BACKGROUND: The Ontario Health Team (OHT) model is a form of integrated care that seeks to provide coordinated delivery of care to communities across Ontario, Canada. Primary care is positioned at the heart of the OHT model, yet physician participation and representation has been severely challenged at planning and governance tables. The purpose of this multiple case study is to examine (1) processes and structures to enable family physician participation in OHTs and (2) describe challenges to family physician participation.
METHODS: We chose a qualitative, exploratory multiple-case study approach following Yin\'s design and methods. The study took place between June and December 2021.We conducted semi-structured interviews with OHT stakeholders in four communities and carried out an analysis of internal and external documents to contextualize interview findings. Thematic analysis was applied within case and between cases.
RESULTS: Four OHTs participated in this study with thirty-nine participants (17 family physicians; 22 other stakeholders). Over 60 documents were analyzed. Within-case analysis found that structures and processes should be formalized and established to facilitate physician participation. Skepticism, burnout, heavy workload, and the COVID-19 pandemic were challenges to participation. Between-case analysis found that participation varied. Face-to-face communication processes were favoured in all cases and history of collaboration facilitated relationship-building. All cases faced similar challenges to physician participation despite regional differences.
CONCLUSIONS: The implementation of OHTs demonstrates that integrated care models can address critical health system issues through a collective approach. Physician participation is vital to the development of an OHT, however, recognition of their challenges (skepticism, burnout, COVID-19 pandemic) to participating must be acknowledged first. To ensure that models like OHTs thrive, physicians must be meaningfully engaged in various aspects and levels of governance and delivery.

In 2012, India Today, a news agency, reported that \'Family Physicians are dying silent death\' in India. The number of practicing family physicians is declining rapidly in the most populous country in the world with pressing public health needs. The previous generation of general practitioners/family physicians/family doctors has entered the age group of the seventies and eighties in both urban and rural areas. Unfortunately, no new family physician is opening the practice in these areas. The recent COVID pandemic has clearly demonstrated the ongoing need, demand, and popularity of family physicians among the general public as first-contact dependable and trustworthy doctors. While it may be an enigma why MBBS doctors are no longer opting to become family physicians, to the experts of this domain, it is not a surprise. To outside observers, this phenomenon may appear to be an outcome of changing times, the expansion of medical sciences, new emerging career choices for medical students, or competition within the healthcare market. However, a closer study reveals that the decline of family physician services in India is not a default situation but an outcome of decades of institutional neglect and perhaps a deliberate exclusion. According to the recently released National Medical Commission (NMC) draft curriculum 2023, the undergraduate medical education program is designed with the national goal of creating an \"Indian Medical Graduate\" possessing the requisite knowledge, skills, attitudes, values, and responsiveness so that she or he may function appropriately and effectively as a PHYSICIAN OF FIRST CONTACT of the community while being globally relevant. However, we are disappointed to note that the Family Medicine subject (discipline of family physicians) component has been entirely excluded from the draft of the MBBS curriculum. The words such as \'Family medicine\', \'Family Physician\', \'General practitioners\', and \'Family Practice\' have not even been mentioned in the entire 83 pages of the draft MBBS curriculum document. This is not an inadvertent occurrence or a default situation. The erstwhile MCI, the Medical Council of India, played a significant role in diminishing the role of family physicians in the Indian health system. It is to be seen if the NMC is able to reverse this trend by easing the regulatory restrictions on family physicians/family medicine training by including it in the MBBS course.

BACKGROUND: In Ontario, Canada, a government agency known as Ontario Health is responsible for making audit and feedback reports available to all family physicians to encourage ongoing quality improvement. The confidential report provides summary data on 3 key areas of practice: safe prescription, cancer screening, and diabetes management.
OBJECTIVE: This report was redesigned to improve its usability in line with evidence. The objective of this study was to explore how the redesign was perceived, with an emphasis on recipients\' understanding of the report and their engagement with it.
METHODS: We conducted qualitative semistructured interviews with family physicians who had experience with both versions of the report recruited through purposeful and snowball sampling. We analyzed the transcripts following an emergent and iterative approach.
RESULTS: Saturation was reached after 17 family physicians participated. In total, 2 key themes emerged as factors that affected the perceived usability of the report: alignment between the report and the recipients\' expectations and capacity to engage in quality improvement. Family physicians expected the report and its quality indicators to reflect best practices and to be valid and accurate. They also expected the report to offer feedback on the clinical activities they perceived to be within their control to change. Furthermore, family physicians expected the goal of the report to be aligned with their perspective on feasible quality improvement activities. Most of these expectations were not met, limiting the perceived usability of the report. The capacity to engage with audit and feedback was hindered by several organizational and physician-level barriers, including the lack of fit with the existing workflow, competing priorities, time constraints, and insufficient skills for bridging the gaps between their data and the corresponding desired actions.
CONCLUSIONS: Despite recognized improvements in the design of the report to better align with best practices, it was not perceived as highly usable. Improvements in the presentation of the data could not overcome misalignment with family physicians\' expectations or the limited capacity to engage with the report. Integrating iterative evaluations informed by user-centered design can complement evidence-based guidance for implementation strategies. Creating a space for bringing together audit and feedback designers and recipients may help improve usability and effectiveness.

Intussusception is one of the common causes of acute abdomen in paediatric age bracket with ileocolic type being the most prevalent. This happens when a proximal segment of bowel (intussusceptum) telescopes into the lumen of the adjacent distal segment (intussuscepiens). Here we report six cases of intussusception in which five were in paediatric age group and one was adult. All children were admitted, resuscitated well, USG abdomen was done to confirm the diagnosis, written and informed consent for surgery and anaesthesia, was taken from parents. However, all were managed successfully by hydrostatic saline reduction under sedation. Only one child had recurrence after one year who was again treated conservatively. Adult case was managed by means of laparotomy by excision of benign polyp being the pathological lead point. We present this case series to analyse the spectrum of presentation, diagnostic and therapeutic options available with review of literature. Since primary care providers and family physicians are first responders, this case series would help them for differential diagnosis and prompt referrals for further management.

UNASSIGNED: In Turkey, childhood vaccination rates are decreasing in the context of increasingly visible antivaccination movements.
UNASSIGNED: To evaluate the antivaccination movement based on communication experiences between family physicians and antivaccine parents in Turkey.
UNASSIGNED: We conducted 39 face-to-face in-depth interviews with family physicians in Sakarya Province who had experiences of communicating with antivaccine parents during October-December 2019. With the permission of the participants, audio recording was obtained in all interviews except one; these were transcribed verbatim and checked. A thematic approach was used to analyse the data.
UNASSIGNED: The most common concern about vaccination was the possible side-effects, followed by the origin of the vaccines, religious concerns and distrust of vaccines. The physicians said they assumed an inquisitive, informative and anxiety-relieving attitude towards antivaccine parents.
They said they were able to persuade most parents to vaccinate their children and that highly educated parents or those whose attitudes and behaviours were strongly influenced by their religious leaders were the hardest to convince. Physicians emphasized the importance of trust in increasing vaccine acceptance and noted the need to educate religious leaders and families to introduce mandatory vaccination policies.
UNASSIGNED: Parents had various reasons for refusing childhood vaccinations, however, the family physicians used persuasive methods to convince them to accept the vaccinations. Strengthening the communication and persuasive skills of health care professionals regarding vaccination may help increase acceptance of childhood vaccinations.
تقييم حركة مناهضة التطعيم في تركيا: تقارير نوعية من أطباء الأسرة.
عبد القادر أيدين، فريد أوزين، حسن إكربيسر، إركوت إتشوغلو، محمد أيدين، إليف كوس، غوركان موراتداجي.
UNASSIGNED: تشهد تركيا تناقصًا في معدلات تطعيم الأطفال في سياق التزايد الواضح لحركات مناهضة التطعيم.
UNASSIGNED: هدفت هذه الدراسة إلى تقييم حركة مناهضة التطعيم من خلال تجارب أطباء الأسرة في التواصل مع الآباء والأمهات المناهضات للتطعيم في تركيا.
UNASSIGNED: أجرينا 39 مقابلة متعمقة وجهًا لوجه مع أطباء الأسرة في محافظة صقاريا الذين كانت لهم تجارب في التواصل مع الآباء والأمهات المناهضات للتطعيم. وحصلنا على تسجيل صوتي لجميع المقابلات باستثناء مقابلة واحدة بإذن من المشاركين؛ وفُرِّغت تلك التسجيلات حرفيًّا وتم التحقق منها. واستُخدم نهج مواضيعي لتحليل البيانات. وجُعت البيانات حتى حد التشبُّع.
UNASSIGNED: كانت الآثار الجانبية المحتملة للتطعيم أكثر الشواغل شيوعًا، يليها منشأ اللقاحات، ثم المخاوف الدينية، وعدم الثقة في اللقاحات. وقال المشاركون إن موقفهم من الآباء والأمهات المناهضات للتطعيم كان فضوليًّا، ومُبرًا بالمعلومات، ومُففًا للقلق. وأفادوا بأنهم استطاعوا إقناع معظم الآباء بتطعيم أطفالهم من خلال توضيح الموقف الصحيح، غير أنه كان من الصعب إقناع الآباء المتعلمين تعليمً عاليًا أو الواقعين تحت تأثير القيادات الدينية. وأشاروا إلى أن وسائل التواصل الاجتماعي هي العامل الأكثر فعالية في انتشار حركة مناهضة التطعيم. وأكدوا على أهمية الثقة في الطبيب في زيادة تقبُّل اللقاح. وأشار البحث إلى بعض الحلول مثل تثقيف القادة الدينيين والأُسر، واستخدام الأدوات الإعلامية بفاعلية، ووضع سياسات التطعيم الإلزامي.
UNASSIGNED: أبدى الآباء أسبابًا مختلفة لرفض تطعيم أطفالهم، ولكن أطباء الأسرة كانوا مقنعين في تواصلهم ونهجهم. وقد يساعد التوجيه الفعَّال لتجارب العاملين في مجال الرعاية الصحية على زيادة تقبُّل تطعيم الأطفال في المستقبل.
Évaluation des mouvements anti-vaccination en Turquie : rapports qualitatifs des médecins de famille.
UNASSIGNED: En Turquie, les taux de vaccination des enfants diminuent dans un contexte de mouvements anti-vaccination de plus en plus visibles.
UNASSIGNED: Évaluer le mouvement anti-vaccination à partir des enseignements tirés par des médecins de famille lors de la communication avec les parents opposés à la vaccination en Turquie.
UNASSIGNED: Nous avons mené 39 entretiens approfondis en face à face avec des médecins de famille de la province de Sakarya qui ont eu des échanges avec des parents opposés à la vaccination d\'octobre à décembre 2019. Avec l\'autorisation des participants, des enregistrements audio ont été obtenus dans tous les entretiens sauf un ; ceux-ci ont été transcrits mot à mot et vérifiés. Une approche thématique a été utilisée pour analyser les données.
UNASSIGNED: Les effets secondaires possibles constituaient la préoccupation la plus courante concernant la vaccination, suivis par l\'origine des vaccins, les motivations d\'ordre religieuses et la méfiance à l\'égard des vaccins. Les médecins ont déclaré avoir adopté une attitude empreinte de curiosité, informative et apaisante à l\'égard des parents opposés à la vaccination. Ils ont ajouté qu\'ils ont pu persuader la plupart des parents de vacciner leurs enfants ; cependant, les parents très instruits ou ceux dont les attitudes et les comportements sont fortement influencés par les chefs religieux étaient les plus difficiles à convaincre. Les médecins ont souligné l\'importance de la confiance pour accroître l\'acceptation du vaccin, et indiqué le besoin d\'éduquer les chefs religieux et les familles pour qu\'ils introduisent des politiques de vaccination obligatoire.
UNASSIGNED: Les parents avaient diverses raisons de refuser la vaccination des enfants, mais les médecins de famille utilisaient des moyens de persuation pour qu\'ils acceptent la vaccination. Renforcer la communication et les talents de persuation des professionnels de santé à l\'égard de la vaccination peut contribuer à améliorer l\'acceptation de la vaccination des enfants.

The number of family caregivers to individuals with dementia is increasing. Family physicians are often the first point of access to the health care system for individuals with dementia and their caregivers. Caregivers are at an increased risk of developing negative physical, cognitive and affective health problems themselves. Caregivers also describe having unmet needs to help them sustain care in the community. Family physicians are in a unique position to help support caregivers and individuals with dementia, but often struggle with keeping up with best practice dementia service knowledge. The Dementia Wellness Questionnaire was designed to serve as a starting point for discussions between caregivers and family physicians by empowering caregivers to communicate their needs and concerns and to enhance family physicians\' access to specific dementia support information. The DWQ aims to alert physicians of caregiver and patient needs. This pilot study aimed to explore the experiences of physicians and caregivers of people using the Questionnaire in two family medicine clinics in Ontario, Canada. Interviews with physicians and caregivers collected data on their experiences using the DWQ following a 10-month data gathering period. Data was analyzed using content analysis. Results indicated that family physicians may have an improved efficacy in managing dementia by having dementia care case specific guidelines integrated within electronic medical records. By having time-efficient access to tailored supports, family physicians can better address the needs of the caregiver-patient dyad and help support family caregivers in their caregiving role. Caregivers expressed that the Questionnaire helped them remember concerns to bring up with physicians, in order to receive help in a more efficient manner.

To identify the sociodemographic, clinical and epidemiological characteristics associated with the presence of infection by the SARS-CoV-2 virus in family physicians who carry out their work in Primary Care (PC) or in Hospital Emergencies.
Observational analytical case-control study. SITE: Primary care.
969 Primare Care Physicians, Hospital Emergency physicians and other extrahospitalry centers that had PCR for the detection of the SARS-CoV-2. Of these, 133 participated as cases (PCR positive) and 836 as controls (PCR negative).
No.
Sociodemographic and work, contact with a COVID-19 patient, symptoms present during the process, first manifested symptom, previous chronic pathologies, and tobacco use.
13.7% (95% CI: 11.6-16.0) were cases infected with SARS-CoV-2. The most frequently declared symptoms by those infected were a feeling of fatigue/tiredness (69.2%; 95% CI: 60.9-77.4%), cough (56.4%; 95% CI: 47.6-65.2%) and headache (55.6%; 95% CI: 46.8-64.4%).Using logistic regression, the variables independently associated with SARS-CoV-2 virus infection in Family Physicians were: previous contact with a COVID-19 patient (OR: 2.3; 95% CI: 1.2-4.2), present fatigue / tiredness (OR: 2.2; 95% CI: 1.2-3.9), smell alteration (4.6; 95% CI: 1.7-12.5), taste alteration (OR: 32.0; 95% CI: 9.6-106.8), cough (OR: 3.0; 95% CI: 1.7-5.3) and fever (OR: 6.1; 95% CI: 3.2-11.4).
Symptoms independently related to SARS-CoV-2 virus infection in Family Physicians were fatigue, fever, cough, and altered taste and smell. The presence of these symptoms could facilitate the diagnosis of suspected COVID-19 disease and the earlier selection of those that require confirmatory tests.

Given that prescribing practices have contributed to the current opioid epidemic and that primary care clinicians are the largest prescribers of opioids, family physicians must consider the twin goals of safely prescribing opioids for patients with chronic pain while effectively identifying and treating those who have developed opioid use disorder (OUD). However, family physicians may feel constrained by a culture and systems in their offices that do not support achieving these twin goals.
In a family medicine clinic within a larger academic institution that cares for an underserved, multicultural patient population in the greater Boston area, we provide a case study that illustrates the twin goals of safe opioid prescribing and treating OUD. We used 2 models of change management-Lewin\'s Three-Step Change Theory and the McKinsey 7S Model of Change-as a framework to describe our 5-year process of using cultural and structural elements to support these efforts.
Deliberate use of change management theory to support both safe opioid prescribing and treating patients with OUD over the past 5 years resulted in changes to the practices, people, skills, and infrastructure within our clinic. These changes have demonstrated a sense of stability and sustainability and hence now represent our clinic\'s current culture.
The Lewin and 7S models of change can be helpful guides to creating and maintaining a foundation of office-wide culture and structural support to meet the twin goals of safe opioid prescribing and treating patients with OUD.

BACKGROUND: Burnout is a psychosocial syndrome, involving feelings of emotional exhaustion, depersonalization, and diminished personal accomplishment at work. Its occurrence is high in healthcare personnel. Job satisfaction is achieved through the feeling of being professionally competent and is an important condition that prevents burnout syndrome.
OBJECTIVE: This study aimed to determine the impact of family physicians\' thoughts on self-efficacy of family physician\'s core competencies on burnout syndrome in İzmir.
METHODS: The study was a nested case-control study and was carried out within the İzmir province from 2013 to 2014. The subject population included 2185 family physicians working in the family medicine centers in the metropolitan districts of İzmir. A total of 395 family physicians who were employed at family medicine centers agreed to participate in the study. After the assessment according to the Maslach Burnout Inventory, 185 physicians had burnout, whereas 210 physicians did not have burnout. Physicians who had burnout were considered as 50% prevalence in the control group; the sampling size was calculated as at least 138 individuals for unpaired cases and control groups, with 0.05 error margin and 80% power.
RESULTS: While burnout syndrome was detected in 80.0% of physicians who thought that they were incompetent, it was detected in 30.1% of physicians who believed that they were sufficiently competent in terms of core competencies.
CONCLUSIONS: Insufficient belief in core competencies by family physicians increases the occurrence of burnout syndrome in these individuals.

Advance care planning conversations traditionally have been promoted using the Standard of Substituted Judgment and the Standard of Best Interests. In practice, both are often inadequate. Patients frequently avoid these conversations completely, making substituted judgment decisions nearly impossible. Surrogates are also often unable to make clinical decisions representing the best interests of family members as patients. Many physicians are unskilled at discussing these difficult and complex decisions with surrogates as well. Using an integrative family medicine ethics approach, we present a case study that demonstrates how skillful family physicians might introduce and conduct these conversations at routine office appointments, reconciling ethical theory with both patient-centered and physician-centered considerations in a practical and time-sensitive fashion. We believe 3 physician behaviors will help prepare patients to engage their surrogates and help empower surrogates to serve their role well, if and when that time comes: 1) thinking broadly about clinical issues and ethical considerations; 2) engaging in a mindful and contemporaneous deliberation with the patient-and surrogate when appropriate and possible-about these issues and considerations; and 3) cultivating a reflective responsiveness to these interactions, both when things go well and when they do not.