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Results for “practice environment”

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PubMed1998

Maternity care practices of navy family practice residency graduates after leaving the military.

BACKGROUND: Nationwide, 32% of residency-trained family physicians deliver babies compared with 73% to 90% in the military. This study describes and defines issues that could ultimately help revive family practice maternity care. METHOD: We surveyed 112 family physicians who had left the navy. RESULTS: Ninety-one percent had delivered babies in the navy, 45% since leaving the military, and 25% currently. Principal maternity care incentives both in and out of the military were personal and professional satisfaction. Reasons for not providing civilian maternity care included malpractice risks, insurance costs, and lifestyle issues. The decision for providing maternity care was usually made before or during residency, whereas the decision against was most often made upon leaving the military. Among more recent graduates (1990-1995), 48% continued to deliver babies in civilian practice. (This is about 20% more than recent civilian graduates.) Malpractice concerns were less important to this group than to earlier graduates. CONCLUSIONS: Factors discouraging family physicians from providing maternity care arise from their practice environment and are not easily overcome with improved training and experience. Recent navy residency graduates are not as easily discouraged.

Adult↗

PubMed2006

Impact of dynamic airflow on human thermal response.

UNLABELLED: Airflow fluctuation is an important factor affecting indoor thermal environments and human thermal response. In this study, dynamic airflows with different fluctuation characteristics were generated by a dynamic air supply terminal. The influence of three different kinds of airflows, constant airflow, simulated natural airflow and sinusoidal airflow, on thermal comfort was studied. Subjective experiments indicated that a dynamic airflow can cause a stronger cold sensation, and that air movement with 1/f fluctuations similar to natural wind is more acceptable than other dynamic airflows in warm environments. Moreover, the impact of draughts in dynamic airflows on human thermal response is different in neutral-warm (30 degrees C) and cool-neutral (26 degrees C) thermal environments. PRACTICAL IMPLICATIONS: By means of a dynamic air supply terminal it is possible to generate artificial airflows that simulate natural wind indoors. This kind of airflow with higher velocity is more comfortable and causes less draught sensation than the constant airflows supplied by conventional fans. While the cooling effect of this airflow is utilized in the built environment, the design temperature of air-conditioning system can be increased and the amount of energy consumption can be reduced dramatically.

Adult↗

PubMed2002

Satisfaction and well-being of primary care providers in managed care.

We compared perceptions about the practice environment and the job satisfaction of physician assistants (PAs), nurse practitioners (NPs), and primary care physicians in a large group-model HMO. The data source was a self-administered mail survey (average response rate = 79%). PA/NPs and primary care physicians reported that professional autonomy was not a problem and were satisfied with most aspects of practice in this setting. Common areas of dissatisfaction included patient load and amount of time with patients. PA/NPs were more likely than the physicians to experience stress on a daily basis, however, and were less likely to report that they would choose the practice setting again. They also were significantly less satisfied than the physicians with their incomes and fringe benefits. Our findings suggest that more attention should be given to practice conditions and compensation of PAs and NPs in managed care.

Adult↗

PubMedDate not supplied

New Mexico pharmacists' knowledge, attitudes, and beliefs toward prescribing oral emergency contraception.

OBJECTIVE: To describe New Mexico pharmacists' knowledge, attitudes, and beliefs toward the prescribing of oral emergency contraception (EC) in their practices. DESIGN: Cross-sectional study. SETTING: New Mexico in January through March 2004. POTENTIAL PARTICIPANTS: New Mexico pharmacists. INTERVENTIONS: Questionnaire containing 74 items. MAIN OUTCOME MEASURE(S): Mean scores were calculated for individual knowledge items, overall knowledge scores, and attitude/belief items. Knowledge and attitude/belief scores were compared across demographic variables using t tests, ANOVA, and chi-square analyses. RESULTS: Of 1392 deliverable questionnaires, 555 (40%) were returned and 523 (38%) were usable; 136 contained written comments. Pharmacists had overall knowledge scores of 71.2% +/- 11.3%. Pharmacists who had participated in a state-approved EC prescribing training program and had time in their practice setting to prescribe EC had significantly higher knowledge scores. Mean scores indicated that pharmacists have positive attitudes and beliefs toward prescribing EC. Overall, 40% of respondents indicated that they would like to become certified to prescribe EC. Pharmacists who agreed that they would like to be certified to prescribe EC were significantly more likely to be male, non-Hispanic, non-Christian, to have liberal or moderate political views, and to indicate that they had employer/manager approval, time, and privacy in their practice setting to prescribe EC. CONCLUSION: New Mexico pharmacists have positive attitudes/beliefs toward EC prescribing; however, their knowledge in this area is average. Although religious, moral, and political views influence pharmacists' willingness to prescribe EC, factors such as education and practice environment must be addressed if more pharmacists are to accept this EC prescriptive authority.

Contraception, Postcoital↗

PubMed1995

Telemedicine and the payment system.

Free medical phone service has become a professional courtesy, but recent changes in the practice environment should prompt a reexamination of this free service as perhaps an anachronism which is getting in the way of progress.

Costs and Cost Analysis↗

PubMedDate not supplied

Implementing practice guidelines for depression: applying a new framework to an old problem.

We discuss the challenges of implementing clinical practice guidelines for depression in the primary care setting. Multiple potential barriers can limit physician guideline adherence and translation of research into improved patient outcomes. Six primary barriers relate to providers (lack of awareness, lack of familiarity, lack of agreement, lack of self efficacy, lack of outcome expectancy, and inertia of previous practice). In addition, factors related to patient, guideline, and practice environment factors encompass external barriers to adherence. By delineating the underlying barriers to adherence, different interventions that are tailored to improve physician adherence to guidelines can be utilized. We review examples of these barriers, as well as interventions to improve guideline adherence. We also review characteristics of successful interventions to improve physician adherence to guidelines for depression. Since different physicians and practice settings may encounter a variety of barriers, multifaceted interventions that are not focused exclusively on the physician tend to be most effective.

Depressive Disorder↗

PubMed2003

Short-term predictors of maintenance of normotension after withdrawal of antihypertensive drugs in the second Australian National Blood Pressure Study (ANBP2).

BACKGROUND: Antihypertensive drug therapy is considered lifelong but in the family practice environment drug cessation may provide an opportunity to attempt nonpharmacologic strategies for blood pressure (BP) control with a clear outcome, maintaining drug-free status. The identification of simple predictors would assist the family physician to select who may or may not have their medication ceased. METHODS: To monitor a drug cessation program in currently treated hypertensive patients in Australian family practice, 25,826 patients aged 65 to 84 years currently receiving antihypertensive medication, were offered drug withdrawal as part of the run-in phase of a large clinical trial. Outcomes investigated were the proportion of patients completing drug withdrawal and maintaining short-term BP control and factors that predicted these patients. RESULTS: A total of 18,993 patients did not enter the withdrawal program; 6291 (92% of those who entered) completed drug withdrawal. In comparison to patients who did not complete drug withdrawal, they were younger and more likely male. A total of 1,228 (18% of those who entered) ceased medication and maintained adequate BP control for 0 to 76 weeks (median, 4 weeks). Cox regression analysis identified lower on therapy systolic and diastolic BP, younger age, type of agent, and monotherapy as predictors of successful drug withdrawal and maintenance of BP control. CONCLUSIONS: Cessation of antihypertensive drug therapy is possible in a substantial proportion (18%) of patients attending family practice who are willing to do so and is most successful in those who are younger with BP controlled on monotherapy. Where this strategy is initiated, use of such predictors, effective behavioral change, and systematic follow-up is recommended.

Age Distribution↗

PubMed2002

A comparison of practice outcomes of graduates from traditional and non-traditional medical schools in Australia.

AIM: The primary aim of the study was to compare the practice outcomes of doctors who graduated from a non-traditional, problem-based medical school (University of Newcastle) with those of graduates from a traditional programme (University of Sydney), matched randomly on the background characteristics of graduation year, age, gender, and rural primary and secondary school education. Our secondary aim was to differentiate admission from curricular influences by comparing the outcomes of Newcastle and Sydney graduates who entered medical school under similar admission criteria ('traditional academic' entry). DESIGN: Nested case-control analysis in a retrospective cohort study. METHODS: A validated mail-out survey was distributed to all Newcastle and Sydney graduates registered to practise in the state of New South Wales, Australia. OUTCOME MEASURES: Current main occupation (clinician or other), clinical career choice (family medicine and psychiatry or other specialties), practice location (urban or rural) and employment sector (public or private). RESULTS: A total of 513 Newcastle respondents (68% of the original, eligible Newcastle sample) were each matched randomly with a Sydney respondent according to the four background characteristics. Medical school background was not related to main occupation; over 90% of all graduates were employed in clinician positions. A greater proportion of Newcastle than Sydney graduates were either training or qualified in family medicine or psychiatry rather than in other specialties. The school of graduation was not related to practice environment; fewer than 20% of all graduates were working in rural locations and around 25% were employed in the public sector. There were no differences in outcome between Newcastle and Sydney graduates who had entered medical school under similar academic criteria. CONCLUSION: Our study suggests that initial selection procedures of medical school candidates with particular background characteristics and attributes may influence practice outcomes. Further research is required to confirm these findings.

Adolescent↗

PubMed1998

Telematics in the northern United Kingdom.

The application, integration and development of methods and technology facilitating the seamless interchange of clinical, demographic and administrative information presented the medical and clinical community with unforeseen problems. Surprisingly, the wealth of existing solutions did not find the expected application and acceptance in hospital/General Practice environments. Even more surprising was the fact of the failure of many computer-based solutions to deliver the expected benefits. This paper outlines the Telematics project established in the Northern United Kingdom and its success in maintaining a working balance between technological needs and the clinical requirements. The result is a robust service linking five major Trusts and 12 General Practices in terms of clinical and administrative data, e-mail and other facilities.

Computer Communication Networks↗

PubMedDate not supplied

Internet supply ordering. Helping medical group practices improve business operations.

Technology has opened the door to a new world of management tools in the physician practice environment. Productivity aids on the Web promise to alter forever the way we do everything--from interacting with vendors to caring for patients. Online medical, surgical and pharmaceutical supply acquisition sites, for example, already offer more efficient alternatives to phone and fax ordering, back-order challenges and supply cost monitoring. Not all sites are the same, however, and physicians and practice administrators must compare and contrast their needs with site offerings.

Cost Control↗

PubMed2004

Wired for success: stimulating excitement in nursing through a summer camp.

The seriousness of the nursing shortage has been addressed by both the public and professional media. The literature documents substantial support for strategies that focus on increasing the enrollment in nursing education programs and/or sustaining practice environments that contribute to higher nurse retention rates. A nursing camp is an example of an innovative strategy to stimulate excitement in a nursing career, and thus potentially limit the severity of the nursing shortage. The camp helps high school students enhance their discernment about being "wired" for nursing; learn selected basic nursing skills; job shadow; interact with current nursing students and practicing nurses; and develop themselves as educated consumers of information about nursing education programs and financial assistance for college. This article details the development and implementation of a summer residential nursing camp and describes associated outcomes for both the students and the nursing program.

Attitude to Health↗

PubMed1989

Comparison of job expectations fulfillment of BS and entry-level PharmD graduates in hospital and community practice.

Job expectations are an important link between work and subsequent employee mental and physical well-being. Schools and colleges play an important role in the development of job expectations. This role gives them the responsibility of not only technically training students but also instilling in them realistic job previews and career expectations. Failure to do so places the graduate in a state of conflict between the reality of work in his/her chosen career and his/her preconceived expectations regarding the work. This state represents a potential source of job-related stress. BS and entry level PharmD training programs represent two approaches to pharmaceutical education in a practice environment which remains essentially the same for graduates of both programs. As such, there is the potential for a mismatch of job expectations resulting from one or both of the degree types. The present study investigated the following research questions: (i) to what extent are job expectations being fulfilled for pharmacists in hospital and community pharmacy; and (ii) in community and hospital practice, does the fulfillment of job expectations of BS and entry level PharmD graduates differ? Questionnaires were mailed to randomly selected 1980 to 1986 graduates of seven schools or colleges of pharmacy to elicit responses regarding fulfillment of job expectations in their present community or hospital pharmacy positions. The response rate was 48 percent. The subsequent data revealed that pharmacists generally felt that their job expectations were being fulfilled. No differences in overall fulfillment of job expectations were found between BS and entry level PharmD graduates in either community or hospital pharmacy practice.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude of Health Personnel↗

PubMedDate not supplied

Pharmacists' attitudes regarding quality of worklife.

OBJECTIVE: To examine the quality of worklife of pharmacists across practice environments. DESIGN: Written survey mailed to a stratified random sample of pharmacists. PARTICIPANTS: 2,014 pharmacist-members of the American Pharmaceutical Association (APhA) residing in the United States. MAIN OUTCOME MEASURES: Work-related attitudes including job satisfaction, career satisfaction, organizational commitment, turnover intention, likelihood of voting for a union, and patient care issues. RESULTS: Usable surveys were returned by 1,199 practicing APhA members (60% response rate). Overall, work-related attitudes were generally positive. However, clear differences were identified in quality-of-worklife perceptions associated with practice setting, area of primary responsibility, and several demographic variables. Some quality-of-worklife concerns were found in all practice settings. While a majority of respondents indicated that they would not vote for a union at their place of employment if given the opportunity, 43% of staff employee pharmacists (who would likely be targeted in any union campaign) indicated that they would definitely or probably vote for a union. CONCLUSION: From the pharmacist's perspective, important quality-of-worklife issues include job and career satisfaction, turnover intention, and patient care concerns. The data provide a point of departure for future dialogue, action, and research aimed at understanding and enhancing the quality of pharmacists' worklife.

Adult↗

PubMed2003

A comparative assessment of West Virginia's financial incentive programs for rural physicians.

CONTEXT: Financial incentive programs are increasingly being used as a strategy to recruit physicians to underserved rural areas. Critical evaluation of state-supported programs is often lacking but is necessary to determine their efficacy and to improve outcomes. PURPOSE: The purpose of this study was to assess 4 service-contingent programs in West Virginia, a state with critical physician shortages. METHODS: Survey instruments were developed to evaluate the effectiveness of these programs and to document the practice environments and career paths of obligated allopathic and osteopathic physicians compared with a control group of nonobligated rural practitioners. Data were also collected from physicians who were recipients of multiple incentive programs and from obligated physicians who had defaulted. FINDINGS: Responses from more than 60% of surveyed physicians indicated that the typical respondent was a married white male who was a midcareer family practice physician. Obligated physicians were more likely than nonobligated physicians to have graduated from a West Virginia medical school and residency program, to be influenced by financial factors in their career decisions, to provide care to uninsured patients, and to work in offices that offered sliding fee scales. Both groups of physicians demonstrated similar retention patterns, reported a high degree of job satisfaction, and expressed a need for more practice management training. CONCLUSIONS: Although these financial incentive programs were found to be effective in recruiting primary care physicians to medically underserved areas of the state, the financial support of these programs was found to be too modest, and improved marketing of the programs was indicated.

Adult↗

PubMed2005

Oncology nurses' knowledge, attitudes, and experiences regarding advance directives.

PURPOSE/OBJECTIVES: To determine oncology nurses' knowledge of, attitudes toward, and experiences with advance directives (ADs). DESIGN: Descriptive, correlation survey. SAMPLE: Usable responses from 794 (21% return) of 3,840 randomly selected members of the Oncology Nursing Society. The typical respondent was female, Caucasian, married or living as married, middle-aged, and Christian. METHODS: A mailed survey using the Knowledge, Attitudinal, and Experiential Survey on Advance Directives instrument. MAIN RESEARCH VARIABLES: Knowledge, attitudes, experiences, confidence, and ADs. FINDINGS: Overall, oncology nurses were most knowledgeable about ADs in general (70% correct) and less knowledgeable about the Patient Self-Determination Act (51% correct) and their state laws (53% correct). The mean total knowledge score based on the three subscales was 17.4 out of a possible 30, or 58% correct. The nurses' experience with ADs was measured using a five-item subscale with a mean score of 4 (SD = 1.11). They were less confident in their ability to assist patients with completing ADs. Respondent attitudes reflected an advocacy role in end-of-life decisions. Attitude items were reviewed individually. Respondents strongly agreed (97%) with the statement that patients should receive sufficient medication to relieve pain even though it may hasten death, which reflects the emphasis in oncology on adequate pain management at the end of life. CONCLUSIONS: Nurses' knowledge scores were low. Nurses in the study were not highly confident in their ability to assist patients with ADs. Demographic variables generally did not influence knowledge, confidence, or experience scores. IMPLICATIONS FOR NURSING: More education related to ADs is needed and could be administered through in-service classes or continuing education. Nurses' responses indicated that they need more time to assist patients with completing ADs. This is difficult in the current practice environment but must be recognized as critically important.

Adult↗

PubMed1996

Integrating acquired physician practices.

Many strategies have been suggested to accomplish successful physician integration, including stock ownership in a for-profit entity created by the health system, sharing in the cost efficiencies caused by changing practice patterns, and compensation attached to service and access standards. One thing that executives overlook goes beyond financial concerns and yet hits at the heart of what is important to most physicians. That is maintaining their ability to make decisions regarding their own practice environment both clinically and administratively. United Health describes its physician-administrator team model, developed to enhance the physician integration process.

Hospital-Physician Relations↗

PubMedDate not supplied

Defensive medicine and obstetrics.

OBJECTIVE: To test the hypothesis that physicians with greater malpractice claims exposure, either through personal experience or in their practice environment, will use more prenatal resources and have a higher cesarean delivery rate than physicians with lesser claims exposure. DESIGN: Retrospective cohort study using county malpractice defendant rate data from the Washington State Physicians Insurance and Exchange Association and prenatal care, delivery method, and self-reported obstetric suit experience data from the Content of Obstetrical Care Study database. SETTING: Washington State obstetric practices. PARTICIPANTS: Stratified random samples of obstetrician-gynecologists and family physicians. MAIN OUTCOME MEASURES: The rates of obstetric ultrasound use, referral and consultation, prenatal care resource use, and cesarean delivery. RESULTS: After controlling for patient, physician, and sociodemographic characteristics, we found no difference in prenatal resource use or cesarean delivery rate for low-risk patients between physicians with more and less exposure to malpractice claims. CONCLUSIONS: This study does not support an association between the malpractice experience or exposure of individual physicians and an increase in the use of prenatal resources or ceserean deliveries for the care of low-risk obstetric patients.

Cesarean Section↗

PubMed1999

Analysis of the degree of undertreatment of hyperlipidemia and congestive heart failure secondary to coronary artery disease.

There is a lack of data evaluating the implementation of guidelines in the management of coronary artery disease (CAD) or congestive heart failure (CHF) in the outpatient setting. We analyzed an administrative data set from the Merck & Co. sponsored national Quality Assurance Program, a retrospective outpatient chart audit of 58,890 adult outpatients from 140 medical practices (80% cardiology only) in the USA with diagnoses of CAD and/or CHF identified from medical claims data. We determined the (1) frequency of lipid documentation and prescription of lipid-lowering agents in patients with CAD, (2) frequency of assessment of left ventricular function and prescription of an angiotensin-converting enzyme inhibitor in patients with CHF, and (3) predictors of medication prescription. Of the 48,586 patients with CAD, 44% had annual diagnostic testing of low-density lipoprotein cholesterol. Only 25% of these patients reached the target low-density lipoprotein cholesterol of < or = 100 mg/dl, and only 39% were taking lipid-lowering therapy, which was less among the elderly than in the younger patients. Of the 16,603 patients with CHF, 64% had diagnostic testing of left ventricular function, and 50% of patients were taking an angiotensin-converting enzyme inhibitor; 67% of patients received medication if they had documented systolic dysfunction. Significant predictors of medication prescription included diagnostic testing, younger age, history of myocardial infarction or coronary artery bypass grafting, hypertension, cardiology specialty, and geographic region. Thus, current practice patterns in the management of CAD and CHF are inadequate. Patient age, diagnostic testing, and practice environment influence medication prescription.

Adult↗