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Determinants of primary medical practice in adult cancer prevention.

https://arctichealth.org/en/permalink/ahliterature237290
Source
Med Care. 1986 Mar;24(3):216-24
Publication Type
Article
Date
Mar-1986
Author
R N Battista
J I Williams
L A MacFarlane
Source
Med Care. 1986 Mar;24(3):216-24
Date
Mar-1986
Language
English
Publication Type
Article
Keywords
Adult
Breast Neoplasms - prevention & control
Colonic Neoplasms - prevention & control
Data Collection
Education, Medical, Continuing
Factor Analysis, Statistical
Female
Humans
Lung Neoplasms - prevention & control
Male
Neoplasms - prevention & control
Physicians, Family
Primary Health Care - standards
Professional Practice
Quebec
Rectal Neoplasms - prevention & control
Smoking - prevention & control
Uterine Cervical Neoplasms - prevention & control
Abstract
The authors conducted a study of primary care physicians in the province of Quebec to ascertain their patterns of preventive practice with respect to cancer in four anatomic sites: breast, cervix, colon-rectum, and lung. They further explored the data set to elicit the determinants of the patterns of preventive practice. Scales were constructed encompassing practice behaviors for each type of cancer, continuing education intensity, knowledge, and belief. The content of these scales was delineated through factor analysis and their reliability assessed using Cronbach's alpha. Other variables were also considered in the conceptual model. Bivariate analysis and multivariate techniques were used. The models tested contained many significant interaction terms. A limited number of the first-order interactions was explored for each of the dependent variables. Different patterns emerged for each cancer type. Mode of reimbursement, continuing education, gender of physician, provider-related barriers to prevention, and knowledge were found to be the major predictors of prevention scores for the cancers studied, but their relative importance varied according to each cancer. The importance of better understanding the determinants of physician behaviors is emphasized and the existence of several possible explanatory models suggested.
PubMed ID
3951264 View in PubMed
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[Two replies on quality registries in primary health care: a misunderstanding seems to be the cause].

https://arctichealth.org/en/permalink/ahliterature144133
Source
Lakartidningen. 2010 Mar 17-23;107(11):771-2
Publication Type
Article
Author
Kjell Lindström
Author Affiliation
Primärvårdens FoU-enhet i Jönköping. kjell.lindstrom@lj.se
Source
Lakartidningen. 2010 Mar 17-23;107(11):771-2
Language
Swedish
Publication Type
Article
Keywords
Humans
Primary Health Care - standards
Quality Assurance, Health Care - economics
Registries - standards
Sweden
Notes
Comment On: Lakartidningen. 2010 Mar 10-16;107(10):656; discussion 65720402248
PubMed ID
20402271 View in PubMed
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[Does Swedish primary health care need guardians?].

https://arctichealth.org/en/permalink/ahliterature144137
Source
Lakartidningen. 2010 Mar 10-16;107(10):656; discussion 657
Publication Type
Article
Author
Kjell Lindström
Author Affiliation
kjell.lindstrom@lj.se
Source
Lakartidningen. 2010 Mar 10-16;107(10):656; discussion 657
Language
Swedish
Publication Type
Article
Keywords
Family Practice - standards
Health Policy
Humans
Internet
Primary Health Care - standards
Quality Assurance, Health Care
Quality Indicators, Health Care
Registries
Sweden
Notes
Comment In: Lakartidningen. 2010 Mar 17-23;107(11):771-220402271
Comment In: Lakartidningen. 2010 Mar 24-30;107(12):846; discussion 84720432836
PubMed ID
20402248 View in PubMed
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Oral vitamin B12 therapy in the primary care setting: a qualitative and quantitative study of patient perspectives.

https://arctichealth.org/en/permalink/ahliterature176089
Source
BMC Fam Pract. 2005 Feb 21;6(1):8
Publication Type
Article
Date
Feb-21-2005
Author
Jeff C Kwong
David Carr
Irfan A Dhalla
Denise Tom-Kun
Ross E G Upshur
Author Affiliation
Department of Family and Community Medicine, University of Toronto, 263 McCaul Street, Toronto, Ontario, M5T 1W7, Canada. jeff.kwong@utoronto.ca
Source
BMC Fam Pract. 2005 Feb 21;6(1):8
Date
Feb-21-2005
Language
English
Publication Type
Article
Keywords
Administration, Oral
Aged
Aged, 80 and over
Family Practice - statistics & numerical data
Female
Humans
Injections
Male
Middle Aged
Ontario
Patient Acceptance of Health Care - psychology - statistics & numerical data
Physician-Patient Relations
Primary Health Care - standards
Questionnaires
Vitamin B 12 - administration & dosage - therapeutic use
Vitamin B 12 Deficiency - drug therapy
Abstract
Although oral replacement with high doses of vitamin B12 is both effective and safe for the treatment of B12 deficiency, little is known about patients' views concerning the acceptability and effectiveness of oral B12. We investigated patient perspectives on switching from injection to oral B12 therapy.
This study involved a quantitative arm using questionnaires and a qualitative arm using semi-structured interviews, both to assess patient views on injection and oral therapy. Patients were also offered a six-month trial of oral B12 therapy. One hundred and thirty-three patients who receive regular B12 injections were included from three family practice units (two hospital-based academic clinics and one community health centre clinic) in Toronto.
Seventy-three percent (63/86) of respondents were willing to try oral B12. In a multivariate analysis, patient factors associated with a "willingness to switch" to oral B12 included being able to get to the clinic in less than 30 minutes (OR 9.3, 95% CI 2.2-40.0), and believing that frequent visits to the health care provider (OR 5.4, 95% CI 1.1-26.6) or the increased costs to the health care system (OR 16.7, 95% CI 1.5-184.2) were disadvantages of injection B12. Fifty-five patients attempted oral therapy and 52 patients returned the final questionnaire. Of those who tried oral therapy, 76% (39/51) were satisfied and 71% (39/55) wished to permanently switch. Factors associated with permanently switching to oral therapy included believing that the frequent visits to the health care provider (OR 35.4, 95% CI 2.9-432.7) and travel/parking costs (OR 8.7, 95% CI 1.2-65.3) were disadvantages of injection B12. Interview participants consistently cited convenience as an advantage of oral therapy.
Switching patients from injection to oral B12 is both feasible and acceptable to patients. Oral B12 supplementation is well received largely due to increased convenience. Clinicians should offer oral B12 therapy to their patients who are currently receiving injections, and newly diagnosed B12-deficient patients who can tolerate and are compliant with oral medications should be offered oral supplementation.
Notes
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PubMed ID
15723708 View in PubMed
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Medication prescribing for asthma and COPD: a register-based cross-sectional study in Swedish primary care.

https://arctichealth.org/en/permalink/ahliterature258559
Source
BMC Fam Pract. 2014;15:54
Publication Type
Article
Date
2014
Author
Paolina Weidinger
J Lars G Nilsson
Ulf Lindblad
Source
BMC Fam Pract. 2014;15:54
Date
2014
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Asthma - diagnosis - drug therapy - epidemiology
Chi-Square Distribution
Child
Child, Preschool
Clinical Competence
Cross-Sectional Studies
Drug Labeling
Drug Prescriptions - standards - statistics & numerical data
Female
Humans
Infant
Infant, Newborn
International Classification of Diseases
Male
Medical Audit
Middle Aged
Physician's Practice Patterns - standards - statistics & numerical data
Primary Health Care - standards
Pulmonary Disease, Chronic Obstructive - diagnosis - drug therapy - epidemiology
Spirometry
Sweden - epidemiology
Young Adult
Abstract
There is a gap between prescribed asthma medication and diagnosed asthma in children and adolescents. However, few studies have explored this issue among adults, where asthma medication is also used for the treatment of chronic obstructive pulmonary disease (COPD). The aim of this study was to examine the relationship between prescribing of medications indicated for asthma and COPD and the recorded diagnosis for these conditions.
In a register-based study, individuals prescribed a medication indicated for asthma and COPD during 2004-2005 (Group A; n = 14 101) and patients with diagnoses of asthma or COPD recorded during 2000-2005 (Group B; n = 12 328) were identified from primary health care centers in Skaraborg, Sweden. From a 5% random sample of the medication users (n = 670), the written medical records were accessed.
prevalence of medication and diagnoses, reasons for prescription.
type and number of prescribed drugs and performance of peak expiratory flow or spirometry.
Medications indicated for asthma and COPD was prescribed to 5.6% of the population in primary care (n = 14 101). Among them, an asthma diagnosis was recorded for 5876 individuals (42%), 1116 (8%) were diagnosed with COPD and 545 (4%) had both diagnoses. The remaining 6564 individuals (46%) were lacking a recorded diagnosis. The gap between diagnosis and medication was present in all age-groups. Medication was used as a diagnostic tool among 30% of the undiagnosed patients and prescribed off-label for 54%. Missed recording of ICD-codes for existing asthma or COPD accounted for 16%.
There was a large discrepancy between prescribing of medication and the prevalence of diagnosed asthma and COPD. Consequently, the prevalence of prescriptions of medications indicated for asthma and COPD should not be used to estimate the prevalence of these conditions. Medication was used both as a diagnostic tool and in an off-label manner. Therefore, the prescribing of medications for asthma and COPD does not adhere to national clinical guidelines. More efforts should be made to improve the prescribing of medication indicated for asthma and COPD so that they align with current guidelines.
Notes
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PubMed ID
24666507 View in PubMed
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Strengthening patient safety in transitions of care: an emerging role for local medical centres in Norway.

https://arctichealth.org/en/permalink/ahliterature286746
Source
BMC Health Serv Res. 2016 Aug 30;16:452
Publication Type
Article
Date
Aug-30-2016
Author
Trond Kongsvik
Kristin Halvorsen
Tonje Osmundsen
Gudveig Gjøsund
Source
BMC Health Serv Res. 2016 Aug 30;16:452
Date
Aug-30-2016
Language
English
Publication Type
Article
Keywords
Administrative Personnel
Attitude of Health Personnel
Community Health Centers - organization & administration - standards
Humans
Interviews as Topic
Norway
Nursing Homes - organization & administration - standards
Patient Safety
Patient Transfer - standards
Primary Health Care - standards
Quality Assurance, Health Care
Abstract
Patient safety has gained less attention in primary care in comparison to specialised care. We explore how local medical centres (LMCs) can play a role in strengthening patient safety, both locally and in transitions between care levels. LMCs represent a form of intermediate care organisation in Norway that is increasingly used as a strategy for integrated care policies. The analysis is based on institutional theory and general safety theories.
A qualitative design was applied, involving 20 interviews of nursing home managers, managers at local medical centres and administrative personnel.
The LMCs mediate important information between care levels, partly by means of workarounds, but also as a result of having access to the different information and communications technology (ICT) systems in use. Their knowledge of local conditions is found to be a key asset. LMCs are providers of competence and training for the local level, as well as serving as quality assurers.
As a growing organisational form in Norway, LMCs have to legitimise their role in the health care system. They represent an asset to the local level in terms of information, competence and quality assurance. As they have overlapping competencies, tasks and responsibilities with other parts of the health care system, they add to organisational redundancy and strengthen patient safety.
Notes
Cites: Int J Qual Health Care. 2009 Feb;21(1):18-2619147597
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Cites: J Biomed Inform. 2011 Jun;44(3):390-419615466
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Cites: BMJ Qual Saf. 2013 Feb;22(2):147-5423178859
PubMed ID
27576322 View in PubMed
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Delivering more equitable primary health care in Northern Canada.

https://arctichealth.org/en/permalink/ahliterature287182
Source
CMAJ. 2017 11 13;189(45):E1377-E1378
Publication Type
Article
Date
11-13-2017
Author
T Kue Young
Susan Chatwood
Source
CMAJ. 2017 11 13;189(45):E1377-E1378
Date
11-13-2017
Language
English
Publication Type
Article
Keywords
Health Equity - standards
Humans
Indians, North American
Inuits
Northwest Territories
Nunavut
Primary Health Care - standards
Rural Population
Notes
Cites: Healthc Policy. 2016 Aug;12(1):59-7027585027
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Cites: CMAJ. 2011 Feb 8;183(2):209-1421041430
Cites: BMC Proc. 2016 Aug 10;10 (Suppl 6):628813543
PubMed ID
29133538 View in PubMed
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District nurses' perceptions of osteoporosis management: a qualitative study.

https://arctichealth.org/en/permalink/ahliterature272307
Source
Osteoporos Int. 2015 Jul;26(7):1911-8
Publication Type
Article
Date
Jul-2015
Author
A. Claesson
E. Toth-Pal
P. Piispanen
H. Salminen
Source
Osteoporos Int. 2015 Jul;26(7):1911-8
Date
Jul-2015
Language
English
Publication Type
Article
Keywords
Accidental Falls - prevention & control
Attitude of Health Personnel
Bone Density Conservation Agents - adverse effects - therapeutic use
Clinical Competence
Clinical Nursing Research - methods
Community Health Services - standards
Delivery of Health Care - standards
Disease Management
Focus Groups
Humans
Interprofessional Relations
Nurses, Community Health - psychology
Osteoporosis - diagnosis - therapy
Osteoporotic Fractures - etiology - prevention & control
Patient Care Team - organization & administration
Primary Health Care - standards
Qualitative Research
Risk Assessment - methods - standards
Sweden
Abstract
Underdiagnosis of osteoporosis is common. This study investigated Swedish district nurses' perceptions of osteoporosis management. They perceived the condition as having low priority, and the consequences of this perception were insufficient awareness of the condition and perceptions of bone-specific medication as unsafe. They perceived, though, competency when working with fall prevention.
Undertreatment of patients with osteoporosis is common. Sweden's medical care strategy dictates prioritisation of various conditions; while guidelines exist, osteoporosis is not prioritised. The aim of this study was to investigate district nurses' perceptions of osteoporosis management within Sweden's primary health care system.
Four semi-structured focus group interviews were conducted with 13 female district nurses. The interviews were analysed using thematic analysis.
The overall theme was perceiving osteoporosis management as ambiguous. The themes were perceiving barriers and perceiving opportunities. These subthemes were linked to perceiving barriers: (i) insufficient procedures, lack of time and not aware of the condition; (ii) insufficient knowledge about diagnosis and about fracture risk assessment tools; (iii) low priority condition and unclear responsibility for osteoporosis management; and (iv) bone-specific medication was sometimes perceived to be unsafe. These subthemes were linked to perceiving opportunities: (i) professional competency when discussing fall prevention in home visit programs, (ii) willingness to learn more about osteoporosis management, (iii) collaboration with other professionals and (iv) willingness to identify individuals at high risk of fracture.
Osteoporosis was reported, by the district nurses, to be a low-priority condition with consequences being unawareness of the condition, insufficient knowledge about bone-specific medications, fracture risk assessment tools and procedures. These may be some of the explanations for the undertreatment of osteoporosis. At the same time, the district nurses described competency performing the home visits, which emerged as an optimal opportunity to discuss fall prevention and to introduce FRAX with the aim to identify individuals at high risk of fracture.
PubMed ID
25792490 View in PubMed
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The quality of electronic patient records in Finnish primary healthcare needs to be improved.

https://arctichealth.org/en/permalink/ahliterature156576
Source
Scand J Prim Health Care. 2008;26(2):117-22
Publication Type
Article
Date
2008
Author
Suvi Vainiomäki
Maisa Kuusela
Paula Vainiomäki
Päivi Rautava
Author Affiliation
The City of Turku/Health Care, Turku, Finland.
Source
Scand J Prim Health Care. 2008;26(2):117-22
Date
2008
Language
English
Publication Type
Article
Keywords
Clinical Competence - standards
Community health centers - standards
Cross-Sectional Studies
Family Practice - standards
Finland
Humans
Medical Records Systems, Computerized - legislation & jurisprudence - standards
Office Visits
Outcome Assessment (Health Care)
Physician-Patient Relations
Primary Health Care - standards
Quality Assurance, Health Care
Abstract
To analyse the technical quality of electronic patient records in relation to legislation and to evaluate their quality associated with the quality of consultations as rated by patients and GPs.
Cross-sectional study of electronic patient records.
Four primary healthcare (PHC) centres in Finland using three different electronic patient record systems.
Patient records of 175 PHC consultations by 50 GPs, rated as the best (n=86) and the worst (n=89) of a total of 2191 consultations.
Documentation of records compared with legislation, the general informative value of records, and its relation to the experienced quality of consultations and to the electronic system employed.
Reason for encounter was mentioned in 79% of cases and patient history in 32%. An acute problem was described moderately well or well in 84%, examination findings in 62%, medical problem or diagnosis in 90%, and treatment in 95% of cases. Medication was documented adequately in 38% of the cases where medication was documented. Concerning general informative value, 18% were assessed as poor, 62% as moderate, and 20% as good. No correspondence was found between experienced quality of consultation and general informative value in the patient records. The quality of patient records was found to change according to the electronic system employed.
Finnish patient records are inadequate documents of consultations and below the standard of that country's legislation. Developing better models of recording would guarantee a higher quality of work.
Notes
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PubMed ID
18570011 View in PubMed
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212 records – page 1 of 22.