To determine the practices, knowledge and opinions of health care providers regarding a prenatal genetic screening program in Ontario.
Cross-sectional self-reported survey.
Ontario.
Random sample of ...2000 family physicians, all 565 obstetricians and all 62 registered midwives in the province. Among subjects who were eligible (those providing antenatal care or attending births) the response rates were 91% (778/851), 76% (273/359) and 78% (46/59) respectively.
Which patients were offered maternal serum screening (MSS), how results were being communicated, knowledge of the test's sensitivity, likes and dislikes about MSS and recommendations regarding the program.
Most (97%) of respondents stated that they were offering MSS to the pregnant women in their practices; 88% were offering it routinely to all pregnant women (87% of the family physicians, 90% of the obstetricians and 100% of the midwives). Most (92%) of the respondents stated that they communicate positive results to their patients personally as soon as they are received; 23% did so for negative results. The respondents correctly identified the initial positive rate but underestimated the false-positive rate. About one-third did not respond to these knowledge questions. Of those who gave feedback on the screening program, 50% recommended that it not be changed, 29% suggested that it be changed, and 22% recommended that it be scrapped.
Participation in the Ontario Maternal Serum Screening Program by health care providers has been good, although knowledge about MSS is far from ideal. Many providers have reservations about the program. In light of concerns raised about the high false-positive rate and the anxiety such results generate in pregnant women, there is a need for more education of providers and patients and a better understanding of women's experiences with genetic screening.
The Ontario Maternal Serum Screening (MSS) Program was introduced by the Ontario Ministry of Health as a province-wide pilot project in 1993. The objective of this study was to determine the ...influence of practice location on Ontario health care providers' use of and opinions regarding MSS, access to follow-up services and recommendations about the program.
A questionnaire was mailed to a random sample of 2000 family physicians, all 565 obstetricians and all 62 registered midwives in Ontario between November 1994 and March 1995.
Among providers who were eligible (those providing antenatal care or attending births) the response rates were 91.4% (778/851), 76.0% (273/359) and 78.0% (46/59) respectively. Fewer respondents in the Northwest region (71.4%) and in rural areas (81.9%) stated that they routinely offer MSS to all pregnant women in their practices compared with respondents in other regions (84.4%-91.5%) and urban centres (90.1%). Fewer respondents in the northern regions (Northeast 49.2%, Northwest 25.0%) than in the Central East region (includes Toronto) (76.6%) felt that follow-up services were readily available. Respondents in the northern regions had less favourable opinions of MSS than those in the other regions in terms of its complexity, cost, the time involved in counselling and the high false-positive rate. More respondents in the Central East region (64.6%) and in urban centres (52.9%) recommended not changing the MSS program than did those in the Northwest (7.1%) and rural areas (39.8%). After provider characteristics were controlled for in a logistic regression analysis, practice location was not the most important factor. Instead, the model showed that respondents who cared for 50 or more pregnant women in the previous year were more likely to offer MSS routinely (OR 2.00, 95% CI 1.21-3.27) and that those who felt that patient characteristics affect the offering of MSS (OR 0.42, 95% CI 0.26-0.67) or that follow-up services were not readily available (OR 0.33, 95% CI 0.20-0.55) were less likely to offer it.
Health care providers in northern and rural Ontario were less likely to offer MSS routinely than those in other regions and were more likely to recommend changing or eliminating the program. Providers' concerns about the social and cultural sensitivity of MSS and the availability of follow-up services affected use.
To describe Ontario emergency physicians' knowledge of colleagues' sexual involvement with patients and former patients, their own personal experience of such involvement, and their attitudes toward ...postvisit relationships.
Mailed survey.
Ontario.
Emergency physicians practising in Ontario.
Of 974 eligible mailed surveys, 599 (61.5%) were returned. Of these respondents, 52 (8.7%) reported being aware of a colleague in emergency practice who had been sexually involved with a patient or former patient. When describing their own behaviour, 37 respondents (6.2%) reported sexual involvement with a former patient. However, of this group, only 9 (25.0%) had met the patient in an emergency department. Thus, of the total number of respondents, only 1.5% (9/599) reported sexual involvement arising out of an emergency department visit. Most respondents (82.4%) agreed that it is inappropriate behaviour to ask a patient for a date after an emergency assessment and before the patient's departure, and 66.4% felt that it is inappropriate to contact the patient after discharge. However, only 10.6% believed it to be unacceptable to request a social meeting after encountering a patient previously cared for in the emergency department in a nonprofessional setting. Most respondents (96.5%) did not believe that sexual involvement could ever be therapeutic for the patient. However, only 66% felt that it was always an abuse of power and 62.4% supported zero tolerance of all sexual involvement between physicians and patients.
Vague regulatory guidelines currently in place have failed to dispel confusion regarding what is acceptable social behaviour for physicians providing emergency care. Our results support the need for clarification, and suggest a basis for guidelines that would be acceptable to the emergency medical community: that an emergency visit should not form the basis for the initiation of personal or sexual relationships, yet neither should it preclude their development in nonmedical settings.
To discover whether family physicians who go through residency training and The College of Family Physicians of Canada's (CFPC) certification process are more responsive than other physicians to ...woman abuse, whether they perceive and approach such abuse more appropriately, and whether they seek out more education on the subject.
A national survey using a pretested 43-item mailed questionnaire to examine perceptions of and approaches to detection and management of woman abuse.
Canadian family and general practice.
A cross-sectional sample of 1574 family physicians and general practitioners, of whom 963 (61%) volunteers responded.
Demographic variables, perceptions of abuse, methods of diagnosing and managing woman abuse.
Most respondents agreed they could not diagnose and treat woman abuse effectively, regardless of certification status. They indicated they were detecting only 33% of cases. Certificants of CFPC, in particular residency-trained certificants, were more likely to think that they should be diagnosing woman abuse than noncertificants; they were also more likely to help victims by referring them to specialists and other agencies. Certificants were also more likely to think they should be treating these patients themselves, and that they were not adequately trained to do so. Although most respondents thought they needed more education, certificants were more likely to know of relevant courses, to have attended such courses, and to have read books or articles on the topic.
Being a certificant is not associated with perceived skills in diagnosing and treating woman abuse, but is associated with an increased awareness of the problem. Certificants know that education on woman abuse is available.
To examine whether male and female family physicians practise maternity care differently, particularly regarding the maternal serum screening (MSS) program.
Mailed survey fielded between October 1994 ...and March 1995.
Ontario family practices.
Random sample of 2000 members of the College of Family Physicians of Canada who care for pregnant women. More than 90% of eligible physicians responded.
Attitudes toward, knowledge about, and behaviour toward MSS.
Women physicians were more likely than men to practise part time, in groups, and in larger communities. Men physicians were more likely to perform deliveries; women were more likely to do shared care. Despite a shorter work week, on average, female physicians cared for more pregnant women than male physicians did. Among those providing intrapartum care, women performed more deliveries, on average, than men. Women physicians were more likely than men to offer MSS to all pregnant patients. Although average time spent discussing MSS before the test was similar, women physicians had better knowledge of when best to do the test and its true-positive rate. All differences reported were statistically significant (P < or = 0.001).
Among family physicians caring for pregnant women, women physicians cared for more pregnant women than men did. Both spent similar time discussing MSS with their patients before offering screening, but more women physicians offered MSS to all their patients and were more knowledgeable about MSS than men physicians.
To describe the health care use patterns of widowers who had participated in a randomized trial of mutual support, and of a matched cohort of married men
Retrospective audit of Ministry of Health use ...data
The family practice unit in a general teaching hospital.
The 113 new widowers (61 treatment, 52 waiting-list controls) who participated in a randomized trial of mutual support, and 111 married men matched for age
Mutual support program
Monthly rates of visits to family physicians, psychiatrists, and all other specialists for the three cohorts
Visit rates to family physicians and specialists (SPs) for the married men were stable for the 20 months of the study; rates for the widowers rose significantly from the time of loss to the end of the intervention (for FPs, f = 13.18, df = 2, P < .01; for SPs, f = 5.34, df = 2, P = .005). Rates for FPs declined after intervention for the treatment group, but kept rising among the controls (f = 4.17, df = 1, P = .044).
The decreased physician visit rate among those taking part in the mutual support program suggests that this program met some of the widowers' social support needs that would otherwise have led to the use of health care resources.
