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PubMed1995

The evolution of pharmacy residency training programs and corresponding standards of accreditation.

Practice-based pharmacy training has a long history, particularly in institutional pharmacy practice. Formal pharmacy residency training programs and accreditation standards were first developed in the early 1960s. Practitioners now practice in a much different environment. Residency programs and accreditation standards have changed dramatically to meet the needs of practitioners, patients, and employers. The authors trace the evolution of programs from general internships through clinical practice and specialty residencies and fellowships and the development of standards and competency-based training.

Accreditation↗
PubMed2001

Consumer focus can spur group practice turnaround.

Many healthcare organizations have lost money on their employed group practices. The solution to this dilemma is not necessarily divestment of the group practices. Instead, some healthcare organizations should view their physicians as an asset. Healthcare organizations and physicians need to develop a new framework for their relationship to optimize their competitive advantage. Three guiding principles that will help accomplish this objective are to recast the healthcare organization-physician relationship to focus on the consumer, reconfigure the economic model to exceed consumer demands, and restructure the group practice to encourage fiscal and service excellence. In developing a new relationship framework, the stakeholders need to define the group practice's mission, strategic direction, composition, infrastructure, compensation model, and structure.

Delivery of Health Care, Integrated↗
PubMedDate not supplied

Adult inpatient training for a family practice residency: a university-versus community-based setting.

BACKGROUND AND OBJECTIVES: Some educators have expressed concern about the quality of inpatient training received by family practice residents in community-based residency programs because of insufficient patient numbers and resources in those programs. This study compared the number, diagnoses, and lengths of stay of patients seen by first-year family practice residents in a large inner-city, university-based medical center's internal medicine service versus those in a family practice teaching service in a smaller, community-based suburban regional hospital. METHODS: The adult inpatient training services of the two training sites were compared for 6 months to determine if any differences existed between the sites in patients'age, gender, primary and secondary diagnoses, average length of hospital stay, or in the number of monthly admissions. RESULTS: A total of 247 patients were admitted to the teaching service of the suburban community hospital, while 317 patients were admitted to the teaching service at the university hospital. The average length of stay for the suburban hospital was 6.1 days and 5.7 days at the university hospital. A total of 107 different diagnoses were made on admission at Kenner Regional Medical Center, while 90 were made at University Hospital. Chest pain/angina was the most frequent diagnosis encountered at admission at both hospitals. CONCLUSIONS: Based on the two inpatient services studied, a broad variety of diagnoses and patient demographics are encountered at community-based hospitals, with similar numbers of patients, lengths of stay, and variation in diagnoses in comparison to an urban-based university hospital. The results indicate that there can be adequate numbers of patients and diagnostic variability to permit effective inpatient teaching at community-based hospitals.

Academic Medical Centers↗
PubMed1991

The value of a new family practice center patient to the academic medical center.

BACKGROUND: Family practice centers are important contributors to the financial viability of academic health centers, although they often are not the direct beneficiaries of their own labor. The greater time commitment and lower costs of most primary care creates significant financial hardships for departments of family medicine in university centers. This study describes the use of inpatient and outpatient health care services by new patients at a university family practice center. METHODS: A sample of 215 new adult enrollees at a university family practice center were examined for a 1-year period after their initial visit to the center. Total billings by the university hospital, specialty services, and the family practice center were tabulated by insurance type. RESULTS: Medicare patients generated the highest average charges (+2501 per patient per year); self-indemnity patients generated the lowest average charges (+301 per patient per year). The largest portion of health services charges was generated by the university hospital inpatient service, which was responsible for approximately 60 cents of every dollar billed to patients in this study. Conversely, the Family Medicine Department billings generated only 17% of the total charges. CONCLUSIONS: The findings of this study indicate that university-based family practice centers are significant contributors to the financial and educational base of the academic health center. If family medicine and associated primary care centers are forced to reduce their size or services because of financial difficulties, the impact will be felt by the university hospitals and by other specialty departments.

Academic Medical Centers↗
PubMed1989

[The treatment of essential hypertension in the hospital and in the office: is there a difference?].

An identical antihypertensive regimen with Metoprolol, a beta-blocking agent, was compared in two groups of patients with mild to moderate hypertension regarding effectiveness and side effects. 17 patients were treated by practitioners, 28 patients at the university clinic. The aim of the comparison was to appreciate possible effects of the clinical setting. With respect to the blood pressure reduction no difference was found between the two groups. Significant differences were noted however regarding side-effects. The practitioners reported fewer and less serious side-effects. This observation should caution about similar phenomena in similar studies and lead to modification of planning in future studies.

Drug Therapy, Combination↗
PubMedDate not supplied

Financial and clinical relationships between family practice and the academic medical center.

The clinical relationship of academic family practice units to their parent tertiary care medical centers was studied. We surveyed the designated family practice contacts in all U.S. medical schools and achieved a response rate of 84%. We found wide variations in the degree to which academic family practice units provide patient care within the walls of the academic medical center. Those departments which perform greater than 50% of their patient care within the academic medical center are more involved in medical center-sponsored alternative health care delivery systems. Residents of these programs receive more than 50% of their training at the academic medical center. These departments are also more likely to teach a required first-year course in the medical school curriculum. Finally, we found a suggestion, not statistically significant, that these departments may be supporting a greater proportion of their total budgets through clinical revenues. We conclude that academic family medicine units may benefit from closer clinical and financial connections to parent academic medical centers.

Academic Medical Centers↗
PubMed1979

Integrating hospital and family practice posts in vocational training for family medicine.

Postgraduate training programmes for family medicine are developing simultaneously in many different parts of the world. In the UK continuity of care is highly valued but vocational training schemes have not been able to provide continuity of care for patients throughout a three-year training course.In Puerto Rico a vocational training scheme exists in which residents are enabled to integrate their hospital and family practice work throughout a three-year course. This arrangement is described and compared and contrasted with vocational training in the UK.

Continuity of Patient Care↗
PubMed1984

Method of evaluating and improving ambulatory medical care.

The usefulness of an action-research model is demonstrated in the evaluation and improvement of ambulatory medical care in a variety of settings: solo office practice, prepaid capitation multiple-specialty group practice, and medical school hospital-based outpatient clinic practice. Improvements in the process of medical care are found to relate directly to the intensity and duration of planned interventions by the study group and are demonstrated to follow organizational changes in the participating sites--primarily managerial and support services initiated by policy decisions in each study site. Improvement in performance approaching one standard deviation results from the most intense intervention, about one-half standard deviation at the next level of intervention, and virtually no change from a simple feedback of performance measures. On the basis of these findings and other operational and research efforts to improve physician performance, it is unlikely that simple feedback of performance measures will elicit a change in behavior. However, noncoercive methods involving health care providers in problem identification, problem solving, and solution implementation are demonstrated to be effective.

Ambulatory Care↗
PubMed2006

The Black Dog Institute Depression Clinic: a subtyping model in practice.

OBJECTIVE: The new Black Dog Institute Depression Clinic adopts a novel clinical service model that argues for the importance of clinically defining separate mood disorders in order to apply specific management strategies. This paper describes clinic nuances and the impact on diagnosis and management for the first 100 patients assessed. METHOD: Patients are assessed via a computerized structured self-report program, a semistructured interview undertaken by a psychiatrist and a colloquium involving several practitioners where diagnostic decisions are formulated. A detailed report with treatment recommendations, incorporating psychiatric and psychological perspectives, is sent to the referring clinician. Such data are examined in this report. RESULTS: We offered a differing diagnostic and treatment paradigm for nearly 90% of those diagnosed with a primary mood disorder. Difficulties encountered by referring practitioners are highlighted and the need for an alternative diagnostic and management model is discussed. CONCLUSIONS: A subtyping diagnostic management model has the capacity to advance treatment outcome, but requires validation. Our future research will assess the comparative utility of the subtyping model in clinical and research arenas.

Ambulatory Care Facilities↗
PubMed2006

National Heart, Lung, and Blood Institute guidelines and asthma management practices among inner-city pediatric primary care providers.

BACKGROUND AND OBJECTIVE: Most surveys of pediatric outpatient asthma management obtain information from parents and caregivers. Studies based on surveys of primary health-care providers are sparse. Suboptimal outpatient management may play a role in the high hospitalization rates among inner-city asthmatic children. Asthma management practices were compared between hospital-based and community-based primary care providers (PCPs). Adherence to National Heart, Lung, and Blood Institute (NHLBI) guidelines was evaluated, along with practices not clearly defined in the guidelines such as use of oral cough medicines and albuterol suspension. DESIGN/METHODS: An 8-point questionnaire was administered to 48 community-based and 32 hospital-based PCPs practicing in inner-city neighborhoods. The questionnaire addressed three "positive" practices (classification of asthma severity, use of asthma action plan, and use of a spacer) and three "negative" practices (use of cough syrup, use of albuterol suspension, and preferential use of leukotriene modifiers instead of inhaled corticosteroids as the first line of preventive therapy). Response options were as follows: never, rarely, sometimes, and always, scored from 0 to 3. The two physician groups were compared on score means for the positive and negative practices using a t test with statistical significance set at p < 0.05. RESULTS: Overall, the rate of adherence to the positive practices was high, with no significant difference between the two groups. Negative practices, while present in both the groups, were reported significantly more often by the community-based group, particularly the use of cough suppressants and albuterol suspension. CONCLUSIONS: Greater emphasis is needed to increase the awareness among PCPs of the NHLBI guideline recommendations, as suboptimal outpatient asthma management may contribute to the disproportionately higher hospitalization rates among inner-city asthmatic children. Clarification on the use of potentially harmful medications and those of doubtful value need to be incorporated in the guidelines. The extent to which these negative practices contribute to the elevated pediatric hospitalization rates warrants further investigation.

Adult↗
PubMed1989

Health care governance: are we keeping pace?

This article reviews current activity of AUPHA programs in the areas of teaching, continuing education, and research in health care governance. Survey data from a sample of 61 AUPHA programs are used to relate these activities to trends in the practice of institutional governance and changes in the health care environment that affect such practices. Areas of concern are identified and recommendations for improvement made.

Community-Institutional Relations↗