Family Practice Group Research Articles

Are we ready for human papillomavirus testing? Assessment of patient knowledge of and preferences for cervical cancer screening in Ontario.

To determine patient knowledge and preferences about primary human papillomavirus (HPV) testing. Cross-sectional survey. Two family practice clinics (urban and suburban) and the social media platforms of 2 hospitals in the greater Toronto area between January and February 2023. A total of 413 Ontario residents aged 25 to 69 years, with a cervix, who qualified for Papanicolaou (Pap) screening and could communicate in English. Electronic survey containing questions about knowledge of, and preferences for, cervical cancer screening, including types of screening and screening intervals, and about education related to HPV and screening intervals. Of 441 potential participants, 426 were eligible and consented to participate in the study; ultimately 413 provided completed or partially completed surveys (96.9% response rate). Of those who completed a recent Pap test, 57.8% (208 of 360) knew of HPV testing. Initially, 27.8% thought HPV testing was better than Pap testing for cervical cancer screening. After learning HPV tests exist and have self-sampling options, most participants preferred HPV testing (self-sampling 46.3%, provider sampling 34.1%). Annual cervical cancer screening was preferred by 50.1% of participants despite knowing that, for most people, Pap tests should be conducted every 3 years (74.8%). After learning about HPV testing, participants were more likely to prefer 5-year screening intervals (43.8%); however, those in the family practice group were still more likely to prefer 3-year intervals compared with those in the social media group (P<.01). Participants in this study identified a preference for HPV testing and self-sampling options. Concerns were raised about extended screening intervals and the safety of self-collected samples that need to be addressed in public health education initiatives during rollout of new screening programs.

Advance Care Planning in Primary Care: A Step toward Normalizing the Conversation.

Despite the number of advance care planning (ACP) conversation guides and tools, ACP conversations are not common in healthcare. In this quality improvement project, we took a different approach and applied complex adaptive systems theory to develop an intervention that emerged from the users (family physicians) themselves - a standardized e-form with prompts. By listening to the users, we were able to integrate ACP best practices, including shifting the focus of ACP conversations from treatment decisions to patient values, in a way that met both users' and patients' needs, addressed barriers and will help normalize ACP conversations in primary care. The intervention was designed for any patient and family physician and may have utility for other family practice groups.

Clinical pharmacy and obstetrics.

Despite there being 3.79 million births in the United States in 2018,1 the pharmacy profession has historically had minimal representation in the field of obstetrics. Pharmacists’ presence is minimal in all areas of obstetric clinical pharmacy, including drug therapy management, clinical research, and teaching.2,3 While the obstetric population may be viewed as healthy young women, the reality is that women are entering into pregnancy older and with more chronic diseases than ever before.4,5 Maternal mortality has been on the rise in the United States since the implementation of the Pregnancy Mortality Surveillance System in 1987.5 The practice site described is a 448-bed, nonprofit, community hospital and is home to the largest birthing center in Wisconsin, performing nearly 5,000 deliveries in 2018. The birthing center contains 10 triage rooms, 17 labor and delivery rooms, 3 obstetrical operating rooms, 10 antepartum rooms, and 48 postpartum rooms. The hospital is partnered with a state university academic hospital to provide all birthing center services for both organizations. A variety of practice groups provide services at the birthing center, including midwifery, private practice, and family practice groups as well as university obstetrics and gynecology and maternal and fetal medicine groups. The birthing center has held the Baby-Friendly designation (Baby-Friendly USA, Inc., Albany, NY) since 2006.

Correction Notice.

Agee, M. D., & Gates, Z. (2014). The Impact of an Insurance Administration-Free Primary Care Office on Hospital Admissions: A Community-Level Comparison With Traditional Fee-for-Service Family Practice Groups. Journal of Primary Care & Community Health, 5, 202-207. doi: 10.1177/2150131914522123 The following Conflict of Interest statement was originally omitted and will be added to the article: Author Zane Gates's affiliation, UPMC Altoona, is the parent organization of Partnering for Health Services. Additionally, author Zane Gates has an ownership interest in the Empower3 Center for Health, a direct-pay primary care clinic using a subscription coverage model, that additionally provides insurance counseling and prescription programs.

The High Costs of “Free” Drug Samples

The High Costs of “Free” Drug Samples

Effectiveness of Physical Therapists Serving as Primary Care Musculoskeletal Providers as Compared to Family Practice Providers in a Deployed Combat Location: A Retrospective Medical Chart Review

A medical records review to compare efficiency and effectiveness of a physical therapist (PT) functioning as a musculoskeletal primary care provider (PCP) compared to family practice (FP) physicians functioning as musculoskeletal PCP. (1) Use of medication/imaging studies will be significantly less with a PT as PCP compared to FP as PCP. (2) Return-to-duty (RTD) rate will show significant increases when patients with musculoskeletal conditions are seen by PT as compared to FP. One PT practicing in a deployed combat location collected data on patients that presented directly to the PT clinic or FP clinic for care of musculoskeletal complaints. Treatment patterns of two Air Force physicians were accessed regarding patients with musculoskeletal conditions. Fifty-four patients were randomly selected for the PT group and 95 patients for FP group. AHLTA was searched for cases reported from June 2009 to January 2010. Data regarding age, gender, medication, imaging use, and return to duty (RTD) rate were collected. Of the study population, 126 (84%) were males, 23 (16%) were females (age range: 19-54, mean 29). RTD rate was 50% greater for PT. Rate of medication and imaging use for PT was 24% and 11%, whereas FP was 90% and 82%, respectively (p < 0.01). Using PT as the musculoskeletal PCP was shown to be an effective and efficient practice model to assess and treat patients with musculoskeletal complaints.

Exploring the Factors Associated with Specialist Referral for Patients with Type 2 Diabetes: Are We Referring Those in Greatest Need?

ObjectiveTo determine the visit and patient factors associated with specialist referral for patients with type 2 diabetes mellitus. MethodsThe sample consisted of 9443 patient-physician visits from 8 family practice groups in southwestern and central Ontario. The generalized estimating equations approach was used for fitting logistic regression models to the referral data from patients' visits. ResultsThe odds of referral decreased if a visit occurred with a female patient and if an albumin-creatinine ratio measurement was not available at the visit. A 1 year increase in the number of years with the family physician resulted in a lower odds of referral. The odds of referral increased if the patient had a specialist appointment in the previous 2 years, if lifestyle counselling occurred and if a neuropathy examination was carried out. ConclusionFurther research should assess the influence of visit level factors on decision making. Guidelines for specialist referral should also be considered.

Abstract 180: The Effectiveness of a HF Training Program among Primary Care Physicians

Background: Heart failure (HF) guidelines recommend beta-blockers (BB) to reduce morbidity and mortality. BB doses are often suboptimal, which do not provide maximum benefit for HF patients. Differences in BB management patterns may exist between family practice (FP) and internal medicine (IM) physicians due to differences in specialty interest and training. Objectives: 1) To determine the effectiveness of a one-day training intervention for primary care physicians (PCPs) designed to optimize BB titration for patients with systolic HF. 2) To compare BB titration rates of FP and IM physicians. We hypothesized the intervention would result in increased PCP BB titration rates for experimental patients, with a more significant benefit in the FP group. Methods: A prospective cohort study was conducted at a county hospital with low-income, underserved HF patients (mean age 54.1±13.1, males 70%, mean ejection fraction 28.2±9.8, mean serum creatinine 1.5±1.0) for up to 7 clinic visits. Twelve participating PCPs, including 5 FP and 7 IM physicians, received a one-day training intervention on HF management with a focus on BB titration. Medical records of control patients who received care 2 years prior to the intervention (n=54) were compared to experimental patients after the intervention (n=81). A linear mixed model examined differences in BB dose between the experimental and control groups and the FP and IM physicians. Results: No sociodemographic or clinical differences were noted between HF patients treated before or after the intervention or between IM and FP physicians (p&gt;0.05). The test of the group by time interaction showed no difference between the experimental and control groups in linear change trajectories for BB dose change (t= -0.12, p=0.91). However, FP physicians showed a significant change in BB titration rates for experimental patients (p=0.04) when compared to IM physicians. Conclusions: There was no difference in BB titration rates between the experimental and control groups following a HF training intervention for PCPs, although the clinical reasons for restricting maximal dosage were not explored. Teaching interventions targeting FP physicians may benefit HF patients in achieving higher BB doses and should be examined further.

A Readiness Analysis of the NCQA Diabetes Physician Recognition Program Standards Attainment for a Chicagoland Family Practice Group

A Readiness Analysis of the NCQA Diabetes Physician Recognition Program Standards Attainment for a Chicagoland Family Practice Group

What I Learned In Quebec

As the new medical director for the University of Medicine and Dentistry of New Jersey (UMDNJ) Physician Assistant (PA) program in Piscataway, I was not sure what to expect from attending my first PAEA Annual Education Forum. I knew I would not be lonely because I was fortunate to be able to go with nine of my PA faculty colleagues. I was also looking forward to getting to know a city with a lot of history. My major concern was how I, a physician, would “fit in” at a conference about PA education. In a sense, this theme of being “the MD” in a PA world has been something I have struggled with since I took on the role of medical director in July. Unlike most medical directors at PA programs, I was hired as a full-time medical director. I jumped at the opportunity to work with my local PA program, one that I have known very well since I was a student 30 years ago. (Yes, I am one of those doctors who trained as a PA first.) I had kept close ties with the program and my classmate Ruth Fixelle, who is now the program’s director. Two of the faculty had worked at my office for many years, and students had rotated through since the office opened in 1986. All of this made for an easier transition as health reasons forced me to leave my family practice group with two other physicians and two PAs. I eagerly awaited the medical director’s retreat on the first day of the conference. My main responsibility since I’ve been at the program has been for the first-year didactic teaching. As the meeting convened and I listened to the other physicians describe their work, I discovered that the other medical directors’ job descriptions were as diverse as the 15 attendees. What we shared was a strong commitment to the concept of MD-PA teamwork and the importance of the PA profession. We all agreed that not having a “mentor” makes the transition into teaching more difficult for physicians. We felt that there was a pressing need to reach out more to the medical directors who were not able to attend the forum. John Houchins, of the University of Utah PA Program, our worthy moderator, agreed to follow-up on the suggestion to create a new electronic forum specifically for medical directors, to foster the communication that we felt has been lacking. Gail Cohan (Stony Brook University PA Program) led a group charged to formulate a “Statement of Purpose,” which she presented at the end of the meeting: “The mission of the PAEA medical directors is to serve as a resource for medical directors and a forum for discussion of PAEA issues among the medical directors in support of the mission and goals of the PAEA.” I have been fortunate to work with some excellent PA clinicians and have helped train dozens of students rotating through my office over the past 20 years. During this time, I never had problems with my role. It came naturally. I was the “supervisor” and they were the “assistants.” Another reason we worked so well together is that I am not possessive by nature. I This feature is intended to provide a forum for the sharing of ideas on the role of medical directors in PA programs. Authors desiring to contribute to Medical Director Dialogue should forward submissions to:

Evaluating the Effects of an Applied Learning Exercise on Students' Interest in Social Policy

There is ample evidence that points out that the majority of social work students have little interest in social policy analysis. In this study, the impact a classroombased policy construction exercise had on the interest level in policy of a differentiated sample (N = 43) of MSW students, in which participants were enrolled in either a community- or family-practice program, was measured. Results of a paired samples t-test suggest that the exercise significantly increased the participants' interest in social policy, as t(42) = 2.59, p < .05. When comparing the effects of the intervention on the respective subsamples, only the family-practice group yielded significant results, as t(20) = 2.14, p < .05. The implications this study has for social work educators striving to increase students' interest in social policy, particularly among aspiring micro practitioners, are also discussed.

A case for the development of family practice rural training tracks.

Enthusiasm for alternate training sites has been strong among practicing family physicians and students seeking family practice residency positions in Wisconsin. The number of rural training tracks in the state is increasing rapidly. The University of Wisconsin currently has 4 residents in two rural training tracks. If 1998 recruitment is successful, there will be 12 residents in seven rural training tracks operated by two sponsoring institutions in the state. The WIsconsin rural training tracks are 1-2 programs,! in which the family practice resident spends the first year in the urban medical center of the home program completing appropriate rotations, such as internal medicine, pediatrics, obstetrics-gynecology, emergency medicine, surgery, and critical care, and the last 2 years in a rural community and rural hospital as an apprentice with a family practice group. During the last 2 years, the resident can receive longitudinal training in specialty areas with visiting subspecialists and can spend time away from the rural medical practice for specialty rotations not available in the rural setting. The development of the WIsconsin rural training tracks was based in part on the pioneering work of Rosenthal et al. 2 The process used to develop the first rural training track was adopted as a template for developing other rural training tracks in WIsconsin and in other states} Not much has been published, however, assessing educational outcomes and documenting the effects of rural training tracks on communities. Despite this lack of documentation, we believe rural tracks have merit as a training model for family practice and

Physicians' recommendations for mammography: do tailored messages make a difference?

Message tailoring, based on individual needs and circumstances, is commonly used to enhance face-to-face patient counseling. Only recently has individual tailoring become feasible for printed messages. This study sought to determine whether printed tailored recommendations addressing women's specific screening and risk status and perceptions about breast cancer and mammography are more effective than standardized printed recommendations. Computer-assisted telephone interviews were conducted with 435 women, aged 40 to 65 years, who had visited family practice groups within the previous 2 years. Subjects were randomly allocated to receive individually tailored or standardized mammography recommendation letters mailed from physicians to patients' homes. Follow-up interviews were conducted 8 months later. Tailored letter recipients were more likely to remember and to have read more of their letters than standardized version recipients. After controlling for baseline status, tailored letter receipt was associated with more favorable follow-up mammography status for women with incomes below $26,000 and for Black women. Tailored messages are a more effective medium for physicians' mammography recommendations; tailoring may be especially important for women of low socioeconomic status.

Rural training tracks in four family practice residencies

The use of rural training tracks (RTTs) in family practice residencies is a new strategy (beginning in the late 1980s) to increase the number of residents selecting rural careers. The authors describe the four residencies (in Washington, Nebraska, New York, and Kentucky) that have established RTTs. The first residency year is completed in an urban tertiary care center, and the second and third years are completed in a distant rural community wherein the primary faculty are the members of a rural family practice group. Inpatient experience for the residents is provided by community hospitals that offer obstetrics, emergency room care, and first-line critical care. The residents' training is supplemented by specialty faculty practicing in the rural communities. The curricula are highly structured and are evaluated to ensure training experiences of high quality. The RTTs' financial support comes from state initiatives, hospital reimbursement, recruitment budgets, and outpatient care revenues. The authors conclude that the RTT concept has the potential to lessen the shortage of rural physicians.

Self-Reported Depression Profiles in Chronic Pain and Family Practice Patients

This study examined profiles of self-reported depressive symptoms in chronic pain patients (n = 51), family practice outpatients (n = 52), and controls (n = 53) who were receiving neither psychological nor medical treatment and were pain free. Subjects in the three groups were matched for age and sex. The short form of the Multiscore Depression Inventory (SMDI) was used. Chronic pain and family practice groups had similar SMDI profiles, with significant elevations on Low Energy, Pessimism, Sad Mood, and Low Self-Esteem subscales compared with controls. Although both groups of medical patients were depressed compared with control subjects, their SMDI profiles were different from those previously reported for psychiatric inpatients with a diagnosis of depression.

An epidemiological follow-up survey of persistent pain sufferers in a group family practice and specialty pain clinic

The course and prognosis of persistent pain are largely unknown. In addition, follow-up studies of chronic pain sufferers have come from specialized pain clinics and have ignored the question of how representative this special group is to the general population who suffer persistent pain. Because health care planners are assumed to require these data for projection of health care needs, it is important to determine the course of persistent pain in those persistent pain sufferers in the general population as well as those referred to a specialty clinic. An epidemiological study compared 2 groups of self-reported persistent pain sufferers from a Family Practice Clinic and a Specialty Pain Clinic over a 2 year period. All subjects reporting a persistent problem with pain at the time of the initial survey were contacted 2 years later to determine whether the initial differences between the 2 groups remained constant over time and whether there were any changes within each group over time. Despite the similarities between the study groups on multiple socioeconomic and demographic variables, the Specialty Pain Clinic group remained distinctly different from the Family Practice pain sufferers on many pain behavior and emotional variables. Thirteen percent of the persistent pain sufferers from the Pain Clinic group and 36% of the persistent pain sufferers from the Family Practice group no longer reported pain as a problem at follow-up. Of those pain sufferers from either group who continued to experience pain at 2 years follow-up, their pain became more intermittent, psychological distress factors improved, and the use of health services decreased. The implications are that persistent pain does not necessarily continue forever and that persistent pain sufferers in the general population have a better prognosis than those who are referred to a Specialty Pain Clinic. All follow-up studies need to be interpreted in light of these findings.

An epidemiological description of physical, social and psychological problems in multiple sclerosis

Chronic disorders such as multiple sclerosis have important behavioural consquences on the lives of patients. The purpose of this study was to describe the frequency distribution of psychosocial disability among a referral clinic population of multiple sclerosis patients and to identify associated factors. A cross-sectional survey was conducted of 301 patients using four health indexes to assess quality of life. An 82% response rate was obtained. In the results are presented the frequencies of behavioural problems compared with the general population and a family practice group. While physical function was found to be closely associated with disease severity, psychosocial disability bore little relationship to the underlying disease or to sociodemographic variables including social class. Eighty percent of psychosocial disability remained unexplained. The physical aspects of multiple sclerosis were not predictive of emotional or social morbidity. The major implication of these findings is that the impact of disease on patients, as distinct from the disease itself, should be dealt with as health problems in their own right.

Provider continuity and quality of medical care. A retrospective analysis of prenatal and perinatal outcome.

It is often assumed that family physicians are able to provide a higher quality of medical care because of the greater degree of continuity inherent in their practices. The authors attempted to measure the association between continuity and quality of medical care using pregnancy as a tracer condition. Using a retrospective cohort study design, two groups of pregnant women were identified--those cared for in the family practice (FP) centers and those cared for in the obstetric (OB) clinics. Process and outcome of medical care were measured along with patient satisfaction. Provider continuity, as measured by the SECON value, was much higher in the FP group, and was highly correlated with the presence of an "attitudinal contract" between patient and physician. Although not statistically significant, four times as many newborns from the OB group were admitted to the neonatal intensive care unit. FP group newborn weight averaged 220 grams more than the OB group (P less than 0.05). This difference remained after control for covariates. While not reaching statistical significance, patient satisfaction scores tended to be higher for the FP group in two of three categories measured. The results suggest that continuity of care was associated with better patient outcome and satisfaction. Directions for causal interpretation and future research are discussed.