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PubMedDate not supplied

The use of infrared ear thermometers in pediatric and family practice offices.

OBJECTIVE: To describe the use of infrared (IR) ear thermometers in pediatric and family practice offices. METHODS: The authors mailed a questionnaire to 350 randomly selected members of the American Academy of Pediatrics and to 355 randomly selected members of the American Academy of Family Physicians. RESULTS: Of respondents in clinical practice, 78% had used IR ear thermometers at least once in the past; 65% of pediatricians and 64% of family practice physicians were current users. Seventeen percent of pediatric offices and 18% of family practice offices that had used IR ear thermometers had discontinued use, most citing inaccuracy or lack of staff trust in the device. Pediatric offices were less likely than family practice offices to use the device in well neonates and sick neonates and more likely to use it in sick children. Advantages cited included rapid readings, ease of use, and accuracy. Seventy-five percent of current users reported at least one problem, including low readings and lack of staff trust. CONCLUSIONS: IR ear thermometers are widely used in pediatric and family practice offices. Some offices limit use of these devices to older children and adults, and most of the offices surveyed report using other devices as a check on the accuracy of IR thermometers. Statements by professional organizations that provide user guidelines and establish appropriate age cut-offs would be helpful.

Adolescent↗

PubMed1986

Research design and statistical procedures used in the Journal of Family Practice.

To determine whether articles published in The Journal of Family Practice contain statistical content that is easily understood by the general reader, all original articles published during a two-year period were reviewed to determine the frequency of use of different research designs and statistical procedures. Eighty-eight percent of the articles used the cross-sectional design. No statistical methods were reported in 46 percent of the articles; 13 percent reported descriptive statistics only. The chi-square statistic and t test were the most commonly used statistical procedures. Readers of The Journal of Family Practice, therefore, needed only an elementary knowledge of statistics to understand the statistical content of three quarters of the original articles.

Cross-Sectional Studies↗

PubMed2002

Predicting the number of headache visits by type of patient seen in family practice.

OBJECTIVES: To examine the number of visits involving a headache diagnosis among patients to four family practice sites between July 1, 1995 and December 31, 1998. BACKGROUND: Although the majority of care-seeking headache sufferers are seen in the primary care setting, few studies have attempted to document the relationship between type of headache as diagnosed by the family practice physician, and number of the patient's headache visits. Design.-Secondary analysis of administrative claims data. METHODS: We compared headache visits per person-year by the age and sex of patient among patients classified according to headache diagnosis received: tension-type only; headache not otherwise specified (NOS) only; migraine only; tension-type and headache NOS; tension-type and migraine; headache NOS and migraine, and migraine, tension-type, and headache NOS. Patients with an International Classification of Diseases (version 9) code of 346 were considered to have a diagnosis of migraine, with 307.81 representing tension-type headache, and 784 representing headache NOS. Age was measured from date of birth to initial visit in the study period and patients were subdivided into 5-year age groups. Person-years "at risk" for each diagnosis was measured from the time of initial visit during the study period to December 31, 1998. RESULTS: We examined data from 4112 patients who made 9322 visits with a headache diagnosis. We found that the average number of visits per person-year increases as the number of different types of headache diagnoses increased and were greatest for patients having migraine as opposed to headache NOS and tension-type diagnoses. CONCLUSIONS: Headache type is an important predictor of the number of office visits involving a headache diagnosis in family practice. Patients with multiple headache diagnoses have more visits. Patients with combinations of headache diagnoses involving migraine are the most frequent visitors.

Adolescent↗

PubMedDate not supplied

Teaching hypnosis within a family practice residency program.

As a result of increasing interest in medical hypnosis, a curriculum has been developed for teaching clinical hypnosis to family practice residents within a Canadian two-year training program. History and theories, demonstrations of techniques, practice of inductions, and clinical applications are presented to all second-year residents within a course titled "Behavioral Medicine in Family Practice." Individual supervision is offered within the family practice teaching unit as well as a one-month elective in behavioral medicine. Residents are encouraged to attend workshops offered by the Canadian Society of Clinical Hypnosis and invited to attend an autogenic training group for patients. Evaluation of continuing use of learned skills in practice settings is in process.

British Columbia↗

PubMed2001

Deception by applicants to family practice residencies.

BACKGROUND AND OBJECTIVES: Our residency program experienced applicants who actively misrepresented qualifications, background, or abilities. The experiences of other family practice residencies were unknown. This study 1) determined what information family practice residency directors required from applicants, 2) assessed whether this information was confirmed or verified, and 3) describes the deceptive application information discovered by program directors. METHODS: A questionnaire was sent to directors of all accredited family practice residencies. Information was collected about required information, data confirmation, and the deception and misrepresentation perceived. RESULTS: Thirty-two percent of the directors responded. Eight of 13 items on the Electronic Residency Application System were designated as required by more than half of responding directors. Only two of the items (licensure and certain facts in the personal statement) were confirmed by a majority of directors who required them. Deception was recognized by nearly half of respondents within the past 5 years. Most cases involved specialty choice or the personal statement of candidates and were recognized during the interview or by direct confirmation of data. CONCLUSIONS: Most directors appear to accept application information at face value. Recognition of deception about application information was reported. Misrepresentation by applicants may be a more common event than previously realized and may require more thorough verification of application credentials.

Clinical Competence↗

PubMed1996

Providing the Advanced Life Support in Obstetrics Course within the military family practice training system.

"The Advanced Life Support in Obstetrics (ALSO) Course is designed to assist health professionals in developing and maintaining the knowledge and skills they will need to effectively manage the emergencies which arise in obstetrics." Given the fact that the vast majority of military family physicians provide maternity care, often in small overseas facilities without in-hospital obstetrician backup, inclusion of this course into the military family practice residency training curriculum would be very beneficial to the mission of family practice within the military. A brief background of the ALSO movement and the ALSO course curriculum are provided. Lessons learned to aid military family practice departments in providing quality ALSO courses are described, as are arguments for the inclusion of ALSO training into military family practice training curriculums.

Curriculum↗

PubMed1992

Rural training tracks in four family practice residencies.

The use of rural training tracks (RTTs) in family practice residencies is a new strategy (beginning in the late 1980s) to increase the number of residents selecting rural careers. The authors describe the four residencies (in Washington, Nebraska, New York, and Kentucky) that have established RTTs. The first residency year is completed in an urban tertiary care center, and the second and third years are completed in a distant rural community wherein the primary faculty are the members of a rural family practice group. Inpatient experience for the residents is provided by community hospitals that offer obstetrics, emergency room care, and first-line critical care. The residents' training is supplemented by specialty faculty practicing in the rural communities. The curricula are highly structured and are evaluated to ensure training experiences of high quality. The RTTs' financial support comes from state initiatives, hospital reimbursement, recruitment budgets, and outpatient care revenues. The authors conclude that the RTT concept has the potential to lessen the shortage of rural physicians.

Family Practice↗

PubMed1983

Psychiatry--family practice liaison: a collaborative approach to clinical training.

In view of the growing need for effective liaison between psychiatry and family practice programs, some of the models for educational and clinical liaison are discussed, and a clinical training program is described in which psychiatry and family practice educators work collaboratively in the training of both family practice and psychiatry residents and medical students. The program is offered as a model for providing comprehensive clinical training to residents and students and comprehensive clinical care to patients.

Education, Medical, Undergraduate↗

PubMed1989

Cost, correlates and effects of malpractice litigation in family practice residency programmes in the United States.

A survey of family practice residency programme directors in the United States was undertaken to look at the impact of malpractice and malpractice insurance on residency education. Of 385 programmes 276 (71.7%) responded to the 20 question survey. The results indicated a mean rate of 0.043 claims per resident or faculty member in the previous year. One-fifth of the respondents did not report the type of malpractice insurance retained for residents and over half did not report the cost of insurance for residents. Current problems with liability were most often related to the region of the country, number of visits to the family practice centre, the number of residents, the number of faculty, the type of faculty employer and the type of resident employer. Programmes which anticipated future problems with liability were most likely to be those with current problems. The areas identified as most concerning to residents included: obstetrics, cost of malpractice insurance, difficulty obtaining coverage, and the general anxiety created by malpractice litigation.

Education, Medical, Graduate↗

PubMed1991

Changing immunization referral patterns among pediatricians and family practice physicians, Dallas County, Texas, 1988.

Family practice physicians and pediatricians in Dallas County, Texas, were surveyed to determine how recent vaccine price increases have changed immunization referral patterns. A total of 73% of responding physicians referred some pediatric patients for immunization in 1988. Public health clinics were the largest referral source with more responding pediatricians (84.4%) referring patients than did responding family practitioners (66.5%). Referrals to the clinics were most often made when patients were unable to afford immunizations in a private practice setting. Between 1979 and 1988, the number of responding pediatricians and family practitioners making immunization referrals increased by 193% and 391%, respectively. The percentages of children referred for immunization increased by 693% during the same decade. It was suggested by our survey of Dallas County physicians that a new influx of patients are using public sector immunizations, potentially creating additional financial stress for public health programs. In addition, this shift to the public sector may undermine the health departments' ability to provide new vaccines or protect greater numbers of children with immunization.

Costs and Cost Analysis↗

PubMed2000

An analysis of trends, perceptions, and use patterns of electronic medical records among US family practice residency programs.

BACKGROUND AND OBJECTIVES: This study intended to quantify electronic medical record (EMR) use in family practice residencies, associate program characteristics with EMR use, and identify perceptions and issues about the use of EMRs. METHODS: A survey was mailed to all 454 US family practice residency programs, with a 72% response rate. The survey, which was pretested and revised, was designed to identify benefits, problems, perceptions, and trends regarding the use of EMRs. RESULTS: Fifty-five of 329 programs (17%) were using an EMR, while 10 (3%) had used an EMR but discontinued. Programs in the South reported the highest EMR use (21%, 21/99), and those in the North Central region reported the lowest use (11%, 11/102). EMR use was highest in university settings (19%, 15/81), programs offering fellowships (26%, 24/92), new programs (36%, 18/48), and programs that require research (22%, 20/91). Of the 329 programs that responded, 43% (143 programs) reported having information systems (IS) committees. Of the 55 programs currently using EMRs, 78% had at least one full-time equivalent IS technician. Of programs that discontinued use, software inadequacy was the most frequently cited reason (40%, 4/10). Programs that had never used EMR systems (n = 264) were more likely than those that had used EMRs (n = 65) to favorably perceive EMRs with respect to 1) meeting program requirements (44% versus 34%), 2) documenting improved patient care (65% versus 43%), 3) providing a reliable research database (94% versus 55%), and 4) documenting resident experience (92% versus 53%). Of the 264 (80%) programs that had never used an EMR, 172 (65%) plan to implement one. CONCLUSIONS: EMR use is low among US family practice residency programs, but some success in implementation of EMRs has been achieved. Based on the responses to this survey, use will likely increase from 55 of 329 programs (17%) to 153 of 329 (47%) by 2000.

Family Practice↗

PubMed1982

Attitudes of patients toward family care in a family practice group.

There is little information documenting the extent to which the ideal of whole family care is represented in the real world of family practice. A previous study of a suburban family practice group revealed that only 28 percent of families obtained whole family care from a single physician. Interviews were conducted on a sample of 97 of these patients in an effort to gain insights into the factors influencing the choice of a single physician or more than one physician providing their health care. There were no significant differences between same-physician and different-physician families with respect to demographic factors or attitudes toward physician characteristics and family care. Most families had no insights into the potential value of having a single physician for the whole family; indeed, only one family specifically selected a single physician with the belief that it would thereby gain better care. If the observations reported here are representative of the situation at large in the country, family physicians have an important task ahead in patient education.

Attitude to Health↗

PubMedDate not supplied

A pilot study of the prevalence of herpes genitalis among selected groups of patients seeking care in a family practice center.

Herpes genitalis is typically studied in patient panels identified at specialized sexually transmitted disease clinics or with information obtained from herpes self-help groups. This article reports the results of a descriptive pilot study of the prevalence of herpes genitalis in family practice. The feasibility of obtaining psychosexual information on sexually transmitted diseases from more than 600 patients from five family practice practices was assessed. These initial data show that in the family practices participating in this study: 1) genital herpes is a low prevalence disease; 2) psychosocial adjustment to the disease among infected persons is usually reported as good, apart from sexual effects; and 3) close to 30% of the study population reported having prior sexually transmitted diseases. Problems involved in generalizing the results of this research and the limitations of conducting collaborative clinical research in family practice settings are reviewed.

Activities of Daily Living↗

PubMed1982

Model for cost-benefit analysis of clinical pharmacy in family practice.

A cost-benefit analysis (CBA) model that can be used to estimate the economic consequences expected from the inclusion of clinical pharmacy services in a family practice clinic was developed; use of the model was demonstrated by applying it to a hypothetical solo-physician practice. The effects that clinical pharmacy services would have on the medical practice were evaluated and classified as either costs or benefits. Equations were derived to quantify all direct effects. Semi-structured, open-ended interviews of 15 family practice physicians and five family practice clinical pharmacists were conducted to generate data describing a hypothetical solo-physician practice. Responses from these interviews were averaged to provide the numerical values called for by the equations in the CBA model. The difference between total costs and total benefits was the net benefit that could be expected by the hypothetical solo-physician practice for the first year after including a clinical pharmacist in that practice. The net benefit determined by these calculations was $2744 assuming a 5% increase in overall quality of care, or $25,658 assuming a 20% increase in overall quality of care. The net-benefit figure obtained by applying the CBA model to the hypothetical case should not be generalized to other practices. Rather, by applying the CBA model, practitioners and administrators can calculate the expected net benefit specific for their particular medical practice.

Cost-Benefit Analysis↗

PubMed1997

Alternative medicine instruction in medical schools and family practice residency programs.

BACKGROUND AND OBJECTIVES: The use of medical therapies outside of mainstream Western medicine, referred to as complementary medicine or alternative medicine (CAM), is rapidly increasing in the United States. Despite evidence of physician interest and willingness to refer to CAM providers, there is currently little information regarding medical education in these practices. This survey assessed the frequency and nature of alternative medicine instruction in US medical schools and family practice residency programs. METHODS: Society of Teachers of Family Medicine staff mailed a 16-question survey to all US medical school family medicine department chairs and non-university-based family practice residency program directors about existing instruction in alternative medicine, planned instruction, and educational programs under consideration. RESULTS: The overall response rate was 77.9% (364/467), with 29.7% (108/364) of all respondents currently teaching, 6.0% (22/364) starting to teach, and 6.3% (23/364) considering teaching some form of alternative medicine. CAM instruction is most common in the Northeast and Rocky Mountain regions. The instruction is predominantly elective (72.2%). Instructional content and methodologies vary widely. CONCLUSIONS: Alternative medicine has begun to establish a presence in US medical schools and family practice residency programs. Offerings in this diverse subject vary widely in content and format.

Career Choice↗

PubMed2000

Family practice training in Nepal.

BACKGROUND: This article describes the health care system in Nepal and the only existing family practice (general practice) training program in that country. The majority of doctors in Nepal still have no residency training, and a specialist focus pervades. The efforts of some leading educators in Nepal led to establishment of a family practice training program in 1982, and the program now enrolls 12 residents per year, half of whom are from India. Major obstacles in education, financing, and policy must be addressed before family practice can have a meaningful presence or effect on the health care in Nepal.

Family Practice↗

PubMedDate not supplied

A study of closure of family practice residency programs.

BACKGROUND: Between July 1, 2000, and July 1, 2002, the Residency Review Committee for Family Practice had received requests for voluntary withdrawal from 27 residency programs. This number represents a significant increase in the rate of program closure over previous years. OBJECTIVES: We compared descriptive data on these closing programs and explored factors contributing to the closure. METHODS: Descriptive program data were collected from the Accreditation Council for Graduate Medical Education, National Resident Matching Program, the American Academy of Family Physicians, and the American Board of Family Practice. Program directors from closing programs were invited to participate in a semi-structured interview to discuss factors contributing to the closure of their program. RESULTS: Seventy-five percent of closing programs were community based, median program age was 11 years, board pass rate averaged 98%, and 69% cared for underserved communities. Financial, political, and institutional leadership changes were most frequently cited by program directors as primary reasons for program closure. CONCLUSIONS: The rate of program closure is increasing, affecting programs that meet most measures of high quality. Quality programs are being lost, and the ultimate impact is yet to be seen. Program directors offer warning signs and advice that is generally applicable to other family practice residency programs.

Family Practice↗

PubMed1982

How family practice patients view their utilization of mental health services.

This study examines to what extent family practice patients perceive themselves as being willing to seek help for personal problems. The study further explores whether this willingness is related to various demographic characteristics. Finally, it investigates family practice patients' preferences in their choice of a source of help for personal problems. Patients in the waiting room of a private family practice center were approached to participate in the study at random times during one month (n = 145). For each item of a list of common personal problems, patients were asked to judge how likely they would be to seek professional help, their preferred setting for this help, and their preference of a professional provider. Respondents' sex was found to be the only demographic characteristic that affected willingness to seek help. "The family physician's office" and "the family physician" were the preferred choices mainly for personal problems associated with physical manifestations. Other providers were chosen for predominantly social or emotional problems. Most respondents stated that they would be more likely to seek help from a mental health professional who worked along with the family physician than they would be to seek help from a professional housed elsewhere.

Adolescent↗