Biomedical subjects

S Flocke

Publications and source records attributed to S Flocke.

6 recordsLinked to original sources

PubMed2001

Tailoring tobacco counseling to the competing demands in the clinical encounter.

OBJECTIVES: We identified patterns of tobacco cessation counseling in primary care practices, including contextual factors that influence its provision. STUDY DESIGN: A cross-sectional study was performed using direct observation of outpatient visits. POPULATION: We included 91 outpatient visits by cigarette smokers visiting 20 family physicians in 7 Nebraska community family practices. OUTCOMES MEASURED: We measured patterns and quality of tobacco counseling assessed by direct observation. RESULTS: A hierarchy of 5 patterns was discernable, ranging from appropriate to inappropriate provision or nonprovision of tobacco cessation counseling. CONCLUSIONS: Since tobacco-specific discussions are appropriate only in approximately three fourths of primary care visits by smokers, clinical practice guidelines that recommend intervention at every visit are unrealistic. However, the finding that only one third of eligible visits addressed tobacco makes it imperative that tobacco cessation counseling be reliably integrated into visits for well care and tobacco-related illnesses that represent teachable moments.

Counseling↗

PubMed2000

Continuous quality improvement and the process of writing for academic publication.

OBJECTIVE: To improve their academic publication productivity by understanding the process of writing and setting long-run productivity goals. METHODS: We used the thinking and methods of continuous quality improvement and a national survey of associate professors of Family Medicine about their level of productivity at the time of their promotion to Associate Professor. RESULTS: Barriers to writing vary. The process from idea to publication takes well over a year on average. The average number of publications associated with successful promotion in Family Medicine ranges from 10 to 14 with substantial variation. CONCLUSION: Knowing the time until the promotion decision, the expected level of productivity, the death rates of started papers, and the duration of time between start to publication allows one to develop a long-range plan for publication productivity.

Adult↗

PubMed1995

Factors associated with research productivity in family practice residencies.

BACKGROUND: Research productivity and the associated features of research productivity in family practice residencies have not been well described. The objectives of this study are to describe residency research productivity and identify the set of independent factors that best characterize programs at various levels of productivity. METHODS: A 23-item survey was mailed to 226 randomly selected family practice residency directors. The survey included items on program demographics, mentoring, resident and faculty research activities, and program research resources. Factor and discriminant analyses were performed to identify the major independent factors associated with productivity. RESULTS: A total of 154 completed surveys were received for a response rate of 68%. Based on a cross tabulation of grants per program and publications per faculty, 22% of programs had high productivity, 46% had medium productivity, and 32% had low productivity. The significant factors of mentor support, amount of research activity, and program size contributed independently to the classification of programs by relative level of research productivity. These associations remained significant when university programs were excluded. CONCLUSIONS: Family practice residencies with relatively higher research productivity are more likely to have three characteristics than lower productivity programs: availability of a research mentor, more faculty research activities, and larger program size.

Efficiency↗

PubMed1994

Family physicians' disagreements with the US Preventive Services Task Force recommendations.

BACKGROUND: The 1989 recommendations of the US Preventive Services Task Force (USPSTF) represent an emerging consensus about which clinical preventive services should be delivered. However, practicing physicians disagree with a number of the recommendations in the Task Force prevention guidelines, and the reasons for disagreement have not been widely explored. METHODS: A survey questionnaire assessing physician agreement or disagreement with the USPSTF recommendations was sent to all 1784 active members of the Ohio Academy of Family Physicians in October 1990. A factor analysis was performed on the items with which at least 5% of physicians disagreed. Associations of physician demographics and attitudes with the factor scores were then examined. RESULTS: At least 5% of the 898 responding physicians disagreed with 67 of 150 USPSTF recommendations. Physicians disagreed with the USPSTF recommendations in three ways: (1) they believed that screening for some cancers is appropriate, even though not recommended by the USPSTF; (2) they believed that screening for other diseases in some populations is appropriate, even though not recommended by the USPSTF; and (3) they disagreed with some USPSTF recommendations for screening that is considered time-consuming or intrusive. Further analyses showed that practice setting and experience with the USPSTF guidelines were predictive of all three disagreement factors. Physician age, race, residency training, and reasons for disagreement were associated with two of the three factors. CONCLUSIONS: Physician disagreement with the USPSTF recommendations was not random but clustered into three distinct factors. An opportunity exists to design educational interventions for targeted subgroups of physicians. The views of practicing physicians should be incorporated into future guidelines.

Adult↗

PubMed1993

Does the system of Papanicolaou test nomenclature affect the rate of referral for colposcopy? A survey of family physicians.

OBJECTIVE: To determine whether a new system of Papanicolaou test nomenclature (the Bethesda system) or other physician variables influence recommendations for colposcopy and biopsy for women with borderline to moderately abnormal Papanicolaou test results. We hypothesized that physician demographic and practice variables, in addition to Papanicolaou test nomenclature, would influence recommendations for colposcopy. DESIGN: A survey was mailed to a random sample of 510 active members of the American Academy of Family Physicians. PARTICIPANTS: Three hundred thirty-five (66%) of the eligible physicians responded, representing all 50 states. Of those in active practice, 78% were in private practice, with a mean age of 44 years and a mean time in practice of 10 years. Ninety-three percent of respondents in active practice performed Papanicolaou tests. MAIN OUTCOME MEASURE: Rates of recommendation for colposcopy and biopsy in response to abnormal Papanicolaou test reports framed by a single clinical scenario. RESULTS: Physicians recommended colposcopy more often when the Bethesda nomenclature system was used to describe the results of the Papanicolaou test. These differences were significant for four specific Papanicolaou smear pairs. Inclusion of recommendations for further evaluation strongly influenced physicians to recommend colposcopy. In multivariable analyses, demographic and practice variables were not associated with recommendations for colposcopy. CONCLUSIONS: The Bethesda system of nomenclature, when compared with a traditional descriptive nomenclature system, influenced family physicians to recommend colposcopy and biopsy more often for abnormal Papanicolaou test results presented in a clinical scenario. Greater utilization of technology and higher medical care costs may result from use of the Bethesda system. Guidelines for evaluation of abnormal Papanicolaou test results are needed for use in conjunction with the Bethesda system guidelines for Papanicolaou test reports.

Adult↗

PubMed1992

Physician agreement with US Preventive Services Task Force recommendations.

BACKGROUND: No large-scale work has yet assessed the reactions of physicians to the report of the US Preventive Services Task Force (USPSTF), despite its potential for fostering a consensus among practitioners. This study undertook a survey of family physicians to assess their agreement with the recommendations of the Task Force. METHODS: A survey containing the verbatim summary recommendations of the USPSTF was mailed to all 1784 active members of the Ohio Academy of Family Physicians. RESULTS: No evidence of selection bias was found among the 898 responding physicians. The average physician agreed with 88% of the recommendations. For a number of recommendations, however, particularly those in which the Task Force differed with the American Cancer Society, there was a high level of disagreement. Physician disagreement with the recommendations was associated with older age, not having completed a residency, male sex, less prior exposure to the USPSTF guidelines, and greater perception of the impracticality of applying them. CONCLUSIONS: The high level of agreement with most USPSTF recommendations implies that they represent an emerging consensus about which preventive services should be delivered. Attempts at USPSTF guideline dissemination should focus on recommendations with high agreement. Additional research is needed to assess the reasons for disagreement.

Age Factors↗