Changing trends in osteoporosis care from specialty to primary care physicians

Abstract

Background:

Inadequate treatment by non-specialty primary care physicians (PCPs) has been a concern in improving osteoporosis care. An increase in outpatient visits by older patients seeking osteoporosis care has been reported. But what percentages of these visits are made to PCPs are unknown. We investigated recent trends of outpatient visits and treatment for osteoporosis in older adults (>50 years) by physician type (PCPs vs. specialty care non-PCPs).     

从胆囊结石研究现状谈基层医生的科研工作

本文分析胆石成因、胆囊结石的流行病学研究、胆囊结石与肿瘤的关系以及胆囊切除术后综合征等胆囊结石研究现状,以期为基层医生提供科研思路。     

The issue of territoriality between pharmacists and physicians in primary care

This paper discusses the utility of the concept of territoriality in order to understand relationships between pharmacists and physicians in the primary care setting. First, we provide background information on the concept of human territoriality. Secondly, we discuss its potential application to the relationships between pharmacists and physicians. Finally, we suggest ways in which understanding and tackling territorial issues may strengthen the pharmacist‐physician link and, in doing so, may improve patient care.     

The training experience of primary care pharmacists

Objectives — To map the tasks, activities and training provision for primary care pharmacists (PCPs) and to identify perceived future training needs. Methods — Survey undertaken in 1998/1999 using a pre‐piloted, postal, self‐completion questionnaire to two samples of PCPs. Setting — PCPs in (a) the West Midlands and (b) England (outside West Midlands). Key findings — The response rate was 66 per cent. A majority (68 per cent) had worked in the role for less than two years. Eighty per cent had some form of continuing education or training for the role although only 50 per cent had a formal qualification. Over two‐thirds had contributed to the funding of their training, with one‐third providing all funding. Seventy‐four per cent of PCPs agreed that pharmacists should go through a procedure to ensure competence (accreditation) before being allowed to work for a general medical practice or primary care group. Views on the need for formal education/training prior to work differed: 82 per cent of those with formal qualifications, but only 46 per cent of those without, considered that this should be a requirement. There was general agreement that training/education had met training needs. Views on future training closely reflected previous training experiences, with a focus upon pharmaceutical roles rather than upon generic skill development and the acquisition of management skills. Conclusions — The study provides a snapshot in time of the experience of pioneer PCPs and the training available to them. PCPs will need further training or updating if they are to provide the wider roles required by the developing needs of the National Health Service. Consideration should be given to formal recognition of the training of PCPs in order to assure competence. The expectation that pharmacists should fund their own training is likely to be a barrier to uptake of training and uncertainties over funding will militate against consistency of training.     

Substance use among persons with homeless experience in primary care

ABSTRACT

Background: Community survey data suggest high prevalence of substance use disorders among currently homeless individuals. There are less data regarding illicit drug and alcohol use problems of homeless-experienced persons engaged in primary care. They may have less severe use and require different care responses from primary care teams. Methods: The authors surveyed currently and formerly homeless, i.e., homeless-experienced, persons engaged in primary care at five federally funded programs in the United States, administering the World Health Organization (WHO) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). The ASSIST definitions of lower, moderate, and high risk were used to assess a spectrum of lifetime and recent substance use, from any use to likely dependence, and to identify sociodemographic and health status characteristics associated with severity of use. Results: Almost one half of the sample (N = 601) had recently (within the past three months) used alcohol, and one third had recently used an illicit drug. The most commonly used illicit drugs in the past three months were cannabis (19%), cocaine (16%), and opioids (7.5%). Over one half (59%) of respondents had ASSIST-defined moderate- or high-risk substance use. A significant proportion (31%) of those identified as at moderate risk had no recent substance use, but did report past problematic use. Ten percent of the lower-risk group had past problematic use of alcohol. Severity of use was associated with worse health status, but not with housing status or type of homelessness experienced. Conclusions: Less severe (moderate-risk) use and past problematic use, potentially indicative of remitted substance use disorders, were more common than high-risk use in this primary care, homeless-experienced sample. These findings highlight the urgency of identifying effective ways to reduce risky substance use and prevent relapse in homeless-experienced persons.     

Youth smoking cessation: an update for primary care physicians

Tobacco use is a major public health problem, and onset usually begins in youth. This article reviews current knowledge and evidence of specific aspects of smoking in youth, tobacco control strategies, and smoking cessation interventions that target young people. Finally, it provides recommendations for primary care physicians.     

How comfortable are primary care physicians and oncologists prescribing medications for comorbidities in patients with cancer?

BackgroundTreating cancer and existing chronic comorbidities requires a dynamic mix of primary care and specialist providers. However, little is known regarding primary care physicians' (PCPs) and oncologists’ comfort level prescribing for comorbid conditions.ObjectivesThe objectives of this study were to describe oncologists' and PCPs': 1) comfort-level prescribing, 2) perceptions of providers’ role in prescribing cardiometabolic and psychiatric medications in persons with cancer and comorbidity, and 3) provider factors associated with comfort-levels.MethodsThis cross-sectional online survey examined responses from practicing U.S. PCPs and oncologists. A 33-question survey was used to assess PCPs' and oncologists' comfort-levels for prescribing 6 classes of medications used to treat common comorbid cardiometabolic or psychiatric conditions. Using t-tests, chi-square tests, or Fisher's Exact tests, physicians' own comfort and comfort with other physicians prescribing medications for shared patients were compared between PCPs and oncologists. Linear regression models were used to analyze predictors of comfort-level scale score for prescribing medications.ResultsOncologists were more comfortable with PCPs initiating or refilling antidiabetics, antihyperlipidemics, antidepressants, and antipsychotics, and PCPs were more comfortable initiating antihypertensives, antidiabetics, antihyperlipidemics, antidepressants, and antipsychotics themselves as opposed to having an oncologist initiate or refill these medications. Compared to oncologists, PCPs reported a 32.3% higher comfort-level for initiating cardiometabolic medications (Adjusted Coefficient (standard error) = 0.323 (0.033), p < 0.001), and a 25.0% higher comfort-level for initiating psychiatric medications in cancer patients (Adjusted Coefficient (standard error) = 0.250 (0.030), p < 0.001), after controlling for prescriber demographics and practice site characteristics.ConclusionsFindings suggest that when a cancer diagnosis is made for patients with pre-existing cardiometabolic or psychiatric conditions, oncologists prefer PCPs to manage these medications. This enhanced understanding of PCPs' and oncologists’ comfort managing these medications may help develop a standard for defining physician roles in medication therapy as part of a shared care plan for patients with cancer and comorbidities.     

医师对临床药学服务需求的国外测量方法介绍及经验借鉴

目的：为我国开发科学合理的医师对临床药学服务测量工具提供参考。方法：通过文献检索归纳和分析国外现有医师对临床药学服务测量工具。结果：国外常用的医师对临床药学服务测量工具主要为加利福尼亚州的Current Expectations-Current Experience-Future Expectations问卷（简称为"California问卷"）和科威特的Perceptions-Expectations-Experience问卷（简称为"Kuwait问卷"）。与California问卷相比，Kuwait问卷的理论基础更加切合我国实际情况，维度内涵与我国部分医师对临床药学服务测量工具相近；Kuwait问卷的题项是以California问卷为基础进行科学合理调整编制；Kuwait问卷的实践应用范围更为广泛，并已在我国部分地区完成相关研究。结论：California问卷和Kuwait问卷对我国测量工具分析框架的明确、开发过程的完善、实证检验的加强具有较强的指导意义。