scholarly journals The Role of Primary Care Physicians (DLP) in Community Care

2018 ◽  
Vol 1 (1) ◽  
pp. 3
Author(s):  
Dhanasari Vidiawati Trisna Sanyoto ◽  
Nur Afrainin Syah
Keyword(s):  
Primary Care ◽  
Family Medicine ◽  
Primary Care Physicians ◽  
Medical Training ◽  
The United States ◽  
Care Physician ◽  
Main Body ◽  
Family Doctors ◽  
Postgraduate Medical Training ◽  
Care Services

Dokter Layanan Primer (DLP) or Primary Care Physician (PCP) is a newly introduced term by the Indonesian government in 2013 since the enforcement of Medical Education Law 20/2013. DLP is a physician who solidifies his/ her education and career in primary care. They have postgraduate medical training in primary care and are experts in this field. In most countries, to be a generalist physician practising at primary care facilities such as health centres and primary care clinics, medical school graduates have to take postgraduate medical training to be proficient in terms of knowledge and skills in primary care services. Family medicine is the main body of knowledge of the primary care postgraduate training program in those countries even though their graduates are called differently among countries. These physicians are called family doctors or family physicians in the United States of America (USA), general practitioners (GPs) in Commonwealth countries, huisarts in the Netherlands. In Indonesia, where social, economic, and cultural diversity is very high in various regions, in addition to Family Medicine, Community Medicine and Public Health....

scholarly journals Teaching Chronic Pain in the Family Medicine Residency

2018 ◽  
Vol 50 (1) ◽  
pp. 22-27
Author(s):  
Kimberly Zoberi ◽  
Kelly M. Everard
Keyword(s):  
Risk Assessment ◽  
Primary Care ◽  
Chronic Pain ◽  
Pain Management ◽  
Family Medicine ◽  
Pain Assessment ◽  
Primary Care Physicians ◽  
The United States ◽  
Care Physician ◽  
Family Medicine Residency

Background and Objectives: Chronic pain is a significant condition affecting many Americans. Primary care physicians play an important role in chronic pain management, but many residents and physicians feel poorly prepared to manage it. Methods: Data were collected as part of the 2016 Council of Academic Family Medicine Educational Research Alliance (CERA) Program Director Survey, which was sent electronically to 484 program directors in the United States. The authors sought to determine whether residency directors’ attitudes about treating chronic pain were associated with the amount of time devoted to teaching family medicine residents about chronic pain assessment, therapy (use of opioids, use adjuvant pain medications, use of other nonopioids, use of nonpharmacological treatments), and risk management (risk assessment, use of pain management contracts, informed consent when prescribing opioids, and urine drug monitoring). Attitudes were assessed by asking whether: (1) chronic pain is best managed by a primary care physician (PCP); (2) prescribing opioid medications is time consuming; (3) prescribing opioids is high-risk; (4) prescribing opioids contributes to opioid misuse; and (4) effective nonopioid treatments exist. An additional question assessed confidence in treating chronic pain. Results: The response rate was 53%. The average family medicine residency devotes about 33 hours to education about pain management topics including 5.4 hours on chronic pain assessment, 16.2 hours on therapy, and 11.4 hours on risk assessment. Residency directors’ belief that there are effective nonopioid treatments for chronic pain was the only attitude item that was associated with teaching about chronic pain. Conclusions: Residency directors’ attitudes do not predict the time devoted to teaching chronic pain in family medicine residencies.

scholarly journals Conditions Influencing Collaboration Among the Primary Care Disciplines as They Prepare the Future Primary Care Physician Workforce

2020 ◽  
Vol 52 (6) ◽  
pp. 398-407 ◽  
Author(s):  
Patricia A. Carney ◽  
Erin K. Thayer ◽  
Larry A. Green ◽  
Eric J. Warm ◽  
Eric S. Holmboe ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Primary Care ◽  
Family Medicine ◽  
Interprofessional Education ◽  
Primary Care Physicians ◽  
The United States ◽  
Care Physician ◽  
Collaborative Practice ◽  
Interprofessional Collaborative Practice ◽  
Resident Graduates

Background and Objectives: Much can be gained by the three primary care disciplines collaborating on efforts to transform residency training toward interprofessional collaborative practice. We describe findings from a study designed to align primary care disciplines toward implementing interprofessional education. Methods: In this mixed methods study, we included faculty, residents and other interprofessional learners in family medicine, internal medicine, and pediatrics from nine institutions across the United States. We administered a web-based survey in April/May of 2018 and used qualitative analyses of field notes to study resident exposure to team-based care during training, estimates of career choice in programs that are innovating, and supportive and challenging conditions that influence collaboration among the three disciplines. Complete data capture was attained for 96.3% of participants. Results: Among family medicine resident graduates, an estimated 87.1% chose to go into primary care compared to 12.4% of internal medicine, and 36.5% of pediatric resident graduates. Qualitative themes found to positively influence cross-disciplinary collaboration included relationship development, communication of shared goals, alignment with health system/other institutional initiatives, and professional identity as primary care physicians. Challenges included expressed concerns by participants that by working together, the disciplines would experience a loss of identity and would be indistinguishable from one another. Another qualitative finding was that overwhelming stressors plague primary care training programs in the current health care climate—a great concern. These include competing demands, disruptive transitions, and lack of resources. Conclusions: Uniting the primary care disciplines toward educational and clinical transformation toward interprofessional collaborative practice is challenging to accomplish.

The Role of the Primary Care Physician in the Care of Children with Serious Heart Disease

PEDIATRICS ◽  
1994 ◽  
Vol 94 (3) ◽  
pp. 284-290
Author(s):  
Paul C. Young ◽  
Yu Shyr ◽  
M. Anthony Schork
Keyword(s):  
Primary Care ◽  
Heart Disease ◽  
Chronic Illness ◽  
Medical Care ◽  
Primary Care Physician ◽  
Primary Care Physicians ◽  
Care Physician ◽  
Care Needs ◽  
Care Services ◽  
Primary Care Services

Objective. To determine the roles of primary care physicians and specialists in the medical care of children with serious heart disease. Setting. Pediatric Cardiology Division; Tertiary Care Children's Hospital. Subjects. Convenience sample of parents, primary care physicians, and pediatric cardiologists of 92 children with serious heart disease. Design. Questionnaire study; questionnaires based on 16 medical care needs, encompassing basic primary care services, care specific to the child's heart disease and general issues related to chronic illness. Results. All children had a primary care physician (PCP), and both they and the parents (P) reported high utilization of PCP for basic primary care services. However, there was little involvement of PCP in providing care for virtually any aspect of the child's heart disease. Parents expressed a low level of confidence in the ability of PCP in general or their child's own PCP to meet many of their child's medical care needs. Both PCP and pediatric cardiologists (PC) were significantly more likely than parents to see a role for PCP in providing for care specific to the heart disease as well as more general issues related to chronic illness. PC and PCP generally agreed about the role PCP should play, although PC saw a bigger role for PCP in providing advice about the child's activity than PCP themselves did. PC were less likely to see the PCP as able to follow the child for long term complications than PCP did. PC were more likely than PCP to believe that PCP were too busy or were inadequately reimbursed to care for children with serious heart disease. Only about one-third of parents reported discussing psychosocial, family, economic, or genetic issues with any provider, and PCP were rarely involved in these aspects of chronic illness. Conclusions. Primary care physicians do not take an active role in managing either the condition-specific or the more general aspects of this serious chronic childhood illness. With appropriate information and support from their specialist colleagues primary care physicians could provide much of the care for this group of children. Generalists and specialists are both responsible for educating and influencing parents about the role primary care physicians can play in caring for children with serious chronic illness.

scholarly journals Medical Cannabis for the Primary Care Physician

2019 ◽  
Vol 10 ◽  
pp. 215013271988483 ◽  
Author(s):  
Deepika Slawek ◽  
Senthil Raj Meenrajan ◽  
Marika Rose Alois ◽  
Paige Comstock Barker ◽  
Irene Mison Estores ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physician ◽  
Primary Care Physicians ◽  
The United States ◽  
Care Physician ◽  
Chronic Health Conditions ◽  
Health Conditions ◽  
Efficacy And Safety ◽  
Medical Cannabis ◽  
Number Of Patients

Medical cannabis use is common in the United States and increasingly more socially acceptable. As more patients seek out and acquire medical cannabis, primary care physicians will be faced with a growing number of patients seeking information on the indications, efficacy, and safety of medical cannabis. We present a case of a patient with several chronic health conditions who asks her primary care provider whether she should try medical cannabis. We provide a review of the pharmacology of medical cannabis, the state of evidence regarding the efficacy of medical cannabis, variations in the types of medical cannabis, and safety monitoring considerations for the primary care physician.

scholarly journals Primary Care Resident Training for Obesity, Nutrition, and Physical Activity Counseling: A Mixed-Methods Study

2016 ◽  
Vol 18 (5) ◽  
pp. 672-680 ◽  
Author(s):  
Elizabeth L. Antognoli ◽  
Eileen L. Seeholzer ◽  
Heidi Gullett ◽  
Brigid Jackson ◽  
Samantha Smith ◽  
...  
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Mixed Methods ◽  
Primary Care Physicians ◽  
Medical Training ◽  
Resident Training ◽  
National Guidelines ◽  
Residency Programs ◽  
Postgraduate Medical Training ◽  
Nutrition And Physical Activity

National guidelines have been established to support the role of primary care physicians in addressing obesity. Preparing primary care residents to recognize and treat overweight/obesity has been identified as an essential component of postgraduate medical training that is currently lacking. This study aims to identify how primary care residency programs are preparing physicians to counsel about obesity, nutrition, and physical activity (ONPA) and to examine program members’ perspectives regarding the place of ONPA counseling in the curriculum, and its relevance in primary care training. Using mixed methods, we collected and analyzed data on 25 family medicine, internal medicine, and obstetrics/gynecology residency programs across Ohio. Programs averaged 2.8 hours of ONPA-related didactics per year. Ten programs (42%) taught techniques for health behavior counseling. Having any ONPA-related didactics was associated with greater counseling knowledge (p = .01) among residents but poorer attitudes (p < .001) and poorer perceived professional norms (p = .004) toward ONPA counseling. Findings from interview data highlighted similar perceived barriers to ONPA counseling across all three specialties but variation in perception of responsibility to provide ONPA counseling. While widespread expectations that primary care physicians counsel their overweight and obese patients prevail, few residency programs provide training to support such counseling.

scholarly journals Retail Therapy: How a Trip to the Store Can Make You Feel Better in the Evolving Health Care Landscape Created by the Affordable Care Act

2015 ◽  
Vol 33 (2) ◽  
pp. 239-260
Author(s):  
Cynthia Liba
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Care Physicians ◽  
The United States ◽  
Care Physician ◽  
Poverty Level ◽  
Health Clinics ◽  
Medicaid Eligibility ◽  
Individual Mandate ◽  
The Individual

As the ACA expands Medicaid eligibility by creating a national Medicaid minimum eligibility level of 133% of the federal poverty level and requires U.S. citizens to purchase health insurance as a result of the individual mandate, the shortage of primary care physicians will become painfully apparent for those seeking treatment. As a result, many health policy analysts and lawmakers are examining the potential ability of retail health clinics (RHCs) to address the consequences of primary care physician shortages in the United States, among other deficiencies in the provision of health care.

ERISA: State Tort Claim for Fraud and Negligent Misrepresentation Survives ERISA Preemption—Shea v. Esensten

2000 ◽  
Vol 28 (2) ◽  
pp. 190-191
Author(s):  
Peter J. Van Hemel
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Financial Incentives ◽  
Primary Care Physicians ◽  
The United States ◽  
State Court ◽  
Family Doctors ◽  
Court Of Appeals ◽  
Original Action ◽  
Wrongful Death

The United States Court of Appeals for the Eighth Circuit held that ERISA did not preempt a Minnesota tort claim alleging fraud and negligent misrepresentation against primary-care physicians who failed to disclose their financial incentives to minimize specialist referrals. The original action (“Shea I”) was filed in state court after the plaintiff's husband died of heart failure, alleging that his family doctors had assured him that referral to a cardiologist was unnecessary. The plaintiff filed a wrongful death suit against the doctors, their clinic, and her husband's HMO. Her complaint against the HMO alleged that certain financial incentives built into the HMO-physician contract were designed to minimize referrals to specialists. The HMO removed the case to the District of Minnesota, contending that ERISA preempted the plaintiff's wrongful death claim.

scholarly journals Transforming a Family Medicine Residency Into a Community-Oriented Learning Environment

2018 ◽  
Vol 50 (7) ◽  
pp. 518-525
Author(s):  
Jennifer Lochner ◽  
Robin Lankton ◽  
Kirsten Rindfleish ◽  
Brian Arndt ◽  
Jennifer Edgoose
Keyword(s):  
Family Medicine ◽  
Faculty Development ◽  
Community Health ◽  
Population Health ◽  
Health Care Access ◽  
Primary Care Physicians ◽  
The United States ◽  
Family Doctors ◽  
Care Access ◽  
Wisconsin Department

Background and Objectives: Improvement in population health has become a key goal of health systems and payers in the United States. Because 80% of health outcomes are driven by social determinants of health beyond medical care and health care access, such improvements require attention to factors outside of the conventional areas of expertise for clinicians. Yet primary care physicians often graduate from training programs with few skills in population and community health. Methods: In 2011, the University of Wisconsin Department of Family Medicine began transformative work to become a Department of Family Medicine and Community Health (DFMCH). As part of this effort, educators in the department addressed deficiencies in its residency’s community and population health curriculum by implementing curricular change and faculty development. A set of guiding principles, “Three Community Health Responsibilities for Family Doctors,” was developed to provide background and structure to current and future work. Results: An annual program evaluation survey was administered to faculty and residents between 2012 and 2016. Respondents reported a significant increase in their understanding of population and community health over the prior year in each year this was assessed (P&lt;0.001). Conclusions: Community and population health principles have become part of the fabric of the entire residency curriculum in the DFMCH. Faculty development was a key part of this work and will be integral to sustaining improvements.

scholarly journals Nurse Practitioners and Their Effects on Visits to Primary Care Physicians

2015 ◽  
Vol 15 (2) ◽  
pp. 837-864
Author(s):  
Yuriy Pylypchuk ◽  
Eric M Sarpong
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Primary Care Physicians ◽  
The United States ◽  
Dynamic Panel ◽  
Allied Health Professions ◽  
Care Services ◽  
Primary Care Services ◽  
To Receive

Abstract The demand for primary care services is expected to increase at a time of persistent shortages of primary care physicians (PCPs) in the United States. A proposed solution is to expand the role of other allied health professions. This study examines the causal effects of visits to nurse practitioners (NPs) on the demand for services from PCPs. We employ a system of simultaneous equations and dynamic panel estimators to control for endogeneity of visits to NPs. Results indicate that patients who visited an NP are significantly less likely to visit PCPs and to receive prescribed medication, medical check-up, and diagnosis from PCPs. Findings were robust to other specification and passed a falsification test. The results suggest that the use of NPs could serve as a potential option to address shortages in supply of primary care services.

scholarly journals Knowledge of final-year medical students at the University of KwaZulu-Natal about family medicine, and long-term career choices

2019 ◽  
Vol 61 (1) ◽  
Author(s):  
R. Omed Ali ◽  
A. J. Ross ◽  
T. C. Nkabinde
Keyword(s):  
Primary Care ◽  
Medical Students ◽  
Family Medicine ◽  
Primary Care Physicians ◽  
Healthcare Delivery ◽  
Care Physician ◽  
Kwazulu Natal ◽  
Care Family ◽  
The University ◽  
Health Programmes

Background: While international experience suggests that well-trained primary care physicians improve the quality and cost effectiveness of health care, family medicine (FM) as the discipline of the specialist primary care physician appears to not be an attractive career for medical graduates in South Africa (SA). The aim of this study was to establish final-year medical students’ knowledge about FM and its relevance to the healthcare system, explore their perceptions of the discipline’s relevance, and identify their specialty preference.Methods: This was a descriptive study conducted amongst final-year medical students at the University of KwaZulu-Natal (UKZN) in 2017 at the conclusion of their seven-week FM module. Data were collected using a self-administered questionnaire and results were analysed descriptively.Results: The response rate of completed questionnaires was 80.2% (157/196). Students reported limited exposure to FM in their early undergraduate years and low levels of awareness about essential public health programmes. Students showed good awareness of the six roles of family physicians (FPs), but FM was only the sixth most popular choice for specialisation.Conclusions: In general, students had favourable views concerning FM and its role in the future of healthcare delivery in SA, although their knowledge of essential health programmes was poor. The majority of students had limited interest in pursuing a career in FM. A key recommendation to address these issues is to introduce FM into the curriculum earlier, to cover the key roles of the FP, and provide teaching that highlights the relevance of FM to health system programmes.

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