Primary Care

CSE_photoshot_KPKirsten Patrick is Deputy Editor at CMAJ. She is currently attending the North American Primary Care Research Group (NAPCRG) annual meeting in Colorado Springs, CO.

 

In the plenary session on providing primary care for refugees, one of the speakers, Kim Griswold, shared an image, now familiar to many, that is designed to help people to understand the difference between equality and equity. It demonstrates how some people start off at a relative disadvantage and need extra help to be able to achieve or access things that more advantaged people are able to experience equityeasily. This image, and similar ones, have been criticized by some social justice thinkers who point out that ...continue reading

Domhnall_MacDomhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK. He is currently attending the North American Primary Care Research Group (NAPCRG) annual meeting in Colorado Springs, CO.

 

Not many primary care doctors have an 8 billion dollar budget. Mitch Katz, who gave the opening keynote address at NAPCRG 2016, is director of the Los Angeles County Health Agency which combines the Departments of Health Service, Public Health and Mental Health into one service. He continues to see patients and described how he had become so specialised in his career in a primary care AIDs clinic in San Francisco, that he found returning to generalist practice extremely difficult. When he focused on AIDS he was on top of his topic like any specialist, but, as a generalist, he had to cope with anything from a heart attack to broken heart.

Los Angeles, until recently, had no ambulatory care ...continue reading

griswoldKim Griswold is Associate Professor of Family Medicine, Psychiatry, and Public Health and Health Professions at Jacobs School of Medicine and Biomedical Sciences in Buffalo, New York. Dr Griswold will be speaking at the forthcoming North American Primary Care Research Group (NAPCRG) annual meeting.

 

Communities in every nation are faced with providing competent, equitable and culturally appropriate services for resettling refugees. Health centric disciplines are not enough to meet the challenges presented by these newly arriving populations, nor to alleviate the disparities they face – such as isolation, limited English proficiency, differences in patients’ attitudes and health literacy levels, and a lack of cultural awareness on the part of providers.

Health inequity can be defined as: “unjust differences in health between persons of different social groups.” ...continue reading

spottieKevin Pottie is Associate Professor of Family Medicine and Epi & Community Medicine at the University of Ottawa, as well as co-Chair of the Canadian Collaboration for Immigrant and Refugee Health, and a family physician at the Immigrant Health Clinic of Ottawa, which he helped to found. Dr Pottie will be speaking at the forthcoming North American Primary Care Research Group (NAPCRG) annual meeting.

 

My residency training in Ottawa began with a wave of refugees from El Salvador and Guatemala.  Most conflict-affected refugees - Somali, Sudanese, Congolese, Karen, Bhutanese, Colombian - come quietly and settle rapidly in our communities.  And, even in instances when the media cover the arrival of large waves of refugees, such as the Vietnamese boat people or the recent Syrian war victims, the refugees themselves settle quietly in our communities.

In the early 1990s, it felt almost revolutionary to care for refugees. There were few primary care practitioners trained and ready to lead ...continue reading

harrisMark Harris is Foundation Professor of General Practice and Executive Director of the Centre for Primary Health Care and Equity at the University of New South Wales in Australia. Dr Harris will be speaking at the forthcoming North American Primary Care Research Group (NAPCRG) annual meeting.

 

After working with refugee populations resettled in the urban fringe of Sydney in the 1990s, I began volunteer clinical work in 2000 with an NGO working with asylum seekers.  Asylum seekers do not have access to the national health insurance system that funds primary care for all Australians and subsidizes medications.  Despite having greater health needs due a variety of acute and chronic physical and mental health problems, refugees often suffer worse access to health care in resettlement countries like Australia. ...continue reading

hauckfFern R. Hauck is Professor of Family Medicine and Public Health Sciences at the University of Virginia. Dr Hauck will be speaking at the forthcoming North American Primary Care Research Group (NAPCRG) annual meeting.

 

The scope of the crisis is staggering!  The number of people displaced by war, conflict or persecution has hit a record high—over 65 million with 21 million of these being refugees. Most face an uncertain future. Those who are resettled to a developed country are among the lucky ones. Nonetheless, they face many challenges in their new home, including accessing culturally sensitive health care.

My involvement with refugees began on the Thai-Cambodian border, where I spent a year providing primary health care to Cambodian refugees who were living in the largest border camp, having fled there after the Khmer Rouge were ousted after years of genocide. Moving to Charlottesville, Virginia, in 2000, I never expected to find that refugees were being resettled in this small city. ...continue reading

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bonnie-larsonBonnie Larson is Family Physician at Calgary Urban Project Society (CUPS) Health Centre

 

Recently I called the emergency department from my outreach clinic in an urban shelter.  Near the end of the day, the nurse mentioned that one of the clients staying there, a young aboriginal woman I will call Ms. Rain, was supposed to follow up on an abnormal lab result from a few days earlier.  As I looked the patient up on the ancient clinic laptop, I thought about the promise I had made to my daughter that morning to try to be home by suppertime.   I willed the computer to load the results a little faster so I could get home to my family.

Finally, several abnormal results, including an elevated D-Dimer, appeared.  ...continue reading

genevieve2015-msgDr Genevieve Gabb is a Senior Staff Specialist in General Medicine at the Royal Adelaide Hospital in Australia; she also works at the Veterans Heart Clinic, Repatriation General Hospital, Daw Park,  in ambulatory cardiovascular medicine.  Genevieve has an interest in drug safety, particularly in relation to medicines commonly used in the prevention and treatment of cardiovascular disease

 

We have scientific consensus that global temperatures are rising.  Despite this, debate and argument continues about whether global warming is occurring, the extent, possible causes and potential solutions to the problem.

In early January 2013, as this debate continued to rage, the Australian Bureau of Meteorology was confronted with a dilemma. Forecast temperatures were so extreme that they exceeded the colour range available for its isotherm charts.  Isotherm charts are used to indicate temperature across the continent, and have lines that join points of equal temperature.  Different colours, starting with cool blues; increasing to yellows and a deep burnt orange are used to show areas of similar temperature.  An ominous, solid black topped the scale, indicating a temperature of 50 degrees Celsius. ...continue reading

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Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK.

 

The premier primary care research meeting in the United Kingdom and Ireland, the Society of Academic Primary Care (SAPC) meeting, was hosted by the Royal College of Surgeons in Ireland.

Margaret Cupples, a long time friend and colleague, gave the opening keynote address, guiding us through the evolving patterns of morbidity and mortality in cardiovascular disease ...continue reading

Domhnall_MacDomhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK.

 

The following brief video summary of the recent International Colloquium on Clinical Academic Careers in Primary Care highlights enthusiasm, strong collaboration and funding as key facilitators for robust primary care research. ...continue reading