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Concept: Primary care physician

390

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

47

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

42

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

36

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

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

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

Concepts: Retrospective, Primary care physician

28

Prediabetes affects 86 million US adults, but primary care providers' (PCPs') knowledge, practices, attitudes and beliefs toward prediabetes are unclear.

Concepts: Epistemology, Primary care physician

28

CME EDUCATIONAL OBJECTIVES1.Review the definition, epidemiology, risk factors, and consequences of neglect.2.Provide a step-wise approach to the assessment of neglect, highlighting situations in which a report to child protective services is necessary.3.Describe promising strategies to help prevent child neglect. Child neglect, the most commonly reported form of maltreatment, can significantly impact a child’s long-term development. Pediatricians must understand how to recognize and respond to neglect. This article reviews the definition, epidemiology, risk factors, and consequences of neglect. It provides a step-wise approach to the assessment of neglect, highlighting the situations in which a report to child protective services is necessary. Additionally, promising strategies for child neglect prevention are described.

Concepts: Report, Educational psychology, Prevention, Pediatrics, Child abuse, Neglect, Primary care physician