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Integrating behavioral health into primary care can improve access to behavioral health and patient health outcomes. We used 2017-2021 American Board of Family Medicine continuing certificate examination registration questionnaire responses to determine the characteristics of family physicians who work collaboratively with behavioral health professionals. With a 100% response rate, 38.8% of 25,222 family physicians reported working collaboratively with behavioral health professionals, with those working in independently owned practices and in the South having substantially lower rates. Future research exploring these differences could help develop strategies to support family physicians implement integrated behavioral health to improve care for patients in these communities. Key words: behavioral medicine; integration of care; mental health services; primary health care https://doi.org/10.1370/afm.2947, INTRODUCTION The complexity of patients presenting in primary care continues to grow with an estimated 1 in 3 adults in the United States presenting with multiple chronic conditions. (1) The [...]

PURPOSE Stigma related to mental health is well documented and a major barrier to using mental and physical health care. Integrated behavioral health (IBH) in primary care, in which behavioral/mental health care services are located within a primary care setting, may reduce the experience of stigma. The purpose of this study was to assess the opinions of patients and health care professionals about mental illness stigma as a barrier to engagement with IBH and to gain insight into strategies to reduce stigma, encourage discussion of mental health, and increase uptake of IBH care. METHODS We conducted semistructured interviews with 16 patients referred to IBH in a prior year and 15 health care professionals (12 primary care physicians and 3 psychologists). Interviews were transcribed and inductively coded separately by 2 coders for common themes and subthemes under the topic headings of barriers, facilitators, and recommendations. RESULTS We identified 10 converging themes from interviews with patients and the health care professionals, representing important complementary perspectives, with respect to barriers, facilitators, and recommendations. Barriers included professionals, families, and the public as sources of stigma, as well as self-stigma or avoidance, or internalizing negative stereotypes. Facilitators and recommendations included normalizing discussion of mental health and mental health care-seeking action, using patient-centered and empathetic communication strategies, sharing by health care professionals of their own experiences, and tailoring the discussion of mental health to patients' preferred understanding. CONCLUSIONS Health care professionals can help reduce perceptions of stigma by having conversations with patients that normalize mental health discussion, use patient-centered communication, promote professional self-disclosure, and are tailored to patients' preferred understanding. Key words: integrated behavioral health; mental health; mental health services delivery; stigma; primary care; health services accessibility; barriers; physician-patient relations; attitude of health personnel; patient acceptance of health care; patient-centered care; communication https://doi.org/10.1370/afm.2924, INTRODUCTION The well-documented stigma of mental illness is a barrier to patients seeking and benefitting from mental and physical health care. Stigma is the societal labeling, stereotyping, and rejecting of [...]

A survey conducted with data from 2008 found that physicians often do not communicate with each other at the time of referral or after consultation. Communication between physicians might have improved since then, with the dissemination of electronic health records (EHRs), but this is not known. We used 2019 survey data to measure primary care physicians' perceptions of communication at the time of referral and after consultation. We found that large gaps in communication persist. The similarity between these survey results suggests that despite the dissemination of EHRs, physicians still do not consistently communicate with each other about the patients they share. Key words: physician communication; primary and specialty care; referral and consultation communication, INTRODUCTION Using 2008 data, O'Malley and Reschovsky found sizeable gaps in communication among physicians caring for mutual patients. (1) Poor communication has been linked to delayed diagnoses, unnecessary testing, and [...]

PURPOSE Researchers aimed to describe general practitioners' understanding of appropriate ultrasound use, to record actual scanning practices of early adopters in general practice, and to identify differences between attitudes and actual practice via a mixed methods analysis. METHODS This study was part of a larger multistage mixed methods research framework exploring the use of ultrasound in general practice in Denmark. We used an exploratory sequential approach in the data collection with initial qualitative findings from an interview study applied to building a quantitative questionnaire utilized in a cohort study. In addition, we merged the qualitative and quantitative data using joint display analysis to compare and contrast the results from the 2 stages of the study. RESULTS In the interviews, general practitioners described appropriate ultrasound use as point-of-care examinations with a clear purpose and limited to predefined specific conditions within delimited anatomic areas. They stated that general practitioners should receive formalized ultrasound training and be skilled in the examinations they perform. In the cohort study, general practitioners performed ultrasound examinations of anatomic areas with or without a defined clinical suspicion. Some performed ultrasound examinations for which they had no previous training or skills. CONCLUSIONS We found a difference between the ideas about the appropriate uses for ultrasound in general practice and the actual use by early adopters in clinical practice. Our findings suggest a need for evidence-based guidelines to support general practitioners in choosing which examinations to perform and strategies for developing and maintaining scanning competency. Key words: family practice, general practice, primary health care, point-of-care systems, ultrasonography Ann Fam Med 2022;20:211-219. https://doi.org/10.1370/afm.2795, INTRODUCTION Point-of-care ultrasonography (POCUS) is performed by a frontline clinician and integrated into the examination of the patient. (1) Despite lack of evidence-based guidelines, POCUS use is growing in general [...]

Background Malnutrition remains a public health problem in Europe, not only in adults, but also in paediatrics. The aim of this study was to evaluate general practitioners (GPs) practices in paediatric malnutrition screening. Methods An anonymised questionnaire was sent to GPs in one French area. We analysed GPs' data: sociodemographic, knowledge of malnutrition screening, practices, tools, and trainings. Results Overall, 102 of 174 GPs replied to the questionnaire (58.6%). 79.4% of GPs routinely measured weight, but only 33.3% measured both height and BMI, despite having tools (98,6%). 43.6% of GPs systematically reviewed growth charts. 71.3% were familiar with dietary recommendations, 30.7% with blood tests for nutritional status assessment, and 13.7% with dietary supplements. GPs who routinely measured BMI reviewed significantly more growth charts (p = 0.001) and prescribed more dietary supplements (p = 0.001). Conclusions GPs do not sufficiently measure children's height and BMI, despite the increasing availability of software. Failure to analyse growth charts can induce delays in malnutrition screening., Author(s): Valérie Bertrand [sup.1] , Benoît Pichot [sup.1] , Pierre Déchelotte [sup.2] [sup.3] , Marie-Pierre Tavolacci [sup.4] Author Affiliations: (1) Paediatric Unit, Le Havre Hospital, Le Havre Cedex, France (2) [...]

Sonia Rapaport, MD, of Chapel Hill, North Carolina, believes her malpractice insurance rates are very reasonable. Rapaport, who is double-boarded in family practice and holistic medicine, adds that she is [...]

General practitioners (GPs) could have an important role in early diagnosis of autism. There have been no studies evaluating the knowledge of GPs regarding autism in Pakistan. We aimed to fill that gap by assessing knowledge and attitude of GPs in Karachi regarding autism. We conducted a cross-sectional survey of 348 GPs; only 148 (44.6%) had heard of 'autism.' Our results show that GPs less than 30 years of age and those who obtained their Medical Degree in the last 5 years are more likely to report knowledge about autism: OR = 3.0; 95% CI: 1.71, 5.31, and OR = 2.56; 95% CI: 1.48, 4.42, respectively. In addition, among those reporting knowledge about autism, many held misconceptions regarding the signs and symptoms and etiology. Keywords Autism spectrum disorders * Knowledge * General practitioner * Pakistan, Autism Spectrum Disorders (ASDs) are complex, lifelong neurodevelopmental and behavioral disorders manifesting in infancy or early childhood. Although the causes of ASDs are unknown, evidence suggests that the origins are [...]