Reflections in family practice. Family physicians as proceduralists: striking a balance.
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Diagnosis↗
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The practicing family physician as a teacher and learner in a family practice residency.
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Education, Medical, Continuing↗
The general practice (family practice) training in New Zealand.
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Family Practice↗
Family practice. The family practice residency training concept.
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Family Practice↗
A comparison of the content of army family practice with nonfederal family practice.
BACKGROUND: To assist with planning for education and practice, family physicians should know the practice content of their practices. The present study compared the content of nonfederal family practice with Army family practice to explore their differences. METHODS: This was a secondary analysis that compared the similar variables within two national data sets: The National Ambulatory Medical Care Survey and the Army's Ambulatory Care Data Base. RESULTS: Army patients were younger and more likely to be female than were nonfederal patients. Army family physicians spent more time with patients in all groups than did nonfederal family physicians. While 12 of the top 20 diagnosis clusters of each sector were the same, there were differences found in the percentages of total visits contained within the top 20 clusters. CONCLUSIONS: Both nonfederal and Army family practice have a wide variation in patients and diagnoses. The two sectors are different in patient age and the frequency of different diagnoses. Knowledge of these differences can assist with planning.
Adolescent↗
Specialty practice of family practice residency graduates, 1969 through 1993. A national study.
OBJECTIVE: To describe demographic and practice characteristics of physicians who graduated from family practice residency training programs. DESIGN: Information was obtained from the databases of the American Academy of Family Physicians, the American Board of Family Practice (ABFP), and the American Medical Association. Data sets were cross-referenced, and quantitative data from medical membership organizations and the certifying board were summarized. Information regarding medical school graduation and family practice residency completion was reported by the participating residency programs, and data on practice specialty were self-designated by the participating physicians. SUBJECTS: Physician graduates of Accreditation Council for Graduate Medical Education-accredited family practice residency programs from 1969 through 1993. MAIN OUTCOME MEASURES: Practice specialty designation by graduates of family practice residency programs. RESULTS: Of the 38659 physicians who graduated from family practice residency programs from 1969 through 1993, 8780 (23%) were women, 2181 (6%) were graduates of colleges of osteopathic medicine, 4777 (12%) were international medical graduates, and 33484 (87%) were certified by the ABFP. Of the 36088 family practice residency graduates who designated a practice specialty, 32764 (91%) identified their specialty as family practice, including 32608 physicians who identified family practice, 129 general practice, 21 family practice-geriatric medicine, and six family practice-sports medicine. Among the 3324 family practice residency graduates (9%) who identified themselves as practicing in another specialty, the most common specialties were emergency medicine (1446 physicians [4%]) and preventive medicine (386 physicians [1%]). No other practice specialty was designated by more that 0.5% of family practice residency graduates. CONCLUSION: The vast majority of family practice residency graduates are self-designated as practicing family medicine. These data suggest that family practice residency programs are an effective mechanism for the production of generalist physicians.
Data Collection↗
Intellectual and attitudinal characteristics of medical students selecting family practice.
Family practice residents were compared with residents in internal medicine, surgery, obstetrics-gynecology, and pediatrics in terms of cognitive and non-cognitive characteristics. Family practice residents were in most instances significantly different from the other four groups. On non-cognitive measures they scored higher on affiliation need and lower on aggression and materialism. Their scores on several cognitive measures were among the highest of the five groups. These results were contrary to others from earlier studies. However, if the trend reported here is confirmed on other samples, it is the more intellectually gifted and idealistic physician who is currently being attracted to the practice of family medicine.
Attitude of Health Personnel↗
Toward clarification of objectives for family practice and family medicine.
This paper analyzes the social boundaries derived from an adequate definition of family practice and family medicine and explores the social dynamics between them and other social institutions and disciplines, More precise objectives for family practice and family medicine are delineated using a model which specifies social targets, methods, and purpose of intervention. Implication for further research in family medicine are discussed as well as their future effect on family practice.
Delivery of Health Care↗
Latino health in California, 1985-1990: implications for family practice.
Family practice, especially when applied to the Community-oriented Primary Care model, needs to incorporate the epidemiological profile and health care needs of a particular community. The rapidly growing Latino population is creating a great number of largely Latino communities. While they tend to have high poverty rates and low education rates, their family and health profiles contradict many assumptions made about poor, underserved minority groups. Data for the 29.8 million California residents, including 7.7 million Latinos, show a strong Latino health profile. Compared to Anglos and blacks, Latinos have high complete nuclear family rates and low non-family rates. They have low rates of low birth weight babies and low infant mortality, about equal to the rate among Anglos and Asians. Latinos also have lower age-adjusted death rates due to heart disease, strokes, and cancers, again, about equal to Asians. Latinos do, however, have higher death rates due to motor vehicle accidents and cirrhosis than Anglos, blacks, or Asians and a diabetes death rate higher than Anglos or Asians. Surprisingly, Latinos have lower age-adjusted death rates due to drug-related causes and weapons-related causes than Anglos or blacks, but substantially higher than Asians. It is suggested that, much against the stereotype, Latinos should be considered a high-level wellness population for whom family practice, based on prevention and primary care, would be an ideal match.
Adolescent↗
Geriatric education and practice of family practice graduates: an alumni survey.
BACKGROUND: The goal of this research was to study the relationship between family practice residency training in geriatrics and subsequent postresidency geriatric practice patterns. METHODS: We surveyed all graduates of the University of Maryland Family Practice Residency Program through 1990 to determine their attitudes toward their geriatric training and the extent of their geriatric practice. Logistic regression analysis was used to identify factors associated with 1) making house calls, 2) making weekly nursing home visits, and 3) having a practice in which more than 25% of patients were older than age 65. RESULTS: The responses of 143 graduates were analyzed. Most respondents (58.8%) made house calls, and the majority (51%) saw nursing home patients weekly. Older respondents and those possessing Certificates of Added Qualifications in Geriatric Medicine (CAQGMs) were more likely to treat patients older than age 65. Respondents with larger nursing home practices rated their geriatric training more favorably. Multivariate logistic regression analysis found that the following factors were associated with making house calls: working in a group family practice (odds ratio [OR] = 3.88, 95% confidence interval [CI] = 2.58-5.84) and a rural practice location (OR = 2.71, 95% CI = 1.77-4.17). Physicians who had additional training after residency (OR = 0.16, 95% CI = 0.10-0.25) were less likely to make house calls. Factors associated with making weekly nursing home visits were: additional training after residency (OR = 0.31, 95% CI = 0.19-0.50) and working in a group family practice (OR = 2.43, 95% CI = 1.63-3.65). Attainment of a CAQGM was the only factor associated with having more than 25% geriatric patients in the office practice (OR = 6.00, 95% CI = 2.72-13.24). CONCLUSIONS: Most graduates of the University of Maryland Family Practice Residency Program maintain significant geriatric practices and value geriatric training, but whether favorable training experiences influence graduates' practices is unknown. Prospective studies of family practice residents are needed to clarify the influence of geriatric curricula on residents' future clinical practices.
Family Practice↗
Generic social work practice and family practice: students build a foundation for partnership.
Generic social work practice and family practice medicine complement each other. Placing first year field students in a family practice residency training program over a period of years can define the social work role broadly and open the door for a wide range of practice opportunities. The social work presence can help family medicine attain its goal of comprehensive, holistic care.
Community Health Services↗
A survey of marketing practices by family practice residency programs.
The purpose of the study reported in this article was to identify marketing practices that are being utilized by family practice residencies in the United States and to differentiate which strategies were felt to be most useful. A survey questionnaire on marketing strategies was mailed to 361 civilian family practice residencies listed in the 1992 Director of Family Practice Residency Programs. A total of 151 questionnaires were returned for a total response rate of 42.1 percent. The results were summarized using descriptive statistics and Chi-square analysis. Family practice residency programs use a number of different strategies to attract patients. The effectiveness of a given program is dependent on local factors, program strengths and the target population desired. The three most useful marketing strategies reported in the survey were HMO listings, emergency department referrals, and patient referrals. The three least effective strategies were health fairs, sports physicals, and school presentations.
Academic Medical Centers↗
The family as the object of care in family practice.
Family practice as a specialty is based upon the continuing and comprehensive care of families. Much emphasis has been placed upon care of the "whole-person" and the family, but actual practice still reflects a predominant focus on the individual, rather than the family, as the object care. There is an important conceptual and practical difference between caring for the individual in the context of the family and caring for the family itself as the patient. Both approaches are required for family medicine to realize its potential in the ongoing care of families. This paper outlines some useful concepts and principles which can help to increase the capability of family physicians to deal with the common problems of individuals and their families.
Behavioral Sciences↗
Advance directives in family practice.
Family physicians can play an important role in helping patients and their families to discuss life-sustaining treatments and to complete advance directives. This article reviews the legal status of, and empirical studies on, advance directives and addresses some important clinical questions about their use relevant to family practice.
Advance Directives↗
A comprehensive patient care system for the family practice.
Family and Community Health Associates (FACHA) has incorporated an in-house, on-line computerized medical information system into a two-office, three-physician family practice medicine group. A Basic Four System 610 minicomputer is utilized to store all the medical, pharmaceutical, financial, and scheduling records. A SOAP-formated encounter form is used to collect the data. Five medical reports are printed prior to each patient encounter. Evaluations of the use and the benefits of this system are presented. A cost study, which calculated the cost of maintaining a computer-stored patient record, showed that a patient record could be updated and maintained for $1.32. A quality of care evaluation revealed that the preaudit of the computer-generated medical reports increased patient compliance to health maintenance suggestions. Another quality of care evaluation revealed that computer-generated flow charts did not significantly improve the diastolic blood pressure value of chronic hypertensive patients.
Comprehensive Health Care↗
Clinical experience of medical students in model family practices and private family practices.
The clinical experience of 21 Duke medical students during their family medicine clerkship is analyzed to compare experience in model family practices with that in private family practices. In model practices where 50 percent of the time involved patient care, students saw an average of 41 different patients for 45 encounters and 73 problem contacts during the month. In private practices with 100 percent time devoted to patient care, students saw 140 patients for 193 encounters and 346 problem contacts during the month. Most patients were seen in the physician office in both sites (89.0 percent model and 70.4 percent private), but fewer were seen as hospital inpatients in the model than in the private practices (6.3 vs 25.7 percent). The types of patient problems were alike, with the same 11 problems ranking in the top 15 most frequently seen in the two locations. The major difference in experience relates to the larger volume of patients and problems encountered in the private than in the model sites.
Clinical Clerkship↗
The state of clinical pharmacy practice in family practice residency programs.
BACKGROUND: Clinical pharmacists have been involved with family practice residencies for more than 20 years. This survey was designed to evaluate the current state of clinical pharmacy services in the family practice residency program (FPRP) in the United States. METHODS: All FPRPs were contacted to identify clinical pharmacists involved with their programs. These pharmacists were directed to a password-protected Web address where the survey was posted. Completed surveys were submitted on-line, and data were retrieved for analysis. RESULTS: Of the 579 residencies, 155 (26.7%) acknowledged 174 clinical pharmacists working within their program. Responses were received by 130 of the pharmacists (74.7% response rate). These pharmacists held academic appointments in both their institution's school of pharmacy (80%) and the school of medicine (53.2%). The mean age of the respondents was 36.5 +/- 8.2 years, and the mean salary was $66,000 (range $46,000-$125,000). A majority of the pharmacists received their funding from a single source, and 32.2% received full salary support from the FPRP. The respondents spent more than half of their time with the residency program. Overall, their time was divided into teaching responsibilities (42.7%), patient care activities (37.1%), research (12.1%), administrative functions (11.8%), and drug distribution (< 5%). CONCLUSIONS: Pharmacists are actively involved in 26.7% of FPRPs. This survey demonstrates increased salary support from the FPRP in comparison to past surveys. Additionally, more pharmacists hold academic appointments within schools of medicine.
Adult↗
Nutrition and physical activity counseling practices of family practice residents.
BACKGROUND: Nutritional behaviors and physical activity can influence risk for the development and prognosis of cancer. This study reports findings of a literature review and a survey of nutrition and physical activity counseling practices of family practice (FP) residents. METHODS: 110 FP residents (response rate = 93.2%) from four clinics that received funding from the Texas Department of Health completed the survey. Hierarchical linear regression models were used to identify determinants of nutrition and physical activity counseling practices. RESULTS: About a fifth of the residents reported that they usually or always asked their patients about nutrition and physical activity. In general, residents were most likely to address these issues with asymptomatic obese adult patients. Perceived effectiveness was a significant predictor of both assessment and counseling, except for nutrition counseling for asymptomatic patients. Attitude toward behavioral counseling predicted assessment, but not counseling. Use of resources predicted counseling on both topics with all patients. CONCLUSION: FP residents assess and counsel about nutrition and physical activity at suboptimal rates. There is a need to convince residents of the value of such assessment and counseling and to increase their belief that patients will follow through on their recommendations.
Adolescent↗