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PubMed2003

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Attitude of Health Personnel↗
PubMed1998

A survey of family physicians and psychiatrists. Psychotropic prescribing practices and educational needs.

The purpose of this study was to compare the psychotropic prescribing practices of family physicians and psychiatric physicians, and to assess their satisfaction with education about psychotropic prescribing. A survey was mailed to 461 active members of the Minnesota Psychiatric Society and to a randomized sample of 461 active members of the Minnesota Academy of Family Physicians. Major depression, panic disorder, and dementia with behavioral disturbance were selected for study. For each disorder, we asked for the estimated number of patients seen and treated as well as a list in order of preference of the three medications they most commonly use. Those surveyed were also asked about their level of satisfaction with the training they received in medical school, residency, and continuing medical education (CME) courses on the topic of psychotropic prescribing. The two physician groups reported similar prescribing practices for the single-drug treatment of depression. Family physicians more frequently prescribed minor tranquilizers and older generation psychotropics than did psychiatrists when treating panic disorder and dementia with behavioral disturbance. Patients with depression were the least likely to be referred to other health professionals. Neither physician group was satisfied with medical school education in this area; family physicians were less satisfied with residency training and in related CME courses than were psychiatric physicians. Additional study is needed to better understand interspecialty practice variation for commonly encountered psychiatric disorders. Medical education programs at all levels could better meet the reported needs of their graduates by providing more attention to prescribing psychotropic agents.

Adolescent↗
PubMed1998

Interphysician variability in defining the planning target volume in the irradiation of prostate and seminal vesicles.

With the improvements in treatment accuracy the risk exists of over-reliance on the capability of the physician to estimate the extent of the tumour. We assessed the variability between six radiotherapists in defining the planning target volume (PTV) on CT slices for three prostate tumour cases. Percentage differences between measured volumes and mean values calculated for each case ranged from -53.64 to +60.48% (SD 36.00%). There is a considerable variation in delineating the PTV, both in the cranio-caudal direction and in the in-slice extension of the areas drawn on each slice (standard deviations ranged from 0.35 to 2.64 cm2). We also checked the uncertainty in the shape and position of the contours on each CT image. The analysis was performed on three slices of one test case. As we expected, the uncertainty seems largest for seminal vesicle slices and smallest for prostatic apex slices. These results endorse the need for uncertainty analysis of all departmental processes in order to define a detailed protocol and consequently to minimize the interphysician differences in PTV delineations.

Analysis of Variance↗
PubMed2003

Questionnaire-based survey on obstetricians and gynaecologists' attitudes towards the surgical management of urinary incontinence in women during their childbearing years.

OBJECTIVE: To determine the appropriate surgical management of incontinence in women who desire to maintain their childbearing capacity. DESIGN: Questionnaire-based survey. METHOD: A postal questionnaire was sent to 251 (every fourth) consultant obstetricians and gynaecologists in the UK practising in both district general hospitals (n=156) and teaching hospitals (n=95). MAIN OUTCOME MEASURES: Clinical consensus in the management of incontinence in women who are interested in childbearing. RESULTS: One hundred and thirty two (53%) consultants responded of which 22 (17%) were not involved in managing this group of women and were therefore excluded from analysis. Thirty-nine (36%) of the replies were from teaching hospital, 71 (65%) were from district general hospitals. Eighty-six (78%) consultants are prepared to perform a continence procedure on women who had not completed their families. One hundred (91%) would offer caesarean section to those continent pregnant women following their continence surgery. (Fisher's exact test' P=0.038). Interestingly, 67 (60.9%) of respondents still perform caesarean section to the pregnant women even if they are incontinent. CONCLUSIONS: The majority of UK consultants would perform a continence procedure in women who wish to maintain their childbearing capacity. Colposuspension is the favoured surgical procedure. If women are continent following surgery, most prefer them to be delivered by caesarean section.

Adult↗
PubMed2004

[Prescription of high dose buprenorphine by general practitioners].

BACKGROUND: Since 1996, prescribing buprenorphine in high dosage as a drug maintenance treatment has been allowing French general practitioners to undertake drug addicts with a pharmacological support. In France, buprenorphine prescriptions seem to spread over general practitioners (buprenorphine was given to 74,300 patients in 2001). This paper assesses the different factors associated with buprenorphine prescription by general practitioners and with the different degrees of general practitioners' commitment in actually caring drug addicts with the help of buprenorphine. METHODS: Two representative samples of private general practitioners, either prescribing buprenorphine (345 over a population of 876) or not prescribing (355 over a population of 1380) have been questioned through a phone interview in the department of South-Eastern France in November and December 2002. Samples have been constituted with the help of a random stratified survey according to sex, age and volume of services (acceptance rate: 65.5%). Survey data have been completed with general practitioners' activity data from Health Insurance and local socioeconomic data from Insee. RESULTS: 37.5% of general practitioners have at least once prescribed buprenorphine during the considered period, but only 26% of the prescribers treated 75% of patients. Prescribers are most often men, younger than 49 years, working in the fixed fees sector and having group practice. They are also most often members of a health care network, trained for drug maintenance treatments and, from an individual point of view, have relatives suffering cancer, or having HIV, or hepatitis C, or who are drug addicts. Low socioeconomic status of the area where GPs exert seems to be particularly associated with general practitioners' prescription of buprenorphine. CONCLUSION: Data handled in this paper show that supply of substitutive treatments is concentrated among a reduced number of general practitioners and in particularly deprived geographic areas. Workload in deprived areas combined to great professional commitment in maintenance treatment reveals unexpected and unwanted specialisation behaviours by general practitioners, as well as more isolated behaviours by general practitioners who do not ask for particular training program or help by colleagues. These results question the consistency of the general framework of support to general practitioners proposed by health authorities with general practitioners actual practice and needs.

Analgesics, Opioid↗
PubMed1997

Physician responses to an educational intervention on improving their long-term prescribing of sedatives.

The current study examined response forms returned by physicians in response to a Medicaid retrospective therapeutic intervention on the long-term use of sedatives. The educational intervention was designed to notify physicians about their patients' long-term use of sedatives and suggest that they reevaluate the patient's need for sedative hypnotic medication and decrease or discontinue prescribing the medication and/or suggest non-pharmacological alternatives if deemed appropriate. Forty-seven percent of physicians responded to the educational intervention. Nineteen percent of responding physicians planned to change the patient's medication in some way. The most common planned change was to decrease the dose. Physicians also stated that they would recommend one or more non-pharmacological alternatives to 17% of patients. Thirty-eight percent of physicians planned to monitor and/or counsel the patient. Over 40% of physicians reported planning no action after receiving the intervention. Twenty-six percent of physicians planned no action because of patient demand for the sedatives. The study concludes that physicians need to be better trained on how to: (1) discuss non-pharmacological treatments with patients and (2) deal with and respond to patients who demand controlled substances.

Adult↗
PubMed2001

Mode of payment, practice characteristics, and physician support for patient self care.

PURPOSE: The purpose of this study was to assess the influence of payment mode and practice characteristics on physicians' attitudes toward and support of self-care among their patients. It is a common practice for health plans and health insurance companies to distribute and make available various self-care services and products to members. These self-care products are generally part of a larger demand-management strategy. The adoption and dissemination of self-care products by both fee-for-service and capitated systems of care suggest an implicit assumption that there is no connection between physician payment mode and the support of self-care products by physicians for their patients. This study empirically examines this assumption. METHODS: Physicians from three Northwest communities were sampled and face-to-face interviews were conducted (N=448). RESULTS: The findings show that younger, primary care, and female physicians are more supportive of self care for their patients. Physicians with more income from capitation or salary are also more supportive of self care for their patients. After controlling for other factors, physician mode of payment is the only statistically significant predictor of support for self care. Research and policy implications are discussed. CONCLUSION: The findings suggest that physicians who are paid on a capitation basis have more motivation to have patients be less reliant on the formal care structure. It is unclear whether the payment mode generates this support, or if physicians supportive of patient self care self-select themselves into capitated systems of care.

Attitude of Health Personnel↗
PubMed2002

Physicians' attitudes and beliefs concerning alcohol abuse prevention in adolescents.

BACKGROUND: Primary alcohol abuse-prevention services delivered to adolescents are inadequate, despite the fact that alcohol abuse is a major health problem. Physicians' attitudes and beliefs regarding primary prevention of adolescent alcohol abuse and appropriate onset ages of alcohol use may be useful in understanding why delivery of prevention services is inadequate, but as yet has not been investigated. OBJECTIVES: To examine (1) physicians' attitudes and beliefs regarding alcohol abuse prevention and practice, and (2) correlates of these attitudes and beliefs, including the delivery of primary alcohol abuse-prevention services to adolescents. METHODS: A national, stratified random sample of pediatricians and family practitioners was drawn from the American Medical Association's Masterfile Registry. Inclusion criteria included active medical practice and seeing at least one adolescent per week. The response rate was 63%, resulting in a final sample of 1842 physicians. Participants were queried about their practice, alcohol use, attitudes and beliefs, and delivery of alcohol-related screening and education to adolescents. RESULTS: On average, physicians reported providing alcohol-related screening to 40.3% (standard error [SE]=0.6) and education to 52.0% (SE=0.8) of their adolescent patients. Participants had positive attitudes toward adolescents, believed that prevention was important, and approved of alcohol screening early in adolescence, but did not feel very comfortable about their adolescent alcohol-management skills. Except for ceremonial use, most physicians did not believe in underage drinking. Attitudes and beliefs were significantly related to the delivery of alcohol screening (R(2)=0.34, p < 0.001) and education (R(2)=0.18, p < 0.001). Participants who delivered more screening and education had more positive beliefs in the importance of prevention (beta=0.14 and beta=0.13, respectively; p < 0.001); approved of early alcohol screening (beta=0.29 and beta=0.09, respectively; p < 0.001); and were more comfortable with their alcohol management skills (beta=0.31 and beta=0.28, respectively; p < 0.001). A profile of physicians with positive attitudes and beliefs is presented. CONCLUSIONS: Physician attitudes and beliefs are associated with variations in alcohol screening and education services delivered to adolescents. A better understanding of physicians' attitudes and beliefs can be useful in providing physician education and training aimed at improving primary alcohol-abuse prevention.

Adolescent↗
PubMed1996

Human health resources: issues concerning the number, distribution, mix and role of physicians in the Canadian health care system.

This article focuses on key health policy issues related to physician health resources. Using the 1991 Barer/Stoddart report, Toward Integrating Medical Resource Policies for Canada, as the starting point for discussion, the author examines such issues as the number and geographic distribution of physicians, reimbursement, licensing standards, specialty mix and scope of practice. The article concludes with recommendations for future directions in public policy.

Canada↗
PubMed1995

Use of antibiotic-impregnated cement during hip and knee arthroplasty in the United States.

A survey of practicing orthopaedists regarding their use of antibiotic(s) in bone-cement (ABC) was carried out. The initial sampling of 2,139 orthopaedists spanned the continental United States. Responses that passed fail-edit criteria were obtained from 1,015 physicians. Clinical practice patterns are highly variable. Adult reconstructive orthopaedic practitioners' belief in antibiotic(s) in bone-cement for the treatment of patients with previous sepsis is favorable. This opinion can be supported at the guideline level. Guidelines suggesting that liquid antibiotics should not be used as additions to polymethyl methacrylate are also supportable. The need for careful scientific inquiry and cost-effectiveness evaluation of the benefits and risks relating to the use of antibiotic additions to polymethyl methacrylate cement in joint arthroplasty exists. On the basis of such inquiry, educational dissemination to reduce practice variation would be indicated.

Anti-Bacterial Agents↗
PubMed2005

Abortion practice in the northeast Caribbean: "Just write down stomach pain".

Small island exigencies and a legacy of colonial jurisprudence set the stage for this three-year study in 2001-2003 of abortion practice on several islands of the northeast Caribbean: Anguilla, Antigua, St Kitts, St Martin and Sint Maarten. Based on in-depth interviews with 26 physicians, 16 of whom were performing abortions, it found that licensed physicians are routinely providing abortions in contravention of the law, and that those services, tolerated by governments and legitimised by European norms, are clearly the mainstay of abortion care on these islands. Medical abortion was being used both under medical supervision and through self-medication. Women travelled to find anonymous services, and also to access a particular method, provider or facility. Sometimes they settled for a less acceptable method if they could not afford a more comfortable one. Significantly, legality was not the main determinant of choice. Most abortion providers accepted the current situation as satisfactory. However, our findings suggest that restrictive laws were hindering access to services and compromising quality of care. Whereas doctors may have the liberty and knowledge to practise illegal abortions, women have no legal right to these services. Interviews suggest that an increasing number of women are self-inducing abortions with misoprostol to avoid doctors, high fees and public stigma. The Caribbean Initiative on Abortion and Contraception is organising meetings, training providers and creating a public forum to advocate decriminalisation of abortion and enhance abortion care.

Ambulatory Care Facilities↗
PubMed2000

Physician perspectives on increasing minorities in cancer clinical trials: an Eastern Cooperative Oncology Group (ECOG) Initiative.

PURPOSE: This paper describes the ECOG-NMA Minority Accrual Initiative to assure minority participation in cancer clinical trials. METHODS: Focus groups were held to identify physician-reported barriers to the enrollment of minority patients in Cleveland, OH, Indianapolis, IN, Santa Clara County, CA, and Philadelphia, PA. Community physicians affiliated with the National Medical Association (NMA), and Eastern Cooperative Oncology Group (ECOG) investigators participated in the focus groups. A four-step process consisting of focus group workshops were conducted to (i) identify barriers, (ii) develop potential solutions to the barriers, (iii) define solutions to barriers involving specific clinical trials, and (iv) implement the solutions. RESULTS: Focus group participants identified physician lack of information, patient fears and suspicion, the fear of losing patients, and distrust of the health care system as the major barriers to enrollment of African Americans. We found significant differences between community physicians and cancer program physicians in several areas. Community physicians emphasized personal contacts to address the lack of information and to overcome patient fears and suspicions, while the cancer program physicians emphasized printed materials. There was no difference by region in the barriers identified in the focus group workshops; however, the proposed solutions to overcoming the barriers were specific to each site. CONCLUSION: The four-step process developed by the ECOG and the NMA used the focus group methodology to identify and overcome barriers to participation of African Americans in cancer clinical trials. Outreach efforts to educate patients, their families, and community physicians about cancer clinical trials should be directed at overcoming patient suspicions and providing practical information to physicians about specific trials and how to enroll patients.

Attitude of Health Personnel↗