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Care of the elderly training: Implications for family medicine.

https://arctichealth.org/en/permalink/ahliterature150986
Source
Can Fam Physician. 2009 May;55(5):510-1.e1-4
Publication Type
Article
Date
May-2009
Author
Christopher Frank
Rachelle Seguin
Author Affiliation
St Mary's of the Lake Hospital, 340 Union St, Kingston, ON K7L 5A2, Canada. frankc@providencecare.ca
Source
Can Fam Physician. 2009 May;55(5):510-1.e1-4
Date
May-2009
Language
English
Publication Type
Article
Keywords
Adult
Aged
Canada
Clinical Competence
Education, Medical, Continuing - methods
Family Practice - education
Female
Health Services for the Aged - standards
Humans
Male
Middle Aged
Questionnaires
Retrospective Studies
Abstract
To examine the practice patterns and clinical and academic roles of family physicians who have care of the elderly training.
Cross-sectional survey.
Family medicine practices or specialized geriatric services programs.
Fifty-two family physicians, surveyed in 2005 and 2006, identified as having 6 or 12 months' care of the elderly training.
Self-reported practice type and description of clinical and academic roles.
Surveys were sent to 103 physicians; the response rate was 50.5% (N = 52). Respondents were relatively young, with a mean age of 42 years. Slightly more respondents had completed 6 months of training than had completed a full year of training (54.9% vs 45.1%). More than half (55.8%) described their medical practice areas as "general family medicine." The remainder worked in "restricted practices" (25.0%) or provided "specialist care" (17.3%); 1 physician was no longer practising medicine. Many provided some care within specialized geriatric service areas, most commonly in-hospital consultation and rehabilitation. More than half (51.9%) provided active hospital care, and a substantial number worked in long-term care facilities as physicians or medical directors. More than 20% provided newborn care, although only a small percentage (7.7%) performed obstetric services. Respondents were actively involved in teaching and other academic activities, including resident supervision.
Care of the elderly physicians provide comprehensive family medicine services, but also often provide care in other areas currently facing physician shortages. Care of the elderly physicians play relevant clinical and academic roles in both family medicine training and specialized geriatric services.
Notes
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Cites: CMAJ. 2002 Oct 15;167(8):869-7012406944
Cites: Can Fam Physician. 2001 Jun;47:1227-3211421051
PubMed ID
19439709 View in PubMed
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Centre for Studies in Primary Care: offering a laboratory of primary care practices.

https://arctichealth.org/en/permalink/ahliterature175545
Source
Can Fam Physician. 2005 Mar;51:393
Publication Type
Article
Date
Mar-2005
Author
Marshall Godwin
Rachelle Seguin
Craig Jones
Debbie Jones
Author Affiliation
Centre for Studies in Primary Care, Department of Family Medicine, Queen's University, Kingston, Ontario.
Source
Can Fam Physician. 2005 Mar;51:393
Date
Mar-2005
Language
English
Publication Type
Article
Keywords
Canada
Health Services Research - organization & administration
Humans
Organizational Objectives
Primary Health Care
PubMed ID
15794024 View in PubMed
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Critical appraisal skills of family physicians in Ontario, Canada.

https://arctichealth.org/en/permalink/ahliterature182576
Source
BMC Med Educ. 2003 Dec 2;3:10
Publication Type
Article
Date
Dec-2-2003
Author
Marshall Godwin
Rachelle Seguin
Author Affiliation
Centre for Studies in Primary Care, Queen's University, Kingston(K7L 5E9), Canada. godwinm@post.queensu.ca
Source
BMC Med Educ. 2003 Dec 2;3:10
Date
Dec-2-2003
Language
English
Publication Type
Article
Keywords
Adult
Clinical Competence
Evidence-Based Medicine
Female
Humans
Knowledge
Male
Middle Aged
Ontario
Physicians, Family
Randomized Controlled Trials as Topic
Review Literature as Topic
Abstract
Our primary objective in this study was to measure family physicians' knowledge of the key elements that go into assessing the validity and interpreting the results in three different types of studies: i) a randomized controlled trial (RCT); ii) a study evaluating a diagnostic test; and iii) a systematic review (SR). Our secondary objectives were to determine the relationship between the above skills and age, gender, and type of practice.
We obtained a random sample of 1000 family physicians in Ontario from the College of Family Physicians of Canada database. These physicians were sent a questionnaire in the mail with follow-up mailings to non-responders at 3 and 8 weeks. The questionnaire was designed to measure knowledge and understanding of the basic concepts of critical appraisal skills. Based on the responses to the questions an Evidence Based Medicine (EBM) Knowledge Score was determined for each physician.
A response rate of 30.2% was achieved. The respondents were younger and more likely to be recent graduates than the population of Ontario Family Physicians as a whole. This was an expected outcome. Just over 50% of respondents were able to answer questions concerning the critical appraisal of methods and the interpretation of results of research articles satisfactorily. The average score on the 12-point EBM Knowledge Scale was 6.4. The younger physicians scored higher than the older physicians, and academic physicians scored higher than community-based physicians. Scores of male and female physicians did not differ.
We have shown that in a population of physicians which is younger than the general population of physicians, about 50% have reasonable knowledge regarding the critical appraisal of the methods and the interpretation of results of a research article. In general, younger physicians were more knowledgeable than were older physicians. EBM principles were felt to be important to the practice of medicine by 95% of respondents.
Notes
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Cites: Med Educ. 1998 Sep;32(5):486-9110211289
Cites: J Gen Intern Med. 2000 Oct;15(10):710-511089714
PubMed ID
14651755 View in PubMed
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A cross sectional survey of urban Canadian family physicians' provision of minor office procedures.

https://arctichealth.org/en/permalink/ahliterature170182
Source
BMC Fam Pract. 2006;7:18
Publication Type
Article
Date
2006
Author
Ian P Sempowski
Arne A Rungi
Rachelle Seguin
Author Affiliation
Department of Family Medicine, Queens University, Kingston, Ontario, Canada. sempowsk@post.queensu.ca
Source
BMC Fam Pract. 2006;7:18
Date
2006
Language
English
Publication Type
Article
Keywords
Biopsy - utilization
Clinical Competence
Cross-Sectional Studies
Current Procedural Terminology
Endometrial Neoplasms - diagnosis
Family Practice - economics - education - statistics & numerical data
Female
Health Care Surveys
Humans
Injections, Intra-Articular - utilization
Office Visits - economics
Ontario
Physician's Practice Patterns - statistics & numerical data
Questionnaires
Referral and Consultation - utilization
Skin Diseases - surgery
Time Factors
Urban Health Services
Abstract
A discordance exists between the proportion of Canadian family physicians that we expect should be able to perform minor office procedures and the actual provision of care. This pattern has not been extensively studied. The objective of this study was to determine the current patterns and obstacles relating to the provision of four minor office procedures by GP/FPs in a small city in Ontario, Canada. An additional goal was to determine the impact of the remuneration method on the provision of such services.
A survey was mailed to all GP/FPs practising in Kingston, Ontario. The main outcomes measured in the study were work setting and remuneration method, current procedural practices with respect to four procedures, reasons for not performing procedures, current skill levels, and desire to upgrade.
Surveys were mailed to all 108 GP/FPs in the City of Kingston. Completed surveys were collected for 82 percent (89/108) and 10 were excluded leaving 79 eligible participants. The percentages of GP/FPs who reported performing the procedure were as follows: dermatological excision (63.3%), endometrial biopsy (35.4%), shoulder injection (31.6%), and knee injection (43.0%). The majority of GP/FPs who would not do the procedure themselves would refer to a specialist colleague rather than to another GP/FP. The top reason cited for not performing a specific procedure was "lack of up to date skills" followed by "lack of time". The latter was the only statistically significant difference reported between GP/FPs working in Family Health Networks and GP/FPs working in fee for service settings (26.7% vs 47.0%, chi2 = 4.191 p = 0.041).
A large number of Kingston, Ontario GP/FPs refer patients who require one of four minor office-based procedures for specialist consultation. Referral to other GP/FP colleagues appears underutilized. A perceived lack of up to date skills and a lack of time appear to be concerns. GP/FPs working in Family Health Networks were more likely to perform these procedures themselves. Further studies would clarify the role of changes in medical education, the role of continuing education, and the impact of different remuneration models.
Notes
Cites: Fam Pract Res J. 1992 Sep;12(3):297-3031414434
Cites: Br J Gen Pract. 1994 Aug;44(385):364-58068396
Cites: Fam Med. 1996 Sep;28(8):565-98884253
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Cites: Br J Gen Pract. 1997 Apr;47(417):205-109196961
Cites: Can Fam Physician. 1998 Mar;44:521-99559192
Cites: Fam Med. 2005 Jul-Aug;37(7):491-515988634
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Cites: Ir Med J. 2000 Jul-Aug;93(5):136-811072921
Cites: Fam Med. 2001 Nov-Dec;33(10):766-7111730294
Cites: Br Med J. 1979 Jun 16;1(6178):1609-10466144
Cites: Br J Gen Pract. 1992 Jan;42(354):13-71586525
PubMed ID
16545142 View in PubMed
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Effectiveness of a protocol-based strategy for achieving better blood pressure control in general practice.

https://arctichealth.org/en/permalink/ahliterature147568
Source
Fam Pract. 2010 Feb;27(1):55-61
Publication Type
Article
Date
Feb-2010
Author
Marshall Godwin
Richard Birtwhistle
Rachelle Seguin
Miu Lam
Ian Casson
Dianne Delva
Susan MacDonald
Author Affiliation
Department of Family Medicine, Memorial University of Newfoundland, 300 Prince Philip Drive, St. John's, Newfoundland, Canada. godwinm@mun.ca
Source
Fam Pract. 2010 Feb;27(1):55-61
Date
Feb-2010
Language
English
Publication Type
Article
Keywords
Aged
Clinical Protocols
Family Practice
Female
Humans
Hypertension - drug therapy
Male
Middle Aged
Ontario
Treatment Outcome
Abstract
There continues be a problem with the proportion of treated hypertension patients who are actually at recommended blood pressure targets.
Is an intensive protocol-based strategy for achieving blood pressure control effective in family practice and will family physicians and their hypertensive patients adhere to such a protocol.
Design of the study is a cluster randomized controlled trial at the Centre for Studies in Primary Care, Queen's University, Kingston, Ontario. Participants were 19 family physicians and 156 (98 intervention group and 58 control group) of their patients in and around the Kingston area. Patients were eligible if they had a diagnosis of hypertension and had not yet achieved their target blood pressure. Patients in the intervention group were managed according to a protocol that involved seeing their family doctor every 2 weeks over a 16-week period and having their antihypertensive medication regimen adjusted at each visit if target was not achieved. This was compared to usual care. Main outcomes were primary effectiveness outcome measured at 12 months was the differences in blood pressure between baseline and 12 months in the two groups. Secondary effectiveness outcomes included rates of achieving BP target and compliance with protocol by physicians and patients. Adherence outcomes were assessed by determining the number of visits made during the 16-week intervention period and the increase in the number of drugs being used.
Of the patients enrolled, 72 (74%) from the intervention group and 41 (71%) in the control group were available for analysis. Improvement between baseline and 12-month follow-up was significantly better for the intervention group than the control for diastolic mean daytime BP on 24 hours ambulatory blood pressure monitoring (4.5 mmHg reduction versus 0.5 mmHg reduction) and for both systolic (14.7 mmHg reduction versus 2.7 mmHg reduction) and diastolic (7.4 mmHg reduction versus 0.6 mmHg increase) blood pressure on BpTRU. Of the 98 patients in the intervention, 80% attended four or more of the eight visits and 25% attended all eight visits; physicians increased the number or dosage of drugs the patient was taking in 52% of the visits. Conclusions. An intensive, protocol-based, management approach to achieving blood pressure control in hypertensive patients in family practice is effective and works even when there is flexibility built into the algorithm to allow family physicians to use their judgement in individual patients.
PubMed ID
19887462 View in PubMed
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E-mail or snail mail? Randomized controlled trial on which works better for surveys.

https://arctichealth.org/en/permalink/ahliterature178748
Source
Can Fam Physician. 2004 Mar;50:414-9
Publication Type
Article
Date
Mar-2004
Author
Rachelle Seguin
Marshall Godwin
Susan MacDonald
Marnie McCall
Author Affiliation
Centre for Studies in Primary Care, Department of Family Medicine, Queen's University, Kingston, Ont.
Source
Can Fam Physician. 2004 Mar;50:414-9
Date
Mar-2004
Language
English
Publication Type
Article
Keywords
Adult
Electronic Mail
Family Practice
Female
Health Care Surveys - methods
Humans
Male
Ontario
Postal Service
Questionnaires
Abstract
To compare e-mail with regular mail for conducting surveys of physicians.
Randomized controlled trial.
Ontario, Canada.
A random sample of physicians listed in the College of Family Physicians of Canada's membership database.
Survey delivered by e-mail and by post.
Response rates and times, and completeness and characteristics of responses to the survey.
Overall response rate was 44.7% (33.6% of e-mail recipients, 52.7% of post recipients who have e-mail, and 47.8% of post recipients without e-mail). While the e-mail rate was significantly lower than for both post groups, e-mail responses were received much faster. There was no significant difference among groups as to completeness of responses, but e-mail responses had more frequent and longer comments.
E-mail provides faster but fewer responses to surveys. Content of structured-response questions was similar in all groups, but e-mail provided more and longer responses to open-ended questions. Where a quick response to a survey is required, e-mail is superior.
Notes
Cites: Eval Health Prof. 1998 Sep;21(3):395-40810350958
Cites: Teach Learn Med. 2000 Spring;12(2):81-411228682
PubMed ID
15318679 View in PubMed
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Faculty's and residents' perceptions of teaching and evaluating the role of health advocate: a study at one Canadian university.

https://arctichealth.org/en/permalink/ahliterature176845
Source
Acad Med. 2005 Jan;80(1):103-8
Publication Type
Article
Date
Jan-2005
Author
Sarita Verma
Leslie Flynn
Rachelle Seguin
Author Affiliation
Queen's University, Department of Family Medicine, 220 Bagot Street, Kingston, Ontario, K7L 5E9, Canada. sv3@post.queensu.ca
Source
Acad Med. 2005 Jan;80(1):103-8
Date
Jan-2005
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Education, Medical, Graduate - standards
Faculty, Medical
Focus Groups
Humans
Internship and Residency - standards
Ontario
Patient Advocacy
Physician's Role
Questionnaires
Schools, Medical
Social Perception
Abstract
To examine the views of faculty and residents about teaching and evaluating health advocacy, one of the more difficult CanMEDS roles to integrate into postgraduate medical education.
In 2002, two focus groups of faculty and two of residents at Queen's University, Kingston, Ontario, Canada, were asked standardized questions to elicit their answers to what was a health care advocate as understood and reported by teachers and residents, and what were the reported barriers and enhancers to teaching and evaluating the role of residents as health care advocates.
The study found that faculty and residents knew little about how to teach and evaluate the role of the health advocate. There was consensus between the two types of groups with congruity between residents and faculty about the key issues. The one exception to this was the disconnect between the faculty members' belief that advocacy was an aspect of their daily work and the residents' apparent lack of awareness of this. The majority of participants were not familiar with the Royal College's description of the role of health advocate and were very keen to receive further guidance on teaching tools and methods of evaluation.
The authors' hypothesis was that little is known about how to teach and evaluate the role of the health advocate. The results confirmed this and identified important areas upon which to build an educational framework. The definition of the health advocate and the expectations require clarity and direction. Academic programs would benefit from clear objectives.
PubMed ID
15618104 View in PubMed
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Family medicine anesthesia: sustaining an essential service.

https://arctichealth.org/en/permalink/ahliterature167800
Source
Can Fam Physician. 2005 Apr;51:538-9
Publication Type
Article
Date
Apr-2005
Author
Glenn Brown
Marshall Godwin
Rachelle Seguin
Edwin L Ashbury
Author Affiliation
Department of Family Medicine, Queen's University, Kingston, Ont. gb11@post.queensu.ca
Source
Can Fam Physician. 2005 Apr;51:538-9
Date
Apr-2005
Language
English
Publication Type
Article
Keywords
Anesthesia, General - utilization
Anesthesiology - education - manpower
Chief Executive Officers, Hospital - statistics & numerical data
Family Practice - statistics & numerical data
Female
Health Care Surveys
Hospitals, Community - manpower
Humans
Male
Needs Assessment
Ontario
Physician's Role
Abstract
To elicit the opinions of family physician anesthetists (FPAs) and hospital Chief Executive Officers (CEOs) regarding the structure of their organizations and the importance of family medicine anesthesia.
Mailed survey.
Ontario hospitals.
The CEOs of Ontario hospitals and family physicians who provide anesthetic services in Ontario hospitals.
Demographics, practices, and opinions of FPAs and CEOs regarding family medicine anesthesia.
Responses were received from 159 of 195 practising FPAs (82%). Of the 128 hospitals in Ontario that offered anesthesia services, 59% used at least one FPA; in 39% of these hospitals, all services were provided by FPAs. Both FPAs and CEOs thought that FPAs were competent to meet the anesthesia needs of small community hospitals. Most FPAs and CEOs supported certification and maintenance of competence programs coordinated by a national body, such as the College of Family Physicians of Canada. Both FPAs and CEOs thought there should be support for additional training programs in family medicine anesthesia.
Small community hospitals rely completely on FPAs to provide essential anesthesia services. Additional training programs and a national structure to coordinate certification and maintenance of competence programs are important to maintain and enhance this essential service.
Notes
Cites: CMAJ. 2002 Feb 19;166(4):429-3411876170
Cites: Can Fam Physician. 2002 Feb;48:324, 33311889892
Cites: Can Fam Physician. 1998 Oct;44:2117-249805166
Cites: Can J Anaesth. 1999 Oct;46(10):962-910522584
PubMed ID
16926929 View in PubMed
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Family medicine research capacity building: five-weekend programs in Ontario.

https://arctichealth.org/en/permalink/ahliterature144886
Source
Can Fam Physician. 2010 Mar;56(3):e94-e100
Publication Type
Article
Date
Mar-2010
Author
Walter Rosser
Marshall Godwin
Rachelle Seguin
Author Affiliation
Department of Family Medicine, Queen's University, 220 Bagot St., Kingston, Ontario. rosserw@post.queensu.ca
Source
Can Fam Physician. 2010 Mar;56(3):e94-e100
Date
Mar-2010
Language
English
Publication Type
Article
Keywords
Biomedical Research - education
Capacity building
Family Practice - education
Humans
Interinstitutional Relations
Leadership
Ontario
Personnel Selection - statistics & numerical data
Pilot Projects
Program Development - methods
Abstract
Research is not perceived as an integral part of family practice by most family physicians working in community practices. OBJECTIVE OF THE PROGRAM To assist community-based practitioners in answering research questions that emerge from their practices in order for them to gain a better understanding of research and its value.
The Ontario College of Family Physicians developed a program consisting of 5 sets of weekend workshops, each 2 months apart. Two pilots of the 5-weekend program occurred between 2000 and 2003. After the pilots, thirteen 5-weekend programs were held in 2 waves by 20 facilitators, who were trained in one of two 1-day seminars.
This 5-weekend program, developed and tested in Ontario, stimulates community practitioners to learn how to answer research questions emerging from their practices. A 1-day seminar is adequate to train facilitators to successfully run these programs. Evaluations by both facilitators and program participants were very positive, with many participants stating that their clinical practices were improved as a result of the program. The program has been adapted for residency training, and it has already been used internationally.
Notes
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Comment In: Can Fam Physician. 2010 May;56(5):41220463267
PubMed ID
20228296 View in PubMed
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Manual and automated office measurements in relation to awake ambulatory blood pressure monitoring.

https://arctichealth.org/en/permalink/ahliterature141463
Source
Fam Pract. 2011 Feb;28(1):110-7
Publication Type
Article
Date
Feb-2011
Author
Marshall Godwin
Richard Birtwhistle
Dianne Delva
Miu Lam
Ian Casson
Susan MacDonald
Rachelle Seguin
Author Affiliation
Department of Family Medicine, Primary Healthcare Research Unit, Memorial University of Newfoundland, 300 Prince Philip Drive, St John's, Newfoundland, Canada. godwinm@mun.ca
Source
Fam Pract. 2011 Feb;28(1):110-7
Date
Feb-2011
Language
English
Publication Type
Article
Keywords
Blood Pressure Monitoring, Ambulatory - instrumentation - methods - standards
Female
Humans
Hypertension - diagnosis
Male
Middle Aged
Office Visits
Ontario
Primary Health Care - methods
Randomized Controlled Trials as Topic
Sphygmomanometers
Abstract
Automated blood pressure (BP) devices are commonly used in doctor's offices. How BP measured on these devices relates to ambulatory BP monitoring is not clear.
To assess how well office-based manual and automated BP predicts ambulatory BP.
Using data on 654 patients, we assessed how well sphygmomanometer measurements and measurements taken with an automated device (BpTRU) predicted results on ambulatory BP monitoring. We assess positive and negative predictive values and overall accuracy. We look at different cut-points for systolic (130, 135 and 140 mmHg) and diastolic (80, 85 and 90 mmHg) BP.
A single automated office BP (AOBP) assessment provides superior predictive values and overall accuracy compared to three manual office BP assessments. For systolic BP, the predictive values are =69% for any of the cut-points while the positive predictive values for the single automated measurement is between 80.0% and 86.9% and the overall accuracy gets as high as 74% for the 130 mmHg cut-point. For diastolic BP, the automated readings are also more predictive but in this case, it is the negative predictive values that are better, as well as the overall accuracy.
Based on the results, we suggest that 135/85 mmHg continue to be used as the cut-point defining high BP with the BpTRU device. However, future research might suggests that values in a grey zone between 130-139 mmHg systolic and 80-89 mmHg diastolic be confirmed using ambulatory BP monitoring. As well, three AOBP assessments might produce much greater accuracy than the single AOBP assessment used in the study.
PubMed ID
20720213 View in PubMed
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13 records – page 1 of 2.