Family practice research journal最新文献

Objective: Family medicine faces significant challenges and opportunities in the next 20 years. This study was conducted to determine the importance of departmental factors to the discipline as perceived by the departmental chairs.

Methods: Following brainstorming of 139 potential important factors, items were grouped into 81 clusters. All 120 family medicine departmental chairs were surveyed as to the importance of each to the discipline. The 81 items were empirically grouped into 9 areas and differences in rankings were analyzed using Friedman's Test.

Results: Fifty-eight (48%) of the chairs responded. Although 35 (43%) of the items received a mean rating of 4.0 or higher, teaching and patient care items were among the highest rated. Research and fellowship items were among those receiving the poorest ratings. Of the 9 areas, teaching and faculty issues were ranked significantly higher and fellowships ranked significantly lower than other areas (F = 183.5, p < .001).

Conclusion: Although responding departmental chairs felt that many of the items were important, teaching and faculty issues were ranked as the most important areas to the discipline while fellowships was ranked least important.

Objective: To evaluate how primary care physician characteristics, patient characteristics, and adequacy of local specialty resources influenced 1) primary care physician mental health treatment practices, and 2) inpatient psychiatric admission rates.

Methods: A mailed survey was conducted of a stratified sample of 107 primary care physicians in six rural and urban locations. Small area variation data were examined for the six areas to relate survey findings to psychiatric admission rates. We compared characteristics and specialty resources to treatment practices and admission rates through linear and logistic regression analyses.

Results: Survey responses were received from 52% of physicians (n = 56). Respondents and nonrespondents had similar demographic characteristics. Physician characteristics, particularly self-rated confidence, were related to referral, prescription, and on-site counseling practices. Primary care treatment practices were associated with admission rates, especially for substance abuse and dependence.

Conclusions: Attention to studies of physician confidence is indicated, as is attention to studies of providing mental health training and treatment guidelines to primary care physicians, especially for substance abuse.

Objective: Early adolescent sexuality has reached epidemic proportions in the US. Most investigations on adolescent sexuality have focused on large urban populations. The objective of this study was to identify the rate of adolescent sexuality in a Southern population and make comparisons to national studies.

Methods: Data were collected by surveying 3370 students in the eighth and tenth grades from across the state of Alabama. The survey utilized was a modified version of the Alabama Adolescent Student Health Survey, an instrument derived from the National Adolescent Student Health Survey.

Results: The male sexual experience rate was 41% compared to the female rate of 39%. Tenth graders (44%) were more sexually experienced than eighth graders (37%). Blacks (50%) were more sexually active than whites (35%). Adolescents from single parent (45%) or non-parent households (46%) were more likely to be sexually active than those from two-parent households (36%).

Conclusions: The rates of reported sexual activity in this survey are alarming and are similar to rates reported in the literature. This study helps document the increasing rate of sexual activity as teenagers span the adolescent years. Family physicians are in an ideal position to help educate adolescents about risky sexual behaviors.

Focus groups have been extensively used in marketing research and recently adapted for studies in the behavioral sciences and primary care. The purpose of this paper is two-fold: 1) to describe the application of focus group methodology to research in family practice, and 2) to demonstrate the use of this qualitative method to examine a specific issue--family physicians' approach to wife abuse.

Objective: This study compares agreement between telephone survey and ambulatory medical record data for an elderly patient population.

Methods: Medical records and telephone survey responses are used to compare health status (chronic medical condition, symptomatology, and functional status) of 142 elderly patients randomly selected from a family practice residency and a geriatric fellowship practice. Chart abstraction was performed by two resident and two faculty physicians after a training period designed to assure high inter-reviewer reliability. Telephone surveys were completed by two professional interviewers. Health status measures were taken from standard, published instruments. The kappa statistic was used to measure the agreement between medical record and survey data.

Results: Overall, there is little agreement between the medical record and the telephone survey results on chronic medical condition, symptomatology, and functional status.

Conclusions: Medical records abstractions and telephone survey methodologies did not yield comparable health status data when applied to the same elderly patient population. Functional status assessment and symptomatology are particularly problematic, but even the presence or absence of chronic diseases is often inconsistent in the two data sources.

Purposes: To determine: 1) prevalence of significant colorectal lesions by demographics and risk factors; 2) frequency of 1 and 2 or more lesions by type, location, and size; 3) relation among villous component, location, and size of adenomas; and 4) frequency of nonsignificant lesions among patients with and without significant lesions.;

Method: One thousand asymptomatic patients, 45 years of age and older, with negative fecal occult blood tests, were screened using 60-cm flexible sigmoidoscopy and, if indicated, using colonoscopy.

Results: Thirty-six of the patients had 62 significant lesions (11 patients had 2 or more lesions). Fifty-four of the lesions were discovered by sigmoidoscopy in 1,000 patients, and 8 additional lesions were discovered in 5 of the 36 patients by colonoscopy. Lesions with villous components were more likely to be found in patients with 2 or more lesions (P = 0.0006). Smokers were more likely than nonsmokers to have significant lesions (P = 0.002). Among these patients, smoking and drinking were associated (P = 0.007). Males were more likely to have significant lesions than females (P = 0.006). Hemorrhoids, diverticulosis, and hyperplastic polyps were not associated with significant lesions.

Conclusions: The relationship between smoking and significant lesions provides further evidence that asymptomatic patients should stop smoking. Physicians should pay particular attention to men who smoke, even if they have negative occult blood tests.

Objective: This study describes the characteristics of emergency room staffing at rural hospitals in Kansas.

Methods: Administrators at 84 rural hospitals in communities of less than 5,000 were surveyed by telephone using a scripted interview.

Results: Seventy-seven hospitals provided physician-staffed emergency room services. Their average daily emergency room census was 4.4. The average hospital medical staff consisted of 2.9 physicians. Eighty-six percent of all hospital staff physicians were family physicians. Ninety-six percent of all hospital emergency room staffing was provided by the local medical staff. Fee-for-service was the only method of reimbursement to physicians in 44 hospitals. Alternatives to emergency room staffing by local physicians included contracted part-time emergency room physicians, locum tenens physicians, mid-level practitioners, or emergency room closure.

Conclusions: Rural family physicians have considerable responsibility for providing emergency care. Physicians must have adequate training in emergency medical care to practice in communities such as these.

Background: Seven thousand women die annually from cervical cancer in the US. This disease is preventable if cervical dysplasia is treated. Loop Electrosurgical Excision of the Cervix (LEEP) is a new treatment for dysplasia. This study evaluates the acceptability and feasibility of having LEEP available in a family physician's office.

Method: We performed a retrospective audit of colposcopy patients at 2 family practice clinics over a 2-year period. We determined the patients who met criteria for LEEP, surveyed the patients and calculated the cost benefit to the clinic.

Result: Out of 288 patients undergoing colposcopy, 40 (14%) were candidates for LEEP. Few complications, minimal discomfort, and performance of the procedure at their primary clinic were important to patients. Patient cost for LEEP in the office is $700 compared to $1450 in the hospital. Nine LEEP procedures per year provides a break-even point for the clinic.

Conclusion: LEEP offers the advantage over laser treatment of lower cost, use of local anesthesia, and provision of a pathology specimen. Performing LEEP in the family physician's office is cost effective and meets patient needs.