PubMed Health⌕ Search

Biomedical subjects

M D Beaulieu

Publications and source records attributed to M D Beaulieu.

At least 19 recordsLinked to original sources
PubMed2001

Loyalty to the regular care provider: patients' and physicians' views.

BACKGROUND: Changes in the organization of primary care practices are likely to have repercussions on the manner in which patients and physicians perceive loyalty to a regular source of care. A better understanding of their views will contribute to conceptual reflections on this poorly documented topic and, where needed, will reinforce efforts to adapt services to patient expectations. OBJECTIVES: The aims of this study are to document and compare the views that patients and GPs have of loyalty to the regular care provider. METHODS: This exploratory study uses the focus group technique. In 1997, we set up three groups of patients and three groups of physicians practising in Montreal. A total of 23 patients and 14 physicians participated in the study. The meetings investigated the participants' points of view on various aspects of the notion of loyalty. Analysis was based on transcripts of the meetings. The emerging themes were identified and the viewpoints were coded independently and then revised (when necessary) in order to obtain a consensus. RESULTS: Patients and physicians have a relatively congruent vision of the notion of loyalty. This tendency to use the regular source of care over time appears to be rooted in a formal or informal contract between patients and their physicians and implies a sustained partnership and a strong interpersonal relationship. The relationship established is neither exclusive nor permanent. Patients periodically reconsider it by evaluating their physician's technical and interpersonal skills. CONCLUSIONS: This study highlights the dynamic and multidimensional nature of the notion of loyalty. It shows that patients clearly identify with a particular physician rather than a clinic. The results challenge the prevailing methods of assessing longitudinality of care.

Adult↗
PubMed2001

Are patients suffering from stable angina receiving optimal medical treatment?

There is good evidence for the use of antiplatelet, beta-blocker and lipid-lowering drugs in the treatment of ischaemic heart disease, but few data on how these medications are used in treating stable angina pectoris. We examined prescription profiles for a sample of patients aged > or =65 years with stable angina, to compare the profiles to local guidelines and to explore the determinants of these profiles, in a cross-sectional study. We identified 11 141 individuals from the Quebec provincial out-patient pharmaceutical database for the period 1 June 1996 to 31 May 1997, and examined the percentage of these patients with and without associated co-morbidities receiving antiplatelet, beta-blocker and lipid-lowering medications. We used hierarchical modelling to examine the role of patient and physician characteristics in explaining the variation in the use of these medications. Calcium-channel blockers were the class of anti-ischaemic drugs most prescribed (63%). Beta-blockers were prescribed in 52.1% of patients. Antiplatelet and lipid-lowering drugs were prescribed to 56.8% and 32.6%, respectively. Increasing age and female gender made patients less likely to be prescribed these treatments. General practitioners were less likely than cardiologists to prescribe beta-blockers and lipid-lowering drugs (OR 0.79, CI 95% 0.68-0.91 and OR 0.77, CI 95% 0.66-0.91, respectively). There is a general under-use of antiplatelet, beta-blocker and lipid-lowering medications in the treatment of stable angina pectoris patients, possibly leading to adverse patient outcomes.

Adrenergic beta-Antagonists↗
PubMed2000

Medical device tracking: results of a case study of the implantable cardioverter defibrillator.

Case reports were received of a fatal tachycardia caused by a malfunction of an implantable cardioverter defibrillator (ICD), a device that is subject to the tracking regulations of the Food and Drug Administration's Center for Devices and Radiological Health. The case reports led to a decision to notify 5,604 patients of the need for reprogramming of their ICDs to prevent the tachycordia. In the first 60 days, a total of 98.7% of the patients were successfully located and their devices reprogrammed. Multiple logistic regression analysis was conducted to examine an extensive array of factors that might have been related to the time to reprogramming. Patient-specific factors such as age, sex, and ejection fraction did not serve as a barrier to reprogramming in the first week (p = NS). Patients whose regular physician had >5 patients with the ICD subject to the recall were significantly more likely to have their ICDs reprogrammed in the first week (odds ratio [OR] 2.11, 95% confidence interval [CI] 1.85 to 2.43, p<0.001). Patients who changed physicians were significantly less likely to undergo reprogramming in the first week (OR 0.73, 95% CI 0.63 to 0.86, p<0.001). The experience of the recall of this tracked device is highly encouraging because it demonstrates that most tracked device recipients can be successfully located and receive medical intervention. Although tracking devices is a manufacturer's responsibility, the clinical community plays a critical role in its success. This report highlights the importance of understanding that role among physicians.

Adult↗
PubMed1999

Practice guidelines for clinical prevention: do patients, physicians and experts share common ground?

BACKGROUND: Clinical practice guidelines, such as those of the Canadian Task Force on Preventive Health Care, although based on sound evidence, may conflict with the perceived needs and expectations of patients and physicians. This may jeopardize the implementation of such guidelines. This study was undertaken to explore patients' and family physicians' acceptance of the task force's recommendations and the values and criteria upon which the opinions of these 2 groups are based. METHODS: Focus groups were used to collect study data. In total, 35 physicians (in 7 groups) and 75 patient representatives (in 9 groups) participated in the focus groups. An inductive approach was used to develop coding grids and to generate themes from the transcripts of the interviews. RESULTS: Physicians expressed resistance to discontinuing the annual check-up, which they viewed as an organizational strategy to counteract the many barriers to preventive care that they encounter. They reported difficulties in explaining to their patients the recommendations of the Canadian Task Force on Preventive Health Care, which they found complex and inconsistent with popular wisdom. Both patients and physicians attributed high value to the detection of insidious diseases, even in the absence of proof of the effectiveness of such activity. INTERPRETATION: The patients and family physicians who participated in this study shared many opinions on the value of preventive activities that depart from the values used by "prevention experts" such as the Canadian Task Force on Preventive Health Care in establishing their recommendations. A better understanding of the values of patients and physicians would help guideline developers to create better targeted communication strategies to take these discrepancies into account.

Adult↗
PubMed1999

Screening mammography referral rates for women ages 50 to 69 years by recently-licensed family physicians: physician and practice environment correlates.

BACKGROUND: Physician mammography referral remains below optimal levels despite a long-standing recommendation that all women ages 50 to 69 years receive screening mammography every 1 to 2 years. The purpose of this study was to determine physician and practice environment predictors of family physicians' screening mammography referral rates to women ages 50-69 years. METHOD: A cohort of 498 recently-licensed family physicians was followed for 18-months of incipient medical practice. The referral rate was the percentage of new clinically eligible women patients seen in a primary care context who had a screening mammogram ordered by the study physician. Mammograms and independent variables were identified from physician claims to a Canadian universal health insurance agency. The effects of factors in a conceptual framework were assessed using multivariable linear regression. RESULTS: Correlates of higher mammography referral rates were female gender, better general prevention knowledge, the combination of comprehensive inquiry and continuity care, lower patient volume, and lower shared primary care (multivariable model R(2) = 0.47). Factors belonging to practice environment explained more of the observed variance than did physician characteristics. CONCLUSIONS: Mammography referral varies enormously and almost half of the variance is explained by physician characteristics and practice preferences. Higher mammography referral is observed in practices with more comprehensive and continuity care.

Adult↗
PubMed1998

Treating hypertension. Are the right drugs given to the right patients?

OBJECTIVE: To evaluate whether physicians are prescribing antihypertensive drugs appropriately and according to the recommendations of the Canadian Hypertension Society. DESIGN: Retrospective cohort study. SETTING: Family medicine teaching clinic in Montreal. PARTICIPANTS: A cohort of 183 patients followed between 1993 and 1995. Of 350 patients registered at the clinic, 167 were excluded because diagnosis of hypertension was not supported by chart review, their charts contained insufficient information, they were pregnant or younger than 18 years, or they had secondary hypertension and complex medical conditions. MAIN OUTCOME MEASURES: The dependent variable was the antihypertensive medication. Independent variables were age and sex of patients, duration of hypertension, total number of visits and number of visits for hypertension, number of physicians consulted at the clinic, associated medical conditions, diagnosis of target organ damage, blood pressure readings, and associated medications. RESULTS: Diuretics were prescribed most frequently (45.9%). Angiotensin-converting enzyme (ACE) inhibitors ranked second (28.4%), followed by calcium channel blockers (26.2%) and beta-blockers (18.0%). Age, sex, duration of hypertension, and blood pressure readings were not associated with medications. Prescription of beta-blockers was strongly associated with previous myocardial infarction, but not with diagnosis of angina pectoris. Patients with contraindications to beta-blockers were less likely to receive them and more likely to receive calcium channel blockers. Only 32% of diabetic patients received ACE inhibitors. CONCLUSION: Results suggest that some prescriptions for antihypertensive medications are inappropriate, but that physicians are following some of the Canadian Hypertension Society's recommendations. A better understanding of physicians' prescribing behaviours could help target continuing education interventions to improve prescribing for hypertension.

Adrenergic beta-Antagonists↗
PubMed1998

[Interobserver agreement on diagnoses classified according the International Classification of Primary Care].

OBJECTIVE: To measure interobserver agreement on diagnoses classified and coded by family physicians using manual or computerized input modes. METHOD: Used increasingly in a variety of information management systems, the International Classification of Primary Care is the system best adapted to primary care. Ten physicians independently viewed 44 taped medical visits. Five physicians were randomly assigned to manual coding and five to computer coding. The study of reproducibility explored three aspects: written diagnoses, manually coded diagnoses, and diagnoses coded using a software program. The K statistic was calculated in order to compare interobserver agreement. RESULTS: Descriptive analysis of interobserver agreement in the written diagnoses revealed an agreement rate of 70.5% (+/- 6.3). Among physicians using manual coding, the agreement rate was 70.2% (+/- 7.2). In the group using the software program, the agreement rate was 75.0% (+/- 8.7). The K coefficients were low, but three were significant with critical ratios (z) above 1.96. CONCLUSION: Results suggest that input method has no bearing on interobserver agreement and that agreement is more a function of clinical presentation of health problems than of coding process.

Abstracting and Indexing↗
PubMed1996

Factors determining compliance with screening mammography.

OBJECTIVE: To determine factors affecting compliance with screening mammography prescribed by family physicians. DESIGN: Secondary analysis of a nonrandomized trial. SETTING: University-affiliated family medicine clinic in Montreal. PATIENTS: Women aged 50 to 69 years who were given a written prescription for a screening mammography during their visit at the clinic between Oct. 12, 1991, and May 31, 1992, and who had not undergone mammography in the preceding 2 years and had never been treated for breast cancer. Information on the potential factors was obtained through a telephone questionnaire 2 months after the visit. OUTCOME MEASURES: Indicator of compliance presence of result of screening mammography in patient chart, potential factors influencing compliance: age, level of education, marital status, socioeconomic level, smoking status, perceived health status, perceived psychological well-being, risk factors for breast cancer, use of health services including frequency of Papanicolaou test, Health Belief Model variables. RESULTS: Of the 171 eligible women, 113 (66.1%) underwent the prescribed mammography within 2 months after the visit to the clinic, and 149 (87.1%) responded to the questionnaire. The patients' socioeconomic characteristics, perceived health status, health utilization indices and risk factors for breast cancer were not found to be predictors of compliance. The strongest predictor of compliance was the number of previous mammograms. Women who had undergone mammography previously were less likely to be noncompliant than those who had not (odds ratio [OR] 0.11, 95% confidence interval [CI] 0.02 to 0.51; p = 0.005). Women who did not comply were less likely than those who did to believe that a prescription from their physician would convince them to undergo mammography (OR 0.21, 95% CI 0.007 to 0.60; p = 0.004). Other factors associated with noncompliance were the expression of fear of mammography (OR 2.09, 95% CI 1.08 to 4.02; p = 0.03) and the lack of time to take the test (OR 3.07, 95% CI 1.21 to 7.80 p = 0.02). Being a smoker was negatively associated with compliance (OR 0.43; 95% CI 0.22 to 0.86; p = 0.02). The stepwise logistic regression model accounted for 87.5% of the outcome (chi2 for goodness of fit = 164.4; p = 0.0001). CONCLUSION: Family physicians who prescribe screening mammography, even to women who consult for other reasons, are likely to overcome some of the barriers observed in association with population screening rates. However, physician-oriented approaches are not likely to reach the 30% to 40% of reluctant women who appear to hold negative views toward physicians' recommendations. Further study is necessary to determine how better to reach these women.

Aged↗
PubMed1994

[Breast cancer screening: is family medicine intervention effective?].

A non-randomized controlled trial was conducted in two family medicine centers. The objectives were to evaluate whether or not a systematic prescription by family physicians of a screening mammography to women aged 50 to 69 belonging in majority to a disadvantaged socio-economic group, would permit to reach at least 60% of them and to explore which factors were associated with compliance to the prescription. The experimental intervention consisted in the prescription by the family physician of a mammogram to those patients found eligible for the screening procedure irrespective of the reason for encounter. A total of 468 of the 870 women who consulted a physician during the study period were eligible for a screening mammography. In the experimental group, the mammography prescription rate was 89% for eligible women. At the end of the study, 58.8% (95% Conf. Int.:51.9%-65.7%) of the women in the experimental group and 13.4% (95% Conf. Int.:9.4%-17.4%) of those in the control group had passed a mammography (p < 0.0001). The adjusted odds ratio for the family physician's intervention was 14.98 (95% Conf. Int.:7.86-28.58). Women over 60 years of age and those who perceived themself more vulnerable to breast cancer were more likely to respond positively to their physician's recommendation. This study confirms that family physicians can effectively reach, in the area of clinical prevention, individuals who might not be reached otherwise.

Aged↗
PubMed1993

Taxonomy of difficulties in general practice.

A questionnaire combining qualitative and quantitative methods was used to compile a taxonomy of the difficulties experienced by general practitioners in their practices. Difficulties are grouped in 11 categories, ranging from clinical diagnosis to physicians' personal feelings. The taxonomy can be used as a guide for planning medical education or as a starting point for further research in general practice.

Attitude of Health Personnel↗
PubMed1990

Why are clinical problems difficult? General practitioners' opinions concerning 24 clinical problems.

This study was conducted to describe the difficulties perceived by general practitioners concerning 24 common clinical problems and to compare their perceptions with those of faculty members in family medicine. A random sample of 467 general practitioners and all 182 faculty members in family medicine in Quebec were sent one of four open-ended questionnaires, each of which dealt with six clinical problems; 214 general practitioners and 114 faculty members participated. A total of 5111 difficulties were reported; the number reported by each subject varied from 0 to 13 (mean 2.6 [standard deviation 2.09]) per problem. The problems that generated the most difficulties were depression, confusion in the elderly, chronic back pain, loss of autonomy in the elderly and sexually transmitted disease. The most frequent difficulties were with the patient's noncompliance with treatment, clinical diagnosis, failure of a specific treatment, inadequate health care resources and the physician's own emotional reactions. The difficulties for each problem were the same in the two groups 70% of the time. Physician's perceptions of their difficulties can be useful in the planning of initial training and continuing medical education.

Adult↗
PubMed1986

[Evaluation and treatment of lateral ankle sprain in the emergency department: is systematic radiography necessary?].

The authors describe the presentation, clinical evaluation and treatment of 151 patients (mean age 36.3 years) who presented to an outpatient clinic or the emergency department between Oct. 29, 1984, and Apr. 15, 1985, for a lateral ankle sprain. About 60% of the sprains were considered minor. Although 141 patients underwent simple radiography of the ankle on the first visit, only five fractures were identified. All the fractures were uncomplicated and were treated conservatively. No common criteria could be identified to explain why some patients with sprains of moderate severity were referred to an orthopedist while others were not. Of the 53 patients interviewed, 22 still had some limitation of physical activity 6 weeks after the sprain. The presence of malleolar soft-tissue swelling, pain in the bony structures and inability to bear weight should raise the suspicion of a fracture. If radiography had been limited to patients with these signs, no fracture would have been missed, and radiography would have been avoided in 70 cases.

Adolescent↗