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PubMed1991

The state of general practice computing in Scotland and the characteristics of computerised practices: a survey of 948 practices.

A survey of 1,179 Scottish practices produced an 81% response rate and gathered data about practice size, environment, state of computerisation as well as future plans for the use of computers in the practice. Results show that the majority of practices are already computerised and that over 90% will be computerised soon. A computer in the practice correlates especially with the presence of a practice manager, a practice nurse and training or teaching status. Scotland is unique in having a national software program (GPASS) for general practice administration. We estimate that by mid 1991 over 750 practices will be using GPASS.

Computers↗

PubMed1989

Do practice guidelines guide practice? The effect of a consensus statement on the practice of physicians.

Guidelines for medical practice can contribute to improved care only if they succeed in moving actual practice closer to the behaviors the guidelines recommend. To assess the effect of such guidelines, we surveyed hospitals and obstetricians in Ontario before and after the release of a widely distributed and nationally endorsed consensus statement recommending decreases in the use of cesarean sections. These surveys, along with discharge data from hospitals reflecting actual practice, revealed that most obstetricians (87 to 94 percent) were aware of the guidelines and that most (82.5 to 85 percent) agreed with them. Attitudes toward the use of cesarean section were congruent with the recommendations even before their release. One third of the hospitals and obstetricians reported changing their practice as a consequence of the guidelines, and obstetricians reported rates of cesarean section in women with a previous cesarean section that were significantly reduced, in keeping with the recommendations (from 72.2 percent to 61.1 percent; P less than 0.01). The surveys also showed, however, that knowledge of the content of the recommendations was poor (67 percent correct responses). Furthermore, data on actual practice after the publication of the guidelines showed that the rates of cesarean section were 15 to 49 percent higher than the rates reported by obstetricians, and they showed only a slight change from the previous upward trend. We conclude that guidelines for practice may predispose physicians to consider changing their behavior, but that unless there are other incentives or the removal of disincentives, guidelines may be unlikely to effect rapid change in actual practice. We believe that incentives should operate at the local level, although they may include system-wide economic changes.

Cesarean Section↗

PubMed1979

Comparisons of solo practices and group practices.

This report of The Manpower Survey of Oral Surgery in 1974 showed that the type of practice, namely solo practice or group practice, had many effects on the characteristics of the practice of oral surgery. It affected significantly the number of offices an oral surgeon had. More oral surgeons in solo practice tended to have a single office than those in group practice. Oral surgeons over 35 years of age and in group practice tended, in general, to have a higher income than those in solo practice. There was a slight tendency for group practices to increase with the size of trade area served. Oral surgeons in group practices reported that they employed more full-time equivalent staff, but there were proportionately fewer full-time equivalent staff members per oral surgeon. Group practices tended to be located in metropolitan areas. Oral surgeons in group practice seemed to perform a larger number of surgical procedures than those in solo practice. They also seemed to spend more time in travel between home and place of work. More oral surgeons under 40 years of age in solo practice indicated that they planned to add an associate or partner in the next five years than those over 40 years of age or those in group practice.

Adult↗

PubMed1975

The orginization of medical practice and practice orientations among physicians in prepaid and nonprepaid primary care settings.

Data are presented on office-based general practitioners and pediatricians working in varying practice settings. Fee-for-service physicians spend more time in direct patient care activities than those in prepaid practice, and devote more time to each patient. The data suggest that the patient load characteristic of general practice in prepaid groups encourages a more assembly line practice which is less responsive to patients than the pattern characteristic of fee-for-service practice. Prepaid physicians work during scheduled hours and may deal with increased load by processing patients more rapidly. Fee-for-service physicians tend to respond to increased demand by working longer hours. The responsiveness of primary care physicians to patient problems seems to reflect primarily their social orientations to medical practice and the time pressures they face. Varying practice settings result in different techniques of coping with the pressures of practice. Data are also presented on sociodemographic and professional characteristics of primary care physicians in varying settings, workload, use of diagnostic and laboratory procedures, social orientations to medical practice, satisfactions and dissatisfactions, and attitudes toward sociopolitical aspects of medical care. Suggestions are offered for improving the responsiveness of prepaid practice.

Adult↗

PubMed1975

Practice objectives and goals; a survey of family practice residents.

This study shows that the majority of family practice residents initially become aware of individual community needs for family physicians in either medical school or early in residency training, but the final decision in regard to the selection of a specific community for private practice is not generally made until late in the third year of residency training. When the final decision as to practice location is established, the family practice resident and his family have regarded at least six different factors as significant. Most family practice residents will enter private practice as members of a group practice, rather than as solo practitioners. There is a direct relationship between the population of the family practice resident's home community and the size of the communities being considered for private practice. The most influential recruiting technique is personal contact by the physicians and citizens of the community, whereas the least effective method of recruiting is through printed material distributed through mail service.

Evaluation Studies as Topic↗

PubMedDate not supplied

Choosing to do obstetrics in practice: factors affecting the decisions of third-year family practice residents.

To investigate factors influencing a resident's decision to participate in obstetrical care, a survey was undertaken of program directors and third-year residents from the 16 Michigan family practice residency programs. Responses indicated that the majority of third-year residents (55%) intended to practice obstetrics on graduation. Rural practice plans were significantly correlated with a decision to practice obstetrics, but suburban practice plans were negatively correlated. Residents who reported the presence of a good family practice obstetric role model were significantly more likely to practice obstetrics; residents deciding against obstetrical practice expressed concerns about legal liability and malpractice fees. These findings have important implications for family practice training programs if obstetrics is to remain a central part of comprehensive family care.

Career Choice↗

PubMed1989

Practice locations of Texas family practice residency graduates, 1979-1987.

The location of a physician's residency training is known to be a factor in selection of a practice location. In this paper, the authors analyze the practice locations of 689 family physicians who graduated from residency programs in Texas between 1979 and 1987 and who were practicing in Texas in 1988. One-third of these graduates were practicing in cities the same size as their residency program city. More than half were in counties located within 60 miles of the residency city. Both of these trends can be explained to a large degree by the fact that a high percentage of graduates remained in their residency city to practice. When these nonmobile graduates are removed from the sample, the findings show no correlation between the size of the residency city and the size of the practice city. More than two-thirds of those graduates who left their residency city were in counties beyond a 60-mile radius. Almost two-thirds were practicing in communities of less than 25,000 population. The authors conclude that state support for family practice residency training has been effective in distributing family physicians in a manner that addresses the needs of the state of Texas as a whole.

Family Practice↗

PubMedDate not supplied