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PubMed1987

The quality of obstetric care in family practice: are family physicians as safe as obstetricians?

A literature review on the quality of obstetric care in family practice was conducted to determine whether family physicians are as competent in providing obstetric care as obstetricians. Three types of studies were reviewed: case series, historical cohorts, and population-based studies. No conclusion on the quality of obstetric care in family practice can be drawn from the available studies because of research design limitations. Available evidence suggests, however, that family physicians are as safe as obstetricians when delivering babies, particularly when they concentrate their efforts on providing personal prenatal care, refer high-risk pregnant women appropriately, and practice less technologically oriented care on women who deliver normal-weight babies. In addition, no evidence emerged that family physicians provided significantly poorer obstetric care than obstetricians. In fact, the results from population-based studies suggest that family physicians may be safer than obstetricians in delivering normal-weight infants because of their hypothesized less use of technological interventions in that low-risk group of patients. Further studies, especially prospective randomized trials in which the outcomes are assessed in a blinded fashion and case mix is rigorously controlled, are needed to provide a definitive answer. As practical, ethical, and economic constraints are likely to preclude such studies, the case-control design may provide a reasonable alternative.

Clinical Competence↗
PubMedDate not supplied

Comparative prescription practices of family practice, internal medicine, and pediatrics residents.

The purpose of this study was to compare the prescribing practices among family practice, pediatric, and internal medicine third-year residents in an inner city ambulatory care setting. A four-month chart audit was made for the prescriptions provided for asthma, osteoarthritis, congestive heart failure, and upper respiratory infection patients by these residents. In general, family physicians prescribed medications that were not different from those used by internists and pediatricians. However, there were significant (p less than 0.01) differences in the number of visits and prescriptions among the specialties. The prescribing practices of the study group differed from a national survey of private practitioners in several drug categories.

Drug Prescriptions↗
PubMedDate not supplied

Edmund D. Pellegrino's philosophy of family practice.

Family medicine has grown as a specialty from its early days of general practice. It was established as a Board Certified specialty in 1969. This growth and maturation can be traced in the philosophy of family medicine as articulated by Edmund D. Pellegrino, M.D. Long before it was popular to do so, Pellegrino supported the development of family medicine. In this essay I examine the development of Pellegrino's philosophical thought about family practice, and contrast it to other thinkers like Ian McWhinney, Kerr White, Walter Spitzer, Donald Ransom, and Hebert Vandervoort. The arguments focus on whether the goals of family medicine and family practice (possibly two distinct entities) can be articulated, especially considering the definitional problems of "family" and "community." I conclude by echoing Pellegrino's hope that family medicine can contribute a fresh alternative to isolated, individualistic and technological thinking in medicine.

Ethicists↗
PubMed1977

The content of family practice: a family medicine resident's 2 1/2-year experience with the E-book.

The purpose of this paper is to present the content of office family practice problems seen over a 2 1/2-year residency period and to afford comparison with the well-known Virginia Study. It illustrates the usefulness of the diagnostic E-Book, with which all the data were collected and preserved. Over a 2 1/2-year period, the author cared for 592 patients in the family practice office. The ratio of one physician to 592 patients compares to the Virginia Study's one physician to approximately 745 patients. A total of 1,640 problems were coded in the E-Book. In this study 55 problems/physician/month were seen, whereas in the Virginia Study approximately 177 problems/physician/month were noted. Respiratory illnesses were the most common diagnostic category in both studies. Among specific problems, obesity ranked first at Hershey, with afebrile colds second, hypertension and Beta streptococcal pharyngitis third, and smoking fourth. Obesity and smoking were ranked considerably lower in the Virginia Study, whereas "health maintenance examinations" were ranked number one. Finally, for age-sex practice profiles, the present data revealed two peak age groups for both sexes, whereas the Virginia work noted only one peak age range.

Acute Disease↗
PubMed1984

Patient and provider satisfaction in Navy family practice and non-family practice clinics.

Differences between family practice and non-family practice health care service delivery have been characterized in terms of patient satisfaction. As health care providers may often behave according to their conceptions of what is satisfying for patients, a clarification of the degree of congruence between patient self-reports and provider impressions is needed. Responses to four patient satisfaction scales were obtained from 136 providers and 1,735 patients in both family practice and non-family practice Navy clinics. Results of separate multiple discriminant analyses conducted between settings for both provider and patient groups indicated that providers emphasized trust and range of services as hallmarks of family-oriented care. Patients, alternatively, emphasized accessibility of services, whereas range of services was not relevant to differentiating between treatment modalities.

Attitude of Health Personnel↗
PubMed1987

Moonlighting policy and practice in family practice residencies.

Moonlighting by residents is a controversial, but little-studied topic. A survey on moonlighting policy and practice was sent to all family practice residency program directors, and an 87 percent response rate obtained. Moonlighting is permitted by 97 percent of nonmilitary programs and is generally thought of by program directors as a positive educational experience. It is practiced by over two thirds of the second- and third-year residents in programs that monitor moonlighting. These residents spend an average of 28 hours each month moonlighting. The most commonly used moonlighting sites are hospital emergency rooms, followed by coverage for private practice physicians. Seventy percent of programs require approval for extracurricular work activity. Only 23 percent of residencies limit moonlighting for all residents, but 47 percent have had occasion to deny moonlighting privileges to individual residents.

Data Collection↗
PubMed1980

Research policies and practices in family practice residencies.

A questionnaire survey of all US family practice residency programs was undertaken to gather information pertaining to the policies and practices of resident research projects. Eight-one percent of the programs responded. The majority of the programs which responded require or encourage research by their residents. Cross-tabulations of the data relate several characteristics of residency programs to their positions on resident research. University based or affiliated/administered programs, programs with fewer residents and larger faculties, and programs in the faculty are engaged in research tend to encourage or require research by residents although these findings are not consistent. Information is also presented pertaining to financing resident research, preparing residents for conducting research, and disseminating the results of residents' projects.

Faculty, Medical↗
PubMed2000

['Decubitus' guideline of the Dutch College of Family Practice; response from family practice].

The guideline on pressure ulcers issued by the Dutch College of General Practitioners gives a lot of practical information for the family doctor and the practical nurse. The main thought is the treatment of decubitus in a moist environment. Furthermore this guideline will help the doctor to make the right choice in the chaos of supplies. It is of great interest that interdisciplinary collaboration will take place on this issue, for a well developed communication gives the best results of treatment.

Family Practice↗
PubMed1993

Breast-feeding counseling practices of family practice residents.

BACKGROUND: Despite breast-feeding being the best newborn feeding method, the percentage of women in the United States who breast-feed has declined. Family physicians are in a unique position to counsel women about breast-feeding because their emphasis on continuity of care provides both prenatal and postnatal contact. Whether family physicians are trained sufficiently to offer such counseling is unknown. METHODS: A pretested questionnaire was distributed to all residents in 11 of 14 residency programs in North Carolina and Georgia. Data were analyzed with descriptive chi-square statistics and backward logistic regression to assess variables independently predictive of residents' counseling behaviors. RESULTS: One hundred fifty-five residents filled out usable surveys (response rate: 69%). The residents' primary teachers of breast-feeding were family physicians (34%) and nurses (33%). Most residents (93%) felt it was their personal responsibility to counsel women about breast-feeding; 67% believed their training was inadequate, and 48% stated they lacked necessary skills. Forty-one percent of residents counseled such women less than 50% of the time. Personal or spousal breast-feeding experiences gave residents more confidence in breast-feeding anticipatory guidance (P < .001), comfort in teaching techniques (P < .001), and effectiveness in counseling (P < .009) but did not lead to improved counseling rates. Multivariate analysis showed that female residents, those with high confidence in their breast-feeding counseling skills, and residents that had adequate training in breast-feeding counseling instructed women more often about breast-feeding. CONCLUSIONS: Breast-feeding counseling skills are an important but neglected aspect of family practice clinical training. Personal breast-feeding experience is an important indicator of breast-feeding counseling confidence and effectiveness, although it doesn't ensure that proper counseling skills are obtained. Family medicine training programs should incorporate breast-feeding educational programs into their residency curricula.

Breast Feeding↗
PubMed1983

Patient satisfaction in adjacent family practice and non-family practice Navy outpatient clinics.

Patient satisfaction was assessed in adjacent family practice and non-family practice clinics at a Naval Regional Medical Center. Results indicated that patients in the family practice clinic (n = 341) were significantly more satisfied with care than those in the other primary care clinic (n = 390). Although older people and men were generally more satisfied with care, demographic factors did not differentially affect patient preferences for the family practice approach to ambulatory care.

Adolescent↗
PubMed1988

Sex problems in family practice.

This study surveyed a group of 76 practicing family practice physicians and a group of 139 residents. They were asked the importance of sex counseling, the value of different kinds of education, who and when they asked about sexual problems, and their ability to deal with 24 problems or issues. Dealing with patient sexual problems was seen as important to both groups and they estimated 20% of their patients to have a problem or concern. A major concern of both groups was sexual abuse. Since the majority indicated they only ask about sexuality if there appears to be a "psycho-sexual sign," it is critical that they receive training in recognizing the signs of sexual problems. Continuing medical education courses were seen to be the most valuable form of training by the practicing family physician in learning about dealing with patient sexual issues and problems.

Adult↗
PubMed1992

Assessing functional status in family practice.

Family physicians need functional assessment skills to care effectively for elderly patients. Self-assessment instruments, such as the COOP charts, offer promise. Educators must give priority to functional assessment and develop specific materials for residency training.

Activities of Daily Living↗
PubMed1987

The effect of an on-site radiology facility on radiologic utilization in family practice.

Family physicians around the world are increasing their use of diagnostic x-ray examinations at a time of controversy about radiologic overutilization. To explore the role of accessibility in utilization, a study was undertaken testing the hypothesis that on-site radiology facilities are an important determinant of usage. Using a historical cohort design with chart review, rates in selected groups of patients were compared between two teaching family medicine centers, one with an on-site radiology service and one without. After controlling for confounding variables, patients with chest-related diagnoses were 2.4 times more likely (P less than .05) to have a chest film in the presence of on-site facilities. Rates for the off-site examination, upper gastrointestinal series, in patients with abdominal-related diagnoses were similar (relative risk 1.34, P greater than .5) at both centers. Higher usage brought no short-term clinical benefit. It was also observed that residents overinterpreted one quarter of chest films when compared with radiologists' reports.

Community Health Centers↗
PubMed1980

Obstetrical care in a prepaid cooperative: a comparison between family practice residents, family physicians, and obstetricians.

The purpose of this study was to compare the obstetrical care provided by three different groups of physicians. Deliveries between July 1975 and July 1977 were tabulated and all 211 deliveries of the family physician (FP) group, and all 199 of the family practice residency (FPR) group were reviewed, as were a randomly selected group of 193 obstetrician (OB) deliveries. All hospital charts were reviewed for 81 variables. The FPR group had more patients who were poor, single, and nulliparous. They presented later in pregnancy, were more often anemic, and had an increased incidence of venereal disease. The FPR and FP groups documented major psychological problems and depression more frequently. The obstetricians used caudal and epidural anesthesia more frequently, whereas the FP and FPR groups used more narcotics. Except for an increased incidence of third degree lacerations in the FP group, total maternal and fetal complications were few and similarly divided among the groups. The FPR and FP groups delivered 78 percent and the OB group 38 percent of their own patients. This paper is an addition to a limited literature base which deals with process and outcome of obstetrical care delivered by various provider groups and is unique in that the study was undertaken in a large prepaid group.

Continuity of Patient Care↗
PubMed1999

What should we be teaching residents about behavioral science? Opinions of practicing family physicians.

BACKGROUND AND OBJECTIVES: A behavioral science curriculum in family practice residency education encompasses a wide range of topics. Time limitations reduce the number of topics that can be emphasized. This study presents the opinions of practicing family physicians regarding the prioritization of behavioral science topics for residency education. METHODS: We mailed a questionnaire to 633 practicing family physicians. Respondents provided demographic data and rated 28 behavioral science topics according to priority to be given in residency education. RESULTS: A total of 447 questionnaires were returned, for a response rate of 71%. On a 4-point scale, the average ratings of the 28 topics ranged from 3.79 (depression) to 2.40 (enuresis/encopresis). Female physicians and physicians with a behaviorist in their practice provided significantly higher overall average ratings. CONCLUSIONS: Practicing family physicians identify specific behavioral science topics to be given high priority during residency education. The list of prioritized topics may provide a useful guide to help family medicine educators decide which topics to emphasize in the behavioral science curriculum.

Behavioral Sciences↗
PubMed1993

Family practice clinics. Survey of family practice residents' attitudes.

All residents of McGill University's Department of Family Medicine were surveyed by mail about their family practice clinic experience. Residents were generally satisfied with their training site and their supervision, but noted problems with volume and diversity of patients, learning certain procedures, and knowledge of community resources. They did not want more family medicine clinic time.

Adult↗