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Biomedical subjects

V J Gilchrist

Publications and source records attributed to V J Gilchrist.

13 recordsLinked to original sources
PubMed1998

Illuminating the 'black box'. A description of 4454 patient visits to 138 family physicians.

BACKGROUND: The content and context of family practice outpatient visits have never been fully described, leaving many aspects of family practice in a "black box," unseen by policymakers and understood only in isolation. This article describes community family practices, physicians, patients, and outpatient visits. METHODS: Practicing family physicians in northeast Ohio were invited to participate in a multimethod study of the content of primary care practice. Research nurses directly observed consecutive patient visits, and collected additional data using medical record reviews, patient and physician questionnaires, billing data, practice environment checklists, and ethnographic fieldnotes. RESULTS: Visits by 4454 patients seeing 138 physicians in 84 practices were observed. Outpatient visits to family physicians encompassed a wide variety of patients, problems, and levels of complexity. The average patient paid 4.3 visits to the practice within the past year. The mean visit duration was 10 minutes. Fifty-eight percent of visits were for acute illness, 24% for chronic illness, and 12% for well care. The most common uses of time were history-taking, planning treatment, physical examination, health education, feedback, family information, chatting, structuring the interaction, and patient questions. CONCLUSIONS: Family practice and patient visits are complex, with competing demands and opportunities to address a wide range of problems of individuals and families over time and at various stages of health and illness. Multimethod research in practice settings can identify ways to enhance the competing opportunities of family practice to improve the health of their patients.

Adult↗
PubMed1995

A practical approach to hirsutism.

Women often express concern about what they consider to be excess body or facial hair. This surplus of hair may be normal or it may signal hypertrichosis or hirsutism. Hirsutism may be idiopathic, secondary to increased responsiveness of hair follicles to normal circulating levels of androgens, or it may result from an excess of androgens, which may be exogenous, or of ovarian or adrenal origin. The evaluation of hirsutism must include the identification, or exclusion, of androgen-producing tumors, but other extensive evaluation is controversial. Treatment includes local measures, antiandrogenic therapy and treatment focused on the underlying source of excess androgen.

Algorithms↗
PubMed1995

Do we practice what we preach? Comparing the patients of faculty and residents.

BACKGROUND AND OBJECTIVES: In academic family practice centers, the distribution of patients between faculty and residents influences the educational milieu. The medical literature has rarely addressed the differential case mix within the ambulatory medical educational setting. The goal of this study was to compare the characteristics of patient visits to resident and faculty physicians in seven community-based, university-affiliated family practice programs. METHODS: Using the National Ambulatory Care Survey instrument and protocol, 98 faculty and resident physicians recorded their ambulatory patient visits for one randomly selected week between July 1991 and June 1992 (n = 1,498). RESULTS: Patients of resident physicians were younger, more likely to be nonwhite (21.7% vs 9.8%, P < .001), and more likely to be reimbursed by Medicaid (34.2% vs 14.3%, P < .001) than patients of faculty physicians. Despite these patient differences, the spectrum of clinical problems was similar. There were minimal differences in the delivery of diagnostic services and therapeutic services. CONCLUSIONS: The patients seen by residents and faculty differ in important demographic characteristics. These differences could adversely affect the education of resident physicians. Academic family practice centers should actively monitor the age/gender/payment profile of resident and faculty patient panels and assign patients to achieve a desirable case mix for resident education. The differential racial distribution of faculty and resident visits suggests an unidentified systematic bias in patient assignment that warrants further investigation.

Academic Medical Centers↗
PubMed1993

Sexual assault.

Estimates are that one in four women will be sexually assaulted at some time during her life. For the victim, it is a life-changing, traumatic event. This paper reviews both the immediate and long-term care of the sexual assault victim. For the victim seen immediately after the assault, physicians must provide empathic, nonjudgmental care that puts the victim back in control of her life. It is essential that the physician provide continued support for the victim and her family through the recovery process. The medical presentations that should prompt the physician to inquire about undisclosed sexual assault and the social and cultural myths that promote sexual assault are reviewed.

Adolescent↗
PubMed1992

The impact of a patient survey or a physician reminder on the provision of adolescent preventive health care.

BACKGROUND: The objective of this study was to determine if the use of a patient survey or a chart stamp could increase the implementation of adolescent preventive health care in a family practice center. METHODS: Subjects were all patients 13 to 18 years old (date of birth 1972 to 1977), who visited the Aultman Family Practice Centers from October 1, 1989, through September 30, 1990 (N = 801 patient visits). Three different 1-month interventions (patient questionnaire, physician stamp, and both patient questionnaire and physician stamp) as well as a 1-month control period were implemented. The effect of the intervention on adolescent preventive health care was measured by review of documentation in the patient's chart. RESULTS: Those charts that indicated that either the questionnaire or stamp had been used showed significantly more documented discussion of issues relating to mood, injury, sexuality, exposure to toxins, and lifestyle (all P < .01). These discussions most commonly took place during a visit for a physical examination. The percentage of visits with documented discussions did not vary significantly according to type of reminder, nor with any physician or patient characteristic. CONCLUSIONS: The use of a reminder, especially in the context of an office visit for a physical examination, significantly increased the implementation of adolescent preventive health care in this family practice center.

Adolescent↗
PubMed1991

Preventive health care for the adolescent.

Adolescents represent the only segment of the population with an increasing mortality rate. The majority of deaths are due to accidents, homicide and suicide. The risks for these events are associated with developing sexuality and the use of drugs and alcohol. Behaviors that put the young person's future health at risk, such as poor nutritional habits, the use of tobacco and lack of exercise, are often established during adolescence. Surveillance of risk and interventions to prevent problems are critical activities for the family physician.

Accidents, Traffic↗
PubMed1991

The prevalence of osteoporosis risk factors and physician intervention.

To determine the prevalence of osteoporosis risk factors and the probability of physician risk recognition and intervention, the medical records of a cohort of 243 women aged 40 to 65 years were reviewed retrospectively. A historical cohort design was used. Risk factors present before the start of the study were identified. Osteoporosis risk recognition (discussion, problem list), osteoporosis specific intervention (counseling about risk, or estrogen or calcium supplementation), or nonspecific intervention (dietary, exercise, smoking, or alcohol counseling) were recorded over a 3-year follow-up period. Seventy-four percent of the women had two or more risk factors. The most common were perimenopausal or postmenopausal status (73%) and absence of estrogen supplementation (ever) (65%). During the period of the study, 46 women (19%) had received an osteoporosis-specific intervention. One hundred eleven women (46%) had received one of the above or a less specific intervention. The medical records of only 25 women (10%) documented an assessment of osteoporosis risk. Only menopausal status predicted osteoporosis intervention, and the probability of intervention decreased as the total number of risk factors increased. The data identify three groups of women who could benefit from increased risk-reduction strategies: premenopausal women, perimenopausal or postmenopausal women who have never previously taken supplemental estrogens, and women with multiple risk factors.

Adult↗
PubMed1988

Correlates of screening mammography in a family practice setting.

The medical records of 243 asymptomatic women aged 50 years or older were reviewed at a community-based family practice center to determine the proportion who had been referred for a screening mammogram and to identify correlates of mammography referral. Patient demographic characteristics, breast cancer risk factors, and characteristics of past patient-physician encounters were considered. Between July 1, 1981, and July 1, 1987, 40 (16 percent) of the women had received a mammography referral from their currently assigned physician. All but two of the women had actually obtained the mammogram. The primary predictors of mammography referral were the known risk factors for breast cancer: a family history of breast cancer (prevalence rate ratio [PRR] = 9.3, P = .001) and a history of benign breast disease (PRR = 7.9, P = .002). Other predictors included having a Papanicolaou test performed by the current physician (PRR = 4.1, P = .03), having a test for stool occult blood returned by the patient (PRR = 10.2, P = .003), having been instructed in smoking cessation by the current physician (PRR = 10.0, P = .05), and, possibly, being a former smoker (PRR = 4.6, P = .09). Patient demographic characteristics, other known breast cancer risk factors (age, obesity, alcohol use, and pregnancy history), and the sex of the physician were not predictive.

Aged↗
PubMedDate not supplied

Practical tools for qualitative community-oriented primary care community assessment.

BACKGROUND AND OBJECTIVES: The evolution of managed care is creating a need for feasible methods for clinical practices to perform community assessments. Since some types of clinically useful data are best obtained through a qualitative community assessment, practical methods of carrying out this type of assessment are needed. Such practical methods are also important for community-oriented primary care, an attractive model for the marriage of population perspectives and clinical primary care. METHODS: Using methods suitable for busy clinical practices, qualitative data useful for clinical purposes were collected either by mail surveys, telephone surveys, or during focus group discussions in a low-income community. Characteristics of data obtained through each method, together with the costs, advantages, and disadvantages of each approach, were examined. RESULTS: All three methods revealed similar themes in their responses, though the range and emotional content of the responses varied by approach. Clinically useful data were obtained, although the potential for sampling and response biases must be considered. Costs, primarily related to professional time, varied by as much as 50% among the methods examined; telephone surveys were the least expensive per enrolled subject. CONCLUSIONS: The methods tested are potentially feasible in busy practices. However, practices should clarify their objectives and resources prior to using these methods.

Adult↗
PubMedDate not supplied

Physician assessment of patient motivation: influence on disposition for follow-up care.

This study of 3,318 outpatient visits evaluated the influence of the physician-assessed level of patient motivation on the level of physician involvement in follow-up care. Data collected included patient demographics, health risk factors, physician-assessed level of patient motivation, and the disposition for follow-up care (return office visit or self-care). Physicians more frequently scheduled patients for a return office visit, regardless of assessed level of patient motivation, when they presented with a traditional biomedical problem. Patients with health promotion-disease prevention problems were more frequently relegated to self-care; patients physicians judged to be poorly motivated were four times as likely to be relegated to self-care. We discuss the implications of physician overuse of self-care strategies on the health status of poorly motivated patients. Factors influencing such physician behavior may include prior unrewarding experiences with poorly motivated patients, perceived lack of skill in affecting behavior change, time constraints, lack of reimbursement for preventive care services, and the actual process of physician education and professional socialization.

Adolescent↗
PubMedDate not supplied

Economic analysis of family practice residency programs: a report from the Northeastern Ohio Network.

BACKGROUND: The financial impact of a family practice residency program on a sponsoring institution is poorly understood. This study intended to describe as fully as possible all the expenses and revenues from five community-based family practice residency programs in northeastern Ohio. METHODS: Direct and indirect expenses, revenues, and demographics were evaluated for 1992. Similarities and differences among the participating programs were examined. RESULTS: Overall expenses per resident were similar in all five programs, with a range from $162,000 to $203,000. Revenues reflected the number of residents in the program, although collection ratios varied. Inpatient collections ranged from 53%-76% and outpatient collections ranged from 60%-76%. An average of 30% of graduates from the past 10 years were on the active medical staff of their sponsoring institution, with a range of 21%-36%. CONCLUSION: Based on the expenses, revenues collected, and reasonable assumptions made about cost of care in the hospital setting, the family practice residencies are probably a break-even operation, excluding the benefit of providing primary care physicians to the community.

Costs and Cost Analysis↗