Cross-sectional multicentre study on the cohort of all the French junior lecturers in general practice

Background: General practice became an academic discipline quite recently in many western countries. In France, junior lecturer work is specified in a three-part mandate: medical work in general practice, teaching in the university, and research. Since 2007, 130 junior lecturers have been appointed in general practice. The aim of the creation of junior lecturer status was to align general practice with other specialties and to develop research and education in primary care.

Objectives: To describe the healthcare, teaching and research undertaken by junior lecturers in general practice, practising in October 2014.

Methods: A cross-sectional multicentre study using an online self-administered questionnaire on the cohort composed of all the junior lecturers in general practice with open questions and the qualitative analysis of written verbatim accounts.

Results: Of the 95 junior lecturers practising at the date of the study, 75 (79%) responded; average age 32 years; gender ratio (F/M) 2.4:1. They spent five, two and three half-days per week respectively in healthcare, teaching and research. The healthcare activity was predominantly carried out in the community (73%). Thirty-nine per cent worked as part of a multi-professional team taking on 50 consultations per week. Most of the educational work involved lecturing and mentoring students specializing in general practice (median 86?hours per year). Research output increased during the fellowship. Research topics were varied and relevant to the disciplinary field.

Conclusion: During the fellowship, the balancing, and even the reinforcement, of healthcare and research contributions were accompanied by a significant investment in educational provision.     

A Human Rights-Based Approach to Farmworker Health: An Overarching Framework to Address the Social Determinants of Health

Migrant and seasonal workers have a right to the highest attainable standard of health. Unfortunately, these farmworkers face a multitude of challenges. They are employed in one of the most dangerous industries and face serious occupational health risks, while positioned at the bottom of the social hierarchy. They often lack formal education and training, English language proficiency, legal status, access to information, and equitable opportunities to health and healthcare. This article will explore the international human rights conventions that support farmworkers’ right to health and healthcare in the United States. International human rights may provide a valuable legal framework that could be used to advocate on behalf of farmworkers and address the social determinants of health. Therefore, a Human Rights-Based Approach to Farmworker health will be presented along with recommendations for how to advance health and access to healthcare among this population. Fostering the health and well-being of migrant and seasonal farmworkers is critical to advancing equity, social justice, and maintaining the workforce required to meet production needs and safeguard the economic competitiveness of the industry.     

Demand-oriented and demand-driven health care: the development of a typology

In most European countries, there is an increasing demand for demand-oriented and demand-driven approaches in the development of health care policy and the organization of health care services. Both approaches, in which the main focus is on 'the demand', are seen as counterparts of the supply-oriented approach, that has 'the supply' as point of departure. However, there is much confusion about the definition of the concepts. To identify the different views, and to examine to what extent there is consensus in the Netherlands about the concepts of demand-orientation and demand-driven care, a Delphi study was done among 26 experts; scientists, health care insurance companies, health care suppliers, the government, independent advisory bodies and client interest groups. The study resulted in a typology. The similarities and differences between the two concepts were demonstrated in five dimensions; responsibility, control, need-determination, formal embedment of vision in organization and choice. Furthermore, the typology was used to identify existing types of services as being either demand-oriented or demand-driven services. The typology provides an understanding of the similarities and differences between the two concepts, and appears to be a useful tool in identifying services to the extent that they are demand oriented or demand driven.     

Evaluating quality in clinical care

Defining and maintaining quality is essential to surgical practice. It is only through structured approaches to assessing outcomes that we can ensure that optimal care is delivered. This article will define quality in healthcare and discuss assessment models with reference to pertinent surgical literature. National initiatives are discussed with a critical appraisal of their role and effectiveness. We discuss the aim of quality improvement initiatives and comment on reporting of outcomes. The difficult question of how to maintain quality during a crisis, such as an infectious disease pandemic, is addressed.     

Unnecessary Magnetic Resonance Imaging of Hips: An Economic Burden to Patients and the Healthcare System

Patients referred to orthopedists for hip pain due to arthritis may already have MRI studies ordered by their referring physicians despite plain radiographs being sufficient in most cases. Hence, we prospectively evaluated every patient referred to our institution during a 36-month period to identify the number of new patients with hip osteoarthritis who had an unnecessary MRI, the additional costs of these MRIs, and the extrapolated cost to the United States healthcare system during the next 10 years. Overall, 15.4% of the patients presented with unnecessary MRIs, approximately, 330 to 440.5 million dollars may be spent on unnecessary hip MRIs in this patient population in America. We believe that referring physicians should not simultaneously order a radiograph and an MRI to evaluate hip pain.     

Emergency Medical Care of Multiple Sclerosis Patients: Primary Data from the Mount Sinai Resource Utilization in Multiple Sclerosis Project

Background and Purpose

There has been no systematic analysis of emergency department (ED) utilization in the multiple sclerosis (MS) population. We investigated the acute-care needs of MS patients using ED as a route for entry into healthcare services.

Methods

ED visits made by MS patients were identified. Data extracted included demographics, medical/neurological history, and workup/management in the ED.

Results

The Mount Sinai ED received 569 visits from 224 MS patients during a 3-year period, of whom 33.5% were covered by Medicaid and 12.9% were uninsured. Patients with an Expanded Disability Status Scale score of ≥6 accounted for 54%, 50.5% of relapsing remitting MS patients were being treated with disease-modifying therapies, and 74.5% of the ED visits were non-neurological. Patients with mild-to-moderate MS were more likely to present to the ED for issues directly related to MS such as acute exacerbations, while those with severe MS presented more often due to medical issues indirectly related to MS, such as urinary tract infections (p<0.0001).

Conclusions

Most MS patients seeking ED care suffer from acute non-neurological problems. The MS patients presenting to the ED tended to be underinsured, had high levels of disability, and were undertreated with disease-modifying therapies. The acute-care needs of MS patients evolve over the disease course, as do the resources that must be utilized in providing emergency care across the spectrum of MS severity. Understanding the characteristics, problems, and needs of MS patients utilizing the ED is an important step in improving care in this population from both clinical and public health perspectives.