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PubMed1997

Are patients who present late with cancer registered with low referring practices?

This study examines whether a clinical outcome (stage of breast or bowel cancer at referral) was related to variations in GP referral rates. A multivariate analysis of breast and bowel cancer patients referred from 183 Nottinghamshire practices during 1993 showed no adverse outcome associated with low GP referral rates. Variables included in the analysis were total and surgical referral rates, fundholding status, UPA(8) score of the practice, partnership size, and age and sex of the referred patient.

Breast Neoplasms↗
PubMed1992

Overall use of proctoscopy in general practice and possible relation to the stage of rectal cancer.

Data from the Danish National Health Service records on activities of each of 146 general practices in the county of North Jutland, Denmark, were studied to determine whether the use of proctoscopy influenced the stage at which cancer of the rectum was recognized. Information for all patients in the county who received the diagnosis of cancer of the rectum was obtained from the Danish Cancer Registry. Proctoscopy was performed significantly more often in partnership practices (96%) than in single practices (81%). The frequency with which the test was used varied from 1 to 107 proctoscopies per general practitioner per year. In the 95 patients with cancer of the rectum, no relationship was found between the stage (Dukes') at the time of diagnosis and work-load, size and activity of practice, or use of proctoscopy.

Denmark↗
PubMed1999

Measuring the impact of prevention research on public health practice.

CONTEXT: Prevention research involves the translation of established and promising methods of disease prevention and health promotion to communities. Despite its importance, relatively little attention has been paid to systematic approaches to determining the impact of prevention research on public health practice. Evaluation of these effects is challenging, particularly in light of multi-factor causation, long time periods between exposure and disease occurrence, and difficulties in determining costs and benefits. OBJECTIVE: To develop a framework that allows the prospective or retrospective evaluation of the effects and effectiveness of prevention research. RESULTS: The proposed framework allows assessment of prevention research in five areas of public health practice: surveillance and disease investigation, program delivery, policies and regulations, recommendations to the public, and public health education and training. A brief case study of environmental tobacco smoke illustrates the public health impact of prevention research. CONCLUSIONS: Greater translation of prevention research findings is needed to accomplish public health goals--efforts are enhanced by academic-practice partnerships. The relevance and utility of the current framework needs additional testing with a variety of public health issues.

Cost-Benefit Analysis↗
PubMed1991

Interaction between diabetic patients, their general practitioners and a hospital diabetic clinic.

OBJECTIVE: The aim of this study was to examine the sociodemographic data of diabetic patients referred to our clinic and to correlate these with characteristics of their individual general practitioners. How these factors affect the interaction between patients, general practitioners and a hospital diabetic clinic was evaluated. DESIGN: Prospective recruitment of consecutive referrals. SETTING: The diabetic clinic of a teaching hospital located in the inner city suburbs of Sydney. PATIENTS: Two hundred and forty-six patients with diabetes (10% insulin dependent), aged 20-86 years, participating in our Shared Care Project, a randomised controlled study on various methods of following up diabetic patients. INTERVENTIONS: Data for the study were gathered by interview and questionnaire during first assessment at the clinic. MAIN OUTCOME MEASURES: Clinical and sociodemographic characteristics of patients; the location of general practitioners, their diagnostic equipment and type of practice; and the level of detail recorded in referral letters from general practitioners. RESULTS: Diabetic patients of migrant background who cannot speak English are older and have less formal education. They see their doctors more often and seek out general practitioners who speak their language, even if it means travelling longer distances. Patients referred from 24 hour medical centres are younger, more educated and have less contact with their doctors both in duration and frequency of visits when compared with patients whose general practitioners operate in conventional sole or partnership practices. Many patients have more than one general practitioner, making communication with hospitals difficult. In their referral letters, general practitioners usually concentrate on hypertension, hypercholesterolaemia and metabolic aspects of diabetes, but under-emphasise diabetic complications; they make insufficient use of measurement of the glycosylated haemoglobin level to assess diabetic control while over-using glucose tolerance testing in making the diagnosis. The referral letter often does not contain enough information to help clinical decision making. CONCLUSIONS: Demography of patients and characteristics of general practitioners are important factors which can affect their interaction with public hospitals. Bearing in mind the work load of general practitioners and the diverse nature of patients, hospitals must implement systems which make it easier for general practitioners and patients to interact with them.

Adult↗
PubMed2004

Work of female rural doctors.

OBJECTIVE: To identify the impact of family life on the ways women practice rural medicine and the changes needed to attract women to rural practice. DESIGN: Census of women rural doctors in Victoria in 2000, using a self-completed postal survey. SETTING: General and specialist practice. SUBJECTS: Two hundred and seventy-one female general practitioners and 31 female specialists practising in Rural, Remote and Metropolitan Area Classifications 3-7. General practitioners are those doctors with a primary medical degree and without additional specialist qualifications. MAIN OUTCOME MEASURE: Interaction of hours and type of work with family responsibilities. RESULTS: Generalist and specialist women rural doctors carry the main responsibility for family care. This is reflected in the number of hours they work in clinical and non-clinical professional practice, availability for on-call and hospital work, and preference for the responsibilities of practice partnership or the flexibility of salaried positions. Most of the doctors had established a satisfactory balance between work and family responsibilities, although a substantial number were overworked in order to provide an income for their families or meet the needs of their communities. Thirty-six percent of female rural general practitioners and 56% of female rural specialists preferred to work fewer hours. Female general practitioners with responsibility for children were more than twice as likely as female general practitioners without children to be in a salaried position and less likely to be a practice partner. The changes needed to attract and retain women in rural practice include a place for everyone in the doctor's family, flexible practice structures, mentoring by women doctors and financial and personal recognition. WHAT THIS PAPER ADDS: Women make up less than a quarter of the rural general practice workforce and an even smaller percentage of the specialist rural medical workforce. As a result their experiences are not well articulated in research on rural medical practice and their needs are not well represented in policies and programs for rural doctors. The incoming cohort of rural general practitioners has a majority of women and it is essential that the practice styles and needs of women doctors are understood in order to attract and retain women in rural medicine. This survey identifies some of the effects of family responsibilities on the work practices of female rural doctors and the changes needed to the structure of rural practice to include the way women work.

Adult↗
PubMed1975

Continuity of care in a university-based practice.

Effects of changes in a pediatric practice--expansion of the number of pediatricians and incorporation into a university hospital setting--on continuity of care and utilization were examined by means of a longitudinal study of a sample of 63 families. Continuity of care was measured by the following index: the number of visits with own physician divided by the total number of pediatric visits per year. Although continuity of well-child visits remained unchanged at the university setting, the continuity of sick visits declined markedly. An increased use of doctor visits for illness care was observed; its relationship with the decline in continuity is analyzed and discussed. While continuity is inherent in a small partnership practice, it is not so in a larger medical organization, particularly when involvement in patient care is part time. In such an organization, deliberate arrangements that enable patients with acute needs to receive care from their own doctors are needed.

Child Health Services↗
PubMed1986

Accident department or general practice?

Ninety two patients, who were registered with one general practice partnership that has a tradition of providing minor trauma services and who had attended a hospital accident and emergency department, completed a questionnaire giving their reasons for not first attending their general practitioners with their ailments. Most had not tried to contact their general practitioner, and of these, only a few were unsuitable for treatment first by the general practitioner. More than half had attended the accident and emergency department because they did not want to bother their own general practitioner or thought that their problem was unsuitable for his attention. A higher proportion had attended for reasons of perceived speed or convenience. In the light of the need to cut costs in the hospital service and of government interest in promoting a wider range of services in general practice further study of such problems is needed. Patients' perceptions of the role of the accident department need to be changed if present behaviour is to be altered.

Emergencies↗
PubMedDate not supplied

Design of a survey to inform state health decision making: a collaborative effort.

BACKGROUND: The North Carolina Health Profile (NCHP), a statewide telephone survey, was introduced as part of the state's Health Policy Information Project aimed at enhancing the use of health data for state policy decision making and program management. A key factor in the creation of the NCHP was a collaboration between the State Center for Health Statistics and the Survey Research Unit at the University of North Carolina at Chapel Hill. The purpose of this article is to describe our partnership, the development of the survey design, and the dissemination of survey results. METHODS: Three designs were considered during the planning and development of the survey. The final design consisted of a random digit dialing sample of 2,400 households in the state's noninstitutionalized population. The questionnaire was comprised of an adult module (addressing adult health care use and insurance coverage), a child module (addressing health care use and insurance coverage of children ages 0-17 years), and a young child module (addressing child development and safety for children ages 0-5 years). RESULTS: Several statistical briefs, a report, a public dataset, and accompanying public use documentation were prepared for a variety of audiences, including state legislative committees and commissions, state agencies, and advocacy groups. DISCUSSION: We learned several lessons in our research and practice partnership including the need for collaboration between data creators and users, for addressing obstacles in soliciting policy information needs, and for prioritization in meeting information needs.

Cooperative Behavior↗
PubMed2001

A comparison of partnership caseload midwifery care with conventional team midwifery care: labour and birth outcomes.

OBJECTIVES: to compare the effects of partnership caseload midwifery care, with conventional team midwifery care. Comparisons of labour interventions and birth outcomes were made between the two models of care. DESIGN: a prospective, non-randomised clinical trial. SETTING: Women's Hospital at Leicester Royal Infirmary, Leicester, UK in 1998. PARTICIPANTS: 303 women from the experimental group and 308 from the control group (611 in total) matched for age, ethnicity, marital status, parity, gravida and height who gave birth between April 1997 and August 1998. INTERVENTION: the control group received conventional team midwifery care during pregnancy, labour and birth, and the experimental group received care from midwives working in partnerships that provided continuity of care during pregnancy, labour and birth. KEY FINDINGS: 21% of women in the experimental group had an epidural compared with 32% of the controls (OR 0.56 95%, CI 0.39-0.81, P=0.002). The normal vaginal birth rate (74% v 66%, OR 1.45, 95% CI 1.02-2.05, P=0.038), upright birth posture rate (60% v 14%, OR 9.64, 95% CI 5.96-15.61, P= or <0.001), intact perineum rate (40% v 30%, OR 1.57, 95% CI 1.05-2.35, P=0.027), and physiological third stage rate (37% v 1.5%, OR 38.69, 95% CI 11.98-124.89, P= or <0.001) were significantly higher in the experimental group. The induction of labour rate (16% v 23%, OR 0.66, 95% CI 0.44-0.98, P=0.042) was significantly lower in the experimental group. Women in the experimental group had more home births (17% v 1.3%, OR 15.38. 95% CI 5.48-43.14, P= or <0.001); used the midwife-led birthing suite more often (28% v 12%, OR 2.77, 95% CI 1.82-4.22, P= or <0.001); were more likely to take an early discharge (two to six hours) from hospital following birth (25% v 3%, OR 11.32. 95% CI 5.55-23.06, P= or <0.001); and were attended in birth more often by either their named midwife (67% v 5%, OR 39.65, 95% CI 22.38-70.25, P= or <0.001) or her partner (known midwife) (84% v 14%, OR 32.74, CI 20.96-51.14, P= or <0.001). IMPLICATIONS FOR PRACTICE: partnership caseload midwifery care resulted in less interventionist labour and more normal birth than conventional team midwifery care. Women in the experimental group had more home births, birth in a midwife-led suite and opted for early discharge home postnatally more often than the controls. They also experienced much higher levels of continuity, particularly of a known midwife during labour and birth. The study findings should encourage other maternity units in the UK to pilot and evaluate the model to see if these benefits are transferable.

Adult↗
PubMedDate not supplied

Compliance with influenza vaccination. Its relation with epidemiologic and sociopsychological factors.

OBJECTIVE: To identify patient characteristics that are associated with compliance with influenza vaccination reminders in high-risk patients. DESIGN: Registration of the vaccination of high-risk patients invited by their family physicians. Factors that might be associated with compliance were evaluated, eg, sex, age, insurance, diagnosis, seriousness, and multiple indications. A questionnaire about sociopsychological factors was sent to all noncompliant patients and a random sample of 25% of compliant patients. SETTING: Four single and 3 partnership practices with 2142 high-risk patients in a total of 26,000 patients in the Netherlands. MAIN OUTCOME MEASURES: (1) Compliance by at-risk group; odds ratios (ORs) for epidemiologic and diagnosis-based factors, adjusted by multiple logistic regression analysis; (2) adjusted ORs (adj ORs) for sociopsychological factors; and (3) decisive reason whether to comply. RESULTS: Compliance was 86% (95% confidence interval [CI], 85%-88%), with little difference between at-risk groups. The epidemiologic factors age older than 50 years (adj OR, 1.9; 95% CI, 1.5-2.5) and multiple indication (adj OR, 2.2; 95% CI, 1.3-3.6) were related to compliance, independent of at-risk group. Belief in the absence of side effects (adj OR, 10.5; 95% CI, 5.5-20.2) and in the efficacy of the vaccine (adj OR, 5.6; 95% CI, 3.0-10.2) were most positively associated with compliance. Perceived susceptibility to influenza also was associated (adj OR, 2.9; 95% CI, 1.5-5.8), but perception of one's health was not. There was a negative association of compliance in the interaction of age younger than 50 years and disbelief in the possible complications of influenza (adj OR, 0.2; 95% CI, 0.0-0.5). These factors and the family physician's invitation were decisive. CONCLUSIONS: Information about the protection and the side effects of vaccination and the complications of influenza should be directed to patients younger than 50 years; no specific high-risk groups require special information.

Female↗
PubMed1983

Survey of men and women residents entering United States obstetrics and gynecology programs in 1981.

In July 1981, questionnaires were distributed to 1,128 residents entering the field of obstetrics and gynecology throughout the United States; 546 (48%) were returned and evaluated, 229 from women (42%) and 317 from men (58%). Factors that related to the choice of the specialty showed a universal interest in the birthing process and the surgical aspects of the specialty, with a large majority also interested in health education, endocrinology, primary care of young people, and achievement of a greater understanding of sexuality. Private partnership practice was favored by most of the respondents. Men attributed a greater importance to income than did women, who were more interested in a salaried practice and less irregularity of hours. Women tended to be more liberal on questions that were related to controversial medical and ethical issues in the field of obstetrics and gynecology. Role models, half of whom were teachers, were equally common to men and women (66%).

Adult↗
PubMed2006

Finding solutions to challenges faced in community-based participatory research between academic and community organizations.

Partnerships between communities and academic institutions have been vital in addressing complex health and psychosocial issues faced by culturally diverse and hard-to-reach populations. Community-based participatory research (CBPR) has been suggested as a strategy to develop trust and build on the strengths of partners from various settings to address significant health issues, particularly those persistent health issues that reveal disparities among minority populations. There have been many challenges to developing these partnerships in the United States. The purpose of this paper is to discuss approaches and solutions used by this research team in response to the challenges they have faced in using CBPR. The team uses CBPR to understand and support the process of disclosure of intimate partner violence (IPV) within the context of the community health centers that provide services for multicultural and multi-lingual populations. While CBPR provides a route to develop trust and build on the strengths of partners from various settings, there are multiple challenges that arise when partnering organizations present with different infrastructures, missions, resources and populations served. Examples of common challenges and solutions from the literature and from the team's experience will be discussed. Implications for partners, partnerships, practice and research will be explored.

Cooperative Behavior↗
PubMed1988

Psychiatrists in primary care: the general practitioner viewpoint.

Within the past few decades, a growing number of psychiatrists in the UK have moved their outpatient clinics out of their hospital bases and have established liaison-attachment clinics in primary care settings within their catchment areas. This study reports the views of the senior general practitioners who have access to such clinics in their practices. The majority described a significant alteration in the nature of their relationships with the specialists. This, together with the opportunity for general practitioners to become involved in integrated management approaches, is believed to significantly improve continuity of patient care.

Community Psychiatry↗
PubMed1994

Restraint reduction: can it be achieved?

This article describes a step-by-step process for implementing restraint reduction programs in two skilled nursing facilities. The combination of using standardized guidelines, customizing others, and involving direct-care staff in facing challenges led to success. A research-practice partnership enabled a formal evaluation of the program. A pre- and posttest study design revealed significant reductions in physical restraints without increasing staff. This project demonstrates that frail, elderly people in nursing homes need not be physically restrained to receive effective care, but that alternatives can include more dignified options.

Accidental Falls↗
PubMed1990

A typology of medical practice organization in Canada. Data from a national survey of physicians.

Different modes of practice organization may result in advantages for physicians and their patients. Compared with solo practice, group practice may produce economies of scale, efficiencies in health care delivery, and improvements in the quality of care. However, in Canada assessment of the implications of differences in practice organization have been impeded by a lack of relevant data and a tendency to treat practice type as a dichotomous variable. Conventional solo/group distinctions fail to address the significance of the growing number of medical practices that are neither solo nor group, but combinations of both, and they obscure the policy implications of the growing number of physicians in institutional as opposed to private practice. This paper develops and applies a theoretically based typology of practice organization to data collected as part of a national survey of 2,398 Canadian physicians conducted in late 1986 and early 1987. The analysis identifies six practice types, describes their distribution and operating characteristics, and identifies the characteristics of physicians working in them.

Canada↗
PubMedDate not supplied

Transformational leadership: the development of a model of nursing case management by the army nurse corps.

Management philosophy and culture of any organization must match the nursing professions' core value of caring. Organizational conflict symptomology includes communication barriers and widely differing values. Employment of accountability based systems and bringing nurses into governance prevents conflict and improves job satisfaction. This article identifies the barriers to case management program development and discusses strategies for its successful implementation. Today's most successful organizations will implement an institution-wide commitment to a culture within which excellence flourishes. Creative staffing models and professional practice partnerships such as nursing case management will be supported and encouraged by executive leadership; they work as a team and will be jointly accountable for positive outcomes The United States Army Nurse Corps has the framework necessary to develop a premiere nursing organization. Case management departments may adopt these techniques to improve working relationships and leadership capacity within their organizations.

Case Management↗