Biomedical subjects

R M Wesley

Publications and source records attributed to R M Wesley.

12 recordsLinked to original sources

PubMed1991

AIDS: family physicians' attitudes and experiences.

A study was developed to examine the current experiences and opinions of a national sample of family physicians with regard to acquired immunodeficiency syndrome (AIDS). The survey response rate was 72.5% (757 questionnaires were returned out of a sample of 1044). Approximately 47% of respondents have cared for an HIV-infected patients. This percentage varied from a low of 31.4% in the Midwest to as high as 56.1% on the East Coast. Thirty-two percent of family physicians practicing in communities of fewer than 2500 have dealt with this illness, while 60% of those in communities of greater than 100,000 have done so. Seventy-seven percent of respondents are willing to provide care to HIV-infected individuals; 62.9% believe that physicians have a right to refuse to care for a patient because he or she is infected with the AIDS virus. Forty percent believe that they would lose patients if it were known that they were caring for an AIDS patient in their office. Finally, the vast majority of those surveyed favor required partner notification and would inform the sexual partner of an HIV-positive patient if the patient refused to do so.

AIDS Serodiagnosis↗

PubMed1990

Withdrawal from maternity care. A comparison of family physicians in Ontario, Canada, and the United States.

To determine the relative importance of factors influencing the withdrawal of family physicians from maternity care, two studies, one done in Ontario, Canada, and the other done in the United States, were compared. The proportion of residency-trained family physicians who provide maternity care at the initiation of their careers and the proportion who have given up maternity care are nearly identical in the United States and Canada. Both studies found that about one half of the family physicians who currently provide maternity care were giving consideration to stopping. The reasons underlying this withdrawal were multifactorial. Malpractice issues were the predominant concern of United States family physicians, but the data from the studies indicate that other issues, such as interference with lifestyle and office practice and the effect of attitudes of obstetricians, should not be overlooked.

Adult↗

PubMed1989

Factors influencing changes in obstetric care provided by family physicians: a national study.

In an effort to determine the factors underlying changes in obstetric practice by family physicians, a random sample of 505 residency-trained family physicians was surveyed by mailed questionnaire. Of the 329 who responded, 65% had at some time practiced obstetrics, but only 45% were practicing obstetrics at the time of the survey. Rising malpractice insurance premiums and fear of lawsuit were factors most likely to influence a family physician's decision to cease obstetric practice. Lifestyle concerns and the number of obstetricians practicing in the area were also important factors for all family physicians. Important differences were found between family physicians who never delivered babies and those who had at some time practiced obstetrics. Family physicians who have given up obstetric practice were found to feel well trained and competent in this practice. Since changes in obstetric practice patterns have had an adverse effect on the obstetric care of women in rural areas and for the medically indigent, these findings have important public health implications.

Attitude of Health Personnel↗

PubMed1989

Present status of obstetrics in family practice and the effects of malpractice issues.

A survey of 800 active members of the American Academy of Family Physicians 1985-1987 membership directory was conducted for the purpose of determining the impact, over time, of malpractice issues upon the practice of obstetrics by family physicians. The survey response rate was 60.4 percent. Almost 20 percent of all respondents reported that they have never provided obstetric care of any type. Another 40 percent have provided obstetric care previously but have now discontinued this care, while the remaining 40 percent currently offer obstetric care to their patients. The proportion of respondents who discontinued the practice of obstetrics because of increased risk of malpractice litigation increased significantly over the years from 1947 to 1986 (P = .0084). The proportion of respondents who discontinued obstetric practice because of increased malpractice insurance costs also increased significantly from 1945 to 1986 (P = .0002). The proportion of those entering practice during the past five years who decided not to offer obstetric services because of malpractice risks was significantly greater than the proportion entering practice earlier (21.0 percent vs 2.0 percent, P = .0090). Although the current patterns of obstetric practice showed regional variation, the accelerating impact of malpractice risk and insurance cost on these patterns was similar throughout the nation.

Family Practice↗

PubMed1988

The practicing doctor's perspective on the surgical curriculum.

The purpose of this study was to identify deficiencies of surgical clerkship and residency curricula in the training of family physicians. Responses to a survey from 202 practicing family practitioners were analyzed. Orthopedics, otolaryngology, urology, neurosurgery, and cardiovascular surgery were surgical specialty areas where more than 40 percent of the respondents thought they had spent too little time. Learning objectives were either not presented or were used ineffectively, according to the majority of respondents. Fifty percent believed that indicating a career interest in family medicine resulted in a negative bias toward them during the surgery clerkship. Over 45 percent thought they were moderately or totally unprepared at the completion of their training to perform several basic surgical procedures. The results of this survey indicate the need for an increased allocation of curricular time to several surgical specialties and an augmented emphasis on outpatient experiences within the surgical curriculum.

Clinical Clerkship↗

PubMed1987

Orthopaedic teaching: the practicing family doctor's perspective.

Two hundred and two family doctors in practice responded to a survey that identified orthopaedics as a surgical specialty in which they would have benefited from more training. Forty percent felt unprepared to apply casts or manage fractures. Learning objectives were either not used or used ineffectively, according to the majority of respondents. Fifty percent reported that indicating a career interest in family medicine resulted in a negative bias toward them during surgery clerkship. The results indicate the need for an increased allocation of curricular time to orthopaedics and an augmented emphasis on outpatient experiences.

Attitude of Health Personnel↗

PubMedDate not supplied

Community-oriented primary care: historical perspective.

BACKGROUND: Community-oriented primary care (COPC) is a systematic approach to health care based upon principles derived from epidemiology, primary care, preventive medicine, and health promotion. We describe the development of COPC from an historical perspective. A critical assessment of current trends and implication for physician education and practice of COPC will be discussed in a companion article in the next issue of The Journal. METHODS: MEDLINE was searched using the key phrase "community-oriented primary care" Other sources of information included books and other documents. RESULTS AND CONCLUSIONS: In the 1950s, Sydney Kark showed dramatic positive changes in the health status of the population of Pholela, South Africa, using this approach. Similar approaches showed positive change in the health status of poor and underserved populations in the United States. The results were so impressive that the Institute of Medicine recommended widespread application of COPC in the United States. Successful COPC practices, however, have historically required considerable external funding from private and government sources. Thus, controversy about the feasibility of implementation of COPC in mainstream primary care practices developed. Schools of medicine and the discipline of family medicine have struggled to implement effective training in COPC within traditional medical school and residency structures. Yet, the societal need for recognition of and intervention in community health problems and coordination of community health resources continues.

Community Health Services↗

PubMedDate not supplied

Community-oriented primary care: critical assessment and implications for resident education.

BACKGROUND: Community-oriented primary care (COPC) is a systematic approach to health care based on principles derived from epidemiology, primary care, preventive medicine, and health promotion that has been shown to have positive health benefits for communities in the United States and worldwide. METHODS: MEDLINE was searched using the key phrase "community-oriented primary care." Other sources of information were books and other documents. RESULTS AND CONCLUSIONS: Because of lack of predictable reimbursement for COPC services and difficulties encountered incorporating COPC in medical and residency curricula, widespread application of COPC has not occurred. Recent trends in public health initiatives, managed health care, and information technology provide an environment ripe for application of COPC in medical practice. Also, recent recommendations made by the Strategic Planning Working Group of the Academic Family Medicine Organizations and the Association of Family Practice Residency Directors regarding specific community competencies for residency training have direct bearing on COPC and family medicine educators. These trends and recommendations, properly configured, will produce a medical training and practice environment conducive to COPC.

Community Health Planning↗

PubMedDate not supplied

Health status, staffing, and medicaid reimbursement in nursing homes: 1985 to 1995.

CONTEXT: Policy changes implemented by Medicaid and Medicare in the early 1980s resulted in a functionally more dependent nursing home population. OBJECTIVES: This paper contends that (1) staffing in nursing homes has become more efficient; (2) nursing home residents are functionally more dependent;(3) Medicaid per diem reimbursement is inadequate. DATA SOURCES: Staffing data came from the National Nursing Home Facility Survey conducted by the National Center for Health Statistics (NCHS) in 1985 and 1995. Functional dependency data, defined as assistance with any of six Activities of Daily Living (ADLs), came from the NCHS National Nursing Home Current Resident Surveys in 1985 and 1995. Reimbursement rates came from the State Medicaid Reimbursement Surveys conducted by the University of California at San Francisco to which the Consumer Price Index, Hospital and Related Services Item was applied. DATA SYNTHESIS: Administration decreased by 4.4 full-time equivalents (FTEs) (80.0%) per 100 beds, whereas patient care increased by 8.2 FTEs (18.9%). Residents requiring assistance with four or more ADLs increased by 9.9%, and the mean number of ADLs per patient increased from 3.9 to 4.3. Applying the Consumer Price Index to the 1984 reimbursement rate indicated an annual deficit of 5526.00 dollars for each Medicaid patient by 1995. CONCLUSIONS: This research strongly supports its contentions but fails to demonstrate them conclusively. The data indicate that long-term care facilities have reallocated staffing to accommodate the requirements of more functionally dependent residents and that Medicaid reimbursement has failed to maintain its initial purchasing power.

Journal Article↗

PubMedDate not supplied

A comparison of resident perceptions of training experience at university and community based family practice residencies.

To determine if differences exist in the perception by residents of the adequacy of training at university or community based programs, a survey was conducted of all 1987 family practice residency graduates in the United States. Of the 2,363 questionnaires mailed and reviewed by graduates, 1,583 were returned (66.8% response rate). Respondents completed the survey within approximately 18 months of completing residency training. The results indicate that overall satisfaction with training, as well as the perception of adequacy of preparation for practice, lessened with increasing university affiliation of the training program (P less than .05). The findings reported here also suggest that university based family practice residency graduates are much more likely to report being treated like "second-class citizens" by attendings and residents of other specialties. In addition, satisfaction with educational rotation experiences is less if competing residencies exist at the institution sponsoring the residency.

Attitude of Health Personnel↗

PubMedDate not supplied

Obstetrics in family medicine: effects on physician work load, income, and age of practice population.

A survey of active members of the American Academy of Family Physicians was conducted to determine the effect of the practice of obstetrics by family physicians on patient age distribution, physician work load, and physician income. A questionnaire was mailed to 800 randomly selected physicians; the survey response rate was 60.4%. Almost 20% of all respondents had never provided obstetrical care of any type. Another 40% had provided obstetrics previously but had discontinued this service, while the remaining 40% currently provided obstetrical care. Physicians who provided obstetrical services reported a significantly higher mean proportion of children and a significantly lower proportion of middle-aged and elderly adults in their patient panels than did physicians who do not provide obstetrics. Those physicians who had never offered obstetrics saw approximately the same number of patients and worked approximately the same number of hours as did those who provided low-risk, routine obstetrics; however, the former group reported a significantly higher average annual income than did the latter group.

Adolescent↗

PubMedDate not supplied

Differences and similarities between patient and physician perceptions of patient pain.

A reasonably accurate perception of pain severity by physicians can be a useful tool in effectively managing acute pain. This study measured the similarities and differences between patient and physician ratings of patient pain through the use of a linear analogue scale of pain severity. A total of 401 patients presenting with acute pain of up to seven days' duration were studied. Data were gathered from patients presenting to the seven family practice clinics associated with the Department of Family Practice and Community Health at the University of Minnesota. Whereas the physician mean rating of patient pain was found to be significantly lower than the patient mean rating (3.52 vs. 4.37, P = 0.001), raw ratings by physicians and patients were found to have a relatively strong and significant correlation (R = 0.66, P = 0.001). The difference in mean ratings between patients and physicians remained the same regardless of physician or patient gender, patient age, whether or not a diagnosis was made, organ system category in which the pain was located, or training level of physician. The physician mean ratings were always significantly lower than the patient mean ratings, and there was no significant difference in the mean differences in ratings among the subgroups compared.

Acute Disease↗