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PubMed2005

Experience of hepatitis C among current or former heroin users attending general practice.

The majority of injecting drug users in Ireland are infected with hepatitis C (HCV) and many attend general practice for methadone maintenance treatment. To describe awareness and experience of HCV infection, related investigations and treatment, a semi-qualitative interview study of current or former heroin users attending a general practice was carried out. Twenty-five patients (69% of total) were interviewed, of whom 23 were on methadone maintenance therapy at the time of the interview and 22 were HCV positive. While awareness of harm reduction measures and health implications of the infection was good, continued high-risk activity was common. Negative experiences at diagnosis, of subsequent investigations and treatments received were common. Only one person had been treated for HCV. We conclude there are a number of barriers to effective HCV management among heroin users and further research is needed to improve our understanding of this issue.

Adolescent↗
PubMed2006

Early recognition and early access for acute coronary syndromes in New Zealand: key links in the chain of survival.

AIMS: We studied the behaviour of patients prior to admission to hospital with symptoms of acute coronary syndromes, and what barriers may exist to early recognition of these symptoms and to early activation of emergency medical services. METHODS: Over a 7-week period, we interviewed 100 patients admitted to the Cardiac Care Unit in Wellington Hospital with suspected acute coronary syndromes. RESULTS: Within 5 minutes of symptom onset, 46 of 100 patients believed they were having a heart attack. Sixty-two of the patients believed that they had a cardiac-related problem. Patients took a median time of 90 minutes (range 0-9600 minutes) to contact a health professional from the time of symptom onset; and a median time of 228 minutes (range 33-9633 minutes) to arrive at hospital. We observed significant differences in both these end-points according to which health professional was contacted first. Patients who presented directly to hospital arrived significantly faster (median 72 minutes) than those who first called an ambulance (180 minutes) or contacted a general practitioner (485 minutes) (p=0.001, Kruskal Wallis test). CONCLUSIONS: Considerable delays exist in the presentation of patients with symptoms of ACS to hospital. These delays are multifactorial, but the psychological intimidation of the 111 telephone system and delays incurred by inappropriate out-of-hospital management of patients with chest pain are probably significant. It is likely that these delays contribute to mortality from acute coronary syndromes.

Adult↗
PubMed1995

Community resources for psychiatric and psychosocial problems. Family physicians' referral patterns in urban Ontario.

OBJECTIVE: To document the number and pattern of psychiatric and psychosocial referrals to community resources by family physicians (FPs) and to determine whether referral practices correlate with physician variables. DESIGN: Cross-sectional survey of referrals by FPs to 34 key psychiatric and psychosocial community resources identified by a panel of FPs, psychiatric social workers, psychiatric nurses, public health nurses, and the local community information service. SETTING: Regional municipality of 434,000 persons in Ontario. PARTICIPANTS: Twenty-seven of 34 (79%) community agencies identified 261 FPs who made 4487 referrals to participating agencies (range 0 to 65, median 15, mean 17.19 +/- 13.42). MAIN OUTCOME MEASURES: Number of referrals to all agencies; variables, such as physician sex, school of graduation, year of graduation, and certificate status in the College of Family Physicians of Canada, related to referral patterns. RESULTS: Referrals to outpatient psychiatric clinics, support services, and general counseling services accounted for 96% of all referrals. Physicians' average annual referral profile was as follows: 8.6 patients to a support service, 6.3 to an outpatient psychiatric service, 1.6 to a counseling service, and 0.46 to a substance abuse service. Referral profiles of individual physicians varied greatly. Female FPs made fewer referrals than male FPs to support services, but both made similar numbers of referrals to psychiatric, counseling, and substance abuse services. The more recent the year of graduation, the greater the number of referrals to psychiatric (r = 0.158, P = 0.0107) and counseling services (r = 0.137, P = 0.0272) and the higher the fraction of referrals to psychiatric services (r = 0.286, P = 0.0001). CONCLUSIONS: Family physicians in Hamilton-Wentworth made few referrals to psychiatric and psychosocial services. Only physician sex and year of graduation correlated significantly with numbers of referrals made. Recent graduates of both sexes made significantly more referrals to psychiatric clinics and counseling services than their older colleagues.

Community Mental Health Services↗
PubMedDate not supplied

Assessing family planning service-delivery practices: the case of private physicians in Jamaica.

This report presents the results of a study of the family planning service-delivery practices of private physicians in Jamaica. All 367 private physicians in Jamaica who offer family planning services, counseling, or referral were included in the survey. The study revealed that a client seeking services might be given a method by one provider and not by another, and that the methods clients use are likely to be influenced by the providers' preferences. Private physicians in Jamaica are in need of access to current international guidance on contraceptive methods and service practices.

Adult↗
PubMed1996

Counseling to reduce road injuries and deaths.

OBJECTIVE: To study undergraduate learning of and current clinical practice on counseling to reduce road injuries and deaths. DESIGN: Questionnaire on high-risk clinical scenarios. SETTING: Canadian medical schools, one family medicine program, and a Toronto trauma centre. PARTICIPANTS: Three groups: 338 final-year medical students from 12 Canadian universities, 183 family practice teachers from the Ontario-wide University of Toronto teaching network, and 45 trauma-team members from a Toronto regional trauma centre. MAIN OUTCOME MEASURES: All health promotion items identified by students are relevant to the clinical scenarios presented to them were tabulated to identify general knowledge of health promotion counseling and specific knowledge of road trauma prevention. The trauma-related counseling practices of family practice teachers were tabulated from their responses to one of the student scenarios. The same process tabulated the counseling that trauma-team members would expect family physicians to do in busy practices. RESULTS: Students' knowledge about health promotion counseling was generally good, except for road trauma prevention, where counseling is seldom done unless heavily prompted. Family practice teacher responses indicated that approximately 15% have not accepted road trauma counseling as part of clinical practice. Trauma-team members ranked trauma prevention items similarly to family practice teachers, but had higher expectations for performance. The neck is the most commonly injured site, but no group identified headrest adjustment as important. CONCLUSIONS: Counseling to prevent road trauma is deficient both in practice and teaching.

Accidents, Traffic↗
PubMed1997

Health career orientation of Oregon high school students.

BACKGROUND AND OBJECTIVES: Because a shortage of physicians for the rural United States persists, it is important to better understand why individuals from rural areas consider careers in medicine. This study assessed and compared rural and urban high school students' interest in careers in medicine. METHODS: Students attending presentations given by medical students about health care careers completed a questionnaire given at high schools between 1991-1994. This questionnaire assessed interest in health and medical careers and self-perceived capability to pursue a medical career. RESULTS: A total of 924 students attended the presentations and returned questionnaires. Approximately 33% of students expressed an interest in some type of health career. Related to choosing such a career were being female, coming from an urban area, and having had a previous talk about a health care career. Among the 13% of students considering becoming a physician, only being from an urban area or having had a previous talk were related to this choice. Rural students who had received previous talks were more likely to consider health care and medicine careers. CONCLUSIONS: Socializing rural high school students to health care and physician careers via structured talks and personal encouragement may increase the number of rural students interested in such careers and help alleviate the shortage of rural health care providers.

Adolescent↗
PubMed1997

Diagnosing and managing dementia patients. Practice patterns of family physicians.

OBJECTIVE: To examine the practice patterns of family physicians in diagnosing and managing patients with dementia. DESIGN: In-depth structured interviews. SETTING: Metropolitan Toronto family practices. PARTICIPANTS: Twenty family physicians who referred patients to a specialized community psychiatry service for the elderly in the previous year. METHOD: Two vignettes focusing on diagnosis and management issues were developed for the study. Physicians were asked how they would handle the clinical problems presented in the vignettes. Their responses were compared to standardized diagnostic and management protocols. MAIN FINDINGS: Participants were more comfortable with diagnosing dementia than with ongoing management issues, and most physicians were not using standardized cognitive screening protocols. Physicians were more oriented to immediate medical and psychiatric problems than to long-term psychosocial issues. CONCLUSIONS: More attention should be paid to the ongoing educational needs of family physicians with respect to this patient population.

Adult↗
PubMed1997

Needle stick injuries in country general practice.

AIMS: The aims of this study were to determine the frequency of needle stick injury (NSI) in general practice, to determine what measures were being taken to protect against needle stick injury, and to gather other information regarding work practices, risk perception, and knowledge of transmission. METHODS: A postal survey was undertaken of all general practitioners and one practice nurse per practice address in selected areas of New Zealand. RESULTS: The response rate was 82%. An incidence rate of 22 needle stick injuries in 100 health care workers per 6 month period was found. For general practitioners alone the incidence rate was 25 in 100 per 6 month period and for practice nurses it was 17 in 100 per 6 month period. Recommended precautionary measures were not being followed by most individuals. CONCLUSIONS: Needle stick injury is a substantial problem in general practice and exposes general practitioners and practice nurses to a serious risk of infection from bloodborne transmissible agents. All patients should be considered to pose a potentially high risk of infection and recommended precautionary measures should be followed at all times.

Accidents, Occupational↗
PubMed1997

Clinical concepts and dilemmas between disease and averse life events.

A visual model of general practice as a field of medicine is presented. Definitions of terminology and concepts to be used are discussed. By the application of this terminology a model of health, including the concept of disability, is constructed. This model is used to define and describe dilemmas occurring in daily work. Such dilemmas are frequent and their nature needs to be explored. They present an area in which psychosomatic medicine could meet with general practice, and vice versa.

Disease↗
PubMed1998

Tuberculosis among health care workers in British Columbia.

OBJECTIVES: To compare the clinical features and prevalence of active TB in British Columbia (BC) health-care workers (HCWs) with those of the general population, between 1991 and 1996. METHODS: Comparison of 25 HCWs and 50 controls randomly selected from the Centres for Disease Control registry, with respect to demographics, prevention, diagnosis and management. RESULTS: HCWs had fewer related risk factors, but more had initiated prior chemoprophylaxis (16% vs. 0%, P < 0.01) and knew their bacille Calmette-Guerin (BCG) (68% vs. 24%, P < 0.001) and purified protein derivative (PPD) status (60% vs 32%, P < 0.05). There were no differences in symptom duration (3.3+/-3.6 vs. 3.0+/-3.4 months), mycobacteriology and diagnostic features, treatment duration (264.9+/-69.9 vs. 239.0+/-78.7 days) and completion rates (84% for both). All HCWs used self-administered treatment (100% vs. 70%, P < 0.01), and fewer were hospitalized (8% vs. 28%, P < 0.05). Disease rates in nurses (3.6+/-4.4 per 100 000) were lower than the general population rates (9.0+/-0.8), but did not differ among physiotherapists (8.96+/-21.95), general practitioners (7.60+/-11.78) and medical residents (30.75+/-75.32); CONCLUSIONS: Clinical features were similar in HCWs, but management strategies differed. BC HCWs are not at increased risk of tuberculosis, but the small sample size limited the power of our study to detect such an increase.

Adult↗
PubMed1997

AIDS surveillance: knowledge, attitudes, and practices of health care professionals in Washington State.

Health professionals in Washington State were surveyed in 1993 to assess acquired immunodeficiency syndrome (AIDS) reporting knowledge, attitudes, and practices. Seventy-five percent responded. Two thirds of previous reporters were informed about the 1993 AIDS case definition and reporting requirements, but 32 percent had neglected to report. Forty-eight percent were concerned about confidentiality of reported cases. Half favored human immunodeficiency virus reporting and 21 percent opposed it. In order to promote complete and timely AIDS reporting, current and future reporters need ongoing education on reporting requirements and methods. The importance of AIDS surveillance data for community planning as well as assurance of protection of confidentiality should be emphasized.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Patient attitudes and knowledge about HIV infection and AIDS.

BACKGROUND: Family physicians are caring for an increasing number of those with human immunodeficiency virus (HIV) infection, those at risk, and those concerned about HIV disease. METHODS: A questionnaire survey of attitudes and knowledge about HIV infection was conducted in 430 patients in three family practices in Monroe County, NY. RESULTS: The majority of those surveyed had worried about catching HIV and had spoken with friends or relatives about HIV. Approximately 7.5% had had the HIV test. Approximately half of all the respondents expressed a desire to discuss HIV-related issues with their family doctor; however, less than 8% had actually done so. The majority of the respondents believed their family doctor was competent to answer questions about HIV disease. Furthermore, the majority were well informed about the modes of transmission of HIV. Many of the respondents were unsure of the lack of risk from casual contact, however, and whether acquired immune deficiency syndrome (AIDS) is incurable at the present time. CONCLUSIONS: Family physicians need to take a more active role in educating and counseling patients about HIV disease.

Acquired Immunodeficiency Syndrome↗
PubMed2000

[Health promotion indicators - selected model approaches].

The aim of the paper is to present the problem, how to find the optimal set of indicators necessary in the different phases of planning, programming and evaluation of health promotion programmes. In health promotion the application of classic health measurements is limited, because they are not related to "positive health". Moreover, time perspective when effects of promotion could appear is difficult to define. Some model approaches are presented. The PRECEDE-PROCEED model is recognised as a robust framework in health promotion. This model provides a continuous series of steps and phases in planning, implementation and evaluation process. Some authors recommend already in the early phase of programming to draw a diagram showing a relationship between the objectives, activities, indicators and resources. In the process of evaluation it seems very important for health promotion initiatives to focus on the changes in human knowledge, attitudes and behaviours. For that reason models like KAP analysis (knowledge, attitudes, practice), HBM (Health Belief Model) and TTM (Transtheoretical Prochaska's model) are commonly applied. However, the- re is still a need to develop and choose indicators, which would consider environmental aspects of health promotion and link local actions with national health promotion policy.

Health Knowledge, Attitudes, Practice↗