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Soler JK, Buono N, Cardillo E, Frese T, Vinker S, Ungan M. The fractured lens: a controversial revision of the International Classification of Primary Care. Front Med (Lausanne) 2024; 10:1230987. [PMID: 38274446 PMCID: PMC10808642 DOI: 10.3389/fmed.2023.1230987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 12/15/2023] [Indexed: 01/27/2024] Open
Abstract
Background The International Classification of Primary Care (ICPC) has represented the international standard reduction for measuring the content of primary care for over 30 years. In the process of its third revision, its authors, the Wonca International Classification Committee (WICC), delegated a major part of the technical work to a purposely formed Consortium. However, in the process of such revision, standard classification principles and rules have been inconsistently applied with the result that ICPC-3 has been published with major errors and an inconsistent structure. Objectives To formally describe and critically appraise the revision process of ICPC-3. Methods The formal review of ICPC-3 performed by an expert group within WICC and commissioned by the Executive Council of Wonca Europe is presented in abridged form. Results ICPC-3 as currently presented introduces major departures from formal classification principles and rules, besides other major errors and inconsistencies, all of which are listed and described. Conclusion Major changes in ICPC-3 defy categorisation and conceptualisation standards. ICPC-3 now represents an untested departure from international standard presentations, without a formal academic base. The direct inclusion of measures of functioning in a classification of reasons for encounter and health problems fails to address the dichotomy of these domains, the boundaries of and relationships between which are not satisfactorily resolved by the system. Analysis of ICPC-3 data will require the development and implementation of alternative, as yet undefined, models of the relationships between disease and health. By including different domains without resolving ambiguity, and by splitting function from other body systems, ICPC-3 becomes an internally fractured instrument.
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Affiliation(s)
| | - Nicola Buono
- Department of General Practice, ICPC Club Italia, Caserta, Italy
| | - Elena Cardillo
- Institute of Informatics and Telematics, National Research Council, Rende, Italy
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Shlomo Vinker
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Leumit Health Services, Tel Aviv, Israel
| | - Mehmet Ungan
- Department of Family Medicine, Ankara University School of Medicine, Ankara, Türkiye
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Buono N, Sassier B, Thulesius H, Hoffman R, Nabbe P, Petek D, Le Reste JY. Translation of the working alliance inventory short revised into Italian using a Delphi procedure and a forward-backward translation. Front Med (Lausanne) 2024; 10:1236273. [PMID: 38274448 PMCID: PMC10808585 DOI: 10.3389/fmed.2023.1236273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 12/11/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction Enhancing treatment adherence, especially for chronic diseases, can be achieved through therapeutic alliance, potentially elevating the quality of care. An instrument to evaluate the therapeutic alliance could be beneficial in routine clinical settings, educational environments, and extensive research efforts at national and European levels. In this study, we translated therapist and patient versions of the Working Alliance Inventory Short Revised (WAI-SR) into Italian. Methodology An email-based Delphi method was employed for the English-to-Italian translation, incorporating a forward-backward process. The initial translation team comprised two Italian family physicians proficient in English, a linguist, and a psychiatrist. The forward translation was then reviewed by 18 Italian family physicians through a Delphi process and was subjected to a backward translation by two Italian English teachers. A cultural correspondence was subsequently identified to adjust translations within a national and international framework. Results All 18 experts fully engaged in the Delphi process, and consensus was achieved by the second Delphi round. A cultural check checked for discrepancies regarding linguistic consistency with other translations and found no difference. Conclusion This Italian translation of the WAI-SR is expected to support Italian family physicians aiming to enhance their clinical practice and therapeutic outcomes. It could also be a valuable tool for Italian medical students to foster therapeutic relationships and improve their communication skills.
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Affiliation(s)
- Nicola Buono
- National Society of Medical Education in General Practice (SNAMID), Caserta, Italy
| | - Béatrice Sassier
- ERA 7479, Departement de Mèdecine Generale, SPURBO Universite de Bretagne Occidentale, Brest, France
| | - Hans Thulesius
- Department of Clinical Sciences in Malmö, Centre for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Robert Hoffman
- Department of Family Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Patrice Nabbe
- ERA 7479, Departement de Mèdecine Generale, SPURBO Universite de Bretagne Occidentale, Brest, France
| | - Davorina Petek
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Jean Yves Le Reste
- ERA 7479, Departement de Mèdecine Generale, SPURBO Universite de Bretagne Occidentale, Brest, France
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Hajdarevic S, Högberg C, Marzo-Castillejo M, Siliņa V, Sawicka-Powierza J, Esteva M, Koskela T, Petek D, Contreras-Martos S, Mangione M, Ožvačić Adžić Z, Asenova R, Gašparović Babić S, Brekke M, Buczkowski K, Buono N, Çifçili SS, Dinant GJ, Doorn B, Hoffman RD, Kuodza G, Murchie P, Pilv L, Puia A, Rapalavicius A, Smyrnakis E, Weltermann B, Harris M. Exploring why European primary care physicians sometimes do not think of, or act on, a possible cancer diagnosis. A qualitative study. BJGP Open 2023; 7:BJGPO.2023.0029. [PMID: 37380218 DOI: 10.3399/bjgpo.2023.0029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/30/2023] [Accepted: 06/06/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND While primary care physicians (PCPs) play a key role in cancer detection, they can find cancer diagnosis challenging, and some patients have considerable delays between presentation and onward referral. AIM To explore European PCPs' experiences and views on cases where they considered that they had been slow to think of, or act on, a possible cancer diagnosis. DESIGN & SETTING A multicentre European qualitative study, based on an online survey with open-ended questions, asking PCPs for their narratives about cases when they had missed a diagnosis of cancer. METHOD Using maximum variation sampling, PCPs in 23 European countries were asked to describe what happened in a case where they were slow to think of a cancer diagnosis, and for their views on why it happened. Thematic analysis was used to analyse the data. RESULTS A total of 158 PCPs completed the questionnaire. The main themes were as follows: patients' descriptions did not suggest cancer; distracting factors reduced PCPs' cancer suspicions; patients' hesitancy delayed the diagnosis; system factors not facilitating timely diagnosis; PCPs felt that they had acted wrongly; and problems with communicating adequately. CONCLUSION The study identified six overarching themes that need to be addressed. Doing so should reduce morbidity and mortality in the small proportion of patients who have a significant, avoidable delay in their cancer diagnosis. The 'Swiss cheese' model of accident causation showed how the themes related to each other.
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Affiliation(s)
- Senada Hajdarevic
- Department of Nursing, Umeå University, Umeå, Sweden
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| | - Cecilia Högberg
- Department of Public Health and Clinical Medicine, Education and Development Östersund, Unit of Research, Umeå University, Umeå, Sweden
| | - Mercè Marzo-Castillejo
- Research Support Unit Metropolitana Sud, University Institute for Primary Health Care Research IDIAPJordi Gol, Catalan Health Institute, Barcelona, Spain
| | - Vija Siliņa
- Department of Family Medicine, Riga Stradiņš University, Riga, Latvia
| | | | - Magadalena Esteva
- Majorca Primary Care Department, Spain
- Balearic Islands Health Research Institute (IdISBa), Balearic Islands, Spain
| | - Tuomas Koskela
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Center of General Practice,Tampere University Hospital, Tampere, Finland
| | - Davorina Petek
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Sara Contreras-Martos
- Research Support Unit Metropolitana Sud, University Institute for Primary Health Care Research IDIAPJordi Gol, Catalan Health Institute, Barcelona, Spain
| | | | - Zlata Ožvačić Adžić
- Department of Family Medicine, University of Zagreb, School of Medicine, Zagreb, Croatia
- Health Center Zagreb-Centar, Zagreb, Croatia
| | - Radost Asenova
- Department Urology and General Practice, Medical University of Plovdiv, Plovdiv, Bulgaria
| | | | - Mette Brekke
- Department of Health and Society, General Practice Research Unit, University of Oslo, Oslo, Norway
| | | | - Nicola Buono
- Department of General Practice, National Society of Medical Education in General Practice (SNaMID), Caserta, Italy
| | | | - Geert-Jan Dinant
- Department of General Practice, Maastricht University, Maastricht, The Netherlands
| | - Babette Doorn
- Department of General Practice, Maastricht University, Maastricht, The Netherlands
| | - Robert D Hoffman
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Family Medicine, Maccabi Healthcare Services, Southern District, Israel
| | - George Kuodza
- Department of Family Medicine and Outpatient Care, Medical Faculty #2, Uzhhorod National University, Uzhgorod, Ukraine
| | - Peter Murchie
- Centre of Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Liina Pilv
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Aida Puia
- Department of Family Medicine, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Aurimas Rapalavicius
- Family Medicine Department, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Emmanouil Smyrnakis
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Michael Harris
- Institute of Primary Health Care Bern (BIHAM), University of Bern, Bern, Switzerland
- College of Medicine & Health, University of Exeter, Exeter, UK
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Buono N, Harris M, Farinaro C, Petrazzuoli F, Cavicchi A, D'Addio F, Scelsa A, Mirra B, Napolitano E, Soler JK. How are reasons for encounter associated with influenza-like illness and acute respiratory infection diagnoses and interventions? A cohort study in eight Italian general practice populations. BMC Fam Pract 2021; 22:172. [PMID: 34454426 PMCID: PMC8401359 DOI: 10.1186/s12875-021-01519-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/13/2021] [Indexed: 12/02/2022]
Abstract
Background Influenza-like illness (ILI) and Acute Respiratory Infections (ARI) are a considerable health problem in Europe. Most diagnoses are made by family physicians (FPs) and based on symptoms and clinical signs rather than on diagnostic testing. The International Classification of Primary Care (ICPC) advocates that FPs record patients’ ‘Reasons for Encounters’ (RfEs) as they are presented to them. This study analyses the association of patients’ RfEs with FPs’ diagnoses of ILI and ARI diagnoses and FPs’ management of those patients. Methods Cohort study of practice populations. Over a 4-month period during the winter season 2013–14, eight FPs recorded ILI and ARI patients’ RfEs and how they were managed. FPs recorded details of their patients using the ICPC format, collecting data in an Episode of Care (EoC) structure. Results There were 688 patients diagnosed as having ILI; between them they presented with a total of 2,153 RfEs, most commonly fever (79.7%), cough (59.7%) and pain (33.0%). The 848 patients with ARI presented with a total of 1,647 RfEs, most commonly cough (50.4%), throat symptoms (25.9%) and fever (19.9%). For patients with ILI, 37.0% of actions were related to medication for respiratory symptoms; this figure was 38.4% for patients with ARI. FPs referred six patients to specialists or hospitals (0.39% of all patients diagnosed with ILI and ARI). Conclusions In this study of patients with ILI and ARI, less than half received a prescription from their FPs, and the illnesses were mainly managed in primary care, with few patients’ needing referral. The ICPC classification allowed a standardised data collection system, providing documentary evidence of the management of those diseases. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01519-4.
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Affiliation(s)
- Nicola Buono
- Department of General Practice, ICPC Club Italia Via Roosevelt 4, 81100, Caserta, Italy.
| | - Michael Harris
- Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, UK.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Carmine Farinaro
- Department of General Practice, ICPC Club Italia Via Roosevelt 4, 81100, Caserta, Italy
| | - Ferdinando Petrazzuoli
- Center for Primary Health Care Research, Clinical Research Centre, Lund University, Malmö, Sweden
| | - Angelo Cavicchi
- Department of General Practice, ICPC Club Italia Via Roosevelt 4, 81100, Caserta, Italy
| | - Filippo D'Addio
- Department of General Practice, ICPC Club Italia Via Roosevelt 4, 81100, Caserta, Italy
| | - Amedeo Scelsa
- Department of General Practice, ICPC Club Italia Via Roosevelt 4, 81100, Caserta, Italy
| | - Baldassarre Mirra
- Department of General Practice, ICPC Club Italia Via Roosevelt 4, 81100, Caserta, Italy
| | - Enrico Napolitano
- Department of General Practice, ICPC Club Italia Via Roosevelt 4, 81100, Caserta, Italy
| | - Jean K Soler
- Mediterranean Institute of Primary Care, Attard, Malta
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Harris M, Brekke M, Dinant GJ, Esteva M, Hoffman R, Marzo-Castillejo M, Murchie P, Neves AL, Smyrnakis E, Vedsted P, Aubin-Auger I, Azuri J, Buczkowski K, Buono N, Foreva G, Babić SG, Jacob E, Koskela T, Petek D, Šter MP, Puia A, Sawicka-Powierza J, Streit S, Thulesius H, Weltermann B, Taylor G. Primary care practitioners' diagnostic action when the patient may have cancer: an exploratory vignette study in 20 European countries. BMJ Open 2020; 10:e035678. [PMID: 33130560 PMCID: PMC7783622 DOI: 10.1136/bmjopen-2019-035678] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Cancer survival rates vary widely between European countries, with differences in timeliness of diagnosis thought to be one key reason. There is little evidence on the way in which different healthcare systems influence primary care practitioners' (PCPs) referral decisions in patients who could have cancer.This study aimed to explore PCPs' diagnostic actions (whether or not they perform a key diagnostic test and/or refer to a specialist) in patients with symptoms that could be due to cancer and how they vary across European countries. DESIGN A primary care survey. PCPs were given vignettes describing patients with symptoms that could indicate cancer and asked how they would manage these patients. The likelihood of taking immediate diagnostic action (a diagnostic test and/or referral) in the different participating countries was analysed. Comparisons between the likelihood of taking immediate diagnostic action and physician characteristics were calculated. SETTING Centres in 20 European countries with widely varying cancer survival rates. PARTICIPANTS A total of 2086 PCPs answered the survey question, with a median of 72 PCPs per country. RESULTS PCPs' likelihood of immediate diagnostic action at the first consultation varied from 50% to 82% between countries. PCPs who were more experienced were more likely to take immediate diagnostic action than their peers. CONCLUSION When given vignettes of patients with a low but significant possibility of cancer, more than half of PCPs across Europe would take diagnostic action, most often by ordering diagnostic tests. However, there are substantial between-country variations.
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Affiliation(s)
- Michael Harris
- Department for Health, University of Bath, Bath, Somerset, UK
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Mette Brekke
- Department of General Practice and General Practice Research Unit, University of Oslo, Oslo, Norway
| | - Geert-Jan Dinant
- Department of General Practice, Maastricht University, Maastricht, The Netherlands
| | - Magdalena Esteva
- Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, Illes Balears, Spain
| | - Robert Hoffman
- Department of Family Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Peter Murchie
- Division of Applied Health Science, University of Aberdeen, Aberdeen, UK
| | - Ana Luísa Neves
- Centre for Health Policy, Imperial College London, London, UK
- Centre for Health Technology and Services Research, Department of Community Medicine, Information and Health Decision Sciences, University of Porto, Porto, Portugal
| | - Emmanouil Smyrnakis
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Peter Vedsted
- Research Unit for General Practice, University of Aarhus, Aarhus, Denmark
| | - Isabelle Aubin-Auger
- Department of General Practice, Université Paris Diderot, Paris, Île-de-France, France
| | - Joseph Azuri
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Krzysztof Buczkowski
- Department of Family Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Nicola Buono
- Department of Family Medicine, National Society of Medical Education in General Practice (SNaMID), Prata Sannita, Italy
| | | | | | - Eva Jacob
- Primary Health Centre, Centro de Saúde Sarria, Sarria, Lugo, Spain
| | - Tuomas Koskela
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Davorina Petek
- Department of Family Medicine, Univerza v Ljubljani, Ljubljana, Slovenia
| | - Marija Petek Šter
- Department of Family Medicine, Univerza v Ljubljani, Ljubljana, Slovenia
| | - Aida Puia
- Family Medicine Department, Iuliu Hagieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | | | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Hans Thulesius
- Department of Research and Development, Lund University, Malmö, Sweden
| | - Birgitta Weltermann
- Institut für Hausarztmedizin, University of Bonn, Bonn, Nordrhein-Westfalen, Germany
| | - Gordon Taylor
- College of Medicine and Health, University of Exeter, Exeter, Devon, UK
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Petrazzuoli F, Vinker S, Palmqvist S, Midlöv P, Lepeleire JD, Pirani A, Frese T, Buono N, Ahrensberg J, Asenova R, Boreu QF, Peker GC, Collins C, Hanževački M, Hoffmann K, Iftode C, Koskela TH, Kurpas D, Reste JYL, Lichtwarck B, Petek D, Schrans D, Soler JK, Streit S, Tatsioni A, Torzsa P, Unalan PC, van Marwijk H, Thulesius H. Unburdening dementia - a basic social process grounded theory based on a primary care physician survey from 25 countries. Scand J Prim Health Care 2020; 38:253-264. [PMID: 32720874 PMCID: PMC7470166 DOI: 10.1080/02813432.2020.1794166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To explore dementia management from a primary care physician perspective. DESIGN One-page seven-item multiple choice questionnaire; free text space for every item; final narrative question of a dementia case story. Inductive explorative grounded theory analysis. Derived results in cluster analyses. Appropriateness of dementia drugs assessed by tertiary care specialist. SETTING Twenty-five European General Practice Research Network member countries. SUBJECTS Four hundred and forty-five key informant primary care physician respondents of which 106 presented 155 case stories. MAIN OUTCOME MEASURES Processes and typologies of dementia management. Proportion of case stories with drug treatment and treatment according to guidelines. RESULTS Unburdening dementia - a basic social process - explained physicians' dementia management according to a grounded theory analysis using both qualitative and quantitative data. Unburdening starts with Recognizing the dementia burden by Burden Identification and Burden Assessment followed by Burden Relief. Drugs to relieve the dementia burden were reported for 130 of 155 patients; acetylcholinesterase inhibitors or memantine treatment in 89 of 155 patients - 60% appropriate according to guidelines and 40% outside of guidelines. More Central and Northern primary care physicians were allowed to prescribe, and more were engaged in dementia management than Eastern and Mediterranean physicians according to cluster analyses. Physicians typically identified and assessed the dementia burden and then tried to relieve it, commonly by drug prescriptions, but also by community health and home help services, mentioned in more than half of the case stories. CONCLUSIONS Primary care physician dementia management was explained by an Unburdening process with the goal to relieve the dementia burden, mainly by drugs often prescribed outside of guideline indications. Implications: Unique data about dementia management by European primary care physicians to inform appropriate stakeholders. Key points Dementia as a syndrome of cognitive and functional decline and behavioural and psychological symptoms causes a tremendous burden on patients, their families, and society. •We found that a basic social process of Unburdening dementia explained dementia management according to case stories and survey comments from primary care physicians in 25 countries. •First, Burden Recognition by Identification and Assessment and then Burden Relief - often by drugs. •Prescribing physicians repeatedly broadened guideline indications for dementia drugs. The more physicians were allowed to prescribe dementia drugs, the more they were responsible for the dementia work-up. Our study provides unique data about dementia management in European primary care for the benefit of national and international stakeholders.
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Affiliation(s)
- Ferdinando Petrazzuoli
- Center for Primary Health Care Research, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
- CONTACT Ferdinando Petrazzuoli Center for Primary Health Care Research, Clinical Research Center, Lund University, Box 50332, Malmö202 13, Sweden
| | - Shlomo Vinker
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sebastian Palmqvist
- Clinical Memory Research Unit, Department of Clinical Sciences in Malmö, Lund University, Sweden
| | - Patrik Midlöv
- Center for Primary Health Care Research, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - Jan De Lepeleire
- Department of Public Health and Primary Care, General Practice, University of Leuven, Leuven, Belgium
| | - Alessandro Pirani
- Family and Nursing Home Practice – Memory Clinic, Alzheimer’s Association “Francesco Mazzucca” Onlus, Ferrara, Italy
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Nicola Buono
- SNAMID (National Society of Medical Education in General Practice), Caserta, Italy
| | - Jette Ahrensberg
- Research Center for Emergency Medicine, Aarhus University, Aarhus, Denmark
| | - Radost Asenova
- Department of Urology and General Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Quintí Foguet Boreu
- Institut Universitari d’Investigació en Atenció Primària- IDIAP Jordi Gol, Universitat Autònoma de Barcelona, Catalonia, Spain
| | - Gülsen Ceyhun Peker
- Department of Family Medicine, Ankara University School of Medicine, Ankara, Turkey
| | | | | | - Kathryn Hoffmann
- Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | | | | | - Donata Kurpas
- Family Medicine Department, Wroclaw Medical University, Wroclaw, Poland
| | - Jean Yves Le Reste
- EA 7479 SPURBO. Department of General Practice, Université de Bretagne Occidentale, Brest, France
| | - Bjørn Lichtwarck
- The Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
| | - Davorina Petek
- Department of Family medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Diego Schrans
- Department of Family Medicine and Primary, Health Care Ghent University, Ghent, Belgium
| | | | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Athina Tatsioni
- Department of Internal Medicine, General Medicine, Faculty of Medicine, University of Ioannina School of Health Sciences, Ioannina, Greece
| | - Péter Torzsa
- Department of Family Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Pemra C. Unalan
- Department of Family Medicine, Marmara University Medical Faculty, Istanbul, Turkey
| | | | - Hans Thulesius
- Center for Primary Health Care Research, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
- Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
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Harris M, Thulesius H, Neves AL, Harker S, Koskela T, Petek D, Hoffman R, Brekke M, Buczkowski K, Buono N, Costiug E, Dinant GJ, Foreva G, Jakob E, Marzo-Castillejo M, Murchie P, Sawicka-Powierza J, Schneider A, Smyrnakis E, Streit S, Taylor G, Vedsted P, Weltermann B, Esteva M. How European primary care practitioners think the timeliness of cancer diagnosis can be improved: a thematic analysis. BMJ Open 2019; 9:e030169. [PMID: 31551382 PMCID: PMC6773305 DOI: 10.1136/bmjopen-2019-030169] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND National European cancer survival rates vary widely. Prolonged diagnostic intervals are thought to be a key factor in explaining these variations. Primary care practitioners (PCPs) frequently play a crucial role during initial cancer diagnosis; their knowledge could be used to improve the planning of more effective approaches to earlier cancer diagnosis. OBJECTIVES This study sought the views of PCPs from across Europe on how they thought the timeliness of cancer diagnosis could be improved. DESIGN In an online survey, a final open-ended question asked PCPs how they thought the speed of diagnosis of cancer in primary care could be improved. Thematic analysis was used to analyse the data. SETTING A primary care study, with participating centres in 20 European countries. PARTICIPANTS A total of 1352 PCPs answered the final survey question, with a median of 48 per country. RESULTS The main themes identified were: patient-related factors, including health education; care provider-related factors, including continuing medical education; improving communication and interprofessional partnership, particularly between primary and secondary care; factors relating to health system organisation and policies, including improving access to healthcare; easier primary care access to diagnostic tests; and use of information technology. Re-allocation of funding to support timely diagnosis was seen as an issue affecting all of these. CONCLUSIONS To achieve more timely cancer diagnosis, health systems need to facilitate earlier patient presentation through education and better access to care, have well-educated clinicians with good access to investigations and better information technology, and adequate primary care cancer diagnostic pathway funding.
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Affiliation(s)
- Michael Harris
- Department for Health, University of Bath, Bath, UK
- Berner Institut für Hausarztmedizin (BIHAM), University of Bern, Bern, Switzerland
| | - Hans Thulesius
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Research and Development, Region Kronoberg, Sweden
| | - Ana Luísa Neves
- Institute of Global Health Innovation, Imperial College London, London, UK
- CINTESIS (Centre for Health Technology and Services Research) and MEDCIDS (Department of Community Medicine, Information and Health Decision Sciences), Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Tuomas Koskela
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Davorina Petek
- Department of Family Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Robert Hoffman
- Department of Family Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mette Brekke
- Department of General Practice and General Practice Research Unit, University of Oslo, Oslo, Norway
| | | | - Nicola Buono
- Department of General Practice, National Society of Medical Education in General Practice (SNaMID), Caserta, Italy
| | - Emiliana Costiug
- Family Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Geert-Jan Dinant
- Department of General Practice, Maastricht University, Maastricht, The Netherlands
| | | | - Eva Jakob
- Primary Health Centre, Centro de Saúde Sarria, Sarria, Lugo, Spain
| | - Mercè Marzo-Castillejo
- Unitat de Suport a la Recerca, IDIAP Jordi Gol, Institut Català de la Salut, Barcelona, Spain
| | - Peter Murchie
- Division of Applied Health Sciences - Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | | | - Antonius Schneider
- TUM School of Medicine, Institute of General Practice and Health Services Research, Technical University of Munich, München, Germany
| | - Emmanouil Smyrnakis
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sven Streit
- Berner Institut für Hausarztmedizin (BIHAM), University of Bern, Bern, Switzerland
| | - Gordon Taylor
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Peter Vedsted
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | | | - Magdalena Esteva
- Research Unit, Majorca Primary Health Care Department, Balearic Islands Health Research Institute (IdISBa), Preventive Activities and Health Promotion Network, Carlos III Institute of Health (RedIAPP-RETICS), Palma de Mallorca, Spain
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Harris M, Vedsted P, Esteva M, Murchie P, Aubin-Auger I, Azuri J, Brekke M, Buczkowski K, Buono N, Costiug E, Dinant GJ, Foreva G, Gašparović Babić S, Hoffman R, Jakob E, Koskela TH, Marzo-Castillejo M, Neves AL, Petek D, Petek Ster M, Sawicka-Powierza J, Schneider A, Smyrnakis E, Streit S, Thulesius H, Weltermann B, Taylor G. Identifying important health system factors that influence primary care practitioners' referrals for cancer suspicion: a European cross-sectional survey. BMJ Open 2018; 8:e022904. [PMID: 30185577 PMCID: PMC6129106 DOI: 10.1136/bmjopen-2018-022904] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES Cancer survival and stage of disease at diagnosis and treatment vary widely across Europe. These differences may be partly due to variations in access to investigations and specialists. However, evidence to explain how different national health systems influence primary care practitioners' (PCPs') referral decisions is lacking.This study analyses health system factors potentially influencing PCPs' referral decision-making when consulting with patients who may have cancer, and how these vary between European countries. DESIGN Based on a content-validity consensus, a list of 45 items relating to a PCP's decisions to refer patients with potential cancer symptoms for further investigation was reduced to 20 items. An online questionnaire with the 20 items was answered by PCPs on a five-point Likert scale, indicating how much each item affected their own decision-making in patients that could have cancer. An exploratory factor analysis identified the factors underlying PCPs' referral decision-making. SETTING A primary care study; 25 participating centres in 20 European countries. PARTICIPANTS 1830 PCPs completed the survey. The median response rate for participating centres was 20.7%. OUTCOME MEASURES The factors derived from items related to PCPs' referral decision-making. Mean factor scores were produced for each country, allowing comparisons. RESULTS Factor analysis identified five underlying factors: PCPs' ability to refer; degree of direct patient access to secondary care; PCPs' perceptions of being under pressure; expectations of PCPs' role; and extent to which PCPs believe that quality comes before cost in their health systems. These accounted for 47.4% of the observed variance between individual responses. CONCLUSIONS Five healthcare system factors influencing PCPs' referral decision-making in 20 European countries were identified. The factors varied considerably between European countries. Knowledge of these factors could assist development of health service policies to produce better cancer outcomes, and inform future research to compare national cancer diagnostic pathways and outcomes.
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Affiliation(s)
- Michael Harris
- Department for Health, University of Bath, Bath, UK
- Institute of Primary Health Care Bern (BIHAM), University of Bern, Bern, Switzerland
| | - Peter Vedsted
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Magdalena Esteva
- Research Unit, Majorca Primary Health Care Department, Balearic Islands Health Research Institute (IdISBa), Palma, Spain
| | - Peter Murchie
- Division of Applied Health Sciences—Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | | | - Joseph Azuri
- Department of Family Medicine, Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Mette Brekke
- Department of General Practice and General Practice Research Unit, University of Oslo, Oslo, Norway
| | | | - Nicola Buono
- Department of General Practice, National Society of Medical Education in General Practice (SNaMID), Caserta, Italy
| | - Emiliana Costiug
- Family Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Geert-Jan Dinant
- Department of General Practice, Maastricht University, Maastricht, The Netherlands
| | | | - Svjetlana Gašparović Babić
- Odjel Socijalne Medicine, The Teaching Institute of Public Health of Primorsko-goranska County, Rijeka, Croatia
| | - Robert Hoffman
- Department of Family Medicine, Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Eva Jakob
- Primary Health Centre, Centro de Saúde Sarria, Sarria, Spain
| | - Tuomas H Koskela
- Department of General Practice, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Mercè Marzo-Castillejo
- Unitat de Suport a la Recerca, IDIAP Jordi Gol, Institut Catala De La Salut, Barcelona, Spain
| | - Ana Luísa Neves
- Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
- CINTESIS (Center for Health Technology and Services Research) and MEDCIDS (Department of Community Medicine, Information and Health Decision Sciences), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Davorina Petek
- Department of Family Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Marija Petek Ster
- Department of Family Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Antonius Schneider
- Institute of General Practice and Health Services Research, Technische Universität München, Munich, Germany
| | - Emmanouil Smyrnakis
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sven Streit
- Institute of Primary Health Care Bern (BIHAM), University of Bern, Bern, Switzerland
| | - Hans Thulesius
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Birgitta Weltermann
- Institute for Family Medicine and General Practice, University of Bonn, Bonn, Germany
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Buono N, Thulesius H, Petrazzuoli F, Castelli E, Cambielli M. Postherpetic neuralgia, diabetic neuropathy, and trigeminal neuralgia - Chronic peripheral neuropathic pain in 58,480 rural Italian primary care patients. J Family Med Prim Care 2017; 6:110-114. [PMID: 29026761 PMCID: PMC5629873 DOI: 10.4103/2249-4863.214980] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Introduction: Chronic peripheral neuropathic pain (CPNP) is a condition due to peripheral nervous system diseases or injury, but its prevalence is unknown in Italian primary care. Aim: The aim of this study is to assess the prevalence of CPNP in a rural primary care area in Northern Italy. Materials and Methods: A multicenter audit study was carried out in a rural area in Northern Italy with 113 participating general practitioners (GPs) seeing 58,480 patients >18 years during 3 months. Patients who for any reason attended GPs’ surgeries and had symptoms suggestive of neuropathic pain (NP) were given the NP diagnostic questionnaire “Douleur Neuropathique en 4 Questions” (DN4) and recorded their pain level on a visual analog scale (VAS). Results: Chronic NP was established by a DN4 score of ≥4 and a VAS pain score of ≥40 mm for >6 months together with a clinical diagnosis in 448 (254 women and 194 men) out of 58,480 patients giving a prevalence of 0.77%. 179 patients (0.31%) had diabetes neuropathy, 142 (0.24%) had postherpetic pain, 41 (0.07%) had trigeminal neuralgia, 27 (0.05%) had NP postinjury, 27 (0.05%) had NP caused by nerve entrapments, 11 (0.02%) had NP triggered by systemic diseases, and 21 (0.04%) had NP of unknown etiology. Conclusions: The prevalence of CPNP in this population of primary care attenders in a rural area in Northern Italy was 0.77%. Diabetes neuropathy (0.31%) and postherpetic pain (0.24%) were the two most common subgroups of NP, followed by trigeminal neuralgia (0.07%).
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Affiliation(s)
- Nicola Buono
- National Society of Medical Education in General Practice (SNAMID), Caserta, Italy
| | - Hans Thulesius
- Department of Research and Development, Kronoberg County Council, Växjö, Sweden.,Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Ferdinando Petrazzuoli
- National Society of Medical Education in General Practice (SNAMID), Caserta, Italy.,Department of Clinical Sciences in Malmö, Centre for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Elena Castelli
- National Society of Medical Education in General Practice (SNAMID), Caserta, Italy
| | - Marco Cambielli
- National Society of Medical Education in General Practice (SNAMID), Caserta, Italy
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Cavicchi A, Venturini S, Petrazzuoli F, Buono N, Bonetti D. INFORMEG, a new evaluation system for family medicine trainees: feasibility in an Italian rural setting. Rural Remote Health 2016. [DOI: 10.22605/rrh3666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Rurik I, Móczár C, Buono N, Frese T, Kolesnyk P, Mahlmeister J, Petrazzuoli F, Pirrotta E, Ungvári T, Vaverkova I, Jancsó Z. Early and Menopausal Weight Gain and its Relationship with the Development of Diabetes and Hypertension. Exp Clin Endocrinol Diabetes 2016; 125:241-250. [PMID: 27420130 DOI: 10.1055/s-0035-1569365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Previous research has revealed a clear relationship between weight gain of persons and their metabolic diseases developing later. These studies have covered only short periods lasting 4-8 years.Our goal was to collect decades' old and often life-long anthropometric data and correlate the figures with the presence of hypertension and diabetes or both. Methods: A retrospective international study was planned and organized to compare self-recorded data of lifelong weight gain among 60-70-year-old patients, analyze their correlation with metabolic diseases they developed, with special attention to women's weight gain around pregnancy, delivery and menopause in primary care settings in Germany, Hungary, Italy, Slovakia and the Ukraine. Results: Of the recruited 815 participants, 319 men and 496 women presented all the required data. Diabetics of both genders had the highest baseline weight at 20 years of age. The weight and BMI of the whole study population increased steadily until their seventies, but to a lesser extent after their fifties. Compared to the control group, changes over decades were the greatest among diabetics and also greater among patients with hypertension. Weight increase in the first decades (20-30-year-old men and 30-40-year-old women) was a significant risk factor for the development of diabetes (OR=1.044; p=0.002; 95% CI: 1.01-1.07). Among patients with diabetes and hypertension, both diagnoses were set up earlier than among those with a single morbidity.Among females, weight increase around pregnancy and menopause correlated significantly with higher odds for the diagnoses of diabetes and/or hypertension, irrespective of the number of children. Conclusions: During their decade-long relationship with their patients, family physicians are expected to identify the higher weight gain of their patients, especially among younger generation and intervene, if necessary.
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Affiliation(s)
- I Rurik
- Department of Family and Occupational Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - C Móczár
- Irinyi Primary Care Health Center, Kecskemét, Hungary
| | - N Buono
- SNAMID (National Society of Medical Education in General Practice), Italy
| | - T Frese
- Department of General Practice, University of Leipzig, Leipzig, Germany
| | - P Kolesnyk
- Department of Family and Internal Medicine, Institute of Postgraduate Education and Undergraduate Training, Uzhgorod National University, Uzhgorod, Ukraine
| | - J Mahlmeister
- Department of General Practice, University of Leipzig, Leipzig, Germany
| | - F Petrazzuoli
- SNAMID (National Society of Medical Education in General Practice), Italy
| | - E Pirrotta
- SNAMID (National Society of Medical Education in General Practice), Italy
| | - T Ungvári
- Department of Family and Occupational Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - I Vaverkova
- Slovak Society of General Practice, Slovak Medical Association, Bratislava, Slovakia
| | - Z Jancsó
- Department of Family and Occupational Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
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Cavicchi A, Venturini S, Petrazzuoli F, Buono N, Bonetti D. INFORMEG, a new evaluation system for family medicine trainees: feasibility in an Italian rural setting. Rural Remote Health 2016; 16:3666. [PMID: 27506900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
INTRODUCTION In Italy the course to become a general practitioner (GP) lasts 3 years and includes both theoretical and practical study. Different from the theoretical part, until recently the practical activity has not been assessed at all. The Emilia Romagna Regional Health Authority has developed a special program called INFORMEG (Management of Tutoring during the Triennial Specific Training in General Practice), aimed at assessing primary doctor trainees' practical skills. INFORMEG includes a list of pre-defined cases of specific diseases, conditions or health problem, a web application and a smartphone app, aimed at assisting trainee self-management and helping the tutor in the assessment of trainee performance. The Emilia Romagna Regional Health Authority divided the pre-defined cases into three categories (A, B and C) according to their relevance to a trainee's education and coded them using the International Classification of Primary Care (ICPC). The aim of this project report is to illustrate the implementation of INFORMEG in a rural setting. METHODS Program evaluation took place from 2 May to 31 October 2013 during GPs' routine clinical activities. The following steps were accomplished during every meeting: (1) consultation recording; (2) identification of the reason for the encounter (RfE); (3) classification of the diagnostic procedure(s) performed (diagnostic/therapeutic/test results/administrative/advice); (4) classification of special procedures called 'practical clinical skills' and (5) elaboration of the final diagnosis after the encounter. RESULTS The number of cases of specific disease or condition encountered by the trainee were 98 for type A, 57 for type B and 22 for type C. A total of 605 RfEs were collected: 376 for type A cases, 147 for type B cases and 82 for type C cases. A total of 976 procedures were performed during the 6 months: 590 procedures for the type A cases, 271 for type B and 115 for type C. CONCLUSIONS The pre-selected health problems were almost all addressed, thus confirming the good degree of representativeness of these clinical cases even in a rural setting. The ICPC coding helped the trainee in the construction of the case according to the logical process of family medicine. Two things to amend in INFORMEG are the absence of common arrhythmic conditions such as atrial fibrillation and the absence of means to assess the patient-trainee relationship.
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Affiliation(s)
| | | | - Ferdinando Petrazzuoli
- Department of Clinical Sciences in Malmö, Centre for Primary Health Care Research, Lund University, Malmö, Sweden.
| | - Nicola Buono
- ICPC Club Italy, Piazza Mazzini, Caserta, Italy.
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Klemenc-Ketis Z, Kurpas D, Tsiligianni I, Petrazzuoli F, Jacquet JP, Buono N, Lopez-Abuin J, Lionis C. Is a practice-based rural research network feasible in Europe? Eur J Gen Pract 2015; 21:203-9. [DOI: 10.3109/13814788.2015.1046376] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Petrazzuoli F, Palmqvist S, Thulesius H, Buono N, Pirrotta E, Cuffari A, Cambielli M, D'Urso M, Farinaro C, Chiumeo F, Marsala V, Wiig EH. A Quick Test of Cognitive Speed: norm-referenced criteria for 121 Italian adults aged 45 to 90 years. Int Psychogeriatr 2014; 26:1-8. [PMID: 24810919 DOI: 10.1017/s1041610214000787] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACT Background: A Quick Test of Cognitive Speed (AQT) is a brief test that can identify cognitive impairment. AQT has been validated in Arabic, English, Greek, Japanese, Norwegian, Spanish, and Swedish. The aim of this study was to develop Italian criterion-referenced norms for AQT. Methods: AQT consists of three test plates where the patient shall rapidly name (1) the color of 40 blue, red, yellow, or black squares (AQT color), (2) the form of 40 black figures (circles, squares, triangles, or rectangles; AQT form), (3) the color and form of 40 figures (consisting of previous colors and forms; AQT color-form). The AQT test was administered to 121 Italian cognitively healthy primary care patients (age range: 45-90 years). Their mean Mini-Mental State Examination (MMSE) score was 28.8 ± 0.9 points (range 26-30 points). AQT naming times in seconds were used for developing preliminary criterion cut-off times for different age groups. Results: Age was found to have a significant moderate positive correlation with AQT naming times color (r = 0.65, p < 0.001), form (r = 0.53, p < 0.001), color-form (r = 0.63, p < 0.001) and a moderate negative correlation with MMSE score (r = -0.44, p < 0.001) and AQT naming times differed significantly between younger (45-55 years old), older (56-70 years old), and the oldest (71-90 years old) participants. Years of education correlated positively but weakly with MMSE score (r = 0.27, p = 0.003) and negatively but weakly with AQT color (r = -0.16, p = ns), form (r = -0.24, p = 0.007), and color-form (r = -0.19, p = 0.005). We established preliminary cut-off times for the AQT test based on +1 and +2 standard deviations according to the approach in other languages and settings. Conclusions: This is the first Italian normative AQT study. Future studies of AQT - a test useful for dementia screening in primary care - will eventually refine cut-off times for normality balancing sensitivity and specificity in cognitive diagnostics.
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Affiliation(s)
| | - Sebastian Palmqvist
- Clinical Memory Research Unit, Department of Clinical Sciences in Malmö, Lund University, Sweden
| | - Hans Thulesius
- Department of Clinical Sciences in Malmö, Centre for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Nicola Buono
- SNAMID (National Society of Medical Education in General Practice), Italy
| | - Enzo Pirrotta
- SNAMID (National Society of Medical Education in General Practice), Italy
| | - Alfredo Cuffari
- SNAMID (National Society of Medical Education in General Practice), Italy
| | - Marco Cambielli
- SNAMID (National Society of Medical Education in General Practice), Italy
| | - Maurizio D'Urso
- SNAMID (National Society of Medical Education in General Practice), Italy
| | - Carmine Farinaro
- SNAMID (National Society of Medical Education in General Practice), Italy
| | - Francesco Chiumeo
- SNAMID (National Society of Medical Education in General Practice), Italy
| | - Valerio Marsala
- SNAMID (National Society of Medical Education in General Practice), Italy
| | - Elisabeth H Wiig
- Department of Communication Disorders, Boston University, Boston, Massachusetts, USA
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Buono N, Petrazzuoli F, D'Addio F, Farinaro C, Soler JK. Audit of cholesterol management among primary care patients in rural southern Italy. Rural Remote Health 2013. [DOI: 10.22605/rrh2225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Buono N, Thulesius H, Petrazzuoli F, Van Merode T, Koskela T, Le Reste JY, Prick H, Soler JK. 40 years of biannual family medicine research meetings--the European General Practice Research Network (EGPRN). Scand J Prim Health Care 2013; 31:185-7. [PMID: 24191874 PMCID: PMC3860292 DOI: 10.3109/02813432.2013.847594] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To document family medicine research in the 25 EGPRN member countries in 2010. DESIGN Semi-structured survey with open-ended questions. SETTING Academic family medicine in 23 European countries, Israel, and Turkey. SUBJECTS 25 EGPRN national representatives. MAIN OUTCOME MEASURES Demographics of the general population and family medicine. Assessments, opinions, and suggestions. RESULTS EGPRN has represented family medicine for almost half a billion people and > 300,000 general practitioners (GPs). Turkey had the largest number of family medicine departments and highest density of GPs, 2.1/1000 people, Belgium had 1.7, Austria 1.6, and France 1.5. Lowest GP density was reported from Israel 0.17, Greece 0.18, and Slovenia 0.4 GPs per 1000 people. Family medicine research networks were reported by 22 of 25 and undergraduate family medicine research education in 20 of the 25 member countries, and in 10 countries students were required to do research projects. Postgraduate family medicine research was reported by 18 of the member countries. Open-ended responses showed that EGPRN meetings promoted stimulating and interesting research questions such as comparative studies of chronic pain management, sleep disorders, elderly care, healthy lifestyle promotion, mental health, clinical competence, and appropriateness of specialist referrals. Many respondents reported a lack of interest in family medicine research related to poor incentives and low family medicine status in general and among medical students in particular. It was suggested that EGPRN exert political lobbying for family medicine research. CONCLUSION Since 1974, EGPRN organizes biannual conferences that unite and promote primary care practice, clinical research and academic family medicine in 25 member countries.
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Affiliation(s)
- Nicola Buono
- 1European General Practice Research Network Council and Executive Board
| | - Hans Thulesius
- 1European General Practice Research Network Council and Executive Board
| | | | - Tiny Van Merode
- 1European General Practice Research Network Council and Executive Board
| | - Tuomas Koskela
- 1European General Practice Research Network Council and Executive Board
| | | | - Hanny Prick
- 1European General Practice Research Network Council and Executive Board
- 2EGPRN Office, Department of Family Medicine, University of Maastricht, The Netherlands
| | - Jean Karl Soler
- 1European General Practice Research Network Council and Executive Board
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Buono N, Petrazzuoli F, D'Addio F, Farinaro C, Soler JK. Audit of cholesterol management among primary care patients in rural southern Italy. Rural Remote Health 2013; 13:2225. [PMID: 24289737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
INTRODUCTION There has not yet been an audit of achievement rates of therapeutic targets for cholesterol management in the rural Italian primary care setting. The purpose of this study was to measure the percentage of patients with hypercholesterolaemia in a rural primary care setting in southern Italy, classify their risk category and measure the proportions of those patients who achieved optimal cholesterol levels according to the Adult Treatment Panel III guidelines. METHODS The audit was completed using records from 1 January 2005 to 31 December 2007. An electronic search key was entered into the electronic clinical records of 10 family doctors in a rural area of southern Italy for subjects with a diagnosis of or being treated for hypercholesterolaemia. A total of 194 hypercholesterolaemic patients were randomly selected from a cohort of patients registered with these family doctors. The low density lipoprotein cholesterol (LDL-C) target level was 100 mg/dL (2.6 mmol/L) in patients with existing cardiovascular disease, 130 mg/dL (3.3 mmol/L) for patients with ≥2 risk factors, and 160 mg/dL (4.1 mmol/L) for all other patients. The results regarding the efficacy of the therapy were categorised as follows: (1) on target, LDL-C lower or equal to levels of affiliated class; (2) poor control, 1-30 mg/dL (0.03-0.78 mmol/L) above the target level of LDL-C; (3) very poor control, ≥31 mg/dL (≥0.8 mmol/L) above the LDL-C target level. RESULTS The average age of the hypercholesterolaemic patients included in the study was 62.0 ± 9.0 years; 55% were males, 30% were smokers, 71.3% suffered from hypertension, 46.3% had diabetes, 39.9% were obese and 31.9% had a family history of coronary disease. There were 114 subjects in Class I (personal history of coronary disease, cardiovascular risk ≥ 20, diabetes mellitus) LDL-C target level. Of these patients, 24.6% were at target, 30.7% had poor control and 44.7% had very poor control. A total of 42.3% of the subjects examined with the score system adopted by the Italian Heart Project showed levels of cardiovascular risk between 5% and 19% and were not eligible for a free prescription of lipid-lowering drugs. CONCLUSIONS These data suggest that cholesterol management in this rural area is not always optimal in patients with high cardiovascular risk. Italian healthcare regulation seems to be a barrier to drug prescription and it may influence optimal LDL-C control.
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Affiliation(s)
- Nicola Buono
- National Italian Society of Medical Education In General Practice, Caserta, Italy.
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Petrazzuoli F, Buono N. EGPRN: EUROPEAN GENERAL PRACTICE RESEARCH NETWORK. Eur J Gen Pract 2012. [DOI: 10.3109/13814788.2012.731687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Petrazzuoli F, Soler JK, Buono N, Dobbs F. Quality of care for hypertensive patients with type 2 diabetes in a rural area of Southern Italy: is the recording of patient data and the achievement of quality indicators targets satisfactory? Rural Remote Health 2010. [DOI: 10.22605/rrh1258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Petrazzuoli F, Soler JK, Buono N, Dobbs F. Quality of care for hypertensive patients with type 2 diabetes in a rural area of Southern Italy: is the recording of patient data and the achievement of quality indicators targets satisfactory? Rural Remote Health 2010; 10:1258. [PMID: 20843159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
INTRODUCTION Type 2 diabetes mellitus and hypertension are commonly associated chronic conditions which require regular structured treatment. In the UK many quality markers have been improved through an incentivisation scheme. The aim of this study was to discover if there is potential for improving the quality of care for patients with type 2 diabetes and hypertension in rural Italy, through a quality and outcome incentivisation scheme. METHODS The study was conducted in a rural practice context in Southern Italy and seven family doctors were involved. The main outcome measures were glycated haemoglobin A1c (HbA1c), LDL cholesterol, and systolic and diastolic blood pressure. The patient characteristics examined were age, sex, educational level, behaviour-related factors such as smoking and BMI, and the presence of comorbidities. RESULTS A poor level of registration was found for important variables such as HBA1c (61.4% compared with the UK Quality Indicator of 90%). An adequate level of registration and control was found only for blood pressure (95.7% and 82.1%, respectively), while an acceptable but not optimal level of control for HBA1c was also achieved (88.4% &#8804;10%). In comparison with levels in UK practices, the Italian district studied performed much less favorably, especially regarding process indicators. Intermediate outcome and treatment indicators were slightly better for blood pressure control but slightly worse for HBA1c and cholesterol control. CONCLUSION The data confirm a poor registration level for important healthcare indicators in the study area, and that optimal levels are rarely reached for many quality indicators. A quality and outcome incentivisation scheme similar to the UK Quality and Outcomes Framework may offer a tool for achieving improvements.
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Sauro A, Scalzitti F, Buono N, Siringano R, Petrazzuoli F, Diodati G, Canzano S, Castellano MC, D'Addio F, Pascarella A, Sortino D. Spirometry is really useful and feasible in the GP's daily practice but guidelines alone are not. Eur J Gen Pract 2005; 11:29-31. [PMID: 15841063 DOI: 10.3109/13814780509178015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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De Caprio L, Cuomo S, Ascione L, Accietto C, Artiaco D, Imparato A, Acanfora D, Buono N, Rengo F. [Effect of beta-receptor block on QT/QS2 behavior during isometric and dynamic exercise]. G Ital Cardiol 1985; 15:960-4. [PMID: 4092914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Our study is aimed to evaluate the change of QT/QS2 ratio in normal subjects during both isometric and dynamic exercise before and after propranolol administration. We studied 10 young volunteers healthy subjects who performed an isometric exercise by squeezing a grip dynamometer at 70% of their maximal voluntary contraction as long as possible. They also performed a dynamic exercise undergoing a submaximal bicycle stress test. Both tests were performed before and after administration of propranolol (0.15 mg/Kg e.v.) QT and QS2 intervals were measured at rest, during exercise and in the recovery period. Heart rate and blood pressure were also determined. Isometric exercise induces a significant shortening of both intervals although minor for QT so that the ratio significantly increases in comparison to baseline (p less than .001). At rest propranolol induces a significant decrease of heart rate and only a slight lengthening of QT and QS2 so that the ratio is unchanged. During exercise propranolol does not influence the increase of heart rate and blood pressure and the shortening of QT interval but prevent exercise-induced QS2 shortening so that the ratio after beta-blockade is significantly reduced at the peak of exercise (p less than .005). During dynamic exercise QT and QS2 behaviour is similar to that of isometric exercise; in fact both intervals are shortened and QS2 decrease is major than QT so that the ratio increases (p less than .001). These results confirm that QT/QS2 ratio can monitor the effects of adrenergic stimulation on the heart during physiological manoeuvres enhancing sympathetic discharge like occurs during both isometric and dynamic exercise.(ABSTRACT TRUNCATED AT 250 WORDS)
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Ascione L, Accietto C, Acanfora D, Zarra A, Giordano A, Casullo G, Buono N, Imparato A, Nicolino A. [Prognostic value of systolic time intervals in patients with ischemic cardiopathy]. Minerva Cardioangiol 1985; 33:425-30. [PMID: 4080177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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De Caprio L, Perillo F, Ascione L, Acanfora D, Accietto C, Guerra N, Buono N, Artiaco D. [Influence of the angiocardiographic severity of ischemic heart disease on QTc duration]. G Ital Cardiol 1985; 15:92-7. [PMID: 4007358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The influence of severity of coronary artery disease (CAD) on the duration of corrected electrical systole (QTc) and the prognostic value to predict sudden death of this index were retrospectively evaluated in 123 non-consecutive patients with history of stable angina who underwent cardiac catheterization. Fifteen patients had no angiographic evidence of CAD (O-V group). The 108 patients with a greater than or equal to 70% luminal diameter narrowing of a major coronary artery were further subdivided: 23 patients had 1-vessel (1-V group), 40 patients had 2-vessel (2-V group) and 45 had 3-vessel (3-V group) coronary artery disease; 26 patients showed normal left ventricular (LV) wall motion (A group), 57 patients showed asynergic contraction of 1 or 2 LV areas (B group) and 25 patients showed 3 or more areas of asynergy and/or aneurysm. Sixty-one patients had a previous myocardial infarction (MI). QT interval, calculated in the lead where it was longer, on 12-lead resting electrocardiograms recorded at a paper speed of 25 mm/sec, was corrected by the formula: QTc = QT/square root R-R. The follow-up was performed by telephone. At the time of angiography there was no significant difference in QTc duration between the different groups according to the severity of CAD (O-V, 1-V, 2-V and 3-V groups). Patients showing three or more areas of abnormal segmental wall motion and/or aneurysm (C group) had a significantly longer QTc (p less than 0.05) than patients with normal LV wall motion (A group).(ABSTRACT TRUNCATED AT 250 WORDS)
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