during their visit (AOR 2.2, ). There were no differences in any outcomes between the groups who received the previsit form with no assistance and usual care. Conclusions. For high-quality patient-centered primary care, it is important to develop and test innovative and scalable interventions for patients and physicians to make the best use of limited clinic time. K. Rodriguez, E. Kaselitz, J. Wong, S. Ligard, D. Peck, V. Hugo Mena, F. Gordillo, D. Serlin, and M. Heisler Copyright © 2015 K. Rodriguez et al. All rights reserved. Changes in Identity after Aphasic Stroke: Implications for Primary Care Wed, 21 Jan 2015 14:08:49 +0000 Background. Stroke survivors with aphasia experience difficulty associated with their communication disorder. While much has been written about aphasia’s impacts on partners/family, we lack data regarding the psychosocial adjustment of aphasic stroke survivors, with a paucity of data from the patients themselves. Methods. Qualitative study of lived experiences of individuals with poststroke aphasia. Each of the stroke survivors with aphasia completed 3-4 semistructured interviews. In most cases, patients’ partners jointly participated in interviews, which were transcribed and analyzed using techniques derived from grounded theory. Results. 12 patients were interviewed, with the total of 45 interviews over 18 months. Themes included poststroke changes in patients’ relationships and identities, which were altered across several domains including occupational identity, relationship and family roles, and social identity. While all these domains were impacted by aphasia, the impact varied over time. Conclusion. Despite the challenges of interviewing individuals with aphasia, we explored aphasia’s impacts on how individuals experience their identity and develop new identities months and years after stroke. This data has important implications for primary care of patients with aphasia, including the importance of the long-term primary care relationship in supporting psychosocial adjustment to life after aphasic stroke. Benjamin Musser, Joanne Wilkinson, Thomas Gilbert, and Barbara G. Bokhour Copyright © 2015 Benjamin Musser et al. All rights reserved. Attention-Deficit Hyperactive Disorder among Primary School Children in Menoufia Governorate, Egypt Wed, 10 Dec 2014 09:04:23 +0000 Background. Attention-deficit hyperactivity disorder (ADHD) is the most commonly diagnosed behavioral problem in children. Global variations in diagnostic criteria and rating scales of ADHD either by DSM-IV or ICD 10 may contribute to variations in its prevalence. Objectives. The study was conducted to estimate the prevalence of ADHD and to determine its risk factors. Methodology. A cross-section comparative study was conducted in a randomly selected four primary schools in Menoufia governorate, Egypt. All children after a valid consent of their parents (. 1362) were subjected to complete history taking, medical and psychological assessment, and IQ estimation. Their parents and teachers were subjected to the corresponding Arabic forms of Conner’s questionnaire. Suspected cases were confirmed and categorized by DSM-IV criteria. The sample was divided into cases and controls to study the risk factors. Results. Prevalence of ADHD was 6.9% and the male : female ratio was 3.5 : 1. The main risk factors were neonatal problems (), family history of psychiatric and medical illnesses ( and 2.8), and male gender (). Conclusion. Prevalence of ADHD among Menoufia school children was 6.9%. Dealing with its risk factors is mandatory for prevention, early management, and better outcome. Taghreed Farahat, Mohammad Alkot, Afaf Rajab, and Reda Anbar Copyright © 2014 Taghreed Farahat et al. All rights reserved. The Effect of Economic, Physical, and Psychological Abuse on Mental Health: A Population-Based Study of Women in the Philippines Thu, 27 Nov 2014 00:10:07 +0000 Background. The comparative effect of economic abuse and other forms of abuse in predicting depression and other mental health disorders has not been previously investigated despite its relevance for mental illness prevention. Objective. To determine the differential association of economic abuse on psychological distress and suicide attempts. Study Design. We used cross-sectional data from women aged 15–49 years in the 2008 Philippines Demographic and Health Surveys (PDHS) (N = 9,316). Results. Adjusting for sociodemographic confounders revealed positive associations between economic, physical, or psychological abuse and suicide attempts and psychological distress. Psychological and economic abuse were the strongest predictors of suicide attempts and psychological distress, respectively. Economic abuse was also negatively associated with psychological distress. Comorbidity with one mental health disorder greatly increased the odds of reporting the other mental health disorder. Conclusion. Overall, the results elucidate the differential effects of these forms of abuse on women’s mental health. Diddy Antai, Ayo Oke, Patrick Braithwaite, and Gerald Bryan Lopez Copyright © 2014 Diddy Antai et al. All rights reserved. Relevance of Chronic Lyme Disease to Family Medicine as a Complex Multidimensional Chronic Disease Construct: A Systematic Review Mon, 24 Nov 2014 00:00:00 +0000 Lyme disease has become a global public health problem and a prototype of an emerging infection. Both treatment-refractory infection and symptoms that are related to Borrelia burgdorferi infection remain subject to controversy. Because of the absence of solid evidence on prevalence, causes, diagnostic criteria, tools and treatment options, the role of autoimmunity to residual or persisting antigens, and the role of a toxin or other bacterial-associated products that are responsible for the symptoms and signs, chronic Lyme disease (CLD) remains a relatively poorly understood chronic disease construct. The role and performance of family medicine in the detection, integrative treatment, and follow-up of CLD are not well studied either. The purpose of this paper is to describe insights into the complexity of CLD as a multidimensional chronic disease construct and its relevance to family medicine by means of a systematic literature review. Liesbeth Borgermans, Geert Goderis, Jan Vandevoorde, and Dirk Devroey Copyright © 2014 Liesbeth Borgermans et al. All rights reserved. A Web-Based Survey of Residents’ Views on Advocating with Patients for a Healthy Built Environment in Canada Tue, 11 Nov 2014 07:54:06 +0000 Purpose. To determine family medicine residents’ perceived knowledge and attitudes towards the built environment and their responsibility for health advocacy and to identify their perceived educational needs and barriers to patient education and advocacy. Methods. A web-based survey was conducted in Canada with University of Toronto family medicine residents. Data were analyzed descriptively. Results. 93% agreed or strongly agreed that built environment significantly impacts health. 64% thought educating patients on built environment is effective disease prevention; 52% considered this a role of family physicians. 78% reported that advocacy for built environment is effective disease prevention; 56% perceived this to be the family physician’s role. 59% reported being knowledgeable to discuss how a patient’s environment may affect his/her health; 35% reported being knowledgeable to participate in community discussions on built environment. 78% thought education would help with integration into practice. Inadequate time (92%), knowledge (73%), and remuneration (54%) were barriers. Conclusions. While residents perceived value in education and advocacy as disease prevention strategies and acknowledged the importance of a healthy built environment, they did not consider advocacy towards this the family physician’s role. Barrier reduction and medical education may contribute to improved advocacy, ultimately improving physical activity levels and patient health outcomes. Matthew Cruickshank and Marcus Law Copyright © 2014 Matthew Cruickshank and Marcus Law. All rights reserved. Knowledge, Attitudes, and Motivations towards Blood Donation among King Abdulaziz Medical City Population Thu, 06 Nov 2014 00:00:00 +0000 Background. Blood donation is remarkably safe medical procedure. However, attitudes, beliefs, and level of knowledge may affect it. Objectives. To measure the level of knowledge regarding blood donation, find out positive and negative attitudes, identify the obstacles, and suggest some motivational factors. Methodology. A cross-sectional study was conducted at King Abdulaziz Medical City (KAMC). Participants were selected by convenient nonrandom sampling technique. A self-created questionnaire was used for data collection. Results. The study included 349 individuals. About 45.8% of the participants claimed that they have a history of blood donation. Reported causes for not donating blood were blood donation not crossing their mind (52.4%), no time for donation (45%), and difficulty in accessing blood donation center (41.3%). Reported motivating factors for donating blood were one day off (81.4%), mobile blood donation caravans in public areas (79.1%), token gifts (31.5%), and finally paying money (18.9%). Conclusion. People in the age group 31–50 years, males, higher education and military were more likely to donate blood as well as People who showed higher knowledge level and positive attitude towards blood donation. More educational programs to increase the awareness in specific targeted populations and also to focus on some motivational factors are recommended. Najd Alfouzan Copyright © 2014 Najd Alfouzan. All rights reserved. Low Back Pain in Primary Care: A Description of 1250 Patients with Low Back Pain in Danish General and Chiropractic Practice Tue, 04 Nov 2014 09:43:23 +0000 Study Design. Baseline description of a multicenter cohort study. Objective. To describe patients with low back pain (LBP) in both chiropractic and general practice in Denmark. Background. To optimize standards of care in the primary healthcare sector, detailed knowledge of the patient populations in different settings is needed. In Denmark, most LBP-patients access primary healthcare through chiropractic or general practice. Methods. Chiropractors and general practitioners recruited adult patients seeking care for LBP. Extensive baseline questionnaires were obtained and descriptive analyses presented separately for general and chiropractic practice patients, Mann-Whitney rank sum test and Pearson’s chi-square test, were used to test for differences between the two populations. Results. Questionnaires were returned from 934 patients in chiropractic practice and 319 patients from general practice. Four out of five patients had had previous episodes, one-fourth were on sick leave, and the LBP considerably limited daily activities. The general practice patients were slightly older and less educated, more often females, and generally worse on all disease-related parameters than chiropractic patients. All differences were statistically significant. Conclusions. LBP in primary care was recurrent, causing sick leave and activity limitations. There were clear differences between the chiropractic and general practice populations in this study. Lise Hestbaek, Anders Munck, Lisbeth Hartvigsen, Dorte Ejg Jarbøl, Jens Søndergaard, and Alice Kongsted Copyright © 2014 Lise Hestbaek et al. All rights reserved. Comparative Analysis: Potential Barriers to Career Participation by North American Physicians in Global Health Mon, 27 Oct 2014 12:14:34 +0000 Physician interest in global health, particularly among family physicians, is reflected by an increasing proliferation of field training and service experiences. However, translating initial training involvement into a defined and sustainable global health career remains difficult and beset by numerous barriers. Existing global health literature has largely examined training experiences and related ethical considerations while neglecting the role of career development in global health. To explore this, this paper extrapolates potential barriers to global health career involvement from existing literature and compares these to salary and skills requirements for archetypal physician positions in global health, presenting a framework of possible barriers to sustained physician participation in global health work. Notable barriers identified include financial limitations, scheduling conflicts, security/family concerns, skills limitations, limited awareness of opportunities, and specialty choice, with family practice often closely aligned with global health experience. Proposed solutions include financial support, protected time, family relocation support, and additional training. This framework delineates barriers to career involvement in global health by physicians. Further research regarding these barriers as well as potential solutions may help direct policy and initiatives to better utilize physicians, particularly family physicians, as a valuable global health human resource. Daniel S. Rhee, Jennifer E. Heckman, Sae-Rom Chae, and Lawrence C. Loh Copyright © 2014 Daniel S. Rhee et al. All rights reserved.