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BackgroundPerson-centered care is critical for delivering high-quality diabetes care. Shared decision making (SDM) is central to person-centered care, and in diabetes care, it can improve decision quality, patient knowledge, and patient risk perception. Delivery of person-centered care can be facilitated with the use of patient decision aids (PtDAs). We developed MyDiabetesPlan, an interactive SDM and goal-setting PtDA designed to help individualize care priorities and support an interprofessional approach to SDM. ObjectiveThis study aims to assess the impact of MyDiabetesPlan on decisional conflict, diabetes distress, health-related quality of life, and patient assessment of chronic illness care at the individual patient level. MethodsA two-step, parallel, 10-site cluster randomized controlled trial (first step: provider-directed implementation only; second step: both provider- and patient-directed implementation 6 months later) was conducted. Participants were adults 18 years and older with diabetes and 2 other comorbidities at 10 family health teams (FHTs) in Southwestern Ontario. FHTs were randomly assigned to MyDiabetesPlan (n=5) or control (n=5) through a computer-generated algorithm. MyDiabetesPlan was integrated into intervention practices, and clinicians (first step) followed by patients (second step) were trained on its use. Control participants received static generic Diabetes Canada resources. Patients were not blinded. Participants completed validated questionnaires at baseline, 6 months, and 12 months. The primary outcome at the individual patient level was decisional conflict; secondary outcomes were diabetes distress, health-related quality of life, chronic illness care, and clinician intention to practice interprofessional SDM. Multilevel hierarchical regression models were used. ResultsAt the end of the study, the intervention group (5 clusters, n=111) had a modest reduction in total decisional conflicts compared with the control group (5 clusters, n=102; −3.5, 95% CI −7.4 to 0.42). Although there was no difference in diabetes distress or health-related quality of life, there was an increase in patient assessment of chronic illness care (0.7, 95% CI 0.4 to 1.0). ConclusionsUse of goal-setting decision aids modestly improved decision quality and chronic illness care but not quality of life. Our findings may be due to a gap between goal setting and attainment, suggesting a role for optimizing patient engagement and behavioral support. The next steps include clarifying the mechanisms by which decision aids impact outcomes and revising MyDiabetesPlan and its delivery. Trial RegistrationClinicalTrials.gov NCT02379078; https://clinicaltrials.gov/ct2/show/NCT02379078

Eating disorders (EDs) are severe psychological conditions, often requiring specialized treatment. Patients with EDs generally first present in primary care before being referred to tertiary centres. Evidence suggests that family physicians do not identify most patients with clinical EDs. The objective of this study was to explore the primary care experiences of adult patients with EDs. Ten individual, semi-structured interviews with adult women with an ED were conducted. A qualitative descriptive approach was adopted using thematic analysis. The researchers identified codes, which were categorized into five major themes: 1) disparate patient experiences in primary care, 2) delayed diagnosis, 3) key family physician qualities for ED care, 4) individual and systemic barriers to recovery, and 5) patient needs in primary care. Most participants reported that their diagnosis was not timely, suggesting a need for improved screening and diagnostic procedures. Inconsistent treatment practices imply that family physicians would benefit from the development of standardized guidelines for ED diagnosis and treatment in primary care as well as additional training in ED care. Family physicians being empathic and nonjudgmental and facilitating access to resources are of particular importance to this patient population. [ABSTRACT FROM AUTHOR]

Background and Objective: Given the increasing discussions of the impact of genetic medicine within family medicine, it is important to determine the most effective way of teaching this material to family medicine residents (FMRs). The objective of this study was to evaluate and compare the impact of three methods of delivering primary care genetic content to FMRs.Methods: Curriculum materials and assessment tools were created to teach and evaluate knowledge, skills, and attitudes around four core competencies in primary care genetics, with a focus on hereditary colorectal cancer (CRC). Participants were randomly allocated to four learning conditions: (1) no intervention (control), (2) web-based module outlining genetic concepts applied to CRC, (3) live presentation of the web-based material, (4) live presentation and subsequent standardized patient (SP) encounter. Three months later, all participants completed a written knowledge test, attitude survey, and a standardized patient-based performance assessment.Results: Sixty FMRs completed the study. All three educational interventions resulted in significantly improved outcome measures in knowledge and skills but not attitudes, compared to control. There was no significant difference in outcomes between intervention groups.Conclusion: FMRs acquired knowledge and improved skills in genetic medicine with three educational methods. Resources such as faculty expertise in genetic medicine and cost should guide decisions on curricular development for this rapidly expanding field. This may be especially relevant for programs with distributed teaching sites. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: Understanding how nonphysician health care providers (NPHCPs) teach medical trainees is integral to optimizing family medicine education. The objective of this study was to examine the teaching roles, level of preparation and support, and the challenges encountered by NPHCPs. METHODS: A cross-sectional web-based survey of NPHCPs was conducted across academic teaching units affiliated with the University of Toronto's Department of Family and Community Medicine (DFCM). The level of preparation for educational roles, perceived support, challenges encountered, and educational training needs of NPHCPs were examined. Variables associated with preparedness to teach were also identified. RESULTS: Of the 193 NPHCPs surveyed, 166 (86%) completed the questionnaire. A total of 126 (82%) of NPHCP educators (nurses, social workers, dietitians, and pharmacists) reported teaching medical trainees. Most did not hold faculty appointments. The majority had no formal training in teaching, and less than half felt prepared for their academic responsibilities. NPHCPs perceived a lack of support for their teaching. NPHCPs also identified predictable challenges such as lack of time and lack of funding. Challenges specific to cross-professional teaching were also identified. NPHCPs expressed an interest in receiving continuing education to improve their teaching skills. NPHCPs' self-reported level of preparedness to teach was variable and associated with years of teaching experience, information received about trainees, challenges faced, and continuing education needs. CONCLUSIONS: NPHCPs are extensively involved in teaching medical trainees. There is variability in their preparation level, and they encounter significant challenges. To advance effective and sustainable inter-professional education (IPE) within family medicine, addressing these issues is crucial. [ABSTRACT FROM AUTHOR]

The role of the facilitator is known to be important in fostering productive interprofessional education (IPE) in the face-to-face (F2F) environment. Online learning can help surmount some of the logistical challenges in IPE by bringing together diverse professionals in multiple geographical locations. Best practices in F2F IPE facilitation are beginning to emerge, but there is scant literature examining IPE facilitation online. What little research exists has focused on the asynchronous environment and suggests that the skill sets of online and F2F facilitators have considerable overlap, but there are further demands in the online setting. This qualitative study sought to examine online synchronous IPE facilitation through the self-reported experiences of seven trained facilitators during a 12-week online course. Data collected through focus groups and targeted interviews were analyzed by the research team using constant comparison techniques. Four major themes were revealed: technology as a dynamic force, reduction in non- verbal cues, evolution of the online IPE group process over time and the importance of co-facilitation. The foundations of IPE facilitation were seen to carry over to the online setting. This study has implications for the training of IPE facilitators and for the design of online IPE learning experiences. [ABSTRACT FROM AUTHOR]

The article focuses on the approach in managing pelvic organ prolapse. It mentions several steps for pelvic organ prolapse management including the presentation of history and risk factors of the disease, the analysis of medical therapy, and the evaluation of the surgical treatment. It states that surgery on pelvic organ prolapse has a success rate of 65-90% and a 30% rate of re-operation. It also cites various complication involving the disease surgery including hematoma and hemorrhage.

The article focuses on pessaries, a contraceptive device used to treat patients suffering from pelvic organ prolapse. It states that a pessary will best function if the uterus is there and the patient has to be at ease with an unknown object in her reproductive organ and be willing to take it out and clean it on a regular basis. It adds that every patient putting on pessaries should be observed by health care practitioners every three to six months in order to check for vaginal wounds.

A personal narrative is presented in which the author describes her experience with a new patient who requested a prescription for oral contraceptive pills (OCP) and the fine line physicians walk when making decisions in their practices.

Objective: To explore patients' perceptions of primary care (PC) in the early development of academic family health teams (aFHTs)--interprofessional PC teams delivering care where family medicine and other health professional learners are trained--focusing on the 4 core domains of PC., Design: Self-administered survey using the Primary Care Assessment Tool Adult Expanded Version (PCAT), which addresses 4 core domains of PC (first contact, continuity, comprehensiveness, and coordination). The PCAT uses a 4-point Likert scale (from definitely not to definitely) to capture patients' responses about the occurrence of components of care., Setting: Six aFHTs in Ontario., Participants: Adult patients attending appointments and administrators at each of the aFHTs., Main Outcome Measures: Mean PCAT domain scores, with a score of 3 chosen as the minimum expected level of care. Multivariate log binomial regression models were used to estimate the adjusted relative risks of PCAT score levels as functions of patient- and clinic-level characteristics., Results: The response rate was 47.3% (1026 of 2167). The mean age of respondents was 49.6 years, and most respondents were female (71.6%). The overall PC score (2.92) was just below the minimum expected care level. Scores for first contact (2.28 [accessibility]), coordination of information systems (2.67), and comprehensiveness of care (2.83 [service available] and 2.36 [service provided]) were below the minimum. Findings suggest some patient groups might not be optimally served by aFHTs, particularly recent immigrants. Characteristics of aFHTs, including a large number of physicians, were not associated with high performance on PC domains. Distributed practices across multiple sites were negatively associated with high performance for some domains. The presence of electronic medical records was not associated with improved performance on coordination of information systems., Conclusion: Patients of these aFHTs rated several core domains of PC highly, but results indicate room for improvement in several domains, particularly first-contact accessibility. A future study will determine what changes were implemented in these aFHTs and if patient ratings have improved. This reflective process is essential to ensuring that aFHTs provide effective models of PC to learners of all disciplines.