Authors:
Sullivan, W. F; Diepstra, H, Heng, J, Ally, S, Bradley, E, Casson, I, Hennen, B, Kelly, M, Korossy, M, McNeil, K, Abells, D, Amaria, K, Boyd, K, Gemmill, M, Grier, E, Kennie-Kaulbach, N, Ketchell, M, Ladouceur, J, Lepp, A, Lunsky, Y, McMillan, S, Niel, U, Sacks, S, Shea, S, Stringer, K, Sue, K, Witherbee, S. PubDate: 2018-04-12T11:10:18-07:00 Issue No:Vol. 64, No. 4 (2018)
Authors:
Turley, J; Vanek, J, Johnston, S, Archibald, D. Abstract: ObjectiveTo describe and compare well-child care (WCC) in Australia, the Netherlands, and the United Kingdom (UK), focusing on the role of nurses and their interactions with other primary care providers in order to derive relevant lessons for Canada’s interprofessional primary care teams.Data sourcesOvid MEDLINE, EMBASE, and CINAHL were searched broadly using the search terms well child care, nursing role, and delivery of care and other synonymous terms. In addition, Google Scholar was used to search for gray literature, and reference mining revealed a few other relevant articles.Study selectionThe original search identified 929 articles. The inclusion criteria were the following: relevant to WCC delivery; focuses on Canada, the Netherlands, the UK, Australia, or an international comparison; describes care of healthy term infants; describes care provided in the community; and describes the role of the nurse in WCC delivery. An abstract review followed by full-text review condensed the search to 25 selected articles.SynthesisSelected articles varied in method and scope; thus, a narrative synthesis was generated using thematic analysis. In Australia, the Netherlands, and the UK, many WCC tasks are performed by trained public health nurses in a separate but parallel system to family medicine, with interaction between nurses and FPs varying greatly among countries. In general, nurses’ roles in WCC remained in the preventive care and screening domains, including monitoring development, providing health education, and supporting parents. The 3 overarching themes that were identified were around professional development and education, integration of care and interprofessional collaboration, and the nurses’ role in an evolving health system.ConclusionInternational examples, given Canada’s primary care reforms, suggest it is time to examine greater role sharing in WCC between nurses and FPs in interdisciplinary primary care teams. PubDate: 2018-04-12T11:10:18-07:00 Issue No:Vol. 64, No. 4 (2018)
Authors:Finkelstein M. Abstract: ObjectiveTo examine the relationship between household income and mortality in a primary care cohort while using personal information obtained from clinical records and administrative data linkages to adjust for confounders.DesignSurvey and analysis of data from several administrative databases.SettingToronto, Ont.ParticipantsPatients of an urban academic family practice who were aged between 45 and 74 and who had made at least 3 visits to the clinic between 1996 and 1997.Main outcome measuresPatients’ self-reported household income. Patients’ personal information obtained from clinical records and linkages to administrative data to adjust for confounders; personal information was used to adjust for health factors as confounders of the relationship between income and mortality risk.ResultsOf the 1064 patients who received surveys, 519 (49%) responded. There was no significant difference in the mortality rate between nonresponders and responders. Mortality rates were lower than those in the general population throughout follow-up. Within the patient cohort, mortality rates were elevated for smokers, those who had not consumed alcohol in the year before the survey, and those who had been diagnosed with diabetes, hypertension, or cancer before the survey. After all adjustments were made, mortality rates were lower among patients in the higher-income categories than among those with lower household incomes.ConclusionUniversal health care does not eliminate income-related differentials in mortality. Differences in health-related behaviour factors are not sufficient to explain the socioeconomic mortality differences within an area. These data suggest that it is not solely personal choice related to health behaviour but that other explanations must be invoked to account for the relationship between lower household income and increased mortality rates. PubDate: 2018-04-12T11:10:18-07:00 Issue No:Vol. 64, No. 4 (2018)
Authors:
Howard, M; Bernard, C, Klein, D, Elston, D, Tan, A, Slaven, M, Barwich, D, You, J. J, Heyland, D. K. Abstract: ObjectiveTo identify barriers to and enablers of advance care planning (ACP) perceived by physicians and other health professionals in primary care.DesignCross-sectional, self-administered survey.SettingOntario, Alberta, and British Columbia.ParticipantsFamily physicians (n = 117) and other health professionals (n = 64) in primary care.Main outcome measuresPerceived barriers relating to the clinician, characteristics of patients, and system factors, rated on a 7-point scale from 0 (not at all) to 6 (an extreme amount), and enablers reported using an open-ended question.ResultsBetween November 2014 and June 2015, questionnaires were returned by 72.2% (117 of 162) of family physicians and 68.8% (64 of 93) of the other health professionals. Physicians rated insufficient time, inability to electronically transfer the advance care plan across care settings, decreased interaction with patients near the end of life owing to transfer of care, and patients’ difficulty understanding limitations and complications of treatment options as the highest barriers. Other health professionals additionally identified their own lack of knowledge and difficulty accessing the physician as barriers. Themes identified as enablers included greater public engagement, clinician attitudes, creating capacity for clinicians, integrating ACP into practice, and system and policy supports.ConclusionIn primary care, there are barriers to engaging patients in ACP at the patient, provider, and system levels that could potentially be addressed through the informed development of multifaceted interventions. PubDate: 2018-04-12T11:10:18-07:00 Issue No:Vol. 64, No. 4 (2018)
Authors:
Sullivan, W. F; Diepstra, H, Heng, J, Ally, S, Bradley, E, Casson, I, Hennen, B, Kelly, M, Korossy, M, McNeil, K, Abells, D, Amaria, K, Boyd, K, Gemmill, M, Grier, E, Kennie-Kaulbach, N, Ketchell, M, Ladouceur, J, Lepp, A, Lunsky, Y, McMillan, S, Niel, U, Sacks, S, Shea, S, Stringer, K, Sue, K, Witherbee, S. Pages: 254 - 279 Abstract: ObjectiveTo update the 2011 Canadian guidelines for primary care of adults with intellectual and developmental disabilities (IDD).MethodsFamily physicians and other health professionals experienced in the care of people with IDD reviewed and synthesized recent empirical, ecosystem, expert, and experiential knowledge. A system was developed to grade the strength of recommendations.RecommendationsAdults with IDD are a heterogeneous group of patients and have health conditions and factors affecting their health that can vary in kind, manifestation, severity, or complexity from those of others in the community. They require approaches to care and interventions that are adapted to their needs. These guidelines provide advice regarding standards of care. References to clinical tools and other practical resources are incorporated. The approaches to care that are outlined here can be applied to other groups of patients that have impairments in cognitive, communicative, or other adaptive functioning.ConclusionAs primary care providers, family physicians play a vital role in promoting the health and well-being of adults with IDD. These guidelines can aid their decision making with patients and caregivers. PubDate: 2018-04-12T11:10:18-07:00 Issue No:Vol. 64, No. 4 (2018)
Authors:
Perry, D; Kolber, M. R, Korownyk, C, Lindblad, A. J, Ramji, J, Ton, J, Allan, G. M. Pages: 280 - 285 Abstract: ObjectiveTo summarize 10 high-quality studies from 2017 that have strong relevance to primary care practice.Quality of evidenceStudy selection involved routine literature surveillance by a group of primary care health professionals. This included screening abstracts of important journals and Evidence Alerts, as well as searching the American College of Physicians Journal Club.Main messageTopics of the 2017 articles include whether treating subclinical hypothyroidism improves outcomes or symptoms; whether evolocumab reduces cardiovascular disease as well as low-density lipoprotein levels; whether lifestyle interventions reduce medication use in patients with diabetes; whether vitamin D prevents cardiovascular disease, cancer, or upper respiratory tract infections; whether canagliflozin reduces clinical events in patients with diabetes; how corticosteroid injections affect knee osteoarthritis; whether drained abscesses benefit from antibiotic treatment; whether patients with diabetes benefit from bariatric surgery; whether exenatide reduces clinical events in patients with diabetes; and whether tympanostomy tubes affect outcomes in recurrent acute otitis media or chronic otitis media. We provide brief summaries, context where needed, and final recommendations for 10 studies with potential effects on primary care. We also briefly review 5 "runner-up" studies.ConclusionResearch from 2017 produced several high-quality studies in diabetes management. These have demonstrated benefit for alternative therapies and offered evidence not previously available. This year’s selection of studies also provided information on a variety of conditions and therapies that are, or might become, more common in primary care settings. PubDate: 2018-04-12T11:10:18-07:00 Issue No:Vol. 64, No. 4 (2018)
Authors:Zaharias G. Pages: 286 - 290 Abstract: ObjectiveTo raise awareness of narrative-based medicine (NBM) as a valuable approach to the consultation, which, if practised more widely by GPs, would convey considerable benefits to both patient and doctor.Sources of informationPrincipally, this article draws on the perspectives of 2 of NBM’s key proponents, John Launer and Rita Charon, and which are complemented by the perspectives of several other authors.Main messageThis article examines NBM in relation to patient-centred care and the particular skills that are required to practise NBM. Narrative-based medicine brings together skills from other fields of practice—skills that are not beyond the capabilities of GPs—conferring benefits on patient and doctor. Narrative-based medicine’s skills enhance the patient-centred method and an evidence-based approach.ConclusionThe literature speaks very loudly about the importance of narrative and of understanding the illness experience. What makes NBM stand out is the fact that it is a collaborative and mutually beneficial process, having the power to create a new narrative—a narrative that heals and transforms the patient and the doctor. PubDate: 2018-04-12T11:10:18-07:00 Issue No:Vol. 64, No. 4 (2018)
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