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PubMed1978

Family practice residency graduates as faculty members.

The demand for teachers of family practice is being met in part by recent residency graduates. The background of these individuals would not predict that they would become teachers, and a major role adaptation is required of them. Yet a number of factors lead them to elect to become faculty members. They possess several qualities different from faculty members coming from practice backgrounds and are, therefore, able to make unique contributions. A combination of recent graduates and practice-experienced faculty members may represent the ideal mix for the further development of academic family practice.

California↗

PubMed1994

Information and communication about overweight in family practice.

OBJECTIVE: To explore whether the family doctor recognizes the problem of overweight in his patients and if this problem was addressed in the communication between patient and doctor, especially in diabetic and hypertensive patients. METHOD: During a period of three months all patients in a German family practice were weighed and measured to calculate their body mass index (BMI). Overweight patients were asked if this issue had been a topic in the communication with their doctor and if he had recommended weight reduction. In addition, the doctor was interviewed about these patients and his concept of counselling and treating obesity. RESULTS: For 75% (740/979) of all patients attending the practice, the BMI could be determined: 35% of men (116/331) and 29% of women (117/409) were were overweight, and more than half of these patients were recruited to answer a structured questionnaire. Thirty-four percent of these patients did not know their ideal weight and 51% could not remember talking about this issue with the doctor. Communication/information about this issue was ranked as good in 29% of patients and in 19% as poor. We found a moderate association between information about overweight and patients' willingness for and success in weight reduction. Only 64% of obese patients (BMI > or = 30) were considered at risk for later disease and in need of treatment by the family physician. The doctor tended to overlook overweight in hypertensive or diabetic patients. CONCLUSION: Our results suggest that more medical attention should be directed to a reliable measurement and documentation of overweight and to respective communication with overweight patients, especially when hypertension and/or diabetes is present.

Adult↗

PubMed1982

Comparative evaluation of clinical pharmacists and physicians in the management of medication-related telephone calls in family practice offices.

A comparative evaluation of clinical pharmacists and physicians in the management of medication-related telephone calls in family practice offices is described. A peer review panel, composed of two family practice physicians and two clinical pharmacists not involved in the study, evaluated the appropriateness of management in 102 medication-related telephone calls. The effects of the following variables on the management ratings were determined by analysis of variance: (1) provider group (staff physicians, family practice residents, clinical pharmacists); (2) caller (patient, community pharmacist, third party, e.g., family member or friend); (3) type of medication-related telephone call (refill, new medication, drug information, or other); (4) consultation with another provider; and (5) recommendation for follow-up. Among the provider groups, a larger proportion of the calls to clinical pharmacists (72.6%) received the highest management rating of "appropriate, best alternative available" compared with staff physicians (39.7%) and residents (34.6%). Analysis of variance indicated that the management by clinical pharmacists was rated significantly more favorably than management by staff physicians or residents (p less than 0.05).] Statistical analyses also indicated that the differences in the management ratings among the provider groups were not explained by differences in the callers, type of medication-related call, consultation with another provider, or recommendation for a follow-up. These data suggest that clinical pharmacists may contribute substantially to improved patient-care through the management of medication-related telephone calls.

Community Pharmacy Services↗

PubMed1985

An intervention to increase mammography screening by residents in family practice.

Two groups of residents in family practice were used to evaluate the effectiveness of a multifaceted educational program that was designed to increase resident compliance with screening for breast cancer. In the experimental group, residents were given a two-hour seminar that responded to the literature on the difficulties of implementing preventive care in clinical practice; group consensus was developed for a more regular (exact frequency left to each resident) screening for women aged over 35 years, and specific barriers to breast cancer screening were analyzed and solutions presented whenever possible. In addition, these residents received two behavioral cues after the intervention to stimulate and reinforce referrals for mammography screening. The study was conducted over a period of one year, including a five-month preintervention period, a three-month post-intervention period, and a three-month follow-up period. As predicted, the increase in mean referral rate for the experimental group was significantly greater than for the comparison group. This increased rate of referral for mammogram was maintained for six months after the intervention. This intervention is easily reproducible in many residency training programs, especially those in family medicine and other small primary care programs.

Adult↗

PubMedDate not supplied

The influence of SCUD missile attacks on the utilization of ambulatory services in a family practice.

The consulting load in a family practice exposed to SCUD missile attacks during the 1991 Gulf War was compared with the equivalent period in 1990. The rate of visits was cut by half, with a relative and absolute increase in psychological consultations, and a decrease in consultations for infectious and respiratory conditions. There were more urgent consultations and fewer planned appointments. It is suggested that the stress of the SCUD missile attacks led to a reduction in consultations for trivial disorders, but an increase in the anxiety level of the population.

Ambulatory Care↗

PubMed2002

Otitis media in children: use of diagnostic tools by family practice residents.

BACKGROUND AND OBJECTIVES: Although otitis media is a common problem in primary care, little is known about the use of diagnostic tools such as pneumatic otoscopy, tympanometry, acoustic reflectometry, or tympanocentesis by family physicians in training. METHODS: This was a self-reported observational study of family practice residents' use of otitis media diagnostic tools. Twenty-three family practice programs in Texas and Oklahoma were surveyed during November and December 2000. Residents were asked about their use of diagnostic tools, and, if tools were not used, they were asked the reason for not using them. Residents were also asked about the criteria they used to diagnose otitis media, and their responses were compared to criteria recommended by national guideline panels. RESULTS: The response rate was 61% (n = 316). The percentage of residents using pneumatic otoscopy was 66%, tympanometry 29%, acoustic reflectometry 2%, and tympanocentesis 0%. The most common reasons cited for not using tools were lack of training or unavailability of equipment. Fifty-five percent of family practice residents do not report pneumatic otoscopy for diagnosing otitis media and thus did not use recommended criteria. Faculty training of residents in the use of diagnostic tools was associated with a higher rate of using these tools. DISCUSSION: Few residents believed that diagnostic tools had no value in the diagnosis of otitis media, but lack of training or equipment problems were reported as contributing to their not using these tools. Half of family practice residents may be inadequately diagnosing middle ear problems since they did not report that pneumatic otoscopy was necessary for diagnosing otitis media. Because training was associated with higher rates of using appropriate diagnostic tools, family medicine faculty can play a significant role in improving the residents' diagnostic skills.

Acoustic Impedance Tests↗

PubMed1981

The office laboratory in family practice residency programs.

A survey of family practice residency programs explored several aspects of the educational and clinical work of the office laboratories in residency centers. Many residency laboratories were found to have limited equipment and undertook only a few of the common procedures. Only 56 percent of residency programs had identified a specific educator for laboratory teaching. Only 15 percent or programs had established a formal curriculum in laboratory medicine. Curricula were poorly developed in the areas of quality control, equipment purchase, laboratory design, and the training of laboratory personnel. Recommendations are made for improving residency laboratories resident education in laboratory medicine.

Family Practice↗

PubMed2001

Advantages of long observation in episode-oriented electronic patient records in family practice.

From 1985-2000, 58 Dutch family physicians (FPs) of the Transition Project collected ICPC-coded data on 47, 2451 episodes of care, first in paper records for direct encounters only, later with a complete electronic patient record (EPR) for all (direct and indirect) encounters. Based on these data, the effects of a long observation period and the inclusion of all encounters (both direct and indirect) in the EPR were studied. Long observation periods in EPRs appear to have important advantages for patient documentation and the assessment of the content of family practice. Comparison of data from a one-year versus a four-year observation period showed a shift in utilization rates. In a long observation period, visiting patients appeared to make less demand on care, while the content of the FP's care for selected chronic diseases was reflected more realistically. The inclusion of all indirect encounters in an EPR (as compared to the previous inclusion of direct encounters only) resulted in more than twice the number of coded entries per listed patient, and thus led to a major shift in perspective on the FP's involvement in patient care.

Adolescent↗

PubMed1989

Financial crisis in a family practice residency: a successful strategy.

A family practice residency program in a California public teaching hospital was faced with a financial crisis that threatened its elimination. Hospital officials and medical leaders developed a strategy that resulted in (1) personnel reductions focused principally on hospital overhead departments, (2) reductions in faculty teaching fees, (3) increased resident and faculty productivity, (4) increased patient access to ambulatory areas, (5) decreased utilization of laboratory, radiology, respiratory, physical therapy, pharmacy, and cardiology services, and (6) more favorable contracts with providers for patient care services. The hospital met its financial objectives primarily as a result of collaborative efforts of the hospital management team and a committed faculty vested in the success of the institution.

California↗

PubMed1987

Symptoms associated with the diagnosis and treatment of depression in family practice.

The diagnosis of depression in family practice is influenced by numerous physician and patient factors. We studied the impact of prior depression history and symptomatology on diagnosis and use of antidepressant therapy. Office visits made by 67 women diagnosed as depressed were coded for vegetative, psychological, and somatic depression-related symptoms. One third of patients diagnosed within the study period had a prior history of depression. Depressed mood and sleep disturbance were the most common symptoms on the diagnostic visit, although symptoms were heterogeneous. Most patients presented with a combination of vegetative, psychological, and/or somatic symptoms. Medication use was associated with prior history and with vegetative symptoms. Further research is needed to compare symptom presentation in recognized depressed patients to patients in whom depression is unrecognized by physicians, and to discriminate patient presentation from interview-elicited data.

Adult↗

PubMed2003

A national survey on the current status of family practice residency education in geriatric medicine.

BACKGROUND AND OBJECTIVES: The dramatic increase in the elderly population expected over the next few decades will place a heavy strain on the current health care system. Family practice residents need to be prepared to take care of this geriatric population. In this study, we document the past, current, and future trends of geriatric education in family practice residency programs. METHODS: A survey was mailed to all family practice residency directors in the United States (n = 471). RESULTS: The response rate was 75%. Ninety-two percent of family practice residencies have a required geriatrics curriculum. Nursing homes, assisted living facilities, and home care are the predominant training sites for geriatrics. Training is most often offered in a longitudinal format. The mean number of physician faculty available to teach geriatrics is 2.6 per program (.83 full-time equivalent). Conflicting time demands with other curricula was ranked as the most significant barrier to geriatric education. Directors rated geriatrics as one of the three most important curriculum topics. CONCLUSIONS: Faculty development to enhance the number of faculty who can teach geriatrics and broadening the exposure of residents to the elderly in a variety of settings will be important to ensure that future generations of family physicians are adequately equipped to care for the geriatric population.

Aged↗

PubMedDate not supplied

Follow-up on family practice residents' perspectives on length and content of training.

BACKGROUND: The structure of family practice residency programs remains essentially unchanged from the model first proposed more than 35 years ago. Advances in medical technology and knowledge combined with increasing restrictions on resident work hours and decreasing medical student interest invite reconsideration of how family physicians are trained. METHODS: We resurveyed 442 third-year family practice residents who had participated in a prior study in 2000 to determine whether their opinions about the length and content of residency had changed and whether they would still choose to be a physician and a family physician. RESULTS: Thirty-seven percent of responding third-year residents favored extending family practice residency to 4 years. Compared as groups, there was relatively little change in opinion between first- and third-year residents. However, residents' individual responses about the settings and content areas for which they would be willing to consider extending training varied considerably between years 1 and 3. Personal characteristics did not seem to influence residents' opinions about length and content of training. Reasons for favoring a 4-year program and barriers to change were similar to those reported previously. Residents' commitment to medicine and family medicine was still strong and was not associated with their opinions about length of training. CONCLUSION: Although most surveyed residents favored a 3-year residency program, a substantial minority still supported extending training to 4 years, and the majority would still choose to enter family medicine programs if they were extended. Given a lack of consensus about specific content areas, family medicine should consider a period of experimentation to determine how to best prepare future family physicians.

Adult↗

PubMedDate not supplied

Economic analysis of family practice residency programs: a report from the Northeastern Ohio Network.

BACKGROUND: The financial impact of a family practice residency program on a sponsoring institution is poorly understood. This study intended to describe as fully as possible all the expenses and revenues from five community-based family practice residency programs in northeastern Ohio. METHODS: Direct and indirect expenses, revenues, and demographics were evaluated for 1992. Similarities and differences among the participating programs were examined. RESULTS: Overall expenses per resident were similar in all five programs, with a range from $162,000 to $203,000. Revenues reflected the number of residents in the program, although collection ratios varied. Inpatient collections ranged from 53%-76% and outpatient collections ranged from 60%-76%. An average of 30% of graduates from the past 10 years were on the active medical staff of their sponsoring institution, with a range of 21%-36%. CONCLUSION: Based on the expenses, revenues collected, and reasonable assumptions made about cost of care in the hospital setting, the family practice residencies are probably a break-even operation, excluding the benefit of providing primary care physicians to the community.

Costs and Cost Analysis↗

PubMed1987

Gatekeeping in primary care: a comparison of internal medicine and family practice.

Five hundred twenty new patients were randomly and prospectively assigned to receive their care in the Internal Medicine Clinic or Family Practice Clinic of a large university hospital. The patients were followed by residents in training under the supervision of board-certified internists or family physicians. After a mean length of care of slightly over two years, the charts were reviewed for frequency of visits to primary care providers (internal medicine or family practice), Emergency Room, Acute Care Clinic, and all clinics other than the two primary care clinics. The records were also reviewed for laboratory tests ordered. Frequency of visits to the clinic of primary care, Emergency Room, Acute Care Clinic, and broken appointments were all significantly higher for patients randomized to the Internal Medicine Clinic. In addition, the median total annual cost of laboratory tests for patients followed by internal medicine physicians was significantly higher, largely because of higher laboratory charges generated by the specialist consultants. Over the study period, internal medicine patients had a significantly higher number of visits to all nonprimary care clinics and specifically to the dermatology, obstetrics and gynecology, and general surgery consultant clinics. It can be concluded that in this clinical environment, the practice styles of internal medicine and family practice are different.

Adult↗

PubMed1991

A practical application of reliability theory to family practice research.

The practical need for short instruments to assess constructs such as general health results in potentially imprecise measurement. According to reliability theory, a consequence of this imprecision is the inclusion of random error in the observed measurement of any construct. To the extent that measures are unreliable, clinicians may find that large changes in obtained measurements must be seen before one can have confidence that a true change in behavior has occurred. Discussion of the standard error of measurement and its application to functional assessment research is included.

Bias↗

PubMed1996

Accuracy of prenatal sonography performed by family practice residents.

BACKGROUND AND OBJECTIVES: Sonographic evaluation of the fetus is a common procedure in modern antepartum management. This study investigates the accuracy of family physicians at different levels of training in performing common prenatal sonographic measurements. METHODS: Records of prenatal sonographic measurements of gestational age (279 scans) and estimated birth weight (62 scans) performed by family practice residents and family medicine teaching faculty at Silas B. Hays Army Community Hospital were compared to actual gestational age and birth weight. Associations between sonographically predicted gestational age and weight, Dubowitz-determined gestational age, actual birth weight, and training level of the operator were examined using analysis of variance. RESULTS: The mean measurement difference in weeks between ultrasound-estimated gestational age and Dubowitz-determined gestational age on sonograms performed between 6 and 20 weeks of gestation was 1 week. The mean measurement difference on sonograms performed between 21 and 30 weeks of gestation was 1.3 weeks, and the mean measurement difference on sonograms performed between 31 and 42 weeks was 1.6 weeks. No significant difference was found between any of the resident year groups and family medicine faculty in accuracy of measuring gestational age. Sonograms estimating fetal weight within 10 days of delivery were within 10% of the actual birth weight. Faculty sonographic estimates were slightly more accurate than resident estimates. CONCLUSIONS: The psychomotor skills necessary to perform accurate prenatal sonographic biometric measurements are easily learned within the confines of a 3-year family practice residency.

Analysis of Variance↗

PubMed1994

Influence of demographics and profitability on physician selection of family practice procedures.

BACKGROUND: Family physicians must make complex decisions regarding which procedures to learn in training and which to perform in practice. Factors that influence these decisions include community needs, the potential profitability of a procedure, and the desires and skills of the individual physician. METHODS: To further clarify some of these influences, we surveyed members of the Wisconsin Academy of Family Physicians. The survey instrument included questions about 27 different procedures, including the perceived profitability of the procedure, which procedures they had discontinued, and which they planned to learn. RESULTS: More than 40% of family physicians reported doing skin surgery, flexible sigmoidoscopy, nonstress obstetrical testing, breast-cyst aspiration, multiple joint arthrocentesis, and Norplant insertion, whereas fewer than 6% perform colonoscopy, esophagogastroduodenoscopy, and nasolaryngoscopy. Fifty-seven percent of physicians had discontinued at least one procedure, and 34% planned to learn one or more procedures. Being younger, male, and practicing in smaller communities correlated with performing a greater number of procedures (P < .001), but female physicians performed more gynecologic procedures (P < .05). There was a statistically significant correlation (r = -.478, P < .05) between perceived low profitability of a procedure and family physicians discontinuing a learned procedure, and a marginal correlation between perceived profitability and planning to learn a procedure (r = .338, P < .1). CONCLUSIONS: Family physicians in Wisconsin vary greatly in the number and types of procedures performed. Community size, sex, and age are important variables associated with the number and type of procedures performed. The performance of procedures is dynamic: physicians both discontinue learned procedures and learn new procedures. The profitability of the procedure influences the learning and discontinuation of procedures.

Adult↗

PubMed1976

Medical records in family practice. A review.

The organisation of general practice in England is outlined and the independent contractor basis of the family practioner emphasised. Data from family practice, like data from hospital practice, may be used for clinical management, practice management, or research. Examples of applications in each of these fields are given. The basic records used in family practice--the medical record envelope, the prescription form and the claim for sickness benefit--are described. Some practices record morbidity (E Book or Diagnostic Index), some record systematically details of their activities (L Book or Activities Ledger) and some maintain age and sex registers and other registers of their patients; all these developments are outlined. Attention is drawn to the introduction of problem orientated records and to the use of computers in family practice, but these innovations are not discussed. Outstanding issues are the same as those in hospital record systems--accuracy, definitions, coverage, confidentiality, clerical support and costs, and the use made of the information.

Confidentiality↗