Acupuncture is the complementary treatment most commonly used by general practitioners. This study describes the use of acupuncture among Norwegian general practitioners trained in acupuncture.
By telephone or mail, a questionnaire was presented to 212 general practitioners who had completed training in complementary acupuncture. They were asked to describe the use and effect of acupuncture and their attitude towards acupuncture.
Of the 111 physicians who replied (53%), 67 (60%) used acupuncture in their clinical practice. 78% had acupuncture courses of less than four weeks' duration only. 52% stated that acupuncture was the preferred treatment in more than 5% of their patients. About 70-80% used acupuncture as a supplement to conventional treatment. Acupuncture was commonly used in patients with musculoskeletal pain (93%), migraine (66%), and headache (63%), less often in patients with nausea, allergy, anxiety, sleep disturbances and gastrointestinal disorders. Improvement was reported in approximately three out of four patients. Lack of time was regarded as the major limitation to the use of acupuncture.
Many general practitioners trained in complementary acupuncture use acupuncture as an integrated part of their clinical practice.
In Canada, the qualification of physicians is the jurisdiction of the College of Family Physicians and the Royal College of Physicians and Surgeons. The Colleges have promoted the training of "generalists" in family medicine and "sophisticated generalists" among the traditional specialties, and the development of subspecialties has not been encouraged. Nevertheless, due to the increasing number of family physicians and specialists practicing a range of new subspecialties, including addiction medicine, the College of Family Physicians has recognized special interest or focused practices, whereas the Royal College has recognized, in psychiatry, 3 subspecialties (child, geriatric, forensic) requiring an extra year of training and may offer others a diploma recognition. These new opportunities will shape the training requirements of addiction medicine leading to available certification through the International and American Medical Societies of Addiction Medicine.
To describe general practitioners' opinions and behaviour regarding alternative medicine.
Cross-sectional survey of a random sample of Ontario and Alberta general practitioners.
General practices in Ontario and Alberta.
A questionnaire was mailed to 400 general practitioners. Of the 384 eligible physicians, 200 completed the questionnaire.
Reported beliefs and practices concerning alternative medicine.
Acupuncture, chiropractic, and hypnosis were considered most useful and reflexology, naturopathy, and homeopathy least useful. Results showed 56% of general practitioners believed that alternative medicine has ideas and methods from which conventional medicine could benefit, 54% referred to alternative practitioners, and 16% practised some form of alternative medicine. Province of practice, place of graduation, training in alternative approaches, number of alternative approaches perceived useful, and attitude toward alternative medicine were clearly related to referring to alternative practitioners. Sex, age, type of practice, training in alternative medicine, referring to alternative practitioners, number of alternative approaches perceived useful, and attitude toward alternative medicine were related to practicing alternative medicine.
Although acceptance and integration of alternative medicine extend only to certain approaches, alternative medicine cannot be discounted in general practice. A study encompassing all Canadian provinces could help in planning medical education and developing policies to guide physician behaviour.
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The causes, symptoms and treatment options for andropause have been well documented; however, not enough is known about the primary care physicians' (PCPs) knowledge in this therapeutic area. This study assesses the PCPs' awareness and knowledge of andropause in Victoria, British Columbia, Canada.
Self-administered questionnaires were developed for family physicians and general practitioners. Each questionnaire included questions in three domains: 1) General knowledge, beliefs and exposure; 2) Knowledge of diagnostic and treatment options and; 3) General demographics.
A very high percentage of PCPs had heard of andropause (96.3%). Of the physicians who completed the survey, 92.6% agreed that men experience something similar to women's menopause when they age and 98.0% agreed that andropause is associated with an increased risk of osteoporosis. Almost all PCPs (91.5%) agreed that prostate cancer is a contraindication to treatment while around one-third (33.9%) agreed that breast cancer was a contraindication. Slightly more than half of physicians (57.4%) felt that they encountered obstacles to their investigation of andropause with the most prevalent complaint being a lack of access to education resources. There is a need for improved continuing medical education (CME) programmes in the Greater Victoria region to give PCPs the skills to diagnose and manage andropause with confidence.
Preventive home visits are offered to community dwelling older people in Denmark aimed at maintaining their functional ability for as long as possible, but only two thirds of older people accept the offer from the municipalities. The purpose of this study is to investigate 1) whether socioeconomic status was associated with acceptance of preventive home visits among older people and 2) whether municipality invitational procedures for the preventive home visits modified the association.
The study population included 1,023 community dwelling 80-year-old individuals from the Danish intervention study on preventive home visits. Information on preventive home visit acceptance rates was obtained from questionnaires. Socioeconomic status was measured by financial assets obtained from national registry data, and invitational procedures were identified through the municipalities. Logistic regression analyses were used, adjusted by gender.
Older persons with high financial assets accepted preventive home visits more frequently than persons with low assets (adjusted OR = 1.5 (CI95%: 1.1-2.0)). However, the association was attenuated when adjusted by the invitational procedures. The odds ratio for accepting preventive home visits was larger among persons with low financial assets invited by a letter with a proposed date than among persons with high financial assets invited by other procedures, though these estimates had wide confidence intervals.
High socioeconomic status was associated with a higher acceptance rate of preventive home visits, but the association was attenuated by invitational procedures. The results indicate that the social inequality in acceptance of publicly offered preventive services might decrease if municipalities adopt more proactive invitational procedures.
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A questionnaire investigation among general practitioners revealed that 29% of these were less positive about vaccination for measles, mumps and German measles (MFR vaccination) than for the remainder of the vaccination programme for children. Knowledge about contraindications for MFR vaccination was incomplete. Thus, only 26% of the general practitioners would advise vaccination if the parents stated that the child was hypersensitive to eggs. Only 70-80% of the general practitioners would advise vaccination if the child had cystic fibrosis, hydrocephalus, ventricle septum defect or had a cold but was apyrexial. Conversely, only 74% and 81% replied negatively to recommend vaccination if the child had had a previous anaphylactic reaction to eggs or was receiving treatment for leukemia. The replies given by the general practitioners were compared with present guidelines for contraindications to MFR vaccination and it is concluded that general practitioners should become more familiar with the knowledge about the MFR programme available at present and that further information from the official health authorities is required.
In this study, we examined Balint group participants' sense of control and satisfaction in their work situation and their attitudes towards caring for patients with psychosomatic problems. Forty-one GPs filled in a questionnaire with a 10-point visual analogue scale. Of these, 20 had participated in Balint groups for more than one year and 21 were a reference group. The Balint physicians reported better control of their work situation (e.g. taking coffee breaks and participating in decision making), thought less often that the patient should not have come for consultation or that psychosomatic patients were a time-consuming burden, and were less inclined to refer patients or take unneeded tests to terminate the consultation with the patient. These results might indicate higher work-related satisfaction and better doctor-patient relationship.
To understand the causes of low childhood immunization rates, physicians were interviewed about their knowledge, attitudes, and self-reported immunization practices.
Trained interviewers conducted a standardized telephone survey of physicians. A random sample of Pennsylvania family physicians, pediatricians, and general practitioners younger than 65 years of age who were in office-based practices was selected from the combined listings of the American Medical Association and American Osteopathic Association. Physicians seeing > or = 5 patients per week under age 6 years, seeing a total of > or = 15 patients per week, and having > or = 50% primary care patients were eligible. Of 383 eligible physicians, 70% (268) responded. The questionnaire was designed using the Health Belief Model, immunization barriers, and input from practitioners in primary care, pediatric infectious disease, maternal/ child health, and preventive medicine.
Respondents were more likely to refer to public vaccine clinics those children without insurance (P 90%) respondents thought that vaccine efficacy was high and that the likelihood of serious side effects was low. However, only 37% gave estimates that corresponded with the literature regarding the likelihood of an infant with pertussis to need hospitalization. Many respondents used invalid vaccine contraindications; for instance, 37% would not administer MMR to a boy whose mother was pregnant. Many respondents (21%) would not administer four vaccines simultaneously.
If the Healthy People 2000 goal to eliminate indigenous cases of measles is to be achieved, free vaccine supplies and increased provider education are needed.
The Russian Federation's recently adopted family medicine as a specialty, but with little or no training in psychosocial and behavioral issues, unlike many training programs in other countries. The purpose of this qualitative study was to explore the perceptions and experiences of Russian primary care physicians regarding the practice of behavioral medicine and psychosocial methods. Semi-structured in-depth interviews were conducted with ten Russian family physicians. Examination of key words, phrases, and concepts used by the physicians revealed five themes that physicians related to their incorporation of psychosocial/behavioral medicine methods: (1) factors limiting the practice of behavioral medicine (inadequate training; cultural barriers); (2) demand for behavioral medicine services; (3) patient-doctor issues related to behavioral medicine (e.g., communication); (4) physician's role strain; and (5) intuition and experience. These findings suggest that Russia's new family physicians would benefit from residency and post-graduate curricula in behavioral sciences, tailored to their unique needs.