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To determine whether graduating family physicians are exposed to collaboration between family physicians and nurse clinicians during their training, as well as their opinions about shared care between doctors and nurse clinicians in the delivery of patient care.Anonymous online survey.Two French-Canadian university family medicine residency programs.The 2010 and 2011 graduating family physicians (N = 343) from the University of Montreal and Laval University in Quebec.The extent to which nurse clinicians in graduating family physicians' training milieu were involved in preventive and curative patient care activities, and graduates' opinions about nurse clinicians sharing care with physicians.Of 343 graduates, 186 (54.2%) participated in the survey. Although as residents in family medicine their exposure to shared care with nurse clinicians was somewhat limited, respondents indicated that they were generally quite open to the idea of sharing care with nurse clinicians. More than 70% of respondents agreed or strongly agreed that nurse clinicians could adjust, according to protocols of clinical guidelines, the treatment of patients with diabetes, hypertension, and asthma, as well as regulate medication for pain control in terminally ill patients. By contrast, respondents were less favourable to nurse clinicians adjusting the treatment of patients with depression. More than 80% of respondents agreed or strongly agreed that nurse clinicians could initiate treatment via a medical directive for routine hormonal contraception, acne, uncomplicated cystitis, and sexually transmitted infections. Respondents' opinions on nurse clinicians initiating treatment for pharyngitis and otitis were more divided.Graduating family physicians are quite open to collaborating with nurse clinicians. Although they have observed some collaboration between physicians and nurses, there are areas of shared clinical activities in which they would benefit from further exposure and training.

Past studies have shown in many instances that elderly people are represented in the hospital emergency room in proportion to their distribution in the population. It is possible, though, that elderly patients in the emergency room are using different types of resources than individuals of a younger age. Samples of two hospital emergency room users were selected in 1981 and in 1986. Patients aged 25 years or older were included in the study. The dependent variable was the extent to which patients used resources available at the hospital emergency room only or at alternative emergency medical services in the community. The effect of age on the use of resources in the hospital emergency rooms was estimated separately for those who were transported to the emergency room by ambulance and for those who were not. Age had an effect on use of resources under both conditions, regardless of the patients' gender, time of the visits, availability of alternative sources of emergency care, and diagnostic categories. The role of the hospital emergency room is to address medical care needs of specific segments of the population in special circumstances. Elderly emergency room patients are indeed one of these specific segments with very special needs.

To investigate how often family physicians see adolescents with mental health problems and how they manage these problems.Mailed survey completed anonymously.Province of Quebec.All 358 French-speaking family physicians who practise primarily in local community health centres (CLSCs), including physicians working in CLSC youth clinics, and 749 French-speaking practitioners randomly selected from private practice.Frequency with which physicians saw adolescents with mental health problems, such as depression, suicidal thoughts, behavioural disorders, substance abuse, attempted suicide, or suicide, during the last year or since they started practice.Response rate was 70%. Most physicians reported having seen adolescents with mental health problems during the last year. About 10% of practitioners not working in youth clinics reported seeing adolescents with these disorders at least weekly. Anxiety was the most frequently seen problem. A greater proportion of physicians working in youth clinics reported often seeing adolescents for all the mental health problems examined in this study. Between 8% and 33% of general practitioners not working in youth clinics said they had not seen any adolescents with depression, behavioural disorders, or substance abuse. More than 80% of physicians had seen adolescents who had attempted suicide, and close to 30% had had adolescent patients who committed suicide.Family physicians play a role in adolescent mental health care. The prevalence of mental health problems seems higher among adolescents who attend youth clinics. Given the high prevalence of these problems during adolescence, we suggest on the basis of our results that screening for these disorders in primary care could be improved.

To document with whom family physicians communicate when evaluating adolescents with mental health problems, to whom they refer these adolescents, and their knowledge and perceptions of the accessibility of mental health services in their communities.Mailed survey completed anonymously.Province of Quebec.All general practitioners who reported seeing at least 10 adolescents weekly (n = 255) among 707 physicians who participated in a larger survey on adolescent mental health care in general practice.Whether family physicians communicated with people (such as parents, teachers, or school nurses) when evaluating adolescents with mental health problems. Number of adolescents referred to mental health services during the last year. Knowledge of mental health services in the community and perception of their accessibility.When asked about the last 5 adolescents seen with symptoms of depression or suicidal thoughts, depending on type of practice, 9% to 19% of physicians reported routinely communicating with parents, and 22% to 32% reported not contacting parents. Between 16% and 43% of physicians referred 5 adolescents or fewer to mental health services during a 12-month period. Most practitioners reported being adequately informed about the mental health services available in their local community clinics. Few physicians knew about services offered by private-practice psychologists, child psychiatrists, or community groups. Respondents perceived mental health services in community clinics (CLSCs) as the most accessible and child psychiatrists as the least accessible services.Few physicians routinely contact parents when evaluating adolescents with serious mental health problems. Collaboration between family physicians and mental health professionals could be improved. The few referrals made to mental health professionals might indicate barriers to mental health services that could mean many adolescents do not receive the care they need. The lack of access to mental health services, notably to child psychiatrists, reported by most respondents could explain why some physicians choose not to refer adolescents.

OBJECTIVES: This study examined physicians' evaluation of sexual health risks during a general medical examination and sexually transmitted disease (STD) counseling during consultations for adolescent contraception and treatment of an STD. METHODS: An anonymous mail survey was conducted in 1995 with a stratified random sample of 1086 general practitioners and all 241 obstetrician-gynecologists practicing in Quebec, Canada. RESULTS: Fewer than half of the respondents reported routinely inquiring about condom use and number of sexual partners during a general medical examination. Female general practitioners engaged in more sexual health risk assessment and counseling than male general practitioners. CONCLUSIONS: This study suggests a low level of involvement in STD prevention by generalists and obstetrician-gynecologists.

Purpose To survey recently trained family physicians about their practices and perceptions regarding sexual history taking, drug-use history taking, and safe-sex counseling. Method The study was conducted with all 1991 graduates from the four family practice residency programs in Quebec, Canada. Data were collected in 1992 by using a mailed questionnaire. Results A total of 148 (80%) of the 186 contacted physicians responded. The physicians reported taking a sexual history less frequently than a drug-use history when seeing patients for a general medical examination (42% versus 71%) or a first pregnancy visit (75% versus 91%). When taken, the sexual history was often too superficial to detect risk behaviors. Consequently, safe-sex counseling was infrequent. Over 20% of the physicians worried about patients' discomfort, were uneasy discussing sexual matters, and did not feel properly trained in sexual history taking. Graduates from the family practice residency at the school that offered training in human sexuality performed better sexual history taking than did graduates from the residencies at the other schools. Conclusions Although infections from sexually transmitted diseases and the human immunodeficiency virus are important causes of morbidity and mortality, family physicians are still not actively involved in their prevention. The study suggests that medical education might be deficient in this area and that more training in human sexuality should be provided for family physicians.

We divided 900 general practitioners into two groups: one group received a questionnaire measuring both attitudes and behaviors toward preventive aspects of medical care, while the other received two separate questionnaires--one measuring behaviors, and one measuring attitudes. Response rates of the two groups were similar. Respondents in the first group retrieved their answer to the attitudinal items when responding to behavioral items, increasing the correlations between attitudes and behaviors by an average of .147 as compared to the second group; hence the second procedure was preferable.

OBJECTIVE: To describe the form of midwifery practice preferred by physicians practising obstetrics, nurses providing maternity care and midwives. DESIGN: Mail survey conducted in 1991. SETTING: Province of Quebec. PARTICIPANTS: A systematic random sample of 844 physicians, 808 nurses and 92 midwives; 597, 723 and 92 respectively completed the questionnaire, for an overall response rate of 80%. MAIN OUTCOME MEASURES: Midwife training options, range of responsibilities, location of midwifery care, relationship to other maternity care providers and degree of autonomy. RESULTS: Most of the physicians, nurses and midwives surveyed agreed that if midwifery was legalized, midwives should have a university degree, provide basic care to women with normal pregnancy and delivery, provide prenatal and postnatal care in hospitals and community health centres, perform delivery in hospitals and work in close collaboration with the other maternity care professionals. Disagreement existed concerning the level of university training required, the need for training in nursing first, the scope of medical intervention performed by midwives, out-of-hospital delivery, the autonomy of midwives and control over their practice. CONCLUSION: Some consensus on midwifery practice exists between physicians, nurses and midwives. In jurisdictions where opposition to midwives is strong, such consensus could serve as the starting point for the introduction of midwifery.

The purpose of the study presented here was to assess medical students' perceptions of the weight given to scientific and humanistic values in their learning environment and to determine whether students' perceptions in a given school vary according to their level of medical training and personal characteristics. The study was conducted in 1979 via a mail questionnaire sent to a sample of 713 freshmen, juniors, and graduates from three U.S. medical schools; 82.2 percent responded. The results indicated that the students' perceptions of school values varied little according to the students' personal characteristics, such as sociodemographic and educational background, interests before medical training, and expected specialty choice. However, important differences were observed in students' perceptions of values emphasized to them at different schools. Preclinical and clinical students' perceptions of the importance given to scientific values were similar. As for humanistic values, significantly lower ratings were given by clinical students than preclinical students in two of the schools.