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Çelik Ö, Apaydın Kaya Ç. Challenges and needs of epilepsy management in primary care (from the perspective of family physicians/general practitioners): A cross-sectional study. Epileptic Disord 2023; 25:739-748. [PMID: 37584561 DOI: 10.1002/epd2.20145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 07/20/2023] [Accepted: 07/30/2023] [Indexed: 08/17/2023]
Abstract
OBJECTIVE Family physicians are expected to have sufficient knowledge and skills in epilepsy management due to frequent encountering with epileptic patients for prescribing antiepileptics, providing preventive services such as vaccination, pre-conceptional counseling, or managing acute health problems of the patients. This study aimed to determine family physicians' challenges and needs regarding managing epilepsy in primary care. METHODS This cross-sectional study was carried out with the family physicians working in Family Health Centers representing the four districts of Istanbul in 2020. After enrolling sociodemographic characteristics, epilepsy knowledge, and self-efficacy questionnaire were filled out by the physicians themselves, and the difficulties and needs in the follow-up of the patients with epilepsy were evaluated with open-ended questions. RESULTS Two hundred and twenty-eight physicians participated in the study (48.7% F; mean age: 43.06 ± 8.82). Most of the physicians reported that they feel incompetent and hesitated while providing health reports (driving [83.3%], sport [95.5%] or work [70.2%]), and prescribing antiepileptics, especially during pregnancy (38.2%) and breastfeeding (31.2%). Despite their high awareness of psychosocial problems in epileptic patients, only 25% of physicians stated that they could make psychosocial assessments. There was no correlation between Epilepsy Knowledge and Self-efficacy scores and physicians' age, graduation period, and family medicine experience (p > .05). Most frequently encountered difficulties were reported as epilepsy-specific (follow-up of pregnant or pediatric patients, lack of information about epilepsy and antiepileptics). Most physicians (82.6%) wanted training in epilepsy management. SIGNIFICANCE The findings of our study suggest that family physicians need knowledge and training in epilepsy management. The main limitation of the present study is its cross-sectional design, which does not allow for causal or directional inferences.
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Affiliation(s)
- Özla Çelik
- Department of Family Medicine, Marmara University School of Medicine, İstanbul, Turkey
| | - Çiğdem Apaydın Kaya
- Department of Family Medicine, Marmara University School of Medicine, İstanbul, Turkey
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Hutchinson K, Herkes G, Shih P, Francis-Auton E, Bierbaum M, Ryder T, Nikpour A, Bleasel A, Wong C, Vagholkar S, Braithwaite J, Rapport F. Identification and referral of patients with refractory epilepsy from the primary to the tertiary care interface in New South Wales, Australia. Epilepsy Behav 2020; 111:107232. [PMID: 32640412 DOI: 10.1016/j.yebeh.2020.107232] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/02/2020] [Accepted: 06/05/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVES This mixed-method feasibility study conducted in New South Wales (NSW), Australia, aimed to explore clinical practices around the identification of patients with refractory epilepsy and referral from primary care to Tertiary Epilepsy Centers. The perceptions of general practitioners, neurologists, and adults living with refractory epilepsy were considered. METHODS Fifty-two data collection events were achieved through 22 semi-structured interviews with six neurologists and 12 adults who currently have, or have had refractory epilepsy, and four family members, 10 clinical observations of patient consultations and 20 surveys with general practitioners. A thematic analysis was conducted on the qualitative data alongside assessment of observational fieldnotes and survey data. FINDINGS Two main themes emerged: 1) Patient healthcare pathways and care experiences highlighted the complex and deeply contextualized experiences of both patients and healthcare professionals, from first identification of people's seizures, in primary and community care settings, to referral to Tertiary Epilepsy Centers, shedding light on a fragmented, nonstandardized referral process, influenced by both individual and shared-care practices. 2) Factors impacting referrals and patient pathways indicated that onward referral to a Tertiary Epilepsy Center is affected by the knowledge, or the lack thereof, of healthcare professionals regarding treatment options. Barriers include limited person-centered care, shared decision-making, and refractory epilepsy education for healthcare professionals, which can delay patients' disease identification and can hinder speedy referral pathways and processes, in Australia for up to 17 years. In addition, person-centered communication around care pathways is affected by relationships between clinicians, patients, and family members. CONCLUSION This study has identified a noticeable lack of standardized care across epilepsy-related healthcare sectors, which recognizes a need for developing and implementing clearer epilepsy-related guidelines and Continuing Professional Development in the primary and community care settings. This, however, requires greater collaboration and commitment in the primary, community, and tertiary care sectors to address the ongoing misconceptions around professional roles and responsibilities to optimize shared-care practices. Ultimately, prioritizing person-centered care on both patients' and professionals' agendas, in order to improve satisfaction with care experiences of people living with complex epilepsy.
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Affiliation(s)
- Karen Hutchinson
- Australian Institute of Health Innovation, Level 6, 75 Talavera Road, Macquarie University, NSW 2109, Australia.
| | - Geoffrey Herkes
- University of Sydney, City Road, Camperdown, NSW 2006, Australia; Royal North Shore Hospital, Reserve Rd, St Leonards, NSW 2065, Australia.
| | - Patti Shih
- Australian Institute of Health Innovation, Level 6, 75 Talavera Road, Macquarie University, NSW 2109, Australia.
| | - Emilie Francis-Auton
- Australian Institute of Health Innovation, Level 6, 75 Talavera Road, Macquarie University, NSW 2109, Australia.
| | - Mia Bierbaum
- Australian Institute of Health Innovation, Level 6, 75 Talavera Road, Macquarie University, NSW 2109, Australia.
| | - Tayhla Ryder
- Australian Institute of Health Innovation, Level 6, 75 Talavera Road, Macquarie University, NSW 2109, Australia.
| | - Armin Nikpour
- University of Sydney, City Road, Camperdown, NSW 2006, Australia; Royal Prince Alfred Hospital, 50 Missenden Rd, Camperdown, NSW 2050, Australia.
| | - Andrew Bleasel
- University of Sydney, City Road, Camperdown, NSW 2006, Australia; Westmead Hospital, Corner Darcy and Hawkesbury Rd, Westmead, NSW 2145, Australia.
| | - Chong Wong
- University of Sydney, City Road, Camperdown, NSW 2006, Australia; Westmead Hospital, Corner Darcy and Hawkesbury Rd, Westmead, NSW 2145, Australia.
| | - Sanjyot Vagholkar
- MQ Health General Practice, Macquarie University, NSW 2109, Australia.
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Level 6, 75 Talavera Road, Macquarie University, NSW 2109, Australia.
| | - Frances Rapport
- Australian Institute of Health Innovation, Level 6, 75 Talavera Road, Macquarie University, NSW 2109, Australia.
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Male LR, Noble A, Snape DA, Dixon P, Marson T. Perceptions of emergency care using a seizure care pathway for patients presenting to emergency departments in the North West of England following a seizure: a qualitative study. BMJ Open 2018; 8:e021246. [PMID: 30269063 PMCID: PMC6169770 DOI: 10.1136/bmjopen-2017-021246] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To establish the appropriateness of a previously developed seizure care pathway by exploring to what extent patients valued the intervention and perceived it as being helpful or not. DESIGN Qualitative descriptive study, using semistructured, in-depth interviews and thematic template analysis, theoretically informed by critical realism. SETTING In North West England, a seizure care pathway has been developed in collaboration with a specialist neurology hospital to support clinical management of seizure patients on initial presentation to the emergency department (ED), as well as access to follow-up services on discharge, with the aim of improving patient experience. Three National Health Service (NHS) EDs and a specialist neurology hospital provided the setting for participant recruitment to this study. PARTICIPANTS 181 patients fulfilled the inclusion criterion with 27 participants taking part following their experience of an ED attendance and outpatient follow-up appointment after a seizure. RESULTS Five main themes emerged from the data: decision to seek care, responsiveness of services, waiting and efficiency, information and support, and care continuity. Two integrative themes spanned the whole study: lived experience and communication. This paper reports on two of the main themes: care continuity, and waiting and efficiency. The average time between ED presentation and interview completion was 100 days. CONCLUSIONS Implementation of a care pathway is a complex intervention, requiring long-term follow-up to assess its integration into practice and effectiveness in service improvement. The seizure care pathway has the potential to enhance the care of seizure patients in the ED and at follow-up by improving continuity and management of care. The study demonstrates good aspects of the seizure care pathway as observed by patients and also recognises shortcomings within current service provision and questions what the NHS should and should not be delivering. Our study suggests various ways to enhance the pathway at service level to potentially drive improved patient experience.
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Affiliation(s)
- Leanne Rachel Male
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Adam Noble
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Darlene Ann Snape
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Peter Dixon
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Tony Marson
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
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Martino T, Lalla A, Carapelle E, Di Claudio MT, Avolio C, d'Orsi G. First-aid management of tonic-clonic seizures among healthcare personnel: A survey by the Apulian section of the Italian League Against Epilepsy. Epilepsy Behav 2018; 80:321-325. [PMID: 29402633 DOI: 10.1016/j.yebeh.2017.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/15/2017] [Accepted: 11/19/2017] [Indexed: 02/07/2023]
Abstract
INTRODUCTION To evaluate the knowledge of healthcare workers about first-aid measures to be performed during and after a tonic-clonic seizure. METHODS One hundred and fifty-four healthcare workers (86 physicians) working at 8 tertiary hospitals in the Apulia region, Italy, responded to a questionnaire comprising of 28 questions based on available Italian and international recommendations about what to do during a tonic-clonic seizure. RESULTS One hundred and fifty-four healthcare workers completed and returned surveys with a response rate of 96.25%. There were 55 nurses (35.7%), 86 physicians (55.8%), and 13 healthcare workers with different roles (Electroencephalograph technicians, psychologists, social workers). Among physicians, there were 7 cardiologists, 3 surgeons, 12 infectious-disease specialists, 11 internal medicine specialists, 2 psychiatrists, 2 gynecologists, 27 specialists working in the emergency department, and 22 physicians with different specializations. Nearly 90% of the respondents identified head protection as important first aid, while 100% responded to not keep the legs elevated. To avoid tongue bite, both physicians and other healthcare workers would put something in the mouth (54.0%), like a Guedel cannula (71.0%) fingers (29.5%). Grabbing arms and legs, trying to stop the seizure, would be potentially performed by 11.6% of our sample. Physicians would administer a benzodiazepine during the seizure (65.7%) and during the postictal phase (29.2%), even if the patient is known to have epilepsy (23.7%), and in this case, 11.3% of respondents would administer the usual antiepileptic medications. More than half of respondents would call the emergency telephone number, because of necessary hospitalization in case of tonic-clonic seizure, even if it is experienced by a patient known to have epilepsy. CONCLUSION Our survey suggests the need for epilepsy educational programs on first-aid management of seizures among healthcare workers.
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Affiliation(s)
- Tommaso Martino
- Epilepsy Centre - Clinic of Nervous System Diseases, Riuniti Hospital, Foggia, Italy
| | - Alessandra Lalla
- Epilepsy Centre - Clinic of Nervous System Diseases, Riuniti Hospital, Foggia, Italy
| | - Elena Carapelle
- Epilepsy Centre - Clinic of Nervous System Diseases, Riuniti Hospital, Foggia, Italy
| | | | - Carlo Avolio
- Epilepsy Centre - Clinic of Nervous System Diseases, Riuniti Hospital, Foggia, Italy
| | - Giuseppe d'Orsi
- Epilepsy Centre - Clinic of Nervous System Diseases, Riuniti Hospital, Foggia, Italy.
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- Epilepsy Centre - Clinic of Nervous System Diseases, Riuniti Hospital, Foggia, Italy
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Pearlman J, Morgan S, van Driel M, Henderson K, Tapley A, McElduff P, Scott J, Spike N, Thomson A, Magin P. Continuity of care in general practice vocational training: prevalence, associations and implications for training. EDUCATION FOR PRIMARY CARE 2015; 27:27-36. [DOI: 10.1080/14739879.2015.1101871] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- James Pearlman
- Discipline of General Practice, University of Newcastle, Callaghan, Australia
| | - Simon Morgan
- Discipline of General Practice, University of Newcastle, Callaghan, Australia
| | - Mieke van Driel
- Discipline of General Practice, University of Queensland, Brisbane, Australia
| | - Kim Henderson
- General Practice Training Valley to Coast, Newcastle, Australia
| | - Amanda Tapley
- General Practice Training Valley to Coast, Newcastle, Australia
| | - Patrick McElduff
- Discipline of General Practice, University of Newcastle, Callaghan, Australia
| | - John Scott
- General Practice Training Valley to Coast, Newcastle, Australia
| | - Neil Spike
- Victorian Metropolitan Alliance, Melbourne, Australia
| | - Allison Thomson
- Discipline of General Practice, University of Newcastle, Callaghan, Australia
| | - Parker Magin
- Discipline of General Practice, University of Newcastle, Callaghan, Australia
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Shay LA, Lafata JE. Where is the evidence? A systematic review of shared decision making and patient outcomes. Med Decis Making 2014; 35:114-31. [PMID: 25351843 DOI: 10.1177/0272989x14551638] [Citation(s) in RCA: 713] [Impact Index Per Article: 71.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite widespread advocacy for shared decision making (SDM), the empirical evidence regarding its effectiveness to improve patient outcomes has not been systematically reviewed. The purpose of this study was to systematically review the empirical evidence linking patient outcomes and SDM, when the decision-making process has been explicitly measured, and to identify under what measurement perspectives SDM is associated with which types of patient outcomes (affective-cognitive, behavioral, and health). DATA SOURCES PubMed (through December 2012) and hand search of article bibliographies. STUDY SELECTION Studies were included if they empirically 1) measured SDM in the context of a patient-clinician interaction and 2) evaluated the relationship between SDM and at least 1 patient outcome. DATA EXTRACTION Study results were categorized by SDM measurement perspective (patient-reported, clinician-reported, or observer-rated) and outcome type (affective-cognitive, behavioral, or health). DATA SYNTHESIS Thirty-nine studies met inclusion criteria. Thirty-three used patient-reported measures of SDM, 6 used observer-rated measures, and 2 used clinician-reported measures. Ninety-seven unique patient outcomes were assessed; 51% affective-cognitive, 28% behavioral, and 21% health. Only 43% of assessments (n = 42) found a significant and positive relationship between SDM and the patient outcome. This proportion varied by SDM measurement perspective and outcome category. It was found that 52% of outcomes assessed with patient-reported SDM were significant and positive, compared with 21% with observer-rated and 0% with clinician-reported SDM. Regardless of measurement perspective, SDM was most likely to be associated with affective-cognitive patient outcomes (54%), compared with 37% of behavioral and 25% of health outcomes. LIMITATIONS The relatively small number of studies precludes meta-analysis. Because the study inclusion and exclusion criteria required both an empirical measure of SDM and an assessment of the association between that measure and a patient outcome, most included studies were observational in design. CONCLUSIONS SDM, when perceived by patients as occurring, tends to result in improved affective-cognitive outcomes. Evidence is lacking for the association between empirical measures of SDM and patient behavioral and health outcomes.
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Affiliation(s)
- L Aubree Shay
- University of Texas School of Public Health, Center for Health Promotions and Research, San Antonio, TX (LAS)
| | - Jennifer Elston Lafata
- Virginia Commonwealth University, Massey Cancer Center and Department of Social and Behavioral Health, Richmond, VA (JEL)
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Wiebe N, Fiest KM, Dykeman J, Liu X, Jette N, Patten S, Wiebe S. Patient satisfaction with care in epilepsy: How much do we know? Epilepsia 2014; 55:448-55. [DOI: 10.1111/epi.12537] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2013] [Indexed: 12/01/2022]
Affiliation(s)
- Natalie Wiebe
- Clinical Research Unit; University of Calgary; Calgary Alberta Canada
- Faculty of Nursing; University of Calgary; Calgary Alberta Canada
| | - Kirsten M. Fiest
- Department of Community Health Sciences and Institute for Public Health; University of Calgary; Calgary Alberta Canada
- Departments of Clinical Neurosciences and Hotchkiss Brain Institute; University of Calgary; Calgary Alberta Canada
- Department of Psychiatry; University of Calgary; Calgary Alberta Canada
| | - Jonathan Dykeman
- Clinical Research Unit; University of Calgary; Calgary Alberta Canada
- Department of Community Health Sciences and Institute for Public Health; University of Calgary; Calgary Alberta Canada
| | - Xiaorong Liu
- Clinical Research Unit; University of Calgary; Calgary Alberta Canada
- Departments of Clinical Neurosciences and Hotchkiss Brain Institute; University of Calgary; Calgary Alberta Canada
- Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University; Guangzhou China
| | - Nathalie Jette
- Clinical Research Unit; University of Calgary; Calgary Alberta Canada
- Department of Community Health Sciences and Institute for Public Health; University of Calgary; Calgary Alberta Canada
- Departments of Clinical Neurosciences and Hotchkiss Brain Institute; University of Calgary; Calgary Alberta Canada
| | - Scott Patten
- Department of Community Health Sciences and Institute for Public Health; University of Calgary; Calgary Alberta Canada
- Department of Psychiatry; University of Calgary; Calgary Alberta Canada
| | - Samuel Wiebe
- Clinical Research Unit; University of Calgary; Calgary Alberta Canada
- Department of Community Health Sciences and Institute for Public Health; University of Calgary; Calgary Alberta Canada
- Departments of Clinical Neurosciences and Hotchkiss Brain Institute; University of Calgary; Calgary Alberta Canada
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Alaqeel A, Alebdi F, Sabbagh AJ. Epilepsy: What do health-care professionals in Riyadh know? Epilepsy Behav 2013; 29:234-7. [PMID: 24034673 DOI: 10.1016/j.yebeh.2013.07.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 07/13/2013] [Indexed: 11/19/2022]
Abstract
PURPOSE The objective of this study was to report on the knowledge of epilepsy, as well as attitudes and practices toward individuals with epilepsy, among health-care professionals in Riyadh, the capital city of Saudi Arabia. METHODS A survey consisting of 23 questions pertaining to epilepsy awareness was distributed to health education workers (n=51), nutritionists (n=56), physicians (n=265), dentists (n=58), pharmacists (n=41), nurses (n=224), physiotherapists (n=65), and fifth-year medical students (n=62) in three tertiary hospitals in Riyadh. RESULTS Of the 822 respondents who completed the questionnaire, 100% had heard about epilepsy, and 92.6% would allow their children to interact with an individual who has epilepsy. However, 67% of respondents would not want their children to marry an individual with epilepsy, 97.9% of respondents believed that individuals with epilepsy should have the same employment opportunities as the general population, 10.5% believe that supernatural power is the cause of epilepsy, 67.2% did not know how to deal with an individual experiencing an epileptic episode, and 56% did not know that surgery was a treatment option for individuals with epilepsy in Saudi Arabia. Of the 822 respondents, 39% would not abide by a physician's advice not to operate a motor vehicle because of their illness, 91% of whom cited problems with the public transportation system as a reason for disregarding the doctor's advice. When asked if the participants had access to any information on how to deal with epilepsy during their professional training, 60.3% had access to such information during their graduate studies. Ninety-eight percent of those with access to this information were physicians and health-care educators (p<0.001). Physicians and health-care educators were significantly more aware of epilepsy than any of the other groups. CONCLUSION The level of epilepsy awareness among health-care professionals in Riyadh needs improvement.
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Affiliation(s)
- Ahmed Alaqeel
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Goodridge DMG, Shorvon SD. The contribution of British general practice to our knowledge of epilepsy and its effects on people. Br Med Bull 2013; 108:115-30. [PMID: 24133115 DOI: 10.1093/bmb/ldt030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION British general practice is a good base for epidemiological research which is evidenced by the study of epilepsy. SOURCES OF DATA A comprehensive search of PubMed using various keywords for articles on epilepsy research performed in British general practice. AREAS OF AGREEMENT Studies in the setting of general practice have contributed significantly to knowledge in the field of epilepsy, especially in relation to epidemiology, studies of prognosis and treatment patterns and psychosocial aspects. AREAS OF CONTROVERSY The extent to which epilepsy can be managed in general practice. GROWING POINTS The importance of primary care research and the importance of collaborative studies between general practice, hospital and university departments. AREAS TIMELY FOR DEVELOPING RESEARCH The effects of interventions at general practice level on seizure control, morbidity and mortality.
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Factors affecting the offer of pulmonary rehabilitation to patients with chronic obstructive pulmonary disease by primary care professionals: a qualitative study. Prim Health Care Res Dev 2008. [DOI: 10.1017/s1463423608000832] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Connaissances, attitudes et pratiques du médecin généraliste d’Eure-et-Loir face au patient épileptique : étude qualitative à partir de 11 entretiens semi-dirigés. Rev Neurol (Paris) 2008; 164:156-61. [DOI: 10.1016/j.neurol.2007.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2007] [Revised: 10/18/2007] [Accepted: 10/27/2007] [Indexed: 10/22/2022]
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Hawley SR, Paschal AM, Ablah E, St Romain T, Liow K, Molgaard CA. Initial Perspectives from Midwestern Neurologists: Epilepsy Patients' Barriers and Motivators for Seeking Treatment. Epilepsia 2007; 48:1920-5. [PMID: 17561955 DOI: 10.1111/j.1528-1167.2006.01137.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Epilepsy is a chronic neurological illness that affects 2.7 million people in the United States, but remains poorly understood. Care providers may not recognize their patients' need for epilepsy information, contributing to treatment barriers, such as stigmatization and poor patient-provider communication. METHODS The current study piloted a survey of epilepsy-related attitudes and perceptions of 33 Midwestern neurologists. The survey included questions about perceived barriers to and motivators for treatment, thoughts on misperceptions of epilepsy in the community and in the patient population, and potential interventions to address misperceptions. RESULTS Respondents perceived misinformation and lack of knowledge in patients and the general public that could be contributing to the barriers that exist to treat patients adequately. Respondents suggested potential methods for addressing misperceptions effectively. DISCUSSION This study of neurologists' perceptions about epilepsy barriers and needs provides an important perspective for the development of interventions to address misperceptions and barriers among patients and the public.
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Affiliation(s)
- Suzanne R Hawley
- Department of Preventive Medicine and Public Health, University of Kansas School of Medicine-Wichita, KS 67214-3199, USA.
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Hawley SR, Paschal AM, Ablah E, St. Romain T, Liow K, Molgaard CA. Initial Perspectives from Midwestern Neurologists: Epilepsy Patients' Barriers and Motivators for Seeking Treatment. Epilepsia 2007. [DOI: 10.1111/j.1528-1167.2007.01137.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Shafiq M, Tanwir M, Tariq A, Kasi PM, Zafar M, Saleem A, Rehman R, Zaidi SZ, Taj F, Khuwaja AA, Shaikh KS, Khuwaja AK. Epilepsy: public knowledge and attitude in a slum area of Karachi, Pakistan. Seizure 2007; 16:330-7. [PMID: 17379542 DOI: 10.1016/j.seizure.2007.02.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2006] [Revised: 05/12/2006] [Accepted: 02/20/2007] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Epilepsy is a common but widely misunderstood illness. Consequently, epileptics suffer from considerable stigmatization in society. Since no studies have detailed the misperceptions about epilepsy in our community, it is not possible to provide focused intervention aimed at eliminating this prejudice. PURPOSE To assess the knowledge and attitude regarding epilepsy in an adult population of a Karachi slum area. METHODS A face-to-face interview was conducted on 487 consenting adult non-epileptics (305 males; 182 females) who were conveniently sampled. Chi-square test was employed to calculate the variability in knowledge and attitude with demographic and other variables. RESULTS In all, 12.5% had never heard about epilepsy. Among the rest, 66.7% identified epilepsy as being non-infectious, while 28.2% were unaware of any treatment available for it. Among the other 71.8%, 62.7% were aware of the existence of anti-epileptic drugs. Religious/spiritual treatment was chosen as the most effective treatment by 33.1%. Males were more likely to identify epilepsy as being non-infectious (p=0.02). Nearly 18% of the respondents would not object to their child marrying an epileptic, 69.5% did not want to socially isolate the epileptics, 83.1% said epileptics could receive academic education, 85.6% said they could perform activities of daily life and 62.4% said they could become useful members of the society. Those who considered epilepsy to be infectious were more likely to carry negative attitudes towards epilepsy (p<0.01 with four attitudes). CONCLUSIONS Considerable gaps exist in the community's knowledge about epilepsy. Some of these may explain the prevalence of negative attitudes towards this ailment.
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Affiliation(s)
- M Shafiq
- Class of 2006, Aga Khan University Medical College, Stadium Road, Karachi 74800, Pakistan.
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Lugtenberg M, Heiligers PJM, de Jong JD, Hingstman L. Internal medicine specialists' attitudes towards working part-time: a comparison between 1996 and 2004. BMC Health Serv Res 2006; 6:126. [PMID: 17026741 PMCID: PMC1617100 DOI: 10.1186/1472-6963-6-126] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2006] [Accepted: 10/06/2006] [Indexed: 11/27/2022] Open
Abstract
Background Although medical specialists traditionally hold negative views towards working part-time, the practice of medicine has evolved. Given the trend towards more part-time work and that there is no evidence that it compromises the quality of care, attitudes towards part-time work may have changed as well in recent years. The aim of this paper was to examine the possible changes in attitudes towards part-time work among specialists in internal medicine between 1996 and 2004. Moreover, we wanted to determine whether these attitudes were associated with individual characteristics (age, gender, investments in work) and whether attitudes of specialists within a partnership showed more resemblance than specialists' attitudes from different partnerships. Methods Two samples were used in this study: data of a survey conducted in 1996 and in 2004. After selecting internal medicine specialists working in general hospitals in The Netherlands, the sample consisted of 219 specialists in 1996 and 363 specialists in 2004. They were sent a questionnaire, including topics on the attitudes towards part-time work. Results Internal medicine specialists' attitudes towards working part-time became slightly more positive between 1996 and 2004. Full-time working specialists in 2004 still expressed concerns regarding the investments of part-timers in overhead tasks, the flexibility of task division, efficiency, communication and continuity of care. In 1996 gender was the only predictor of the attitude, in 2004 being a full- or a part-timer, age and the time invested in work were associated with this attitude. Furthermore, specialists' attitudes were not found to cluster much within partnerships. Conclusion In spite of the increasing number of specialists working or preferring to work part-time, part-time practice among internal medicine specialists seems not to be fully accepted. The results indicate that the attitudes are no longer gender based, but are associated with age and work aspects such as the number of hours worked. Though there is little evidence to support them, negative ideas about the consequences of part-time work for the quality of care still exist. Policy should be aimed at removing the organisational difficulties related to part-time work and create a system in which part-time practice is fully integrated and accepted.
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Affiliation(s)
- Marjolein Lugtenberg
- NIVEL – Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Phil JM Heiligers
- NIVEL – Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Utrecht University, Department of Social Sciences, Utrecht, The Netherlands
| | - Judith D de Jong
- NIVEL – Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Lammert Hingstman
- NIVEL – Netherlands Institute for Health Services Research, Utrecht, The Netherlands
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