Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Generalists”

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 91 records · Page 5Linked to original sources
PubMed2001

Comparison of quality of care by specialist and generalist physicians as usual source of asthma care for children.

OBJECTIVE: To determine whether care for children was more consistent with national asthma guidelines when a specialist rather than a generalist was the usual source of asthma care. DESIGN: Cross-sectional survey. SETTING: Two large managed care organizations in the United States. PARTICIPANTS: A total of 260 parents of children with asthma. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Parent reports of the physician primarily responsible for asthma care (specialist, generalist, or both equally) and whom they would call (specialist or generalist) for questions about asthma care were used to define usual source of care. We assessed consistency of care with 1997 National Asthma Education and Prevention Program guidelines using 11 indicators in 4 domains of asthma care: patient education, control of factors contributing to asthma symptoms, periodic physiologic assessment and monitoring, and proper use of medications. RESULTS: In all 4 domains, care was more likely to be consistent with guidelines when specialists were the usual source of care. These differences remained after adjustment for symptom severity, recent care encounters, and parent demographics. Greatest differences for specialist versus generalist management were for use of controller medications (odds ratio [OR] 6.7; 95% confidence interval [CI]: 1.5-30.4), ever having a pulmonary function test (OR 6.5; 95% CI: 2.4-18.1), and having been told about asthma triggers and how to avoid them (OR 5.9; 95% CI: 1.3-26.2). CONCLUSIONS: In these managed care organizations, asthma care in children was more likely to be consistent with national guidelines when a specialist was the primary provider. Greater use of specialists or altering generalist physicians' care may improve the degree to which the care of children with asthma is consistent with national guidelines.

Adolescent↗
PubMed2006

Using stable isotopes to reveal shifts in prey consumption by generalist predators.

The effectiveness of generalist predators in biological control may be diminished if increased availability of alternative prey causes individual predators to decrease their consumption of crop pests. Farming practices that enhance densities of microbidetritivores in the detrital food web can lead to increased densities of generalist predators that feed on pest species. The ability to predict the net biocontrol impact of increased predator densities depends upon knowing the extent to which individual predators may shift to detrital prey and feed less on crop pests when prey of the detritus-based food web are more abundant. We addressed this question by comparing ratios of stable isotopes of carbon (delta13C) and nitrogen (delta15N) in generalist ground predators and two types of prey (crop pests and microbidetritivores) in replicated 8 x 8 m cucurbit gardens subjected to one of two treatments: a detrital subsidy or no addition of detritus (control). Small sheet-web spiders (Linyphiidae) and small wolf spiders (Lycosidae) had delta13C values similar to those of Collembola in both the detrital and control treatments, indicating that small spiders belong primarily to the detrital food web. In control plots the larger generalist predators had delta13C values similar to those of the major insect pests, consistent with their known effectiveness as biocontrol agents. Adding detritus may have caused delta13C of one species of large wolf spider to shift toward that of the microbi-detritivores, although evidence is equivocal. In contrast, another large wolf spider displayed no shift in delta13C in the detrital treatment. Thus, stable isotopes revealed which generalist predators will likely continue to feed on pest species in the presence of greater densities of alternative prey.

Animals↗
PubMed1996

Differences in generalists' and cardiologists' perceptions of cardiovascular risk and the outcomes of preventive therapy in cardiovascular disease.

OBJECTIVE: To compare generalists' and cardiologists' estimates of baseline cardiovascular risk and the outcomes of preventive therapy. DESIGN: Cross-sectional mail survey using written case simulations of typical patients from primary prevention trials for hypercholesterolemia and isolated systolic hypertension, and tertiary prevention studies of coronary artery bypass surgery for chronic stable angina with left main coronary stenosis. PARTICIPANTS: Nationally representative sample of 599 practicing family physicians, general internists, and cardiologists selected from the American Medical Association masterfile. Among eligible physicians, 84 (44%) of 191 family physicians, 77 (40%) of 194 general internists, and 66 (34%) of 194 cardiologists responded. MEASUREMENTS: Estimates of risk at baseline and after therapy, and whether therapy generally would be recommended. RESULTS: For both primary prevention case simulations (scenarios), cardiologists provided lower, more accurate estimates of baseline cardiovascular risk and of absolute therapeutic benefit than either family physicians or general internists. The range of the generalists' estimates was extremely wide. Perceptions of relative risk reduction and treatment recommendations for the primary prevention scenarios did not differ among specialties. Overall, generalists who would not recommend primary preventive therapy in these scenarios appeared to give more accurate estimates than did generalists who would recommend such therapy. CONCLUSIONS: Many generalists have inflated perceptions of cardiovascular risk without treatment and of the benefit of risk-modifying medical treatment. Further study should assess the reasons for these misperceptions and their effect on counseling about primary preventive therapy.

Adult↗
PubMedDate not supplied

Generalists or specialists--who does it better?

Managed care companies encourage primary care physicians to limit referrals to specialists and provide as much of the needed services themselves. As a result, generalist and specialist physicians are now in direct competition with one another. Is the care provided by generalist and specialist physicians different in terms of quality and cost? The authors reviewed the literature over the past five years and found 21 articles comparing the care between specialists and generalists. They realized asking who does it better, the generalists or the specialists, is the wrong question to explore. Physicians must come together to design systems of care that maximize the long-term health of patients and deliver care in a coordinated and efficient manner. The emphasis should be on creating value for the consumer across the continuum of providers and through time. Competition between generalists and specialists in a fragmented system only serves to further weaken the position of physicians in the health care industry.

Cost Control↗
PubMed2000

HMO growth and the geographical redistribution of generalist and specialist physicians, 1987-1997.

OBJECTIVE: To assess the impact of the growth in HMO penetration in different metropolitan areas on the change in the number of generalists, specialists, and total physicians, and on the change in the proportion of physicians who are generalists. DATA SOURCES/STUDY SETTING: The American Medical Association Physician Masterfile, to obtain the number of patient care generalists and specialists in 1987 and in 1997 who were practicing in each of 316 metropolitan areas in the United States. Additional data for each metropolitan area were obtained from a variety of sources, and included HMO penetration in 1986 and 1996. STUDY DESIGN: We estimated multivariate regression models in which the change in the number of physicians between 1987 and 1997 was a function of HMO penetration in 1986, the change in HMO penetration between 1986 and 1996, population characteristics and physician fees in 1986, and the change in population characteristics and fees between 1986 and 1996. Each model was estimated using ordinary least squares (OLS) and two-stage least squares (TSLS). PRINCIPAL FINDINGS: HMO penetration did not affect the number of generalist physicians or hospital-based specialists, but faster HMO growth led to smaller increases in the numbers of medical/surgical specialists and total physicians. Faster HMO growth also led to larger increases in the proportion of physicians who were generalists. Our best estimate is that an increase in HMO penetration of .10 between 1986 and 1996 reduced the rate of increase in medical/surgical specialists by 10.3 percent and reduced the rate of increase in total physicians by 7.2 percent. CONCLUSIONS: The findings of this study support the notion that HMOs reduce the demand for physician services, particularly for specialists' services. The findings also imply that, during the past decade, there has been a redistribution of physicians-especially medical/surgical specialists-from metropolitan areas with high HMO penetration to low-penetration areas.

Catchment Area, Health↗
PubMed2002

The generalist's patient and the subspecialist.

OBJECTIVE: To examine if required referring procedures from generalists to subspecialists for managed care patients affect communication between the physicians. BACKGROUND: Collaboration between generalists and subspecialists is essential for successful referrals and a satisfactory relationship between the physicians. However, breakdowns in information transfers in outpatient referrals continue to be described. Moreover, the referral process within managed care systems may be adding new elements that interfere with communication between physicians, promoting fragmentation of care. OBSERVATIONS: Current referral forms or electronic approval mechanisms encourage responses for billing approval, but neglect methods to require questions from generalists and replies from the subspecialist. Other barriers to communication between physicians are discussed. Responsibilities for agencies, patients, and doctors are reviewed. CONCLUSIONS: Insuring agencies need to provide uniform rules and educational mechanisms describing patients' timely responsibilities in the consultation process. In addition, methods need to be created to convey reasons and data for referral from generalists to subspecialists, and recommendations from subspecialists back to the generalists.

Communication↗
PubMed1992

The case of the disappearing generalist: does it need to be solved?

The proportion of generalist physicians in the United States has declined steadily over 50 years, bringing it to the lowest percentage of trained primary care physicians of any developed country; the trend toward subspecialization is accelerating. Many analysts believe this imbalance between generalists and subspecialists to be a major cause of America's high health care costs, heavy dependence on biotechnology, and consumer dissatisfaction. Others argue that sub-specialists can provide excellent primary care services, and the decrease in the number of generalists is not a problem. Three contrasting views on the implications of this trend state that today's generalists are an important and scarce resource that must be bolstered; that subspecialists can replace generalists as providers of primary care; and that the free market will determine the best manpower mix. A final view, on the marketplace option, posits that generalism will not recover until it creates a vital, and unique, role in handling the primary care challenges of the twenty-first century. These competing viewpoints are used to clarify assumptions underlying our major policy options in the arena of health manpower.

Consumer Behavior↗
PubMedDate not supplied

Are patients who use a generalist physician healthier than those who seek specialty care directly?

BACKGROUND: American health care consumers want the option of seeing specialists whenever they wish, but given this option, do they in fact use it without consideration of their health status? This paper reports on a cross-sectional analysis that compares the demographics and health status of fee-for-service Medicare enrollees who exhibited four different patterns of physician access. METHODS: The Medicare Beneficiary Survey data from 1998 were used. Subjects ages 65 and older were categorized into one of four groups: those with no physician claim, those who saw a generalist only, those who saw a specialist only, and those who saw both. Age, income, education, health status, level of impairment, and disease burden for the four patient groups were compared using ANOVA. Urban/rural status, race, ethnicity, mortality rates, and gender for the four patient groups were compared using chi-square. A predictive model using mutinomial logistic regression was created. RESULTS: Twelve percent of subjects saw no physician in 1998, 11.6% saw a generalist only, 14.2% visited a specialist only, and 62.1% visited both types of physicians. Subjects who saw both physician types had significantly worse health status and more chronic diseases than the other groups. Subjects who saw generalists only or specialists only had intermediate levels of health status and disease burden that were not significantly different from each other. Subjects who saw a specialist only were the most affluent and highly educated group. Subjects who saw no physician had the best health status and the fewest chronic diseases of all subject groups. Urban residents were more likely to visit some type of physician than were rural residents and were more likely to see a specialist only. Regional differences were noted, with New England showing the highest rates of specialist only use. DISCUSSION: As expected, the healthiest subjects were least likely to visit any health care provider. Subjects with the worst health status were likely to access both generalists and specialists for their care. Subjects who visited a specialist only had higher incomes, more education, and urban residence but no difference in health status when compared to subjects who visited a generalist only.

Aged↗
PubMed1994

Defining the generalist physician's training.

OBJECTIVE: To determine the extent to which various specialties prepare residents in the broad competencies required for primary care practice and to propose guidelines for improving generalist physician training. DATA SOURCES: Leading causes of morbidity and mortality, 1991 National Ambulatory Medical Care Survey data, expert reports, and the special requirements for residency training. DESIGN: From the data sources we identified the common presenting conditions and diagnoses that broadly trained generalist physicians could be expected to manage in primary care practice. We then compiled a list of 60 requisite residency training components grouped according to seven practice criteria for generalist physicians. Using the special requirements for residency training for family practice, internal medicine, pediatrics, obstetrics and gynecology, and emergency medicine, we determined the extent to which the requirements addressed the 60 components and continuity-of-care training. RESULTS: Almost all of the 60 generalist training components were required by family practice (95%), internal medicine (91%), and pediatrics (91%), compared with emergency medicine (42%) and obstetrics and gynecology (47%). Family practice, internal medicine, and pediatric residencies also require lengthy, well-defined continuity-of-care experiences. CONCLUSION: Family practice, internal medicine, and pediatric programs prepare residents in the broad competencies necessary for primary care practice. To train competent generalist physicians, we recommend that residency programs require training in 90% or more of the 60 components, 50% or more of the components in each of the seven categories, and a continuity-of-care experience for a panel of patients during at least 10% of the entire residency training period.

Clinical Competence↗
PubMed1997

Hip fracture surgery in Nova Scotia: a comparison of treatment provided by "generalist" general surgeons and orthopedic surgeons.

OBJECTIVE: To determine quality of hip fracture services provided by "generalist" general surgeons (generalists) in Nova Scotia. DESIGN: Chart review and postoperative, blinded, random-ordered radiologic analysis. SETTING: Three community hospitals and 1 tertiary care hospital in Nova Scotia. PARTICIPANTS: Seven generalists who performed 120 hip fracture repairs and 7 orthopedic surgeons (specialists) who performed 135 hip fracture repairs. OUTCOME MEASURES: Patient demographics, preoperative, perioperative, postoperative and discharge information, technical quality of reduction as determined through postoperative radiologic assessment. RESULTS: There were no differences between patients treated by generalists and those treated by specialists with respect to age, sex, American Society of Anesthesiologists' class, level of function and fracture type. Intraoperatively, the patient groups were similar with respect to type of anesthesia, use of antibiotics, number of transfusions and surgical complications. Significant differences were noted in length of operation (54.4 v. 41.1 minutes), use of C-arm imaging (6.7% v. 85.9%) and management of Garden classes 1 and 2 subcapital fractures. Postoperatively, the 2 groups had similar numbers of medical complications, wound complications, reoperations, readmissions and deaths, and a similar level of function on discharge. Significant differences included the number of intensive care unit admissions (5.8% v. 15.6%) and length of stay there (5.7 v. 2.8 days) and of postoperative stay (14.5 v. 10.7 days). The assessment of radiographs did not demonstrate any significant difference in the quality of reduction. CONCLUSION: In Nova Scotia the outcomes of hip fracture surgery performed by generalists are comparable to those performed by specialists.

Activities of Daily Living↗
PubMed1997

Geographic distribution, supply, and need for generalist physicians in Alaska.

This study provides the first comprehensive description of Alaska's geographic distribution of generalist physicians relative to population. All 443 generalist care physicians (family, general, general internal medicine, and pediatric) or their office managers were questioned about their specialties, ZIP codes, employers, populations served, and hours spent per week offering direct patient care. The results indicated a 30% overall shortage of generalist physicians for the state, representing roughly 141 full-time-equivalent generalists relative to national practice patterns and trends of health maintenance organizations. Of 17 primary health care areas, including the Anchorage area, 15 showed a need for additional generalist physicians. Most areas had a 20 to 40% shortage. Concerns about transportation and financial barriers to access to care, especially in remote regions, were raised. Other needs emphasized included knowledge of contributions of midlevel health care professionals, Alaska Native versus non-Native care, efforts to train and retain physicians in Alaska, and the need for longitudinal tracking of practice patterns.

Alaska↗
PubMed2006

A model of teaching-learning transactions in generalist-specialist consultations.

INTRODUCTION: A new paradigm in continuing medical education is characterized by emphasis on physicians' learning in practice. Consistent with this paradigm, our study examined a subset of clinical practice--generalist-specialist consultations--from an educational perspective. METHODS: We applied the grounded-theory method with semistructured interviews. Ten primary care physicians and 9 internal medicine subspecialists were interviewed regarding their approaches to learning and teaching during generalist-specialist consultations. RESULTS: Based on 48 formal and informal consultations reported by physicians, we developed a theory of teaching-learning transactions in generalist-specialist consultations. DISCUSSION: As a teaching-learning transaction, the mutual learning process in generalist-specialist consultations involves 3 components: needs assessment, dialogue, and sufficiency. Providers of continuing medical education may use the proposed theoretical framework to help clinicians and health care organizations analyze and enhance educationally valuable interactions at the interface of primary and secondary care.

Education, Medical, Continuing↗
PubMed2002

Evolving the division of labour: generalists, specialists and task allocation.

The evolutionary dynamics of specialization, in the context of the division of labour, are investigated. Individuals associate in groups in which benefits are shared and costs borne individually; each individual is either a generalist who can perform all the necessary tasks, a specialist who performs a sub-set of the necessary tasks, or a parasite who contributes nothing to the group. The implications of the model are explored analytically and through both numerical and Monte Carlo methods. These methods demonstrate the evolution of populations towards stable arrangements of specialists and generalists. The fittest populations are those that divide tasks fairly and associate in large, highly specialized groups. Generalists have a distinct advantage in small groups, but the presence of generalists, ironically, lowers group fitness. Parasites are able to invade both specialized and non-specialized populations. A basic model for the continuous division of labour is also presented, demonstrating a tendency for populations to evolve increasingly unfair divisions of labour. This last result implies that an evolutionary ratchet favours disparity between the workload of specialist populations.

Animals↗
PubMed1994

Collaboration in the preparation of the generalist physician.

Collaborative efforts among health care professionals and institutions at all levels will be essential to the increased production of generalist physicians. There have been many successful collaborations in education and patient care among certifying boards, faculty, physicians in practice, specialists, generalists, and non-physician health professionals, as well as among the three generalist specialties. Recommended strategies to encourage collaboration in the preparation of generalist physicians include: creation of an institutional collaborative curriculum committee; design of a longitudinal curriculum on collaboration for physicians-in-training and other health professionals; implementation of collaborative patient care in ambulatory care teaching clinics; development of integrated systems of care that link inpatient, outpatient, and community-based health services; and education of physicians-in-training in these and other collaborative and co-practice models of patient care.

Adult↗
PubMed1994

The changing role of academic health care centers in generalist education and practice support.

Academic medical centers have been more compatible with the training and support of specialist and subspecialist physicians than that of their generalist colleagues. To meet the increasing demand for well-prepared generalist physicians, academic centers must change the manner in which they discharge their traditional missions of patient care, education, and training. This will require alteration of their organizational structures, changes in the allocation of resources, and an evolution of the culture of academic medicine toward one that is supportive of generalist education and practice. This paper discusses 1) the present organizational, structural, and cultural elements of the academic health care center that are inadequate for that goal; 2) a model for reorganizing academic health care centers to best achieve that goal; and 3) educational programs and technologies that promise to address the continuing educational needs of generalists.

Academic Medical Centers↗
PubMed2003

Dietary shift and lowered biomass gain of a generalist herbivore in species-poor experimental plant communities.

Species loss of primary producers is likely to affect processes on other trophic levels. We studied consumption and individual performance of the generalist herbivore Parapleurus alliaceus (Orthoptera) in relation to the species richness of primary producers. Adult grasshoppers were caged and left to feed for 2 weeks on experimental grassland communities ranging in plant species richness from one, two, four, eight to 32 species. Low plant diversity had a negative effect on both plant community biomass and on biomass gain of female grasshoppers, feeding to produce eggs (male grasshoppers did not gain biomass during the feeding period). This was surprising because plots with high plant diversity had a low proportion of grass biomass and grasshoppers preferentially selected grasses, leading to a greater exploitation of grasses in experimental communities of higher diversity. Thus, the concurrent increase in non-grass species in the diet from these high-diversity communities must have been beneficial to the generalist herbivore. In addition to the positive effects of plant diversity, the presence of legumes in a mixture with grasses further enhanced the biomass gain of grasshoppers at a given level of diversity. These findings suggest that plant species loss may lead to shifts in herbivore population sizes, reducing those of generalists and benefiting specialists of the remaining plant species. Our results further suggest that generalist herbivores, by having feeding preferences, can also change the relative abundances of plant species with different functional characteristics. This may feedback on both composition and diversity of plant communities.

Animals↗
PubMed2005

Effects of quantitative variation in allelochemicals in Plantago lanceolata on development of a generalist and a specialist herbivore and their endoparasitoids.

Studies in crop species show that the effect of plant allelochemicals is not necessarily restricted to herbivores, but can extend to (positive as well as negative) effects on performance at higher trophic levels, including the predators and parasitoids of herbivores. We examined how quantitative variation in allelochemicals (iridoid glycosides) in ribwort plantain, Plantago lanceolata, affects the development of a specialist and a generalist herbivore and their respective specialist and generalist endoparasitoids. Plants were grown from two selection lines that differed ca. 5-fold in the concentration of leaf iridoid glycosides. Development time of the specialist herbivore, Melitaea cinxia, and its solitary endoparasitoid, Hyposoter horticola, proceeded most rapidly when reared on the high iridoid line, whereas pupal mass in M. cinxia and adult mass in H. horticola were unaffected by plant line. Cotesia melitaearum, a gregarious endoparasitoid of M. cinxia, performed equally well on hosts feeding on the two lines of P. lanceolata. In contrast, the pupal mass of the generalist herbivore, Spodoptera exigua, and the emerging adult mass of its solitary endoparasitoid, C. marginiventris, were significantly lower when reared on the high line, whereas development time was unaffected. The results are discussed with regards to (1) differences between specialist and generalist herbivores and their natural enemies to quantitative variation in plant secondary chemistry, and (2) potentially differing selection pressures on plant defense.

Adaptation, Physiological↗
PubMed2005

Differences in effects of pyrrolizidine alkaloids on five generalist insect herbivore species.

The evolution of the diversity in plant secondary compounds is often thought to be driven by insect herbivores, although there is little empirical evidence for this assumption. To investigate whether generalist insect herbivores could play a role in the evolution of the diversity of related compounds, we examined if (1) related compounds differ in their effects on generalists, (2) there is a synergistic effect among compounds, and (3) effects of related compounds differed among insect species. The effects of pyrrolizidine alkaloids (PAs) were tested on five generalist insect herbivore species of several genera using artificial diets or neutral substrates to which PAs were added. We found evidence that structurally related PAs differed in their effects to the thrips Frankliniella occidentalis, the aphid Myzus persicae, and the locust Locusta migratoria. The individual PAs had no effect on Spodoptera exigua and Mamestra brassicae caterpillars. For S. exigua, we found indications for synergistic deterrent effects of PAs in PA mixtures. The relative effects of PAs differed between insect species. The PA senkirkine had the strongest effect on the thrips, but had no effect at all on the aphids. Our results show that generalist herbivores could potentially play a role in the evolution and maintenance of the diversity of PAs.

Animals↗