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Documents  Soins de santé primaires | enregistrements trouvés : 37

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Conjoint analyses of patients' preferences for primary care: a systematic review | Septembre 2022 H

Article (Médecine familiale et soins primaires)

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Background
While patients’ preferences in primary care have been examined in numerous conjoint analyses, there has been little systematic effort to synthesise the findings. This review aimed to identify, to organise and to assess the strength of evidence for the attributes and factors associated with preference heterogeneity in conjoint analyses for primary care outpatient visits.

Methods
We searched five bibliographic databases (PubMed, Embase, PsycINFO, Econlit and Scopus) from inception until 15 December 2021, complemented by hand-searching. We included conjoint analyses for primary care outpatient visits. Two reviewers independently screened papers for inclusion and assessed the quality of all included studies using the checklist by ISPOR Task Force for Conjoint Analysis. We categorized the attributes of primary care based on Primary Care Monitoring System framework and factors based on Andersen’s Behavioural Model of Health Services Use. We then assessed the strength of evidence and direction of preference for the attributes of primary care, and factors affecting preference heterogeneity based on study quality and consistency in findings.

Results
Of 35 included studies, most (82.4%) were performed in high-income countries. Each study examined 3–8 attributes, mainly identified through literature reviews (n = 25). Only six examined visits for chronic conditions, with the rest on acute or non-specific / other conditions. Process attributes were more commonly examined than structure or outcome attributes. The three most commonly examined attributes were waiting time for appointment, out-of-pocket costs and ability to choose the providers they see. We identified 24/58 attributes with strong or moderate evidence of association with primary care uptake (e.g., various waiting times, out-of-pocket costs) and 4/43 factors with strong evidence of affecting preference heterogeneity (e.g., age, gender).

Conclusions
We found 35 conjoint analyses examining 58 attributes of primary care and 43 factors that potentially affect the preference of these attributes. The attributes and factors, stratified into evidence levels based on study quality and consistency, can guide the design of research or policies to improve patients’ uptake of primary care. We recommend future conjoint analyses to specify the types of visits and to define their attributes clearly, to facilitate consistent understanding among respondents and the design of interventions targeting them.
Background
While patients’ preferences in primary care have been examined in numerous conjoint analyses, there has been little systematic effort to synthesise the findings. This review aimed to identify, to organise and to assess the strength of evidence for the attributes and factors associated with preference heterogeneity in conjoint analyses for primary care outpatient visits.

Methods
We searched five bibliographic databases (PubMed, ...

Soins de santé primaires

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Background
While quitting smoking dramatically decreases overall mortality, general practitioners (GPs) are less likely to prescribe medications for smoking cessation than other cardiovascular risk factors. Guidelines recommend providers first assess patients’ “readiness” to quit, an “opt-in” strategy, but only a minority of tobacco users are ready to quit on a given day. An “opt-out” strategy offering treatment as the default choice increased quit attempts in hospital and with pregnant women, but has not been tested in primary care. We will assess the efficacy of training GPs to offer treatment as the default choice using an encounter decision aid with current smokers seen in primary care.

Methods
This is a pragmatic cluster-randomized controlled superiority trial with block randomization at the GP level in private practice in French-speaking Switzerland. GPs will be blinded to the arm allocation. The intervention is a half-day training course teaching an ‘opt-out’ approach to smoking cessation using an encounter decision aid (paper or electronic). GPs in the enhanced usual care group receives a brief refresher training about smoking cessation without changing their behaviour. GPs in both arms will recruit 23 patients each prior to routine primary care visits. The primary outcome is the effect of consulting a GP who received the intervention on the 7-day, point prevalence, smoking abstinence 6 months after the baseline appointment. Secondary outcomes include continuous abstinence; number of quit attempts; use of smoking cessation aids; patient-perceived involvement in discussions; and changes in GP behaviour. Patient outcomes will be collected using paper and telephone questionnaires. Assuming 15% drop-out, recruiting 46 GPs with 23 patients each will give us 80% power to detect an increase in smoking cessation from 4% (control) to 10.5% (intervention), with an alpha < 0.05.

Discussion
GP visits are an opportunity to administer proven smoking cessation treatments. We hypothesize GPs offering smoking cessation treatment as the default choice using an encounter decision aid will increase the number of patients who quit. This study could significantly change our approach to smoking cessation in primary care. Default choices and the electronic decision aid are low-cost, easily diffusible interventions.

Trial registration
ClinicalTrials.gov Identifier: NCT04868474, First Posted May 3, 2021, Last Update Posted October 6, 2021.
Background
While quitting smoking dramatically decreases overall mortality, general practitioners (GPs) are less likely to prescribe medications for smoking cessation than other cardiovascular risk factors. Guidelines recommend providers first assess patients’ “readiness” to quit, an “opt-in” strategy, but only a minority of tobacco users are ready to quit on a given day. An “opt-out” strategy offering treatment as the default choice increased ...

Tabagisme - Traitement ; Tabagisme ; Soins de santé primaires

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Quality indicator framework for primary care of patients with dementia | Septembre 2022 H

Article (Médecine familiale et soins primaires)

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Objective To develop a framework of population-based primary care quality indicators adapted to patients with dementia and to identify a subset of stakeholder-driven priority indicators.

Design Framework development was carried out through the selection of an initial framework based on a rapid review and identification of relevant indicators and enrichment based on existing dementia indicators and guidelines. Prioritization of indicators was carried out through a stakeholder survey.

Setting Ontario, Quebec, New Brunswick, and Saskatchewan.

Participants Stakeholders in community dementia care (N=109) including clinicians, patients, caregivers, decision makers, and managers.

Main outcome measures Primary care quality indicators.

Results The framework comprised 34 indicators across 8 domains of quality (access, integration, effective care, efficient care, equity, safety, population health, and patient-centred care). Access to a regular primary care provider, continuity of care, early-stage diagnosis, and access to home care were consistently rated as priorities. Equitable care was a specific priority among patients and caregivers; clinicians reported avoidable hospitalizations as among their priorities.

Conclusion A framework of indicators was established for persons with dementia that adds an important dimension to existing primary care and dementia quality indicators by providing primary care and population-based perspectives. This framework could set a foundation for the ongoing monitoring of primary care practices and policies for persons with dementia at a population level.

Dementia, including Alzheimer disease, has been recognized by the World Health Organization as a global public health crisis.1,2 Half a million Canadians live with dementia, a number expected to double over the next generation.3 Moreover, more than 60% of persons with dementia live at home and are cared for in the community.4 There is growing consensus in Canada and elsewhere that family physicians, with the support of other health care professionals, are ideally positioned to provide a person-centred approach with respect to the prevention of dementia and to the diagnosis, treatment, and follow-up of most persons with dementia.5-9 Given the growing role of primary care in the care of the population with dementia, it is essential to monitor and evaluate ongoing quality initiatives or policy interventions aimed at improving the quality of care of persons with dementia in primary care. Quality indicators that align with stakeholders’ needs and can be measured routinely using readily available sources are necessary to ensure feedback and improvement are continuous and decision making is efficient and timely.10,11

Within the primary care literature, several general frameworks have been proposed to measure the quality of primary care.12-14 However, it is unclear whether these frameworks are applicable or appropriate for persons with dementia; incorporate indicators relevant to dementia and of importance to stakeholders; and have indicators that can be measured using routinely collected data such as health administrative data. In addition, within the dementia literature, work on indicators has focused on clinical processes of care assessed primarily through chart review.15-19 While these indicators provide an essential component of the evaluation of the quality of care provided to patients with dementia, they cannot easily be measured routinely.

This study aimed to develop a framework of primary care quality indicators for persons with dementia based on health administrative data and to identify stakeholder-relevant priority indicators for ongoing quality monitoring in this population.
Objective To develop a framework of population-based primary care quality indicators adapted to patients with dementia and to identify a subset of stakeholder-driven priority indicators.

Design Framework development was carried out through the selection of an initial framework based on a rapid review and identification of relevant indicators and enrichment based on existing dementia indicators and guidelines. Prioritization of indicators was ...

Soins de santé primaires ; Démence

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Physician Satisfaction With Telehealth: A Systematic Review and Agenda for Future Research | Juillet / Septembre 2022 H

Article (Gestion, administration et droit de la santé)

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Background and Objectives: The use of telehealth has risen dramatically due to the Covid-19 pandemic and is expected to be a regular part of patient care moving forward. We know little currently about how satisfied physicians are with this type of patient care. The present systematic review examines physician satisfaction with telehealth, as physician acceptance remains vital to telehealth gaining wider and more permanent adoption.

Methods: A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-guided systematic review of empirical articles published between 2010 and 2020 that contain a finding examining physician satisfaction with using telehealth, using 4 article databases (PubMed, Web of Science, COCHRANE, and CINAHL), to identify relevant studies. A standardized data abstraction Excel sheet was used to extract relevant information from each of the included studies. Relevant study findings related to physician satisfaction with telehealth were reviewed for each of the 37 studies by the coauthors.

Results: A total of 37 published studies were included in the review. Thirty-three of the 37 (89%) studies reviewed were classified as having findings showing moderate to high levels of physician satisfaction with telehealth. Just under 60% of the studies focused on physician satisfaction with providing telemedicine to patients (21/37). Twelve other studies focused on physician satisfaction with teleconsultations with other providers. Four studies examined physician satisfaction with both. The type of patient telemedicine or provider teleconsultation performed varied greatly across the 37 studies, with several different diagnoses or care situations included. Research designs used in the studies were less robust, with all studies using primary data for assessing physician satisfaction but only one study providing any type of multivariate analysis of physician satisfaction with telehealth.

Conclusion: The results of this review support the observation that physicians across different specialties, geographic locations, practice locations, and care situations appear satisfied with engaging in telehealth for both patient care and consultations with other physicians. The research on telehealth should be enhanced, given how ubiquitous telehealth has become due to the Covid-19 pandemic. This enhancement should include larger physician sample sizes in studies of telehealth satisfaction; more research focused on telehealth in the primary care setting; and the types of virtual modalities that have become more commonplace for physicians to use due to the Covid-19 pandemic.
Background and Objectives: The use of telehealth has risen dramatically due to the Covid-19 pandemic and is expected to be a regular part of patient care moving forward. We know little currently about how satisfied physicians are with this type of patient care. The present systematic review examines physician satisfaction with telehealth, as physician acceptance remains vital to telehealth gaining wider and more permanent adoption.

Methods: A ...

Télémédecine ; Soins de santé primaires

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- 764 p.
Cote : WB102 D2491c 2022

guidelines and recommendations for the most common outpatient conditions - from sources you can trust!

- Organized into topics related to disease screening, prevention and management, and further subdivided into organ systems for quick reference
- Consolidates informations form government agencies, medical and scientific organizations, and expert panels into concise recommendations and guidelines
- Updated with more than 90 new guidelines
- Significant updates to colorectal cancer screening, migraine prevention, and management of diabetes, cellulitis, asthma, and chronic pain among many others
- New sections on orthopedics and sports medicine in addition to expanded specialty areas such as addiction medicine, transgender health, maternity care and hospital medicine
- Spans all areas of general medicine and covers primary care topics in both ambulatory and hospital settings
- Includes website addresses for U.S. government agencies and professional societies
guidelines and recommendations for the most common outpatient conditions - from sources you can trust!

- Organized into topics related to disease screening, prevention and management, and further subdivided into organ systems for quick reference
- Consolidates informations form government agencies, medical and scientific organizations, and expert panels into concise recommendations and guidelines
- Updated with more than 90 new guidelines
- ...

MÉDECINE CLINIQUE ; Médecine préventive ; Soins de santé primaires ; Médecine familiale

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Presque tous les cas de cancer du col (CC) sont causés par une infection persistante au virus du papillome humain (VPH). Le cancer du col est le deuxième carcinome en importance chez les femmes; malgré tout, les taux de dépistage pour le Canada en 2017 ont raté l’objectif par 19 %. On a, par exemple, observé des taux aussi bas que 57,6 % dans les quartiers défavorisés de l’Ontario, comparativement à 70 % dans les quartiers aisés. Des obstacles complexes et multifactoriels nuisent à la participation des femmes au dépistage du cancer du col (DCC). Les écueils les plus courants sont directement liés aux disparités dans les déterminants de santé, notamment l’appartenance à une minorité ethnique, le faible statut socio-économique, une moins grande éducation, et la difficulté d’accès aux soins de santé. Les infirmières praticiennes (IP) peuvent aplanir ces obstacles en prodiguant des soins d’avant-garde, fondés sur la recherche, respectueux de la culture et attentifs aux besoins des femmes tout en établissant des liens de confiance avec les patientes, jouant ainsi un rôle plus vaste dans la prévention de la maladie. L’objectif de la présente revue de littérature est de résumer les contraintes au DCC et le rôle que peuvent jouer les IP canadiennes pour les alléger.
Presque tous les cas de cancer du col (CC) sont causés par une infection persistante au virus du papillome humain (VPH). Le cancer du col est le deuxième carcinome en importance chez les femmes; malgré tout, les taux de dépistage pour le Canada en 2017 ont raté l’objectif par 19 %. On a, par exemple, observé des taux aussi bas que 57,6 % dans les quartiers défavorisés de l’Ontario, comparativement à 70 % dans les quartiers aisés. Des obstacles ...

Infirmiers - Rôle professionnel ; Infirmières - Rôle professionnel ; Soins de santé primaires ; Cancer - Diagnostic ; Col de l'utérus - Cancer ; Col de l'utérus - Cancer - Dépistage ; Dépistage (Médecine)

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Introduction : La rétention des professionnels de la santé (PS) dans le réseau de la santé durant une pandémie telle que celle de la COVID-19 est un enjeu crucial. Mieux comprendre les facteurs pouvant motiver ou dissuader les PS de fournir des soins aux personnes atteintes de la COVID-19 permettrait la mise en place de mesures favorisant le maintien et la qualité des soins.
Objectif : Cette étude vise à identifier les facteurs modulant l’intention des PS à éviter de prendre soin de personnes atteintes de la COVID-19.
Méthode : Les PS du Québec (Canada) ont été invités à répondre à un questionnaire en ligne, entre les mois d’avril et août 2020, durant la première vague de la pandémie de la COVID-19 dans ce pays. Ce questionnaire portait sur leur intention de prendre soin des personnes atteintes de la COVID-19, leur expérience dans la prise en charge de tels patients et leur niveau d’anxiété par rapport à la pandémie. Des analyses statistiques descriptives et des régressions multiples ont été réalisées afin de déterminer si certains PS présentaient un profil différent en regard de l’intention d’éviter de prendre soin d’une personne atteinte de la COVID-19.
Résultats : Un total de 430 PS ont répondu au questionnaire. Les PS étaient en majorité des femmes (87 %) et des infirmières (50 %). De ce nombre, certains ont dit avoir pensé (12 %) ou avoir pris des mesures (5 %) pour se soustraire à l’administration de soins aux personnes atteintes de la COVID-19. Dix-huit pour cent ont dit être prêts à saisir une occasion qui leur permettrait de ne pas prendre soin de tels patients. Être médecin (RC : 0,47 IC 0,23-0,94) et avoir antérieurement prodigué des soins à des personnes atteintes de la COVID-19 (RC : 0,56 IC 0,36-0,86) étaient significativement associés à une intention moindre d’éviter de prendre soin de personnes atteintes de la COVID-19. Une plus grande intention d’éviter de travailler avec de tels patients a été associée positivement avec l’augmentation du score d’anxiété des PS (RC : 1,06 IC 1,04-1,08).
Conclusion : Avoir antérieurement prodigué des soins à une personne atteinte de la COVID-19 et le fait d’être médecin étaient associés à une intention d’évitement moindre à soigner des patients infectés par la COVID-19. L’anxiété représenterait un facteur prédictif de la volonté des PS de se retirer de la prise en charge de personnes atteintes de la COVID-19. L’identification des déterminants de l’anxiété chez les PS et des facteurs pouvant les motiver à fournir des soins aux personnes atteintes de la COVID-19 pourrait permettre l’élaboration de stratégies adaptées visant le bien-être global et la rétention du personnel de santé en temps de pandémie.
Introduction : La rétention des professionnels de la santé (PS) dans le réseau de la santé durant une pandémie telle que celle de la COVID-19 est un enjeu crucial. Mieux comprendre les facteurs pouvant motiver ou dissuader les PS de fournir des soins aux personnes atteintes de la COVID-19 permettrait la mise en place de mesures favorisant le maintien et la qualité des soins.
Objectif : Cette étude vise à identifier les facteurs modulant ...

COVID-19 ; Coronavirus ; Anxiété ; Motivation en éducation ; Personnel médical - Responsabilité professionnelle ; Infirmières - Rôle professionnel ; Médecins - Responsabilité professionnelle ; Soins de santé primaires ; Santé publique - Enquêtes

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A Model for Sleep Apnea Management in Underserved Patient Populations | Janvier 2022 H

Article (Médecine familiale et soins primaires)

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Introduction:
Obstructive sleep apnea (OSA) is a common condition in the United States that is strongly linked to metabolic disease, cardiovascular disease, and increased mortality. Uninsured populations experience sleep health disparities, including delayed recognition, diagnosis, and treatment of OSA due to barriers accessing and affording care. Partnerships between primary care clinics and sleep medicine specialists for sleep apnea management have the potential to increase screening, testing, and treatment among underserved populations. Here, we present an integrated and cost-effective model that is easier to navigate for patients while maintaining high quality care.

Methods:
We designed and implemented a specialty sleep clinic at Shade Tree Clinic, Vanderbilt’s student-run, free primary care clinic. Patients with signs and symptoms of OSA were identified at primary care appointments and screened using the STOP-BANG questionnaire. Clinic visits took place over telehealth with a medical student and sleep specialist. Patients were diagnosed using a home sleep test, and if indicated, were prescribed and given a CPAP device for treatment. CPAP adherence was monitored using a cloud-based remote monitoring system.

Results:
From December 2020 through August 2021, we hosted 6 telehealth Sleep Clinics, seeing a total of 28 patients across these visits. We have received a total of 37 referrals and have coordinated sleep evaluations and diagnostic testing for 18 of these patients so far. Prior to initiation of the sleep clinic, there were 17 patients on our primary care panel at Shade Tree with a diagnosis of OSA. These patients were using donated equipment and many had been lost to follow-up or had broken parts. We were able to replace 10 of these patient’s CPAP devices and plan to replace the remaining seven.

Conclusions:
We have created a model of integrated specialty care that is efficient and cost-effective. This paradigm can be replicated for the many specialties that are typically overlooked and undertreated when working with uninsured patients. As awareness of this sleep medicine program becomes more widespread at Shade Tree Clinic, we anticipate reaching more primary care patients with signs and symptoms of sleep apnea through student education, cost-effective diagnostics, and partnership with sleep specialists.
Introduction:
Obstructive sleep apnea (OSA) is a common condition in the United States that is strongly linked to metabolic disease, cardiovascular disease, and increased mortality. Uninsured populations experience sleep health disparities, including delayed recognition, diagnosis, and treatment of OSA due to barriers accessing and affording care. Partnerships between primary care clinics and sleep medicine specialists for sleep apnea management ...

Syndromes des apnées du sommeil ; Services de santé - Accessibilité ; Soins de santé primaires

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Exploring Foot Care Conditions for People Experiencing Homelessness: A Community Participatory Approach | Janvier 2022 H

Article (Médecine familiale et soins primaires)

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Introduction:
People experiencing homelessness are faced with complex challenges and are at high risk of illness due to inequities and disparities in access to health care services.

Objective:
To explore the health and foot care problems related to people experiencing homelessness in British Columbia.

Methods:
A community participatory research approach was used with a sample of 65 people experiencing homelessness. Data were collected using a survey questionnaire and face-to-face semistructured interviews.

Results:
Thematic findings shows risk of foot injuries, lack of foot care resources, and absence of family support. Barriers to equitable access to services for most participants experiencing homelessness were lack of housing (76.92%), inability to work (72.31%), and inability to afford the cost of living on their own (63.08%).

Conclusions:
There is a pressing need for early screening and detection by health care professionals and enhanced foot care services to reduce foot problems and improve foot care wellness of homeless people. Addressing foot-related care are necessary steps in promoting health, preventing illness, and improving access to health services among people experiencing homelessness.
Introduction:
People experiencing homelessness are faced with complex challenges and are at high risk of illness due to inequities and disparities in access to health care services.

Objective:
To explore the health and foot care problems related to people experiencing homelessness in British Columbia.

Methods:
A community participatory research approach was used with a sample of 65 people experiencing homelessness. Data were collected using a ...

Services de santé - Accessibilité ; Soins de santé primaires ; Sans-abris - Services de santé

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PURPOSE To determine whether acute respiratory infection (ARI) decision aids and a general practitioner (GP) training package reduces antibiotic dispensing rate and improves GPs’ knowledge of antibiotic benefit-harm evidence.

METHODS A cluster randomized trial of 27 Australian general practices (13 intervention, 14 control) involving 122 GPs. Intervention group GPs were given brief decision aids for 3 ARIs (acute otitis media, acute sore throat, acute bronchitis) and video-delivered training. Primary outcome was dispensing rate of target antibiotic classes (routinely used for ARIs), extracted for 12 months before, and following, randomization. Secondary outcomes were GPs’ knowledge of antibiotic benefit-harm evidence; prescribing influences; acceptability, usefulness, and self-reported resource use; and dispensing rate of all antibiotics.

RESULTS The baseline mean dispensing rate of ARI-related antibiotics was 3.5% (intervention GPs) and 3.2% (control GPs) of consultations. After 12 months, mean rates decreased (to 2.9% intervention; 2.6% control): an 18% relative reduction from baseline but similar in both groups (rate ratio 1.01; 95% CI, 0.89-1.15). Greater increases in knowledge were seen in the intervention group than control; a significant increase (average 3.6; 95% CI, 2.4-4.7, P <.001) in the number of correct responses to the 22 knowledge questions. There were no between-group differences for other secondary outcomes. The intervention was well received, perceived as useful, and reported as used by about two-thirds of intervention GPs.

CONCLUSIONS A brief shared decision-making intervention provided to GPs did not reduce antibiotic dispensing more than usual care, although GPs’ knowledge of relevant benefit-harm evidence increased significantly.
PURPOSE To determine whether acute respiratory infection (ARI) decision aids and a general practitioner (GP) training package reduces antibiotic dispensing rate and improves GPs’ knowledge of antibiotic benefit-harm evidence.

METHODS A cluster randomized trial of 27 Australian general practices (13 intervention, 14 control) involving 122 GPs. Intervention group GPs were given brief decision aids for 3 ARIs (acute otitis media, acute sore ...

Appareil respiratoire - Infections ; Antibiotiques ; Soins de santé primaires

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Addressing COVID-19 Immunization Disparities Through Targeted Primary Care Outreach | Janvier 2022 H

Article (Médecine familiale et soins primaires)

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THE INNOVATION
Despite the availability of coronavirus disease 2019 (COVID-19) vaccinations in the United States, vaccine hesitancy and care gaps exist among patients. A community health clinic developed an outreach process utilizing primary care to eliminate COVID-19 vaccination barriers and misconceptions for their most vulnerable patients.

COVID-19 ; Coronavirus ; Soins de santé primaires

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PURPOSE The COVID-19 pandemic has dramatically affected all areas of health care. Primary care practices are on the front lines for patients seeking health care during this period. Understanding clinical and administrative staff members’ strategies for managing the broad-ranging changes to primary care service delivery is important for the support of workforce well-being, burnout, and commitment to primary care.

METHODS Thirty-three staff members from 8 practices within a single health care system completed short, semistructured interviews from May 11, 2020 to July 20, 2020. Interviews were coded using a combination of conventional and directed content analysis.

RESULTS Themes emerged from the data that mapped onto the Job Demands-Control-Social Support model. Participants reported that every aspect of primary care service delivery needed to be adapted for COVID-19, which increased their job demands significantly. Several also described pride in their development of new skills, and in most interviews, they expressed that the experience brought staff together. Staff engaged in active cognitive reframing of events during the interviews as they coped with increased workplace stress. However, as the pandemic changed from an acute stress event to a chronic stressor, staff were more likely to indicate signs of burnout.

CONCLUSIONS Primary care teams absorbed tremendous burdens during COVID-19 but also found that some stress was offset by increased support from management and colleagues, belief in their own necessity, and new development opportunities. Considering high prepandemic strain levels, the ability of primary care teams to persist under these conditions might erode as the crisis becomes an enduring challenge.
PURPOSE The COVID-19 pandemic has dramatically affected all areas of health care. Primary care practices are on the front lines for patients seeking health care during this period. Understanding clinical and administrative staff members’ strategies for managing the broad-ranging changes to primary care service delivery is important for the support of workforce well-being, burnout, and commitment to primary care.

METHODS Thirty-three staff ...

COVID-19 ; Stress ; Angoisse ; Soins de santé primaires ; Épuisement professionnel

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Increasing Capacity for Treatment of Opioid Use Disorder in Rural Primary Care Practices | Janvier 2022 H

Article (Médecine familiale et soins primaires)

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PURPOSE Evidence supports treatment for opioid use disorder (OUD) with buprenorphine in primary care practices (PCPs). Barriers that slow implementation of this treatment include inadequately trained staff. This study aimed to increase the number of rural PCPs providing OUD treatment with buprenorphine. This evaluation describes the impact of a practice team training on the implementation and delivery of OUD treatment with buprenorphine in PCPs of rural Colorado.

METHODS Implementing Technology and Medication Assisted Treatment Team Training in Rural Colorado (IT MATTTRs) was a multilevel implementation study that included a practice-focused intervention to improve awareness, adoption, and use of buprenorphine treatment for OUD. Participating PCP teams received the IT MATTTRs Practice Team Training and support. Practices’ implementation of treatment components was assessed before and after training. Practice-reported and population-level data from the Prescription Drug Monitoring Program were obtained to describe changes in delivery of treatment after training.

RESULTS Forty-two practices received team training. Practices reported an average of 4.7 treatment-related components in place at baseline compared with 13.0 at 12-month follow-up (F[2,56] = 31.17, P <.001). The proportion of participating practices providing or referring patients for treatment increased from 18.8% to 74.4%. The increase in number of people with a prescription for buprenorphine was significantly greater in the study region over a 4-year period compared with the rest of the state (Wald χ2 = 15.73, P <.001).

CONCLUSIONS The IT MATTTRs training for PCP teams in OUD treatment with buprenorphine addressed elements beyond clinician waiver training to make implementation feasible and effectively increased implementation and delivery of this treatment in rural Colorado.
PURPOSE Evidence supports treatment for opioid use disorder (OUD) with buprenorphine in primary care practices (PCPs). Barriers that slow implementation of this treatment include inadequately trained staff. This study aimed to increase the number of rural PCPs providing OUD treatment with buprenorphine. This evaluation describes the impact of a practice team training on the implementation and delivery of OUD treatment with buprenorphine in PCPs ...

Opioïdes ; Soins de santé primaires ; Dépendance (Psychologie)

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Cote : W84.6 E785 2021

Essential Med Notes is a clinical complement and resource for medical trainees. This 37th edition features substantial content revisions to the main text, figures, graphics, and evidence-based medicine boxes of all 31 chapters across the 3 volumes - Primary, Medicine, and Surgery.

Primary:
- Ethical, legal, and organizational medicine
- Anesthesia
- Clinical Pharmacology
- Dermatology
- Emergency medicine
- Family Medicine
- Medical Genetics
- Medical Imaging
- Pediatrics
- Psychiatry
- Public Health and Preventice Medicine
Essential Med Notes is a clinical complement and resource for medical trainees. This 37th edition features substantial content revisions to the main text, figures, graphics, and evidence-based medicine boxes of all 31 chapters across the 3 volumes - Primary, Medicine, and Surgery.

Primary:
- Ethical, legal, and organizational medicine
- Anesthesia
- Clinical Pharmacology
- Dermatology
- Emergency medicine
- Family Medicine
- Medical Genetics
- ...

Soins de santé primaires ; Éthique médicale ; Anesthésie ; Pharmacologie clinique ; Dermatologie ; Médecine d'urgence ; Médecine familiale ; Génétique médicale ; Imagerie médicale ; Pédiatrie ; PSYCHIATRIE ; Santé publique ; Médecine préventive

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- 1095 p.
Cote : WB39 F5652 2021

Make the most effective diagnostic and therapeutic decisions quickly and efficiently
Practical and highly organized, The 5-Minute Clinical Consult 2021 is a reliable, go-to resource for primary care physicians, nurse practitioners, and physician assistants. This bestselling title provides rapid access to guidance on diagnosis, treatment, medications, follow-up, and associated factors for more than 540 diseases and conditions. The 5-Minute Clinical Consult 2021 delivers clinical confidence efficiently, allowing you to focus your valuable time on giving your patients the best possible care.
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Make confident decisions aided by current evidence-based designations in each topic.
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Written by esteemed internal medicine and family medicine practitioners and published by the leading publisher in medical content, The 5-Minute Clinical Consult 2021, 29th Edition is your best resource for patient care.
5MinuteConsult.com is an evidence-based, online workflow tool easily integrated at the point of care and provides online-exclusive content, including:
More than 1,200 additional topics, including the full contents of The 5-Minute Pediatric Consult and The 5-Minute Sports Medicine Consult
New online-exclusive topics and algorithms on COVID-19 and Telemedicine
Differential diagnosis support from an expanded collection of algorithms
Current evidence-based designations highlighted in each topic
Thousands of images to help support visual diagnosis of all conditions
A video library of procedures, treatment, and physical therapy techniques
An A-to-Z Drug Database from Facts & Comparisons®
Guidance on laboratory test interpretation from Wallach’s Interpretation of Diagnostic Tests
More than 3,500 patient handouts in English and Spanish
Approximately 100 Diseases and Conditions in Spanish
ICD-10 codes and DSM-5 criteria
FREE point-of-care CME and CE: 0.5 credits each time you search the site to find the best treatment for your patients. This activity has been reviewed and is acceptable for up to 20 prescribed credits by the AAFP and the ANCC
Make the most effective diagnostic and therapeutic decisions quickly and efficiently
Practical and highly organized, The 5-Minute Clinical Consult 2021 is a reliable, go-to resource for primary care physicians, nurse practitioners, and physician assistants. This bestselling title provides rapid access to guidance on diagnosis, treatment, medications, follow-up, and associated factors for more than 540 diseases and conditions. The 5-Minute ...

Soins de santé primaires ; Médecine familiale ; MÉDECINE CLINIQUE ; Médecine factuelle

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Les résidents en médecine familiale au Canada sont formés pour utiliser une méthode clinique centrée sur le patient lorsqu’ils évaluent des patients qui se présentent avec des symptômes particuliers1. Cette approche repose sur une évaluation biomédicale, de même que sur une prise en compte des points de vue et des préoccupations des patients. Par conséquent, les patients et les médecins s’engagent dans une prise de décisions conjointe concernant la prise en charge des symptômes en cause chez ces patients. Des données probantes de plus en plus nombreuses révèlent que plusieurs symptômes communs, et pourtant incapacitants, peuvent être traités par une thérapie cognitivo-comportementale (TCC). En intégrant les principes sous-jacents de la TCC, les médecins de famille pourraient être capables d’améliorer ces symptômes courants chez leurs patients. En revanche, les médecins de famille devraient recevoir une formation appropriée pour utiliser efficacement cette approche durant leurs soins aux patients au quotidien.
Les résidents en médecine familiale au Canada sont formés pour utiliser une méthode clinique centrée sur le patient lorsqu’ils évaluent des patients qui se présentent avec des symptômes particuliers1. Cette approche repose sur une évaluation biomédicale, de même que sur une prise en compte des points de vue et des préoccupations des patients. Par conséquent, les patients et les médecins s’engagent dans une prise de décisions conjointe concernant ...

Soins de santé primaires ; Thérapie cognitivo-comportementale

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- xviii, 329 p.
Cote : W84.6 H847 2019

Soins de santé primaires ; Recherche - Méthodologie

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Descripteurs

Soins de santé primaires [37]

Médecine familiale [6]

COVID-19 [3]

Interdisciplinarité [3]

MÉDECINE CLINIQUE [3]

Pédiatrie [3]

Services de santé - Accessibilité [3]

Coronavirus [2]

Équipes de travail [2]

Infirmières - Rôle professionnel [2]

Médecine préventive [2]

PSYCHIATRIE [2]

Services communautaires de santé [2]

Anesthésie [1]

Angoisse [1]

Antibiotiques [1]

Anxiété [1]

Appareil respiratoire - Infections [1]

Cancer - Diagnostic [1]

Col de l'utérus - Cancer [1]

Col de l'utérus - Cancer - Dépistage [1]

Démence [1]

Dépendance (Psychologie) [1]

Dépistage (Médecine) [1]

Dermatologie [1]

Diagnostics biologiques [1]

Diagnostics biologiques - Manuels de laboratoire [1]

Diagnostics différentiels [1]

Douleur - Traitement [1]

Enfants - Développement [1]

Enfants - Maladies [1]

Enfants - Psychologie [1]

Enfants - Santé et hygiène [1]

Enfants atteints de troubles du spectre de l'autisme [1]

Épuisement professionnel [1]

Éthique médicale [1]

Exclusion sociale [1]

Fractures [1]

Garçons - Santé et hygiène [1]

Génétique médicale [1]

Hommes - Santé et hygiène [1]

Hommes - Sexualité [1]

Imagerie médicale [1]

Infirmières - Formation [1]

Infirmières - Pratique [1]

Infirmières - Responsabilité professionnelle [1]

Infirmières cliniciennes [1]

Infirmiers - Rôle professionnel [1]

Justice sociale [1]

Lésions et blessures - Traitement [1]

Maladies mentales - Diagnostic [1]

Maladies mentales - Traitement [1]

Médecine clinique - Prise de décision [1]

Médecine d'urgence [1]

Médecine factuelle [1]

Médecins - Responsabilité professionnelle [1]

Motivation en éducation [1]

Nourrissons - Soins [1]

Opioïdes [1]

Organisation mondiale de la santé [1]

Personnel médical - Responsabilité professionnelle [1]

Pharmacologie clinique [1]

Politique sanitaire [1]

Prématurés [1]

Prostate - Maladies [1]

Recherche - Méthodologie [1]

Sans-abris - Services de santé [1]

Santé publique [1]

Santé publique - Enquêtes [1]

Service à la clientèle [1]

Signes et symptômes [1]

Soins à domicile [1]

Stress [1]

Syndromes des apnées du sommeil [1]

Tabagisme [1]

Tabagisme - Traitement [1]

Télémédecine [1]

Thérapie cognitivo-comportementale [1]

Traitement ambulatoire [1]

Urgences médicales [1]

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