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PubMed1999

Family practice and the advancement of medical understanding. The first 50 years.

In the last half of the twentieth century, family practice has emerged as a strong influence in both community practice and academic medical centers. Since the formation in 1947 of the American Academy of General Practice, family practice has changed from a group of physicians applying the knowledge of other disciplines into a recognized specialty with its own body of learning. Family medicine has advanced medical understanding in: (1) relationship-based health care as the foundation of a specialty; (2) the process of comprehensive clinical reasoning; (3) the recognition of problems of living as a health care concern; (4) the meanings of words such as pain, disease, and disability; (5) the systems approach to primary health care; and (6) the clinical encounter as the definable unit of family practice. These 6 concepts have helped expand the specialty's body of knowledge and clarify its values. They will also serve as a template for the future evolution of family practice as the specialty faces new challenges, including managed care, the aging population, the rapid growth of medical knowledge, and the increased use of computers and technology in health care.

Family Practice↗
PubMedDate not supplied

Transferring hospital sponsorship of a family practice residency: financial implications.

Family practice residency programs close each year, many in which there is a perception by the sponsoring institution that the program was too costly. Upon the imminent closure of a program's sponsoring hospital, we analyzed and projected the residency's budget and revenues to convince another community hospital to accept transfer of the sponsorship of the program. Revenues directly attributable to the residency (family practice center, grants, Medicare graduate medical education reimbursement) were identified. In addition, we identified that portion of new inpatient revenues necessary to offset the balance of the residency budget. We found that the program could account for reimbursement of 51.8% of its budget through patient care services, requiring 5.2% to be subsidized through state grants and 43.1% through federal graduate medical education reimbursement. Consistent with studies by several authors, family practice residency programs continue to require financial subsidy to balance their budgets. The nation's need for family physicians can only be ensured if state and federal priorities for needed primary health manpower are translated into continued and enhanced financial support.

California↗
PubMed1984

Continued assessment of flexible sigmoidoscopy in a family practice residency.

The UCLA Family Practice Residency continues to use 60-cm flexible sigmoidoscopy in the care of patients. Between July 1980 and June 1983, 450 patients received an examination with the 60-cm flexible sigmoidoscope. One or more adenomatous polyps were detected in 21 patients. Adenocarcinoma was found in five patients. Four patients were found to have a villous adenoma, and four patients were determined to have inflammatory bowel disease. Of the 34 discrete lesions, 32 percent, 41 percent, and 27 percent were located between 0 and 20 cm, 21 and 35 cm, and 36 and 60 cm, respectively, from the anus. No complications were encountered. Sixty-four percent of the examinations were done by a family practice resident supervised by a full-time faculty member. The remaining 36 percent of the examinations were performed by full-time faculty. The overall detection rate for significant pathology was 8.0 percent. Most pathology by far was found in symptomatic patients. These results validate the safety and viability of 60-cm flexible sigmoidoscopy when performed by properly trained family physicians and family practice residents-in-training.

Adenocarcinoma↗
PubMed1998

Family practice residency programs and the graduation of rural family physicians.

BACKGROUND AND OBJECTIVES: Family practice residency programs graduate about 600 rural physicians each year. Increases in resident positions have not increased the numbers who choose rural practice. This study examines the relationship between program characteristics and the graduation rate of rural physicians. METHODS: From 1994-1996, we sent an annual survey to the directors of all nonmilitary family practice residency programs; 353 programs (96% response rate) returned questionnaires. Weighted least-squares regression was used to analyze the relationship between program factors and the percentage of graduates who chose practices in 1992, 1993, and 1994 in towns of less than 25,000 not adjacent to a larger metropolitan area. RESULTS: Family practice residency programs that graduated more rural physicians had more required rural and obstetrical training months, had a full or partial rural mission, were located in more rural states, had the program director as the rural contact, had a procedural emphasis, had fewer residents who were minorities or female, and used fewer types of other major graduate programs for rotations. CONCLUSIONS: This study outlines the important contribution of rural emphasis and training in family practice residency programs. Future studies should explore rural, procedural, and obstetrical training interventions and examine gender, minority, and program location issues.

Career Choice↗
PubMed1995

On content of practice. The advantage of computerized information systems in family practice.

BACKGROUND: Computerized medical records have been widely used in family practice in Iceland for several years. Extensive data have been accumulated; however, how best to use and implement these data has been debated. OBJECTIVES: The main objectives of this study was to determine the advantage of computerized information systems in family practice. MAIN RESULTS: The results provided broad epidemiological information on the content of family practice in Iceland. The study population consisted of 50,865 Icelanders and their 257,188 contacts with 17 community health centres over one whole year, 1988. Services were provided by 50 doctors, 43 nurses and nurses' assistants, and 7 midwives. Almost 90% of the rural population made at least one contact over the year of study; the mean rate of contacts per individual was 5.1, office visit 2.8-3.3, phone calls 1.1-1.6, and home-visits 0.4, females (40%) more often than males, increasing in number with increasing age. Disease symptoms were the reason for contact in 35-39% of cases, the initiative of the health care provider in 44-50%, and administration in 9-12%. The mean number of health problems recorded were 2.3 per individual per year. Extensive prevalence numbers are provided by age and sex. The largest categories were respiratory, injuries and musculoskeletal with a prevalence of over 200/1000 individuals per year. The most frequent contacts were made by persons with cancer and mental problems. The actions taken (processes) as a result of these contacts were numerous, an average of 1.6 per contact; 648 medications/1000 contacts, 141 laboratory tests, 126 surgical procedures, 15-24 referrals, and 15-26 hospital admissions. Prescriptions were most frequently for central nervous system medication (93-117/1000 contacts), for anti-infectives (100-106), and for cardiovascular (58-99). The cost of x-rays was shown to be $866 per 1000 contacts, and the odds for having an x-ray decreased by 18% for every 1000 individuals added to a practice. A quality study showed 16% of x-ray requests and 13% of office prescriptions were lacking. CONCLUSION: The information obtained reflects health problems of the population as observed by family doctors. The information is useful for observing and influencing the health of a nation, the practices of health care providers, the generation of cost in the health system, and the use of appropriate health services. It is also useful to health care planners and researchers, as well as educators of health care providers. This study serves as a baseline for these tasks.

Adolescent↗
PubMed2001

Establishing a practice based primary care research network. The University Family Practice Network in South Australia.

BACKGROUND: Practice based research networks enable the study of primary care problems in a primary care setting. To be successful, our experience indicates that a network will need to incorporate a number of key components. In South Australia, a University Family Practice Network has been established to undertake primary health care research and teaching and to contribute to the general practice workforce. The University Family Practice Network is composed of five practices and is managed jointly by the Department of General Practice, Adelaide University and the South Australian Centre for Rural and Remote Health, Adelaide University and the University of South Australia. OBJECTIVE: This article details the successful establishment of the University Family Practice Network in the hope of providing a model for other universities who may be interested in setting up a practice based research network. DISCUSSION: The characteristics of this network include fractional academic positions for general practitioners, computerised medical records, location in rural and urban sites, regular meetings and the appointment of a research fellow. A number of benefits have arisen since the network's establishment that will assist its future development and sustainability. These include collocation with allied health services, development of local expertise and workforce support.

Australia↗
PubMed1996

Medical students' and private family physicians' perceptions of family practice.

BACKGROUND: Many studies have attempted to determine what factors influence medical students' career selections. This study determined students' perceptions of family practice, examined what variables influenced these perceptions, and measured whether medical students' perceptions were similar to or different from those of practicing family physicians. METHODS: The two populations studied were students sampled at an Ohio medical school over the first 3 years of their training and a random sample of Ohio family physicians. Each subject was asked to complete a questionnaire that asked about perceptions of family practice and demographic information. RESULTS: A total of 719 (69%) students and 295 (59%) family physicians responded to the survey. Sixty-seven percent of the physician responders were actively involved in medical student teaching. More than 94% of the students had exposure to family physicians during their preclinical education. Students' perceptions were different than physicians' perceptions about lifestyle issues, patient care, and practice characteristics; over time, these approached the physicians' perceptions. However, the perceptions of family physicians and students about professional issues were similar. DISCUSSION: Medical students and family physicians have different perceptions about family practice. Students' perceptions become similar to physicians' perceptions as they progress through the educational system, while, at the same time, their interest in family practice declines.

Attitude↗
PubMed1980

The spectrum of otitis media in family practice.

Individual and family factors which relate to acute purulent otitis media were investigated in a family practice population. In a practice with more than 11,000 patients, 442 persons had 527 episodes of otitis media during a one-year period. More than 20 percent of the cases occurred in patients of age 15 years and over, but the case rate per year for this group was 11 cases per 1,000 as opposed to 109.7 cases per 1,000 for patients under the age of 15 years. Twenty percent of young children had two or more episodes during the year as compared with five percent for adults. Females had more multiple episodes than did males. The incidence of multiple cases in families is greater than would be expected if cases were distributed randomly (P less than 0.05). However, significantly fewer families with three or more children reported cases of otitis media as compared with smaller families (P less than 0.05).

Adolescent↗
PubMed2001

Quality of a family medicine preceptorship is significantly associated with matching into family practice.

OBJECTIVES: This study tested whether clinical experiences in family practice are associated with matching into family practice. METHODS: We conducted a prospective cohort study of 913 medical students who completed the Family Practice Preceptorship (FPP) at the University of Iowa from 1990-1996. Using univariate techniques and logistic regression, we compared the background and experiences of those who matched into family practice with those who chose other specialties. RESULTS: Twenty-nine percent (n=267) matched into family practice. Positive independent predictors of family practice match were hometown size less than 10,000 (odds ratio [OR] 1.8), anticipating choosing family practice at matriculation (OR 4.2), and liking to help others (OR 4.1). Negative independent predictors included parental income of at least $120,000 (OR .61), desiring to perform technical procedures (OR .51), and liking the scientific method and research (OR .54). The effect of an early summer clinical experience at a community hospital varied depending on the level of student interest in family practice at matriculation. Students who rated the educational value of the FPP as high or very high were significantly more likely to go into family practice (OR 2.9), even after adjusting for all other student characteristics. CONCLUSIONS: A number of student characteristics and preferences, early clinical experiences, and the perceived quality of a required family medicine preceptorship were significantly and independently associated with students matching into family practice.

Adult↗
PubMed2002

Family practice in the United States: position and prospects.

Family practice became the 20th U.S. medical specialty in 1969. It has delivered on its promise to reverse the decline of general practice and care for people with diverse problems in all areas of the country. But many important health care problems remain unsolved, in part because of poor role delineation for family physicians, poor differentiation of family practice from other fields, and insufficient changes in the cultural and political environment. Family practice's problems include confusion about whether it is a reform movement or an incumbent specialty; disagreement about its role in controlling and assuring care; confusion about whether family physicians are generalists or specialists; lack of clarity about family practice as vital for all versus a possible option for some; misunderstanding about the knowledge requirements for family practice; and inadequate business models. Family practice's mistakes include expending much effort on justification and less on assuring practical means to accomplish its work; permitting an erosion of public trust; failing to strengthen relationships with interfacing specialties and organizations; and neglecting research. Nonetheless, there are promising opportunities to improve health and health care through strengthening family practice that depend in part on redesigning the family practice setting, defining carefully critical interactions with other elements of the health care system, fostering discovery of family practice, and further differentiating family practice as a scientific and caring field. Another period of adaptation by family practice is already under way; this may be the first time in history that its ambitious aspirations are actually achievable.

Family Practice↗
PubMed1977

The effect of the organization and status of family practice undergraduate programs on residency selection.

Family practice, as a medical specialty, is designed to help fill the void in primary care availability. In order to expose medical students to family practice and provide a basis for choosing a residency in the field, many medical schools have developed undergraduate programs in family practice. This paper reports the results of a survey conducted in March 1975 on the status of undergraduate programs with particular focus on the relationships between administrative status, size of program, faculty size, and type of undergraduate curricula to the number of graduates choosing family practice as a specialty. The data indicate that there is a relationship between the commitment of the school to family practice, the size of the program, and the presence of required courses in the curriculum to the success of the program, as measured by the proportion of students in each school who choose family practice residencies.

Education, Medical, Undergraduate↗
PubMed1985

The research environment in family practice.

Both the place of family practice in academic medicine and the intellectual underpinning of the specialty itself are thought by many to depend on the development of successful research programs in academic departments of family medicine. Yet many believe less research than desired is being done in such departments, even by faculty trained in research. To gain additional information on this important subject, a survey was conducted of the departmental research experiences of 42 graduates of the several Robert Wood Johnson Foundation Family Practice Academic Fellowship Programs who had had the opportunity for at least one year of faculty experience. The responses indicate that the majority of such graduates spend 20 percent or less of their time in research, that most perceive administrative duties as interfering with research, that a minority have budgeted research time, and few have departmental research funds. Despite these obstacles, those who do research publish with surprising frequency, about one paper per fellow per year. Several ways are presented to improve the research environment in departments of family practice and to lead to even more productive, secure research activities of these and other family practice faculty.

Academic Medical Centers↗
PubMed1999

The development and goals of the AAFP center for policy studies in family practice and primary care. American Academy of Family Physicians.

In this article we describe the creation and role of the Center for Policy Studies in Family Practice and Primary Care established by the American Academy of Family Physicians in Washington, DC, this year. We recount the events leading to the decision to implement the Center, list its guiding assumptions, and explain its initial structure and function. We also identify the 3 themes that will guide the early work of the Center: sustaining the functional domain of family practice and primary care; investing in key infrastructures; and securing universal health coverage.

District of Columbia↗
PubMedDate not supplied

Zebras on the commons: rare conditions in family practice.

BACKGROUND: Family physicians (FPs) specialize in the management of common problems, but we know little about their role in the care of patients with rare conditions. OBJECTIVE: To describe the roles FPs play in the identification and management of patients with rare conditions in a typical practice. METHODS: Office record review of 100 patients with rare conditions in the everyday, community-based, private practice of 4 FPs. Analysis of patient demographic characteristics, diagnoses, and the roles played by the FP in the patient's care, including diagnosis, treatment, referral, and long-term patient management. RESULTS: These FPs cared for patients with a wide variety of rare disorders across the spectrum of patient age and sex, organ system involved, and medical specialty area. FPs identified the problem in 89%, diagnosed the disorder in 54%, provided acute care in 56%, and provided continuing care for 76% of patients. FPs consulted other physicians in 85% of cases. The condition was life threatening in 58% of patients. CONCLUSIONS: Family physicians provide a broad range of services to a wide variety of patients with rare medical problems.

Adolescent↗
PubMed1977

Research in the family practice residency program.

Research activity in family practice is becoming increasingly important as the specialty matures past its initial organizational and developmental phase. Family practice residency programs are directly involved in the definition and implementation of modern concepts in family medicine and frequently have available the necessary tools and resources for substantive research of various types. These programs therefore have both the opportunity and responsibility to become actively involved in research. Significant contributions have already been made in this area by faculty and residents in a number of family practice residency programs. This paper provides an overview of research areas in family practice, presents some examples of research to date, and suggests some practical approaches to facilitate further research efforts in family practice residency programs.

Family Practice↗
PubMed1988

Surgeon and family physician opinions of the general surgical needs of family practice residents: a pilot study.

There is a lack of data assessing needs and evaluating educational objectives in general surgery for family practice residents. Studies suggest that family practice residency graduates feel underprepared in some surgical areas. This study provides results of a survey of 28 surgeons, practicing family physicians and family practice residents in the Northeast regarding the importance of 166 surgical objectives. The groups are compared to each other to detect differences in perceptions about what family practice residents should be taught in general surgery. Surgeons attached significantly less importance to nine of 21 general categories of learning objectives (e.g. emergency skills) than did practicing family physicians or family practice residents. No differences in ratings of surgical objectives were observed for 12 of 21 general categories.

Clinical Competence↗