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PubMedDate not supplied

A comparison of the content of army family practice with nonfederal family practice.

BACKGROUND: To assist with planning for education and practice, family physicians should know the practice content of their practices. The present study compared the content of nonfederal family practice with Army family practice to explore their differences. METHODS: This was a secondary analysis that compared the similar variables within two national data sets: The National Ambulatory Medical Care Survey and the Army's Ambulatory Care Data Base. RESULTS: Army patients were younger and more likely to be female than were nonfederal patients. Army family physicians spent more time with patients in all groups than did nonfederal family physicians. While 12 of the top 20 diagnosis clusters of each sector were the same, there were differences found in the percentages of total visits contained within the top 20 clusters. CONCLUSIONS: Both nonfederal and Army family practice have a wide variation in patients and diagnoses. The two sectors are different in patient age and the frequency of different diagnoses. Knowledge of these differences can assist with planning.

Adolescent↗
PubMed1996

Responsibility taking and role definition in family practice: effect of training and practice setting.

There is evidence that family physicians (FPs) reduce health care costs by reducing patient referral to more expensive secondary and tertiary care facilities. Presumably, the effectiveness of FPs in meeting patients' needs is related to their role definition and willingness to assume responsibility. The purpose of this study was to determine the influence of training and practice setting on responsibility taking and role definition of FPs. A previously developed and validated self-administered questionnaire was completed by 153 certified FPs and FP residents from five departments of family practice in Israel. The main independent variables were previous training and practice setting. The main outcome measures were self-reported data on responsibility taking, role boundaries, and reported role performance. The results showed that certified FPs were more willing to assume responsibility, to define broader role boundaries, and to perform more specialized interventions than residents. Differences in practice setting affected only reported performance, with physicians who practice in rural clinics performing more specialized activities than those in urban clinics. Multiple regression analysis shows that professional development is associated with an increased willingness to assume responsibility; this willingness affects role boundaries definitions, which affects reported performance. Practice setting alters the tendency to perform a wider range of interventions, but does not affect physicians' attitudes.

Adult↗
PubMed1998

An interactive workshop: An effective means of integrating the Canadian Cardiovascular Society clinical practice guidelines on congestive heart failure into Canadian family physicians' practice.

OBJECTIVE: To use an interactive workship as a means of integrating clinical practice guidelines on congestive heart failure into Canadian family physicians' practice. SETTING: Interested practitioners from the Association des Médecins Omnipraticiens de Québec, the Centre de Santé Publique de Québec and the continuing medical education (CME) department, Merck Frosst Canada, Montreal, formed the initial task force. Train-the-trainer sessions took place in many provinces in a variety of CME settings. DESIGN: The interactive, problem-based workshop was facilitated by local interested general practitioners, while local experts served as consultants to reinforce key messages from clinical practice guidelines and to guide participants through the learning process. MAIN RESULTS: By December 31, 1996, 187 family practitioners and 81 specialists had been trained in train-the-trainer sessions across the country. A total of 1698 general practitioners had participated in over 52 workshops during the same time. Pre- and postworkshop testing indicate that the workshops improved knowledge, and that the knowledge gained during the workshop was retained at three- and six-months' follow-up. Separate chart evaluations conducted before and after the workshop showed that participants provided more complete chart information related to congestive heart failure and that they significantly increased their use of angiotensin-converting enzyme inhibitor therapy after the workshop. Participant evaluation of the workshop also indicates a high index of satisfaction with the presentation and the content of the workshop as being relevant to clinical practice. CONCLUSION: An interactive, problem-based, small group workshop developed by a core group of interested practitioners and guided by local trained facilitators and experts is an effective teaching tool through which clinical practice guidelines can be successfully transferred into clinical practice in a timely and meaningful way.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1991

Obstetric practice patterns among family practice residency graduates.

Obstetric services are a critical health care need in the southeastern United States. Until recently, many family physicians included obstetrics as a part of their practice. In recent years there has been significant attrition from the practice of obstetrics among family physicians. This survey looks at attrition among graduates of the Tuscaloosa Family Practice Residency Program and their practice patterns, as well as the reasons family physicians give for discontinuing obstetric practice. We also discuss implications for residency curricula and remedial measures at the state and national levels.

Alabama↗
PubMed2005

Orthodontic practices in Australasia: practice activity.

OBJECTIVE: To collect baseline data on practice types and services provided by orthodontists in Australia and New Zealand. METHOD: A total of 510 questionnaires was sent and 258 were returned. The response rate was 53 per cent. RESULTS: The average age of respondents was 50 years (SD: 9.8 years) with female orthodontists being younger (Mean: 42.3 years; SD: 6.5). The ratio of responding female to male orthodontists was 1:8.8. Overall, more orthodontists were in solo private practice than associateships or partnerships. New Zealand orthodontists were more likely to be in associateships. Australian orthodontists had twice the number of practices (Mean: 2.4; SD: 1.4) than their New Zealand counterparts (Mean: 1.1; SD: 0.3). Orthodontists estimated they saw a mean of 21.3 (SD: 11.3) patients per day. Older orthodontists saw few patients in a day and spent fewer hours in any practice activity in a week. The mean waiting time for a consultation appointment in the private sector in New Zealand was nearly twice that in Australia. There was a significant association between male orthodontists and referral of patients by general dental practitioners. More than three quarters of respondents incorporated retention fees into the treatment fee. Overall, orthodontists were satisfied with the workload and did not want more orthodontists in their geographical area. CONCLUSION: This study provides a sound basis for consideration of challenges in practice and changes over time.

Adult↗
PubMed1995

Human immunodeficiency virus seroprevalence in community-based primary care practices, 1990-1992. A report from the Ambulatory Sentinel Practice Network.

OBJECTIVE: To estimate the seroprevalence of human immunodeficiency virus type 1 (HIV-1) infection in primary care practices. METHODS: Fifty-four practices in the United States participated in an anonymous, unlinked HIV seroprevalence study between January 1990 and December 1992. Residual blood samples drawn for routine clinical tests from patients 15 to 49 years of age were centrally tested for the HIV-1 antibody for 1 month of each quarter. Information about patient demographics, clinician-recognized risk factors, the known HIV status of the patient, and whether the blood was drawn for HIV testing was recorded with each specimen. RESULTS: Of 21,998 specimens collected, 99 (0.45%) were seropositive. Of these 99 seropositive persons, 31.3% (a seroprevalence of 0.15%) were not suspected by their clinicians of being infected with HIV. Seroprevalences in men (0.96%) exceeded those in women (0.22%), and rates in rural practices (0.18%) were lower than in urban practices (0.71%). Among patients with unsuspected HIV infection, however, the gender differences, especially in rural areas, were less pronounced. Risk factors for HIV infection were infrequently noted. There was an increase in the overall seroprevalence during the 1990 to 1992 study period (0.36% to 0.53%); however, this trend was not statistically significant. CONCLUSIONS: Within a 3-year period, clinicians in at least two of five primary care practices can expect to encounter patients infected with HIV, regardless of practice location. Also, nearly one third of the patients with HIV infection will not be suspected of having this condition by their clinician.

Adolescent↗
PubMed1993

[Professional practice, years of practice in the performance of health prevention and promotion activities in first-line physicians of the Sousse region].

In order to identify the impact of the area of activity and years of practice on doctor's attitudes and practices regarding prevention and health promotion, a survey has been conducted among all primary health care practitioners active in the area of Sousse (central Tunisia). There are more positive attitudes among doctors working in public service as compared with those working in the private sector; however, in practice, the behaviors are similar between the two groups. Although young practitioners are less involved than others in prevention and health promotion activities, the impact of years of practice are not obvious. For both groups, the main obstacles to prevention and health promotion activities are: 1. the doctor's belief that his advice has little impact on individuals' changes of behavior, 2. his perception of the difficulty in changing behavior in general and 3. the lack of time for these activities. In this analysis, at least 2 factors have to be considered: a patients' differential attraction to a specific mode of practice and a doctors' differential attraction to public or private health practice.

Adult↗
PubMed1995

Training and education in practice nursing: the perspectives of the practice nurse, employing general practitioner and Family Health Service Authority.

Continuing training and education, although fundamental to the development of practice nursing, is subject to considerable debate. This paper, by drawing on material from a national qualitative study funded by the Department of Health and Welsh Office, explores the role of continuing training and education from the perspectives of practice nurses, general practitioners, representatives from Family Health Service Authorities (FHSAs), commissioners of community nursing services and managers of community nursing provider units. The paper demonstrates how practice nurses make use of a variety of education and training opportunities and do not seem particularly disadvantaged in their training pathways. Problems, however, have began to emerge. The informal arrangements covering training and education have been felt by many practice nurses, to leave them in a potentially needs might not be so easily accommodated. More generally, the paper concludes that debates about training and education cannot take place without referring to the type of work it is appropriate for a practice nurse to perform. The role expected of general medical services and the general development of primary health care provision, therefore, will influence practice nurses' training and educational needs.

Education, Nursing, Continuing↗
PubMed2000

The development of evidence-based clinical practice guidelines. Integrating medical science and practice.

Practice guidelines are rapidly becoming preferred decision-making resources in medicine, as advances in technology and pharmaceutics continue to expand. An evidence-based approach to the development of practice guidelines serves to anchor healthcare policy to scientific documentation, and in conjunction with practitioner opinion can provide a powerful and practical clinical tool. Three sources of information are essential to an evidence-based approach: a) an exhaustive literature synthesis; b) meta-analysis; and c) consensus opinion. The systematic merging of evidence from these sources offers healthcare providers a scientifically supportable document that is flexible enough to deal with clinically complex problems. Evidence-based practice guidelines, in conjunction with practice standards and practice advisories, are invaluable resources for clinical decision making. The judicious use of these documents by practitioners will serve to improve the efficiency and safety of health care well.

Anesthesiology↗
PubMed2004

Predicting performance times from deliberate practice hours for triathletes and swimmers: what, when, and where is practice important?

In Studies 1 and 2, the authors evaluated deliberate practice theory through analyses of the relationship between practice and performance for 2 populations of athletes: triathletes and swimmers, respectively. In Study 3, the authors obtained evaluations of practice from athletes' diaries. Across athletes, length of time involved in fitness activities was not related to performance. For the triathletes, a significant percentage of variance in performance was captured by practice. This was not so for sprint events for the swimmers, in which gender was a significant predictor. In the diaries, physical activities were perceived as enjoyable. In contrast to the results obtained from questionnaires, enjoyment did not covary with an activity's relevance to improving performance. Although these findings highlight the importance of sport-specific practice, the authors question a domain-independent account of expertise based on deliberate practice.

Adolescent↗
PubMed1999

Patient presentation at medical practices with dental problems: an analysis of the 1996 General Practice Morbidity Database for Wales.

OBJECTIVE: To describe the characteristics of attendances and patients who present to family medical practitioners with oral or dental problems. DESIGN: Secondary analysis of standard consultation data. SETTING: 30 family medical practices in the General Practice Morbidity Database for Wales. SUBJECTS: All patients who presented at the practices with an oral or dental complaint during 1996. RESULTS: Of the 1,650,882 patient attendances at the 30 medical practices in the study year, 4,891 (0.3%) were for oral/dental problems. The frequency of these attendances varied considerably between practices (ranging from 0.02 to 0.67% of all attendances); 44.2% of the attendances included tooth-related problems, and 42.3% were for diseases of soft tissue, salivary glands or the tongue. On average patients with dental problems attended their doctor twice as frequently as other patients. The majority (75%) of oral/dental attendances were related solely to these problems. Patients with tooth-related dental problems were three times more likely to seek treatment at weekends than patients attending for other reasons. CONCLUSIONS: The rate of attendance for oral/dental problems varies substantially between practices, but is generally low. The higher rate of attendance for tooth-related problems at weekends suggests that some of the attendances for oral problems might be related to a perceived or actual lack of dental services at these times.

Adolescent↗
PubMed1994

The role and self-perceived training needs of nurses employed in general practice: observations from a national census of practice nurses in England and Wales.

This paper outlines the results of a national census of practice nurses in England and Wales. It not only shows that the numbers of practice nurses have increased dramatically in recent years but also demonstrates how their role has evolved. Many practice nurses are now involved in health promotion, and home visiting, as well as advice and counselling. The findings also indicate that many practice nurses express a need for training. Continuing education for practice nurses is important in ensuring practice nurses are fully qualified and trained for the tasks they undertake. In addition, it also enables them to develop their role and work alongside other community health professionals.

Adult↗
PubMed2004

[Modular training in practical medicine: electronic evaluation of student education in general practice].

Effective from spring 2004, new regulations for undergraduate medical education in Germany require a two-week practical training in general practice. Similar to other forms of medical education, this practical training should be regularly evaluated by students. With regard to special conditions of the training, we preferred a web based evaluation. Since adequate models were not available, we designed, implemented and tested an electronic way of evaluation. The following aspects turned out to be of special importance: teamwork, time, data protection and cost. Meanwhile, the evaluation is established and still accessible as demo-version for visitors of the home page. This electronic evaluation of medical training in general practice is highly appropriate for a timely evaluation allowing us to obtain a comparison between students' expectations and actual experience as well as a continuous supervision and to provide feedback to the participating practices. This is an important step for quality assurance of medical education in practices inside and outside the university.

Computer-Assisted Instruction↗
PubMed2001

Preparing to practice and manage: A program for educating orthodontic residents in practice management.

The purpose of this article is to describe how the integration of practice management principles into orthodontic graduate programs can help young practitioners avoid many of the mistakes commonly made in developing an orthodontic practice and to provide guidelines and resources for starting off in the right direction. This article also describes how practice management education was integrated as one of the 4 principal components of contemporary orthodontic education at a California university. Specific goals, concepts, and components of a comprehensive practice management program are outlined. A structured practice management curriculum can provide opportunities for residents and alumni to learn some of the latest developments and techniques in orthodontic practice management.

Curriculum↗
PubMed2001

Audit in general practice: how much and how complete? Frequency of audit in general practice.

The aim of this study was to determine the frequency of audit and the proportion completed in a group of practices. Data obtained by interviewing a member of each practice and inspecting practice records were independently coded by researchers. Practices initiated an average of 3.5 (range 1-7) audits in 2 years, of which an average of 0.9 (range 0-3) were completed. Ten of 16 completed audits were externally funded or facilitated. Few audits are completed in general practice and practices require continuing support for audit.

Abstracting and Indexing↗
PubMed2002

General practice-specific care categories: a method to examine the impact of morbidity on general practice workload.

BACKGROUND: Governments are increasing pressure on GPs to provide better services to their patients without giving consideration or due recognition to the impact of those initiatives on their already heavy workload. OBJECTIVE: This pilot study aimed to measure accurately the impact of case mix on general practice workload. METHOD: The general practice-specific care category (GP-SCC) model was developed and applied to a random sample of patients who attended a four-doctor suburban practice four or more times between July 1995 and June 1997. RESULTS: The random sample comprised 245 patients (126 males, 119 females) out of a total practice population of approximately 4000. The mean patient age was 42.7 years (CI 39.6-45.8; range: 0-95). The mean patient consulted 10.70 times (CI 9.62-11.77) and discussed 13.19 health problems (CI 11.74-14.63), which equated to 1.20 problems per consultation (CI 1.17-1.23). The ambulatory case mix concept allowed the development of the GP-SCC model--defined as GP-SCC 1, acute/self-limiting problems and preventive care; GP-SCC 2, primarily chronic health problems; GP-SCC 3, psychological problems in conjunction with up to two other problem categories; and GP-SCC 4, a combination of four or more problem categories. GP-SCC 1 comprised 31.1% of patients (CI 29.1-35.1), accounting for 25.6% of visits (CI 24.0-27.3) and 21.9% of all problems encountered (CI 20.5-23.3); GP-SCC 2 comprised 16.7% of patients (CI 10.6-19.6), accounting for 10.6% of visits (CI 9.5-11.9) and 9.9% of all problems encountered (CI 8.9-11.0); GP-SCC 3 comprised 7.1% of patients (CI 4.4-11.2), accounting for 7.8% of visits (CI 6.8-8.9) and 7.7% of all problems encountered (CI 6.8-8.7); and GP-SCC 4 comprised 42.0% of all patients (CI 35.8-48.2), accounting for 56.0% of all visits (CI 54.2-57.8) and 60.5% of all problems encountered (CI 58.8-62.2). CONCLUSIONS: The GP-SCC model, built on the ambulatory case mix concept, is a useful tool to analyse the morbidity of practice populations, and has a good predictive value in terms of a practice' workload.

Adult↗
PubMed2002

Continuity in UK general practice: a multilevel model of patient, doctor and practice factors associated with patients seeing their usual doctor.

BACKGROUND: Personal continuity is a 'core value' for UK general practice, but often appears ignored by organizational change. OBJECTIVES: The aim of the present study was to examine practice, GP and patient factors associated with personal continuity of care. METHODS: A cross-sectional survey was carried out of 25 994 people aged >15 consulting over a 2-week period in 53 general practices in four regions of the UK. The outcome measure was whether or not the patient was seeing their usual or regular doctor. RESULTS: Compared with the smallest quintile of practices, the odds ratios [95% confidence interval (CI)] for patients seeing their usual doctor for the two largest quintiles of list size (6337-11 036 and >11 037) were 0.24 (0.12-0.46) and 0.19 (0.10-0.37). Patients in the five practices with personal list systems were more likely to be seeing their usual doctor (odds ratio 3.27, 95% CI 1.87-5.70). Older patients were considerably more likely to be seeing their usual doctor. Young men were less likely, but by middle age there were no differences between men and women. Compared with patients who only wished to discuss a new or urgent physical problem, those wishing to discuss psychological (odds ratio 2.28, 95% CI 2.01-2.58) or longstanding physical problems (odds ratio 1.92, 95% CI 1.78-2.08) were more likely to be seeing their usual doctor. CONCLUSIONS: In this study, list sizes over approximately 6000-6500 were associated with marked reductions in personal continuity. If GPs are serious about the importance of personal continuity, then the size of the primary care team needs to be examined. There may be potential in separating the administrative functions of the practice from the clinical functions of the primary care team.

Adult↗
PubMed2004

Isolation, flexibility and change in vocational training for general practice: personal and educational problems experienced by general practice registrars in Australia.

BACKGROUND: GP registrars, in common with other doctors, frequently experience high levels of stress; however, little is known about the nature and outcomes of personal and educational problems experienced during vocational training for general practice. OBJECTIVES: The purpose of our study was to elicit the nature, causes and effects of more severe problems experienced during vocational training for general practice from the registrar's viewpoint and put these into the context of their personal circumstances and background. METHODS: This qualitative study used detailed semi-structured telephone interviews with a selected subgroup of 33 of the 1999 entry cohort of general practice registrars in Australia who had reported serious self-defined problems during an earlier longitudinal questionnaire study. Registrars were asked about the nature, antecedents and outcomes of problems experienced during GP training, actions taken to resolve the problem, and their perceptions of what might have helped prevent or minimize the problem. RESULTS: Problems reported by registrars fell into five major themes: isolation (structural isolation, social isolation and professional isolation); flexibility and choice (administrative issues and balancing work with personal life); change and uncertainty (within general practice and training, intergenerational changes); teaching problems; and work conditions. Actions taken and effects of problems are also discussed in the light of workforce imperatives. Results have been used to develop a list of suggestions for the providers of general practice training. CONCLUSIONS: Registrars commonly experience problems during vocational training. These may be related to structural, social and professional isolation, or a lack of flexibility in training arrangements and balancing work and other commitments. Some of these problems may be amenable to relatively simple solutions involving term placements, selection of training practices and administrative adjustments.

Attitude of Health Personnel↗