Sample records for care physician cognitive

  1. Physicians' Perspectives on Caring for Cognitively Impaired Elders.(author Abstract) (United States)

    Adams, Wendy L.; McIlvain, Helen E.; Geske, Jenenne A.; Porter, Judy L.


    Purpose: This study aims to develop ah in-depth understanding of the issues important to primary care physicians in providing care to cognitively impaired elders. Design and Methods: In-depth interviews were conducted with 20 primary care physicians. Text coded as "cognitive impairment" was retrieved and analyzed by use of grounded theory analysis…

  2. Attitudes of pediatric intensive care unit physicians towards the use of cognitive aids: a qualitative study. (United States)

    Weiss, Matthew J; Kramer, Chelsea; Tremblay, Sébastien; Côté, Luc


    Cognitive aids are increasingly recommended in clinical practice, yet little is known about the attitudes of physicians towards these tools. We employed a qualitative, descriptive design to explore physician attitudes towards cognitive aids in pediatric intensive care units (PICUs). Semi-structured interviews elicited the opinions of a convenience sample of practicing PICU physicians towards the use of cognitive aids. We analyzed interview data for thematic content to examine the three factors of intention to use cognitive aids as defined by the Theory of Planned Behavior (TPB), attitudes, social norms, and perceived control. Analysis of 14 interviews suggested that in the PICU setting, cognitive aids are widely used. Discovered themes related to their use touched on all three TPB factors of intention and included: aids are perceived to improve team communication; aids may improve patient safety; aids may hinder clinician judgment; physicians may resist implementation if it occurs prior to demonstration of benefit; effective adoption requires cognitive aids to be integrated into local workplace culture; and implementation should take physician concerns into account. Our sample of PICU physicians were open to cognitive aids in their practice, as long as such aids preserve the primacy of clinical judgment, focus on team communication, demonstrate effectiveness through preliminary testing, and are designed and implemented with the local culture and work environment in mind. Future knowledge translation efforts to implement cognitive aids would benefit from consideration of these issues.

  3. Family Physicians May Benefit From Cognitive Behavioral Therapy Skills in Primary Care Setting.

    Directory of Open Access Journals (Sweden)

    Omer Serkan Turan


    Full Text Available Dr Francis Peabody commented that the swing of the pendulum toward specialization had reached its apex, and that modern medicine had fragmented the health care delivery system too greatly. Thus the system was in need of a generalist physician to provide comprehensive personalized care. Family physician is the perfect candidate to fill the gap which Dr Peabody once speaks of and grants biopsychosocial model as its main philosophy. Biopsychosocial model proposes physician to consider multiple aspects of patient's life in order to manage disease. Behavioral pathogens such as poor diet, lack of physical activity, stress, substance abuse, unsafe sexual activity, inadequate emotional support, nonadherence to medical advice contribute to disease progress. Family physician can guide patient like a coach to obtain higher levels in Maslow’s hierarchy of needs as biopsychosocial model suggests and obtain the change in behavior towards a healthier life with using cognitive behavioral therapy skills. So family physician, biopsychosocial model and cognitive behavioral skills are three pillars of comprehensive personalized care and family physicians having these skill sets can be very helpful in making positive changes in the life of the patient. [JCBPR 2017; 6(2.000: 98-100

  4. Cognitive and Other Strategies to Mitigate the Effects of Fatigue. Lessons from Staff Physicians Working in Intensive Care Units. (United States)

    Henrich, Natalie; Ayas, Najib T; Stelfox, Henry T; Peets, Adam D


    Fatigue is common among physicians and adversely affects their performance. To identify strategies that attending physicians use when fatigued to maintain clinical performance in the intensive care unit (ICU). We conducted a qualitative study using focus groups and structured interviews of attending ICU physicians working in academic centers in Canada. In three focus group meetings, we engaged a total of 11 physicians to identify strategies used to prevent and cope with fatigue. In the focus groups, 21 cognitive strategies were identified and classified into 9 categories (minimizing number of tasks, using techniques to improve retention of details, using a structured approach to patient care, asking for help, improving opportunities for focusing, planning ahead, double-checking, adjusting expectations, and modulating alertness). In addition, various lifestyle strategies were mentioned as important in preventing fatigue (e.g., protecting sleep before call, adequate exercise, and limiting alcohol). Telephone interviews were then conducted (n = 15 physicians) with another group of intensivists. Structured questions were asked about the strategies identified in the focus groups that were most useful during ICU activities. In the interviews, the most useful and frequently used strategies were prioritizing tasks that need to be done immediately and postponing tasks that can wait, working systematically, using a structured approach, and avoiding distractions. ICU physicians reported using a variety of deliberate cognitive and lifestyle strategies to prevent and cope with fatigue. Given the low cost and intuitive nature of the majority of these strategies, further investigations should be done to better characterize their effectiveness in improving performance.

  5. Physician self-care

    African Journals Online (AJOL)

    impact on patient care, increasing the number of medical errors, lowering both patient and physician satisfaction and lengthening the recovery phase.[1-3]. Joan Halifax[4] has taught at programmes in palliative care for health professional caregivers for many years. She identified frequent challenges facing healthcare ...

  6. Evaluation of Physicians' Cognitive Styles. (United States)

    Djulbegovic, Benjamin; Beckstead, Jason W; Elqayam, Shira; Reljic, Tea; Hozo, Iztok; Kumar, Ambuj; Cannon-Bowers, Janis; Taylor, Stephanie; Tsalatsanis, Athanasios; Turner, Brandon; Paidas, Charles


    Patient outcomes critically depend on accuracy of physicians' judgment, yet little is known about individual differences in cognitive styles that underlie physicians' judgments. The objective of this study was to assess physicians' individual differences in cognitive styles relative to age, experience, and degree and type of training. Physicians at different levels of training and career completed a web-based survey of 6 scales measuring individual differences in cognitive styles (maximizing v. satisficing, analytical v. intuitive reasoning, need for cognition, intolerance toward ambiguity, objectivism, and cognitive reflection). We measured psychometric properties (Cronbach's α) of scales; relationship of age, experience, degree, and type of training; responses to scales; and accuracy on conditional inference task. The study included 165 trainees and 56 attending physicians (median age 31 years; range 25-69 years). All 6 constructs showed acceptable psychometric properties. Surprisingly, we found significant negative correlation between age and satisficing (r = -0.239; P = 0.017). Maximizing (willingness to engage in alternative search strategy) also decreased with age (r = -0.220; P = 0.047). Number of incorrect inferences negatively correlated with satisficing (r = -0.246; P = 0.014). Disposition to suppress intuitive responses was associated with correct responses on 3 of 4 inferential tasks. Trainees showed a tendency to engage in analytical thinking (r = 0.265; P = 0.025), while attendings displayed inclination toward intuitive-experiential thinking (r = 0.427; P = 0.046). However, trainees performed worse on conditional inference task. Physicians capable of suppressing an immediate intuitive response to questions and those scoring higher on rational thinking made fewer inferential mistakes. We found a negative correlation between age and maximizing: Physicians who were more advanced in their careers were less willing to spend time and effort in an

  7. Dutch family physicians' awareness of cognitive impairment among the elderly

    NARCIS (Netherlands)

    van den Dungen, Pim; Moll van Charante, Eric P.; van de Ven, Peter M.; Foppes, Gerbrand; van Campen, Jos P. C. M.; van Marwijk, Harm W. J.; van der Horst, Henriëtte E.; van Hout, Hein P. J.


    Dementia is often not formally diagnosed in primary care. To what extent this is due to family physicians' (FPs) watchful waiting, reluctance to diagnose or to their unawareness of the presence of cognitive impairment is unclear. The objective of this study was to assess FPs' awareness of cognitive

  8. Physician attitudes towards pharmacological cognitive enhancement: safety concerns are paramount.

    Directory of Open Access Journals (Sweden)

    Opeyemi C Banjo


    Full Text Available The ethical dimensions of pharmacological cognitive enhancement have been widely discussed in academic circles and the popular media, but missing from the conversation have been the perspectives of physicians - key decision makers in the adoption of new technologies into medical practice. We queried primary care physicians in major urban centers in Canada and the United States with the aim of understanding their attitudes towards cognitive enhancement. Our primary hypothesis was that physicians would be more comfortable prescribing cognitive enhancers to older patients than to young adults. Physicians were presented with a hypothetical pharmaceutical cognitive enhancer that had been approved by the regulatory authorities for use in healthy adults, and was characterized as being safe, effective, and without significant adverse side effects. Respondents overwhelmingly reported increasing comfort with prescribing cognitive enhancers as the patient age increased from 25 to 65. When asked about their comfort with prescribing extant drugs that might be considered enhancements (sildenafil, modafinil, and methylphenidate or our hypothetical cognitive enhancer to a normal, healthy 40 year old, physicians were more comfortable prescribing sildenafil than any of the other three agents. When queried as to the reasons they answered as they did, the most prominent concerns physicians expressed were issues of safety that were not offset by the benefit afforded the individual, even in the face of explicit safety claims. Moreover, many physicians indicated that they viewed safety claims with considerable skepticism. It has become routine for safety to be raised and summarily dismissed as an issue in the debate over pharmacological cognitive enhancement; the observation that physicians were so skeptical in the face of explicit safety claims suggests that such a conclusion may be premature. Thus, physician attitudes suggest that greater weight be placed upon the

  9. Physician self-care

    African Journals Online (AJOL)

    patient relationship. Both have a ... Doctors often struggle to balance the demands of their own personal and family ... In end-of-life care, especially for children, one can easily .... non-judgemental openness, self-kindness and compassion towards.

  10. Aging and Cognitive Performance: Challenges and Implications for Physicians Practicing in the 21st Century (United States)

    Durning, Steven J.; Artino, Anthony R.; Holmboe, Eric; Beckman, Thomas J.; van der Vleuten, Cees; Schuwirth, Lambert


    The demands of physician practice are growing. Some specialties face critical shortages and a significant percentage of physicians are aging. To improve health care it is paramount to understand and address challenges, including cognitive issues, facing aging physicians. In this article, we outline several issues related to cognitive performance…

  11. Dutch family physicians' awareness of cognitive impairment among the elderly

    NARCIS (Netherlands)

    van den Dungen, P.; van Charante, E.P.M.; van de Ven, P.M.; Foppes, G.; van Campen, J.P.C.M.; van Marwijk, H.W.J.; van der Horst, H.E.; van Hout, H.P.J.


    Background: Dementia is often not formally diagnosed in primary care. To what extent this is due to family physicians' (FPs) watchful waiting, reluctance to diagnose or to their unawareness of the presence of cognitive impairment is unclear. The objective of this study was to assess FPs' awareness

  12. Cognitive analysis of physicians' medication ordering activity. (United States)

    Pelayo, Sylvia; Leroy, Nicolas; Guerlinger, Sandra; Degoulet, Patrice; Meaux, Jean-Jacques; Beuscart-Zéphir, Marie-Catherine


    Computerized Physician Order Entry (CPOE) addresses critical functions in healthcare systems. As the name clearly indicates, these systems focus on order entry. With regard to medication orders, such systems generally force physicians to enter exhaustively documented orders. But a cognitive analysis of the physician's medication ordering task shows that order entry is the last (and least) important step of the entire cognitive therapeutic decision making task. We performed a comparative analysis of these complex cognitive tasks in two working environments, computer-based and paper-based. The results showed that information gathering, selection and interpretation are critical cognitive functions to support the therapeutic decision making. Thus the most important requirement from the physician's perspective would be an efficient display of relevant information provided first in the form of a summarized view of the patient's current treatment, followed by in a more detailed focused display of those items pertinent to the current situation. The CPOE system examined obviously failed to provide the physicians this critical summarized view. Following these results, consistent with users' complaints, the Company decided to engage in a significant re-engineering process of their application.

  13. Physician-patient communication in managed care.


    Gordon, G H; Baker, L; Levinson, W


    The quality of physician-patient communication affects important health care outcomes. Managed care presents a number of challenges to physician-patient communication, including shorter visits, decreased continuity, and lower levels of trust. Good communication skills can help physicians create and maintain healthy relationships with patients in the face of these challenges. We describe 5 communication dilemmas that are common in managed care and review possible solutions suggested by recent ...

  14. Physicians Care for Connecticut, Inc. Business philosophy. (United States)

    Czarsty, C W; Coffey, J R


    Physicians Care will distinguish itself from competitors in the marketplace through the introduction of products with significant value. Physicians Care is dedicated to working closely with providers to identify the contributions made by each party to the building of product value and to appropriately reward providers for those efforts. The ultimate goal is the development of an insurance company in which physicians are truly invested and committed to best clinical practices and who exercise enhanced autonomy in managing their patient's care with clinical and administrative support from Physicians Care.

  15. Physician fees and managed care plans. (United States)

    Zwanziger, Jack


    One of the objectives of managed care organizations (MCOs) has been to reduce the rate of growth of health care expenditures, including that of physician fees. Yet, due to a lack of data, no one has been able to determine whether MCOs have been successful in encouraging the growth of price competition in the market for physician services in order to slow the growth in physician fees. This study uses a unique, national-level data set to determine what factors influenced the physician fees that MCOs negotiated during the 1990-92 period. The most influential characteristics were physician supply and managed care penetration, which suggest that the introduction of competition into the health care market was an effective force in reducing physician fees.

  16. Night shift decreases cognitive performance of ICU physicians. (United States)

    Maltese, François; Adda, Mélanie; Bablon, Amandine; Hraeich, Sami; Guervilly, Christophe; Lehingue, Samuel; Wiramus, Sandrine; Leone, Marc; Martin, Claude; Vialet, Renaud; Thirion, Xavier; Roch, Antoine; Forel, Jean-Marie; Papazian, Laurent


    The relationship between tiredness and the risk of medical errors is now commonly accepted. The main objective of this study was to assess the impact of an intensive care unit (ICU) night shift on the cognitive performance of a group of intensivists. The influence of professional experience and the amount of sleep on cognitive performance was also investigated. A total of 51 intensivists from three ICUs (24 seniors and 27 residents) were included. The study participants were evaluated after a night of rest and after a night shift according to a randomized order. Four cognitive skills were tested according to the Wechsler Adult Intelligence Scale and the Wisconsin Card Sorting Test. All cognitive abilities worsened after a night shift: working memory capacity (11.3 ± 0.3 vs. 9.4 ± 0.3; p night shift. The cognitive abilities of intensivists were significantly altered following a night shift in the ICU, regardless of either the amount of professional experience or the duration of sleep during the shift. The consequences for patients' safety and physicians' health should be further evaluated.

  17. Access to care: the physician's perspective. (United States)

    Tice, Alan; Ruckle, Janessa E; Sultan, Omar S; Kemble, Stephen


    Private practice physicians in Hawaii were surveyed to better understand their impressions of different insurance plans and their willingness to care for patients with those plans. Physician experiences and perspectives were investigated in regard to reimbursement, formulary limitations, pre-authorizations, specialty referrals, responsiveness to problems, and patient knowledge of their plans. The willingness of physicians to accept new patients from specific insurance company programs clearly correlated with the difficulties and limitations physicians perceive in working with the companies (p<0.0012). Survey results indicate that providers in private practice were much more likely to accept University Health Alliance (UHA) and Hawaii Medical Services Association (HMSA) Commercial insurance than Aloha Care Advantage and Aloha Quest. This was likely related to the more favorable impressions of the services, payments, and lower administrative burden offered by those companies compared with others. Hawaii Medical Journal Copyright 2011.

  18. Burnout Among Anesthetists and Intensive Care Physicians. (United States)

    Mikalauskas, Audrius; Benetis, Rimantas; Širvinskas, Edmundas; Andrejaitienė, Judita; Kinduris, Šarūnas; Macas, Andrius; Padaiga, Žilvinas


    Burnout is a syndrome of depersonalization, emotional exhaustion, and low personal accomplishment. Little is known about burnout in physicians. Our objective was to determine the prevalence of burnout among anesthetists and intensive care physicians, and associations between burnout and personal, as well as professional, characteristics. In total, 220 anesthetists and intensive care physicians were contacted by email, asking them to participate in the study. For depression screening the PHQ-2 questionnaire, for problem drinking, CAGE items were used. Burnout was measured by the Maslach Burnout Inventory. Overall, 34% anesthetists and intensive care physicians indicated high levels of emotional exhaustion, 25% indicated high levels of depersonalization, and 38% showed low personal accomplishment. Burnout was found more frequent among subjects with problem drinking (OR 3.2, 95% CI 1.5-6.8), depressiveness (OR 10.2, 95% CI 4.6-22.6), cardiovascular disorders (OR 3.4, 95% CI 1.7-7.1), and digestive disorders (OR 2.2, 95% CI 1.2-4.0). Some favorite after-work activities positively correlated with burnout, such as sedative medications abuse (OR 4.8, 95% CI 1.8-12.5), alcohol abuse (OR 2.4, 95% CI 1.3-4.5), eating more than usual (OR 1.9, 95% CI 1.1-3.5), and transferring the accumulated stress to relatives (OR 2.8, 95% CI 1.4-5.5). In contrast, reading of non-medical literature seemed to have a protective effect (OR 0.5, 95% CI 0.2-0.9). Burnout was highly prevalent among anesthetists and intensive care physicians with two fifths of them meeting diagnostic criteria. It was strongly correlated with problem drinking, depressiveness, cardiovascular and digestive disorders, use of sedatives and overeating.

  19. Palliative Care Physicians' Attitudes Toward Patient Autonomy and a Good Death in East Asian Countries. (United States)

    Morita, Tatsuya; Oyama, Yasuhiro; Cheng, Shao-Yi; Suh, Sang-Yeon; Koh, Su Jin; Kim, Hyun Sook; Chiu, Tai-Yuan; Hwang, Shinn-Jang; Shirado, Akemi; Tsuneto, Satoru


    Clarification of the potential differences in end-of-life care among East Asian countries is necessary to provide palliative care that is individualized for each patient. The aim was to explore the differences in attitude toward patient autonomy and a good death among East Asian palliative care physicians. A cross-sectional survey was performed involving palliative care physicians in Japan, Taiwan, and Korea. Physicians' attitudes toward patient autonomy and physician-perceived good death were assessed. A total of 505, 207, and 211 responses were obtained from Japanese, Taiwanese, and Korean physicians, respectively. Japanese (82%) and Taiwanese (93%) physicians were significantly more likely to agree that the patient should be informed first of a serious medical condition than Korean physicians (74%). Moreover, 41% and 49% of Korean and Taiwanese physicians agreed that the family should be told first, respectively; whereas 7.4% of Japanese physicians agreed. Physicians' attitudes with respect to patient autonomy were significantly correlated with the country (Japan), male sex, physician specialties of surgery and oncology, longer clinical experience, and physicians having no religion but a specific philosophy. In all 12 components of a good death, there were significant differences by country. Japanese physicians regarded physical comfort and autonomy as significantly more important and regarded preparation, religion, not being a burden to others, receiving maximum treatment, and dying at home as less important. Taiwanese physicians regarded life completion and being free from tubes and machines as significantly more important. Korean physicians regarded being cognitively intact as significantly more important. There are considerable intercountry differences in physicians' attitudes toward autonomy and physician-perceived good death. East Asia is not culturally the same; thus, palliative care should be provided in a culturally acceptable manner for each country

  20. The desired moral attitude of the physician: (III) care. (United States)

    Gelhaus, Petra


    In professional medical ethics, the physician traditionally is obliged to fulfil specific duties as well as to embody a responsible and trustworthy personality. In the public discussion, different concepts are suggested to describe the desired moral attitude of physicians. In a series of three articles, three of the discussed concepts are presented in an interpretation that is meant to characterise the morally emotional part of this attitude: "empathy", "compassion" and "care". In the first article of the series, "empathy" has been developed as a mainly cognitive and morally neutral capacity of understanding. In the second article, the emotional and virtuous core of the desired professional attitude-compassion-has been presented. Compassion as a professional attitude has been distinguished from a spontaneous feeling of compassion, and has been related to a general idea of man as vulnerable and solidary being. Thus, the dignity of the patient is safeguarded in spite of the asymmetry of compassion. In this article, the third concept of the triad-"care"-is presented. Care is conceived as an attitude as well as an activity which can be directed to different objects: if it is directed to another sentient being, it is regarded as intrinsically morally valuable; implying (1) the acceptance of being addressed, (2) a benevolent inclination to help and to foster, and (3) activity to realize this. There are different forms of benevolence that can underlie caring. With regard to the professional physician's ethos, the attitude of empathic compassion as developed in the two previous articles is proposed to be the adequate underlying attitude of care which demands the right balance between closeness and professionalism and the right form of attention to the person of the patient. 'Empathic compassionate care' does not, however, describe the whole of the desired attitude of a physician, but focuses on the morally-emotive aspects. In order to get also the cognitive and practical

  1. [Cognitive remediation and nursing care]. (United States)

    Schenin-King, Palmyre; Thomas, Fanny; Braha-Zeitoun, Sonia; Bouaziz, Noomane; Januel, Dominique


    Therapies based on cognitive remediation integrate psychiatric care. Cognitive remediation helps to ease cognitive disorders and enable patients to improve their day-to-day lives. It is essential to complete nurses' training in this field. This article presents the example of a patient with schizophrenia who followed the Cognitive Remediation Therapy programme, enabling him to access mainstream employment. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  2. Cognitive challenges to minimising low value care. (United States)

    Scott, Ian A


    Clinical decisions often rely on pattern recognition, simple rules of thumb, tacit knowledge and habit. In many instances, such intuitive decisions are fast and accurate, but they can be subject to cognitive biases leading to delivery of care of low value at odds with scientific evidence of best practice. If programmes, such as EVOLVE (Evaluating Evidence, Enhancing Efficiencies) and Choosing Wisely are to have maximal impact in minimising low value care, such biases, and the factors that hide and accentuate them, need to be exposed and addressed in a collegiate and non-judgemental manner. © 2017 Royal Australasian College of Physicians.

  3. Studying physician effects on patient outcomes: physician interactional style and performance on quality of care indicators. (United States)

    Franks, Peter; Jerant, Anthony F; Fiscella, Kevin; Shields, Cleveland G; Tancredi, Daniel J; Epstein, Ronald M


    Many prior studies which suggest a relationship between physician interactional style and patient outcomes may have been confounded by relying solely on patient reports, examining very few patients per physician, or not demonstrating evidence of a physician effect on the outcomes. We examined whether physician interactional style, measured both by patient report and objective encounter ratings, is related to performance on quality of care indicators. We also tested for the presence of physician effects on the performance indicators. Using data on 100 US primary care physician (PCP) claims data on 1,21,606 of their managed care patients, survey data on 4746 of their visiting patients, and audiotaped encounters of 2 standardized patients with each physician, we examined the relationships between claims-based quality of care indicators and both survey-derived patient perceptions of their physicians and objective ratings of interactional style in the audiotaped standardized patient encounters. Multi-level models examined whether physician effects (variance components) on care indicators were mediated by patient perceptions or objective ratings of interactional style. We found significant physician effects associated with glycohemoglobin and cholesterol testing. There was also a clinically significant association between better patient perceptions of their physicians and more glycohemoglobin testing. Multi-level analyses revealed, however, that the physician effect on glycohemoglobin testing was not mediated by patient perceived physician interaction style. In conclusion, similar to prior studies, we found evidence of an apparent relationship between patient perceptions of their physician and patient outcomes. However, the apparent relationships found in this study between patient perceptions of their physicians and patient care processes do not reflect physician style, but presumably reflect unmeasured patient confounding. Multi-level modeling may contribute to better

  4. Physicians' impression on the elders' functionality influences decision making for emergency care. (United States)

    Rodríguez-Molinero, Alejandro; López-Diéguez, María; Tabuenca, Ana I; de la Cruz, Juan J; Banegas, José R


    This study analyzes the elements that compose the emergency physicians' criterion for selecting elderly patients for intensive care treatment. This issue has not been studied in-depth. A cross-sectional study was conducted at 4 university teaching hospitals, covering 101 randomly selected elderly patients admitted to emergency department and their respective physicians. Physicians were asked to forecast their plans for treatment or therapeutic abstention, in the event that patients might require aggressive measures (cardiopulmonary resuscitation or admission to critical care units). Data were collected on physicians' reasons for taking such decisions and their patients' functional capacity and cognitive status (Katz index and Informant Questionnaire on Cognitive Decline in the Elderly). A logistic regression model was constructed taking physicians' decisions as the dependent variables and adjusting for patient factors and physician impressions. The functional status reported by reliable informants and the mental status measured by validated instruments were not coincident with the physicians' perception (functional status κ, 0.47; mental status κ, 0.26). A multivariate analysis showed that the age and the functional and mental status of patients, as perceived by the physicians, were the variables that better explained the physicians' decisions. Physicians' impressions on the functional and mental status of their patients significantly influenced their selection of patients for high-intensity treatments despite the fact that some of these impressions were not correct. Copyright © 2010 Elsevier Inc. All rights reserved.

  5. Pharmaceutical industry gifts to physicians: patient beliefs and trust in physicians and the health care system. (United States)

    Grande, David; Shea, Judy A; Armstrong, Katrina


    Pharmaceutical industry gifts to physicians are common and influence physician behavior. Little is known about patient beliefs about the prevalence of these gifts and how these beliefs may influence trust in physicians and the health care system. To measure patient perceptions about the prevalence of industry gifts and their relationship to trust in doctors and the health care system. Cross sectional random digit dial telephone survey. African-American and White adults in 40 large metropolitan areas. Respondents' beliefs about whether their physician and physicians in general receive industry gifts, physician trust, and health care system distrust. Overall, 55% of respondents believe their physician receives gifts, and 34% believe almost all doctors receive gifts. Respondents of higher socioeconomic status (income, education) and younger age were more likely to believe their physician receives gifts. In multivariate analyses, those that believe their personal physician receives gifts were more likely to report low physician trust (OR 2.26, 95% CI 1.56-3.30) and high health care system distrust (OR 2.03, 95% CI 1.49-2.77). Similarly, those that believe almost all doctors accept gifts were more likely to report low physician trust (OR 1.69, 95% CI 1.25-2.29) and high health care system distrust (OR 2.57, 95% CI 1.82-3.62). Patients perceive physician-industry gift relationships as common. Patients that believe gift relationships exist report lower levels of physician trust and higher rates of health care system distrust. Greater efforts to limit industry-physician gifts could have positive effects beyond reducing influences on physician behavior.

  6. Burnout syndrome among physicians working in primary health care ...

    African Journals Online (AJOL)

    Objective: The aim of the study was to reveal extent of burnout problem among primary care physicians and the socio-demographic factors affecting its occurrence. Methods: The target population included all physicians working in these two health regions in Kuwait. Two hundred physicians working in the primary health ...

  7. Physicians' opinions on palliative care and euthanasia in the Netherlands. (United States)

    Georges, Jean-Jacques; Onwuteaka-Philipsen, Bregje D; van der Heide, Agnes; van der Wal, Gerrit; van der Maas, Paul J


    In recent decades significant developments in end-of-life care have taken place in The Netherlands. There has been more attention for palliative care and alongside the practice of euthanasia has been regulated. The aim of this paper is to describe the opinions of physicians with regard to the relationship between palliative care and euthanasia, and determinants of these opinions. Cross-sectional. Representative samples of physicians (n = 410), relatives of patients who died after euthanasia and physician-assisted suicide (EAS; n = 87), and members of the Euthanasia Review Committees (ERCs; n = 35). Structured interviews with physicians and relatives of patients, and a written questionnaire for the members of the ERCs. Approximately half of the physicians disagreed and one third agreed with statements describing the quality of palliative care in The Netherlands as suboptimal and describing the expertise of physicians with regard to palliative care as insufficient. Almost two thirds of the physicians disagreed with the suggestion that adequate treatment of pain and terminal care make euthanasia redundant. Having a religious belief, being a nursing home physician or a clinical specialist, never having performed euthanasia, and not wanting to perform euthanasia were related to the belief that adequate treatment of pain and terminal care could make euthanasia redundant. The study results indicate that most physicians in The Netherlands are not convinced that palliative care can always alleviate all suffering at the end of life and believe that euthanasia could be appropriate in some cases.

  8. Physicians' fees and public medical care programs. (United States)

    Lee, R H; Hadley, J


    In this article we develop and estimate a model of physicians' pricing that explicitly incorporates the effects of Medicare and Medicaid demand subsidies. Our analysis is based on a multiperiod model in which physicians are monopolistic competitors supplying services to several markets. The implications of the model are tested using data derived from claims submitted by a cohort of 1,200 California physicians during the years 1972-1975. We conclude that the demand for physician's services is relatively elastic; that increases in the local supply of physicians reduce prices somewhat; that physicians respond strategically to attempts to control prices through the customary-prevailing-reasonable system; and that price controls limit the rate of increase in physicians' prices. The analysis identifies a family of policies that recognize the monopsony power of public programs and may change the cost-access trade-off. PMID:7021479

  9. Evaluating physician performance at individualizing care: a pilot study tracking contextual errors in medical decision making. (United States)

    Weiner, Saul J; Schwartz, Alan; Yudkowsky, Rachel; Schiff, Gordon D; Weaver, Frances M; Goldberg, Julie; Weiss, Kevin B


    Clinical decision making requires 2 distinct cognitive skills: the ability to classify patients' conditions into diagnostic and management categories that permit the application of research evidence and the ability to individualize or-more specifically-to contextualize care for patients whose circumstances and needs require variation from the standard approach to care. The purpose of this study was to develop and test a methodology for measuring physicians' performance at contextualizing care and compare it to their performance at planning biomedically appropriate care. First, the authors drafted 3 cases, each with 4 variations, 3 of which are embedded with biomedical and/or contextual information that is essential to planning care. Once the cases were validated as instruments for assessing physician performance, 54 internal medicine residents were then presented with opportunities to make these preidentified biomedical or contextual errors, and data were collected on information elicitation and error making. The case validation process was successful in that, in the final iteration, the physicians who received the contextual variant of cases proposed an alternate plan of care to those who received the baseline variant 100% of the time. The subsequent piloting of these validated cases unmasked previously unmeasured differences in physician performance at contextualizing care. The findings, which reflect the performance characteristics of the study population, are presented. This pilot study demonstrates a methodology for measuring physician performance at contextualizing care and illustrates the contribution of such information to an overall assessment of physician practice.

  10. Health care workplace discrimination and physician turnover. (United States)

    Nunez-Smith, Marcella; Pilgrim, Nanlesta; Wynia, Matthew; Desai, Mayur M; Bright, Cedric; Krumholz, Harlan M; Bradley, Elizabeth H


    To examine the association between physician race/ ethnicity, workplace discrimination, and physician job turnover. Cross-sectional, national survey conducted in 2006-2007 of practicing physicians (n = 529) randomly identified via the American Medical Association Masterfile and the National Medical Association membership roster. We assessed the relationships between career racial/ethnic discrimination at work and several career-related dependent variables, including 2 measures of physician turnover, career satisfaction, and contemplation of career change. We used standard frequency analyses, odds ratios and chi2 statistics, and multivariate logistic regression modeling to evaluate these associations. Physicians who self-identified as nonmajority were significantly more likely to have left at least 1 job because of workplace discrimination (black, 29%; Asian, 24%; other race, 21%; Hispanic/Latino, 20%; white, 9%). In multivariate models, having experienced racial/ethnic discrimination at work was associated with high job turnover (adjusted odds ratio, 2.7; 95% CI, 1.4-4.9). Among physicians who experienced workplace discrimination, only 45% of physicians were satisfied with their careers (vs 88% among those who had not experienced workplace discrimination, p value workplace discrimination, p value Workplace discrimination is associated with physician job turnover, career dissatisfaction, and contemplation of career change. These findings underscore the importance of monitoring for workplace discrimination and responding when opportunities for intervention and retention still exist.

  11. The Relationships among Physician Nonverbal Immediacy and Measures of Patient Satisfaction with Physician Care. (United States)

    Conlee, Connie J.; And Others


    Examines the relationship among four dimensions of patient satisfaction with physician care and nonverbal immediacy. Finds a significant positive correlation between nonverbal immediacy and overall patient satisfaction, with the strongest correlation to the attention/respect factor. (SR)

  12. Physician Networks and Ambulatory Care-sensitive Admissions. (United States)

    Casalino, Lawrence P; Pesko, Michael F; Ryan, Andrew M; Nyweide, David J; Iwashyna, Theodore J; Sun, Xuming; Mendelsohn, Jayme; Moody, James


    Research on the quality and cost of care traditionally focuses on individual physicians or medical groups. Social network theory suggests that the care a patient receives also depends on the network of physicians with whom a patient's physician is connected. The objectives of the study are: (1) identify physician networks; (2) determine whether the rate of ambulatory care-sensitive hospital admissions (ACSAs) varies across networks--even different networks at the same hospital; and (3) determine the relationship between ACSA rates and network characteristics. We identified networks by applying network detection algorithms to Medicare 2008 claims for 987,000 beneficiaries in 5 states. We estimated a fixed-effects model to determine the relationship between networks and ACSAs and a multivariable model to determine the relationship between network characteristics and ACSAs. We identified 417 networks. Mean size: 129 physicians; range, 26-963. In the fixed-effects model, ACSA rates varied significantly across networks: there was a 46% difference in rates between networks at the 25th and 75th performance percentiles. At 95% of hospitals with admissions from 2 networks, the networks had significantly different ACSA rates; the mean difference was 36% of the mean ACSA rate. Networks with a higher percentage of primary-care physicians and networks in which patients received care from a larger number of physicians had higher ACSA rates. Physician networks have a relationship with ACSAs that is independent of the physicians in the network. Physician networks could be an important focus for understanding variations in medical care and for intervening to improve care.

  13. Predictors and Outcomes of Burnout in Primary Care Physicians. (United States)

    Rabatin, Joseph; Williams, Eric; Baier Manwell, Linda; Schwartz, Mark D; Brown, Roger L; Linzer, Mark


    To assess relationships between primary care work conditions, physician burnout, quality of care, and medical errors. Cross-sectional and longitudinal analyses of data from the MEMO (Minimizing Error, Maximizing Outcome) Study. Two surveys of 422 family physicians and general internists, administered 1 year apart, queried physician job satisfaction, stress and burnout, organizational culture, and intent to leave within 2 years. A chart audit of 1795 of their adult patients with diabetes and/or hypertension assessed care quality and medical errors. Women physicians were almost twice as likely as men to report burnout (36% vs 19%, P stress (P work conditions (P work control (P work-life balance (P burnout, care quality, and medical errors. Burnout is highly associated with adverse work conditions and a greater intention to leave the practice, but not with adverse patient outcomes. Care quality thus appears to be preserved at great personal cost to primary care physicians. Efforts focused on workplace redesign and physician self-care are warranted to sustain the primary care workforce. © The Author(s) 2015.

  14. Physician Knowledge and Attitudes around Confidential Care for Minor Patients. (United States)

    Riley, Margaret; Ahmed, Sana; Reed, Barbara D; Quint, Elisabeth H


    Minor adolescent patients have a legal right to access certain medical services confidentially without parental consent or notification. We sought to assess physicians' knowledge of these laws, attitudes around the provision of confidential care to minors, and barriers to providing confidential care. An anonymous online survey was sent to physicians in the Departments of Family Medicine, Internal Medicine-Pediatrics, Obstetrics/Gynecology, and Pediatrics at the University of Michigan. Response rate was 40% (259/650). The majority of physicians felt comfortable addressing sexual health, mental health, and substance use with adolescent patients. On average, physicians answered just over half of the legal knowledge questions correctly (mean 56.6% ± 16.7%). The majority of physicians approved of laws allowing minors to consent for confidential care (90.8% ± 1.7% approval), while substantially fewer (45.1% ± 4.5%) approved of laws allowing parental notification of this care at the physician's discretion. Most physicians agreed that assured access to confidential care should be a right for adolescents. After taking the survey most physicians (76.6%) felt they needed additional training on confidentiality laws. The provision of confidential care to minors was perceived to be most inhibited by insurance issues, parental concerns/relationships with the family, and issues with the electronic medical record. Physicians are comfortable discussing sensitive issues with adolescents and generally approve of minor consent laws, but lack knowledge about what services a minor can access confidentially. Further research is needed to assess best methods to educate physicians about minors' legal rights to confidential healthcare services. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  15. Invasive candidosis: contrasting the perceptions of infectious disease physicians and intensive care physicians

    Directory of Open Access Journals (Sweden)

    Vanessa Schultz


    Full Text Available Introduction We analyze how infectious disease physicians perceive and manage invasive candidosis in Brazil, in comparison to intensive care unit specialists. Methods A 38-question survey was administered to 56 participants. Questions involved clinicians' perceptions of the epidemiology, diagnosis, treatment and prophylaxis of invasive candidosis. P < 0.05 was considered statistically significant. Results The perception that candidemia not caused by Candida albicans occurs in less than 10% of patients is more commonly held by intensive care unit specialists (p=0.018. Infectious disease physicians almost always use antifungal drugs in the treatment of patients with candidemia, and antifungal drugs are not as frequently prescribed by intensive care unit specialists (p=0.006. Infectious disease physicians often do not use voriconazole when a patient's antifungal treatment has failed with fluconazole, which also differs from the behavior of intensive care unit specialists (p=0.019. Many intensive care unit specialists use fluconazole to treat candidemia in neutropenic patients previously exposed to fluconazole, in contrast to infectious disease physicians (p=0.024. Infectious disease physicians prefer echinocandins as a first choice in the treatment of unstable neutropenic patients more frequently than intensive care unit specialists (p=0.013. When candidemia is diagnosed, most infectious disease physicians perform fundoscopy (p=0.015, whereas intensive care unit specialists usually perform echocardiograms on all patients (p=0.054. Conclusions This study reveals a need to better educate physicians in Brazil regarding invasive candidosis. The appropriate management of this disease depends on more drug options being available in our country in addition to global coverage in private and public hospitals, thereby improving health care.

  16. Estimated time spent on preventive services by primary care physicians

    Directory of Open Access Journals (Sweden)

    Gradison Margaret


    Full Text Available Abstract Background Delivery of preventive health services in primary care is lacking. One of the main barriers is lack of time. We estimated the amount of time primary care physicians spend on important preventive health services. Methods We analyzed a large dataset of primary care (family and internal medicine visits using the National Ambulatory Medical Care Survey (2001–4; analyses were conducted 2007–8. Multiple linear regression was used to estimate the amount of time spent delivering each preventive service, controlling for demographic covariates. Results Preventive visits were longer than chronic care visits (M = 22.4, SD = 11.8, M = 18.9, SD = 9.2, respectively. New patients required more time from physicians. Services on which physicians spent relatively more time were prostate specific antigen (PSA, cholesterol, Papanicolaou (Pap smear, mammography, exercise counseling, and blood pressure. Physicians spent less time than recommended on two "A" rated ("good evidence" services, tobacco cessation and Pap smear (in preventive visits, and one "B" rated ("at least fair evidence" service, nutrition counseling. Physicians spent substantial time on two services that have an "I" rating ("inconclusive evidence of effectiveness", PSA and exercise counseling. Conclusion Even with limited time, physicians address many of the "A" rated services adequately. However, they may be spending less time than recommended for important services, especially smoking cessation, Pap smear, and nutrition counseling. Future research is needed to understand how physicians decide how to allocate their time to address preventive health.

  17. Knowledge of Primary Care Physicians Regarding Domestic Violence.

    African Journals Online (AJOL)

    Knowledge of Primary Care Physicians Regarding Domestic Violence. ... prevalence of DV, and 4 main aspects relevant to DV, namely deprivation, psychological, ... and instructions about DV from scientific formal sources as medical schools, ...

  18. Physician directed networks: the new generation of managed care. (United States)

    Bennett, T; O'Sullivan, D


    The external pressure to reduce cost while maintaining quality and services is moving the whole industry into a rapid mode of integration. Hospitals, vendors, MCOs, and now, physicians, are faced with the difficult decisions concerning how their operations will be integrated into the larger health care delivery system. These pressures have forced physicians to consolidate, build leverage, and create efficiencies to become more productive; thereby better positioning themselves to respond to the challenges and the opportunities that lie before them. This initial phase of consolidation has given many physicians the momentum to begin to wrestle back the control of health care and the courage to design the next generation of managed care: Physician Directed Managed Care. What will be the next phase? Perhaps, the next step will be fully-integrated specialty and multi-specialty groups leading to alternate delivery sites. "Everyone thinks of changing the world, but no one thinks of changing himself." - Leo Tolstoy

  19. Impact of Physician Asthma Care Education on Patient Outcomes (United States)

    Cabana, Michael D.; Slish, Kathryn K.; Evans, David; Mellins, Robert B.; Brown, Randall W.; Lin, Xihong; Kaciroti, Niko; Clark, Noreen M.


    Objective: We evaluated the effectiveness of a continuing medical education program, Physician Asthma Care Education, in improving pediatricians' asthma therapeutic and communication skills and patients' health care utilization for asthma. Methods: We conducted a randomized trial in 10 regions in the United States. Primary care providers were…

  20. US Approaches to Physician Payment: The Deconstruction of Primary Care


    Berenson, Robert A.; Rich, Eugene C.


    The purpose of this paper is to address why the three dominant alternatives to compensating physicians (fee-for-service, capitation, and salary) fall short of what is needed to support enhanced primary care in the patient-centered medical home, and the relevance of such payment reforms as pay-for-performance and episodes/bundling. The review illustrates why prevalent physician payment mechanisms in the US have failed to adequately support primary care and why innovative approaches to primary ...

  1. Primary Care Physicians' Perspectives About HPV Vaccine. (United States)

    Allison, Mandy A; Hurley, Laura P; Markowitz, Lauri; Crane, Lori A; Brtnikova, Michaela; Beaty, Brenda L; Snow, Megan; Cory, Janine; Stokley, Shannon; Roark, Jill; Kempe, Allison


    Because physicians' practices could be modified to reduce missed opportunities for human papillomavirus (HPV) vaccination, our goal was to: (1) describe self-reported practices regarding recommending the HPV vaccine; (2) estimate the frequency of parental deferral of HPV vaccination; and (3)identify characteristics associated with not discussing it. A national survey among pediatricians and family physicians (FP) was conducted between October 2013 and January 2014. Using multivariable analysis, characteristics associated with not discussing HPV vaccination were examined. Response rates were 82% for pediatricians (364 of 442) and 56% for FP (218 of 387). For 11-12 year-old girls, 60% of pediatricians and 59% of FP strongly recommend HPV vaccine; for boys,52% and 41% ostrongly recommen. More than one-half reported ≥25% of parents deferred HPV vaccination. At the 11-12 year well visit, 84% of pediatricians and 75% of FP frequently/always discuss HPV vaccination. Compared with physicians who frequently/always discuss , those who occasionally/rarely discuss(18%) were more likely to be FP (adjusted odds ratio [aOR]: 2.0 [95% confidence interval (CI): 1.1-3.5), be male (aOR: 1.8 [95% CI: 1.1-3.1]), disagree that parents will accept HPV vaccine if discussed with other vaccines (aOR: 2.3 [95% CI: 1.3-4.2]), report that 25% to 49% (aOR: 2.8 [95% CI: 1.1-6.8]) or ≥50% (aOR: 7.8 [95% CI: 3.4-17.6]) of parents defer, and express concern about waning immunity (aOR: 3.4 [95% CI: 1.8-6.4]). Addressing physicians' perceptions about parental acceptance of HPV vaccine, the possible advantages of discussing HPV vaccination with other recommended vaccines, and concerns about waning immunity could lead to increased vaccination rates. Copyright © 2016 by the American Academy of Pediatrics.

  2. Maternity care and maternal serum screening. Do male and female family physicians care for women differently? (United States)

    Woodward, C A; Carroll, J C; Ryan, G; Reid, A J; Permaul-Woods, J A; Arbitman, S; Domb, S B; Fallis, B; Kilthei, J


    To examine whether male and female family physicians practise maternity care differently, particularly regarding the maternal serum screening (MSS) program. Mailed survey fielded between October 1994 and March 1995. Ontario family practices. Random sample of 2000 members of the College of Family Physicians of Canada who care for pregnant women. More than 90% of eligible physicians responded. Attitudes toward, knowledge about, and behaviour toward MSS. Women physicians were more likely than men to practise part time, in groups, and in larger communities. Men physicians were more likely to perform deliveries; women were more likely to do shared care. Despite a shorter work week, on average, female physicians cared for more pregnant women than male physicians did. Among those providing intrapartum care, women performed more deliveries, on average, than men. Women physicians were more likely than men to offer MSS to all pregnant patients. Although average time spent discussing MSS before the test was similar, women physicians had better knowledge of when best to do the test and its true-positive rate. All differences reported were statistically significant (P women, women physicians cared for more pregnant women than men did. Both spent similar time discussing MSS with their patients before offering screening, but more women physicians offered MSS to all their patients and were more knowledgeable about MSS than men physicians.

  3. [Health care economics, uncertainty and physician-induced demand]. (United States)

    Domenighetti, G; Casabianca, A


    The health care market is a very particular one that is mainly characterized by the absence of information and transparency at every level, particularly between the physician-supplier and the patient-consumer. On this market it is up to the physician to evaluate and define the patient's needs and to decide which are the most effective goods for the patient. The determinants of medical prescription are not only related to the health status of the patient, but also to the payment system (fee for services, salary), to physician density, professional uncertainty, the role and status of the physician in his profession, the legal framework which rules the medical profession, and also the information level of the patient. Agency relationship and professional uncertainty are the most relevant determinants of supplier-induced demand. Professional uncertainty inherent in the practice of a stochastic art such as medicine will "always" give an ethical justification for supplier-induced demand or for the pursuit of "maximal" and/or "defensive" care when market competition is perceived by the physician as a threat to his/her income or employment. Time is ripe for consumers and physicians empowerment in the aim to promote better self-management of health and more thoughtful access to care (for consumers) and more evidences based medicine for physicians.

  4. The Exnovation of Chronic Care Management Processes by Physician Organizations. (United States)

    Rodriguez, Hector P; Henke, Rachel Mosher; Bibi, Salma; Ramsay, Patricia P; Shortell, Stephen M


    Policy Points The rate of adoption of chronic care management processes (CMPs) by physician organizations has been fairly slow in spite of demonstrated effectiveness of CMPs in improving outcomes of chronic care. Exnovation (ie, removal of innovations) by physician organizations largely explains the slow population-level increases in practice use of CMPs over time. Expanded health information technology functions may aid practices in retaining CMPs. Low provider reimbursement by Medicaid programs, however, may contribute to disinvestment in CMPs by physician organizations. Exnovation is the process of removal of innovations that are not effective in improving organizational performance, are too disruptive to routine operations, or do not fit well with the existing organizational strategy, incentives, structure, and/or culture. Exnovation may contribute to the low overall adoption of care management processes (CMPs) by US physician organizations over time. Three national surveys of US physician organizations, which included common questions about organizational characteristics, use of CMPs, and health information technology (HIT) capabilities for practices of all sizes, and Truven Health Insurance Coverage Estimates were integrated to assess organizational and market influences on the exnovation of CMPs in a longitudinal cohort of 1,048 physician organizations. CMPs included 5 strategies for each of 4 chronic conditions (diabetes, asthma, congestive heart failure, and depression): registry use, nurse care management, patient reminders for preventive and care management services to prevent exacerbations of chronic illness, use of nonphysician clinicians to provide patient education, and quality of care feedback to physicians. Over one-third (34.1%) of physician organizations exnovated CMPs on net. Quality of care data feedback to physicians and patient reminders for recommended preventive and chronic care were discontinued by over one-third of exnovators, while nurse

  5. The Exnovation of Chronic Care Management Processes by Physician Organizations (United States)



    Policy Points The rate of adoption of chronic care management processes (CMPs) by physician organizations has been fairly slow in spite of demonstrated effectiveness of CMPs in improving outcomes of chronic care.Exnovation (ie, removal of innovations) by physician organizations largely explains the slow population‐level increases in practice use of CMPs over time.Expanded health information technology functions may aid practices in retaining CMPs. Low provider reimbursement by Medicaid programs, however, may contribute to disinvestment in CMPs by physician organizations. Context Exnovation is the process of removal of innovations that are not effective in improving organizational performance, are too disruptive to routine operations, or do not fit well with the existing organizational strategy, incentives, structure, and/or culture. Exnovation may contribute to the low overall adoption of care management processes (CMPs) by US physician organizations over time. Methods Three national surveys of US physician organizations, which included common questions about organizational characteristics, use of CMPs, and health information technology (HIT) capabilities for practices of all sizes, and Truven Health Insurance Coverage Estimates were integrated to assess organizational and market influences on the exnovation of CMPs in a longitudinal cohort of 1,048 physician organizations. CMPs included 5 strategies for each of 4 chronic conditions (diabetes, asthma, congestive heart failure, and depression): registry use, nurse care management, patient reminders for preventive and care management services to prevent exacerbations of chronic illness, use of nonphysician clinicians to provide patient education, and quality of care feedback to physicians. Findings Over one‐third (34.1%) of physician organizations exnovated CMPs on net. Quality of care data feedback to physicians and patient reminders for recommended preventive and chronic care were discontinued by over one

  6. Burnout among physicians in palliative care: Impact of clinical settings. (United States)

    Dréano-Hartz, Soazic; Rhondali, Wadih; Ledoux, Mathilde; Ruer, Murielle; Berthiller, Julien; Schott, Anne-Marie; Monsarrat, Léa; Filbet, Marilène


    Burnout syndrome is a work-related professional distress. Palliative care physicians often have to deal with complex end-of-life situations and are at risk of presenting with burnout syndrome, which has been little studied in this population. Our study aims to identify the impact of clinical settings (in a palliative care unit (PCU) or on a palliative care mobile team (PCMT)) on palliative care physicians. We undertook a cross-sectional study using a questionnaire that included the Maslach Burnout Inventory (MBI), and we gathered sociodemographic and professional data. The questionnaire was sent to all 590 physicians working in palliative care in France between July of 2012 and February of 2013. The response rate was 61, 8% after three reminders. Some 27 (9%) participants showed high emotional exhaustion, 12 (4%) suffered from a high degree of depersonalization, and 71 (18%) had feelings of low personal accomplishment. Physicians working on a PCMT tended (p = 0.051) to be more likely to suffer from emotional exhaustion than their colleagues. Physicians working on a PCMT worked on smaller teams (fewer physicians, p < 0.001; fewer nonphysicians, p < 0.001). They spent less time doing research (p = 0.019), had fewer resources (p = 0.004), and their expertise seemed to be underrecognized by their colleagues (p = 0.023). The prevalence of burnout in palliative care physicians was low and in fact lower than that reported in other populations (e.g., oncologists). Working on a palliative care mobile team can be a more risky situation, associated with a lack of medical and paramedical staff.

  7. Physicians and AIDS care: does knowledge influence their attitude ...

    African Journals Online (AJOL)

    Adequate knowledge, positive attitude, and feeling of comfort are important factors in providing compassionate care to patients. The purpose of this study was to assess physicians' knowledge, attitude and global comfort in caring for patients with AIDS (PWA), to determine the sociodemographic variables that could influence ...

  8. Physician education programme improves quality of diabetes care ...

    African Journals Online (AJOL)

    Objectives. To determine if a physician education programme and a structured consultation schedule would improve the quality of diabetes patient care in a diabetes clinic. Setting. Two tertiary care diabetes clinics at Kalafong Hospital, Pretoria. Study design. Quasi-experimental controlled before-and-after study. Methods.

  9. The evolution of physician-directed managed care. (United States)

    Unland, J J


    The health care industry is evolving. In the near term, POs will become the state of the art in physician-directed managed care. Eventually, POs will merge into fully integrated group practices. From there, regional POs and group practices will develop their own insurance products. But because these organizations will be dominated by physicians who wish to practice medicine, rather than sell insurance, money will be made by appropriately managing risk and providing high-quality care. In time, physicians will take control and "manage" managed care, as they are the only ones--not administrators, executives, or other business people--who are in a position to fundamentally revise the way medicine is practiced.

  10. Physician Competition in the Era of Accountable Care Organizations. (United States)

    Richards, Michael R; Smith, Catherine T; Graves, Amy J; Buntin, Melinda B; Resnick, Matthew J


    To calculate physician concentration levels for all U.S. markets using detailed data on integration and accountable care organization (ACO) participation. 2015 SK&A office-based physician survey linked to all commercial and public payer ACOs. We construct three separate Herfindahl-Hirschman Index (HHI) measures and plot their distributions. We then investigate how prevailing levels of concentration change when incorporating more detailed organizational features into the HHI measure. Horizontal and vertical integration strongly influences measures of physician concentration; however, ACOs have limited impact overall. ACOs are often present in competitive markets, and only in a minority of these markets do ACOs substantively increase physician concentration. Monitoring ACO effects on physician competition will likely have to proceed on a case-by-case basis. © Health Research and Educational Trust.

  11. Psychosocial determinants of physicians' intention to practice euthanasia in palliative care. (United States)

    Lavoie, Mireille; Godin, Gaston; Vézina-Im, Lydi-Anne; Blondeau, Danielle; Martineau, Isabelle; Roy, Louis


    Euthanasia remains controversial in Canada and an issue of debate among physicians. Most studies have explored the opinion of health professionals regarding its legalization, but have not investigated their intentions when faced with performing euthanasia. These studies are also considered atheoretical. The purposes of the present study were to fill this gap in the literature by identifying the psychosocial determinants of physicians' intention to practice euthanasia in palliative care and verifying whether respecting the patient's autonomy is important for physicians. A validated anonymous questionnaire based on an extended version of the Theory of Planned Behavior was mailed to a random sample of 445 physicians from the province of Quebec, Canada. The response rate was 38.3% and the mean score for intention was 3.94 ± 2.17 (range: 1 to 7). The determinants of intention among physicians were: knowing patients' wishes (OR = 10.77; 95%CI: 1.33-86.88), perceived behavioral control-physicians' evaluation of their ability to adopt a given behavior-(OR = 4.35; 95%CI: 1.44-13.15), moral norm-the appropriateness of adopting a given behavior according to one's personal and moral values-(OR = 3.22; 95%CI: 1.29-8.00) and cognitive attitude-factual consequences of the adoption of a given behavior-(OR = 3.16; 95%CI: 1.20-8.35). This model correctly classified 98.8% of physicians. Specific beliefs that might discriminate physicians according to their level of intention were also identified. For instance, physicians' moral norm was related to the ethical principle of beneficence. Overall, physicians have weak intentions to practice euthanasia in palliative care. Nevertheless, respecting patients' final wishes concerning euthanasia seems to be of particular importance to them and greatly affects their motivation to perform euthanasia.

  12. Stoicism, the physician, and care of medical outliers

    Directory of Open Access Journals (Sweden)

    Papadimos Thomas J


    Full Text Available Abstract Background Medical outliers present a medical, psychological, social, and economic challenge to the physicians who care for them. The determinism of Stoic thought is explored as an intellectual basis for the pursuit of a correct mental attitude that will provide aid and comfort to physicians who care for medical outliers, thus fostering continued physician engagement in their care. Discussion The Stoic topics of good, the preferable, the morally indifferent, living consistently, and appropriate actions are reviewed. Furthermore, Zeno's cardinal virtues of Justice, Temperance, Bravery, and Wisdom are addressed, as are the Stoic passions of fear, lust, mental pain, and mental pleasure. These concepts must be understood by physicians if they are to comprehend and accept the Stoic view as it relates to having the proper attitude when caring for those with long-term and/or costly illnesses. Summary Practicing physicians, especially those that are hospital based, and most assuredly those practicing critical care medicine, will be emotionally challenged by the medical outlier. A Stoic approach to such a social and psychological burden may be of benefit.

  13. [Travel times of patients to ambulatory care physicians in Germany]. (United States)

    Schang, Laura; Kopetsch, Thomas; Sundmacher, Leonie


    The time needed by patients to get to a doctor's office represents an important indicator of realised access to care. In Germany, findings on travel times are only available from surveys or for some regions. For the first time, this study examines nationwide and physician group-specific travel times in the ambulatory care sector in Germany and describes demographic, supply-side and spatial determinants of variations. Using a full review of patient consultations in the statutory health insurance system from 2009/2010 for 14 physician groups (approximately 518 million cases), case-related travel times by car between patients' places of residence and physician's practices were estimated at the municipal level. Physicians were reached in less than 30 min in 90.8% of cases for primary care physicians and up to 63% of cases for radiologists. Patients between 18 and under 30 years of age travel longer to get to the doctor than other age groups. The average travel time at the county level systematically differs between urban and rural planning areas. In the case of gynecologists, dermatologists and ophthalmologists, the average journey time decreases with increasing physician density at the county level, but remains approximately constant from a recognisable point of inflection. There is no association between primary care physician density and travel time at the district level. Spatial analyses show physician group-specific patterns of regional concentrations with an increased proportion of cases with very long travel times. Patients' travel times are influenced by supply- and demand-side determinants. Interactions between influential determinants should be analysed in depth to examine the extent to which the time travelled is an expression of regional under- or over-supply rather than an expression of patient preferences.

  14. Naturopathic physicians: holistic primary care and integrative medicine specialists. (United States)

    Litchy, Andrew P


    The use of Complimentary and Alternative Medicine (CAM) is increasing in the United States; there is a need for physician level practitioners who possess extensive training in both CAM and conventional medicine. Naturopathic physicians possess training that allows integration of modern scientific knowledge and the age-old wisdom of natural healing techniques. Naturopathic philosophy provides a framework to implement CAM in concert with conventional therapies. The naturopathic physician's expertise in both conventional medicine and CAM allows a practice style that provides excellent care through employing conventional and CAM modalities while utilizing modern research and evidence-based medicine.

  15. Cognitive systems engineering in health care

    CERN Document Server

    Bisantz, Ann M; Fairbanks, Rollin J


    Cognitive Engineering for Better Health Care Systems, Ann M. Bisantz, Rollin J. Fairbanks, and Catherine M. BurnsThe Role of Cognitive Engineering in Improving Clinical Decision Support, Anne Miller and Laura MilitelloTeam Cognitive Work Analysis as an Approach for Understanding Teamwork in Health Care, Catherine M. BurnsCognitive Engineering Design of an Emergency Department Information System, Theresa K. Guarrera, Nicolette M. McGeorge, Lindsey N. Clark, David T. LaVergne, Zachary A. Hettinger, Rollin J. Fairbanks, and Ann M. BisantzDisplays for Health Care Teams: A Conceptual Framework and Design Methodology, Avi ParushInformation Modeling for Cognitive Work in a Health Care System, Priyadarshini R. PennathurSupport for ICU Clinician Cognitive Work through CSE, Christopher Nemeth, Shilo Anders, Jeffrey Brown, Anna Grome, Beth Crandall, and Jeremy PamplinMatching Cognitive Aids and the "Real Work" of Health Care in Support of Surgical Microsystem Teamwork, Sarah Henrickson Parker and Shawna J. PerryEngageme...

  16. Physicians' and consumers' conflicting attitudes toward health care advertising. (United States)

    Krohn, F B; Flynn, C


    The purpose of this paper is to explore the conflicting attitudes held by physicians and health care consumers toward health care advertising in an attempt to resolve the question. The paper introduces the differing positions held by the two groups. The rationale behind physicians' attitudes is then presented that advertising can be unethical, misleading, deceptive, and lead to unnecessary price increases. They believe that word-of-mouth does and should play the major role in attracting new patients. The opposite view of consumers is then presented which contends that health care advertising leads to higher consumer awareness of services, better services, promotes competitive pricing, and lowers rather than raises health care costs. The final section of the paper compares the arguments presented and concludes that health care advertising clearly has a place in the health care industry.

  17. Job satisfaction among primary care physicians: results of a survey. (United States)

    Behmann, Mareike; Schmiemann, Guido; Lingner, Heidrun; Kühne, Franziska; Hummers-Pradier, Eva; Schneider, Nils


    A shortage of primary care physicians (PCPs) seems likely in Germany in the near future and already exists in some parts of the country. Many currently practicing PCPs will soon reach retirement age, and recruiting young physicians for family practice is difficult. The attractiveness of primary care for young physicians depends on the job satisfaction of currently practicing PCPs. We studied job satisfaction among PCPs in Lower Saxony, a large federal state in Germany. In 2009, we sent a standardized written questionnaire on overall job satisfaction and on particular aspects of medical practice to 3296 randomly chosen PCPs and internists in family practice in Lower Saxony (50% of the entire target population). 1106 physicians (34%) responded; their mean age was 52, and 69% were men. 64% said they were satisfied or very satisfied with their job overall. There were particularly high rates of satisfaction with patient contact (91%) and working atmosphere (87% satisfied or very satisfied). In contrast, there were high rates of dissatisfaction with administrative tasks (75% dissatisfied or not at all satisfied). The results were more indifferent concerning payment and work life balance. Overall, younger PCPs and physicians just entering practice were more satisfied than their older colleagues who had been in practice longer. PCPs are satisfied with their job overall. However, there is significant dissatisfaction with administrative tasks. Improvements in this area may contribute to making primary care more attractive to young physicians.

  18. Regional variations in health care intensity and physician perceptions of quality of care. (United States)

    Sirovich, Brenda E; Gottlieb, Daniel J; Welch, H Gilbert; Fisher, Elliott S


    Research has documented dramatic differences in health care utilization and spending across U.S. regions with similar levels of patient illness. Although patient outcomes and quality of care have been found to be no better in regions of high health care intensity, it is unknown whether physicians in these regions feel more capable of providing good patient care than those in low-intensity regions. To determine whether physicians in high-intensity regions feel better able to care for patients than physicians in low-intensity regions. Physician telephone survey. 51 metropolitan and 9 nonmetropolitan areas of the United States and a supplemental national sample. 10,577 physicians who provided care to adults in 1998 or 1999 were surveyed for the Community Tracking Study (response rate, 61%). The End-of-Life Expenditure Index, a measure of spending that reflects differences in the overall quantity of medical services provided rather than differences in illness or price, was used to determine health care intensity in the physicians' community. Outcomes included physicians' perceived availability of clinical services, ability to provide high-quality care to patients, and career satisfaction. Although the highest-intensity regions have substantially more hospital beds and specialists per capita, physicians in these regions reported more difficulty obtaining needed services for their patients. The proportion of physicians who felt able to obtain elective hospital admissions ranged from 50% in high-intensity regions to 64% in the lowest-intensity region (P market factors (for example, managed care penetration); the difference in perceived ability to provide high-quality care was no longer statistically significant (P = 0.099). The cross-sectional design prevented demonstration of a causal relationship between intensity and physician perceptions of quality. Despite more resources, physicians in regions of high health care intensity did not report greater ease in obtaining

  19. The effect of cognitive load and patient race on physicians' decisions to prescribe opioids for chronic low back pain: a randomized trial. (United States)

    Burgess, Diana J; Phelan, Sean; Workman, Michael; Hagel, Emily; Nelson, David B; Fu, Steven S; Widome, Rachel; van Ryn, Michelle


    To test the hypothesis that racial biases in opioid prescribing would be more likely under high levels of cognitive load, defined as the amount of mental activity imposed on working memory, which may come from environmental factors such as stressful conditions, chaotic workplace, staffing insufficiency, and competing demands, one's own psychological or physiological state, as well as from demands inherent in the task at hand. Two (patient race: White vs Black) by two (cognitive load: low vs high) between-subjects factorial design. Ninety-eight primary care physicians from the Veterans Affairs Healthcare System. Web-based experimental study. Physicians were randomly assigned to read vignettes about either a Black or White patient, under low vs high cognitive load, and to indicate their likelihood of prescribing opioids. High cognitive load was induced by having physicians perform a concurrent task under time pressure. There was a three-way interaction between patient race, cognitive load, and physician gender on prescribing decisions (P = 0.034). Hypotheses were partially confirmed. Male physicians were less likely to prescribe opioids for Black than White patients under high cognitive load (12.5% vs 30.0%) and were more likely to prescribe opioids for Black than White patients under low cognitive load (30.8% vs 10.5%). By contrast, female physicians were more likely to prescribe opioids for Black than White patients in both conditions, with greater racial differences under high (39.1% vs 15.8%) vs low cognitive load (28.6% vs 21.7%). Physician gender affected the way in which patient race and cognitive load influenced decisions to prescribe opioids for chronic pain. Future research is needed to further explore the potential effects of physician gender on racial biases in pain treatment, and the effects of physician cognitive load on pain treatment. Published 2014. This article is a U.S. Government work and is in the public domain in the USA.

  20. Dutch criteria of due care for physician-assisted dying in medical practice: a physician perspective

    NARCIS (Netherlands)

    Buiting, H. M.; Gevers, J. K. M.; Rietjens, J. A. C.; Onwuteaka-Philipsen, B. D.; van der Maas, P. J.; van der Heide, A.; van Delden, J. J. M.


    Introduction: The Dutch Euthanasia Act (2002) states that euthanasia is not punishable if the attending physician acts in accordance with the statutory due care criteria. These criteria hold that: there should be a voluntary and well-considered request, the patient's suffering should be unbearable

  1. Preconception care by family physicians and general practitioners in Japan

    Directory of Open Access Journals (Sweden)

    Fetters Michael D


    Full Text Available Abstract Background Preconception care provided by family physicians/general practitioners (FP/GPs can provide predictable benefits to mothers and infants. The objective of this study was to elucidate knowledge of, attitudes about, and practices of preconception care by FP/GPs in Japan. Methods A survey was distributed to physician members of the Japanese Academy of Family Medicine. The questionnaire addressed experiences of preconception education in medical school and residency, frequency of preconception care in clinical practice, attitudes about providing preconception care, and perceived need for preconception education to medical students and residents. Results Two hundred and sixty-eight of 347 (77% eligible physicians responded. The most common education they reported receiving was about smoking cessation (71%, and the least was about folic acid supplementation (12%. Many participants reported providing smoking cessation in their practice (60%, though only about one third of respondents advise restricting alcohol intake. Few reported advising calcium supplementation (10% or folic acid supplementation (4%. About 70% reported their willingness to provide preconception care. Almost all participants believe medical students and residents should have education about preconception care. Conclusion FP/GPs in Japan report little training in preconception care and few currently provide it. With training, most participants are willing to provide preconception care themselves and think medical students and residents should receive this education.

  2. The comprehensive care project: measuring physician performance in ambulatory practice. (United States)

    Holmboe, Eric S; Weng, Weifeng; Arnold, Gerald K; Kaplan, Sherrie H; Normand, Sharon-Lise; Greenfield, Sheldon; Hood, Sarah; Lipner, Rebecca S


    To investigate the feasibility, reliability, and validity of comprehensively assessing physician-level performance in ambulatory practice. Ambulatory-based general internists in 13 states participated in the assessment. We assessed physician-level performance, adjusted for patient factors, on 46 individual measures, an overall composite measure, and composite measures for chronic, acute, and preventive care. Between- versus within-physician variation was quantified by intraclass correlation coefficients (ICC). External validity was assessed by correlating performance on a certification exam. Medical records for 236 physicians were audited for seven chronic and four acute care conditions, and six age- and gender-appropriate preventive services. Performance on the individual and composite measures varied substantially within (range 5-86 percent compliance on 46 measures) and between physicians (ICC range 0.12-0.88). Reliabilities for the composite measures were robust: 0.88 for chronic care and 0.87 for preventive services. Higher certification exam scores were associated with better performance on the overall (r = 0.19; pmeasures and by sampling feasible numbers of patients for each condition. © Health Research and Educational Trust.

  3. Communication-related allegations against physicians caring for premature infants. (United States)

    Nguyen, J; Muniraman, H; Cascione, M; Ramanathan, R


    Maternal-fetal medicine physicians (MFMp) and neonatal-perinatal medicine physicians (NPMp) caring for premature infants and their families are exposed to significant risk for malpractice actions. Effective communication practices have been implicated to decrease litigious intentions but the extent of miscommunication as a cause of legal action is essentially unknown in this population. Analysis of communication-related allegations (CRAs) may help toward improving patient care and physician-patient relationships as well as decrease litigation risks. We retrospectively reviewed the Westlaw database, a primary online legal research resource used by United States lawyers and legal professionals, for malpractice cases against physicians involving premature infants. Inclusion criteria were: 22 to 36 weeks gestational age, cases related to peripartum events through infant discharge and follow-up, and legal records with detailed factual narratives. The search yielded 736 legal records, of which 167 met full inclusion criteria. A CRA was identified in 29% (49/167) of included cases. MFMp and/or NPMp were named in 104 and 54 cases, respectively. CRAs were identified in 26% (27/104) and 35% (19/54) of MFMp- and NPMp-named cases, respectively, with a majority involving physician-family for both specialties (81% and 74%, respectively). Physician-family CRAs for MFMp and NPMp most often regarded lack of informed consent (50% and 57%, respectively), lack of full disclosure (41% and 29%, respectively) and lack of anticipatory guidance (36% and 21%, respectively). This study of a major legal database identifies CRAs as significant causes of legal action against MFMp and NPMp involved in the care of high-risk women and infants delivered preterm. Physicians should be especially vigilant with obtaining genuine informed consent and maintaining open communication with families.

  4. Physician leadership: a health-care system's investment in the future of quality care. (United States)

    Orlando, Rocco; Haytaian, Marcia


    The current state of health care and its reform will require physician leaders to take on greater management responsibilities, which will require a set of organizational and leadership competencies that traditional medical education does not provide. Physician leaders can form a bridge between the clinical and administrative sides of a health-care organization, serving to further the organization's strategy for growth and success. Recognizing that the health-care industry is rapidly changing and physician leaders will play a key role in that transformation, Hartford HealthCare has established a Physician Leadership Development Institute that provides advanced leadership skills and management education to select physicians practicing within the health-care system.

  5. Providing primary health care with non-physicians. (United States)

    Chen, P C


    The definition of primary health care is basically the same, but the wide variety of concepts as to the form and type of worker required is largely due to variations in economic, demographic, socio-cultural and political factors. Whatever form it takes, in many parts of the developing world, it is increasingly clear that primary health care must be provided by non-physicians. The reasons for this trend are compelling, yet it is surprisingly opposed by the medical profession in many a developing country. Nonetheless, numerous field trials are being conducted in a variety of situations in several countries around the world. Non-physician primary health care workers vary from medical assistants and nurse practitioners to aide-level workers called village mobilizers, village volunteers, village aides and a variety of other names. The functions, limitations and training of such workers will need to be defined, so that an optimal combination of skills, knowledge and attitudes best suited to produce the desired effect on local health problems may be attained. The supervision of such workers by the physician and other health professionals will need to be developed in the spirit of the health team. An example of the use of non-physicians in providing primary health care in Sarawak is outlined.

  6. Burnout among primary care physicians in Jos-Plateau, north ...

    African Journals Online (AJOL)

    Background: Developing countries health systems are bedeviled with numerous challenges including resource scarcity, high workload, unfavourable working conditions, Physical and Psychosocial stress. The Aim of this study was to assess the burden of burnout among primary care physicians working in such challenging ...

  7. Overweight and Obesity and the Demand for Primary Physician Care

    DEFF Research Database (Denmark)

    Datta Gupta, Nabanita; Greve, Jane

    -60 years drawn from the National Health Interview (NHI) survey 2000 and merged to Danish register data, we compare differences in the impact of being overweight and obese relative to being normal weight on the demand for primary physician care. Estimated bodyweight effects vary across latent classes...

  8. Determinants of nutrition guidance practices of primary-care physicians

    NARCIS (Netherlands)

    Hiddink, G.J.


    The aim of the studies described in this thesis was to analyze nutrition guidance practices of primary-care physicians (PCPs), their nutritional attitudes and knowledge and their interest in the role of nutrition in health and disease. A second objective was to identify the determinants

  9. Ultrasound for critical care physicians: tiny bubbles

    Directory of Open Access Journals (Sweden)

    Aslam K


    Full Text Available No abstract available. Article truncated after first page. A 59 year old woman with a past medical history significant for stage IV MALT lymphoma (after chemotherapy and in remission presented from a long term care facility for respiratory distress and altered mental status. The patient was in hypercarbic respiratory failure with a severe lactic acidosis. Her blood pressure deteriorated, she was begun on vasopressors and intubated. Pertinent labs demonstrated a white blood cell count of 0.9 X106 /ml, a hemoglobin of 7.1 g/dl, and a platelet count 66 X106 /ml. The patient was started on Cefepime and Linezolid presumptively for septic shock. Ultrasounds of her thorax were performed (Videos 1 & 2. What is the best explanation for the ultrasound findings shown above?1. Large pleural effusion; 2. Pneumothorax; 3. Consolidation due to pneumonia; 4. Ruptured diaphragm; 5. Lung abscess

  10. Impact of patient satisfaction ratings on physicians and clinical care

    Directory of Open Access Journals (Sweden)

    Zgierska A


    Full Text Available Aleksandra Zgierska,1 David Rabago,1 Michael M Miller2–4 1Department of Family Medicine, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI, 2American Society of Addiction Medicine, Chevy Chase, MD, 3Department of Psychiatry, University of Wisconsin-Madison, School of Medicine and Public Health, 4Herrington Recovery Center, Rogers Memorial Hospital, Oconomowoc, WI, USA Background: Although patient satisfaction ratings often drive positive changes, they may have unintended consequences. Objective: The study reported here aimed to evaluate the clinician-perceived effects of patient satisfaction ratings on job satisfaction and clinical care. Methods: A 26-item survey, developed by a state medical society in 2012 to assess the effects of patient satisfaction surveys, was administered online to physician members of a state-level medical society. Respondents remained anonymous. Results: One hundred fifty five physicians provided responses (3.9% of the estimated 4,000 physician members of the state-level medical society, or approximately 16% of the state's emergency department [ED] physicians. The respondents were predominantly male (85% and practicing in solo or private practice (45%, hospital (43%, or academia (15%. The majority were ED (57%, followed by primary care (16% physicians. Fifty-nine percent reported that their compensation was linked to patient satisfaction ratings. Seventy-eight percent reported that patient satisfaction surveys moderately or severely affected their job satisfaction; 28% had considered quitting their job or leaving the medical profession. Twenty percent reported their employment being threatened because of patient satisfaction data. Almost half believed that pressure to obtain better scores promoted inappropriate care, including unnecessary antibiotic and opioid prescriptions, tests, procedures, and hospital admissions. Among 52 qualitative responses, only three were positive. Conclusion

  11. Medicare managed care. How physicians can make it better. (United States)

    Roggin, G M


    The federal government is attempting to control anticipated, increased Medicare health care costs by providing the senior population with incentives to encourage their movement into managed care programs. For-profit corporate HMOs that currently dominate the managed care arena are coming under increased competitive pressure at a time when their perception of profiteering is undergoing increased public scrutiny. If physicians are to take advantage of this window of opportunity and successfully enter the Medicare managed care marketplace, they must identify the major deficiencies existing in the current model, and fashion a new product that divests itself of the profit orientation of current corporate HMOs. A nonprofit version of a highly integrated, multispecialty provider service organization (PSO) provides an appropriate model to effectively compete with the corporate HMO. The ideal physician-controlled managed care model must: develop a responsive policy board structure; create practice guidelines that decrease variation in physician practice; achieve an appropriate balance between primary and specialty medical care; and adopt a quality-assurance program that effectively addresses both process and outcome data.

  12. Evaluating topic model interpretability from a primary care physician perspective. (United States)

    Arnold, Corey W; Oh, Andrea; Chen, Shawn; Speier, William


    Probabilistic topic models provide an unsupervised method for analyzing unstructured text. These models discover semantically coherent combinations of words (topics) that could be integrated in a clinical automatic summarization system for primary care physicians performing chart review. However, the human interpretability of topics discovered from clinical reports is unknown. Our objective is to assess the coherence of topics and their ability to represent the contents of clinical reports from a primary care physician's point of view. Three latent Dirichlet allocation models (50 topics, 100 topics, and 150 topics) were fit to a large collection of clinical reports. Topics were manually evaluated by primary care physicians and graduate students. Wilcoxon Signed-Rank Tests for Paired Samples were used to evaluate differences between different topic models, while differences in performance between students and primary care physicians (PCPs) were tested using Mann-Whitney U tests for each of the tasks. While the 150-topic model produced the best log likelihood, participants were most accurate at identifying words that did not belong in topics learned by the 100-topic model, suggesting that 100 topics provides better relative granularity of discovered semantic themes for the data set used in this study. Models were comparable in their ability to represent the contents of documents. Primary care physicians significantly outperformed students in both tasks. This work establishes a baseline of interpretability for topic models trained with clinical reports, and provides insights on the appropriateness of using topic models for informatics applications. Our results indicate that PCPs find discovered topics more coherent and representative of clinical reports relative to students, warranting further research into their use for automatic summarization. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  13. Maternity Care Services Provided by Family Physicians in Rural Hospitals. (United States)

    Young, Richard A

    The purpose of this study was to describe how many rural family physicians (FPs) and other types of providers currently provide maternity care services, and the requirements to obtain privileges. Chief executive officers of rural hospitals were purposively sampled in 15 geographically diverse states with significant rural areas in 2013 to 2014. Questions were asked about the provision of maternity care services, the physicians who perform them, and qualifications required to obtain maternity care privileges. Analysis used descriptive statistics, with comparisons between the states, community rurality, and hospital size. The overall response rate was 51.2% (437/854). Among all identified hospitals, 44.9% provided maternity care services, which varied considerably by state (range, 17-83%; P maternity care, a mean of 271 babies were delivered per year, 27% by cesarean delivery. A mean of 7.0 FPs had privileges in these hospitals, of which 2.8 provided maternity care and 1.8 performed cesarean deliveries. The percentage of FPs who provide maternity care (mean, 48%; range, 10-69%; P maternity care who are FPs (mean, 63%; range, 10-88%; P maternity care services in US rural hospitals, including cesarean deliveries. Some family medicine residencies should continue to train their residents to provide these services to keep replenishing this valuable workforce. © Copyright 2017 by the American Board of Family Medicine.

  14. Canadian physicians' responses to cross border health care. (United States)

    Runnels, Vivien; Labonté, Ronald; Packer, Corinne; Chaudhry, Sabrina; Adams, Owen; Blackmer, Jeff


    The idea for this survey emanated from desk research and two meetings for researchers that discussed medical tourism and out-of-country health care, which were convened by some of the authors of this article (VR, CP and RL). A Cross Border Health Care Survey was drafted by a number of the authors and administered to Canadian physicians via the Canadian Medical Association's e-panel. The purpose of the survey was to gain an understanding of physicians' experiences with and views of their patients acquiring health care out of country, either as medical tourists (paying out-of-pocket for their care) or out-of-country care patients funded by provincial/territorial public health insurance plans. Quantitative and qualitative results of the survey were analyzed. 631 physicians responded to the survey. Diagnostic procedures were the top-ranked procedure for patients either as out-of-country care recipients or medical tourists. Respondents reported that the main reason why patients sought care abroad was because waiting times in Canada were too long. Some respondents were frustrated with a lack of information about out-of-country procedures upon their patients' return to Canada. The majority of physician respondents agreed that it was their responsibility to provide follow-up care to medical travellers on return to Canada, although a substantial minority disagreed that they had such a responsibility. Cross-border health care, whether government-sanctioned (out-of-country-care) or patient-initiated (medical tourism), is increasing in Canada. Such flows are thought likely to increase with aging populations. Government-sanctioned outbound flows are less problematic than patient-initiated flows but are constrained by low approval rates, which may increase patient initiation. Lack of information and post-return complications pose the greatest concern to Canadian physicians. Further research on both types of flows (government-sanctioned and patient-initiated), and how they affect

  15. US approaches to physician payment: the deconstruction of primary care. (United States)

    Berenson, Robert A; Rich, Eugene C


    The purpose of this paper is to address why the three dominant alternatives to compensating physicians (fee-for-service, capitation, and salary) fall short of what is needed to support enhanced primary care in the patient-centered medical home, and the relevance of such payment reforms as pay-for-performance and episodes/bundling. The review illustrates why prevalent physician payment mechanisms in the US have failed to adequately support primary care and why innovative approaches to primary care payment play such a prominent role in the PCMH discussion. FFS payment for office visits has never effectively rewarded all the activities that comprise prototypical primary care and may contribute to the "hamster on a treadmill" problems in current medical practice. Capitation payments are associated with risk adjustment challenges and, perhaps, public perceptions of conflict with patients' best interests. Most payers don't employ and therefore cannot generally place physicians on salary; while in theory such salary payments might neutralize incentives, operationally, "time is money;" extra effort devoted to meeting the needs of a more complex patient will likely reduce the services available to others. Fee-for-service, the predominant physician payment scheme, has contributed to both the continuing decline in the primary care workforce and the capability to serve patients well. Yet, the conceptual alternative payment approaches, modified fee-for-service (including fee bundles), capitation, and salary, each have their own problems. Accordingly, new payment models will likely be required to support restoration of primary care to its proper role in the US health care system, and to promote and sustain the development of patient-centered medical homes.

  16. Primary care physician insights into a typology of the complex patient in primary care. (United States)

    Loeb, Danielle F; Binswanger, Ingrid A; Candrian, Carey; Bayliss, Elizabeth A


    Primary care physicians play unique roles caring for complex patients, often acting as the hub for their care and coordinating care among specialists. To inform the clinical application of new models of care for complex patients, we sought to understand how these physicians conceptualize patient complexity and to develop a corresponding typology. We conducted qualitative in-depth interviews with internal medicine primary care physicians from 5 clinics associated with a university hospital and a community health hospital. We used systematic nonprobabilistic sampling to achieve an even distribution of sex, years in practice, and type of practice. The interviews were analyzed using a team-based participatory general inductive approach. The 15 physicians in this study endorsed a multidimensional concept of patient complexity. The physicians perceived patients to be complex if they had an exacerbating factor-a medical illness, mental illness, socioeconomic challenge, or behavior or trait (or some combination thereof)-that complicated care for chronic medical illnesses. This perspective of primary care physicians caring for complex patients can help refine models of complexity to design interventions or models of care that improve outcomes for these patients. © 2015 Annals of Family Medicine, Inc.

  17. Caring for LGBTQ patients: Methods for improving physician cultural competence. (United States)

    Klein, Elizabeth W; Nakhai, Maliheh


    This article summarizes the components of a curriculum used to teach family medicine residents and faculty about LGBTQ patients' needs in a family medicine residency program in the Pacific Northwest region of the United States. This curriculum was developed to provide primary care physicians and physicians-in-training with skills to provide better health care for LGBTQ-identified patients. The curriculum covers topics that range from implicit and explicit bias and appropriate terminology to techniques for crafting patient-centered treatment plans. Additionally, focus is placed on improving the understanding of specific and unique barriers to competent health care encountered by LGBTQ patients. Through facilitated discussion, learners explore the health disparities that disproportionately affect LGBTQ individuals and develop skills that will improve their ability to care for LGBTQ patients. The goal of the curriculum is to teach family medicine faculty and physicians in training how to more effectively communicate with and treat LGBTQ patients in a safe, non-judgmental, and welcoming primary care environment. © The Author(s) 2016.

  18. Physicians' attitudes about artificial feeding in older patients with severe cognitive impairment in Japan: a qualitative study

    Directory of Open Access Journals (Sweden)

    Kai Ichiro


    Full Text Available Abstract Background The question of whether to withhold artificial nutrition and hydration (ANH from severely cognitively impaired older adults has remained nearly unexplored in Japan, where provision of ANH is considered standard care. The objective of this study was to identify and analyze factors related to the decision to provide ANH through percutaneous endoscopic gastrostomy (PEG in older Japanese adults with severe cognitive impairment. Methods Retrospective, in-depth interviews with thirty physicians experienced in the care of older, bed-ridden, non-communicative patients with severe cognitive impairment. Interview content included questions about factors influencing the decision to provide or withhold ANH, concerns and dilemmas concerning ANH and the choice of PEG feeding as an ANH method. The process of data collection and analysis followed the Grounded Theory approach. Results Data analysis identified five factors that influence Japanese physicians' decision to provide ANH through PEG tubes: (1 the national health insurance system that allows elderly patients to become long-term hospital in-patients; (2 legal barriers with regard to limiting treatment, including the risk of prosecution; (3 emotional barriers, especially abhorrence of death by 'starvation'; (4 cultural values that promote family-oriented end-of-life decision making; and (5 reimbursement-related factors involved in the choice of PEG. However, a small number of physicians did offer patients' families the option of withholding ANH. These physicians shared certain characteristics, such as a different perception of ANH and repeated communication with families concerning end-of-life care. These qualities were found to reduce some of the effects of the factors that favor provision of ANH. Conclusion The framework of Japan's medical-legal system unintentionally provides many physicians an incentive to routinely offer ANH for this patient group through PEG tubes. It seems

  19. When and Why Do Neonatal and Pediatric Critical Care Physicians Consult Palliative Care? (United States)

    Richards, Claire A; Starks, Helene; O'Connor, M Rebecca; Bourget, Erica; Lindhorst, Taryn; Hays, Ross; Doorenbos, Ardith Z


    Parents of children admitted to neonatal and pediatric intensive care units (ICUs) are at increased risk of experiencing acute and post-traumatic stress disorder. The integration of palliative care may improve child and family outcomes, yet there remains a lack of information about indicators for specialty-level palliative care involvement in this setting. To describe neonatal and pediatric critical care physician perspectives on indicators for when and why to involve palliative care consultants. Semistructured interviews were conducted with 22 attending physicians from neonatal, pediatric, and cardiothoracic ICUs in a single quaternary care pediatric hospital. Transcribed interviews were analyzed using content and thematic analyses. We identified 2 themes related to the indicators for involving palliative care consultants: (1) palliative care expertise including support and bridging communication and (2) organizational factors influencing communication including competing priorities and fragmentation of care. Palliative care was most beneficial for families at risk of experiencing communication problems that resulted from organizational factors, including those with long lengths of stay and medical complexity. The ability of palliative care consultants to bridge communication was limited by some of these same organizational factors. Physicians valued the involvement of palliative care consultants when they improved efficiency and promoted harmony. Given the increasing number of children with complex chronic conditions, it is important to support the capacity of ICU clinical teams to provide primary palliative care. We suggest comprehensive system changes and critical care physician training to include topics related to chronic illness and disability.

  20. Physician burnout, work engagement and the quality of patient care. (United States)

    Loerbroks, A; Glaser, J; Vu-Eickmann, P; Angerer, P


    Research suggests that burnout in physicians is associated with poorer patient care, but evidence is inconclusive. More recently, the concept of work engagement has emerged (i.e. the beneficial counterpart of burnout) and has been associated with better care. Evidence remains markedly sparse however. To examine the associations of burnout and work engagement with physicians' self-perceived quality of care. We drew on cross-sectional data from physicians in Germany. We used a six-item version of the Maslach Burnout Inventory measuring exhaustion and depersonalization. We employed the nine-item Utrecht Work Engagement Scale to assess work engagement and its subcomponents: vigour, dedication and absorption. We measured physicians' own perceptions of their quality of care by a six-item instrument covering practices and attitudes. We used continuous and categorized dependent and independent variables in linear and logistic regression analyses. There were 416 participants. In multivariable linear regression analyses, increasing burnout total scores were associated with poorer perceived quality of care [unstandardized regression coefficient (b) = 0.45, 95% confidence interval (CI) 0.37, 0.54]. This association was stronger for depersonalization (b = 0.37, 95% CI 0.29, 0.44) than for exhaustion (b = 0.26, 95% CI 0.18, 0.33). Increasing work engagement was associated with higher perceived quality care (b for the total score = -0.20, 95% CI -0.28, -0.11). This was confirmed for each subcomponent with stronger associations for vigour (b = -0.21, 95% CI -0.29, -0.13) and dedication (b = -0.16, 95% CI -0.24, -0.09) than for absorption (b = -0.12, 95% CI -0.20, -0.04). Logistic regression analyses yielded comparable results. Physician burnout was associated with self-perceived poorer patient care, while work engagement related to self-reported better care. Studies are needed to corroborate these findings, particularly for work engagement. © The Author 2017. Published by Oxford

  1. Physician Religion and End-of-Life Pediatric Care: A Qualitative Examination of Physicians' Perspectives. (United States)

    Bateman, Lori Brand; Clair, Jeffrey Michael


    Physician religion/spirituality has the potential to influence the communication between physicians and parents of children at the end of life. In order to explore this relationship, the authors conducted two rounds of narrative interviews to examine pediatric physicians' perspectives (N=17) of how their religious/spiritual beliefs affect end-of-life communication and care. Grounded theory informed the design and analysis of the study. As a proxy for religiosity/spirituality, physicians were classified into the following groups based on the extent to which religious/spiritual language was infused into their responses: Religiously Rich Responders (RRR), Moderately Religious Responders (MRR), and Low Religious Responders (LRR). Twelve of the 17 participants (71%) were classified into the RRR or MRR groups. The majority of participants suggested that religion/spirituality played a role in their practice of medicine and communication with parents in a myriad of ways and to varying degrees. Participants used their religious/spiritual beliefs to support families' spirituality, uphold hope, participate in prayer, and alleviate their own emotional distress emerging from their patients' deaths.

  2. Increasing Military Physician Productivity in a Managed Care Environment (United States)


    allows us to obtain to a common denominator, or one single rating even though the services are dissimilar and the input units are not "weighted." Serway ...many ideas as possible to catalyze the process. In removing barriers to productivity in the work environment, a thorough analysis of the physical ...physician and the organization has increased. The whole text of the book "Doctor’s Decisions and the Cost of Medical Care" is dedicated to this concept

  3. [Evolution of burnout and associated factors in primary care physicians]. (United States)

    Matía Cubillo, Angel Carlos; Cordero Guevara, José; Mediavilla Bravo, José Javier; Pereda Riguera, Maria José; González Castro, Maria Luisa; González Sanz, Ana


    To analyse the course of burnout and develop an explanatory model. Prospective cohort dynamics. SITE: All primary health care centres in Burgos. All physicians except medical emergencies, paediatrics and residents. Anonymous self-report questionnaire: Maslach Burnout Inventory (MBI) and related variables. An analysis was performed using the Student-t, X(2) test and logistic regression. The response rate was 47.76% in 2007, which was lower than that of 2005. There were significant differences between 2005 and 2007, for increases in the percentage of physicians who smoked, postgraduate training, residency, and those who believe that coordination with nursing and specialist care and institutional communication is appropriate. There was an increase in the prevalence of burnout by almost one point compared with 2005, a decrease in maximum burnout and emotional exhaustion (EC), and an increase in depersonalisation (DP) and personal accomplishment (RP). The incidence density of burnout was 1/113. 5 primary care physicians per year. The existence of burnout is associated with the use of chronic medication and inadequate coordination between nursing and EC, and also with the high workload. The increase in the prevalence found is consistent with the idea of burnout as a dynamic development and the theoretical model described. Stable and quality employment is one way to indirectly mitigate (by encouraging internal communication) professional burnout. In the multivariate analysis, the most critical variable in the onset of burnout is the inadequate coordination with nursing. Copyright © 2008 Elsevier España, S.L. All rights reserved.

  4. Explaining the de-prioritization of primary prevention: Physicians' perceptions of their role in the delivery of primary care

    Directory of Open Access Journals (Sweden)

    Kuo Christina L


    Full Text Available Abstract Background While physicians are key to primary preventive care, their delivery rate is sub-optimal. Assessment of physician beliefs is integral to understanding current behavior and the conceptualization of strategies to increase delivery. Methods A focus group with regional primary care physician (PCP Opinion Leaders was conducted as a formative step towards regional assessment of attitudes and barriers regarding preventive care delivery in primary care. Following the PRECEDE-PROCEED model, the focus group aim was to identify conceptual themes that characterize PCP beliefs and practices regarding preventive care. Seven male and five female PCPs (family medicine, internal medicine participated in the audiotaped discussion of their perceptions and behaviors in delivery of primary preventive care. The transcribed audiotape was qualitatively analyzed using grounded theory methodology. Results The PCPs' own perceived role in daily practice was a significant barrier to primary preventive care. The prevailing PCP model was the "one-stop-shop" physician who could provide anything from primary to tertiary care, but whose provision was dominated by the delivery of immediate diagnoses and treatments, namely secondary care. Conclusions The secondary-tertiary prevention PCP model sustained the expectation of immediacy of corrective action, cure, and satisfaction sought by patients and physicians alike, and, thereby, de-prioritized primary prevention in practice. Multiple barriers beyond the immediate control of PCP must be surmounted for the full integration of primary prevention in primary care practice. However, independent of other barriers, physician cognitive value of primary prevention in practice, a base mediator of physician behavior, will need to be increased to frame the likelihood of such integration.

  5. Help-seeking preferences in the area of mild cognitive impairment: comparing family physicians and the lay public. (United States)

    Werner, Perla; Heinik, Jeremia; Giveon, Shmuel; Segel-Karpas, Dikla; Kitai, Eliezer


    Mild cognitive impairment (MCI) or mild neurocognitive disorder is a well-established clinical entity included in current diagnostic guidelines for Alzheimer's disease and in major psychiatric classifications. In all, a loosely defined concern obtained from conceptually different sources (the individual, a knowledgeable informant, or a clinician) regarding a decline in cognition and change in functioning constitutes a sine qua non for initiating diagnostics and providing therapy and support. This concern in practice may translate into complex proactive help-seeking behavior. A better understanding of help-seeking preferences is required in order to promote early detection and management. To compare help-seeking preferences of family physicians and the lay public in the area of MCI. A structured questionnaire was used to collect data from 197 family physicians (self-administered) and 517 persons aged 45 and over from the lay public (face to face). Information regarding familiarity with MCI and help-seeking preferences was assessed. The vast majority in both samples reported that family physician, spouse, and children are the most highly recommended sources of help-seeking. In regard to professional sources of help-seeking, a higher percentage of the physicians than the lay public sample consistently recommended seeking help from nurses and social workers and psychiatrists, but a higher percentage of the lay public recommended turning to a neurologist for help. There were both similarities and differences between family physicians and the lay public in their preferences regarding help-seeking for a person with MCI. Most prominent is the physicians' greater tendency to recommend professional sources of help-seeking. Understanding of help-seeking preferences of both physicians and lay persons might help overcome barriers for establishing diagnosis, receiving care, and improving communication between doctors and patients.

  6. The management of health care service quality. A physician perspective. (United States)

    Bobocea, L; Gheorghe, I R; Spiridon, St; Gheorghe, C M; Purcarea, V L


    Applying marketing in health care services is presently an essential element for every manager or policy maker. In order to be successful, a health care organization has to identify an accurate measurement scale for defining service quality due to competitive pressure and cost values. The most widely employed scale in the services sector is SERVQUAL scale. In spite of being successfully adopted in fields such as brokerage and banking, experts concluded that the SERVQUAL scale should be modified depending on the specific context. Moreover, the SERVQUAL scale focused on the consumer's perspective regarding service quality. While service quality was measured with the help of SERVQUAL scale, other experts identified a structure-process-outcome design, which, they thought, would be more suitable for health care services. This approach highlights a different perspective on investigating the service quality, namely, the physician's perspective. Further, we believe that the Seven Prong Model for Improving Service Quality has been adopted in order to effectively measure the health care service in a Romanian context from a physician's perspective.

  7. Views of US physicians about controlling health care costs. (United States)

    Tilburt, Jon C; Wynia, Matthew K; Sheeler, Robert D; Thorsteinsdottir, Bjorg; James, Katherine M; Egginton, Jason S; Liebow, Mark; Hurst, Samia; Danis, Marion; Goold, Susan Dorr


    Physicians' views about health care costs are germane to pending policy reforms. To assess physicians' attitudes toward and perceived role in addressing health care costs. A cross-sectional survey mailed in 2012 to 3897 US physicians randomly selected from the AMA Masterfile. Enthusiasm for 17 cost-containment strategies and agreement with an 11-measure cost-consciousness scale. A total of 2556 physicians responded (response rate = 65%). Most believed that trial lawyers (60%), health insurance companies (59%), hospitals and health systems (56%), pharmaceutical and device manufacturers (56%), and patients (52%) have a "major responsibility" for reducing health care costs, whereas only 36% reported that practicing physicians have "major responsibility." Most were "very enthusiastic" for "promoting continuity of care" (75%), "expanding access to quality and safety data" (51%), and "limiting access to expensive treatments with little net benefit" (51%) as a means of reducing health care costs. Few expressed enthusiasm for "eliminating fee-for-service payment models" (7%). Most physicians reported being "aware of the costs of the tests/treatments [they] recommend" (76%), agreed they should adhere to clinical guidelines that discourage the use of marginally beneficial care (79%), and agreed that they "should be solely devoted to individual patients' best interests, even if that is expensive" (78%) and that "doctors need to take a more prominent role in limiting use of unnecessary tests" (89%). Most (85%) disagreed that they "should sometimes deny beneficial but costly services to certain patients because resources should go to other patients that need them more." In multivariable logistic regression models testing associations with enthusiasm for key cost-containment strategies, having a salary plus bonus or salary-only compensation type was independently associated with enthusiasm for "eliminating fee for service" (salary plus bonus: odds ratio [OR], 3.3, 99% CI, 1

  8. Monitoring quality in Israeli primary care: The primary care physicians' perspective

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    Nissanholtz-Gannot Rachel


    Full Text Available Abstract Background Since 2000, Israel has had a national program for ongoing monitoring of the quality of the primary care services provided by the country's four competing non-profit health plans. Previous research has demonstrated that quality of care has improved substantially since the program's inception and that the program enjoys wide support among health plan managers. However, prior to this study there were anecdotal and journalistic reports of opposition to the program among primary care physicians engaged in direct service delivery; these raised serious questions about the extent of support among physicians nationally. Goals To assess how Israeli primary care physicians experience and rate health plan efforts to track and improve the quality of care. Method The study population consisted of primary care physicians employed by the health plans who have responsibility for the quality of care of a panel of adult patients. The study team randomly sampled 250 primary-care physicians from each of the four health plans. Of the 1,000 physicians sampled, 884 met the study criteria. Every physician could choose whether to participate in the survey by mail, e-mail, or telephone. The anonymous questionnaire was completed by 605 physicians – 69% of those eligible. The data were weighted to reflect differences in sampling and response rates across health plans. Main findings The vast majority of respondents (87% felt that the monitoring of quality was important and two-thirds (66% felt that the feedback and subsequent remedial interventions improved medical care to a great extent. Almost three-quarters (71% supported continuation of the program in an unqualified manner. The physicians with the most positive attitudes to the program were over age 44, independent contract physicians, and either board-certified in internal medicine or without any board-certification (i.e., residents or general practitioners. At the same time, support for the

  9. Physician and staff turnover in community primary care practice. (United States)

    Ruhe, Mary; Gotler, Robin S; Goodwin, Meredith A; Stange, Kurt C


    The effect of a rapidly changing healthcare system on personnel turnover in community family practices has not been analyzed. We describe physician and staff turnover and examine its association with practice characteristics and patient outcomes. A cross-sectional evaluation of length of employment of 150 physicians and 762 staff in 77 community family practices in northeast Ohio was conducted. Research nurses collected data using practice genograms, key informant interviews, staff lists, practice environment checklists, medical record reviews, and patient questionnaires. The association of physician and staff turnover with practice characteristics, patient satisfaction, and preventive service data was tested. During a 2-year period, practices averaged a 53% turnover rate of staff. The mean length of duration of work at the current practice location was 9.1 years for physicians and 4.1 years for staff. Longevity varied by position, with a mean of 3.4 years for business employees, 4.0 years for clinical employees, and 7.8 years for office managers. Network-affiliated practices experienced higher turnover than did independent practices. Physician longevity was associated with a practice focus on managing chronic illness, keeping on schedule, and responding to insurers' requests. No association was found between turnover and patient satisfaction or preventive service delivery rates. Personnel turnover is pervasive in community primary care practices and is associated with employee role, practice network affiliation, and practice focus. The potentially disruptive effect of personnel turnover on practice functioning, finances, and longitudinal relationships with patients deserves further study despite the reassuring lack of association with patient satisfaction and preventive service delivery rates.

  10. Verbal communication among Alzheimer's disease patients, their caregivers, and primary care physicians during primary care office visits. (United States)

    Schmidt, Karen L; Lingler, Jennifer H; Schulz, Richard


    Primary care visits of patients with Alzheimer's disease (AD) often involve communication among patients, family caregivers, and primary care physicians (PCPs). The objective of this study was to understand the nature of each individual's verbal participation in these triadic interactions. To define the verbal communication dynamics of AD care triads, we compared verbal participation (percent of total visit speech) by each participant in patient/caregiver/PCP triads. Twenty-three triads were audio taped during a routine primary care visit. Rates of verbal participation were described and effects of patient cognitive status (MMSE score, verbal fluency) on verbal participation were assessed. PCP verbal participation was highest at 53% of total visit speech, followed by caregivers (31%) and patients (16%). Patient cognitive measures were related to patient and caregiver verbal participation, but not to PCP participation. Caregiver satisfaction with interpersonal treatment by PCP was positively related to caregiver's own verbal participation. Caregivers of AD patients and PCPs maintain active, coordinated verbal participation in primary care visits while patients participate less. Encouraging verbal participation by AD patients and their caregivers may increase the AD patient's active role and caregiver satisfaction with primary care visits.

  11. Verbal Communication among Alzheimer’s Disease Patients, their Caregivers, and Primary Care Physicians during Primary Care Office Visits (United States)

    Schmidt, Karen L.; Lingler, Jennifer H.; Schulz, Richard


    Objective Primary care visits of patients with Alzheimer’s disease (AD) often involve communication among patients, family caregivers, and primary care physicians (PCPs). The objective of this study was to understand the nature of each individual’s verbal participation in these triadic interactions. Methods To define the verbal communication dynamics of AD care triads, we compared verbal participation (percent of total visit speech) by each participant in patient/caregiver/PCP triads. Twenty three triads were audio taped during a routine primary care visit. Rates of verbal participation were described and effects of patient cognitive status (MMSE score, verbal fluency) on verbal participation were assessed. Results PCP verbal participation was highest at 53% of total visit speech, followed by caregivers (31%) and patients (16%). Patient cognitive measures were related to patient and caregiver verbal participation, but not to PCP participation. Caregiver satisfaction with interpersonal treatment by PCP was positively related to caregiver’s own verbal participation. Conclusion Caregivers of AD patients and PCPs maintain active, coordinated verbal participation in primary care visits while patients participate less. Practice Implications Encouraging verbal participation by AD patients and their caregivers may increase the AD patient’s active role and caregiver satisfaction with primary care visits. PMID:19395224

  12. Selective mutism: are primary care physicians missing the silence? (United States)

    Schwartz, Richard H; Freedy, Alicia S; Sheridan, Michael J


    To survey parents of children with selective mutism (SM) in regard to (1) the role of the primary care physician in the diagnosis of SM; (2) the social and school consequences of SM; and (3) their opinion of the effectiveness of different treatment modalities, a 39-item written survey was mailed to 27 parents with at least one child diagnosed with SM on the basis of diagnostic and statistical manual IV-text revision (DSM IV-TR) criteria. Twenty-seven parents (100%), with a total of 33 children with SM, completed the survey. There were 24 girls and 9 boys. The mean age when parents had strong concerns about symptoms of SM was 3.8 years, but diagnosis did not occur until nearly a year later. Twenty-three (69.7%) of the children with SM were never diagnosed accurately or referred by their primary care physicians. SM caused important school/social problems for 17 (51.5%) of the children. Speech therapy was provided for 36.4% of children and was thought to have been helpful for 30% of them. Behavior modification was the treatment for 45.5% of children and perceived to be helpful for 66.7% of them. Selective serotonin re-uptake inhibitor pharmacotherapy was prescribed for 17 (51.5%) of the children and believed to be effective for 11 (65%) of them. Primary care physicians in this study rarely diagnosed accurately or referred children with SM in a timely fashion, even though symptoms of the condition were generally very apparent and parents had expressed concern. Behavioral modification, pharmacotherapy with SSRIs, and early intervention are viable treatment options. Early diagnosis is key to preventing long-term effects of this condition.

  13. Exodus of male physicians from primary care drives shift to specialty practice. (United States)

    Tu, Ha T; O'Malley, Ann S


    An exodus of male physicians from primary care is driving a marked shift in the U.S. physician workforce toward medical-specialty practice, according to a national study by the Center for Studying Health System Change (HSC). Two factors have helped mask the severity of the shift--a growing proportion of female physicians, who disproportionately choose primary care, and continued reliance on international medical graduates (IMGs), who now account for nearly a quarter of all U.S. primary care physicians. Since 1996-97, a 40 percent increase in the female primary care physician supply has helped to offset a 16 percent decline in the male primary care physician supply relative to the U.S. population. At the same time, primary care physicians' incomes have lost ground to both inflation and medical and surgical specialists' incomes. And women in primary care face a 22 percent income gap relative to men, even after accounting for differing characteristics. If real incomes for primary care physicians continue to decline, there is a risk that the migration of male physicians will intensify and that female physicians may begin avoiding primary care--trends that could aggravate a predicted shortage of primary care physicians.

  14. Physicians' experiences of caring for late-stage HIV patients in the post-HAART era: challenges and adaptations. (United States)

    Karasz, Alison; Dyche, Larry; Selwyn, Peter


    As medical treatment for AIDS has become more complex, the need for good palliative and end-of-life care has also increased for patients with advanced disease. Such care is often inadequate, especially among low-income, ethnic minority patients. The current study investigated physicians' experiences with caring for dying HIV patients in an underserved, inner city community in the Bronx, NY. The goals of the study included: (1) to investigate the barriers to effective end-of-life care for HIV patients; and (2) to examine physicians' experiences of role hindrance and frustration in caring for dying patients in the era of HAART. Qualitative, open-ended interviews were conducted with 16 physicians. Physicians identified two core, prescriptive myths shaping their care for patients with HIV. The 'Good Doctor Myth' equates good medical care with the delivery of efficacious biomedical care. The role of the physician is defined as technical curer, while the patient's role is limited to consultation and compliance. The 'Good Death Myth' envisions an ideal death which is acknowledged, organized, and pain free: the role of the physician is defined as that of comforter and supporter in the dying process. Role expectations associated with these myths were often disappointed. First, late-stage patients refused to adhere to treatment and were thus dying "unnecessarily." Second, patients often refused to acknowledge, accept, or plan for the end of life and as a result died painful, chaotic deaths. These realities presented intense psychological and practical challenges for providers. Adaptive coping included both behavioral and cognitive strategies. Successful adaptation resulted in "positive engagement," experienced by participants as a continuing sense of fascination, gratification, and joy. Less successful adaptation could result in detachment or anger. Participants believed that engagement had a powerful impact on patient care. Working with dying HIV patients in the post

  15. [Job satisfaction among primary care physicians at the IMSS]. (United States)

    Valderrama-Martínez, José Arturo; Dávalos-Díaz, Guillermina


    To know factors related to job satisfaction among primary care Physicians from the Mexican Social Security Institute. Cross-sectional survey applied to physicians of outpatient visit areas in four Family Medicine Units in Leon, Guanajuato, from February to May 2007. The survey explored six areas. We used 95% confidence intervals and One-Way ANOVA to compare means among clinics and Chi square and OR'95% confidence intervals to compare proportions. One hundred sixty physicians participated (response rate 88.9%), three were excluded. Most physicians were satisfied with their work (86%). Half of the doctors feel satisfied with their economic benefits (48%), non-economic benefits (52%), and those from the collective bargaining agreement (53%), as well as with the labor union (46%) and their actual insurances (45%). Only one third or less of participants refer to receive incentives (31%) or recognitions for their work (33%), were satisfied with the opportunities for training (31%), the economic incentives (29%), or the salary (24%). The satisfaction's means of work, benefits, insurances, labor union and collective bargaining agreement were significantly higher than the means of salary and economic incentives. Satisfaction means were significantly higher in Clinic #53 than in Clinic #51 for job satisfaction and opportunities for training, as well as percentages of response in institutional support, incentives and recognitions for their work, were higher in Clinic 53 compared to all other clinics; however, it's the smallest clinic in this study. Family doctors find satisfaction in their practice, and factors such as institutional support, recognition and incentives may improve their general job satisfaction.

  16. Gastroesophageal reflux disease: A clinical overview for primary care physicians. (United States)

    Pandit, Sudha; Boktor, Moheb; Alexander, Jonathan S; Becker, Felix; Morris, James


    GERD is among the most common outpatient disease processes encountered by clinicians on a daily basis. This review provides insights about how to approach GERD in terms of disease management and treatment. Review articles were searched using PUBMED and MEDLINE using criteria that included English language articles published in the last 5 years concerning studies carried out only in humans. The key words used in the searches were GERD, PPI, and erosive esophagitis. Recommendations from the American College of Gastroenterology are also included in this manuscript. The search resulted in ∼260 articles. The manuscript brings together and presents the results of recent recommendations from professional societies and recently published review articles on GERD. GERD is one of the most common diagnoses made by gastroenterologists and primary care physicians. It is important to recognize the typical and atypical presentations of GERD. This paper helps primary care physicians understand the disease's pathophysiology, and when, how, and with what to treat GERD before referring patients to gastroenterologists or surgeons. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. Developing a decision support system for tobacco use counselling using primary care physicians

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    Theodore Marcy


    Conclusions A multi-method evaluation process utilising primary care physicians proved useful for developing a CDSS that was acceptable to physicians and patients, and feasible to use in their clinical environment.

  18. [Screening methods for mild cognitive impairment in primary care]. (United States)

    Freire Pérez, Alberto


    Diagnosis of mild cognitive impairment (MCI) is always clinical and screening methods only indicate that the patient has a higher risk of this condition. In MCI, there is a slight decline in some cognitive abilities that does not affect activities of daily living and therefore does not produce social or occupational disability. The definitive diagnosis of MCI requires a considerable time investment that is very rarely possible to provide in primary care (PC) consultations. Hence the need for PC physicians to employ rapid and simple screening methods (brief cognitive assessment -BCA-) that allow objective identification of patients likely to have MCI in a few minutes. This article reviews the BCA tools that can truly be applied in less than 10 minutes. The phototest is a brief screening tool that is easy to use and interpret by physicians and is well accepted by patients. Consequently, it is one of the most useful tests in PC for screening of both MCI and dementia. In addition to BCA, instrumental activities of daily living scales should also be applied to differentiate MCI from dementia. Copyright © 2017 Sociedad Española de Geriatría y Gerontología. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. When doctor becomes patient: challenges and strategies in caring for physician-patients. (United States)

    Domeyer-Klenske, Amy; Rosenbaum, Marcy


    The current study was aimed at exploring the challenges that arise in the doctor-patient relationship when the patient is also a physician and identifying strategies physicians use to meet these challenges. No previous research has systematically investigated primary care physicians' perspectives on caring for physician-patients. Family medicine (n=15) and general internal medicine (n=14) physicians at a large Midwestern university participated in semi-structured interviews where they were asked questions about their experiences with physician-patients and the strategies they used to meet the unique needs of this patient population. Thematic analysis was used to identify common responses. Three of the challenges most commonly discussed by physician participants were: (1) maintaining boundaries between relationships with colleagues or between roles as physician/colleague/friend, (2) avoiding assumptions about patient knowledge and health behaviors, and (3) managing physician-patients' access to informal consultations, personal test results, and opinions from other colleagues. We were able to identify three main strategies clinicians use in addressing these perceived challenges: (1) Ignore the physician-patient's background, (2) Acknowledge the physician-patient's background and negotiate care, and (3) Allow care to be driven primarily by the physician-patient. It is important that primary care physicians understand the challenges inherent in treating physicians and develop a strategy with which they are comfortable addressing them. Explicitly communicating with the physician-patient to ensure boundaries are maintained, assumptions about the physician-patient are avoided, and physician-patient access is properly managed are key to providing quality care to physician-patients.

  20. Primary care physician perceptions of the nurse practitioner in the 1990s. (United States)

    Aquilino, M L; Damiano, P C; Willard, J C; Momany, E T; Levy, B T


    To evaluate factors associated with primary care physician attitudes toward nurse practitioners (NPs) providing primary care. A mailed survey of primary care physicians in Iowa. Half (N = 616) of the non-institutional-based, full-time, primary care physicians in Iowa in spring 1994. Although 360 (58.4%) responded, only physicians with complete data on all items in the model were used in these analyses (n = 259 [42.0%]). There were 2 principal dependent measures: physician attitudes toward NPs providing primary care (an 11-item instrument) and physician experience with NPs in this role. Bivariate relationships between physician demographic and practice characteristics were evaluated by chi 2 tests, as were both dependent variables. Ordinary least-squares regression was used to determine factors related to physician attitudes toward NPs. In bivariate analyses, physicians were significantly more likely to have had experience with an NP providing primary care if they were in pediatrics or obstetrics-gynecology (78.3% and 70.0%, respectively; P < .001), had been in practice for fewer than 20 years (P = .045), or were in practices with 5 or more physicians. The ordinary least-squares regression indicated that physicians with previous experience working with NPs providing primary care (P = .01), physicians practicing in urban areas with populations greater than 20,000 but far from a metropolitan area (P = .03), and general practice physicians (P = .04) had significantly more favorable attitudes toward NPs than did other primary care physicians. The association between previous experience with a primary care NP and a more positive attitude toward NPs has important implications for the training of primary care physicians, particularly in community-based, multidisciplinary settings.

  1. Patients report better satisfaction with part-time primary care physicians, despite less continuity of care and access. (United States)

    Panattoni, Laura; Stone, Ashley; Chung, Sukyung; Tai-Seale, Ming


    The growing number of primary care physicians (PCPs) reducing their clinical work hours has raised concerns about meeting the future demand for services and fulfilling the continuity and access mandates for patient-centered care. However, the patient's experience of care with part-time physicians is relatively unknown, and may be mediated by continuity and access to care outcomes. We aimed to examine the relationships between a physicians' clinical full-time equivalent (FTE), continuity of care, access to care, and patient satisfaction with the physician. We used a multi-level structural equation estimation, with continuity and access modeled as mediators, for a cross-section in 2010. The study included family medicine (n = 104) and internal medicine (n = 101) physicians in a multi-specialty group practice, along with their patient satisfaction survey responses (n = 12,688). Physician level FTE, continuity of care received by patients, continuity of care provided by physician, and a Press Ganey patient satisfaction with the physician score, on a 0-100 % scale, were measured. Access to care was measured as days to the third next-available appointment. Physician FTE was directly associated with better continuity of care received (0.172% per FTE, p part-time PCPs in practice redesign efforts and initiatives to meet the demand for primary care services.

  2. [Communication between the primary care physician, hospital staff and the patient during hospitalization]. (United States)

    Menahem, Sasson; Roitgarz, Ina; Shvartzman, Pesach


    HospitaL admission is a crisis for the patient and his family and can interfere with the continuity of care. It may lead to mistakes due to communication problems between the primary care physician and the hospital medical staff. To explore the communication between the primary care physician, the hospital medical staff, the patient and his family during hospitalization. A total of 269 questionnaires were sent to all Clalit Health Services-South District, primary care physicians; 119 of these questionnaires (44.2%) were completed. Half of the primary care physicians thought that they should, always or almost always, have contact with the admitting ward in cases of internal medicine, oncology, surgery or pediatric admissions. However, the actual contact rate, according to their report, was only in a third of the cases. A telephone contact was more common than an actual visit of the patient in the ward. Computer communication between the hospital physicians and the primary care physicians is still insufficiently developed, although 96.6% of the primary care physicians check, with the aid of computer software, for information on their hospitalized patients. The main reasons to visit the hospitalized patient were severe medical conditions or uncertainty about the diagnosis; 79% of the physicians thought that visiting their patients strengthened the level of trust between them and their patients. There are sometimes communication difficulties and barriers between the primary care physicians and the ward's physicians due to partial information delivery and rejection from the hospital physicians. The main barriers for visiting admitted patients were workload and lack of pre-allocated time on the work schedule. No statistically significant differences were found between communication variables and primary care physician's personal and demographic characteristics. The communication between the primary care physician and the hospital physicians should be improved through

  3. Effects of online palliative care training on knowledge, attitude and satisfaction of primary care physicians

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    Agra Yolanda


    Full Text Available Abstract Background The Spanish Palliative Care Strategy recommends an intermediate level of training for primary care physicians in order to provide them with knowledge and skills. Most of the training involves face-to-face courses but increasing pressures on physicians have resulted in fewer opportunities for provision of and attendance to this type of training. The effectiveness of on-line continuing medical education in terms of its impact on clinical practice has been scarcely studied. Its effect in relation to palliative care for primary care physicians is currently unknown, in terms of improvement in patient's quality of life and main caregiver's satisfaction. There is uncertainty too in terms of any potential benefits of asynchronous communication and interaction among on-line education participants, as well as of the effect of the learning process. The authors have developed an on-line educational model for palliative care which has been applied to primary care physicians in order to measure its effectiveness regarding knowledge, attitude towards palliative care, and physician's satisfaction in comparison with a control group. The effectiveness evaluation at 18 months and the impact on the quality of life of patients managed by the physicians, and the main caregiver's satisfaction will be addressed in a different paper. Methods Randomized controlled educational trial to compared, on a first stage, the knowledge and attitude of primary care physicians regarding palliative care for advanced cancer patients, as well as satisfaction in those who followed an on-line palliative care training program with tutorship, using a Moodle Platform vs. traditional education. Results 169 physicians were included, 85 in the intervention group and 84 in the control group, of which five were excluded. Finally 82 participants per group were analyzed. There were significant differences in favor of the intervention group, in terms of knowledge (mean 4.6; CI

  4. Effects of online palliative care training on knowledge, attitude and satisfaction of primary care physicians. (United States)

    Pelayo, Marta; Cebrián, Diego; Areosa, Almudena; Agra, Yolanda; Izquierdo, Juan Vicente; Buendía, Félix


    The Spanish Palliative Care Strategy recommends an intermediate level of training for primary care physicians in order to provide them with knowledge and skills. Most of the training involves face-to-face courses but increasing pressures on physicians have resulted in fewer opportunities for provision of and attendance to this type of training. The effectiveness of on-line continuing medical education in terms of its impact on clinical practice has been scarcely studied. Its effect in relation to palliative care for primary care physicians is currently unknown, in terms of improvement in patient's quality of life and main caregiver's satisfaction. There is uncertainty too in terms of any potential benefits of asynchronous communication and interaction among on-line education participants, as well as of the effect of the learning process.The authors have developed an on-line educational model for palliative care which has been applied to primary care physicians in order to measure its effectiveness regarding knowledge, attitude towards palliative care, and physician's satisfaction in comparison with a control group.The effectiveness evaluation at 18 months and the impact on the quality of life of patients managed by the physicians, and the main caregiver's satisfaction will be addressed in a different paper. Randomized controlled educational trial to compared, on a first stage, the knowledge and attitude of primary care physicians regarding palliative care for advanced cancer patients, as well as satisfaction in those who followed an on-line palliative care training program with tutorship, using a Moodle Platform vs. traditional education. 169 physicians were included, 85 in the intervention group and 84 in the control group, of which five were excluded. Finally 82 participants per group were analyzed. There were significant differences in favor of the intervention group, in terms of knowledge (mean 4.6; CI 95%: 2.8 to 6.5 (p = 0.0001), scale range 0-33), confidence

  5. Sexual minorities and selection of a primary care physician in a midwestern U.S. city. (United States)

    Labig, Chalmer E; Peterson, Tim O


    How and why sexual minorities select a primary care physician is critical to the development of methods for attracting these clients to a physician's practice. Data obtained from a sample of sexual minorities in a mid-size city in our nation's heartland would indicate that these patients are loyal when the primary care physician has a positive attitude toward their sexual orientation. The data also confirms that most sexual minorities select same sex physicians but not necessarily same sexual orientation physicians because of lack of knowledge of physicians' sexual orientation. Family practice physicians and other primary care physicians can reach out to this population by encouraging word of mouth advertising and by displaying literature on health issues for all sexual orientations in their offices.

  6. Patient and Physician Characteristics Associated with the Provision of Weight Loss Counseling in Primary Care (United States)

    Dutton, Gareth R.; Herman, Katharine G.; Tan, Fei; Goble, Mary; Dancer-Brown, Melissa; Van Vessem, Nancy; Ard, Jamy D.


    Background A variety of physician and patient characteristics may influence whether weight loss counseling occurs in primary care encounters. Objectives This study utilized a cross-sectional survey of primary care patients, which examined patient characteristics, physician characteristics, and characteristics of the physician-patient relationship associated with weight loss counseling and recommendations provided by physicians. Participants Participants (N=143, mean age=46.8 years, mean BMI=36.9 kg/m2, 65% Caucasian) were overweight and obese primary care patients participating in a managed care weight loss program. Measures Participants completed self-report surveys in the clinic prior to the initial weight loss session. Surveys included items assessing demographic/background characteristics, weight, height, and a health care questionnaire evaluating whether their physician had recommended weight loss, the frequency of their physicians’ weight loss counseling, and whether their physician had referred them for obesity treatment. Results Patient BMI and physician sex were most consistently associated with physicians’ weight loss counseling practices. Patients seen by female physicians were more likely to be told that they should lose weight, received more frequent obesity counseling, and were more likely to have been referred for obesity treatment by their physician. Length and frequency of physician-patient contacts were unrelated to the likelihood of counseling. Conclusions These findings add to previous evidence suggesting possible differences in the weight loss counseling practices of male and female physicians, although further research is needed to understand this potential difference between physicians. PMID:24743007

  7. How sequestration cuts affect primary care physicians and graduate medical education. (United States)

    Chauhan, Bindiya; Coffin, Janis


    On April 1, 2013, sequestration cuts went into effect impacting Medicare physician payments, graduate medical education, and many other healthcare agencies. The cuts range from 2% to 5%, affecting various departments and organizations. There is already a shortage of primary care physicians in general, not including rural or underserved areas, with limited grants for advanced training. The sequestration cuts negatively impact the future of many primary care physicians and hinder the care many Americans will receive over time.

  8. [Management of the esophageal candidiasis by the primary care physician]. (United States)

    Behrens, Garance; Bocherens, Astrid; Senn, Nicolas


    Esophageal candidiasis is one of the most common opportunistic infections in patients infected by human immunodeficiency virus (HIV). This pathology is also found in patients without overt immunodeficiency. Other risk factors are known to be associated with this disease like inhaled or systemic corticosteroid treatment or proton-pump inhibitors and H2 receptor antagonists. In the absence of identified risk factors, a primary immune deficiency should be sought. Prevention of esophageal candidiasis is based primarily on the identification of risk factors, and a better control of them. This article presents a review of the physiopathology, clinical presentation and management of esophageal candidiasis by primary care physicians. We will also discuss ways of preventing esophageal candidiasis when necessary.

  9. Social anxiety disorder. A guide for primary care physicians. (United States)

    Elliott, H W; Reifler, B


    Social anxiety disorder is prevalent, potentially disabling, but quite treatable. A thorough and directed history can distinguish social phobia from depression, panic disorder, and OCD. It can also screen for and identify possible substance abuse. Once the diagnosis is made, a combination of pharmacologic and psychotherapy is indicated. The SSRIs, MAOIs, benzodiazepines, and beta-blockers--as well as CBT--can effectively treat social anxiety symptoms. Primary care physicians may well want to begin by prescribing an SSRI like paroxetine, along with a high potency benzodiazepine to be taken on a regular or an as-needed basis, and a beta-blocker to take as needed in anticipation of stressful social situations. A referral for CBT should be considered. If the patient has marked side effects from drug treatment or a lack of adequate response to medication, psychiatric referral is definitely indicated.

  10. The Complexity Of Billing And Paying For Physician Care. (United States)

    Gottlieb, Joshua D; Shapiro, Adam Hale; Dunn, Abe


    The administrative costs of providing health insurance in the US are very high, but their determinants are poorly understood. We advance the nascent literature in this field by developing new measures of billing complexity for physician care across insurers and over time, and by estimating them using a large sample of detailed insurance "remittance data" for the period 2013-15. We found dramatic variation across different types of insurance. Fee-for-service Medicaid is the most challenging type of insurer to bill, with a claim denial rate that is 17.8 percentage points higher than that for fee-for-service Medicare. The denial rate for Medicaid managed care was 6 percentage points higher than that for fee-for-service Medicare, while the rate for private insurance appeared similar to that of Medicare Advantage. Based on conservative assumptions, we estimated that the health care sector deals with $11 billion in challenged revenue annually, but this number could be as high as $54 billion. These costs have significant implications for analyses of health insurance reforms.

  11. Helicobacter pylori infection: approach of primary care physicians in a developing country

    Directory of Open Access Journals (Sweden)

    Ali Shah Hasnain


    Full Text Available Abstract Background The aim of the study was to assess the knowledge and practices of primary care physicians in diagnosis and management of Helicobacter pylori (H. pylori infection in developing country. Methods This convenient sample based, cross sectional study was conducted in primary care physicians of Karachi, Pakistan from March 2008 to August 2008 through a pretested self-designed questionnaire, which contained 11 items pertaining to H. pylori route of transmission, diagnosis, indication for testing, treatment options, follow up and source of information. Results Out of 509 primary care physicians, 451 consented to participate with the response rate of 88.6%. Responses of 426 primary care physicians were analyzed after excluding 19 physicians. 78% of the physicians thought that contaminated water was the source of spread of infection, dyspepsia was the most frequent indication for investigating H. pylori infection (67% of the physicians, while 43% physicians were of the view that serology was the most appropriate test to diagnose active H. pylori infection. 77% of physicians thought that gastric ulcer was the most compelling indication for treatment, 61% physicians preferred Clarithromycin based triple therapy for 7–14 days. 57% of the physicians would confirm H. pylori eradication after treatment in selected patients and 47% physicians preferred serological testing for follow-up. In case of treatment failure, only 36% of the physicians were in favor of gastroenterologist referral. Conclusion The primary care physicians in this study lacked in knowledge regarding management of H. pylori infection. Internationally published guidelines and World gastroenterology organization (WGO practice guideline on H. pylori for developing countries have little impact on current practices of primary care physicians. We recommend more teaching programs, continuous medical education activities regarding H. pylori infection.

  12. Transition from specialist to primary diabetes care: A qualitative study of perspectives of primary care physicians

    Directory of Open Access Journals (Sweden)

    Liddy Clare


    Full Text Available Abstract Background The growing prevalence of diabetes and heightened awareness of the benefits of early and intensive disease management have increased service demands and expectations not only of primary care physicians but also of diabetes specialists. While research has addressed issues related to referral into specialist care, much less has been published about the transition from diabetes specialists back to primary care. Understanding the concerns of family physicians related to discharge of diabetes care from specialist centers can support the development of strategies that facilitate this transition and result in broader access to limited specialist services. This study was undertaken to explore primary care physician (PCP perspectives and concerns related to reassuming responsibility for diabetes care after referral to a specialized diabetes center. Methods Qualitative data were collected through three focus groups. Sessions were audio-taped and transcribed verbatim. Data were coded and sorted with themes identified using a constant comparison method. The study was undertaken through the regional academic referral center for adult diabetes care in Ottawa, Canada. Participants included 22 primary care physicians representing a variety of referral frequencies, practice types and settings. Results Participants described facilitators and barriers to successful transition of diabetes care at the provider, patient and systems level. Major facilitators included clear communication of a detailed, structured plan of care, ongoing access to specialist services for advice or re-referral, continuing education and mentoring for PCPs. Identified provider barriers were gaps in PCP knowledge and confidence related to diabetes treatment, excessive workload and competing time demands. Systems deterrents included reimbursement policies for health professionals and inadequate funding for diabetes medications and supplies. At the PCP-patient interface

  13. Nurse Practitioner-Physician Comanagement: A Theoretical Model to Alleviate Primary Care Strain. (United States)

    Norful, Allison A; de Jacq, Krystyna; Carlino, Richard; Poghosyan, Lusine


    Various models of care delivery have been investigated to meet the increasing demands in primary care. One proposed model is comanagement of patients by more than 1 primary care clinician. Comanagement has been investigated in acute care with surgical teams and in outpatient settings with primary care physicians and specialists. Because nurse practitioners are increasingly managing patient care as independent clinicians, our study objective was to propose a model of nurse practitioner-physician comanagement. We conducted a literature search using the following key words: comanagement; primary care; nurse practitioner OR advanced practice nurse. From 156 studies, we extracted information about nurse practitioner-physician comanagement antecedents, attributes, and consequences. A systematic review of the findings helped determine effects of nurse practitioner-physician comanagement on patient care. Then, we performed 26 interviews with nurse practitioners and physicians to obtain their perspectives on nurse practitioner-physician comanagement. Results were compiled to create our conceptual nurse practitioner-physician comanagement model. Our model of nurse practitioner-physician comanagement has 3 elements: effective communication; mutual respect and trust; and clinical alignment/shared philosophy of care. Interviews indicated that successful comanagement can alleviate individual workload, prevent burnout, improve patient care quality, and lead to increased patient access to care. Legal and organizational barriers, however, inhibit the ability of nurse practitioners to practice autonomously or with equal care management resources as primary care physicians. Future research should focus on developing instruments to measure and further assess nurse practitioner-physician comanagement in the primary care practice setting. © 2018 Annals of Family Medicine, Inc.

  14. Identification of physicians providing comprehensive primary care in Ontario: a retrospective analysis using linked administrative data. (United States)

    Schultz, Susan E; Glazier, Richard H


    Given the changing landscape of primary care, there may be fewer primary care physicians available to provide a broad range of services to patients of all age groups and health conditions. We sought to identify physicians with comprehensive primary care practices in Ontario using administrative data, investigating how many and what proportion of primary care physicians provided comprehensive primary care and how this changed over time. We identified the pool of active primary care physicians in linked population-based databases for Ontario from 1992/93 to 2014/15. After excluding those who saw patients fewer than 44 days per year, we identified physicians as providing comprehensive care if more than half of their services were for core primary care and if these services fell into at least 7 of 22 activity areas. Physicians with 50% or less of their services for core primary care but with more than 50% in a single location or type of service were identified as being in focused practice. In 2014/15, there were 12 891 physicians in the primary care pool: 1254 (9.7%) worked fewer than 44 days per year, 1619 (12.6%) were in focused practice, and 1009 (7.8%) could not be classified. The proportion in comprehensive practice ranged from 67.5% to 74.9% between 1992/93 and 2014/15, with a peak in 2002/03 and relative stability from 2009/10 to 2014/15. Over this period, there was an increase of 8.8% in population per comprehensive primary care physician. We found that just over two-thirds of primary care physicians provided comprehensive care in 2014/15, which indicates that traditional estimates of the primary care physician workforce may be too high. Although implementation will vary by setting and available data, this approach is likely applicable elsewhere. Copyright 2017, Joule Inc. or its licensors.

  15. Bridges to Excellence--recognizing high-quality care: analysis of physician quality and resource use. (United States)

    Rosenthal, Meredith B; de Brantes, Francois S; Sinaiko, Anna D; Frankel, Matthew; Robbins, Russell D; Young, Sara


    To examine whether physicians who sought and received Bridges to Excellence (BTE) recognition performed better than similar physicians on a standardized set of population-based performance measures. Cross-sectional comparison of performance data. Using a claims dataset of all commercially insured members from 6 health plans in Massachusetts, we examined population-based measures of quality and resource use for physicians recognized by the BTE programs Physician Office Link and Diabetes Care Link, compared with nonrecognized physicians in the same specialties. Differences in performance were tested using generalized linear models. Physician Office Link-recognized physicians performed significantly better than their nonrecognized peers on measures of cervical cancer screening, mammography, and glycosylated hemoglobin testing. Diabetes Care Link-recognized physicians performed significantly better on all 4 diabetes process measures of quality, with the largest differences observed in microalbumin screening (17.7%). Patients of Physician Office Link-recognized physicians had a significantly greater percentage of their resource use accounted for by evaluation and management services (3.4%), and a smaller percentage accounted for by facility (-1.6%), inpatient ancillary (-0.1%), and nonmanagement outpatient services (-1.0%). After adjustment for patient age and sex, and case mix, Physician Office Link-recognized physicians had significantly fewer episodes per patient (0.13) and lower resource use per episode (dollars 130), but findings were mixed for Diabetes Care Link-recognized physicians. Our findings suggest that the BTE approach to ascertaining physician quality identifies physicians who perform better on claims-based quality measures and primary care physicians who use a less resource-intensive practice style.

  16. The duty of the physician to care for the family in pediatric palliative care: context, communication, and caring. (United States)

    Jones, Barbara L; Contro, Nancy; Koch, Kendra D


    Pediatric palliative care physicians have an ethical duty to care for the families of children with life-threatening conditions through their illness and bereavement. This duty is predicated on 2 important factors: (1) best interest of the child and (2) nonabandonment. Children exist in the context of a family and therefore excellent care for the child must include attention to the needs of the family, including siblings. The principle of nonabandonment is an important one in pediatric palliative care, as many families report being well cared for during their child's treatment, but feel as if the physicians and team members suddenly disappear after the death of the child. Family-centered care requires frequent, kind, and accurate communication with parents that leads to shared decision-making during treatment, care of parents and siblings during end-of-life, and assistance to the family in bereavement after death. Despite the challenges to this comprehensive care, physicians can support and be supported by their transdisciplinary palliative care team members in providing compassionate, ethical, and holistic care to the entire family when a child is ill.

  17. [Perceptions of primary care physicians in Madrid on the austerity measures in the health care system]. (United States)

    Heras-Mosteiro, Julio; Otero-García, Laura; Sanz-Barbero, Belén; Aranaz-Andrés, Jesús María


    To address the current economic crisis, governments have promoted austerity measures that have affected the taxpayer-funded health system. We report the findings of a study exploring the perceptions of primary care physicians in Madrid (Spain) on measures implemented in the Spanish health system. We carried out a qualitative study in two primary health care centres located in two neighbourhoods with unemployment and migrant population rates above the average of those in Madrid. Interviews were conducted with 12 primary health care physicians. Interview data were analysed by using thematic analysis and by adopting some elements of the grounded theory approach. Two categories were identified: evaluation of austerity measures and evaluation of decision-making in this process. Respondents believed there was a need to promote measures to improve the taxpayer-funded health system, but expressed their disagreement with the measures implemented. They considered that the measures were not evidence-based and responded to the need to decrease public health care expenditure in the short term. Respondents believed that they had not been properly informed about the measures and that there was adequate professional participation in the prioritization, selection and implementation of measures. They considered physician participation to be essential in the decision-making process because physicians have a more patient-centred view and have first-hand knowledge of areas requiring improvement in the system. It is essential that public authorities actively involve health care professionals in decision-making processes to ensure the implementation of evidence-based measures with strong professional support, thus maintaining the quality of care. Copyright © 2016 SESPAS. Published by Elsevier Espana. All rights reserved.

  18. Seniors’ Perceptions Of Health Care Not Closely Associated With Physician Supply (United States)

    Nyweide, David J.; Anthony, Denise L.; Chang, Chiang-Hua; Goodman, David


    We conducted a national random survey of Medicare beneficiaries to better understand the association between the supply of physicians and patients’ perceptions of their health care. We found that patients living in areas with more physicians per capita had perceptions of their health care that were similar to those of patients in regions with fewer physicians. In addition, there were no significant differences between the groups of patients in terms of numbers of visits to their personal physician in the previous year; amount of time spent with a physician; or access to tests or specialists. Our results suggest that simply training more physicians is unlikely to lead to improved access to care. Instead, focusing health policy on improving the quality and organization of care may be more beneficial. PMID:21289342

  19. Young adult cancer survivors' follow-up care expectations of oncologists and primary care physicians. (United States)

    Hugh-Yeun, Kiara; Kumar, Divjot; Moghaddamjou, Ali; Ruan, Jenny Y; Cheung, Winson Y


    Young adult cancer survivors face unique challenges associated with their illness. While both oncologists and primary care physicians (PCPs) may be involved in the follow-up care of these cancer survivors, we hypothesized that there is a lack of clarity regarding each physician's roles and responsibilities. A self-administered survey was mailed to young adult cancer survivors in British Columbia, Canada, who were aged 20 to 39 years at the time of diagnosis and alive at 2 to 5 years following the diagnosis to capture their expectations of oncologists and PCPs in various important domains of cancer survivorship care. Multivariate logistic regression models that adjusted for confounders were constructed to examine for predictors of the different expectations. Of 722 young cancer survivors surveyed, 426 (59%) responded. Among them, the majority were White women with breast cancer. Oncologists were expected to follow the patient's most recent cancer and treatment-related side effects while PCPs were expected to manage ongoing and future cancer surveillance as well as general preventative care. Neither physician was perceived to be responsible for addressing the return to daily activities, reintegration to interpersonal relationships, or sexual function. Older survivors were significantly less likely to expect oncologists (p = 0.03) and PCPs (p = 0.01) to discuss family planning when compared to their younger counterparts. Those who were White were significantly more likely to expect PCPs to discuss comorbidities (p = 0.009) and preventative care (p = 0.001). Young adult cancer survivors have different expectations of oncologists and PCPs with respect to their follow-up care. Physicians need to better clarify their roles in order to further improve the survivorship phase of cancer care for young adults. Young adult cancer survivors have different expectations of their oncologists and PCPs. Clarification of the roles of each physician group during follow-up can

  20. Examining the Role of Primary Care Physicians and Challenges Faced When Their Patients Transition to Home Hospice Care. (United States)

    Shalev, Ariel; Phongtankuel, Veerawat; Lampa, Katherine; Reid, M C; Eiss, Brian M; Bhatia, Sonica; Adelman, Ronald D


    The transition into home hospice care is often a critical time in a patient's medical care. Studies have shown patients and caregivers desire continuity with their physicians at the end of life (EoL). However, it is unclear what roles primary care physicians (PCPs) play and what challenges they face caring for patients transitioning into home hospice care. To understand PCPs' experiences, challenges, and preferences when their patients transition to home hospice care. Nineteen semi-structured phone interviews with PCPs were conducted. Study data were analyzed using standard qualitative methods. Participants included PCPs from 3 academic group practices in New York City. Measured: Physician recordings were transcribed and analyzed using content analysis. Most PCPs noted that there was a discrepancy between their actual role and ideal role when their patients transitioned to home hospice care. Primary care physicians expressed a desire to maintain continuity, provide psychosocial support, and collaborate actively with the hospice team. Better establishment of roles, more frequent communication with the hospice team, and use of technology to communicate with patients were mentioned as possible ways to help PCPs achieve their ideal role caring for their patients receiving home hospice care. Primary care physicians expressed varying degrees of involvement during a patient's transition to home hospice care, but many desired to be more involved in their patient's care. As with patients, physicians desire to maintain continuity with their patients at the EoL and solutions to improve communication between PCPs, hospice providers, and patients need to be explored.

  1. Substitution of physicians by nurses in primary care: a systematic review and meta-analysis

    NARCIS (Netherlands)

    Martinez-Gonzalez, N.A.; Djalali, S.; Tandjung, R.; Huber-Geismann, F.; Markun, S.; Wensing, M.; Rosemann, T.


    BACKGROUND: In many countries, substitution of physicians by nurses has become common due to the shortage of physicians and the need for high-quality, affordable care, especially for chronic and multi-morbid patients. We examined the evidence on the clinical effectiveness and care costs of

  2. Patient Care Physician Supply and Requirements: Testing COGME Recommendations. Council on Graduate Medical Education, Eighth Report. (United States)

    Council on Graduate Medical Education.

    This report reassesses recommendations made by the Council on Graduate Medical Education in earlier reports which had, beginning in 1992, addressed the problems of physician oversupply. In this report physician supply and requirements are examined in the context of a health care system increasingly dominated by managed care. Patterns of physician…

  3. Improving dementia diagnosis and management in primary care: a cohort study of the impact of a training and support program on physician competency, practice patterns, and community linkages. (United States)

    Lathren, Christine R; Sloane, Philip D; Hoyle, Joseph D; Zimmerman, Sheryl; Kaufer, Daniel I


    Primary care physicians routinely provide dementia care, but may lack the clinical skills and awareness of available resources to provide optimal care. We conducted a community-based pilot dementia training intervention designed to both improve clinical competency and increase utilization of local dementia care services. Physicians (N = 29) and affiliated staff (N = 24) participated in a one-day training program on dementia screening, diagnosis and management that included direct engagement with local support service providers. Questionnaires about their dementia care competency and referral patterns were completed before and 6 months after the training intervention. Physicians reported significantly higher overall confidence in their dementia care competency 6 months post-training compared to pre-training. The largest reported improvements were in their ability to educate patients and caregivers about dementia and making appropriate referrals to community care services. Participants also reported markedly increased use of cognitive screening tools in providing care. Community service providers recorded approximately 160 physician-initiated referrals over a 2 year-period post-training, compared to few beforehand. Combining a targeted physician practice-based educational intervention with community service engagement improves dementia care competency in clinicians and promotes linkages between clinical and community dementia care providers.

  4. Collaboration between physicians and a hospital-based palliative care team in a general acute-care hospital in Japan

    Directory of Open Access Journals (Sweden)

    Nishikitani Mariko


    Full Text Available Abstract Background Continual collaboration between physicians and hospital-based palliative care teams represents a very important contributor to focusing on patients' symptoms and maintaining their quality of life during all stages of their illness. However, the traditionally late introduction of palliative care has caused misconceptions about hospital-based palliative care teams (PCTs among patients and general physicians in Japan. The objective of this study is to identify the factors related to physicians' attitudes toward continual collaboration with hospital-based PCTs. Methods This cross-sectional anonymous questionnaire-based survey was conducted to clarify physicians' attitudes toward continual collaboration with PCTs and to describe the factors that contribute to such attitudes. We surveyed 339 full-time physicians, including interns, employed in a general acute-care hospital in an urban area in Japan; the response rate was 53% (N = 155. We assessed the basic characteristics, experience, knowledge, and education of respondents. Multiple logistic regression analysis was used to determine the main factors affecting the physicians' attitudes toward PCTs. Results We found that the physicians who were aware of the World Health Organization (WHO analgesic ladder were 6.7 times (OR = 6.7, 95% CI = 1.98-25.79 more likely to want to treat and care for their patients in collaboration with the hospital-based PCTs than were those physicians without such awareness. Conclusion Basic knowledge of palliative care is important in promoting physicians' positive attitudes toward collaboration with hospital-based PCTs.

  5. Optimizing physicians' instruction of PACS through e-learning: cognitive load theory applied. (United States)

    Devolder, P; Pynoo, B; Voet, T; Adang, L; Vercruysse, J; Duyck, P


    This article outlines the strategy used by our hospital to maximize the knowledge transfer to referring physicians on using a picture archiving and communication system (PACS). We developed an e-learning platform underpinned by the cognitive load theory (CLT) so that in depth knowledge of PACS' abilities becomes attainable regardless of the user's prior experience with computers. The application of the techniques proposed by CLT optimizes the learning of the new actions necessary to obtain and manipulate radiological images. The application of cognitive load reducing techniques is explained with several examples. We discuss the need to safeguard the physicians' main mental processes to keep the patient's interests in focus. A holistic adoption of CLT techniques both in teaching and in configuration of information systems could be adopted to attain this goal. An overview of the advantages of this instruction method is given both on the individual and organizational level.

  6. Oncologists' perspectives on post-cancer treatment communication and care coordination with primary care physicians. (United States)

    Klabunde, C N; Haggstrom, D; Kahn, K L; Gray, S W; Kim, B; Liu, B; Eisenstein, J; Keating, N L


    Post-treatment cancer care is often fragmented and of suboptimal quality. We explored factors that may affect cancer survivors' post-treatment care coordination, including oncologists' use of electronic technologies such as e-mail and integrated electronic health records (EHRs) to communicate with primary care physicians (PCPs). We used data from a survey (357 respondents; participation rate 52.9%) conducted in 2012-2013 among medical oncologists caring for patients in a large US study of cancer care delivery and outcomes. Oncologists reported their frequency and mode of communication with PCPs, and role in providing post-treatment care. Seventy-five per cent said that they directly communicated with PCPs about post-treatment status and care recommendations for all/most patients. Among those directly communicating with PCPs, 70% always/usually used written correspondence, while 36% always/usually used integrated EHRs; telephone and e-mail were less used. Eighty per cent reported co-managing with PCPs at least one post-treatment general medical care need. In multivariate-adjusted analyses, neither communication mode nor intensity were associated with co-managing survivors' care. Oncologists' reliance on written correspondence to communicate with PCPs may be a barrier to care coordination. We discuss new research directions for enhancing communication and care coordination between oncologists and PCPs, and to better meet the needs of cancer survivors post-treatment. © 2017 John Wiley & Sons Ltd.

  7. Viscosupplementation for Osteoarthritis: a Primer for Primary Care Physicians (United States)


    Introduction Osteoarthritis (OA) constitutes a growing public health burden and the most common cause of disability in the United States. Non-pharmacologic modalities and conservative pharmacologic therapies are recommended for the initial treatment of OA, including acetaminophen, and topical and oral non-steroidal anti-inflammatory drugs. However, safety concerns continue to mount regarding the use of these treatments and none have been shown to impact disease progression. Viscosupplementation with injections of hyaluronans (HAs) are indicated when non-pharmacologic and simple analgesics have failed to relieve symptoms (e.g., pain, stiffness) associated with knee OA. This review evaluates literature focusing on the efficacy and/or safety of HA injections in treating OA of the knee and in other joints, including the hip, shoulder, and ankle. Methods Relevant literature on intra-articular (IA) HA injections as a treatment for OA pain in the knee and other joints was identified through PubMed database searches from inception until January 2013. Search terms included “hyaluronic acid” or “hylan”, and “osteoarthritis”. Discussion Current evidence indicates that HA injections are beneficial and safe for patients with OA of the knee. IA injections of HAs treat the symptoms of knee OA and may also have disease-modifying properties, potentially delaying progression of OA. Although traditionally reserved for second-line treatment, evidence suggests that HAs may have value as a first-line therapy in the treatment of knee OA as they have been shown to be more effective in earlier stages and grades of disease, more recently diagnosed OA, and in less severe radiographic OA. Conclusion For primary care physicians who treat and care for patients with OA of the knee, IA injection with HAs constitutes a safe and effective treatment that can be routinely administered in the office setting. PMID:24203348

  8. The Phoenix Physician: defining a pathway toward leadership in patient-centered care. (United States)

    Good, Robert G; Bulger, John B; Hasty, Robert T; Hubbard, Kevin P; Schwartz, Elliott R; Sutton, John R; Troutman, Monte E; Nelinson, Donald S


    Health care delivery has evolved in reaction to scientific and technological discoveries, emergent patient needs, and market forces. A current focus on patient-centered care has pointed to the need for the reallocation of resources to improve access to and delivery of efficient, cost-effective, quality care. In response to this need, primary care physicians will find themselves in a new role as team leader. The American College of Osteopathic Internists has developed the Phoenix Physician, a training program that will prepare primary care residents and practicing physicians for the changes in health care delivery and provide them with skills such as understanding the contributions of all team members (including an empowered and educated patient), evaluating and treating patients, and applying performance metrics and information technology to measure and improve patient care and satisfaction. Through the program, physicians will also develop personal leadership and communication skills.

  9. Veterans’ Health Care: Improved Oversight of Community Care Physicians Credentials Needed (United States)


    five of the most common types of care— obstetrics and gynecology, ophthalmology, primary care, psychiatry, and surgery—across each of the four census...Bank for verifying malpractice history .16 The standards also call for documentation of credentials verification activities, such that there is...Health Net and TriWest verify licenses, education and training, and malpractice history for each PC3 physician, and conduct reverification at least

  10. Core Competencies in Integrative Pain Care for Entry-Level Primary Care Physicians. (United States)

    Tick, Heather; Chauvin, Sheila W; Brown, Michael; Haramati, Aviad


    The objective was to develop a set of core competencies for graduating primary care physicians in integrative pain care (IPC), using the Accreditation Council for Graduate Medical Education (ACGME) domains. These competencies build on previous work in competencies for integrative medicine, interprofessional education, and pain medicine and are proposed for inclusion in residency training. A task force was formed to include representation from various professionals who are involved in education, research, and the practice of IPC and who represent broad areas of expertise. The task force convened during a 1.5-day face-to-face meeting, followed by a series of surveys and other vetting processes involving diverse interprofessional groups, which led to the consensus of a final set of competencies. The proposed competencies focus on interprofessional knowledge, skills, and attitudes (KSAs) and are in line with recommendations by the Institute of Medicine, military medicine, and professional pain societies advocating the need for coordination and integration of services for effective pain care with reduced risk and cost and improved outcomes. These ACGME domain compatible competencies for physicians reflect the contributions of several disciplines that will need to be included in evolving interprofessional settings and underscore the need for collaborative care. These core competencies can guide the incorporation of KSAs within curricula. The learning experiences should enable medical educators and graduating primary care physicians to focus more on integrative approaches, interprofessional team-based, patient-centered care that use evidence-based, traditional and complementary disciplines and therapeutics to provide safe and effective treatments for people in pain. Wiley Periodicals, Inc.

  11. Use of spirometry among chest physicians and primary care physicians in India. (United States)

    Vanjare, Nitin; Chhowala, Sushmeeta; Madas, Sapna; Kodgule, Rahul; Gogtay, Jaideep; Salvi, Sundeep


    Although spirometry is the gold-standard diagnostic test for obstructive airways diseases, it remains poorly utilised in clinical practice. We aimed to investigate the use of spirometry across India, the change in its usage over a period of time and to understand the reasons for its under-utilisation. Two nationwide surveys were conducted in the years 2005 and 2013, among four groups of doctors: chest physicians (CPs), general physicians (GenPs), general practitioners (GPs) and paediatricians (Ps). A total of 1,000 physicians from each of the four groups were randomly selected from our database in the years 2005 and 2013. These surveys were conducted in 52 cities and towns across 15 states in India. A questionnaire was administered to the physicians, which captured information about their demographic details, type of practice and use of spirometry. The overall response rates of the physicians in 2005 and 2013 were 42.8% and 54.9%, respectively. Spirometry was reported to be used by 55% CPs, 20% GenPs, 10% GPs and 5% Ps in 2005, and this increased by 30.9% among CPs (P value spirometry varied between 2005 and 2013. In all, 32.2% of physicians were unaware of which predicted equation they were using. The use of spirometry in India is low, although it seems to have improved over the years. The reasons identified in this study for under-utilisation should be used to address initiatives to improve the use of spirometry in clinical practice.

  12. Physician education programme improves quality of diabetes care

    African Journals Online (AJOL)

    diabetes have been compiled and circulated to health care workers, but ... studied and attempted to improve the quality of diabetes care in primary care ..... project indicators in the Indian Health Service primary care setting. Diabetes Care ...

  13. Health care restructuring and family physician care for those who died of cancer

    Directory of Open Access Journals (Sweden)

    Johnston Grace


    Full Text Available Abstract Background During the 1990s, health care restructuring in Nova Scotia resulted in downsized hospitals, reduced inpatient length of stay, capped physician incomes and restricted practice locations. Concurrently, the provincial homecare program was redeveloped and out-of-hospital cancer deaths increased from 20% (1992 to 30% (1998. These factors all pointed to a transfer of end-of-life inpatient hospital care to more community-based care. The purpose of this study was to describe the trends in the provision of Family Physician (FP visits to advanced cancer patients in Nova Scotia (NS during the years of health care restructuring. Methods Design Secondary multivariate analysis of linked population-based datafiles including the Queen Elizabeth II Health Sciences Centre Oncology Patient Information System (NS Cancer Registry, Vital Statistics, the NS Hospital Admissions/Separations file and the Medical Services Insurance Physician Services database. Setting Nova Scotia, an eastern Canadian province (population: 950,000. Subjects: All patients who died of lung, colorectal, breast or prostate cancer between April 1992 and March 1998 (N = 7,212. Outcome Measures Inpatient and ambulatory FP visits, ambulatory visits by location (office, home, long-term care facility, emergency department, time of day (regular hours, after hours, total length of inpatient hospital stay and number of hospital admissions during the last six months of life. Results In total, 139,641 visits were provided by family physicians: 15% of visits in the office, 10% in the home, 5% in the emergency department (ED, 5% in a long-term-care centre and 64% to hospital inpatients. There was no change in the rate of FP visits received for office, home and long-term care despite the fact that there were 13% fewer hospital admissions, and length of hospital stay declined by 21%. Age-sex adjusted estimates using negative binomial regression indicate a decline in hospital inpatient FP

  14. Patient care information systems and physicians: the transition from technology icon to health care instrument. (United States)

    Bria, W F


    We have discussed several important transitions now occurring in PCIS that promise to improve the utility and availability of these systems for the average physician. Charles Babbage developed the first computers as "thinking machines" so that we may extend our ability to grapple with more and more complex problems. If current trends continue, we will finally witness the evolution of patient care computing from information icons of the few to clinical instruments improving the quality of medical decision making and care for all patients.

  15. Nonphysician Care Providers Can Help to Increase Detection of Cognitive Impairment and Encourage Diagnostic Evaluation for Dementia in Community and Residential Care Settings. (United States)

    Maslow, Katie; Fortinsky, Richard H


    In the United States, at least half of older adults living with dementia do not have a diagnosis. Their cognitive impairment may not have been detected, and some older adults whose physician recommends that they obtain a diagnostic evaluation do not follow through on the recommendation. Initiatives to increase detection of cognitive impairment and diagnosis of dementia have focused primarily on physician practices and public information programs to raise awareness about the importance of detection and diagnosis. Nonphysician care providers who work with older adults in community and residential care settings, such as aging network agencies, public health agencies, senior housing, assisted living, and nursing homes, interact frequently with older adults who have cognitive impairment but have not had a diagnostic evaluation. These care providers may be aware of signs of cognitive impairment and older adults' concerns about their cognition that have not been expressed to their physician. Within their scope of practice and training, nonphysician care providers can help to increase detection of cognitive impairment and encourage older adults with cognitive impairment to obtain a diagnostic evaluation to determine the cause of the condition. This article provides seven practice recommendations intended to increase involvement of nonphysician care providers in detecting cognitive impairment and encouraging older adults to obtain a diagnostic evaluation. The Kickstart-Assess-Evaluate-Refer (KAER) framework for physician practice in detection and diagnosis of dementia is used to identify ways to coordinate physician and nonphysician efforts and thereby increase the proportion of older adults living with dementia who have a diagnosis. © The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail:

  16. Building relationships with physicians. Internal marketing efforts help strengthen organizational bonds at a rural health care clinic. (United States)

    Peltier, J W; Boyt, T; Westfall, J E


    Physician turnover is costly for health care organizations, especially for rural organizations. One approach management can take to reduce turnover is to promote physician loyalty by treating them as an important customer segment. The authors develop an information--oriented framework for generating physician loyalty and illustrate how this framework has helped to eliminate physician turnover at a rural health care clinic. Rural health care organizations must develop a more internal marketing orientation in their approach to establishing strong relationship bonds with physicians.

  17. The impact of the hospital work environment on social support from physicians in breast cancer care. (United States)

    Ansmann, Lena; Wirtz, Markus; Kowalski, Christoph; Pfaff, Holger; Visser, Adriaan; Ernstmann, Nicole


    Research on determinants of a good patient-physician interaction mainly disregards systemic factors, such as the work environment in healthcare. This study aims to identify stressors and resources within the work environment of hospital physicians that enable or hinder the physicians' provision of social support to patients. Four data sources on 35 German breast cancer center hospitals were matched: structured hospital quality reports and surveys of 348 physicians, 108 persons in hospital leadership, and 1844 patients. Associations between hospital structures, physicians' social resources as well as job demands and control and patients' perceived support from physicians have been studied in multilevel models. Patients feel better supported by their physicians in hospitals with high social capital, a high percentage of permanently employed physicians, and less physically strained physicians. The results highlight the importance of the work environment for a good patient-physician interaction. They can be used to develop interventions for redesigning the hospital work environment, which in turn may improve physician satisfaction, well-being, and performance and consequently the quality of care. Health policy and hospital management could create conditions conducive to better patient-physician interaction by strengthening the social capital and by increasing job security for physicians. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  18. Family physicians' attitude and practice of infertility management at primary care--Suez Canal University, Egypt. (United States)

    Eldein, Hebatallah Nour


    The very particular natures of infertility problem and infertility care make them different from other medical problems and services in developing countries. Even after the referral to specialists, the family physicians are expected to provide continuous support for these couples. This place the primary care service at the heart of all issues related to infertility. to improve family physicians' attitude and practice about the approach to infertility management within primary care setting. This study was conducted in the between June and December 2010. The study sample comprised 100 family physician trainees in the family medicine department and working in family practice centers or primary care units. They were asked to fill a questionnaire about their personal characteristics, attitude, and practice towards support, investigations, and treatment of infertile couples. Hundred family physicians were included in the study. They were previously received training in infertility management. Favorable attitude scores were detected among (68%) of physicians and primary care was considered a suitable place for infertility management among (77%) of participants. There was statistically significant difference regarding each of age groups, gender and years of experience with the physicians' attitude. There was statistically significant difference regarding gender, perceiving PHC as an appropriate place to manage infertility and attitude towards processes of infertility management with the physicians' practice. Favorable attitude and practice were determined among the study sample. Supporting the structure of primary care and evidence-based training regarding infertility management are required to improve family physicians' attitude and practice towards infertility management.

  19. Training Physicians to Provide High-Value, Cost-Conscious Care A Systematic Review

    NARCIS (Netherlands)

    Stammen, L.A.; Stalmeijer, R.E.; Paternotte, E.; Pool, A.O.; Driessen, E.W.; Scheele, F.; Stassen, L.P.S.


    Importance Increasing health care expenditures are taxing the sustainability of the health care system. Physicians should be prepared to deliver high-value, cost-conscious care. Objective To understand the circumstances in which the delivery of high-value, cost-conscious care is learned, with a goal

  20. Surgery in Brazilian Health Care: funding and physician distribution. (United States)

    Alonso, Nivaldo; Massenburg, Benjamin B; Galli, Rafael; Sobrado, Lucas; Birolini, Dario


    to analyze demographic Brazilian medical data from the national public healthcare system (SUS), which provides free universal health coverage for the entire population, and discuss the problems revealed, with particular focus on surgical care. data was obtained from public healthcare databases including the Medical Demography, the Brazilian Federal Council of Medicine, the Brazilian Institute of Geography and Statistics, and the National Database of Healthcare Establishments. Density and distribution of the medical workforce and healthcare facilities were calculated, and the geographic regions were analyzed using the public private inequality index. Brazil has an average of two physicians for every 1,000 inhabitants, who are unequally distributed throughout the country. There are 22,276 board certified general surgeons in Brazil (11.49 for every 100,000 people). The country currently has 257 medical schools, with 25,159 vacancies for medical students each year, with only around 13,500 vacancies for residency. The public private inequality index is 3.90 for the country, and ranges from 1.63 in the Rio de Janeiro up to 12.06 in Bahia. A significant part of the local population still faces many difficulties in accessing surgical care, particularly in the north and northeast of the country, where there are fewer hospitals and surgeons. Physicians and surgeons are particularly scarce in the public health system nationwide, and better incentives are needed to ensure an equal public and private workforce. analisar dados demográficos do Sistema Único de Saúde (SUS) brasileiro, que promove cobertura de saúde universal a toda população, e discutir os problemas revelados, com particular ênfase nos cuidados cirúrgicos. os dados foram obtidos a partir dos bancos de dados de saúde pública da Demografia Médica, do Conselho Federal de Medicina, do Instituto Brasileiro de Geografia e Estatística e do Cadastro Nacional dos Estabelecimentos de Saúde. A densidade e a

  1. [Alternative and complementary medicine from the primary care physician's viewpoint]. (United States)

    Soós, Sándor Árpád; Eőry, Ajándék; Eőry, Ajándok; Harsányi, László; Kalabay, László


    The patients initiate the use of complementary and alternative medicine and this often remains hidden from their primary care physician. To explore general practitioners' knowledge and attitude towards complementary and alternative medicine, and study the need and appropriate forms of education, as well as ask their opinion on integration of alternative medicine into mainstream medicine. A voluntary anonymous questionnaire was used on two conferences for general practitioners organized by the Family Medicine Department of Semmelweis University. Complementary and alternative medicine was defined by the definition of the Hungarian Academy of Sciences and certified modalities were all listed. 194 general practitioners answered the questionnaire (39.8% response rate). 14% of the responders had licence in at least one of the complementary and alternative therapies, 45% used complementary and alternative therapy in their family in case of illness. It was the opinion of the majority (91.8%) that it was necessary to be familiar with every method used by their patients, however, 82.5% claimed not to have enough knowledge in complementary medicine. Graduate and postgraduate education in the field was thought to be necessary by 86% of the responders; increased odds for commitment in personal education was found among female general practitioners, less than 20 years professional experience and personal experience of alternative medicine. These data suggest that general practitioners would like to know more about complementary and alternative medicine modalities used by their patients. They consider education of medical professionals necessary and a special group is willing to undergo further education in the field.

  2. Physicians' Psychosocial Work Conditions and Quality of Care: A Literature Review

    Directory of Open Access Journals (Sweden)

    Peter Angerer


    Full Text Available Background: Physician jobs are associated with adverse psychosocial work conditions. We summarize research on the relationship of physicians' psychosocial work conditions and quality of care. Method: A systematic literature search was conducted in MEDLINE and PsycINFO. All studies were classified into three categories of care quality outcomes: Associations between physicians' psychosocial work conditions and (1 the physician-patient-relationship, or (2 the care process and outcomes, or (3 medical errors were examined. Results: 12 publications met the inclusion criteria. Most studies relied on observational cross-sectional and controlled intervention designs. All studies provide at least partial support for physicians’ psychosocial work conditions being related to quality of care. Conclusions: This review found preliminary evidence that detrimental physicians’ psychosocial work conditions adversely influence patient care quality. Future research needs to apply strong designs to disentangle the indirect and direct effects of adverse psychosocial work conditions on physicians as well as on quality of care.Keywords: psychosocial work conditions, physicians, quality of care, physician-patient-relationship, hospital, errors, review, work stress, clinicians

  3. Assessing the critical behavioral competencies of outstanding managed care primary care physicians. (United States)

    Duberman, T L


    This study used job competence assessment to identify the behavioral characteristics that distinguish outstanding job performances of primary care physicians (PCPs) within a network-model HMO. Primary care physicians were chosen for the study based on six standard performance measures: (1) member satisfaction, (2) utilization, (3) patient complaints, (4) emergency room referrals, (5) out-of-network referrals, and (6) medical record completeness. Outstanding PCPs (N = 16) were identified as those performing within one standard deviation above the mean on all six of the performance measures. A control group of typical PCPs (N = 10) was selected from those performing outside the peer group mean on at least two performance measures. Subjects were administered the Behavioral Event Interview and the Picture Story Exercise. Higher overall competency levels of achievement orientation, concern for personal influence, empathic caregiving, and empowerment drive distinguished outstanding from typical PCPs. Outstanding PCPs also had higher overall frequency of competency in building team effectiveness and interpersonal understanding when compared with typical PCPs. This study suggests that PCP performance is the product of measurable competencies that are potentially amenable to improvement. Competency assessment and development of PCPs may benefit both organizational efficiency and physician and patient satisfaction.

  4. Regional Supply of Chiropractic Care and Visits to Primary Care Physicians for Back and Neck Pain (United States)

    Davis, Matthew A.; Yakusheva, Olga; Gottlieb, Daniel J.; Bynum, Julie P.W.


    Background Whether availability of chiropractic care affects use of primary care physician (PCP) services is unknown. Methods We performed a cross-sectional study of 17.7 million older adults who were enrolled in Medicare from 2010 to 2011. We examined the relationship between regional supply of chiropractic care and PCP services using Spearman correlation. Generalized linear models were used to examine the association between regional supply of chiropractic care and number of annual visits to PCPs for back and/or neck pain. Results We found a positive association between regional supply of chiropractic care and PCP services (rs = 0.52; P neck pain was apparent. The number of PCP visits for back and/or neck pain was 8% lower (rate ratio, 0.92; 95% confidence interval, 0.91–0.92) in the quintile with the highest supply of chiropractic care compared to the lowest quintile. We estimate chiropractic care is associated with a reduction of 0.37 million visits to PCPs nationally, at a cost of $83.5 million. Conclusions Greater availability of chiropractic care in some areas may be offsetting PCP services for back and/or neck pain among older adults. (J Am Board Fam Med 2015;28:000–000.) PMID:26152439

  5. Impact of physician-less pediatric critical care transport: Making a decision on team composition. (United States)

    Kawaguchi, Atsushi; Nielsen, Charlene C; Saunders, L Duncan; Yasui, Yutaka; de Caen, Allan


    To explore the impact of a physician non-accompanying pediatric critical care transport program, and to identify factors associated with the selection of specific transport team compositions. Children transported to a Canadian academic children's hospital were included. Two eras (Physician-accompanying Transport (PT)-era: 2000-07 when physicians commonly accompanied the transport team; and Physician-Less Transport (PLT)-era: 2010-15 when a physician non-accompanying team was increasingly used) were compared with respect to transport and PICU outcomes. Transport and patient characteristics for the PLT-era cohort were examined to identify factors associated with the selection of a physician accompanying team, with multivariable logistic regression with triage physicians as random effects. In the PLT-era (N=1177), compared to the PT-era (N=1490) the probability of PICU admission was significantly lower, and patient outcomes including mortality were not significantly different. Associations were noted between the selection of a physician non-accompanying team and specific transport characteristics. There was appreciable variability among the triage physicians for the selection of a physician non-accompanying team. No significant differences were observed with increasing use of a physician non-accompanying team. Selection of transport team compositions was influenced by clinical and system factors, but appreciable variation still remained among triage physicians. Crown Copyright © 2018. Published by Elsevier Inc. All rights reserved.

  6. Health care reform and job satisfaction of primary health care physicians in Lithuania

    Directory of Open Access Journals (Sweden)

    Blazeviciene Aurelija


    Full Text Available Abstract Background The aim of this research paper is to study job satisfaction of physicians and general practitioners at primary health care institutions during the health care reform in Lithuania. Methods Self-administrated anonymous questionnaires were distributed to all physicians and general practitioners (N = 243, response rate – 78.6%, working at Kaunas primary health care level establishments, in October – December 2003. Results 15 men (7.9% and 176 women (92.1% participated in the research, among which 133 (69.6% were GPs and 58 (30.4% physicians. Respondents claimed to have chosen to become doctors, as other professions were of no interest to them. Total job satisfaction of the respondents was 4.74 point (on a 7 point scale. Besides 75.5% of the respondents said they would not recommend their children to choose a PHC level doctor's profession. The survey also showed that the respondents were most satisfied with the level of autonomy they get at work – 5.28, relationship with colleagues – 5.06, and management quality – 5.04, while compensation (2.09, social status (3.36, and workload (3.93 turned to be causing the highest dissatisfaction among the respondents. The strongest correlation (Spearmen's ratio was observed between total job satisfaction and such factors as the level of autonomy – 0.566, workload – 0.452, and GP's social status – 0.458. Conclusion Total job satisfaction of doctors working at primary health care establishments in Lithuania is relatively low, and compensation, social status, and workload are among the key factors that condition PHC doctors' dissatisfaction with their job.

  7. Effect of communication style and physician-family relationships on satisfaction with pediatric chronic disease care. (United States)

    Swedlund, Matthew P; Schumacher, Jayna B; Young, Henry N; Cox, Elizabeth D


    Over 8% of children have a chronic disease and many are unable to adhere to treatment. Satisfaction with chronic disease care can impact adherence. We examine how visit satisfaction is associated with physician communication style and ongoing physician-family relationships. We collected surveys and visit videos for 75 children ages 9-16 years visiting for asthma, diabetes, or sickle cell disease management. Raters assessed physician communication style (friendliness, interest, responsiveness, and dominance) from visit videos. Quality of the ongoing relationship was measured with four survey items (parent-physician relationship, child-physician relationship, comfort asking questions, and trust in the physician), while a single item assessed satisfaction. Correlations and chi square were used to assess association of satisfaction with communication style or quality of the ongoing relationship. Satisfaction was positively associated with physician to parent (p relationships (p communication style and the quality of the ongoing relationship contribute to pediatric chronic disease visit satisfaction.

  8. SimCare: A Model for Studying Physician Decisionmaking Activity

    National Research Council Canada - National Science Library

    Dutta, Pradumna; Biltz, George R; Johnson, Paul E; Sperl-Hillen, JoAnn M; Rush, William A; Duncan, Jane E; O'Connor, Patrick J


    A major factor that contributes to the high rates of medical error in the treatment of patients with diabetes and other chronic diseases is the complexity of the tasks that physicians must complete...

  9. Time-trend of melanoma screening practice by primary care physicians: A meta-regression analysis


    Valachis, Antonis; Mauri, Davide; Karampoiki, Vassiliki; Polyzos, Nikolaos P; Cortinovis, Ivan; Koukourakis, Georgios; Zacharias, Georgios; Xilomenos, Apostolos; Tsappi, Maria; Casazza, Giovanni


    Objective To assess whether the proportion of primary care physicians implementing full body skin examination (FBSE) to screen for melanoma changed over time. Methods Meta-regression analyses of available data. Data Sources: MEDLINE, ISI, Cochrane Central Register of Controlled Trials. Results Fifteen studies surveying 10,336 physicians were included in the analyses. Overall, 15%?82% of them reported to perform FBSE to screen for melanoma. The proportion of physicians using FBSE screening ten...

  10. End-of-life care beliefs among Hindu physicians in the United States. (United States)

    Ramalingam, Vijaya Sivalingam; Saeed, Fahad; Sinnakirouchenan, Ramapriya; Holley, Jean L; Srinivasan, Sinnakirouchenan


    Several studies from the United States and Europe showed that physicians' religiosity is associated with their approach to end-of-life care beliefs. No such studies have focused exclusively on Hindu physicians practicing in the United States. A 34-item questionnaire was sent to 293 Hindu physicians in the United States. Most participants believed that their religious beliefs do not influence their practice of medicine and do not interfere with withdrawal of life support. The US practice of discussing end-of-life issues with the patient, rather than primarily with the family, seems to have been adopted by Hindu physicians practicing in the United States. It is likely that the ethical, cultural, and patient-centered environment of US health care has influenced the practice of end-of-life care by Hindu physicians in this country. © The Author(s) 2013.

  11. The effect of reimbursement on medical decision making: do physicians alter treatment in response to a managed care incentive? (United States)

    Melichar, Lori


    The empirical literature that explores whether physicians respond to financial incentives has not definitively answered the question of whether physicians alter their treatment behavior at the margin. Previous research has not been able to distinguish that part of a physician response that uniformly alters treatment of all patients under a physician's care from that which affects some, but not all of a physician's patients. To explore physicians' marginal responses to financial incentives while accounting for the selection of physicians into different financial arrangements where others could not, I use data from a survey of physician visits to isolate the effect that capitation, a form of reimbursement wherein physicians receive zero marginal revenue for a range of physician provided services, has on the care provided by a physician. Fixed effects regression results reveal that physicians spend less time with their capitated patients than with their non-capitated patients.

  12. A cognitive evaluation of four online search engines for answering definitional questions posed by physicians. (United States)

    Yu, Hong; Kaufman, David


    The Internet is having a profound impact on physicians' medical decision making. One recent survey of 277 physicians showed that 72% of physicians regularly used the Internet to research medical information and 51% admitted that information from web sites influenced their clinical decisions. This paper describes the first cognitive evaluation of four state-of-the-art Internet search engines: Google (i.e., Google and Scholar.Google), MedQA, Onelook, and PubMed for answering definitional questions (i.e., questions with the format of "What is X?") posed by physicians. Onelook is a portal for online definitions, and MedQA is a question answering system that automatically generates short texts to answer specific biomedical questions. Our evaluation criteria include quality of answer, ease of use, time spent, and number of actions taken. Our results show that MedQA outperforms Onelook and PubMed in most of the criteria, and that MedQA surpasses Google in time spent and number of actions, two important efficiency criteria. Our results show that Google is the best system for quality of answer and ease of use. We conclude that Google is an effective search engine for medical definitions, and that MedQA exceeds the other search engines in that it provides users direct answers to their questions; while the users of the other search engines have to visit several sites before finding all of the pertinent information.

  13. Consultation with specialist palliative care services in palliative sedation: considerations of Dutch physicians. (United States)

    Koper, Ian; van der Heide, Agnes; Janssens, Rien; Swart, Siebe; Perez, Roberto; Rietjens, Judith


    Palliative sedation is considered a normal medical practice by the Royal Dutch Medical Association. Therefore, consultation of an expert is not considered mandatory. The European Association of Palliative Care (EAPC) framework for palliative sedation, however, is more stringent: it considers the use of palliative sedation without consulting an expert as injudicious and insists on input from a multi-professional palliative care team. This study investigates the considerations of Dutch physicians concerning consultation about palliative sedation with specialist palliative care services. Fifty-four physicians were interviewed on their most recent case of palliative sedation. Reasons to consult were a lack of expertise and the view that consultation was generally supportive. Reasons not to consult were sufficient expertise, the view that palliative sedation is a normal medical procedure, time pressure, fear of disagreement with the service and regarding consultation as having little added value. Arguments in favour of mandatory consultation were that many physicians lack expertise and that palliative sedation is an exceptional intervention. Arguments against mandatory consultation were practical obstacles that may preclude fulfilling such an obligation (i.e. lack of time), palliative sedation being a standard medical procedure, corroding a physician's responsibility and deterring physicians from applying palliative sedation. Consultation about palliative sedation with specialist palliative care services is regarded as supportive and helpful when physicians lack expertise. However, Dutch physicians have both practical and theoretical objections against mandatory consultation. Based on the findings in this study, there seems to be little support among Dutch physicians for the EAPC recommendations on obligatory consultation.

  14. Democratic and Republican physicians provide different care on politicized health issues (United States)

    Hersh, Eitan D.; Goldenberg, Matthew N.


    Physicians frequently interact with patients about politically salient health issues, such as drug use, firearm safety, and sexual behavior. We investigate whether physicians’ own political views affect their treatment decisions on these issues. We linked the records of over 20,000 primary care physicians in 29 US states to a voter registration database, obtaining the physicians’ political party affiliations. We then surveyed a sample of Democratic and Republican primary care physicians. Respondents evaluated nine patient vignettes, three of which addressed especially politicized health issues (marijuana, abortion, and firearm storage). Physicians rated the seriousness of the issue presented in each vignette and their likelihood of engaging in specific management options. On the politicized health issues—and only on such issues—Democratic and Republican physicians differed substantially in their expressed concern and their recommended treatment plan. We control for physician demographics (like age, gender, and religiosity), patient population, and geography. Physician partisan bias can lead to unwarranted variation in patient care. Awareness of how a physician’s political attitudes might affect patient care is important to physicians and patients alike. PMID:27698126

  15. Primary health care physicians' treatment of psychosocial problems: implications for social work.

    NARCIS (Netherlands)

    Gross, R.; Rabinowitz, J.; Feldman, D.; Boerma, W.


    This study explores the extent to which primary care physicians serve as gatekeepers for the treatment of psychosocial problems and the extent to which they have contact with social workers. We also attempted to identify physician variables related to gatekeeping and amount of contact with social

  16. Physician's sociodemographic profile and distribution across public and private health care: an insight into physicians' dual practice in Brazil. (United States)

    Miotto, Bruno Alonso; Guilloux, Aline Gil Alves; Cassenote, Alex Jones Flores; Mainardi, Giulia Marcelino; Russo, Giuliano; Scheffer, Mário César


    The intertwined relation between public and private care in Brazil is reshaping the medical profession, possibly affecting the distribution and profile of the country's medical workforce. Physicians' simultaneous engagement in public and private services is a common and unregulated practice in Brazil, but the influence played by contextual factors and personal characteristics over dual practice engagement are still poorly understood. This study aimed at exploring the sociodemographic profile of Brazilian physicians to shed light on the links between their personal characteristics and their distribution across public and private services. A nation-wide cross-sectional study using primary data was conducted in 2014. A representative sample size of 2400 physicians was calculated based  on the National Council of Medicine database registries; telephone interviews were conducted to explore physicians' sociodemographic characteristics and their engagement with public and private services. From the 2400 physicians included, 51.45% were currently working in both the public and private services, while 26.95% and 21.58% were working exclusively in the private and public sectors, respectively. Public sector physicians were found to be younger (PR 0.84 [0.68-0.89]; PR 0.47 [0.38-0.56]), less experienced (PR 0.78 [0.73-0.94]; PR 0.44 [0.36-0.53]) and predominantly female (PR 0.79 [0.71-0.88]; PR 0.68 [0.6-0.78]) when compared to dual and private practitioners; their income was substantially lower than those working exclusively for the private (PR 0.58 [0.48-0.69]) and mixed sectors (PR 0.31 [0.25-0.37]). Conversely, physicians from the private sector were found to be typically senior (PR 1.96 [1.58-2.43]), specialized (PR 1.29 [1.17-1.42]) and male (PR 1.35 [1.21-1.51]), often working less than 20 h per week (PR 2.04 [1.4-2.96]). Dual practitioners were mostly middle-aged (PR 1.3 [1.16-1.45]), male specialists with 10 to 30 years of medical practice (PR 1.23 [1

  17. Physician's self-perceived abilities at primary care settings in Indonesia. (United States)

    Istiono, Wahyudi; Claramita, Mora; Ekawati, Fitriana Murriya; Gayatri, Aghnaa; Sutomo, Adi Heru; Kusnanto, Hari; Graber, Mark Alan


    Southeast Asian countries with better-skilled primary care physicians have been shown to have better health outcomes. However, in Indonesia, there has been a large number of inappropriate referrals, leading to suboptimal health outcomes. This study aimed to examine the reasons underlying the unnecessary referrals as related to Indonesian physicians' standard of abilities. This was a multiple-case study that explored physicians' self-evaluation of their abilities. Self-evaluation questionnaires were constructed from the Indonesian Standards of Physicians Competences of 2006-2012 (ISPC), which is a list of 155 diseases. This study was undertaken in three cities, three towns, and one "border-less developed" area during 2011-2014. The study involved 184 physicians in those seven districts. Data were collected using one-on-one, in-depth interviews, focus group discussions (FGDs), and clinical observations. This study found that primary care physicians in Indonesia felt that they were competent to handle less than one-third of "typical" primary care cases. The reasons were limited understanding of person-centered care principles and limited patient care services to diagnosis and treatment of common biomedical problems. Additionally, physical facilities in primary care settings are lacking. Strengthening primary health care in Indonesia requires upscaling doctors' abilities in managing health problems through more structured graduate education in family medicine, which emphasizes the bio-psycho-socio-cultural background of persons; secondly, standardizing primary care facilities to support physicians' performance is critical. Finally, a strong national health policy that recognizes the essential role of primary care physicians in health outcomes is an urgent need.

  18. Using attachment theory in medical settings: implications for primary care physicians. (United States)

    Hooper, Lisa M; Tomek, Sara; Newman, Caroline R


    Mental health researchers, clinicians and clinical psychologists have long considered a good provider-patient relationship to be an important factor for positive treatment outcomes in a range of therapeutic settings. However, primary care physicians have been slow to consider how attachment theory may be used in the context of patient care in medical settings. In the current article, John Bowlby's attachment theory and proposed attachment styles are proffered as a framework to better understand patient behaviors, patient communication styles with physicians and the physician-patient relationship in medical settings. The authors recommend how primary care physicians and other health care providers can translate attachment theory to enhance practice behaviors and health-related communications in medical settings.

  19. Unethical business practices in U.S. health care alarm physician leaders. (United States)

    Weber, David O


    Learn the results of ACPE's recent survey on ethical business practices and find out why physician executives are very concerned about the impact unethical behaviors appear to be having on health care.

  20. Physician office vs retail clinic: patient preferences in care seeking for minor illnesses. (United States)

    Ahmed, Arif; Fincham, Jack E


    Retail clinics are a relatively new phenomenon in the United States, offering cheaper and convenient alternatives to physician offices for minor illness and wellness care. The objective of this study was to investigate the effects of cost of care and appointment wait time on care-seeking decisions at retail clinics or physician offices. As part of a statewide random-digit-dial survey of households, adult residents of Georgia were interviewed to conduct a discrete choice experiment with 2 levels each of 4 attributes: price ($59; $75), appointment wait time (same day; 1 day or longer), care setting-clinician combination (nurse practitioner in retail clinic; physician in private office), and acute illness (urinary tract infection [UTI]; influenza). The respondents indicated whether they would seek care under each of the 16 resulting choice scenarios. A cooperation rate of 33.1% yielded 493 completed telephone interviews. The respondents preferred to seek care for both conditions; were less likely to seek care for UTI (beta = -0.149; P = .008); preferred to seek care from a physician (beta = 1.067; P clinic and $82.12 to wait 1 day or more. Time and cost savings offered by retail clinics are attractive to patients, and they are likely to seek care there given sufficient cost savings. Appointment wait time is the most important factor in care-seeking decisions and should be considered carefully in setting appointment policies in primary care practices.

  1. arriba-lib: evaluation of an electronic library of decision aids in primary care physicians

    Directory of Open Access Journals (Sweden)

    Hirsch Oliver


    Full Text Available Abstract Background The successful implementation of decision aids in clinical practice initially depends on how clinicians perceive them. Relatively little is known about the acceptance of decision aids by physicians and factors influencing the implementation of decision aids from their point of view. Our electronic library of decision aids (arriba-lib is to be used within the encounter and has a modular structure containing evidence-based decision aids for the following topics: cardiovascular prevention, atrial fibrillation, coronary heart disease, oral antidiabetics, conventional and intensified insulin therapy, and unipolar depression. The aim of our study was to evaluate the acceptance of arriba-lib in primary care physicians. Methods We conducted an evaluation study in which 29 primary care physicians included 192 patients. The physician questionnaire contained information on which module was used, how extensive steps of the shared decision making process were discussed, who made the decision, and a subjective appraisal of consultation length. We used generalised estimation equations to measure associations within patient variables and traditional crosstab analyses. Results Only a minority of consultations (8.9% was considered to be unacceptably extended. In 90.6% of consultations, physicians said that a decision could be made. A shared decision was perceived by physicians in 57.1% of consultations. Physicians said that a decision was more likely to be made when therapeutic options were discussed “detailed”. Prior experience with decision aids was not a critical variable for implementation within our sample of primary care physicians. Conclusions Our study showed that it might be feasible to apply our electronic library of decision aids (arriba-lib in the primary care context. Evidence-based decision aids offer support for physicians in the management of medical information. Future studies should monitor the long-term adoption of

  2. Job satisfaction of primary care physicians in Switzerland: an observational study. (United States)

    Goetz, Katja; Jossen, Marianne; Szecsenyi, Joachim; Rosemann, Thomas; Hahn, Karolin; Hess, Sigrid


    Job satisfaction of physicians is an important issue for performance of a health care system. The aim of the study was to evaluate the job satisfaction of primary care physicians in Switzerland and to explore associations between overall job satisfaction, individual characteristics and satisfaction with aspects of work within the practice separated by gender. This cross-sectional study was based on a job satisfaction survey. Data were collected from 176 primary care physicians working in 91 primary care practices. Job satisfaction was measured with the 10-item Warr-Cook-Wall job satisfaction scale. Stepwise linear regression analysis was performed for physicians separated by gender. The response rate was 92.6%. Primary care physicians reported the highest level of satisfaction with 'freedom of working method' (mean = 6.45) and the lowest satisfaction for 'hours of work' (mean = 5.38) and 'income' (mean = 5.49). Moreover, some aspects of job satisfaction were rated higher by female physicians than male physicians. Within the stepwise regression analysis, the aspect 'opportunity to use abilities' (β = 0.644) showed the highest association to overall job satisfaction for male physicians while for female physicians it was income (β = 0.733). The presented results contribute to an understanding of factors that influence levels of satisfaction of female and male physicians. Therefore, research and intervention about job satisfaction should consider gender as well as the stereotypes that come along with these social roles. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail:

  3. Effects of a physician-led home care team on terminal care. (United States)

    Zimmer, J G; Groth-Juncker, A; McCusker, J


    Inconsistent results in studies of cost-effectiveness of home health care have led to the need for identification of target populations for whom cost-savings can be anticipated if expanded home care programs are introduced. This analysis of results of a randomized controlled study of efficacy of a physician/geriatric nurse practitioner/social worker home care team identifies such a potential target population. The team provides round-the-clock on-call medical services in the home when needed, in addition to usual nursing and other home care services, to home-bound chronically or terminally ill elderly patients. Overall health services utilization and estimated costs were not substantially different for the patients who did not die while in the study; however, for those who did die, team patients had considerably lower rates of hospitalization and overall cost than controls, and more frequently died at home. Of 21 team and 12 control patients who died but had at least two weeks of utilization experience in the study, team patients had about half the number of hospital days compared with controls during the terminal two weeks, and although they had more home care services, had only 69 per cent of the estimated total health care costs of the controls. Satisfaction with care received was significantly greater among the total group of team patients, and especially among their family caretakers, than among controls. This model is effective in providing appropriate medical care for seriously ill and terminal patients, and in enabling them to die at home if they so wish, while at the same time reducing costs of care during the terminal period.

  4. Adherence of Primary Care Physicians to Evidence-Based Recommendations to Reduce Ovarian Cancer Mortality


    Stewart, Sherri L.; Townsend, Julie S.; Puckett, Mary C.; Rim, Sun Hee


    Ovarian cancer is the deadliest gynecologic cancer. Receipt of treatment from a gynecologic oncologist is an evidence-based recommendation to reduce mortality from the disease. We examined knowledge and application of this evidence-based recommendation in primary care physicians as part of CDC gynecologic cancer awareness campaign efforts and discussed results in the context of CDC National Comprehensive Cancer Control Program (NCCCP). We analyzed primary care physician responses to questions...

  5. Physician Acceptance of Gateway to Care at Irwin Army Community Hospital (United States)


    frontier cavalry post once commanded by General George Armstrong Custer. Today it is the home of almost 20,000 soldiers of the Big Red One, First Infantry...especially important for the future. Physicians, as key "players" in healthcare organizations, are also key to the success of Gateway to Care. Kotler and...research (3rd ed.). New York: Holt. Physician Acceptance 32 Kotler , P., & Clarke, R. (1987). Marketing for health care organizations. Englewood Cliffs

  6. The views of primary care physicians on health risks from electromagnetic fields

    DEFF Research Database (Denmark)

    Berg-Beckhoff, Gabi; Heyer, Kristina; Kowall, Bernd


    The aim of this study was to find out what primary care physicians in Germany think about the possible health risks of electromagnetic fields (EMF) and how they deal with this topic in discussions with patients.......The aim of this study was to find out what primary care physicians in Germany think about the possible health risks of electromagnetic fields (EMF) and how they deal with this topic in discussions with patients....

  7. Physician Burnout and the Calling to Care for the Dying: A National Survey. (United States)

    Yoon, John D; Hunt, Natalie B; Ravella, Krishna C; Jun, Christine S; Curlin, Farr A


    Physician burnout raises concerns over what sustains physicians' career motivations. We assess whether physicians in end-of-life specialties had higher rates of burnout and/or calling to care for the dying. We also examined whether the patient centeredness of the clinical environment was associated with burnout. In 2010 to 2011, we conducted a national survey of US physicians from multiple specialties. Primary outcomes were a validated single-item measure of burnout or sense of calling to end-of-life care. Primary predictors of burnout (or calling) included clinical specialty, frequency of encounters with dying patients, and patient centeredness of the clinical environments ("My clinical environment prioritizes the need of the patient over maximizing revenue"). Adjusted response rate among eligible respondents was 62% (1156 of 1878). Nearly a quarter of physicians (23%) experienced burnout, and rates were similar across all specialties. Half of the responding physicians (52%) agreed that they felt called to take care of patients who are dying. Burned-out physicians were more likely to report working in profit-centered clinical environments (multivariate odds ratio [OR] of 1.9; confidence interval [CI]: 1.3-2.8) or experiencing emotional exhaustion when caring for the dying (multivariate OR of 2.1; CI: 1.4-3.0). Physicians who identified their work as a calling were more likely to work in end-of-life specialties, to feel emotionally energized when caring for the dying, and to be religious. Physicians from end-of-life specialties not only did not have increased rates of burnout but they were also more likely to report a sense of calling in caring for the dying.

  8. Knowledge, attitudes and misconceptions of primary care physicians regarding fever in children: a cross sectional study

    Directory of Open Access Journals (Sweden)

    Demir Figen


    Full Text Available Abstract Background Fever is an extremely common sign in paediatric patients and the most common cause for a child to be taken to the doctor. The literature indicates that physicians and parents have too many misconceptions and conflicting results about fever management. In this study we aim to identify knowledge, attitudes and misconceptions of primary care physicians regarding fever in children. Methods This cross-sectional study was conducted in April-May 2010 involving primary care physicians (n=80. The physicians were surveyed using a self-administered questionnaire. Descriptive statistics were used. Results In our study only 10% of the physicians knew that a body temperature of above 37.2°C according to an auxiliary measurement is defined as fever. Only 26.2% of the physicians took into consideration signs and symptoms other than fever to prescribe antipyretics. 85% of the physicians prescribed antipyretics to control fever or prevent complications of fever especially febrile seizures. Most of the physicians (76.3% in this study reported that the height of fever may be used as an indicator for severe bacterial infection. A great majority of physicians (91.3% stated that they advised parents to alternate the use of ibuprofen and paracetamol. Conclusions There were misconceptions about the management and complications of fever. There is a perceived need to improve the recognition, assessment, and management of fever with regards to underlying illnesses in children.

  9. Self-care as a professional imperative: physician burnout, depression, and suicide. (United States)

    Kuhn, Catherine M; Flanagan, Ellen M


    Burnout has been identified in approximately half of all practicing physicians, including anesthesiologists. In this narrative review, the relationship between burnout, depression, and suicide is explored, with particular attention to the anesthesiologist. Throughout this review, we highlight our professional imperative regarding this epidemic. The authors searched the existing English language literature via PubMed from 1986 until present using the search terms physician burnout, depression, and suicide, with particular attention to studies regarding anesthesiologists and strategies to address these problems. Burnout and depression have increased among physicians, while the rate of suicide has remained relatively the same. There are many factors associated with burnout and depression as well as many causes. Certain individual factors include sex, amount of social support, and mental health history. Systems factors that play a role in burnout and depression include work compression, demands of electronic health records, production pressure, and lack of control over one's professional life. Medical license applications include questions that reinforce the stigma of psychological stresses and discourage physicians from seeking appropriate care. The concept of physician well-being is multidimensional and includes factors related to each physician as an individual as well as to the working environment. Anesthesiologists must actively engage in self-care. Anesthesiology practices and healthcare organizations should evaluate the balance between demands they place on physicians and the resources provided to sustain an engaged, productive, and satisfied physician workforce. National efforts must be rallied to support physicians seeking help for physical and psychological health problems.

  10. Nurses' and physicians' perceptions of Confusion Assessment Method for the intensive care unit for delirium detection

    DEFF Research Database (Denmark)

    Oxenbøll-Collet, Marie; Egerod, Ingrid; Christensen, Vibeke


    of this study was to identify nurses' and physicians' perceived professional barriers to using the CAM-ICU in Danish ICUs. Methods: This study uses a qualitative explorative multicentre design using focus groups and a semi-structured interview guide. Five focus groups with nurses (n=20) and four with physicians......-ICU screening affected nursing care, clinical judgment and professional integrity; (2) Instrument reliability: nurses and physicians expressed concerns about CAM-ICU assessment in non-sedated patients, patients with multi-organ failure or patients influenced by residual sedatives/opioids; and (3) Clinical...... consequence: after CAM-ICU assessment, physicians lacked evidence-based treatment options, and nurses lacked physician acknowledgment and guidelines for disclosing CAM-ICU results to patients. Conclusion: In this study, ICU nurses and physicians raised a number of concerns regarding the use of the CAM...

  11. Prescription opioid use and misuse: piloting an educational strategy for rural primary care physicians. (United States)

    Srivastava, Anita; Kahan, Meldon; Jiwa, Ashifa


    To evaluate the feasibility and effectiveness of a multifaceted educational intervention to improve the opioid prescribing practices of rural family physicians in a remote First Nations community. Prospective cohort study. Sioux Lookout, Ont. Family physicians. Eighteen family physicians participated in a 1-year study of a series of educational interventions on safe opioid prescribing. Interventions included a main workshop with a lecture and interactive case discussions, an online chat room, video case conferencing, and consultant support. Responses to questionnaires at baseline and after 1 year on knowledge, attitudes, and practices related to opioid prescribing. The main workshop was feasible and was well received by primary care physicians in remote communities. At 1 year, physicians were less concerned about getting patients addicted to opioids and more comfortable with opioid dosing. Multifaceted education and consultant support might play an important role in improving family physician comfort with opioid prescribing, and could improve the treatment of chronic pain while minimizing the risk of addiction.

  12. Using the theory of reasoned action to model retention in rural primary care physicians. (United States)

    Feeley, Thomas Hugh


    Much research attention has focused on medical students', residents', and physicians' decisions to join a rural practice, but far fewer studies have examined retention of rural primary care physicians. The current review uses Fishbein and Ajzen's Theory of Reasoned Action (TRA) to organize the literature on the predictors and correlates of retention of rural practicing physicians. TRA suggests turnover behavior is directly predicted by one's turnover intentions, which are, in turn, predicted by one's attitudes about rural practice and perceptions of salient others' (eg, spouse's) attitudes about rural practice and rural living. Narrative literature review of scholarship in predicting and understanding predictors and correlates of rural physician retention. The TRA model provides a useful conceptual model to organize the literature on rural physician retention. Physicians' subjective norms regarding rural practice are an important source of influence in the decision to remain or leave one's position, and this relation should be more fully examined in future research.

  13. [Professional Burnout Syndrome of intensive care physicians from Salvador, Bahia, Brazil]. (United States)

    Tironi, Márcia Oliveira Staffa; Nascimento Sobrinho, Carlito Lopes; Barros, Dalton de Souza; Reis, Eduardo José Farias Borges; Marques Filho, Edson Silva; Almeida, Alessandro; Bitencourt, Almir; Feitosa, Ana Isabela Ramos; Neves, Flávia Serra; Mota, Igor Carlos Cunha; França, Juliana; Borges, Lorena Guimarães; Lordão, Manuela Barreto de Jesus; Trindade, Maria Valverde; Teles, Marcelo Santos; Almeida, Mônica Bastos T; Souza, Ygor Gomes de


    Describe prevalence of the Burnout syndrome in intensive care physicians of Salvador, associated to demographic data and aspects of the work environment (psychological demand and job control). This cross sectional study has investigated the association between work conditions and Burnout Syndrome in a population of 297 Intensive Care Physicians from Salvador, Bahia, Brazil. An individual, self-report questionnaire evaluated the physicians' psychological aspects of work, using the demand-control model (Job Content Questionnaire) and their mental health, using the Maslash Burnout Inventory (MBI). The study found work overload,a high proportion of on duty physicians and low income for the hours worked. Prevalence of the Burnout Syndrome was 7.4% and it was more closely associated with aspects of the job's psychological demand than with its control. Physicians under great stress (high demand and low control) presented prevalence of the Bornout Syndrome 10.2 times higher than those under low stress (low demand and high control) jobs.

  14. Addressing domestic violence in primary care: what the physician ...

    African Journals Online (AJOL)

    Domestic violence (DV) is quite prevalent and negatively impacts the health and mental wellbeing of those affected. Victims of DV are frequent users of health service, yet they are infrequently recognized. Physicians tend to treat the presenting complaints without addressing the root cause of the problem. Lack of knowledge ...

  15. Health Care Resource Utilization for Outpatient Cardiovascular Disease and Diabetes Care Delivery Among Advanced Practice Providers and Physician Providers in Primary Care. (United States)

    Virani, Salim S; Akeroyd, Julia M; Ramsey, David J; Deswal, Anita; Nasir, Khurram; Rajan, Suja S; Ballantyne, Christie M; Petersen, Laura A


    Although effectiveness of diabetes or cardiovascular disease (CVD) care delivery between physicians and advanced practice providers (APPs) has been shown to be comparable, health care resource utilization between these 2 provider types in primary care is unknown. This study compared health care resource utilization between patients with diabetes or CVD receiving care from APPs or physicians. Diabetes (n = 1,022,588) or CVD (n = 1,187,035) patients with a primary care visit between October 2013 and September 2014 in 130 Veterans Affairs facilities were identified. Using hierarchical regression adjusting for covariates including patient illness burden, the authors compared number of primary or specialty care visits and number of lipid panels and hemoglobinA1c (HbA1c) tests among diabetes patients, and number of primary or specialty care visits and number of lipid panels and cardiac stress tests among CVD patients receiving care from physicians and APPs. Physicians had significantly larger patient panels compared with APPs. In adjusted analyses, diabetes patients receiving care from APPs received fewer primary and specialty care visits and a greater number of lipid panels and HbA1c tests compared with patients receiving care from physicians. CVD patients receiving care from APPs received more frequent lipid testing and fewer primary and specialty care visits compared with those receiving care from physicians, with no differences in the number of stress tests. Most of these differences, although statistically significant, were numerically small. Health care resource utilization among diabetes or CVD patients receiving care from APPs or physicians appears comparable, although physicians work with larger patient panels.

  16. Mobility of US Rural Primary Care Physicians During 2000-2014. (United States)

    McGrail, Matthew R; Wingrove, Peter M; Petterson, Stephen M; Bazemore, Andrew W


    Despite considerable investment in increasing the number of primary care physicians in rural shortage areas, little is known about their movement rates and factors influencing their mobility. We aimed to characterize geographic mobility among rural primary care physicians, and to identify location and individual factors that influence such mobility. Using data from the American Medical Association Physician Masterfile for each clinically active US physician, we created seven 2-year (biennial) mobility periods during 2000-2014. These periods were merged with county-level "rurality," physician supply, economic characteristics, key demographic measures, and individual physician characteristics. We computed (1) mobility rates of physicians by rurality; (2) linear regression models of county-level rural nonretention (departure); and (3) logit models of physicians leaving rural practice. Biennial turnover was about 17% among physicians aged 45 and younger, compared with 9% among physicians aged 46 to 65, with little difference between rural and metropolitan groups. County-level physician mobility was higher for counties that lacked a hospital (absolute increase = 5.7%), had a smaller population size, and had lower primary care physician supply, but area-level economic and demographic factors had little impact. Female physicians (odds ratios = 1.24 and 1.46 for those aged 45 or younger and those aged 46 to 65, respectively) and physicians born in a metropolitan area (odds ratios = 1.75 and 1.56 for those aged 45 or younger and those aged 46 to 65, respectively) were more likely to leave rural practice. These flndings provide national-level evidence of rural physician mobility rates and factors associated with both county-level retention and individual-level departures. Outcomes were notably poorer in the most remote locations and those already having poorer physician supply and professional support. Rural health workforce planners and policymakers must be cognizant of

  17. Job Resources, Physician Work Engagement, and Patient Care Experience in an Academic Medical Setting. (United States)

    Scheepers, Renée A; Lases, Lenny S S; Arah, Onyebuchi A; Heineman, Maas Jan; Lombarts, Kiki M J M H


    Physician work engagement is associated with better work performance and fewer medical errors; however, whether work-engaged physicians perform better from the patient perspective is unknown. Although availability of job resources (autonomy, colleague support, participation in decision making, opportunities for learning) bolster work engagement, this relationship is understudied among physicians. This study investigated associations of physician work engagement with patient care experience and job resources in an academic setting. The authors collected patient care experience evaluations, using nine validated items from the Dutch Consumer Quality index in two academic hospitals (April 2014 to April 2015). Physicians reported job resources and work engagement using, respectively, the validated Questionnaire on Experience and Evaluation of Work and the Utrecht Work Engagement Scale. The authors conducted multivariate adjusted mixed linear model and linear regression analyses. Of the 9,802 eligible patients and 238 eligible physicians, respectively, 4,573 (47%) and 185 (78%) participated. Physician work engagement was not associated with patient care experience (B = 0.01; 95% confidence interval [CI] = -0.02 to 0.03; P = .669). However, learning opportunities (B = 0.28; 95% CI = 0.05 to 0.52; P = .019) and autonomy (B = 0.31; 95% CI = 0.10 to 0.51; P = .004) were positively associated with work engagement. Higher physician work engagement did not translate into better patient care experience. Patient experience may benefit from physicians who deliver stable quality under varying levels of work engagement. From the physicians' perspective, autonomy and learning opportunities could safeguard their work engagement.

  18. Roles of primary care physicians in managing bipolar disorders in adults

    Directory of Open Access Journals (Sweden)

    CPG Secretariat


    Full Text Available Management of bipolar disorder (BD is challenging due to its multiple and complex facets of presentations as well as various levels of interventions. There is also limitation of treatment accessibility especially at the primary care level. Local evidence-based clinical practice guidelines address the importance of integrated care of BD at various levels. Primary care physicians hold pertinent role in maintaining remission and preventing relapse by providing systematic monitoring of people with BD. Pharmacological treatment in particular mood stabilisers remain the most effective management with psychosocial interventions as adjunct. This paper highlights the role of primary care physicians in the management of BD.

  19. Mother's time allocation, child care and child cognitive development


    BRILLI, Ylenia


    This paper analyzes the effects of maternal employment and non-parental child care on child cognitive development, taking into account the mother's time allocation between leisure and child-care time. I estimate a behavioral model, in which maternal labor supply, non-parental child care, goods expenditure and time allocation decisions are considered to be endogenous choices of the mother. The child cognitive development depends on maternal and non-parental child care and on the goods bought f...

  20. Patient autonomy and advance care planning: a qualitative study of oncologist and palliative care physicians' perspectives. (United States)

    Johnson, Stephanie B; Butow, Phyllis N; Kerridge, Ian; Tattersall, Martin H N


    Patients' are encouraged to participate in advance care planning (ACP) in order to enhance their autonomy. However, controversy exists as to what it means to be autonomous and there is limited understanding of how social and structural factors may influence cancer patients' ability to exercise their autonomy. The objective of this study is to explore oncologists' and palliative care physicians' understanding of patient autonomy, how this influences reported enactment of decision-making at the end of life (EOL), and the role of ACP in EOL care. Qualitative semi-structured interviews were conducted with consultant oncologists (n = 11) and palliative medicine doctors (n = 7) working in oncology centres and palliative care units across Australia. We found that doctors generally conceptualized autonomy in terms of freedom from interference but that there was a profound disconnect between this understanding of autonomy and clinical practice in EOL decision-making. The clinicians in our study privileged care, relationships and a 'good death' above patient autonomy, and in practice were reluctant to 'abandon' their patients to total non-interference in decision-making. Patient autonomy in healthcare is bounded, as while patients were generally encouraged to express their preferences for care, medical norms about the quality and 'reasonableness' of care, the availability of services and the patients' family relationships act to enhance or limit patients' capacity to realize their preferences. While for many, this disconnect between theory and practice did not diminish the rhetorical appeal of ACP; for others, this undermined the integrity of ACP, as well as its relevance to care. For some, ACP had little to do with patient autonomy and served numerous other ethical, practical and political functions. The ethical assumptions regarding patient autonomy embedded in academic literature and policy documents relating to ACP are disconnected from the realities of clinical care

  1. Word of mouth and physician referrals still drive health care provider choice. (United States)

    Tu, Ha T; Lauer, Johanna R


    Sponsors of health care price and quality transparency initiatives often identify all consumers as their target audiences, but the true audiences for these programs are much more limited. In 2007, only 11 percent of American adults looked for a new primary care physician, 28 percent needed a new specialist physician and 16 percent underwent a medical procedure at a new facility, according to a new national study by the Center for Studying Health System Change (HSC). Among consumers who found a new provider, few engaged in active shopping or considered price or quality information--especially when choosing specialists or facilities for medical procedures. When selecting new primary care physicians, half of all consumers relied on word-of-mouth recommendations from friends and relatives, but many also used doctor recommendations (38%) and health plan information (35%), and nearly two in five used multiple information sources when choosing a primary care physician. However, when choosing specialists and facilities for medical procedures, most consumers relied exclusively on physician referrals. Use of online provider information was low, ranging from 3 percent for consumers undergoing procedures to 7 percent for consumers choosing new specialists to 11 percent for consumers choosing new primary care physicians

  2. An Evolving Identity: How Chronic Care Is Transforming What it Means to Be a Physician. (United States)

    Bogetz, Alyssa L; Bogetz, Jori F


    Physician identity and the professional role physicians play in health care is rapidly evolving. Over 130 million adults and children in the USA have complex and chronic diseases, each of which is shaped by aspects of the patient's social, psychological, and economic status. These patients have lifelong health care needs that require the ongoing care of multiple health care providers, access to community services, and the involvement of patients' family support networks. To date, physician professional identity formation has centered on autonomy, authority, and the ability to "heal." These notions of identity may be counterproductive in chronic disease care, which demands interdependency between physicians, their patients, and teams of multidisciplinary health care providers. Medical educators can prepare trainees for practice in the current health care environment by providing training that legitimizes and reinforces a professional identity that emphasizes this interdependency. This commentary outlines the important challenges related to this change and suggests potential strategies to reframe professional identity to better match the evolving role of physicians today.

  3. Migraine-preventive prescription patterns by physician specialty in ambulatory care settings in the United States. (United States)

    Takaki, Hiroko; Onozuka, Daisuke; Hagihara, Akihito


    Many adults with migraine who require preventive therapy are often not prescribed the proper medications. The most likely reason is that primary care physicians are unacquainted with preventive medications for migraine. The present study assessed the migraine-preventive prescription patterns in office visits using data from the National Ambulatory Medical Care Survey from 2006 to 2009 in the United States. Patients who were 18 years or older and diagnosed with migraine were included in the analysis. In accordance with the recommendations of the headache guidelines, we included beta-blockers, antidepressants, triptans for short-term prevention of menstrual migraine, and other triptans for acute treatment. Weighted visits of adults with migraine prescribed with preventive medication ranged from 32.8% in 2006 to 38.6% in 2009. Visits to primary care physicians accounted for 72.6% of the analyzed adult migraine visits. Anticonvulsants (odds ratio [OR] 0.29, 95% confidence interval [CI] 0.14-0.57, p  < 0.001) and triptans for menstrual migraine (OR 0.50, 95% CI 0.28-0.91, p  = 0.025) were less frequently prescribed by primary care physicians compared with specialty care physicians, such as neurologists and psychiatrists. There were no significant differences in the prescription patterns of antidepressants and beta-blockers between primary and specialty care physicians. Beta-blockers were prescribed to patients with comorbidity of hypertension, and antidepressants were used by patients with comorbidity of depression. There are differences in the prescription patterns of certain type of preventive medications between primary care physicians and specialty care physicians.

  4. Migraine-preventive prescription patterns by physician specialty in ambulatory care settings in the United States

    Directory of Open Access Journals (Sweden)

    Hiroko Takaki


    Full Text Available Many adults with migraine who require preventive therapy are often not prescribed the proper medications. The most likely reason is that primary care physicians are unacquainted with preventive medications for migraine. The present study assessed the migraine-preventive prescription patterns in office visits using data from the National Ambulatory Medical Care Survey from 2006 to 2009 in the United States. Patients who were 18 years or older and diagnosed with migraine were included in the analysis. In accordance with the recommendations of the headache guidelines, we included beta-blockers, antidepressants, triptans for short-term prevention of menstrual migraine, and other triptans for acute treatment. Weighted visits of adults with migraine prescribed with preventive medication ranged from 32.8% in 2006 to 38.6% in 2009. Visits to primary care physicians accounted for 72.6% of the analyzed adult migraine visits. Anticonvulsants (odds ratio [OR] 0.29, 95% confidence interval [CI] 0.14–0.57, p < 0.001 and triptans for menstrual migraine (OR 0.50, 95% CI 0.28–0.91, p = 0.025 were less frequently prescribed by primary care physicians compared with specialty care physicians, such as neurologists and psychiatrists. There were no significant differences in the prescription patterns of antidepressants and beta-blockers between primary and specialty care physicians. Beta-blockers were prescribed to patients with comorbidity of hypertension, and antidepressants were used by patients with comorbidity of depression. There are differences in the prescription patterns of certain type of preventive medications between primary care physicians and specialty care physicians.

  5. Emergency Physicians, Beware of the Consent Standard of Care


    Moore, Gregory P.; Matlock, Aaron G.; Kiley, John L.; Percy, Katherine D.


    Many emergency physicians view informed consent as a necessary component of treatments or procedures to be performed on their patients. When such procedures are necessary, often there is a discussion of risks, benefits and alternatives with forms signed to validate the discussion. Two Wisconsin emergency department medical-legal cases have expanded liability of the duty of informed consent. These cases have focused on withholding medication and diagnostic tests.

  6. Benefits of High-Intensity Intensive Care Unit Physician Staffing under the Affordable Care Act

    Directory of Open Access Journals (Sweden)

    Sachin Logani


    Full Text Available The Affordable Care Act signed into law by President Obama, with its value-based purchasing program, is designed to link payment to quality processes and outcomes. Treatment of critically ill patients represents nearly 1% of the gross domestic product and 25% of a typical hospital budget. Data suggest that high-intensity staffing patterns in the intensive care unit (ICU are associated with cost savings and improved outcomes. We evaluate the literature investigating the cost-effectiveness and clinical outcomes of high-intensity ICU physician staffing as recommended by The Leapfrog Group (a consortium of companies that purchase health care for their employees and identify ways to overcome barriers to nationwide implementation of these standards. Hospitals that have implemented the Leapfrog initiative have demonstrated reductions in mortality and length of stay and increased cost savings. High-intensity staffing models appear to be an immediate cost-effective way for hospitals to meet the challenges of health care reform.

  7. The effect of financial incentives on the quality of health care provided by primary care physicians. (United States)

    Scott, Anthony; Sivey, Peter; Ait Ouakrim, Driss; Willenberg, Lisa; Naccarella, Lucio; Furler, John; Young, Doris


    The use of blended payment schemes in primary care, including the use of financial incentives to directly reward 'performance' and 'quality' is increasing in a number of countries. There are many examples in the US, and the Quality and Outcomes Framework (QoF) for general practitioners (GPs) in the UK is an example of a major system-wide reform. Despite the popularity of these schemes, there is currently little rigorous evidence of their success in improving the quality of primary health care, or of whether such an approach is cost-effective relative to other ways to improve the quality of care. The aim of this review is to examine the effect of changes in the method and level of payment on the quality of care provided by primary care physicians (PCPs) and to identify:i) the different types of financial incentives that have improved quality;ii) the characteristics of patient populations for whom quality of care has been improved by financial incentives; andiii) the characteristics of PCPs who have responded to financial incentives. We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) and Cochrane Database of Systematic Reviews (CDSR) (The Cochrane Library), MEDLINE, HealthSTAR, EMBASE, CINAHL, PsychLIT, and ECONLIT. Searches of Internet-based economics and health economics working paper collections were also conducted. Finally, studies were identified through the reference lists of retrieved articles, websites of key organisations, and from direct contact with key authors in the field. Articles were included if they were published from 2000 to August 2009. Randomised controlled trials (RCT), controlled before and after studies (CBA), and interrupted time series analyses (ITS) evaluating the impact of different financial interventions on the quality of care delivered by primary healthcare physicians (PCPs). Quality of care was defined as patient reported outcome

  8. Organizational factors affecting the adoption of diabetes care management processes in physician organizations. (United States)

    Li, Rui; Simon, Jodi; Bodenheimer, Thomas; Gillies, Robin R; Casalino, Lawrence; Schmittdiel, Julie; Shortell, Stephen M


    To describe the extent of adoption of diabetes care management processes in physician organizations in the U.S. and to investigate the organizational factors that affect the adoption of diabetes care management processes. Data are derived from the National Survey of Physician Organizations and the Management of Chronic Illness, conducted in 2000-2001. A total of 1,104 of the 1,590 physician organizations identified responded to the survey. The extent of adoption of four diabetes care management processes is measured by an index consisting of the organization's use of diabetic patient registries, clinical practice guidelines, case management, and physician feedback. The ordinary least-squares model is used to determine the association of organizational characteristics with the adoption of diabetes care management processes in physician organizations. A logistic regression model is used to determine the association of organizational characteristics with the adoption of individual diabetes care management processes. Of the 987 physician organizations studied that treat patients with diabetes, 48% either do not use any or use only one of the four diabetes care management processes. A total of 20% use two care management processes, and 32% use three or four processes. External incentives to improve quality, computerized clinical information systems, and ownership by hospitals or health maintenance organizations are strongly associated with the diabetes care management index and the adoption of individual diabetes care management processes. Policies to encourage external incentives to improve quality and to facilitate the adoption of computerized clinical information technology may promote greater use of diabetes care management processes. Copyright 2004 American Diabetes Association

  9. Educational outreach and collaborative care enhances physician's perceived knowledge about Developmental Coordination Disorder. (United States)

    Gaines, Robin; Missiuna, Cheryl; Egan, Mary; McLean, Jennifer


    Developmental Coordination Disorder (DCD) is a chronic neurodevelopmental condition that affects 5-6% of children. When not recognized and properly managed during the child's development, DCD can lead to academic failure, mental health problems and poor physical fitness. Physicians, working in collaboration with rehabilitation professionals, are in an excellent position to recognize and manage DCD. This study was designed to determine the feasibility and impact of an educational outreach and collaborative care model to improve chronic disease management of children with DCD. The intervention included educational outreach and collaborative care for children with suspected DCD. Physicians were educated by and worked with rehabilitation professionals from February 2005 to April 2006. Mixed methods evaluation approach documented the process and impact of the intervention. Physicians: 750 primary care physicians from one major urban area and outlying regions were invited to participate; 147 physicians enrolled in the project. Children: 125 children were identified and referred with suspected DCD. The main outcome was improvement in knowledge and perceived skill of physicians concerning their ability to screen, diagnose and manage DCD. At baseline 91.1% of physicians were unaware of the diagnosis of DCD, and only 1.6% could diagnose condition. Post-intervention, 91% of participating physicians reported greater knowledge about DCD and 29.2% were able to diagnose DCD compared to 0.5% of non-participating physicians. 100% of physicians who participated in collaborative care indicated they would continue to use the project materials and resources and 59.4% reported they would recommend or share the materials with medical colleagues. In addition, 17.6% of physicians not formally enrolled in the project reported an increase in knowledge of DCD. Physicians receiving educational outreach visits significantly improved their knowledge about DCD and their ability to identify and

  10. What matters in the patients' decision to revisit the same primary care physician? (United States)

    Antoun, Jumana M; Hamadeh, Ghassan N; Adib, Salim M


    To assess the priority of various aspects of the patient-primary care physician relationship in the decision to visit again that same physician. STUDY SETTINGS: A total of 400 community residents in Ras Beirut, Lebanon. A cross-sectional community based study sampled by a nonrandom sex-education quota-based procedure. Participants were asked to fill a survey where they indicated the ranking of nine items by importance in their decision to revisit the same physician. The nine items were chosen from three categories of factors: professional expertise of the physician; characteristics of the patient-physician relationship, office organization. Having a physician that gives the patient adequate time for discussion prevailed as rank 1 and luxurious clinic ranked as 9th. Affordability was one of the main concerns among men, those with poor health and those of lower socioeconomic status. Accessibility of the physician's phone was considered highly important among women and those of lesser education status. This study emphasizes the importance of adequate time with the patient, accessibility and affordability of the physician in maintaining continuity of care and patient satisfaction, beyond mere medical expertise.

  11. Perceptions of community health center impact on private primary care physician practice. (United States)

    Duffrin, Christopher; Jackson, Natalie; Whetstone, Lauren; Cummings, Doyle; Watson, Ricky; Wu, Qiang


    Community health centers (CHCs) were created in the mid-1960s to expand access to care in impoverished and underserved areas. The number of CHC sites has more than tripled in eastern North Carolina from 28 primary care centers in 2000 to 89 in 2010. This study determined the perceptions of physicians on the impact of CHC expansion on the local practice environment. Descriptive statistics and correlations were used to compare responses regarding perceptions and differences between practice characteristics as well as physician ratios by year. Both CHC and private practice physician addresses were mapped using ArcGIS. Surveys were sent to 1422 (461 returns/32.5% response rate) primary care physicians residing in 43 predominantly rural eastern North Carolina counties. A large percentage of the respondents (82.7%) affirmed that they felt neutral or did not view CHCs to be competitors, whereas a minority (17%) did view them to be difficult to compete against. Forty-two percent of private practice respondents disagreed that CHCs offer a wider range of services despite significantly more CHC physicians than private practice respondents indicating that their facility provided basic services. The CHCs were perceived to offer a wider range of services, employ more staff, and have more practice locations than private practices. However, private practice physicians did not perceive CHCs to have a competitive advantage or to unfairly impact their practices, possibly due to inconsistent population growth in relation to the physician retention during the last 10 years.

  12. Health care management of sickness certification tasks: results from two surveys to physicians. (United States)

    Lindholm, Christina; von Knorring, Mia; Arrelöv, Britt; Nilsson, Gunnar; Hinas, Elin; Alexanderson, Kristina


    Health care in general and physicians in particular, play an important role in patients' sickness certification processes. However, a lack of management within health care regarding how sickness certification is carried out has been identified in Sweden. A variety of interventions to increase the quality of sickness certification were introduced by the government and County Councils. Some of these measures were specifically aimed at strengthening health care management of sickness certification; e.g. policy making and management support. The aim was to describe to what extent physicians in different medical specialties had access to a joint policy regarding sickness certification in their clinical settings and experienced management support in carrying out sickness certification. A descriptive study, based on data from two cross-sectional questionnaires sent to all physicians in the Stockholm County regarding their sickness certification practice. Criteria for inclusion in this study were working in a clinical setting, being a board-certified specialist, sickness certification consultations at least a few times a year. These criteria were met by 2497 physicians in 2004 and 2204 physicians in 2008. Proportions were calculated regarding access to policy and management support, stratified according to medical specialty. The proportions of physicians working in clinical settings with a well-established policy regarding sickness certification were generally low both in 2004 and 2008, but varied greatly between different types of medical specialties (from 6.1% to 46.9%). Also, reports of access to substantial management support regarding sickness certification varied greatly between medical specialties (from 10.5% to 48.8%). More than one third of the physicians reported having no such management support. Most physicians did not work in a clinical setting with a well-established policy on sickness certification tasks, nor did they experience substantial support from

  13. Prescribing exercise for older adults: A needs assessment comparing primary care physicians, nurse practitioners, and physician assistants. (United States)

    Dauenhauer, Jason A; Podgorski, Carol A; Karuza, Jurgis


    To inform the development of educational programming designed to teach providers appropriate methods of exercise prescription for older adults, the authors conducted a survey of 177 physicians, physician assistants, and nurse practitioners (39% response rate). The survey was designed to better understand the prevalence of exercise prescriptions, attitudes, barriers, and educational needs of primary care practitioners toward older adults. Forty-seven percent of primary care providers report not prescribing exercise for older adults; 85% of the sample report having no formal training in exercise prescription. Practitioner attitudes were positive toward exercise, but were not predictive of their exercise prescribing behavior, which indicates that education efforts aimed at changing attitudes as a way of increasing exercise-prescribing behaviors would not be sufficient. In order to facilitate and reinforce practice changes to increase exercise-prescribing behaviors of primary care providers, results suggest the need for specific skill training on how to write an exercise prescription and motivate older adults to follow these prescriptions.

  14. Physician attitude toward depression care interventions: Implications for implementation of quality improvement initiatives

    Directory of Open Access Journals (Sweden)

    Chanin Johann C


    Full Text Available Abstract Background Few individuals with depression treated in the primary care setting receive care consistent with clinical treatment guidelines. Interventions based on the chronic care model (CCM have been promoted to address barriers and improve the quality of care. A current understanding of barriers to depression care and an awareness of whether physicians believe interventions effectively address those barriers is needed to enhance the success of future implementation. Methods We conducted semi-structured interviews with 23 primary care physicians across the US regarding their experience treating patients with depression, barriers to care, and commonly promoted CCM-based interventions. Themes were identified from interview transcripts using a grounded theory approach. Results Six barriers emerged from the interviews: difficulty diagnosing depression, patient resistance, fragmented mental health system, insurance coverage, lack of expertise, and competing demands and other responsibilities as a primary care provider. A number of interventions were seen as helpful in addressing these barriers – including care managers, mental health integration, and education – while others received mixed reviews. Mental health consultation models received the least endorsement. Two systems-related barriers, the fragmented mental health system and insurance coverage limitations, appeared incompletely addressed by the interventions. Conclusion CCM-based interventions, which include care managers, mental health integration, and patient education, are most likely to be implemented successfully because they effectively address several important barriers to care and are endorsed by physicians. Practices considering the adoption of interventions that received less support should educate physicians about the benefit of the interventions and attend to physician concerns prior to implementation. A focus on interventions that address systems-related barriers is

  15. Difficulties faced by family physicians in primary health care centers in Jeddah, Saudi Arabia. (United States)

    Mumenah, Sahar H; Al-Raddadi, Rajaa M


    The aim was to determine the difficulties faced by family physicians, and compare how satisfied those working with the Ministry of Health (MOH) are with their counterparts who work at some selected non-MOH hospitals. An analytical, cross-sectional study was conducted at King Abdulaziz University Hospital, King Faisal Specialist Hospital and Research Center (KFSH and RC), and 40 MOH primary health care centers across Jeddah. A structured multi-item questionnaire was used to collect demographic data and information on the difficulties family physicians face. The physicians' level of satisfaction and how it was affected by the difficulties was assessed. Women constituted 71.9% of the sample. Problems with transportation formed one of the main difficulties encountered by physicians. Compared to non-MOH physician, a significantly higher proportion of MOH physicians reported unavailability of radiology technicians (P = 0.011) and radiologists (P building maintenance (P < 0.001). Family physicians with the MOH were less satisfied with their jobs compared with non-MOH physicians (P = 0.032). MOH family physicians encountered difficulties relating to staff, services, and infrastructure, which consequently affected their level of satisfaction.

  16. Patient-care time allocation by nurse practitioners and physician assistants in the intensive care unit. (United States)

    Carpenter, David L; Gregg, Sara R; Owens, Daniel S; Buchman, Timothy G; Coopersmith, Craig M


    Use of nurse practitioners and physician assistants ("affiliates") is increasing significantly in the intensive care unit (ICU). Despite this, few data exist on how affiliates allocate their time in the ICU. The purpose of this study was to understand the allocation of affiliate time into patient-care and non-patient-care activity, further dividing the time devoted to patient care into billable service and equally important but nonbillable care. We conducted a quasi experimental study in seven ICUs in an academic hospital and a hybrid academic/community hospital. After a period of self-reporting, a one-time monetary incentive of $2,500 was offered to 39 affiliates in each ICU in which every affiliate documented greater than 75% of their time devoted to patient care over a 6-month period in an effort to understand how affiliates allocated their time throughout a shift. Documentation included billable time (critical care, evaluation and management, procedures) and a new category ("zero charge time"), which facilitated record keeping of other patient-care activities. At baseline, no ICUs had documentation of 75% patient-care time by all of its affiliates. In the 6 months in which reporting was tied to a group incentive, six of seven ICUs had every affiliate document greater than 75% of their time. Individual time documentation increased from 53% to 84%. Zero-charge time accounted for an average of 21% of each shift. The most common reason was rounding, which accounted for nearly half of all zero-charge time. Sign out, chart review, and teaching were the next most common zero-charge activities. Documentation of time spent on billable activities also increased from 53% of an affiliate's shift to 63%. Time documentation was similar regardless of during which shift an affiliate worked. Approximately two thirds of an affiliate's shift is spent providing billable services to patients. Greater than 20% of each shift is spent providing equally important but not reimbursable

  17. Exploring dementia management attitudes in primary care: a key informant survey to primary care physicians in 25 European countries. (United States)

    Petrazzuoli, Ferdinando; Vinker, Shlomo; Koskela, Tuomas H; Frese, Thomas; Buono, Nicola; Soler, Jean Karl; Ahrensberg, Jette; Asenova, Radost; Foguet Boreu, Quintí; Ceyhun Peker, Gülsen; Collins, Claire; Hanževački, Miro; Hoffmann, Kathryn; Iftode, Claudia; Kurpas, Donata; Le Reste, Jean Yves; Lichtwarck, Bjørn; Petek, Davorina; Pinto, Daniel; Schrans, Diego; Streit, Sven; Tang, Eugene Yee Hing; Tatsioni, Athina; Torzsa, Péter; Unalan, Pemra C; van Marwijk, Harm; Thulesius, Hans


    Strategies for the involvement of primary care in the management of patients with presumed or diagnosed dementia are heterogeneous across Europe. We wanted to explore attitudes of primary care physicians (PCPs) when managing dementia: (i) the most popular cognitive tests, (ii) who had the right to initiate or continue cholinesterase inhibitor or memantine treatment, and (iii) the relationship between the permissiveness of these rules/guidelines and PCP's approach in the dementia investigations and assessment. Key informant survey. Primary care practices across 25 European countries. Four hundred forty-five PCPs responded to a self-administered questionnaire. Two-step cluster analysis was performed using characteristics of the informants and the responses to the survey. Two by two contingency tables with odds ratios and 95% confidence intervals were used to assess the association between categorical variables. A multinomial logistic regression model was used to assess the association of multiple variables (age class, gender, and perceived prescription rules) with the PCPs' attitude of "trying to establish a diagnosis of dementia on their own." Discrepancies between rules/guidelines and attitudes to dementia management was found in many countries. There was a strong association between the authorization to prescribe dementia drugs and pursuing dementia diagnostic work-up (odds ratio, 3.45; 95% CI 2.28-5.23). Differing regulations about who does what in dementia management seemed to affect PCP's engagement in dementia investigations and assessment. PCPs who were allowed to prescribe dementia drugs also claimed higher engagement in dementia work-up than PCPs who were not allowed to prescribe.

  18. International variations in primary care physician consultation time: a systematic review of 67 countries. (United States)

    Irving, Greg; Neves, Ana Luisa; Dambha-Miller, Hajira; Oishi, Ai; Tagashira, Hiroko; Verho, Anistasiya; Holden, John


    To describe the average primary care physician consultation length in economically developed and low-income/middle-income countries, and to examine the relationship between consultation length and organisational-level economic, and health outcomes. This is a systematic review of published and grey literature in English, Chinese, Japanese, Spanish, Portuguese and Russian languages from 1946 to 2016, for articles reporting on primary care physician consultation lengths. Data were extracted and analysed for quality, and linear regression models were constructed to examine the relationship between consultation length and health service outcomes. One hundred and seventy nine studies were identified from 111 publications covering 28 570 712 consultations in 67 countries. Average consultation length differed across the world, ranging from 48 s in Bangladesh to 22.5 min in Sweden. We found that 18 countries representing about 50% of the global population spend 5 min or less with their primary care physicians. We also found significant associations between consultation length and healthcare spending per capita, admissions to hospital with ambulatory sensitive conditions such as diabetes, primary care physician density, physician efficiency and physician satisfaction. There are international variations in consultation length, and it is concerning that a large proportion of the global population have only a few minutes with their primary care physicians. Such a short consultation length is likely to adversely affect patient healthcare and physician workload and stress. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  19. Physician workload in primary care: what is the optimal size of practices? A cross-sectional study.

    NARCIS (Netherlands)

    Wensing, M.J.P.; Hombergh, P. van den; Akkermans, R.P.; Doremalen, J.H.M. van; Grol, R.P.T.M.


    OBJECTIVE: To determine the impact of practice size and scope of services on average physician workload in primary care practices in The Netherlands, and to examine the associations between average physician workload, average assistant volume and organisational practice characteristics. METHODS:

  20. Feasibility and validity of the self-administered computerized assessment of mild cognitive impairment with older primary care patients. (United States)

    Tierney, Mary C; Naglie, Gary; Upshur, Ross; Moineddin, Rahim; Charles, Jocelyn; Jaakkimainen, R Liisa


    We investigated whether a validated computerized cognitive test, the Computerized Assessment of Mild Cognitive Impairment (CAMCI), could be independently completed by older primary care patients. We also determined the optimal cut-off for the CAMCI global risk score for mild cognitive impairment against an independent neuropsychological reference standard. All eligible patients aged 65 years and older, seen consecutively over 2 months by 1 family practice of 13 primary care physicians, were invited to participate. Patients with a diagnosis or previous work-up for dementia were excluded. Primary care physicians indicated whether they, the patient, or family had concerns about each patient's cognition. A total of 130 patients with cognitive concerns and a matched sample of 133 without cognitive concerns were enrolled. The CAMCI was individually administered after instructions to work independently. Comments were recorded verbatim. A total of 259 (98.5%) completed the entire CAMCI. Two hundred and forty-one (91.6%) completed it without any questions or after simple acknowledgment of their question. Lack of computer experience was the only patient characteristic that decreased the odds of independent CAMCI completion. These results support the feasibility of using self-administered computerized cognitive tests with older primary care patients, given the increasing reliance on computers by people of all ages. The optimal cut-off score had a sensitivity of 80% and specificity of 74%.

  1. Attitudes of palliative home care physicians towards palliative sedation at home in Italy. (United States)

    Mercadante, Sebastiano; Masedu, Francesco; Mercadante, Alessandro; Marinangeli, Franco; Aielli, Federica


    Information about the attitudes towards palliative sedation (PS) at home is limited. The aim of this survey was to assess the attitudes of palliative care physicians in Italy regarding PS at home. A questionnaire was submitted to a sample of palliative care physicians, asking information about their activity and attitudes towards PS at home. This is a survey of home care physicians in Italy who were involved in end-of-life care decisions at home. One hundred and fifty participants responded. A large heterogeneity of home care organizations that generate some problems was found. Indications, intention and monitoring of PS seem to be appropriate, although some cultural and logistic conditions were limiting the use of PS. Specialized home care physicians are almost involved to start PS at home. Midazolam was seldom available at home and opioids were more frequently used. These data should prompt health care agencies to make a minimal set of drugs easily available for home care. Further research is necessary to compare attitudes in countries with different sociocultural profiles.

  2. A personal letter to an aspiring physician or nurse (or other caring professional). (United States)

    Savett, Laurence A


    In a letter to an aspiring physician or nurse, the author describes some of the important dimensions and timeless values of a fulfilling career in health care, the importance of the professional-patient relationship, ways to make an informed career choice, the guidance provided by sound values, and his response to some of the myths about health care careers.

  3. The primary care physician and Alzheimer's disease: an international position paper.

    NARCIS (Netherlands)

    Villars, H.; Oustric, S.; Andrieu, S.; Baeyens, J.P.; Bernabei, R.; Brodaty, H.; Brummel-Smith, K.; Celafu, C.; Chappell, N.; Fitten, J.; Frisoni, G.; Froelich, L.; Guerin, O.; Gold, G.; Holmerova, I.; Iliffe, S.; Lukas, A.; Melis, R.J.F.; Morley, J.E.; Nies, H.; Nourhashemi, F.; Petermans, J.; Ribera Casado, J.; Rubenstein, L.; Salva, A.; Sieber, C.; Sinclair, A.; Schindler, R.; Stephan, E.; Wong, R.Y.; Vellas, B.


    This paper aims to define the role of the primary care physician (PCP) in the management of Alzheimer's disease (AD) and to propose a model for a work plan. The proposals in this position paper stem from a collaborative work of experts involved in the care of AD patients. It combines evidence from a

  4. Physicians' perceptions about the quality of primary health care services in transitional Albania

    NARCIS (Netherlands)

    Kellici, Neritan; Dibra, Arvin; Mihani, Joana; Kellici, Suela; Burazeri, Genc

    AIM: To date, the available information regarding the quality of primary health care services in Albania is scarce. The aim of our study was to assess the quality of primary health care services in Albania based on physicians' perceptions towards the quality of the services provided to the general

  5. How family physicians address diagnosis and management of depression in palliative care patients.

    NARCIS (Netherlands)

    Warmenhoven, F.C.; Rijswijk, H.C.A.M. van; Hoogstraten, E. van; Spaendonck, K.P.M. van; Lucassen, P.L.B.J.; Prins, J.B.; Vissers, K.; Weel, C. van


    PURPOSE Depression is highly prevalent in palliative care patients. In clinical practice, there is concern about both insufficient and excessive diagnosis and treatment of depression. In the Netherlands, family physicians have a central role in delivering palliative care. We explored variation in

  6. Breast and Cervical Cancer Screening Among Medicaid Beneficiaries: The Role of Physician Payment and Managed Care. (United States)

    Sabik, Lindsay M; Dahman, Bassam; Vichare, Anushree; Bradley, Cathy J


    Medicaid-insured women have low rates of cancer screening. There are multiple policy levers that may influence access to preventive services such as screening, including physician payment and managed care. We examine the relationship between each of these factors and breast and cervical cancer screening among nonelderly nondisabled adult Medicaid enrollees. We combine individual-level data on Medicaid enrollment, demographics, and use of screening services from the Medicaid Analytic eXtract files with data on states' Medicaid-to-Medicare fee ratios and estimate their impact on screening services. Higher physician fees are associated with greater screening for comprehensive managed care enrollees; for enrollees in fee-for-service Medicaid, the findings are mixed. Patient participation in primary care case management is a significant moderator of the relationship between physician fees and the rate of screening, as interactions between enrollee primary care case management status and the Medicaid fee ratio are consistently positive across models of screening.

  7. The physician-administrator as patient: distinctive aspects of medical care. (United States)

    Cappell, Mitchell S


    This article examines distinctive aspects of medical care experienced by a 55-year-old hospitalized for quintuple coronary artery bypass surgery who was also a senior physician-administrator (chief of gastroenterology) at the same hospital. The article describes eight distinctive aspects of administrator-physicians as patients, including special patient treatment; exalted patient expectations by hospital personnel; patient suppression of emotions; patient denial; self-doctoring; job stress contributing to disease; self-sacrifice to achieve better health; and rational medical decisions when not under stress. Health-care workers should recognize how these distinctive aspects of medical care and behavior affect administrator-physicians as patients, in order to mitigate their negative effects, potentiate their positive effects, and optimize the care of these patients.

  8. Non-physician providers of obstetric care in Mexico: Perspectives of physicians, obstetric nurses and professional midwives

    Directory of Open Access Journals (Sweden)

    DeMaria Lisa M


    Full Text Available Abstract Background In Mexico 87% of births are attended by physicians. However, the decline in the national maternal mortality rate has been slower than expected. The Mexican Ministry of Health’s 2009 strategy to reduce maternal mortality gives a role to two non-physician models that meet criteria for skilled attendants: obstetric nurses and professional midwives. This study compares and contrasts these two provider types with the medical model, analyzing perspectives on their respective training, scope of practice, and also their perception and/or experiences with integration into the public system as skilled birth attendants. Methodology This paper synthesizes qualitative research that was obtained as a component of the quantitative and qualitative study that evaluated three models of obstetric care: professional midwives (PM, obstetric nurses (ON and general physicians (GP. A total of 27 individual interviews using a semi-structured guide were carried out with PMs, ONs, GPs and specialists. Interviews were transcribed following the principles of grounded theory, codes and categories were created as they emerged from the data. We analyzed data in ATLAS.ti. Results All provider types interviewed expressed confidence in their professional training and acknowledge that both professional midwives and obstetric nurses have the necessary skills and knowledge to care for women during normal pregnancy and childbirth. The three types of providers recognize limits to their practice, namely in the area of managing complications. We found differences in how each type of practitioner perceived the concept and process of birth and their role in this process. The barriers to incorporation as a model to attend birth faced by PMs and ONs are at the individual, hospital and system level. GPs question their ability and training to handle deliveries, in particular those that become complicated, and the professional midwifery model particularly as it relates to

  9. Cutting out the middleman: physicians can contract directly with employers--a viable alternative to adversarial managed care agreements. (United States)

    Lester, Howard


    HMOs, PPOs, and other managed care "middlemen" control the means by which most physicians do business with employers. As physicians face dwindling reimbursements, greater practice restrictions, and increased pressure to sign adversarial middleman contracts, interest in direct contracting has grown. This article introduces direct contracting as an important alternative to commercial managed care agreements; cites the key advantages and process of direct contracting; and offers practical recommendations for helping physician practices successfully negotiate direct physician/employer agreements.

  10. Physician self-care | Kirby | South African Medical Journal

    African Journals Online (AJOL)

    They make significant sacrifices in family life, sleep, personal time and hobbies to be able to pursue this ideal. Moving away from cure to compassionate care of dying patients, is a paradigm shift. This can be particularly difficult when caring for children with terminal illness. It is easier to accept death in the elderly as it is part ...

  11. Using Behavioral Economics to Design Physician Incentives That Deliver High-Value Care. (United States)

    Emanuel, Ezekiel J; Ubel, Peter A; Kessler, Judd B; Meyer, Gregg; Muller, Ralph W; Navathe, Amol S; Patel, Pankaj; Pearl, Robert; Rosenthal, Meredith B; Sacks, Lee; Sen, Aditi P; Sherman, Paul; Volpp, Kevin G


    Behavioral economics provides insights about the development of effective incentives for physicians to deliver high-value care. It suggests that the structure and delivery of incentives can shape behavior, as can thoughtful design of the decision-making environment. This article discusses several principles of behavioral economics, including inertia, loss aversion, choice overload, and relative social ranking. Whereas these principles have been applied to motivate personal health decisions, retirement planning, and savings behavior, they have been largely ignored in the design of physician incentive programs. Applying these principles to physician incentives can improve their effectiveness through better alignment with performance goals. Anecdotal examples of successful incentive programs that apply behavioral economics principles are provided, even as the authors recognize that its application to the design of physician incentives is largely untested, and many outstanding questions exist. Application and rigorous evaluation of infrastructure changes and incentives are needed to design payment systems that incentivize high-quality, cost-conscious care.

  12. Estimating a reasonable patient panel size for primary care physicians with team-based task delegation. (United States)

    Altschuler, Justin; Margolius, David; Bodenheimer, Thomas; Grumbach, Kevin


    PURPOSE Primary care faces the dilemma of excessive patient panel sizes in an environment of a primary care physician shortage. We aimed to estimate primary care panel sizes under different models of task delegation to nonphysician members of the primary care team. METHODS We used published estimates of the time it takes for a primary care physician to provide preventive, chronic, and acute care for a panel of 2,500 patients, and modeled how panel sizes would change if portions of preventive and chronic care services were delegated to nonphysician team members. RESULTS Using 3 assumptions about the degree of task delegation that could be achieved (77%, 60%, and 50% of preventive care, and 47%, 30%, and 25% of chronic care), we estimated that a primary care team could reasonably care for a panel of 1,947, 1,523, or 1,387 patients. CONCLUSIONS If portions of preventive and chronic care services are delegated to nonphysician team members, primary care practices can provide recommended preventive and chronic care with panel sizes that are achievable with the available primary care workforce.

  13. Addressing the primary care physician shortage in an evolving medical workforce

    Directory of Open Access Journals (Sweden)

    Lakhan Shaheen E


    Full Text Available Abstract Background Primary care physicians have been shown to play an important role in the general health of the communities in which they serve. In spite of their importance, however, there has been a decrease in the number of physicians interested in pursuing primary care fields, while the proportion of specialists continues to increase. The prediction of an overall physician shortage only augments this issue in the US, where this uneven distribution is particularly evident. As such, serious effort to increase the number of practicing primary care physicians is both necessary and beneficial for meeting this country's health care needs. Discussion There are several factors at play which contribute to the decrease in the number of practicing physicians in primary specialties. Lifestyle concerns, such as schedule and income, as well as the lack of prestige associated with this field seem to be among the most prevalent reasons cited for the diminishing interest. Multifaceted concerns such as these, however, are difficult to adequately invalidate; doing so would not only require a great deal research, but also a good deal of time – a resource which is in short supply given the current physician shortage being faced. Thus, a more immediate solution may lie in the increased recruitment and continued support of those individuals who are already associated with primary care service. This is particularly relevant given the Association of American Medical College's goal of increasing medical school enrollment by 15% over the next 10 years. Several groups have been shown to be large contributors to primary care in the US. Here, we focus on three such groups: minority students, International Medical Graduates (IMGs and Osteopathic Physicians (DOs. Although these groups are highly diverse individually, they all share the distinction of being underutilized in regard to the current primary care shortages faced. Thus, through more fully accentuating these

  14. Job satisfaction among primary health care physicians and nurses in Al-madinah Al-munawwara. (United States)

    Al Juhani, Abdullah M; Kishk, Nahla A


    Job satisfaction is the affective orientation that an employee has towards his work. Greater physician satisfaction is associated with greater patient adherence and satisfaction. Nurses' job satisfaction, have great impact on the organizational success. Knowing parts of job dissatisfaction among physicians and nurses is important in forming strategies for retaining them in primary health care (PHC) centers. Therefore, this study aimed at assessing the level of job satisfaction among PHC physicians and nurses in Al- Madina Al- Munawwara. Also, to explore the relationship of their personal and job characteristics with job satisfaction. A descriptive cross- sectional epidemiological approach was adopted. A self completion questionnaire was distributed to physicians and nurses at PHC centers. A multi-dimensional job scale adopted by Traynor and Wade (1993) was modified and used. The studied sample included 445 health care providers, 23.6% were physicians and 76.4% were nurses. Job dissatisfaction was highly encountered where 67.1% of the nurses & 52.4% of physicians were dissatisfied. Professional opportunities, patient care and financial reward were the most frequently encountered domains with which physicians were dissatisfied. The dissatisfying domains for majority of nurses were professional opportunities, workload and appreciation reward. Exploring the relation between demographic and job characteristics with job satisfaction revealed that older, male, non-Saudi, specialists physicians had insignificantly higher mean score of job satisfaction than their counterparts. While older, female, non-Saudi, senior nurses had significantly higher mean score than their counterparts. It is highly recommended to reduce workload for nurses and provision of better opportunities promotional for PHC physicians and nurses.

  15. Physicians and implicit bias: how doctors may unwittingly perpetuate health care disparities. (United States)

    Chapman, Elizabeth N; Kaatz, Anna; Carnes, Molly


    Although the medical profession strives for equal treatment of all patients, disparities in health care are prevalent. Cultural stereotypes may not be consciously endorsed, but their mere existence influences how information about an individual is processed and leads to unintended biases in decision-making, so called "implicit bias". All of society is susceptible to these biases, including physicians. Research suggests that implicit bias may contribute to health care disparities by shaping physician behavior and producing differences in medical treatment along the lines of race, ethnicity, gender or other characteristics. We review the origins of implicit bias, cite research documenting the existence of implicit bias among physicians, and describe studies that demonstrate implicit bias in clinical decision-making. We then present the bias-reducing strategies of consciously taking patients' perspectives and intentionally focusing on individual patients' information apart from their social group. We conclude that the contribution of implicit bias to health care disparities could decrease if all physicians acknowledged their susceptibility to it, and deliberately practiced perspective-taking and individuation when providing patient care. We further conclude that increasing the number of African American/Black physicians could reduce the impact of implicit bias on health care disparities because they exhibit significantly less implicit race bias.

  16. Physicians in health care management: 2. Managing performance: who, what, how and when?


    Lemieux-Charles, L


    Physicians are becoming more involved in performance management as hospitals restructure to increase effectiveness. Although physicians are not hospital employees, they are subject to performance appraisals because the hospitals are accountable to patients and the community for the quality of hospital services. The performance of a health care professional may be appraised by the appropriate departmental manager, by other professionals in a team or program or by peers, based on prior agreemen...

  17. Controlling health costs: physician responses to patient expectations for medical care. (United States)

    Sabbatini, Amber K; Tilburt, Jon C; Campbell, Eric G; Sheeler, Robert D; Egginton, Jason S; Goold, Susan D


    Physicians have dual responsibilities to make medical decisions that serve their patients' best interests but also utilize health care resources wisely. Their ability to practice cost-consciously is particularly challenged when faced with patient expectations or requests for medical services that may be unnecessary. To understand how physicians consider health care resources and the strategies they use to exercise cost-consciousness in response to patient expectations and requests for medical care. Exploratory, qualitative focus groups of practicing physicians were conducted. Participants were encouraged to discuss their perceptions of resource constraints, and experiences with redundant, unnecessary and marginally beneficial services, and were asked about patient requests or expectations for particular services. Sixty-two physicians representing a variety of specialties and practice types participated in nine focus groups in Michigan, Ohio, and Minnesota in 2012 MEASUREMENTS: Iterative thematic content analysis of focus group transcripts Physicians reported making trade-offs between a variety of financial and nonfinancial resources, considering not only the relative cost of medical decisions and alternative services, but the time and convenience of patients, their own time constraints, as well as the logistics of maintaining a successful practice. They described strategies and techniques to educate patients, build trust, or substitute less costly alternatives when appropriate, often adapting their management to the individual patient and clinical environment. Physicians often make nuanced trade-offs in clinical practice aimed at efficient resource use within a complex flow of clinical work and patient expectations. Understanding the challenges faced by physicians and the strategies they use to exercise cost-consciousness provides insight into policy measures that will address physician's roles in health care resource use.

  18. How do high cost-sharing policies for physician care affect total care costs among people with chronic disease? (United States)

    Xin, Haichang; Harman, Jeffrey S; Yang, Zhou


    This study examines whether high cost-sharing in physician care is associated with a differential impact on total care costs by health status. Total care includes physician care, emergency room (ER) visits and inpatient care. Since high cost-sharing policies can reduce needed care as well as unneeded care use, it raises the concern whether these policies are a good strategy for controlling costs among chronically ill patients. This study used the 2007 Medical Expenditure Panel Survey data with a cross-sectional study design. Difference in difference (DID), instrumental variable technique, two-part model, and bootstrap technique were employed to analyze cost data. Chronically ill individuals' probability of reducing any overall care costs was significantly less than healthier individuals (beta = 2.18, p = 0.04), while the integrated DID estimator from split results indicated that going from low cost-sharing to high cost-sharing significantly reduced costs by $12,853.23 more for sick people than for healthy people (95% CI: -$17,582.86, -$8,123.60). This greater cost reduction in total care among sick people likely resulted from greater cost reduction in physician care, and may have come at the expense of jeopardizing health outcomes by depriving patients of needed care. Thus, these policies would be inappropriate in the short run, and unlikely in the long run to control health plans costs among chronically ill individuals. A generous benefit design with low cost-sharing policies in physician care or primary care is recommended for both health plans and chronically ill individuals, to save costs and protect these enrollees' health status.

  19. Non-verbal communication between primary care physicians and older patients: how does race matter? (United States)

    Stepanikova, Irena; Zhang, Qian; Wieland, Darryl; Eleazer, G Paul; Stewart, Thomas


    Non-verbal communication is an important aspect of the diagnostic and therapeutic process, especially with older patients. It is unknown how non-verbal communication varies with physician and patient race. To examine the joint influence of physician race and patient race on non-verbal communication displayed by primary care physicians during medical interviews with patients 65 years or older. Video-recordings of visits of 209 patients 65 years old or older to 30 primary care physicians at three clinics located in the Midwest and Southwest. Duration of physicians' open body position, eye contact, smile, and non-task touch, coded using an adaption of the Nonverbal Communication in Doctor-Elderly Patient Transactions form. African American physicians with African American patients used more open body position, smile, and touch, compared to the average across other dyads (adjusted mean difference for open body position = 16.55, p non-verbal communication with older patients. Its influence is best understood when physician race and patient race are considered jointly.

  20. Physician Charity Care in America: Almost Always an Illusion, Ever More Commercial

    Directory of Open Access Journals (Sweden)

    Bruce D. White


    Full Text Available The first Code of Medical Ethics promulgated by the American Medical Association (AMA in 1847 included a provision that essentially obligated physicians to care for those in their communities who could not afford to pay for professional services. The spirit of that provision remains embodied in today’s Code. However, a “charity care” ethical obligation may not make as much professional sense as it once did. Health care institutions have assumed a much greater role in providing charity care and many physicians are now under legal and quasi-legal obligations to provide care in some cases. Under the recently enacted Affordable Care Act (ACA—if fully implemented—it is theorized that as many as 95% of Americans will be covered by some basic insurance plan. Perhaps today’s physicians should tailor the charity care mandate into a new jacket, which envisions that all doctors share equally in the care for those without adequate means. An individual obligation may have to make way for a more communal one in professional codes. Moreover, it may be wise to consider if there are any lessons to draw from other health care systems (e.g., the Dutch, where questions about charity care still exist within a universal health care system context.

  1. The communication between patient relatives and physicians in intensive care units. (United States)

    Cicekci, Faruk; Duran, Numan; Ayhan, Bunyamin; Arican, Sule; Ilban, Omur; Kara, Iskender; Turkoglu, Melda; Yildirim, Fatma; Hasirci, Ismail; Karaibrahimoglu, Adnan; Kara, Inci


    Patients in intensive care units (ICUs) are often physically unable to communicate with their physicians. Thus, the sharing of information about the on-going treatment of the patients in ICUs is directly related to the communication attitudes governing a patient's relatives and the physician. This study aims to analyze the attitudes displayed by the relatives of patients and the physician with the purpose of determining the communication between the two parties. For data collection, two similar survey forms were created in context of the study; one for the relatives of the patients and one for the ICU physicians. The questionnaire included three sub-dimensions: informing, empathy and trust. The study included 181 patient relatives and 103 ICU physicians from three different cities and six hospitals. Based on the results of the questionnaire, identification of the mutual expectations and substance of the messages involved in the communication process between the ICU patients' relatives and physicians was made. The gender and various disciplines of the physicians and the time of the conversation with the patients' relatives were found to affect the communication attitude towards the patient. Moreover, the age of the patient's relatives, the level of education, the physician's perception, and the contact frequency with the patient when he/she was healthy were also proven to have an impact on the communication attitude of the physician. This study demonstrates the mutual expectations and substance of messages in the informing, empathy and trust sub-dimensions of the communication process between patient relatives and physicians in the ICU. The communication between patient relatives and physicians can be strengthened through a variety of training programs to improve communication skills.

  2. US primary care physicians' opinions about conscientious refusal: a national vignette experiment. (United States)

    Brauer, Simon G; Yoon, John D; Curlin, Farr A


    Previous research has found that physicians are divided on whether they are obligated to provide a treatment to which they object and whether they should refer patients in such cases. The present study compares several possible scenarios in which a physician objects to a treatment that a patient requests, in order to better characterise physicians' beliefs about what responses are appropriate. We surveyed a nationally representative sample of 1504 US primary care physicians using an experimentally manipulated vignette in which a patient requests a clinical intervention to which the patient's physician objects. We used multivariate logistic regression models to determine how vignette and respondent characteristics affected respondent's judgements. Among eligible respondents, the response rate was 63% (896/1427). When faced with an objection to providing treatment, referring the patient was the action judged most appropriate (57% indicated it was appropriate), while few physicians thought it appropriate to provide treatment despite one's objection (15%). The most religious physicians were more likely than the least religious physicians to support refusing to accommodate the patient's request (38% vs 22%, OR=1.75; 95% CI 1.06 to 2.86). This study indicates that US physicians believe it is inappropriate to provide an intervention that violates one's personal or professional standards. Referring seems to be physicians' preferred way of responding to requests for interventions to which physicians object. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  3. Study of relation of continuing medical education to quality of family physicians' care. (United States)

    Dunn, E V; Bass, M J; Williams, J I; Borgiel, A E; MacDonald, P; Spasoff, R A


    A random sample of 120 physicians in Ontario was studied to assess quality of care in primary care and test an hypothesis that quality of care was related to continuing medical education (CME) activities. The quality-of-care scores were obtained by an in-office audit of a random selection of charts. The scores were global scores for charting, prevention, the use of 13 classes of drugs, and care of a two-year period for 182 different diagnoses. There were no relationships between global quality-of-care scores based on these randomly chosen charts and either the type or quantity of the physicians' CME activities. These activities were reading journals, attending rounds, attending scientific conferences, having informal consultations, using audio and video cassettes, and engaging in self-assessment. The implications of these findings are significant for future research in CME and for planners of present CME programs.

  4. The patient-centered medical home neighbor: A primary care physician's view. (United States)

    Sinsky, Christine A


    The American College of Physicians' position paper on the patient-centered medical home neighbor (PCMH-N) extends the work of the patient-centered medical home (PCMH) as a means of improving the delivery of health care. Recognizing that the PCMH does not exist in isolation, the PCMH-N concept outlines expectations for comanagement, communication, and care coordination and broadens responsibility for safe, effective, and efficient care beyond primary care to include physicians of all specialties. As such, it is a fitting follow-up to the PCMH and moves further down the road toward improved care for complex patients. Yet, there is more work to be done. Truly transforming the U.S. health care system around personalized medical homes embedded in highly functional medical neighborhoods will require better staffing models; more robust electronic information tools; aligned incentives for quality and efficiency within payment and regulatory policies; and a culture of greater engagement of patients, their families, and communities.

  5. Does trust of patients in their physician predict loyalty to the health care insurer? The Israeli case study. (United States)

    Gabay, Gillie


    This pioneer study tests the relationship between patients' trust in their physicians and patients' loyalty to their health care insurers. This is a cross-sectional study using a representative sample of patients from all health care insurers with identical health care plans. Regression analyses and Baron and Kenny's model were used to test the study model. Patient trust in the physician did not predict loyalty to the insurer. Loyalty to the physician did not mediate the relationship between trust in the physician and loyalty to the insurer. Satisfaction with the physician was the only predictor of loyalty to the insurer.

  6. Employed family physician satisfaction and commitment to their practice, work group, and health care organization. (United States)

    Karsh, Ben-Tzion; Beasley, John W; Brown, Roger L


    Test a model of family physician job satisfaction and commitment. Data were collected from 1,482 family physicians in a Midwest state during 2000-2001. The sampling frame came from the membership listing of the state's family physician association, and the analyzed dataset included family physicians employed by large multispecialty group practices. A cross-sectional survey was used to collect data about physician working conditions, job satisfaction, commitment, and demographic variables. The response rate was 47 percent. Different variables predicted the different measures of satisfaction and commitment. Satisfaction with one's health care organization (HCO) was most strongly predicted by the degree to which physicians perceived that management valued and recognized them and by the extent to which physicians perceived the organization's goals to be compatible with their own. Satisfaction with one's workgroup was most strongly predicted by the social relationship with members of the workgroup; satisfaction with one's practice was most strongly predicted by relationships with patients. Commitment to one's workgroup was predicted by relationships with one's workgroup. Commitment to one's HCO was predicted by relationships with management of the HCO. Social relationships are stronger predictors of employed family physician satisfaction and commitment than staff support, job control, income, or time pressure.

  7. Use of humour in primary care: different perceptions among patients and physicians. (United States)

    Granek-Catarivas, M; Goldstein-Ferber, S; Azuri, Y; Vinker, S; Kahan, E


    (1) To explore the frequency with which humorous behaviour and statements occur in family medicine practice in Israel, and (2) to quantitatively assess the correlation between the subjective perceptions of humour in medical encounters between patients and physicians. In a cross sectional study, two populations (doctors and patients) were surveyed with paired structured questionnaires completed immediately after primary care practice visits. Two hundred and fifty consecutive encounters from 15 practices were sampled. The physician questionnaire was self administered, and patient questionnaire was administered by a trained research assistant. A mean of 16.7 questionnaires was completed per physician (range 6-20). The physicians reported having used some humour in only 95 encounters (38%), whereas almost 60% of patients agreed with the statement, "The doctor used some humour during the visit". At the same time, for specific encounters, the agreement between patients' perception and physicians' perceptions on the use of humour, although not completely by chance (p = 0.04), is low (kappa = 0.115). Patient characteristics (age, education, gender, family status, mother tongue, self perceived heath status, stress, mood, and expectations) were not related to the degree of agreement between the patients' and physicians' perceptions. Humour was used in a large proportion of encounters, independently of patient characteristics. Patients seem to be more sensitised to humour than physicians, probably because of their high stress level during medical encounters. Cultural differences may also play a part. Physicians should be made aware of this magnifying effect, and the issue should be discussed in medical schools.

  8. More than half the families of mobile intensive care unit patients experience inadequate communication with physicians. (United States)

    Debaty, Guillaume; Ageron, François-Xavier; Minguet, Laetitia; Courtiol, Guillaume; Escallier, Christophe; Henniche, Adeline; Maignan, Maxime; Briot, Raphaël; Carpentier, Françoise; Savary, Dominique; Labarere, José; Danel, Vincent


    This study aimed to assess comprehension by family members of the patient's severity in the prehospital setting. We conducted a cross-sectional study in four mobile intensive care units (ICUs, medicalized ambulances) in France from June to October 2012. Nurses collected data on patients, patient's relatives, and mobile ICU physicians. For each patient, one relative and one physician independently rated the patient's severity using a simplified version of the Clinical Classification of Out-of-Hospital Emergency Patients scale (CCMS). Relatives were also asked to assess their interview with the physician. The primary outcome was agreement between the relative's and physician's ratings of the patient's severity. Data were available for 184 patients, their relatives, and mobile ICU physicians. Full and partial agreement between relatives and physicians regarding the patient's severity was found for 79 (43%) and 121 (66%) cases, respectively [weighted kappa = 0.32 (95% confidence interval, CI, 0.23-0.42)]. Relatives overestimated the patient's severity assessed by the physician [6 (5-8) vs. 4 (3-7), p communicated by mobile ICU physicians.

  9. Physician Practice Participation in Accountable Care Organizations: The Emergence of the Unicorn (United States)

    Shortell, Stephen M; McClellan, Sean R; Ramsay, Patricia P; Casalino, Lawrence P; Ryan, Andrew M; Copeland, Kennon R


    Objective To provide the first nationally based information on physician practice involvement in ACOs. Data Sources/Study Setting Primary data from the third National Survey of Physician Organizations (January 2012–May 2013). Study Design We conducted a 40-minute phone survey in a sample of physician practices. A nationally representative sample of practices was surveyed in order to provide estimates of organizational characteristics, care management processes, ACO participation, and related variables for four major chronic illnesses. Data Collection/Extraction Methods We evaluated the associations between ACO participation, organizational characteristics, and a 25-point index of patient-centered medical home processes. Principal Findings We found that 23.7 percent of physician practices (n = 280) reported joining an ACO; 15.7 percent (n = 186) were planning to become involved within the next 12 months and 60.6 percent (n = 717) reported no involvement and no plans to become involved. Larger practices, those receiving patients from an IPA and/or PHO, those that were physician-owned versus hospital/health system-owned, those located in New England, and those with greater patient-centered medical home (PCMH) care management processes were more likely to have joined an ACO. Conclusions Physician practices that are currently participating in ACOs appear to be relatively large, or to be members of an IPA or PHO, are less likely to be hospital-owned and are more likely to use more care management processes than nonparticipating practices. PMID:24628449

  10. Physician practice participation in accountable care organizations: the emergence of the unicorn. (United States)

    Shortell, Stephen M; McClellan, Sean R; Ramsay, Patricia P; Casalino, Lawrence P; Ryan, Andrew M; Copeland, Kennon R


    To provide the first nationally based information on physician practice involvement in ACOs. Primary data from the third National Survey of Physician Organizations (January 2012-May 2013). We conducted a 40-minute phone survey in a sample of physician practices. A nationally representative sample of practices was surveyed in order to provide estimates of organizational characteristics, care management processes, ACO participation, and related variables for four major chronic illnesses. We evaluated the associations between ACO participation, organizational characteristics, and a 25-point index of patient-centered medical home processes. We found that 23.7 percent of physician practices (n = 280) reported joining an ACO; 15.7 percent (n = 186) were planning to become involved within the next 12 months and 60.6 percent (n = 717) reported no involvement and no plans to become involved. Larger practices, those receiving patients from an IPA and/or PHO, those that were physician-owned versus hospital/health system-owned, those located in New England, and those with greater patient-centered medical home (PCMH) care management processes were more likely to have joined an ACO. Physician practices that are currently participating in ACOs appear to be relatively large, or to be members of an IPA or PHO, are less likely to be hospital-owned and are more likely to use more care management processes than nonparticipating practices. © Health Research and Educational Trust.

  11. Barriers to optimal care between physicians and lesbian, gay, bisexual, transgender, and questioning adolescent patients. (United States)

    Kitts, Robert Li


    The objective of this article was to identify barriers to optimal care between physicians and LGBTQ (lesbian, gay, bisexual, transgender, and questioning) adolescents. To this end, 464 anonymous, self-administered surveys were distributed in 2003 to residents and attending physicians in pediatrics, internal medicine, obstetrics-gynecology, psychiatry, emergency medicine, and family practice at Upstate Medical University. The survey included questions pertaining to practice, knowledge, and attitude pertaining to lesbian, gay, transgender, or questioning (LGBTQ) adolescents. One hundred eight four surveys were returned. The majority of physicians would not regularly discuss sexual orientation, sexual attraction, or gender identity while taking a sexual history from a sexually active adolescent. As well, the majority of physicians would not ask patients about sexual orientation if an adolescent presented with depression, suicidal thoughts, or had attempted suicide. If an adolescent stated that he or she was not sexually active, 41% of physicians reported that they would not ask additional sexual health-related questions. Only 57% agreed to an association between being a LGBTQ adolescent and suicide. The majority of physicians did not believe that they had all the skills they needed to address issues of sexual orientation with adolescents, and that sexual orientation should be addressed more often with these patients and in the course of training. This study concludes that barriers in providing optimal care for LGBTQ adolescents can be found with regard to practice, knowledge, and attitude regardless of medical field and other demographics collected. Opportunities exist to enhance care for LGBTQ adolescents.

  12. Factors and outcomes in primary care physician retention in rural ...

    African Journals Online (AJOL)


    2 ... that will reduce disparities and increase access to quality health care. ... in the specialties of family medicine (58%), general internal medicine (53%) .... satisfaction was lack of shopping or restaurants (15%). However, 80% ...

  13. Physician attitudes regarding pregnancy, fertility care, and assisted reproductive technologies for HIV-infected individuals and couples. (United States)

    Yudin, Mark H; Money, Deborah M; Cheung, Matthew C; Loutfy, Mona R


    Family and pregnancy planning are important for HIV-infected individuals and couples. There is a paucity of data regarding physician attitudes with respect to reproduction in this population, but some evidence suggests that attitudes can influence the information, advice, and services they will provide. To determine physician attitudes toward pregnancy, fertility care, and access to assisted reproductive technologies for HIV-infected individuals, and to determine whether attitudes differed based on specific physician characteristics. A survey was sent electronically to obstetrician/gynecologists and infectious disease specialists in Canada. Items were grouped into 5 key domains: physician demographics, physician attitudes toward pregnancy and adoption, physician attitudes toward fertility care, physician attitudes toward assisted reproductive technology, and challenges for an HIV-infected population. Attitudes were determined based on answers to individual questions and also for each domain. Univariate and logistic regression analyses were used to determine the influence of specific physician characteristics on attitudes. Completed surveys were received from 165 physicians. Most had positive attitudes regarding pregnancy or adoption (89%), fertility care (72%), and assisted reproductive technology (79%). In multivariate analyses, having cared for HIV-infected patients was significantly associated with having a positive attitude toward fertility care or assisted reproductive technology. In this national survey of Canadian physicians, most had positive attitudes toward pregnancy, adoption, fertility care, and use of assisted reproductive technology among HIV-infected persons. Physicians who had cared for HIV-infected individuals in the past were more likely to have positive attitudes than those who had not.

  14. Euthanasia and physician-assisted suicide: A white paper from the European Association for Palliative Care. (United States)

    Radbruch, Lukas; Leget, Carlo; Bahr, Patrick; Müller-Busch, Christof; Ellershaw, John; de Conno, Franco; Vanden Berghe, Paul


    In recognition of the ongoing discussion on euthanasia and physician-assisted suicide, the Board of Directors of the European Association for Palliative Care commissioned this white paper from the palliative care perspective. This white paper aims to provide an ethical framework for palliative care professionals on euthanasia and physician-assisted suicide. It also aims to provide an overview on the available evidence as well as a discourse of ethical principles related to these issues. Starting from a 2003 European Association for Palliative Care position paper, 21 statements were drafted and submitted to a five-round Delphi process A panel with 17 experts commented on the paper in round 1. Board members of national palliative care or hospice associations that are collective members of European Association for Palliative Care were invited to an online survey in rounds 2 and 3. The expert panel and the European Association for Palliative Care board members participated in rounds 4 and 5. This final version was adopted as an official position paper of the European Association for Palliative Care in April 2015. Main topics of the white paper are concepts and definitions of palliative care, its values and philosophy, euthanasia and physician-assisted suicide, key issues on the patient and the organizational level. The consensus process confirmed the 2003 European Association for Palliative Care white paper and its position on the relationship between palliative care and euthanasia and physician-assisted suicide. The European Association for Palliative Care feels that it is important to contribute to informed public debates on these issues. Complete consensus seems to be unachievable due to incompatible normative frameworks that clash. © The Author(s) 2015.

  15. Acceptance of New Medicaid Patients by Primary Care Physicians and Experiences with Physician Availability among Children on Medicaid or the Children's Health Insurance Program (United States)

    Decker, Sandra L


    Objective To estimate the relationship between physicians' acceptance of new Medicaid patients and access to health care. Data Sources The National Ambulatory Medical Care Survey (NAMCS) Electronic Health Records Survey and the National Health Interview Survey (NHIS) 2011/2012. Study Design Linear probability models estimated the relationship between measures of experiences with physician availability among children on Medicaid or the Children's Health Insurance Program (CHIP) from the NHIS and state-level estimates of the percent of primary care physicians accepting new Medicaid patients from the NAMCS, controlling for other factors. Principal Findings Nearly 16 percent of children with a significant health condition or development delay had a doctor's office or clinic indicate that the child's health insurance was not accepted in states with less than 60 percent of physicians accepting new Medicaid patients, compared to less than 4 percent in states with at least 75 percent of physicians accepting new Medicaid patients. Adjusted estimates and estimates for other measures of access to care were similar. Conclusions Measures of experiences with physician availability for children on Medicaid/CHIP were generally good, though better in states where more primary care physicians accepted new Medicaid patients. PMID:25683869

  16. Who steers the ship? Rural family physicians' views on collaborative care models for patients with dementia. (United States)

    Kosteniuk, Julie; Morgan, Debra; Innes, Anthea; Keady, John; Stewart, Norma; D'Arcy, Carl; Kirk, Andrew


    Little is known about the views of rural family physicians (FPs) regarding collaborative care models for patients with dementia. The study aims were to explore FPs' views regarding this issue, their role in providing dementia care, and the implications of providing dementia care in a rural setting. This study employed an exploratory qualitative design with a sample of 15 FPs. All rural FPs indicated acceptance of collaborative models. The main disadvantages of practicing rural were accessing urban-based health care and related services and a shortage of local health care resources. The primary benefit of practicing rural was FPs' social proximity to patients, families, and some health care workers. Rural FPs provided care for patients with dementia that took into account the emotional and practical needs of caregivers and families. FPs described positive and negative implications of rural dementia care, and all were receptive to models of care that included other health care professionals.

  17. Use of tobacco and alcohol by Swiss primary care physicians: a cross-sectional survey

    Directory of Open Access Journals (Sweden)

    Künzi Beat


    Full Text Available Abstract Background Health behaviours among doctors has been suggested to be an important marker of how harmful lifestyle behaviours are perceived. In several countries, decrease in smoking among physicians was spectacular, indicating that the hazard was well known. Historical data have shown that because of their higher socio-economical status physicians take up smoking earlier. When the dangers of smoking become better known, physicians began to give up smoking at a higher rate than the general population. For alcohol consumption, the situation is quite different: prevalence is still very high among physicians and the dangers are not so well perceived. To study the situation in Switzerland, data of a national survey were analysed to determine the prevalence of smoking and alcohol drinking among primary care physicians. Methods 2'756 randomly selected practitioners were surveyed to assess subjective mental and physical health and their determinants, including smoking and drinking behaviours. Physicians were categorised as never smokers, current smokers and former smokers, as well as non drinkers, drinkers (AUDIT-C Results 1'784 physicians (65% responded (men 84%, mean age 51 years. Twelve percent were current smokers and 22% former smokers. Sixty six percent were drinkers and 30% at risk drinkers. Only 4% were never smokers and non drinkers. Forty eight percent of current smokers were also at risk drinkers and 16% of at risk drinkers were also current smokers. Smoking and at risk drinking were more frequent among men, middle aged physicians and physicians living alone. When compared to a random sample of the Swiss population, primary care physicians were two to three times less likely to be active smokers (12% vs. 30%, but were more likely to be drinkers (96% vs. 78%, and twice more likely to be at risk drinkers (30% vs. 15%. Conclusion The prevalence of current smokers among Swiss primary care physicians was much lower than in the general

  18. Physician Communication in Pediatric End-of-Life Care: A Simulation Study. (United States)

    Bateman, Lori Brand; Tofil, Nancy M; White, Marjorie Lee; Dure, Leon S; Clair, Jeffrey Michael; Needham, Belinda L


    The objective of this exploratory study is to describe communication between physicians and the actor parent of a standardized 8-year-old patient in respiratory distress who was nearing the end of life. Thirteen pediatric emergency medicine and pediatric critical care fellows and attendings participated in a high-fidelity simulation to assess physician communication with an actor-parent. Fifteen percent of the participants decided not to initiate life-sustaining technology (intubation), and 23% of participants offered alternatives to life-sustaining care, such as comfort measures. Although 92% of the participants initiated an end-of-life conversation, the quality of that discussion varied widely. Findings indicate that effective physician-parent communication may not consistently occur in cases involving the treatment of pediatric patients at the end of life in emergency and critical care units. The findings in this study, particularly that physician-parent end-of-life communication is often unclear and that alternatives to life-sustaining technology are often not offered, suggest that physicians need more training in both communication and end-of-life care. © The Author(s) 2015.

  19. Moral distress, autonomy and nurse-physician collaboration among intensive care unit nurses in Italy. (United States)

    Karanikola, Maria N K; Albarran, John W; Drigo, Elio; Giannakopoulou, Margarita; Kalafati, Maria; Mpouzika, Meropi; Tsiaousis, George Z; Papathanassoglou, Elizabeth D E


    To explore the level of moral distress and potential associations between moral distress indices and (1) nurse-physician collaboration, (2) autonomy, (3) professional satisfaction, (4) intention to resign, and (5) workload among Italian intensive care unit nurses. Poor nurse-physician collaboration and low autonomy may limit intensive care unit nurses' ability to act on their moral decisions. A cross-sectional correlational design with a sample of 566 Italian intensive care unit nurses. The intensity of moral distress was 57.9 ± 15.6 (mean, standard deviation) (scale range: 0-84) and the frequency of occurrence was 28.4 ± 12.3 (scale range: 0-84). The mean score of the severity of moral distress was 88.0 ± 44 (scale range: 0-336). The severity of moral distress was associated with (1) nurse-physician collaboration and dissatisfaction on care decisions (r = -0.215, P intention to resign (r = 0.244, P intention of nurses to resign (r = -0. 209, P intention to resign, whereas poor nurse-physician collaboration appears to be a pivotal factor accounting for nurses' moral distress. Enhancement of nurse-physician collaboration and nurses' participation in end-of-life decisions seems to be a managerial task that could lead to the alleviation of nurses' moral distress and their retention in the profession. © 2013 John Wiley & Sons Ltd.

  20. Physician self-referral for imaging and the cost of chronic care for Medicare beneficiaries. (United States)

    Hughes, Danny R; Sunshine, Jonathan H; Bhargavan, Mythreyi; Forman, Howard


    As the cost of both chronic care and diagnostic imaging continue to rise, it is important to consider methods of cost containment in these areas. Therefore, it seems important to study the relationship between self-referral for imaging and the cost of care of chronic illnesses. Previous studies, mostly of acute illnesses, have found self-referral increases utilization and, thus, probably imaging costs. To evaluate the relationship between physician self-referral for imaging and the cost of episodes of chronic care. Using Medicare's 5% Research Identifiable Files for 2004 to 2007, episodes of care were constructed for 32 broad chronic conditions using the Symmetry Episode Treatment Grouper. Using multivariate regression, we evaluated the association between whether the treating physician self-referred for imaging and total episode cost, episode imaging cost, and episode nonimaging cost. Analyses were controlled for patient characteristics (eg, age and general health status), the condition's severity, and treating physician specialty. Self-referral in imaging was significantly (P nonimaging costs were much more often significantly higher (in 24 combinations) with self-referral than being lower (in 4 combinations). We find broad evidence that physician self-referral for imaging is associated with significantly and substantially higher chronic care costs. Unless self-referral has empirically demonstrable benefits, curbing self-referral may be an appropriate route to containing chronic care costs.

  1. Perceptions of substance use, treatment options and training needs among Iranian primary care physicians

    Directory of Open Access Journals (Sweden)

    Dolan Kate A


    Full Text Available Abstract In order to be optimally effective, continuing training programmes for health-care professionals need to be tailored so that they target specific knowledge deficits, both in terms of topic content and appropriate intervention strategies. A first step in designing tailored treatment programmes is to identify the characteristics of the relevant health-care professional group, their current levels of content and treatment knowledge, the estimated prevalence of drug and alcohol problems among their patients and their preferred options for receiving continuing education and training. This study reports the results of a survey of 53 primary care physicians working in Iran. The majority were male, had a mean age of 44 years and saw approximately 94 patients per week. In terms of their patients' drug use, primary care physicians thought most patients with a substance use problem were male, women were most likely to use tobacco (52%, opium (32% and marijuana/hashish and young people were most likely to use tobacco, alcohol, marijuana and heroin. Counselling and nicotine patches were the treatments most commonly provided. Although the majority (55% reported referring patients to other services, more than a third did not. Most primary care physicians reported being interested in attending further training on substance abuse issues. The implications of these data for ongoing education and training of primary care physicians in Iran are discussed.

  2. [Social change in the physician's role and medical practice caused by managed care in Switzerland]. (United States)

    Meyer, P C; Denz, M D


    Switzerland is the first European country where health maintenance organizations (HMOs) characterised by capitation (per capita lumpsum) and gatekeeping were implemented according to the HMO staff model known in the USA. The development of managed health care in Switzerland relies on the belief that adequate economic incentives and competition result in cost reduction and high quality health care. Whether this is true or not--in any case the deregulation of legally accepted forms of health insurance and managed care result in profound changes in the Swiss health care system. Observations are made by using expert interviews and analysis of documents. The implementation of managed care induces socio-cultural changes of the medical profession which are as profound as the induced economic changes. We discuss conflicts of interests among physicians using four main dimensions of conflict: (1) control, (2) monopolization, (3) valuation, and (4) specialization. In the HMOs we observe pronounced conflicts of the physicians' role. The changes of the physicians' role in HMOs is on the one hand the result of new duties. On the other hand it expresses strategies of coping with the role conflict between the main clinical duties and the new obligation to control cost and to monitor treatment via gatekeeping. In HMOs the teamwork of doctors and the quality control of care promotes the satisfaction of physicians with their work, however, it can also have dysfunctional effects.

  3. Physician satisfaction with a critical care clinical information system using a multimethod evaluation of usability. (United States)

    Hudson, Darren; Kushniruk, Andre; Borycki, Elizabeth; Zuege, Danny J


    Physician satisfaction with electronic medical records has often been poor. Usability has frequently been identified as a source for decreased satisfaction. While surveys can identify many issues, and are logistically easier to administer, they may miss issues identified using other methods This study sought to understand the level of physician satisfaction and usability issues associated with a critical care clinical information system (eCritical Alberta) implemented throughout the province of Alberta, Canada. All critical care attending physicians using the system were invited to participate in an online survey. Questions included components of the User Acceptance of Information Technology and Usability Questionnaire as well as free text feedback on system components. Physicians were also invited to participate in a think aloud test using simulated scenarios. The transcribed think aloud text and questionnaire were subjected to textual analysis. 82% of all eligible physicians completed the on-line survey (n = 61). Eight physicians were invited and seven completed the think aloud test. Overall satisfaction with the system was moderate. Usability was identified as a significant factor contributing to satisfaction. The major usability factors identified were system response time and layout. The think aloud component identified additional factors beyond those identified in the on-line survey. This study found a modestly high level of physician satisfaction with a province-wide clinical critical care information system. Usability continues to be a significant factor in physician satisfaction. Using multiple methods of evaluation can capture the benefits of a large sample size and deeper understanding of the issues. Copyright © 2018 Elsevier B.V. All rights reserved.

  4. Physicians' perceptions of capacity building for managing chronic disease in seniors using integrated interprofessional care models. (United States)

    Lee, Linda; Heckman, George; McKelvie, Robert; Jong, Philip; D'Elia, Teresa; Hillier, Loretta M


    To explore the barriers to and facilitators of adapting and expanding a primary care memory clinic model to integrate care of additional complex chronic geriatric conditions (heart failure, falls, chronic obstructive pulmonary disease, and frailty) into care processes with the goal of improving outcomes for seniors. Mixed-methods study using quantitative (questionnaires) and qualitative (interviews) methods. Ontario. Family physicians currently working in primary care memory clinic teams and supporting geriatric specialists. Family physicians currently working in memory clinic teams (n = 29) and supporting geriatric specialists(n = 9) were recruited as survey participants. Interviews were conducted with memory clinic lead physicians (n = 16).Statistical analysis was done to assess differences between family physician ratings and geriatric specialist ratings related to the capacity for managing complex chronic geriatric conditions, the role of interprofessional collaboration within primary care, and funding and staffing to support geriatric care. Results from both study methods were compared to identify common findings. Results indicate overall support for expanding the memory clinic model to integrate care for other complex conditions. However, the current primary care structure is challenged to support optimal management of patients with multiple comorbidities, particularly as related to limited funding and staffing resources. Structured training, interprofessional teams, and an active role of geriatric specialists within primary care were identified as important facilitators. The memory clinic model, as applied to other complex chronic geriatric conditions, has the potential to build capacity for high-quality primary care, improve health outcomes,promote efficient use of health care resources, and reduce healthcare costs.

  5. The Relationship between Child Care Subsidies and Children's Cognitive Development (United States)

    Hawkinson, Laura E.; Griffen, Andrew S.; Dong, Nianbo; Maynard, Rebecca A.


    Child care subsidies help low-income families pay for child care while parents work or study. Few studies have examined the effects of child care subsidy use on child development, and no studies have done so controlling for prior cognitive skills. We use rich, longitudinal data from the ECLS-B data set to estimate the relationship between child…

  6. Differences in cardiovascular disease risk factor management in primary care by sex of physician and patient. (United States)

    Tabenkin, Hava; Eaton, Charles B; Roberts, Mary B; Parker, Donna R; McMurray, Jerome H; Borkan, Jeffrey


    The purpose of this study was to evaluate differences in the management of cardiovascular disease (CVD) risk factors based upon the sex of the patient and physician and their interaction in primary care practice. We evaluated CVD risk factor management in 4,195 patients cared for by 39 male and 16 female primary care physicians in 30 practices in southeastern New England. Many of the sex-based differences in CVD risk factor management on crude analysis are lost once adjusted for confounding factors found at the level of the patient, physician, and practice. In multilevel adjusted analyses, styles of CVD risk factor management differed by the sex of the physician, with more female physicians documenting diet and weight loss counseling for hypertension (odds ratio [OR] = 2.22; 95% confidence interval [CI], 1.12-4.40) and obesity (OR = 2.14; 95% CI, 1.30-3.51) and more physical activity counseling for obesity (OR = 2.03; 95% CI, 1.30-3.18) and diabetes (OR = 6.55; 95% CI, 2.01-21.33). Diabetes management differed by the sex of the patient, with fewer women receiving glucose-lowering medications (OR = 0.49; 95% CI, 0.25-0.94), angiotensin-converting enzyme inhibitor therapy (OR = 0.39; 95% CI, 0.22-0.72), and aspirin prophylaxis (OR = 0.30; 95% CI, 0.15-0.58). Quality of care as measured by patients meeting CVD risk factors treatment goals was similar regardless of the sex of the patient or physician. Selected differences were found in the style of CVD risk factor management by sex of physician and patient.

  7. Evidence-based medicine in primary care: qualitative study of family physicians

    Directory of Open Access Journals (Sweden)

    Dantas Guilherme


    Full Text Available Abstract Background The objectives of this study were: a to examine physician attitudes to and experience of the practice of evidence-based medicine (EBM in primary care; b to investigate the influence of patient preferences on clinical decision-making; and c to explore the role of intuition in family practice. Method Qualitative analysis of semi-structured interviews of 15 family physicians purposively selected from respondents to a national survey on EBM mailed to a random sample of Canadian family physicians. Results Participants mainly welcomed the promotion of EBM in the primary care setting. A significant number of barriers and limitations to the implementation of EBM were identified. EBM is perceived by some physicians as a devaluation of the 'art of medicine' and a threat to their professional/clinical autonomy. Issues regarding the trustworthiness and credibility of evidence were of great concern, especially with respect to the influence of the pharmaceutical industry. Attempts to become more evidence-based often result in the experience of conflicts. Patient factors exert a powerful influence on clinical decision-making and can serve as trumps to research evidence. A widespread belief that intuition plays a vital role in primary care reinforced views that research evidence must be considered alongside other factors such as patient preferences and the clinical judgement and experience of the physician. Discussion Primary care physicians are increasingly keen to consider research evidence in clinical decision-making, but there are significant concerns about the current model of EBM. Our findings support the proposed revisions to EBM wherein greater emphasis is placed on clinical expertise and patient preferences, both of which remain powerful influences on physician behaviour.

  8. Evidence-based medicine in primary care: qualitative study of family physicians. (United States)

    Tracy, C Shawn; Dantas, Guilherme Coelho; Upshur, Ross E G


    The objectives of this study were: a) to examine physician attitudes to and experience of the practice of evidence-based medicine (EBM) in primary care; b) to investigate the influence of patient preferences on clinical decision-making; and c) to explore the role of intuition in family practice. Qualitative analysis of semi-structured interviews of 15 family physicians purposively selected from respondents to a national survey on EBM mailed to a random sample of Canadian family physicians. Participants mainly welcomed the promotion of EBM in the primary care setting. A significant number of barriers and limitations to the implementation of EBM were identified. EBM is perceived by some physicians as a devaluation of the 'art of medicine' and a threat to their professional/clinical autonomy. Issues regarding the trustworthiness and credibility of evidence were of great concern, especially with respect to the influence of the pharmaceutical industry. Attempts to become more evidence-based often result in the experience of conflicts. Patient factors exert a powerful influence on clinical decision-making and can serve as trumps to research evidence. A widespread belief that intuition plays a vital role in primary care reinforced views that research evidence must be considered alongside other factors such as patient preferences and the clinical judgement and experience of the physician. Primary care physicians are increasingly keen to consider research evidence in clinical decision-making, but there are significant concerns about the current model of EBM. Our findings support the proposed revisions to EBM wherein greater emphasis is placed on clinical expertise and patient preferences, both of which remain powerful influences on physician behaviour.

  9. Burnout of Physicians Working in Primary Health Care Centers under Ministry of Health Jeddah, Saudi Arabia. (United States)

    Bawakid, Khalid; Abdulrashid, Ola; Mandoura, Najlaa; Shah, Hassan Bin Usman; Ibrahim, Adel; Akkad, Noura Mohammad; Mufti, Fauad


    Introduction The levels of physicians' job satisfaction and burnout directly affect their professionalism, punctuality, absenteeism, and ultimately, patients' care. Despite its crucial importance, little is known about professional burnout of the physicians in Saudi Arabia. The objectives of this research are two-fold: (1) To assess the prevalence of burnout in physicians working in primary health care centers under Ministry of Health; and (2) to find the modifiable factors which can decrease the burnout ratio. Methodology Through a cross-sectional study design, a representative sample of the physicians working in primary health care centers (PHCCs) Jeddah (n=246) was randomly selected. The overall burnout level was assessed using the validated abbreviated Maslach burnout inventory (aMBI) questionnaire. It measures the overall burnout prevalence based on three main domains i.e., emotional exhaustion, depersonalization, and personal accomplishment. Independent sample T-test, analysis of variance (ANOVA), and multivariate regression analysis were performed using Statistical Package for the Social Sciences (SPSS Version 22, IBM, Armonk, NY). Results Overall, moderate to high burnout was prevalent in 25.2% of the physicians. Emotional exhaustion was noted in 69.5%. Multivariate regression analysis showed that patient pressure/violence (p burnout. The patient's pressure/violence was the only significant independent predictor of overall burnout. Conclusion Emotional exhaustion is the most prominent feature of overall burnout in the physicians of primary health care centers. The main reasons include patient's pressure/violence, unorganized patient flow, less cooperative colleague doctors, fewer support services at the PHCCs, more paperwork, and less cooperative colleagues. Addressing these issues could lead to a decrease in physician's burnout.

  10. [Shortage of physicians in anaesthesiology and intensive care medicine - Causes, consequences and solutions]. (United States)

    Papenfuß, Tim; Roch, Carmen


    74% of all hospitals had vacant positions in 2011, also departments of anaesthesiology and intensive care medicine. More than 50% of these departments work with locums. There are couple of reasons for the shortage of physicians. The consequences in anaesthesiology and intensive care medicine can result in qualitative and financial loss. To solve the shortage of physicians one has to solve the reasons. Main reasons are increasing feminization of medical profession and part-time-work, work-life-balance and a poor specialised education. © Georg Thieme Verlag Stuttgart · New York.

  11. Addressing domestic violence in primary care: what the physician ...

    African Journals Online (AJOL)


    Mar 14, 2014 ... stance abuse, suicidal behavior, somatizing disorders, eating disorders, and ... anxiety disorders, and PTSD are at a higher risk of experiencing adult ... reported by mental health and primary care professionals. (29) included ... about the nature and course of DV and assessing the level of readiness to ...

  12. Are primary care physicians equipped enough to act as first ...

    African Journals Online (AJOL)

    Background: Prompt and appropriate management of dental trauma has been shown to significantly improve the prognosis of the resulting injuries in numerous cases. Frequently it is other health professionals that provide emergency care following traumatic dental injuries including tooth avulsion. The objective of this study ...

  13. Comparison of Attitude of Primary Health Care Physicians and ...

    African Journals Online (AJOL)

    Background: Domestic violence (DV) against women has increased during the past few years and became an important public health problem. Personal values and beliefs of primary health care workers can affect both diagnostic and management procedures adopted to deal with battered women. Objectives: The current ...

  14. Physician Perspectives on Palliative Care for Children With Neuroblastoma: An International Context. (United States)

    Balkin, Emily M; Thompson, Daria; Colson, K Ellicott; Lam, Catherine G; Matthay, Katherine K


    Studies have shown that children with cancer globally lack access to palliative care. Little is known regarding physicians' perceptions of palliative care, treatment access, and self-reported competence in providing palliative care. Members of the Global Neuroblastoma Network (online tumor board) were surveyed. Eighty-three respondents met inclusion criteria; 53 (64%) completed the survey. Most respondents trained in high-income countries (HIC) but practice in low- and middle-income countries (LMIC), and care for more than five patients with neuroblastoma annually. WHO Essential Medicines in palliative care varied in availability, with incomplete access across LMIC centers. Nonpharmacologic therapies were inconsistently available. Contrary to international definitions, 17% of respondents inappropriately considered palliative care as that initiated only after curative therapy is stopped. Mean physician competence composite score (Likert scale 1-5, 5 = very competent) in providing symptomatic relief and palliative care across phases of care was 2.93 (95% CI 2.71-3.22). Physicians reported significantly greater competence in symptom management during cure-directed therapy than during end-of-life (P = 0.02) or when patients are actively dying (P = 0.007). Practicing in HIC, prior palliative care training, having access to radiotherapy, and not having to turn patients away due to bed shortages were significantly predictive of perceived competence in providing palliative care at end of life. An international sample identified gaps in treatment and palliative care service availability, in understanding the definition of palliative care, and in self-reported competence in providing palliative care. Increased perceived competence was associated with training, which supports the need for increased palliative care education and advocacy, especially in LMIC. © 2016 Wiley Periodicals, Inc.

  15. Physicians' social competence in the provision of care to persons living in poverty: research protocol

    Directory of Open Access Journals (Sweden)

    Bedos Christophe P


    Full Text Available Abstract Background The quality of the physician-patient therapeutic relationship is a key factor in the effectiveness of care. Unfortunately, physicians and people living in poverty inhabit very different social milieux, and this great social distance hinders the development of a therapeutic alliance. Social competence is a process based on knowledge, skills and attitudes that support effective interaction between the physician and patient despite the intervening social distance. It enables physicians to better understand their patients' living conditions and to adapt care to patients' needs and abilities. Methods/Design This qualitative research is based on a comprehensive design using in-depth semi-structured interviews with 25 general practitioners working with low-income patients in Montreal's metropolitan area (Québec, Canada. Physicians will be recruited based on two criteria: they provide care to low-income patients with at least one chronic illness, and are identified by their peers as having expertise in providing care to a poor population. For this recruitment, we will draw upon contacts we have made in another research study (Loignon et al., 2009 involving clinics located in poor neighbourhoods. That study will include in-clinic observations and interviews with physicians, both of which will help us identify physicians who have developed skills for treating low-income patients. We will also use the snowball sampling technique, asking participants to refer us to other physicians who meet our inclusion criteria. The semi-structured interviews, of 60 to 90 minutes each, will be recorded and transcribed. Our techniques for ensuring internal validity will include data analysis of transcribed interviews, indexation and reduction of data with software qualitative analysis, and development and validation of interpretations. Discussion This research project will allow us to identify the dimensions of the social competence process that helps

  16. Physician knowledge of and attitudes toward the Patient Protection and Affordable Care Act. (United States)

    Rocke, Daniel J; Thomas, Steven; Puscas, Liana; Lee, Walter T


    To assess otolaryngology physician knowledge of and attitudes toward the Patient Protection and Affordable Care Act (PPACA) and compare the association of bias toward the PPACA with knowledge of the provisions of the PPACA. Cross-sectional survey. Nationwide assessment. Members of the American Academy of Otolaryngology-Head and Neck Surgery. Otolaryngology physicians answered 10 true/false questions about major provisions of the PPACA. They also indicated their level of agreement with 9 statements about health care and the PPACA. Basic demographic information was collected. Email solicitation was sent to 9972 otolaryngologists and 647 responses were obtained (6.5% response rate). Overall correct response rate was 74%. Fewer than 60% of physicians correctly answered questions on whether small businesses receive tax credits for providing health insurance, the effect of the PPACA on Medicare benefits, and whether a government-run health insurance plan was created. Academic center practice setting, bias toward the PPACA, and Democratic Party affiliation were associated with significantly more correct responses. Overall physician knowledge of the PPACA is assessed as fair, although better than the general public in 2010. There are several areas where knowledge of physicians regarding the PPACA is poor, and this knowledge deficit is more pronounced within certain subgroups. These knowledge issues should be addressed by individual physicians and medical societies.

  17. Perspectives of family medicine physicians on the importance of adolescent preventive care: a multivariate analysis. (United States)

    Taylor, Jaime L; Aalsma, Matthew C; Gilbert, Amy L; Hensel, Devon J; Rickert, Vaughn I


    The study objective was to identify commonalities amongst family medicine physicians who endorse annual adolescent visits. A nationally weighted representative on-line survey was used to explore pediatrician (N = 204) and family medicine physicians (N = 221) beliefs and behaviors surrounding adolescent wellness. Our primary outcome was endorsement that adolescents should receive annual preventive care visits. Pediatricians were significantly more likely (p family medicine physicians, bivariate comparisons were conducted between those who endorsed an annual visit (N = 164) compared to those who did not (N = 57) with significant predictors combined into two multivariate logistic regression models. Model 1 controlled for: patient race, proportion of 13-17 year olds in provider's practice, discussion beliefs scale and discussion behaviors with parents scale. Model 2 controlled for the same first three variables as well as discussion behaviors with adolescents scale. Model 1 showed for each discussion beliefs scale topic selected, family medicine physicians had 1.14 increased odds of endorsing annual visits (p family medicine physicians had 1.15 increased odds of also endorsing the importance of annual visits (p Family medicine physicians that endorse annual visits are significantly more likely to affirm they hold strong beliefs about topics that should be discussed during the annual exam. They also act on these beliefs by talking to parents of teens about these topics. This group appears to focus on quality of care in thought and deed.

  18. Intersections of Physician Autonomy, Religion, and Health Care When Working With LGBT+ Patients. (United States)

    Prairie, Tara M; Wrye, Bethany; Murfree, Sarah


    The purpose of this study is to explore the ways that some health care providers perceive the intersectionality of their autonomy, religious faith, and their medical practice, specifically when it comes to providing care for the LGBT+ (lesbian, gay, bisexual, transgender, queer, intersex, and asexual) community. Physicians (n = 25) and medical residents (n = 17) located in the southeast completed a qualitative survey regarding their views of working with LGBT+ patients. Five main themes resulted from the analysis: adequate education, communication, discrimination, duty versus physician autonomy, and religious exemption. In this analysis, we focus specifically on duty versus physician autonomy and religious exemption since the other themes have been addressed in literature. The physicians and medical residents in this sample were divided among groups on the right to refuse treatment. Although there was not a question specific to religion, participants discussed religion in their responses to whether they believe in the right to refuse treatment. This division supports the need to decrease the current gap in knowledge regarding how religious views can affect physician treatment of LGBT+ patients and research effective ways to bridge the gap between physician autonomy and the duty to provide treatment.

  19. Exploring family physicians' reasons to continue or discontinue providing intrapartum care: Qualitative descriptive study. (United States)

    Dove, Marion; Dogba, Maman Joyce; Rodríguez, Charo


    To examine the reasons why family physicians continue or discontinue providing intrapartum care in their clinical practice. Qualitative descriptive study. Two hospitals located in a multicultural area of Montreal, Que, in November 2011 to June 2012. Sixteen family physicians who were current or former providers of obstetric care. Data were collected using semistructured qualitative interviews. Thematic analysis was used to analyze the interview transcripts. Three overarching themes that help create understanding of why family doctors continue to provide obstetric care were identified: their attraction, often initiated by role models early in their careers, to practising complete continuity of care and accompanying patients in a special moment in their lives; the personal, family, and organizational pressures experienced while pursuing a family medicine career that includes obstetrics; and their ongoing reflection about continuing to practise obstetrics. The practice of obstetrics was very attractive to family physician participants whether they provided intrapartum care or decided to stop. More professional support and incentives might help keep family doctors practising obstetrics. Copyright© the College of Family Physicians of Canada.

  20. Electroconvulsive therapy: Promoting awareness among primary care physicians. (United States)

    Sicher, Sarah; Gedzior, Joanna


    This article aims to promote awareness among primary care providers and support electroconvulsive therapy as a generally well-tolerated, effective therapeutic modality to treat specific psychiatric conditions in appropriately selected patients. There seem to be several potential barriers to treatment with electroconvulsive therapy including stigma, lack of providers who preform it, and lack of awareness among providers referring patients who may be appropriate candidates. The article provides a brief overview of electroconvulsive therapy principles and topics and includes a case report to illustrate clinical utility. The article proposes the concept that a potential way to overcome barriers to treatment with electroconvulsive therapy may be to promote education and awareness of it as a viable treatment modality among primary care providers. © The Author(s) 2016.

  1. Adult-onset celiac disease for the primary care physician

    Directory of Open Access Journals (Sweden)

    Kamil Naidoo


    Full Text Available Celiac disease is a common autoimmune condition with a prevalence of 1%–2%. In recent years there has been a paradigm shift in management from tertiary care into the community. With a wide array of manifestations, including nonspecific and extraintestinal symptoms, this disorder can be difficult to diagnose, prolonging morbidity for patients. This review article aims to augment the primary physician’s knowledge of the common presentation, diagnosis, management, and follow-up of this disease.

  2. Consumerism in action: how patients and physicians negotiate payment in health care. (United States)

    Oh, Hyeyoung


    Drawing from the medical sociology literature on the patient-doctor relationship and microeconomic sociological scholarship about the role of money in personal relationships, I examined patient-physician interactions within a clinic that offered eye health and cosmetic facial services in the United States. Relying on ethnographic observations conducted in 2008, I evaluated how financial pressures shape the patient-physician relationship during the clinical encounter. To gain a financial advantage, patients attempted to reshape the relationship toward a socially intimate one, where favor and gift exchanges are more common. To ensure the rendering of services, the physician in turn allied herself with the patient, demonstrating how external parties are the barriers to affordable care. This allied relationship was tested when conflicts emerged, primarily because of the role of financial intermediaries in the clinical encounter. These conflicts resulted in the disintegration of the personal relationship, with patient and physician pitted against one another.

  3. Which journals do primary care physicians and specialists access from an online service? (United States)

    McKibbon, K Ann; Haynes, R Brian; McKinlay, R James; Lokker, Cynthia


    The study sought to determine which online journals primary care physicians and specialists not affiliated with an academic medical center access and how the accesses correlate with measures of journal quality and importance. Observational study of full-text accesses made during an eighteen-month digital library trial was performed. Access counts were correlated with six methods composed of nine measures for assessing journal importance: ISI impact factors; number of high-quality articles identified during hand-searches of key clinical journals; production data for ACP Journal Club, InfoPOEMs, and Evidence-Based Medicine; and mean clinician-provided clinical relevance and newsworthiness scores for individual journal titles. Full-text journals were accessed 2,322 times by 87 of 105 physicians. Participants accessed 136 of 348 available journal titles. Physicians often selected journals with relatively higher numbers of articles abstracted in ACP Journal Club. Accesses also showed significant correlations with 6 other measures of quality. Specialists' access patterns correlated with 3 measures, with weaker correlations than for primary care physicians. Primary care physicians, more so than specialists, chose full-text articles from clinical journals deemed important by several measures of value. Most journals accessed by both groups were of high quality as measured by this study's methods for assessing journal importance.

  4. Association between quality domains and health care spending across physician networks (United States)

    Rahman, Farah; Guan, Jun; Glazier, Richard H.; Brown, Adalsteinn; Bierman, Arlene S.; Croxford, Ruth; Stukel, Therese A.


    One of the more fundamental health policy questions is the relationship between health care quality and spending. A better understanding of these relationships is needed to inform health systems interventions aimed at increasing quality and efficiency of care. We measured 65 validated quality indicators (QI) across Ontario physician networks. QIs were aggregated into domains representing six dimensions of care: screening and prevention, evidence-based medications, hospital-community transitions (7-day post-discharge visit with a primary care physician; 30-day post-discharge visit with a primary care physician and specialist), potentially avoidable hospitalizations and emergency department (ED) visits, potentially avoidable readmissions and unplanned returns to the ED, and poor cancer end of life care. Each domain rate was computed as a weighted average of QI rates, weighting by network population at risk. We also measured overall and sector-specific per capita healthcare network spending. We evaluated the associations between domain rates, and between domain rates and spending using weighted correlations, weighting by network population at risk, using an ecological design. All indicators were measured using Ontario health administrative databases. Large variations were seen in timely hospital-community transitions and potentially avoidable hospitalizations. Networks with timely hospital-community transitions had lower rates of avoidable admissions and readmissions (r = -0.89, -0.58, respectively). Higher physician spending, especially outpatient primary care spending, was associated with lower rates of avoidable hospitalizations (r = -0.83) and higher rates of timely hospital-community transitions (r = 0.81) and moderately associated with lower readmission rates (r = -0.46). Investment in effective primary care services may help reduce burden on the acute care sector and associated expenditures. PMID:29614131

  5. The effect of physician feedback and an action checklist on diabetes care measures. (United States)

    Schectman, Joel M; Schorling, John B; Nadkarni, Mohan M; Lyman, Jason A; Siadaty, Mir S; Voss, John D


    The objective was to evaluate whether physician feedback accompanied by an action checklist improved diabetes care process measures. Eighty-three physicians in an academic general medicine clinic were provided a single feedback report on the most recent date and result of diabetes care measures (glycosylated hemoglobin [A1c], urine microalbumin, serum creatinine, lipid levels, retinal examination) as well as recent diabetes medication refills with calculated dosing and adherence on 789 patients. An educational session regarding the feedback and adherence information was provided. The physicians were asked to complete a checklist accompanying the feedback on each of their patients, indicating requested actions with respect to follow-up, testing, and counseling. The physicians completed 82% of patient checklists, requesting actions consistent with patient needs on the basis of the feedback. Of the physicians, 93% felt the patient information and intervention format to be useful. The odds of urine microalbumin testing, serum creatinine, lipid profile, A1c, and retinal examination increased in the 6 months after the feedback. The increase was sustained at 1 year only for microalbumin and retinal exams. There was no significant change in refill adherence for the group overall after the feedback, although adherence did improve among patients of physicians attending the educational session. No significant change was noted in lipid or A1c levels during the study period. In conclusion, a simple physician feedback tool with action checklist can be both helpful and popular for improving rates of diabetes care guideline adherence. More complex interventions are likely required to improve diabetes outcomes.

  6. Primary care physicians' willingness to disclose oncology errors involving multiple providers to patients. (United States)

    Mazor, Kathleen; Roblin, Douglas W; Greene, Sarah M; Fouayzi, Hassan; Gallagher, Thomas H


    Full disclosure of harmful errors to patients, including a statement of regret, an explanation, acceptance of responsibility and commitment to prevent recurrences is the current standard for physicians in the USA. To examine the extent to which primary care physicians' perceptions of event-level, physician-level and organisation-level factors influence intent to disclose a medical error in challenging situations. Cross-sectional survey containing two hypothetical vignettes: (1) delayed diagnosis of breast cancer, and (2) care coordination breakdown causing a delayed response to patient symptoms. In both cases, multiple physicians shared responsibility for the error, and both involved oncology diagnoses. The study was conducted in the context of the HMO Cancer Research Network Cancer Communication Research Center. Primary care physicians from three integrated healthcare delivery systems located in Washington, Massachusetts and Georgia; responses from 297 participants were included in these analyses. The dependent variable intent to disclose included intent to provide an apology, an explanation, information about the cause and plans for preventing recurrences. Independent variables included event-level factors (responsibility for the event, perceived seriousness of the event, predictions about a lawsuit); physician-level factors (value of patient-centred communication, communication self-efficacy and feelings about practice); organisation-level factors included perceived support for communication and time constraints. A majority of respondents would not fully disclose in either situation. The strongest predictors of disclosure were perceived personal responsibility, perceived seriousness of the event and perceived value of patient-centred communication. These variables were consistently associated with intent to disclose. To make meaningful progress towards improving disclosure; physicians, risk managers, organisational leaders, professional organisations and

  7. The effect of physician staffing model on patient outcomes in a medical progressive care unit. (United States)

    Yoo, E J; Damaghi, N; Shakespeare, W G; Sherman, M S


    Although evidence supports the impact of intensivist physician staffing in improving intensive care unit (ICU) outcomes, the optimal coverage for progressive care units (PCU) is unknown. We sought to determine how physician staffing models influence outcomes for intermediate care patients. We conducted a retrospective observational comparison of patients admitted to the medical PCU of an academic hospital during 12-month periods of high-intensity and low-intensity staffing. A total of 318 PCU patients were eligible for inclusion (143 high-intensity and 175 low-intensity). We found that low-intensity patients were more often stepped up from the emergency department and floor, whereas high-intensity patients were ICU transfers (61% vs 42%, P = .001). However, Mortality Probability Model scoring was similar between the 2 groups. In adjusted analysis, there was no association between intensity of staffing and hospital mortality (odds ratio, 0.84; 95% confidence interval, 0.36-1.99; P = .69) or PCU mortality (odds ratio, 0.96; 95% confidence interval, 0.38-2.45; P = .69). There was also no difference in subsequent ICU admission rates or in PCU length of stay. We found no evidence that high-intensity intensivist physician staffing improves outcomes for intermediate care patients. In a strained critical care system, our study raises questions about the role of the intensivist in the graded care options between intensive and conventional ward care. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. How to Manage Hospital-Based Palliative Care Teams Without Full-Time Palliative Care Physicians in Designated Cancer Care Hospitals: A Qualitative Study. (United States)

    Sakashita, Akihiro; Kishino, Megumi; Nakazawa, Yoko; Yotani, Nobuyuki; Yamaguchi, Takashi; Kizawa, Yoshiyuki


    To clarify how highly active hospital palliative care teams can provide efficient and effective care regardless of the lack of full-time palliative care physicians. Semistructured focus group interviews were conducted, and content analysis was performed. A total of 7 physicians and 6 nurses participated. We extracted 209 codes from the transcripts and organized them into 3 themes and 21 categories, which were classified as follows: (1) tips for managing palliative care teams efficiently and effectively (7 categories); (2) ways of acquiring specialist palliative care expertise (9 categories); and (3) ways of treating symptoms that are difficult to alleviate (5 categories). The findings of this study can be used as a nautical chart of hospital-based palliative care team (HPCT) without full-time PC physician. Full-time nurses who have high management and coordination abilities play a central role in resource-limited HPCTs. © The Author(s) 2015.

  9. Barriers for administering primary health care services to battered women: Perception of physician and nurses

    Directory of Open Access Journals (Sweden)

    Eman H. Alsabhan


    Full Text Available Background: Violence against women is an important public-health problem that draws attention of a wide spectrum of clinicians. However, multiple barriers undermine the efforts of primary health care workers to properly manage and deal with battered women. Objectives: The aim of the present study was to reveal barriers that might impede administering comprehensive health care to battered women and compare these barriers between nurses and physicians and identify factors affecting such barriers. Methods: A total of 1553 medical staff from 78 primary health care units agreed to share in this study, of these 565 were physicians and 988 were nurses. Results: Barriers related to the battered woman topped the list of ranks for both physicians (93.1 ± 17.4% and nurses (82.1 ± 29.3%. Institutional barriers (87.2 ± 21.5%, barriers related to the health staff (79.8 ± 20. 5%, and social barriers (77.5 ± 21.7% followed, respectively, in the rank list of physicians while for the list of nurses, social barriers (75.1 ± 30.1%, institutional barriers (74.3 ± 31.7% followed with barriers related to health staff (70.0 ± 30.0% at the bottom of the list. Only duration spent at work and degree of education of nurses were significantly affecting the total barrier score, while these factors had no significant association among physicians. Conclusion: Real barriers exist that might interfere with administering proper comprehensive health care at the primary health care units by both physicians and nurses. This necessitates design of specific programs to improve both the knowledge and skills of the medical staff to deal with violence among women. Also, available resources and infrastructure must be strengthened to face this problem and enable primary health care staff to care for battered women. Keywords: Battered women, Barriers, Physicians, Nurses, Primary health care

  10. Experiences of primary care physicians and staff following lean workflow redesign. (United States)

    Hung, Dorothy Y; Harrison, Michael I; Truong, Quan; Du, Xue


    In response to growing pressures on primary care, leaders have introduced a wide range of workforce and practice innovations, including team redesigns that delegate some physician tasks to nonphysicians. One important question is how such innovations affect care team members, particularly in view of growing dissatisfaction and burnout among healthcare professionals. We examine the work experiences of primary care physicians and staff after implementing Lean-based workflow redesigns. This included co-locating physician and medical assistant dyads, delegating significant responsibilities to nonphysician staff, and mandating greater coordination and communication among all care team members. The redesigns were implemented and scaled in three phases across 46 primary care departments in a large ambulatory care delivery system. We fielded 1164 baseline and 1333 follow-up surveys to physicians and other nonphysician staff (average 73% response rate) to assess workforce engagement (e.g., job satisfaction, motivation), perceptions of the work environment, and job-related burnout. We conducted multivariate regressions to detect changes in experiences after the redesign, adjusting for respondent characteristics and clustering of within-clinic responses. We found that both physicians and nonphysician staff reported higher levels of engagement and teamwork after implementing redesigns. However, they also experienced higher levels of burnout and perceptions of the workplace as stressful. Trends were the same for both occupational groups, but the increased reports of stress were greater among physicians. Additionally, members of all clinics, except for the pilot site that developed the new workflows, reported higher burnout, while perceptions of workplace stress increased in all clinics after the redesign. Our findings partially align with expectations of work redesign as a route to improving physician and staff experiences in delivering care. Although teamwork and engagement

  11. Care Provision and Prescribing Practices of Physicians Treating Children and Adolescents With ADHD. (United States)

    Patel, Ayush; Medhekar, Rohan; Ochoa-Perez, Melissa; Aparasu, Rajender R; Chan, Wenyaw; Sherer, Jeffrey T; Alonzo, Joy; Chen, Hua


    Care provision and prescribing practices of physicians treating children with attention-deficit hyperactivity disorder (ADHD) were compared. A retrospective cohort study was conducted with the 1995-2010 General Electric Centricity Electronic Medical Record database. The sample included children (≤18 years) with newly diagnosed ADHD (ICD-9-CM code 314.XX) who received a prescription for a stimulant or atomoxetine. Identification of comorbid psychiatric disorders, duration from initial ADHD diagnosis to treatment, prescription of other psychotropic medications, and follow-up care during the ten months after the ADHD treatment initiation were compared across provider type (primary care physicians [PCPs], child psychiatrists, and physicians with an unknown specialty). The associations between provider type and practice variations were further determined by multivariate logistic regression accounting for patient demographic characteristics, region, insurance type, and prior mental health care utilizations. Of the 66,719 children identified, 75.8% were diagnosed by PCPs, 2.6% by child psychiatrists, and 21.6% by physicians whose specialty was unknown. Child psychiatrists were less likely than PCPs to initiate ADHD medication immediately after the diagnosis. However, once the ADHD treatment was initiated, they were more likely to prescribe psychotropic polytherapy even after analyses accounted for the comorbid psychiatric disorders identified. Only one-third of ADHD cases identified by both PCPs and child psychiatrists have met the HEDIS quality measure for ADHD medication-related follow-up visits. Differences were found by physician type in care of children with ADHD. Additional studies are needed to understand clinical consequences of these differences and the implications for care coordination across provider specialties.

  12. Continuous Palliative Sedation for Existential Distress? A Survey of Canadian Palliative Care Physicians' Views. (United States)

    Voeuk, Anna; Nekolaichuk, Cheryl; Fainsinger, Robin; Huot, Ann


    Palliative sedation can be used for refractory symptoms during end-of-life care. However, continuous palliative sedation (CPS) for existential distress remains controversial due to difficulty determining when this distress is refractory. The aim was to determine the opinions and practices of Canadian palliative care physicians regarding CPS for existential distress. A survey focusing on experience and views regarding CPS for existential distress was sent to 322 members of the Canadian Society of Palliative Care Physicians. Eighty-one surveys returned (accessible target, 314), resulting in a response rate of 26%. One third (31%) of the respondents reported providing CPS for existential distress. On a 5-point Likert-type scale, 40% of participants disagreed, while 43% agreed that CPS could be used for existential distress alone. Differing opinions exist regarding this complex and potentially controversial issue, necessitating the education of health-care professionals and increased awareness within the general public.

  13. Nursing Home Physicians' Assessments of Barriers and Strategies for End-of-Life Care in Norway and The Netherlands. (United States)

    Fosse, Anette; Zuidema, Sytse; Boersma, Froukje; Malterud, Kirsti; Schaufel, Margrethe Aase; Ruths, Sabine


    Working conditions in nursing homes (NHs) may hamper teamwork in providing quality end-of-life (EOL) care, especially the participation of NH physicians. Dutch NH physicians are specialists or trainees in elderly care medicine with NHs as the main workplace, whereas in Norway, family physicians usually work part time in NHs. Thus, we aimed at assessing and comparing NH physicians' perspectives on barriers and strategies for providing EOL care in NHs in Norway and in The Netherlands. A cross-sectional study using an electronic questionnaire was conducted in 2015. All NH physicians in Norway (approximately 1200-1300) were invited to participate; 435 participated (response rate approximately 35%). Of the total 1664 members of the Dutch association of elderly care physicians approached, 244 participated (response rate 15%). We explored NH physicians' perceptions of organizational, educational, financial, legal, and personal prerequisites for quality EOL care. Differences between the countries were compared using χ 2 test and t-test. Most respondents in both countries reported inadequate staffing, lack of skills among nursing personnel, and heavy time commitment for physicians as important barriers; this was more pronounced among Dutch respondents. Approximately 30% of the respondents in both countries reported their own lack of interest in EOL care as an important barrier. Suggested improvement strategies were routines for involvement of patients' family, pain- and symptom assessment protocols, EOL care guidelines, routines for advance care planning, and education in EOL care for physicians and nursing staff. Inadequate staffing levels, as well as lack of competence, time, and interest emerge as important barriers to quality EOL care according to Dutch and Norwegian NH physicians. Their perspectives were mostly similar, despite large educational and organizational differences. Key strategies for improving EOL care in their facilities comprise education and

  14. Michigan's fee-for-value physician incentive program reduces spending and improves quality in primary care. (United States)

    Lemak, Christy Harris; Nahra, Tammie A; Cohen, Genna R; Erb, Natalie D; Paustian, Michael L; Share, David; Hirth, Richard A


    As policy makers and others seek to reduce health care cost growth while improving health care quality, one approach gaining momentum is fee-for-value reimbursement. This payment strategy maintains the traditional fee-for-service arrangement but includes quality and spending incentives. We examined Blue Cross Blue Shield of Michigan's Physician Group Incentive Program, which uses a fee-for-value approach focused on primary care physicians. We analyzed the program's impact on quality and spending from 2008 to 2011 for over three million beneficiaries in over 11,000 physician practices. Participation in the incentive program was associated with approximately 1.1 percent lower total spending for adults (5.1 percent lower for children) and the same or improved performance on eleven of fourteen quality measures over time. Our findings contribute to the growing body of evidence about the potential effectiveness of models that align payment with cost and quality performance, and they demonstrate that it is possible to transform reimbursement within a fee-for-service framework to encourage and incentivize physicians to provide high-quality care, while also reducing costs. Project HOPE—The People-to-People Health Foundation, Inc.

  15. Postgraduate Education of Allied Physicians for Innovation Technologies for Nursery Care, Diagnostics and Pathology Treatment

    Directory of Open Access Journals (Sweden)

    T.M. Klimenko


    Full Text Available The possibilities and positive results of the postgraduate education of allied physicians on neonatology at the specialized department as well as studying innovation techno­logies of caring, diagnostics and treatment of newborn patho­logy are considered.

  16. Overweight and Obesity Among Wage-Earners and the Demand for Primary Physician Care

    DEFF Research Database (Denmark)

    Datta Gupta, Nabanita; Greve, Jane

    -earners aged 25-60 years drawn from the National Health Interview (NHI) survey 2000 and merged to Danish register data, we compare differences in the impact of being overweight or obese relative to being normal weight on the demand for primary physician care. Estimated bodyweight effects vary across latent...

  17. Transfers from intensive care unit to hospital ward: a multicentre textual analysis of physician progress notes. (United States)

    Brown, Kyla N; Leigh, Jeanna Parsons; Kamran, Hasham; Bagshaw, Sean M; Fowler, Rob A; Dodek, Peter M; Turgeon, Alexis F; Forster, Alan J; Lamontagne, Francois; Soo, Andrea; Stelfox, Henry T


    Little is known about documentation during transitions of patient care between clinical specialties. Therefore, we examined the focus, structure and purpose of physician progress notes for patients transferred from the intensive care unit (ICU) to hospital ward to identify opportunities to improve communication breaks. This was a prospective cohort study in ten Canadian hospitals. We analyzed physician progress notes for consenting adult patients transferred from a medical-surgical ICU to hospital ward. The number, length, legibility and content of notes was counted and compared across care settings using mixed-effects linear regression models accounting for clustering within hospitals. Qualitative content analyses were conducted on a stratified random sample of 32 patients. A total of 447 patient medical records that included 7052 progress notes (mean 2.1 notes/patient/day 95% CI 1.9-2.3) were analyzed. Notes written by the ICU team were significantly longer than notes written by the ward team (mean lines of text 21 vs. 15, p notes; mean agreement of patient issues was 42% [95% CI 31-53%]. Qualitative analyses identified eight themes related to focus (central point - e.g., problem list), structure (organization, - e.g., note-taking style), and purpose (intention - e.g., documentation of patient course) of the notes that varied across clinical specialties and physician seniority. Important gaps and variations in written documentation during transitions of patient care between ICU and hospital ward physicians are common, and include discrepancies in documentation of patient information.

  18. Physician-Pharmacist Collaborative Care for Dyslipidemia Patients: Knowledge and Skills of Community Pharmacists (United States)

    Villeneuve, Julie; Lamarre, Diane; Lussier, Marie-Therese; Vanier, Marie-Claude; Genest, Jacques; Blais, Lucie; Hudon, Eveline; Perreault, Sylvie; Berbiche, Djamal; Lalonde, Lyne


    Introduction: In a physician-pharmacist collaborative-care (PPCC) intervention, community pharmacists were responsible for initiating lipid-lowering pharmacotherapy and adjusting the medication dosage. They attended a 1-day interactive workshop supported by a treatment protocol and clinical and communication tools. Afterwards, changes in…

  19. Job Satisfactions of Nurses and Physicians Working in the Same Health Care Facility in Turkey


    Züleyha Alper; Đlker Ercan; Güven Özkaya; Neriman Akansel


    Background: Job satisfaction is defined as the degree to which employees like or enjoy their jobs and the degreeof satisfaction is based on the importance placed upon this reward and benefit.Objective: Aim of this study was to determine the job satisfaction levels of nurses and physicians working in thesame health care facility, analyze the factors that may affect job satisfaction levels. This study was conducted asa descriptive study and was carried out in one Medical Care Center Northwester...

  20. The Attitudes of Indian Palliative-Care Nurses and Physicians toward Pain Control and Palliative Sedation


    Gielen, Joris; Gupta, Harmala; Rajvanshi, Ambika; Bhatnagar, Sushma; Mishra, Seema; Chaturvedi, Arvind K.; Van den Branden, Stef; Broeckaert, Bert


    Aim: We wanted to assess Indian palliative-care nurses and physicians’ attitudes toward pain control and palliative sedation. Materials and Methods: From May to September 2008, we interviewed 14 physicians and 13 nurses working in different palliative-care programs in New Delhi, using a semi-structured questionnaire, and following grounded-theory methodology (Glaser and Strauss). Results: The interviewees did not consider administration of painkillers in large doses an ethical problem, ...

  1. The attitudes of Indian palliative-care nurses and physicians to pain control and palliative sedation


    Joris Gielen; Harmala Gupta; Ambika Rajvanshi; Sushma Bhatnagar; Seema Mishra; Arvind K Chaturvedi; Stef Van den Branden; Bert Broeckaert


    Aim: We wanted to assess Indian palliative-care nurses and physicians′ attitudes toward pain control and palliative sedation. Materials and Methods: From May to September 2008, we interviewed 14 physicians and 13 nurses working in different palliative-care programs in New Delhi, using a semi-structured questionnaire, and following grounded-theory methodology (Glaser and Strauss). Results: The interviewees did not consider administration of painkillers in large doses an ethical problem...

  2. Association of Financial Integration Between Physicians and Hospitals With Commercial Health Care Prices. (United States)

    Neprash, Hannah T; Chernew, Michael E; Hicks, Andrew L; Gibson, Teresa; McWilliams, J Michael


    Financial integration between physicians and hospitals may help health care provider organizations meet the challenges of new payment models but also may enhance the bargaining power of provider organizations, leading to higher prices and spending in commercial health care markets. To assess the association between recent increases in physician-hospital integration and changes in spending and prices for outpatient and inpatient services. Using regression analysis, we estimated the relationship between changes in physician-hospital integration from January 1, 2008, through December 31, 2012, in 240 metropolitan statistical areas (MSAs) and concurrent changes in spending. Adjustments were made for patient, plan, and market characteristics, including physician, hospital, and insurer market concentration. The study population included a cohort of 7,391,335 nonelderly enrollees in preferred-provider organizations or point-of-service plans included in the Truven Health MarketScan Commercial Database during the study period. Data were analyzed from December 1, 2013, through July 13, 2015. Physician-hospital integration, measured using Medicare claims data as the share of physicians in an MSA who bill for outpatient services with a place-of-service code indicating employment or practice ownership by a hospital. Annual inpatient and outpatient spending per enrollee and associated use of health care services, with utilization measured by price-standardized spending (the sum of annual service counts multiplied by the national mean of allowed charges for the service). Among the 240 MSAs, physician-hospital integration increased from 2008 to 2012 by a mean of 3.3 percentage points, with considerable variation in increases across MSAs (interquartile range, 0.8-5.2 percentage points). For our study sample of 7,391,335 nonelderly enrollees, an increase in physician-hospital integration equivalent to the 75th percentile of changes experienced by MSAs was associated with a mean

  3. Cognitive impairment and self-care in heart failure

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    Hajduk AM


    Full Text Available Alexandra M Hajduk,1,2 Stephenie C Lemon,3 David D McManus,1,2,4 Darleen M Lessard,1 Jerry H Gurwitz,1,2,4 Frederick A Spencer,5 Robert J Goldberg,1,2 Jane S Saczynski1,2,4 1Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA; 2Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA; 3Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA; 4Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA; 5Department of Medicine, McMaster University, Hamilton, ON, Canada Background: Heart failure (HF is a prevalent chronic disease in older adults that requires extensive self-care to prevent decompensation and hospitalization. Cognitive impairment may impact the ability to perform HF self-care activities. We examined the association between cognitive impairment and adherence to self-care in patients hospitalized for acute HF. Design: Prospective cohort study. Setting and participants: A total of 577 patients (mean age = 71 years, 44% female hospitalized for HF at five medical centers in the United States and Canada. Measurements and methods: Participants were interviewed for information on self-reported adherence to self-care using the European Heart Failure Self-care Behaviour Scale. We assessed cognitive impairment in three domains (memory, processing speed, and executive function using standardized measures. Patients' demographic and clinical characteristics were obtained through medical record review. Multivariable linear regression was used to examine the association between cognitive impairment and self-care practices adjusting for demographic and clinical factors. Results: A total of 453 patients (79% were impaired in at least one cognitive

  4. Cognitive assessment on elderly people under ambulatory care

    Directory of Open Access Journals (Sweden)

    Bruna Zortea


    Full Text Available Objective: to evaluate the cognitive state of elderly people under ambulatory care and investigating the connection between such cognitive state and sociodemographic variables, health conditions, number of and adhesion to medicine. Methods: transversal, exploratory, and descriptive study, with a quantitative approach, realized with 107 elderly people under ambulatory care in a university hospital in southern Brazil, in november, 2013. The following variables were used: gender, age, civil status, income, schooling, occupation, preexisting noncommunicable diseases, number and type of prescribed medications, adhesion, mini-mental state examination score, and cognitive status. Data was analyzed through inferential and descriptive statistics. Results: the prevalence of cognitive deficit was of 42.1% and had a statistically significant connection to schooling, income, civil status, hypertension, and cardiopathy. Conclusion: nurses can intervene to avoid the increase of cognitive deficit through an assessment of the elderly person, directed to facilitative strategies to soften this deficit.

  5. A national probability survey of American Medical Association gynecologists and primary care physicians concerning menopause. (United States)

    Singh, Betsy; Liu, Xiao-Dong; Der-Martirosian, Claudia; Hardy, Mary; Singh, Vijay; Shepard, Neil; Gandhi, Sonal; Khorsan, Raheleh


    This survey intended to clarify physicians' understanding of the issues surrounding women, menopause, alternative medicine, and drug therapy for the treatment of menopause. This study was designed as a national probability sample survey of primary care physicians and gynecologists nationwide. Its focus was to identify major concerns and issues identified by patients about menopause and perceived communication with effectiveness how to communicate with their patients. Physicians were also asked to rate their comfort level in recommending the use of herbal remedies and which herbal remedy they felt comfortable recommending to interested patients. Data indicated that a patient's complaint about menopausal symptoms was the most common factor leading to discussion of menopausal issues with physicians (91%) and that the primary concern to the patient was management of menopausal symptoms. Other factors were controversies about hormone replacement therapy, long-term health implications of menopause, and hormone replacement therapy. Eighty percent of the physician found confusing messages with regard to menopause to be the most challenging aspect in patient communication. The second most challenging issue is "inconclusive data about hormone replacement therapy" (56%). Seventy-six percent of the physicians found "showing sympathy" to be the most important factor for the physicians to communicate effectively with patients, whereas "being honest and open" was the most important patient attitude cited for the same purpose. When it comes to herbal therapy for menopause symptom control, only 4% of the physicians indicated that none of their patients take any remedies. Only 18% were not very comfortable in discussing or recommending herbal therapies, whereas the rest ranged from fairly comfortable to completely comfortable. This study has provided data with regard to physician understanding of menopause treatment options and their primary interaction with patients on this issue

  6. Caring for the forensic population: recognizing the educational needs of emergency department nurses and physicians. (United States)

    Henderson, Elizabeth; Harada, Nahoko; Amar, Angela


    The Emergency Department (ED) is a point of contact for victims of violence after an act of criminal activity has occurred. Hence, ED clinicians are in a key position to have a significant impact on both the medical and legal outcomes of the forensic patient population. The purpose of this study was to describe and compare forensic knowledge, practice, and experiences of ED nurses and physicians. Specific aims were to (1) describe experiences of nurses and physicians related to forensic practice; (2) compare clinical forensic knowledge and experience between nurses and physicians; and (3) describe forensic learning needs. This descriptive, correlational study utilized a survey questionnaire completed by 134 ED nurses and physicians. Results of the survey revealed no significant differences in the education, knowledge, and confidence with forensic patients between ED nurses and physicians. However, just over half of the sample reported feeling confident in managing forensic patients indicating a need for increased forensic education. Practice implications indicate that forensic education is needed and desired among ED nurses and physicians within the clinical setting. Further studies must be done to gain a more in depth understanding of existing forensic practices and protocols to elevate the level of care received by forensic patients within the ED setting. © 2012 International Association of Forensic Nurses.

  7. Health care professionals' and students' attitude toward collaboration between pharmacists and physicians in Croatia. (United States)

    Seselja-Perisin, Ana; Mestrovic, Arijana; Klinar, Ivana; Modun, Darko


    As traditional roles of pharmacists and physicians seem nowadays insufficient to ensure patient safety and therapy effectiveness, interprofessional collaboration has been suggested to improve health outcomes. To assess and compare the attitudes of physicians and pharmacists, as well as medical and pharmacy students in Croatia, toward interprofessional collaboration in primary health care. The study included 513 pharmacists and physicians, and 365 students of pharmacy and medicine from Croatia. The validated questionnaire, Scale of Attitudes Toward Physician–Pharmacist Collaboration, was translated in Croatian and completed, anonymously and voluntarily, by all participants. Results Pharmacists showed a more positive attitude toward collaboration than physicians (53.8 ± 4.8 vs. 50.7 ± 5.0). Pharmacy students expressed the most positive attitude (56.2 ± 4.9), while medical students showed the remarkably lowest attitude toward collaboration (44.6 ± 6.2). Pharmacists and physicians in Croatia expressed a relatively positive attitude toward their collaboration, comparable with their colleges in the USA. On the other hand, medical students expressed a 21 % less positive attitude than pharmacy students which could have an effect on interprofessional collaboration in the future when those students start working as health care professionals. Future studies, focusing on the promotion of this collaboration, on both under-graduated and post-graduated level, are warranted.

  8. Shared Decision Making and Effective Physician-Patient Communication: The Quintessence of Patient-Centered Care

    Directory of Open Access Journals (Sweden)

    Huy Ming Lim


    Full Text Available The Institute of Medicine’s (IOM 2001 landmark report, Crossing the Quality Chasm: A New Health System for the 21st Century, identified patient-centeredness as one of the fundamental attributes of quality health care, alongside safety, effectiveness, timeliness, efficiency, and equity. The IOM defined patient-centeredness as “providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.” This concept of patient-centered care represents a paradigm shift from the traditional disease-oriented and physician-centered care, grounding health care in the subjective experience of illness and the needs and preferences of individual patients rather than the evaluation and treatment of diseases which emphasizes on leveraging clinical expertise and evidence derived from population-based studies. Regrettably, despite the ubiquitous talk about patient-centered care in modern health care, shared decision-making and effective physician-patient communication—the two cruxes of patient-centered care—are yet to become the norms. Strategies to promote and enhance shared decision-making and effective communication between clinicians and patients should be rigorously implemented to establish a health care system that truly values patients as individuals and turn the rhetoric of patient-centered care into reality.

  9. Supporting frail seniors through a family physician and Home Health integrated care model in Fraser Health

    Directory of Open Access Journals (Sweden)

    Grace Haeson Park


    Full Text Available Background: A major effort is underway to integrate primary and community care in Canada's western province of British Columbia and in Fraser Health, its largest health authority. Integrated care is a critical component of Fraser Health's planning, to meet the challenges of caring for a growing, elderly population that is presenting more complex and chronic medical conditions. Description of integrated practice: An integrated care model partners family physicians with community-based home health case managers to support frail elderly patients who live at home. It is resulting in faster response times to patient needs, more informed assessments of a patient's state of health and pro-active identification of emerging patient issues. Early results: The model is intended to improve the quality of patient care and maintain the patients’ health status, to help them live at home confidently and safely, as long as possible. Preliminary pilot data measuring changes in home care services is showing positive trends when it comes to extending the length of a person's survival/tenure in the community (living in their home vs. admitted to residential care or deceased. Conclusion: Fraser Health's case manager–general practitioner partnership model is showing promising results including higher quality, appropriate, coordinated and efficient care; improved patient, caregiver and physician interactions with the system; improved health and prevention of acute care visits by senior adult patients.

  10. Integrating Doulas Into First-Trimester Abortion Care: Physician, Clinic Staff, and Doula Experiences. (United States)

    Chor, Julie; Lyman, Phoebe; Ruth, Jean; Patel, Ashlesha; Gilliam, Melissa


    Balancing the need to provide individual support for patients and the need for an efficient clinic can be challenging in the abortion setting. This study explores physician, staff, and specially trained abortion doula perspectives on doula support, one approach to patient support. We conducted separate focus groups with physicians, staff members, and doulas from a high-volume, first-trimester aspiration abortion clinic with a newly established volunteer abortion doula program. Focus groups explored 1) abortion doula training, 2) program implementation, 3) program benefits, and 4) opportunities for improvement. Interviews were transcribed and computer-assisted content analysis was performed; salient findings are presented. Five physicians, 5 staff members, and 4 abortion doulas participated in separate focus group discussions. Doulas drew on both their prior personal skills and experiences in addition to their abortion doula training to provide women with support at the time of abortion. Having doulas in the clinic to assist with women's emotional needs allowed physicians and staff to focus on technical aspects of the procedure. In turn, both physicians and staff believed that introducing doulas resulted in more patient-centered care. Although staff did not experience challenges to integrating doulas, physicians and doulas experienced initial challenges in incorporating doula support into the clinical flow. Staff and doulas reported exchanging skills and techniques that they subsequently used in their interactions with patients. Physicians, clinic staff, and doulas perceive abortion doula support as an approach to provide more patient-centered care in a high-volume aspiration abortion clinic. © 2018 by the American College of Nurse-Midwives.

  11. The process of disclosing a diagnosis of dementia and mild cognitive impairment: A national survey of specialist physicians in Denmark. (United States)

    Nielsen, T Rune; Svensson, Birthe Hjorth; Rohr, Gitte; Gottrup, Hanne; Vestergaard, Karsten; Høgh, Peter; Waldemar, Gunhild


    Background Although general recommendations for diagnostic disclosure of dementia are available, little is known about how these recommendations are implemented. The aim of the current study was to investigate the process and content of dementia diagnostic disclosure meetings, and to compare key aspects of disclosing a diagnosis of dementia and mild cognitive impairment. Method A total of 54 specialist physicians in Danish dementia diagnostic departments completed an online survey on their practices regarding diagnostic disclosure of dementia and mild cognitive impairment. The influence of respondent characteristics was assessed, and differences on key aspects of disclosing a diagnosis of dementia and mild cognitive impairment were analyzed. Results The results suggest that among Danish specialist physicians, there is a general consensus regarding the organization of diagnostic disclosure meetings. However, differences in employed terminology and information provided when disclosing a dementia diagnosis were evident. Significant differences were present on key aspects of the diagnostic disclosure of dementia and mild cognitive impairment. For instance, 91% would use the term dementia during diagnostic disclosures compared to just 72% for mild cognitive impairment. Conclusion The range of practices reflected in the present study confirms the complexity of diagnostic disclosure and highlights the importance of preparation and follow-up strategies to tailor the disclosure process to the needs of individual patients with dementia and their caregivers. Due to earlier diagnosis of neurodegenerative disorders, more research is urgently needed on this aspect of the diagnostic process, especially to develop evidence-based models for the disclosure of mild cognitive impairment.

  12. Responses to assisted suicide requests: an interview study with Swiss palliative care physicians. (United States)

    Gamondi, Claudia; Borasio, Gian Domenico; Oliver, Pam; Preston, Nancy; Payne, Sheila


    Assisted suicide in Switzerland is mainly performed by right-to-die societies. Medical involvement is limited to the prescription of the drug and certification of eligibility. Palliative care has traditionally been perceived as generally opposed to assisted suicide, but little is known about palliative care physicians' involvement in assisted suicide practices. This paper aims to describe their perspectives and involvement in assisted suicide practices. A qualitative interview study was conducted with 23 palliative care physicians across Switzerland. Thematic analysis was used to interpret data. Swiss palliative care physicians regularly receive assisted suicide requests while none reported having received specific training in managing these requests. Participants reported being involved in assisted suicide decision making most were not willing to prescribe the lethal drug. After advising patients of the limits on their involvement in assisted suicide, the majority explored the origins of the patient's request and offered alternatives. Many participants struggled to reconcile their understanding of palliative care principles with patients' wishes to exercise their autonomy. The majority of participants had no direct contact with right-to-die societies, many desired better collaboration. A desire was voiced for a more structured debate on assisted suicide availability in hospitals and clearer legal and institutional frameworks. The Swiss model of assisted suicide gives palliative care physicians opportunities to develop roles which are compatible with each practitioner's values, but may not correspond to patients' expectations. Specific education for all palliative care professionals and more structured ways to manage communication about assisted suicide are warranted. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  13. Nursing Home Physicians' Assessments of Barriers and Strategies for End-of-Life Care in Norway and The Netherlands

    NARCIS (Netherlands)

    Fosse, Anette; Zuidema, Sytse; Boersma, Froukje; Malterud, Kirsti; Schaufel, Margrethe Aase; Ruths, Sabine


    OBJECTIVES: Working conditions in nursing homes (NHs) may hamper teamwork in providing quality end-of-life (EOL) care, especially the participation of NH physicians. Dutch NH physicians are specialists or trainees in elderly care medicine with NHs as the main workplace, whereas in Norway, family

  14. Antibiotic resistance rates and physician antibiotic prescription patterns of uncomplicated urinary tract infections in southern Chinese primary care


    Wong, Carmen Ka Man; Kung, Kenny; Au-Doung, Philip Lung Wai; Ip, Margaret; Lee, Nelson; Fung, Alice; Wong, Samuel Yeung Shan


    Uncomplicated urinary tract infections (UTI) are common in primary care. Whilst primary care physicians are called to be antimicrobial stewards, there is limited primary care antibiotic resistance surveillance and physician antibiotic prescription data available in southern Chinese primary care. The study aimed to investigate the antibiotic resistance rate and antibiotic prescription patterns in female patients with uncomplicated UTI. Factors associated with antibiotic resistance and prescrip...

  15. Association between education in EOL care and variability in EOL practice: a survey of ICU physicians. (United States)

    Forte, Daniel Neves; Vincent, Jean Louis; Velasco, Irineu Tadeu; Park, Marcelo


    This study investigated the association between physician education in EOL and variability in EOL practice, as well as the differences between beliefs and practices regarding EOL in the ICU. Physicians from 11 ICUs at a university hospital completed a survey presenting a patient in a vegetative state with no family or advance directives. Questions addressed approaches to EOL care, as well physicians' personal, professional and EOL educational characteristics. The response rate was 89%, with 105 questionnaires analyzed. Mean age was 38 ± 8 years, with a mean of 14 ± 7 years since graduation. Physicians who did not apply do-not-resuscitate (DNR) orders were less likely to have attended EOL classes than those who applied written DNR orders [0/7 vs. 31/47, OR = 0.549 (0.356-0.848), P = 0.001]. Physicians who involved nurses in the decision-making process were more likely to be ICU specialists [17/22 vs. 46/83, OR = 4.1959 (1.271-13.845), P = 0.013] than physicians who made such decisions among themselves or referred to ethical or judicial committees. Physicians who would apply "full code" had less often read about EOL [3/22 vs. 11/20, OR = 0.0939 (0.012-0.710), P = 0.012] and had less interest in discussing EOL [17/22 vs. 20/20, OR = 0.210 (0.122-0.361), P EOL is associated with variability in EOL decisions in the ICU. Moreover, actual practice may differ from what physicians believe is best for the patient.

  16. Difficulties faced by family physicians in primary health care centers in Jeddah, Saudi Arabia

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    Sahar H Mumenah


    Full Text Available Aim: The aim was to determine the difficulties faced by family physicians, and compare how satisfied those working with the Ministry of Health (MOH are with their counterparts who work at some selected non-MOH hospitals. Methods: An analytical, cross-sectional study was conducted at King Abdulaziz University Hospital, King Faisal Specialist Hospital and Research Center (KFSH and RC, and 40 MOH primary health care centers across Jeddah. A structured multi-item questionnaire was used to collect demographic data and information on the difficulties family physicians face. The physicians′ level of satisfaction and how it was affected by the difficulties was assessed. Results: Women constituted 71.9% of the sample. Problems with transportation formed one of the main difficulties encountered by physicians. Compared to non-MOH physician, a significantly higher proportion of MOH physicians reported unavailability of radiology technicians (P = 0.011 and radiologists (P < 0.001, absence of the internet and computer access (P < 0.001, unavailability of laboratory services (P = 0.004, reagents (P = 0.001, X-ray equipment (P = 0.027, ultrasound equipment (P < 0.001, an electronic medical records system (P < 0.001, insufficient laboratory tests (P = 0.0001, and poor building maintenance (P < 0.001. Family physicians with the MOH were less satisfied with their jobs compared with non-MOH physicians (P = 0.032. Conclusion: MOH family physicians encountered difficulties relating to staff, services, and infrastructure, which consequently affected their level of satisfaction.

  17. Primary care physicians' attitudes and beliefs towards chronic low back pain: an Asian study.

    Directory of Open Access Journals (Sweden)

    Regina W S Sit

    Full Text Available Chronic low back pain is a serious global health problem. There is substantial evidence that physicians' attitudes towards and beliefs about chronic low back pain can influence their subsequent management of the condition.(1 to evaluate the attitudes and beliefs towards chronic low back pain among primary care physicians in Asia; (2 to study the cultural differences and other factors that are associated with these attitudes and beliefs.A cross sectional online survey was sent to primary care physicians who are members of the Hong Kong College of Family Physician (HKCFP. The Pain Attitudes and Beliefs Scale for Physiotherapist (PABS-PT was used as the questionnaire to determine the biomedical and biopsychosocial orientation of the participants.The mean Biomedical (BM score was 34.8+/-6.1; the mean biopsychosocial (BPS score was 35.6 (+/- 4.8. Both scores were higher than those of European doctors. Family medicine specialists had a lower biomedical score than General practitioners. Physicians working in the public sector tended to have low BM and low BPS scores; whereas physicians working in private practice tended to have high BM and high BPS scores.The lack of concordance in the pain explanatory models used by private and public sector may have a detrimental effect on patients who are under the care of both parties. The uncertain treatment orientation may have a negative influence on patients' attitudes and beliefs, thus contributing to the tension and, perhaps, even ailing mental state of a person with chronic LBP.

  18. Cognitive behavioral therapy for treatment of primary care patients ...

    African Journals Online (AJOL)


    Mar 31, 2014 ... developing countries, it is important for primary care physicians to provide services to patients with ... involves one-on-one session between a trained psy- ... ensure the patient a better quality of life. ... Program (mhGAP) launched by the WHO, is to train ..... depression symptoms as well as quality of life in the.

  19. Cognitive behavioral therapy for treatment of primary care patients ...

    African Journals Online (AJOL)

    Mental disorders affect a great number of people worldwide. Four out of the 10 leading causes of disability in the world are mental disorders. Because of the scarcity of specialists around the world and especially in developing countries, it is important for primary care physicians to provide services to patients with mental ...

  20. Trust in physicians and racial disparities in HIV care. (United States)

    Saha, Somnath; Jacobs, Elizabeth A; Moore, Richard D; Beach, Mary Catherine


    Mistrust among African Americans is often considered a potential source of racial disparities in HIV care. We sought to determine whether greater trust in one's provider among African-American patients mitigates racial disparities. We analyzed data from 1,104 African-American and 201 white patients participating in a cohort study at an urban, academic HIV clinic between 2005 and 2008. African Americans expressed lower levels of trust in their providers than did white patients (8.9 vs. 9.4 on a 0-10 scale; p African Americans were also less likely than whites to be receiving antiretroviral therapy (ART) when eligible (85% vs. 92%; p = 0.02), to report complete ART adherence over the prior 3 days (83% vs. 89%; p = 0.005), and to have a suppressed viral load (40% vs. 47%; p = 0.04). Trust in one's provider was not associated with receiving ART or with viral suppression but was significantly associated with adherence. African Americans who expressed less than complete trust in their providers (0-9 of 10) had lower ART adherence than did whites (adjusted OR, 0.40; 95% CI, 0.25-0.66). For African Americans who expressed complete trust in their providers (10 of 10), the racial disparity in adherence was less prominent but still substantial (adjusted OR, 0.59; 95% CI, 0.36-0.95). Trust did not affect disparities in receipt of ART or viral suppression. Our findings suggest that enhancing trust in patient-provider relationships for African-American patients may help reduce disparities in ART adherence and the outcomes associated with improved adherence.

  1. Care Partner Responses to the Onset of Mild Cognitive Impairment (United States)

    Blieszner, Rosemary; Roberto, Karen A.


    Purpose: We examined characteristics, responses, and psychological well-being of care partners who support and assist older adults recently diagnosed with mild cognitive impairment (MCI). Design and Methods: Based on a sample of 106 care partners of community residents diagnosed with MCI at memory clinics, we conducted face-to-face interviews…

  2. Drug utilization research in primary health care as exemplified by physicians' quality assessment groups. (United States)

    von Ferber, L; Luciano, A; Köster, I; Krappweis, J


    Drugs in primary health care are often prescribed for nonrational reasons. Drug utilization research investigates the prescription of drugs with an eye to medical, social and economic causes and consequences of the prescribed drug's utilization. The results of this research show distinct differences in drug utilization in different age groups and between men and women. Indication and dosage appear irrational from a textbook point of view. This indicates nonpharmacological causes of drug utilization. To advice successfully changes for the better quality assessment groups of primary health care physicians get information about their established behavior by analysis of their prescriptions. The discussion and the comparisons in the group allow them to recognize their irrational prescribing and the social, psychological and economic reasons behind it. Guidelines for treatment are worked out which take into account the primary health care physician's situation. After a year with 6 meetings of the quality assessment groups the education process is evaluated by another drug utilization analysis on the basis of the physicians prescription. The evaluation shows a remarkable improvement of quality and cost effectiveness of the drug therapy of the participating physicians.

  3. Life-sustaining treatment decisions in Portuguese intensive care units: a national survey of intensive care physicians. (United States)

    Cardoso, Teresa; Fonseca, Teresa; Pereira, Sofia; Lencastre, Luís


    The objective of the present study was to evaluate the opinion of Portuguese intensive care physicians regarding 'do-not-resuscitate' (DNR) orders and decisions to withhold/withdraw treatment. A questionnaire was sent to all physicians working on a full-time basis in all intensive care units (ICUs) registered with the Portuguese Intensive Care Society. A total of 266 questionnaires were sent and 175 (66%) were returned. Physicians from 79% of the ICUs participated. All participants stated that DNR orders are applied in their units, and 98.3% stated that decisions to withhold treatment and 95.4% stated that decisions to withdraw treatment are also applied. About three quarters indicated that only the medical group makes these decisions. Fewer than 15% of the responders stated that they involve nurses, 9% involve patients and fewer than 11% involve patients' relatives in end-of-life decisions. Physicians with more than 10 years of clinical experience more frequently indicated that they involve nurses in these decisions (P atheist doctors more frequently involve patients' relatives in decisions to withhold/withdraw treatment (P religious beliefs of the respondents influences the way in which these decisions are made.

  4. The role of primary care physicians in the Israel Defense Forces: a self-perception study. (United States)

    Zimlichman, Eyal; Mandel, Dror; Mimouni, Francis B; Vinker, Shlomo; Kochba, Ilan; Kreiss, Yitshak; Lahad, Amnon


    The health system of the medical corps of the Israel Defense Force is based primarily upon primary healthcare. In recent years, health management organizations have considered the primary care physician responsible for assessing the overall health needs of the patient and, accordingly, introduced the term "gatekeeper." To describe and analyze how PCPs in the IDF view their roles as primary care providers and to characterize how they perceive the quality of the medical care that they provide. We conducted a survey using a questionnaire that was mailed or faxed to a representative sample of PCPs. The questionnaire included demographic background, professional background, statements on self-perception issues, and ranking of roles as a PCP in the IDF. Statements concerning commitment to the patient were ranked higher than statements concerning commitment to the military organization. Most physicians perceive the quality of the medical care service that they provide as high; they also stated that they do not receive adequate continuous medical education. Our survey shows that PCPs in the IDF, like civilian family physicians, perceive their primary obligation as serving the needs of their patients but are yet to take on the full role of "gatekeepers" in the IDF's healthcare system. We conclude that the Medical Corps should implement appropriate steps to ensure that PCPs are prepared to take on a more prominent role as "gatekeepers" and providers of high quality primary medical care.

  5. Physicians Perceptions of Shared Decision-Making in Neonatal and Pediatric Critical Care. (United States)

    Richards, Claire A; Starks, Helene; O'Connor, M Rebecca; Bourget, Erica; Hays, Ross M; Doorenbos, Ardith Z


    Most children die in neonatal and pediatric intensive care units after decisions are made to withhold or withdraw life-sustaining treatments. These decisions can be challenging when there are different views about the child's best interest and when there is a lack of clarity about how best to also consider the interests of the family. To understand how neonatal and pediatric critical care physicians balance and integrate the interests of the child and family in decisions about life-sustaining treatments. Semistructured interviews were conducted with 22 physicians from neonatal, pediatric, and cardiothoracic intensive care units in a single quaternary care pediatric hospital. Transcribed interviews were analyzed using content and thematic analysis. We identified 3 main themes: (1) beliefs about child and family interests; (2) disagreement about the child's best interest; and (3) decision-making strategies, including limiting options, being directive, staying neutral, and allowing parents to come to their own conclusions. Physicians described challenges to implementing shared decision-making including unequal power and authority, clinical uncertainty, and complexity of balancing child and family interests. They acknowledged determining the level of engagement in shared decision-making with parents (vs routine engagement) based on their perceptions of the best interests of the child and parent. Due to power imbalances, families' values and preferences may not be integrated in decisions or families may be excluded from discussions about goals of care. We suggest that a systematic approach to identify parental preferences and needs for decisional roles and information may reduce variability in parental involvement.

  6. Physician Compare (United States)

    U.S. Department of Health & Human Services — Physician Compare, which meets Affordable Care Act of 2010 requirements, helps you search for and select physicians and other healthcare professionals enrolled in...

  7. The Leapfrog initiative for intensive care unit physician staffing and its impact on intensive care unit performance: a narrative review. (United States)

    Gasperino, James


    The field of critical care has changed markedly in recent years to accommodate a growing population of chronically critically ill patients. New administrative structures have evolved to include divisions, departments, and sections devoted exclusively to the practice of critical care medicine. On an individual level, the ability to manage complex multisystem critical illnesses and to introduce invasive monitoring devices defines the intensivist. On a systems level, critical care services managed by an intensivist-led multidisciplinary team are now recognized by their ability to efficiently utilize hospital resources and improve patient outcomes. Due to the numerous cost and quality issues related to the delivery of critical care medicine, intensive care unit physician staffing (IPS) has become a charged subject in recent years. Although the federal government has played a large role in regulating best practices by physicians, other third parties have entered the arena. Perhaps the most influential of these has been The Leapfrog Group, a consortium representing 130 employers and 65 Fortune 500 companies that purchase health care for their employees. This group has proposed specific regulatory guidelines for IPS that are purported to result in substantial cost containment and improved quality of care. This narrative review examines the impact of The Leapfrog Group's recommendations on critical care delivery in the United States. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  8. Randomized controlled trial of primary care physician motivational interviewing versus brief advice to engage adolescents with an Internet-based depression prevention intervention: 6-month outcomes and predictors of improvement

    NARCIS (Netherlands)

    Hoek, W.; Marko, M.; Fogel, J.; Schuurmans, J.; Gladstone, T.; Bradford, N.; Domanico, R.; Fagan, B.; Bell, C.; Reinecke, M.A.; van Voorhees, B.


    We believe that primary care physicians could play a key role in engaging youth with a depression prevention intervention. We developed CATCH-IT (Competent Adulthood Transition with Cognitive Behavioral and Interpersonal Training), which is an adolescent Internet-based behavior change model. We

  9. Temporal and subjective work demands in office-based patient care: an exploration of the dimensions of physician work intensity. (United States)

    Jacobson, C Jeff; Bolon, Shannon; Elder, Nancy; Schroer, Brian; Matthews, Gerald; Szaflarski, Jerzy P; Raphaelson, Marc; Horner, Ronnie D


    Physician work intensity (WI) during office-based patient care affects quality of care and patient safety as well as physician job-satisfaction and reimbursement. Existing, brief work intensity measures have been used in physician studies, but their validity in clinical settings has not been established. Document and describe subjective and temporal WI dimensions for physicians in office-based clinical settings. Examine these in relation to the measurement procedures and dimensions of the SWAT and NASA-TLX intensity measures. A focused ethnographic study using interviews and direct observations. Five family physicians, 5 general internists, 5 neurologists, and 4 surgeons. Through interviews, each physician was asked to describe low and high intensity work responsibilities, patients, and events. To document time and task allotments, physicians were observed during a routine workday. Notes and transcripts were analyzed using the editing method in which categories are obtained from the data. WI factors identified by physicians matched dimensions assessed by standard, generic instruments of work intensity. Physicians also reported WI factors outside of the direct patient encounter. Across specialties, physician time spent in direct contact with patients averaged 61% for office-based services. Brief work intensity measures such as the SWAT and NASA-TLX can be used to assess WI in the office-based clinical setting. However, because these measures define the physician work "task" in terms of effort in the presence of the patient (ie, intraservice time), substantial physician effort dedicated to pre- and postservice activities is not captured.

  10. Time-trend of melanoma screening practice by primary care physicians: a meta-regression analysis. (United States)

    Valachis, Antonis; Mauri, Davide; Karampoiki, Vassiliki; Polyzos, Nikolaos P; Cortinovis, Ivan; Koukourakis, Georgios; Zacharias, Georgios; Xilomenos, Apostolos; Tsappi, Maria; Casazza, Giovanni


    To assess whether the proportion of primary care physicians implementing full body skin examination (FBSE) to screen for melanoma changed over time. Meta-regression analyses of available data. MEDLINE, ISI, Cochrane Central Register of Controlled Trials. Fifteen studies surveying 10,336 physicians were included in the analyses. Overall, 15%-82% of them reported to perform FBSE to screen for melanoma. The proportion of physicians using FBSE screening tended to decrease by 1.72% per year (P =0.086). Corresponding annual changes in European, North American, and Australian settings were -0.68% (P =0.494), -2.02% (P =0.044), and +2.59% (P =0.010), respectively. Changes were not influenced by national guide-lines. Considering the increasing incidence of melanoma and other skin malignancies, as well as their relative potential consequences, the FBSE implementation time-trend we retrieved should be considered a worrisome phenomenon.

  11. Information needs of physicians, care coordinators, and families to support care coordination of children and youth with special health care needs (CYSHCN). (United States)

    Ranade-Kharkar, Pallavi; Weir, Charlene; Norlin, Chuck; Collins, Sarah A; Scarton, Lou Ann; Baker, Gina B; Borbolla, Damian; Taliercio, Vanina; Del Fiol, Guilherme


    Identify and describe information needs and associated goals of physicians, care coordinators, and families related to coordinating care for medically complex children and youth with special health care needs (CYSHCN). We conducted 19 in-depth interviews with physicians, care coordinators, and parents of CYSHCN following the Critical Decision Method technique. We analyzed the interviews for information needs posed as questions using a systematic content analysis approach and categorized the questions into information need goal types and subtypes. The Critical Decision Method interviews resulted in an average of 80 information needs per interview. We categorized them into 6 information need goal types: (1) situation understanding, (2) care networking, (3) planning, (4) tracking/monitoring, (5) navigating the health care system, and (6) learning, and 32 subtypes. Caring for CYSHCN generates a large amount of information needs that require significant effort from physicians, care coordinators, parents, and various other individuals. CYSHCN are often chronically ill and face developmental challenges that translate into intense demands on time, effort, and resources. Care coordination for CYCHSN involves multiple information systems, specialized resources, and complex decision-making. Solutions currently offered by health information technology fall short in providing support to meet the information needs to perform the complex care coordination tasks. Our findings present significant opportunities to improve coordination of care through multifaceted and fully integrated informatics solutions. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email:

  12. A Survey of Hospice and Palliative Care Physicians Regarding Palliative Sedation Practices. (United States)

    Lux, Michael R; Protus, Bridget McCrate; Kimbrel, Jason; Grauer, Phyllis


    Patients nearing the end of life may experience symptoms that are refractory to standard therapeutic options. Physicians may consider palliative sedation to relieve intolerable suffering. There is limited clinical literature regarding preferred medications for palliative sedation. To determine the preferred medications physicians use when implementing palliative sedation. An Internet-based, cross-sectional survey of hospice and palliative care physicians in the United States. A link to the survey was e-mailed to 3130 physician members of the American Academy of Hospice and Palliative Medicine, of which 381 physicians completed the survey. Physicians were not required to answer all questions. Nearly all (n = 335, 99%) respondents indicated that palliative sedation may be used (acceptable by 73% [n = 248] for refractory symptoms and acceptable by 26% [n = 87] only for imminently dying patients). Seventy-nine percent (n = 252) believed that opioids should not be used to induce palliative sedation but should be continued to provide pain control. Midazolam was the most commonly selected first-line choice for palliative sedation (n = 155, 42%). The most commonly reported second-line agents for the induction of palliative sedation were lorazepam, midazolam (for those who did not select midazolam as first-line agent), and phenobarbital with a reported preference of 20% (n = 49), 19% (n = 46), and 17% (n = 40), respectively. Of the physicians surveyed, 99% (n = 335) felt that palliative sedation is a reasonable treatment modality. Midazolam was considered a drug of choice for inducing and maintaining sedation, and opioids were continued for pain control.

  13. Perspectives on the value of advanced medical imaging: a national survey of primary care physicians. (United States)

    Hughes, Christine M; Kramer, Erich; Colamonico, Jennifer; Duszak, Richard


    To understand perceptions of primary care physicians (PCPs) about the value of advanced medical imaging. A national quantitative survey of 500 PCPs was conducted using an online self-administered questionnaire. Questions focused on advanced medical imaging (CT, MRI, and PET) and its perceived impact on the delivery of patient care. Responses were stratified by physician demographics. Large majorities of the PCPs indicated that advanced imaging increases their diagnostic confidence (441; 88%); provides data not otherwise available (451; 90%); permits better clinical decision making (440; 88%); increases confidence in treatment choices (438; 88%), and shortens time to definitive diagnosis (430; 86%]). Most (424; 85%) believe that patient care would be negatively affected without access to advanced imaging. PCPs whose clinical careers predated the proliferation of advanced imaging modalities (>20 years of practice) assigned higher value to advanced imaging on several dimensions compared with younger physicians whose training overlapped widespread technology availability. By a variety of metrics, large majorities of PCPs believe that advanced medical imaging provides considerable value to patient care. Those whose careers predated the widespread availability of advanced imaging tended to associate it with even higher value. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  14. The Latino Physician Shortage: How the Affordable Care Act Increases the Value of Latino Spanish-Speaking Physicians and What Efforts Can Increase Their Supply. (United States)

    Daar, David A; Alvarez-Estrada, Miguel; Alpert, Abigail E


    The United States Latino population is growing at a rapid pace and is set to reach nearly 30% by 2050. The demand for culturally and linguistically competent health care is increasing in lockstep with this growth; however, the supply of doctors with skills and experience suited for this care is lagging. In particular, there is a major shortage of Latino Spanish-speaking physicians, and the gap between demand and supply is widening. The implementation of the Affordable Care Act (ACA) has increased the capacity of the US healthcare system to care for the growing Latino Spanish-speaking population, through health insurance exchanges, increased funding for safety net institutions, and efforts to improve efficiency and coordination of care, particularly with Accountable Care Organizations and the Hospital Readmissions Reduction Program. With these policies in mind, the authors discuss how the value of Latino Spanish-speaking physicians to the healthcare system has increased under the environment of the ACA. In addition, the authors highlight key efforts to increase the supply of this physician population, including the implementation of the Deferred Action for Childhood Arrivals Act, premedical pipeline programs, and academic medicine and medical school education initiatives to increase Latino representation among physicians.

  15. Ambiguity and uncertainty tolerance, need for cognition, and their association with stress. A study among Italian practicing physicians. (United States)

    Iannello, Paola; Mottini, Anna; Tirelli, Simone; Riva, Silvia; Antonietti, Alessandro


    Medical practice is inherently ambiguous and uncertain. The physicians' ability to tolerate ambiguity and uncertainty has been proved to have a great impact on clinical practice. The primary aim of the present study was to test the hypothesis that higher degree of physicians' ambiguity and uncertainty intolerance and higher need for cognitive closure will predict higher work stress. Two hundred and twelve physicians (mean age = 42.94 years; SD = 10.72) from different medical specialties with different levels of expertise were administered a set of questionnaires measuring perceived levels of work-related stress, individual ability to tolerate ambiguity, stress deriving from uncertainty, and personal need for cognitive closure. A linear regression analysis was performed to examine which variables predict the perceived level of stress. The regression model was statistically significant [R 2  = .32; F(10,206) = 8.78, p ≤ .001], thus showing that, after controlling for gender and medical specialty, ambiguity and uncertainty tolerance, decisiveness (a dimension included in need for closure), and the years of practice were significant predictors of perceived work-related stress. Findings from the present study have some implications for medical education. Given the great impact that the individual ability to tolerate ambiguity and uncertainty has on the physicians' level of perceived work-related stress, it would be worth paying particular attention to such a skill in medical education settings. It would be crucial to introduce or to empower educational tools and strategies that could increase medical students' ability to tolerate ambiguity and uncertainty. JSQ: Job stress questionnaire; NFCS: Need for cognitive closure scale; PRU: Physicians' reactions to uncertainty; TFA: Tolerance for ambiguity.

  16. Impact of Medical Scribes on Physician and Patient Satisfaction in Primary Care. (United States)

    Pozdnyakova, Anastasia; Laiteerapong, Neda; Volerman, Anna; Feld, Lauren D; Wan, Wen; Burnet, Deborah L; Lee, Wei Wei


    Use of electronic health records (EHRs) is associated with physician stress and burnout. While emergency departments and subspecialists have used scribes to address this issue, little is known about the impact of scribes in academic primary care. Assess the impact of a scribe on physician and patient satisfaction at an academic general internal medicine (GIM) clinic. Prospective, pre-post-pilot study. During the 3-month pilot, physicians had clinic sessions with and without a scribe. We assessed changes in (1) physician workplace satisfaction and burnout, (2) time spent on EHR documentation, and (3) patient satisfaction. Six GIM faculty and a convenience sample of their patients (N = 325) at an academic GIM clinic. A 21-item pre- and 44-item post-pilot survey assessed physician workplace satisfaction and burnout. Physicians used logs to record time spent on EHR documentation outside of clinic hours. A 27-item post-visit survey assessed patient satisfaction during visits with and without the scribe. Of six physicians, 100% were satisfied with clinic workflow post-pilot (vs. 33% pre-pilot), and 83% were satisfied with EHR use post-pilot (vs. 17% pre-pilot). Physician burnout was low at baseline and did not change post-pilot. Mean time spent on post-clinic EHR documentation decreased from 1.65 to 0.76 h per clinic session (p = 0.02). Patient satisfaction was not different between patients who had clinic visits with vs. without scribe overall or by age, gender, and race. Compared to patients 65 years or older, younger patients were more likely to report that the physician was more attentive and provided more education during visits with the scribe present (p = 0.03 and 0.02, respectively). Male patients were more likely to report that they disliked having a scribe (p = 0.03). In an academic GIM setting, employment of a scribe was associated with improved physician satisfaction without compromising patient satisfaction.

  17. Adherence of Primary Care Physicians to Evidence-Based Recommendations to Reduce Ovarian Cancer Mortality (United States)

    Stewart, Sherri L.; Townsend, Julie S.; Puckett, Mary C.; Rim, Sun Hee


    Ovarian cancer is the deadliest gynecologic cancer. Receipt of treatment from a gynecologic oncologist is an evidence-based recommendation to reduce mortality from the disease. We examined knowledge and application of this evidence-based recommendation in primary care physicians as part of CDC gynecologic cancer awareness campaign efforts and discussed results in the context of CDC National Comprehensive Cancer Control Program (NCCCP). We analyzed primary care physician responses to questions about how often they refer patients diagnosed with ovarian cancer to gynecologic oncologists, and reasons for lack of referral. We also analyzed these physicians’ knowledge of tests to help determine whether a gynecologic oncologist is needed for a planned surgery. The survey response rate was 52.2%. A total of 84% of primary care physicians (87% of family/general practitioners, 81% of internists and obstetrician/gynecologists) said they always referred patients to gynecologic oncologists for treatment. Common reasons for not always referring were patient preference or lack of gynecologic oncologists in the practice area. A total of 23% of primary care physicians had heard of the OVA1 test, which helps to determine whether gynecologic oncologist referral is needed. Although referral rates reported here are high, it is not clear whether ovarian cancer patients are actually seeing gynecologic oncologists for care. The NCCCP is undertaking several efforts to assist with this, including education of the recommendation among women and providers and assistance with treatment summaries and patient navigation toward appropriate treatment. Expansion of these efforts to all populations may help improve adherence to recommendations and reduce ovarian cancer mortality. PMID:26978124

  18. Principles of effective communication with patients who have intellectual disability among primary care physicians. (United States)

    Werner, S; Yalon-Chamovitz, S; Tenne Rinde, M; Heymann, A D


    Examine physicians' implementation of effective communication principles with patients with intellectual disabilities (ID) and its predictors. Focus groups helped construct a quantitative questionnaire. The questionnaire (completed by 440 physicians) examined utilization of effective communication principles, attitudes toward individuals with ID, subjective knowledge and number of patients with ID. Subjective knowledge of ID and more patients with ID increased utilization of effective communication principles. Provision of knowledge that allows patients to make their own medical decisions was predicted by more patients with ID, lower attitudes that treatment of this population group is not desirable, less negative affect and greater perception that treatment of this group is part of the physician's role. Effective preparation of patients with ID for treatment was predicted by higher perception of treatment of this group as part of the physician's role, lower perception of this field as undesirable and higher perception of these individuals as unable to make their own choice. Simplification of information was predicted by a greater perception of treatment of this group as part of the physician's role and more negative affect. Greater familiarity may enhance care for these patients. Increase exposure to patients with ID within training. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. Statewide Policy Change in Pediatric Dental Care, and the Impact on Pediatric Dental and Physician Visits. (United States)

    Zlotnick, Cheryl; Tam, Tammy; Ye, Yu


    Introduction In 2007, the California signed legislation mandating a dental visit for all children entering kindergarten or first grade; no such mandate was made for physician visits. This study examines the impact of this policy change on the risk factors associated with obtaining pediatric dental and physician health care visits. Methods Every 2 years, California Health Interview Survey conducts a statewide survey on a representative community sample. This cross-sectional study took advantage of these data to conduct a "natural experiment" assessing the impact of this policy change on both pediatric physician and dental care visits in the past year. Samples included surveys of adults and children (ages 5-11) on years 2005 (n = 5096), 2007 (n = 4324) and 2009 (n = 4100). Results Although few changes in risk factors were noted in pediatric physician visits, a gradual decrease in risk factors was found in pediatric dental visits from 2005 to 2009. Report of no dental visit was less likely for: younger children (OR -0.81, CI 0.75-0.88), insured children (OR 0.34, CI 0.22-0.53), and children who had a physician's visit last year (OR 0.37, CI 0.25-0.53) in 2005. By 2007, absence of insurance was the only risk factor related to having no dental visit (OR 0.34, CI 0.19-0.61). By 2009, no a priori measured risk factors were associated with not having a dental visit for children aged 5-11 years. Conclusions A statewide policy mandating pediatric dental visits appears to have reduced disparities. A policy for medical care may contribute to similar benefits.

  20. Who needs a gatekeeper? Patients' views of the role of the primary care physician. (United States)

    Gross, R; Tabenkin, H; Brammli-Greenberg, S


    The primary care physician serving as a 'gatekeeper' can make judicious decisions about the appropriate use of medical services, and thereby contribute to containing costs while improving the quality of care. However, in Israel, sick funds competing for members have not adopted this model for fear of endangering their competitive stance. The purpose of this study was to examine, for the first time, the stated preferences and actual behaviour of a national sample of members of the four Israeli sick funds regarding self-referral to specialists, and to identify the characteristics of patients who prefer the gatekeeper model. Data were derived from a national telephone survey carried out in 1997. A random representative sample of 1084 of all adult sick fund members were interviewed, with a response rate of 81%. Bivariate analysis was conducted using over all chi-square tests, and multivariate analysis was performed using logistic regression models. A third of all respondents prefer self-referral to a specialist, 40% prefer their family physician to act as gatekeeper and 19% prefer the physician to co-ordinate care but to refer themselves to a specialist. Independent variables predicting preference for the gatekeeper model are: living in the periphery, sick fund membership, low level of education, being male, fair or poor health status, having a permanent family physician and being satisfied with the professional level of the family physician. A significant correlation was found between practising self-referral and preference for self-referral. CONCLUSIONS.: The findings indicate the importance of surveying patients' attitudes as an input in policy formulation. The study identified specific population groups which prefer the gatekeeper model, and explored the advantages of a flexible model of gatekeeping.

  1. Association between satisfaction and stress with aspects of job and practice management among primary care physicians. (United States)

    Mazzaglia, Giampiero; Lapi, Francesco; Silvestri, Caterina; Roti, Lorenzo; Giustini, Saffi Ettore; Buiatti, Eva


    Reforms introduced in the last decade in Italian general practice, have contributed to the changing role of primary care physicians (PCPs) within the Italian National Health Service, with potential difficulties adapting that may lead to job stress and dissatisfaction. The present study aims to compare job satisfaction and stress levels of PCPs working in primary healthcare teams (PHCTs) with those for practitioners operating in single ambulatory offices, and to assess potential associations with aspects of job and practice management. A postal survey was conducted between January and March 2005 among PCPs working in Tuscany. Data were collected by using a structured questionnaire containing questions concerning personal, professional, job and practice characteristics. The Warr-Cook-Wall scale and the Cooper test were used to assess job satisfaction and stress, respectively. From 3043 PCPs, a response rate of 45.2% was achieved. Significant differences were found between PHCT physicians and solo practitioners in several aspects of their job. Physicians working in PHCTs appeared more satisfied in some aspects of their practice such as organisation, whereas they were less satisfied about workload and interaction with other healthcare providers. Multivariate modelling showed relevant aspects of dissatisfaction and stress, particularly the difficulties of collaboration with other healthcare providers, and access to specialised services. Reform strategies aimed at improving the quality of care among PCPs needs to take into account the contextual determinants of physician satisfaction and stress, and should highlight programmes that might be pursued to improve the integration of PCPs within the Italian National Health System.

  2. Impact of Burnout on Self-Reported Patient Care Among Emergency Physicians

    Directory of Open Access Journals (Sweden)

    Dave W. Lu


    Full Text Available Introduction: Burnout is a syndrome of depersonalization, emotional exhaustion and sense of low personal accomplishment. Emergency physicians (EPs experience the highest levels of burnout among all physicians. Burnout is associated with greater rates of self-reported suboptimal care among surgeons and internists. The association between burnout and suboptimal care among EPs is unknown. The objective of the study was to evaluate burnout rates among attending and resident EPs and examine their relationship with self-reported patient care practices. Methods: In this cross-sectional study burnout was measured at two university-based emergency medicine residency programs with the Maslach Burnout Inventory. We also measured depression, quality of life (QOL and career satisfaction using validated questionnaires. Six items assessed suboptimal care and the frequency with which they were performed. Results: We included 77 out of 155 (49.7% responses. The EP burnout rate was 57.1%, with no difference between attending and resident physicians. Residents were more likely to screen positive for depression (47.8% vs 18.5%, p=0.012 and report lower QOL scores (6.7 vs 7.4 out of 10, p=0.036 than attendings. Attendings and residents reported similar rates of career satisfaction (85.2% vs 87.0%, p=0.744. Burnout was associated with a positive screen for depression (38.6% vs 12.1%, p=0.011 and lower career satisfaction (77.3% vs 97.0%, p=0.02. EPs with high burnout were significantly more likely to report performing all six acts of suboptimal care. Conclusion: A majority of EPs demonstrated high burnout. EP burnout was significantly associated with higher frequencies of self-reported suboptimal care. Future efforts to determine if provider burnout is associated with negative changes in actual patient care are necessary.

  3. Personal characteristics associated with resident physicians' self perceptions of preparedness to deliver cross-cultural care. (United States)

    Lopez, Lenny; Vranceanu, Ana-Maria; Cohen, Amy P; Betancourt, Joseph; Weissman, Joel S


    Recent reports from the Institute of Medicine emphasize patient-centered care and cross-cultural training as a means of improving the quality of medical care and eliminating racial and ethnic disparities. To determine whether, controlling for training received in medical school or during residency, resident physician socio-cultural characteristics influence self-perceived preparedness and skill in delivering cross-cultural care. National survey of resident physicians. A probability sample of residents in seven specialties in their final year of training at US academic health centers. Nine resident characteristics were analyzed. Differences in preparedness and skill were assessed using the chi(2) statistic and multivariate logistic regression. Fifty-eight percent (2047/3500) of residents responded. The most important factor associated with improved perceived skill level in performing selected tasks or services believed to be useful in treating culturally diverse patients was having received cross-cultural skills training during residency (OR range 1.71-4.22). Compared with white residents, African American physicians felt more prepared to deal with patients with distrust in the US healthcare system (OR 1.63) and with racial or ethnic minorities (OR 1.61), Latinos reported feeling more prepared to deal with new immigrants (OR 1.88) and Asians reported feeling more prepared to deal with patients with health beliefs at odds with Western medicine (1.43). Cross-cultural care skills training is associated with increased self-perceived preparedness to care for diverse patient populations providing support for the importance of such training in graduate medical education. In addition, selected resident characteristics are associated with being more or less prepared for different aspects of cross-cultural care. This underscores the need to both include medical residents from diverse backgrounds in all training programs and tailor such programs to individual resident needs in

  4. A conceptual model of physician work intensity: guidance for evaluating policies and practices to improve health care delivery. (United States)

    Horner, Ronnie D; Matthews, Gerald; Yi, Michael S


    Physician work intensity, although a major factor in determining the payment for medical services, may potentially affect patient health outcomes including quality of care and patient safety, and has implications for the redesign of medical practice to improve health care delivery. However, to date, there has been minimal research regarding the relationship between physician work intensity and either patient outcomes or the organization and management of medical practices. A theoretical model on physician work intensity will provide useful guidance to such inquiries. To describe an initial conceptual model to facilitate further investigations of physician work intensity. A conceptual model of physician work intensity is described using as its theoretical base human performance science relating to work intensity. For each of the theoretical components, we present relevant empirical evidence derived from a review of the current literature. The proposed model specifies that the level of work intensity experienced by a physician is a consequence of the physician performing the set of tasks (ie, demands) relating to a medical service. It is conceptualized that each medical service has an inherent level of intensity that is experienced by a physician as a function of factors relating to the physician, patient, and medical practice environment. The proposed conceptual model provides guidance to researchers as to the factors to consider in studies of how physician work intensity impacts patient health outcomes and how work intensity may be affected by proposed policies and approaches to health care delivery.

  5. Pregnancy Options Counseling and Abortion Referrals Among US Primary Care Physicians: Results From a National Survey. (United States)

    Holt, Kelsey; Janiak, Elizabeth; McCormick, Marie C; Lieberman, Ellice; Dehlendorf, Christine; Kajeepeta, Sandhya; Caglia, Jacquelyn M; Langer, Ana


    Primary care physicians (PCPs) can play a critical role in addressing unintended pregnancy through high-quality options counseling and referrals. We surveyed a nationally representative sample of 3,000 PCPs in general, family, and internal medicine on practices and opinions related to options counseling for unintended pregnancy. We assessed predictors of physician practices using multivariable logistic regression weighted for sampling design and differential non-response. Response rate was 29%. Seventy-one percent believed residency training in options counseling should be required, and 69% believed PCPs have an obligation to provide abortion referrals even in the presence of a personal objection to abortion. However, only 26% reported routine options counseling when caring for women with unintended pregnancy compared to 60% who routinely discuss prenatal care. Among physicians who see women seeking abortion, 62% routinely provide referrals, while 14% routinely attempt to dissuade women. Family physicians were more likely to provide routine options counseling when seeing patients with unintended pregnancy than internal medicine physicians (32% vs 21%, P=0.002). In multivariable analyses, factors associated with higher odds of routine abortion referrals were more years in practice (OR=1.03 for each additional year, 95% CI: 1.00-1.05), identifying as a woman vs a man (OR=2.11, 95% CI: 1.31-3.40), practicing in a hospital vs private primary care/multispecialty setting (OR=3.17, 95% CI: 1.10-9.15), and no religious affiliation of practice vs religious affiliation (OR for Catholic affiliation=0.27, 95% CI: 0.11-0.66; OR for other religious affiliation=0.36, 95% CI: 0.15-0.83). Personal Christian religious affiliation among physicians who regularly attend religious services vs no religious affiliation was associated with lower odds of counseling (OR=0.48, 95% CI: 0.26-0.90) and referrals (OR=0.31, 95% CI: 0.15-0.62), and higher odds of abortion dissuasion (OR=4.03, 95

  6. Care mapping in clinical neuroscience settings: Cognitive impairment and dependency. (United States)

    Leigh, Andrew James; O'Hanlon, Katie; Sheldrick, Russell; Surr, Claire; Hare, Dougal Julian


    Person-centred care can improve the well-being of patients and is therefore a key driver in healthcare developments in the UK. The current study aims to investigate the complex relationship between cognitive impairment, dependency and well-being in people with a wide range of acquired brain and spinal injuries. Sixty-five participants, with varied acquired brain and spinal injuries, were selected by convenience sampling from six inpatient clinical neuroscience settings. Participants were observed using Dementia Care Mapping - Neurorehabilitation (DCM-NR) and categorised based on severity of cognitive impairment. A significant difference in the behaviours participants engaged in, their well-being and dependency was found between the severe cognitive impairment group and the mild, moderate or no cognitive impairment groups. Dependency and cognitive impairment accounted for 23.9% of the variance in well-ill-being scores and 17.2% of the variance in potential for positive engagement. The current study highlights the impact of severe cognitive impairment and dependency on the behaviours patients engaged in and their well-being. It also affirms the utility of DCM-NR in providing insights into patient experience. Consideration is given to developing DCM-NR as a process that may improve person-centred care in neuroscience settings.

  7. Physicians' perceptions of quality of care, professional autonomy, and job satisfaction in Canada, Norway, and the United States. (United States)

    Tyssen, Reidar; Palmer, Karen S; Solberg, Ingunn B; Voltmer, Edgar; Frank, Erica


    We lack national and cross-national studies of physicians' perceptions of quality of patient care, professional autonomy, and job satisfaction to inform clinicians and policymakers. This study aims to compare such perceptions in Canada, the United States (U.S.), and Norway. We analyzed data from large, nationwide, representative samples of physicians in Canada (n = 3,213), the U.S. (n = 6,628), and Norway (n = 657), examining demographics, job satisfaction, and professional autonomy. Among U.S. physicians, 79% strongly agreed/agreed they could provide high quality patient care vs. only 46% of Canadian and 59% of Norwegian physicians. U.S. physicians also perceived more clinical autonomy and time with their patients, with differences remaining significant even after controlling for age, gender, and clinical hours. Women reported less adequate time, clinical freedom, and ability to provide high-quality care. Country differences were the strongest predictors for the professional autonomy variables. In all three countries, physicians' perceptions of quality of care, clinical freedom, and time with patients influenced their overall job satisfaction. Fewer U.S. physicians reported their overall job satisfaction to be at-least-somewhat satisfied than did Norwegian and Canadian physicians. U.S. physicians perceived higher quality of patient care and greater professional autonomy, but somewhat lower job satisfaction than their colleagues in Norway and Canada. Differences in health care system financing and delivery might help explain this difference; Canada and Norway have more publicly-financed, not-for-profit health care delivery systems, vs. a more-privately-financed and profit-driven system in the U.S. None of these three highly-resourced countries, however, seem to have achieved an ideal health care system from the perspective of their physicians.

  8. Do family physicians need more payment for working better? Financial incentives in primary care. (United States)

    Kolozsvári, László Róbert; Orozco-Beltran, Domingo; Rurik, Imre


    Financial incentives are widely used in health services to improve the quality of care or to reach some specific targets. Pay for performance systems were also introduced in the primary health care systems of many European countries. Our study aims to describe and compare recent existing primary care indicators and related financing in European countries. Literature search was performed and questionnaires were sent to primary care experts of different countries within the European General Practice Research Network. Ten countries have published primary care quality indicators (QI) associated with financial incentives. The number of QI varies from 1 to 134 and can modify the finances of physicians with up to 25% of their total income. The implementations of these schemes should be critically evaluated with continuous monitoring at national or regional level; comparison is required between targets and their achievements, health gains and use of resources as well. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  9. The role of emergency medicine physicians in trauma care in North America: evolution of a specialty

    Directory of Open Access Journals (Sweden)

    Grossman Michael D


    Full Text Available Abstract The role of Emergency Medicine Physicians (EMP in the care of trauma patients in North America has evolved since the advent of the specialty in the late 1980's. The evolution of this role in the context of the overall demands of the specialty and accreditation requirements of North American trauma centers will be discussed. Limited available data published in the literature examining the role of EMP's in trauma care will be reviewed with respect to its implications for an expanded role for EMPs in trauma care. Two training models currently in the early stages of development have been proposed to address needs for increased manpower in trauma and the critical care of trauma patients. The available information regarding these models will be reviewed along with the implications for improving the care of trauma patients in both Europe and North America.

  10. The Attitudes of Indian Palliative-care Nurses and Physicians to Pain Control and Palliative Sedation. (United States)

    Gielen, Joris; Gupta, Harmala; Rajvanshi, Ambika; Bhatnagar, Sushma; Mishra, Seema; Chaturvedi, Arvind K; den Branden, Stef Van; Broeckaert, Bert


    We wanted to assess Indian palliative-care nurses and physicians' attitudes toward pain control and palliative sedation. From May to September 2008, we interviewed 14 physicians and 13 nurses working in different palliative-care programs in New Delhi, using a semi-structured questionnaire, and following grounded-theory methodology (Glaser and Strauss). The interviewees did not consider administration of painkillers in large doses an ethical problem, provided the pain killers are properly titrated. Mild palliative sedation was considered acceptable. The interviewees disagreed whether palliative sedation can also be deep and continuous. Arguments mentioned against deep continuous palliative sedation were the conviction that it may cause unacceptable side effects, and impedes basic daily activities and social contacts. A few interviewees said that palliative sedation may hasten death. Due to fears and doubts regarding deep continuous palliative sedation, it may sometimes be too easily discarded as a treatment option for refractory symptoms.

  11. Satisfaction with electronic health records is associated with job satisfaction among primary care physicians

    Directory of Open Access Journals (Sweden)

    Christine D Jones


    Full Text Available Objective To evaluate the association between electronic health record (EHR satisfaction and job satisfaction in primary care physicians (PCPs.Method Cross-sectional survey of PCPs at 825 primary care practices in North Carolina.Results Surveys were returned from 283 individuals across 214 practices (26% response rate for practices, of whom 122 were physicians with EHRs and no missing information. We found that for each point increase in EHR satisfaction, job satisfaction increased by ~0.36 points both in an unadjusted and an adjusted model (β 0.359 unadjusted, 0.361 adjusted; p < 0.001 for both models.Conclusion We found that EHR satisfaction was associated with job satisfaction in a cross-sectional survey of PCPs. Our conclusions are limited by suboptimum survey response rate, but if confirmed may have substantial implications for how EHR vendors develop their product to support the needs of PCPs.

  12. Training primary care physicians in community eye health. Experiences from India.

    Directory of Open Access Journals (Sweden)

    Gupta Sanjeev


    Full Text Available This paper describes the impact of training on primary-care physicians in community eye health through a series of workshops. 865 trainees completed three evaluation formats anonymously. The questions tested knowledge on magnitude of blindness, the most common causes of blindness, and district level functioning of the National Programme for Control of Blindness (NPCB. Knowledge of the trainers significantly improved immediately after the course (chi 2 300.16; p < 0.00001. This was independent of the timing of workshops and number of trainees per batch. Presentation, content and relevance to job responsibilities were most appreciated. There is immense value addition from training primary-care physicians in community eye health. Despite a long series of training sessions, trainer fatigue was minimal; therefore, such capsules can be replicated with great success.

  13. Training in male sexual and reproductive health for a primary care physician. (United States)

    Shaiful, Bi


    In 2006, I was awarded a scholarship from Universiti Sains Malaysia for Fellowship training at Monash University (MU) for one year. The objective of the training programme was to develop knowledge and skills in several areas, including androgen deficiency, male infertility, prostate disease, testicular tumours, sexual dysfunction and sexually transmitted diseases. The training programme consisted of attachments with clinical specialists, completion of a course work module and a research project. After completion of the training programme, I believe that Primary Care Physicians (PCPs) will benefit from undertaking the training programme that I had completed. It will enable PCPs to assume leadership roles in this multidisciplinary area. The ability of PCPs in handling sexual and reproductive health issues in men will definitely be a more cost effective form of care for patients, particularly as the number of specialists is limited, and even more importantly, it will be satisfying for the patient and the physician.


    Directory of Open Access Journals (Sweden)



    Full Text Available In 2006, I was awarded a scholarship from Universiti Sains Malaysia for Fellowship training at Monash University (MU for one year. The objective of the training programme was to develop knowledge and skills in several areas, including androgen deficiency, male infertility, prostate disease, testicular tumours, sexual dysfunction and sexually transmitted diseases. The training programme consisted of attachments with clinical specialists, completion of a course work module and a research project. After completion of the training programme, I believe that Primary Care Physicians (PCPs will benefit from undertaking the training programme that I had completed. It will enable PCPs to assume leadership roles in this multidisciplinary area. The ability of PCPs in handling sexual and reproductive health issues in men will definitely be a more cost effective form of care for patients, particularly as the number of specialists is limited, and even more importantly, it will be satisfying for the patient and the physician.

  15. Physicians' accounts of frontline tensions when implementing pilot projects to improve primary care. (United States)

    Mansfield, Elizabeth; Bhattacharyya, Onil; Christian, Jennifer; Naglie, Gary; Steriopoulos, Vicky; Webster, Fiona


    Purpose Canada's primary care system has been described as "a culture of pilot projects" with little evidence of converting successful initiatives into funded, permanent programs or sharing project outcomes and insights across jurisdictions. Health services pilot projects are advocated as an effective strategy for identifying promising models of care and building integrated care partnerships in local settings. In the qualitative study reported here, the purpose of this paper is to investigate the strengths and challenges of this approach. Design/methodology/approach Semi-structured interviews were conducted with 34 primary care physicians who discussed their experiences as pilot project leads. Following thematic analysis methods, broad system issues were captured as well as individual project information. Findings While participants often portrayed themselves as advocates for vulnerable patients, mobilizing healthcare organizations and providers to support new models of care was discussed as challenging. Competition between local healthcare providers and initiatives could impact pilot project success. Participants also reported tensions between their clinical, project management and research roles with additional time demands and skill requirements interfering with the work of implementing and evaluating service innovations. Originality/value Study findings highlight the complexity of pilot project implementation, which encompasses physician commitment to addressing care for vulnerable populations through to the need for additional skill set requirements and the impact of local project environments. The current pilot project approach could be strengthened by including more multidisciplinary collaboration and providing infrastructure supports to enhance the design, implementation and evaluation of health services improvement initiatives.

  16. A national survey to define a new core curriculum to prepare physicians for managed care practice. (United States)

    Meyer, G S; Potter, A; Gary, N


    All levels of medical education will require modification to address the challenges in health care practice brought about by managed care. Because preparation for practice in a managed care environment has received insufficient attention, and because the need for change is so great, in 1995 the authors sought information from a variety of sources to serve as a basis for identifying the core curricular components and the staging of these components in the medical education process. This research effort consisted of a survey of 125 U.S. medical school curriculum deans (or equivalent school representatives); four focus groups of managed care practitioners, administrators, educators, and residents; and a survey of a national sample of physicians and medical directors. Findings indicate that almost all the 91 responding school representatives recognized the importance of revising their curricula to meet the managed care challenge and that the majority either had or were developing programs to train students for practice in managed care environments. The focus groups identified a core set of competencies for managed care practice, although numbers differed on whether the classroom or a managed care setting was the best place to teach the components of a new curriculum. Although medical directors and staff physicians differed with respect to the relative levels of importance of these competencies, the findings suggest that before medical school, training should focus on communication and interpersonal skills, information systems, and customer relations; during medical school, on clinical epidemiology, quality assurance, risk management, and decision analysis; during residency, on utilization management, managed care essentials, and multidisciplinary team building; and after residency, on a review of customer relations, communication skills, and utilization management. The authors conclude that a core curriculum and its sequencing can be identified, that the majority of

  17. Patient satisfaction and alliance as a function of the physician's self-regulation, the physician's stress, and the content of consultation in cancer care. (United States)

    De Vries, A M M; Gholamrezaee, M M; Verdonck-de Leeuw, I M; Passchier, J; Despland, J-N; Stiefel, F; de Roten, Y


    To investigate which characteristics of the physician and of the consultation are related to patient satisfaction with communication and working alliance. Real-life consultations (N = 134) between patients (n = 134) and their physicians (n = 24) were audiotaped. All of the patients were aware of their cancer diagnosis and consulted their physician to discuss the results of tests (CT scans, magnetic resonance imaging, or tumor markers) and the progression of their cancer. The consultations were transcribed and coded with the "Defense Mechanisms Rating Scale-Clinician." The patients and physicians completed questionnaires about stress, satisfaction, and alliance, and the data were analyzed using robust linear modeling. Patient satisfaction with communication and working alliance was high. Both were significantly (negatively) related to the physician's neurotic and action defenses-in particular to the defenses of displacement, self-devaluation, acting out, and hypochondriasis-as well as to the physician's stress level. The content of the consultation was not significantly related to the patient outcomes. Our study shows that patient satisfaction with communication and working alliance is not influenced by the content of the consultation but is significantly associated with the physician's self-regulation (defense mechanisms) and stress. The results of this study might contribute to optimizing communication skills training and to improving communication and working alliance in cancer care. Copyright © 2016 John Wiley & Sons, Ltd.

  18. [Opinion of primary care physicians from Ourense on various features of the pharmaceutical prescription]. (United States)

    Díaz Grávalos, G J; Palmeiro Fernández, G; Núnñez Masid, E; Casado Górriz, I


    To learn the opinion of the primary care Physicians of Ourense (Spain) with respect to certain aspects of their prescription of medicines, such as their awareness of the price of drugs, the induced prescribing perceived, their relationship with the pharmaceutical industry and their opinions concerning possible measures for reducing the expenditure on medicines. In this transversal descriptive study, all of the primary care physicians in the province of Ourense (243) were surveyed by means of a previously-approved questionnaire sent to them by post. The questionnaire included demographic characteristics of the physicians, the influence of cost when prescribing medicines, their estimate of the price of 15 drugs routinely prescribed and their opinion on different aspects relating to induced prescription, the pharmaceutical industry and different strategies in order to curtail the expenditure on medicines. In order to analyze the results, the chi 2 and Student's t tests and an analysis of the variance were used, together with the Spearman correlation coefficient with alpha = 0.05. The level of participation of the physicians surveyed was 42.8% (104). The average daily duration of visits by pharmaceutical company representatives was 13.6 minutes, with new specialities being the topic of greatest interest. Close to 27% admitted to having participated in clinical testing sponsored by the industry. 23% considered the price to be a priority when prescribing. Induced prescription accounted for 39.7% of the total. The majority of physicians chose co-payment as the means for reducing expenditure on medicines. In the estimate of prices, the overall percentage of error was 45.7%, underestimating the more expensive medicines and overestimating the less expensive. There is a significant lack of awareness of the price of drugs among the primary care physicians. Most of the physicians do not feel that the price of a drug should be a priority when prescribing medicines. There is a

  19. Impact of non-physician health professionals' BMI on obesity care and beliefs. (United States)

    Bleich, Sara N; Bandara, Sachini; Bennett, Wendy L; Cooper, Lisa A; Gudzune, Kimberly A


    Examine the impact of non-physician health professional body mass index (BMI) on obesity care, self-efficacy, and perceptions of patient trust in weight loss advice. A national cross-sectional Internet-based survey of 500 US non-physician health professionals specializing in nutrition, nursing, behavioral/mental health, exercise, and pharmacy collected between January 20 and February 5, 2014 was analyzed. Normal-BMI professionals were more likely than overweight/obese professionals to report success in helping patients achieve clinically significant weight loss (52% vs. 29%, P = 0.01). No differences by health professional BMI about the appropriate patient body weight for weight-related care (initiate weight loss discussions and success in helping patients lose weight), confidence in ability to help patients lose weight, or in perceived patient trust in their advice were observed. Most health professionals (71%) do not feel successful in helping patients lose weight until they are morbidly obese, regardless of BMI. Normal-BMI non-physician health professionals report being more successful than overweight and obese health professionals at helping obese patients lose weight. More research is needed to understand how to improve self-efficacy for delivering obesity care, particularly among overweight and class I obese patients. © 2014 The Obesity Society.

  20. Changes in Payer Mix and Physician Reimbursement After the Affordable Care Act and Medicaid Expansion (United States)

    Jones, Christine D.; Scott, Serena J.; Anoff, Debra L.; Pierce, Read G.; Glasheen, Jeffrey J.


    Although uncompensated care for hospital-based care has fallen dramatically since the implementation of the Affordable Care Act and Medicaid expansion, the changes in hospital physician reimbursement are not known. We evaluated if payer mix and physician reimbursement by encounter changed between 2013 and 2014 in an academic hospitalist practice in a Medicaid expansion state. This was a retrospective cohort study of all general medicine inpatient admissions to an academic hospitalist group in 2013 and 2014. The proportion of encounters by payer and reimbursement/inpatient encounter were compared in 2013 versus 2014. A sensitivity analysis determined the relative contribution of different factors to the change in reimbursement/encounter. Among 37 540 and 40 397 general medicine inpatient encounters in 2013 and 2014, respectively, Medicaid encounters increased (17.3% to 30.0%, P reimbursement/encounter increased 4.2% from $79.98/encounter in 2013 to $83.36/encounter in 2014 (P reimbursement for encounter type by payer accounted for −0.7%, 0.8%, 2.0%, and 2.3% of the reimbursement change, respectively. From 2013 to 2014, Medicaid encounters increased, and uninsured and private payer encounters decreased within our hospitalist practice. Reimbursement/encounter also increased, much of which could be attributed to a change in payer mix. Further analyses of physician reimbursement in Medicaid expansion and non-expansion states would further delineate reimbursement changes that are directly attributable to Medicaid expansion. PMID:26310500

  1. Financial incentives and measurement improved physicians' quality of care in the Philippines. (United States)

    Peabody, John; Shimkhada, Riti; Quimbo, Stella; Florentino, Jhiedon; Bacate, Marife; McCulloch, Charles E; Solon, Orville


    The merits of using financial incentives to improve clinical quality have much appeal, yet few studies have rigorously assessed the potential benefits. The uncertainty surrounding assessments of quality can lead to poor policy decisions, possibly resulting in increased cost with little or no quality improvement, or missed opportunities to improve care. We conducted an experiment involving physicians in thirty Philippine hospitals that overcomes many of the limitations of previous studies. We measured clinical performance and then examined whether modest bonuses equal to about 5 percent of a physician's salary, as well as system-level incentives that increased compensation to hospitals and across groups of physicians, led to improvements in the quality of care. We found that both the bonus and system-level incentives improved scores in a quality measurement system used in our study by ten percentage points. Our findings suggest that when careful measurement is combined with the types of incentives we studied, there may be a larger impact on quality than previously recognized.

  2. The Effect of Physician Delegation to Other Health Care Providers on the Quality of Care for Geriatric Conditions (United States)

    Lichtenstein, Brian J.; Reuben, David B.; Karlamangla, Arun S.; Han, Weijuan; Roth, Carol P.; Wenger, Neil S.


    OBJECTIVES to examine the effects of delegation on quality of care that patients receive for three common geriatric conditions: dementia, falls, and incontinence. DESIGN pooled analysis of 8 the Assessing Care of Vulnerable Elders (ACOVE) projects from 1998 to 2010. SETTING 15 ambulatory practice sites across the United States PARTICIPANTS 4,776 patients age ≥ 65 years, of mixed demographic backgrounds who participated in ACOVE studies. INTERVENTION multivariate analysis of prior ACOVE observation and intervention studies was conducted, with in addition to two retrospectively defined variables: “intent to delegate” and “maximum delegation” for each ACOVE quality indicator (QI). MEASUREMENTS The primary outcome for the study was QI pass probability, by level of delegation, for 47 ACOVE quality indicators. RESULTS A total of 4,776 patients were evaluated, with 16,204 QIs included for analysis. Across all studies, QI pass probabilities were 0.36 for physician-performed tasks; 0.55 for nurse practitioner (NP), physician assistant (PA), and registered nurse (RN)-performed tasks; and 0.61 for medical assistant (MA), or licensed vocational nurse (LVN)-performed tasks. In multiply adjusted models, the independent pass-probability effect of delegation to NPs, PAs, or RNs was 1.37 (p = 0.055) CONCLUSIONS Delegation to non-physician providers is associated with higher quality of care for geriatric conditions in community practices and supports the value of interdisciplinary team management for common outpatient conditions among older adults. PMID:26480977

  3. One positive impact of health care reform to physicians: the computer-based patient record. (United States)

    England, S P


    The health care industry is an information-dependent business that will require a new generation of health information systems if successful health care reform is to occur. We critically need integrated clinical management information systems to support the physician and related clinicians at the direct care level, which in turn will have linkages with secondary users of health information such as health payors, regulators, and researchers. The economic dependence of health care industry on the CPR cannot be underestimated, says Jeffrey Ritter. He sees the U.S. health industry as about to enter a bold new age where our records are electronic, our computers are interconnected, and our money is nothing but pulses running across the telephone lines. Hence the United States is now in an age of electronic commerce. Clinical systems reform must begin with the community-based patient chart, which is located in the physician's office, the hospital, and other related health care provider offices. A community-based CPR and CPR system that integrates all providers within a managed care network is the most logical step since all health information begins with the creation of a patient record. Once a community-based CPR system is in place, the physician and his or her clinical associates will have a common patient record upon which all direct providers have access to input and record patient information. Once a community-level CPR system is in place with a community provider network, each physician will have available health information and data processing capability that will finally provide real savings in professional time and effort. Lost patient charts will no longer be a problem. Data input and storage of health information would occur electronically via transcripted text, voice, and document imaging. All electronic clinical information, voice, and graphics could be recalled at any time and transmitted to any terminal location within the health provider network. Hence

  4. State variation in primary care physician supply: implications for health reform Medicaid expansions. (United States)

    Cunningham, Peter J


    Under the Patient Protection and Affordable Care Act (PPACA), Medicaid enrollment is expected to grow by 16 million people by 2019, an increase of more than 25 percent. Given the unwillingness of many primary care physicians (PCPs) to treat new Medicaid patients, policy makers and others are concerned about adequate primary care capacity to meet the increased demand. States with the smallest number of PCPs per capita overall--gen­erally in the South and Mountain West--potentially will see the largest per­centage increases in Medicaid enrollment, according to a new national study by the Center for Studying Health System Change (HSC). In contrast, states with the largest number of PCPs per capita--primarily in the Northeast--will see more modest increases in Medicaid enrollment. Moreover, geograph­ic differences in PCP acceptance of new Medicaid patients reflect differences in overall PCP supply, not geographic differences in PCPs' willingness to treat Medicaid patients. The law also increases Medicaid reimbursement rates for certain services provided by primary care physicians to 100 percent of Medicare rates in 2013 and 2014. However, the reimbursement increases are likely to have the greatest impact in states that already have a large number of PCPs accepting Medicaid patients. In fact, the percent increase of PCPs accepting Medicaid patients in these states is likely to exceed the percent increase of new Medicaid enrollees. The reimbursement increases will have much less impact in states with a relatively small number of PCPs accepting Medicaid patients now because many of these states already reimburse primary care at rates close to or exceeding 100 percent of Medicare. As a result, growth in Medicaid enrollment in these states will greatly outpace growth in the num­ber of primary care physicians willing to treat new Medicaid patients.

  5. Burnout of Physicians Working in Primary Health Care Centers under Ministry of Health Jeddah, Saudi Arabia (United States)

    Bawakid, Khalid; Mandoura, Najlaa; Shah, Hassan Bin Usman; Ibrahim, Adel; Akkad, Noura Mohammad; Mufti, Fauad


    Introduction The levels of physicians' job satisfaction and burnout directly affect their professionalism, punctuality, absenteeism, and ultimately, patients' care. Despite its crucial importance, little is known about professional burnout of the physicians in Saudi Arabia. The objectives of this research are two-fold: (1) To assess the prevalence of burnout in physicians working in primary health care centers under Ministry of Health; and (2) to find the modifiable factors which can decrease the burnout ratio. Methodology Through a cross-sectional study design, a representative sample of the physicians working in primary health care centers (PHCCs) Jeddah (n=246) was randomly selected. The overall burnout level was assessed using the validated abbreviated Maslach burnout inventory (aMBI) questionnaire. It measures the overall burnout prevalence based on three main domains i.e., emotional exhaustion, depersonalization, and personal accomplishment. Independent sample T-test, analysis of variance (ANOVA), and multivariate regression analysis were performed using Statistical Package for the Social Sciences (SPSS Version 22, IBM, Armonk, NY). Results Overall, moderate to high burnout was prevalent in 25.2% of the physicians. Emotional exhaustion was noted in 69.5%. Multivariate regression analysis showed that patient pressure/violence (p <0.001), unorganized patients flow to clinics (p=0.021), more paperwork (p<0.001), and less co-operative colleague doctors (p=0.045) were the significant predictors for high emotional exhaustion. A positive correlation was noted between the number of patients per day and burnout. The patient’s pressure/violence was the only significant independent predictor of overall burnout. Conclusion Emotional exhaustion is the most prominent feature of overall burnout in the physicians of primary health care centers. The main reasons include patient’s pressure/violence, unorganized patient flow, less cooperative colleague doctors, fewer

  6. Medical tourism in India: perceptions of physicians in tertiary care hospitals. (United States)

    Qadeer, Imrana; Reddy, Sunita


    Senior physicians of modern medicine in India play a key role in shaping policies and public opinion and institutional management. This paper explores their perceptions of medical tourism (MT) within India which is a complex process involving international demands and policy shifts from service to commercialisation of health care for trade, gross domestic profit, and foreign exchange. Through interviews of 91 physicians in tertiary care hospitals in three cities of India, this paper explores four areas of concern: their understanding of MT, their views of the hospitals they work in, perceptions of the value and place of MT in their hospital and their views on the implications of MT for medical care in the country. An overwhelming majority (90%) of physicians in the private tertiary sector and 74.3 percent in the public tertiary sector see huge scope for MT in the private tertiary sector in India. The private tertiary sector physicians were concerned about their patients alone and felt that health of the poor was the responsibility of the state. The public tertiary sector physicians' however, were sensitive to the problems of the common man and felt responsible. Even though the glamour of hi-tech associated with MT dazzled them, only 35.8 percent wanted MT in their hospitals and a total of 56 percent of them said MT cannot be a public sector priority. 10 percent in the private sector expressed reservations towards MT while the rest demanded state subsidies for MT. The disconnect between their concern for the common man and professionals views on MT was due to the lack of appreciation of the continuum between commercialisation, the denial of resources to public hospitals and shift of subsidies to the private sector. The paper highlights the differences and similarities in the perceptions and context of the two sets of physicians, presents evidence, that questions the support for MT and finally analyzes some key implications of MT on Indian health services, ethical

  7. Physician Rating Websites: What Aspects Are Important to Identify a Good Doctor, and Are Patients Capable of Assessing Them? A Mixed-Methods Approach Including Physicians' and Health Care Consumers' Perspectives. (United States)

    Rothenfluh, Fabia; Schulz, Peter J


    Physician rating websites (PRWs) offer health care consumers the opportunity to evaluate their doctor anonymously. However, physicians' professional training and experience create a vast knowledge gap in medical matters between physicians and patients. This raises ethical concerns about the relevance and significance of health care consumers' evaluation of physicians' performance. To identify the aspects physician rating websites should offer for evaluation, this study investigated the aspects of physicians and their practice relevant for identifying a good doctor, and whether health care consumers are capable of evaluating these aspects. In a first step, a Delphi study with physicians from 4 specializations was conducted, testing various indicators to identify a good physician. These indicators were theoretically derived from Donabedian, who classifies quality in health care into pillars of structure, process, and outcome. In a second step, a cross-sectional survey with health care consumers in Switzerland (N=211) was launched based on the indicators developed in the Delphi study. Participants were asked to rate the importance of these indicators to identify a good physician and whether they would feel capable to evaluate those aspects after the first visit to a physician. All indicators were ordered into a 4×4 grid based on evaluation and importance, as judged by the physicians and health care consumers. Agreement between the physicians and health care consumers was calculated applying Holsti's method. In the majority of aspects, physicians and health care consumers agreed on what facets of care were important and not important to identify a good physician and whether patients were able to evaluate them, yielding a level of agreement of 74.3%. The two parties agreed that the infrastructure, staff, organization, and interpersonal skills are both important for a good physician and can be evaluated by health care consumers. Technical skills of a doctor and outcomes

  8. Effectiveness of Group Cognitive Behavioral Therapy for Insomnia (CBT-I) in a Primary Care Setting. (United States)

    Davidson, Judith R; Dawson, Samantha; Krsmanovic, Adrijana


    Primary care is where many patients with insomnia first ask for professional help. Cognitive-behavioral therapy for insomnia (CBT-I) is the recommended treatment for chronic insomnia. Although CBT-I's efficacy is well established, its effectiveness in real-life primary care has seldom been investigated. We examined the effectiveness of CBT-I as routinely delivered in a Canadian primary care setting. The patients were 70 women and 11 men (mean age = 57.0 years, SD = 12.3); 83% had medical comorbidity. For the first 81 patients who took the six-session group program we compared initial and postprogram sleep diaries, sleep medication use, Insomnia Severity Index (ISI), the Hospital Anxiety and Depression Scale (HADS), and visits to the family physician. Sleep onset latency, wake after sleep onset, total sleep time, sleep efficiency, and ISI scores improved significantly (p 7). Wait-list data from 42 patients showed minimal sleep and mood improvements with the passage of time. Number of visits to the family physician six months postprogram decreased, although not significantly (p = .108). The CBT-I program was associated with improvement on all sleep and mood measures. Effect sizes were similar to, or larger than, those found in randomized controlled trials, demonstrating the real-world effectiveness of CBT-I in an interdisciplinary primary care setting.

  9. PTSD in Primary Care: A Physician’s Guide to Dealing with War-Induced PTSD (United States)


    Engel, C.C. (2007). Association of posttraumatic stress disorder with somatic symptoms, health care visits, and absenteeism among Iraq War veterans...L., Orazem, R., & Gutner, C. (2005). Can we cure PTSD? Five-year follow-up of a clinical trial comparing Cognitive Processing Therapy and Prolonged

  10. Five-year Retrospective Review of Physician and Non-physician Performed Ultrasound in a Canadian Critical Care Helicopter Emergency Medical Service. (United States)

    O'Dochartaigh, Domhnall; Douma, Matthew; MacKenzie, Mark


    To describe the use of prehospital ultrasonography (PHUS) to support interventions, when used by physician and non-physician air medical crew (AMC), in a Canadian helicopter emergency medical service (HEMS). A retrospective review was conducted of consecutive patients who underwent ultrasound examination during HEMS care from January 1, 2009 through March 10, 2014. An a priori created data form was used to record patient demographics, type of ultrasound scan performed, ultrasound findings, location of scan, type of interventions supported by PHUS, factors that affected PHUS completion, and quality indicator(s). Data analysis was performed through descriptive statistics, Student's t-test for continuous variables, Z-test for proportions, and Mann-Whitney U Test for nonparametric data. Outcomes included interventions supported by PHUS, factors associated with incomplete scans, and quality indicators associated with PHUS use. Differences between physician and AMC groups were also assessed. PHUS was used in 455 missions, 318 by AMC and 137 by physicians. In combined trauma and medical patients, in the AMC group interventions were supported by PHUS in 26% of cases (95% CI 18-34). For transport physicians the percentage support was found to be significantly greater at 45% of cases (95% CI 34-56) p = reasons included patient obesity, lack of time, patient access, and clinical reasons. Quality indicators associated with PHUS were rarely identified. The use of PHUS by both physicians and non-physicians was found to support interventions in select trauma and medical patients. Key words: emergency medical services; aircraft; helicopter; air ambulance; ultrasonography; emergency care, prehospital; prehospital emergency care.

  11. Physicians' leadership styles in rural primary medical care: how are they perceived by staff? (United States)

    Hana, Jan; Kirkhaug, Rudi


    This study investigates which leadership styles can be identified among general practice lead physicians and how they are associated with and predicted by staff and context characteristics like profession, gender, age, work experience, and team size. METHOD/MATERIAL: In a cross-sectional study self-administered questionnaires were distributed to staff physicians (42% females) and support staff (98% females) at 101 primary health care centres in North Norway. A total of 127 and 222, respectively, responded (response rate 59%). Items were ranked on Likert scales (range 1-5). Analysis revealed three significantly different styles (mean scores/Cronbach's alpha): change style (3.36/0.898), task style (3.17/0.885), and relation style (2.88/0.900). The lead physicians were perceived as practising change style the most and relation style the least. Males experienced significantly more of all three styles. Support staff scored lowest for all styles. Age was negatively correlated with relation style and change style, while work experience was negatively correlated with change style. No significant association was found between styles and team size. Leadership in rural general practice can be identified in terms of task, relation, and change styles. Change style is the most perceived style. Males seem to be most attentive to leadership styles. However, within the staff physician group, there is less difference between genders. Support staff scores lowest for all styles; this might indicate either less need for leadership or dissatisfaction with leadership. Age and work experience seem to reduce employees' attention to relation and change styles, indicating that maturity reduces needs for these leadership styles. Due to growing demands for leaders to take care of efficiency and change in general practice, more young female physicians, and more diverse staff groups, these findings may be useful to understand leadership and leadership training for general practice.

  12. Screening mammography beliefs and recommendations: a web-based survey of primary care physicians

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    Yasmeen Shagufta


    Full Text Available Abstract Background The appropriateness and cost-effectiveness of screening mammography (SM for women younger than 50 and older than 74 years is debated in the clinical research community, among health care providers, and by the American public. This study explored primary care physicians' (PCPs perceptions of the influence of clinical practice guidelines for SM; the recommendations for SM in response to hypothetical case scenarios; and the factors associated with perceived SM effectiveness and recommendations in the US from June to December 2009 before the United States Preventive Services Task Force (USPSTF recently revised guidelines. Methods A nationally representative sample of 11,922 PCPs was surveyed using a web-based questionnaire. The response rate was 5.7% (684; (41% 271 family physicians (FP, (36% 232 general internal medicine physicians (IM, (23% 150 obstetrician-gynaecologists (OBG, and (0.2% 31 others. Cross-sectional analysis examined PCPs perceived effectiveness of SM, and recommendation for SM in response to hypothetical case scenarios. PCPs responses were measured using 4-5 point adjectival scales. Differences in perceived effectiveness and recommendations for SM were examined after adjusting for PCPs specialty, race/ethnicity, and the US region. Results Compared to IM and FP, OBG considered SM more effective in reducing breast cancer mortality among women aged 40-49 years (p = 0.003. Physicians consistently recommended mammography to women aged 50-69 years with no differences by specialty (p = 0.11. However, 94% of OBG "always recommended" SM to younger and 86% of older women compared to 81% and 67% for IM and 84% and 59% for FP respectively (p = p = Conclusions A majority of physicians, especially OBG, favour aggressive breast cancer screening for women from 40 through 79 years of age, including women with short life expectancy. Policy interventions should focus on educating providers to provide tailored recommendations for

  13. Knowledge and attitudes towards cardiopulmonary resuscitation and defibrillation amongst Asian primary health care physicians

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    Marcus Eh Ong


    Full Text Available Marcus Eh Ong1, Susan Yap1, Kim P Chan1, Papia Sultana2, Venkataraman Anantharaman11Department of Emergency Medicine, 2Department of Clinical Research, Singapore General Hospital, SingaporeObjective: To assess the knowledge and attitudes of local primary health care physicians in relation to cardiopulmonary resuscitation (CPR and defibrillation.Methods: We conducted a survey on general practitioners in Singapore by using a self-administered questionnaire that comprised 29 questions.Results: The response rate was 80%, with 60 of 75 physicians completing the questionnaire. The average age of the respondents was 52 years. Sixty percent of them reported that they knew how to operate an automated external defibrillator (AED, and 38% had attended AED training. Only 36% were willing to perform mouth-to-mouth ventilation during CPR, and 53% preferred chest compression-only resuscitation (CCR to standard CPR. We found those aged <50 years were more likely to be trained in basic cardiac life support (BCLS (P < 0.001 and advanced cardiac life support (P = 0.005 or to have ever attended to a patient with cardiac arrest (P = 0.007. Female physicians tended to agree that all clinics should have AEDs (P = 0.005 and support legislation to make AEDs compulsory in clinics (P < 0.001. We also found that a large proportion of physicians who were trained in BCLS (P = 0.006 were willing to perform mouth-to-mouth ventilation.Conclusion: Most local primary care physicians realize the importance of defibrillation, and the majority prefer CCR to standard CPR.Keywords: general practitioners, cardiac arrest, resuscitation, defibrillation, attitude, knowledge

  14. Coordination of cancer care between family physicians and cancer specialists: Importance of communication. (United States)

    Easley, Julie; Miedema, Baukje; Carroll, June C; Manca, Donna P; O'Brien, Mary Ann; Webster, Fiona; Grunfeld, Eva


    To explore health care provider (HCP) perspectives on the coordination of cancer care between FPs and cancer specialists. Qualitative study using semistructured telephone interviews. Canada. A total of 58 HCPs, comprising 21 FPs, 15 surgeons, 12 medical oncologists, 6 radiation oncologists, and 4 GPs in oncology. This qualitative study is nested within a larger mixed-methods program of research, CanIMPACT (Canadian Team to Improve Community-Based Cancer Care along the Continuum), focused on improving the coordination of cancer care between FPs and cancer specialists. Using a constructivist grounded theory approach, telephone interviews were conducted with HCPs involved in cancer care. Invitations to participate were sent to a purposive sample of HCPs based on medical specialty, sex, province or territory, and geographic location (urban or rural). A coding schema was developed by 4 team members; subsequently, 1 team member coded the remaining transcripts. The resulting themes were reviewed by the entire team and a summary of results was mailed to participants for review. Communication challenges emerged as the most prominent theme. Five key related subthemes were identified around this core concept that occurred at both system and individual levels. System-level issues included delays in medical transcription, difficulties accessing patient information, and physicians not being copied on all reports. Individual-level issues included the lack of rapport between FPs and cancer specialists, and the lack of clearly defined and broadly communicated roles. Effective and timely communication of medical information, as well as clearly defined roles for each provider, are essential to good coordination of care along the cancer care trajectory, particularly during transitions of care between cancer specialist and FP care. Despite advances in technology, substantial communication challenges still exist. This can lead to serious consequences that affect clinical decision making

  15. Physician anger: Leggo dem managed care blues--leadership beyond the era of managed cost. (United States)

    Kirz, H L


    While managed care has caused great disruption, it has also provided physician executives with a natural leadership raison d'être. Managed care, with all its pros and cons, is largely a response to certain unrelenting trends. The core functions of leaders comprise the stewardship of organizations and colleagues in response to these trends. Four trends are explored: (1) The demise of open-ended funding of American health care; (2) continued competition for health care resources; (3) thriving pluralism; and (4) patients continually adjusting to assure themselves of appropriate health care access, quality, and service. In the 21st century, the industry will need a new brand of leader, one capable of balancing the needs of the professionals with the business and accountability requirements of a permanently competitive and resource-constrained service industry. The keys to successful leadership in the future include: (1) Clear service differentiation and a compelling vision to match it; (2) recruiting and retaining top clinical talent, including the required return to physician self-direction and governance; (3) successful partnerships with others outside your organization; and (4) a steady focus on performance in all its dimensions.

  16. Physician cooperation in outpatient cancer care. An amplified secondary analysis of qualitative interview data. (United States)

    Engler, J; Güthlin, C; Dahlhaus, A; Kojima, E; Müller-Nordhorn, J; Weißbach, L; Holmberg, C


    The importance of outpatient cancer care services is increasing due to the growing number of patients having or having had cancer. However, little is known about cooperation among physicians in outpatient settings. To understand what inter- and multidisciplinary care means in community settings, we conducted an amplified secondary analysis that combined qualitative interview data with 42 general practitioners (GPs), 21 oncologists and 21 urologists that mainly worked in medical practices in Germany. We compared their perspectives on cooperation relationships in cancer care. Our results indicate that all participants regarded cooperation as a prerequisite for good cancer care. Oncologists and urologists mainly reported cooperating for tumour-specific treatment tasks, while GPs' reasoning for cooperation was more patient-centred. While oncologists and urologists reported experiencing reciprocal communication with other physicians, GPs had to gather the information they needed. GPs seldom reported engaging in formal cooperation structures, while for specialists, participation in formal spaces of cooperation, such as tumour boards, facilitated a more frequent and informal discussion of patients, for instance on the phone. Further research should focus on ways to foster GPs' integration in cancer care and evaluate if this can be reached by incorporating GPs in formal cooperation structures such as tumour boards. © 2017 John Wiley & Sons Ltd.

  17. Unhealthy Pressure: How Physician Pay Demands Put the Squeeze on Provincial Health-Care Budgets

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    Hugh M. Grant


    Full Text Available In the 11 years since the Romanow Commission warned that the income of physicians was threatening to become a significant driver of Canadian health-care costs, doctors in this country proceeded to chalk up some of their most rapid gains in earnings since the implementation of medicare. Since 2000, the gap between what the average physician makes, and what the average fully employed Canadian worker earns, has diverged like never before. In the last decade, the average doctor went from earning three-and-a-half times the average Canadian worker’s salary, to earning nearly four-and-a-half times as much, a more than 25 per cent relative increase. In constant dollars, today’s average Canadian physician is earning about 30 per cent more than he or she was just a decade ago. All of this has occurred while physicians have actually provided slightly fewer services to patients. Since the implementation of medicare, the payment of doctors has been rather a matter of politics, as provinces became the ultimate paymasters for health-care personnel. The natural result was an ongoing competition between provinces and physicians for public support, each with its own claim to being the guardian of public health care. In the last two decades, however, doctors have succeeded in outmaneuvering governments, marshaling greater public support for higher pay for their work, even as provinces have been more often viewed as underfunding basic health care needs. There are signs that this may have finally gone too far: Ontario was recently able to freeze remuneration for doctors in a negotiated contract deal and Alberta shortly after imposed a unilateral settlement on its doctors after breaking off negotiations. Stories about “millionaire doctors” are now proliferating in the mainstream media and, as provinces across the countries struggle with deficits, the public’s sympathy appears to be shifting. There were periods, during the ’70s and ’90s, when governments

  18. The productivity of physician assistants and nurse practitioners and health work force policy in the era of managed health care. (United States)

    Scheffler, R M; Waitzman, N J; Hillman, J M


    Managed care is spreading rapidly in the United States and creating incentives for physician practices to find the most efficient combination of health professionals to deliver care to an enrolled population. Given these trends, it is appropriate to reexamine the roles of physician assistants (PAs) and nurse practitioners (NPs) in the health care workforce. This paper briefly reviews the literature on PA and NP productivity, managed care plans' use of PAs and NPs, and the potential impact of PAs and NPs on the size and composition of the future physician workforce. In general, the literature supports the idea that PAs and NPs could have a major impact on the future health care workforce. Studies show significant opportunities for increased physician substitution and even conservative assumptions about physician task delegation imply a large increase in the number of PAs and NPs that can be effectively deployed. However, the current literature has certain limitations that make it difficult to quantify the future impact of PAs and NPs. Among these limitations is the fact that virtually all formal productivity studies were conducted in fee-for-service settings during the 1970s, rather than managed care settings. In addition, the vast majority of PA and NP productivity studies have viewed PAs and NPs as physician substitutes rather than as members of interdisciplinary health care teams, which may become the dominant health care delivery model over the next 10-20 years.

  19. A report card on the physician work force: Israeli health care market--past experience and future prospects. (United States)

    Toker, Asaf; Shvarts, Shifra; Glick, Shimon; Reuveni, Haim


    The worldwide shortage of physicians is due not only to the lack of physicians, but also to complex social and economic factors that vary from country to country. To describe the results of physician workforce planning in a system with unintended policy, such as Israel, based on past experience and predicted future trends, between 1995 and 2020. A descriptive study of past (1995-2009) and future (through 2020) physician workforce trends in Israel. An actuarial equation was developed to project physician supply until 2020. In Israel a physician shortage is expected in the very near future. This finding is the result of global as well as local changes affecting the supply of physicians: change in immigration pattern, gender effect, population growth, and transparency of data on demand for physicians. These are universal factors affecting manpower planning in most industrial countries all over the world. We describe a health care market with an unintended physician workforce policy. Sharing decision makers' experience in similar health care systems will enable the development of better indices to analyze, by comparison, effective physician manpower planning processes, worldwide.

  20. Partnering for optimal respiratory home care: physicians working with respiratory therapists to optimally meet respiratory home care needs. (United States)

    Spratt, G; Petty, T L


    The need for respiratory care services continues to increase, reimbursement for those services has decreased, and cost-containment measures have increased the frequency of home health care. Respiratory therapists are well qualified to provide home respiratory care, reduce misallocation of respiratory services, assess patient respiratory status, identify problems and needs, evaluate the effect of the home setting, educate the patient on proper equipment use, monitor patient response to and complications of therapy, monitor equipment functioning, monitor for appropriate infection control procedures, make recommendations for changes to therapy regimen, and adjust therapy under the direction of the physician. Teamwork benefits all parties and offers cost and time savings, improved data collection and communication, higher job satisfaction, and better patient monitoring, education, and quality of life. Respiratory therapists are positioned to optimize treatment efficacy, maximize patient compliance, and minimize hospitalizations among patients receiving respiratory home care.

  1. [Perceptions on electronic prescribing by primary care physicians in madrid healthcare service]. (United States)

    Villímar Rodríguez, A I; Gangoso Fermoso, A B; Calvo Pita, C; Ariza Cardiel, G

    To investigate the opinion of Primary Care physicians regarding electronic prescribing. Descriptive study by means of a questionnaire sent to 527 primary care physicians. June 2014. The questionnaire included closed questions about interest shown, satisfaction, benefits, weaknesses, and barriers, and one open question about difficulties, all of them referred to electronic prescribing. Satisfaction was measured using 1-10 scale, and benefits, weaknesses, and barriers were evaluated by a 5-ítems Likert scale. Interest was measured using both methods. The questionnaire was sent by e-mail for on line response through Google Drive® tool. A descriptive statistical analysis was performed. The response rate was 47% (248/527). Interest shown was 8.7 (95% CI; 8.5-8.9) and satisfaction was 7.9 (95% CI; 7.8-8). The great majority 87.9% (95% CI; 83.8-92%) of respondents used electronic prescribing where possible. Most reported benefits were: 73.4% (95% CI; 67.8-78.9%) of respondents considered that electronic prescribing facilitated medication review, and 59.3% (95% CI; 53.1-65.4) of them felt that it reduced bureaucratic burden. Among the observed weaknesses, they highlighted the following: 87.9% (95% CI; 83.8-92%) of respondents believed specialist care physicians should also be able to use electronic prescribing. Concerning to barriers: 30.2% (95% CI; 24.5-36%) of respondents think that entering a patient into the electronic prescribing system takes too much time, and 4% (95% CI; 1.6-6.5%) of them perceived the application as difficult to use. Physicians showed a notable interest in using electronic prescribing and high satisfaction with the application performance. Copyright © 2016 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Personal care services provided to children with special health care needs (CSHCN) and their subsequent use of physician services. (United States)

    Miller, Thomas R; Elliott, Timothy R; McMaughan, Darcy M; Patnaik, Ashweeta; Naiser, Emily; Dyer, James A; Fournier, Constance J; Hawes, Catherine; Phillips, Charles D


    Medicaid Personal Care Services (PCS) help families meet children's needs for assistance with functional tasks. However, PCS may have other effects on a child's well-being, but research has not yet established the existence of such effects. To investigate the relationship between the number of PCS hours a child receives with subsequent visits to physicians for evaluation and management (E&M) services. Assessment data for 2058 CSHCN receiving PCS were collected in 2008 and 2009. Assessment data were matched with Medicaid claims data for the period of 1 year after the assessment. Zero-inflated negative binomial and generalized linear multivariate regression models were used in the analyses. These models included patient demographics, health status, household resources, and use of other medical services. For every 10 additional PCS hours authorized for a child, the odds of having an E&M physician visit in the next year were reduced by 25%. However, the number of PCS hours did not have a significant effect on the number of visits by those children who did have a subsequent E&M visit. A variety of demographic and health status measures also affect physician use. Medicaid PCS for CSHCN may be associated with reduced physician usage because of benefits realized by continuity of care, the early identification of potential health threats, or family and patient education. PCS services may contribute to a child's well-being by providing continuous relationships with the care team that promote good chronic disease management, education, and support for the family. Copyright © 2013 Elsevier Inc. All rights reserved.

  3. Patient and family physician preferences for care and communication in the eventuality of anthrax terrorism. (United States)

    Kahan, Ernesto; Fogelman, Yacov; Kitai, Eliezer; Vinker, Shlomo


    The threat of bioterrorism consequent to the September 11, 2001 attack in the USA generated suggestions for improved medical response mainly through hospital preparedness. The aim of the present study was to investigate the impact of this period of tension on patients' first choice for care and for receiving relevant information, and on primary care doctors' feelings of responsibility in the eventuality of an anthrax attack. During October 11-31, 2001, 500 patients from 30 clinics throughout Israel were asked to complete a questionnaire on their awareness of the anthrax threat, measures taken to prepare for it, and preferred sources of care and information. Their 30 physicians, and an additional 20, completed a questionnaire on knowledge about anthrax and anthrax-related patient behaviours and clinic visits. The outstanding finding was the low rate (30%) of patients who chose the hospital emergency department as their first choice for care or information if they were worried about an anthrax attack or the media communicated that an attack was in progress. The other two-thirds preferred their family doctor or the health authorities. Most of the physicians (89%) felt it was their responsibility to treat anthrax-infected patients and that they should therefore be supplied with appropriate guidelines. This study suggests that in Israel, a country with a high degree of awareness of civil defence aspects, both patients and primary care doctors believe that family physicians should have a major role in the case of bioterrorist attacks. This must be seriously considered during formulation of relevant health services programmes.

  4. Muslim physicians and palliative care: attitudes towards the use of palliative sedation. (United States)

    Muishout, George; van Laarhoven, Hanneke W M; Wiegers, Gerard; Popp-Baier, Ulrike


    Muslim norms concerning palliative sedation can differ from secular and non-Muslim perceptions. Muslim physicians working in a Western environment are expected to administer palliative sedation when medically indicated. Therefore, they can experience tension between religious and medical norms. To gain insight into the professional experiences of Muslim physicians with palliative sedation in terms of religious and professional norms. Interpretative phenomenological study using semi-structured interviews to take a closer look at the experiences of Muslim physicians with palliative sedation. Data were recorded, transcribed and analysed by means of interpretative phenomenological analysis (IPA). Ten Muslim physicians, working in the Netherlands, with professional experience of palliative sedation. Two main themes were identified: professional self-concept and attitudes towards death and dying. Participants emphasized their professional responsibility when making treatment decisions, even when these contravened the prevalent views of Islamic scholars. Almost all of them expressed the moral obligation to fight their patients' pain in the final stage of life. Absence of acceleration of death was considered a prerequisite for using palliative sedation by most participants. Although the application of palliative sedation caused friction with their personal religious conceptions on a good death, participants followed a comfort-oriented care approach corresponding to professional medical standards. All of them adopted efficient strategies for handling of palliative sedation morally and professionally. The results of this research can contribute to and provide a basis for the emergence of new, applied Islamic ethics regarding palliative sedation.

  5. Chaperone use during intimate examinations in primary care: postal survey of family physicians

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    Upshur Ross EG


    Full Text Available Abstract Background Physicians have long been advised to have a third party present during certain parts of a physical examination; however, little is known about the frequency of chaperone use for those specific intimate examinations regularly performed in primary care. We aimed to determine the frequency of chaperone use among family physicians across a variety of intimate physical examinations for both male and female patients, and also to identify the factors associated with chaperone use. Methods Questionnaires were mailed to a randomly selected sample of 500 Ontario members of the College of Family Physicians of Canada. Participants were asked about their use of chaperones when performing a variety of intimate examinations, namely female pelvic, breast, and rectal exams and male genital and rectal exams. Results 276 of 500 were returned (56%, of which 257 were useable. Chaperones were more commonly used with female patients than with males (t = 9.09 [df = 249], p Conclusion Clinical practice concerning the use of chaperones during intimate exams continues to be discordant with the recommendations of medical associations and medico-legal societies. Chaperones are used by only a minority of Ontario family physicians. Chaperone use is higher for examinations of female patients than of male patients and is highest for female pelvic exams. The availability of a nurse in the clinic to act as a chaperone is associated with more frequent use of chaperones.

  6. Attitudes towards euthanasia among Greek intensive care unit physicians and nurses. (United States)

    Kranidiotis, Georgios; Ropa, Julia; Mprianas, John; Kyprianou, Theodoros; Nanas, Serafim


    To investigate the attitudes of Greek intensive care unit (ICU) medical and nursing staff towards euthanasia. ICU physicians and nurses deal with end-of-life dilemmas on a daily basis. Therefore, the exploration of their stances on euthanasia is worthwhile. This was a descriptive quantitative study conducted in three ICUs in Athens. The convenience sample included 39 physicians and 107 nurses. Of respondents, 52% defined euthanasia inaccurately, as withholding or withdrawal of treatment, while 15% ranked limitation of life-support among the several forms of euthanasia, together with active shortening of the dying process and physician - assisted suicide. Only one third of participants defined euthanasia correctly. While 59% of doctors and 64% of nurses support the legalization of active euthanasia, just 28% and 26% of them, respectively, agree with it ethically. Confusion prevails among Greek ICU physicians and nurses regarding the definition of euthanasia. The majority of staff disagrees with active euthanasia, but upholds its legalization. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Attitudes to brain death and organ procurement among university students and critical care physicians in poland. (United States)

    Kubler, A; Lipinska-Gediga, M; Kedziora, J; Kubler, M


    The practice of retrieving vital organs from brain-dead heart-beating donors is legally and medically accepted in Poland, but public beliefs and opinions regarding these matters have not been sufficiently explored. The purpose of this study was to evaluate the attitude of university students to the concepts of brain death and organ retrieval, compared with the attitude of critical care physicians. The cohorts of 989 students and 139 physicians completed a questionnaire based on a survey instrument developed in an earlier reported study on Ohio residents. Participants assessed 3 scenarios: (1) brain death, (2) coma, and (3) vegetative state. More than 48% of students classified the patient from the brain death scenario as alive, and 51% of them were willing to donate organs of this patient. Ninety percent of students classified the patients in coma and in a vegetative state as alive, but still 34% of them would donate organs of those patients. The group of physicians properly determined the patients' diagnoses, but 10% of them accepted organ procurement from patients in coma and in a vegetative state. Our results supported the earlier observations of low public knowledge and inadequate understanding of brain death criteria and organ procurement processes. The majority of students were willing to accept organ procurement from severely ill but alive patients, in contrast with physicians. A considerable increase in public educational activity in this field is urgently recommended.

  8. Multicountry survey of emergency and critical care medicine physicians' fluid resuscitation practices for adult patients with early septic shock

    DEFF Research Database (Denmark)

    McIntyre, Lauralyn; Rowe, Brian H; Walsh, Timothy S


    and Ringer's solutions were the preferred crystalloid fluids used 'often' or 'always' in 53.1% (n=556) and 60.5% (n=632) of instances, respectively. However, emergency physicians indicated that they would use normal saline 'often' or 'always' in 83.9% (n=376) of instances, while critical care physicians said...

  9. Workforce ethnic diversity and culturally competent health care: the case of Arab physicians in Israel. (United States)

    Popper-Giveon, Ariela; Liberman, Ido; Keshet, Yael


    In recent years, a growing body of literature has been calling for ethnic diversity in health systems, especially in multicultural contexts. Ethnic diversity within the health care workforce is considered to play an important role in reducing health disparities among different ethnic groups. The present study explores the topic using quantitative data on participation of Arab employees in the Israeli health system and qualitative data collected through semi-structured interviews with Arab physicians working in the predominantly Jewish Israeli health system. We show that despite the underrepresentation of Arabs in the Israeli health system, Arab physicians who hold positions in Israeli hospitals do not perceive themselves as representatives of the Arab sector; moreover, they consider themselves as having broken through the 'glass ceiling' and reject stereotyping as Arab 'niche doctors.' We conclude that minority physicians may prefer to promote culturally competent health care through integration and advocacy of interaction with the different cultures represented in the population, rather than serving as representatives of their own ethnic minority population. These findings may concern various medical contexts in which issues of ethnic underrepresentation in the health system are relevant, as well as sociological contexts, especially those regarding minority populations and professions.

  10. Knowledge, Perceptions, and Communication about Colorectal Cancer Screening among Chinese American Primary Care Physicians

    Directory of Open Access Journals (Sweden)

    Wenchi Liang D.D.S., Ph.D.


    Full Text Available Objective To assess Chinese American primary care physicians’ knowledge, attitude, and barriers to recommending colorectal cancer (CRC screening to their Chinese American patients. Methods Chinese American primary care physicians serving Chinese American patients in two metropolitan areas were invited to complete a mailed survey on CRC screening knowledge, attitudes toward shared decision making and CRC screening, and CRC screening recommendation patterns. Results About half of the 56 respondents did not know CRC incidence and mortality figures for Chinese Americans. Those aged 50 and younger, graduating from U.S. medical schools, or working in non-private settings had higher knowledge scores ( p < 0.01. Physicians graduating from U.S. medical schools had more favorable attitudes toward shared decision making ( p < 0.01. Lack of health insurance, inconsistent guidelines, and insufficient time were the most frequently cited barriers to recommending CRC screening. Conclusions Most Chinese American physicians had knowledge, attitude, and communication barriers to making optimal CRC screening recommendations.

  11. ICU nurses and physicians dialogue regarding patients clinical status and care options-a focus group study. (United States)

    Kvande, Monica; Lykkeslet, Else; Storli, Sissel Lisa


    Nurses and physicians work side-by-side in the intensive care unit (ICU). Effective exchanges of patient information are essential to safe patient care in the ICU. Nurses often rate nurse-physician communication lower than physicians and report that it is difficult to speak up, that disagreements are not resolved and that their input is not well received. Therefore, this study explored nurses' dialogue with physicians regarding patients' clinical status and the prerequisites for effective and accurate exchanges of information. We adopted a qualitative approach, conducting three focus group discussions with five to six nurses and physicians each (14 total). Two themes emerged. The first theme highlighted nurses' contributions to dialogues with physicians; nurses' ongoing observations of patients were essential to patient care discussions. The second theme addressed the prerequisites of accurate and effective dialogue regarding care options, comprising three subthemes: nurses' ability to speak up and present clinical changes, establishment of shared goal and clinical understanding, and open dialogue and willingness to listen to each other. Nurses should understand their essential role in conducting ongoing observations of patients and their right to be included in care-related decision-making processes. Physicians should be willing to listen to and include nurses' clinical observations and concerns.

  12. Medical tourism in india: perceptions of physicians in tertiary care hospitals (United States)


    Senior physicians of modern medicine in India play a key role in shaping policies and public opinion and institutional management. This paper explores their perceptions of medical tourism (MT) within India which is a complex process involving international demands and policy shifts from service to commercialisation of health care for trade, gross domestic profit, and foreign exchange. Through interviews of 91 physicians in tertiary care hospitals in three cities of India, this paper explores four areas of concern: their understanding of MT, their views of the hospitals they work in, perceptions of the value and place of MT in their hospital and their views on the implications of MT for medical care in the country. An overwhelming majority (90%) of physicians in the private tertiary sector and 74.3 percent in the public tertiary sector see huge scope for MT in the private tertiary sector in India. The private tertiary sector physicians were concerned about their patients alone and felt that health of the poor was the responsibility of the state. The public tertiary sector physicians’ however, were sensitive to the problems of the common man and felt responsible. Even though the glamour of hi-tech associated with MT dazzled them, only 35.8 percent wanted MT in their hospitals and a total of 56 percent of them said MT cannot be a public sector priority. 10 percent in the private sector expressed reservations towards MT while the rest demanded state subsidies for MT. The disconnect between their concern for the common man and professionals views on MT was due to the lack of appreciation of the continuum between commercialisation, the denial of resources to public hospitals and shift of subsidies to the private sector. The paper highlights the differences and similarities in the perceptions and context of the two sets of physicians, presents evidence, that questions the support for MT and finally analyzes some key implications of MT on Indian health services, ethical

  13. The physician assistant workforce in Indiana: preparing to meet future health care needs. (United States)

    Snyder, Jennifer; Zorn, Jennifer; Gjerde, Tom; Burkhart, Jennifer; Rosebrock, Lori


    This study identifies baseline demographic and descriptive statistics for physician assistants (PAs) in Indiana from 1978 to 2010. Data were obtained from Indiana Professional Licensing Agency applications, the Indiana State Department of Health, and PA educational programs. Descriptive statistics were used to characterize the PA workforce as well as their supervising physicians. Most PAs working in Indiana were born and educated outside the state. Of those educated in Indiana, 77% obtained an initial license in Indiana; as of May 2010, 62% were still licensed in the state. In the past 8 years, Indiana had a 97% increase in active licensed PAs. Only 24% of PAs work in primary care; 92% work in metropolitan areas. For 40 years, PAs have increasingly worked in areas that are medically underserved or experiencing a shortage of health professionals. However, the overall numbers of PAs working in those areas remain low. More PAs in Indiana are practicing in medical specialties than in primary care. As health care policy and regulatory changes evolve, future studies will be needed to understand the impact on the health care workforce of Indiana PAs. This study will serve as a baseline for those studies.

  14. Physician-assisted suicide and/or euthanasia: Pragmatic implications for palliative care [corrected]. (United States)

    Hudson, Peter; Hudson, Rosalie; Philip, Jennifer; Boughey, Mark; Kelly, Brian; Hertogh, Cees


    Despite the availability of palliative care in many countries, legalization of euthanasia and physician-assisted suicide (EAS) continues to be debated-particularly around ethical and legal issues--and the surrounding controversy shows no signs of abating. Responding to EAS requests is considered one of the most difficult healthcare responsibilities. In the present paper, we highlight some of the less frequently discussed practical implications for palliative care provision if EAS were to be legalized. Our aim was not to take an explicit anti-EAS stance or expand on findings from systematic reviews or philosophical and ethico-legal treatises, but rather to offer clinical perspectives and the potential pragmatic implications of legalized EAS for palliative care provision, patients and families, healthcare professionals, and the broader community. We provide insights from our multidisciplinary clinical experience, coupled with those from various jurisdictions where EAS is, or has been, legalized. We believe that these issues, many of which are encountered at the bedside, must be considered in detail so that the pragmatic implications of EAS can be comprehensively considered. Increased resources and effort must be directed toward training, research, community engagement, and ensuring adequate resourcing for palliative care before further consideration is given to allocating resources for legalizing euthanasia and physician-assisted suicide.

  15. Prevalence of chronic pancreatitis: Results of a primary care physician-based population study. (United States)

    Capurso, Gabriele; Archibugi, Livia; Pasquali, Piera; Aceti, Alessandro; Balducci, Paolo; Bianchi, Patrizia; Buono, Francesco; Camerucci, Stefano; Cantarini, Rosanna; Centofanti, Sergio; Colantonio, Patrizia; Cremaschi, Riccarda; Crescenzi, Sergio; Di Mauro, Caterina; Di Renzi, Davide; Filabozzi, Andrea; Fiorillo, Alfonso; Giancaspro, Giuseppe; Giovannetti, Paola; Lanna, Giuseppe; Medori, Claudio; Merletti, Emilio; Nunnari, Enzo; Paris, Francesca; Pavone, Marco; Piacenti, Angela; Rossi, Almerindo; Scamuffa, Maria Cristina; Spinelli, Giovanni; Taborchi, Marco; Valente, Biagio; Villanova, Antonella; Chiriatti, Alberto; Delle Fave, Gianfranco


    Data on chronic pancreatitis prevalence are scanty and usually limited to hospital-based studies. Investigating chronic pancreatitis prevalence in primary care. Participating primary care physicians reported the prevalence of chronic pancreatitis among their registered patients, environmental factors and disease characteristics. The data were centrally reviewed and chronic pancreatitis cases defined according to M-ANNHEIM criteria for diagnosis and severity and TIGAR-O classification for etiology. Twenty-three primary care physicians participated in the study. According to their judgment, 51 of 36.401 patients had chronic pancreatitis. After reviewing each patient data, 11 turned out to have definite, 5 probable, 19 borderline and 16 uncertain disease. Prevalence was 30.2/100.000 for definite cases and 44.0/100.000 for definite plus probable cases. Of the 16 patients with definite/probable diagnosis, 8 were male, with mean age of 55.6 (±16.7). Four patients had alcoholic etiology, 5 post-acute/recurrent pancreatitis, 6 were deemed to be idiopathic. Four had pancreatic exocrine insufficiency, 10 were receiving pancreatic enzymes, and six had pain. Most patients had initial stage and non-severe disease. This is the first study investigating the prevalence of chronic pancreatitis in primary care. Results suggest that the prevalence in this context is higher than in hospital-based studies, with specific features, possibly representing an earlier disease stage. Copyright © 2016 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  16. Effect of a tailor-made continuous medical education program for primary care physicians on self-perception of physicians' roles and quality of care. (United States)

    Twig, Gilad; Lahad, Amnon; Kochba, Ilan; Ezra, Vered; Mandel, Dror; Shina, Avi; Kreiss, Yitshak; Zimlichman, Eyal


    A survey conducted among Israel Defense Force primary care physicians in 2001 revealed that they consider patients' needs more than they do organizational needs and that the education PCPs currently receive is inadequate. In 2003 the medical corps initiated a multi-format continuous medical education program aimed at improving skills in primary care medicine. To measure and analyze the effect of the tailor-made CME program on PCPs' self-perception 3 years after its implementation and correlate it to clinical performance. In 2006 a questionnaire was delivered to a representative sample of PCPs in the IDF. The questionnaire included items on demographic and professional background, statements on self-perception issues, and ranking of roles. We compared the follow-up survey (2006) to the results of the original study (2001) and correlated the survey results with clinical performance as measured through objective indicators. In the 2006 follow-up survey PCPs scored higher on questions dealing with their perception of themselves as case managers (3.8 compared to 4.0 on the 2001 survey on a 5 point scale, P = 0.046), perceived quality of care and education (3.5 vs. 3.8, P = 0.06), and on questions dealing with organizational commitment (3.5 vs. 3.8, P = 0.01). PCPs received higher scores on clinical indicators in the later study (odds ratio 2.05, P < 0.001). PCPs in the IDF perceived themselves more as case managers as compared to the 2001 survey. A tailor-made CME program may have contributed to the improvement in skills and quality of care.

  17. Effect of Physician Delegation to Other Healthcare Providers on the Quality of Care for Geriatric Conditions. (United States)

    Lichtenstein, Brian J; Reuben, David B; Karlamangla, Arun S; Han, Weijuan; Roth, Carol P; Wenger, Neil S


    The quality of care of older adults in the United States has been consistently shown to be inadequate. This gap between recommended and actual care provides an opportunity to improve the value of health care for older adults. Prior work from the Assessing Care of Vulnerable Elders (ACOVE) investigators first defined, and then sought to improve, clinical practice for common geriatric conditions. A critical component of the ACOVE intervention for practice improvement was an emphasis on the delegation of specific care processes, but the independent effect of delegation on the quality of care has not been evaluated. This study analyzed the pooled results of prior ACOVE projects from 1998 to 2010. Totaled, these studies included 4,776 individuals aged 65 and older of mixed demographic backgrounds and 16,204 ACOVE quality indicators (QIs) for three geriatric conditions: falls, urinary incontinence, and dementia. In unadjusted analyses, QI pass probabilities were 0.36 for physician-performed tasks, 0.55 for nurse practitioner (NP)-, physician assistant (PA)-, and registered nurse (RN)-performed tasks; and 0.61 for medical assistant- and licensed vocational nurse-performed tasks. In multiply adjusted models, the independent pass-probability effect of delegation to NPs, PAs, and RNs was 1.37 (P = .05). These findings suggest that delegation of selected tasks to nonphysician healthcare providers is associated with higher quality of care for these geriatric conditions in community practices and supports the value of interdisciplinary team management for common outpatient conditions in older adults. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

  18. Generalizable items and modular structure for computerised physician staffing calculation on intensive care units. (United States)

    Weiss, Manfred; Marx, Gernot; Iber, Thomas


    Intensive care medicine remains one of the most cost-driving areas within hospitals with high personnel costs. Under the scope of limited budgets and reimbursement, realistic needs are essential to justify personnel staffing. Unfortunately, all existing staffing models are top-down calculations with a high variability in results. We present a workload-oriented model, integrating quality of care, efficiency of processes, legal, educational, controlling, local, organisational and economic aspects. In our model, the physician's workload solely related to the intensive care unit depends on three tasks: Patient-oriented tasks, divided in basic tasks (performed in every patient) and additional tasks (necessary in patients with specific diagnostic and therapeutic requirements depending on their specific illness, only), and non patient-oriented tasks. All three tasks have to be taken into account for calculating the required number of physicians. The calculation tool further allows to determine minimal personnel staffing, distribution of calculated personnel demand regarding type of employee due to working hours per year, shift work or standby duty. This model was introduced and described first by the German Board of Anesthesiologists and the German Society of Anesthesiology and Intensive Care Medicine in 2008 and since has been implemented and updated 2012 in Germany. The modular, flexible nature of the Excel-based calculation tool should allow adaption to the respective legal and organizational demands of different countries. After 8 years of experience with this calculation, we report the generalizable key aspects which may help physicians all around the world to justify realistic workload-oriented personnel staffing needs.

  19. Survey of the knowledge and management of transient ischemic attacks among primary care physicians and nurses. (United States)

    Purroy, F; Cruz Esteve, I; Galindo Ortego, M G; Marsal Mora, J R; Oró, M; Plana, A


    Transient ischaemic attack (TIA) patients often report that Primary Care physicians (PCPs) and nurses are their main medical contacts after onset of symptoms in our health area. There are few studies on the knowledge and management of TIA among Community and Family Medicine professionals. Our aim was to study the current knowledge and practice in the management of TIA patients among Primary Care physicians and nurses. A cross-sectional survey with seven questions about TIA was conducted among 640 PCPs and nurses from Primary Care centres in our health area. In total, 285 (46.7% PCPs) took participate in the study. Of these, 239 (83.9%) participants knew the duration of a TIA. However only 40 (14%) recognised all clinical symptoms. An urgent neuroimaging was preferred by 67%. Only 42.5% agreed that an urgent cervical duplex would be useful in these patients. Transcranial Doppler was recognised by only 35.4%. A majority (78.2%) of participants agreed that TIA patients must be admitted to hospital. PCPs had the best knowledge of TIA (odds ratio [OR] 2.138; 95% CI 1.124-4.067; P = 0.021) but there were no differences between physicians and nurses on the management of these patients. Nurses from rural Primary Care centers had the worst level of knowledge (OR 0.410; 95% CI 0.189-0.891; P = 0.024). TIA was well recognized as a medical emergency. However, knowledge of clinical symptoms of TIA must be improved. Copyright © 2010 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

  20. Ethical challenges in the neonatal intensive care units: perceptions of physicians and nurses; an Iranian experience. (United States)

    Kadivar, Maliheh; Mosayebi, Ziba; Asghari, Fariba; Zarrini, Pari


    The challenging nature of neonatal medicine today is intensified by modern advances in intensive care and treatment of sicker neonates. These developments have caused numerous ethical issues and conflicts in ethical decision-making. The present study surveyed the challenges and dilemmas from the viewpoint of the neonatal intensive care personnel in the teaching hospitals of Tehran University of Medical Sciences (TUMS) in the capital of Iran. In this comparative cross-sectional study conducted between March 2013 and February 2014, the physicians' and nurses' perceptions of the ethical issues in neonatal intensive care units were compared. The physicians and nurses of the study hospitals were requested to complete a 36-item questionnaire after initial accommodations. The study samples consisted of 284 physicians (36%) and nurses (64%). Content validity and internal consistency calculations were used to examine the psychometric properties of the questionnaire. Data were analyzed by Pearson's correlation, t-test, ANOVA, and linear regression using SPSS v. 22. Respecting patients' rights and interactions with parents were perceived as the most challenging aspects of neonatal care. There were significant differences between sexes in the domains of the perceived challenges. According to the linear regression model, the perceived score would be reduced 0.33 per each year on the job. The results of our study showed that the most challenging issues were related to patients' rights, interactions with parents, communication and cooperation, and end of life considerations respectively. It can be concluded, therefore, that more attention should be paid to these issues in educational programs and ethics committees of hospitals.

  1. Addressing domestic violence in primary care: what the physician needs to know (United States)

    Usta, Jinan; Taleb, Rim


    Domestic violence (DV) is quite prevalent and negatively impacts the health and mental wellbeing of those affected. Victims of DV are frequent users of health service, yet they are infrequently recognized. Physicians tend to treat the presenting complaints without addressing the root cause of the problem. Lack of knowledge on adequately managing cases of DV and on appropriate ways to help survivors is commonly presented as a barrier. This article presents the magnitude of the problem of DV in the Arab world, highlights the role of the primary care physician in addressing this problem, and provides practical steps that can guide the clinician in the Arab world in giving a comprehensive and culturally sensitive service to the survivors of DV. PMID:24647277

  2. Identification of cognitive impairment and mental illness in elderly homeless men: Before and after access to primary health care. (United States)

    Joyce, David P; Limbos, Marjolaine


    To describe the occurrence of mental health problems and cognitive impairment in a group of elderly homeless men and to demonstrate how clinical examination and screening tests used in a shelter setting might be helpful in identifying mental illness and cognitive impairment. Cross-sectional study including face-to-face interviews and review of medical records. A community-based homeless shelter in an urban metropolitan centre (Toronto, Ont). A total of 49 male participants 55 years of age or older. The average duration of homelessness was 8.8 (SD 10.2) years. Participants were admitted to a community-based shelter that offered access to regular meals, personal support and housing workers, nursing, and a primary care physician. Medical chart review was undertaken to identify mental illness or cognitive impairment diagnosed either before or after admission to the facility. The 15-item Geriatric Depression Scale (GDS-15) and the Folstein Mini-Mental State Examination (MMSE) were administered. Previous or new diagnosis of mental illness or cognitive impairment. Thirty-six of the participants (73.5%) had previous or new diagnoses. The most prevalent diagnosis was schizophrenia or psychotic disorders (n = 17), followed by depression (n = 11), anxiety disorders (n = 3), cognitive impairment (n = 8), and bipolar affective disorder (n = 1). A total of 37% of participants were given new mental health diagnoses during the study. The GDS-15 identified 9 people with depression and the MMSE uncovered 11 individuals with cognitive impairment who had not been previously diagnosed. This study suggests that providing access to primary care physicians and other services in a community-based shelter program can assist in identification of mental illness and cognitive impairment in elderly homeless men. Use of brief screening tools for depression and cognitive impairment (like the GDS-15 and the MMSE) could be helpful in this highrisk group.

  3. Cognitive load predicts point-of-care ultrasound simulator performance. (United States)

    Aldekhyl, Sara; Cavalcanti, Rodrigo B; Naismith, Laura M


    The ability to maintain good performance with low cognitive load is an important marker of expertise. Incorporating cognitive load measurements in the context of simulation training may help to inform judgements of competence. This exploratory study investigated relationships between demographic markers of expertise, cognitive load measures, and simulator performance in the context of point-of-care ultrasonography. Twenty-nine medical trainees and clinicians at the University of Toronto with a range of clinical ultrasound experience were recruited. Participants answered a demographic questionnaire then used an ultrasound simulator to perform targeted scanning tasks based on clinical vignettes. Participants were scored on their ability to both acquire and interpret ultrasound images. Cognitive load measures included participant self-report, eye-based physiological indices, and behavioural measures. Data were analyzed using a multilevel linear modelling approach, wherein observations were clustered by participants. Experienced participants outperformed novice participants on ultrasound image acquisition. Ultrasound image interpretation was comparable between the two groups. Ultrasound image acquisition performance was predicted by level of training, prior ultrasound training, and cognitive load. There was significant convergence between cognitive load measurement techniques. A marginal model of ultrasound image acquisition performance including prior ultrasound training and cognitive load as fixed effects provided the best overall fit for the observed data. In this proof-of-principle study, the combination of demographic and cognitive load measures provided more sensitive metrics to predict ultrasound simulator performance. Performance assessments which include cognitive load can help differentiate between levels of expertise in simulation environments, and may serve as better predictors of skill transfer to clinical practice.

  4. Primary care physician decision making regarding referral for bariatric surgery: a national survey. (United States)

    Stolberg, Charlotte Røn; Hepp, Nicola; Juhl, Anna Julie Aavild; B C, Deepti; Juhl, Claus B


    Bariatric surgery is the most effective treatment for severe obesity. It results in significant and sustained weight loss and reduces obesity-related co-morbidities. Despite an increasing prevalence of severe obesity, the number of bariatric operations performed in Denmark has decreased during the past years. This is only partly explained by changes in the national guidelines for bariatric surgery. The purpose of the cross-sectional study is to investigate referral patterns and possible reservations regarding bariatric surgery among Danish primary care physicians (PCPs). Primary care physicians in Denmark METHODS: A total of 300 Danish PCPs were invited to participate in a questionnaire survey regarding experiences with bariatric surgery, reservations about bariatric surgery, attitudes to specific patient cases, and the future treatment of severe obesity. Most questions required a response on a 5-point Likert scale (strongly disagree, disagree, neither agree nor disagree, agree, and strongly agree) and frequency distributions were calculated. 133 completed questionnaires (44%) were returned. Most physicians found that they had good knowledge about the national referral criteria for bariatric surgery. With respect to the specific patient cases, a remarkably smaller part of physicians would refer patients on their own initiative, compared with the patient's initiative. Fear of postoperative surgical complications and medical complications both influenced markedly the decision to refer patients for surgery. Only 9% of the respondents indicated that bariatric surgery should be the primary treatment option for severe obesity in the future. Danish PCPs express severe concerns about surgical and medical complications following bariatric surgery. This might, in part, result in a low rate of referral to bariatric surgery. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  5. Palliative care professionals' willingness to perform euthanasia or physician assisted suicide. (United States)

    Zenz, Julia; Tryba, Michael; Zenz, Michael


    Euthanasia and physician assisted suicide (PAS) are highly debated upon particularly in the light of medical advancement and an aging society. Little is known about the professionals' willingness to perform these practices particularly among those engaged in the field of palliative care and pain management. Thus a study was performed among those professionals. An anonymous questionnaire was handed out to all participants of a palliative care congress and a pain symposium in 2013. The questionnaire consisted of 8 questions regarding end of life decisions. Proposed patient vignettes were used. A total of 470 eligible questionnaires were returned, 198 by physicians, 272 by nurses. The response rate was 64 %. The majority of professionals were reluctant to perform euthanasia or PAS: 5.3 % of the respondents would be willing to perform euthanasia on a patient with a terminal illness if asked to do so. The reluctance grew in case of a patient with a non-terminal illness. The respondents were more willing to perform PAS than euthanasia. Nurses were more reluctant to take action as opposed to the physicians. The majority of the respondents would attempt to treat the patient's symptoms first before considering life-ending measures. As regards any decision making process the majority would consult with a colleague. This is the first German study to ask about the willingness of professionals to take action as regards euthanasia and PAS without biased phrasing. As opposed to the general acceptance that is respectively high, the actual willingness to perform life-ending measures is low. The German debate on physician assisted suicide and its possible legalization should also incorporate clarifications regarding the responsibility who should eventually perform these acts.

  6. Primary care physicians' reported use of pre-screening discussions for prostate cancer screening: a cross-sectional survey. (United States)

    Linder, Suzanne K; Hawley, Sarah T; Cooper, Crystale P; Scholl, Lawrence E; Jibaja-Weiss, Maria; Volk, Robert J


    Professional medical organizations recommend individualized patient decision making about prostate cancer screening. Little is known about primary care physicians' use of pre-screening discussions to promote informed decision making for prostate cancer screening. The aim of this study is to explore physicians' use of pre-screening discussions and reasons why physicians would or would not try to persuade patients to be screened if they initially refuse testing. Primary care physicians completed a self-administered survey about prostate cancer screening practices for informed decision making. Sixty-six physicians (75.9%) completed the survey, and 63 were used in the analysis. Thirteen physicians (20.6%) reported not using prescreening discussions, 45 (71.4%) reported the use of prescreening discussions, and 3 (4.8%) reported neither ordering the PSA test nor discussing it with patients. Sixty-nine percent of physicians who reported not having discussions indicated they were more likely to screen African American patients for prostate cancer, compared to 50% of physicians who reported the use of discussions (Chi-square(1) = 1.62, p = .20). Similarly, 91% of physicians who reported not having discussions indicated they are more likely to screen patients with a family history of prostate cancer, compared to 46% of those who reported the use of discussion (Chi-square(1) = 13.27, p practice styles. Future research needs to consider the nature of discussions and the degree to which informed decision making is being achieved in clinical practice.

  7. Direct-to-consumer advertising: physicians' views of its effects on quality of care and the doctor-patient relationship. (United States)

    Murray, Elizabeth; Lo, Bernard; Pollack, Lance; Donelan, Karen; Lee, Ken


    The objective of the study was to determine physicians' views of the effects of Direct-to-Consumer Advertising (DTCA) on health service utilization, quality of care, and the doctor-patient relationship. Cross-sectional survey of a nationally representative sample of US physicians to determine their perceptions of the effects of patients discussing information from DTCA on time efficiency; requests for specific interventions; health outcomes; and the doctor-patient relationship. Physicians reported that more than half (56%) of patients who discussed information from DTCA in a visit did so because they wanted a specific intervention, such as a test, change in medication, or specialist referral. The physician deemed 49% of these requests clinically inappropriate. Physicians filled 69% of requests they deemed clinically inappropriate; 39% of physicians perceived DTCA as damaging to the time efficiency of the visit, and 13% saw it as helpful. Thirty-three percent of physicians thought discussing DTCA had improved the doctor-patient relationship; 8% felt it had worsened it. The effect on the relationship was strongly associated with doing what the patient wanted. DTCA can have good and bad effects on quality of care, the doctor-patient relationship, and health service utilization. The benefits might be maximized, and the harms minimized, by increasing the accuracy of information in advertisements; enhancing physicians' communication and negotiation skills; and encouraging patients to respect physicians' clinical expertise.

  8. A cluster randomized trial to improve adherence to evidence-based guidelines on diabetes and reduce clinical inertia in primary care physicians in Belgium: study protocol [NTR 1369].

    NARCIS (Netherlands)

    Borgermans, L.D.A.; Goderis, G.; Broeke, C.V.; Mathieu, C.; Aertgeerts, B.; Verbeke, G.; Carbonez, A.; Ivanova, A.; Grol, R.P.T.M.; Heyrman, J.


    ABSTRACT: BACKGROUND: Most quality improvement programs in diabetes care incorporate aspects of clinician education, performance feedback, patient education, care management, and diabetes care teams to support primary care physicians. Few studies have applied all of these dimensions to address

  9. Primary care physicians' use of the proposed classification of common mental disorders for ICD-11

    DEFF Research Database (Denmark)

    Goldberg, David P.; Lam, Tai-Pong; Minhas, Fareed


    Background. The World Health Organization is revising the classification of common mental disorders in primary care for ICD-11. Major changes from the ICD-10 primary care version have been proposed for: (i) mood and anxiety disorders; and (ii) presentations of multiple somatic symptoms (bodily...... stress syndrome). This three-part field study explored the implementation of the revised classification by primary care physicians (PCPs) in five countries. Methods. Participating PCPs in Brazil, China, Mexico, Pakistan and Spain were asked to use the revised classification, first in patients...... that they suspected might be psychologically distressed (Part 1), and second in patients with multiple somatic symptoms causing distress or disability not wholly attributable to a known physical pathology, or with high levels of health anxiety (Part 2). Patients referred to Part 1 or Part 2 underwent a structured...

  10. Medicaid Primary Care Physician Fees and the Use of Preventive Services among Medicaid Enrollees (United States)

    Atherly, Adam; Mortensen, Karoline


    Objective The Patient Protection and Affordable Care Act (ACA) increases Medicaid physician fees for preventive care up to Medicare rates for 2013 and 2014. The purpose of this paper was to model the relationship between Medicaid preventive care payment rates and the use of U.S. Preventive Services Task Force (USPSTF)–recommended preventive care use among Medicaid enrollees. Data Sources/Study Session We used data from the 2003 and 2008 Medical Expenditure Panel Survey (MEPS), a national probability sample of the U.S. civilian, noninstitutionalized population, linked to Kaiser state Medicaid benefits data, including the state Medicaid-to-Medicare physician fee ratio in 2003 and 2008. Study Design Probit models were used to estimate the probability that eligible individuals received one of five USPSF-recommended preventive services. A difference-in-difference model was used to separate out the effect of changes in the Medicaid payment rate and other factors. Data Collection/Extraction Methods Data were linked using state identifiers. Principal Findings Although Medicaid enrollees had a lower rate of use of the five preventive services in univariate analysis, neither Medicaid enrollment nor changes in Medicaid payment rates had statistically significant effects on meeting screening recommendations for the five screenings. The results were robust to a number of different sensitivity tests. Individual and state characteristics were significant. Conclusions Our results suggest that although temporary changes in primary care provider payments for preventive services for Medicaid enrollees may have other desirable effects, they are unlikely to substantially increase the use of these selected USPSTF-recommended preventive care services among Medicaid enrollees. PMID:24628495

  11. A clinical study of COPD severity assessment by primary care physicians and their patients compared with spirometry. (United States)

    Mapel, Douglas W; Dalal, Anand A; Johnson, Phaedra; Becker, Laura; Hunter, Alyssa Goolsby


    Primary care physicians often do not use spirometry to confirm the diagnosis of chronic obstructive pulmonary disease. This project was designed to see how well physicians' impressions about their patients' chronic obstructive pulmonary disease severity correlate with the severity of airflow obstruction measured by spirometry and to assess whether spirometry results subsequently changed the physicians' opinions about chronic obstructive pulmonary disease severity and treatment. We performed a multicenter, cross-sectional, observational study conducted in 83 primary care clinics from across the United States. A total of 899 patients with a clinical diagnosis of chronic obstructive pulmonary disease completed a questionnaire and spirometry testing. Physicians completed a questionnaire and case report forms. Concordance among physician ratings, patient ratings, and spirometry results was evaluated. Physicians' chronic obstructive pulmonary disease severity ratings before spirometry were accurate for only 30% of patients with evaluable spirometry results, and disease severity in 41% of patients was underestimated. Physicians also underestimated severity compared with patients' self-assessment among 42% of those with evaluable results. After spirometry, physicians changed their opinions on the severity for 30% of patients and recommended treatment changes for 37%. Only 75% of patients performed at least 1 high-quality spirometry test; however, the physicians' opinions and treatment decisions were similar regardless of suboptimal test results. Without performing spirometry, physicians are likely to underestimate their patients' chronic obstructive pulmonary disease severity or inadequately characterize their patients' lung disease. Spirometry changed the physicians' clinical impressions and treatments for approximately one third of these patients; thus, spirometry is a valuable tool for chronic obstructive pulmonary disease management in primary care. Copyright © 2015

  12. Insulin initiation and intensification in patients with T2DM for the primary care physician

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    Unger J


    Full Text Available Jeff UngerCatalina Research Institute, Chino, CA, USAAbstract: Type 2 diabetes mellitus (T2DM is characterized by both insulin resistance and inadequate insulin secretion. All patients with the disease require treatment to achieve and maintain the target glycosylated hemoglobin (A1C level of 6.5%–7%. Pharmacological management of T2DM typically begins with the introduction of oral medications, and the majority of patients require exogenous insulin therapy at some point in time. Primary care physicians play an essential role in the management of T2DM since they often initiate insulin therapy and intensify regimens over time as needed. Although insulin therapy is prescribed on an individualized basis, treatment usually begins with basal insulin added to a background therapy of oral agents. Prandial insulin injections may be added if glycemic targets are not achieved. Treatments may be intensified over time using patient-friendly titration algorithms. The goal of insulin intensification within the primary care setting is to minimize patients' exposure to chronic hyperglycemia and weight gain, and reduce patients' risk of hypoglycemia, while achieving individualized fasting, postprandial, and A1C targets. Simplified treatment protocols and insulin delivery devices allow physicians to become efficient prescribers of insulin intensification within the primary care arena.Keywords: diabetes, basal, bolus, regimens, insulin analogs, structured glucose testing

  13. Collecting Practice-level Data in a Changing Physician Office-based Ambulatory Care Environment: A Pilot Study Examining the Physician induction interview Component of the National Ambulatory Medical Care Survey. (United States)

    Halley, Meghan C; Rendle, Katharine A; Gugerty, Brian; Lau, Denys T; Luft, Harold S; Gillespie, Katherine A


    Objective This report examines ways to improve National Ambulatory Medical Care Survey (NAMCS) data on practice and physician characteristics in multispecialty group practices. Methods From February to April 2013, the National Center for Health Statistics (NCHS) conducted a pilot study to observe the collection of the NAMCS physician interview information component in a large multispecialty group practice. Nine physicians were randomly sampled using standard NAMCS recruitment procedures; eight were eligible and agreed to participate. Using standard protocols, three field representatives conducted NAMCS physician induction interviews (PIIs) while trained ethnographers observed and audio recorded the interviews. Transcripts and field notes were analyzed to identify recurrent issues in the data collection process. Results The majority of the NAMCS items appeared to have been easily answered by the physician respondents. Among the items that appeared to be difficult to answer, three themes emerged: (a) physician respondents demonstrated an inconsistent understanding of "location" in responding to questions; (b) lack of familiarity with administrative matters made certain questions difficult for physicians to answer; and (c) certain primary care‑oriented questions were not relevant to specialty care providers. Conclusions Some PII survey questions were challenging for physicians in a multispecialty practice setting. Improving the design and administration of NAMCS data collection is part of NCHS' continuous quality improvement process. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

  14. Changes in Payer Mix and Physician Reimbursement After the Affordable Care Act and Medicaid Expansion

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    Christine D. Jones MD, MS


    Full Text Available Although uncompensated care for hospital-based care has fallen dramatically since the implementation of the Affordable Care Act and Medicaid expansion, the changes in hospital physician reimbursement are not known. We evaluated if payer mix and physician reimbursement by encounter changed between 2013 and 2014 in an academic hospitalist practice in a Medicaid expansion state. This was a retrospective cohort study of all general medicine inpatient admissions to an academic hospitalist group in 2013 and 2014. The proportion of encounters by payer and reimbursement/inpatient encounter were compared in 2013 versus 2014. A sensitivity analysis determined the relative contribution of different factors to the change in reimbursement/encounter. Among 37 540 and 40 397 general medicine inpatient encounters in 2013 and 2014, respectively, Medicaid encounters increased (17.3% to 30.0%, P < .001, uninsured encounters decreased (18.4% to 6.3%, P < 0.001, and private payer encounters also decreased (14.1% to 13.3%, P = .001. The median reimbursement/encounter increased 4.2% from $79.98/encounter in 2013 to $83.36/encounter in 2014 (P < .001. In a sensitivity analysis, changes in length of stay, proportions in encounter type by payer, payer mix, and reimbursement for encounter type by payer accounted for −0.7%, 0.8%, 2.0%, and 2.3% of the reimbursement change, respectively. From 2013 to 2014, Medicaid encounters increased, and uninsured and private payer encounters decreased within our hospitalist practice. Reimbursement/encounter also increased, much of which could be attributed to a change in payer mix. Further analyses of physician reimbursement in Medicaid expansion and non-expansion states would further delineate reimbursement changes that are directly attributable to Medicaid expansion.

  15. Chronic Pain, Patient-Physician Engagement, and Family Communication Associated With Drug-Using HIV Patients' Discussing Advanced Care Planning With Their Physicians. (United States)

    Hansen, Eric D; Mitchell, Mary M; Smith, Tom; Hutton, Nancy; Keruly, Jeanne; Knowlton, Amy R


    In the era of effective antiretroviral therapy, persons living with HIV/AIDS (PLWHA) are living longer, transforming HIV into a serious chronic illness, warranting patient-provider discussion about advanced care planning (ACP). Evidence is needed to inform physicians on how to approach ACP for these patients. Chronic pain is common in PLWHA, particularly in those who have substance use disorders; although it is known that this population is at risk for poorer patient-physician engagement, the effects on ACP are unknown. To further characterize factors associated with successful ACP in PLWHA, we examined associations between patient-physician relationship, chronic pain, family communication and problem-solving skills, and rates of patients discussing ACP with their physicians. Data were from the Affirm Care study (N = 325), which examined social and environmental factors associated with health outcomes among PLWHA and their informal caregivers. In multivariate analysis, higher odds of patient reports of discussing ACP with their physicians were associated with their higher rating of their relationship with their physician (adjusted odds ratio [AOR] 1.73; P family arguments about end-of-life medical decisions (AOR 2.43; P family members about problems (AOR 1.33; P family communication and family problem-solving skills. The findings also suggest that PLWHA with chronic pain and prior family discord over end-of-life medical decisions may be primed for ACP. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  16. Improved knowledge of and difficulties in palliative care among physicians during 2008 and 2015 in Japan: Association with a nationwide palliative care education program. (United States)

    Nakazawa, Yoko; Yamamoto, Ryo; Kato, Masashi; Miyashita, Mitsunori; Kizawa, Yoshiyuki; Morita, Tatsuya


    Palliative care education for health care professionals is a key element in improving access to quality palliative care. The Palliative Care Emphasis Program on Symptom Management and Assessment for Continuous Medical Education (PEACE) was designed to provide educational opportunities for all physicians in Japan. As of 2015, 57,764 physicians had completed it. The objective of this study was to estimate the effects of the program. This study was an analysis of 2 nationwide observational studies from 2008 and 2015. We conducted 2 questionnaire surveys for representative samples of physicians. The measurements used were the Palliative Care Knowledge Test (range, 0-100) and the Palliative Care Difficulties Scale (range, 1-4). Comparisons were made with the unpaired Student t test and with a multivariate linear regression model using 2 cohorts and a propensity score-matched sample. This study analyzed a total of 48,487 physicians in 2008 and a total of 2720 physicians in 2015. Between 2008 and 2015, physicians' knowledge and difficulties significantly improved on the Palliative Care Knowledge Test with total scores of 68 and 78, respectively (P PEACE program had a higher knowledge score (74 vs 86; P PEACE program may have contributed to these improvements. Cancer 2018;124:626-35. © 2017 American Cancer Society. © 2017 American Cancer Society.

  17. Physicians' Knowledge of and Attitudes Toward Use of Opioids in Long-Term Care Facilities. (United States)

    Griffioen, Charlotte; Willems, Eva G; Kouwenhoven, Sanne M; Caljouw, Monique A A; Achterberg, Wilco P


    Insufficient pain management in vulnerable older persons living in long-term care facilities is common, and opiophobia might contribute to this. As opiophobia and its related factors have not been investigated in long-term care, this study evaluates the degree of knowledge of opioids among elderly-care physicians (ECPs) and ECP trainees, as well as their attitudes and other factors possibly influencing the clinical use of opioids in these facilities. A questionnaire was designed and distributed among ECPs and ECP trainees by email, regional symposia, and all three university training faculties for elderly-care medicine in the Netherlands. Respondents were 324 ECPs and 111 ECP trainees. Fear of addiction did not influence the prescription of opioids. Main barriers to the clinical use of opioids were patients' reluctance to take opioids (83.3%); unknown degree of pain (79.2%); and pain of unknown origin (51.4%). ECPs' average knowledge scores were sufficient: those who felt that their knowledge of opioids was poor scored lower than those who felt that their knowledge was good. Factors identified in this study may help provide better pain management for vulnerable older persons living in a long-term care facility. Also, more patient information on the pros and cons of opioid use is needed, as well as appropriate tools for better clinical assessment of pain in a long-term care population. © 2016 World Institute of Pain.

  18. Relationship between job satisfaction and performance of primary care physicians after the family physician reform of east Azerbaijan province in Northwest Iran. (United States)

    Jabbari, Hossein; Pezeshki, Mohamad Zakarria; Naghavi-Behzad, Mohammad; Asghari, Mohammad; Bakhshian, Fariba


    Following the implementation of family physician program in 2004 in Iranian healthcare system, the understanding in changes in physicians' practice has become important. The objective of this study was to determine the level of family physicians' job satisfaction and its relationship with their performance level. A cross-sectional study was conducted among all 367 family physicians of East Azerbaijan province in during December 2009 to May 2011 using a self-administered, anonymous questionnaire for job satisfaction. The performance scores of primary care physicians were obtained from health deputy of Tabriz Medical University. In this study, overall response rate was 64.5%. The average score of job satisfaction was 42.10 (±18.46), and performance score was 87.52 (±5.74) out of 100. There was significant relationships between working history and job satisfaction (P = 0.014), marital status (P = 0.014), and sex (P = 0.018) with performance among different personal and organizational variables. However, there was no significant relationship between job satisfaction and performance, but satisfied people had about three times better performance than their counterparts (all P performance and job satisfaction are obvious indications for more extensive research in identifying causes and finding mechanisms to improve the situation, especially in payment methods and work condition, in existing health system.

  19. Accounting for graduate medical education production of primary care physicians and general surgeons: timing of measurement matters. (United States)

    Petterson, Stephen; Burke, Matthew; Phillips, Robert; Teevan, Bridget


    Legislation proposed in 2009 to expand GME set institutional primary care and general surgery production eligibility thresholds at 25% at entry into training. The authors measured institutions' production of primary care physicians and general surgeons on completion of first residency versus two to four years after graduation to inform debate and explore residency expansion and physician workforce implications. Production of primary care physicians and general surgeons was assessed by retrospective analysis of the 2009 American Medical Association Masterfile, which includes physicians' training institution, residency specialty, and year of completion for up to six training experiences. The authors measured production rates for each institution based on physicians completing their first residency during 2005-2007 in family or internal medicine, pediatrics, or general surgery. They then reassessed rates to account for those who completed additional training. They compared these rates with proposed expansion eligibility thresholds and current workforce needs. Of 116,004 physicians completing their first residency, 54,245 (46.8%) were in primary care and general surgery. Of 683 training institutions, 586 met the 25% threshold for expansion eligibility. At two to four years out, only 29,963 physicians (25.8%) remained in primary care or general surgery, and 135 institutions lost eligibility. A 35% threshold eliminated 314 institutions collectively training 93,774 residents (80.8%). Residency expansion thresholds that do not account for production at least two to four years after completion of first residency overestimate eligibility. The overall primary care production rate from GME will not sustain the current physician workforce composition. Copyright © by the Association of American medical Colleges.

  20. Self-reported smoking cessation activities among Swiss primary care physicians

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    Ruffieux Christiane


    Full Text Available Abstract Background Individual counselling, pharmacotherapy, and group therapy are evidence-based interventions that help patients stop smoking. Acupuncture, hypnosis, and relaxation have no demonstrated efficacy on smoking cessation, whereas self-help material may only have a small benefit. The purpose of this study is to assess physicians' current clinical practice regarding smokers motivated to stop smoking. Methods The survey included 3385 Swiss primary care physicians. Self-reported use of nine smoking cessation interventions was scored. One point was given for each positive answer about practicing interventions with demonstrated efficacy, i.e. nicotine replacement therapy, bupropion, counselling, group therapy, and smoking cessation specialist. No points were given for the recommendation of acupuncture, hypnosis, relaxation, and self-help material. Multivariable logistic analysis was performed to identify factors associated with a good practice score, defined as ≥ 2. Results The response rate was 55%. Respondents were predominately over the age of 40 years (88%, male (79%, and resided in urban areas (74%. Seventeen percent reported being smokers. Most of the physicians prescribed nicotine replacement therapy (84%, bupropion (65%, or provided counselling (70%. A minority of physicians recommended acupuncture (26%, hypnosis (8%, relaxation (7%, or self-help material (24%. A good practice score was obtained by 85% of respondents. Having attended a smoking cessation-training program was the only significant predictor of a good practice score (odds ratio: 6.24, 95% CI 1.95–20.04. Conclusion The majority of respondents practice recommended smoking cessation interventions. However, there is room for improvement and implementing an evidence-based smoking cessation-training program could provide additional benefit.

  1. The ethical self-fashioning of physicians and health care systems in culturally appropriate health care. (United States)

    Shaw, Susan J; Armin, Julie


    Diverse advocacy groups have pushed for the recognition of cultural differences in health care as a means to redress inequalities in the U.S., elaborating a form of biocitizenship that draws on evidence of racial and ethnic health disparities to make claims on both the state and health care providers. These efforts led to federal regulations developed by the U.S. Office of Minority Health requiring health care organizations to provide Culturally and Linguistically Appropriate Services. Based on ethnographic research at workshops and conferences, in-depth interviews with cultural competence trainers, and an analysis of postings to a moderated listserv with 2,000 members, we explore cultural competence trainings as a new type of social technology in which health care providers and institutions are urged to engage in ethical self-fashioning to eliminate prejudice and embody the values of cultural relativism. Health care providers are called on to re-orient their practice (such as habits of gaze, touch, and decision-making) and to act on their own subjectivities to develop an orientation toward Others that is "culturally competent." We explore the diverse methods that cultural competence trainings use to foster a health care provider's ability to be self-reflexive, including face-to-face workshops and classes and self-guided on-line modules. We argue that the hybrid formation of culturally appropriate health care is becoming detached from its social justice origins as it becomes rationalized by and more firmly embedded in the operations of the health care marketplace.

  2. [Use of sedation in the palliative care situation by respiratory physicians]. (United States)

    Grijol-Cariou, A-L; Goupil, F; Hubault, P; Jouanneau, J


    The prognosis of advanced stage chronic lung disease, including lung cancer, is often poor and associated with uncomfortable symptoms for the patient, especially in the end of life phase. In the case of intolerable symptoms, refractory to maximal treatment, sedation may then be considered. This is sometimes a source of confusion and difficulty for clinicians who need to know the official guidelines. The purpose of this study was to investigate the use of sedation by respiratory physicians, in order to understand their difficulties in these complex situations. The study was conducted using semi-structured, anonymous interviews of volunteers. The topics discussed included their definition of sedation, its indications, their possible difficulties or reluctance in using it, the information given to the patient and the traceability of the sedation prescription. All respiratory physicians agreed to participate in the study, indicating a major interest in this topic. No sedation decision is taken without careful consideration. The majority of physicians understand the difference between anxiolysis and sedation, most defining the latter as using a drug to sedate a patient faced with uncontrollable symptoms. All doctors refused to link sedation to euthanasia, although half expressed a feeling of causality between sedation and the patient's death - knowing that few consider the possibility of transient sedation. The main reluctance among doctors is in chronic respiratory insufficiency. Any decision concerning sedation should be discussed beforehand with the care team and the resident in charge of the patient, but not necessarily with another colleague. There is rarely evidence of this discussion in the medical records or of the information given to the patient and his family, thus increasing the difficulties of decision-making, especially at nights or weekends. The decision to start sedation is seen as difficult because it presupposes that a life-threatening short

  3. A cross-country comparison of intensive care physicians' beliefs about their transfusion behaviour: a qualitative study using the Theoretical Domains Framework. (United States)

    Islam, Rafat; Tinmouth, Alan T; Francis, Jill J; Brehaut, Jamie C; Born, Jennifer; Stockton, Charlotte; Stanworth, Simon J; Eccles, Martin P; Cuthbertson, Brian H; Hyde, Chris; Grimshaw, Jeremy M


    Evidence of variations in red blood cell transfusion practices have been reported in a wide range of clinical settings. Parallel studies in Canada and the United Kingdom were designed to explore transfusion behaviour in intensive care physicians. The aim of this paper is three-fold: first, to explore beliefs that influence Canadian intensive care physicians' transfusion behaviour; second, to systematically select relevant theories and models using the Theoretical Domains Framework (TDF) to inform a future predictive study; and third, to compare its results with the UK study. Ten intensive care unit (ICU) physicians throughout Canada were interviewed. Physicians' responses were coded into theoretical domains, and specific beliefs were generated for each response. Theoretical domains relevant to behaviour change were identified, and specific constructs from the relevant domains were used to select psychological theories. The results from Canada and the United Kingdom were compared. Seven theoretical domains populated by 31 specific beliefs were identified as relevant to the target behaviour. The domains Beliefs about capabilities (confident to not transfuse if patients' clinical condition is stable), Beliefs about consequences (positive beliefs of reducing infection and saving resources and negative beliefs about risking patients' clinical outcome and potentially more work), Social influences (transfusion decision is influenced by team members and patients' relatives), and Behavioural regulation (wide range of approaches to encourage restrictive transfusion) that were identified in the UK study were also relevant in the Canadian context. Three additional domains, Knowledge (it requires more evidence to support restrictive transfusion), Social/professional role and identity (conflicting beliefs about not adhering to guidelines, referring to evidence, believing restrictive transfusion as professional standard, and believing that guideline is important for other

  4. The Attitudes of Indian Palliative-care Nurses and Physicians to Pain Control and Palliative Sedation (United States)

    Gielen, Joris; Gupta, Harmala; Rajvanshi, Ambika; Bhatnagar, Sushma; Mishra, Seema; Chaturvedi, Arvind K; den Branden, Stef Van; Broeckaert, Bert


    Aim: We wanted to assess Indian palliative-care nurses and physicians’ attitudes toward pain control and palliative sedation. Materials and Methods: From May to September 2008, we interviewed 14 physicians and 13 nurses working in different palliative-care programs in New Delhi, using a semi-structured questionnaire, and following grounded-theory methodology (Glaser and Strauss). Results: The interviewees did not consider administration of painkillers in large doses an ethical problem, provided the pain killers are properly titrated. Mild palliative sedation was considered acceptable. The interviewees disagreed whether palliative sedation can also be deep and continuous. Arguments mentioned against deep continuous palliative sedation were the conviction that it may cause unacceptable side effects, and impedes basic daily activities and social contacts. A few interviewees said that palliative sedation may hasten death. Conclusion: Due to fears and doubts regarding deep continuous palliative sedation, it may sometimes be too easily discarded as a treatment option for refractory symptoms. PMID:21633619

  5. Health care politics and policy: the business of medicine: a course for physician leaders. (United States)

    Marmor, Theodore Richard


    This article is a condensed and edited version of a speech delivered to the business of medicine: A Course for Physician Leaders symposium presented by Yale-New Haven Hospital and the Medical Directors Leadership Council at Yale University in November 2012 and drawn from Politics, Health, and Health Care: Selected Essays by Theodore R. Marmor and Rudolf Klein [1]. It faithfully reflects the major argument delivered, but it does not include the typical range of citations in a journal article. The material presented here reflects more than 40 years of teaching a course variously described as Political Analysis and Management, Policy and Political Analysis, and The Politics of Policy. The aim of all of these efforts is to inform audiences about the necessity of understanding political conflict in any arena, not least of which is the complex and costly world of medical care.

  6. Barriers to Colorectal Cancer Screening in Primary Care Settings: Attitudes and Knowledge of Nurses and Physicians

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    Joshua Kanaabi Muliira


    Full Text Available Objective: Healthcare providers (HCPs play a critical role in reducing colorectal cancer (CRC related morbidity and mortality. This study aimed at exploring the attitudes and knowledge of nurses and physicians working in primary care settings regarding CRC screening. Methods: A total of 142 HCPs (57.7% nurses and 42.3% physicians participated in a cross-sectional survey. Data were collected using a Self-administered Questionnaire. The participants were clinically experienced (mean = 9.39 years; standard deviation [SD] = 6.13, regularly taking care of adults eligible for CRC screening (62% and had positive attitudes toward CRC screening (83.1%. Most participants (57% had low levels of knowledge about CRC screening (mean = 3.23; SD = 1.50. The participants were most knowledgeable about the recommended age for initiating screening (62.7% and the procedures not recommended for screening (90.8%. Results: More than 55% did not know the frequency of performing specific screening procedures, the upper age limit at which screening is not recommended, and the patients at high-risk for CRC. There were no significant differences between nurses′ and physicians′ attitudes and knowledge. The participants′ perceptions about professional training (odds ratio [OR] = 2.17, P = 0.003, colonoscopy (OR = 2.60, P = 0.014, and double-contrast barium enema (OR = 0.53, P = 0.041, were significantly associated with knowledge about CRC screening. Conclusions: The inadequate knowledge levels among nurses and physicians may be one of the barriers affecting CRC screening. Enhancing HCPs knowledge about CRC screening should be considered a primary intervention in the efforts to promote CRC screening and prevention.

  7. Patient-Physician Communication in Oncology Care : The character of, barriers against, and ways to evaluate patient-physician communication, with focus on the psychosocial dimensions


    Fagerlind, Hanna


    The overall aim of this thesis was to characterize patient-physician communication in oncology care with focus on the content and quality of the consultations from the perspectives of patients, oncologists and observer. Further, the aim was to explore oncologists’ perceived barriers against psychosocial communication in out-patient consultations. Finally, the aim was to evaluate different methods for evaluating communication in this setting. Routine oncology out-patient consultations from two...

  8. Attitudes of intensive care and emergency physicians in Australia with regard to the organ donation process: A qualitative analysis. (United States)

    Macvean, Emily; Yuen, Eva Yn; Tooley, Gregory; Gardiner, Heather M; Knight, Tess


    Specialized hospital physicians have direct capacity to impact Australia's sub-optimal organ donation rates because of their responsibility to identify and facilitate donation opportunities. Australian physicians' attitudes toward this responsibility are examined. A total of 12 intensive care unit and three emergency department physicians were interviewed using a constructionist grounded theory and situational analysis approach. A major theme emerged, related to physicians' conflicts of interest in maintaining patients'/next-of-kin's best interests and a sense of duty-of-care in this context. Two sub-themes related to this main theme were identified as follows: (1) discussions about organ donation and who is best to carry these out and (2) determining whether organ donation is part of end-of-life care; including the avoidance of non-therapeutic ventilation; and some reluctance to follow clinical triggers in the emergency department. Overall, participants indicated strong support for organ donation but would not consider it part of end-of-life care, representing a major obstacle to the support of potential donation opportunities. Findings have implications for physician education and training. Continued efforts are needed to integrate the potential for organ donation into end-of-life care within intensive care units and emergency departments.

  9. Attitude of clinical faculty members in Shiraz Medical University towards private practice physicians' participation in ambulatory care education

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    Khatereh Mahori


    Full Text Available Background: Improvement of medical education is necessary for meeting health care demands. Participation of private practice physicians in ambulatory care training is an effective method for enhancing medical students' skills. Purpose This study was undertaken to determine clinical professors' views about participation of physicians with private office in ambulatory care training. Methods: Participants composed of 162 Shiraz Medical University faculty members from 12 disciplines. A questionnaire requesting faculty members' views on different aspects of ambulat01y care teaching and interaction of community-based organizations was distributed. Results: Of 120 (74.1% respondents, 64 (54.2% believed that clinical settings of medical university are appropriate for ambulatory care training. Private practice physicians believed more than academic physicians without private office that private offices have wider range of patients, more common cases, and better follow up chance; and is also a better setting for learning ambulatory care compared with medical university clinical centers. Overall, 32 (29.1% respondent’s found the participation of physicians with private practice on medical education positive. Key words medical education, ambulatory medicine, private practice

  10. Preventing dehydration-related hospitalizations: a mixed-methods study of parents, inpatient attendings, and primary care physicians. (United States)

    Shanley, Leticia; Mittal, Vineeta; Flores, Glenn


    The goal of this study was to identify the proportion of dehydration-related ambulatory care-sensitive condition hospitalizations, the reasons why these hospitalizations were preventable, and factors associated with preventability. A cross-sectional survey of primary care providers (PCPs), inpatient attending physicians, and parents was conducted in a consecutive series of children with ambulatory care-sensitive conditions admitted to an urban hospital over 14 months. Eighty-five children were diagnosed with dehydration. Their mean age was 1.6 years; most had public (74%) or no (17%) insurance, and were nonwhite (91%). The proportion of hospitalizations assessed as preventable varied from 12% for agreement among all 3 sources to 45% for any source. Parents identified inadequate prevention (50%), poor self-education (34%), and poor quality of care (38%) as key factors. PCPs identified parents providing insufficient home rehydration (33%), not visiting the clinic (25%), and not calling earlier (16%) as reasons. Inpatient attending physicians cited home rehydration (40%), delays in seeking care (40%), and lacking a PCP (20%) as contributors. Physicians (PCPs and inpatient attending physicians) were more likely than parents to describe the admission as inappropriate (75% vs 67% vs 0%; P dehydration-related hospitalizations may be preventable. Inadequate parental education by physicians, insufficient home rehydration, deferring clinic visits, insurance and cost barriers, inappropriate admissions, poor quality of care, and parental dissatisfaction with PCPs are the reasons that these hospitalizations might have been prevented.

  11. Characteristics of physicians and patients who join team-based primary care practices: evidence from Quebec's Family Medicine Groups. (United States)

    Coyle, Natalie; Strumpf, Erin; Fiset-Laniel, Julie; Tousignant, Pierre; Roy, Yves


    New models of delivering primary care are being implemented in various countries. In Quebec, Family Medicine Groups (FMGs) are a team-based approach to enhance access to, and coordination of, care. We examined whether physicians' and patients' characteristics predicted their participation in this new model of primary care. Using provincial administrative data, we created a population cohort of Quebec's vulnerable patients. We collected data before the advent of FMGs on patients' demographic characteristics, chronic illnesses and health service use, and their physicians' demographics, and practice characteristics. Multivariate regression was used to identify key predictors of joining a FMG among both patients and physicians. Patients who eventually enrolled in a FMG were more likely to be female, reside outside of an urban region, have a lower SES status, have diabetes and congestive heart failure, visit the emergency department for ambulatory sensitive conditions and be hospitalized for any cause. They were also less likely to have hypertension, visit an ambulatory clinic and have a usual provider of care. Physicians who joined a FMG were less likely to be located in urban locations, had fewer years in medical practice, saw more patients in hospital, and had patients with lower morbidity. Physicians' practice characteristics and patients' health status and health care service use were important predictors of joining a FMG. To avoid basing policy decisions on tenuous evidence, policymakers and researchers should account for differential selection into team-based primary health care models. Copyright © 2014. Published by Elsevier Ireland Ltd.

  12. Virtual patient care: an interprofessional education approach for physician assistant, physical therapy and occupational therapy students. (United States)

    Shoemaker, Michael J; Platko, Christina M; Cleghorn, Susan M; Booth, Andrew


    The purpose of this retrospective qualitative case report is to describe how a case-based, virtual patient interprofessional education (IPE) simulation activity was utilized to achieve physician assistant (PA), physical therapy (PT) and occupational therapy (OT) student IPE learning outcomes. Following completion of a virtual patient case, 30 PA, 46 PT and 24 OT students were required to develop a comprehensive, written treatment plan and respond to reflective questions. A qualitative analysis of the submitted written assignment was used to determine whether IPE learning objectives were met. Student responses revealed three themes that supported the learning objectives of the IPE experience: benefits of collaborative care, role clarification and relevance of the IPE experience for future practice. A case-based, IPE simulation activity for physician assistant and rehabilitation students using a computerized virtual patient software program effectively facilitated achievement of the IPE learning objectives, including development of greater student awareness of other professions and ways in which collaborative patient care can be provided.

  13. Osteoporosis practice patterns in 2006 among primary care physicians participating in the NORA study. (United States)

    Weiss, T W; Siris, E S; Barrett-Connor, E; Miller, P D; McHorney, C A


    This study investigated osteoporosis management trends from 1998 to 2006 among 808 primary care physicians involved in the US-based NORA (National Osteoporosis Risk Assessment) study. These results suggest some significant improvements in osteoporosis management over the past eight years. The purpose of this study was to investigate osteoporosis management trends among a large cohort of primary care physicians (PCPs) involved in the US-based NORA (National Osteoporosis Risk Assessment) study. In 2006, we undertook a resurvey of the 2,836 NORA PCPs who completed a baseline survey in 1998. Of the 2,199 PCPs for whom we had current contact information and who were still practicing, we collected usable surveys from 808 (37% response rate). From 1998 to 2006, more than double the percentage of NORA PCPs reported using BMDs "often" (35% vs. 87%). There was a doubling of the percentage of NORA PCPs who reported that a T-score of NORA PCPs who reported using bone turnover markers to screen, diagnosis, or monitor osteoporosis almost tripled (19% vs. 55%). The percentage of patients prescribed or recommended hormone therapy dropped sixfold (67% to 11%), and the percentage of patients prescribed bisphosphonates increased fourfold from 15% to 59%. These results suggest some significant improvements in osteoporosis management over the past eight years.

  14. Magnitude and risk factors for burnout among primary health care physicians in Asir Province, Saudi Arabia. (United States)

    Al-Sareai, N S; Al-Khaldi, Y M; Mostafa, O A; Abdel-Fattah, M M


    Job-related burnout is an occupational hazard for health care professionals. This study aimed to determine the prevalence of burnout and its associated factors among physicians working at primary health care centres in Asir province, Saudi Arabia. In a cross-sectional survey applying the Maslach Burnout Inventory (MBI) with standard cutoffs, 29.5% of respondents reported high emotional exhaustion, 15.7% high depersonalization and 19.7% low personal accomplishment, with 6.3% scoring high in all 3 dimensions. High emotional exhaustion score was associated with younger age, Saudi nationality and salary 15,000-20,000 SR. Physicians who had more working days and those who had longer duration of annual vacation were less likely to report emotional exhaustion. High depersonalization score was associated with Saudi nationality, working for 5-15 years and salary > 20,000 SR. Low personal accomplishment score was associated with younger age, non-Saudi nationality, working for > or =5 years and more annual vacation.

  15. Mental health in young adults and adolescents - supporting general physicians to provide holistic care. (United States)

    Jurewicz, Izabela


    In the era of an ageing population, young adults on medical wards are quite rare, as only 12% of young adults report a long-term illness or disability. However, mental health problems remain prevalent in the younger population. In a recent report, mental health and obesity were listed as the most common problems in young adults. Teams set up specifically for the needs of younger adults, such as early intervention in psychosis services are shown to work better than traditional care and have also proven to be cost effective. On the medical wards, younger patients may elicit strong emotions in staff, who often feel protective and may identify strongly with the young patient's suffering. In order to provide holistic care for young adults, general physicians need to recognise common presentations of mental illness in young adults such as depression, deliberate self-harm, eating disorders and substance misuse. Apart from treating illness, health promotion is particularly important for young adults. © 2015 Royal College of Physicians.

  16. Organizational and safety culture in Canadian intensive care units: relationship to size of intensive care unit and physician management model. (United States)

    Dodek, Peter M; Wong, Hubert; Jaswal, Danny; Heyland, Daren K; Cook, Deborah J; Rocker, Graeme M; Kutsogiannis, Demetrios J; Dale, Craig; Fowler, Robert; Ayas, Najib T


    The objectives of this study are to describe organizational and safety culture in Canadian intensive care units (ICUs), to correlate culture with the number of beds and physician management model in each ICU, and to correlate organizational culture and safety culture. In this cross-sectional study, surveys of organizational and safety culture were administered to 2374 clinical staff in 23 Canadian tertiary care and community ICUs. For the 1285 completed surveys, scores were calculated for each of 34 domains. Average domain scores for each ICU were correlated with number of ICU beds and with intensivist vs nonintensivist management model. Domain scores for organizational culture were correlated with domain scores for safety culture. Culture domain scores were generally favorable in all ICUs. There were moderately strong positive correlations between number of ICU beds and perceived effectiveness at recruiting/retaining physicians (r = 0.58; P organizational and safety culture. Differences in perceptions between staff in larger and smaller ICUs highlight the importance of teamwork across units in larger ICUs. Copyright © 2012 Elsevier Inc. All rights reserved.

  17. Neuropsychologists as primary care providers of cognitive health: A novel comprehensive cognitive wellness service delivery model. (United States)

    Pimental, Patricia A; O'Hara, John B; Jandak, Jessica L


    By virtue of their extensive knowledge base and specialized training in brain-behavior relationships, neuropsychologists are especially poised to execute a unique broad-based approach to overall cognitive wellness and should be viewed as primary care providers of cognitive health. This article will describe a novel comprehensive cognitive wellness service delivery model including cognitive health, anti-aging, lifelong wellness, and longevity-oriented practices. These practice areas include brain-based cognitive wellness, emotional and spiritually centric exploration, and related multimodality health interventions. As experts in mind-body connections, neuropsychologists can provide a variety of evidence-based treatment options, empowering patients with a sense of value and purpose. Multiple areas of clinical therapy skill-based learning, tailor-made to fit individual needs, will be discussed including: brain stimulating activities, restorative techniques, automatic negative thoughts and maladaptive thinking reduction, inflammation and pain management techniques, nutrition and culinary focused cognitive wellness, spirituality based practices and mindfulness, movement and exercise, alternative/complimentary therapies, relationship restoration/social engagement, and trauma healing/meaning. Cognitive health rests upon the foundation of counteracting mind-body connection disruptions from multiple etiologies including inflammation, chronic stress, metabolic issues, cardiac conditions, autoimmune disease, neurological disorders, infectious diseases, and allergy spectrum disorders. Superimposed on these issues are lifestyle patterns and negative health behaviors that develop as ill-fated compensatory mechanisms used to cope with life stressors and aging. The brain and body are electrical systems that can "short circuit." The therapy practices inherent in the proposed cognitive wellness service delivery model can provide preventative insulation and circuit breaking against

  18. African Female Physicians and Nurses in the Global Care Chain: Qualitative Explorations from Five Destination Countries.

    Directory of Open Access Journals (Sweden)

    Silvia Wojczewski

    Full Text Available Migration of health professionals is an important policy issue for both source and destination countries around the world. The majority of migrant care workers in industrialized countries today are women. However, the dimension of mobility of highly skilled females from countries of the global south has been almost entirely neglected for many years. This paper explores the experiences of high-skilled female African migrant health-workers (MHW utilising the framework of Global Care Chain (GCC research. In the frame of the EU-project HURAPRIM (Human Resources for Primary Health Care in Africa, the research team conducted 88 semi-structured interviews with female and male African MHWs in five countries (Botswana, South Africa, Belgium, Austria, UK from July 2011 until April 2012. For this paper we analysed the 34 interviews with female physicians and nurses using the qualitative framework analysis approach and the software atlas.ti. In terms of the effect of the migration on their career, almost all of the respondents experienced short-term, long-term or permanent inability to work as health-care professionals; few however also reported a positive career development post-migration. Discrimination based on a foreign nationality, race or gender was reported by many of our respondents, physicians and nurses alike, whether they worked in an African or a European country. Our study shows that in addition to the phenomenon of deskilling often reported in GCC research, many female MHW are unable to work according to their qualifications due to the fact that their diplomas are not recognized in the country of destination. Policy strategies are needed regarding integration of migrants in the labour market and working against discrimination based on race and gender.

  19. Mindfulness, resilience, and burnout subtypes in primary care physicians: The possible mediating role of positive and negative affect

    NARCIS (Netherlands)

    Montero-Marin, J.; Tops, M.; Manzanera, R.; Marcos Piva Demarzo, M.; Álvarez de Mon, M.; Garcia Campayo, J.


    Purpose: Primary care health professionals suffer from high levels of burnout. The aim of the present study was to evaluate the associations of mindfulness and resilience with the features of the burnout types (overload, lack of development, neglect) in primary care physicians, taking into account

  20. Extended use of electronic health records by primary care physicians: Does the electronic health record artefact matter? (United States)

    Raymond, Louis; Paré, Guy; Marchand, Marie


    The deployment of electronic health record systems is deemed to play a decisive role in the transformations currently being implemented in primary care medical practices. This study aims to characterize electronic health record systems from the perspective of family physicians. To achieve this goal, we conducted a survey of physicians practising in private clinics located in Quebec, Canada. We used valid responses from 331 respondents who were found to be representative of the larger population. Data provided by the physicians using the top three electronic health record software products were analysed in order to obtain statistically adequate sub-sample sizes. Significant differences were observed among the three products with regard to their functional capability. The extent to which each of the electronic health record functionalities are used by physicians also varied significantly. Our results confirm that the electronic health record artefact 'does matter', its clinical functionalities explaining why certain physicians make more extended use of their system than others.

  1. The effect of professional identity on comprehensiveness in strategic decision making: physician executives in the Canadian health care context. (United States)

    Karmali, Shazia


    This paper explores differences in decision-making approaches between physician executives and nonphysician executives in a managerial setting. Fredrickson and Mitchell's (1984) conceptualization of the construct of comprehensiveness in strategic decision making is the central construct of this paper. Theories of professional identity, socialization, and institutional/dominant logics are applied to illustrate their impact on strategic decision-making approaches of physician and nonphysician executives. This paper proposes that high-status professionals, specifically physicians, occupying senior management roles are likely to approach decision making in a way that is consistent with their professional identity, and by extension, that departments led by physician executives are less likely to exhibit comprehensiveness in strategic decision-making processes than departments led by nonphysician executives. This paper provides conceptual evidence that physicians and nonphysicians approach management differently, and introduces the utility of comprehensiveness as a construct for strategic decision making in the context of health care management.

  2. Physician payment 2008 for interventionalists: current state of health care policy. (United States)

    Manchikanti, Laxmaiah; Giordano, James


    Physicians in the United States have been affected by significant changes in the pattern(s) of medical practice evolving over the last several decades. These changes include new measures to 1) curb increasing costs, 2) increase access to patient care, 3) improve quality of healthcare, and 4) pay for prescription drugs. Escalating healthcare costs have focused concerns about the financial solvency of Medicare and this in turn has fostered a renewed interest in the economic basis of interventional pain management practices. The provision and systemization of healthcare in North America and several European countries are difficult enterprises to manage irrespective of whether these provisions and systems are privatized (as in the United States) or nationalized or seminationalized (as in Great Britain, Canada, Australia and France). Consequently, while many management options have been put forth, none seem to be optimally geared toward affording healthcare as a maximized individual and social good, and none have been completely enacted. The current physician fee schedule (released on July 12, 2007) includes a 9.9% cut in payment rate. Since the Medicare program was created in 1965, several methods have been used to determine physicians' rate(s) for each covered service. The sustained growth rate (SGR) system, established in 1998, has evoked negative consequences on physician payment(s). Based on the current Medicare expenditure index, practice expenses are projected to increase by 34.5% from 2002 to 2016, whereas, if actual practice inflation is considered, this increase will be 90%. This is in contrast to projected physician payment cuts that are depicted to be 51%. No doubt, this scenario will be devastating to many practices and the US medical community at large. Resolutions to this problem have been offered by MedPAC, the Government Accountability Office, physician organizations, economists, and various other interested groups. In the past, temporary measures have

  3. Identifying frailty in primary care: a qualitative description of family physicians' gestalt impressions of their older adult patients. (United States)

    Korenvain, Clara; Famiyeh, Ida-Maisie; Dunn, Sheila; Whitehead, Cynthia R; Rochon, Paula A; McCarthy, Lisa M


    Many tools exist to guide family physicians' impressions about frailty status of older adults, but no single tool, instrument, or set of criteria has emerged as most useful. The role of physicians' subjective impressions in frailty decisions has not been studied. This study explores how family physicians conceptualize frailty, and the factors that they consider when making subjective decisions about patients' frailty statuses. Descriptive qualitative study of family physicians who practice in a large urban academic family medicine center as they participated in one-on-one "think-aloud" interviews about the frailty status of their patients aged 80 years and over. Of 23 eligible family physicians, 18 shared their impressions about the frailty status of their older adult patients and the factors influencing their decisions. Interviews were audio-recorded, transcribed, and thematically analyzed. Four themes were identified, the first of which described how physicians conceptualized frailty as a spectrum and dynamic in nature, but also struggled to conceptualize it without a formal definition in place. The remaining three themes described factors considered before determining patients' frailty statuses: physical characteristics (age, weight, medical conditions), functional characteristics (physical, cognitive, social) and living conditions (level of independence, availability of supports, physical environment). Family physicians viewed frailty as multifactorial, dynamic, and inclusive of functional and environmental factors. This conceptualization can be useful to make comprehensive and flexible evaluations of frailty status in conjunction with more objective frailty tools.

  4. Utilization of health services and prescription patterns among lupus patients followed by primary care physicians and rheumatologists in Puerto Rico. (United States)

    Molina, María J; Mayor, Angel M; Franco, Alejandro E; Morell, Carlos A; López, Miguel A; Vilá, Luis M


    To examine the utilization of health services and prescription patterns among patients with systemic lupus erythematosus (SLE) followed by primary care physicians and rheumatologists in Puerto Rico. The insurance claims submitted by physicians to a health insurance company of Puerto Rico in 2003 were examined. The diagnosis of lupus was determined by using the International Classification of Diseases, Ninth Revision, code for SLE (710.0). Of 552,733 insured people, 665 SLE patients were seen by rheumatologists, and 92 were followed by primary care physicians. Demographic features, selected co-morbidities, healthcare utilization parameters, and prescription patterns were examined. Fisher exact test, chi2 test, and analysis of variances were used to evaluate differences between the study groups. SLE patients followed by rheumatologists had osteopenia/osteoporosis diagnosed more frequently than did patients followed by primary care physicians. The frequency of high blood pressure, diabetes mellitus, hypercholesterolemia, coronary artery disease, and renal disease was similar for both groups. Rheumatologists were more likely to order erythrocyte sedimentation rate, anti-dsDNA antibodies, and serum complements. No differences were observed for office or emergency room visits, hospitalizations, and utilization of routine laboratory tests. Rheumatologists prescribed hydroxychloroquine more frequently than did primary care physicians. The use of nonsteroidal anti-inflammatory drugs, cyclooxygenase-2 inhibitors, glucocorticoids, azathioprine, cyclophosphamide, and methotrexate was similar for both groups. Overall, the utilization of health services and prescription patterns among SLE patients followed by primary care physicians and rheumatologists in Puerto Rico are similar. However, rheumatologists ordered SLE biomarkers of disease activity and prescribed hydroxychloroquine more frequently than did primary care physicians.

  5. Impact of physician specialty on quality care for patients hospitalized with decompensated cirrhosis.

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    Nicholas Lim

    Full Text Available Decompensated cirrhosis is a common precipitant for hospitalization, and there is limited information concerning factors that influence the delivery of quality care in cirrhotic inpatients. We sought to determine the relation between physician specialty and inpatient quality care for decompensated cirrhosis.We reviewed 247 hospital admissions for decompensated cirrhosis, managed by hospitalists or intensivists, between 2009 and 2013. The primary outcome was quality care delivery, defined as adherence to all evidence-based specialty society practice guidelines pertaining to each specific complication of cirrhosis. Secondary outcomes included new complications, length-of-stay, and in-hospital death.Overall, 147 admissions (59.5% received quality care. Quality care was given more commonly by intensivists, compared with hospitalists (71.7% vs. 53.1%, P = .006, and specifically for gastrointestinal bleeding (72% vs. 45.8%, P = .03 and hepatic encephalopathy (100% vs. 63%, P = .005. Involvement of gastroenterology consultation was also more common in admissions in which quality care was administered (68.7% vs. 54.0%, P = .023. Timely diagnostic paracentesis was associated with reduced new complications in admissions for refractory ascites (9.5% vs. 46.6%, P = .02, and reduced length-of-stay in admissions for spontaneous bacterial peritonitis (5 days vs. 13 days, P = .02.Adherence to quality indicators for decompensated cirrhosis is suboptimal among hospitalized patients. Although quality care adherence appears to be higher among cirrhotic patients managed by intensivists than by hospitalists, opportunities for improvement exist in both groups. Rational and cost-effective strategies should be sought to achieve this end.

  6. Developing physician consensus on the reporting of patients with mild cognitive impairment and mild dementia to transportation authorities in a region with mandatory reporting legislation. (United States)

    Rapoport, Mark J; Naglie, Gary; Herrmann, Nathan; Zucchero Sarracini, Carla; Mulsant, Benoit H; Frank, Christopher; Kiss, Alex; Seitz, Dallas; Vrkljan, Brenda; Masellis, Mario; Tang-Wai, David; Pimlott, Nicholas; Molnar, Frank


    To establish consensus among dementia experts about which patients with mild cognitive impairment (MCI) or mild dementia should be reported to transportation authorities. We conducted a literature review of predictors of driving safety in patients with dementia and combined these into 26 case scenarios. Using a modified Delphi technique, case scenarios were reviewed by 38 dementia experts (geriatric psychiatrists, geriatricians, cognitive neurologists and family physicians with expertise in elder care) who indicated whether or not they would report the patient in each scenario to regional transportation authorities and recommend a specialized on-road driving test. Scenarios were presented up to five times to achieve consensus, defined as 85% agreement, and discrepancies were discussed anonymously online. By the end of the fifth iteration, there was cumulative consensus on 18 scenarios (69%). The strongest predictors of decision to report were the combination of caregiver concern about the patient's driving and abnormal Clock Drawing Test, which accounted for 62% of the variance in decision to report at the same time as or without a road test (p driving safety is uncertain for patients with MCI and emphasizes the importance of assessing executive dysfunction and caregiver concern about driving. Copyright © 2014 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

  7. Anticipating and Training the Physician of the Future: The Importance of Caring in an Age of Artificial Intelligence. (United States)

    Johnston, S Claiborne


    Artificial intelligence and other forms of information technology are only just beginning to change the practice of medicine. The pace of change is expected to accelerate as tools improve and as demands for analyzing a rapidly growing body of knowledge and array of data increase. The medical students of today will practice in a world where information technology is sophisticated and omnipresent. In this world, the tasks of memorization and analysis will be less important to them as practicing physicians. On the other hand, the non-analytical, humanistic aspects of medicine-most importantly, the art of caring-will remain a critical function of the physician, and facility with improving systems of care will be required. Communication, empathy, shared decision making, leadership, team building, and creativity are all skills that will continue to gain importance for physicians. These skills should be further prioritized in medical school curricula to produce an even more effective physician for the future.

  8. Plastic Surgery Overseas: How Much Should a Physician Risk in the Pursuit of Higher-Quality Continuity of Care? (United States)

    Schweikart, Scott


    In this article I discuss medical tourism, whereby patients go overseas for plastic surgery treatment in order to save money. However, if malpractice occurs abroad, there are several barriers that make it difficult for patients to recover damages. I explain these legal barriers and then discuss the possible causes of action patients can have over their "domestic physician" (their personal physician who might have referred surgery abroad or who gives postoperative follow-up care) and how these causes of action can create avenues of legal recovery not otherwise available. The possible liability of the domestic physician in the context of surgical malpractice abroad creates an ethical tension in the pursuit of higher-quality continuity of care, as the more involved the physician becomes in the process, the more likely he or she will assume liability. © 2018 American Medical Association. All Rights Reserved.

  9. Primary care physicians' reported use of pre-screening discussions for prostate cancer screening: a cross-sectional survey

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    Cooper Crystale P


    Full Text Available Abstract Background Professional medical organizations recommend individualized patient decision making about prostate cancer screening. Little is known about primary care physicians' use of pre-screening discussions to promote informed decision making for prostate cancer screening. The aim of this study is to explore physicians' use of pre-screening discussions and reasons why physicians would or would not try to persuade patients to be screened if they initially refuse testing. Methods Primary care physicians completed a self-administered survey about prostate cancer screening practices for informed decision making. Results Sixty-six physicians (75.9% completed the survey, and 63 were used in the analysis. Thirteen physicians (20.6% reported not using prescreening discussions, 45 (71.4% reported the use of prescreening discussions, and 3 (4.8% reported neither ordering the PSA test nor discussing it with patients. Sixty-nine percent of physicians who reported not having discussions indicated they were more likely to screen African American patients for prostate cancer, compared to 50% of physicians who reported the use of discussions (Chi-square(1 = 1.62, p = .20. Similarly, 91% of physicians who reported not having discussions indicated they are more likely to screen patients with a family history of prostate cancer, compared to 46% of those who reported the use of discussion (Chi-square(1 = 13.27, p Conclusion Although guidelines recommend discussing the risks and benefits of prostate cancer screening, physicians report varying practice styles. Future research needs to consider the nature of discussions and the degree to which informed decision making is being achieved in clinical practice.

  10. Nurse-physician communication in the long-term care setting: perceived barriers and impact on patient safety. (United States)

    Tjia, Jennifer; Mazor, Kathleen M; Field, Terry; Meterko, Vanessa; Spenard, Ann; Gurwitz, Jerry H


    Clear and complete communication between health care providers is a prerequisite for safe patient management and is a major priority of the Joint Commission's 2008 National Patient Safety Goals. The goal of this study was to describe nurses' perceptions of nurse-physician communication in the long-term care (LTC) setting. Mixed-method study including a self-administered questionnaire and qualitative semistructured telephone interviews of licensed nurses from 26 LTC facilities in Connecticut. The questionnaire measured perceived openness to communication, mutual understanding, language comprehension, frustration, professional respect, nurse preparedness, time burden, and logistical barriers. Qualitative interviews focused on identifying barriers to effective nurse-physician communication that may not have previously been considered and eliciting nurses' recommendations for overcoming those barriers. Three hundred seventy-five nurses completed the questionnaire, and 21 nurses completed qualitative interviews. Nurses identified several barriers to effective nurse-physician communication: lack of physician openness to communication, logistic challenges, lack of professionalism, and language barriers. Feeling hurried by the physician was the most frequent barrier (28%), followed by finding a quiet place to call (25%), and difficulty reaching the physician (21%). In qualitative interviews, there was consensus that nurses needed to be brief and prepared with relevant clinical information when communicating with physicians and that physicians needed to be more open to listening. A combination of nurse and physician behaviors contributes to ineffective communication in the LTC setting. These findings have important implications for patient safety and support the development of structured communication interventions to improve quality of nurse-physician communication.

  11. [Familial characteristics and self-perceived health among female and male primary care physicians in Andalusia (Spain)]. (United States)

    Delgado, Ana; Saletti-Cuesta, Lorena; López-Fernández, Luis Andrés; Toro-Cárdenas, Silvia


    To determine the relationships between a group of professional and family characteristics and the components of physical and mental health in female and male primary care physicians working in health centers in Andalusia (Spain). A descriptive, cross-sectional, multicenter study was performed. The population consisted of urban health centers in Andalusia and their physicians. The sample comprised 88 health centers and 500 physicians. Measurements consisted of sex, age, professional characteristics (postgraduate training in family medicine, position of health center manager, accreditation as a residents' tutor, and workload based on patient quota and the mean number of patients/day); family responsibilities, defined by two dimensions of the family-work relationship (support overload-family support deficit and family-work conflict); and perceived physical and mental health. The data source was a self-administered questionnaire sent by surface mail. Multiple regression analyses were performed for physical and mental health for the whole sample and by gender. Responses were obtained from 368 physicians (73.6%). Mental health was worse in female physicians than in male physicians; no differences were found between genders in physical health. The family-work conflict was associated with physical and mental health in physicians of both genders. Physical health deteriorated with increasing age in both genders, improved in the female tutors of residents, and decreased with increasing family-work conflict in male physicians. Mental health decreased with increasing housework on the weekends and with family-work conflict in both genders. In male physicians, mental health deteriorated with postgraduate training in family medicine and improved if they were health center managers. Workload and professional characteristics have little relationship with the health of primary care physicians. Family characteristics play a greater role. Copyright © 2012 SESPAS. Published by Elsevier

  12. Challenges faced by palliative care physicians when caring for doctors with advanced cancer

    NARCIS (Netherlands)

    Noble, S. I. R.; Nelson, A.; Finlay, I. G.


    Background: It is possible that patients with advanced cancer, who are from the medical profession, have different or additional care needs than other patients. Previous training, professional experiences and access to information and services may influence their needs and subsequent illness

  13. Exploring education and training needs in palliative care among family physicians in Mumbai: A qualitative study

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    Anuja Damani


    Full Text Available Context: Patients with chronic life-limiting conditions on palliative care (PC prefer to be treated at home. Medical care by family physicians (FPs reduces demand on costly and busy hospital facilities. Working of PC team in collaboration with FPs is thus helpful in home-based management of patients.Aims: This study aimed at exploring the extent of knowledge of FPs about PC and the need for additional training. Settings and Design: Semi-structured interviews were conducted with ten FPs from two suburbs of Mumbai, currently served by home care services of a tertiary cancer care center. Subjects and Methods: Data were digitally recorded, transcribed, and analyzed using exploratory analysis followed by content analysis to develop thematic codes.Results and Conclusions: FPs perceive PC as symptom control and psychological support helpful in managing patients with advanced life-limiting illnesses. Further training would help them in PC provision. Such training programs should preferably focus on symptom management and communication skills. There is a need for further research in designing a training module for FPs to get better understanding of the principles of PC.

  14. Exploring Education and Training Needs in Palliative Care among Family Physicians in Mumbai: A Qualitative Study. (United States)

    Damani, Anuja; Ghoshal, Arunangshu; Dighe, Manjiri; Dhiliwal, Sunil; Muckaden, Maryann


    Patients with chronic life-limiting conditions on palliative care (PC) prefer to be treated at home. Medical care by family physicians (FPs) reduces demand on costly and busy hospital facilities. Working of PC team in collaboration with FPs is thus helpful in home-based management of patients. This study aimed at exploring the extent of knowledge of FPs about PC and the need for additional training. Semi-structured interviews were conducted with ten FPs from two suburbs of Mumbai, currently served by home care services of a tertiary cancer care center. Data were digitally recorded, transcribed, and analyzed using exploratory analysis followed by content analysis to develop thematic codes. FPs perceive PC as symptom control and psychological support helpful in managing patients with advanced life-limiting illnesses. Further training would help them in PC provision. Such training programs should preferably focus on symptom management and communication skills. There is a need for further research in designing a training module for FPs to get better understanding of the principles of PC.

  15. Assessing predictors of intention to prescribe sick leave among primary care physicians using the theory of planned behaviour. (United States)

    Swarna Nantha, Yogarabindranath; Wee, Lei Hum; Chan, Caryn Mei-Hsien


    Providing sickness certification is a decision that primary care physicians make on a daily basis. The majority of sickness certification studies in the literature involve a general assessment of physician or patient behaviour without the use of a robust psychological framework to guide research accuracy. To address this deficiency, this study utilized the Theory of Planned Behaviour (TPB) to specifically gauge the intention and other salient predictors related to sickness certification prescribing behaviour amongst primary care physicians. A cross-sectional study was conducted among N = 271 primary care physicians from 86 primary care practices throughout two states in Malaysia. Questionnaires used were specifically developed based on the TPB, consisting of both direct and indirect measures related to the provision of sickness leave. Questionnaire validity was established through factor analysis and the determination of internal consistency between theoretically related constructs. The temporal stability of the indirect measures was determined via the test-retest correlation analysis. Structural equation modelling was conducted to determine the strength of predictors related to intentions. The mean scores for intention to provide patients with sickness was low. The Cronbach α value for the direct measures was good: overall physician intent to provide sick leave (0.77), physician attitude towards prescribing sick leave for patients (0.77) and physician attitude in trusting the intention of patients seeking sick leave (0.83). The temporal stability of the indirect measures of the questionnaire was satisfactory with significant correlation between constructs separated by an interval of two weeks (p sick leave to patients. An integrated behavioural model utilizing the TPB could help fully explain the complex act of providing sickness leave to patients. Findings from this study could assist relevant agencies to facilitate the creation of policies that may help

  16. The role of the primary care physician in helping adolescent and adult patients improve asthma control. (United States)

    Yawn, Barbara P


    Many adolescents and adults with asthma continue to have poorly controlled disease, often attributable to poor adherence to asthma therapy. Failure to adhere to recommended treatment may result from a desire to avoid regular reliance on medications, inappropriate high tolerance of asthma symptoms, failure to perceive the chronic nature of asthma, and poor inhaler technique. Primary care physicians need to find opportunities and methods to address these and other issues related to poor asthma control. Few adolescents or adults with asthma currently have asthma "checkup" visits, usually seeking medical care only with an exacerbation. Therefore, nonrespiratory-related office visits represent an important opportunity to assess baseline asthma control and the factors that most commonly lead to poor control. Tools such as the Asthma Control Test, the Asthma Therapy Assessment Questionnaire, the Asthma Control Questionnaire, and the Asthma APGAR provide standardized, patient-friendly ways to capture necessary asthma information. For uncontrolled asthma, physicians can refer to the stepwise approach in the 2007 National Asthma Education and Prevention Program guidelines to adjust medication use, but they must consider step-up decisions in the context of quality of the patient's inhaler technique, adherence, and ability to recognize and avoid or eliminate triggers. For this review, a literature search of PubMed from 2000 through August 31, 2010, was performed using the following terms (or a combination of these terms): asthma, asthma control, primary care, NAEPP guidelines, assessment, uncontrolled asthma, burden, impact, assessment tools, triggers, pharmacotherapy, safety. Studies were limited to human studies published in English. Articles were also identified by a manual search of bibliographies from retrieved articles and from article archives of the author.

  17. Does legal physician-assisted dying impede development of palliative care? The Belgian and Benelux experience. (United States)

    Chambaere, Kenneth; Bernheim, Jan L


    In 2002, physician-assisted dying was legally regulated in the Netherlands and Belgium, followed in 2009 by Luxembourg. An internationally frequently expressed concern is that such legislation could stunt the development of palliative care (PC) and erode its culture. To study this, we describe changes in PC development 2005-2012 in the permissive Benelux countries and compare them with non-permissive countries. Focusing on the seven European countries with the highest development of PC, which include the three euthanasia-permissive and four non-permissive countries, we compared the structural service indicators for 2005 and 2012 from successive editions of the European Atlas of Palliative Care. As an indicator for output delivery of services to patients, we collected the amounts of governmental funding of PC 2002-2011 in Belgium, the only country where we could find these data. The rate of increase in the number of structural PC provisions among the compared countries was the highest in the Netherlands and Luxembourg, while Belgium stayed on a par with the UK, the benchmark country. Belgian government expenditure for PC doubled between 2002 and 2011. Basic PC expanded much more than endowment-restricted specialised PC. The hypothesis that legal regulation of physician-assisted dying slows development of PC is not supported by the Benelux experience. On the contrary, regulation appears to have promoted the expansion of PC. Continued monitoring of both permissive and non-permissive countries, preferably also including indicators of quantity and quality of delivered care, is needed to evaluate longer-term effects. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  18. Female genital cutting: an evidence-based approach to clinical management for the primary care physician. (United States)

    Hearst, Adelaide A; Molnar, Alexandra M


    The United States has more than 1.5 million immigrants from countries in Africa and the Middle East where female genital cutting (FGC) is known to occur. Often, FGC occurs in infancy and childhood in the countries where it is practiced, but patients of any age can present with complications. Lack of understanding of this common problem can potentially alienate and lower quality of care for this patient population. We provide an introduction to the practice of FGC and practice guidelines for the primary care physician. We reviewed original research, population-based studies, and legal research from PubMed, Scopus, CINAHL plus, PsycINFO, and Legal Trac. The terms searched included female genital cutting, female genital circumcision, and female genital mutilation alone and with the term complications or health consequences; no limit on date published. Legal databases were searched using the above terms, as well as international law and immigration law. Editorials and review articles were excluded. This review discusses the different types of FGC, important cultural considerations for physicians caring for patients with FGC, the common early and late medical complications and their management, and psychosocial issues associated with FGC. Current laws pertaining to FGC are briefly reviewed, as well as implications for patients seeking asylum status in the United States because of FGC. Finally, the article presents evidence-based, culturally sensitive approaches to discussions of FGC with girls and women for whom this is an issue. Copyright © 2013 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  19. Cognitive systems at the point of care: The CREDO program. (United States)

    Fox, John


    CREDO is a framework for understanding human expertise and for designing and deploying systems that support cognitive tasks like situation and risk assessment, decision-making, therapy planning and workflow management. The framework has evolved through an extensive program of research on human decision-making and clinical practice. It draws on concepts from cognitive science, and has contributed new results to cognitive theory and understanding of human expertise and knowledge-based AI. These results are exploited in a suite of technologies for designing, implementing and deploying clinical services, early versions of which were reported by Das et al. (1997) [9] and Fox and Das (2000) [26]. A practical outcome of the CREDO program is a technology stack, a key element of which is an agent specification language (PROforma: Sutton and Fox (2003) [55]) which has proved to be a versatile tool for designing point of care applications in many clinical specialties and settings. Since software became available for implementing and deploying PROforma applications many kinds of services have been successfully built and trialed, some of which are in large-scale routine use. This retrospective describes the foundations of the CREDO model, summarizes the main theoretical, technical and clinical contributions, and discusses benefits of the cognitive approach. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

  20. Screening for cancer: advice for high-value care from the American College of Physicians. (United States)

    Wilt, Timothy J; Harris, Russell P; Qaseem, Amir


    Cancer screening is one approach to reducing cancer-related morbidity and mortality rates. Screening strategies vary in intensity. Higher-intensity strategies are not necessarily higher value. High-value strategies provide a degree of benefits that clearly justifies the harms and costs incurred; low-value screening provides limited or no benefits to justify the harms and costs. When cancer screening leads to benefits, an optimal intensity of screening maximizes value. Some aspects of screening practices, especially overuse and underuse, are low value. Screening strategies for asymptomatic, average