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At least 739 records · Page 41Linked to original sources
PubMed1996

Differences between generalist and specialist physicians regarding Helicobacter pylori and peptic ulcer disease.

OBJECTIVES: To assess differences between gastroenterologists and primary care physicians in the United States in their attitudes, timing of adoption, and practice patterns concerning the use of Helicobacter pylori eradication therapy in peptic ulcer disease (PUD) patients. METHODS: We surveyed a random sample of 4500 gastroenterologists, family practitioners, and general internists shortly after a National Institutes of Health Consensus Conference recommended eradication of H. pylori in PUD patients. RESULTS: The survey response rate was 30%. Bivariate comparisons revealed significant differences between primary care physicians and gastroenterologists in sources of information about H. pylori, beliefs about the strength of the evidence supporting the relationship between H. pylori and PUD, adoption of H. pylori eradication therapy and timing of first use, and patients likely to receive eradication therapy. Although adoption of H. pylori eradication therapy was nearly universal among gastroenterologists by April 1994 (99%), approximately one-third of primary care providers had never prescribed H. pylori eradication therapy. Practice patterns of physicians using eradication therapy also varied significantly by specialty group. CONCLUSIONS: Gastroenterologists were more aware of the relationship of H. pylori to PUD and adapted their practices more quickly to this emerging information than did primary care providers. Specialty differences in attitudes and adoption patterns of medical innovation existed, even when the new intervention did not require specialized training or equipment. These findings have important clinical implications as the role of primary care physicians expands and managed care delivery systems decrease the use of specialist services.

Adult↗
PubMedDate not supplied

Regional attitudes of generalists, specialists, and subspecialists about management of atrial fibrillation.

BACKGROUND: It is unknown whether physicians' attitudes about the management of atrial fibrillation (AF) reflect the recommendations of published guidelines. METHODS: To obtain information about physicians' attitudes about management of AF, a questionnaire was returned by 904 (20.1%) of 4500 physicians involved in managing AF (385 cardiologists, 326 internists, and 193 electrophysiologists). The cardiologists and internists were from Massachusetts or California; the electrophysiologists were from around the United States. The questionnaire called for 86 separate answers about use of resources and drug therapy for different types of AF, including recent-onset AF, paroxysmal AF, and chronic AF of less than 6 months' and more than 3 years' duration. RESULTS: Transthoracic echocardiography and thyroid function were requested by more than 90% of physicians; transesophageal echocardiography and catheterization were requested by 10% of physicians. To control ventricular response, digoxin was the overwhelming first-line therapy; calcium channel blockers were favored over beta-blockers for adjunct therapy. To prevent thromboemboli, warfarin sodium was preferred for chronic AF; warfarin or aspirin were equally considered for paroxysmal AF. In considering sinus rhythm, respondents agreed about factors determining whether to revert, the number of drug trials, and the first-line drug choice (quinidine sulfate) but disagreed about second-line antiarrhythmic drugs and whether to hospitalize the patient before initiating drug therapy. CONCLUSIONS: Physicians ranging from primary care providers to subspecialists agree on issues of AF management such as heart rate control and anticoagulation. Attitudes vary widely about issues such as antiarrhythmic drugs.

Atrial Fibrillation↗
PubMedDate not supplied

Overcoming parochialism: interdisciplinary training of the generalist team.

The work force that will staff most health care systems of the future will include a complex array of professionals working together in teams. The traditional inpatient model of patient care has been only multidisciplinary--nurses, medical social workers, dietitians, pharmacists, and physicians, all interested in each patient, but with divided responsibilities, training formats, and faculties--whereas interdisciplinary teams openly share decision making, expectations for care, goals for the team, and mutual respect.

Decision Making, Organizational↗
PubMed1997

["Doctor, my knee hurts...", the generalist's point of view].

Knee pain is a relatively common symptom in family practice. It is occurring at the rate of 48 fo 1000 patients/year in the Dutch general practitioner's non selected population. The different investigation techniques are listed and studied, leading to a global classification (non inflammatory (degenerative, mechanical or traumatic), inflammatory or septic knee), then to a more specific and more operational one for an optimal therapeutic way.

Decision Trees↗