OAR@UM Community:

A qualitative study : the experience of general practitioners with elderly patients with osteoarthritis

2023-07-10T07:19:40Z

Title: A qualitative study : the experience of general practitioners with elderly patients with osteoarthritis Abstract: Background: Osteoarthritis is a degenerative condition commonly effecting elderly patients in the community. There is a "demographic transition" leading to an ageing population. Aim: To perform a qualitative study about how general practitioners (GPs) look at osteoarthritis, its effects on patients' lives as regards the biopsychosocial model. The aim is to analyse the GPs' perspectives about the local available sources and any possible improvements. Methods: Interpretative phenomenological analysis (IPA) was used as it allows discovering the details of each individual GP. Two GPs who have been practising for more than 5 years within the community where selected through the Malta Association for Family Doctors. Snow balling was used to recruit the other two. Semi-structured interviews were then conducted transcribed and analysed. Results: There was a common feeling that dealing with such a common disease is challenging within the community and there is a need for a specialised osteoarthritis clinic in the community to cater for all these patients' needs via a multidisciplinary team. The need for a holistic approach was agreed amongst all the participants. Conclusion: Osteoarthritis is a common, challenging condition which is treated by GPs; but being multi-faceted input from other professionals is required. Description: M.SC.FAMILY MEDICINE

Communication between Primary Health Care and the Emergency Department during transfer of care of patients in Malta

2023-02-22T08:43:19Z

Title: Communication between Primary Health Care and the Emergency Department during transfer of care of patients in Malta Abstract: The main aims of this research are: To understand what doctors working in Primary Health Care and the Emergency Department feel about the current communication system and see what their ideas on improvement are. The main objectives are: To carry out interviews elements of which are based on previous published research on informational needs from both the hospital and community; compare the results obtained from General Practice Physicians and Emergency Physicians; investigate whether there was an agreement in the requirements between the departments regarding improved communication systems and patient care, and finally, to determine which is the preferred system by physicians from working in General Practice and the Emergency Department. The data for this study was collected via semi-structured interviews carried online for convenience and COVID-19 safety measures. The target populations were doctors working in the Emergency Department, Private General Practice and Public General Practice. The data collected was of a qualitative nature. Twelve participants were involved in the study: four from the Emergency Department, four from Private General Practice and four from Public General Practice. The data collected was transcribed, transcripts were then confirmed with the participants, and analysed using the Thematic Analysis method to elicit common themes. These were: Introduction to Roles and Similarities between them; Frequency of Communication; Reasons for Communication; The Current Methods of Communication and Opinions; Recommendations; Nurturing Relationships and Respect; The Physician’s Perception of the Patient’s Experience. The general consensus between the participants was that there was a marked improvement in communication; however, there was still more work to be done. Several participants were in favour of bettering direct contact such as calling. Interpersonal relationships were deemed as an important factor to ameliorate communication. In this regard, most participants agreed that increasing networking events to help get to know each other better would greatly improve this. It was acknowledged that the majority of the data collected and analysed was in agreement with the current literature. Further research should be done regarding this particular subject, to better understand the current local condition of communication and transfer of care between the Emergency Department and General Practice. Description: M.Sc. Fam. Med.(Melit.)

Are family physicians' musculo-skeletal imaging requests indicated for diagnostic or clinical management purposes?

2021-04-12T09:26:43Z

Title: Are family physicians' musculo-skeletal imaging requests indicated for diagnostic or clinical management purposes? Abstract: Research Objectives This research study aimed to address the following objectives: To evaluate the current level of awareness of state health centres general practitioners (G.Ps) about radiation safety and musculo-skeletal imaging referring criteria; To explore the differences between the state health-centres G.Ps’ awareness on these two aforementioned topics in relation to their routes of attainment of the Family Medicine specialization, their years of work experience, their usage of imaging referring guidelines as well as the amount of individually-sought training that has been pursued in relation to radiation safety and the imaging referral criteria; To explore the current beliefs and practices of state health centres G.Ps in imaging referral processes in Malta. Finally, the author also sought to determine whether the patients' exposures to ionizing radiation via plain musculoskeletal radiography are indicated for the diagnostic or clinical management purposes, according to standards defined in the European Commission (Radiation safety 118) Referral Guidelines for Imaging (2001), as well as the Royal College of Radiologists (RCR) i-Refer guidelines (2017). Research Methodology and Data Analysis A non-experimental, exploratory research design was adopted to answer the objectives of this study. Data were collected at two particular points in time; namely through the 694 electronic, musculoskeletal imaging requests that were selected via cluster random sampling, as well as through 39 structured, online questionnaires via non-random, convenience sampling. The data collected were quantitative in nature. The study had a low response rate of 32.8 % from the returned questionnaires, as well as a narrow 3.7 % margin of error (at a confidence level of 95 %) in relation to the analysed imaging request forms. Data were analyzed using descriptive and inferential statistics. A p-value of ≤ 0.05 at a confidence level of 95 % was considered as statistically significant. Results and Discussion On average, the state health centres G.Ps’ awareness on radiation safety measures was lower (mean score of 3.8 out of 9 answers correct / SD 1.9) when compared to their awareness on the musculo-skeletal imaging referral criteria (mean score of 12 out of 16 answers correct / SD 2.1). Moreover, the mean total awareness scores on these two aforementioned topics was noted to be higher in those: G.P. respondents who had obtained their Family Medicine specialization through the completion of the G.P. training programme as opposed to those who have benefited from the grand-father clause; G.P. respondents who have between 3 to 8 years of work experience as opposed to 16 or more years of work exprience, G.P. respondents who have made use of imaging referral guidelines throughout their respective careers; G.P. respondents who have personally taken the initiative to update themselves on the imaging referral criteria. Furthermore, only 20.5 % of plain, musculoskeletal imaging requests that are being referred by state health centres G.Ps are classified as indicated for the diagnostic or clinical management purposes. In addition, 65.3 % of plain, musculoskeletal imaging requests were classified in the not routinely indicated category. The lumbo-sacral spine is the region that has registered the highest number of cases in the not routinely indicated category; being closely followed by the knee and the cervical spine respectively. These findings indicate that there is a greater tendency for state health centres G.Ps to request plain, musculoskeletal imaging investigations which are not routinely warranted according to the European Commission RP118 (2001) or the RCR i-Refer (2017) gold-standard imaging referral guidelines. Moreover, 40.0 % of these imaging requests were also referred with insufficient clinical details. Conclusions and Recommendations Based on the research findings as well as the available literature, the following recommendations are being suggested: Continuing medical education in radiation safety and the imaging referral criteria for state health centres G.Ps and G.P. trainees; Issuing regular departmental memos about any related evidence-based research findings; Ensuring the availability of the imaging referral guidelines on the desktops of all workplace computers, and promoting the use of imaging referral guidelines as well as kindling the safety-net of asking for advice from senior colleagues or radiologists whenever the referrers are in doubt about the management of a particular clinical case; Promoting the development of refinements and updates of locally applicable imaging referral guidelines to address any potential gaps in the older versions; Considering the introduction of a pro-forma clinical checklist for requesting plain imaging investigations on iClinical Manager™, to aid G.Ps in improving the appropriateness of their imaging requests at times of clinical controversy, as well as in providing all the relevant clinical details for reporting; Extending the radiation protection campaign which was founded by the local, state hospital Medical Imaging Department to both the Primary Health Care Department (Malta) as well as to members of the general public and considering the use of radiation protection booklets or posters that may be distributed or show-cased to the patients whilst still in the primary care clinics waiting areas. Description: M.SC.FAMILY MEDICINE

Prevalence of obesity in Maltese children aged 5 and 9 years

2022-05-06T07:02:03Z

Title: Prevalence of obesity in Maltese children aged 5 and 9 years Abstract: Reason for research: The steady increase in body weight noted in many developed countries over the last decades has also been noted in the Maltese population. As a result of childhood obesity, an increased burden at all levels of the healthcare system will occur. This study aims to assess by means of an epidemiological investigation of a representative random sample of Maltese schoolchildren aged 5 and 9 years: • The current prevalence of obesity in Maltese children in a given sample and relate it to other developed countries. • The risk factors which may be associated with the development of childhood obesity. Methodology: This study was carried out on a random sample of a total of 431 children: 220 males (51.1 %) and 211 females (48.9%) representative of the target population. Body Mass Index (BMI) and waist circumference were measured from the study population. On calculation of the BMI, the school children were divided into three groups: lean, overweight and obese using the International Obesity Task Force (IOTF) classification (Cole T.J. et aI, 2000). A validated questionnaire was distributed to the children included in the sample population. The questionnaire was filled out by the parents and assessed child lifestyle characteristics including physical activity, nutrition, family general characteristics and birth weight. Both the anthropometric measurements and the variables assessed in the questionnaire were analysed to examine for any possible associations. Results: The prevalence of childhood overweight / obesity in the five year old children was 28.8% for boys and 32.7% for girls while the prevalence rates for the 9 year olds was 48.9% for boys and 45.1 % for girls. Inter-relationships were found between a history of metabolic disease in parents and obesity in the corresponding children. A statistically significant relationship was found between a history of a lack of breast feeding and obesity in the 5 year old children [p=0.04]. Statistically significant observations between birth weight [p=0.002], anthropomorphic measures [p=0.0l] and physical activity [p=0.002] were noted. Certain observations were also found between physical activity and corresponding obesity in both age groups, as were statistically significant relationships between diet and childhood obesity especially in the nine year olds. The overweight/obese nine year children consumed less fruit juice, milk whole fat and flavoured milk [p=0.03, p=0.004, p=0.03] respectively as compared to their lean counterparts. Discussion: The increase of prevalence of overweight and obese children especially in the nine year olds has reached alarming rates. The 'U' odds-risk pattern described in previous studies as the thrifty phenotype hypothesis of obesity was noted in this study. Here the nine year olds born in both the low [<2500g] and high birth weight [>4000g] groups showed to have higher anthropomorphic measures as compared to the children who were born of a normal birth weight [2500-3900g]. Obese children could be spending more time performing passive activities instead of sleeping. It was also noted that the obese nine year olds were deliberately restricting the consumption of energy dense food in order to control weight. Conclusion: The family physician is ideally placed to directly help reduce the impact of childhood obesity on the eventual health of the individual and indirectly reduce the demands placed on the health services. Childhood obesity has to be monitored more closely by the family physician especially with children exhibiting risk factors to becoming obese. These include children born of a low and high birth weights, lack of breast feeding, and a history of metabolic syndrome in the parents. Description: M.SC.FAMILY MEDICINE