Family practice
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Multicenter Study
Multicentre descriptive cross-sectional study of Japanese home visit patients: reasons for encounter, health problems and multimorbidity.
GP in Japan are encouraged to conduct home visits for older adults. However, most previous studies on home visits were based on secondary analyses of billing data that did not include reasons for the encounter. ⋯ The main reasons for encounter were prescriptions for chronic conditions. Emergency visits accounted for 8% of all visits. Around half of the patients had multimorbidity. This information may help GPs and policy makers to better assess home visit patients' needs.
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General Practitioners' (GPs') workload has been suggested to increase in many countries; how does this impact patient follow-up? ⋯ Increased use of GP consultations, mainly among the healthiest participants, encourage further research into whether these patients displace patients with heavier and more complex needs.
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Randomized Controlled Trial
Self-efficacy and doctor support as mediators of depression outcomes following counselling by family doctors for intimate partner violence.
Previous research shows counselling delivered by trained family doctors reduces depression for women experiencing intimate partner violence (IPV). However, the potential for self-efficacy, doctor support and safety enquiry to mediate these effects has not been examined. ⋯ Counselling by trained family doctors can help increase support and self-efficacy of women who have experienced IPV, mediating reduced depression.
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Multicenter Study
Primary care clinicians' confidence, willingness participation and perceptions of roles in advance care planning discussions with patients: a multi-site survey.
People who engage in advance care planning (ACP) are more likely to receive health care that is concordant with their goals at the end of life. Little discussion of ACP occurs in primary care. ⋯ Current engagement of primary care clinicians in ACP is low. Given the high willingness and acceptability for non-physician clinician involvement, increasing the capacity of non-physician clinicians could enable uptake of ACP in primary care.
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The 3P model proposes that predisposing, precipitating, and perpetuating factors all play a role in sleep disturbance. ⋯ The unmet need for affordable long-term housing and greater experiences of classism were associated with more sleep disturbance, suggesting that both acted as precipitating factors. In a structural equation model with adequate fit indices, anxiety mediated the relationships with sleep disturbance for both the unmet need for affordable long-term housing and classism, suggesting that it serves as a perpetuating factor. Medical providers are recommended to explore these potential needs in safety-net primary care when patients present with sleep disturbance or anxiety. Assisting with connections to long-term housing and helping patients counteract and cope with classist discrimination may be effective in improving sleep in safety-net primary care.