Family practice research journal最新文献

Objective: Compared to younger persons, the elderly use disproportionately greater health care resources. We wondered if this difference persisted when care of both older and younger patients was managed by physicians of a single specialty, family practice.

Methods: The design was a retrospective analysis of a family practice clinical database. The setting was a 622-bed suburban teaching hospital. The subjects were all acute-care patients (112 short-stay unit and 232 hospitalized patients) cared for by a family practice residency service during a one-year period. The main outcome measures were site of care (inpatient versus short-stay unit), hospital length of stay, and in-hospital consultant use.

Results: When cared for by the same physicians, the elderly are more likely to be admitted to the hospital rather than be successfully cared for in a short-stay unit (p = 0.001), to stay in the hospital longer (mean days: less than age 20 years, 5.1; age 80 and older, 8.5; p = 0.004), and to have a greater number of consultants (mean number of consultants: less than age 60 years, 0.80; age 60 and older, 1.16; p = 0.001).

Conclusions: Our study, in which patient care for patients of all ages was provided by one group of family practice residency physicians, indicated greater relative health care resource consumption by the elderly. We cannot exclude the possibility that age was simply a surrogate for unexplored factors, such as insurance status. The generalizability of a study from one group in one institution is limited.

Objective: This case-control study proposed to define risk factors for progression of cervical disease beyond an atypical level, and to explore the possibility of a clinical tool that would aid the clinician in deciding on the need for colposcopy.

Methods: Twenty-three hundred (2,300) abnormal Papanicolaou smears were reviewed to identify documented cases of class II Papanicolaou smears that had progressed. Controls were randomly chosen for each case from the remaining pool of available class II Papanicolaou smears that did not progress. Data analyses were conducted to determine the predictive value of information that would be in a patient's chart with respect to progression from class II Papanicolaou smear to a higher level of disease.

Results: A univariate analysis revealed several significant variables, including age, education, attendance at a public clinic, marital status, notification of Papanicolaou results, and a history of sexually transmitted disease. Next, a multivariate analysis demonstrated that a group of significant variables could not be defined, and only notification of an atypical Papanicolaou smear was significant.

Conclusions: The study's findings suggest that the data available in a patient's medical record are not sufficient to develop a risk assessment scale and provide evidence of the need for continued study in this area.

This study surveyed 30 residency-trained family physicians all currently in practice to determine the nature of their psychosocial interactions with patients. In general, respondents were satisfied with the quality of their psychosocial training in residency and generally evaluated their competency on a range of psychosocial skills as adequate to excellent. Physician psychosocial competency was most strongly related to residency, but not to postresidency, behavioral science training or to psychosocial screening practices. Frequency of performing psychosocial behaviors was also related to behavioral science training, as well as to length of time in practice. Neither frequency nor self-perceived competency related to physician age, gender, patient volume, or type of practice.

Objective: The purpose of this investigation was to determine family physicians' and gynecologists' attitudes toward and understanding of the Bethesda System, a new cervical cytology classification and reporting system.

Methods: A convenience sample of 159 family physicians and gynecologists completed a questionnaire that assessed attitudes, knowledge, and opinions about the Bethesda System.

Results: Compared with family physicians, gynecologists thought the Bethesda System was more likely to cause patient management problems (p < 0.001) and preferred not to combine viral cytologic effects with mild dysplasia when reporting a low-grade squamous intraepithelial lesion (p < 0.004). However, increased understanding of the system by physicians correlated with greater preference for the Bethesda System (p < 0.02). In this exploratory study, family physicians, rather than gynecologists, were more inclined to use the Bethesda System and perceived it as a means to reduce clinical evaluation and patient management problems. Gynecologists reported a fuller understanding of the Bethesda System, yet they were more critical of the cytology categorizations. Within each specialty, greater understanding of the Bethesda System led to its wider acceptance.

Research has begun to identify elements in the practice environment that influence practice styles and health outcomes. One key element known to influence physician-patient interaction is the type of treatment environment: fee-for-service or health maintenance organization. Observers using the Davis Observation Code coded 82 physician-patient encounters in private practice settings and 72 encounters in a health maintenance organization. Populations were similar on all demographic measures except age, with health maintenance organization patients being older. Fee-for-service visits were shorter but included more coded behaviors per observation interval, resulting in equivalent total numbers of coded behaviors in each type of visit. Health maintenance organization visits included significantly more patient questions, preventive services, disease prevention, treatment planning, and discussion of substance use. Results may have reflected physician gender differences across sites or patient self-selection to sites rather than site differences. These results have implications for developing further research to explore treatment environment, process, and outcome.

Physician recommendation may not be sufficient to motivate patients to comply with health maintenance activities. During a physician visit, female patients over age 50 were reminded to schedule mammography; more than 10% overtly refused. A telephone questionnaire of 20 age-matched refusers and compliers was performed to assess knowledge, attitudes, behavior, and demographics. Refusers and compliers were similar in many respects; there was no significant difference in how the groups perceived their current health. Paradoxically, refusers had less knowledge of bad experiences with mammograms (p < .01). Refusers were more likely not to know if their insurance covered screening (p < .01), and were less likely to recall their physicians recommending screening even though recommendation was documented in the chart (p < .05). Refusers were less likely to have ever had a mammogram (p < .05). This subgroup of patients does not obtain mammograms, finds physician recommendation an insufficient stimulus for mammography, and considers insurance coverage a concern without investigating it.

In response to a recent study indicating that primary care physicians were interested in receiving breast-screening education, an office-based training program was developed and delivered to fourteen physicians in Vermont and Florida. A nonphysician trainer and simulated patient provided instruction and feedback in clinical breast examination and in patient instruction in breast self-examination. Measurements of physician palpation skills before and after the training showed substantial skill improvement, and the office-based session was found to be highly acceptable by all participants.

This study examines the association between depressive symptoms preceding induced abortion and dissatisfaction with family relationships. In a cross-sectional survey, 304 women undergoing a first-trimester abortion completed a short version of the Center for Epidemiologic Studies Depression Scale, the Family APGAR, and a researcher-designed questionnaire. Bivariate analyses revealed that depressive symptoms decreased as measures of age, educational attainment, Family APGAR scores, marriage, and subjective health increased. Depressive symptoms increased as measures of denial, difficulties communicating with male partners, pregnancy symptoms, contraceptive use, and dissatisfaction with choosing abortion increased. Controlling for the effects of these significant bivariate associations, increased depressive symptoms were independently predicted by Family APGAR scores, age, communications difficulties, pregnancy symptoms, contraceptive use, and denial. Low Family APGAR scores exhibited the strongest overall effect. Clinicians who encounter women experiencing depressive symptoms preceding abortion may wish to explore family relationships and the possibility of underlying family dysfunction.