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PubMed1989

Hemoglobinopathies in a general and family practice setting.

The incidence of sickle cell trait varies among blacks in North America. Although the average hemoglobin (Hb)-AS gene frequency is 8% in the United States, a value of 13.4% was recorded in South Carolina. Preliminary studies during a two-day community sponsored health fair in Selma, Alabama, revealed a sickle cell gene frequency of 15.96%. This study also found an intermediate frequency of 12.4% in a family practice center that is accredited for a residency program. Through a screening program, sickle cell trait was detected, a rigorous training program for resident physicians in family practice was implemented, and proper counseling to patients with hemoglobinopathies was provided. In the authors' judgment, laboratory screening for sickle cell trait is a first step toward genetic counseling and medical practice by family physicians and general practitioners.

Alabama↗

PubMed1979

Applicability of crisis intervention in family practice.

Crisis intervention is a specialized approach useful to family physicians who frequently are called upon to deal with patients in psychosocial crisis. The use of a systematic method of evaluation and treatment will aid physicians in helping patients with their problems in a fashion that is constructive for both patient and physician. A crisis may occur as a result of a change in an important social role or relationship. Appropriate intervention which is immediately available can result in a marked reduction in physical and emotional symptoms that are stress related. This paper reviews the need for crisis intervention, its historical development, theory and technique, and several examples of crises familiar to all family physicians. A case illustration is presented as a demonstration of crisis intervention in family practice.

Adult↗

PubMed1980

Comparison of diagnostic methods of family practice and internal medicine residents.

The diagnostic methods of third year residents in internal medicine (N=23) and family practice (N=22) were compared with respect to common ambulatory patient problems. Five written simulated patients were presented and the dependent variables were: initial and revised diagnostic hypotheses, physical examination items, and laboratory charges. The two groups considered the same number and type of diagnostic hypotheses. There were large differences in the selection of physical examination items (P less than .001), with the family practice group selecting fewer items. Laboratory charges were significantly greater for the internal medicine group with two patients (P less than .05), and the charges were nearly identical with two patients. A high degree of patient-specific behavior was demonstrated by both groups. These findings have implications for the future training of primary care physicians.

Adult↗

PubMed1980

The disgruntled patient: how family practice residency programs handle requests for a physician change.

The purpose of this study was to investigate the alternatives available in family practice residency programs for handling patients who expressed dissatisfaction with their physician. Letters were sent to 150 family practice residency programs asking how they handled this problem. Of those who replied, it was determined that this problem is generally handled in one of three ways: (1) patient automatically transferred to another physician, (2) patient referred to original physician for discussion, or (3) patient referred to a designated authority. The rationale and implications of each method are discussed.

Consumer Behavior↗

PubMed1995

Use of decision analysis in a family practice residency for a patient with an abdominal aortic aneurysm.

BACKGROUND: A patient at the Tatem-Brown Family Practice Center with many medical problems asked for advice about elective surgical resection of a large abdominal aortic aneurysm. METHODS: The best course of action was not obvious, so a decision tree was constructed using data from the medical literature and the patient's rating of several quality of life issues. RESULTS: Elective surgery was the optimal choice for this patient, but the decision was sensitive to values chosen for two variables in the decision model. CONCLUSION: Decision analysis has benefits in a family practice residency. Residents become familiar with vigorous literature review and decision-analytic tools and principles. They gain a deeper knowledge of the patient, due to the need to understand the patient's relative values for potential outcomes of medical intervention.

Aged↗

PubMed1981

Educating the family practice resident in the use of community resources.

Training in the knowledge and use of community resources is a requirement for family practice residency programs. This article describes the community resources sequence of the behavioral science curriculum developed for a family practice residency program affiliated with a 450-bed community hospital on the far northwest side of the city of Chicago. During the first 2 years of the program, residents have been exposed to a variety of community services, including a visit to a model transitional living facility operated by a local community mental health center and a demonstration session by a self-help group for the terminally ill. Residents have been enthusiastic in their participation, and basic program objectives have been met.

Behavioral Sciences↗

PubMed2001

Addressing multiple problems in the family practice office visit.

OBJECTIVES: The purpose of the study was to describe the number of problems addressed during family practice outpatient visits, the nature of additional problems raised, how they affect the duration of the visit, and how well they are reflected in the billing record. STUDY DESIGN: Cross-sectional. POPULATION: We studied a total 266 randomly selected adult patient encounters representing 37 physicians. OUTCOMES MEASURED: A problem was defined as an issue requiring physician action in the form of a decision, diagnosis, treatment, or monitoring. Visit duration and the number of billing diagnoses were also assessed. RESULTS: On average, 2.7 problems and 8 physician actions were observed during an encounter. More than one problem was addressed during 73% of the encounters; 36% of these additional problems were raised by the physician and 58% by the patient. On average, each additional problem increased the length of the visit by 2.5 minutes (P<.001). The concordance between the number of problems observed and the number of problems on the billing sheet indicated a trend toward underbilling the number of problems addressed. CONCLUSIONS: Multiple problems are commonly addressed during family practice outpatient visits and are raised by both the physicians and the patients. Our findings suggest that current views of physician productivity and the billing record are poor indicators of the reality of providing primary care.

Adult↗

PubMed1984

Analysis of a rural family-practice-based evening clinic staffed by a PA.

A family practice in rural Breckenridge, Colorado began an evening clinic during the winter months of 1981-82 to serve the extra 1,000 to 2,000 residents that that community accommodated each year during the ski season. The clinic was staffed by a PA, who was aided by an office assistant, on weekdays from 5 P.M. to 10 P.M.; after 10 P.M., the PA took calls at home until the office again opened at 9 A.M. The pilot program was successful enough to warrant continuation. This article analyzes the Breckenridge Medical Center's experience during that first year with a PA-staffed evening clinic, in terms of morbidity profile of the after-hours cases, the amount of physician involvement required, the economic aspects of maintaining evening hours, and the ratio of day to evening patients that can be expected. The authors conclude that their extended office hours have proven to be an effective, affordable solution to their practice's after-hours medical care problem.

Ambulatory Care Facilities↗

PubMed1980

Measuring continuity of care in a family practice residency program.

While the significance of continuity of care in medical practice has not yet been completely assessed, this concept has been espoused by the new specialty of family practice along with some other specialties. It is an integral component in family practice residency programs. The purpose of this paper is to identify several methods of measuring continuity of care in a residency setting and to demonstrate their application. Measurements called COC (Continuity of Care) and UPC (Usual Provider Continuity) will be described as they apply to overall patient visits, visits for chronic conditions, and visits by family members.

Continuity of Patient Care↗

PubMed1984

Inpatient diagnosis clusters: analyzing hospital care in family practice.

Hospital care is an important component of family practice in the United States, but the study of this area has been impeded by the lack of a simple and clinically meaningful method of categorizing the diagnostic problems that make up the inpatient workload. This paper extends the method of diagnosis clusters--first used in the analysis of ambulatory care--to the hospital setting. Using the University of Southern California Medical Activities and Manpower Study of office-based general and family physicians, 52 clinically discrete diagnosis clusters were developed that include 78 percent of all principal diagnoses recorded in the hospital during the study interval. Fifty percent of all hospital encounters can be incorporated in only 15 clusters. Data clustered using this technique demonstrate that clinical problems such as ischemic heart disease and malignant neoplasms represent a major part of the family physician's hospital workload, a fact that has important implications for training and practice. Diagnosis clustering should facilitate further study of the hospital activities of primary care physicians.

California↗

PubMed2002

Premenstrual syndrome. Evidence-based treatment in family practice.

OBJECTIVE: To evaluate the strength of evidence for treatments for premenstrual syndrome (PMS) and to derive a set of practical guidelines for managing PMS in family practice. QUALITY OF EVIDENCE: An advanced MEDLINE search was conducted from January 1990 to December 2001. The Cochrane Library and personal contacts were also used. Quality of evidence in studies ranged from level I to level III, depending on the intervention. MAIN MESSAGE: Good scientific evidence shows that calcium carbonate (1200 mg/d) and selective serotonin reuptake inhibitors are effective treatments for PMS. The most commonly used therapies (including vitamin B6, evening primrose oil, and oral contraceptives) are based on inconclusive evidence. Other treatments for which there is inconclusive evidence include aerobic exercise, stress reduction, cognitive therapy, spironolactone, magnesium, nonsteroidal anti-inflammatory drugs, various hormonal regimens, and a complex carbohydrate-rich diet. Although evidence for them is inconclusive, it is reasonable to recommend healthy lifestyle changes given their overall health benefits. Progesterone and bromocriptine, which are still widely used, are ineffective. CONCLUSION: Calcium carbonate should be recommended as first-line therapy for women with mild-to-moderate PMS. Selective serotonin reuptake inhibitors can be considered as first-line therapy for women with severe affective symptoms and for women with milder symptoms who have failed to respond to other therapies. Other therapies may be tried if these measures fail to provide adequate relief.

Adult↗

PubMed2000

Conference formats in family practice residencies.

BACKGROUND: This study was intended to establish national baseline data of the current structure of conferences at family practice residencies and to determine if there are differences in conference formats among types of residencies. METHODS: An author-developed survey was mailed to 331 programs stratified by type and randomly selected. Statistical analysis included chi-square tests and non-parametric tests. RESULTS: The response rate was 84%. The average time devoted to lectures was 4.5 hours a week, with the noon hour the most common time. Most speakers were from within the program, and community-based family physicians were rarely present. Structural changes were frequent. CONCLUSIONS: Results indicate that a variety of formats are implemented for meeting Residency Review Committee requirements in the structure of family practice residencies' conferences. Program settings do influence how conferences are structured. More research is needed on this neglected area of formal resident education.

Chi-Square Distribution↗

PubMed2000

Family practice research networks. Experiences from 3 countries.

Access to data about the clinical problems, patients, and processes that characterise family practice is essential for the development of this specialty. Practice-based research networks (PBRNs) play an increasing role in obtaining these data. We compared 3 PBRNs: one in Wisconsin in the United States, one in Wessex in the United Kingdom, and one in Nijmegen in the Netherlands. We organized our data into 4 key areas for review: the mission of the network, its contribution to the evidence base of family medicine, the management of the network, and the financing of the network infrastructure. Extending the evidence base of family practice is the overriding objective of these networks, and their main focus is on common morbidities. They provide access to unselected patient populations, but there are differences in their size. There are aspects of PBRNs that are common in countries with different health care systems, despite the fact that local circumstances--the research mission or the characteristics of the health care system under which they operate--determine their form and structure. Networks develop over time and their focus and activities may evolve. Financial support for these networks continues to be a problem.

Family Practice↗

PubMedDate not supplied

Knowledge and attitudes of family practice residents toward geriatric patients.

The knowledge and attitudes of family practice residents toward geriatric patients was surveyed in eight residencies. Since geriatric care will, in the future, become a more important aspect of the family physician's practice, it is important to ascertain the knowledge and attitude level of physicians in training concerning their geriatric patients. Three aspects of this study indicate serious deficits in the educational background of these residents: the number and quality of courses offered to them is inadequate; they demonstrate a paucity of knowledge concerning the aged; the residents show a low preference for working with the aged. Clearly, medical education should address these needs and deficits.

Aged↗

PubMed1994

Screening women in family practice settings: association between depression and smoking cigarettes.

OBJECTIVE: The purpose of this survey study was to test female family practice outpatients for an association between depression and cigarette smoking. METHODS: The survey consisted of demographic items including questions on smoking, and an eight-item self-report depression screening instrument. Eighty percent of the women (ages 18-91) approached agreed to participate in this study (N = 695). RESULTS: Thirty-two percent scored positive for depression and 28% smoked cigarettes. Cigarette smokers had significantly higher depression scores than did nonsmokers, and heavier smokers (> 10/day) had higher scores than did smokers of 10 or fewer cigarettes/day. CONCLUSION: There appears to be an association between smoking and depression among female family practice patients. This warrants both patient care and research attention.

Adolescent↗

PubMed1989

Building an ambulatory clinical information system in a family practice residency.

A programmable database may be implemented on a personal computer to manage the educational and clinical information needs of a family practice residency. Such a system can usefully and efficiently be based on the existing clinical encounter form. Data entry for a practice of 7500 patients with 20,000 visits per year requires little computer expertise and only 1 hour per day of clerical data entry time. The cost of such a system can be reduced to as low as $2500. A flexible, programmable database, rather than a commercial practice management system, is recommended as more efficient in accommodating continued development of strategies to meet the educational and clinical data needs in the family practice residency setting.

Ambulatory Care Information Systems↗

PubMed2003

Type 2 diabetes in family practice. Room for improvement.

OBJECTIVE: To further knowledge of diabetes management in family practice. DESIGN Retrospective, observational chart audit study. SETTING: Southwestern Ontario. PARTICIPANT: A random sample of non-academic family physicians and a random selection of their patients with type 2 diabetes mellitus. MAIN OUTCOME MEASURES: Glycemic control as measured by HbA1c and adherence to recommendations in clinical practice guidelines (CPGs). RESULTS: Eighty-four percent of patients had at least one HbA1c test ordered in the previous year. Overall mean HbA1c was 0.079 and half-the patients had levels deemed acceptable by 1992 CPGs. Screening for microvascular complications was disappointing; only 28% were tested for microalbuminuria, and 15% were examined for diabetes-related foot conditions. Screening for macrovascular complications was more comprehensive; blood pressure was measured in 88%, and lipid profiles documented in 48%, of patient charts. CONCLUSION: Management of glycemic control and screening for microvascular and macrovascular disease in family practice can be improved.

Adult↗

PubMed1999

A cost construction model to assess the cost of a family practice residency program.

BACKGROUND AND OBJECTIVES: This study uses a cost construction approach to evaluate the cost of training family practice residents in a university-based residency program. The approach calculates the cost of the educational program from a global institutional perspective, including all monetary and nonmonetary costs, independently of how they are financed. METHODS: Cost construction analysis is used to compute the instructional cost, which includes the cost of faculty and resident time directly related to teaching and the support of the teaching program. The value of the clinical care and supervision provided by the family practice residents is assessed as a replacement cost. Sensitivity analysis examines a range of assumptions concerning residents' productivity, replacement costs, and the cost allocation of activities that jointly produce clinical care and education. RESULTS: For a junior resident, the instructional cost is $94,835 per year, and the replacement cost is $65,052 per year. The value of the teaching and clinical services provided by senior residents, $124,247 per year, exceeds the cost of the resources used to educate them, $98,364 per year. CONCLUSIONS: The cost construction model can be used as a tool to allocate resources, negotiate for funding, and estimate variations in cost due to changes in curriculum and in the health care environment.

Costs and Cost Analysis↗