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PubMed1997

Screening for domestic violence in a rural family practice.

This study evaluates the effectiveness of a screening form used to assess the incidence of current and past domestic abuse among patients seen in a rural family practice. Two of nine family physicians screened most adult women they saw at a rural primary care clinic for three months in early 1996. Of the 280 women who completed surveys, 94(34%) reported experiencing physical or emotional abuse at some time in the past. Twenty-three (8%) reported physical abuse within the past year. Fourteen women (5%) reported being currently afraid of their partner or someone else. Although current or past abuse was seen across all groups, women reporting abuse were more likely to be unmarried, younger, and on medical assistance. They were also more likely to have children at home. We concluded that the prevalence of women reporting current abuse in a rural family practice is sufficient to warrant mass screening.

Adult↗

PubMed1970

The role of a medical faculty in reorganizing family practice to meet current community needs.

There exists a crisis in the delivery of medical services, particularly by family doctors of whom there is an apparent shortage.A STUDY OF FAMILY PRACTICE IN KINGSTON, ONTARIO, AND IN THE NEARBY COUNTRYSIDE INDICATES THREE CRITICAL NEEDS IN FAMILY PRACTICE: professional assistants for the family doctors, efficient office facilities and new methods of delivering family medical care in rural areas. The Faculty of Medicine at Queen's University has involved itself in a study of these matters and is developing a program to help solve them, by research into the nature of the problems and into methods for alleviating them, by keeping practising physicians informed through research reports and the continuing education program of the Medical School, by the development of pilot projects, and by the evaluation of new services aimed at these problems, independently launched by physicians in the community. Pilot projects to date include two designed to study the use of registered nurses as doctor assistants and another which involves the organization and operation of a university-sponsored community health centre. Last, but by no mean least, the Provincial Government is continually briefed on all these activities.

Attitude of Health Personnel↗

PubMed1993

The structure and regulation of family practice residency laboratories.

BACKGROUND: Increasing regulation of physician office laboratories (POLs), increased complexity of outpatient care, and technological advances have increased the need to train family practice residents in POL management. There is little information on how residency laboratories are organized, how they are regulated, and how often quality controls and proficiency testing are done. METHODS: A questionnaire was sent to 385 ACGME-approved family practice residencies to determine the scope of testing, quality-assurance activities, and administrative structure of the residency laboratory. RESULTS: Two hundred and ninety-seven programs responded, for a response rate of 77%; 91.6% were performing routine office tests and 40.7% were performing automated testing. Of programs that performed automated tests, 71.2% were performing daily normal and abnormal quality-control specimens. Proficiency testing was only performed by 57.8% of programs. The program's parent hospital viewed the residency laboratory as a POL in 55.6% of cases and as a satellite of the hospital laboratory in 32.6%. CONCLUSIONS: Residency laboratories are more frequently organized as POLs than satellite laboratories of the parent hospitals. The POL model offers an excellent opportunity to teach residents about office laboratory management. Residency laboratories should be implementing proficiency testing for both patient safety and resident teaching. Many residency laboratories will need to increase the frequency of quality controls as the new CLIA '88 regulations are implemented. Accreditation by a private organization may be an attractive option for family practice office laboratories.

Clinical Laboratory Techniques↗

PubMed1984

Incidence and detection of bulimia in a family practice population.

In a study of a family practice population, 20 percent of the 176 participants, ranging in age from 14 to 42 years, showed abnormal eating concerns and habits as indicated by their responses on a modified version of the Eating Attitudes Test (EAT). Clinically these patients had more visits to a physician per year and more complaints per visit, but these differences were not statistically significant. Over 10.9 percent of the sample population appeared to fulfill the criteria for the eating disorder bulimia. These patients were also significantly heavier than patients who did not have abnormal eating concerns and habits.

Adolescent↗

PubMedDate not supplied

Family practice specialty selection: a research agenda.

This article examines the declining interest in family practice by US medical students and trends in specialty selection over the past decade. Four factors affecting specialty choice (medical student characteristics, medical school, residencies, and certain aspects of the health care system) are discussed, and a research agenda is developed for each area. Researchers and funding agencies are urged to begin an exploration of these issues to better understand the dynamics behind current specialty choices so that successful policies to increase the number of students entering family practice can be developed.

Career Choice↗

PubMedDate not supplied

Adult inpatient training for a family practice residency: a university-versus community-based setting.

BACKGROUND AND OBJECTIVES: Some educators have expressed concern about the quality of inpatient training received by family practice residents in community-based residency programs because of insufficient patient numbers and resources in those programs. This study compared the number, diagnoses, and lengths of stay of patients seen by first-year family practice residents in a large inner-city, university-based medical center's internal medicine service versus those in a family practice teaching service in a smaller, community-based suburban regional hospital. METHODS: The adult inpatient training services of the two training sites were compared for 6 months to determine if any differences existed between the sites in patients'age, gender, primary and secondary diagnoses, average length of hospital stay, or in the number of monthly admissions. RESULTS: A total of 247 patients were admitted to the teaching service of the suburban community hospital, while 317 patients were admitted to the teaching service at the university hospital. The average length of stay for the suburban hospital was 6.1 days and 5.7 days at the university hospital. A total of 107 different diagnoses were made on admission at Kenner Regional Medical Center, while 90 were made at University Hospital. Chest pain/angina was the most frequent diagnosis encountered at admission at both hospitals. CONCLUSIONS: Based on the two inpatient services studied, a broad variety of diagnoses and patient demographics are encountered at community-based hospitals, with similar numbers of patients, lengths of stay, and variation in diagnoses in comparison to an urban-based university hospital. The results indicate that there can be adequate numbers of patients and diagnostic variability to permit effective inpatient teaching at community-based hospitals.

Academic Medical Centers↗

PubMed1986

Family practice patients' perception of symptoms.

One hundred family practice patients aged 18 or greater were divided into infrequent and frequent user categories. They were surveyed regarding their perceptions about a list of 20 symptoms on 6 perceptual scales. Perception of symptoms was not related to frequency of attendance, sex of patient, education, or marital status. Age of the patient was the major factor influencing perception of symptoms. Probably due to the heterogeneity of the study population, several previously described factors which were thought to influence perception of symptoms and frequency of attendance were not replicated in this study.

Activities of Daily Living↗

PubMedDate not supplied

Physicians who are certified in family practice and psychiatry: who are they and how do they use their combined skills?

BACKGROUND: The American Board of Family Practice (ABFP) and the American Board of Psychiatry and Neurology (ABPN) have jointly established their guidelines for a combined residency training program in family practice-psychiatry. As the new combined programs develop, it is of interest to learn about those physicians who are already board certified in both family practice and psychiatry. METHODS: The ABFP provided a list of the 39 physicians in the United States who in 1995 held certification by both the ABFP and the ABPN. A questionnaire eliciting demographic data, information on practice patterns, and comments was mailed to each of them. RESULTS: Ninety percent of the physicians responded. Sixty percent reported that they practice both family medicine and psychiatry, 20 percent practice in communities with a population of 30,000 or less, and the great majority were very satisfied with their choice of specialties. CONCLUSION: The responding family physician-psychiatrists chose their specialties one at a time, in sequence. Although their practice patterns are interesting, we believe residents who select a combined residency will have different practice patterns, choosing to practice both specialties from the outset. After graduates of these newly emerging combined residencies have entered practice, it will be useful to study how they make use of their combined skills.

Certification↗

PubMed1997

Improving information management in family practice: testing an adult learning model.

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 eight provided full data, whereas only one of the eleven practices in the written information group, and only one of the eleven practices in the control group provided full data. 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↗

PubMed1981

The telephone survey in family practice.

Patient surveys can be useful methods of obtaining information for the purposes of improving health services, practice management, or research in family medicine. The telephone interview is an effective and economical method of undertaking such a survey. The advantages and disadvantages of the telephone survey method are briefly illustrated by a study conducted in the Family Practice Center at the University of North Carolina concerning patient perspectives on their after-hours medical encounters with physicians.

Cost-Benefit Analysis↗

PubMed1992

Lessons in caring: how social work integrates psychosocial values into family practice residency training in Israel.

This paper presents a model of social work consultation to family practice physicians in two locations in Israel, a kibbutz and an urban family practice medical center. When residents learned to identify and understand how psychosocial factors interact to enhance or impair the physician-patient encounter, they experienced improved quality in their relationships and practice. Physicians learned how the identification of needs can enhance their comfort and effectiveness with patients and how an appropriately made referral to a mental health professional is seen as an act of caring.

Adult↗

PubMed1993

Clinical evaluation of ankle inversion injuries in family practice offices.

BACKGROUND: The use of radiography in evaluating inversion ankle injuries remains high despite several studies suggesting that x-ray examination should be limited to patients meeting certain clinical criteria. These studies were all done in emergency departments. The present study examined detection of ankle fractures by clinical evaluation alone in private family practice offices. METHODS: Twelve physicians in three family practice offices participated. Check-off forms were developed to record clinical data. The physicians all attended a session to standardize terminology. The physicians then evaluated 94 consecutive patients with inversion ankle injuries. RESULTS: Eight fractures were detected by radiography, five of which had not been suspected on clinical examination (5.9% false-negative rate). Only one fracture required treatment different from that for a sprain. Tenderness on the dorsum of the foot, impaired weight-bearing ability, recentness of injury (less than 12 hours earlier), and presence of additional injuries were significantly associated with a fracture. Unlike several previous studies, swelling was not associated with fractures. If radiography had been limited to patients presenting with inability to bear weight fully or tenderness on the dorsum of the foot, none of the fractures would have been missed, and the use of radiography would have been reduced from 90% to 61%. CONCLUSIONS: The fracture rate in these family practice offices is lower than that reported in most emergency department studies. It is important that family physicians order radiographs judiciously rather than routinely for patients with inversion ankle injuries. The clinical criteria reported here are likely to reduce unnecessary ordering of radiographs and are compatible with recently published, prospectively validated rules for acute ankle injury in an emergency department setting.

Adult↗

PubMed2001

Family practice triumphs by the year 2020: what will we have done right?

For family practice in the United States to be considered a success in the year 2020, several things will need to be done right between now and then. These include (1) an emphasis on quality of care, (2) a dependence on new technologies to enhance quality, (3) availability of and access to primary care for the entire US population, (4) increased political power for the specialty of family practice, (5) enhanced research and research funding, and (6) learning to work with patients so that they are the masters of their own care. If successful in 2020, family physicians will be perceived as quality physicians who use technology that everyone wants and who use their political power to advocate for patients' rights to quality health care and the research important to the discipline and quality health care. Family physicians will have become the "go-to doctors" who put patients in charge.

Family Practice↗

PubMed1985

Rheumatology training at internal medicine and family practice residency programs.

The Medical Research Education Subcommittee of the American Rheumatism Association surveyed a random selection of large and small programs in internal medicine and family practice residency programs in order to evaluate their rheumatology training. Formal rheumatology training is offered in 90% of these residency programs, but many available positions are not being filled. A full-time staff rheumatologist was present at 69% of large internal medicine programs, 32% of small internal medicine programs, and 11% of family practice programs. The methods of rheumatology training are similar in most programs, although small internal medicine programs and family practice programs more often utilize physicians' offices or outside medical centers for the rheumatology elective training. A majority of the directors of these residency programs thought that many basic skills and techniques were not taught adequately and that the training of their rheumatology residents was not equal to that of residents in cardiology or gastroenterology.

Evaluation Studies as Topic↗

PubMed2002

The state of community medicine training in family practice residency programs.

OBJECTIVES: This paper describes the state and nature of community medicine training in family practice residency programs. METHODS: A random sample of 224 family practice residency programs was surveyed about the perceived value of community medicine in their residency, the teaching modalities they use, the extent to which their training provides competency in four defined dimensions of community medicine, and which program characteristics and curricula were predictive of higher perceived competency. RESULTS: The participation rate of our survey was 72%. Respondents ranked professional interest, institutional support, and departmental support highly. Less than half the programs provide instruction in community-oriented primary care (COPC), and less than half rate their department's involvement in the community highly. Most programs report that their training provides at least a moderate level of competency in four defined dimensions of community medicine. Curricular methods that are predictive of perceived competency include health department clinical experiences, home visits, cultural sensitivity training, participation in a longitudinal project, meetings with community leaders, and instruction in COPC. CONCLUSIONS: Community medicine is valued in residency curricula, but there is limited uniformity in curricular content and methods. Active and structured education modalities might be more likely to result in competency in community medicine.

Community Medicine↗

PubMed1983

Emergency department chart auditing in a family practice residency program.

A prospective audit of process on 1,200 consecutive patients seen in the emergency department by family practice residents was performed at the Family Practice Residency Program in Gainesville, Florida. The overall quality of care delivered conformed to the standards of "good medical care" as judged by the author in 85.6 percent of cases. Resident errors were detected in the remaining 14.4 percent of cases, and occurred most frequently among physicians in the earlier years of training (P less than .005). Ultimate patient management was changed by the audit in only 1 percent of cases but potentially had an important impact on the care of these patients. Errors of inadequate documentation were common among residents irrespective of their level of training. An ongoing audit of emergency department charts with regular feedback on medical process and recording appears to be useful both as an educational tool and as a method of improving emergency care.

Emergency Medicine↗

PubMed1982

The diagnostic content of family practice: 50 most common diagnoses recorded in the WAMI community practices.

Because there are several methodological deficiencies in previously published studies, a prospective study was carried out of the 50 most common diagnoses of community-based family practices in the Pacific Northwest. Age and sex of patients and reliability of data were controlled. The data reported show reasonable concordance with other published accounts for 10 most common diagnostic categories. For less frequent diagnoses, however, high variability in rank order is the rule, both within this study and by comparison with other studies. This suggests that the diagnostic content of family practice is far from universal and that diagnostic idiosyncrasies of physicians, regional differences in rates of disease, practice style, and as yet other unexplained factors may significantly influence the diagnostic content of family practice.

Adolescent↗

PubMed1979

The effect of relocation of a family practice center on one resident's experience in continuity of care.

In July 1977, the Hollywood Family Practice Unit of the University of Miami Department of Family Medicine was relocated eight miles from its former structure. Analysis of patient encounter data gathered by one resident during the 2 six-month periods prior to and following the move showed little effect of the relocation on five indexes of continuity of care. According to four indexes (percentage of revisits, percentage of revisits for new problems, percentage of revisits for previously recorded problems, and percentage of families with more than one member attending), the author experienced a gradual and uninterrupted increase in continuity of patient care. A fith index, percentage of psychosocial diagnoses, dropped slightly during the third study period. Overall continuity was low, however, when compared with established practices. Although family practice residencies should accept disruption in continuity of patient care due to their structure and purposes, steps are noted which can be taken to improve continuity of care.

Community Health Centers↗