Family practice research journal最新文献

Objective: Although community oriented primary care (COPC) is conceptually appealing, lack of practical methodology has limited its application. To implement the initial portions of COPC, most practitioners need to have available inexpensive, quick methods of doing community assessment. Use of community members identified as key informants is one method for conducting the qualitative portion of a community assessment. A key informant "tree" was developed at an inner city health center to analyze its costs, benefits, and limitations as a tool for COPC.

Methods: Using a semi-structured format, 14 of 24 key informants were interviewed using open-ended, closed-ended, and rating questions. An analysis was conducted of the costs of this approach and of the responses received.

Results: Planning and implementation of the tree took 6 hours of physician time and 8 hours of nonphysician time. Useful data was obtained from each of the different types of questions, although it appeared best suited to open-ended questions. Response bias was an important problem. The key informant approach appeared most useful with informal community leaders.

Conclusions: With appropriate recognition of the potential biases, key informant trees appear to be a practical and clinically useful tool for the subjective portion of the community assessment component of COPC.

Objective: This study measures the effectiveness of post card appointment reminders in a residency-based family practice center.

Methods: Outcomes of 1,380 consecutive appointments before institution of reminders were compared with 1,303 appointments afterward. Then, 140 patients were informally surveyed in follow-up.

Results: Before reminders, overall office no-show rate was 13.0%, cancellations were 19.4%, and arrivals were 67.6%. No-shows correlated with length of time from scheduling date to appointment date, seeing a resident rather than faculty, and patient payment classification (p < 0.0001). Post card reminders did not significantly improve arrivals by patients or change no-shows to cancellations. The reminders were well received by patients.

Conclusions: Post card appointment reminders were simple to institute and appreciated by patients but had little effect on improving appointment-keeping behavior.

The clinical process used to make sense of patient concerns closely parallels the analysis process of qualitative research. This partly explains why qualitative research methods are appropriate for many family practice research questions. Unfortunately, the language used by qualitative researchers, especially with regards to analysis, is often obscure. This impedes family physicians from implementing qualitative research. This paper overviews qualitative analysis and introduces a language and means by which family physicians can begin to make sense of qualitative data. The concepts, "reflexivity," "iteration," "data saturation," and "text," are defined. Three core steps of qualitative analysis are identified and compared to the diagnostic process. They consist of choosing an organizing system, reducing the data, and making connections. Four idealized ways for conducting these steps, editing, template, quasistatistical, and immersion/crystallization, are presented and compared to four ways of approaching patient concerns. Finally, the process of creating an appropriate qualitative analysis strategy is described for a hypothetical research study and some pitfalls and principles of qualitative analysis are reviewed.

Objective: This study assesses the prevalence and characteristics of sexual assault among women patients attending two family medicine residency training clinics.

Methods: Two hundred four consecutive women patients 18 years and older were asked to complete a questionnaire; one hundred eighty-eight (92.2%) agreed.

Results: Fifty-four (28.7%) of the 188 women patients reported some type of sexual assault. Approximately 15% of patients reported being victims of rape; 8% reported attempted rape, and 5.3% reported forced sexual contact. Twelve (41.4%) of the 29 rape victims indicated that they had been raped more than once. Only 24% of rape and attempted rape victims reported the incident to police, 18.2% sought medical attention, and 21% sought counseling.

Conclusions: Family physicians should be aware of the prevalence of sexual assault in their practices and should understand proper questioning, management, counseling, and referral of patients.

Objective: This study examined the prevalence of dementia and depression symptoms as assessed through screening instruments in older patients visiting a family practice clinic, compared screening results with indications of either a dementia or depression-related diagnosis as reported on patients' medical records and billing statements, and examined the relationship between screening instrument results and patients' demographics.

Methods: A total of 214 patients were interviewed and completed a written survey relating to dementia (Mini-Mental State Exam), depression (Beck Depression Inventory), medical conditions, and demographics. Patients were 60 years of age and older visiting a family practice clinic serving an outpatient population in northwest Illinois and southern Wisconsin. The clinic is an undergraduate teaching site of the University of Illinois College of Medicine at Rockford. Patients were interviewed at the time of their visits for routine medical care as they appeared on study recruitment days.

Results: The response rate was greater than 90%. About 20% of the patients scored in the range of possible cognitive impairment and over 22% scored in the range of possible mild to moderate depression. Overall, about 38% of the patients showed symptoms of either dementia or depression, or both. Based on chart review, there was significant under-reporting of dementia or cognitive difficulties and low correlation between screening results and chart and billing information related to depression.

Conclusions: The results reaffirm a significant rate of mental health problems in older patients in outpatient settings. This situation warrants examination of the reasons for under-reporting of mental health problems and the potential relationship between mental health problems and the general health status of elderly patients.

Background: This study examines the long term effects of a prompter directed at a single screening test on the performance of preventive tests 12 to 24 months later.

Methods: A retrospective chart review was performed that compared 114 patients who had a Papanicolau (Pap) smear prompter placed on their charts in 1990 with 86 patients who did not have a prompter placed. Chart audits determined if a Pap smear, breast examination, mammogram, rectal examination, stool occult blood, or serum cholesterol determination was performed 12 to 24 months after the prompter had been placed.

Results: In the patient population that received prompters more than one year earlier, a significant increase was observed in Pap smears (40% vs 24%, p = 0.05), breast examinations (37% vs 20%, p = 0.009), and digital rectal examinations in patients 50 years of age and older (20% vs 0%).

Conclusions: When a prompter is placed on a chart to change physician behavior, a lasting effect is seen over one year later. However, increased screening is only observed in patients who initially had prompters placed on their charts. This may indicate that this change in screening behaviors is due to alterations in patient and not physician behaviors.

Objective: Although modern methods of natural family planning (NFP) are effective both to avoid and to achieve pregnancy, relatively few women use these methods. It is not known whether this is due primarily to lack of interest or to other factors. We therefore explored the level of interest in NFP among female family practice patients.

Methods: We mailed information about NFP to 400 female patients between ages 21 and 42 and conducted follow-up interviews by telephone. We excluded 162 women for whom we could not obtain accurate addresses or phone numbers, 68 women we could not reach by telephone, 67 women who were not currently at risk of pregnancy, and 15 women for other reasons. Twenty-eight women refused to participate in the study. Sixty women completed telephone interviews.

Results: Forty-three percent of respondents (n = 60) were interested in learning more about NFP, 24% said they were likely to use NFP to avoid pregnancy, and 32% were likely to use NFP to achieve pregnancy. Younger women and women who were Christian but not Catholic and not of a major Protestant denomination were more interested in NFP.

Conclusion: Some female family practice patients are interested in learning and using NFP.

Objective: Burnout and career-choice regret among physicians in early practice may contribute to physician impairment and attrition as well as patient dissatisfaction.

Method: Fifty residency-trained family physicians in early practice completed the Maslach Burnout Inventory and a questionnaire on career-choice, demographics, and practice characteristics.

Results: The sample showed moderate burnout related to emotional exhaustion and depersonalization of patients but low burnout related to lack of personal accomplishment. Although only 52% reported that they would definitely choose a medical career again, 70% reported that they would definitely choose the specialty of family practice again. At the 0.01 level of significance, those who worked more hours were more emotionally exhausted, and those with children and those with more children under the age of 5 reported less depersonalization.

Conclusions: This sample of physicians in early practice reported slightly less burnout and less specialty-choice regret than a comparable sample of family practice residents, suggesting possible attenuation of burnout with the transition from training to practice. Nonetheless, the importance of overwhelming time demands as a precipitant of exhaustion and potential physician impairment is noted.