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PubMed2003

Patients' attitudes regarding physical characteristics of family practice physicians.

BACKGROUND: This study examined patient perceptions and attitudes toward various aspects of the male and female physician's professional appearance in the family practice setting. METHODS: Four hundred ninety-six patients from two family practice clinics in Knoxville, Tennessee, completed a valid and reliable questionnaire. Questionnaires were offered to all patients on registering at their respective clinic during a 2-week period. RESULTS: Most patients had no preference regarding the age or sex of their medical care provider. A nametag, white coat, and visible stethoscope were the most desirable characteristics, whereas sandals, clogs, and tennis shoes were the least desirable items. Younger patients were generally more accepting of casual attire than were older patients. Office clinic location was the most important predictor of preferences in six of the significant characteristics. CONCLUSION: Our findings support the results of both studies published two decades earlier and more recently. Patients prefer a traditionally dressed physician as opposed to one who is dressed more casually.

Adult↗

PubMed1977

A family practice rotation on a psychiatric service: the experiences, the opportunity, and the challenge.

There is a considerable range of mutual interests between the disciplines of family practice and psychiatry. Each field has much to offer and receive from collaborative activities in teaching programs, particularly at the level of residency training. This paper describes the goals, content, methods, and initial experience of a one-month family practice rotation on a psychiatric service with a focus on Emergency and Consultation-Liason Psychiatry.

Emergency Service, Hospital↗

PubMed1986

Smoking cessation in family practice: the effects of advice and nicotine chewing gum prescription.

The efficacy of physician anti-smoking intervention with 289 patients in a family practice setting was assessed. The design included two treatment conditions, physician advice and physician advice plus the offer of nicotine chewing gum (NCG) prescription. A no-advice group permitted assessment of the effects of repeated testing. The NCG group had higher rates of abstinence at all follow-up points, but the difference approached statistical significance at 3 months only (p less than .10). Comparison of those who actually used NCG to all other groups revealed significantly more users were abstinent at 1- and 3-month follow-up. A similar pattern occurred for proportion attempting cessation and smoking reduction. A dose-response relationship of gum use to outcome was identified. Long-term users (greater than 20 days) had 86% abstinence at 3 months versus 18% for short-term users. Thus, NCG does appear to have a role in family practice for promoting short-term cessation.

Adolescent↗

PubMed1997

The educational value of an OSCE in a family practice residency.

PURPOSE: To assess the educational value of an objective structured clinical examination (OSCE) administered in three consecutive years (1992-93 to 1994-95) to first-year residents in a family practice residency. METHOD: Each year an OSCE was administered early in a family practice residency based at the University of North Carolina at Chapel Hill School of Medicine. The OSCE encompassed eight to ten stations, each 15 minutes long: ten minutes for tasks and five minutes for feedback. After the OSCE, focus groups with participating faculty and residents assessed the strengths and weakness of specific stations as well as the overall OSCE structure. Each year the residents' OSCE scores were correlated with their scores on the American Board of Family Physicians In-Training Examination (ITE). Pearson product--moment correlation coefficients were calculated for both the composite ITE scores and the clinical set problem scores. Test reliability was measured by Cronbach's alpha. In the spring of 1995 the faculty completed global evaluations of all the residents in the program at the time, including 16 of the 17 residents who had participated in the OSCEs. The faculty rated the residents in four areas, and a four-point scale was based on the percentile ranges a resident's rating could fall into for each area. Correlation coefficients were calculated for the OSCE scores and the faculty's perceptions of the residents' overall performance. RESULTS: The OSCE scores correlated significantly with the faculty's global assessments of knowledge and clinical skills, but not with in-training examination scores. Concurrent validity and reliability estimates did not support using an OSCE for decisions about the residents' competency. The faculty valued the opportunity to observe basic skills for the whole group of residents; the residents found the experience educational but stressful and valued the immediate performance feedback included at each station. CONCLUSION: The OSCE is a useful tool for teaching basic clinical skills and for forming initial impressions of interns' clinical styles and abilities, but it should be used with caution for summative assessments.

Educational Measurement↗

PubMed1980

Patients' satisfaction with an Army family practice setting.

Using the Patient Satisfaction Questionnaire to assess consumer satisfaction, patients were very satisfied with the quality of the health care received. The care received by patients who visited the family practice clinics was rated as significantly more satisfying than the care received at either the non-family practice clinics or at the General Medical clinic.

Consumer Behavior↗

PubMedDate not supplied

Physician-elder interaction in community family practice.

OBJECTIVE: To determine whether outpatient visits by elders seeing community family physicians differ in length or content from visits by younger patients; socioemotional preferences predict visit content; and satisfaction correlates with visit content differentially across age. METHODS: In a multimethod cross-sectional study of 84 community family practices in northeastern Ohio, 3453 adult patient visits with 138 community family physicians were observed; 2362 of these patients completed self-report questionnaires. Three age groups were compared: 18 to 64, 65 to 74, and over 74 years. Length and content of the physician-patient encounter was determined using the Davis Observation Code (DOC); satisfaction was assessed using the MOS 9-item Visit Rating Scale. RESULTS: Controlling for reason for visit and demographics, visit length averaged 10.7 minutes for each group. Visit content differed significantly on 13 of 20 DOC codes between one of the older groups and the younger group; in 4 instances, content varied between the 2 older groups. Although visit content varied as predicted by socioemotional theory, no consistent patterns of association between visit content and satisfaction emerged. DISCUSSION: Older patient visits differ from those of younger patients as might be predicted by socioemotional selectivity theory; however, there was little association of visit content with patient satisfaction.

Adult↗

PubMedDate not supplied

LEEP in the family practice setting.

BACKGROUND: We wanted to review our 7-year experience using the loop electrical excision procedure (LEEP) for the treatment of cervical dysplasia in a family practice residency setting in the rural South. METHODS: We conducted a retrospective study with data gathered from chart review of a mostly Medicaid and uninsured patient population of rural Southern women referred from outlying health departments or private practices within an 80-mile radius. The women received follow-up Papanicolaou smears, and outcome measurements were either recurrence of dysplasia or at least 1 year with two negative Papanicolaou smears. Any surgical tissue obtained after LEEP was used to ascertain residual or recurrent dysplasia. RESULTS: Rates of disease recurrence and incomplete excision of cervical intraepithelial neoplasia grade 2/3 (CIN 2/3) compared favorably with results published by expert US gynecologists but were worse than those reported by European authors, who excise all CIN (CIN 1, CIN 2, and CIN 3). CONCLUSION: CIN 2 and CIN 3 can be diagnosed and treated appropriately with LEEP in the setting of a family practice residency.

Adult↗

PubMed1983

A study of family practice in New York City.

The purpose of this study was to describe the family physician's patient population in epidemiologic terms and to elucidate why a person would choose to see a family physician rather than other specialists in an urban area. The patient populations of family practices in New York City are described in terms of their demographic and practice attendance characteristics. Comparing their family physicians with other specialists, the patients rated their family physicians on the 12 aspects of care shown in the literature to be most important to patients in terms of physician consulting behavior (continuity, comprehensiveness, family care, rapport, low cost, convenience, interest, time with patient, support, personalized care, convenience of appointment and follow-up, and waiting time). Family physicians scored significantly better than other specialists on each aspect of care (P less than .0001). This study indicates that patients choose to consult family physicians rather than other specialists in New York City because patients view the family physician as performing better than other specialists those aspects of care most important to the patient. There is a need for further study to determine the attitudes of patients seeing other specialists.

Adolescent↗

PubMed1995

Family practice residents' learning needs and beliefs about office-based psychological counseling.

BACKGROUND AND OBJECTIVES: Teaching office-based psychological counseling is an essential component of family practice training. Most counseling training has been adapted from other disciplines without adequately identifying residents' learning needs, attitudes, and beliefs about counseling. This study was designed to 1) assess family practice residents' perceived learning needs for counseling, and 2) elicit and clarify their attitudes and beliefs about counseling. METHODS: Three consecutive groups of residents anonymously recorded their questions about psychological counseling. These questions were presented to the residents in focus groups for elaboration and clarification of underlying attitudes and beliefs. A consensus panel then categorized the learning needs and identified residents' attitudes and beliefs. RESULTS: Eighty-six distinct learning need questions were identified. These items clustered into four categories: skill development, problem/patient selection, practice management, and role confusion. Focus group findings identified four major themes: the need for limits and boundaries, limited understanding of change and the therapeutic process, doubts about personal readiness, and difficulty with the integration of mind and body. CONCLUSION: These findings parallel the concerns of physicians in practice and reinforce the need to identify resident concerns about office-based counseling. Failure to identify and respond to learner concerns may limit the effectiveness of teaching efforts in this curricular area.

Attitude of Health Personnel↗

PubMedDate not supplied

Outcomes of the first Family Practice Chief Resident Leadership Conference.

In June 1989 the first Family Practice Chief Resident Leadership Conference was presented to 27 Texas second-year residents who had been selected to serve as chief residents during their third year. The objectives of the conference were to assist these emerging leaders to develop better stress management and leadership skills and to strengthen their ties with the Texas Academy of Family Physicians. The conference featured two major workshops on stress management and leadership skills, and included plenary speeches and large and small group discussions. This article reports the outcomes of the conference as measured by the evaluation instrument completed by participants. Analysis of the results indicated that the conference had a positive effect on the residents.

Curriculum↗

PubMed1975

Emergency room use by patients from a family practice. Patterns of illness and motivation.

Patient visits to hospital Emergency Rooms, often for non-urgent illnesses, have increased phenomenally. Yet, an Emergency Room cannot give satisfactory care for those non-urgent illnesses since its management is fragmented and episodic, the antithesis of family practice. This study of private patients from a family practice explores the total spectrum of illness taken to an Emergency Room over a six-month period and the motivation behind the patients' visits. Diagnoses were not distributed at random but fell into discrete patterns of illness of epidemiological interest and which suggest possibilities for prevention. Emergency Room visits were made at times of self-perceived crisis when the private physician was considered inaccessible, and the hospital came to mind as a convenient and reliable source. The family physician should be aware of the special characteristics of his patients who visit Emergency Rooms and alert to the possibility of prevention of traumatic episodes. He should also consider follow-up care on those patients who make Emergency Room visits, with particular reference to exploring those common psycho-social problems which may have loomed large in the motivation for the hospital visit and yet were not recognized or treated at that time.

Adolescent↗

PubMed1982

Sphygmomanometers in hospital and family practice: problems and recommendations.

The accuracy and working condition of 210 sphygmomanometers were tested: 100 (50 and mercury and 50 aneroid) models were used in family practices and 100 mercury models in hospitals. Faults in the inflation-deflation system were common and caused mainly by dirt or wear in the control valves. Leakage occurred in 48% of the hospital and 33% of the family practice sphygmomanometers. In the mercury models the mercury or air vents were often in an unsatisfactory condition or the calibrated glass tube dirty. The accuracy of the gauges was examined at 90 and 150 mm Hg: fewer than 2% of the mercury sphygmomanometers but 30% of the aneroid models had errors greater than +/- 4 mm Hg at either pressure. Over half of the cuffs examined had bladders widths less than the recommended size, and 94% had bladders shorter than the length recommended for use on normal adults. Mercury sphygmomanometers should be bought in preference to aneroid models as they are more accurate, less expensive in the long term, and can be maintained by the owner; they should be checked every six to 12 months depending on usage. Replacement parts should be kept readily available.

Equipment Failure↗

PubMed1990

A randomized study of cancer screening in a family practice setting using a recall model.

A randomized controlled study that evaluated a recall system and patient education material by mail in 178 asymptomatic female family practice patients aged 50 to 69 years showed no effect on the proportion of patients who had cancer screening tests (P = .20) and a significant adverse effect on the mean number of tests performed (P = .05) after 4 months. In a subgroup of previous compliers (those who had one or more tests 12 months before the study), however, there was a lower proportion of patients receiving one or more tests (P = .019) with a lower mean number of tests (P = .007) than previous compliers in the control group. Recall strategies for cancer screening tests need to be more extensively studied in the United States before they are routinely adopted in family practice.

Aged↗

PubMedDate not supplied

Training family practice residents in abortion and other reproductive health care: a nationwide survey.

The majority of residents responding to a 1995 survey of program directors and chief residents at 244 family medicine residency programs in the United States reported they had no clinical experience in cervical cap fitting, diaphragm fitting or IUD insertion and removal. For all family planning methods except oral contraceptives, no more than 24% of residents had experience with 10 or more patients. Although 29% of programs included first-trimester abortion training as either optional or routine, only 15% of chief residents had clinical experience providing first-trimester abortions. Five percent of residents stated they certainly or probably would provide abortions, while 65% of residents stated they certainly would not provide abortions. A majority (65%) of residents agreed that first-trimester abortion training should be optional within family practice residency programs. Residents were more likely to agree with inclusion of optional abortion training and with the appropriateness of providing abortions in family practice if their program offered the training.

Abortion, Induced↗

PubMed1999

A long-term perspective on family practice residency match success: 1984-1998.

BACKGROUND AND OBJECTIVES: Knowing which factors predict National Resident Matching Program (Match) success is critical for medical students, student advisors, and residency faculty, but published reports have focused on a limited number of program characteristics or a small number of years. METHODS: We obtained information about region, affiliation, hospital size, population served, intern salary, and intern call schedule from the Directory of Family Practice Residency Programs for all US family practice programs from 1984-1998 and correlated them with initial Match results, using both univariate and multivariate techniques. RESULTS: Over 15 years, there have been substantial increases in programs and positions offered, salaries, proportion of larger programs, and reduced intern call frequency. Western region, larger program size, and community hospital affiliation were associated with a higher initial Match rate, but only 7%-19% of the variance was explained. In the late 1980s, salary had an effect, as did call in the worst Match years; in recent years, suburban programs have filled better and rural programs less well. Hospital size had no relationship to fill rates. CONCLUSIONS: Program characteristics have a real but modest impact on initial Match rates; the significance may increase in times of decreased interest in family medicine, such as the late 1980s and early 1990s.

Family Practice↗

PubMed1993

Migraine in family practice: prevalence and influence of sex hormonal status.

BACKGROUND: The objective of this study was to determine the prevalence of migraine headache in a family practice patient population. In addition, this study evaluated the simultaneous presence of Raynaud's phenomenon (RP) and migraine and examined the influence of sex hormonal status on migraine symptoms. METHODS: Data from the Continuous Morbidity Registration Project (CMR) of Nijmegen, the Netherlands, were used to identify all patients in the registration who had migraine headache and a comparison group of patients with nonvasospastic tension headache. Questionnaires were used to verify the diagnosis and to determine signs and symptoms of both headaches. RESULTS: There was an average annual prevalence of migraine headache of four per 1,000 men and 16 per 1,000 women. Eighty-five percent of patients diagnosed by family physicians as having migraine were found to fulfill the International Classification of Health Problems in Primary Care (ICHPPC) criteria for migraine headache. Migraine differed from tension headache with regard to the duration of the attacks, concomitant photo- and phonophobia, provoking factors, and the need to use analgesic medications. RP was present in 15% of the migraine group and in 16% of the tension headache group and occurred almost exclusively in women. The headaches were worse during and before menstruation in both groups and improved during pregnancy and menopause in the migraine group to greater extent than in the tension headache group. CONCLUSIONS: The use of the ICHPPC criteria for migraine headache is reliable in morbidity surveys in family practice. Although there was an overlap, migraine differed in various aspects from tension headache. Digital vasospasm and the influence of female hormonal changes were present in both headache groups.

Adolescent↗

PubMed1981

Adult medicine inpatient experience: a comparison of family practice and internal medicine residency services.

The charts of 1,272 hospitalized adult medicine patients were reviewed to compare the amount of inpatient management experienced by family practice and internal medicine resident services during a 12-month period. In a random sample of 251 patients, the diagnostic categories, age and sex distribution, race, length of hospitalization, and numbers of patients managed by both services were reviewed and analyzed. Family practice residents with an autonomous inpatient medicine service were found to have an adult inpatient experience similar to that of internal medicine residents in the same multispecialty teaching hospital.

Adult↗

PubMed1981

A study of patients with psychosocial problems in a family practice.

This study was conducted to test the hypothesis that family practice patients with intrapersonal psychosocial problems are likely to be identified as having more health problems in general than patients not afflicted in this way. A second general objective of the study was to provide a health profile of patients having intrapersonal problems as compared with patients who do not. The total number of patients identified as having intrapersonal problems was 321 patients, 30.5 percent of this teaching practice population, but for purposes of the study a small sample (n = 94) was randomly selected. A control group was randomly selected from patients matched by age and sex in the practice. Study group patients were found to have a significantly greater number of family problems, hospital admissions, major surgical procedures, number of visits to the practice, gastrointestinal disorders, and illness due to inflammatory causes when compared to controls. This group was also found to have received more psychiatric care, more attention from allied health professionals, and more frequent psychotropic drugs. This study suggests that family physicians care for a cohort of patients with a high frequency of psychosocial problems and that these patients have an increased use of health care services.

Adolescent↗