Knowledge of Primary Care Physicians on Lysosomal Storage Disorders

Background: Depression occurs in 3-8% of the population of the world and ranks fourth in the world's most prevalent diseases. Based on data from Riskesdas 2013, the rate of mental disorders (depression and anxiety) reached 6% for ages 15 and older. The mental disorder most prevalent in primary care is the depressive disorder (10%), but the diagnosis of depression by general practitioners in primary care is only 1%. Coverage of mental health in primary care is low, partly because primary care physicians who are in Community and Primary Health Care Centers (Puskesmas) are still experiencing difficulties in diagnosing mental disorders, especially depression.Objective: To determine the effectiveness of mhGAP training in improving the knowledge and skills of primary care physicians in diagnosing and treating depression in Gunungkidul.Research Methods: This study was a quasi-experimental research with pretest-posttest design with one group, in order to find a causal relationship involving one treatment group.Results: The knowledge of the primary care physician improved about diagnosis of depression before and after intervention training modules, p=0.000. Patients with depression mostly suffered in the female group ages 19-60 years old. An increase in the diagnosis of depression after training mhGAP with validation by a psychiatric specialist was at 49.41%.Conclusion: Training with modules mhGAP improved education for physicians in the diagnosis of depression and improved referral rates of depression cases from community health centers to district hospitals in Wonosari.

Introduction: We sought to assess baseline knowledge related to GLP-1 receptor agonist (GLP-1RA) use in combination with basal insulin and determine if an online, video-based, continuing medical education (CME) activity could improve the clinical knowledge of primary care physicians (PCPs) and diabetologists/endocrinologists (D/Es). Methods: A 3-question knowledge and 1-question confidence linked pre-/post-assessment study design with McNemar’s chi-squared test (5% significance level, P <.05) and Cramer’s V (<0.05 no effect; 0.06-0.15 noticeable effect; 0.16-0.30 considerable effect; >0.30 significant effect) assessed educational impact. The activity launched August 23, 2018, and data collected through September 19, 2018. Results: Overall improvements were seen after participation in the CME activity for both PCPs (n = 254, P<.0001, noticeable effect of V= 0.115) and D/Es (n = 95, P=.0284, noticeable effect of V= 0.091). Improvements include: 11% more PCPs (P=.013) and 5% more D/Es (P=.3597) accurately identified the profound effect of combining a GLP-1RA with basal insulin; 9% more of PCPs (P=.0327) and 14% more D/Es (P=.0311) correctly identified the effect of adding exenatide once weekly to insulin glargine in patients with T2D failing basal insulin; 14% more of PCPs (P=0.0016) and 3% more of D/Es (P=.545) accurately identified which combination of therapy resulted in significantly greater reductions in HbA1c, blood glucose (fasting and postprandial), weight, and systolic blood pressure; 28% of D/Es and 41% of PCPs reported increased confidence in recommending a GLP-1RA or SGLT2 inhibitor for a patient failing basal insulin. Conclusion: This study demonstrates the success of online, video-based CME on improving clinical knowledge and confidence of PCPs and D/Es related to using GLP-1RA in combination with basal insulin. Disclosure A. Larkin: None. M. LaCouture: None. A. Le: None. Funding AstraZeneca

Recently, several prospective randomized prostate cancer screening studies have been reported. We report the results of a questionnaire administered to primary care physicians (PCPs) to determine their attitudes on prostate cancer screening and compared these results to those obtained when the same questionnaire was administered to a different large cohort of PCPs in 2006 prior to the reporting of these randomized studies. A 24-item questionnaire designed to assess prostate cancer knowledge and screening attitudes was administered to PCPs within central Florida and those PCPs attending a state conference. Completed surveys were returned and analyzed. All reported p values were two-sided, and those p values less than 0.05 were considered to be statistically significant. Seven hundred and eighty PCPs received the study questionnaire, and 168 (22 %) PCPs returned the completed questionnaire. Sixty-eight percent of responders stated that they recommend prostate cancer screening to >75 % of their patients over the age of 50 years, up from 47 % in 2006 (p < 0.001). Seventy-four percent of responders felt screening was effective. The overall mean score of the knowledge survey was 66 %, which was similar to the cohort from 2006. Knowledge scores were not associated with screening attitudes and behaviors. On multivariate analysis, practice setting and percentage of Medicaid patients in the practice were associated with attitude scores. Our current findings imply that despite the recent landmark studies published on prostate cancer screening, PCPs' screening attitudes have changed minimally over the past 5 years.

Background: Vaginal discharge is one of the most common gynecological complaints among women of reproductive age. Its effective management depends on the knowledge, attitudes, and practices (KAP) of primary health care physicians. In regions such as Alahsa, Saudi Arabia, assessing physician competence is essential to improve patient outcomes and address cultural and systemic barriers to care.Methods: A cross-sectional study was conducted in 2024 among 233 primary health care physicians in Alahsa. Participants were selected using a convenience sampling technique. Data were collected through a structured self-administered questionnaire covering demographics, knowledge of vaginal discharge etiologies and treatments, attitudes toward clinical management, and diagnostic and treatment behaviors. Data analysis included descriptive statistics, chi-square tests, and multivariate regression using SPSS.Results: A total of 210 (90.1%) of participants demonstrated good knowledge, particularly regarding common etiologies and first-line treatments for bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis. However, diagnostic knowledge was more limited; only 96 (41.2%) correctly identified saline wet mount as a diagnostic tool for Trichomonas vaginalis. Attitudes were generally favorable, with strong support for guideline adherence and patient education. Marital status and professional level were significantly associated with knowledge levels (p < 0.05), while other sociodemographic factors were not. Clinical practices varied considerably, with limited use of physical examinations and diagnostic testing, often attributed to resource constraints or cultural sensitivities.Conclusion: Primary health care physicians in Alahsa exhibit good knowledge and positive attitudes regarding the management of vaginal discharge. However, inconsistencies in clinical practice, particularly in diagnostic approaches, highlight the need for targeted training and improved diagnostic accessibility to enhance the quality of care.

To assess the current knowledge and practices in diabetic eye care and referral system regarding diabetic retinopathy (DR) in health centers of Islamabad and Rawal-Pindi. A cross-sectional study was carried out in 4 government and private health centers in Rawalpindi-Islamabad from May 2018 to Oct. 2018. A total of 38 Primary Care Physicians (general practitioners, family physicians, and internists) were recruited out of which data for 2 were either not returned, or were missing partially. Data were collected through a 27-item consented & validated, multiple-choice questionnaire based on physician characteristics, knowledge and practice of diabetic eye care and challenges faced due current DR referral system. Descriptive analyses for all variables were performed including, mean and standard deviation. Analytical analyses were also conducted to study association between different study variables. Mean scores of knowledge for general practitioners, family physicians, and internists were 41.7%, 42.0% and 46.6% respectively. A lack of knowledge, and suboptimal practices were observed regarding signs, symptoms, screening, testing, evaluation and referral of DR regardless of physicians' specialty, or years in practice. Lack of expertise regarding direct ophthalmoscopy, interpretation of findings, and referral to an ophthalmologist were noted. Physicians who performed consultation and counselling according to patients' needs referred more patients to an ophthalmologist than those who restricted their consultation to a fixed amount of time and had more patients per unit time (P=0.01). Physicians who had taken care of less than 5 number of patients with DR marked less incorrect answers with no significantly greater number or correct answers compared to physicians who had taken care of more than 5 number of patients with DR (P=0.044). An association of more than 5 patients with DR taken care of with more need based patient consultation and counselling was also noted (P=0.017). An evaluation of the current referral system for DR revealed major loopholes in the health care infrastructure, proper guidelines, properly functioning equipment, check and balances, and lack of guidance to physicians regarding acquiring and updating knowledge regarding DR. Lack of updated and adequate knowledge, practices among primary care physicians, and suboptimal diabetic eye care and referral system have contributed to late presentation of DR. Interventions are needed to improve current diabetic eye care, and knowledge and practices of primary care physicians.

Background: Terminology used to describe upper gastrointestinal disorders differs by country and language. However, the extent of variation in physician understanding of GERD and associated conditions and symptoms is not known. Aim: To determine the knowledge of primary care physicians with regard to: terminology related to GERD, their understanding of related complications and extra-esophageal symptoms/conditions, and their use of guidelines relating to GERD. Methods: Gastroenterologists from 17 countries asked primary care physician colleagues to complete a one-page online survey on GERD. Results: 352 primary care physicians, (77% community-based, 23% hospital-based) completed the questionnaire. Gastroesophageal reflux disease/GERD (84%) or reflux/reflux disease (47%) were the terms mostly often used to record a diagnosis for patients with reflux-related symptoms or clinical manifestations; dyspepsia (15%), epigastric pain (10%), and gastritis (9%) were infrequently used. Erosive esophagitis, Barrett’s esophagus, stricture, and esophageal adenocarinoma were recognized as being associated with GERD by 88, 71, 61 and 51% of physicians, respectively. Extra-esophageal problems of cough, sleep-related disorders, laryngitis and asthma were recognized to be associated with GERD by 74, 50, 48 and 47% of respondents. Thirty-nine percent of physicians stated that they did not use a specific definition of GERD; 33% used an international and 14% used a national guideline in managing patients. Conclusions: (1) GERD is well recognized, but its related terminology is variable throughout the world. (2) There was variable and incomplete recognition of extra-esophageal manifestations GERD. (3) Recognition of extra-esophageal diseases caused by GERD is variable. (4) Current GERD guidelines are infrequently used by primary care physicians.

Changing the psychiatric knowledge of primary care physicians: The effects of a brief intervention on clinical diagnosis and treatment

In 2014, over a million people were internally displaced after the launch of a military operation in North Waziristan, a tribal region on Pakistan's side of the Durand Line. Despite security concerns and restrictions, a collaborative mental health and psychosocial support initiative was undertaken in the district of Bannu. Monthly mental health camps were conducted for a period of 6 months by a multidisciplinary mental health team. The initiative also helped to assess mental health needs and plan training for primary care staff to strengthen existing resources. As part of this initiative, Mental Health Gap Action Programme (mhGAP) training was conducted for physicians and psychosocial staff in the affected district. This marked the first instance of implementing these guidelines in Pakistan following a humanitarian crisis. This paper describes the training process including the adaptation of the mhGAP curriculum, training of trainers, training workshops for primary care staff and an analysis of results of pre- and post-testing of their knowledge about common mental disorders using a 25-item questionnaire. The gaps in knowledge of primary care physicians in recognizing and managing common mental disorders were clearly identified. The mean pre- and post-test scores of the participants were 15.43, 62% (p value 0.000, s.d. 4.05) and 19.48, 78% (p value 0.000, s.d. 3.13) respectively, which showed significant improvement. Despite the challenges of a humanitarian crisis, mhGAP guidelines can be successfully implemented to train primary care physicians in in low- and middle-income countries such as Pakistan. However, the dearth of primary care resources can hinder the complete integration of mental health services into primary healthcare.

Introduction: Bariatric surgery is the most effective procedure for sustained weight loss and control of obesity-associated comorbidities among morbidly obese patients. Successful bariatric surgery depends on a multidisciplinary approach involving all healthcare workers, including the primary care physicians, from the referral of patients to long-term follow-up. The present study assessed the knowledge, attitude, and potential referral barriers of primary care physicians to bariatric surgery and associated sociodemographic factors. Materials and methods: The present analytical cross-sectional study was conducted among 280 randomly selected primary care physicians using a standard and validated data collection tool. We performed an independent t-test and one-way ANOVA to find the association between sociodemographic characteristics and knowledge, attitude, and referral barrier scores. Furthermore, multilinear regression analysis was executed to determine the association among knowledge, attitude, and barriers. Results: The current study found that 52.9%, 19.3%, and 59.3% had a low score in the knowledge, attitude, and barriers categories. The attitude scores were significantly associated with the education status (p = 0.005) and current position at primary health centers (p = 0.012), and the referral barriers score was significantly associated with the work experience duration (p = 0.004). We found a positive relationship between knowledge and attitude (regression coefficient (β) [95% CI]:0.389 [0.154 to 0.585], p = 0.001) and a negative relationship between knowledge and referral barriers (β [95% CI]: −0.291 [−0.127 to −0.058], p = 0.007). Conclusions: Our survey findings suggest that a lack of knowledge regarding bariatric surgery led to several concerns and referral barriers among the physicians. Therefore, the recommendation is to improve the primary care physicians’ knowledge through continuing medical education, symposium, and other suitable training methods with a special focus on obesity care in the curriculum. Furthermore, a mixed-method survey involving other provinces of the KSA is warranted to formulate the region-specific training needs.

Introduction: The less prominent role of triglycerides in determining cardiovascular risk keeps these lipids from being top-of-mind for practicing clinicians, yet epidemiologic data affirm that hypertriglyceridemia contributes to atherosclerotic disease development and progression. We sought to determine if online continuing medical education (CME) could improve the clinical knowledge and competence of primary care physicians (PCPs) and cardiologists regarding hypertriglyceridemia and the use of omega-3 fatty acids in its treatment. Methods: The effects of two educational interventions about advances in hypertriglyceridemia treatment (activity 1) and educating patients about omega-3 fatty acid products (activity 2) were analyzed to determine efficacy of online education presented in the form of online video-based roundtable discussions. The activities launched online in May and June, 2015 respectively, and data were collected through July, 2015. The effects of education were assessed using knowledge- and case-based matched pre-assessment/post-assessments. The effect sizes were calculated with Cohen’s d (&gt; 0.8 is large, 0.8-0.4 is medium, and &lt; 0.4 is small). Results: In total, 842 PCPs and 75 cardiologists who completed all pre/post assessment questions in any of the two activities during the study period were included in analyses. Significant overall improvements were seen for PCPs (activity 1: n = 452, P &lt;.05, effect d= 0.68; activity 2: n = 390, P &lt;.05, effect d= 0.96) and cardiologists (activity 1: n = 35, P &lt;.05, effect d= 0.77; activity 2: n = 40, P &lt;.05, effect d= 0.9). Compared with baseline, specific areas of improvements include: • 22% more PCPs and 31% more cardiologists identified weight loss as a nonpharmacological intervention that can effectively lower triglyceride levels for overweight/obese patients with hypertriglyceridemia, (both P &lt; .05) • 35% more PCPs and 32% more cardiologists identified the appropriate dosing of prescription omega-3 fatty acids (both P &lt;.05) • 23% more PCPs ( P &lt; .05) and 20% more cardiologists ( P =.068 ) recognized that reducing the risk for pancreatitis is a primary medical objective in patients with severe elevations in triglyceride levels Areas identified as needing additional education include: • 57% of all physicians remain unaware that omega-3 fatty acids reduce apolipoprotein C3 • 61% of PCPs and 60% of cardiologists did not demonstrate a thorough understanding of the differences between prescription omega-3 fatty acids and omega-3 supplements Conclusion: This study demonstrates the success of a targeted educational intervention with two educational components on improving knowledge, competence, and clinical decision-making of PCPs and cardiologists regarding hypertriglyceridemia treatment and the role of omega-3 fatty acid products in its treatment.

Primary care physicians are uniquely positioned to initiate and promote smoking cessation. However, their attitude towards smoking cessation is influenced by many factors, including their own smoking habits and knowledge. The aim of the study was to assess the impact of smoking habits, knowledge, and personal characteristics of primary care physicians on their attitude towards smoking cessation in comparison to a previous study conducted a decade ago. Overall, 302 primary care physicians filled out a questionnaire designed specifically to evaluate knowledge, smoking habits, and smoking cessation interventions they use. More never-smoking physicians initiate conversations about smoking cessation, recommend smoking cessation groups, and set quit date to their smoking patients. They also invest greater efforts in patients with smoking complications. More current-smoking physicians advise Nicotine Replacement Therapy and joining Internet forums and telephone consultations. Keeping good relations with the patients plays an important role in the willingness of physicians to initiate a talk. A large proportion of physicians state they would prescribe smoking cessation medications to patients even when contraindicated. The various approaches of primary care physicians emphasize the importance of physician education according to their own smoking habits.

Sleep disorders are highly prevalent in primary care. Obstructive sleep apnea (OSA) is one of the most common sleep disorders in the world, and it is estimated that only 10 to 20% of OSA cases are diagnosed. Primary care physicians (PCP) play an important role in screening for OSA. Knowledge of sleep disorders among PCP varies widely and has been generally reported as low. In this study, we aimed to assess the knowledge and attitudes towards OSA among primary care physicians in the Middle East and North Africa regions. A cross-sectional study using the Obstructive Sleep Apnea Knowledge and Attitudes (OSAKA) self-administered questionnaire was distributed to PCP attending the Lebanese Society of Family Medicine annual conference, the Lebanese Society of Internal Medicine annual conference, and World Organization of Family Doctors (WONCA) East Mediterranean region conference. Of 300 physicians approached, 256 (85%) completed the questionnaires. The range of possible scores was 0 to 18. The mean total knowledge score with standard deviation (SD) was 12.6 (2.5). Internal medicine specialists showed a higher mean knowledge score of 14.1 (2.3) compared to general/family medicine specialists 12.4 (2.4) and other specialties 11.9 (2.8), p = 0.001. Though 78% of all physicians felt confident in identifying patients with OSA, only 26% felt confident in managing patients with continuous positive airway pressure. Overall, there was a weak positive correlation between knowledge and attitude. There were gaps in knowledge and attitudes regarding managing patients with OSA. Training in managing patients with OSA is needed.

Background Hypothyroidism, a common endocrine disorder in women of reproductive age, can cause serious maternal and fetal complications if not diagnosed and managed early. Pregnancy increases thyroid hormone demand, potentially destabilizing some patients. Primary care physicians play a key role in screening and follow-up.Aim: This study aimed to assess the knowledge, attitudes, and practices of primary care physicians in the Kairouan region regarding hypothyroidism management during pregnancy, to identify gaps and propose recommendations for improved maternal–fetal outcomes. Materials and Methods: A cross-sectional study was conducted among primary care physicians working in the Kairouan region. Participants completed a questionnaire assessing their knowledge of gestational hypothyroidism, their attitudes toward screening and management, and their self-reported clinical practices. The survey assessed participants’ sociodemographic characteristics, knowledge, attitudes, and clinical practices regarding hypothyroidism in pregnancy. Data were analyzed descriptively using SPSS 25, and ethical principles, including anonymity and informed consent, were strictly followed. Results: The sample was predominantly female (64%), with a mean age of 47.8 years. Knowledge about the role of thyroid hormones and the complications of hypothyroidism during pregnancy was generally satisfactory (69% and 63% correct answers, respectively). Most physicians (96%) were aware that screening should be targeted; however, only 64% knew the recommended first-trimester TSH target value, 35% followed the recommended monthly monitoring frequency, and only 17% knew that levothyroxine dosage should be increased once pregnancy is confirmed. While a majority (85%) recognized their essential role in management, fewer than 60% felt competent in doing so. In practice, 49% preferred to refer patients to a specialist rather than initiate treatment themselves. The availability of standardized protocols and documentation of therapeutic adjustments remained insufficient. Conclusion: Although primary care physicians in Kairouan are generally aware of the importance of gestational hypothyroidism, significant gaps persist in several key aspects of diagnosis and therapeutic follow-up. Strengthening continuous medical education, disseminating clear local guidelines, and improving physicians’ autonomy are essential steps to optimize management and reduce maternal and fetal risks.

Physician Knowledge and Practice Patterns Relating to Diabetic Nephropathy

Knowledge and beliefs of primary care physicians, pharmacists, and parents on antibiotic use for the pediatric common cold