SEARCH · PubMed Health

Results for “Family Practice”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 937 records · Page 52Linked to original sources

PubMed2000

Results of the 2000 National Resident Matching Program: family practice.

The results of the 2000 National Resident Matching Program (NRMP) reflect substantial volatility in the perceptions and career choices of physicians entering graduate medical education in the United States. Ninety-four fewer positions (191 fewer US seniors) were filled in family practice residency programs through the NRMP in 2000, compared with 1999, as well as 60 fewer (66 fewer US seniors) in primary care internal medicine, 12 fewer in pediatrics-primary care (6 fewer US seniors), and 10 fewer (9 fewer US seniors) in internal medicine-pediatric programs. In contrast, 37 more positions (36 more US seniors) were filled in anesthesiology and 4 more (13 more US seniors) in diagnostic radiology, two "marker" disciplines that have recently been market sensitive. Twelve fewer positions (63 fewer US seniors) were also filled in categorical internal medicine, while 35 fewer positions (104 fewer US seniors) were filled in categorical pediatrics programs, where trainees perceive options for practicing as generalists or entering subspecialty fellowships, depending on the market. While the needs of the nation, especially rural and underserved populations, continue to offer a market for family physicians, family practice experienced a third year of decline through the 2000 NRMP. Current forces, including media hype, market factors, lifestyle choices, debt, and the turbulence of the health care environment, appear to be influencing many students to choose subspecialty rather than primary care careers.

Anesthesiology↗

PubMed1999

Family planning training in Maryland family practice and obstetrics/gynecology residency programs.

OBJECTIVE: To examine the extent of family planning and abortion training in Maryland family practice (FP) and obstetrics/gynecology (OB) residency training programs. METHODS: All final-year residents in every FP and OB residency training program in Maryland were asked in 1998 how many cases (0, 1-10, > 10) of ten methods of contraception and abortion they had managed. RESULTS: Seventy-five percent (55) of the 73 residents responded. Fifty percent of FP residents had never inserted an intrauterine device (IUD), 43% had never inserted an implant (Nor-plant), 37% had never prescribed emergency contraceptive pills, and 30% had never fitted a diaphragm. Ninety-seven percent of FP residents had no experience with elective termination of pregnancy, and 83% had no experience with sterilization. Twenty percent of OB residents had never inserted an IUD, 16% had never inserted implants or prescribed emergency contraceptive pills, 20% had never fitted a diaphragm, and 36% had no experience in elective termination of pregnancy. Not one FP resident had inserted or fitted more than ten IUDs, implants, diaphragms, or cervical caps. Except for oral and injectable contraception, the majority of OB residents had not managed more than ten cases of any other reversible contraceptive method: 80% had not inserted more than ten IUDs, 72% had not inserted more than ten implants, 88% had not fitted more than ten diaphragms, and 100% had not fitted more than ten cervical caps. CONCLUSION: These survey results indicate a need for more formal instruction in most contraceptive methods for OB and FP residency programs in Maryland. This study concurs with previous national studies showing deficits in family planning training.

Contraceptive Devices, Female↗

PubMed1992

An evaluation of a commercial co-agglutination test for the diagnosis of group A streptococcal tonsillitis in a family practice.

The result of a rapid co-agglutination test was compared with the clinical diagnosis of group A streptococcal tonsillitis, a laboratory culture from the throat serving as the correct result. The study was carried out in a family practice, with two GPs partaking: it included 105 consecutive patients. The outcome of the rapid test was significantly correlated to the degree of growth determined by throat culture, and it was superior to the clinical judgement. The statistical analysis of the results of the rapid test revealed (95% confidence limits in brackets) a specificity of 97% (91-100), sensitivity of 68% (48-84), a positive predictive value of 90% (70-99), and a negative predictive value of 89% (81-95). Although the co-agglutination test was superior to the clinical diagnosis, the sensitivity of this test is rather low when compared with other recently evaluated rapid tests for use in family practice.

Adolescent↗

PubMed2004

Assessing the predictive value of the American Board of Family Practice In-training Examination.

BACKGROUND AND OBJECTIVES: The American Board of Family Practice In-training Examination (ABFP ITE) is a cognitive examination similar in content to the ABFP Certification Examination (CE). The ABFP ITE is widely used in family medicine residency programs. It was originally developed and intended to be used for assessment of groups of residents. Despite lack of empirical support, however, some residency programs are using ABFP ITE scores as individual resident performance indicators. This study's objective was to estimate the positive predictive value of the ABFP ITE for identifying residents at risk for poor performance on the ABFP CE or a subsequent ABFP ITE. METHODS: We used a normal distribution model for correlated test scores and Monte Carlo simulation to investigate the effect of test reliability (measurement errors) on the positive predictive value of the ABFP ITE. RESULTS: The positive predictive value of the composite score was .72. The positive predictive value of the eight specialty subscales ranged from .26 to .57. CONCLUSIONS: Only the composite score of the ABFP ITE has acceptable positive predictive value to be used as part of a comprehension resident evaluation system. The ABFP ITE specialty subscales do not have sufficient positive predictive value or reliability to warrant use as performance indicators.

Certification↗

PubMed1996

Family practice, internal medicine, and pediatrics as partners in the education of generalists.

The generalist of the future will play an integral role in the health care delivery system, yet the three recognized generalist specialties have developed and functioned along largely separate tracks. No matter what form of generalism evolves, family practice, internal medicine, and pediatrics must begin to cooperate and collaborate in developing new graduate medical education programs that are sufficiently flexible to meet whatever emerges in the future. They must devote their energies to working together, rather than competing; to emphasizing those parts of their programs that have similarities; and to sharing their knowledge, skills, attitudes, and perspectives about the care of patients. They must develop training experiences in which residents will obtain maximum contact with a wide variety of problems and patients in many different settings; a substantial portion of such training should be generic and virtually interchangeable among the three specialties. As the health care system evolves, so should these disciplines; they must begin to "train physicians to provide continuing, comprehensive and coordinated medical care to a population undifferentiated by gender, disease or organ system," as urged by the American Boards of Family Practice and Internal Medicine.

Education, Medical, Graduate↗

PubMedDate not supplied

Quality improvement in family practice: a recipe for change.

A new recipe is presented, splitting quality improvement into 4 levels. The Q1 level corresponds to the everyday processes that guide our daily work flow. Q2 corresponds to commonly thought of outcome measures such as HEDIS criteria. Q3 relates to the executive functions that permit seasoned clinicians to draw generalizations about care for individual patients by synthesizing large amounts of data from both psychosocial as well as classical history/physical sources. Finally Q4 reflects more population-based quality improvement activities. Examples are given for each. Each of these levels requires a different approach for improvement activities. Each must be seen in the context of an expanded "quality compass" and in the paradigm of the PLAN-DO-CHECK-ACT cycle of quality improvement. Finally, a practical application of how this could be instituted at a Family Practice residency is given.

Family Practice↗

PubMed1968

Undergraduate preparation for family practice.

DR R H REYNOLDS DISCUSSES NORTH AMERICAN EFFORTS AT UNDERGRADUATE PREPARATION FOR FAMILY PRACTICE, AS ILLUSTRATED BY: student attachment schemes, teaching of behavioural sciences, family care programmes, departments of general practice and comprehensive medical clinics.Dr H J Wright reviews the dichotomy of hospital and general practitioner services and goes on to consider the advantages of integration and the methods by which this may be accomplished. In particular he stresses the importance of general practitioner hospital appointments and access to diagnostic facilities.Dr F H Staines describes health services in Israel, New Zealand and Australia and draws lessons from them which could be used to improve the NHS service in this country.

Behavioral Sciences↗

PubMedDate not supplied

Supervision and boundaries in a combined family practice and psychiatry residency training program: the National Capital Consortium experience.

OBJECTIVES: The combined discipline of family practice and psychiatry was created in 1995. There are no established guidelines for 1) teaching residents how to integrate these two specialties, 2) providing appropriate supervision, and 3) helping residents develop personal and professional boundaries. The authors share their approach and aim to stimulate dialogue and promote the establishment of standards for combined programs. METHOD: The authors review some of the difficulties encountered in supervising family practice-psychiatry residents and the rationale for their approach. RESULTS: Providing residents with clear boundaries of practice and supervision that initially separate the two specialties during training facilitates the development of specialty knowledge and skills as well as the capacity to form clear boundaries. CONCLUSION: Our experience suggests that only when residents learn the appropriate practice and boundaries of each specialty can they successfully integrate the two without boundary or role confusion.

Education↗

PubMedDate not supplied

Comparison of a family practice teaching service and a hospitalist model: costs, charges, length of stay, and mortality.

BACKGROUND AND OBJECTIVES: One third of our nation's health care costs are incurred in the hospital. This study compares the inpatient outcomes between a family practice teaching service (FPTS) and a hospitalist group in the same suburban community hospital. METHODS: All patients discharged by the hospitalist group or the FPTS between April 1998 and June 1999 were included for study if they had one of the 10 most frequent principal diagnoses on discharge. The outcomes compared between the groups were length of stay, mortality, total charges, laboratory charges, radiology charges, and direct costs. Student's t test, chi-square, and analysis of variance were used to compare the outcomes, after adjusting data for severity of illness. RESULTS: Mean severity of illness for the FPTS patients was 2.42 and for the hospitalist patients was 2.26, with higher scores indicating greater severity of illness. After adjusting for severity of illness, there were no differences between the two groups of physicians for total charges, laboratory charges, radiology charges, direct costs, length of stay, or mortality rates. CONCLUSIONS: This study failed to demonstrate a statistically significant difference in the use of hospital resources between a family practice residency teaching service and a hospitalist team. Given the outcomes measured in this community teaching hospital, the residency teaching service appears to be a financially competitive model for delivery of inpatient care.

Analysis of Variance↗

PubMedDate not supplied

Outdoor-based leadership training and group development of family practice interns.

BACKGROUND AND OBJECTIVES: Current trends in health care demand expanded competencies for future physicians, including group process skills that traditional medical curricula rarely address. One approach to enhancing group dynamics and teaching teamwork skills is outdoor-based experiential learning. This study examines the effect of an outdoor-based learning intervention on family practice interns' group problem solving, team building, and communication. METHODS: Two of 13 programs in the University of Washington Family Practice Residency Network included structured, outdoor-based experimental leadership training during intern orientation. The other 11 programs served as controls. Within 1 month following orientation, surveys were sent to all University of Washington Network interns. Respondents completed 27 questions designed to assess perceptions of trust, group awareness, group problem solving, group effectiveness, and interpersonal communication within an intern class. RESULTS: The survey response rate was 85%. Study and control groups were not significantly different with respect to age or gender. The study group scored higher on all individual questions and variables, with statistically significant differences on 10 questions and three variables. CONCLUSIONS: Experiential, outdoor-based leadership training may positively influence intern class group formation and development. Experiential training early in residency may reduce intern stress by accelerating intra-class relationships and may represent a foundation on which to build effective group process curricula for residents.

Adult↗

PubMed1993

Satisfactions and dissatisfactions of graduating family practice residents.

BACKGROUND: This study was conducted to determine whether the types of professional satisfactions and dissatisfactions experienced by family practice residents in one program were characteristic of those experienced by residents from other programs. METHODS: Materials and procedures developed previously were used in a study of 23 residents from five family medicine programs. Respondents were interviewed in the spring of their graduation year. Transcripts of these interviews were examined for the presence of specific themes relating to professional satisfactions and dissatisfactions. RESULTS: Themes found in the interviews from all five programs were similar to each other and to the themes uncovered previously. Satisfactions were related to the interpersonal aspects of patient care, the intellectual aspects of medicine, the process of delivering care, and instances of intervention in critical situations. An additional source of satisfaction, not found previously, was derived from activities in certain specific content areas of family medicine. Dissatisfactions reflected concerns about the bureaucratic climate in which medicine is currently practiced, time demands of a medical career, frustrations with patient behavior, and negative feelings about the professional situation of the family practice resident. CONCLUSIONS: Having corroborated the existence of satisfaction and dissatisfaction themes found earlier, results of this research may provide information to educators about the professional identity of the family physicians they are training.

Family Practice↗

PubMedDate not supplied

Diabetes management quality improvement in a family practice residency program.

BACKGROUND: Diabetes is a devastating chronic disease. Although optimal diabetes control reduces chronic complications, actual provision of diabetes care frequently falls short of accepted guidelines. We wanted to determine whether locally developed diabetes care initiatives can result in improvements in the provision of diabetes care. METHODS: This study was a retrospective cohort analysis using Medicare claims and chart abstraction data to ascertain diabetes care indicator utilization rates at the Northeast Iowa Family Practice Clinic (NEIFPC), which serves as the training site for the Northeast Iowa Family Practice Residency Program. Diabetic patients receiving care at the NEIFPC during 1996, 1997, and 1998 were included. Diabetes care rates are compared with those of other Iowa practices. Diabetes initiatives included chart audits, glycosylated hemoglobin (HbA1c) measurement reminder cards, educational symposia, an endocrinology outreach clinic, resident elective rotations, diabetes flow sheet utilization, pharmacist interface, and nursing foot-examination preparations. The primary outcome was the utilization rate of accepted diabetes care indicators. RESULTS: Diabetic patients at NEIFPC had greater utilization of diabetes care indicators than did patients of Iowa collaborators in 1997 and 1998. NEIFPC patients had HbA1c levels measured more frequently in 1997 and 1998 (84% and 88%, respectively) than did patients of Iowa collaborators (49% and 41%, respectively) (P < .001). The mean 1997 and 1998 HbA1c levels of 7.32% and 7.25%, respectively, are impressive compared with that of Iowa collaborators (8.83% and 8.36%) (P < .001) and other published data (8.5%-10%). The percentage of NEIFPC patients with good glycemic control (HbA1c < 8%) was 75%, compared with the reported 50% of all US patients. CONCLUSIONS: Our findings suggest that multimodal diabetes care quality improvement initiatives, applied longitudinally, can result in significant improvements in the provision and documentation of diabetes care.

Aged↗

PubMedDate not supplied

The geographic and temporal patterns of residency-trained family physicians: University of Washington Family Practice Residency Network.

BACKGROUND: There is a clear national mandate to increase the proportion of generalist physicians within the medical community and to increase their numbers within rural and underserved urban locations. Little is known, however, about the geographic and temporal career patterns of family physicians or about how these patterns differ by sex and graduation cohort. METHODS: Using information from a follow-up survey of the University of Washington Family Practice Residency Network, we analyzed the characteristics of 358 graduate physicians and their 493 practices, including data on geographic practice locations. RESULTS: Two thirds of graduates began their practices in urban locations, and one third initially settled in rural communities. Female graduates were much less likely than their male peers to choose rural practice locations. Few physicians left practices after they had practiced in them for 5 or 6 years. The majority of graduates were still in the practice where they started as long as 18 years earlier. CONCLUSIONS: The most important career decision made by the graduate of a family medicine residency involves practice location. Because women are less likely to practice in rural areas, the increasing proportion of women graduating from family practice residencies might presage shortages of rural physicians in the future.

Career Choice↗

PubMed2006

[Clinical research in family practices. A site management organisation for general practitioners: a unique experience in Belgium].

As a general practitioner, taking part in clinical research is an improvement regarding his professional activities. It brings an extra value in the continuing education, relationship with patients and helps learning rigour. He is involved in the improvement of the quality of medical care and the valorisation of the general practice. Before committing himself with clinical research, he has to be aware of the constraints linked to this activity. An appropriate training is essential. He will have to submit to the specific rules of the sector such as the " Good Clinical Practices", respect ethic and legal requirements. The commitment in terms of time is sizeable. The administrative burden is heavy. All this should not make him forget his first concern, the interest of his patient. Belgium benefits from a well-established reputation in clinical research. However, the family practice remains the poor relation, but it is essential because the conditions of the trials in family practice are the closest to reality. After analyzing the weaknesses of clinical research in general medicine, the authors suggest a solution: a structured network recruiting, training and managing the GP Investigators.

Belgium↗

PubMed1998

Identifying left lower lobe pneumonia at chest radiography: performance of family practice residents before and after a didactic session.

RATIONALE AND OBJECTIVES: The authors sought to determine whether the lateral chest radiograph is helpful in identifying left lower lobe pneumonia among inexperienced readers. MATERIALS AND METHODS: The authors selected all patients who presented to a family practice training program with radiologic and clinical evidence of left lower lobe pneumonia (n = 65). They then selected an equal number of patients in whom chest radiographs were taken to "rule out pneumonia" and were found to be normal. Eight 1st-year family practice residents were asked to read the radiographs before and after a didactic session that emphasized lateral chest radiograph interpretation. The radiographs were presented under two viewing conditions: posteroanterior (PA) only versus PA and lateral. Receiver operating characteristic (ROC) curve methods were used to compare the effect of both the didactic session and the viewing condition on diagnostic accuracy. RESULTS: There were no significant differences in performance before and after the didactic session and no differences between the two viewing conditions. After including only abnormal radiographs that demonstrated the "spine sign" (an apparent increased opacification of the lower vertebral bodies on the lateral view), the residents performed better when presented with both PA and lateral radiographs than when presented with the PA radiograph only (area under ROC curve, .8158 vs .7418, respectively; P = 0.24). CONCLUSION: In patients with left lower lobe pneumonia whose radiographs demonstrated the spine sign, diagnostic accuracy improved when the lateral chest radiograph was viewed.

Case-Control Studies↗

PubMed2000

Use of office-based smoking cessation activities in family practices.

BACKGROUND: Smoking is the leading cause of morbidity and mortality in the United States. Recommendations for increasing physician effectiveness in smoking cessation through the use of office-based activities have been disseminated, but the extent of implementation is unknown. We describe the degree to which selected family practices in Nebraska have implemented 15 specific office-based activities. METHODS: We employed a cross-sectional integrated multimethod design. A research nurse observed a target physician and his or her staff during a 1-day visit in a random sample of 89 family practices. Data collection consisted of focused observation of the practice environment, key informant interviews, medical record reviews, and in-depth interviews with the physicians. RESULTS: The majority of the practices sampled had an office environment that restricted smoking, but few used visual cessation messages or information in the waiting room offering help and encouraging patients to quit. Most had educational materials that were supplied by pharmaceutical companies for promoting nicotine replacement systems. These materials were easily accessible in more than half of the practices. Smoking cessation activities were initiated and carried out by physicians with minimal use of their staff. Smoking status was documented in 51% of the medical records reviewed but seldom in a place readily accessible to the physician. All physicians were very aware of the importance of smoking cessation counseling, and most felt confident in their skills. CONCLUSIONS: Despite identification of patient smoking as a problem, most practices were not using office-based activities to enhance and support physician counseling. New perspectives for helping practices with this task need to be explored.

Cross-Sectional Studies↗

PubMed2004

Telephone-based treatment for family practice patients with mild depression.

The need for treating milder forms of depression has recently been of increased interest. This was a randomized, controlled study to evaluate the effects of telephone-based problem-solving therapy for mild depression. Comparison groups were a treatment-as-usual group and another group receiving stress-management training by telephone. From 1,742 family practice patients screened for depression, 54 with mild depression entered the study. Treatment was provided by experienced family practice nurses, trained and supervised in the treatments. The Hamilton Rating Scale for Depression was administered before and after the intervention period, and the Beck Depression Inventory and Duke Health Profile were administered at the end of the intervention period. Of the 36 subjects assigned to the problem-solving and stress-management groups, half dropped out early in the study. Five from the treatment-as-usual group were lost to follow-up. In the remaining subjects, there was a significant decrease in depression scores. There were no significant differences in the amount of decrease between the groups on any scores. The small sample and high dropout rate limit the interpretation of the findings. However, since all subjects tended to improve, regardless of treatment received, mild levels of depression may generally remit even without focal intervention, and watchful waiting may be a reasonable alternative for management.

Adult↗

PubMed1997

Increasing clinical prevention efforts in a family practice residency program through CQI methods.

BACKGROUND: As primary care physicians develop ongoing relationships with their patients, each contact provides another opportunity for primary, secondary, or tertiary prevention activities. In 1991 an interdisciplinary prevention project team using continuous quality improvement (CQI) principles was established to improve family practice residents' provision of such services. DIAGNOSTIC JOURNEY: For a random sample of 60 patient charts, abstractors looked for documentation of 23 clinical preventive services, including nursing screens, physician on-site and off-site implemented services, lifestyle education (diet, tobacco use), and self-screening education. After the chart review, the physicians, nurses, residents, and clinical staff used a fishbone analysis to identify physician-, clinic system-, and patient-centered factors contributing to the lack of conformance with clinical prevention guidelines. REMADIAL JOURNEY: The residency program began a series of didactic sessions on clinical prevention and instituted a procedures rotation to teach prevention procedure skills such as flexible sigmoidoscopy, stress testing, and colposcopy. On the CQI team's recommendation, a checklist developed by physicians and staff which itemized age- and gender-specific clinical prevention services was placed at the front of all patient charts. Clinic-system and patient factors were also addressed. HOLDING THE GAINS--MONITORING PERFORMANCE: The 1993 postintervention chart review showed significant improvements for 17 (81%) of the 21 targeted services. DISCUSSION: Providing educational sessions on prevention, permitting residents to select the areas of prevention on which to focus, and giving feedback on resident and staff performance through ongoing, nonpunitive monitoring resulted in increased provision of clinical prevention services in a family practice residency training center.

Family Practice↗