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PubMed2001

Trends in the rural-urban distribution of general pediatricians.

OBJECTIVE: A major objective of national and state health policy has been to increase primary care physician supply in rural areas. It is not known whether this objective has been met for general pediatricians. This study examines trends in the rural-urban distribution of general pediatricians in the United States from 1981 to 1996. DESIGN: Descriptive serial cross-sectional study. PARTICIPANTS: At selected 5-year intervals, all clinically active general pediatricians in the United States listed in the American Medical Association Physician Masterfile. MAIN OUTCOME MEASURES: The proportion of pediatricians practicing in rural counties and the ratio of pediatricians to the child population (per 100 000 children <18 years old) for US counties. RESULTS: Between 1981 and 1996, the total number of general pediatricians increased from 19 739 to 34 100. However, rural pediatrician-to-child population ratios (PCPRs) remained well below urban ratios. Although rural counties of all population sizes experienced some gains over time, only those over 25 000 populations had a meaningful increase in their PCPR. Overall, the urban PCPR increased by 14.0 (or an additional pediatrician for every 7150 children) whereas the rural ratio only increased by 4.1 (an additional pediatrician for every 24 400 children). The percentage of recent residency graduates opting for rural practice declined by half (14.6% to 7.4%) over the 15-year study period. Women and international graduates were consistently less likely to practice in rural counties than were men and US graduates, respectively. CONCLUSIONS: The near doubling in general pediatrician numbers from 1981 to 1996 yielded only a modest increase in pediatrician availability for rural children. The discrepancy between urban and rural pediatrician supply increased during this period and should continue growing based on the increasingly urban location of recent residency graduates and the continued growth of women in pediatrics. New policy strategies are needed to improve rural pediatrician availability, including focusing on larger rural counties and addressing barriers to rural practice for women. pediatrics/manpower, pediatrics/trends, rural health, physicians/supply and distribution, medically underserved area.

Cross-Sectional Studies↗
PubMedDate not supplied

Pediatric nursing health care delivery plan for humanitarian missions in developing countries.

In today's health care environment, pediatric nurses are being called upon to perform humanitarian missions in tropical developing countries. During these missions, pediatric nurses often are faced with providing short-term health care to children in the villages of the developing countries visited. These efforts involve a group of pediatric health care personnel traveling to a poor, medically underserved area; establishing provisional clinics; and seeing a large number of children over several days. Usually only the most necessary resources are taken along, including varying amounts of medications and supplies and possibly minimal laboratory capabilities. To date, health care delivery plans for pediatric nurses as part of an interdisciplinary team on these missions are unavailable. This article provides literature and experience-based guidance for pediatric nurses performing humanitarian missions around the world in tropical developing countries to provide care in a manner that is safe, appropriate, and offers the greatest likelihood of benefit to the children in these countries.

Child↗
PubMed1975

Development of the index of medical underservice.

A mathematical model was developed to predict experts' relative assessments of scarcity of personal health services. This model provides, quickly and inexpensively, estimates of the relative assessments experts would make of any area in the country, in the form of an Index of Medical Underservice. The index is being used by the Bureau of Community Health Services in the preliminary designation of medically underserved areas for the federal HMO program.

Age Factors↗
PubMed2001

Implementation and evaluation of a telemedicine course for physician assistants.

Clinical telemedicine uses interactive video technologies and telecommunications networks to deliver medical consultations to distant patients and their primary care providers. Telemedicine provides real-time access to specialists whose services might not otherwise be available in rural or medically underserved areas. While recently there has been dramatic growth in the use of telemedicine, there is little evidence that telemedicine as a patient care delivery system has been incorporated into the medical school curriculum. The authors describe the current status of telemedicine in medical curricula and report on efforts at the University of Iowa to incorporate telemedicine into the curriculum of its Physician Assistant Program.

Curriculum↗
PubMed1988

Comprehensive family practice clerkship in a minority institution.

A comprehensive family practice clerkship program at Howard University College of Medicine has been conducted since 1970. This institution is one of three predominantly black institutions offering a family practice program. The senior clerkship is mandatory and at least 20 to 25 percent of each class elect to participate in a four-to six- week family practice preceptorship. As a result of the clerkship's success, over 50 percent of the program's graduates actively practice in primary medical manpower shortage or medically underserved areas.

Black or African American↗
PubMed1996

A survey of graduates in practice from the University of New Mexico's conventional and community-oriented, problem-based tracks.

PURPOSE: To survey graduates in practice from the first four classes of the University of New Mexico School of Medicine's (UNMSOM's) parallel curricular tracks, and compare data about the graduates' practice patterns, learning behaviors, and satisfaction with the profession of medicine. METHOD: Between 1979 and 1993, the UNMSOM had two tracks for the first two years of medical school: a conventional track and the Primary Care Curriculum (PCC), a community-oriented, problem-based track. In 1990, a survey was conducted of the 140 graduates from the first four classes (1983-1986) who had completed their postgraduate training: 40 from the PCC and 100 from the conventional track. Statistical methods included two-way analyses of variance, logistic regression, and chi-square, adjusted by Bonferroni methods. Comparisons between tracks are reported after adjustments were made for specialty effects. RESULTS: Thirty-three graduates (83%) from the PCC and 87 (87%) from the conventional tracks responded. The PCC graduates were much more likely to work in medically underserved areas, practice in publicly funded health care settings, and care for non-paying patients. The PCC graduates more often identified patient problems and curiosity as providing motivation for their learning. They more frequently studied clinical medicine and community health topics and spent time in community activities. The PCC graduates felt better prepared for practice by their undergraduate medical education. There was no difference between the graduates of the two tracks in the sizes of the populations in which they practiced, in the criteria they used for deciding on referrals to other physicians, in the ranges of community resource utilization, or in the degrees of satisfaction within their chosen professions. Large percentages of graduates from both tracks (67% conventional and 79% PCC) considered themselves to be practicing either primary care or a combination of primary care and non-primary care. In addition, 38% of all the graduates practiced in the state of New Mexico. More PCC graduates chose careers in family practice; however, no significant difference was found in a comparison between the proportions of PCC and conventional-track graduates who chose primary care careers. CONCLUSION: Track differences favorable to the PCC were evident in relation to the two major goals established by the program: to attract graduates to careers in primary care in rural and underserved areas and to provide graduates with self-directed, lifelong learning skills. Some expected track effects were not found.

Academic Medical Centers↗
PubMed1977

Distribution of physicians in family practice and other medical specialties in Texas, 1969-1973: a statistical review.

This article documents distributional patterns of allopathic family practice physicians (including general practitioners) in Texas as compared with allopathic physicians in all other medical specialties in the state during the period 1969-1973, for which there are reliable data. Statistical analysis of this information shows that there was a significant difference between the growth of family practice compared to all other medical specialties in both metropolitan and nonmetropolitan counties. This study draws no conclusions that the medical needs in many of these areas are not being met, since patient travel may, to some degree, compensate for disproportionate physician distribution. There is no unanimous agreement on what constitutes an ideal ratio of physicians in any specialty to a population in so-called "medically underserved" areas.

Family Practice↗
PubMed1986

The AHEC library program and consortia development in California.

A brief history of the first Area Health Education Center (AHEC) Library Program in California is presented, with a description of methodology and results. The goals of this program were to develop and improve hospital library resources and services, to train hospital library personnel, and to promote resource sharing in a medically underserved area. The health sciences library consortium that evolved became a model for the ten other library consortia in the state. Based on AHEC's twelve years' experience with consortia, from 1973 to 1985, recommendations are made as to size, composition, leadership, outside funding, group participation, publicity, and linkages.

Area Health Education Centers↗
PubMed1990

Providing medical services through school-based health programs. Council on Scientific Affairs.

Resolution 162, which was adopted at the 1987 Annual Meeting by the Board of Trustees, called on the American Medical Association to study the efficacy of school-based health clinics. Recent data show that a significant number of school-aged youth are in need of an adequate source of health care. School-based health programs constitute a promising avenue for providing health services to adolescents, particularly in medically underserved areas. Although there are insufficient data to support universal establishment of school-based health programs, small-scale studies suggest that such programs are a viable means to increase access to health care for youth.

Adolescent↗
PubMed1989

Physician supply and distribution in Georgia.

Physician supply in Georgia must be considered an urgent issue. Several important points must be recognized and addressed. The lowest physicians rates are in the more rural county population groupings. The only county population grouping with a surplus of physicians is in the over 150,000 population. The majority of physicians are concentrated in the metropolitan counties. Sixteen percent of all physicians practice in the 134 counties having less than 50,000 population. The majority of physicians are in primary care specialties. Family practice is the most dominant specialty in rural areas. By the year 2000, Georgia can expect to add 5,600 physicians due to growth. By the year 2000, Georgia can expect to lose 2,600 physicians due to retirement. Family practitioners are the most uniformly distributed of the specialties examined. They are also the specialty most needed. The average age of Georgia physicians is 46. General surgeons are in the oldest average age group (50), whereas internists are in the youngest (44). Older physicians are concentrated in the more rural areas. A significant number of all physicians are over age 55. The majority of these will be retired by the year 2000. Physicians over age 65 represent 9.2% of all physicians from the survey. In Georgia, 13.6% of all physicians were Foreign Medical School Graduates. They tend to locate their practices in medically underserved areas. The specialty choices most frequently favored by FMGs are: pediatrics, internal medicine, family practice, and obstetrics/gynecology. A total of 71.2% of all physicians accept Medicare patients; 83.8% accept Medicare patients. Ninety-two percent of all obstetricians accept obstetric patients, but this participation is threatened by problems with malpractice insurance.

Adult↗
PubMed1989

Providing medical services through school-based health programs. Council on Scientific Affairs.

Resolution 162, which was adopted at the 1987 Annual Meeting by the Board of Trustees, called on the American Medical Association to study the efficacy of school-based health clinics. Recent data show that a significant number of school-aged youth are in need of an adequate source of health care. School-based health programs constitute a promising avenue for providing health services to adolescents, particularly in medically underserved areas. Although there are insufficient data to support universal establishment of school-based health programs, small-scale studies suggest that such programs are a viable means to increase access to health care for youth.

Adolescent↗
PubMed1993

A proposal to provide care to the uninsured through a network of community health centers.

While a national health insurance plan is needed, this alone will not provide access for approximately 30 million persons who face geographic, cultural, language, or health care system barriers, or who live in areas with provider shortages. These barriers often coexist with lack of insurance coverage, but they also affect millions who have public, or even private, coverage. Moreover, large segments of this population suffer from health problems not adequately addressed by the traditional medical model: teenage pregnancy, AIDS, injury, substance abuse, and the like. To provide appropriate care for these underserved persons, we propose to expand the existing network of community health centers over the next 10 years to a total of approximately 3,000. Such an expansion would provide a cost-effective approach to improving provider distribution, increasing consumer input, combining personal health services with health promotion, and removing both financial and nonfinancial barriers to care. This model can be implemented either independent of or in conjunction with other health care system reform efforts.

Community Health Centers↗
PubMed2004

Differences in patient and clinic characteristics at CARE Act funded versus non-CARE Act funded HIV clinics.

The Ryan White CARE Act supports comprehensive care to persons with HIV infection. With an annual budget of over $1 billion, it is the largest federally funded programme for HIV care in the USA. We analysed data from the HIV Costs and Services Utilization Study, a nationally representative sample of HIV patients. Patient data were collected in 1996-97 and clinic data were collected in 1998-99. We examined whether CARE Act funded clinics differed from other HIV clinics in (1) the characteristics of their patients, and (2) their organization, staffing, and services. We found that patients at CARE Act clinics were younger, less educated, poorer, and more likely to be female, non-white, unemployed, uninsured, and have heterosexual contact as an HIV risk factor, compared to patients at other HIV clinics. CARE Act clinics tended to specialize in HIV care, had more infectious disease specialists, had fewer total patients, and provided more support services (e.g. mental health, nutrition, case management, child care). These results are consistent with findings of other studies that were limited by non-probability samples or restricted geographical areas.

Adolescent↗
PubMed1998

A comparison of the evaluation and treatment of cervical dysplasia by gynecologists and nurse practitioners.

Cervical dysplasia, a precursor to cervical cancer, affects approximately 6% to 10% of women in the United States. Although cervical dysplasia traditionally is diagnosed and treated by gynecologists, nurse practitioners with special education and expertise in the evaluation and treatment of the condition have begun providing care to many women in rural and other medically underserved areas where there is limited access to specialized physicians. This study compared cervical dysplasia evaluation and treatment techniques of 11 gynecologists and 6 nurse practitioners using abstracted patient records. The MDs showed a greater variation in performance than nurse practitioner colposcopists (NPCs) when evaluated on 10 criteria. NPC practices fell within the range of MDs, and when they were statistically different, NPC practices were more consistent with generally accepted medical practice. These data suggest that NPCs were more likely to adhere to a consistent set of practices. It can be concluded that NPCs are viable alternative providers in the evaluation and treatment of cervical dysplasia.

Adolescent↗