Family medicine
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The misuse and abuse of opioids has increased across the United States in recent years, associated with a rise in opioid-related overdose deaths. Physicians report having difficulty discerning substance abuse or drug diversion, which can lead to over- or under-prescribing of opioids and poor pain management. Additionally, research suggests that patient characteristics (eg, sex, ethnicity/race, age) may unduly influence the pain management decisions of health care providers. This investigation aimed to assist in physicians' prescribing decisions and reduce prescribing bias through the assistance of mental health professionals. ⋯ These findings suggest that providing physicians with additional information about their patients' opioid abuse potential aids in prescribing decisions and may reduce prescribing bias based on demographic factors.
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The last decade has seen a number of educational programs in family medicine begin throughout the African region as many countries have recognized that family medicine offers an efficient way to meet the growing health demands of their country. Zambia's health situation is similar to many countries in sub-Saharan Africa by having a wide array of compelling health demands and a health sector with a limited capacity to meaningfully respond. This paper describes the efforts to begin Zambia's first post-graduate training program for family medicine. ⋯ Significant outputs achieved during the start-up period include: changes to the organizational structure of the medical school, budget reconciliation, and recruitment of the teaching faculty. Challenges that remain for the near-term include identifying appropriate district-level teaching facilities and the recruitment and retention of qualified faculty. Zambia's experience in developing family medicine may prove useful to other academic medical institutions throughout the region or in comparable socioeconomic circumstances as they look to address similar health sector challenges.
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Although current research suggests that patient-provider prenatal communication and expectation-setting affects women's outcomes, more needs to be understood about the kinds of communication experiences that shape women's expectations, the nature of expectations that women hold, and how those expectations influence their appraisal of labor and delivery. The goal of this study is to draw connections between provider communication, birth experience expectations, and birth experience appraisals. ⋯ Mothers continue to rely on providers as partners in health care. Through patient-centered communication, providers can help mothers develop flexible expectations of the birth experience, which in turn can result in positive appraisals of delivery.
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Few studies have addressed whether male family medicine residents have more exposure to men's health issues than their female colleagues. Additionally, the association between panel demographics or continuity of care and the differential experience with gender-specific health care is unclear. ⋯ Both male and female resident physicians acquire more experience with same-gender health care visits during training. Panel demographics and continuity do not explain the differential experience. Patient preferences and/or biased scheduling selection may explain why residents accumulate same-gender health care visits at twice the rate of opposite-gender health care visits.
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Over 70% of smokers visit a physician annually, and physicians are well-positioned to assist patients in smoking cessation. Residency offers the ideal setting to train physicians in best practices for treatment of nicotine dependence. We hypothesized that experiential learning during a smoking cessation medical clinic (SCMC) rotation would be associated with an improvement in smoking cessation practice of internal medicine (IM) interns in outpatient primary care and inpatient settings. ⋯ SCMC experience positively impacted smoking cessation treatment by IM interns, causing a measurable change in their practice.