Results for ' Primary Care'

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  1.  8
    Construction of nursing knowledge in commodified contexts: Views and experiences of nurses regarding primary care.Ana Martínez-Rodríguez, Laura Martínez-Faneca & Núria Fabrellas - 2023 - Nursing Inquiry 30 (4):e12579.
    The commodification of health care, particularly primary care, presents challenges to care and knowledge development. The purpose of this study is to examine how nurses perceive and develop their knowledge in a commodified context. A mixed‐methods study was conducted that included a closed‐question survey and in‐depth interviews with nurses in public primary care in Catalonia. There were 104 valid responses to the questionnaire and 10 in‐depth interviews. The main findings of the survey were related (...)
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  2.  8
    Primary Care Nurse Practitioners' Integrity When Faced With Moral Conflict.Carolyn Ann Laabs - 2007 - Nursing Ethics 14 (6):795-809.
    Primary care presents distressful moral problems for nurse practitioners (NPs) who report frustration, powerlessness, changing jobs and leaving advanced practice. The purpose of this grounded theory study was to describe the process NPs use to manage moral problems common to primary care. Twenty-three NPs were interviewed, commenting on hypothetical situations depicting ethical issues common to primary care. Coding was conducted using a constant comparative method. A theory of maintaining moral integrity emerged consisting of the (...)
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  3.  17
    Primary care and abortion legislation in Chile: A failed point of entry.Lidia Casas, Lieta Vivaldi, Adela Montero, Natalia Bozo, Juan José Álvarez & Jorge Babul - 2023 - Developing World Bioethics 23 (2):154-165.
    While Chile's partial decriminalization of abortion in 2017 was a long overdue recognition of women's sexual and reproductive rights, nearly four years later the caseload remains well below expectations. This pattern is the product of standing barriers in access to abortion‐related health services, especially at the primary care point of entry. This study seeks to identify and describe these barriers. The findings presented here were obtained through a qualitative, exploratory study based on 19 semi‐structured interviews with relevant actors (...)
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  4.  7
    Primary Care Ethics is Just Medical Ethics: A Philosophical Argument for the Feasibility of Transitioning Acute Care Ethics to the Primary Care Setting.Stephen Perinchery-Herman - 2021 - HEC Forum 35 (1):73-94.
    Whether practiced by ethics committees or clinical ethicists, medical ethics enjoys a solid foundation in acute care hospitals. However, medical ethics fails to have a strong presence in the primary care setting. Recently, some ethicists have argued that the reason for this disparity between ethics in the acute and primary care setting is that primary care ethics is distinct from acute care ethics: the failure to translate ethics to the primary (...) setting stems from the incorrect belief that acute care ethics can be applied to the primary care setting. In this paper, I argue that primary care ethics and acute care ethics are species of the same ethical genus, and that the ethical differences are not ones of kind but of circumstance. I do this by appealing to the role obligations that underlie acute care and primary care clinicians’ medical ethical obligations and the shared institutions that ground those obligations. (shrink)
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  5.  8
    Evaluating primary care doctors' evidence‐based medicine skills in a busy clinical setting.Kerem Shuval, Aviv Shachak, Shai Linn, Mayer Brezis & Shmuel Reis - 2007 - Journal of Evaluation in Clinical Practice 13 (4):576-580.
  6.  2
    Handbook of primary care ethics.Andrew Papanikitas & John Spicer (eds.) - 2018 - Boca Raton, FL: CRC Press/Taylor & Francis Group.
    This Handbook offers much-needed insights into the ethics of primary healthcare. Topics range from the issues arising in primary care interactions, to working with different sources of vulnerability among patients, from contexts connected with teaching and learning, to issues in relation to justice and resources.
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  7.  8
    Moral flux in primary care : the effect of complexity.John Spicer, Sanjiv Ahluwalia & Rupal Shah - 2021 - Journal of Medical Ethics 47 (2):86-89.
    In this article, we examine the inter-relationship between moral theory and the unpredictable and complex world of primary health care, where the values of patient and doctor, or groups of patients and doctors, may often clash. We introduce complexity science and its relevance to primary care; going on to explore how it can assist in understanding ethical decision making, as well as considering implications for clinical practice. Throughout the article, we showcase aspects and key concepts using (...)
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  8.  5
    Pearls for primary care: integrating biochemistry, physiology, and clinical skills to optimize outpatient medicine.Michael B. Jacobs - 2021 - Irvine: Universal Publishers.
    This book is a resource for providers and students, integrating germane basic science information with clinical-medicine insights. The goal is to improve primary-care outpatient interactions for physicians, APRNs, and PAs. It is unique, integrating germane basic-science information with clinical-medicine. Unlike other resources that introduce these concepts more distinctly, this book bridges the gap and provides insights for providers and students. Also, there are succinct, yet comprehensive, presentations on managing the more common out-patient problems. The book is designed for (...)
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  9.  72
    Primary Care Doctors’ Assessment of and Preferences on Their Remuneration.Stefanos Karakolias, Catherine Kastanioti, Mamas Theodorou & Nikolaos Polyzos - 2017 - Inquiry: The Journal of Health Care Organization, Provision, and Financing 54:004695801769227.
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  10.  7
    Primary Care Groups and NHS Rationing: Implications of the Child B Case.Susan Pickard & Rod Sheaff - 1999 - Health Care Analysis 7 (1):37-56.
    Implementing The new NHS and the 1997 NHS (Primary Care) Act will gradually extend cash-limiting into primary health care, especially general practice. UK policy-makers have avoided providing clear, unambivalent direction about how to 'ration' NHS resources. The 'Child B' case became an epitome of public debate about NHS rationing. Among many other decision-making processes which occurred, Cambridge and Huntingdon Health Authority applied an ethical code to this rationing decision. Using new data this paper analyses the rationing (...)
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  11.  19
    Primary care confidentiality for Spanish adolescents: fact or fiction?M. D. Perez-Carceles - 2006 - Journal of Medical Ethics 32 (6):329-334.
    Background: By providing healthcare to adolescents, a major opportunity is created to help them cope with the challenges in their lives, develop healthy behaviour and become responsible healthcare consumers. Confidentiality is a major issue in adolescent healthcare, and its perceived absence may be the main barrier to an adolescent seeking medical care. Little is known, however, about confidentiality for adolescents in primary care practices in Spain.Objective: To ascertain the attitudes of Spanish family doctors towards the right of (...)
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  12.  97
    Long COVID and Health Inequities: The Role of Primary Care.Zackary Berger, V. Altiery de Jesus, S. A. Assoumou & T. Greenhalgh - 2021 - Milbank Quarterly 99 (2):519-541.
    An estimated 700,000 people in the United States have "long COVID," that is, symptoms of COVID-19 persisting beyond three weeks. COVID-19 and its long-term sequelae are strongly influenced by social determinants such as poverty and by structural inequalities such as racism and discrimination. Primary care providers are in a unique position to provide and coordinate care for vulnerable patients with long COVID. Policy measures should include strengthening primary care, optimizing data quality, and addressing the multiple (...)
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  13.  8
    Influences on Primary Care Provider Imaging for a Hypothetical Patient with Low Back Pain.Hh le, Matt DeCamp, Amanda Bertram, Minal Kale & Zackary Berger - 2018 - Southern Journal of Medicine 12 (111):758-762.
    OBJECTIVE: How outside factors affect physician decision making remains an open question of vital importance. We sought to investigate the importance of various influences on physician decision making when clinical guidelines differ from patient preference. -/- METHODS: An online survey asking 469 primary care providers (PCPs) across four practice sites whether they would order magnetic resonance imaging for a patient with uncomplicated back pain. Participants were randomized to one of four scenarios: a patient's preference for imaging (control), a (...)
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  14.  7
    Structured primary care for type 2 diabetes has positive effects on clinical outcomes.Andrea S. Fokkens, P. Auke Wiegersma, Frank W. Beltman & Sijmen A. Reijneveld - 2011 - Journal of Evaluation in Clinical Practice 17 (6):1083-1088.
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  15.  6
    Establishing Clinical Ethics Committees in Primary Care: A Study from Norwegian Municipal Care.Morten Magelssen, Heidi Karlsen & Lisbeth Thoresen - 2023 - HEC Forum 35 (2):201-214.
    Would primary care services benefit from the aid of a clinical ethics committee (CEC)? The implementation of CECs in primary care in four Norwegian municipalities was supported and their activities followed for 2.5 years. In this study, the CECs’ structure and activities are described, with special emphasis on what characterizes the cases they have discussed. In total, the four CECs discussed 54 cases from primary care services, with the four most common topics being patient (...)
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  16.  2
    A nursing solution to primary care delivery shortfall.Michael Carter, Phillip Moore & Nina Sublette - 2018 - Nursing Inquiry 25 (4):e12245.
    Many countries project that they will have difficulty to meet their demand for primary care based on an inadequate supply of primary care doctors. There are many reasons for this, and they tend to vary by country. The policy options available to these countries are to increase the number of local primary care doctors, recruit doctors from other countries, ration primary care, shift more primary care to specialists, or authorize other (...)
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  17.  6
    When are primary care physicians untruthful with patients? A qualitative study.Stephanie R. Morain, Lisa I. Iezzoni, Michelle M. Mello, Elyse R. Park, Joshua P. Metlay, Gabrielle Horner & Eric G. Campbell - 2017 - AJOB Empirical Bioethics 8 (1):32-39.
    Background: Notwithstanding near-universal agreement on the theoretical importance of truthfulness, empirical research has documented gaps between ethical norms and physician behaviors. Although prior research has explored situations in which physicians may not be truthful with patients, it has focused on contexts within specialty practice. In this article, we report on a qualitative study of truthfulness in primary care. Methods: We conducted a qualitative study during December 2014–March 2015 involving both focus groups and in-depth, semistructured interviews with 32 (...) care physicians from the Boston, MA, and Baltimore, MD, metro areas in three specialties: internal medicine, family practice, and pediatrics. Interviews and focus groups were led using a semistructured guide, which explored situations in which primary care physicians find it difficult to be honest with patients; factors shaping truthfulness; and rationales for truthful and untruthful communication. Results: While physicians described outright lying to patients as rare, other deviations from truthfulness were not uncommon, including slanting and deliberately withholding information. Physicians described a range of factors as influencing truthfulness, from patient-level characteristics such as educational background to societal considerations including avoiding unnecessary tests and procedures. Physicians described truthfulness as an ethical requirement, deviations from which required further justification. Perceived justifications included promoting patient well-being and avoiding harm. Conclusions: Our results suggest a potential need to augment opportunities for training in “everyday ethics” challenges, such as the appropriateness of deception in response to patient requests for inappropriate tests or pain medications. Furthermore, they indicate that, in various circumstances encountered in primary care, physicians perceive other moral duties as potentially in conflict with the duty of truthfulness. Further ethical analysis should focus on identifying when deviations from complete truthfulness do and do not serve patients' interests, to guide physicians in striking a reasonable balance among principles of medical ethics that may conflict with one another. (shrink)
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  18.  8
    Primary care for tinnitus: practice and opinion among GPs in England.Suliman K. El-Shunnar, Derek J. Hoare, Sandra Smith, Phillip E. Gander, Sujin Kang, Kathryn Fackrell & Deborah A. Hall - 2011 - Journal of Evaluation in Clinical Practice 17 (4):684-692.
  19.  3
    Aging, Primary Care, and Self-Sufficiency: Health Care Workforce Challenges Ahead.Fitzhugh Mullan, Seble Frehywot & Laura J. Jolley - 2008 - Journal of Law, Medicine and Ethics 36 (4):703-708.
    A combination of “environmental factors” in the U.S. has led to an increased demand for health care professionals. However, there has been a significant decrease in the number of U.S. medical graduates selecting careers in family medicine and general internal medicine, thus driving demand for international medical graduates. At the heart of our national workforce policy needs to be good domestic and foreign policies, such as self-sufficiency approaches that include strategies to incentivize rural and underserved practice for U.S. medical (...)
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  20.  4
    Professional ethics and primary care medicine: beyond dilemmas and decorum.Harmon L. Smith - 1986 - Durham: Duke University Press. Edited by Larry R. Churchill.
    This volume moves beyond ethics as problem-solving or ethics as etiquette to offer a look at ethics in primary care—as opposed to life-or-death—medical care. Professional Ethics and Primary Care Medicine deals with the ethics of routine, day-to-day encounters between doctors and patients. It probes beneath the hard decisions to look at the moral frameworks, habits of thought, and customs of practice that underlie choices. Harmon Smith and Larry Churchill argue that primary care, far (...)
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  21.  4
    Aging, Primary Care, and Self-Sufficiency: Health Care Workforce Challenges Ahead.Fitzhugh Mullan, Seble Frehywot & Laura J. Jolley - 2008 - Journal of Law, Medicine and Ethics 36 (4):703-708.
    Health care depends on people. It is the health workforce — doctors, nurses, pharmacists, lab technicians, and nursing assistants, to mention a few — that, in large measure, determine the quality and effectiveness of any health enterprise. The nature of the health workforce was integral to the health care reform debates of the early 1990s and will surely be central in proposals to improve the quality, accessibility, and cost of U.S. health care in the future. Therefore, as (...)
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  22.  5
    Primary care physician attitudes and values toward end-of-life care and physician-assisted death.David J. Doukas, Daniel W. Gorenflo & Barbara Supanich - 1999 - Ethics and Behavior 9 (3):219 – 230.
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  23.  10
    Primary care providers' perceptions of care.Mary C. Keizer, John-François Kozak & John F. Scott - forthcoming - Journal of Palliative Care.
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  24.  7
    On challenges to respect for autonomous decision making in primary care.John Spicer, Sanjiv Ahluwalia & Rupal Shah - 2022 - Clinical Ethics 17 (4):458-464.
    Primary health care is characterised by timely and appropriate health care access, delivered continuously over time to a specific population, providing a comprehensive service, with coordination of care for those that need it. Practitioners deal with a multiplicity of clinical issues within longitudinal relationships, embedded in the context of families and communities. We propose that these aspects of primary care have a bearing on how matters of decision making are considered and implemented. Further, the (...)
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  25. Primary care case management for medicaid recipients: evaluation of the Maryland access to care program.W. N. Evans, J. A. Schoenman & L. C. Schur - 2002 - Inquiry: The Journal of Health Care Organization, Provision, and Financing 34:155-170.
     
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  26. Primary Care and Clinical Governance.N. H. S. Executive, A. McColl, P. Roberick, H. Smith, E. Wilkinson, M. Moore, A. Farooqui, K. Khunti & R. Sorrie - 2002 - Journal of Evaluation in Clinical Practice 6 (2):111-20.
     
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  27.  5
    Primary care physicians and the duty to inform about genetic discrimination.Anita Silvers - 2001 - American Journal of Bioethics 1 (3):1 – 2.
  28.  13
    Ethics Case Consultation in Primary Care: Contextual Challenges for Clinical Ethicists.Anne Slowther - 2009 - Cambridge Quarterly of Healthcare Ethics 18 (4):397.
    The development of ethics case consultation over the past 30 years, initially in North America and recently in Western Europe, has primarily taken place in the secondary or tertiary healthcare settings. The predominant model for ethics consultation, in some countries overwhelmingly so, is a hospital-based clinical ethics committee. In the United States, accreditation boards suggest the ethics committee model as a way of meeting the ethics component of the accreditation requirement for payment by Health Maintenance Organizations, and in some European (...)
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  29.  8
    Attitudes and knowledge of primary care professionals towards evidence‐based practice: a postal survey.Catherine A. O'Donnell - 2004 - Journal of Evaluation in Clinical Practice 10 (2):197-205.
  30.  7
    US primary care physicians’ opinions about conscientious refusal: a national vignette experiment.Simon G. Brauer, John D. Yoon & Farr A. Curlin - 2016 - Journal of Medical Ethics 42 (2):80-84.
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  31.  3
    Primary care doctor attributions for why patients did not receive adequate antidepressant treatment.Paul A. Pirraglia, Vyshali Murthy & Jeffrey B. Weilburg - 2007 - Journal of Evaluation in Clinical Practice 13 (3):473-475.
  32.  11
    Primary care, patient autonomy, and healthcare justice.Christopher P. Morley - 2008 - American Journal of Bioethics 8 (10):22 – 23.
  33.  2
    Primary Care Physicians Need a Better Understanding of Temperamental Variation.William B. Carey - 2011 - Hastings Center Report 41 (2):S14-S14.
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  34.  10
    How do primary care doctors deal with uncertainty in making diagnostic decisions?Antonius Schneider, Bernd Löwe, Stefan Barie, Stefanie Joos, Peter Engeser & Joachim Szecsenyi - 2010 - Journal of Evaluation in Clinical Practice 16 (3):431-437.
  35.  1
    Putting Primary Care into Practice.Edward Volpintesta - 1998 - Hastings Center Report 28 (3):3.
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  36.  3
    Patients bringing information to primary care consultations: a cross‐sectional (questionnaire) study of doctors' and nurses' views of its impact.Greg Dilliway & Gillian Maudsley - 2008 - Journal of Evaluation in Clinical Practice 14 (4):545-547.
  37.  11
    The accuracy of primary care teams in diagnosing disorders of the shoulder.Shelain Patel, Fahad S. Hossain, Henry B. Colaco, Moataz El-Husseiny & Marcus H. Lee - 2011 - Journal of Evaluation in Clinical Practice 17 (1):118-122.
  38.  12
    Evidence‐based practice among primary care physicians in Kuwait.Abeer Sh Ahmad, Nouf Be Al‐Mutar, Fahad As Al‐Hulabi, Eman Sl Al‐Rashidee & Lukman Thalib - 2009 - Journal of Evaluation in Clinical Practice 15 (6):1125-1130.
  39.  18
    Identifying patterns in primary care consultations: a cluster analysis.Joachim P. Sturmberg, Eu-Gene Siew, Leonid Churilov & Kate Smith-Miles - 2009 - Journal of Evaluation in Clinical Practice 15 (3):558-564.
  40.  9
    Social Justice, Equality and Primary Care: (How) Can ‘Big Data’ Help?Kristin Voigt - 2019 - Philosophy and Technology 32 (1):57-68.
    A growing body of research emphasises the role of ‘social determinants of health’ in generating inequalities in health outcomes. How, if at all, should primary care providers respond? In this paper, I want to shed light on this issue by focusing on the role that ‘big data’ might play in allowing primary care providers to respond to the social determinants that affect individual patients’ health. The general idea has been proposed and endorsed by the Institute of (...)
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  41.  6
    What is primary care? Developments in Britain since the 1960s.Jane Lewis - 1998 - Health Care Analysis 6 (4):324-329.
    Since 1994, health policy in the UK has focused explicitly on making the NHS ‘primary care-led’. However, the meaning of primary is contested by different health professions and by policy-makers. This paper charts the major points of debate since the 1960s and suggests that there are limitations as to what general practice can be expected to deliver in respect of primary care.
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  42.  11
    Primary care physicians' views about gatekeeping in clinical research recruitment: A qualitative study.Marilys Guillemin, Rosalind McDougall, Dominique Martin, Nina Hallowell, Alison Brookes & Lynn Gillam - 2017 - AJOB Empirical Bioethics 8 (2):99-105.
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  43.  3
    The Consent Continuum: A New Model of Consent, Assent, and Nondissent for Primary Care.Marc Tunzi, David J. Satin & Philip G. Day - 2021 - Hastings Center Report 51 (2):33-40.
    The practice around informed consent in clinical medicine is both inconsistent and inadequate. Indeed, in busy, contemporary health care settings, getting informed consent looks little like the formal process developed over the past sixty years and presented in medical textbooks, journal articles, and academic lectures. In this article, members of the Society of Teachers of Family Medicine (STFM) Collaborative on Ethics and Humanities review the conventional process of informed consent and its limitations, explore complementary and alternative approaches to doctor‐patient (...)
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  44.  3
    Collaborating with a primary care‐based research network.Emma J. Frew, Vicky Hammersley, Jane Wolstenholme & David K. Whynes - 2001 - Journal of Evaluation in Clinical Practice 7 (3):339-342.
  45.  6
    Patient safety in primary care has many aspects: an interview study in primary care doctors and nurses.Sander Gaal, Esther Van Laarhoven, René Wolters, Raymond Wetzels, Wim Verstappen & Michel Wensing - 2010 - Journal of Evaluation in Clinical Practice 16 (3):639-643.
  46. Computerized encounter registers in primary care research: Is there a gold standard?Howard Brody - 1988 - Theoretical Medicine and Bioethics 9 (2).
    Computer technology as well as the need to conduct research in primary care settings, has stimulated the creation in the U.S. of information networks linking private physicians' offices and other primary care practice sights. These networks give rise to several problems which have philosophic interest. One is a numerator problem created by the difficulty in primary care of using the more complicated or invasive diagnostic technologies commonly employed in tertiary care research. Another is (...)
     
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  47. The importance of primary care for theoretical medicine: A commentary.Howard Brody - 1992 - Theoretical Medicine and Bioethics 13 (3).
    Froom and Froom all attention to referral bias as a frequent cause for misinterpreting the medical literature. This is particularly a source of false certainty, and therefore false science, in U.S. practice, where referral centers are often seen as the only legitimate source of medical knowledge and where primary care is discounted as a source of scientific observations. Appreciation of the primary care setting is therefore a critical element in theoretical understanding of medical epistemology.
     
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  48.  3
    Pain and the collision of expertise in primary care physical exams.Amanda McArthur - 2019 - Discourse Studies 21 (5):522-539.
    Using conversation analysis and a collection of naturally occurring US primary care consultations, this article explores the search for pain during primary care physical exams. Inhabiting this activity is a ‘collision’ of expertise between physicians’ clinical knowledge about bodies and patients’ knowledge about their bodies. I show how patients responding to questions like does that hurt? tacitly guide physicians to their pain using pain displays, glottal cutoffs and response delays to observably react to the physician’s touch, (...)
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  49.  9
    Chronic disease, prevention policy, and the future of public health and primary care.Rick Mayes & Blair Armistead - 2013 - Medicine, Health Care and Philosophy 16 (4):691-697.
    Globally, chronic disease and conditions such as diabetes, cardiovascular disease, depression and cancer are the leading causes of morbidity and mortality. Why, then, are public health efforts and programs aimed at preventing chronic disease so difficult to implement and maintain? Also, why is primary care—the key medical specialty for helping persons with chronic disease manage their illnesses—in decline? Public health suffers from its often being socially controversial, personally intrusive, irritating to many powerful corporate interests, and structurally designed to (...)
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  50.  6
    Measuring organizational attributes in primary care: a validation study in Germany.Dominik Ose, Tobias Freund, Cornelia U. Kunz, Joachim Szecsenyi, Iris Natanzon, Johanna Trieschmann, Michel Wensing & Antje Miksch - 2010 - Journal of Evaluation in Clinical Practice 16 (6):1289-1294.
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