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At least 739 records · Page 41Linked to original sources
PubMed1996

Health problems in family practice. An Icelandic multicentre study.

OBJECTIVE: To establish epidemiological data on the health problems within family practice in Iceland by multicentre analysis of well-defined geographic areas. DESIGN: Prospective practice audit. SUBJECTS AND SETTINGS: Thirteen Icelandic health centres (HC) with computerized contact data from 1 January - 31 December 1988. MAIN OUTCOME MEASURES: Health problems during one year in a population, as perceived by health care providers. RESULTS: A total of 176 384 health problems during one year in a population of 31 248, as perceived by the health care provider, were analysed. Musculoskeletal disorders accounted for 9.3% of all health problems (prevalence 210.6/1000 inhabitants), respiratory disorders 9.4% (189.9/1000), accidents 7.4% (203.2/1000), cardiovascular disorders 7.4% (112.0/1000) and mental disorders 6.1% (87.6/1000). The commonest single health problems were: hypertension, upper respiratory tract infections and non-articular rheumatism. The health problems accounting for the most frequent contacts were: mental disorders (4.0 contacts per individual per year), cardiovascular (3.7), and endocrine, nutrition and metabolic (3.2). CONCLUSION: Problem-oriented medical records from HCs, computerized in a uniform standardized way, can give extensive information about the content and burden of health problems in family practice and presumably public health. Our results are valuable because the population (the denominator) and the geographic study area are well defined. This information is an important part of clinical epidemiology and can be of great value for educators and health care planners.

Adolescent↗
PubMed1984

A third-year family medicine clerkship based in an academic family practice center.

In this paper, the authors describe the planning, curriculum, and evaluation of a five-week family medicine clinical clerkship for third-year students based in an academic family practice center. The program is an outpatient experience utilizing several innovative techniques: (a) problem-based learning that focuses on patient management tutorials, (b) consultation sessions with individuals offering specialized expertise, (c) supervised patient care in a family practice center and with a nursing home inpatient teaching service, and (d) workshops on various topics, such as office-surgical techniques, practice management, and alternative methods of health care. Evaluation of the course has demonstrated the merits of careful planning with student input, the need for flexibility, and the value of focusing on concepts in ambulatory care.

Academic Medical Centers↗
PubMedDate not supplied

Low high-density lipoprotein cholesterol and other coronary heart disease risk factors in patients with total cholesterol levels greater than 5.17 mmol/L (200 mg/dL) in family practice. A report from CEN.

BACKGROUND: A multisite, open-label, prospective study in 327 family practices across the United States analyzed the demography of a large population of dyslipidemic patients and examined the effects of diet and exercise, as well as of gemfibrozil therapy, on serum levels of total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides. METHODS: The 3328 patients enrolled comprised a heterogenous population who had wide age range (20 to 88 years), were of both sexes and various ethnic backgrounds, and had multiple cardiac risk factors. All had a history of serum cholesterol levels of 5.17 mmol/L (200 mg/dL) or more, and some may have been previously identified as having an HDL of 1.03 mmol/L (40 mg/dL). After determining their cardiac risk factor and lipid profiles, eligible patients were assigned to a protocol of diet and exercise, followed by concomitant gemfibrozil therapy, if warranted. Treatment efficacy data will be reported in a subsequent paper. RESULTS: The study population was 60 percent men. Ninety-four percent of the patients were white, 4.1 percent were black, and 1.9 percent were of other races. Women patients tended to be more overweight, and elderly women had more hypertension; they were less likely to have angina pectoris or to have had previous myocardial infarctions, angioplasty, or bypass surgery. The prevalence of low HDL cholesterol (less than 1.03 mmol/L [40 mg/dL]) was substantially higher in men. Statistically significant differences between men and women were observed for mean values of total cholesterol, 6.47 versus 6.84 mmol/L (250.3 versus 264.4 mg/dL); HDL cholesterol, 0.94 versus 1.18 mmol/L (36.3 versus 45.5 mg/dL); LDL cholesterol, 4.62 versus 4.76 mmol/L (178.7 versus 184.2 mg/dL); non-HDL cholesterol, 5.54 versus 5.66 mmol/L (214.1 versus 218.9 mg/dL); and the total cholesterol-HDL ratio, 6.84 versus 5.64. CONCLUSIONS: Current National Cholesterol Education Program (NCEP) guidelines suggest lipoprotein analysis at cholesterol levels between 5.17 and 6.21 mmol/L (200 and 240 mg/dL) only if two or more risk factors are also present. Persons whose total cholesterol values are less than 6.21 mmol/L (240 mg/dL) can still be at risk because of the presence of other cardiovascular risk factors or a low level of HDL cholesterol. In this study, 74.3 percent of men and 41.3 percent of women with total cholesterol greater than or equal to 5.17 mmol/L (200 mg/dL) were also found to have a low HDL level, less than 1.03 mmol/L (40 mg/dL). The prevalence of other risk factors in this patient population was also high: 40.5 percent had hypertension, 9.6 percent had diabetes, and 20.3 percent smoked. These data suggest that routine lipoprotein analysis in the family practice setting could reveal low HDL cholesterol as an additional risk factor in a patient population where other risk factors have already been identified.

Adult↗
PubMed1980

Results of a needs assessment strategy in developing a family practice program in an inner-city community.

The planners of an inner-city clinic and family practice residency program conducted a four-step needs assessment study to identify the importance, availability, and feasibility of local family practice services and objectives. Using mailout-mailback and supervised questionnaire data collection techniques, they contacted 1,020 consumers and providers. Those objectives rated most important and feasible and least available were given top priority for implementation, while the objectives rated important and unavailable but not currently feasible received research priorities.

California↗
PubMed1988

Comparison of two Papanicolaou smear techniques in a family practice setting.

Papanicolaou smear adequacy is directly dependent upon endocervical cell recovery. Ineffective physician sampling techniques and advancing patient age are responsible for most inadequate smears. Two thousand four hundred seventy-eight routine Papanicolaou smears were reviewed from the Department of Family Practice and the Department of Gynecology for the presence of these cells. A retrospective review showed approximately 25 percent cell recovery in women aged over 45 years from both departments. Recovery on the family practice service, however, was 19.4 percent greater than recovery on the gynecology service for younger women (57 percent vs 37.6 percent). Two prospective interventions were introduced in family practice in an attempt to improve these rates. A combined spatula-saline swab technique did not improve cell recovery in either age group. A combined spatula-Cytobrush cell collector technique, however, dramatically improved endocervical cell recovery by 200 percent in older women and by 57 percent in younger women. This method significantly improves endocervical cell recovery and may therefore improve the value of the Papanicolaou smear as a cancer screening test.

Adolescent↗
PubMed1992

Maternity leave for practicing family physicians.

BACKGROUND: Approximately 37% of all medical students and 36% of family medicine residents in training in the United States are women. The American Academy of Family Physicians (AAFP) has developed a recommended parental leave policy for residents in training but has not established a similar policy for physicians in practice. The purpose of this study was to assess the prevalence of maternity leave policies for practicing family physicians. METHODS: A 14-item self-administered survey questionnaire was designed and mailed to 940 AAFP members randomly selected from the total active female membership. RESULTS: A 52% response rate was obtained. The mean age of respondents was 35 years. Only one third of the physicians not in solo practice reported having a stated maternity leave policy in their current place of practice. Academic programs, when compared with single specialty family practice groups, multispecialty groups and health maintenance organization (HMO) or preferred provider organization (PPO) groups, were more likely to have maternity leave policies and to provide salary on leave. Practice groups with eight or more partners were more likely to have policies that provided salary and benefits while on leave. Ninety percent of respondents requested maternity leave guidelines for practicing family physicians. CONCLUSIONS: Women family physicians expressed strong interest in the development of maternity leave guidelines for their specialty. Guideline components are outlined.

Adult↗
PubMed1990

Effect of a clinical pharmacist program on the cost of hypertension treatment in an HMO family practice clinic.

This study evaluated the impact of a clinical pharmacy service on the cost of antihypertensive drug therapy in an HMO family practice clinic. The service was provided to five family practice physicians. Pharmacists identified hypertensive patients prior to their regularly scheduled office visits from April through June 1986. Patient's medical records and computerized drug files were reviewed, and written recommendations for drug therapy changes were placed in patients' medical record by the pharmacists. When appropriate, pharmacists alerted prescribers to lower cost alternatives. A matched control group of physicians was selected. Hypertensive patients were identified retrospectively in the control group. We found that the cost of antihypertensive drug therapy was significantly higher for study physicians' patients when compared with control physicians' patients in the period prior to implementing the service. The difference between the two groups was not significant after six months. Clinical pharmacist intervention decreased the average cost of antihypertensive treatment from 33.4 to 27.2 cents per day.

Adult↗
PubMed1980

Family practice in Massachusetts: a comparison of residency trained family physicians with the general practitioner experience of 1967-1968.

An analysis of data collected from a one-year survey of the activities of seven residency trained family physicians practicing in Massachusetts was carried out. These data were compared to a study of activities of Massachusetts general practitioners done in 1967-1968, and to the Virginia Study of 1976. Both hospital and health center encounters were analyzed. The age distribution of the practices paralleled that of the general practitioners, particularly the younger general practitioners. The sex distribution was also comparable. However, over one third of all health problems recorded during the study were for preventive or non-illness visits. This represented a significant percentage increase over the general practitioners as well as the family physicians in the Virginia Study. The site of activity was also different in showing a ten percent increase in office visits over 1967-1968. Women's health issues, which include maternity and family planning care, represented a larger percentage of the practices of the residency graduates than was the case in the Virginia Study. Educational and health manpower implications of the study are discussed.

Adolescent↗
PubMed1996

Prevalence of abnormal Pap smears in rural family practice.

The purpose of this study was to examine the prevalence of abnormal Pap smears in rural family practice, to compare this to the published literature, and to determine if the prevalence of abnormalities is higher in the younger age group (<=35 years of age). A retrospective chart audit was performed on all Pap smears from four rural family practice sites during a 12-month period. Data collected were Pap smear result, patient's age, and interval since previous Pap smear. Statistical analysis was used to determine if the prevalence of abnormal Pap smears was consistent among the practices as well as similar to the three larger published studies. Also, chi-square analysis was used to compare the prevalence of abnormal Pap smears in the younger (<=35 years of age) versus the older (>35 years of age) age groups. There were 2,891 Pap smears reviewed, with 782 (27%) recorded as abnormal. The prevalence of cervical intraepithelial neoplasia (CIN) (76 or 2.6%) was compared to the published literature and was found to be statistically significantly higher (chi square=772.194, P=0.000). The prevalence of abnormal Pap smears was higher in the younger than age 35 group when compared to the older than age 35 age group (chi square=20.953, P=0.000). Pap smear interval and age varied between the four practice sites, but the prevalence of CIN was not statistically different (chi square=3.154, P=0.368). The results of this study suggest that rural family physicians may encounter abnormal Pap smears at rates similar to those reported in the literature. This study also suggests that the prevalence of abnormal Pap smears may be higher in the younger groups in this population.

Adult↗
PubMed2003

Application of the high risk model of threat perception to medical illness and service utilization in a family practice.

This study was designed to test the High Risk Model of Threat Perception in a family practice population. Predisposing, triggering, and buffering factors were assessed in 165 patients using psychological inventories. The relationship between these factors and self-reported symptoms, diagnosed chronic problems, and utilization was assessed. Negative affect and number and intensity of life events increased the risk for chronic illness and reported symptoms, while social support and approach style of coping decreased the apparent risk. The numbers of encounters and telephone calls to the office, obtained from the office database, were statistically correlated with negative affect and inversely with social support. The regression analysis predicted 27% of the variance in reported symptoms with negative affect, life events, and avoidance coping as significant predictors. Only 8% and 16% of the variance of telephone calls and office visits, respectively, could be predicted with a similar regression model. These results emphasize the importance of psychosocial factors in medical illness. Routine assessment of psychosocial risk factors in family practice patients is suggested.

Adaptation, Psychological↗
PubMedDate not supplied

Medical abortion in family practice: a case series.

BACKGROUND: We wanted to determine the outcomes of medical abortions in four family practice centers. METHODS: This study was a retrospective case series of consecutive medical abortions in four community health centers between November 2000 and April 2002. We defined a successful medical abortion as one that required no further intervention after the administration of the medications mifepristone and misoprostol. The subset of abortions in patients who had suction procedures were called failures. RESULTS: In this series of 236 abortions, only 1 woman had a viable pregnancy after taking the medication as directed, and she had an elective suction procedure to terminate the pregnancy. None of the patients under the complete care of family physicians received suction procedures for other indications. Two patients underwent suction procedures at other institutions for unknown indications. Eight were lost to follow-up. One did not adhere to the protocol and so was excluded from the data analysis. The failure rate of the protocol for patients cared for by the family physicians at follow-up was 0.4%. CONCLUSIONS: Medical abortion in a family practice setting is a safe and effective procedure. If practiced widely, it could make abortion care much more accessible to women.

Abortifacient Agents, Steroidal↗
PubMedDate not supplied

Psychological distress as a predictor of frequent attendance in family practice: a cohort study.

In cross-sectional studies, psychological distress has been associated with frequent health care utilization. However, there is a need for prospective studies to confirm these findings. This cohort study evaluated whether psychological distress predicted frequent attendance in family practice. In 1990, 185 consecutive adults who consulted their primary care physician (PCP) about an illness were rated on two psychometric scales (Hopkins Symptom Check List [SCL-8] and Whiteley-7), and their annual number of face-to-face contacts with a family practice was followed until 1996. Frequent attenders (FAs) were defined as the top 10%. A logistic regression analysis showed a significantly increased risk of becoming an FA with an increase of 1 point (odds ratio [OR] 1.17 [1.03-1.33]) on SCL and 1.28 (1.06-1.53) on Whiteley). An association was found between score and number of years as an FA (OR 1.16 [0.99-1.36] for SCL and OR 1.31 [1.05-1.65] for Whiteley). Psychological distress involved an increased risk of future frequent attendance among adult patients consulting family practice in the daytime about an illness.

Adult↗
PubMed1999

Satisfaction with obstetric care. Patient survey in a family practice shared-call group.

OBJECTIVE: To examine patients' satisfaction with their obstetric care in a family medicine shared-call group. DESIGN: A survey was given to a convenience sample of patients who came to see their doctors over a 6-week period. SETTING: Brameast Family Practice in Brampton, Ont, where eight doctors participate in a shared obstetrics call group with 16 other physicians, each taking call 1 day in 23 days. PARTICIPANTS: Mothers in the practice who had delivered in the previous 8 months. MAIN OUTCOME MEASURES: Demographic data, interventions during delivery, and satisfaction ratings. RESULTS: Of the 70% of women who responded, 96% were delivered by a doctor other than their own. Eighty-eight percent of these women were satisfied with their medical care at delivery and 96% were satisfied with their prenatal care. Nearly 79% said they would choose this shared-call group again. CONCLUSIONS: This pilot study demonstrated a high level of patient satisfaction with obstetric care, despite the fact that most patients were delivered by a doctor other than their own. Family practice groups sharing obstetric call offer a feasible alternative for physicians who wish to avoid the interference with lifestyle and office appointments that practising obstetrics usually entails.

Adult↗
PubMedDate not supplied

Vaginal birth after cesarean: a 5-year experience in a family practice residency program.

BACKGROUND: The national health objective for the year 2000 is to have an overall Cesarean section rate of 15 percent, a primary Cesarean section rate of 12 percent, and a vaginal birth after Cesarean (VBAC) rate of 35 percent. The current national statistics for the most recent year available, 1991, are 23.5 percent, 17 percent, and 24.2 percent, respectively. This study evaluates a VBAC program at a community-hospital-based family practice residency program. METHODS: This study was a retrospective chart review of 996 family practice service deliveries from 1988 to 1992. RESULTS: Of the 98 patients who had a previous Cesarean section, 87 patients (89 percent) were eligible for a trial of labor. Fifty-six patients (64 percent) accepted a trial of labor and 31 patients (36 percent) refused. The overall Cesarean section rate was 15 percent, the primary Cesarean section rate was 11 percent, the VBAC rate was 44 percent, and the successful VBAC rate was 77 percent. CONCLUSION: We report a successful VBAC program at a community-hospital-based family practice residency program.

Adolescent↗
PubMed2003

Family practice graduate preparedness in the six ACGME competency areas: prequel.

BACKGROUND AND OBJECTIVES: Since July 2002, family practice residency program accreditation requires evidence of teaching and assessing residents in six competency areas. This study was conducted to obtain baseline information about family practice graduates' perceptions of the importance of specific competencies and the extent to which residency training prepared them to perform skills representative of the six competency areas. METHODS: A national, cross-sectional survey was conducted of family physicians who had graduated from residency programs from 1998 to 2000. RESULTS: The response rate was 54% (n=1,228). Graduates reported the most preparation in patient care skills, followed by interpersonal and communication skills and then professionalism. The least preparation was reported for skills pertinent to practice-based learning and improvement, systems-based practice, and some areas of professionalism. CONCLUSIONS: Areas of residency education that appear to warrant improvement include education about system aspects of care, practice-based learning and improvement, and selected professionalism issues.

Accreditation↗
PubMed1979

Health action alliance: a consumer approach to improving ambulatory care in a family practice residency clinic.

"The Health Action Alliance for Family Practice Clinic--St. Marys" is a group of physicians, patients, and clinic personnel who meet regularly for the purpose of providing a forum for interaction between health care personnel and patients. The group deals with patient training for effective participation in general clinic activities, participation in decision making processes of the clinic, health education, and other topics as the group decides. This paper discusses the formation of the group, its purposes, accomplishments, and plans for the future.

Ambulatory Care↗
PubMed1981

Clinical pharmacy in the family practice residency programs.

A descriptive study of all family practice residencies in the United States was conducted to determine the level of teaching by clinical pharmacists. Ninety percent of the programs were covered, and 29 percent of them had teaching involvement by pharmacists. Two thirds of all pharmacists held an academic appointment. One half of the pharmacists had a Doctor of Pharmacy degree. Three fourths were under 36 years of age and the salary ranged from +15,000 to over +27,000. Duties of the pharmacists were extremely varied. In general, residency directors reported that adding clinical pharmacy to the teaching program was a positive asset.

Academic Medical Centers↗