Authors:
Freyens, A; Dejeanne, M, Fabre, E, Rouge-Bugat, M.-E, Oustric, S. Abstract: ObjectiveTo explore representations of the first pelvic examination (PE) among adolescents who had not yet had this examination and to identify their criteria for a positive experience of it.DesignQualitative study using semistructured interviews.SettingMidi-Pyrénées and Auvergne in France.ParticipantsAdolescents aged 15 to 19 years who had never had a PE.MethodsParticipants were recruited through snowball sampling and targeted sampling until data saturation was reached. Maximum variation was sought in the profiles of the study participants. Open-ended questions dealt with the interviewee’s sources of information, knowledge of the PE, criteria for a positive PE experience, and representations of the PE itself. Verbatim transcripts were immediately subjected to longitudinal analysis with the context (researchers’ notes) and key themes of the interview. Cross-sectional analysis was then performed.Main findingsMany adolescents lack knowledge about the PE and believe that it is mandatory. According to study participants, the ideal PE would take place when they felt ready. They would be given adequate information in advance and the option of being accompanied by a friend or family member. They described the ideal examining room as warm, comfortable, and reassuring. The quality of their relationship with the examining physician would also affect their acceptance of this examination.ConclusionAn information session before the consultation for the PE would make it possible to reduce the patient’s apprehension, improve her level of knowledge, and set the right tone for the upcoming PE, both for her and for the physician. PubDate: 2017-08-14T07:01:51-07:00 Issue No:Vol. 63, No. 8 (2017)
Authors:
Liddy, C; Drosinis, P, Fogel, A, Keely, E. Abstract: ObjectiveTo identify the proportion and evaluate the content of eConsults (electronic consultations) in which the Champlain BASE (Building Access to Specialists through eConsultation) eConsult process prompted a referral to a specialist that was not originally contemplated by the primary care provider (PCP).DesignCross-sectional study of all eConsults submitted between April 15, 2011, and January 31, 2015.SettingChamplain Local Health Integration Network, a large health region in eastern Ontario.ParticipantsPrimary care providers registered to use the Champlain BASE eConsult service.Main outcome measuresAnswers from a close-out survey—completed by PCPs at the conclusion of each eConsult—stating that specialist referral was not originally contemplated but that the eConsult process had prompted referral. The logs containing the communication exchanged between the PCPs and the specialists were reviewed, and each prompted referral case was categorized by the type of question asked, if pharmaceutical advice was given, if the referral was redirected to a different specialty group, and if the referral was urgent.ResultsA total of 188 (3.4%) of 5601 eConsults completed during the study period were cases in which PCPs stated that they had originally not contemplated referring the patient to a specialist but that the Champlain BASE eConsult process had prompted referral. Prompted referrals were most often directed to cardiologists (10.6%), dermatologists (10.6%), infectious disease specialists (9.0%), hematologists (9.0%), and urologists (8.5%). The most common questions were about diagnosis (34.0%), drug treatment (18.0%), and management (15.0%). Pharmaceutical advice was given in 28.0% of prompted referral cases, and in 26.0% of cases, the face-to-face referral was redirected to another specialty group. In 5.0% of cases, the specialist stated the referral was urgent. The median specialist response time was 0.96 days (interquartile range 0.17 to 3.80 days).ConclusionBy providing PCPs with increased access to specialists, the Champlain BASE eConsult service serves an important role in identifying and preventing the potential detrimental consequences of delayed medical referrals across specialty groups. PubDate: 2017-08-14T07:01:51-07:00 Issue No:Vol. 63, No. 8 (2017)
Authors:
Dove, M; Dogba, M. J, Rodriguez, C. Abstract: ObjectiveTo examine the reasons why family physicians continue or discontinue providing intrapartum care in their clinical practice.DesignQualitative descriptive study.SettingTwo hospitals located in a multicultural area of Montreal, Que, in November 2011 to June 2012.ParticipantsSixteen family physicians who were current or former providers of obstetric care.MethodsData were collected using semistructured qualitative interviews. Thematic analysis was used to analyze the interview transcripts.Main findingsThree overarching themes that help create understanding of why family doctors continue to provide obstetric care were identified: their attraction, often initiated by role models early in their careers, to practising complete continuity of care and accompanying patients in a special moment in their lives; the personal, family, and organizational pressures experienced while pursuing a family medicine career that includes obstetrics; and their ongoing reflection about continuing to practise obstetrics.ConclusionThe practice of obstetrics was very attractive to family physician participants whether they provided intrapartum care or decided to stop. More professional support and incentives might help keep family doctors practising obstetrics. PubDate: 2017-08-14T07:01:51-07:00 Issue No:Vol. 63, No. 8 (2017)
Authors:
Madzima, T. R; Vahabi, M, Lofters, A. Pages: 597 - 601 Abstract: ObjectiveTo provide a focused critical review of the literature on the acceptability, feasibility, and uptake of human papillomavirus (HPV) self-sampling among hard-to-reach women.Quality of evidenceA focused search to obtain relevant literature published in English between 1997 and 2015 was done using PubMed and EMBASE using search terms including HPV self-test or HPV self-sample or HPV kit in combination with acceptability or feasibility. Only studies that focused on never-screened or underscreened populations were included in this review.Main messageHuman papillomavirus self-sampling was found to be highly acceptable and feasible among these hard-to-reach women across most studies. Mailing of self-sampling kits has been shown to increase participation among hard-to reach women. Some concerns remain regarding adherence to further follow-up among high-risk women with positive test results for HPV after screening.ConclusionThere is a strong body of evidence to support the usefulness of HPV self-sampling in increasing participation of hard-to-reach women in screening programs (level I evidence). Convenience, privacy, ease of use, and, likely, cost-effectiveness of HPV self-sampling are driving forces in its emerging role in cervical cancer screening among hard-to-reach women. Key barriers to participation could be addressed by overcoming disparities in HPV-related knowledge and perceptions about cervical cancer screening. PubDate: 2017-08-14T07:01:50-07:00 Issue No:Vol. 63, No. 8 (2017)
Authors:
Arya, N; Dahlman, B, Gibson, C, Ponka, D, Haq, C, Rouleau, K, Hansel, S. Pages: 602 - 606 Abstract: ObjectiveTo assess family medicine’s role in developing strong, coordinated, community-based, integrated health care systems in low-resource settings globally.Composition of the committeeA subgroup of the Besrour Centre of the College of Family Physicians of Canada developed connections with selected international colleagues with expertise in international family medicine practice, health systems and capacity building, and teaching to map family medicine globally and give a bird’s eye view of family medicine internationally.MethodsFollowing a background literature review, the authors collectively reflected on their substantial international experience to attempt to describe best practices for various contexts.ReportWith the failure of vertical, disease-oriented models to provide sustained improvements in health outcomes, the need to develop integrated primary care involving the most appropriate health professionals for differing contexts is becoming apparent worldwide. Health system planning is required to develop policies on health professional training to achieve this. Advocating and offering appropriate incentives for, and coordination of, local opportunities within the health system also becomes paramount. The adaptability and generalist nature of family medicine allows it to respond to the unique needs of a given population. Family physicians with adequate financial and physical resources can function most effectively as members of interdisciplinary teams, thus providing valuable, comprehensive health services in any area of the world. PubDate: 2017-08-14T07:01:50-07:00 Issue No:Vol. 63, No. 8 (2017)
Authors:
Sakulchit, T; Benseler, S. M, Goldman, R. D. Pages: 607 - 609 Abstract: Question A 7-year-old child in my office was recently discharged from the hospital after receiving intravenous immunoglobulin for Kawasaki disease. Should I continue treatment with acetylsalicylic acid (ASA), and if so, what is the appropriate dose'Answer The role of ASA for Kawasaki disease during the acute febrile phase has recently been called into question. According to several studies, ASA might reduce the duration of fever but it does not appear to directly reduce the incidence of coronary artery complications. However, with no high-quality randomized controlled trials, the evidence is scarce and more studies with good methodology are needed to determine the value of ASA in the treatment of Kawasaki disease. Currently, guidelines recommending the use of ASA should be followed. PubDate: 2017-08-14T07:01:50-07:00 Issue No:Vol. 63, No. 8 (2017)
Authors:
Neimanis, I; Gaebel, K, Dickson, R, Levy, R, Goebel, C, Zizzo, A, Woods, A, Corsini, J. Pages: 619 - 624 Abstract: ObjectiveTo evaluate the response times to requests for consultations from FPs and the wait times for patient appointments.DesignMailed invitation to participate in a survey about non-FP specialist consultation requests from April 28 to May 9, 2014.SettingHamilton, Ont.ParticipantsAll active physicians with community practices from the Department of Family Medicine at St Joseph’s Healthcare Hamilton and Hamilton Health Sciences.Main outcome measuresAll non-FP specialist consultation requests for a 2-week period.ResultsThirty-four practices (9.6% response rate) collected data on 816 consultation requests. Requests for referrals were most commonly made to the following 5 specialties: dermatology, surgery, gastroenterology, orthopedics, and obstetrics and gynecology. Overall, 36.4% of the requests for consultation received no response from the non-FP specialist’s office by the end of the follow-up period. The mean wait time for a patient appointment was 60.1 days (range 23.3 to 168.5 days). Five specialties had particularly lengthy wait times of 105.9 to 168.5 days.ConclusionAllowing 5 to 7 weeks for a response from a non-FP specialist, there was still a 36.4% nonresponse rate (similar to a pilot survey administered in 2010). Patient and physician frustration is certainly heightened and more office time and energy is expended when no acknowledgment of a referral is received within 7 weeks. This gives our community wait times much longer than those reported by any of the national bodies. PubDate: 2017-08-14T07:01:50-07:00 Issue No:Vol. 63, No. 8 (2017)
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