Patient Relationships and the Personal Physician in Tomorrow's Health System: A Perspective from the Keystone IV Conference.

A group of senior leaders from the early generation of academic family medicine reflect on the meaning of being a personal physician, based on their own clinical experiences and as teachers of residents and students in academic health centers. Recognizing that changes in clinical care and education at national and local systems levels have added extraordinary demands to the role of the personal physician, the senior group offers examples of how the discipline might go forward in changing times. Differently organized care such as the Family Health Team model in Ontario, Canada; value-based payment for populations in large health systems; and federal changes in reimbursement for populations can have positive effects on physician satisfaction.

Gastrointestinal adverse effects of varenicline at maintenance dose: a meta-analysis.

Background: Tobacco smoking remains the leading modifiable health hazard and varenicline is amongst the most popular pharmacological options for smoking cessation. The purpose of this study is to critically evaluate the extent of gastrointestinal adverse effects of varenicline when used at maintenance dose (1 mg twice a day) for smoking cessation.

Methods: We conducted a meta-analysis of randomised controlled trials published in PUBMED and EMBASE according to the PRISMA guidelines.

Progress of Ontario's Family Health Team model: a patient-centered medical home.

Ontario's Family Health Team (FHT) model, implemented in 2005, may be North America's largest example of a patient-centered medical home. The model, based on multidisciplinary teams and an innovative incentive-based funding system, has been developed primarily from fee-for-service primary care practices. Nearly 2 million Ontarians are served by 170 FHTs.

Update on pharmacologic and nonpharmacologic therapies for smoking cessation.

Objective: To review the evidence on the efficacy and safety of pharmacologic and nonpharmacologic therapies for smoking cessation.

Quality Of Evidence: MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews were searched for randomized controlled trials, meta-analyses, and systematic reviews (level I evidence) pertinent to pharmacologic and nonpharmacologic smoking cessation therapies.

Main Message: Pharmacologic smoking cessation aids are recommended for all smokers trying to quit, unless contraindicated.

Global health and primary care research.

A strong primary health care system is essential to provide effective and efficient health care in both resource-rich and resource-poor countries. Although a direct link has not been proven, we can reasonably expect better economic status when the health of the population is improved. Research in primary care is essential to inform practice and to develop better health systems and health policies.

Improving health care globally: a critical review of the necessity of family medicine research and recommendations to build research capacity.

An invitational conference led by the World Organization of Family Doctors (Wonca) involving selected delegates from 34 countries was held in Kingston, Ontario, Canada, March 8 to 12, 2003. The conference theme was "Improving Health Globally: The Necessity of Family Medicine Research." Guiding conference discussions was the value that to improve health care worldwide, strong, evidence-based primary care is indispensable.

Educating physicians to reduce benzodiazepine use by elderly patients: a randomized controlled trial.

Background: Benzodiazepine use by elderly patients is associated with adverse outcomes including increased risk of falls and fractures, motor vehicle accidents and cognitive impairment. Recent studies suggest that individualized feedback and education to physicians may improve drug prescribing. In this study, we evaluated an intervention to address the inappropriate prescribing of benzodiazepines for elderly patients.

Nutritional advice in Canadian family practice.

The National Health Survey in Canada found that 40% of adults and teenagers are overweight or suffer from poor nutrition. Frail elderly, in particular, are at high risk for poor nutrition. Medical students and family medicine residents have some exposure to nutritional issues during their training.

Five years of family health care in São José.

In 1994, the Federal Government of Brazil enacted legislation to share the costs with municipalities of establishing or remodelling up to 20 000 health clinics, covering a population of 69 million people. São José clinic was established with family physicians in 1993 in a community of 3000 in the City of Curitiba. The clinic was functioning by 1995 when the Canadian four principles of Family Medicine were introduced to clinic staff.