SciCombinator

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Concept: Primary care physician

457

To describe the average primary care physician consultation length in economically developed and low-income/middle-income countries, and to examine the relationship between consultation length and organisational-level economic, and health outcomes.

Concepts: Medicine, Economics, Social sciences, Primary care physician

170

BACKGROUND: Although collaborative team models (CTM) improve care processes and health outcomes, their diffusion poses challenges related to difficulties in securing their adoption by primary care clinicians. The objectives of this study are to understand: (1) how the perceived characteristics of a CTM influenced clinicians' decision to adopt -or not- the model; and (2) the model’s diffusion process. METHODS: We conducted a longitudinal case study based on the Diffusion of Innovations Theory. First, diffusion curves were developed for all 175 primary care physicians (PCPs) and 59 nurses practicing in one borough of Paris. Second, semi-structured interviews were conducted with a representative sample of 40 PCPs and 15 nurses to better understand the implementation dynamics. RESULTS: Diffusion curves showed that 3.5 years after the start of the implementation, 100% of nurses and over 80% of PCPs had adopted the CTM. The dynamics of the CTM’s diffusion were different between the PCPs and the nurses. The slopes of the two curves are also distinctly different. Among the nurses, the critical mass of adopters was attained faster, since they adopted the CTM earlier and more quickly than the PCPs. Results of the semi-structured interviews showed that these differences in diffusion dynamics were mostly founded in differences between the PCPs' and the nurses' perceptions of the CTM’s compatibility with norms, values and practices and its relative advantage (impact on patient management and work practices). Opinion leaders played a key role in the diffusion of the CTM among PCPs. CONCLUSION: CTM diffusion is a social phenomenon that requires a major commitment by clinicians and a willingness to take risks; the role of opinion leaders is key. Paying attention to the notion of a critical mass of adopters is essential to developing implementation strategies that will accelerate the adoption process by clinicians. Key-words: primary care, primary care physician, nurses, chronic disease, collaboration, health service research, diffusion of innovation.

Concepts: Sociology, Diffusion, Adoption, Case study, Innovation, Primary care physician, Diffusion of innovations, Opinion leadership

142

Primary care panel sizes are an important component of primary care practices. Determining the appropriate panel size has implications for patient access, physician workload, and care comprehensiveness and will have an impact on quality of care. An often quoted standard panel size is 2500. However, this number seems to arise in the literature anecdotally, without a basis in research. Subsequently, multiple studies observed that a panel size of 2500 is not feasible because of time constraints and results in incomplete preventive care and health care screening services. In this article we review the origins of a panel size of 2500, review the subsequent work examining this number and effectively debunking it as a feasible panel size, and discuss the importance of primary care physicians setting an appropriate panel size.

Concepts: Health care, Medicine, Public health, Physician, Pediatrics, General practitioner, Physicians, Primary care physician

59

Little information exists about what primary care physicians (PCPs) and patients experience if patients are invited to read their doctors' office notes.

Concepts: Physician, Primary care, Primary care physician

53

Avoidable hospitalizations due to adverse drug events and high-risk prescribing are common in older people. Primary care physicians prescribe most on-going medicines. Deprescribing has long been essential to best prescribing practice. We sought to explore the views of primary care physicians on the barriers and facilitators to deprescribing in everyday practice to inform the development of an intervention to support safer prescribing.

Concepts: Pharmacology, Medicine, Drug, Adverse drug reaction, Pharmaceutical drug, Primary care, Medical prescription, Primary care physician

43

Inappropriate medication prescription is a common cause of preventable adverse drug events among elderly persons in the primary care setting.

Concepts: Pharmacology, Prescription drug, Illness, Adverse drug reaction, Pharmaceutical drug, Morality, Medical prescription, Primary care physician

31

Adolescent depression is a serious and undertreated public health problem. Nonetheless, pediatric primary care providers (PCPs) may have low rates of antidepressant prescribing due to structural and training barriers. This study examined the impact of symptom severity and provider characteristics on initial depression treatment decisions in a setting with fewer structural barriers, an integrated behavioral health network.

Concepts: Health care, Primary care physician

29

: Finding ways to reinvent primary health care is imperative. One way is to change practices from a physician-focused model to an interdisciplinary team approach where other health professionals (nurses, nurse practitioners, dieticians, rehabilitation therapists, and other qualified primary care providers) collectively take on much stronger roles-often providing services instead of the physician. Health care policy makers and professionals agree that these new practices are a good idea, and yet they have not been widely adopted.

Concepts: Health care, Medicine, General practitioner, Nursing, Health science, Primary care physician, Primary health care, Healthcare occupations

28

Evidence is lacking on the prognosis and prognostic factors for back-related leg pain and sciatica in patients seeing their primary care physicians. This could guide timely appropriate treatment and referral decisions.

Concepts: Medical terms, Physician, Medical diagnosis, Prognosis, Primary care, Primary care physician

28

To examine the development and implementation of a novel income security intervention in primary care.

Concepts: Retrospective, Primary care physician