全科医师人文素质培养体会

全科医学是一个面向社区与家庭,整合临床医学、预防医学、康复医学以及人文社会学科相关内容于一体的综合性医学专业学科。全科医生作为基层医疗保健体系的中坚骨干力量,为个人、家庭和社区提供一体化的医疗保健服务,这就需要良好的人文素质,为适应全科医学的发展和新医学模式的建立,培养全科医师人文素质已成为全科医学发展的必然和需要。     

浙江省编教材《全科医学导论》教学的实践与探索

全科医学近30年来在世界范围内有了长足的发展，已经成为初级医疗保健领域内的新学科。《全科医学导论》是全科医学这门学科的总论部分，主要介绍全科医学的基本概念、全科医生的作用、整体医学观、系统整体性方法，全科医生应该掌握的提供以病人为中心、家庭为单位、社区为范围、预防为导向     

双导师制在全科医学专业学位硕士研究生培养中的实践探索

<正>全科医学是服务社区及家庭、整合各种医学学科的综合性医学专业,范围涵盖了不同年龄、性别、各个器官系统以及各类疾病。随着现代医学模式的转变以及人民群众对医疗保健的迫切需求,全科医学的生物-心理-社会医学模式逐渐显露优势并发挥重要作用。国务院从2012年正式开始建立全科医学硕士专业学位研究生培养体系,意味着培养高素质的全科医生成为医疗教育的新趋势。10年来国家针对全科医学专业学位硕士研究生（以下简称“全科专硕”）的培养模式不断更新,     

国内全科医师培训中存在的问题及对策

全科医疗是近20多年来发展起来的基层医疗保健体系,现已在世界上50多个国家和地区推行,尤其在许多发达的西方国家,全科医疗已得到医学界和公众的普遍认可。随着医学模式的转变和医疗环境的不断变化,专科服务已难以满足人民群众日益增长的卫生服务需要,只有推行全科医疗与专     

我国循证全科医疗实践的模式特点及问题

全科医学是一门新兴学科,与循证医学有着“以患者为中心”和“以证据为基础”的共同特点。循证医学方法现已渗透到临床实践的各个领域,在包括全科医学在内的众多医疗卫生及医学教育等领域有不同程度的应用。本文通过探讨目前中国全科医生开展循证实践的意义、实践的模式特点及实践中需注意的问题,以期为促进我国循证全科医疗实践提供借鉴。     

我国全科医学的学科发展前景

近几年来,我国医疗改革不断深入,国家基本医疗政策不断完善,推进了全科医学的迅猛发展。自2011年国务院发表《关于建立全科医生制度的指导意见》以来,充分认识了我国建立全科医生制度的重要性和必要性,进一步明确了建立全科医师制度的总体目标。为全科医学带来新的发展契机。     

亚专长培养模式在全科医学专业研究生培养过程中的思考

<正>分级诊疗制度是我国医疗卫生体制改革的重点,全科医学教育的发展则是我国实施分级诊疗体制改革的重要保障和必经之路。随着医疗卫生改革的不断深入和现代医学模式的转变,全科医生教育培训体系在我国得到了极大的发展,全科医学专业研究生的培养也极大地提高了全科医学人才的产出效率。但是,目前我国的全科医生教育培训体系依旧处于初期阶段,尚未形成完善的、统一有效的持续发展体系^[1,2]。同时,由于全科医生的数量不足、整体医疗素质参差不齐以及全科与专科之间无法进行有效地衔接,     

结合西方国家全科医学发展史反思我国的全科医学现状

文章回顾了美、英等西方国家的全科医学发展史,揭示了全科医学是适应社会需要的、最经济、最适宜的医疗服务模式。中国现阶段医疗体系仍以专科化发展为主,全科医学的发展面临认识不足、政策支持力度不够、全科医学人才严重短缺等问题。在借鉴他国经验教训的基础上,将发展全科医学提高到国家战略的高度来加以重视和执行,吸引更多优秀人才投身全科医学事业是保证中国全科医学快速健康发展的关键。     

中国发展全科医学势在必行：兼谈我校全科医学办学的几点体会

全科医学是真正体现医学模式的转变,具有集预防、保健、医疗、康复与一体,并以人为本为服务特色,有利于合理利用卫生资源,降低日益增长的医疗费用,并 提高我国人口的卫生健康水平。要推进全科医疗,道德需要培养大量的全科医生,适合我国当前卫生体制改革和模式转变的需要,符合中国的国情。     

转变观念,提高认识,稳步推动全科医学教育和学科建设

全科医学是20世纪60年代末在北美兴起一门适应医学模式转变的综合性学科。我国20世纪80年代引进全科医学的概念，随着社会、经济的发展愈来愈受到人们的重视。按照“十一五”规划，到2010年，全国地级以上城市和有条件的县级市要建立比较完善的城市社区卫生服务体系。达到社区卫生服务机构设置合理、服务功能健全、人员素质较高、运行机制科学、监督管理规范，居民可以在社区享受到疾病预防等公共卫生服务和一般常见病、多发病的基本医疗服务。卫生部有关负责人在2006年“海峡两岸四地全科医学与家庭医学学术大会”上指出，按照国际最低标准计算，我国仅城市就需要全科医生16万以上，而2005年我国有全科医生资格者不足4000人。以社区医疗服务为中心的全科医学体系亦不完善，影响力不大，全科医学发展仍处于初级阶段，加强全科医学教育，规范全科医学学科建设是提高全科医学水平的关键。     

The rural health care workforce implications of practice guideline implementation

BACKGROUND: Rural health care workforce forecasting has not included adjustments for predictable changes in practice patterns, such as the introduction of practice guidelines. PURPOSE: To estimate the impact of a practice guideline for a single health condition on the needs of a rural health professional workforce. METHODS: The current care of a cohort of rural Medicare recipients with diabetes mellitus was compared with the care recommended by a diabetes practice guideline. The additional tests and visits that were needed to comply with the guideline were translated into additional hours of physician services and total physician full-time equivalents. RESULTS: The implementation of a practice guideline for Medicare recipients with diabetes in rural Minnesota would require over 30,000 additional hours of primary care physician services and over 5,000 additional hours of eye care professionals' time per year. This additional need represents a 1.3% to 2.4% increase in the number of primary care physicians and a 1.0% to 6.6% increase in the number of eye-care clinicians in a state in which the rural medical provider to population ratios already meet some recommended workforce projections. CONCLUSIONS: The implementation of practice guidelines could result in an increased need for rural health care physicians or other providers. That increase, caused by guideline implementation, should be accounted for in future rural health care workforce predictions.     

Quality Assurance in Primary Medical Care

Some general ideas of the evaluation of the work of the physician applicable also to primary care physicians are taken up in this article. The presentation is not trying to be a complete review of the topic. It tries, however, to direct attention to the importance of the subject from the point of view of the practising physician and also to point out some ideas of the possible difficulties to be faced in connection with primary medical care. Certain basic weaknesses of the original audit method in the primary setting are indicated. The usefulness of the structure-process-outcome model and of the understanding of the complex interactions and relationships between the various components of this model are stressed. Finally, a couple of promising methods relating to the work of the primary care physician are described.

From the practice point of view the basic problem is to decide to what extent either the process or outcome are valid indicators of quality. Here one should keep in mind that correlation between these two measurements may be low and that it has been expressed by some (1) that, fundamentally, validity depends on the strength of the relationship between process and outcome and on our understanding of that relationship.     

Advance directives in the primary care setting

Advance directives have been available for more than 20 years, yet only 2% of patients report having had a discussion about them with their physician. Physicians and patients appear to be reluctant to bring up the subject despite evidence that patients not only want help with advance directives, but report more satisfaction with their health care when the topic is addressed. The primary care setting is particularly well-suited to the establishment of advance directives. A clearer understanding of the benefits of advance directives to physicians and their patients can hopefully increase the use of this important health care resource.     

An 8-year prospective follow-up study of physicians departing health care in Belgium (1994-2002)

Several OECD countries have capped the number of physicians to be licensed to practice. However, a relevant cap must take into account changes in physician activities. We set out to study the transitions leading physicians to leave health care or to stop any activity in health system. These transitions were assessed using a register of medical practice. We studied changes in activity between 1994 and 2002 for about 19,840 physicians who in 1994 were already working for 5 years and were in 2002 less than 65 years old. After 8 years of career, one physician out of 20 were inactive in health system. Some medical specialties such as surgery and radiotherapy had a greater risk of leaving health care while GP's had a lower risk. Gender differences in leaving health system were mostly non-existant in younger age groups but then increased with age. Among physicians aged 55 and over, women were more likely to leave health system. We conclude that the percentage of physicians leaving health care after 5 years of practice is significant and deserve being taken into account for manpower planning and that planning should be aware of that some groups of physicians are more at risk than others to leave health care. Qualitative studies would help understand better this drop out.     

Pharmacotherapy and the primary care physician

Clinical pharmacy services and pharmacotherapy specialists did not begin in primary care settings. Rather, the initial interdisciplinary teams took root in large hospitals and tertiary medical center inpatient services during the middle 1960s. By the early 1970s, however, numerous papers appeared that described a unique and exciting practice model that incorporated primary care physicians and clinical pharmacists. The sole purpose of the interdisciplinary concept was to allow each member to contribute their own expertise to improve patient care. In my experience, primary care physicians have been eager to consult clinical pharmacists and other health professionals. I believe that the reason for this is a fundamental philosophy that distinguishes these physicians from other medical specialists. Ingrained in their philosophy are concepts such as continuity of care and care of the entire patient. The latter relates, not only to multiple organ systems, but also the spiritual and behavioral characteristics of the person. The primary care physician is also viewed as the coordinator for all health care services required by their patients. Most primary care physicians welcome others' expertise as long as they continue to be the health care coordinator for the patient. The health care structure of the United States continues to shift to ambulatory care. This will provide additional opportunities for the types of group models described in this article. After 20 years, the positive impact that physician and pharmacotherapist teams can have on drug therapy is being recognized on a broader scale. These models should continue to move from the academic laboratory to private group practice.(ABSTRACT TRUNCATED AT 250 WORDS)     

The evolving role of nurses in primary care medical settings

The role of nurses in primary care is understudied. The purpose of this study was to describe the current registered nurse (RN) role in three Primary Care Networks (PCNs) in western Canada and to identify opportunities for optimal utilization of RNs in these settings. Case study methodology included interviews and document review. Although the RN role evolved during the study, most RNs focused on chronic disease management. Role ambiguity was evident between nurses and with interprofessional team members. Relationships of RNs to other providers, particularly physicians, impacted the enactment of the nursing role. Other barriers to role enactment included physician fee‐for‐service remuneration, management structures and processes, lack of access to electronic medical records and lack of previous opportunities to apply primary health‐care education in the practice setting. Further work is needed to optimize the RN role in primary care to ensure maximum impact for patients, providers and the health system overall.     

Professional personnel in health care among secondary school athletics in Alabama

To ascertain the use of professional personnel in health care among secondary school athletics in Alabama, a survey was sent to all high schools in the state. Smaller schools (classified 1A) are located an average of 10.8 miles from the nearest medical facility, while for larger schools (classified 4A) the average is 3.2 miles. Overall, 55% have a team physician; primary care physicians represent 65.8% and orthopedists 13%. Only 40% of the team physicians conduct preseason physical examinations for the boys and 25% for the girls. Also, 65% of all the schools reported that a physician was not readily available for practice and games for boys' or girls' teams. Almost 90% of the 4A schools reported that a physician lives in the community, compared to 30% for the 1A schools. On this survey, a physician or athletic trainer outranked a medical facility or training room as being most important to their athletic program, suggesting that the greatest need in health care among high schools in Alabama is the presence of personnel trained in athletic injuries.     

An evaluation of personal medical services: the times they are a changin'

The Personal Medical Services (PMS) pilot sites, launched in England in 1997 by the Secretary of State for the then Conservative government, introduced a local contract for primary care, aimed at promoting flexibility, innovation and policy participation. As part of the National Evaluation of PMS, this paper considers the professional and organisational relationships established between service providers working in those PMS sites which specifically set out to address inequalities in access to primary care for vulnerable populations. The introduction of PMS enabled a change of cultural values in primary care, particularly regarding GPs’ relationships with nurses and practice staff. However, PMS has not necessarily led to equal partnerships within primary care teams. Rather, in the selected sites evaluated new interprofessional relationships emerged. There was evidence of intra and interprofessional partnerships being forged, providing the basis for further improved intersectoral collaboration. There was also evidence that the GP based medical model made way for a community oriented/public health model with emphasis on health maintenance for the vulnerable.     

Diabetes care for older patients in America

Background: Underuse of diabetes care was common for older patients. This study examined whether patient or physician practice characteristics predict the likelihood of diabetes care. Methods: We studied the 2006 and 2007 National Ambulatory Medical Care Survey data for a nationally‐representative sample of 2912 visits by older patients with diabetes. We examined the patterns of diabetes care, including diagnostic testing (glucose, haemoglobinA1c, blood pressure and cholesterol) and patient counselling services (diet/nutrition, exercise). Multivariate analysis was performed to identify independent predictors of diabetes care, controlling for patient and physician practice characteristics. All analyses were adjusted for the complex survey design. Results: Having a designated primary care physician and the availability of electronic medical record or on‐site laboratory testing were associated with more effective diabetes care (p < 0.05). If physician compensation relied on the productivity, physicians were less likely to provide diabetes care services (odds ratio = 0.5). The patterns of patient counselling and diagnostic testing services were similar (odds ratio = 2.5 and 18.2 for men; odds ratio = 1.8 and 9.6 for women). Older patients with diabetes were substantially more likely to receive diagnostic testing services than patient counselling. Conclusion: A designated primary care physician is crucial for providing recommended diabetes care services for older patients. Strengthening structural capabilities of primary care practices and implementing patient‐centred primary care initiatives in concert with health system reforms are necessary to deliver the co‐ordinated diabetes care with maximised health outcomes.     

Addiction treatment: level of care determination

Substance use disorders occur in 10% to 20% of patients presenting to the primary care physician. It is estimated that every fifth patient in a primary care practice has a substance use disorder. One of the challenges for the primary care physician after the initial assessment is a referral to the appropriate level of care. Substance abuse treatment is now a multibillion dollar industry, and there are a wide variety of options for those with resources. Most patients depend on community resources and state- and county-funded programs.