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At least 595 records · Page 33Linked to original sources
PubMed1989

A preliminary investigation of the relationship between certain practice characteristics and practice location: chiropractor-population ratio.

Two surveys of 121 preselected Victorian and South Australian chiropractors were conducted during the period of December 1986 to February 1987 in order to investigate whether practice location (metropolitan area and country town) and chiropractor/population ratio (number of chiropractors per 10,000 inhabitants) have any effect on patient numbers, practice procedures and practitioner attitudes. Practitioners' response rates to the first and second questionnaires were 82% and 61%, respectively. Analysis of data revealed that metropolitan chiropractors utilized more adjunctive therapies than their country town colleagues. Most chiropractors felt that the number of chiropractors in their area was sufficient. However, there appeared to be no difference in patient numbers (patient visits and new patients) and ratio of new patients to patient visits as related to practitioner density or practice location. Patient volume appeared to be practitioner-induced; fewer new patients corresponded to a higher number of revisiting patients, and maintenance care corresponded to a higher number of patient visits.

Adult↗
PubMed1987

Introducing a drug formulary to general practice--effects on practice prescribing costs.

A drug formulary comprising 249 preparations of 132 drugs and drug combinations was prepared by the partners in a three-doctor general practice serving more than 5000 patients. No attempt was made to change to generic prescribing nor were repeat prescription drugs altered. Introduction of the formulary in September 1981 was followed by an increase in the proportion of prescriptions containing drugs from the formulary from about 55% to more than 60% for both repeat and non-repeat prescriptions. The proportion of formulary drugs on non-repeat prescriptions reached a maximum of 78% within the first year with the additional influence of information feedback. Over the first year the level of formulary drugs used for both repeat and nonrepeat prescribing levelled off at about 62%. Even with these modest changes, when compared with the costs of general practice prescribing in Scotland as a whole, the introduction of the formulary resulted in savings of approximately 10% within the practice for the mean ingredient costs both per patient and per prescription.

Costs and Cost Analysis↗
PubMed1993

[Computerization in private urologic practice with multiple practice locations: the use of medical software and a portable microcomputer].

The authors have used a medical programme, Medistory, since June 1990 to computerize a private urological practice. This programme allows personalization of data collection adapted to urology: interview sheets related to the disease, standard report forms, edition of letters, creation of a multi-entry file and entering of accounts. The consultation was always held without a paper support with real-time data acquisition and the accounting was performed at the end of the visit. Letters were printed separately at home, at the end of the day, so as not to delay the patient. A back-up was performed every second day on hard disk. We used a portable Macintosh with 20 mega octets of REM and a 40 mega octet internal hard disk as our practice is based at several sites. This computerisation benefited from the Macintosh interface which facilitated learning and use of the programme. No time loss and no patient discomfort were recorded in comparison with a conventional consultation. The possibility of opening several files at the same time allowed a simple reply to any demands for other information. Two files out of 700 were lost (0.3%) due to an error when saving data. No accounting errors were detected. The use of a medical programme is particularly well adapted to private urological practice with multiple offices. The advantages of a personal computer include the gain of place, rapidity, unlimited storage capacity and the possibility of recovering data with other standard programmes. Medistory, a programme created for general practitioners, is perfectly adapted to this use due to the ease of personalization allowing the creation of interview sheets related to the disease and the edition of reports and various letters.

Computer Security↗
PubMed1995

The effectiveness of a nutrition education program for family practice residents conducted by a family practice resident-dietitian.

BACKGROUND AND OBJECTIVES: Despite current interest in the role of diet in disease prevention, physicians frequently lack adequate nutrition knowledge. This project sought to test family practice residents' nutrition knowledge, heighten their understanding of nutrition concepts, and implement a method of teaching nutrition in a residency program. METHODS: Following a pretest, family practice residents participated in four teaching sessions during a 5-month period conducted by a fellow resident who was also a dietitian. The residents were asked to keep a 3-day diet diary, which was analyzed with nutrition analysis software. A posttest measure changes in nutrition knowledge and interest. Pretests and posttests were also given to a control group of residents at another campus of the same university-administered program. RESULTS: The intervention group's mean scores increased from 54.7% to 70% (P<.001). Residents who kept a diet diary increased their scores by 23.5%, compared with a 7.4% increase for those who did not. Scores for control-group residents who took both pretests and posttests fell from 43.4% to 42.1%. CONCLUSIONS: Residents who attended lectures conducted by a family practice resident- dietitian and examined their diets showed remarkable improvement in posttest scores of nutrition knowledge. Factors most influential in increasing residents' nutrition knowledge include increasing residents' interest in nutrition, involving them in a longitudinal series of lectures, and providing support for their knowledge and its application.

Adult↗
PubMed1997

An epidemiological study of diagnostic and therapeutic strategies in office practice patients with subacute or chronic pain in the thoracic or low back. Comparison of practices in primary care and rheumatology settings.

UNLABELLED: There is a paucity of epidemiological data on diagnostic and therapeutic practices in office practice patients with subacute or chronic pain in the thoracic or low back. STUDY OBJECTIVE: to describe diagnostic and therapeutic strategies used in such patients. PATIENTS AND METHODS: descriptive, prospective, two-month epidemiological study in 50 general practitioners and 50 rheumatologists. Each physician was asked to provide data on the demographics, clinical features, history of spinal disease, investigations, prior treatments and treatments prescribed on D0 and D30 in two patients with low back pain and two with thoracic back pain, of one to 12 months' duration. RESULTS: A total of 352 patients were included. In the 217 patients with low back pain, including 107 women and 110 men, duration of the pain was 4.3 +/- 0.2 months and mean age was 49.6 +/- 1 years; 67% of these patients were economically active and 22% were retired; 59% were recruited by rheumatologists. In the thoracic back pain group, there were 135 patients, including 82 women (61%) and 53 men, with a mean duration of pain of 3.8 +/- 0.3 months and a mean age of 47.7 +/- 1.4 years; 60% were economically active and 22% were retired; 49% were recruited by rheumatologists. A history of conservatively-treated low or thoracic back pain was reported for 95.4% of patients in the low back pain group and 94% in the thoracic back pain group. Of the patients with low back pain, 6.3% had had spinal surgery. Investigations were as follows: roentgenograms in 85% of low back pain and 75% of thoracic back pain patients, computed tomography in 11% and 5.8%, magnetic resonance imaging in 2% and 1% and laboratory tests in 14% and 20%. Ninety-one per cent of low back pain and 84% of thoracic back pain patients were already under therapy on D0. Ninety-six per cent of patients overall were given a prescription at the end of the D0 visit, for a nonsteroidal antiinflammatory drug or an analgesic in 80% of low back pain and 63% of thoracic back pain patients, for muscle relaxants in 62% and 69%, for drugs aimed at preventing gastric side effects in 19% and 9.5%, for myotonic agents in 10% and 8% and for sedatives in 5% and 11%. A local steroid injection was given to 20% of low back pain patients. Twenty-four per cent of low back pain and 14% of thoracic back pain patients missed days of work (mean, 11 +/- 1.7 days and 13 +/- 4.6 days, respectively). Physical therapy was prescribed to 36% of low back pain and 27% of thoracic back pain patients and a lumbar support belt to 17% of low back pain patients. On D30, the pain had abated in 86% of low back pain and 89% of thoracic back pain patients and complete freedom from pain was reported by 28% and 32% of patients in these two groups, respectively. Treatments prescribed on D30 were physical therapy (43% and 31%), analgesics (40% and 36%) muscle relaxants (25% and 30%), and nonsteroidal antiinflammatory drugs (23% and 12%). Conclusion. This preliminary study provides data on common practices in subacute and chronic low back and back pain and may prove useful for health care cost estimations.

Acute Disease↗
PubMed1997

The practicality of using the SMAST and AUDIT to screen for alcoholism among adolescents in an urban private family practice.

We assessed the practicality of using the Short Michigan Alcoholism Screening Test (SMAST) and the Alcohol Use Disorders Identification Test (AUDIT) in screening adolescents for alcoholism in a primary care setting. In addition, we sought to determine the prevalence of alcohol use among adolescents, 16-21 years of age, presenting to a private Family Medicine practice for medical care. A consecutive sample of 67 subjects presenting for medical care were asked to complete the SMAST and AUDIT questionnaires. Overall, 52 (78%) of the questionnaires were returned with complete data. Of the 52 patients, 25 (48%) admitted to drinking. Using a "positive" score on either the SMAST or AUDIT as a positive test for alcohol use yielded a sensitivity of 40% and a predictive value positive of 100%. Using a "negative" score on both the SMAST and AUDIT as a negative test for alcohol use yielded a specificity of 100% and a predictive value negative of 64%. Although alcohol use was relatively common considering the age group, using the SMAST and AUDIT to screen for alcoholism is labor intensive and is not practical in this situation. Because patients appeared to misinterpret some questions and were often accompanied to the office by their parents, their answers may not be valid. History of alcoholism taken upon typical office examination and relevant advice appears to be a better alternative to the use of questionnaires in determining the prevalence of alcohol use in this age group.

Adolescent↗
PubMed2000

New guidelines for potassium replacement in clinical practice: a contemporary review by the National Council on Potassium in Clinical Practice.

This article is the result of a meeting of the National Council on Potassium in Clinical Practice. The Council, a multidisciplinary group comprising specialists in cardiology, hypertension, epidemiology, pharmacy, and compliance, was formed to examine the critical role of potassium in clinical practice. The goal of the Council was to assess the role of potassium in terms of current medical practice and future clinical applications. The primary outcome of the meeting was the development of guidelines for potassium replacement therapy. These guidelines represent a consensus of the Council members and are intended to provide a general approach to the prevention and treatment of hypokalemia.

Arrhythmias, Cardiac↗
PubMed2005

Improving colorectal cancer screening by targeting office systems in primary care practices: disseminating research results into clinical practice.

BACKGROUND: Randomized trials have shown the efficacy of an office systems approach in improving colorectal cancer (CRC) screening behaviors; its feasibility in real-world primary care practices has not been well studied. METHODS: Between August 1, 2000, and December 1, 2001, we enrolled 185 primary care clinicians identified through purchased database lists. At the end of follow-up (December 31, 2002), 127 clinicians had completed preintervention and postintervention questionnaires. Trained staff from the American Cancer Society visited practices and identified areas for improvement in CRC screening. They provided clinicians with resources, tools, and support to facilitate positive change. We defined 5 clinician behavior areas related to successful CRC screening, including educating patients, identifying patients due for screening, enabling patient compliance, monitoring patient compliance, and notifying patients of their test results. We measured these areas before and after the intervention using questionnaires and data extracted from medical records. RESULTS: We demonstrated improvements in the passive use of posters and brochures about CRC screening (baseline, 20.5% and follow-up, 69.3%; P<.001) and in the monitoring of fecal occult blood tests using manual tracking systems (baseline, 20.6% and follow-up, 37.3%; P<.05). Based on medical records data among 551 patients, we found a statistically significant increase in the number of patients who became up-to-date with CRC screening recommendations and tests (P< .001 for both). CONCLUSION: Methods shown to improve CRC screening processes in protocol-driven randomized trials may be effective in community practice, and wider dissemination of these strategies shows promise to increase CRC screening.

Colorectal Neoplasms↗
PubMed2005

Enhancing quality of practice through theory of change-based evaluation: science or practice?

This paper describes the evaluation component of Partnerships for Success (PfS), a comprehensive community effort designed to address youth development issues. The evaluation component is referred to as "theory of change-based evaluation." The author considers the implications of applying community practice tools such as theory of change-based evaluation to the current conceptualization of community science. More specifically, the author argues that the current conceptualization of community science pays scant attention to community practice. This paper concludes by suggesting that the current conceptualization of community science be modified to recognize the importance of community practice as an equal aspiration for community psychologists.

Adolescent↗
PubMed1996

Unlocking patients' records in general practice for research, medical education and quality assurance: the Registration Network Family Practices.

General practitioners (GPs) possess a wealth of information on the health of their patients. Hence, they are in a unique position to gather information for research, education or management. The chief goal of the Registration Network Family Practices is to establish a computerized database containing certain patient characteristics and all relevant health problems excluding minor, temporary illnesses. The database can be seen as a dynamic population sampling frame of chronic and/or severe morbidity, also including risk factors and psychosocial problems. The best way to make use of the Registration Network Family Practices is by researchers identifying and sampling patients with particular health problems. The database contained patient characteristics and problemlists of 61,887 persons, on September 1, 1995. At that time 214,389 health problems had been entered in the database. The database is increasingly being used as a source of information for studies by researchers and students. Researchers find the database a useful tool, but they have to keep in mind that data on the process of care are not directly available. Furthermore, there is a limit to the number of studies which can be performed in the network practices, due to time limitations and the burden on the doctors and patients.

Data Collection↗
PubMedDate not supplied

Education-practice partnerships: faculty practice as faculty development.

The importance of establishing service-education partnerships in nursing is well recognized. Many such associations will include provisions for faculty practice, ideally occurring within the context of a comprehensive program that advances clearly stated goals put forth by all participants. We describe the continuing clinical education component of faculty practice, and discuss its place within a hypothetical, broader program. Faculty practice is conceptualized as one aspect of ongoing faculty development.

Boston↗
PubMed2004

Adherence with osteoporosis practice guidelines: a multilevel analysis of patient, physician, and practice setting characteristics.

PURPOSE: The diagnosis and treatment of patients at risk of fragility fractures is uncommon. We examined the patient, physician, and practice characteristics associated with adherence to local osteoporosis guidelines. METHODS: Data were obtained from electronic medical records from one academic medical center. Local guidelines suggest screening and consideration of treatment for at-risk patients, including women aged > or =65 years, women aged 50 to 64 years who smoke cigarettes, persons who used more than 5 mg of oral prednisone for >3 months, and those with a history of a fracture after age 45 years. Clinical notes, medication lists, and radiology records were reviewed to determine whether patients had undergone bone mineral density testing or received any medications for osteoporosis. Possible correlates of guideline adherence, including patient, physician, and practice site characteristics, were assessed in mixed multivariable models. RESULTS: We identified 6311 at-risk patients seen by 160 doctors at 10 primary care sites during 2001 to 2002. Of these patients, 45% (n = 2820) had a prior bone mineral density test and 30% (n = 1922) had received a medication for osteoporosis; 54% (n = 3401) had one or the other. After adjusting for patient case mix, 17% to 71% of patients had been managed according to local guidelines and had undergone at least bone mineral density testing or received a medication. Patient variables that significantly lowered the probability of guideline adherence included age >74 years (odds ratio [OR] = 0.49; 95% confidence interval [CI]: 0.43 to 0.55), age <55 years (OR = 0.34; 95% CI: 0.28 to 0.42), male sex (OR = 0.17; 95% CI: 0.12 to 0.23), black race (OR = 0.40; 95% CI: 0.34 to 0.47), and having more than one comorbid condition (OR = 0.79; 95% CI: 0.69 to 0.89). Patients seen by male physicians were less likely to have care that was adherent with guidelines (OR = 0.70; 95% CI: 0.55 to 0.89). CONCLUSION: Rates of adherence with local osteoporosis guidelines for patients at risk of fragility fractures vary by patient, physician, and practice site characteristic.

Aged↗
PubMed2006

Clinical practice guideline use by oncology advanced practice nurses.

Understanding how clinical practice guidelines (CPGs) are utilized and the effects of their implementation on outcomes is an important goal. The purpose of this investigation was to determine if oncology advanced practice nurse (APN) interventions provided to men with prostate cancer were consistent with Agency for Healthcare Policy and Research CPGs regarding pain [U.S. Department of Health and Human Services. (1993). Acute pain management in adults: Operative procedures. Quick reference guide for clinicians number 1a (AHCPR Publication No. 92-0019). Retrieved, February 23, 2002, from National Library of Medicine HSTAT Collection Online ], depressive symptoms [U.S. Department of Health and Human Services. (1993). Depression in primary care: Detection, diagnosis, and treatment. Quick reference guideline number 5 (AHCPR Publication No. 93-0552). Retrieved, February 23, 2002, from National Library of Medicine HSTAT Collection Online ], and urinary incontinence [U.S. Department of Health and Human Services. (1996). Managing acute and chronic urinary incontinence. Quick reference guide for clinicians number 2 (1996 update) (AHCPR Publication No. 96-0686). Retrieved, February 23, 2002, from National Library of Medicine HSTAT Collection Online ] and to evaluate if levels of consistency affected pain, depressive symptom, and incontinence outcomes. Mean levels of consistency between interventions and pain, incontinence guidelines, and depression were 91%, 80%, and 69%, respectively. Consistency did not predict outcomes in this sample. High levels of consistency suggest that oncology APNs are aware of practices outlined in CPGs.

Aged↗
PubMed2004

Practice management and patient care: is there an ideal situation for both patients and physician practices in light of legislative reform?

The Medicare reimbursement rules have changed, and urologists must be prepared to change as well. They must take an active role in the management of their office practices, for the alternative will almost certainly have a negative impact on access for many patients, including those with prostate cancer. Urologists need to critically evaluate the daily operation of their practice, with an eye toward eliminating excess and increasing efficiency. This article discusses areas, such as staffing, collections, coding, and ancillary services, which can be optimized to meet the requirements of a successful urology practice in this changing environment.

Delivery of Health Care↗
PubMed1997

The role of financial incentives in shaping clinical practice patterns and practice efficiency.

The US healthcare system is evolving from one in which most providers have been paid on some variation of a fee-for-service basis to one in which many or most providers will be paid on a capitated basis. Will this change in financial incentives make a difference in how coronary artery disease and heart failure are treated and managed? Although the evidence is equivocal and limited, two recent studies suggest that capitation and other global payment incentives may dramatically alter clinical practice patterns in treating cardiovascular disease and substantially reduce cardiac-care costs. Clinical cost-effectiveness research efforts must be intensified. Thought leaders in the field of cardiology must move forcefully in developing, disseminating, and encouraging cardiac-care providers to accept and implement evidence-based clinical practice guidelines. The alternative may be ill-advised tradeoffs decided in a decentralized, competitive marketplace, with algorithms being developed de facto by individual practitioners or groups in response to capitated reimbursement constraints. The resulting practice could reduce healthcare use and spending without being cost-effective. Unexpected and undesirable health outcomes could ensue.

Capitation Fee↗
PubMed1987

The practice of pediatric surgery in a medical school environment: is there a conflict between private practice and academic pursuits?

An 11-year review of the clinical practice and the academic activity of the Section of Pediatric Surgery at the University of Michigan was carried out. This was done in an attempt to determine whether or not increased clinical practice in a medical school environment would have a detrimental effect on academic productivity. Clinical activity was evaluated by analyzing the number of patients seen, the number of operations, patient days, admissions, and revenue generated. Academic activity was analyzed by measuring the number of hours of formal lectures and conferences, research space and personnel, the number of completed and active projects, grant support, and the number of publications. During this 11-year period, the number of operations performed increased from 525 per year to over 1,350, the number of office visits increased from 11 per week to 60 to 65, and the gross revenue increased six-fold. At the same time, the number of formal lectures and conferences given increased from 50 to 267 hours per year, the research space increased from 200 to 1,612 square feet, the research budget increased from $20,000 to $120,000 per year, grant support increased from 0 to $62,000 per year, and the number of publications increased from five to 17 per full-time equivalent (FTE) per year. In fact, this review indicates that during the time that clinical practice and revenue generation increased, so did academic productivity in the form of manuscript writing, project completion, and grant acquisition.(ABSTRACT TRUNCATED AT 250 WORDS)

Academic Medical Centers↗
PubMed1998

Algorithm for the diagnosis and management of asthma: a practice parameter update: Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma and Immunology, the American College of Allergy, Asthma and Immunology, and the Joint Council of Allergy, Asthma and Immunology.

This algorithm on the diagnosis and treatment of asthma is intended to complement and update the previously published Practice Parameters for the Diagnosis and Treatment of Asthma. Both documents were developed by the Joint Task Force on Practice Parameters, representing the AAAAI, ACAAI, and the JCAAI. The authors of this asthma algorithm have attempted to include all the elements essential for the diagnosis and care of patients with asthma. Every effort was made to keep the algorithm clear and concise, yet thorough and complete (Fig 1). Each component of the algorithm is elaborated further in a brief annotation. For further discussion, the reader is referred to the more extensive Practice Parameters for the Diagnosis and Treatment of Asthma.

Acute Disease↗
PubMedDate not supplied

Developing an evidence-based practice protocol: implications for midwifery practice.

Evidence-based practice is defined and its importance to midwifery practice is presented. Guidelines are provided for the development of an evidence-based practice protocol. These include: identifying the clinical question, obtaining the evidence, evaluating the validity and importance of the evidence, synthesizing the evidence and applying it to the development of a protocol or clinical algorithm, and, finally, developing an evaluation plan or measurement strategy to see if the new protocol is effective.

Clinical Protocols↗