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At least 397 records · Page 22Linked to original sources
PubMed1995

A survey of marketing practices by family practice residency programs.

The purpose of the study reported in this article was to identify marketing practices that are being utilized by family practice residencies in the United States and to differentiate which strategies were felt to be most useful. A survey questionnaire on marketing strategies was mailed to 361 civilian family practice residencies listed in the 1992 Director of Family Practice Residency Programs. A total of 151 questionnaires were returned for a total response rate of 42.1 percent. The results were summarized using descriptive statistics and Chi-square analysis. Family practice residency programs use a number of different strategies to attract patients. The effectiveness of a given program is dependent on local factors, program strengths and the target population desired. The three most useful marketing strategies reported in the survey were HMO listings, emergency department referrals, and patient referrals. The three least effective strategies were health fairs, sports physicals, and school presentations.

Academic Medical Centers↗
PubMedDate not supplied

Practice financing options for small to mid-sized medical practices.

In today's competitive marketplace, finding and using capital in the most effective manner can help bring greater economic success to medical practices. This article focuses on the most common capital needs of practices ranging in size from solo practices to 25 physicians--practice acquisition, real estate, operating cash needs, and medical equipment--and the types of capital providers for these size practices--health care financing firms, banks, and equipment leasing companies. Interviews with various capital finding providers and various research information, including a 1998 study commissioned by AMA Solutions, Inc. (a subsidiary of the American Medical Association) form the basis for the information provided.

Capital Financing↗
PubMed2001

Prostate cancer in general practice. Results of a five year prospective clinical study in one practice.

BACKGROUND: Despite the fact that 10% of men over 50 will develop clinically significant prostate cancer, little clinical research exists about the disease at the primary care level. AIM: To examine the acceptability of using digital rectal examination (DRE) and prostate specific antigen (PSA) as early detection tests for prostate cancer in a general practice setting. Also, to examine the incidence of the disease, treatment received and outcomes for patients in the practice studied. METHOD: An opportunistic, prospective, practice based study involving men aged 40 years and over attending a suburban general practice over a five year period. RESULTS: Acceptance of DRE and PSA was quite high with over 84% for the former and 98% for the latter. Watchful waiting (31%) was the commonest mode of treatment followed by hormone treatment and orchidectomy (both 24%). Only four patients (14%) had radical prostatectomies while two (7%) had radiotherapy. Six (67%) of the nine deaths were due directly to prostate cancer. CONCLUSION: Guidelines to help general practitioners manage older men wishing to be tested for prostate cancer would be useful. Not all patients with abnormal tests necessarily proceed to further invasive investigations. There is a likelihood that the incidence of the disease is lower in general practice than hospital based studies suggest. Adequate counselling to facilitate informed decision making and minimise anxiety is essential.

Adult↗
PubMed2001

Rate of case reporting, physician compliance, and practice volume in a practice-based research network study.

OBJECTIVE: Practice-based research is one method for answering questions about common problems that are seen infrequently in referral centers. We explored the potential limitations of this method. STUDY DESIGN: This was a prospective observational cohort study of participants in a practice-based research network who submitted data on 231 patients with dyspepsia from a total of 45,337 patient encounters over a 53-week period. Reporting of individual cases involved use of a relatively high-burden data instrument. Outcome measures were compared using rank correlation. POPULATION: We included 18 physicians in a Wisconsin research network study on initial management of dyspepsia in primary care settings. OUTCOMES MEASURED: The outcomes we measured were the rate of dyspepsia visits, average weekly patient volume, and self-reported compliance to the study protocol for each physician. RESULTS: A significant negative correlation existed between physician patient volume and the reported rate of dyspepsia visits. Self?reported compliance with the protocol was negatively correlated to patient volume and positively correlated to the reported rate of dyspepsia visits. CONCLUSIONS: Practice volume may influence the results in practice-based research. Investigators using practice-base research networks need to consider the complexity of their protocols and should be cognizant of compliance-sensitive measures.

Attitude of Health Personnel↗
PubMed2002

[General practice in a modern health care system--consequences for medical research, education and practice].

This first of two articles describes the far-reaching changes to the practice and theory of general practice that are leading from the old-style general practitioner changing to the modern-day primary health care specialist. These already partly accomplished changes, whilst bringing into focus the future role of general practice in a modern health care system, are altering the self-awareness of the profession and the way it defines itself. Specifics of the theory and practice of decision-making in primary health care, within this context of vital importance but as yet barely taken into account, are explained on the basis of Bayes' theorem and with the aid of examples of empirical data on the rational diagnosis of thyroid dysfunction. Making use of examples of coronary heart disease diagnostics, the second part of this article illustrates important differences between health care-service levels and the consequences arising from these differences for medical research, education and practice.

Delivery of Health Care↗
PubMed2002

Managing practice statistics for practice success.

The incorporation of computers into the dental practice has enabled the dentist and staff to quickly access information vital to monitoring practice growth and vitality. Despite the fact this information is available at the click of a mouse, the information available to the dentist and staff is often ignored. Even if an effort is made to assess the data, the dental team is clueless on how to use it to control changing economics in the practice. This is accomplished by charting statistical data collected by the dentist and staff. Compilation of this data enables the dentist and staff to recognize trends that will affect the growth and profitability of the practice and develop strategies that reinforce positive trends and reverse negative trends. This paper discusses the value of using data as a tool for practice management.

Data Interpretation, Statistical↗
PubMed2002

One Dorset practice's experience of using a quality improvement approach to practice professional development planning.

There has been considerable discussion on and recommendation of the idea that Practice Professional Development Plans (PPDPs) should develop the whole practice as a healthcare resource, integrating and improving the educational process. In this study the PPDP concept was launched in a practice in Dorset, following the Bournemouth PPDP framework. The practice linked the educational activities of individuals, small working groups and the whole team to meeting the needs of the patients using a continuous quality improvement approach. The learning needs of the practice team were identified and learning actions were planned leading to a better response to patients' needs.

Education, Medical, Continuing↗
PubMed2003

Teaching practical procedures in general practice. A primer for supervisors of medical students and registrars.

BACKGROUND: Practical procedures are central to many general practitioners' job satisfaction and their ability to provide comprehensive care. Despite this, students lack opportunities to learn skills and fewer GPs perform them. OBJECTIVE: This article develops a framework for teaching practical skills and their assessment in general practice. DISCUSSION: True competence means more than performing a task in isolation: knowledge, skills and attitudes are needed to perform in the workplace. Teaching should be closely related to assessment in general practice. A four stage method of instruction can facilitate learning of task skills. This should be followed by a series of case discussions, scenarios or simulations to teach and assess the learners' ability to manage tasks in the work environment. Linking teaching, assessment and feedback is integral to improving learning opportunities in general practice.

Clinical Competence↗
PubMed2003

Evaluating the C-section rate of different physician practices: using machine learning to model standard practice.

The C-section rate of a population of 22,175 expectant mothers is 16.8%; yet the 17 physician groups that serve this population have vastly different group C-section rates, ranging from 13% to 23%. Our goal is to determine retrospectively if the variations in the observed rates can be attributed to variations in the intrinsic risk of the patient sub-populations (i.e. some groups contain more "high-risk C-section" patients), or differences in physician practice (i.e. some groups do more C-sections). We apply machine learning to this problem by training models to predict standard practice from retrospective data. We then use the models of standard practice to evaluate the C-section rate of each physician practice. Our results indicate that although there is variation in intrinsic risk among the groups, there also is much variation in physician practice.

Artificial Intelligence↗
PubMedDate not supplied

Practice nurses--working smarter in general practice.

BACKGROUND: Recent government funding initiatives have increased the number of nurses in general practice and the range of tasks undertaken by them. These nurses are trained, professionally regulated health care professionals who can make a significant contribution to the work of the practice. OBJECTIVE: Approaches are described that enhance available general practice services, allow for the nurse to substitute for the general practitioner in some tasks, and leads to a delegation of roles that can improve patient health outcomes. DISCUSSION: A well educated, well supported practice nurse can enhance both the services provided by a general practice and the income derived from such services.

Australia↗
PubMed1991

Abortion attitudes and practices of family and general practice physicians.

BACKGROUND: Approximately 1.5 million abortions are performed each year in the United States. Little information has been published on the abortion attitudes and practices of family physicians. The object of this investigation was to assess the abortion attitudes and practices of family and general practice physicians in Kansas. METHODS: A 19-item self-administered survey questionnaire was designed and mailed to 856 family and general practice physicians in Kansas. RESULTS: A 63% survey response rate was obtained. Seventy-eight percent of the physicians reported that abortion should be legal, but only 56% of the respondents classified themselves as pro-choice. Conversely, only 8% reported that legal abortion should not be available, even though 33% classified themselves as pro-life. The majority of physicians reported that abortion is an appropriate option to save the life of the mother, in cases of rape or incest, and when a fetal anomaly is diagnosed. Only three respondents (0.5%) had performed abortions during the previous year. In general, female physicians and physicians over the age of 40 years (regardless of sex) were more likely to be pro-choice and to view a woman's personal decision as a circumstance in which abortion may be appropriate. CONCLUSIONS: Physician's views about abortion and their practice patterns are important components of health care for thousands of women each day.

Abortion, Induced↗
PubMedDate not supplied

Family practice obstetrics: style of practice.

Prevalent birth practices reflecting a family-centered, minimally invasive style of obstetrical practice were surveyed among 235 family physicians practicing obstetrics in Michigan. Respondents older than 35 years and those without an academic affiliation reported fewer "family-centered" and more "intrusive" practices than did younger or academically affiliated respondents. Compared to published data on California obstetricians, Michigan family physicians were more likely to report practices that appear family centered and, particularly for more recent graduates, ones less likely to routinely involve obstetrical interventions.

Adult↗
PubMed1988

Assessing alcohol consumption in general practice patients--a comparison between questionnaire and interview (findings of the Medical Research Council's general practice research framework study on lifestyle and health).

A self-administered questionnaire, the Health Survey Questionnaire (HSQ) was distributed to patients registered with 47 group general practices. The HSQ assesses alcohol consumption using a quantity frequency scale and includes the four CAGE questions and a question on whether respondents think they have an alcohol problem. A random stratified sample of those patients who returned an HSQ (2666 men and 1537 women) were subsequently invited to attend their general practice for an interview with the practice nurse, where weekly alcohol consumption was estimated using both a quantity frequency scale and a systematic enquiry about alcohol consumption for the week immediately preceding the interview. The latter method was taken as the 'gold standard'. Excessive drinkers were defined as men whose weekly consumption by this method was not less than 35 units per week and women drinking at least 21 units per week. After weighing the results to take account of the sampling bias in favour of the excessive drinkers, 11.7% of men and 2.9% of women were excessive drinkers according to the estimate of alcohol consumption at interview. This compares with the 7.6% of men and 2.7% of women who were heavy drinkers by the HSQ quantity frequency scale. The two interview estimates were comparable but in general the HSQ tended to underestimate consumption compared with these estimates. The questionnaire was found to be most effective in screening for excessive drinkers if all the patients who indicated concern about their drinking (i.e. those who were with CAGE positive or had a self-assessed drinking problem), as well as all of those who were above the limits for the trial on the quantity frequency scale, were selected as being potentially excessive drinkers. In the weighted sample, 14.8% of men and 6.9% of women were in this group. Using these selection criteria and taking the interview as the standard for determining the excessive drinkers a sensitivity of 58.6% and specificity of 91.08% was obtained for men, with a positive predictive value of 46.1% and a negative predictive value of 94.3%. For women the test was more sensitive (69.7%) and more specific (95.0%) and had a better negative predictive value (99.1%) than for men. The positive predictive value for women at 29.6% was not as good as that obtained for men. This analysis shows that the HSQ is a fairly effective tool for detecting excessive drinkers in general practices with a small proportion of false positive results. It is both economical and acceptable to patients in a wide range of practice settings.

Alcohol Drinking↗
PubMed1994

Provision of care to general practice patients with disabling long-term mental illness: a survey in 16 practices.

BACKGROUND: Increasing numbers of long-term mentally ill people now live in the community, many of whom lose contact with psychiatric services and come to depend on general practitioners for medical care. However, it has been suggested that general practitioners may be unaware of some of these patients and their needs. AIM: This study set out to investigate the care received by this group of patients. METHOD: Case registers of adults disabled by long-term mental illness were set up in 16 of 110 group general practices asked to participate. A search of each practice's record systems was combined with a survey of local psychiatric and social service teams, to seek practice patients who might not be identified from the general practice data. RESULTS: Of the 440 patients found, 90% were identified from information within the practices, mainly computerized repeat prescription and diagnostic data. The other 10% were identified only by psychiatric services. Over one third of the patients had no current contact with psychiatric services. Patients in contact with psychiatric services had been ill for a shorter time than those not in contact. More patients suffering from psychotic illnesses were in current contact than those with non-psychotic diagnoses. Over 90% of the patients had been seen by their general practitioners within 12 months, on average eight times. Most consultations were for minor physical disorders, repeat prescriptions and sickness certificates. Elements of the formal mental state examination were recorded in one third of cases and adjustments of psychotropic medication in one fifth. CONCLUSION: These findings suggest that patients in long-term contact with specialist services cannot be taken as representative of the whole population with long-term mental illness. General practitioners could use their frequent contacts with long-term mentally ill people to play a greater role in monitoring the mental state and drug treatment of this group.

Community Mental Health Services↗
PubMed1993

The Family Practice Residency in Baton Rouge: practice patterns of graduates.

One hundred twenty-four physicians have completed the Baton Rouge Family Practice Residency since 1973. Eighty-two percent of the graduates who are currently active physicians are practicing medicine in Louisiana. Most are practicing family medicine. The graduates were sent questionnaires asking about practice characteristics, office procedures performed, hospital privileges held, and career satisfaction. Responses were received from 74 family physicians serving small, medium, and large communities. Most reported they are satisfied with their career choices. The respondents perform a variety of procedures in their offices. This finding was not affected by community size. Hospital privileges were affected by community size. The residency is meeting its principal mission: (1) training family practitioners for Louisiana, and (2) training doctors to practice in any sized community.

Certification↗
PubMed1993

Determining the appropriate scope of nursing practice for particular practice settings: guidelines for registered nurses: Alberta Association of Registered Nurses.

The depth and breadth of the scope of nursing practice in Alberta places registered nurses in a position where they make a significant contribution to health care. The nature of the contribution of registered nurses in a given practice setting must rely on a determination of the appropriate scope of practice for registered nurses in that setting. That determination should be guided by the principles outlined above, and in accordance with the documents cited in this paper. Within these guiding principles, activities performed by registered nurses in a given practice setting should be mutually agreed upon between health care professionals, should be time constant, and should be driven by the needs and consent of the client, not by the desire for convenience in health care professionals in the practice setting.

Alberta↗
PubMed1995

On content of practice. The advantage of computerized information systems in family practice.

BACKGROUND: Computerized medical records have been widely used in family practice in Iceland for several years. Extensive data have been accumulated; however, how best to use and implement these data has been debated. OBJECTIVES: The main objectives of this study was to determine the advantage of computerized information systems in family practice. MAIN RESULTS: The results provided broad epidemiological information on the content of family practice in Iceland. The study population consisted of 50,865 Icelanders and their 257,188 contacts with 17 community health centres over one whole year, 1988. Services were provided by 50 doctors, 43 nurses and nurses' assistants, and 7 midwives. Almost 90% of the rural population made at least one contact over the year of study; the mean rate of contacts per individual was 5.1, office visit 2.8-3.3, phone calls 1.1-1.6, and home-visits 0.4, females (40%) more often than males, increasing in number with increasing age. Disease symptoms were the reason for contact in 35-39% of cases, the initiative of the health care provider in 44-50%, and administration in 9-12%. The mean number of health problems recorded were 2.3 per individual per year. Extensive prevalence numbers are provided by age and sex. The largest categories were respiratory, injuries and musculoskeletal with a prevalence of over 200/1000 individuals per year. The most frequent contacts were made by persons with cancer and mental problems. The actions taken (processes) as a result of these contacts were numerous, an average of 1.6 per contact; 648 medications/1000 contacts, 141 laboratory tests, 126 surgical procedures, 15-24 referrals, and 15-26 hospital admissions. Prescriptions were most frequently for central nervous system medication (93-117/1000 contacts), for anti-infectives (100-106), and for cardiovascular (58-99). The cost of x-rays was shown to be $866 per 1000 contacts, and the odds for having an x-ray decreased by 18% for every 1000 individuals added to a practice. A quality study showed 16% of x-ray requests and 13% of office prescriptions were lacking. CONCLUSION: The information obtained reflects health problems of the population as observed by family doctors. The information is useful for observing and influencing the health of a nation, the practices of health care providers, the generation of cost in the health system, and the use of appropriate health services. It is also useful to health care planners and researchers, as well as educators of health care providers. This study serves as a baseline for these tasks.

Adolescent↗
PubMed1998

The philosophy of clinical practice guidelines: purposes, problems, practicality and implementation.

There are a number of technical and professional challenges to the use of clinical practice guidelines in the United Kingdom. Until recently, many guidelines have been consensus-based rather than being explicitly linked to evidence of effectiveness and have also been of variable quality. Moreover, clarity of purpose has been lacking with some guidelines being developed as a means of limiting access to secondary care rather than as a means of assisting clinical decision-making. Implementation of new research into practice and of clinical practice guideline recommendations shares many of the same barriers to changing clinician behaviour. Without local support systems to assist with implementation, including clinical audit programmes and methods of feeding back information on current practice, it is unlikely that guidelines will change practice in the majority of clinicians. Progress on the implementation of guidelines in the British National Health Service is discussed.

Employee Performance Appraisal↗