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Objective: To evaluate a curriculum for teaching family physicians (FPs) in rural and underserviced areas about children's mental health, and to evaluate a collaborative model of teaching using child psychiatrists and FPs. Methods: A child psychiatrist and a rural FP provided training to rural FPs in attention-deficit/hyperactivity disorder (ADHD) and disruptive behaviour disorders (DBDs). Training consisted of a half-day workshop in 11 communities located in southwestern Ontario. Workshops included didactic teaching, observation of standardized videos demonstrating interviewing skills, and interactive discussion. Participants completed pre- and posttraining questionnaires about their confidence in managing these conditions, and completed standardized questionnaires on the effectiveness of the workshop and videos. One month after the training, participants were randomly assigned to receive individual interviews. Three months later 2 questionnaires were mailed to participants for evaluation of their confidence after their training and for evaluation of the impact on their practice. Results: Fifty-six FPs attended the workshops and, of these, 80% completed the study. Family physicians reported improved confidence in their abilities to diagnose and treat ADHD and DBDs after the training. Conclusion: Didactic presentations by child psychiatrists and FPs, followed by video examples of interviewing skills, and informal discussions with small groups, was found to be an effective curriculum for teaching rural FPs about children's mental health. [ABSTRACT FROM AUTHOR]

Introduction: The objectives of this paper are 1) to analyze the characteristics of rural physicians who currently practise obstetrics, their training background and the environment in which they work and 2) to develop strategies to sustain rural obstetrical services. Methods: Information was gathered using both a survey and brief individual interviews. Participants: A survey was sent to 56 family physicians who currently practise obstetrics, as well as those who had stopped within the past 2 years, in the Southwestern Ontario communities of Clinton, Goderich, Hanover, Kincardine, Markdale, Mount Forest, Palmerston, Walkerton, Wiarton and Wingham. Results: Forty-four physicians responded to the survey. Results indicate that current obstetrical training programs are lacking in the following areas: the provision of positive role models/mentors, rural placements, experience in complex decision-making, and instilling confidence in graduates. Physicians appear to be internally motivated to practise obstetrics, claiming it is important to their professional goals and personal values. Support systems of colleagues, nursing staff, administration family and friends, were identified as vital components of a successful obstetrical program. Conclusion: Educators are advised to identify students with an internal motivation to practise rural obstetrics early in their medical training and provide them with mentors, rural placements, confidence and experience in complex decision-making. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Primary care physicians are the first-line assessors of children's mental health. Previous studies have shown a trend of over-reliance on referrals to child and adolescent psychiatrists and an underutilization of children's mental health agencies. A survey was conducted to a) examine the criteria used by family physicians and primary-care paediatricians in deciding how to refer youth to mental health services, and b) assess interest in developing a set of formal guidelines outlining when to consider referral to child and adolescent psychiatrists and children's mental health agencies. METHOD: A mail-out survey was conducted using elements of the Dillman method. Two regions in Ontario were surveyed, Northwestern Ontario and Middlesex County, allowing for comparison between rural and urban settings. RESULTS: Of the 266 physicians eligible for the study, 116 returned completed surveys, for a response rate of 40%. Awareness and utilization of children's mental health agencies was higher than predicted in both regions. A number of referral trends were identified. A majority of respondents in both regions indicated that they would like a standardized protocol and/or guidelines when referring to both psychiatrists and children mental health agencies. CONCLUSION: This study demonstrated that, in addition to referring to child and adolescent psychiatrists, the majority of primary care physicians are aware of and utilize children's mental health agencies in Ontario. [ABSTRACT FROM AUTHOR]

Introduction: Primary Care Physicians (PCP) play a key role in the recognition and management of child/adolescent mental health struggles. In rural and under-serviced areas of Canada, there is a gap between child/adolescent mental health needs and service provision., Methods: From a Canadian national needs assessment survey, PCPs' narrative comments were examined using quantitative and qualitative approaches. Using the phenomenological method, individual comments were drawn upon to illustrate the themes that emerged. These themes were further analyzed using chi-square to identify significant differences in the frequency in which they were reported., Results: Out of 909 PCPs completing the survey, 39.38% (n = 358) wrote comments. Major themes that emerged were: 1) psychiatrist access, including issues such as long waiting lists, no child/adolescent psychiatrists available, no direct access to child/adolescent psychiatrists; 2) poor communication/continuity, need for more systemized/transparent referral processes, and need to rely on adult psychiatrists; and, 3) referral of patients to other mental health professionals such as paediatricians, psychologists, and social workers., Conclusions: Concerns that emerged across sites primarily revolved around lack of access to care and systems issues that interfere with effective service delivery. These concerns suggest potential opportunities for future improvement of service delivery., Implications: Although the survey only had one comment box located at the end, PCPs wrote their comments throughout the survey. Further research focusing on PCPs' expressed written concerns may give further insight into child/adolescent mental health care service delivery systems. A comparative study targeting urban versus rural regions in Canada may provide further valuable insights.

Objectives: This study examined the referral patterns of rural/remote primary care physicians (PCPs) as well as their needs and interests for further training in child/adolescent mental health., Methods: Surveys were mailed to Canadian rural/remote PCPs requesting participants' demographic information, training and qualifications, referral patterns, and identification of needs and interests for continuing medical education (CME)., Results: PCPs were most likely to refer to mental health programs, and excessive wait times are the most common deterrent. Major reasons for referral were to obtain recommendations regarding medications and assessing non-responsive patients. While PCPs expressed higher levels of confidence in making appropriate referrals, they were much less confident in their knowledge and skills in managing mental health problems. Professional development in child/adolescent psychiatry is a moderate or highly perceived CME need. Overall, attention deficit/hyperactivity disorder (ADHD) was the most commonly chosen topic of interest and CME in the community was preferred, but some regional differences emerged., Conclusions: PCPs viewed limited community resources and self-identified gaps in skills as barriers to service provision. Professional development in child and adolescent mental health for PCPs by preferred modes appears desired.

Objective: To evaluate a curriculum for teaching family physicians (FPs) in rural and underserviced areas about children's mental health, and to evaluate a collaborative model of teaching using child psychiatrists and FPs., Methods: A child psychiatrist and a rural FP provided training to rural FPs in attention-deficit/hyperactivity disorder (ADHD) and disruptive behaviour disorders (DBDs). Training consisted of a half-day workshop in 11 communities located in southwestern Ontario. Workshops included didactic teaching, observation of standardized videos demonstrating interviewing skills, and interactive discussion. Participants completed pre- and posttraining questionnaires about their confidence in managing these conditions, and completed standardized questionnaires on the effectiveness of the workshop and videos. One month after the training, participants were randomly assigned to receive individual interviews. Three months later 2 questionnaires were mailed to participants for evaluation of their confidence after their training and for evaluation of the impact on their practice., Results: Fifty-six FPs attended the workshops and, of these, 80% completed the study. Family physicians reported improved confidence in their abilities to diagnose and treat ADHD and DBDs after the training., Conclusion: Didactic presentations by child psychiatrists and FPs, followed by video examples of interviewing skills, and informal discussions with small groups, was found to be an effective curriculum for teaching rural FPs about children's mental health.

Of preschool children registered at a university family medicine centre, 82% were found to be adequately immunized. A review of patient charts, however, showed that 31% contained immunization information that was difficult to interpret; extensive home follow-up was required to confirm immunization data. Special emphasis must be placed on producing accurate, easily retrievable chart information. Practices where nurses had a major role in infant care had better immunization records. Given that immunization is now a requirement for school admission in Ontario, the cost and feasibility of a recall system of child immunization should be explored.