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PubMed2002

Clinical practice among rheumatologists: managing patients with rheumatoid arthritis.

The objective of this study was to review evaluations of current clinical practice among rheumatologists managing patients with rheumatoid arthritis. We reviewed articles retrieved through PubMed using the search terms 'rheumatoid arthritis', 'clinical practice', 'physician's practice patterns', and 'health service research'. We set the time limits at January 1990 and May 2001. Marked variability was found in initial tests, initial treatment, changes in clinical status by number of visits, second-line treatment prescription and monitoring, use of monitoring criteria, clinical outcomes by type of health care insurance, and management of a fictional case. The data were obtained by survey in some studies and by prospective collection in others. This literature review indicates a need for developing recommendations for the management of rheumatoid arthritis.

Arthritis, Rheumatoid↗
PubMed2006

Physician perspectives on end-of-life care: factors of race, specialty, and geography.

OBJECTIVES: To describe physicians' end-of-life practices, perceptions regarding end-of-life care and characterize differences based upon physician specialty and demographic characteristics. To illuminate physicians' perceptions about differences among their African-American and Caucasian patients' preferences for end-of-life care. DESIGN AND METHODS: Twenty-four African-American and 16 Caucasian physicians (N=40) participated in an in-person interview including 23 primary care physicians, 7 cardiologists, and 10 oncologists. Twenty-four practices were in urban areas and 16 were in rural counties. RESULTS: Physicians perceived racial differences in preferences for end-of-life care between their Caucasian and African-American patients. Whereas oncologists and primary care physicians overwhelmingly reported having working relationships with hospice, only 57% of cardiologists reported having those contacts. African-American physicians were more likely than Caucasian physicians to perceive racial differences in their patients preferences for pain medication. SIGNIFICANCE OF RESULTS: Demographic factors such as race of physician and patient may impact the provider's perspective on end-of-life care including processes of care and communication with patients.

Adult↗
PubMed2001

Doctor discontent. A comparison of physician satisfaction in different delivery system settings, 1986 and 1997.

OBJECTIVE: To examine the differences in physician satisfaction associated with open- versus closed-model practice settings and to evaluate changes in physician satisfaction between 1986 and 1997. Open-model practices refer to those in which physicians accept patients from multiple health plans and insurers (i.e., do not have an exclusive arrangement with any single health plan). Closed-model practices refer to those wherein physicians have an exclusive relationship with a single health plan (i.e., staff- or group-model HMO). DESIGN: Two cross-sectional surveys of physicians; one conducted in 1986 (Medical Outcomes Study) and one conducted in 1997 (Study of Primary Care Performance in Massachusetts). SETTING: Primary care practices in Massachusetts. PARTICIPANTS: General internists and family practitioners in Massachusetts. MEASUREMENTS: Seven measures of physician satisfaction, including satisfaction with quality of care, the potential to achieve professional goals, time spent with individual patients, total earnings from practice, degree of personal autonomy, leisure time, and incentives for high quality. RESULTS: Physicians in open- versus closed-model practices differed significantly in several aspects of their professional satisfaction. In 1997, open-model physicians were less satisfied than closed-model physicians with their total earnings, leisure time, and incentives for high quality. Open-model physicians reported significantly more difficulty with authorization procedures and reported more denials for care. Overall, physicians in 1997 were less satisfied in every aspect of their professional life than 1986 physicians. Differences were significant in three areas: time spent with individual patients, autonomy, and leisure time (P < or =.05). Among open-model physicians, satisfaction with autonomy and time with individual patients were significantly lower in 1997 than 1986 (P < or =.01). Among closed-model physicians, satisfaction with total earnings and with potential to achieve professional goals were significantly lower in 1997 than in 1986 (P < or =.01). CONCLUSIONS: This study finds that the state of physician satisfaction in Massachusetts is extremely low, with the majority of physicians dissatisfied with the amount of time they have with individual patients, their leisure time, and their incentives for high quality. Satisfaction with most areas of practice declined significantly between 1986 and 1997. Open-model physicians were less satisfied than closed-model physicians in most aspects of practices.

Adult↗
PubMed1988

Comparison of graduates of regular curriculum and unified basic-science-clinical curriculum.

The purpose of the study reported here was to identify differences between graduates who were in different curricula at Loyola University of Chicago Stritch School of Medicine. The physicians who had been in the special track, which combined the basic and clinical sciences throughout the program, chose specialties in family practice and psychiatry more than the regular track students and more often were salaried. One-third of those in the special curriculum felt the greatest strength of their medical school training was the preparation for independent learning, and a majority viewed a practice in which there were uncertainties in diagnosis as desirable. The traditional program graduate preferred to deal with cases in which important decisions had to be made rapidly and the effects of treatment could be immediately addressed. The two groups disagreed as to who should have major control of health care, on issues of peer review in the office, and on the emphasis physicians should give preventive care.

Attitude of Health Personnel↗
PubMed2004

Management of childhood asthma: physicians' perspective in Turkey.

Many attempts have been made to decrease asthma-related mortality and morbidity, including preparation and distribution of guidelines. However, several studies from different regions of the world have reported low asthma control among children as well as adults. A questionnaire-based study was performed involving a number of Turkish physicians taking care of pediatric asthmatics, and aimed to document asthma-related knowledge. Of 219 physicians, 126 (57%) completed the questionnaire. The majority were pediatricians (92%), with an average of 253 +/- 14.1 outpatients per week, and an asthmatic ratio of 15.8%. According to the self-reported knowledge, management of acute asthma received the highest (3.42 +/- 0.05) and chronic asthma the lowest scores (3.18 +/- 0.06). The study group further credited inhaled and oral steroids similarly for the treatment of exacerbations and reported infrequent usage of spirometry and oxygen saturation than physical finding to estimate attack severity. Although with regard to most subjects, physicians' opinions appeared to be in agreement with the guidelines, there were certain differences implying need for future educational training. Chronic management, reported as the least understood part of the guidelines, suggests requirement of new models for estimating chronic disease severity.

Adrenal Cortex Hormones↗
PubMed1998

Rural proceduralists: an endangered species. Report of the Queensland Rural Indemnity Study, 1997.

Surveys and interviews of a random sample of rural doctors in Queensland were undertaken to investigate the degree to which indemnity costs influence the types of practice and future plans of rural proceduralists. A survey of 135 rural doctors sought details of the procedural profiles, current indemnity status and the future plans of doctors presently undertaking procedures. Also under investigation was the degree to which concerns over indemnity related issues was likely to influence the continuing participation of these doctors in rural procedural medicine at current levels. The results indicate that the proportion of rural doctors in Queensland willing to offer procedural medicine is declining. Over the past 5 years, 52% of those surveyed had changed from procedural to non-procedural indemnity cover and of the 48% of doctors remaining, one-third indicated that they were considering such a change. Over 75% of current procedural doctors in the sample were able to identify an indemnity premium rate at which they would consider that procedural practice was no longer a viable option. Of the 104 respondents to the study, only 27 regard their status as totally stable with regard to long-term procedural practice regardless of indemnity costs.

Adult↗
PubMed1992

Hospital nuclear pharmacy--a comparison of physician and pharmacist practice.

OBJECTIVE: Nuclear pharmacy is practiced in every hospital with a nuclear medicine clinic. Pharmacists control this practice in fewer than four percent of these institutions. The authors wish to bring to the attention of hospital pharmacists an area of practice in which they can make a significant contribution to the state of pharmacy practice. METHOD: The current state of the physician practice of nuclear pharmacy is described and compared with the accepted standards of pharmacy practice. CONCLUSIONS: Hospital pharmacists can improve pharmaceutical care administered in nuclear medicine by their participation in nuclear pharmacy practice and by the application of hospital pharmacy practice standards. It is also suggested that nuclear pharmacy should be integrated into the pharmacy curriculum at schools of pharmacy.

Education, Medical, Graduate↗
PubMed2006

Variations in management of common inpatient pediatric illnesses: hospitalists and community pediatricians.

OBJECTIVE: The goal was to test the hypothesis that pediatric hospitalists use evidence-based therapies and tests more consistently in the care of inpatients and use therapies and tests of unproven benefit less often, compared with community pediatricians. METHODS: A national survey was administered to hospitalists and a random sample of community pediatricians. Hospitalists and community pediatricians reported their frequency of use of diagnostic tests and therapies, on 5-point Likert scales (ranging from never to almost always), for common inpatient pediatric illnesses. Responses were compared in univariate and multivariable logistic regression analyses controlling for gender, race, years out of residency, days spent attending per year, hospital practice type, and completion of fellowship/postgraduate training. RESULTS: Two hundred thirteen pediatric hospitalists and 352 community pediatricians responded. In multivariable regression analyses, hospitalists were significantly more likely to report often or almost always using the following evidence-based therapies for asthma: albuterol and ipratropium in the first 24 hours of hospitalization. After the first urinary tract infection, hospitalists were more likely to report obtaining the recommended renal ultrasound and voiding cystourethrogram. Hospitalists were significantly more likely than community pediatricians to report rarely or never using the following therapies of unproven benefit: levalbuterol, inhaled steroid therapy, and oral steroid therapy for bronchiolitis; stool culture and rotavirus testing for gastroenteritis; and ipratropium after 24 hours of hospitalization for asthma. CONCLUSION: Overall, in comparison with community pediatricians, hospitalists reported greater adherence to evidence-based therapies and tests in the care of hospitalized patients and less use of therapies and tests of unproven benefit.

Administration, Inhalation↗
PubMed1999

Predictors of success in medicine.

Many different variables have been used in an attempt to predict performance in medical school, residency, and practice. The extensive literature on this subject has been reviewed and evaluated. Admission to medical school should not be based solely on grade point average and Medical College Admission Test scores because these offer no measure of extremely important noncognitive attributes. Although performance in the preclinical years is predicted by the grade point average and Medical College Admission Test scores, no such correlation exists for achievements in the clinical years, for postgraduate training, or as physicians. Thus, even though underrepresented minority applicants to medical school tend to have lower grade point averages and Medical College Admission Test scores than majority applicants, ultimate success in postgraduate training and as practicing physicians is equivalent to that attained by majority students.

Achievement↗
PubMed1999

[Dependence, abuse and misuse of drugs: knowledge and attitudes of private physicians in the Ile-de-France].

BACKGROUND: The rise in drug consumption and poorly adapted prescription practices are currently a growing problem. In the face of this trend, "L'Union Professionnelle des Médecins Libéraux d'Ile-de-France" investigated the awareness and the attitude of physicians towards drug dependency, abuse and misuse. METHODS: One hundred physicians and 50 specialists, randomly selected, were contacted by phone. They were asked to give their own description of dependency, abuse and misuse based on patients' attitudes. They were to describe cases of their patients classifying them according to each category. In the second part of the phone interview, the physicians were to give their view about existing and potential tools to solve these problems. RESULTS: Dependency, abuse and misuse problems were well known and frequent: 94% of physicians have such experience and among those, 60% saw such a patient more than once a week. The population concerned by these problems were generally middle-aged women with chronic disease. Misuse behavior was less easily identified (53% of the physicians described such patients). They generally concerned young men, most often drug addicts. From a global point of view, psychotropes were the most frequently misuse drugs, followed by the pain drugs and nsaids. These types of drugs are used routinely, some of them being sold without prescription. Diseases concerned were essentially psychiatric disorders, sleeping troubles and long lasting pains well classified. To face these problem, physicians recommend a dialogue between medical members and patients as well as a changing in professional (physicians and pharmacists) behavior such as firmness, education and listening. CONCLUSION: Situations evoked during the survey were frequent but non systematically discerned as damageable. As a matter of fact, these observations are only a piece of an "intuitive" estimation of the risk versus benefit of the prescription of the drugs mentioned above. Actual regulation and control tools seem to be somewhat irrelevant to solve the problem.

Adult↗
PubMedDate not supplied

[The practice of medicine at the end of the Second Empire: according to a book, appearing in 1865, by Dr. Camille Delvaille, physician in Bayonne].

Dr Camille Delvaille (1835-1904) was a physician in Bayonne. He wrote many books about scientific problems and social medicine; he was one of the first to suggest medical control at school. In a book, written in 1865, he studied everyday practice in France. He complained against the "Officiers de Sante" who exercised medicine mainly in the countryside but were not doctors and had followed very short medical studies. Dr Delvaille deplored that it meant two kinds of cares: doctors for top people and Officiers de Sante for poor patients. In fact, the end of the Officiat de Sante occured only in 1892. Dr Delvaille studied also some problems related to medical demography; he purposed for our country a law cutting down foreign practice in France. Then, he put forward nomination of Professors or hospital's physicians through an examination instead of routine cooptation. Some of his minds are ahead and were applied later.

France↗
PubMedDate not supplied

[Adapting medical education to meet the physician recruitment needs of rural and remote regions in Canada, the US and Australia].

Australia, Canada and the United States have large land masses containing many sparsely populated regions. Each of these countries has experienced difficulty in meeting the physician recruitment needs of its rural and remote regions. This paper reports on a study of selected Australian, Canadian and American medical education programs designed to meet the health professional needs of rural and remote areas. The study is based on published material from the institutions studies, supplemented by a series of interviews with senior academic officials in the institutions involved. The paper focuses on a range of strategies, from recruitment and admissions policies, to exposure to rural clinical practice and modified curricula, each designed to produce medical graduates with a strong orientation to rural practice. The study highlights the important role played by special government funding targeted at rural medical education initiatives and discusses the challenges that such initiatives face.

Australia↗
PubMed1989

A profile of academic physicians in British Columbia.

To determine the extent of involvement of British Columbia's physician community in the operation of the province's only medical school, the authors sent questionnaires to all physicians who had any affiliation with the University of British Columbia (UBC). About 20 percent of the province's physicians were involved in some capacity with the UBC Faculty of Medicine, which accepts about 120 students into the first year annually. Most faculty held "clinical" appointments, meaning that they pursued largely non-academic careers. Full-time academic appointees worked more than 20 percent more hours annually than did their "clinical" counterparts, and average hours for men exceeded those for women. As many as two-thirds of the full-time faculty were also engaged in sufficient clinical practice activity to be classified as full-time practicing physicians by a definition adopted by a provincial Joint Medical Manpower Committee.

Adult↗
PubMed1993

Multiple-site physician practices and their effect on service distribution.

OBJECTIVE: This study explores the impact of multiple-site practices on the distribution of physician services within a medical service region. DATA SOURCES AND STUDY SETTING: A questionnaire was mailed to all urologists (100 percent response rate) practicing in north central Connecticut (the Hartford medical service area) and adjacent communities in September 1990. Data on community characteristics were obtained from the 1990 U.S. census and state government documents. STUDY DESIGN: Descriptive statistics and maps were used to summarize the attributes of single- and multiple-site practices and the communities where they were located. Key practice and community variables were analyzed. DATA COLLECTION/EXTRACTION METHODS: The questionnaires were coded and entered into a digital database with the tabulated community data. Responses of individual physicians were grouped by practice. PRINCIPAL FINDINGS: Multiple-site practices were common. Second-order sites accounted for 23 percent of total appointment capacity and were located in communities with higher than average elderly populations and incomes and lower than average minority populations. CONCLUSIONS: Analysis of multiple-site practices is important for the accurate assessment of medical service availability. Further research is needed to document the functioning of multiple-site practices across other specialties and geographic areas.

Catchment Area, Health↗
PubMedDate not supplied

African-American physicians' and dentists' perceptions of smoking cessation: solo versus HMO practices.

This study sought to assess the differences in smoking cessation (SC) patient practices and attitudes of physicians and dentists by type of practice (i.e. solo versus group or health maintenance organization [HMO]). Few studies have compared demographics, attitudes, and practices between solo and group providers. The results from this survey of African-American (AA) physicians and dentists provide insights into the perceptions of SC by AA health-care providers in a Southern metropolitan area. Approximately 373 physicians and 90 dentists were mailed questionnaires along with a letter describing the purpose of the study and elements of confidentiality. Dentists and physicians reported nearly the same percentage of smoke-free offices. Physicians were more likely to report that they record information on patients' smoking status and that they counsel patients to quit. Measuring attitudes and current practices among physicians and dentists with regards to SC is essential if health promotion efforts are to have an impact among the AA population.

Adult↗
PubMed1995

US national survey of physician practices for the secondary and tertiary prevention of ischemic stroke. Design, service availability, and common practices.

BACKGROUND AND PURPOSE: Stroke is largely a preventable disease. However, there are little data available concerning the use of stroke prevention diagnostic and treatment modalities by practicing physicians. These data are critical for the rational allocation of resources and targeting of educational efforts. The purposes of this national survey were to gather information about physicians' stroke prevention practice patterns and their attitudes and beliefs regarding secondary and tertiary stroke prevention strategies. METHODS: We conducted a national survey of stroke prevention practices among a stratified random sample of 2000 physicians drawn from the American Medical Association's Physician Masterfile. The survey focused on the availability of services and the use of diagnostic and preventive strategies for patients at elevated risk of stroke. RESULTS: Sixty-seven percent (n = 1006) of eligible physicians completed the survey. Diagnostic studies considered readily available by at least 90% of physicians included carotid ultrasonography, transthoracic echocardiography, Holter monitoring, and brain CT and MRI scans. MR angiography was perceived as being readily available by 68% and transesophageal echocardiography by 74% of respondents. Twelve percent of physicians reported cerebral arteriography and 10% reported carotid endarterectomy as not being readily available. Multiple logistic regression analyses showed that the availability of services varied with physician specialty (noninternist primary care, internal medicine, neurology, surgery), practice setting (nonmetropolitan versus small metropolitan or large metropolitan areas), and for carotid endarterectomy, region of the country (South, Central, Northeast, and West). The odds of carotid endarterectomy being reported as readily available were approximately 2.5 to 3.5 times greater for physicians practicing in the central, northeastern, and western regions compared with those practicing in the South, independent of practice setting and specialty. With regard to stroke prevention practices, 61% of physicians reported prescribing 325 mg of aspirin for stroke prevention, while 33% recommend less than 325 mg and 4% use doses of 650 mg or more. Seventy-one percent of physicians using warfarin reported monitoring anticoagulation with international normalized ratios, and 78% reported monitoring anticoagulated patients at least once a month. Fewer than 20% of physicians reported knowing the perioperative carotid endarterectomy complication rates at the hospital where they perform the operation themselves or refer patients to have the procedure done. CONCLUSIONS: Although all routine and most specialized services for secondary and tertiary stroke prevention are readily available to most physicians, variation in availability exists. The use of international normalized ratios for monitoring warfarin therapy has not yet become universal. Physician knowledge of carotid endarterectomy complication rates is generally lacking. Depending on their causes, these problems may be addressed through targeted physician education efforts and systematic changes in the way in which services are provided.

Aspirin↗
PubMed1997

Changing physician behavior: the Maine Medical Assessment Foundation.

Methods to produce change in physician practice patterns are of increasing importance to payers and regulators as well as to physicians themselves. Because some of the strategies being adopted occur without physician input and participation, they have aroused concern in the medical community. We describe the methods used and results achieved by the Maine Medical Assessment Foundation, a nonprofit education and research organization, that has been active in practice pattern analysis since the late 1970s. The foundation has successfully engaged clinicians in a program of systematic assessment of medical care provided to residents of Maine. Significant change in practice patterns has been documented. Physicians have become active participants in the process of voluntary self-assessment, education, and quality improvement.

Databases, Factual↗