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PubMedDate not supplied

Assessing the impact of psychological intervention on family practice clinic visits.

The effects of brief psychological intervention on rates of medical utilization were investigated in a family practice clinic. Patients referred to the psychology service served as experimental subjects. These subjects underwent psychological assessment and treatment from supervised clinical psychology externs in joint working arrangements with family practice residents. Control subjects were other family practice patients, matching the experimental group in age, sex, and race. The number of medical visits to the family practice clinic, specialty clinics, and the emergency room were the dependent measures. The study period was two years. Results indicated that the experimental subjects were more likely than control subjects to decrease medical utilization of the family practice clinic. The findings are consistent with earlier work showing an association between brief psychosocial intervention and decreases in the frequency of clinic visits. However, this study suggests that preinternship-level clinical psychology trainees can be equally as effective in providing this intervention as mental health professionals who have completed their training.

Adolescent↗
PubMed2000

Entry of US medical school graduates into family practice residencies: 1999-2000 and 3-year summary.

This is the 19th report prepared by the American Academy of Family Physicians (AAFP) on the percentage of each US medical school's graduates entering family practice residency programs. Approximately 13.4% of the 16,143 graduates of US medical schools between July 1998 and June 1999 were first-year family practice residents in 1999, compared with 15.4% in 1998 and 16.6% in 1997. Medical school graduates from publicly funded medical schools were almost twice as likely to be first-year family practice residents in October 1999 than were residents from privately funded schools, 16.2% compared with 9.3%. The West North Central region reported the highest percentage of medical school graduates who were first-year residents in family practice programs in October 1999 at 20.6%; the Middle Atlantic and New England regions reported the lowest percentages at 7.7% and 8.0%, respectively. Nearly half of the medical school graduates (48.4%) entering a family practice residency program as first-year residents in October 1999 entered a program in the same state where they graduated from medical school. The percentages for each medical school have varied substantially from year to year since the AAFP began reporting this information. This article reports the average percentage for each medical school for the last 3 years. Also reported are the number and percentage of graduates from colleges of osteopathic medicine who entered Accreditation Council for Graduate Medical Education-accredited family practice residency programs, based on estimates provided by the American Association of Colleges of Osteopathic Medicine.

Education, Medical, Graduate↗
PubMed2001

Entry of US medical school graduates into family practice residencies: 2000-2001 and 3-year summary.

This is the 20th report prepared by the American Academy of Family Physicians (AAFP) on the percentage of each US medical school's graduates entering family practice residency programs. Approximately 12.8% of the 15,825 graduates of US medical schools between July 1999 and June 2000 were first-year family practice residents in 2000, compared with 13.4% in 1999 and 15.4% in 1998. Medical school graduates from publicly funded medical schools were almost twice as likely to be first-year family practice residents in October 2000 than were residents from privately funded schools, 15.6% compared with 8.7%. The West North Central region reported the highest percentage of medical school graduates who were first-year residents in family practice programs in October 2000 at 18.2%; the Middle Atlantic and New England regions reported the lowest percentages at 8.3% and 6.8%, respectively. Nearly half of the medical school graduates (47.0%) entering a family practice residency program as first-year residents in October 2000 entered a program in the same state where they graduated from medical school. The percentages for each medical school have varied substantially from year to year since the AAFP began reporting this information. This article reports the average percentage for each medical school for the last 3 years. Also reported are the number and percentage of graduates from colleges of osteopathic medicine who entered Accreditation Council for Graduate Medical Education-accredited family practice residency programs, based on estimates provided by the American Association of Colleges of Osteopathic Medicine.

Career Choice↗
PubMed2002

Validating an instrument for selecting interventions to change physician practice patterns: a Michigan Consortium for Family Practice Research study.

OBJECTIVES: The goal of this study was to develop a psychometric instrument that classified physiciansamprsquo response styles to new information as seekers, receptives, traditionalists, or pragmatists. This classification was based on specific combinations of 3 scales: (a) belief in evidence vs experience as the basis of knowledge, (b) willingness to diverge from common or previous practice, and (c) sensitivity to pragmatic concerns of practice. The instrument will help focus efforts to change practice more accurately. STUDY DESIGN: This was a cross-sectional study of physician responses to a psychometric instrument. Paper-and-pencil survey forms were distributed to 3 waves of physicians, with revision for improved internal consistency at each iteration. POPULATION: Participants were 1393 primary care physicians at continuing education events in the Midwest or at primary care clinic sites in the Veteransamprsquo Health Administration system. OUTCOMES MEASURED: Internal consistency was measured by factor analysis with orthogonal rotation and Cronbachamprsquos alpha. RESULTS: A total of 1287 usable instruments were returned (106, 1120, and 61 in the 3 iterations, respectively), representing approximately three fourths of distributed forms. Final scale internal consistencies were a = 0.79, b = 0.74, and c = 0.68. The patterns of scores on the 3 scales were consistent with the predictions of the theoretical scheme of physician types. The "seeker" type was the rarest, at fewer than 3%. CONCLUSIONS: It is possible to reliably classify physicians into categories that a theoretical framework predicts will respond differently to different interventions for implementing guidelines and translating research findings into practice. The next step is to demonstrate that the classification predicts physician practice behavior.

Adult↗
PubMed2000

An evaluation of patient satisfaction with family practice care in Slovenia.

OBJECTIVE: To describe the level of patient satisfaction with family practice in Slovenia. DESIGN: An internationally developed instrument for patients' evaluations of general practice care was used in a postal survey. SETTING: A representative sample of 36 family practices in Slovenia. STUDY PARTICIPANTS: Sixty consecutive patients in every practice were approached and offered a self-administered questionnaire. A total of 2160 questionnaires were handed out. MAIN OUTCOME MEASURE: Percentages of patients reporting level of satisfaction on a 5-point Likert scale for the items in the questionnaire. RESULTS: On average 58.2% of respondents rated the level of care received as excellent. Waiting in the waiting room was the item rated poorest (26.0%). Participants were also less satisfied with perceived time during the consultation (51.6%) and with connectional aspects of care: the feeling that family practitioners showed interest in their personal situation (46.5%); the feeling that family practitioners made it easy to explain problems (49.1%). On the other hand patients praised many other aspects of family practice care in Slovenia: confidentiality of medical records (77.0%); listening capacity of their family physicians (69.4%); being able to speak to the family practitioner on the 'phone (72%). CONCLUSIONS: Patient satisfaction with family practice care in Slovenia was shown to be relatively high and can be compared to other European countries. The results showed areas in which quality improvement is required: organizational changes to shorten the waiting time in the waiting room and greater emphasis on communication skills.

Evaluation Studies as Topic↗
PubMed1993

The University of Kentucky's Accelerated Family Practice Residency Program.

The University of Kentucky's Department of Family Medicine and the American Board of Family Practice experimented during 1989 and 1990 with the implementation of an accelerated family practice residency program. This pilot program, called the Accelerated Residency Program (ARP), allowed three fourth-year medical students to serve as first-year residents in family practice while simultaneously fulfilling their fourth-year medical school requirements. This allowed the students to complete medical school and residency training in six years instead of seven. Advantages of the program included maintaining clinical skills that might otherwise have been lost during the elective fourth year of medical school, stimulating interest in active learning, earlier entry into a wage-earning position, and an ultimate decrease in the length of the educational process. Disadvantages of the program included having to make important clinical decisions with less training, loss of elective and other training opportunities during the fourth year of medical school, the need for students to make an earlier career/specialty choice, and the possibility that other physicians might perceive graduates of the program as being less well trained.

Curriculum↗
PubMed1995

Entry of US medical school graduates into family practice residences: 1994-1995 and 3-year summary.

This is the 14th report prepared by the American Academy of Family Physicians (AAFP) on the percentage of each US medical school's graduates entering family practice residency programs. Approximately 13.4% of the 15,620 graduates of US medical schools between July 1993 and June 1994 were first-year family practice residents in October 1994, compared with 12.3% the previous year. This is the highest percentage since 1980-1981, when this series of studies began. Medical school graduates from publicly funded medical schools were almost twice as likely to be first-year family practice residents in October 1993 than were residents from privately funded schools, 16.4% compared with 9.0%. The West North Central region reported the highest percentage of medical school graduates who were first-year residents in family practice programs in October 1994 at 20.1%; the Middle Atlantic and New England regions continued with the lowest percentages at 7.5% and 8.7%, respectively. At least one in four graduates from 12 medical schools during the reporting period was in a family practice residency program in October 1994, compared with nine in October 1993 and only two medical schools in 1992. Approximately one in two medical school graduates entering a family practice residency program as first-year residents in October 1994 entered a program in the same state where they graduated from medical school. The percentages for each medical school have varied substantially from year to year since the AAFP began reporting this information. The average percentage for each medical school for the last 3 years is reported.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1996

Entry of US medical school graduates into family practice residencies: 1995-1996 and 3-year summary.

This is the 15th report prepared by the American Academy of Family Physicians (AAFP) on the percentage of each US medical school's graduates entering family practice residency programs. Approximately 14.6% of the 16,124 graduates of US medical schools between July 1994 and June 1995 were first-year family practice residents in October 1995, compared with 13.4% in 1994 and 12.3% in 1993. This is the highest percentage since 1980-1981 (12.8%), when this series of studies began. Medical school graduates from publicly funded medical schools were almost twice as likely to be first-year family practice residents in October 1995 than were residents from privately funded schools, 18% compared with 9.7%. The West North Central region reported the highest percentage of medical school graduates who were first-year residents in family practice programs in October 1995 at 24.8%; the Middle Atlantic and New England regions continued with the lowest percentages at 7.6% and 9.3%, respectively. Approximately one in two medical school graduates (46.7%) entering a family practice residency program as first-year residents in October 1995 entered a program in the same state where they graduated from medical school. The percentages for each medical school have varied substantially from year to year since the AAFP began reporting this information. The average percentage for each medical school for the last 3 years is reported. In addition, the number and percentage of graduates from colleges of osteopathic medicine who entered Accreditation Council for Graduate Medical Education-accredited family practice residency programs are reported.

Censuses↗
PubMed1998

Entry of US medical school graduates into family practice residencies: 1997-1998 and 3-year summary.

This is the 17th report prepared by the American Academy of Family Physicians (AAFP) on the percentage of each US medical school's graduates entering family practice residency programs. Approximately 16.6% of the 15,894 graduates of US medical schools between July 1996 and June 1997 were first-year family practice residents in October 1997, compared with 15.9% in 1996 and 14.6% in 1995. This is the highest percentage since this series of studies began in 1980-1981 (12.8%). Medical school graduates from publicly funded medical schools were almost twice as likely to be first-year family practice residents in October 1997 than were residents from privately funded schools, 19.8% compared with 11.8%. The Mountain region reported the highest percentage of medical school graduates who were first-year residents in family practice programs in October 1997 at 25.8%; the Middle Atlantic and New England regions reported the lowest percentages at 11.7% and 10.7%, respectively. Nearly half of the medical school graduates (48.1%) entering a family practice residency program as first-year residents in October 1997 entered a program in the same state where they graduated from medical school. The percentages for each medical school have varied substantially from year to year since the AAFP began reporting this information. This article reports the average percentage for each medical school for the last 3 years. Also reported are the number and percentage of graduates of colleges of osteopathic medicine who entered Accreditation Council for Graduate Medical Education-accredited family practice residency programs, based on estimates provided by the American Association of Colleges of Osteopathic Medicine.

Career Choice↗
PubMedDate not supplied

The use of alternative health care by a family practice population.

BACKGROUND: This study examined the characteristics of family practice patients using alternative medicine, the problems that led them to use it, and their satisfaction with its use. METHODS: A confidential questionnaire was mailed to 250 randomly selected adults enrolled in a large military family practice clinic, with a final response rate of 71 percent. RESULTS: More than 28 percent of patients used some form of alternative medicine. The typical user was 30 to 49 years old, female, white, and well educated. Common methods used were chiropractic (64 percent), massage therapy (36 percent), herbal therapy (32 percent), and acupuncture (16 percent). The most common problems for which patients sought alternative care were back pain (56 percent), other musculoskeletal pain (22 percent), and stress or other psychosocial problems (20 percent). Fewer than one half were satisfied with their alternative health care, although 82 percent reported at least some improvement in their conditions. Most (63 percent) had not told their family physician of their use of alternative health care. CONCLUSIONS: A substantial number of family practice patients are using alternative medicine. Although most derive some benefit, most are not satisfied with the results. Reasons for this disparity between satisfaction and effectiveness of alternative medicine deserve further study.

Adolescent↗
PubMedDate not supplied

The position of chief resident in family practice residencies.

A large majority of family practice residencies have a chief resident position, but little has been written about the role and functions of the chief resident. The results of a 1988 survey of family practice residency directors provide an overall description of the chief resident position.

Adult↗
PubMed1996

Results of the 1996 National Resident Matching Program: family practice.

The results of the 1996 National Resident Matching Program (NRMP) set records in the number of positions filled in family practice residencies, with a 10.8% increase over 1995 (2,840 vs 2,563) and a 9.4% increase in positions filled with US seniors (2,276 vs 2,081). This is the largest number of US seniors choosing family practice in the history of the NRMP. A total of 196 (6.7%) more positions were offered in family practice through the NRMP, compared with 1995 (3,137 vs 2,941). Thus, 195 of these additional 196 positions were filled with US seniors. In keeping with the trend begun in 1992, 242 more positions were filled on July 1, 1996, than 1995 (3,494 vs 3,252), for a fill rate of 97.8%. Internal medicine residencies matched 67 fewer US seniors in 1996, while pediatric residencies matched 85 more US seniors. During the past 4 years, family practice has been the choice of 82.6% of the additional US seniors choosing a primary care residency. With continued record increased interest in family practice as a career choice and the need for more family physicians, priority support for the nation's family practice residency programs continues to be of critical importance.

Family Practice↗
PubMed2001

The domain of family practice: scope, role, and function.

The family physician is the physician generalist who takes professional responsibility for the comprehensive care of unselected patients with undifferentiated problems and who is committed to the person regardless of age, gender, illness, or organ system. The clinical specialty of family practice is patient centered, evidence based,family focused, and problem oriented. Family physicians acquire and maintain a broad array of competencies that depend on the needs of the patients and communities they serve. The scope of their practice is not defined by diagnoses or procedures but by human needs. Family physicians do not treat diseases; they take care of people. Nodal points in the family life cycle, such as birth, serious illness, and the end of life, deserve special attention. Family physicians are expert at managing common complaints, recognizing important diseases, uncovering hidden conditions, and managing most acute and chronic illnesses. They emphasize health promotion and disease prevention. Their knowledge, skills, and attitudes target community practice, current science, and continuous quality improvement. Family practice has a distinct clinical approach that requires special skills to identify concerns, focus issues, negotiate plans, and help solve problems. The recognition, integration, and prioritization of multiple concerns and the synthesis of solutions are critical clinical competencies. The variety of human needs require targeting the clinical process, sharing responsibility, and managing uncertainty. Focus on the person requires refined abilities to observe, communicate, understand, and care. Commitment to patients and populations involves activism and advocacy. Family medicine can lead in redefining what it means to be a professional, a physician, and a generalist.

Clinical Competence↗
PubMed2002

A national survey of research requirements for family practice residents and faculty.

BACKGROUND AND OBJECTIVES: The Accreditation Council for Graduate Medical Education recognizes that research education is a fundamental, although not always required, aspect of resident training. Since there is little information available on family practice resident research requirements, directors of US family practice training programs were surveyed about their programs' research requirements and research curricula. METHODS: A questionnaire survey was mailed to directors of family practice residency training programs listed in the American Academy of Family Physicians Directory of Family Practice Residency Programs. Seventy-five percent of residency program directors participated in the study. RESULTS: Almost half (48.6%) of responding programs required a resident research project, but only one fourth linked annual resident promotions to progress on the research project. Programs that required a project were more likely to say they provide a research curriculum, but information on these varied widely. Only 12.9% said faculty were required to engage in research/scholarly activities. The top two reasons for requiring resident research were (1) to develop critical thinking and patient care skills and (2) to understand the medical literature. The top two reasons for not requiring resident research were (1) attitude that it isn't necessary and (2) lack of faculty or time. CONCLUSIONS: The research requirement during family practice residency appears to be growing. However, the nature and benefit of family practice residency research education still remains undefined.

Faculty, Medical↗
PubMed2000

Evaluation and management services. A comparison of medical record documentation with actual billing in community family practice.

OBJECTIVE: To compare the concordance of family physicians' billing for evaluation and management services with medical record documentation. DESIGN: Multi-method, cross-sectional observation study. SETTING: Eighty-four family practices in northeast Ohio. PARTICIPANTS: Four thousand fifty-four outpatients visiting 138 family physicians. MAIN OUTCOME MEASURE: The degree of concordance between evaluation and management Current Procedural Terminology codes billed by physicians, with those codes assigned by trained research nurses using American Medical Association criteria to code medical records for the same visits. RESULTS: Discrepancies between the multifactorial nature of family practice outpatient visits and the Current Procedural Terminology coding criteria, which dictate overcoding for depth rather than breadth, made coding difficult (multiple-rater kappa statistic between research nurses = 0.36). Among 4137 outpatient visits with complete billing information, 57% of the Current Procedural Terminology codes generated by medical record review were concordant with the actual billing code assigned by physicians. Undercoding and overcoding occurred at a similar frequency (21% and 19%, respectively) and differed by more than 1 code in fewer than 4% of visits. Visits by new patients were more likely to be inaccurately coded than visits by established patients. CONCLUSIONS: Record documentation by community family physicians largely reflects the level of services billed using evaluation and management codes. Undercoding is as common as overcoding. Efforts from regulatory agencies should be redirected from penalizing physicians for overcoding to focusing on the development of coding criteria that reflect the multifactorial nature of outpatient primary care practice.

Cross-Sectional Studies↗
PubMed1983

Pediatric behavioral science in family practice.

Behavioral science is a well-accepted component of family practice, but official guidelines and proposed curricula have a predominantly adult focus. This paper describes a pediatric behavioral science curriculum for family practice residents that has been successfully integrated into the three-year family practice residency curriculum at the University of Colorado. Details of development and implementation are presented: the requisite knowledge base, skills, and attitudes; the core pediatric behavioral science topics and diagnoses; the family physician's role in handling each core diagnosis; guidelines for making management decisions; suggested approaches to teaching the curriculum; and a reference list for behavioral science faculty.

Attitude of Health Personnel↗
PubMed1983

A multi-institutional study of depression in family practice.

Depression among outpatients of three descriptively and geographically dissimilar family practice residency programs was studied. The Beck Depression Inventory, the Popoff Index of Depression, and the Multiscore Depression Inventory (MDI) were compared. Reliabilities of all three instruments were high, as were correlations among the instruments. The only significant differences among the three populations were on the social introversion and sad mood subscales of the MDI. Regression analyses were then performed to compute equivalent scores on the Beck Depression Inventory short form from the MDI and Popoff instruments. This allowed approximate conversion of scores to the four levels of severity of depression described by Beck and Beck. This study provides the first extensive normative data for family practice on these measures, thus providing family physicians with a comparison group appropriate for a family practice rather than a psychiatric population.

Adolescent↗
PubMed1986

The influence of a family practice residency on the costs of inpatient diagnostic testing.

A retrospective review of hospital records for 333 patients admitted to a large community teaching hospital by family physicians and family practice residents was performed to determine whether teaching programs in family practice led to a significant increase in the cost of care to patients. Three patient populations were identified for comparison: patients admitted by private family physicians when residents were not involved in patient care, patients admitted by the same family physicians while they served as attending physicians on the family practice service and allowed residents to participate in the care of their patients, and patients admitted by residents from the patient population at the Family Practice Center. After taking into account differences in case mix, an analysis of laboratory charges, radiology use, frequency of procedures, and use of consultants showed that the three groups were not different. Family practice residents managed their own patients as cost effectively as physicians in private practice, which suggests that experience alone is not necessary to develop methods of cost-efficient care. When these two groups were combined into a teaching unit, with few exceptions this efficiency was maintained. These results imply that the introduction of family practice residents into patient care does not invariably increase expenses to the patient.

Aged↗