Bmc Fam Pract
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Randomized Controlled Trial
Using a brief web-based 5A intervention to improve weight management in primary care: results of a cluster-randomized controlled trial.
The primary health care setting is considered a major starting point in successful obesity management. However, research indicates insufficient quality of weight counseling in primary care. Aim of the present study was to implement and evaluate a 5A online tutorial aimed at improving weight management and provider-patient-interaction in primary health care. The online tutorial is a stand-alone low-threshold minimal e-health intervention for general practitioners based on the 5As guidance for obesity management by the Canadian Obesity Network. ⋯ To our knowledge, the present study provides the first long-term results for a 5A-based intervention in the context of the German primary care setting. The results suggest that a stand-alone low-threshold minimal e-health intervention for general practitioners does not improve weight management in the long term. To improve weight management in primary care, more comprehensive strategies are needed. However, due to recruitment difficulties the final sample was smaller than intended. This may have contributed to the null results.
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Many patients consult their primary care physician with persistent somatic symptoms such as pain or sickness. Quite often these consultations and further diagnostic measures yield no medical explanation for the symptoms - patients and physicians are left in uncertainty. In fact, diagnostic and treatment barriers in primary care hinder timely health-care provision for patients suffering from persistent somatic symptoms (PSS). The significance of individual barriers is still unknown. We compare and quantify these barriers from the perspective of primary care physicians and identify subpopulations of primary care physicians who experience particular barriers as most severe. ⋯ The PCPs in our survey answered that the obligation to rule out severe physical disease and the demand to relieve patients from symptoms belong to the most severe barriers for adequate treatment and diagnosis. Moreover, many physicians admitted to not knowing the appropriate treatment guidelines for these patients. Based on our results, raising awareness of guidelines and improving knowledge about the management of persistent somatic symptoms appear to be promising approaches for overcoming the barriers to diagnosis and treatment of persistent somatic symptoms in primary care.
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Randomized Controlled Trial Multicenter Study
Effect of physician attire on patient perceptions of empathy in Japan: a quasi-randomized controlled trial in primary care.
There is limited quantitative research on the effect of physician attire on patient-physician relationships. This study aimed to measure the influence of Japanese family physicians' attire on the "human" aspects of medical care in terms of patient-perceived relational empathy. ⋯ This study demonstrated that physician attire (white coat or casual attire) in a primary care setting did not affect patient-perceived relational empathy overall. However, male patients of physicians wearing casual attire reported higher physician empathy. Although empathy cannot be reduced to simple variables such as attire, white coats may have a negative effect on patients, depending on the context. Family physicians should choose their attire carefully.
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Most patients nearing the end of life can benefit from a palliative approach in primary care. We currently do not know how to measure a palliative approach in family practice. The objective of this study was to describe the provision of a palliative approach and evaluate clinicians' perceptions of the results. ⋯ This study identified measurable indicators of a palliative approach in family practice, that can be used as the basis for quality improvement.
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Stroke is one of the top contributors to burden of disability-adjusted life-years worldwide. Family physicians have key role in optimising secondary prevention following stroke by managing clinical risk factors and promoting overall control in accordance with clinical practice guidelines. ⋯ We reported sub-optimal level of overall control. Among individuals following stroke, those with diabetes had higher proportion of sub-optimal control as compared to those without diabetes. Irrespective of diabetic status, being female, having high BMI, and of Malay ethnicity as compared to Chinese ethnicity were associated with poorer overall risk factor control.