Home care: a key to the future of family medicine?

This essay is about my transition from family medicine residency into house call/home-based primary care practice. Though some aspects of making home visits have been difficult and uncomfortable, I have found a higher level of satisfaction and sense of purpose than I had as a resident in a traditional outpatient clinic. This enhanced satisfaction is, in part, due to my discovery that a lower-volume, time-intensive house call practice is a more appropriate way than the brief office visit to care for older patients who have multiple morbidities. In light of the aging population, advances in portable medical technology, and changes in Medicare reimbursement, home care could become a key to the future success and ongoing relevance of family medicine.     

The 21st century: the age of family medicine research?

Family medicine has matured as an academic and scientific discipline with its own core concepts, knowledge, skills, and research domains. It has acquired much expertise in studying common illnesses; the integration of medical, psychological, social, and behavioral sciences; patient-centered care; and health services delivery. Many health care challenges in the 21st century will place a great demand on primary care, which can serve its purpose only if it is of high quality and evidence based. Family medicine research can contribute to many areas of primary care, ranging from the early diagnosis to equitable health care. Stakeholders, such as the World Health Organization, governments, and funding agencies, are becoming more supportive to family medicine research because they recognize its key importance in improving the quality of primary care and bridging the gap between biomedical research and clinical practice. Family medicine can play a leading role in shifting the paradigm of medical research from the laboratory to the person. The 21st century should be a golden age of family medicine research because the time is right for the discipline, the health care environment is most suitable, and stakeholders are supportive. Family medicine must prepare for it by building up its research track record and capacity.     

Smoking cessation within the context of family medicine: which smokers take action?

BACKGROUND: According to Prochaska's transtheorical model, the stage of action is a milestone in the long-term smoking cessation process. Describing smokers' variables preceding this stage is essential. METHODS: A retrospective case-study design using data from the FAMUS primary care register. The objective was to develop a predictive model for the smoker's action of quitting smoking. The quit-attempt rate (QAR) is defined as the proportion of patients who attempted to quit at least once during the follow-up period. Tree-based and logistic regression models were applied to 7,567 smokers with at least two recorded visits. RESULTS: The QAR is 25% and is higher for men (26.5%) than for women (24.5%). For men, the groups generated by the trees are light (15). For women, the pattern observed involves four groups: very light (1 cigarette), moderate-low (2-10), moderate-high (11-20), and heavy smokers (>20). In both cases, the QAR decreases from light to heavy smokers, and the number of cigarettes, nicotine replacement therapy, and age remain relevant factors predicting the QAR. CONCLUSIONS: Medical professionals should consider smoking an addiction and take specific approaches to smoking cessation based on age, gender, and cigarettes consumed.     

Measuring the impact of family medicine research: scientific citations or societal impact?

The ultimate goal of research in medicine, a spectrum startingwith basic biomedical research via clinical trials to implementationresearch, is to improve the health and the quality of life ofindividuals and communities. Research should therefore be ofthe very best quality and assessment of its quality is important.Traditionally, research and researchers are evaluated by meansof the ‘scientific impact’ of research output, i.e.publications in biomedical journals. The higher the impact factorof a journal, the better the research scores. Journals knowhow they can polish up their impact factor and for some thisis even a deliberate     

How can departments of community medicine shape the future of public health education in India?

In order to effectively respond to a changing public health paradigm, it is imperative that the medical education and overall public health education (PHE) parallel the public health challenges faced by countries. Community medicine departments play a crucial role in PHE. This review analyzes the current situation of community medicine departments in the context of PHE, using a framework that outlines academic activities undertaken by these departments. This framework includes the syllabus of academic programs, internship, and infrastructure and faculty strength in the community medicine departments. The review also discusses how skill building of existing faculty members can help us in addressing emerging public health issues, and the role of partnerships and collaborative activities in advancing the PHE agenda, thereby continuing to shape the role played by these departments toward shaping the future of PHE in India.     

Future of research in family medicine: where to from here?

Desired research outcomes in family medicine vary according to the developmental stage of the discipline and the context of practice. Several milestones in the evolution of family practice research worldwide have been achieved. Now family medicine researchers face the challenge of discovering how evidence-based primary health care can be delivered in a sustainable way to individuals within communities. To advance family medicine research, we must ensure that trainees have a positive research attitude, develop academic clinician-researchers, lobby for primary care research funding, support practitioners who wish to do research in their own practices, sustain practice-based research networks, and study important questions.     

PubMed perspective of family medicine research: where does it stand?

OBJECTIVE: The aim of this study was to obtain a view of family medicine research by analyzing PubMed citations from 1960-2003. METHOD: Family practice (FP) citations in PubMed from 1960 to 2003 were downloaded in MEDLINE format. This was written into relation database using 'PubMed Grabber/Analyzer' software developed at University of Kelaniya, Sri Lanka. Search Query Language (SQL) and online PubMed queries were used for further analysis. RESULTS: There were 50288 FP citations from 80 countries. Of these, 33712 (67%) citations were from 15 FP journals. United Kingdom (18760), United States (13584), Australia (3262), Canada (1848), Germany-west (1340) were the five countries which had the most citations and 22 countries had less than 5 citations. Van Weel C (118), Geyman JP (116), Olesen F (87), Jones R (83) and Knottnerus JA (82) were numerically, the top five authors. Only 921 authors had more than 10 citations and the vast majority of authors had only one citation. Letters (5121), review (2715), editorial (2259), randomized controlled trials-RCT (1585) and Meta-analysis (44) were the top publication types. 40 citations found under 'qualitative research'. Discussion. The relatively few PubMed FP citations (50288) are by a small number of academics in developed countries. Citations showed an upsurge from the mid 1980s to the late 1990's but reached a plateau in the new millennium. Compared to PubMed citations from 1960-2003 in other specialties such as 2737655 for public health, 1151194 for cardiology & cardiovascular diseases and 318538 for medical informatics, the 50288 FP citations were paltry. Paucity of RCT (1585) and meta-analysis (44) was noted. The low 'qualitative research' citations (44) could have been due to the late introduction of the MeSH concept in 2003. CONCLUSIONS: Priority should be given to increase FP research and also to ensure the indexing of FP journals that are not currently indexed in PubMed. Efforts to increase citations in Medline may not give the desired results because of low priority given primary care specialties such as family medicine in the USA. Alternative solution of a separate bibliographic database for FP similar to PsycInfo may be too costly.