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Biomedical subjects

J P Geyman

Publications and source records attributed to J P Geyman.

At least 19 recordsLinked to original sources
PubMed2001

What does family practice need to do next? A cross-generational view.

BACKGROUND AND OBJECTIVES: This paper presents a 60-year view of family practice, including its first 30 years and best projections for its next 30 years as a discipline and field of practice. METHODS: An objective cross-generational approach was taken based on available evidence. RESULTS: Five lessons are drawn from the past 30 years: (1) Neither medical education, medical practice, nor the health care system have been reformed by family medicine. (2) Family practice remains but one of several options for primary care. (3) The generalist-specialist ratio has shifted farther to specialists since 1970. (4) The United States is unique among Western industrialized nations in having multiple generalist specialties. (5) The three primary care specialties are on parallel but separate courses. The health care system is now very different from that of 1970, as a result of managed care; increased burden of chronic illness in an aging population; de-emphasis of hospital care; proliferation of primary care providers; increased emphasis on shared decision making with patients, cost-effectiveness, and value of health care services; and advances in information and communication technology. CONCLUSIONS: The following course changes are recommended for family practice: (1) Embrace new paradigms of care (eg, evidence-based medicine, population-based care, chronic disease management). (2) Modify practice style and redesign systems of care. (3) Embrace further differentiation within family practice. (4) Reassess and revise educational programs at all levels. (5) Increase emphasis on practice-based research and expansion of clinical electronic databases. (6) Explore feasibility of a unified generalist discipline through new alliances with other primary care specialties. (7) Build organizational and political strength through alliances in advocating for structural change of the health care system to include universal coverage and a generalist primary care physician for all Americans.

Delivery of Health Care↗
PubMed2000

Educating generalist physicians for rural practice: how are we doing?

Although about 20 percent of Americans live in rural areas, only 9 percent of physicians practice there. Physicians consistently and preferentially settle in metropolitan, suburban and other nonrural areas. The last 20 years have seen a variety of strategies by medical education programs and by federal and state governments to promote the choice of rural practice among physicians. This comprehensive literature review was based on MEDLINE and Health STAR searches, content review of more than 125 relevant articles and review of other materials provided by members of the Society of Teachers of Family Medicine Working Group on Rural Health. To the extent possible, a particular focus was directed to "small rural" communities of less than 10,000 people. Significant progress has been made in arresting the downward trend in the number of physicians in these communities but 22 million people still live in health professions shortage areas. This report summarizes the successes and failures of medical education and government programs and initiatives that are intended to prepare and place more generalist physicians in rural practice. It remains clear that the educational pipeline to rural medical practice is long and complex, with many places for attrition along the way. Much is now known about how to select, train and place physicians in rural practice, but effective strategies must be as multifaceted as the barriers themselves.

Career Choice↗
PubMed1996

Out-of-hospital cardiac arrest in a rural area: a 16-year experience with lessons learned and national comparisons.

STUDY OBJECTIVE: To evaluate the effectiveness of the emergency medical services (EMS) system in a rural island community in resuscitating victims of out-of-hospital cardiac arrest over the past 16 years. METHODS: We conducted a retrospective analysis of all EMS responses to cardiac arrests on San Juan Island, a rural island community of 5,000 people in the Pacific Northwest. Data were collected between January 1977 and July 1994 on the basis of the Utstein criteria. From these data, we calculated survival rates and compared them with published data from other rural and nonrural areas in the United States. RESULTS: During this study, 22% of all the patients who sustained a cardiac arrest of cardiac origin on the island survived to hospital discharge. The survival rate for witnessed cases of ventricular fibrillation and ventricular tachycardia was 43%. CONCLUSION: The combined paramedic/emergency medical technician system used on San Juan Island has yielded survival rates comparable to those of urban areas. This system may serve as a model for other rural communities, especially those with well-defined geographic areas and established 911 central dispatching.

Aged↗
PubMed1990

Family medicine as an academic discipline: progress, challenges, and opportunities.

Family practice as a specialty, now just over 20 years of age, arose in response to increasing public pressure and societal needs, not primarily from a breakthrough in new clinical knowledge or technology advances. Its academic discipline of family medicine is necessarily derived more from its clinical principles and functions in practice than from a unique body of knowledge and skills. Nevertheless, the mixture of knowledge, skills, and attitudes are collectively unique as applied by the family physician, and are teachable, learnable, and subject to critical inquiry and research. This paper presents an overview of the progress, present challenges, and future opportunities of family medicine as an academic discipline. A comparative analysis of the literature in the three primary care specialties reveals more commonalities than differences. Family practice has much to contribute to needed reforms in medical education and the health care system. The field is ideally positioned to be an active part of future resolutions to today's problems in both arenas.

Family Practice↗
PubMed1989

The economic impact and multiplier effect of a family practice clinic on an academic medical center.

Academic medical centers are facing the need to expand their primary care referral base in an increasingly competitive medical environment. This study describes the medical care provided during a 1-year period to 6304 patients registered with a family practice clinic located in an academic medical center. The relative distribution of primary care, secondary referrals, inpatient admissions, and their associated costs are presented. The multiplier effect of the primary care clinic on the academic medical center was substantial. For every $1 billed for ambulatory primary care, there was $6.40 billed elsewhere in the system. Each full-time equivalent family physician generated a calculated sum of $784,752 in direct, billed charges for the hospital and $241,276 in professional fees for the other specialty consultants. The cost of supporting a primary care clinic is likely to be more than offset by the revenues generated from the use of hospital and referral services by patients who received care in the primary care setting.

Age Factors↗
PubMed1989

The Journal of Family Practice 1974-1988. Window to an evolving academic discipline.

This paper examines the spontaneous evolution of original work in family practice as published in The Journal of Family Practice over the 15-year period since it began publication in 1974. An analysis was carried out by principal content and type of paper for the last five years in a manner comparable to an earlier analysis of the journal's first ten years of publication. Trends that emerge from this reanalysis provide a window to observe the further development of family medicine as a scientific and academic discipline. The last five years have seen a marked increase in clinical content of papers (from approximately 60 to 80 percent of published papers) together with continued emphasis on health services subjects. There has been a concurrent sharp increase in research papers, continued strong representation of case studies, and some decrease in both reviews and methods papers. Descriptive research continues to predominate among research papers. Although experimental research still represents only 5 percent of published papers, this percentage has more than doubled over the last five years. The reanalysis also revealed a substantial decline in the proportion of educational papers, as other journals in the field have assumed the primary role for this content area. It appears that the manuscript supply represented by original work in the field is still limited and that there is at present adequate or even surplus journal capacity for publication of work carried out in family practice settings. The quality and type of work continue to mature consistent with the needs of family medicine as a scientific and academic discipline.

Family Practice↗
PubMed1986

Ophthalmology training in US family practice residencies.

Training in office ophthalmology is important in family practice residencies, especially because ophthalmology problems are common in family practice and only one quarter of medical students take structured ophthalmology clerkships in US medical schools. A joint committee of the American Academy of Family Physicians (AAFP) and the American Academy of Ophthalmology (AAO) has developed for family practice residents a core curriculum in ophthalmology listing essential cognitive knowledge and psychomotor skills. A national study on the extent and type of training currently available in US family practice residencies was performed. Based on a response rate of 82 percent, structured ophthalmology training experiences are provided on a required basis by 93 percent of the programs. Of these, 63 percent offer block rotations normally of two or four weeks' duration. Although a majority of the cognitive areas and psychomotor skills recommended by the AAFP-AAO joint committee are likely to be covered in existing family practice residencies, gaps identified in both categories call for closer attention to improving the learning experiences of residents in this field.

Curriculum↗