Mental Health Well-Being and Attitudes on Mental Health Disorders among Family Physicians during COVID-19 Pandemic: A Connection with Resilience and Healthy Lifestyle

Family physicians (FPs) are exposed to high amounts of stress, and could be susceptible to the development of mental health disorders (MHD), especially after the emergence of the COVID-19 pandemic. The aim of the current study was to assess MHD history, attitudes toward MHDs and stress‑coping strategies in FPs. An additional goal was to estimate their comprehensive well-being and investigate connections with resilience and a healthy lifestyle. A total of 483 FPs submitted their responses via online survey. MHD attitudes were assessed with the according questionnaires, while burnout levels, healthy lifestyle, resilience, job and life satisfaction were estimated with validated scales. Results have shown that 32.5% of FPs disclosed positive MHD history, while 68.7% used professional help. Resilience and healthy lifestyle levels were significantly higher in MHD negative FPs (p < 0.001), while burnout levels were lower (p < 0.001). Moreover, healthy lifestyle (β = 0.03, p < 0.001) was an independent correlate of resilience, while healthy lifestyle (β= −0.35, p < 0.001, and resilience (β= −1.82, p < 0.001) were of burnout levels. Finally, resilience (OR = 0.387, p < 0.001) and healthy lifestyle (OR = 0.970, p = 0.021) were shown as independent predictors of positive MHD history status. Strong promotion and education of FP population regarding resilience and healthy lifestyle should be utilized in practice in order to alleviate the possibility of mental health disturbances and the according consequences.

A qualitative study of resident and early-career family physicians’ focused practice choices in Canada

Background: Although focused practice within family medicine may be increasing globally, there is limited research on the factors contributing to decisions to focus practice. Aim: We aimed to examine the factors influencing resident and early-career family physician choices of focused practice across three Canadian provinces. Design and Setting: We analyzed a subset of qualitative interview data from a study across British Columbia, Ontario, and Nova Scotia. Method: A total of 22 resident family physicians and 38 early-career family physicians in their first 10 years of practice who intend to or currently practice in a focused area were included in our analysis. We compared participant types, provinces, and the degree of focused practice while identifying themes related to factors influencing the pursuit of focused practice. Results: We identified three key themes of factors contributing to choices of focused practice: self-preservation within the current health care system, support from colleagues, and experiences in medical school and/or residency. Minor themes included alignment of practice with skills, personal values, or ability to derive professional satisfaction; personal lived experiences; and having many attractive opportunities for focused practice. Conclusion: Both groups of participants unanimously viewed focused practice as a way to circumvent the burnout or exhaustion they associated with comprehensive practice in the current structure of the health care system. This finding, in addition to other influential factors, was consistent across the three provinces. More research is needed to understand the implications of resident and early-career family physician choices of focused practice within the physician workforce.

The Impact of Linguistic Concordance and the Active Offer of French Language Services on Patient Satisfaction

Communication is essential to providing quality primary care. Linguistic concordance between patients and physicians has been linked to improved health outcomes and greater patient satisfaction. Although Canadian Francophones often struggle to access linguistics concordant health services, the concept of the active offer of French Language Services (FLS) has emerged as a means of ensuring the availability of such services and improving the francophone patient experience. However, the impact of language concordance and the active offer of FLS on patient satisfaction among Ontario Francophones remain largely unknown. Patient satisfaction surveys were collected as part of a continuing education program targeted at family physicians in Northeastern Ontario. Participating physicians distributed patient surveys consisting of select patient satisfaction questions from the Physicians Achievement Review (PAR) and select questions from the Active Offer of French Language Services in Minority Context Measure. Valid surveys were received from 235 patients. Just under half of these (44%) identified as Francophones, 62.6% had a French-speaking family physician; however, only 17.2% reported regularly speaking in French with their family physician. As hypothesized, there was a consistent tendency for Francophones who experience stronger linguistic concordance with their family physician to report higher satisfaction scores. Francophones who regularly speak French with their family physicians were more satisfied ( = 4.63) than those who rarely/never speak French ( = 4.29, F(1; 83) = 4.852; p < 0.05). There was also a statistically significant interaction between the patients' language of preference and the service language. Francophones who prefer French and regularly speak it with their family physician (linguistic concordance; adj= 4.82) were significantly more satisfied than those who prefer French yet rarely/never speak it (linguistic discordance; adj= 4.06, F(1; 75) = 11.950; p < 0.001). Furthermore, a positive correlation between patient satisfaction and the active offer was observed in Francophones (r = 0.49, p<0.001). The present findings provide evidence of the impact of linguistically adapted health care services on the satisfaction of Ontario Francophones and suggest that patient satisfaction may be improved through the active offer of FLS. A larger and more diverse sample is required to confirm these findings.

Physician Attitudes and Self-reported Practices Toward Prostate Cancer Screening in Black and White Men

Background and Objectives: Updated 2018 prostate cancer screening guidelines recommend informed decision-making discussions, which should include education on prostate cancer’s disproportionate impact on Black men. It is unknown whether academic family physicians follow these guidelines. Methods: Family physicians were surveyed as part of the 2020 Council of Academic Family Medicine Educational Research Alliance (CERA) survey. We used χ2 to compare physicians’ knowledge and screening practices stratified by physician age, gender, and percentage of Black patients in patient panel. We calculated logistic regressions predicting shared decision-making conversations, barriers to shared decision-making, inclusion of race in prostate cancer screening approach, and prostate-specific antigen (PSA) testing adjusted for physician age, gender, and percentage of Black patients. Results: Physicians reported engaging in shared decision-making for prostate cancer screening in half of eligible men. Only 29.2% of physicians reported routinely informing Black men of their increased prostate cancer risk. In logistic regressions, physician gender (female) and fewer Black patients in panel (&lt;25%) were associated with lower frequency of shared decision-making with Black patients. Physician age (&lt;40 years) was associated with not discussing race during screening discussions (OR 2.24, 95% CI 1.55–3.23). Conclusions: Most academic family physicians do not appropriately inform Black men of increased prostate cancer risk, with younger physicians less likely to discuss race than older physicians. Female physicians, and physicians who see fewer Black patients, are less likely to have shared decision-making conversations with Black patients. This suggests educational efforts for these groups are needed to address health disparities in prostate cancer.

Family Medicine and Emergency Redeployment: Unrealized Potential

Background and Objectives: Discussions of scope of practice among family physicians has become a crucial topic amidst the COVID-19 pandemic, coupled with new attention to residency training requirements. Family medicine has seen a gradual narrowing of practice due to a host of issues, including physician choice, expanding scope of practice from physician assistants and nurses, an increased emphasis on patient volume, clinical revenue, and residency training competency requirements. We sought to demonstrate the flexibility of the family medicine workforce as shown through their scopes of practice, and argue that this is indication of their potential for redeployment during emergencies. Methods: This study computes scopes of practice for 78,416 family physicians who treat Medicare beneficiaries. We used Evaluation and Management (E/M) codes in Medicare’s 2017 Part-B public use file to calculate volumes of services done across six sites of service per physician. We aggregated counts and proportions of physicians and the E/M services they provided across sites of practice to characterize scope, and performed a separate analysis on rural physicians. Results: The study found most family physicians practicing at a single site, namely, the ambulatory clinic. However, family physicians in rural areas, where need is greater, exhibit broader scope. This suggests that a significant number of family physicians have capacity for COVID-19 deployment into other settings, such as emergency rooms or hospitals. Conclusions: Family physicians are a potential resource for emergency redeployment, however the current breadth of scope for most family physicians is not aligned with current residency training requirements and raises questions about the future of family medicine scope of practice.

Current Recommendations on the Management of Pediatric Asthma and Allergic Rhinitis during the COVID-19 Pandemic versus Real-Life Practice

<b><i>Introduction:</i></b> Several statements and position papers on the management of childhood asthma and allergies during the COVID-19 pandemic have been published of late. The aim of this study was to evaluate the knowledge and awareness of pediatricians and family physicians regarding the management of asthma and allergic rhinitis during the pandemic according to recently published updated guidelines. <b><i>Method:</i></b> We conducted an online survey among pediatricians and family physicians in Turkey, using a questionnaire designed to evaluate 4 items: (1) the relationship between COVID-19 infection risk and pediatric asthma/allergic rhinitis and medications used in treatment; (2) the follow-up and management of asthma/allergic rhinitis according to published updated recommendations; (3) pediatricians’ and family physicians’ observations and perceptions of treatment compliance and the attitudes of their pediatric asthma patients; and (4) pediatricians and family physicians’ attitudes to using telehealth in the follow-up and management of pediatric asthma patients during the pandemic. <b><i>Results:</i></b> A total of 346 participants responded to the survey. The relationship between the risk of COVID-19 and asthma was known by less than 25% of the participants. More than 33% of family physicians and 20% of pediatricians were unaware that asthma medication does not lead to a susceptibility to COVID-19 infection; 55% of family physicians and 48% of pediatricians thought that patients showed better compliance with asthma controller medication; over 33% of pediatricians and approximately 50% of family physicians stated that they could not distinguish between an asthma attack and lung involvement in COVID-19 infection; of the respondents, over 75% stated that they prefer face-to-face visits with patients, even in situations that do not require a physical examination. <b><i>Conclusion:</i></b> The overall knowledge and awareness of pediatricians and, especially, family physicians regarding the management of pediatric asthma/allergic rhinitis during the pandemic is not at a satisfactory level. There is an urgent need to inform them about updated recommendations appearing in recent guidelines published by allergy organizations.