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PubMed1994

Screening for hazardous drinking. Using the CAGE and measures of alcohol consumption in family practice.

OBJECTIVE: To determine the drinking practices of a family practice population, to examine the CAGE and questions about drinking as a method of screening for hazardous alcohol use, and to examine the relationship between alcohol consumption and CAGE items, particularly in a subgroup of hazardous drinkers. DESIGN: Random survey of patients representative of a clinic population. SETTING: Family practice clinic. PATIENTS: Of 1420 patients approached while waiting to see a family physician for medical reasons, 1376 agreed to participate; 1334 turned in usable questionnaires. MAIN OUTCOME MEASURES: Drinking measures and CAGE items; CAGE questions and levels of alcohol use were used to determine current drinking practices. A subgroup of hazardous drinkers was examined in greater detail. RESULTS: Forty percent of male patients and 11% of female patients reported at least one "hazardous" drinking (four or more drinks) day in the past month. Answering yes to CAGE items was more specific to drinking for male subjects, who also reported a greater number of maximum drinks with a CAGE score of 2 or more. CONCLUSIONS: This brief questionnaire was a feasible tool for identifying family practice patients who could be at risk for developing alcohol problems. All patients could be invited to complete the questionnaire while waiting for their appointments.

Adolescent↗
PubMedDate not supplied

Anticipating the future: a national survey of family practice residency directors.

The directors of family practice residencies were surveyed to measure the effect on family practice of the multitude of recent changes in medical organization and practice. The survey achieved a response rate of 80% (N = 306) and revealed that 90% of program directors were generally optimistic about the current status and future vigor of the specialty. Of the respondents, 72% expressed positive opinions regarding the effects of HMOs, and 93% perceived sufficient availability of practice opportunities. Due in large part to these perceptions, only 11% supported a proposal to combine family practice and internal medicine residencies. Teachers of family medicine are encouraged to pass along these measures of positive growth and optimism to medical students considering the specialty of family practice.

Career Mobility↗
PubMed2003

Perception of competency to perform procedures and future practice intent: a national survey of family practice residents.

PURPOSE: A national survey of family practice (FP) chief residents to identify the type of procedural skills they have completed, assess their perceptions of competence to perform those procedures, and identify the procedures they anticipate performing in practice. METHOD: A questionnaire asking about training and competency in 31 core procedures for family medicine (FM) was developed from the literature and pilot tested on residency directors for face validity and clarity. The questionnaires were mailed to chief residents at the 463 FM residency programs in the United States between July and October 2001. RESULTS: A total of 265 (57%) questionnaires were returned. Ninety-six percent of respondents were PGY3 seconds, and 40% were women. All residents had performed excision of a lesion, drainage of an abscess, and simple suturing. Residents were least likely to have performed vasectomy (46%), thoracotomy (41%), and rigid sigmoidoscopy (34%). The mean number of procedures performed during residency and the number of procedures the resident intended to perform in practice differed by gender. Residents who planned to practice in rural areas anticipated performing more procedures than did those who planned to practice in suburban areas (20 versus 17; p >/=.001). Over 90% of residents felt competent to perform obstetrics, but fewer than 50% planned to in practice. CONCLUSION: Despite reports that core procedural skills are taught, this study suggests significant numbers of residents are not being taught certain procedures in a manner that results in residents feeling competent to perform them.

Clinical Competence↗
PubMed1997

[The practice nurse in British Family practice. Lessons for Dutch experiments].

In the Netherlands, experiments are taking place in which nurses work in general practice with physicians. In the United Kingdom, so-called practice nurses have been working in general practice since the 1960's. In this article, the experiences in the United Kingdom with the practice nurse are outlined. The focus is on the lessons that can be learned from these experiences. In the United Kingdom, the majority of practice nurses are employed by general practitioners. The most important reason for introducing nurses into the general practice setting was to decrease the physicians' workload. The practice nurse in the United Kingdom has evolved from a 'cheap, task-oriented practice assistant' to a more or less autonomous colleague of the general practitioner. The practice nurses' activities vary greatly. Problems encountered in the United Kingdom primarily concern the lack of training, the absence of a clear definition of the function and responsibilities and the problems associated with working conditions which result from the employment contract with a specific general practitioner. The previously mentioned Dutch experiments show a great deal of variation in terms of the nurses' activities and their position within general practice. Consequently, the development of a clear definition of the function and an adequate training programme are also difficult in the Dutch situation. An additional point of consideration for the Dutch situation is the difference in tasks and responsibilities between the practice nurse and other nurses employed in primary care settings.

Clinical Competence↗
PubMed1980

Attitudes toward the geriatric patient among family practice residents.

For the Family Practitioner, elderly patients are a highly significant group. In the past, some health professionals have expressed negative attitudes toward the elderly. Thus a need exists to study specific factors that may influence a Family Practice resident's willingness to treat older patients. A Likert-type questionnaire was developed that utilized the Thurstone-Likert discrimination technique. Five categories were chosen for study: general attitudes, cost effectiveness, time and energy, therapeutic potential, and educational preparation. Responses of 150 Family Practice residents were then analyzed. The attitudes of the residents were significantly positive in all categories except Educational Preparation. Noteworthy was the finding that the attitudes improved from the first year through the third year of residency. This is the first medical specialty group to demonstrate such a trend. Certain negative attitudes observed in the Educational Preparation category re-emphasize the need for training programs to improve professional geriatric instruction.

Aged↗
PubMedDate not supplied

Family practice maternity care in America: ruminations on reproducing an endangered species--family physicians who deliver babies.

BACKGROUND: The majority of family physicians do not deliver babies. One reason might be the family physician's intrinsic comfort with person- or patient-centered care compared with the common obstetric approach of disease or physician-centered maternity care. Another reason might be the uncritical intrusion of technology into maternity care. In addition, family physicians often are made to feel unwelcome in many maternity care systems. METHODS: The medical literature from 1984 to 1994 was searched for the topics of obstetrics, maternity care, family-centered birthing, and family practice education. Reasons to argue whether family physicians should provide maternity care were selected, and articles were chosen that described the self-reported reasons students, residents, or physicians give whether to provide maternity care. RESULTS AND CONCLUSIONS: There is no scientifically supportable reason for excluding family physicians from maternity care in any setting, and the current maternity care system, in many locations, creates an attitude of taught helplessness among family physicians. In addition, family practice educators must for a variety of reasons be the primary role models and teachers of family-centered birthing for family practice learners. Generally, the groups that should be involved in providing maternity care in the future should include (1) better informed and more independent pregnant patients, (2) maternity care nurses, (3) doulas, (4) midwives, (5) family physicians, and (6) specialized physicians. Specifically, family physicians and midwives have a historic and philosophic similarity that would argue for a much closer working and practicing relationship between these two professionals. Family-centered birthing provides excellent outcomes. Birthing is both foundational and intrinsic to family practice. Conversely, without family physicians maternity care in America might not be able to reach its full potential.

Attitude of Health Personnel↗
PubMed1980

Non-rotational teaching of obstetrics in a family practice residency.

The E. W. Sparrow Family Practice Residency Program has developed a unique system of training family practice residents in obstetrics. A continuous obstetrical training experience is provided on a non-rotational basis over the three-year residency training period. This experience has been arranged through the creation of the family practice obstetrical population, the use of family practice faculty as primary teachers, and the use of residents and faculty in obstetrics-glynecology as consultants. Extensive documentation and evaluation is used to allow residents to progress through varied levels of privileges in preparation for private practice.

Curriculum↗
PubMed1982

Factors influencing family practice residency selection: a national survey.

The changes in family practice residency selection from 1978 to 1981 were studied by means of a questionnaire, and selection of family practice residency was identified by region. The relationship between the administrative status of family practice (department, division, or no formal unit) and selection of family practice residency was studied, and the opinions of medical school faculty respondents were sought concerning why interest in family practice has increased (or decreased) at their institution. The average percentage of graduates selecting family practice residency varies by region. Schools with stronger institutional commitment to family practice, as evidenced by departmental status, have a higher percentage of graduates entering family practice. Respondents felt that the presence or absence of student contact with family practice was the most important reason for changes seen in residency choice.

Career Choice↗
PubMedDate not supplied

Choosing to do obstetrics in practice: factors affecting the decisions of third-year family practice residents.

To investigate factors influencing a resident's decision to participate in obstetrical care, a survey was undertaken of program directors and third-year residents from the 16 Michigan family practice residency programs. Responses indicated that the majority of third-year residents (55%) intended to practice obstetrics on graduation. Rural practice plans were significantly correlated with a decision to practice obstetrics, but suburban practice plans were negatively correlated. Residents who reported the presence of a good family practice obstetric role model were significantly more likely to practice obstetrics; residents deciding against obstetrical practice expressed concerns about legal liability and malpractice fees. These findings have important implications for family practice training programs if obstetrics is to remain a central part of comprehensive family care.

Career Choice↗
PubMed1995

Current health policy initiatives and options. New-to-practice family physicians' attitudes.

OBJECTIVE: To obtain information about new-to-practice family physicians' attitudes toward current health policy options and initiatives. DESIGN: Cross-sectional, mailed survey. SETTING: Ontario family practices. PARTICIPANTS: Residency-trained Ontario family physicians (395 of 564 eligible physicians replied) who were certified between 1989 and 1991. MAIN OUTCOME MEASURES: Extent of approval or disapproval for 14 health policy options and initiatives. RESULTS: A 70% response rate was achieved. More than half of surveyed physicians expressed approval for shifting resources from acute care into preventive care and health promotion (71.6% approved), stricter immigration requirements to limit licensing of foreign physicians in Canada (60.4%), offering physicians salaries as an alternative to fee-for-service (54.0%), and incentives to physicians who wish to practise in community health centres or other forms of salaried group practice (51.1%). Some diversity of opinion was associated with sex, type of practice, primary source of remuneration, and practice location. CONCLUSIONS: These new-to-practice family physicians display diverse views and should not be seen as sharing a single opinion of health care policy options and initiatives. Many approve of changes to the health care system or are willing to consider policy alternatives.

Adult↗
PubMed2003

Boundaries and family practices: implications for assessing child abuse.

Family practices related to hygiene, affection behavior, and privacy were studied using a sample of mental health and child welfare professionals. The professionals were asked to use their own experience to state up to what age it was acceptable for parents and children of the same gender and mixed gender to engage in certain family practices. For virtually all family practices, respondents reported lower appropriate ages for mixed gender pairs. Family practices were acceptable for mothers with their daughters up to older ages than fathers with their sons. Results indicate high variability in the responses regarding appropriate ages, as well as whether the behavior was ever acceptable. The implications of these substantial differences among professionals who often assess these practices as "soft signs" related to abuse are discussed.

Adult↗
PubMed1994

Focus groups in family practice research: an example study of family physicians' approach to wife abuse.

Focus groups have been extensively used in marketing research and recently adapted for studies in the behavioral sciences and primary care. The purpose of this paper is two-fold: 1) to describe the application of focus group methodology to research in family practice, and 2) to demonstrate the use of this qualitative method to examine a specific issue--family physicians' approach to wife abuse.

Adult↗
PubMed1977

The Residency Assistance Program in family practice.

The Residency Assistance Program in family practice was inaugurated in September 1975 as a plan to mobilize and finance the matching of consultant expertise in family practice residency education with program directors desiring to improve the quality of their residency programs through consultative assistance. The Residency Assistance Program is administered by a Project Board composed of representatives of four national family practice organizations. A panel of 30 consultants, carefully selected by the Project Board, are prepared for rendering effective consultative services through intensive training in consultative skills. They operate under the guidance of concensually developed standards for quality graduate education in family practice. Consultations are only scheduled at the written request of a residency program director. The confidential, nonpunitive, and voluntary nature of a Residency Assistancy Program consultation is carefully guarded, because it is felt that these qualities enhance the information-sharing, collaborative problem-solving nature of the consultative process. This paper describes the development, features, and operational process of this Program.

Attitude of Health Personnel↗
PubMed1993

The statistical power of family practice research.

To determine the statistical power of family practice research, we conducted a survey of all family practice studies published in 3 major family practice journals in 1988. Only 5 of 86 studies calculated statistical power, although 67 (78%) reported statistically nonsignificant results. Calculations of statistical power revealed that more than 80% of family practice studies had sufficient statistical power to detect medium to large effect sizes, but not small effect sizes, which some readers might deem clinically important. We conclude that the authors of family practice research studies do not pay enough attention to the issue of statistical power when reporting statistically nonsignificant results, leaving their readers in doubt as to whether a clinically significant effect could have been detected.

Data Interpretation, Statistical↗
PubMed2002

Put prevention into practice (PPIP): evaluating PPIP in two family practice residency sites.

BACKGROUND AND OBJECTIVES: The Put Prevention Into Practice (PPIP) office system is a set of office tools designed to address physician, patient, and system barriers to the provision of clinical preventive services. This study evaluated the effect of using PPIP on the delivery of clinical preventive services at two family practice residency sites. METHODS: After a careful planning process at each clinic, a 1-year trial was conducted with implementation of PPIP at two residency sites compared to two control residency sites. The subjects included adults age 19 and older Data were collected via chart extraction on 300 randomly selected patients per clinic for the following three outcomes: health risk factor assessment (for limited physical activity, poor nutrition habits, and tobacco use), health promotion/counseling (for nutrition, physical activity, and tobacco use), and screening rates (clinical breast exam, cholesterol, fecal occult blood test, mammography, and Pap smear). RESULTS: Only inconsistent or sporadic differences in risk factor assessment, health promotion counseling, and screening were seen when comparing implementation and control sites. CONCLUSIONS: PPIP had little effect on the delivery of clinical preventive services. Future research should include a careful analysis of the users of PPIP and the environments in which they practice.

Adult↗