Family practice
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Multicenter Study
Multicentre descriptive cross-sectional study of Japanese home visit patients: reasons for encounter, health problems and multimorbidity.
GP in Japan are encouraged to conduct home visits for older adults. However, most previous studies on home visits were based on secondary analyses of billing data that did not include reasons for the encounter. ⋯ The main reasons for encounter were prescriptions for chronic conditions. Emergency visits accounted for 8% of all visits. Around half of the patients had multimorbidity. This information may help GPs and policy makers to better assess home visit patients' needs.
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Multicenter Study
Primary care clinicians' confidence, willingness participation and perceptions of roles in advance care planning discussions with patients: a multi-site survey.
People who engage in advance care planning (ACP) are more likely to receive health care that is concordant with their goals at the end of life. Little discussion of ACP occurs in primary care. ⋯ Current engagement of primary care clinicians in ACP is low. Given the high willingness and acceptability for non-physician clinician involvement, increasing the capacity of non-physician clinicians could enable uptake of ACP in primary care.
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Strategic management of primary health care centres is necessary for creating an efficient global health care system that delivers good care. ⋯ Data envelopment analysis extends the scope of tools used to analyse primary care functioning. It can support health economic analyses when assessing primary care efficiency. The main issues are setting outputs and inputs and selecting a model best suited for the range of products and services in the primary health care sector. This article serves as a step forward in the standardization of data envelopment analysis, but further research is needed.
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Randomized Controlled Trial
Self-efficacy and doctor support as mediators of depression outcomes following counselling by family doctors for intimate partner violence.
Previous research shows counselling delivered by trained family doctors reduces depression for women experiencing intimate partner violence (IPV). However, the potential for self-efficacy, doctor support and safety enquiry to mediate these effects has not been examined. ⋯ Counselling by trained family doctors can help increase support and self-efficacy of women who have experienced IPV, mediating reduced depression.
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The 3P model proposes that predisposing, precipitating, and perpetuating factors all play a role in sleep disturbance. ⋯ The unmet need for affordable long-term housing and greater experiences of classism were associated with more sleep disturbance, suggesting that both acted as precipitating factors. In a structural equation model with adequate fit indices, anxiety mediated the relationships with sleep disturbance for both the unmet need for affordable long-term housing and classism, suggesting that it serves as a perpetuating factor. Medical providers are recommended to explore these potential needs in safety-net primary care when patients present with sleep disturbance or anxiety. Assisting with connections to long-term housing and helping patients counteract and cope with classist discrimination may be effective in improving sleep in safety-net primary care.