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PubMedDate not supplied

North Carolina family practice physicians' perceptions of pharmacists as vaccinators.

OBJECTIVE: To determine whether family practice physicians are aware that pharmacists can administer vaccines and assess their support of pharmacists as vaccinators. DESIGN: Cross-sectional study. SETTING: North Carolina. PARTICIPANTS: 571 family practice physicians. INTERVENTIONS: Mail survey. MAIN OUTCOME MEASURES: Physician attitudes toward pharmacists' involvement with a variety of vaccines and patient populations. RESULTS: A total of 25% of physicians correctly reported that pharmacists could administer vaccines in North Carolina, a state that had recently passed legislation permitting this practice. Almost 50% of the physicians supported pharmacists administering the influenza vaccine. Pharmacist administration of other vaccines received less support. Physicians who were newer to family practice had more positive attitudes than physicians who were in practice for longer periods of time. CONCLUSION: While agreeing that the role of the pharmacist in patient care is becoming more important, physicians were neither very knowledgeable about nor supportive of pharmacists as vaccinators.

Aged↗

PubMed2001

Patient care staffing patterns and roles in community-based family practices.

OBJECTIVES: Our study describes patient care staff patterns and roles in community-based family practices. STUDY DESIGN: We used a multimethod comparative case study design that included detailed descriptive field notes of the office environment of 18 family practices and of 1637 clinical encounters, as well as in-depth interviews of practice staff and physicians. Systematic analysis of these data provided detailed descriptions of patient care staff patterns and functions. POPULATION: We included physicians and staff in 18 community-based Nebraska family practices. RESULTS: Practices are staffed with a range of clinical personnel, including registered nurses, licensed practical nurses, certified medical assistants, radiology technicians, and trained and untrained medical assistants. Each of these has specific educational preparation that potentially qualifies them for different patient care roles; however, staff roles were determined primarily by local needs and physician expectations rather than by education, training, or licensure. Staffing patterns varied greatly; the majority of practices employed at least one registered nurse (10 of 18), one licensed practical nurse (5), or both (4). Still, the overall majority of practices used non-nursing personnel as the predominate patient care staff. Patient care staff-to-clinician ratios ranged from a low of 0.5 to a high of 3.3. CONCLUSIONS: Many recent recommendations about collaborative models of clinical care seem problematic when put into a context of the findings of current staffing patterns and use of personnel in family practices. Staff members often fulfill roles independent of training. Staff leadership is also potentially important for designing effective collaborative care models; however, we found leadership only occurred with the approval of clinic authorities. These practical issues are rarely addressed in normative recommendations about system change and intervention. Our findings indicate that there are considerable opportunities for better use of the nursing and other patient care staff in the delivery of clinical services. Developing a collaborative practice model should include formalizing expectations of staff to reflect training and experience, and explicitly configuring staff to meet the needs, values, and goals of a practice.

Community Health Services↗

PubMed1995

Family practice center-based training in skin disorders: a photographic approach.

BACKGROUND: The majority of family practice residency programs rely on lectures and rotations in dermatologists' offices for training their residents about skin disorders. However, in a dermatologist's office, residents may not receive enough exposure to the types of skin problems typically seen in a family physician's office. METHODS: A longitudinal, family practice center-based training experience was developed in which residents photographed patients with skin conditions and presented the cases to a dermatologist at a monthly teaching conference. Fifteen residents who were exposed to two different instructional methods (the photography conference and rotations with dermatologists) were surveyed to determine their preferred instructional method for learning to diagnose and manage skin disorders. RESULTS: Over a 2-year period, a total of 232 skin lesions were photographed and presented. The distribution of the photographed skin disorders differed from the distribution of skin problems found in a national survey of dermatologists' practices. Of the residents surveyed, 93% preferred monthly photography conferences to rotations in dermatologists' offices for learning about children's skin problems. Eighty-six percent preferred using the photography conferences for learning about treatment of skin diseases. CONCLUSIONS: A longitudinal, family practice center-based experience using photographic presentations of skin lesions is a valuable adjunct for teaching family practice residents about skin disorders.

Curriculum↗

PubMed1982

A family practice orthopedic trauma clinic.

In order to help provide care for acute orthopedic injuries to a portion of a military patient population and to add simultaneously a new aspect to the orthopedic rotation of family practice residents, a family practice orthopedic trauma clinic, staffed solely by family physicians, was initiated, and the records for six months were examined and summarized. A total of 540 patient visits, 286 (52.9 percent) of whom were adults during 45 sessions of this clinic were noted. Fractures accounted for 79.2 percent of the injuries, while sprains and contusions accounted for 17.7 and 3.1 percent, respectively. The most frequent injuries were fractures of the radius, fractures of hand phalanges, and ankle sprains. Orthopedic consultation was obtained at 88 (16.2 percent) of the patient visits. The results of this study indicate that family physicians can effectively manage the majority of nonsurgical, acute orthopedic injuries and that a clinic of this type may be a valuable addition to the orthopedic rotation of a family practice residencies.

Adolescent↗

PubMed1994

Interest in natural family planning among female family practice patients.

OBJECTIVE: Although modern methods of natural family planning (NFP) are effective both to avoid and to achieve pregnancy, relatively few women use these methods. It is not known whether this is due primarily to lack of interest or to other factors. We therefore explored the level of interest in NFP among female family practice patients. METHODS: We mailed information about NFP to 400 female patients between ages 21 and 42 and conducted follow-up interviews by telephone. We excluded 162 women for whom we could not obtain accurate addresses or phone numbers, 68 women we could not reach by telephone, 67 women who were not currently at risk of pregnancy, and 15 women for other reasons. Twenty-eight women refused to participate in the study. Sixty women completed telephone interviews. RESULTS: Forty-three percent of respondents (n = 60) were interested in learning more about NFP, 24% said they were likely to use NFP to avoid pregnancy, and 32% were likely to use NFP to achieve pregnancy. Younger women and women who were Christian but not Catholic and not of a major Protestant denomination were more interested in NFP. CONCLUSION: Some female family practice patients are interested in learning and using NFP.

Adult↗

PubMedDate not supplied

Research in a busy family practice training program.

A newly designed framework for starting research projects in an Army family practice residency incorporates a timeline and a Family Practice Research Advisory Committee to stimulate research among residents and staff. Seventy-five percent of second- and third-year residents participated in approved projects compared to none two years ago. Sixty-six percent of the faculty have initiated research projects since implementation of the new guidelines. The combination of the committee and the timeline centralizes research within the family practice department and provides an academic environment for the department.

Curriculum↗

PubMedDate not supplied

Entry of U.S. medical school graduates into family practice residencies: 1988-1989 and eight-year summary.

This study continues a series of reports from the American Academy of Family Physicians on the percentage of each medical school's graduates who enter family practice residency programs. Approximately 10.7% of the 15,947 graduates of United States medical schools between July 1987 and June 1988 were first-year residents in family practice in October 1988. This compares to 12.0% in the previous year. The Mountain region reported the highest percentage of medical school graduates who are first-year residents in family practice programs in October 1988; the Middle Atlantic and New England regions had the lowest percentages. Medical school graduates from publicly funded medical schools were twice as likely to be first-year residents in family practice in October 1988 as were graduates from privately funded medical schools. The percentages for each medical school have varied substantially from year to year in the eight years that the AAFP has reported this information. The average percentage for each medical school for the last eight years, as well as the cumulative percentage for each medical school, are reported. Although school-specific percentages may show wide year-to-year variations, the total percentage of U.S. medical school graduates entering family practice residencies has been generally stable near 12.0% in the previous seven years. The decline to 10.7% for 1987-88 is cause for careful review.

Career Choice↗

PubMed1977

Human relations training for family practice residents: a four year retrospective review.

The Family Practice Center of Akron has developed and implemented a human relations training program as an integral part of the family practice residency curriculum. Following two years of planning and experimenting, a 12-month course of study was formalized in July 1975. Two full-time behavioral scientists are responsible for planning, coordinating, and teaching the curriculum. The curriculum includes a variety of learning experiences throughout the three years and represents approximately ten percent of educational programming and costs.

Behavioral Sciences↗

PubMedDate not supplied

Entry of U.S. medical school graduates into family practice residencies: 1987-1988.

Family Practice↗

PubMed1998

One-two rural residency tracks in family practice: are they getting the job done?

BACKGROUND: In the 1990s, the Residency Review Committee for Family Practice (RRCFP) and the American Board of Family Practice used the development of rural training programs as a strategy to bridge training experiences across urban referral centers and rural community hospitals. These programs are relatively small and attract trainees who are predisposed to rural practice. Aggregating data from several programs yields insight about their challenges and their ability to produce graduates who enter rural practice. METHODS: This descriptive analysis is based on self-reported data from a 1996 survey mailed to the residency program directors of rural training programs, identified by the RRCFP office as one-two programs. RESULTS: More than half of the rural training programs surveyed were located in health professions shortage areas, most in communities with little urban influence. These programs are equally likely to be sponsored by university- or community-based residency programs. Most (75%) placed two or fewer residents per year in the rural site; minorities accounted for 4% of placements. Thirty percent of programs report unfilled positions. Seventy-five percent use televideo communications and find experiences in surgery and obstetrics relatively easy to arrange but dermatology and critical care difficult. Seventy-six percent of graduates enter rural practice after graduation. CONCLUSIONS: This survey suggests that family practice rural one-two residencies are meeting the goal of providing trainees with a rural immersion experience, in anticipation of selecting rural practice after graduation.

Community Health Services↗

PubMed1994

The fourth-year chief resident position in family practice training, 1987-1992.

BACKGROUND: The status of fourth-year chief resident (FYCR) positions in US family practice postgraduate training over the period 1987 to 1992 was assessed to better understand the role of the FYCR in family practice education. METHODS: Questionnaires were mailed to the residency directors of all US family practice residency training programs in 1987 and again in late 1991. RESULTS: Response rates were 77% and 78% in 1987 and 1992, respectively. Nineteen programs had FYCR positions in 1987 and 15 had them in 1992. There was no statistically significant change in the number of FYCR positions during this time period. Family practice fellowships existed in 63% of programs. The major justifications for the position were administrative assistance, clinical instruction, and faculty development. Most FYCRs were funded through institutional salary lines or patient care revenue. Inpatient and outpatient clinical attending responsibilities were held by most FYCRs and increasingly, FYCRs are involved in faculty development training. CONCLUSION: Between 1987 and 1992, FYCRs have taken on greater administrative and clinical instructor roles, and more programs are involving FYCRs in faculty development. The position offers a unique role for the transition between trainee and faculty.

Adult↗

PubMed1979

The costs of a family practice residency ambulatory care program.

The cost of patient care service and education occurring in a family practice residency unit of a community based prepaid health program was determined from accounting records. The cost of producing the same number of patient visits in comparable family practice units which did not have residents on-site was determined in a similar manner. The cost per visit in the residency unit was $15.53 while that in the nonresidency unit was $13.92. There was an excess cost of $1.61 per visit in the residency, or, based on the number of residents present, a net cost of $7 per resident per day. None of the costs of central residency program administration or of ambulatory based subspecialty rotations were included. While a small increase (ten percent) in productivity or efficiency would result in the residency patient care unit itself being self-sustaining, this study casts considerable doubt on the ability of the model family practice residency unit to offset the full costs of the ambulatory care portion of family practice residency training.

Ambulatory Care↗

PubMed1994

Physical therapy education in family practice residency programs.

BACKGROUND: This study investigated the role and extent of physical therapy education in family practice residency programs. Physical therapy is not specifically included in graduate curricula guidelines, and the literature contains little information on its involvement in programs. METHODS: A questionnaire was developed to determine how physical therapy education is taught in family practice residencies. The questionnaire was mailed to all (391) directors of US-accredited family practice residency programs. RESULTS: A total of 256 directors (65.5%) responded. The majority of directors (67%) stated that there was a significant need for the physical therapy component. Only 52% (133/256), however, included physical therapy in their curricula. Physical therapy education was most frequently (67.6%, 92/136) included in required rotations (eg, orthopedics) and taught mostly by hospital-based physical therapists (77.0%, 104/135) or subspecialists (55.6%, 75/135). CONCLUSION: This study shows that physical therapy education offers a potentially relevant and important element of family practice residency training, but it has been underemphasized.

Curriculum↗

PubMed1996

SASPREN -- a new development in family practice research in South Africa.

Research in the family practice setting can make unique contributions to our understanding of health, illness, and disease at the level of the individual patient as well as the population. In November 1990 a family practice research network (SASPREN) was established in South Africa. The network consists of sentinel practitioners who have volunteered to provide information on patients seen in their practices. This article describes the development of the network, focusing particularly on its accomplishments in the first 3 years. It is hoped that SASPREN will help overcome some of the obstacles to research encountered by family doctors and ultimately improve the care of patients in the community.

Family Practice↗

PubMed1986

Gender-specific differences in family practice graduates.

In 1979 the American Academy of Family Physicians (AAFP) conducted a study of family practice residency graduates to develop a database of personal and professional characteristics. Questionnaires were sent to 4,295 physicians, and results were based on a total of 3,021 respondents. Female physicians made up 7.1 percent of this sample; however, analysis of the data at that time did not distinguish between men and women. The current study is a reanalysis of the data collected by the AAFP to include comparisons of male and female respondents and to determine whether gender differences that have been reported in the literature continue to persist. Results indicate that gender differences did persist in four of six areas studied; however, these differences were not so large as described in earlier studies. Areas in which differences were found are demographics, family structure, practice arrangements, and salary. Notable differences were not found in the areas of career choice development and professional activities. Now that the number of female physicians approaches 20 percent of all new family physicians, further data collection efforts are needed to determine their impact on family practice as a specialty.

Family Characteristics↗

PubMedDate not supplied

Assessing prenatal care in a family practice residency clinic.

BACKGROUND AND OBJECTIVES: This study demonstrates how one family practice residency clinic characterized obstetric clinic patients and assessed obstetric care using birth certificate data (demographic characteristics and risk factors) and birth outcome indicators. METHODS: We compared clinical characteristics and birth outcomes for 901 patients who were delivered by family physicians from the family practice residency clinic with a matched and unmatched group of patients who were delivered by other physicians in the county during 1990-1993. RESULTS: The study clinic patients were at higher risk and had lower use of prenatal care. However, the outcomes of the study clinic patients were significantly better (fewer labor and delivery complications, procedures, Cesarean deliveries, abnormal conditions of newborn, low birth weight deliveries, and preterm birth) or no different from the comparison group of non-clinic patients. CONCLUSIONS: The analysis of birth certificate data provided a favorable assessment of prenatal care provided by a family practice residency clinic. This type of analysis permits comparisons of birth outcomes with other local or regional providers, statewide providers, and the year 2000 national objectives established by the National Center for Health Statistics.

Adolescent↗

PubMed2001

Sexual problems of male patients in family practice.

OBJECTIVES: Little is known about men's expectations of their family physicians regarding sexual disorders. Our goal was to evaluate the frequency of sexual problems among male patients in family practice and to assess their need for help. STUDY DESIGN: We performed a cross-sectional survey based on structured questionnaires answered by patients and physicians in German family practices. POPULATION: We approached 43 family physicians; 20 (43%) participated. On a single day all men 18 years and older visiting the participating practices were approached, and 307 (84%) took part in the survey. OUTCOMES MEASURED: Patients were asked about their frequency and type of sexual problems, their need for help, and their expectations of their physicians. The physicians described their perceptions and management of sexual problems in family practice. RESULTS: Nearly all patients (93%) reported at least 1 sexual problem from which they suffered seldom or more often. The most common problems were low sexual desire (73%) and premature ejaculation (66%). Occupational stress was considered causative by more than half of the men (107/201). Forty-eight percent considered it important to talk with their physicians about sexual concerns. However, most physicians initiated a discussion about sexual concerns only seldom or occasionally. There was a nonsignificant correlation between the physicians' assumed knowledge and the patients' wish to contact them in case of sexual problems (rho=0.26). CONCLUSIONS: The high frequency of self-reported sexual disorders and the hesitancy of family physicians to deal with this topic signals a neglected area in primary health care. Certain conditions, such as occupational stress, which may be associated with sexual concerns, should encourage the physician to initiate discussions about sexuality.

Adult↗

PubMed1996

A progress report on accelerated residency programs in family practice.

BACKGROUND: In 1991 the American Board of Family Practice (ABFP) approved 12 programs to participate in an experiment in medical education. Selected students in 12 medical schools are able to complete their first year of family practice residency while completing their fourth year of school. This paper reports on the progress of the programs and residents participating in this project. METHOD: Data from the ABFP in-training examination and certification examination were compiled for all trainees and graduates through 1994. Performances were compared with national norms and the performances of traditional residents in the same programs. The program directors were surveyed to assess their experiences, program effectiveness, benefits, liabilities, and implementation problems. RESULTS: Accelerated residents performed better than their peers and national norms on the ABFP in-training and certification examinations. The directors rated the clinical performance of accelerated residents as equal to or better than the clinical performance of traditional residents by the end of the program. Advantages of accelerated residency included improvements in recruiting, image, and morale. Problems occurred in order and prescription writing and acceptance of the accelerated residents by nurses, other residents, and physicians in other disciplines. CONCLUSION: Early entry into residency training of bright, highly motivated, and mature students appears to offer benefits for trainees and programs alike.

Educational Measurement↗