Page 346 - TNFlipTest

FM48 Family Medicine
Primary Care Models
Toronto Notes 2019
Table 25. Common Herbal Products
Common Name
Black Cohosh
Chamomile Echinacea
Evening Primrose
Feverfew Flaxseed Oil
Garlic
Ginger Ginkgo Biloba
Ginseng Glucosamine
(Chondroitin)
Saw Palmetto St. John’s Wort
Valerian Root
Reported Uses
Menopausal symptoms, PMS, labour induction, arthritis
Mild sedative, anxiolytic,
GI complaints, common cold
Common cold, flu, wound treatment, UTI, cancer
Dysmenorrhea, menopausal Sx, inflammation, allergies, eczema, arthritis, MS
Migraine prevention, RA, anti- inflammatory
Laxative, menopausal symptoms, source of omega-3 fatty acids
Elevated lipids, HTN, hyperglycemia, antimicrobial
Nausea, motion sickness, dyspepsia, anti-inflammatory
Increases peripheral circulation (AD, dementia, intermittent claudication), premenstrual syndrome, vertigo
Energy enhancer, decreases stress, adjunct support for chemotherapy/ radiation
Osteoarthritis
BPH, adjunct to finasteride Mild to moderate depression
Sedative, anxiolytic, muscle relaxant, PMS
Possible Adverse Effects
Hepatitis, liver failure, headaches, GI discomfort, heaviness in legs, weight problems
Allergic/contact dermatitis, anaphylaxis
Hypersensitivity, hepatotoxicity with prolonged use, avoid use if immunosuppressed
Headache, restlessness, nausea, diarrhea, may decrease seizure threshold
Anxiety, upset stomach, skin rash, miscarriage
Diarrhea
GI irritation, contact dermatitis, may increase post-operative bleeding
Heartburn, not to be used for morning sickness
Headache, cramping, bleeding, mild digestive problems; reports of intracranial hemorrhage
HTN, nervousness,insomnia, breakthrough bleeding, palpitations
GI distress, headache, drowsiness, palpitations
Mild GI distress
Photosensitivity, increased liver enzymes, drowsiness, dizziness, nausea, headache
Drowsiness, headache, digestive problems, paradoxical insomnia
Possible Drug Interactions
None reported
Anxiolytics, sedatives Potentiates warfarin
Anticoagulants, antiplatelets
Anticoagulants, antiplatelets
Do not take with other medications as fibre content can bind drugs
Anticoagulants, potentiates antihypertensives
None known
Anticoagulants, thiazide diuretics, MAO inhibitors
Stimulant medications, antihypertensives, hormonal therapies
Caution if shellfish allergy
α-adrenergics, finasteride CNS depressants,
contraindicated with indinavir
CNS depressants, antihistamines
Zink T, Chaffin J. Herbal “health”products: What family physicians need to know. American Family Physician 1998;58:1133-1140; NIH National Centre for Complementary and Alternative Medicine website (http://nccam.nih.gov/)
Primary Care Models
Table 26. Primary Care Models (Adapted from www.healthforceontario.ca) Characteristics
Comprehensive Care Model Family Health Team
Family Health Group
Family Health Network Family Health Organization
FPs/GPs in solo practice with limited after-hours availability Payment model: fee-for-service
Groups of health care professionals (e.g. FPs, GPs, RNs, NPs, dieticians, social workers)
Wider range of services (e.g. rehabilitation, palliative care), with increased after-hours availability Receives provincial funding for allied health
Patient enrolment is strongly encouraged
Payment model: blended capitation model i.e. age- and sex-adjusted base rate renumeration plus bonuses and incentives
Group of ≥3 FPs, can utilize nurse-staffed, telephone health advisory services to provide around the clock primary care coverage
Physicians commit to enroll patients
Payment model: blended capitation model i.e. age- and sex-adjusted base rate remuneration plus bonuses and incentives
Group of ≥3 FPs, can utilize NPs, with telephone health advisory services to provide around the clock primary care coverage
Payment model: salary-based
Same as FHT but usually larger in scale in terms of personnel
Physicians commit to enroll patients
Must sign governance and Family Health Organization agreements to join
Payment model: blended capitation model i.e. age- and sex-adjusted base rate remuneration plus bonuses and incentives
FP = family physician; GP = general practitioner; RN = registered nurse; NP = nurse practitioner; FHT = family health teadm