Biomedical subjects

T S Nesbitt

Publications and source records attributed to T S Nesbitt.

16 recordsLinked to original sources

PubMed1995

A comparison of the investment in hospital-based obstetrical ultrasound in Wales and Washington state.

The purpose of this study was to examine differences in the way Britain and the United States invest in and deploy a new medical technology. We used structured interviews to obtain information on the technical sophistication and approximate replacement value of all hospital-based obstetrical ultrasound machines in every maternity hospital in Washington state and Wales. The supply of hospital-based ultrasound machines--approximately two machines per 1,000 births--was similar in both countries. Wales had fewer advanced ultrasound machines than Washington state, and they were based exclusively in high-volume district general hospitals; there were no obstetric ultrasound machines in the private sector. In Washington state, the majority of advanced machines were in small and medium-sized hospitals, and many private offices had ultrasound machines. The approximate replacement value of hospital-based machines was three times as high per birth in Washington state as in Wales. In the case of obstetrical ultrasound, centralization of facilities, a relatively small private sector, and global budgeting lead to lower expenditures per patient within the National Health Service without compromising access to care.

Birth Rate↗

PubMed1994

The advanced life support in obstetrics course. A national program to enhance obstetric emergency skills and to support maternity care practice.

Unexpected emergencies occur during routine maternity care. Perceived or actual deficiencies in training may decrease the quality of care and increase liability risks and anxiety among providers. This may lead the provider to discontinue obstetrics, which results in problems in access to care. To improve the training for obstetric emergency management, an Advanced Life Support in Obstetrics (ALSO) course was developed. This skill-enhancing course, modeled after other life support courses, is designed to improve the quality and availability of maternity care through standardized training in the management of emergencies and improved communication between maternity care providers. A total of 1315 physicians and nurses attended 35 ALSO courses from 1991 through 1993. Seventy-six percent were family physicians in practice; 20% were from rural areas. About 15% were in hospitals with no obstetricians or pediatricians on staff. Attendees reported a significant increase in their level of comfort in the management of obstetric emergencies and a greater intention to continue maternity care.

Adult↗

PubMed1994

The diffusion of obstetric technology into rural U.S. hospitals.

We determined the distribution and sophistication of obstetric technologies in all 80 maternity hospitals in the state of Washington and examined the effect of rural or urban location, birth volume, and physician staffing on technological intensity. Although smaller and more rural hospitals refer most premature and low-birth-weight infants to regional referral centers, sophisticated prenatal and intrapartum technologies are available in the majority of even the smallest and most remote rural units. Rural hospitals have slightly lower obstetrical intervention rates than do their urban counterparts, but the differences are not great.

Female↗

PubMed1994

Trends in maternity care by graduates and the effect of an intervention.

BACKGROUND AND OBJECTIVES: Only 24% of family physicians in the United States deliver babies, a figure that declined remarkably during the decade of the 1980s. This study examines the content of practice, with regard to maternity care, of graduates of the University of California, Davis Family Practice Residency Network over the past 20 years, and the effectiveness of residency training intervention designed to increase maternity care activity among graduates. METHODS: Using a mailed survey instrument, graduates of the UC Davis Family Practice Residency Network have been periodically surveyed on practice characteristics since 1978. Using data from these surveys, maternity care and other practice characteristics of all graduates were analyzed using descriptive statistics. Data on trends in maternity care of two groups of residents who graduated a decade apart were evaluated. A separate evaluation of the two most recent graduating classes was performed to evaluate an intervention at the Network's university-based program. The program had been designed to increase the number of graduates who provide maternity care. RESULTS: Survey responses from previous graduates of the six network programs showed that only 31% included maternity care in their practices at the time of the 1991 survey. Sixty-one percent of a cohort of graduates from a 3-year period from 1979 through 1981 included maternity care upon entering practice. The 3-year cohort of residents graduating a decade later, during the years 1988-1990, had an initial participation rate in maternity care of only 37% in 1991. However, only 11% of the graduates from the university-based program in the 1988-1990 cohort made an initial decision to include maternity care in their practice. For the graduates of this program from 1991 and 1992, a period following the specific intervention, participation in maternity care increased to 50%. CONCLUSIONS: This study documents the decrease in interest in providing obstetrical services by recent family practice residency graduates when compared to graduates a decade earlier. Further, it suggests that residency programs, even with very low rates of participation in maternity care, can increase the interest and participation of residents to include these services in their practices after graduation.

California↗

PubMed1993

Is being a doctor still fun?

Over the past two decades, a decline in physician job and career satisfaction has been reported. This study was developed to determine the current state of physician satisfaction and to define factors correlated with overall satisfaction. We mailed a survey to 406 physicians in Solano County, California. Responses were anonymous, and data were analyzed by several methods. Of the 406 physicians, 251 (62%) responded. Most respondents were satisfied with their jobs (80%). The vast majority felt good about their ability to help their patients (92%), enjoyed the relationships they had with patients (93%) and colleagues (86%), and found their work intellectually satisfying (89%). Nearly two thirds (63%) of respondents thought their job was "fun." This ability to derive great pleasure from work showed the strongest correlation with overall satisfaction. Overall satisfaction did not differ between primary care and non-primary care physicians or between physicians in a large health maintenance organization and those in mostly solo and small-group fee-for-service practices. Despite substantial challenges to physician morale and autonomy, most responding physicians in our study continued to enjoy overall job satisfaction, and a solid majority thought that their work was fun.

Humans↗

PubMed1993

Access to obstetric care.

Initially, this article examines the relationship between access to components of obstetric care and birth outcomes. It goes on to describe the significant decline in physician participation in obstetrics and its possible relationship to increasing rates of late or no prenatal care in the United States. The limitations of obstetric capacity and future access to providers of obstetric care in the United States versus Canada are explored. The article concludes with a discussion of strategies for improving access to obstetric care.

Female↗

PubMed1992

Factors influencing family physicians to continue providing obstetric care.

To determine the reasons some family physicians continue to practice obstetrics when most of their colleagues do not, we surveyed family physicians in 26 counties of northern California whose practices include obstetrics and those who have recently discontinued it. In all, 70% of family physicians practicing obstetrics cited enjoying it as a reason for continuing this practice. Over a third of family physicians practicing obstetrics thought that obstetric practice was a responsibility to the community. Only 1 in 6 reported obstetrics to be important in terms of financial implications. Despite this, family physicians practicing obstetrics had a mean gross income derived from obstetric practice of $30,000 above the cost of their total malpractice premium. In contrast, a comparison group of family physicians who had recently discontinued obstetrics cited malpractice insurance costs most frequently as the reason for discontinuing it. Nearly 40% of these physicians indicated that they would be willing to return to obstetrics if circumstances were to change substantially. The most frequently cited change necessary for these physicians to return to obstetrics was a reduction in malpractice insurance rates.

California↗

PubMed1992

Teaching family-centered perinatal care in family medicine, Part 2.

Pregnancy, childbirth, postpartum, and infant care are a continuum in the family life cycle for which the family physician is especially qualified to provide primary, comprehensive care. The purpose of this paper is to document and share the controversies, wisdom, and knowledge about caring for women and their families before, during, and after pregnancy. Family physicians can be leaders in developing an appropriate perinatal care system for the community. The level of care the family physician chooses to provide is discretionary. However, the family physician should be invested in ensuring that all families receive the greatest benefit from pregnancy, birth, and the newborn experience. Interest in perinatal care in family medicine is increasing, as reflected by the growing numbers participating in the Society of Teachers of Family Medicine Working Group on Family-Centered Perinatal Care. The authors of this article, who are active in this working group, hope that this information is useful in designing a balanced curriculum and delivery system for perinatal care in family medicine training programs.

Anesthesia, Obstetrical↗

PubMed1991

Obstetric care, Medicaid, and family physicians. How policy changes affect physicians' attitudes.

Recent expansion of Medicaid eligibility for pregnant women and increased reimbursement to physicians who provide perinatal services were designed to improve access to care. Family physicians provide a relatively high proportion of care to pregnant women on Medicaid, especially in rural areas. We surveyed all family physicians who provide obstetric services in 26 northern California counties regarding these changes and perceived barriers to providing obstetric care to women on Medicaid. Of surveyed physicians who limited the number of their Medicaid obstetric patients, 58% stated that recent Medicaid policy changes had increased their willingness to accept new Medicaid obstetric patients. Despite these policy changes, administrative issues and poor reimbursement were cited as the two most notable barriers to providing obstetric care to women on Medicaid. Fear of being sued by Medicaid patients is still seen as a barrier by physicians who have recently discontinued practicing obstetrics and by those who continue to care for a large number of Medicaid obstetric patients.

Attitude of Health Personnel↗

PubMed1990

Access to obstetric care in rural areas: effect on birth outcomes.

Hospital discharge data from 33 rural hospital service areas in Washington State were categorized by the extent to which patients left their local communities for obstetrical services. Women from communities with relatively few obstetrical providers in proportion to number of births were less likely to deliver in their local community hospital than women in rural communities with greater numbers of physicians practicing obstetrics in proportion to number of births. Women from these high-outflow communities had a greater proportion of complicated deliveries, higher rates of prematurity, and higher costs of neonatal care than women from communities where most patients delivered in the local hospital.

Adolescent↗

PubMedDate not supplied

Will family physicians really return to obstetrics if malpractice insurance premiums decline?

BACKGROUND: The loss of family physicians as obstetrics providers during the last decade has had a significant impact on access to obstetric services, especially for rural populations. The expense of malpractice premiums has been cited often as a reason for physicians' discontinuation of this service. METHODS: Seventy-six family physicians in northern California who recently discontinued obstetrics were surveyed regarding their decisions related to obstetric practice. Those physicians who indicated that a decrease in malpractice premiums would allow them to consider resuming obstetrics were resurveyed by telephone the following year. This telephone survey occurred following a 25 percent decrease in malpractice premiums for obstetrics by the major malpractice insurance carrier for family physicians practicing obstetrics in the study area. RESULTS: Twenty-nine of the 76 physicians in the original survey who had recently discontinued obstetrics stated they would consider resuming if conditions changed. Twenty-six (90 percent) of these physicians indicated that malpractice premiums needed to change for them to consider resuming obstetrics. Following the reduction in premiums, none of these physicians reported plans to resume obstetrics or even a likelihood that they would be resuming obstetrics. CONCLUSION: This study found that family physicians who discontinued obstetrics and cited malpractice premiums as a barrier to resuming obstetrics are unlikely to resume when rates decline. This finding suggests that other issues might be equally or more important in this decision.

Adult↗

PubMedDate not supplied