Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “practice”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 505 records · Page 28Linked to original sources
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↗
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↗
PubMed1982

The diagnostic content of family practice: 50 most common diagnoses recorded in the WAMI community practices.

Because there are several methodological deficiencies in previously published studies, a prospective study was carried out of the 50 most common diagnoses of community-based family practices in the Pacific Northwest. Age and sex of patients and reliability of data were controlled. The data reported show reasonable concordance with other published accounts for 10 most common diagnostic categories. For less frequent diagnoses, however, high variability in rank order is the rule, both within this study and by comparison with other studies. This suggests that the diagnostic content of family practice is far from universal and that diagnostic idiosyncrasies of physicians, regional differences in rates of disease, practice style, and as yet other unexplained factors may significantly influence the diagnostic content of family practice.

Adolescent↗
PubMed1980

A family practice education system based on patient care outcomes in family practice settings.

The philosophy, goals, objectives, methodology, and results of a family practice faculty development program are described. Developing family practice educators who will create an education system based on patient care outcomes in family practice settings is the central philosophical purpose of this faculty development program. On completion of the program all participants recognized the essential nature of this philosophical goal and were more comfortable and confident in their ability to: (1) determine resident learning needs; (2) organize curriculum units; (3) use different teaching techniques; and (4) understand their own personal teaching needs and interests. The implications of these changes for developing a family practice curriculum based on patient needs are described.

Faculty, Medical↗
PubMed1993

Nursing specialty practice guidelines: the implications for clinical scholarship and early intervention practice. American Nurses' Association.

Specialty practice guidelines provide the nursing profession with the opportunity to examine, document, and revise practice, thus contributing to clinical scholarship and nursing science. The development and evaluation of one particular specialty practice guideline, the Children with Special Health Care Needs Guidelines, and the implications for early intervention practice are described. Recommendations for clinical research and usage for the Education of the Handicapped Act Amendment of 1986 (Public Law 99-457) are included.

Child↗
PubMed1995

The independent practice association in theory and practice. Lessons from experience.

This article examines an advanced managed care area, the San Francisco East Bay Area in California, for basic organizational issues posed by managed care for the medical profession. Of the three basic structures found, the independent practice association (IPA) model is theoretically most promising. Unlike the integrated health plan, the IPA seeks to retain traditional practice autonomy. Unlike the isolating direct gatekeeper model, the IPA assembles physicians in self-directed groups to invent and implement solutions and to exert political influence upward. In practice, however, it has proved difficult to balance practice autonomy with IPA authority. Both large, successful East Bay Area IPAs show signs (perhaps inevitably) of favoring authority over autonomy, as shown by their policies on governance, membership, and administration. Several policies are suggested to help redress this balance. Medical leaders must act now, before all the evidence is in, or the institutions of the past--hospitals and insurance companies--will control our future.

Decision Making, Organizational↗
PubMed1993

[Preventive health examinations of pregnant women in Denmark. Anamnestic practice and discussion of prenatal diagnosis in early pregnancy examinations in general practice, birth clinics and birthing centers].

In Denmark, pregnant women are offered antenatal care in a nationwide programme. This programme is organized around health examinations in general practice, hospital outpatient departments and at midwives' centres. During winter 1986-1987, a nationwide investigation of antenatal care was carried out. A random sample of approximately 1/3 of the general practitioners, all of the midwives who had antenatal consultations and the medical staffs of 26 departments of obstetrics and gynaecology received a questionnaire about content of a definite antenatal examination. 62% of the general practitioners, 63% of the doctors at the place of delivery and 86% of the midwives replied. Among the pregnant women, 92% replied from general practice, 84% from hospital outpatient departments and 91% from midwives' centres. The interviews about date of delivery and genetic counselling at early visits in general practice, hospital outpatient departments and at midwives' centres were in agreement with the nationwide guidelines. Employment of routine ultrasound scanning was not associated with less detailed history taking by the doctors at hospital outpatient departments, where ultrasound scanning was employed only on special indications. It was concluded that there was a considerable overlap between the interview about the date of delivery and genetic counselling at early visits in general practice and in hospital outpatient departments and, to some extent, at the midwives' centres. The sharing of responsibility for care of pregnant women by three professional groups requires specification of the content of the consultation. Official guidelines should be more specific about this point.

Birthing Centers↗
PubMed1996

The role of the practice nurse in primary health care: managing and supervising the practice nurse resource.

This paper, by drawing on material from a qualitative study funded by the Department of Health and Welsh Office, examines the supervision and management of the practice nurse in general practice. In doing so it explores the perspectives of practice nurses, the GPs who employ them, representatives from FHSAs, those responsible for commissioning community nursing services, and managers of community nursing provider units. Within this context the paper explores the nature of the supervisory relationship between GP and practice nurse, and the wider role of the FHSA, commissioners of community nursing services and managers of community nursing provider units.

Community Health Nursing↗
PubMed1996

[Social medicine for general practice--initial evaluation of a practice relevant teaching concept].

The form and contents of lectures in social medicine as part of medical studies have caused controversy for some time. In the winter term of 1992/93 a new concept of main lectures in social medicine oriented to medical practice was introduced at the Friedrich-Alexander University of Erlangen-Nuremberg. In particular, these lectures deal with primary medical topics relevant to social medicine, interspersed with case examples, visits to patients and excursions. As a means for students to express critism of the lectures offered, at the end of the summer term of 1994 an evaluation of university tuition was first carried out using an anonymous, standardised questionnaire. Fifty-five of the 179 students registered for the lecture, studying in terms 7 to 12, took part in the survey. Among the regular lecture-goers there was a high acceptance of the concept and presentation of the lecture contents in 75% of those asked. This was not found to be dependent on sex or on how far the students had progressed in their studies. Despite interest in social medicine in 80% of cases, for the vast majority of those asked the subject does not yet play any role as a future field of research or occupation. While 60% of the participants in the questionnaire accorded sociomedical topics an important rank in the study of human medicine, 35% regarded an independent chair for social medicine, against the background of over-full timetables, as unnecessary. On the other hand, the practical relevance and usefulness of what is taught was regarded by 72% as high. Despite a general lack of enthusiasm for lectures the practically-oriented approach has obviously succeeded in making clear to the students the importance of sociomedical topics in routine medical practice.

Adult↗
PubMedDate not supplied

On-site colposcopy services in a family practice residency clinic: impact on physician test-ordering behavior, patient compliance, and practice revenue generation.

BACKGROUND: Using colposcopy as a model, we examined the impact of introducing a new diagnostic technology into the ambulatory primary care setting. METHODS: Records of patients with abnormal findings on Papanicolaou smears were reviewed from three study periods: 1 year before, 1 year after, and 5 years after initiation of on-site colposcopy services. Data analyzed include physician management decisions, site of colposcopic service, and patient compliance. Practice revenue estimates were based upon patterns of physician management and patient compliance found during each study period. RESULTS: Management of low-grade squamous intraepithelial lesions varied during each study period. By period 3, however, most patients were undergoing colposcopy (P = 0.03). High-grade squamous intraepithelial lesions were uniformly managed with colposcopy during all study periods (P < 0.001). Introduction of on-site colposcopic services resulted in a rapid shift to the on-site location for evaluation of low-grade squamous intraepithelial lesions and a more gradual shift to the on-site location for evaluation of high-grade squamous intraepithelial lesions. Patient compliance was not affected by the introduction of on-site services. On-site colposcopy resulted in a nearly 100 percent transfer of revenue to the practice, but the economic benefit was quite modest. CONCLUSIONS: Although offering on-site colposcopy services might have had some impact on physician management of low-grade squamous intraepithelial lesions, the lack of benefit regarding patient compliance, the relatively small patient volume for this procedure, and its modest impact on practice revenue cause us to question the value of including colposcopy in everyday practice.

Adult↗
PubMed1998

[Compulsory collegial guidance. What do candidates in general practice think about training of practical procedures?].

In 1994 a new module addressing the quality of practical procedures was added to the Norwegian general practice specialisation programme. Over a five-year period 31 practical procedures must be performed under the supervision of fellow GPs. In 1995 a survey was carried out by questionnaire among all specialist candidates registered in the new programme (n = 165, response rate 83%) and a control group consisting of all candidates registered in 1993 (n = 162, response rate 62%). The aims of the survey were to evaluate the candidates' motivation, self-rated level of competence, and the presence of barriers to programme implementation. The main group and control group were almost identical; mean age has 36.5 years, 37% were females. There were no differences in the self-rated levels of competence between the groups. The majority (80%) reported a need to improve their performance of practical procedures, and 93% stated that mutual guidance with colleagues would be of considerable benefit by improving technical performance, professional confidence and the quality of relationships with colleagues. The main barriers to mutual guidance were shortage of time, lack of structured opportunities for performing procedures in the presence of colleagues, and lack of instruction manuals or videos detailing the correct performance of procedures.

Adult↗
PubMed2002

Bringing the patient back in. Guidelines, practice variations, and the social context of medical practice.

We challenge assumptions that have guided much research and policy aimed at understanding and reducing medical practice variation. Paramount is the focus on doctors as the cause of variation to the neglect of other possible influences. Some research literature suggests that patients, families, and the community context of practice may also influence treatment decisions. Failure to question present assumptions, despite weak evidence in support of them, may account for inability to explain persistent practice variation, develop appropriate implementable guidelines, or anticipate the effect on treatment decisions of greater patient involvement. In this paper, we discuss the weak response to the NIH Consensus Conference on early stage breast cancer because it may have reflected these problems. We urge a more complex and more empirical approach in explaining treatment choice and guidelines sensitive to the potential for value differences.

Attitude to Health↗
PubMed1980

An analysis of dental practice from 1952 to 1976. Council on Dental Practice and Bureau of Economic and Behavioral Research.

From 1952 through 1976, dentists have changed the organization and configuration of their practices in response to several economic, scientific, and personal factors. For instance, there has been an increase in the number of dentists who are shareholders in incorporated practices or who are involved in various cost-sharing arrangements. Technological advances and the increased use of auxiliaries have allowed dentists to provide more dental services in a shorter time, increasing their potential productivity. This is reflected in the increase in the numbers of patients, visits, and visits per hour from 1952 to 1972, and in turn may contribute to the decrease in office hours, allowing dentists to pursue other business or personal interests. Changes in the size of practice may signify innovations in technology and training as well as reflect dentists' personal preferences.

American Dental Association↗
PubMed2002

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

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

Adult↗
PubMed2002

[The Dutch College of General Practitioners' practice guidelines, "Examination of the neonate": response from the perspective of general practice medicine].

With the publication of the Dutch College of General Practitioners' practice guideline 'Examination of the neonate', a discussion which has lasted several decades has been brought to an end. Up to now a second neonatal examination by the general practitioner on the third, fourth or fifth day after a midwife-assisted birth was recommended. The arguments in support of this recommendation were based on the following: (a) the limited expertise of midwives in the past, (b) the experience that general practitioners had in examining children, although this experience was not specifically related to the defects for which neonates should be checked, and (c) the government bodies' wish to restrict the number of hospital deliveries by giving greater structure to the organisation of midwife care, which in practice, did not lead to large changes. Based on three studies, the practice guideline recommends that a second examination is of no added value.

Clinical Competence↗
PubMed2004

[The practice guideline 'Dementia' (second revision) from the Dutch College of General Practitioners; a response from the perspective of general practice].

With growing numbers of older adults in the population, the number suffering from dementia will increase. The general practitioner has to try to determine the difference between Alzheimer's disease and vascular dementia on the one hand, and fronto-temporal dementia and dementia with Lewy bodies on the other hand, while also considering the therapeutic options now and in the future. Support for patients and their family is the responsibility of the general practitioner, who must also consider the patient's driving proficiency and the wishes for euthanasia of the demented older adult. The revised version of the practice guideline 'Dementia' of the Dutch College of General Practitioners is well suited to the work of the general practitioner. It is advisable to read the practice guideline several times and in such cases not only to use the summary card but the entire practice guideline.

Dementia↗
PubMed2004

[The practice guideline 'Atrial fibrillation' from the Dutch College of General Practitioners; a response from the perspective of general practice].

The practice guideline 'Atrial fibrillation' (AF) from the Dutch College of General Practitioners is a clearly written survey on the diagnosis and treatment of AF in general practice. Rapid cardioversion is no longer an indication for acute referral in AF. As AF, heart failure and COPD often occur simultaneously among elderly people, the exact cause of the symptoms can be unclear. In these complicated cases, with the risk of polypharmacy, a single consultation between general practitioner and cardiologist would be more effective. For control of the rate of ventricular contraction during the treatment of AF, lipophilic beta-blockers are preferable to hydrophilic beta-blockers because the pharmacokinetics in elderly people are substantially different. When there is a high risk of thrombo-embolic complications with AF, treatment with coumarin derivatives is advised. However, little research has been done on this subject among elderly people in a general practice setting. In this age group, the risk of complications due to treatment with coumarin derivatives is sometimes higher than the advantages it offers. This is why the GP should always consider carefully whether or not elderly people with AF should be treated with coumarin derivatives.

Age Factors↗
PubMed2004

[The practice guideline 'Stable angina pectoris' (second revision) from the Dutch College of General Practitioners; a response from the perspective of general practice].

The Dutch College of General Practitioners' (Dutch acronym: NHG) practice guideline 'Stable angina pectoris' (second revision) provides clear guidelines for the diagnosis and treatment of patients who experience chest pains as a result of angina pectoris, especially if coronary artery disease is the underlying cause of the complaints. The practice guideline clearly indicates for which complaints the general practitioner should suspect angina pectoris and which information from the anamnesis, family history and risk factors can contribute to distinguishing between stable and unstable angina pectoris. However, the physical examination should not be omitted because this can provide important indications for coronary or pulmonary dysfunction. According to the practice guideline, the treatment policy is determined by the estimated risk of significant coronary artery disease. However, additional tests can be useful even in the case of a small risk, as these can reassure patients. The indications and contraindications for medicinal substances are clearly presented.

Angina Pectoris↗