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PubMedDate not supplied

Outpatient consultations from a family practice residency program: nine years' experience.

Previous reports of consultation rates from family practice physicians have included small sample sizes and have suggested higher rates in residency training programs. This report summarizes 9 years of data involving 161 family practice physicians in a residency training program and shows an overall rate of 1.4 percent for outpatient consultations. Otolaryngology, orthopedics, obstetrics/gynecology, and general surgery were the most frequent disciplines consulted. These data are helpful in designing health care systems that include family practice residency programs.

Family Practice↗
PubMed1983

Training doctors for family practice in primary health care work in Sri Lanka.

Over one-third of the doctors in Sri Lanka are involved in the delivery of PHC. They form one of seven categories of PHC workers--others being the ayurveda physician, the assistant medical practitioner, nurse, midwife, traditional healer and unqualified practitioner. PHC workers function either in the government or private sector. Their functions in the PHC system are not defined and are dependent on state health policies and people's expectations of health care. The secondary and tertiary levels of the health system are managed by the government through a network of hospitals. These hospitals provide Western type health care facilities free to the people. Government PHC workers have access to referral facilities and back up services provided through this hospital system. Doctors functioning within the PHC system had neither undergraduate nor postgraduate training in PHC. Private general practitioners were the first to realise the need for training doctors in PHC. They sought and got government and university approval for postgraduate training in family practice. The family practice training programme is conducted by the Postgraduate Institute of Medicine of the University of Colombo. The course consists of educational and clinical components which could be completed in a minimum of 1 year or maximum of 4 years. Nine private general practitioners and 19 government medical officers registered for the course. Fifteen completed the course in 1 year. Family practice trained doctors will function in a PHC system in which the services provided are not coordinated. Changes in the PHC system are being considered.(ABSTRACT TRUNCATED AT 250 WORDS)

Curriculum↗
PubMedDate not supplied

Medical ethics programs in family practice residencies.

Ethics is an integral part of medical practice and needs explicit attention in family practice residency training programs. One difficulty, however, in developing a medical ethics program in a family practice residency is the lack of information about ethics programs and their strengths and weaknesses. This report provides baseline data on what is being done in 182 family medicine residencies throughout the country. It contains demographic data on locale, size, and age of residency and the perceptions of program directors and chief residents as to the usefulness of such programs, the most frequently discussed issues, the staffing, the amount of curriculum time allocated, and the format employed. Differences of opinion between the two groups are reported.

Curriculum↗
PubMed1992

Qualitative research and family practice: a marriage made in heaven?

Recent years have seen the development of interest in the usefulness of qualitative methods in family practice research. This paper shows how the underlying concerns of family practice medicine parallel those of the qualitative research tradition. After contrasting the philosophical underpinnings of both quantitative and qualitative methods, we go on to describe the methodological commitments of qualitative research. We relate this emerging debate within family practice to that which has taken place in other disciplines, particularly that of education. We discuss the relative strengths of qualitative and quantitative methods, and argue that these two traditions have complementary contributions to make to the discipline of family practice medicine.

Family Practice↗
PubMedDate not supplied

Family practice physicians' beliefs, attitudes, and practices regarding obesity.

This study examined 318 family practice physicians' beliefs, attitudes, and practices regarding obese patients. Most physicians surveyed were aware of the health effects of obesity and that normal weight is important to the health of their patients. Beliefs, attitudes, and practices differed significantly based on the physicians' sex, weight, years in practice, and belief that counseling patients on weight loss is professionally gratifying and that most obese patients can lose significant amounts of weight. A notable number of respondents held negative or stereotypical attitudes toward obese patients (i.e., obese patients lack self-control, are lazy and sad). The most commonly recommended weight loss techniques were decreasing caloric consumption (92 percent), participating in Weight Watchers (84 percent), consulting a dietitian/nutritionist (76 percent), and aerobic exercise (75 percent). The two sources of weight control information most frequently cited were past experience (73 percent) and medical journals (71 percent). The results of this survey indicate that there is considerable room for improvement in the beliefs, attitudes, and practices of family physicians regarding obese patients.

Adult↗
PubMedDate not supplied

Residency education in the nursing home: a national survey of internal medicine and family practice programs.

OBJECTIVE: To assess the role of the nursing home in postgraduate medical education. DESIGN: A survey questionnaire addressing the following issues: 1) prevalence of nursing home rotations in internal medicine and family practice residency programs, 2) duration and type of rotation, 3) extent of residents' responsibilities, 4) patterns of faculty supervision, 5) program directors' assessments of nursing home experience, and 6) frequently encountered problems. PARTICIPANTS: Directors of accredited internal medicine and family practice residency programs in the United States. MEASUREMENTS AND MAIN RESULTS: A total of 502 surveys were returned for a response rate of 60%. Nursing home rotations were more frequent in family practice programs (87%) compared with internal medicine programs (32%). Rotations in internal medicine were generally optional and limited to a short block of time compared with family practice, where rotations were most often required and longitudinal. Internal medicine residents received more intense supervision, whereas family practice residents had greater clinical responsibilities. Few faculty had formal geriatric training or certification. Reimbursement for physician services was low. Although availability of faculty, resident interest, and conflict with other clinical services were identified as problem areas, program directors in both internal medicine and family practice were supportive of nursing home rotations for their trainees.

Data Collection↗
PubMed1996

Development of the Woman Abuse Screening Tool for use in family practice.

BACKGROUND: This study developed a screening tool for use by family physicians to identify and assess women patients experiencing emotional and/or physical abuse by their partner. METHODS: An initial set of eight questions developed for the Woman Abuse Screening Tool (WAST) was completed by both abused and non-abused women. Participants were also asked to indicate their comfort in answering the questions in both research and family practice contexts. They also completed the Abuse Risk Inventory and a demographic questionnaire. Analysis of the WAST included 1) standard assessment of the validity and reliability of the measure and 2) examination of the efficacy of further reducing the number of questions on the WAST for screening purposes. RESULTS: The final samples of abused (n = 24) and non-abused women (n = 24) differed significantly on a number of demographic and abuse variables. After eliminating one of the original items, a strong single factor structure was identified for the WAST that accounted for 85% of the total variance in responses to the WAST items. The WAST was found to be a highly reliable measure; coefficient alpha was estimated at.95. The scale also demonstrated construct and discriminant validity. The abused women reported being less comfortable responding to the WAST questions, in both the research and family practice contexts, than the non-abused women. The two WAST questions the abused women reported being most comfortable with were used to construct the WAST-Short for initial screening purposes. The WAST-Short correctly classified 100% of the non-abused women and 91.7% of the abused women. CONCLUSIONS: The WAST demonstrated good reliability and validity and discriminated between abused and non-abused women. Development of the WAST-Short provides physicians with a relatively unobtrusive screening tool for assessing abuse. The use of additional WAST questions can be used to further explore the possibility that a woman patient is experiencing abuse by her partner. Further study includes field testing the WAST in the family practice setting.

Battered Women↗
PubMed1996

The role of office-based procedures in family practice residency training.

BACKGROUND: Fifteen years ago, the American Board of Family Practice determined the need for a procedural "core" list requirement for residency training. Program directors at that time could not reach a consensus about a specific list of procedures. This study examined the current attitudes of residency directors about a core list of office-based procedures required for residency training. METHODS: A questionnaire was designed to elicit general information about attitudes toward establishing a core requirement of office-based procedures. The program directors were asked to select from a list of 35 office-based procedures those they felt should be required. The questionnaire was mailed to all 421 US family practice residency directors. RESULTS: The response rate was 78%. Of responding directors, 68% favored a core list requirement. Eleven out of 35 procedures received at least 80% consensus by those directors favoring a core list requirement. Programs situated in rural areas were more likely to oppose the core list requirement. Geographic region of the residency program impacted on the number of core procedures respondents felt residents should master in their training. CONCLUSIONS: The majority of residency directors who responded believe that the potential advantages of a core list requirement outweigh the potential disadvantages. The directors approximated consensus (80% agreement) on seven procedures across all geographic regions. With this evidence in mind, it would seem appropriate for the governing bodies of family practice to reexamine the core procedure issue.

Ambulatory Surgical Procedures↗
PubMed2001

What does family practice need to do next? A cross-generational view.

BACKGROUND AND OBJECTIVES: This paper presents a 60-year view of family practice, including its first 30 years and best projections for its next 30 years as a discipline and field of practice. METHODS: An objective cross-generational approach was taken based on available evidence. RESULTS: Five lessons are drawn from the past 30 years: (1) Neither medical education, medical practice, nor the health care system have been reformed by family medicine. (2) Family practice remains but one of several options for primary care. (3) The generalist-specialist ratio has shifted farther to specialists since 1970. (4) The United States is unique among Western industrialized nations in having multiple generalist specialties. (5) The three primary care specialties are on parallel but separate courses. The health care system is now very different from that of 1970, as a result of managed care; increased burden of chronic illness in an aging population; de-emphasis of hospital care; proliferation of primary care providers; increased emphasis on shared decision making with patients, cost-effectiveness, and value of health care services; and advances in information and communication technology. CONCLUSIONS: The following course changes are recommended for family practice: (1) Embrace new paradigms of care (eg, evidence-based medicine, population-based care, chronic disease management). (2) Modify practice style and redesign systems of care. (3) Embrace further differentiation within family practice. (4) Reassess and revise educational programs at all levels. (5) Increase emphasis on practice-based research and expansion of clinical electronic databases. (6) Explore feasibility of a unified generalist discipline through new alliances with other primary care specialties. (7) Build organizational and political strength through alliances in advocating for structural change of the health care system to include universal coverage and a generalist primary care physician for all Americans.

Delivery of Health Care↗
PubMed1999

A Screening Instrument to Identify Adults with Nutritional Risks in a Family Medicine Practice.

Family practice is the point of entry for many individuals seeking medical attention in the community. It is an ideal site for instituting preventative measures aimed at risk management. The objective of this study was to develop a valid, reliable instrument to screen adults for risk of suboptimal nutrition in a family practice population. A self-administered nutrition questionnaire was developed and sent to 50 registered dietitians in Alberta to establish face validity. The ability of the tool to identify nutritional risk was established by comparing the results of the screen to a dietitian's full assessment, that would include weight, weight changes, body mass index, adequacy of nutrition intake, available laboratory data, and medical and social factors that influence nutrition status. A score of 12 or higher on the screen was found to have an 80% sensitivity and defined the high-risk individuals who required immediate nutrition intervention (14% of our study population). At a score of seven, the screening instrument had a sensitivity of 67% and a specificity of 77%. This score was used to define moderate risk individuals, who required some nutrition advice. Screen scores below seven corresponded with individuals who were not at nutritional risk. The study has shown that a simple, self-administered screening tool can effectively identify the nutritional risk of adults in a family medicine practice.

Journal Article↗
PubMed1997

Interventions for improving information management in family practice.

Information management training has been neglected in family practice in the UK in the past. An adult learning model for such training is introduced. A pilot study using the adult learning approach showed improvements in information management processes over the six-month study period. The research project described in this paper compares the effectiveness of on-site training using adult learning methods, written information, and no intervention, in 33 family practices in the UK. Nine of the eleven practices in the on-site training group completed the training sessions and provided data, whereas only four of the eleven practices in the written information group provided data, and only three of the eleven practices in the control group did so. Preliminary analysis demonstrates that on-site training practices made considerable changes to the information systems in their practices, and appreciated the importance of high-quality data, both for patient care and reporting requirements. Full comparisons of data quality and information management methods are presented, and an assessment of priority training needs for maximum benefit is made.

Adult↗
PubMed1975

Medical student's perspective on preceptors in family practice.

Preceptorships have become an important means by which medical students are exposed to family practice. In order for a preceptor to be successful in nurturing student interest in family practice, he must have a good understanding of certain characteristics of today's medical students. Important differences exist between preclinical and clinical students, and the preceptorship must be designed accordingly. Unless preceptors are carefully selected and trained, they may have a negative influence on student interest in family practice.

Family Practice↗
PubMed1992

Income expectations of first-year students at Jefferson Medical College as a predictor of family practice specialty choice.

The recent decline in the number of medical students choosing careers in the primary care specialties has engendered increasing concern that economic factors are becoming more important in influencing the career choices of medical students. In order to assess the relationship of first-year medical students' income expectations to whether they chose to specialize in family practice, the authors analyzed data from 532 graduates of Jefferson Medical College (classes of 1987-1989), using the Jefferson Longitudinal Study. At entrance to medical school, each student listed his or her initial specialty preference and future expected peak income; the determination of actual specialty choice was based on the first year of postgraduate training. Both expected peak incomes and freshman specialty choices were independent predictors of actual specialty choices. The students who entered family practice residencies had lower initial expected peak incomes than did the students entering other specialties, especially the surgery specialties. In addition, according to logistic regression analysis, the students with relatively lower income expectations and a freshman preference for family practice were predicted to be nine times more likely to enter family practice residencies than were students with higher income expectations and no initial family practice preference (56% versus 6%). This study suggests that a freshman's income expectation is an important predictor of family practice specialty choice, independent of age, sex, degree of indebtedness, and initial specialty preference. The authors discuss their results in light of the decline in the number of medical students choosing family practice and the other primary care specialties.

Career Choice↗
PubMed2000

Following depression in primary care: do family practice physicians ask about depression at different rates than internal medicine physicians?

OBJECTIVE: To determine whether the chronically or recurrently depressed patients of family practice and internal medicine physicians differed in the proportion reporting that their primary care physician asked them about depression symptoms. DESIGN: A cross-sectional observational study of chronically or recurrently depressed survey respondents who identified a family practice or internal medicine physician as their primary care provider. SETTING: A large not-for-profit group-model health maintenance organization in the northwestern United States, with a population representative of its service area. PATIENTS: Health maintenance organization members (n= 1161) with ongoing or recurring depression or dysthymia who responded to a 1993 survey and who identified either a family practice or internal medicine physician as their primary care provider. MAIN OUTCOME MEASURE: Patients' self-report of their primary care physician asking them: (1) whether they had been feeling sad, blue, or depressed; (2) to fill out a questionnaire about their mood or feelings; and (3) whether they had been thinking about death or suicide. RESULTS: Chronically or recurrently depressed patients of family practice physicians were more likely to report that their physician asked them about depressive symptoms than were patients of internal medicine physicians (34.0% vs 27.3%) (P=.02). This finding persisted in a multivariate analysis. CONCLUSION: Family practice physicians may be more attentive to depressive disorders than internal medicine physicians.

Cross-Sectional Studies↗
PubMed1978

A family practice residency network. Affiliated programs in the Pacific Northwest.

The Department of Family Medicine at the University of Washington School of Medicine has developed a regional network of affiliated family practice residency programs in the Pacific Northwest. Collaborative efforts among the seven participating programs are directed to common needs such as curriculum development, sharing of educational resources, program evaluation, problem-solving of operational programs, and coordination of resident rotations. This family practice residency network is a logical and necessary extension of the program that has been developed in Washington, Alaska, Montana, and Idaho for teaching medical students. Regional undergraduate and graduate teaching programs in family practice represent an important role for the university relating to its surrounding region through the collaborative efforts of the medical school and participating hospitals and physicians in the community.

Curriculum↗
PubMed1975

Continuity of care in family practice. Part 1: dimensions of continuity.

This is the first in a series of four articles exploring the issue of continuity of care in family practice. There are four dimensions of continuity of care in family practice: chronological, geographical, interdisciplinary, and interpersonal. Each of these dimensions can be measured by specific actions and can, therefore, be evaluated and learned. Subsequent articles will deal with implications of continuity of care in family practice, its measurement and evaluation, and problems with its integration into family practice residency training.

Comprehensive Health Care↗
PubMed1988

The future of family practice. Implications of the changing environment of medicine. Council on Long Range Planning and Development in cooperation with the American Academy of Family Physicians.

The Council on Long Range Planning and Development of the American Medical Association has identified trends in the environment of medicine and the implications of these trends for specific medical specialties. This report considers the evolution of family practice as a specialty and its role in the future of health care delivery. As a specialty established less than 20 years ago, family practice has successfully surmounted several obstacles to achieve recognition within the medical community and among the public. However, the Council has identified new challenges and opportunities facing this specialty. In particular, the areas of graduate medical education, reimbursement, professional liability, and several health-related societal and ethical issues will pose challenges for and place constraints on family physicians. Family practice will encounter a number of opportunities in the evolving environment of medicine, due in part to demographic trends in the population and the growth in managed care. The Council concludes that, despite the challenges, the increasing demand for the services of family physicians has positive implications for the future of this specialty.

Education, Medical, Graduate↗