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The landscape of medical specialty choice is dynamic, undergoing significant changes as students' progress through undergraduate and graduate medical training. These shifts are influenced by various factors, with financial considerations becoming increasingly relevant among medical students' preferences. This study conducts a retrospective analysis of specialty match rates and physician compensation, suggesting a potential trend where primary care fields, though fundamental to healthcare, appear less competitive and often associated with less financial reward compared to other specialties. The existence of this disparity is not without consequences. It contributes significantly to the ongoing and anticipated primary care physician shortages. This situation requires a comprehensive approach to tackle the complex factors influencing medical students' career choices. Understanding these dynamics is critical for healthcare policy and planning. This paper investigates how financial considerations sway medical students' specialty choices, emphasizing the economic disparities between primary care and other specialties.

The purpose of this qualitative study was to identify and prioritize the mental health needs of rural communities in Texas Public Health Region 11 utilizing the Delphi method. Rural individuals face unique challenges when attempting to receive treatment for serious mental illness and mental health care. Stigma, a lack of privacy when seeking treatment, a shortage of mental health workforce professionals, a lack of culturally competent care, affordability, and transportation are all factors that complicate the need for treatment. This study utilized the Delphi method to engage rural community members in identifying and addressing critical issues related to mental healthcare delivery in their county. The sample for this study was selected from the population which comprise Texas Public Health Region 11 communities that were identified as rural communities within Health Professional Shortage Areas (HPSA) using an exponential nondiscriminatory snowball sampling method. Knowledge gained from the study will help to address challenges and critical issues in mental healthcare delivery in rural communities, such as workforce shortages, access issues, anonymity, stigma, integration of mental health services into primary care, and suicide prevention. The study's implications for refining, developing, and increasing rural mental health research, and implications for practice for mental health treatment providers in rural communities are discussed.

The integration of behavioral health care within primary care settings, otherwise known as integrated care, has emerged as a treatment modality for counselors to reach a wide range of clients. However, previous counseling scholars have noted the lack of integrated care representation in counseling journals. In this scoping review, we identified 27 articles within counseling journals that provide integrated care implications. These articles appeared in 10 unique counseling journals, and the publication years ranged from 2004-2023. Articles were classified as: (a) conceptual, (b) empirical, or (c) meta-analyses and systematic reviews. The data extracted from the articles focused on the implications for integrated care training and practice for the next generation of counselors, evidence-based treatment approaches, and future research directions.

Attention-deficit hyperactivity disorder (ADHD) is among the most commonly diagnosed disorders of children and youth. Young people receive their ADHD diagnoses and medical treatment in primary health care settings and can experience a range of behavioral and educational disabilities treated in the clinic, at home, and at school. We propose a team-based collaborative care model (TBCCM) to foster communication and collaboration among health care and education teams, embedding implementation science methods to promote and sustain evidence-based practices for youth with ADHD. Key features of the model include (a) effective leadership and teamwork within the two universal systems of education and health care, (b) use of data from multiple informants who describe and monitor student behavior within and across contexts, and (c) adoption and adaptation of evidence-based practices. We expect that these efforts to embed implementation science methods within a collaborative team structure will improve the uptake of evidence by intervention teams in the two systems, and thus optimize outcomes for children and youth with ADHD.

Modern communication between health care professionals and patients increasingly relies upon secure messages (SMs) exchanged through an electronic patient portal. Despite the convenience of secure messaging, challenges include gaps between physician and patient expertise along with the asynchronous nature of such communication. Importantly, less readable SMs from physicians (e.g., too complicated) may result in patient confusion, non-adherence, and ultimately poorer health outcomes. The current simulation trial synthesizes work on patient physician electronic communication, message readability assessments, and feedback to explore the potential for automated strategy feedback to improve the readability of physicians' SMs to patients. Within a simulated secure messaging portal featuring multiple simulated patient scenarios, computational algorithms assessed the complexity of SMs written by 67 participating physicians to patients. The messaging portal provided strategy feedback for how physician responses might be improved (e.g., adding details and information to reduce complexity). Analyses of changes in SM complexity revealed that automated strategy feedback indeed helped physicians compose and refine more readable messages. Although the effects for any individual SM were slight, the "cumulative" effects within and across patient scenarios showed trends of decreasing complexity. Physicians appeared to learn how to craft more readable SMs via interactions with the feedback system. Implications for secure messaging systems and physician training are discussed, along with considerations for further investigation of broader physician populations and effects on patient experience.

Interprofessional education (IPE) is championed as an innovative approach to prepare the future health workforce to address the complex needs of consumers and tackle a range of contemporary healthcare challenges worldwide. An interprofessional work-integrated learning experience (WIL), whereby students were immersed in international and rural settings and worked in teams to deliver primary healthcare project outcomes, was developed, implemented, and evaluated with undergraduate health students. Qualitative evaluation of the IPE program aimed to investigate the experiences and perceptions of 62 students through focus group interviews, is reported. Students regarded the placement as a rich learning environment and reported positive experiences in interprofessional collaborative competencies. Major themes included: overall perceptions and attitudes, scope of practice, improved teamwork skills, future practice, and placement preparation. Students strengthened their learning with, from and about other professional groups and identified challenges and implementation issues. Findings from this study will inform future implementation of interprofessional WIL experiences.

The coordination of primary and behavioral health care that holistically targets clients' physical and mental needs is known as "integrated care." Primary care is increasingly becoming a de facto mental health system because of behavioral health care shortages and patient preferences. Primary care behavioral health (PCBH) is a gold standard model used to assist in the integration process. Although counselor training addresses some aspects of integrated care, best practices for counselor education and supervision within the PCBH framework are underdeveloped. This article provides an overview of the Program for the Integrated Training of Counselors in Behavioral Health (PITCH). The authors discuss challenges in implementation; solutions; and implications for counselor training, clinical practice, and behavioral health workforce development.

The objective of this study was to present lessons learned about engagement, delivery modality and pandemic impact while delivering a collaborative care intervention with a socioeconomically, racially and ethnically diverse sample. Participants completed a post-intervention survey (n = 41) on experiences and preferred intervention delivery modality, coronavirus 2019 (COVID-19) Impact Survey (n = 50) and provided open-ended feedback about the intervention (n = 27). Intervention process data included attendance, modality, and withdrawals. Data were analyzed using descriptive statistics and inductive content analyses. Of 71 intervention participants, 6 (8%) withdrew before session 1. Completers adhered to intervention timeline better than withdrawals. Participants liked the in-person interaction, efficient coach support, accountability of in-person and Zoom vs. phone sessions and the flexibility and convenience of phone and Zoom vs. in-person sessions. A majority of participants reported experiencing pandemic impacts such as heightened emotional distress, decreased activity engagement, poorer eating behaviors and being unable to meet basic needs. Participants deviating from intervention timelines may be re-engaged by targeted outreach attempts. Videoconference has the potential for providing as-needed coaching. Future interventions may be optimized to account for and address areas impacted by the pandemic. Findings revealed specific strategies that can be implemented in future interventions to improve emotional and physical health among diverse populations.

Purpose: Nutrition education through low cost information and communication technologies could improve the quality of health service delivery and build up health workers' capacity especially at the primary health care level. The study examined the utilization of Information and Communication Technologies (ICT) for nutrition education in Imo state, Nigeria. Methods: Multi-stage sampling procedure was used to select 111 community health workers, out of which 95 were subjected to analysis. Questionnaire was used to collect primary data from community health workers. Data were analysed using descriptive and inferential statistics at a[subscript 0.05]. Results: The respondents' age was 37.74 ±8.49 years; data obtained indicated that there were more female community health workers (85.3%) than male (14.7%). All the respondents had more than one year of working experience with 29.5% of them having between six to ten years work experience. Respondents had low usage (9.83±6.90) of ICTs for nutrition education, however Global System for Mobile (GSM) communication ranked highest (1.74 ± 0.65) among the available ICTs used. Nutritional knowledge of community health workers was high, and most of them had favorable perception to the use of ICTs. Inadequate instructors ranked as the highest limiting factor to use of ICTs (X[bar] = 1.34). Availability of ICTs was significantly (r = 0.433) related to utilization of ICTs for nutrition education, while there is no significant difference (t = -1.55) in the utilization of ICTs for nutrition education between community health workers that received in-service training and those that did not. Conclusion: Respondents' were favorably disposed to ICTs' use for nutrition education, but its utilization was low.

This study focuses on interprofessional learning and education in collaborative care teams in primary health care. Using a case study methodology, the researcher collected data through semi-structured interviews and document analysis. Through purposeful sampling, the study explores the experiences of five diverse health professionals (two nurses, two dietitians, one physician) working within collaborative care. A critical incident framework approach was used to identify interprofessional learning themes, which were classified as collaborative, continuous, and reflective. The study identified enablers to interprofessional learning as supportive time and space, trusting relationships, and shared values among team members. The interpretive framework of this study aligned experiential learning, situated cognition, and reflective practice learning theories to support the interprofessional learning process within collaborative practice teams. The study affirms the importance of informal interprofessional learning among health-care professionals.

Worksite wellness programs continue to demonstrate a high return on investment by controlling and reducing employer shares of health care expenditures. Health risk assessments (HRA) are commonly used to establish priorities. This crosssectional study utilized an online HRA grounded by constructs from the Health Belief Model and the Theory of Planned Behavior. An online anonymous survey was disseminated to employees at an urban academic-medical institution, n=816 responses were obtained for a 12% response rate. The majority of respondents were female. Seventy-one percent (71%) of employees believed they were at-risk for pre-diabetes/diabetes, 49% perceived they were at risk for high blood pressure, and 43% indicated they were at risk for depression. Less than 10% reported their health status as being excellent. One in five respondents were unable to see a primary care provider (PCP) due to challenges in their life and 14% did not have a PCP. The average employee exercises 3-4 times per week and consumes on average 12.41 servings of fruits and vegetables per week. Self-efficacy was associated with intention (r(702) = 0.45, p = <0.001). The results indicate insufficient achievement of health behaviors and the need for evidence based programs that encourage self-efficacy, accountability, and positive perceived norms.

Background/Objective: Competency in health professions education when separated from culture is a 'detached mastery' of a discreet skill; there are no values considered, no human behind the understanding. This can result in an uneven understanding, proficiency, and commitment concerning individuals' cultural differences. To increase cultural competency and improve care delivery to veterans, health professional students, participated in an interprofessional education immersion with clinical practicum at a Veteran's Administration primary care clinic. Methods: Fifty-four graduate students from nursing, clinical psychology, pharmacy and social work participated in an interprofessional education course on military culture. Students' knowledge and attitudes concerning veterans were evaluated at the start and end of the 8-week immersion course. Results: In both the Knowledge Assessment, a 10-item survey covering the core aspects of the course content, and Health Professionals' Attitudes Toward Veterans Scale, student knowledge and attitudes improved relating to veterans care. Conclusions: Veterans seeking care in veterans' and civilian facilities require a culturally competent health professional workforce. Interprofessional education coursework specifically focused on veterans and military culture has shown promise in increasing knowledge and compassion in health professional students working with veteran patients.

Background: Rates of child insurance coverage have increased due to expansions in public programs, but many eligible children remain uninsured. Uninsured children are less likely to receive preventative care, which leads to poorer health and achievement in the long term. This study is an evaluation of a school-based health insurance outreach initiative, ''Healthy and Ready to Learn,'' aiming to identify and enroll uninsured kindergarteners in areas of high economic need in 16 counties in North Carolina. Methods: Regression discontinuity design and difference-in-differences analyses were used to estimate the effect of the initiative on Medicaid and CHIP enrollment (primary outcome) and preventive care use (well-child visits; secondary outcome). Focus groups and key-informant interviews were conducted to assess best practices and identify barriers to outreach for child enrollment. Results: The initiative increased enrollment rates by 12.2% points and increased well-child exam rates by 8.6% points in the RD models, but not differences-in-differences, and did not significantly increase well-child visits. Conclusions: Findings demonstrate the potential benefits of using schools as a point of intervention in enrolling young children in public health insurance and as a source of trusted information for low-income parents. [This article is published in "Journal of School Health" (EJ1163159).]

This study aimed to identify patients' sub-groups through measures of socio-demographic variables, alcohol consumption and alcohol health literacy. Instruments were administered to a sample of 118 patients in Colombia. Multiple Correspondence Analysis (MCA) was used to identify subgroups of individuals with common characteristics. Two groups were identified: one of women with good knowledge about alcohol consequences, low acceptability of regular alcohol intake, lower levels of alcohol drinking, and less openness to discussing alcohol with health practitioners; and one of men with lower levels of knowledge, higher levels of cultural acceptability of drinking, higher levels of consumption, and more openness to discussing alcohol. Results indicate that the higher the risk of alcohol, the more openness to discussing alcohol with health practitioners.

The use of evidence-based smoking cessation interventions (SCIs) can significantly increase the number of successful smoking cessation attempts. To obtain an overview of the knowledge and viewpoints on the effectiveness and use of SCIs, a three-round online Delphi study was conducted among researchers and primary care professionals (PCPs). The four objectives of this study are to gain an overview of (i) the criteria important for recommending SCIs, (ii) the perceptions of both groups on the effectiveness of SCIs, (iii) the factors to consider when counseling different (high-risk) groups of smokers and (iv) the perceptions of both groups on the use of e-cigarettes as an SCI. We found a high level of agreement within groups on which smoker characteristics should be considered when recommending an SCI to smokers. We also found that PCPs display a lower degree of consensus on the effectiveness of SCIs. Both groups see a value in the use of special protocols for different (high-risk) groups of patients, but the two groups did not reach consensus on the use of e-cigarettes as a means to quit. Making an inventory of PCPs' needs regarding SCIs and their usage may provide insight into how to facilitate a better uptake in the primary care setting.

Background/Objective: The number of veterans and their families seeking healthcare and support within civilian communities is increasing worldwide. There is a need for healthcare providers to provide sensitive, comprehensive care for veterans with both physical and behavioral health conditions. Many civilian providers are unfamiliar with veterans' issues and need training on military culture and combat experiences in order to provide compassionate, high quality care. An interprofessional (IPE) course to increase health professional students' understanding of military culture and the associated health problems of veterans was implemented and evaluated. Methods: An 8-week IPE immersion course was offered for students with clinical experience at a Veterans' Health primary care clinic and a didactic component. The class content included military culture, behavioral and physical health disorders common among veterans, and the related behavioral and pharmacological treatments. Faculty-led discussions with students in IPE teams used veteran-focused case studies and standardized patients to prepare students to work in IPE teams in the clinical care of veterans. Results: This educational project was evaluated using quantitative surveys and qualitative reflection questions and focus groups. Students scored high for readiness for interprofessional learning pre-course. Post-course students reported valuing the team approach to veterans care and students engaged in high levels of communication and collaboration within the team. Students' knowledge scores increased related to understanding of military culture and their patient advocate role. Conclusions: Students learned about military culture and the provision of humanistic, high quality care for military veterans in this clinical and didactic immersion IPE course.

The computer-based information system (CBIS) is adopted by almost all of in health care setting, including the primary health center in East Java Province Indonesia. Some of softwares available were SIMPUS, SIMPUSTRONIK, SIKDA Generik, e-puskesmas. Unfortunately they were most of the primary health center did not successfully implemented. This study applied the Unified Theory of Acceptance and Use of Technology (UTAUT) to assess intention and usage of CBIS in East Java. It was a cross-sectional survey, conducted on February-Maret 2015. A total 30 of user CBIS were identified and questioners were distributed which 100% completed. The user's CBIS intention was significantly influenced by performance expectancy, effort expectancy and social influence. CBIS usage was significantly influenced by user's intention and facilitating conditions. UTAUT results indicated that the facilitating conditions have a major impact to use of CBIS in primary health center. The results of this study can be helpful to the East Java provincial Health Office to adjust their program strategies and tactic for providing user's CBIS facilities in order to implement CBIS successfully.

We review the development of the Jamaican home visiting intervention for children under 4 years and its evidence base. The intervention has focused on supporting mothers to promote the development of their children through interacting in a responsive way, labelling the environment and activities. The curriculum is structured and cognitively orientated. It has been used in 13 studies in 4 countries, 7 in Jamaica, 6 in Bangladesh, one each in Colombia and Peru. In all studies some benefit to children's cognitive and language development has been found. Different types of children from severely malnourished to children living in poverty have benefited. Three long term follow ups have found sustained benefits to cognition; the longest study went to 22 years and found comprehensive benefits, to behaviour, school attainment and achievement, IQ, depression and wages. The curriculum is currently being used in 8 different countries and different delivery strategies are being evaluated including mother and child groups with meetings of different frequencies. A web package, Reach Up, to facilitate training with manuals and demonstration videos has been developed. Some unanswered questions include, what is the most effective age and duration for the intervention to have sustained benefits? Research is needed to find cost-effective implementation models and how to monitor and maintain intervention quality when going to scale.

Back ground and objectives: Self-medication is the use of medicines by the people on their own inventiveness or on the suggestion of others without consulting a qualified health care professional; its practice is continuously increasing worldwide. The aim of this study was addressing the prevalence of self-medication in Erbil city. Methods: This cross sectional, health care center based study was conducted in five primary health care centers of Erbil city, data was collected by direct interviewing with 500 adult patients by using questionnaire. Results: The Prevalence of self-medication was 52.6%, 64.6% of the users practiced it in the past 2 weeks before the survey, significant association was found between its practice and; urban residency (p value <0.001), high socio-economic status (p value 0.004), hearing about side effect (p value 0.013), and patients who experienced side effect (p value <0.001), self-medication was for many reasons; most commonly due to previous benefit (41.7%). Medications were got from pharmacy by (70.5%); source of information about the used drug was mostly from previous prescription (44.1%). Analgesics and antibiotics were the most frequent drugs used by the respondents. Common cold was the most common condition for which drug was used without prescription followed by headache. Conclusion: Self-medication is a common practice in Erbil-city, its prevalence varied significantly with a number of socio-demographic factors and some patients' knowledge and practices about the drugs. Many patients can easily practice self-medication for the management of wide range of conditions whether simple or not. The pharmacies are the main source of getting medications.

Context: Review of the origins, history, and attributes of primary care demonstrates continued challenges for the future of primary care and care delivery. The profession of athletic training may benefit from a critical self-review to examine its readiness to assist in reinventing primary care. Objective: To explore parity between primary care attributes and athletic training practice and promote a timely and relevant discussion of primary care and public health integration native to athletic training practice, competency-based education with an emphasis on milestones, and the development of clinical specialists to prepare a well-trained workforce. Background: General practitioners developed educational reforms through graduate medical education that resulted in primary care as it is known today. Graduate medical education has refined its assessment of students to include milestones for the purpose of describing the progression of clinical competence with identifiable behaviors. The development of future clinical specialists in primary care will also involve competence in public health. Recommendation(s): Practicing clinicians and educators should begin to critically explore the congruencies between the primary care attributes and athletic training practice. It is important to conceptualize traditional models of care within the frameworks of primary care and public health, given that athletic training practice routinely engages patients at personal, community, and environmental levels. The athletic training skill mix should be purposefully presented within interprofessional health care teams in primary care so that stakeholders can appropriately integrate athletic trainers (ATs) at the point of first contact. It is plausible that continued structural changes in the traditional practice settings will be required to facilitate integration of ATs into primary care. Conclusion(s): The impact of ATs in ambulatory settings and primary care possesses a foundation in the current literature. The ATs are uniquely suited to create a symbiotic pattern of care integrating both primary care and public health for improved outcomes.

Introduction: Commercial Sexual Exploitation of Children (CSEC), which encompasses acts of domestic minor sex trafficking, is a hidden problem in the U.S. that affects an estimated 300,000 children. Significant health impacts to victims include violence, substance abuse, mental illness, sexually transmitted diseases, and unintended pregnancy. However, due to the covert nature of sexual exploitation, the lack of understanding among service providers and law enforcement, and complex psychological factors experienced by victims, identifying CSEC is a tremendous challenge. Primary care providers can play a critical role in identifying CSEC victims within clinical settings to help address this silent epidemic. Objective: The goal of this project was to assess the prevalence of CSEC using a clinic-based screening tool within a community health center serving indigent populations, with a large proportion of the patients being of Asian and Pacific Islander descent. Methods: Medical charts were reviewed of young female patients (n=621) between 13-23 years of age and seeking clinical services in Asian Health Services' Teen Clinic from 2008 through 2011, during the implementation of a clinic-based CSEC screening tool used by primary care providers. The CSEC screening tool consists of two questions about sexual exploitation. Results: Of the 621 patients in the study, 57.5% were Asian and Pacific Islander. Clinical providers applied the CSEC screening tool on 28.5% (n=177) of female patients in the study. Of the 177 patients who were screened, 7.3% (n=13) responded positive to questions about commercial sexual exploitation. Discussion: Using a clinic-based screening tool with patients who have identified risk factors helps primary care providers identify CSEC victims and link them to available resources. Under-reporting among victims and under-screening among providers remain major considerations in estimating CSEC prevalence. To address under-screening, it is important to raise awareness among primary care providers around the CSEC epidemic and their potential role for intervention, including screening for a history of sexual exploitation among youth patients.

Interprofessional education may be defined as an occasion when two or more professions learn with, from, and about each other in order to improve collaboration and quality of care. We studied the self-reported experiences from Norwegian health care students participating in interprofessional workplace learning in primary care. We discuss the results particularly in light of self-determination theory. During 2012, 24 students from eight different health educations at the University of Bergen and Bergen University College participated in interprofessional learning in primary care organized by the Center for Inter-professional Workplace Learning in Primary Care, Bergen. The students had their training in nursing homes and public health clinics, and they wrote reflective notes describing their learning experiences. The material was analyzed by systematic text condensation. The qualitative data analyses revealed five major areas of learning experiences from workplace practice: learning in an interprofessional setting, teamwork, relationships among the teamwork members, consequences for the patient, and consequences for the future. The results indicate that there is a high degree of learning potential in interprofessional workplace activity in primary care. This kind of learning strategy is an important supplement to traditional training within all health professions.

The use of traditional medicine as alternative or complimentary therapy is gaining prominence in primary health care worldwide. This is because of the efficacy in the management of mild, chronic seemingly incurable ailments/diseases. Though the publicity is on the increase from country to country in the world, however, one cannot conclude that the information has reached all classes of people. This study therefore investigated identification, knowledge and consumption practice of herbal medicine among the hearing-impaired. The study adopted survey research design. A total of 50 students with hearing impairment were selected from different locations in Ibadan, Oyo State, Nigeria. Traditional medicinal inventory was used to collect data with reliabilities of 0.72, 0.80 and 0.67 respectively based on perception, knowledge and consumption practices. Two research questions were answered and two hypotheses tested. Result revealed wrong perception and low knowledge of traditional/alternative therapy. Also, there was no significant difference in the identification and consumption practice and no significant influence of religion on consumption practice among the respondents. Based on the results, it is recommended that proper education should be given to students with hearing impairment about traditional medicine.

Purpose: This paper aims to present a literature review of the health workforce, hospital and clinic systems, infrastructure, primary care, regulatory climate, the pharmaceutical industry and community health behavior of the Kenyan health-care system with the purpose of providing a thorough background on the health-care environment in Kenya. Design/methodology/approach: A systematic literature review was conducted using Pub Med, searching for "Kenya" in the title of articles published from January 1, 2015 to February 24, 2016; this provided a broad overview of the type of research being conducted in Kenya. Other data provided by governmental agencies and non-governmental agencies was also reviewed to describe the current state of population health in Kenya. Findings: An initial review of 615 Pubmed articles included 455 relevant articles. A complete review of these studies was conducted, resulting in a final sample of 389 articles. These articles were categorized into three main subject areas with 14 secondary subject areas (Figure 1). Research limitations/implications: The narrow scope of the search parameters set for the systematic review was a necessary limitation to focus on the most relevant literature. The findings of this study provide a thorough background on health care in Kenya to researchers and practitioners. Originality/value: This compilation of data specific to Kenya provides a detailed summary of both the country's health-care services and health status, focusing on potential means of realizing increased quality and length of life.

Background: Point of care ultrasound (POCUS) is increasingly used in primary care. This study seeks to determine the educational needs of primary care physicians. Methods: All primary care practitioners in Calgary, Alberta, on the electronic departmental newsletter distribution list were invited to participate in an online survey. Interests in learning 25 POCUS applications and 9 procedures were assessed using a 5-point Likert scale. Results: Of the 1394 members on the distribution list, 96 responded. Of these, 88 completed the survey. The majority of the participants (n = 69, 78%) were office-based while 19 (21%) were hospital-based. The top applications for office-based participants included: (1) confirming fetal heart rate, (2) assessing fetal lie, and (3) confirming intrauterine pregnancy. For hospital-based participants, these were: (1) assessing soft tissue/superficial abscesses, (2) looking for ascites, and (3) confirming volume status of the patient. Of the 75 participants who perform procedures, both office- and hospital-based participants were most interested in learning incision and drainage for superficial abscesses and joint aspirations/injections; other procedural interests significantly differed between the two groups. Conclusions: Interests of office-based primary care practitioners in learning POCUS differed significantly from hospital-based practitioners. We recommend that separate office vs. hospital practice streams be offered to address their educational needs.

With the increasing survival of cancer patients, primary care residents must be familiar with the late effects of cancer treatment and be able to offer appropriate survivorship care in partnership with cancer care specialists. To address these paired public health and educational needs, an interdisciplinary group at our institution is developing, implementing, and evaluating an online cancer survivorship curriculum for primary care residents. In the development phase of our survivorship curriculum we administered an online needs assessment survey questionnaire and conducted a focus group interview with the family medicine residents at our institution. Residents indicated that they rarely utilized survivorship care plans or explicitly negotiated a program of shared patient care with the patient's cancer specialists. Less than satisfactory elements of cancer survivorship education were identified. Cancer survivorship care is common in family medicine residency care and opportunities exist to improve education, care, and collaboration.

The challenges of resolving the oral health disparities among children and other vulnerable populations requires a well-organized community safety net, along with a sincere commitment to prioritize the elimination of this common, but preventable, dental disease. Adequate funding for basic health needs, while incorporating oral health care into a comprehensive primary care model in our neighborhoods provides the best chance for a successful outcome. In order to build better communities for our children, improvement in the access and delivery of dental care must be part of the equation.

From a perspective of patient-centered healthcare, exploring patients' (a) preconceptions, (b) treatment experiences, (c) quality of life, (d) satisfaction, (e) illness understandings, and (f) design are all critical components in improving primary health care and research. Utilizing qualitative approaches to discover patients' experiences can provide valuable information for practitioners and investigators alike. In this paper, the author describes how researchers can select from among five major qualitative designs (i.e., primary qualitative research, qualitative evaluation, collaborative inquiry, mixed method, and qualitative meta-study) and five preeminent qualitative methodologies (i.e., descriptive, phenomenology, grounded theory, ethnography, and narrative) to create studies to meet their patient-centered research needs.

Imagine a partnership of university and community which addresses the needs of the community to keep its citizens healthy as long as possible. Through a planning exercise to address the community's needs in primary health care and health promotion, the university has developed key strategic directions to help support the needs of the community it serves. This inter-professional education and practice initiative serve to change health care delivery through the education of practitioners who, by working in teams with the community, will actively improve health and health outcomes. With specific interest in the explosion of diabetes within the surrounding community, teams of students and faculty are working to improve high risk groups for diabetes by involvement in health education, physical fitness and coaching activities. Through positioning of inter-professional teams in our community engagement center, the prevention and management of this key health issue is addressed. This center is located in a high poverty and immigrant area, with a high predisposition for diabetes. Academic and community partnerships for action are highlighted in this paper. (Contains 4 figures.) [This paper was presented at the International Conference on Health, Wellness & Society, Berkeley, CA, Jan. 20, 2011.]

Given the chorus of approval for primary care emanating from every party to the health reform debate, one might suppose that the future for primary physicians is bright. Yet this is far from certain. And when one looks to history and recognizes that primary care medicine has failed virtually every conceivable market test in recent years, its prognosis is--to use doctor jargon--"guarded" at best. Primary care careers do not appeal much to today's American medical students. General practitioners, sensing both a loss of status and not wanting to be left behind professionally, began renaming themselves family practitioners and extending their own residency training after medical school to equal that of the internists. Naturally, this blurred the difference between the two groups of doctors and added to the difficulty of defining what is meant by "primary care." The entry of nurse practitioners only added to the confusion. These uncertainties contribute to the sinking status of primary care medicine. In this article, the author talks about primary care's dim prognosis and focuses on the negative aspects of primary care since they help explain the difficult predicament for primary physicians and for those thinking of a career in primary care. The author suggests that, if government and insurance carriers believe that patients need reminders to have evidence-based health screening, they should send them out directly. He stresses that the public health role of primary physicians must be reexamined. The author also suggests that primary care physicians must be allowed to work more sensibly than they are now and provides a real-life example.

Purpose: The purpose of this paper is to present proposed solutions and interventions to some of the major barriers to providing adequate access to healthcare in Kenya. Specific business models are proposed to improve access to quality healthcare in low- and middle-income countries. Finally, strategies are developed for the retail clinic concept (RCC). Design/methodology/approach: Google Scholar, PubMed and EBSCOhost were among the databases used to collect articles relevant to the purpose in Kenya. Various governmental and news articles were collected from Google searches. Relevant business models from other sectors were considered for potential application to healthcare and the retail clinic concept. Findings: After a review of current methodologies and approaches to business and franchising models in various settings, the most relevant models are proposed as solutions to improving quality healthcare in Kenya through the RCC. For example, authors reviewed physician recruitment strategies, insurance plans and community engagement. The paper is informed by existing literature and reports as well as key informants. Research limitations/implications: This paper lacks primary data collection within Kenya and is limited to a brief scoping review of literature. The findings provide effective strategies for various business and franchising models in healthcare. Originality/value: The assembling of relevant information specific to Kenya and potential business models provides effective means of improving health delivery through business and franchising, focusing on innovative approaches and models that have proven effective in other settings.

Malpractice litigation is an increasing concern in general practice and other healthcare services but possibly is susceptible to changes in education schemes. In this study using Danish register data, we aimed to investigate the association between general practitioners' risk of becoming involved in a malpractice complaint in a 1-year time frame and their educational trajectory. Greater age at graduation was associated with increased odds of later complaints, but decreased odds of complaints leading to critique by a disciplinary board. In addition, the time following specialisation, in particular, was associated with increased odds of complaints. Complaint occurrence appeared unrelated to place of education. These findings suggest that, from the point of view of complaints, attention may reasonably be drawn to the significance of medical education and continuing professional development.

In 1978, the World Health Organization (WHO) and the international health community convoked a conference in Alma-Ata, Kazakhstan, to address global inequalities in health. The conference resulted in the publication of the "Declaration of Alma-Ata," which made the ambitious call "for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all the people of the world." In addition, a new tool, primary health care, was developed to carry out this project. In this research project, the author examines the district of Kedougou and the conditions of health and of primary health care therein as they are defined in the "Declaration of Alma-Ata." Kedougou provided a well-focused lens through which to analyze the principles of primary health care and the goals set out in the "Declaration of Alma-Ata"; and, conversely, the "Declaration of Alma-Ata" provided a framework through which to gauge the health problems, their causes, and the possible solutions in the district of Kedougou. Before focusing specifically on Kedougou, the author attempts to put the conditions of health of Kedougou and of Senegal into context by examining international differences in health--specifically between the United States and Senegal. The "Results" portion of this paper examines the official structures of primary health care that are concentrated in the city of Kedougou. One of the main focuses in the "analysis" portion of this paper is the "related sectors" of "community development," such as agriculture and nutrition, in the rural areas of Kedougou. Finally, because health is defined in the "Declaration of Alma-Ata" as not only "the absence of disease and infirmity," but also as a "state of complete physical, mental, and social wellbeing," the cultural practices surrounding seeking and giving health care are also briefly examined in the "Analysis." The author concludes that solutions to the main health problems of Kedougou, or of any community for that matter, are not to be found in documents. Instead, all feasible solutions and successful actions for improvement in health must be found within the community concerned. Not only are the main health problems best understood by the community itself, but any successful attempt to resolve them cannot be carried out without the active participation of the community. (Contains 21 notes.)