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INTRODUCTION Oral pre‐exposure prophylaxis (PrEP) is highly effective in reducing the risk of HIV acquisition when used appropriately [1, 2]. Making PrEP broadly available and accessible is essential to reduce [...], : Introduction: In Belgium, oral HIV pre‐exposure prophylaxis (PrEP) is primarily provided in specialized clinical settings. Optimal implementation of PrEP services can help to substantially reduce HIV transmission. However, insights into implementation processes, and their complex interactions with local context, are limited. This study examined factors that influence providers’ adaptive responses in the implementation of PrEP services in Belgian HIV clinics. Methods: We conducted a qualitative multiple case study on PrEP care implementation in eight HIV clinics. Thirty‐six semi‐structured interviews were conducted between January 2021 and May 2022 with a purposive sample of PrEP care providers (e.g. physicians, nurses, psychologists), supplemented by 50 hours of observations of healthcare settings and clinical interactions. Field notes from observations and verbatim interview transcripts were thematically analysed guided by a refined iteration of extended Normalisation Process Theory. Results: Implementing PrEP care in a centralized service delivery system required considerable adaptive capacity of providers to balance the increasing workload with an adequate response to PrEP users’ individual care needs. As a result, clinic structures were re‐organized to allow for more efficient PrEP care processes, compatible with other clinic‐level priorities. Providers adapted clinical and policy norms on PrEP care (e.g. related to PrEP prescribing practices and which providers can deliver PrEP services), to flexibly tailor care to individual clients’ situations. Interprofessional relationships were reconfigured in line with organizational and clinical adaptations; these included task‐shifting from physicians to nurses, leading them to become increasingly trained and specialized in PrEP care. As nurse involvement grew, they adopted a crucial role in responding to PrEP users’ non‐medical needs (e.g. providing psychosocial support). Moreover, clinicians’ growing collaboration with sexologists and psychologists, and interactions with PrEP users’ family physician, became crucial in addressing complex psychosocial needs of PrEP clients, while also alleviating the burden of care on busy HIV clinics. Conclusions: Our study in Belgian HIV clinics reveals that the implementation of PrEP care presents a complex—multifaceted—undertaking that requires substantial adaptive work to ensure seamless integration within existing health services. To optimize integration in different settings, policies and guidelines governing PrEP care implementation should allow for sufficient flexibility and tailoring according to respective local health systems.

INTRODUCTION: In this case study, four lead miners sought care in our clinic for the purpose of lowering their blood lead levels. In each of the four cases their blood [...]

The health and well-being of individuals in rural areas are in part dependent on access to health care resources. (1) Yet the availability of health care professionals, including physicians, is [...], Objectives: As part of a larger case study exploring physician retention factors and strategies employed by rural communities, the objective of this analysis was to explore the community factors that promoted physician retention. Methods: A qualitative, collective case study design was employed to study four rural communities (cases) in Alberta that retained family physicians for four years or longer. Participants included physicians, staff members, spouses and community members (all were patients from the communities studied). Communities were selected through a retention-specific matrix; each quadrant represented a particular community typology. Case data collected from interviews, documents and observations were analyzed, and similarities and differences among cases were assessed. Results: A range of community factors that could influence physicians' decisions to stay in a particular community were described by participants. Four themes, Appreciation, Connection, Active Support and Physical/Recreational Assets, were positively related to physician retention in the four communities studied. These community factors existed to different degrees but were present in all communities. Reciprocity was a fifth factor that emerged in three of the four communities studied. Conclusion: Physicians, policy-makers, community members and health care professionals are encouraged to consider the community domain when planning and implementing strategies to retain rural physicians and other health care professionals. The four communities studied were able to promote retention of their primary care physicians by showing appreciation to them, building connections with them and their families, actively supporting their physicians and local health facilities, maintaining and improving local physical/recreational amenities, and nurturing reciprocal rapport with physicians. Key words: Physician; retention; community; rural health services; case study Objectifs : Dans le cadre d'une vaste etude de cas sur les facteurs et les strategies de fidelisation des medecins en milieu rural, nous avons voulu analyser les facteurs communautaires qui favorisent le maintien en poste de ces medecins. Methode : Nous avons mene une etude qualitative et collective dans quatre communautes rurales de l'Alberta (les " cas ") ayant conserve leurs medecins de famille quatre ans et plus. Les participants etaient des medecins, des membres du personnel, des conjoints et des residents (tous des patients des communautes a l'etude). Les communautes ont ete choisies selon une matrice portant specifiquement sur la fidelisation; chaque quadrant representait une typologie communautaire particuliere. Nous avons recueilli les donnees au moyen d'entretiens, de documents et d'observations, analyse ces donnees, puis evalue les similitudes et les differences entre les cas. Resultats : Les participants ont cite divers facteurs communautaires ayant pu influencer la decision des medecins de rester dans une communaute donnee. Quatre themes (appreciation, relations, soutien actif et equipements physiques/recreatifs) etaient positivement lies a la fidelisation des medecins dans les quatre communautes etudiees. Ces facteurs etaient presents a differents degres dans toutes les communautes. Un cinquieme facteur, la reciprocite, etait present dans trois des quatre communautes. Conclusion : Nous encourageons les medecins, les strateges, les residents et les professionnels de la sante a tenir compte de l'aspect communautaire lorsqu'ils planifient et mettent en oeuvre des strategies pour fideliser les medecins et autres professionnels de la sante en milieu rural. Les quatre communautes a l'etude ont reussi a fideliser leurs medecins de premier recours en leur montrant leur appreciation, en tissant des relations avec eux et leurs familles, en appuyant activement leurs medecins et leurs etablissements de sante locaux, en entretenant et en ameliorant les equipements physiques et recreatifs locaux et en entretenant des rapports de reciprocite avec les medecins. Mots cles : medecin; fidelisation; communaute; service sante milieu rural; etudes de cas

This paper seeks to examine how immigrants in a multicultural society access and utilize culturally- and linguistically-diverse family physicians. It focuses on Mainland Chinese (MLC) immigrants--the most important source of immigrants to Canada since 1996--in the Toronto Census Metropolitan Area (CMA), Canada. Specifically, the paper aims to explore the choice between Chinese-speaking and non-Chinese-speaking family physicians by MLC immigrants and to determine the underlying reasons for MLC immigrants use of ethnically- and linguistically-matched family physicians. A wide range of data are analyzed including survey and focus group data, physician data from the College of Physicians and Surgeons of Ontario (CPSO) and geo-referenced 2001 Canadian Census data. A mixed-method approach is employed combining quantitative analysis of survey data and Census data, spatial analysis of patient travel behaviour based on the survey and qualitative analysis based on focus groups. The paper reveals an overwhelming preference among MLC survey respondents for Chinese-speaking family physicians regardless of study areas and socioeconomic and demographic status. The focus groups suggest that language, culture and ethnicity are intertwined in a complex way to influence the choice of health care providers and health management strategies in the host society. The paper yields important policy implications for identifying health professional shortage areas for culturally-diverse populations, addressing issues related to foreign-trained physicians and enhancing primary care delivery relevant for immigrant populations. Keywords: Ethnicity Health care Family physician Toronto Mainland Chinese immigrants Canada Utilization Language

With increasingly fewer family physicians in many countries and students less interested in primary care careers, generalists are becoming an endangered species. This situation is a major health care resource management challenge. In a rapidly changing health care environment, family medicine is struggling for a clear identity--a matter which is crucial to health system restructuring because it affects the roles and functioning of other professions in the system. The objective of our study was to explore representations of roles and responsibilities of family physicians held by future family and specialist physicians and their clinical teachers in four Canadian medical school faculties of medicine, using both focus groups and individual interviews. In addition to family medicine, we targeted residency programs in general psychiatry, radiology and internal medicine--three areas that interface significantly between primary care and specialized medicine. In each faculty, respondents included the vice-dean of postgraduate studies; the director of each relevant program; educators in the program; residents in each specialty in their last year of training. Findings are centred around three major themes: (1) the definition of family medicine; (2) family medicine as an endangered species, and (3) the generation gap between young family physicians and their educators. The sustained physician-patient relationship is considered a core characteristic of family medicine that is much valued by patients and physicians--both generalists and specialists--as something to be preserved in any model of collaboration to be developed. Overall, two divergent directions emerge: preserving all the professions' traditional functions while adapting to changing contexts, or concentrating on areas of expertise and moving towards creating 'specialist' general practitioners, in response to a rapidly expanding scope of practice, and to the high value attributed to specialization by society and the professional system. Keywords: Family medicine Professional identity Sociology of professions Canada Primary care General practitioners

ABSTRACT We previously developed a method to assess the clinical impact of electronic knowledge resources. This method has potential to advance e-health research by serving as a new outcome measure [...]

ABSTRACT E-prescribing automates the manual prescription process which enables physicians, pharmacies and payers to gain access to information that contributes to patient safety, controlling costs, and gaining business intelligence. In [...]

Objective: To report on the experiences of introducing a nurse practitioner (NP) into a rural physicians' clinic in Taber, Alberta. Design: Case study, grounded theory qualitative approach. Setting: A rural [...]