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At least 883 records · Page 49Linked to original sources

PubMed1999

A new look at low back complaints in primary care: a RAMBAM Israeli Family Practice Research Network study.

BACKGROUND: Low back pain (LBP) is one of the most frequent reasons patients seek consultations in primary care, and it is a major cause of disability. Our research examines the natural history of LBP and the prediction of chronicity in the context of patients presenting to family medicine clinics. METHODS: We performed a prospective cohort study of new episodes of LBP within the framework of a national family practice research network. The setting was 28 primary care family practice clinics located throughout Israel. Of 238 eligible subjects, 219 (92%) completed the study. RESULTS: During the 2-month study period, 2 subjects were referred to the emergency department and discharged, and 2 others were hospitalized. Forty-five percent did not require bed rest, and 38% of the employed were not absent from work. Seventy-one percent showed improvement in functional status; however, only 37% noted complete pain relief. Clinical and demographic data usually did not predict LBP-episode outcomes. The strongest predictors of chronicity were depression, history of job change due to LBP in the past, history of back contusion, lack of social support, family delegitimization of patient's pain, dissatisfaction with first office visit, family history of LBP or other chronic pain, coping style, and unemployment. CONCLUSIONS: The cohort patients displayed a relatively benign natural history of LBP, matched by benign clinical behavior from their physicians. In Israeli primary health care, acute LBP is infrequently associated with hospitalization or prolonged work absenteeism. Although most patients have functional improvement, pain often lingers. Almost all predictors of chronicity are psychosocial.

Adult↗

PubMed1986

Perceptions of fever among adults in a family practice setting.

Febrile illnesses are common clinical problems for the family physician. A questionnaire study was conducted of 100 adult patients in a family practice clinic to gain understanding of their knowledge about fever and its management. Many misconceptions were documented among adult patients about their own fevers and those of children for whom they cared. Misconceptions included the conviction that fever is more dangerous in children than in adults and a distorted concern about bodily damage from fever. Patients demonstrated a poor understanding of normal body temperature, minimum and maximum febrile temperatures, and minimum temperatures warranting antipyresis. Though many owned thermometers, they indicated improper usage and demonstrated inaccurate temperature-reading technique. Questionnaire responses indicated that health care providers had done poorly in educating patients about fever, its consequences, and its proper treatment.

Adult↗

PubMed2004

Randomized trial in family practice of a brief intervention to reduce STI risk in young adults.

BACKGROUND: Young adults represent a high-risk group for sexually transmissible infections (STIs). No randomized controlled trials of interventions in family practice to reduce sexual risk have been reported. OBJECTIVES: We evaluated the impact of brief advice initiated in routine consultations in 20 family practices to modify young adults' risk perception and self-reported risk behaviour for STIs, particularly human immunodeficiency virus (HIV) and hepatitis. METHODS: Patients aged 18-25 years completed self-administered confidential questionnaires in the waiting-room before seeing participating family physicians (FPs). Patients were unobtrusively randomized to receive advice about safe sex and complementary resources from their FP (INT group) or usual care (CONTROL group). Three months later, patients completed mailed follow-up questionnaires to assess changes in risk perception and behaviour. RESULTS: Three hundred and twelve patients completed baseline questionnaires. Of 237 who agreed to follow-up, 156 (68%) returned self-administered follow-up questionnaires. At post-test, we found equivalent self-reported use of questions to assess any new sexual partner's risk (33 versus 36%) and equivalent self-reported use of condoms on first occasion of sex with a new partner (73 versus 77%). While self-reported behaviour did not change significantly, we demonstrated significant change from pre- to post-test for knowledge of hepatitis risk, for both intervention and control groups. Multiple regression showed that the odds of risk perceptions were significantly higher at post-test than at pre-test for the CONTROL group but not the INT group. CONCLUSION: FPs remain to be convinced that allocation of time within consultations to opportunistic health promotion is worthwhile. Indeed, there are many competing demands for such time. Our results do not yet provide compelling evidence for the impact of a brief intervention about STI risk by FPs. As primary prevention efforts for young adults remain important, randomized controlled trials of larger scope are needed.

Adolescent↗

PubMedDate not supplied

Radiology in family practice: a descriptive study of office practice.

This study examined all x-rays from five family practice clinics for the year 1987, recording x-ray type together with the age and sex of the patient x-rayed. A total of 4,024 x-rays was obtained from 71,192 patient visits--an x-ray utilization rate of 5.65 percent. Most office x-rays were of the chest (39.6 percent), upper extremities (21.3 percent) or lower extremities (21.0 percent). These three categories predominated for all age groups of both sexes, for all months of the year, and for all clinics studied. Males utilized x-rays much more frequently than did females (8.86 percent overall rate for males; 3.95 percent overall rate for females) at all ages except for the age group 0-10 (2.19 percent for males, 3.04 percent for females). The gender combined age group with the highest utilization rate was between 51-60 (8.39 percent) whereas the gender combined age group 0-10 had the lowest utilization rate (2.61 percent). Uniformity was demonstrated from clinic to clinic on type of x-rays obtained, frequency of x-rays by gender, and frequency of x-rays per month. A major difference, however, was noted in utilization rates between clinics. There was a two-fold difference in x-ray utilization between the clinic with the highest utilization rate and the one with the lowest. This data is useful for focusing the content of residency training and continuing medical education in radiology, for providing a content base to evaluate family physicians in radiology, and for providing a foundation upon which further investigations into office radiology can be constructed.

Adolescent↗

PubMed1985

Family practice residents' prescribing patterns.

Prescription patterns of physicians in a family practice residency office were analyzed retrospectively from the following perspectives: frequency of prescribing for individual drugs and drug categories; effect of the level of postgraduate training on prescribing patterns; and effect of patient payment systems (Medicare-Medicaid, self-pay, third-party insurance) on the number of prescriptions. Antibiotics, antihistamine-decongestants, and antihypertensive medications were the most commonly prescribed medications. Psychotropic medications were used infrequently. An average of 0.70 prescriptions was issued on each office visit. Per office visit, first-year residents averaged 0.59 prescriptions, second-year residents averaged 0.69 prescriptions, third-year residents averaged 0.72 prescriptions, and the faculty averaged 0.98 prescriptions. Patients on Medicare-Medicaid averaged 0.78 prescriptions per office visit, self-pay patients averaged 0.25 prescriptions per visit, and patients with third-party insurance averaged 1.49 prescriptions per visit. The differences in the prescription rates between each payment group were significant.

Connecticut↗

PubMed1996

Neuroticism in a family practice population in India.

This study was conducted to assess the prevalence of neuroticism and its correlation with the various sociodemographic factors and presenting complaints among patients attending a family practice outpatient clinic. One hundred and forty two consecutive patients attending the outpatient clinic were administered PGI Health Questionnaire N2. Higher incidence of neuroticism was observed in middle age group population, in females (especially housewives), unskilled workers, patients with lower educational status and those belonging to small and nuclear families. A significant number of such patients had presented with vague symptoms, were visiting the clinics frequently and had associated chronic diseases. The results suggest that patients visiting the family practice clinics frequently with multiple somatic complaints with no suggested organic basis should undergo an in-depth psychiatric evaluation.

Adult↗

PubMedDate not supplied

The communication patterns of internal medicine and family practice physicians.

BACKGROUND: Although differences between Internal Medicine (IM) and Family Practice (FP) physicians have been examined in terms of care outcomes and cost, there have been few studies of specialty differences in physician-patient communication. METHODS: In 1995, 277 clinical encounters with 29 full-time, community-based FP physicians and 287 clinical encounters with 30 full-time, community based IM physicians were audiotaped. Communication was evaluated with the Roter Interaction Analysis System to reflect data gathering, patient education and counseling, rapport building, partnership building, verbal dominance, and patient-centeredness. Patient satisfaction was measured with an exit questionnaire. RESULTS: IM clinicians ask more biomedical questions (P =.02). FP clinicians engage in more psychosocial discussion (P =.02) and tend to engage in more emotionally supportive exchanges such as empathy and reassurance (P =.06). Significant interaction effects show differential treatment of patient subgroups by specialty; FP physicians were more verbally dominant with female patients (P <.01) and more patient-centered in their communication style with minority patients (P =.03). Although patient satisfaction was similar for IM and FP, satisfaction was more closely linked to measures of rapport and patient-centeredness for patients of FP physicians than for patients of internists. CONCLUSIONS: The current work adds insight into FP and IM differences in both physician-patient communication and predictors of patient satisfaction.

Adult↗

PubMed2003

Use of hormone replacement therapy by menopausal women in six family-practice teaching clinics in Israel.

BACKGROUND: The necessity of hormone replacement therapy (HRT) remains a controversial subject, but guidelines suggest that the subject be discussed with all menopausal women. AIM: To determine the rate of HRT use among women cared for in family-practice, university-affiliated teaching clinics. METHODS: Physicians from six family-practice teaching clinics enrolled all menopausal patients, aged between 50 and 70 years, registered in their practice. A detailed questionnaire was completed regarding demographic and health variables, gynecological history and the nature of HRT use. RESULTS: In total, 682 women were invited to participate in the study; 587 (86%) participated. Some 74% of the women were married, 64% were secular and 43% stated that they performed regular exercise. Current HRT use was reported by 156 women (26.6%). Most women (83%) had been treated for over 1 year. Common indications for starting treatment were hot flushes (75%), and routine recommendation by their physician (68%). Eighty-three (14%) women were past HRT users. It was stated by 45% of never-users that HRT had never been offered to them. Current users of HRT were found to be younger than non-users (mean age 58.2 years vs. 61.5 years, p < 0.0001), more secular than traditional or religious (p < 0.0001) with more years of formal education (p < 0.0001), and more likely to be of Western or European ("Ashkenazi") origin (p < 0.0001). Current HRT users reported fewer chronic illnesses than did non-users (p = 0.001); they were more likely to report being engaged in regular exercise (p < 0.002) and were less likely to be obese (p < 0.005). In a multiple regression model, HRT use was associated with more years of formal education and a secular identity. CONCLUSION: Our study found a higher proportion of women using HRT than in other Israeli studies. HRT use was more prevalent among women with improved health status and higher socioeconomic status. The most common reason given for not using HRT was that a physician had not raised the subject, indicating that physician-related factors might contribute to using HRT. Thus, comparing HRT prescribing rates in non-teaching clinics should clarify this factor.

Aged↗

PubMedDate not supplied

Accuracy of blood pressure measurement in the family practice center.

BACKGROUND: Equipment, physiologic, and technique factors can influence the accuracy of blood pressure measurement. The current study was designed to isolate certain technique factors and then assess the accuracy of nursing personnel measurements of blood pressure in three residency family practice centers. METHODS: An experienced registered nurse was trained in applying the American Heart Association recommendations for determining blood pressure by sphygmomanometry; three 1.5-hour practice sessions demonstrated her accuracy. Nine full days were then spent in the family practice centers rechecking as many staff blood pressure readings as possible while controlling for confounding variables. RESULTS: The following findings were significant: (1) the average absolute differences between control and study nurse systolic and diastolic blood pressure readings were 6.2 mmHg and 4.7 mmHg, respectively; (2) a unidirectional error of 3.8 mmHg in the measurement of diastolic blood pressure was found in one center, possibly because less care was taken with afternoon measurements; (3) variability in systolic blood pressure readings was higher in all three centers (+/- 8.5 mmHg) than attained during the training sessions for the control nurse (+/- 5.8 mmHg); (4) the average errors attributable to technique factors studied that were potentially correctable by training were only 1.8 mmHg for systolic and 0.7 mmHg for diastolic pressures. CONCLUSIONS: The degree of inaccuracy in ambulatory nursing blood pressure readings attributable to errors in technique is quantified by this study. Training can reduce, but not abolish, this inaccuracy. Careful attention to proper blood pressure measurement technique and such variables as equipment calibration is essential for both nursing and physician observers. Taking multiple blood pressure measurements before making clinical decisions can limit the effect of these inaccuracies.

Adult↗

PubMedDate not supplied

Family practice obstetrics: style of practice.

Prevalent birth practices reflecting a family-centered, minimally invasive style of obstetrical practice were surveyed among 235 family physicians practicing obstetrics in Michigan. Respondents older than 35 years and those without an academic affiliation reported fewer "family-centered" and more "intrusive" practices than did younger or academically affiliated respondents. Compared to published data on California obstetricians, Michigan family physicians were more likely to report practices that appear family centered and, particularly for more recent graduates, ones less likely to routinely involve obstetrical interventions.

Adult↗

PubMed1987

Content of the model teaching unit ambulatory care training and continuity of care in six family practice residency programs.

This article summarizes the practice content and continuity for 35 senior residents in six family medicine residency model teaching units utilizing a computerized information management system. Comparisons are drawn with the content of family practices in the National Ambulatory Medical Care Survey (NAMCS), showing that family medicine third-year residents provide a large proportion of pregnancy care and general medical examinations and treat a smaller number of chronic illness patients compared with family physicians in practice. Third-year residents performed few surgical procedures in the model teaching units. Continuity of care, though espoused by family medicine residencies in principle, was deficient in the model teaching units studied. Intensive training to compensate for these deficiencies is recommended.

Ambulatory Care↗

PubMed1988

Smoking cessation counseling by resident physicians in internal medicine, family practice, and pediatrics.

Residents in primary care specialties care for many patients who smoke cigarettes, but little is known about their smoking cessation counseling (SCC). We surveyed 309 residents (72 family practice, 171 internal medicine, and 66 pediatrics residents) in 13 programs to determine their practices, knowledge, attitudes, and training in SCC. More than 90% thought physicians are responsible for SCC, the majority routinely took smoking histories, and 80% attempted to motivate patients to quit smoking. However, 25% or fewer reported discussing obstacles to quitting, setting a quit date, prescribing nicotine gum, scheduling follow-up visits, or providing self-help materials. Family practice residents used more SCC techniques (1.8) than did internal medicine (0.8) and pediatrics (0.1) residents. Only 54% of residents reported recent SCC training and 13% reported formal SCC training. Recent training correlated with the number of counseling techniques used. Residents in primary care specialties report positive attitudes but inadequate practice and training in SCC.

Attitude of Health Personnel↗

PubMed1997

Undocumented smokeless tobacco use in a family practice population.

BACKGROUND: Smokeless tobacco (ST) use is associated with significant health risks and is increasing in prevalence in the United States. This study examined the prevalence of ST use among patients seen in two family practice centers and the documentation of that ST use in the medical record. METHODS: A survey of 209 patients seen in two family practice centers in northeast Tennessee was done to determine current and former smoking and ST use. Charts of all current ST users were reviewed for additional data. RESULTS: Current ST use was reported by 7.7% of patients. Highest rates were found in middle-aged men (27.8%) and elderly women (14.8%). Physicians rarely recorded ST use as a significant problem in the medical record. In several cases, management of other medical conditions may have been compromised by the physicians' lack of awareness of the ST use. CONCLUSIONS: The use of smokeless tobacco may be an important unrecognized problem in patients seen in family physicians' offices.

Adolescent↗

PubMed1975

A teaching bank of audiovisual materials for family practice.

Although increasing emphasis has been placed in recent years on the production and use of audiovisual materials in medical education, little work has yet been done on the identification and application of these materials in family practice teaching programs. This paper describes the content, uses, limitations, and initial experience of a Teaching Bank developed to support family practice teaching in varied settings. Video cassette and tape-slide units are most useful; audio cassettes alone are less likely to be selected. The evaluation of content, quality, and effectiveness of audiovisual media poses a particular problem. Although audiovisual materials can enhance learning based on different individual learning needs and styles, they cannot stand alone and usually must be supplemented by other teaching methods.

Audiovisual Aids↗

PubMed1982

Depression in a family practice elderly population.

This study addresses several major methodologic issues in the assessment of depressive illness among the elderly family practice living in the community. These include the selection of screening locale, the definition of depression in the elderly, and the evaluation of age trends within this group. The family physician's office is viewed as the optimal screening locale; this facility serves as the chief link between the elderly patient and the community health care system, for psychologic as well as physical complaints. In the definition of depression, a type of depressive illness particularly affecting the elderly may be distinguished from a syndrome more characteristic of depression in the population at large. Emphasis is laid on viewing aging as an evolving process rather than as a steady state. A pilot study of 166 chronically ill family practice patients living in the community was conducted. A large proportion of them, all without previously diagnosed psychiatric impairment, had elevated depression scores according to the Zung Depression Status Inventory. Distinct symptom clusters characteristic of depression in the aged were identified. The data also suggested a systematic age trend, with different peaks of depression for men and women within the elderly age range.

Age Factors↗

PubMed1991

Intolerance of ambiguity among family practice residents.

The art of clinical medicine involves learning to deal with varying levels of ambiguity and uncertainty. Tolerance of ambiguity was examined by giving Budner's Intolerance of Ambiguity Scale to a sample of 37 family practice residents from a university hospital residency and 22 from a community hospital residency. Residents in both the community and university programs had similar scores. No differences existed between men and women. Compared to studies of medical students, first-year family practice residents were slightly more intolerant of ambiguity. However, intolerance of ambiguity was lower among third-year residents, suggesting that as training advances, residents may become more tolerant of ambiguity. The residency training process may lead to a reduction in intolerance of ambiguity, which produces physicians who can deal with the ambiguity and uncertainty of clinical practice.

Adult↗

PubMed1976

A data bank for patient care, curriculum, and research in family practice: 526,196 patient problems.

The health care problems that 88,000 patients presented to 118 family physicians over two years were evaluated. As a result, 526,196 health care problems were noted. Ninety percent of all problems were contained within 169 descriptive problems using the RCGP coding system for primary care. Knowledge of the profile of patient problems as they present to the family physician will alow for the development of a logical curriculum for the family practice resident and of patient care systems in family medicine. An appropriate methodology for the development of curriculum is discussed.

Curriculum↗

PubMedDate not supplied

The relationship between self-esteem and physical health in a family practice population.

This study explored the relationship between self-esteem and physical health in a primary care setting. Sixty-eight adult patients (33 males and 35 females) at a Family Practice Center completed a questionnaire assessing self-esteem and physical health. Multiple regression analysis was used in exploring the effects of self-esteem, and the control variables age, gender, employment and marital status on health status, as assessed from the patient's chart, and on number of symptoms, as assessed through patient self-report. The regression on health status was significant overall (F = 4.12, p less than .001) with each of the predictors yielding significant coefficients. Those with high self-esteem, younger people, men, and employed people had significantly higher health status scores as assessed from the patient's chart. The regression on number of symptoms was marginally significant overall (F = 2.28, p less than .06) with self-esteem emerging as a significant predictor (p less than .05). Those with high self-esteem had significantly fewer symptoms as reported on the Hopkins Symptom Check List. These results support the existence of a positive relationship between self-esteem and physical health in a family practice patient population.

Adult↗