Since noncommunicable diseases (NCDs) are generally controllable rather than curable, more emphasis is placed on prevention than on treatment. For the early detection of diseases, primary care physicians (PCPs), as well as general practitioners and family physicians, should interpret screening results accurately and provide screenees with appropriate information about prevention and treatment, including potential harms. The concept of quaternary prevention (QP), which was introduced by Jamoulle and Roland in 1995, has been applied to screening results. This article summarizes situations that PCPs encounter during screening tests according to the concept of QP, and suggests measures to face such situations. It is suggested that screening tests be customized to fit individual characteristics instead of being performed based on general guidelines. Since screening tests should not be carried out in some circumstances, further studies based on the concept of prevention levels proposed by Jamoulle and Roland are required for the development of strategies to prevent NCDs, including cancers. Thus, applying the concept of QP helps PCPs gain better insights into screening tests aimed at preventing NCDs and also helps improve the doctor-patient relationship by helping screenees understand medical uncertainties.
Diagnosis ; Early Detection of Cancer ; General Practitioners ; Humans ; Mass Screening* ; Patient Compliance ; Physicians, Family ; Physicians, Primary Care ; Primary Health Care* ; Professional-Patient Relations

BACKGROUD: It is known that patients with depression can have physical and social dysfunction. Even though adolescents spend most of their time in school, researches on the relationship between adolescent depression and school adjustment are lacking. Therefore, this research surveys depression of adolescents and deals with the relationship between depression and school adjustment or school achievement. METHOD: Questionnaires were distributed to 572 students in one coed high school located in Incheon. Depression tendency was based upon BDI as cut off point 21. School adjustment was based on school related adjustment scale and the dass standing following the first semester. RESULTS: 25% (143) of 572 responses belonged to the depression tendency group. The school related adjustment scale of the depression tendency group averaged 80.06 14.78, while that of the non-depression tendency group averaged 91.78 14.98. The relationship between depression tendency and school adjustment was statistically significant(P<0.001). The relationship between depression tendency and school lifereated adjustment, school environment related adjustment, school friend related adjustment, school teacher related adjustment or school instruction-related adjustment was statistically significant(P<0. 001). In addition, the relationship between depression tendency and dass standirg was statistically significant (P<0.001). CONCLUSIONS: There was a significant relationship between depression tendency and school adjustment or school achievement. As a result, family physicians as primary care physicians need to consider examination of psychiatric symptoms such as depression tendency as well as physical symptoms, when consulting with adolescents who have trouble adjusting to school or those who bave low school achievements.
Adolescent ; Depression* ; Friends ; Humans ; Incheon ; Physicians, Family ; Physicians, Primary Care ; Surveys and Questionnaires

BACKGROUND: After referral system had been established, patients wishing to consult with a specialist with 'self- referral' in mind is increasing in university hospital family medicine clinics. This study was conducted to know whether those by self-referral to a specialist in a university hospital could benefit from family physician's consultation or not. METHODS: Three hundred and sixty patients were serially assigned to either 'simple referral' group provided with a referral note without consultation or 'referral after consultation' group with consultation from a family physician. Patient satisfaction was rated by using questionnaires with 5-point Likert scale. RESULTS: Patients in the 'simple referral' group were more satisfied with the whole process of family physicians' consultation compared to the 'referral after practice' group in both the appropriateness and patient satisfaction of the consultation (both, P<0.001). Males, longer encounter time, and shorter waiting time were significantly influenced patient satisfaction compared to each counterpart. CONCLUSION: Patients who want only a referral note from a family physician in a university hospital may received some benefit from the coordination and comprehensive care by a family physician. Health delivery system should be rectified according to the consideration of the role of the primary care physician such as a family physician.
Humans ; Male ; Patient Satisfaction ; Physicians, Family ; Physicians, Primary Care ; Referral and Consultation ; Specialization ; Surveys and Questionnaires

BACKGROUNDS: The education by the family physician. is important for more practical primary care medicine education. In this study, we try to know the presnent state of education and the future and the number of education resource and how to multiply this resource. METHODS: we have got the list of family physicians who have their clinic in Seoul by the help of the Korean Academy of Family Medicine. And we performed telephone questionary. We also asked the demographic factors RESULTS: 134 persons were asked questionary by the telephone. 17persons were joining in education. Trainee by the 3rd grade hospitals was the major, the next was by 2nd grade hospital, and doctors who did not have the training. 14 persons have begun education by asking of the training hospital, 3 persons wanted it, but none thought it beneficial to them. 44 persons wanted to join education in the future, and there was no difference between the 3rd and the 2nd grade hospital trainee. CONCLUSION: There was no difference between the 3rd and 2nd grade hospital trainee but 2nd grade hospital trainee was less joining than the 3rd. This shows that the 2nd grade hospital trainee can be the good pool of the future education if there are adequate supply. So many adequate supply is necessary.
Demography ; Education* ; Humans ; Physicians, Family* ; Primary Health Care ; Seoul* ; Telephone

BACKGROUND: This study was performed to evaluate the effect of group intervention by primary care physicians on the changes of drinking behaviors in Korean heavy drinkers. METHODS: A total of 32 male heavy drinkers participated in group intervention by family physicians of Chungnam National University Hospital. Initially, they were assessed for general characteristics, family function and drinking characteristics prior to the intervention conducted 4 times (about 40 minutes/each session). Reassessment on their drinking frequencies (times/week), drinking amounts (drinks/drinking day) and Alcohol Use Disorders Identification Test (AUDIT) score was achieved at directly, at 12 weeks and at 1 year after intervention. RESULTS: The mean drinking frequency was significantly (P < 0.01) decreased from 5.2 +/- 1.7 before to 3.5 +/- 2.4 at directly, 3.9 +/- 2.3 at 12 weeks and 4.0 +/- 2.3 at 1 year after intervention. The mean drinking amounts were significantly (P < 0.01) decreased from 17.0 +/- 16.5 before to 11.0 +/- 16.9 at directly, 14.2 +/- 17.8 at 12 weeks and 13.9 +/- 17.8 at 1 year after intervention. The mean AUDIT score was significantly (P < 0.01) decreased from 29.4 +/- 5.8 before to 19.1 +/- 11.0 at directly, 21.8 +/- 9.1 at 12 weeks and 23.0 +/- 9.4 at 1 year after intervention. The number of heavy drinkers and binge drinkers were significantly (P < 0.05) decreased from 32 (100%) and 32 (100%) before to 20 (62.5%) and 22 (68.8%) at directly, 23 (71.9%) and 24 (75.0%) at 12 weeks, and 22 (68.8%) and 19 (59.4%) at 1 year after intervention. CONCLUSION: It is suggested that group intervention by family physicians may be effective on the improvement of drinking behavior at 12 weeks and 1 year after the intervention in heavy drinkers.
Drinking ; Drinking Behavior ; Family Characteristics ; Follow-Up Studies ; Humans ; Male ; Physicians, Family ; Physicians, Primary Care ; Primary Health Care

In order to reinforce the role of primary care physician and to improve doctor-patient relationship, the Korean government tried to introduce 'Family Doctor Registration Program' into Seocho-Gu in Seoul, Ansung-Gun and Paju city in Kyunggi-Do in Oct. 1996. Community residents and doctors in those area did not show much interest in this project because of low incentives. We have done this study to see how much people know 'Family Doctor Registration Program' and what is people's real needs about 'Family Doctor Registration Program. We selected l,800 telephone numbers in Seoul, Chongju city, and Ansung-Gun by multi-stage stratified random sampling. Three trained survey personnels called them and got answers to the premade questionnaire until they completed the questionnaires of 200 persons in each community. The calling time was 7-9 p.m. from Monday to Friday, 3-9 p.m. on Saturday, and 9 a.m. to 9 p.m. on Sunday. We dropped out the persons who did not respond 3 times. The subjects consisted of 222 male and 367 female residents. Their ages ranged from 20 to 78: 24.8% in their 30s, 23.4% in their 20s, 22.5% in their 40s in male, and 35.2% in their 30s, 22.5% in their 40s, 18.5% in their 20s in female. 9.9% of male and 13.2% of female had their Family Doctors. The specialties of their Family, Doctors were internists in 56.2%, general surgeons in ll.0%. The persons who did not have their family, doctors were asked which doctors they would prefer if they had choices of family doctor. The results were internists in 50.3%, family physicians in 13.0%, pediatricians in 4.8%. Only 16.0% residents knew that government tried to introduce Family Doctor Registration Program. The 'Family Doctor Registration Program' was not well known to people. The results of our study showed that more effective incentives and public notifications are needed to activate this program.
Female ; Gyeonggi-do ; Humans ; Male ; Motivation ; Physicians, Family ; Physicians, Primary Care ; Primary Health Care ; Surveys and Questionnaires ; Research Personnel ; Seoul ; Telephone*

BACKGROUND: Recently, a revised telehealth legislation that allows direct doctor to patient teleconsultation was proposed in Korea. However, there have been some debates. This study aimed to examine the attitude of primary care physicians towards telehealth. METHODS: A questionnaire asking attitude towards telehealth and revised telehealth legislation was self-administered to 1,988 registered members of Practitioners Council of Korean Academy of Family Medicine. A total of 218 complete responses by family physicians were included in the study. RESULTS: Large proportion (60.6%) of participants disagreed to the main clause of revised telehealth legislation, which allowed doctor to patient teleconsultation. Participants tended to expect that negative outcomes are more likely to occur than positive outcomes after the enforcement of the revised telehealth legislation. Around 50% of participants had an intention to adopt telehealth just as soon (4.6%) or afterwards (45.4%). The majority of participants suggested that; primary care clinic as the most appropriate telehealth facility (75.4%); patients with low accessibility to medical care (74.3%) as the best target of telehealth service; and tele-radiology (61.9%) or tele-pathology (41.3%) as the most applicable medical field for telehealh service. Around 89% of participants suggested telehealth service fee to be similar or higher than current medical consultation fee. CONCLUSION: The majority of family physicians participating in this study were not in favor of the revised telehealth legislation. However, the majority of the participants had an intention to adopt telehealth to their practice and held clear opinion about practical aspects of telehealth.
Fees and Charges ; Humans ; Intention ; Korea ; Physicians, Family ; Physicians, Primary Care ; Primary Health Care ; Private Practice ; Remote Consultation ; Telemedicine

BACKGROUND: Physicians rarely take patients' sexual history during routine medical visit, although it would give very helpful information to reach accurate diagnosis and proper management. This survey was conducted to assess the primary physicians' perspectives towards sexual history taking and their actual behaviors on it. METHODS: The survey questionnaire was made through the literature review, in-depth interview and pilot survey. We mailed this questionnaire to 400 primary care physicians who were randomly selected from the lists of internists and family physicians in Seoul and Gyunggi province and 73 of them responded. RESULTS: The mean age of the respondents was 44.3 years. Most of them responded that sexual history is necessary only when the patients' chief complaints are directly related to sexual issues. Among the total, 94% of them answered that he or she took sexual history in less than 25% of the patients who visited his/her own clinic during last one month. The most prevalent barriers to initiate sexual history taking were fear of patients' misunderstanding about sexual harassment or intrusion into patients' personal life (60.3%) and uncertainty to conducting sexual history taking (53.4%). They thought that they were not well educated enough to take sexual history with confidence and more structured education is needed in medical schools and postgraduate residency training. CONCLUSION: Sexual history seemed not to be taken by primary care physicians as a routine medical practice and physicians showed rather passive attitude. Beneficial effects of sexual history taking on patients' management and related communication skills should be emphasized and systematically educated.
Surveys and Questionnaires ; Humans ; Internship and Residency ; Physicians, Family ; Physicians, Primary Care ; Postal Service ; Primary Health Care ; Schools, Medical ; Sexual Harassment ; Uncertainty

Introduction: Dermatologic diseases are one of the common reasons for consult in primary care. Primary care physicians such as the doctors to the barrios (DTTBs) assigned in geographically isolated areas play a critical role in providing primary skin health services since they are the first, and sometimes, only doctors patients rely on for consult. In managing skin diseases, adequate knowledge and skills are needed to arrive at a correct diagnosis, and a physician’s proper initial treatment and timely referral to dermatologists will lead to less affectation on quality of life. Identifying what is lacking in skin health services and referral system would aid dermatologists in finding out how to bridge the gap in knowledge and access to our specialized skin health care. Objectives: The study aimed to determine the knowledge, attitudes, practices, and perceptions of primary care physicians in the Philippines regarding common dermatologic conditions. Methods: This is a cross-sectional study that utilized a self-administered questionnaire to collect data from rural government primary care phy- sicians (doctors to the barrios). At the end of the study, the proponents collated the data and data analysis was done using STATA 13.1 guided by a statistician. Results: A total of 118 DTTBs were included in the study. The mean age of the physicians is 28 years old. One-half of the physicians were assigned to low-income class municipalities; 26.85% and 25% are from 4th class and 5th class municipalities respectively. Factors such as age, sex and clinical experience were not associated with level of knowledge of the respondents. Majority or 55% of the primary care physicians were classified as hav- ing insufficient knowledge on common skin diseases. The respondents have an average of 250 consultations per week and 6% of these are derma- tologic diseases. The most common skin diseases they encountered were impetigo (46.61%), scabies (46.61%), contact dermatitis (43.22%), fungal infection (25.42%) and cellulitis (20.34%). The most prescribed and available medications for skin diseases are oral and systemic antibiotics. Only 42.37% of the physicians are able to refer to dermatologists through various online communication platforms while the rest refer through phone calls or advise their patients to seek dermatologic consult. 25% of the respondents have direct access to dermatologists. DTTBs also have recog- nized the importance of having adequate knowledge on skin diseases and majority are very interested in learning more about these conditions. The top 3 barriers to the proper management of skin diseases were lack of training, lack of experience, and lack of medications. Most of the re- spondents have rated themselves as average to bad in their perceived competency in diagnosing and managing different common skin diseases. Conclusion The study showed that majority of the respondents had insufficient knowledge on the diagnosis and management of common der- matological diseases but had a strong interest to learn more. A significant number of the respondents do not always refer to dermatologists and have poor access to specialty care. Overall, our findings suggest that there are indeed barriers to delivery of skin-related health services that should be addressed.
Physicians, Primary Care

BACKGROUND: PAP smear has been highly appraised for screening cervical cancer. Generally regarded is that women physicians regularly screen for PAP would promote patients' early detection and treatment rate by their strong recommendation. Hereby we investigated PAP-screening in primary care women physicians, recommending proportion and associated factors. METHODS: Questionnaires were sent to 981 members of the Korean Academy of Family Medicine, Korean Association of Family Practitioners, Korean Medical Women's Association, and Songpa-gu and Kangdong-gu family practitioners. a total of 193 respondents was analyzed. RESULTS: Among the total 55.4% of the respondents screened for PAP smear regularly, either annually (23.9%), or from their treating gynecologists (61.6%) or through routine check-up (81.1%). Common reasons for not screening were lack of time (40.7%) and forgetfulness (38.4%). Recommending proportion for PAP to patients was 49.2%. Reasons for not recommending were lack of equipment, forgetfulness (18.8% each). Confidence of PAP as a screening test was very high (71.5%); significantly related to PAP-screening and to recommending proportion (P=0.033, P=0.005, respectively). Many of the respondents thought physician's own PAP-screening affected its recommendation (45.3%), whereas significant relation to their actual PAP-screening was not found (P=0.845). PAP-screening in physicians showed no significant relationship with recommending proportion (P=0.053). Internal disease history had meaningful relation only with recommending proportion (P=0.001). CONCLUSION: Though physicians show strong confidence in PAP and undergo more than the general public, most do not screen for it regularly and the recommending proportion was low. To improve physician's PAP-screening and recommending proportion, re-education of physicians and provision of proper clinical equipment are required.
Surveys and Questionnaires ; Female ; Humans ; Mass Screening ; Physicians, Women* ; Primary Health Care* ; Uterine Cervical Neoplasms