Shared care practices between nurses and physicians in primary care

Backgrounds:Child abuse or child maltreatment is physical, sexual, or psychological maltreatment or neglect of a child or children, especially by a parent or other caregiver. Child abuse may include any act or failure to act by a parent or other caregiver that results in actual or potential harm to a child, and can occur in a child's home or in the organizations, schools, or communities the child interacts with. This study was conducted to assess the primary health care (PHC) centers’ physicians’ knowledge and attitude toward child abuse including its types, and child neglect with their behavior regarding reporting of abuse cases.Methods:A cross-sectional study was conducted in Abha which is the capital of Aseer Province, including all PHC physicians (about 475) working in PHC centers. Data regarding physicians’ demographic characteristics, perception, and awareness regarding child abuse and neglect were collected by self-administrative questionnaire in the PHC center during their time between patients’ consultation.Results:The study included 300 PHC physicians whose ages ranged from 25 to 50 years old with mean age of 28 years. About 65% of the physicians were males and 69% of them were married with about 73% having at least one child. Overall, 96.3% of the physicians recorded good awareness level regarding types of child abuse and 97.3% recorded good awareness level regarding child neglect patterns. Underreporting of child abuse cases was recorded by about 64% of physicians.Conclusion:Regarding child abuse and neglect, PHC physicians have good knowledge, optimal attitude, and positive perception. There was also the problem of underreporting of suspected child abuse cases among PHC physicians in Saudi Arabia, with many barriers to report, such as community traditions; unclear reporting strategy was identified.

OBJECTIVES/GOALS: Assistive technology (AT) can improve older adults’ function in daily activities. However, Latinos are among the least likely to use AT. Given that primary health care physicians (PCPs) have low awareness about AT, this study aims to evaluate the usability and acceptability of an AT WebAPP among PCPs to increase older Latinos’ access to AT. METHODS/STUDY POPULATION: A team of an established researcher, a sub-graduate faculty and student, and a graduate student will recruit ten PCPs in Puerto Rico and will interview them to explore their current practice in addressing the functional needs of older Spanish-speaking Latinos. The researchers will then train PCPs in the use of a Spanish evidence-based AT WebAPP developed in one of our earlier studies. PCP participants will use the APP with their older patients for 30 days. At the end of the usage period, the analysis will include a mixed method design, consisting of the simultaneous collection of quantitative data using a validated scale followed by qualitative data through individual interviews. Quantitative data will be analyzed with descriptive statistics and qualitative data with thematic content analysis. RESULTS/ANTICIPATED RESULTS: We expect that the AT WebAPP will be rated as particularly useful and acceptable by the PCPs to increase older Latinos’ access to information about AT that could compensate for their physical function disabilities. We also expect that PCPs will offer recommendations for enhancing the design and usability of the AT WebAPP. DISCUSSION/SIGNIFICANCE: Studying the usability and acceptability of this AT WebAPP among PCPs will advance our understanding of its feasibility in enhancing PCPs AT knowledge and recommendations of AT devices for older adults with disabilities in Puerto Rico and in Latino communities in the continental United States.

Background:Sedentary life style and consequent obesity prevail in both developed and developing nations; gender- and age-independently. Physical inactivity in a population in a life style transition–like Saudi Arabia–causes metabolic syndrome with its immediate and long-term complications. Healthcare workers are in a better position for role modeling and counseling of appropriate health behaviors. Personal physical activity and body built among physicians influences to some degree their exercise counseling. Realizing such principle necessitates gauging the extent of physical activity among physicians and assessing the likelihood of counseling the patients on physical activities.Methods:A cross-sectional study enrolled primary health care physicians (PHCPs) from primary health care centers and general hospitals of two cities (Sakaka and Dumat Al-Jandal) of Aljouf region, Saudi Arabia. Both genders were included. English version of step-wise questionnaire of World Health Organization was used for data collection.Results:The response rate was 64.2%. 65.2% of respondent PHCPs were doing moderate to vigorous physical exercise and 34.8% of them were physically inactive. Majority of physically inactive PHCPs had intention to increase their physical activity. Neither gender, nationality nor city-wise significant differences were recorded. However, physically active PHCPs significantly impart advice and role modeling on physical activity to their patients compared to physically inactive PHCPs (p<0.01).Conclusion:Most PHCPs in Sakaka and Dumat Al-Jandal cities were physically active and were able to impart the healthy behavior counseling to their patients. A strong intention prevailed to increase physical activity among physically inactive Primary Health care Physicians (PHCPs).

Aim: The goal of this study is to explore the family physicians’ perspectives of the barriers in initiating insulin for adult patients with Type 2 diabetes mellitus (T2DM) in their primary health care settings. Background: Insulin therapy often becomes necessary when oral anti-hyperglycemic agents are not enough, no longer effective or even as an initial choice. Timely insulin initiation was noticed to be a clinical problem among people with type 2 diabetes mellitus (T2DM) registered in primary health care centers (PHCCs) of Tabouk Province, KSA. Tackling this inertia or insulinophobia is a challenge in order to delay or prevent serious complications of uncontrolled diabetes. Our study and many other studies indicated that this therapeutic inertia is inappropriately due to many patient, system and physician-related factors. The present study aimed to investigate physicians’ perspectives of barriers to insulin initiation for adults with T2DM registered in PHCCs, Tabouk Province - KSA and to identify opportunities for better outcomes. Materials and Methods: This is a cross sectional study where 102 primary health care physicians (PHCPs) (58 females and 44 males) from multi PHCCs in Tabouk Health Province – Kingdom of Saudi Arabia (KSA), responded correctly to online reliable self-administered questionnaire (Cronbach alpha of 0.77344) to address their perspectives of barriers to insulin initiation for adult patients with T2DM. All participants were physicians attending PHCCs with well-equipped diabetes care clinics. Data were collected during a period from 6th – 17th June 2021. Participants included 11 (10.8%) family medicine consultants, 14 (13.7%) family medicine specialists and 77 (75.5%) general physicians. Results: 68.6 of the study participants had barriers in initiating insulin for their patients with T2DM. A significant statistical disproportional correlation was found between the level of specialty and the rate of reporting barriers to insulin initiation (P&lt;0.001). The top 10 listed barriers included the following: patients’ refusal to initiate insulin (71.4%), physicians’ fear of hypoglycemia (51.4%), inability of patients to perform home blood glucose monitoring (HMGM) (50%), physicians have no access to second opinion (44.3%), insufficient educational courses for physicians (37.1%), no family support for patients (34.3%), no clear MOH circular to support physicians’ initiation of insulin at PHCCs (28.6%) , insufficient hypoglycemic medications at PHCCs (25,7%), inability of patients to manage hypoglycemia (24.3%), and patients’ noncompliance to insulin regimen (24.3%). Conclusion: Despite the free of cost availability of all types of insulin, including the safest and peak less ultra-long (degludec) and long (Glargine), the availability of free of cost glucometers for all people with diabetes, the presence of a well-equipped diabetes clinic at every PHCC, the long list of guidelines and educational courses as well as an appointment system with electronic health information system (HIS), insulin inertia is a common problem among PHCPs working in Tabouk Health Region. Key words: Barriers, insulin initiation, insulin, primary health care, type 2 diabetes mellitus.

Introduction: Physical inactivity has been linked to various noncommunicable diseases and their related health problems. As primary health care physicians (PHCPs) play a crucial role in promoting health and preventing disease, this study aims to determine the extent of physical inactivity among PHCPs and its impact on their counseling practices. Methods: A cross-sectional study was conducted across all primary health care centers in Qatar, targeting 511 physicians. A modified self-administered WHO stepwise tool was used to measure physical activity (PA) with another questionnaire to assess the counseling practices among PHCPs. Results: Out of 511 physicians, 306 (59.9%) responded to the survey. The majority of the participants were male (58.1%) with an average age of 45.8 ± 7.9 years. The majority of PHCPs were from the UK (44.3%), while only 4.1% were Qatari. Family physician consultants made up 51% of the respondents, while 30.2% were general practitioners, and the average years of experience were 14 ± 8.3 years. Only 39.5% of the respondents met the WHO PA recommendations. 50.5% of the physicians were overweight, and 23.1% were obese. The median percentage of patients counseled about PA was only 60 [IQR: 40–80]%, and there was no link found between a physician’s PA level and the percentage of patients they counseled on the subject. Conclusion: Physicians reported a high prevalence of physical inactivity. Furthermore, the practice of counseling the public on PA was low. Interventions are needed inside and outside the workplace to improve the PA among PHCPs and their counseling practices.

Background: Psychiatric illnesses are a public health problem worldwide, affecting people of all age. Mental health is an important sector of primary health care services. An increasing number of Saudi citizens and residents utilize primary healthcare services for mental health concerns; hence, there is a need to objectively assess these doctors' attitudes towards people with mental illness.&#x0D; Objectives: Assessment of the attitudes toward mentally ill people among a sample of primary health care physicians in Saudi Arabia &amp; determination of risk factors associated with bad attitudes.&#x0D; Methods: A cross-sectional study was conducted over a period of 30 days (1st September 2021 to 30 September 2021). The study has been conducted on Convenient Sample of Arabic speaking physicians working in primary health care centers in Saudi Arabia who accepted to share in research. Demographic Data was gathered using an electronic self‑administered questionnaire and physicians’ attitudes towards mentally ill people have been evaluated by an Arabic previously validated Questionnaire.&#x0D; Results: This study included 214 physicians, 114 male physicians and 100 females. 72% of participants have a highly positive attitude toward mentally ill patients with a mean score (50±4) and only 28% of participants have a negative attitude with a mean score (38±4). Better attitudes were significantly associated with being female, having (Board, PhD or Fellowship), working for less than a year and having a history of involvement in the care of a mentally ill person. There were no statistically significant differences regarding participants age, nationality, marital status, place and mode of residency, specialty, and having current or past history of mental illness.&#x0D; Conclusions: Primary health care physicians in Saudi Arabia have positive attitudes toward mentally ill patients, female physicians , having (Board, PhD or Fellowship), working for less than a year and having a history of involvement in the care of a mentally ill person were significantly associated with better attitudes.&#x0D; Recommendations: Further larger studies are needed on large number of primary health care centers physicians in Saudi Arabia and other Arab countries. Additional research and programmatic work are needed to understand the reasons for negative attitudes. Effective teaching and training programs is necessary to bring in positive attitude change towards mentally ill people among primary health care physicians.

Annual influenza vaccination is an effective way to reduce the burden of disease throughout the year. A cross-sectional study was conducted in primary healthcare centres in Qatar to determine vaccination coverage among physicians, motivators, and barriers. The vaccination rate was higher among physicians aged 45 years and above (p-value < 0.005). Most primary care physicians (95 %) strongly agree that being vaccinated reduces the risk of disease spread. The most frequently mentioned barriers were the belief that one could still get influenza after being vaccinated and the fear of side effects (92.6 % and 29.5 %, respectively). Health authorities can implement strategies that take these factors into account to increase immunization coverage.

Background: Atopic dermatitis is a chronic relapsing-remitting dermatosis commonly presented in primary healthcare facilities. Although there is no cure for atopic dermatitis, early diagnosis, and appropriate treatment are essential in the management of atopic dermatitis and in preventing its complications. Primary healthcare physicians are the first to encounter most patients with atopic dermatitis; hence, correct practices and knowledge of atopic dermatitis are important among primary healthcare physicians. This study aims to assess the knowledge and practice of primary healthcare physicians concerning diagnosing and treating patients with atopic dermatitis. Methods: A cross-sectional study was conducted among primary health care physicians working at governmental primary health centers in Bahrain to determine the knowledge, attitudes, and practices towards atopic dermatitis. In addition, a self-administered online questionnaire was distributed among the participants using online surveys. Results: A total of two hundred and eighty (n=280) primary healthcare physicians were recruited (response rate 80%). The average knowledge score (correct answers) was 46.7 ± 14.0 out of 100. Being a general practitioner (P&lt;0.002), having more years of experience (P=0.044), and being of older age (P=0.003) were significantly associated with a lower knowledge score. The study also showed a wide range of varying practices among participants in managing patients with atopic dermatitis. Conclusion: There were significant variations in the knowledge and practice amongst primary care physicians towards atopic dermatitis that could delay the treatment of the condition and, therefore, possibly decrease treatment adherence. Conducting targeted educational interventions and developing strategies by dermatologists could minimize such gaps in practice and knowledge.

Objective: The purpose of this pilot study was to determine the understanding of nurses within a shared care model and the degree of interaction evident in their practice in the shared care nursing environment in a rural caresetting. Sharing of care between different nursing teams can allow for the improved use of minimal resources available in rural communities. The objectives of the research were firstly, to identify the interactions of nursing teams in a shared care model and secondly, to determine how shared care is evident in their practice. The final objective was to draw attention to the importance of shared care models in rural health settings and to develop recommendationsto support shared care models. Design: A qualitative, non experimental, grounded theory descriptive study was used in this research. Setting: Primary care. Subjects: The sample comprised the generalist community health team, which consisted of registered nurses with more than 5 years post registration experience in community health nursing and two external nursing teams, comprised of a palliative care team and an aged care team. Main Outcome Measures: Identification of the nursing interactions and shared care practices in order to develop recommendations to foster and support shared care models in changing health structures. Results: The study generated four themes: a lack of understanding of each teams’ roles; difficulties in communication of information; the importance of setting shared goals in care planning; and the need for collaboration to ensure clarity in case coordination. Conclusion: Results suggest that confusion around role, skills, communication, care planning and coordination of care within a shared care model are creating barriers to effective sharing of care. Co‑location of services should enhance sharing of care. These results should facilitate the development of care approaches that maximise health outcomes and contribute to a better understanding of collaborative processes that can assist in the provision of health care in rural settings.

PurposeThis paper aims to test the idea generation capabilities of online text-based focus groups as compared to the traditional in-person focus groups using sustainability in the hospitality industry as the idea generation topic. Idea generation quantity and quality are analyzed and the theoretical and practical implications for the hospitality industry are discussed.Design/methodology/approachAn experimental study tested the quality of ideas generated by online versus in-person focus groups. Participants were purposively sampled from the hospitality program at a large southeastern United States university and randomly assigned into one of two treatment groups: online text-based or traditional in-person focus groups. During both treatment groups participants generated ideas focused on sustainability in the hospitality industry.FindingsThe online focus group generated a comparable quantity of ideas, in addition to a similar average quality of ideas and number of good ideas.Practical implicationsThe generation of ideas and the selection of opportunities drive the innovation process through which firms can strengthen their competitive advantage and maintain and grow market share and profitability. The results of this study may assist hospitality firms in determining which form of qualitative research delivers the highest return on investment by generating the best ideas at the lowest cost.Originality/valueThis paper breaks new ground by assessing the effectiveness of idea generation in online versus traditional focus groups, comparing both the quantity and quality of ideas generated from an experimental study that uses random assignment.

Context:Evidence-based medicine (EBM) is essential for safe and cost-effective care provision to the population.Aims:To assess the awareness, attitude and practices and barriers among primary care physicians about EBM in Buraidah, Qassim.Settings and Design:Cross-sectional study in Primary Health Care centers (PHCCs) of Buraidah, Qassim.Materials and Methods:The study was conducted among physicians working in PHCCs of Buraidah. Data were collected online through Google forms.Statistical Analysis Used:Descriptive analysis was carried out to measure the frequencies and proportions. Chi-square test was used to compare barriers based on gender, academic degree, and experience categories.Results:A total of 96 out of 144 physicians (66.7%) responded to the invitation. About 82.3% of the participants welcomed the promotion of EBM and 92% of the physicians knew about concept of EBM. About 94.8% of the physicians agreed that EBM will improve patient outcomes. The reported barriers were; patient load (87.5%), time availability (70.8%), computer availability (33.3%), internet availability (45.8%), and 56.3% stated updated clinical letters, journals, or guidelines are not available.Conclusions:This study found that there was high self-reported knowledge about the EBM concept; however, the knowledge about tools was poor. A number of barriers were found such as patient load, time, availability of clinical guidelines and journals and other resources such as internet and computers. Primary care physicians should be trained and facilitated for EBM.

Gout, the most common inflammatory arthritis in developed countries, can lead to deformities and disabilities, significantly affecting quality of life. Primary care physicians (PCPs) play a crucial role in its management and must adhere to recent guidelines. This study assessed PCPs’ knowledge and adherence to gout treatment recommendations in Saudi Arabia using a questionnaire survey. A total of 367 PCPs completed the survey, with 86.4% practicing in Saudi Arabia. The respondents included general physicians (53.1%) and family physicians (49.9%), with a nearly equal gender distribution. For acute gout management, 25.34% recommended nonsteroidal anti-inflammatory drugs combined with corticosteroids. Colchicine was considered safe by 69.8% of participants. Knowledge of urate-lowering therapy was suboptimal, with only 7.9% correctly identifying the appropriate initiation timing and 43.1% recognizing the target serum uric acid (SUA) level. While 74.1% recommended modifying therapy if the SUA target was unmet, only 32% advocated for long-term urate-lowering therapy. Additionally, 18% correctly identified the proper time to measure SUA levels. Lifestyle modifications were acknowledged by 57.2%, and 55% recognized the cardiovascular risks associated with gout. Overall, PCPs demonstrated poor compliance with gout management guidelines. Strategies to improve adherence include continuing medical education, disease-management websites, and smartphone apps. Rheumatologists should serve as key resources for PCPs, providing education through consultations, formal training, and conference presentations.

Diabetes mellitus (DM) is a primary cause of chronic kidney disease (CKD), a significant and growing global health issue. Primary healthcare physicians (PHPs) are crucial in detecting, managing, and preventing CKD, but many lack the necessary knowledge and skills to effectively diagnose and manage the disease. This study assessed the knowledge and competence of PHPs in managing diabetes-related CKD. This cross-sectional study was conducted among all Primary Healthcare Physicians (PHPs) working at Primary Healthcare Center (PHC) in King Abdulaziz Medical City of the National Guard, Jeddah, Saudi Arabia. An online questionnaire was sent to all PHPs and data were collected from January 2024 to February 2024. Data analysis performed utilizing RStudio (version 4.3.1). Categorical variables were expressed as frequencies and percentages, whereas mean and standard deviations were computed for continuous variables. Kruskal-Wallis rank sum test was used to determine differences in confidence scores across various demographic and occupational characteristics. A multivariable linear regression analysis was performed to identify factors related to confidence. Of 141 PHPs, 122 filled online questionnaire yielding a response rate of 86.5%. responded. The majority (90.2%) were 18-45 years of age, 68.0% were qualified as family physicians, 38.0% belonged to the specialized poly clinic, and 54.9% had less than 5 years of experience. PHPs showed a varied levels of confidence and knowledge. While 76.2% were confident about the stages of kidney disease and 65.6% acknowledged the importance of the urine albumin-creatinine ratio (uACR) test, 58.1% were uncertain of interpreting uACR results and CKD diagnostic criteria. More than 60.0% were uncertain of the treatment steps postdiagnosis and prediction of CKD prognosis. Age, qualification, specialization in family medicine, and clinic affiliation were significantly related to confidence levels. The study underscores notable gaps in PHPs' knowledge and confidence concerning CKD screening, diagnosis, and management. Continuous education and targeted interventions are essential for the improvement of PHPs' competence and patient outcomes in the management of CKD.

There is growing evidence that shared care, where the oncologist, primary care physician, and/or other specialty physicians jointly participate in care, can improve the quality of patients' cancer care. This cross-sectional study of breast and colorectal cancer patients (N = 534) recruited from the New Jersey State Cancer Registry examined patient and health system factors associated with receipt of shared care during cancer treatment into the early survivorship phase. We also assessed whether shared care was associated with quality indicators of cancer care: receipt of comprehensive care, follow-up care instructions, and written treatment summaries. Less than two-thirds of participants reported shared care during their cancer treatment. The odds of reporting shared care were 2.5 (95% CI: 1.46-4.17) times higher for colorectal than breast cancer patients and 52% (95% CI: 0.24-0.95) lower for uninsured compared with privately insured, after adjusting for other sociodemographic, clinical/tumor, and health system factors. No significant relationships were observed between shared care and quality indicators of cancer care. Given a substantial proportion of patients did not receive shared care, there may be missed opportunities for integrating primary care and nononcology specialists in cancer care, who can play critical roles in care coordination and managing comorbidities during cancer treatment.

Objectives:To evaluate the general knowledge among primary health care (PHC) physicians regarding the management of common urological problems in Saudi Arabia.Methods:This is an observational prospective study, where a self-administered questionnaire was distributed to practicing PHC physicians in the western region of Saudi Arabia on January 2017. The questionnaire consisted of 21-item questions, inquiring about demographics and general urological knowledge and skills. The management of common urological problems was assessed by case scenarios for specific urological condition, including urethral catheterization, definition and evaluation of hematuria, recognition of age-specific increase in prostatic specific antigen (PSA), and management of lower urinary tract symptoms.Results:A total of 148 questionnaires were distributed, with a response rate of 75.7%, where 112 respondents completed the questionnaires, including 54.3% residents, 39% general practitioners, and 5.4% specialists. Fifty-seven percent of respondents were males and 68% were Saudi practitioners. A higher number of respondents expressed that they were able to catheterize a male than female patient (56.5% versus 34.3%). Only 6.4% of respondents defined microscopic hematuria accurately. Knowledge about hematuria, serum prostate specific antigen and overactive bladder was low in all groups. Apart from hematuria, seeking urological consultations was less than 35% for all other disease entities.Conclusion:Urological knowledge among PHC physicians seems to be insufficient. Significant percentages of the participants were unable to catheterize a female patient, did not know the definition of hematuria; and whether to ask for urological consultations in cases of hematuria, increased PSA, and overactive bladder.