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Warren P Newton

Publications and source records attributed to Warren P Newton.

17 recordsLinked to original sources
PubMed2003

Early radical prostatectomy improves disease-specific but not overall survival.

For now, a reasonable strategy is to consider watchful waiting as an acceptable alternative to radical prostatectomy for patients with early prostate cancer and a lifespan of less than 10 years. For other patients, discuss the benefits and risks of the treatment options, balancing expected side effects of the operation and the impact of other illnesses on survival with the possible benefit of the operation or other kinds of treatment. We still lack sufficient evidence whether early detection by PSA screening can reduce morbidity or mortality. In this study, radical prostatectomy for early prostate cancer decreased disease-specific mortality, but did not improve overall mortality. A companion study (1) showed that non-nerve-sparing radical prostatectomy yielded no difference in subjective quality of life, although clinically important increases in erectile dysfunction (number needed to harm [NNH]=3) and urinary leakage (NNH=4) did occur, compared with watchful waiting. Clinicians should understand that these results might not apply to patients with highly undifferentiated cancer; patients identified by screening to have elevated prostate-specific antigen (PSA) concentrations and no clinically symptomatic disease; or patients with significant comorbidities.

Comment↗
PubMed2002

Increasing physician comfort level in screening and counseling patients for intimate partner violence: hands-on practice.

A paucity of literature exists on implementing and evaluating residency curriculum addressing intimate partner violence. We used unknown simulated patients in a university-based family practice clinic following a pilot curriculum intervention. The curriculum focused on physician comfort with screening, counseling, and referral of patients, using standard conferences as well as a role-play session. Subsequently, unknown simulated patients were inserted into residents' clinic schedules during videotaped sessions. Evaluation included skills checklists from simulated patients, review of videotapes, and post-study resident interviews. Use of unknown simulated patients encouraged residents to consider and screen for intimate partner violence. Using simulated patients is logistically complex but provides a powerful residency training tool. Residents reported attitude changes favoring a more comprehensive role and reported greater comfort and confidence with screening and counseling.

Adult↗
PubMed2002

Resource-based relative value units: a primer for academic family physicians.

The Resource-based Relative Value Scale (RBRVS) is the prevailing model used to reimburse physician services today. Based on empirical research, relative value units (RVUs) quantify the relative work, practice expense, and malpractice costs for specific physician services to appropriately establish payment. The fee schedule, implemented by the Health Care Financing Administration in 1992, dramatically affected physician reimbursement, with the goal of correcting disparities across disciplines. In the first 6 years, Medicare payments to family physicians increased by 36%, while payments to specialists decreased by as much as 18%. Recent changes include new practice expense estimates and adjustment of payment based on facility type. The impact of RVUs is even more widespread as many private payers use the fee schedule to set payment rates and as RVUs become the yardstick for physician productivity measures. Despite the initial successes, the ability of RVUs to capture the work done by primary care providers is still limited. Primary care services today are not as easily quantified as surgical procedures, and coding limitations hinder documentation of services. Rapid changes in health care make comparisons to work done 2 decades ago difficult. Understanding the strengths and limitations of RVUs as they apply to family physicians is fundamental to safeguarding the role of primary care.

Centers for Medicare and Medicaid Services, U.S.↗
PubMedDate not supplied

Shaping the future of academic health centers: the potential contributions of departments of family medicine.

Academic health centers (AHCs) must change dramatically to meet the changing needs of patients and society, but how to do this remains unclear. The purpose of this supplement is to describe ways in which departments of family medicine can play leadership roles in helping AHCs evolve. This overview provides background for case studies and commentaries about the contribution of departments of family medicine in 5 areas: (1) ambulatory and primary care, (2) indigent care, (3) education in community and international settings, (4) workforce policy and practice, and (5) translational research. The common theme is a revitalization of the relationship between AHCs and the communities they serve across all missions. Family medicine leadership can provide dramatic organizational improvement in primary and ambulatory care networks and foster opportunities for leadership by AHCs in improving the health of the population. Departments of family medicine can also play a leading role in developing new partnerships with community-based organizations, managing the care of the indigent, and developing new curricula in community and international settings. Finally, family medicine departments and their faculty have a central role in helping AHCs respond to workforce needs and in developing translational research that emphasizes the health of the population and effectiveness of care. AHCs are a public good that must now evolve substantially to meet the needs of patients and society. By pushing for substantial change, by helping to reinvigorate the relationship between AHCs and the communities they serve, and by emphasizing fundamental innovation in clinical care, teaching, and research, family medicine can help lead the renewal of the AHC.

Academic Medical Centers↗