Number Of Primary Care Physicians Research Articles

Is a high level of primary care use associated with low under-5 mortality rate in rural China? A county-based cross-sectional study

BackgroundThere is increasing recognition of the role of primary care in improved health outcomes. This study aimed to explore the association between primary care use and under-5 mortality rate (U5MR) in rural China. MethodsIn this cross-sectional study, we used county-level data from routine reports of each county provided by the National Health Commission and Bureau of Statistics. The primary outcome was U5MR per 1000 live births, in 1965 rural counties from all 31 provinces of China in 2014. Primary care use was measured as outpatient visits per 1000 inhabitants in primary health institutions, and we used the level of primary health institution use as a proxy for the level of primary care use. Multilevel regression analysis with a random intercept model was conducted to estimate the association between the level of primary care use and U5MR, adjusting for the number of primary care physicians per 1000 people, demographics and socioeconomic determinants of health. FindingsThe results indicate that an increase of one primary care physician per 1000 people was associated with 2·7 fewer under-5 deaths per 1000 children (p=0·0001) after controlling for socioeconomic factors. Moreover, we found that a higher level of primary care use moderated this relationship, and was correlated with lower U5MR (p=0·004), whereas the number of specialist physicians per 1000 people had a statistically insignificant association with lower U5MR (p=0·125). In addition, higher GDP per capita and lower female illiteracy rate were significantly associated with lower U5MR (p=0·001 and p<0·0001, respectively). InterpretationLower U5MR is associated with higher per capita primary care use, which may indicate that primary care is more effective for the health outcome that we measured. A strong primary care system could be recognised as a critical strategy for improving population health. FundingHL was supported by the China Scholarship Council for 1 year of study at Harvard University.

A spatial analysis of geographic variation and factors associated with hospitalization for bacterial pneumonia in Korea

BackgroundThe incidence of pneumonia in Korea started to increase in the 1990’s after a period of decrease and stabilization, and the mortality and hospitalization rates for pneumonia in Korea are alarmingly high. This study was performed to examine geographic variation and factors associated with hospitalization for bacterial pneumonia in Korea.MethodsData were acquired from the inpatient claims of the 2015 period of the National Health Insurance Service. The age- and sex-standardized hospitalization rates for bacterial pneumonia were calculated for three age groups. Geographic variation was measured with the coefficient of variation, the ratio of the 90th to the 10th percentile of the distribution of rates, and the systematic component of variation. Considering the results of Moran’s I statistic which suggested spatial autocorrelation, we estimated spatial regression models using spatial error models.ResultsThe hospitalization rate for bacterial pneumonia was 79.1 per 10,000 population, and the rate was the highest in the age group 0–14 at 325.3, and it was 161.5 among the elderly. The geographic variation statistics showed high variation with the coefficient variation at 0.6. The deprivation score showed positive associations, and the number of primary care physicians had a negative association with the hospitalization rates across all age groups but the age group 0–14. The number of beds in hospitals with less than 300 beds had a positive association with the hospitalization rates for bacterial pneumonia, and the impact was the strongest in the age group 0–14.ConclusionsThe present study shows that pneumonia can be a major public health issue even in a developed country. Socioeconomic conditions can still be a concern for pneumonia in developed countries, and the role of primary care physicians in preventing hospitalization for bacterial pneumonia needs to be recognized. Most of all, the strong impact of hospital beds on the hospitalization rates for pneumonia, especially for the children, should be addressed. High disease burden of pneumonia in Korea can partly be attributable to oversupply of hospital beds. These factors should be taken into consideration in establishing policy measures for the rise in pneumonia.

Abstract WMP57: Geographic Disparities in Stroke and Life Expectancy Significantly Attributable to Ambient PM2.5 Pollution Across the Counties of the United States

Background: We aimed to test the hypotheses that ambient particulate matter (PM2.5) is significantly associated with the risk of stroke mortality and life expectancy (LE) reduction, and the degrees of these associations differ across the counties and regions of the United States (U.S). Methods: Annual average county-level data (n=1561 counties) from U.S. Centers for Disease Control and Prevention, and Environmental Protection Agency on PM2.5 measures in 2005-2010, age-adjusted stroke mortality in adults aged ≥35 in 2013-2015, and LE in 2010, as well as % of poverty rate, number of primary care physicians per 1000 residents (as a marker of healthcare support) and county-level % of rural population as covariates were analyzed using linear and multilevel hierarchical regression analyses. Results: Significant county-level variations in annual average PM2.5 levels (range: 7.2-14.7 ug/ 3 ), stroke mortality (30.1-219.0 per 100,000 population in males, and 35.0-249.0 in females), and LE (65.0-81.7 years in males and 72.7-85.0 in females) were observed across the nation. Population-weighted PM2.5 levels were significantly and positively associated with stroke mortality in males (r=0.49, p&lt;.0001), and in females (r=0.42, p&lt;.0001), and negatively associated with LE in males (r=-0.39, p&lt;.0001) and females (r=-0.37, p&lt;.0001). Adjusted multilevel analysis indicates that PM2.5 was significantly associated with stroke mortality rates (β=1.27, p&lt;.0001) in both sexes, and with LE in males (β=-0.18, p=&lt;.001), and in females (β=-0.09, p&lt;.001). The adverse impacts of PM2.5 were even worse in counties with higher % of poverty rates and poorer healthcare support compared to their counterparts. Analyses by regions indicate that the highest risk of PM2.5 for stroke (assessed by regression coefficients) was shown for males and females living in the South, followed by Midwest, Northeast, and West. Similar results of the risk of PM2.5 for LE reduction were observed across the regions. Conclusion: The study, using U.S. national representative datasets provides new and important evidence that geographic disparities in stroke mortality and LE are significantly attributable to ambient PM2.5 pollution across the nation.

Practice nurse support and task suitability in a general practice: a cross-sectional survey in Belgium

ABSTRACTSingle-handed general practices and group practices are the two predominant modes of primary care provision across European countries. In Belgium, single-handed practices have been the main form of primary care provision for years, but recently a trend is emerging towards introducing more group practices where a number of primary care physicians collaborate with other health professionals such as primary care nurses. The aim of this study was to measure the current support in general practices, and to gain insight in the general practitioner attitudes towards being supported by a practice nurse. A cross-sectional study was conducted among general practitioners who were currently working in a general practice in Flanders (Belgium). 271 general practitioners filled out an online questionnaire. 30% declared to be supported by a practice nurse. The majority (>80%) of general practitioners showed positive attitudes towards collaboration with practice nurses, however the job profile and ethical framework of practice nurses remain insufficiently clear. Nurses are found most suitable to take on tasks concerning patient education and technical nursing skills. Despite the lack of governmental incentives in Belgium, general practitioners have taken the initiative to employ practice nurses – possibly – based upon an experienced necessity.

Systematic Review of Standardized Patient Use in Continuing Medical Education.

The standardized patient (SP) has assumed a fundamental role in undergraduate medical education since first conceived over 50 years ago. While widely used in student training and assessment of communication and clinical examination across health disciplines, little is known how SPs enhance knowledge or skill development among professionals. We conducted a systematic review to determine the effectiveness of SPs in continuing medical education (CME) programs. Authors independently searched for studies published between 1966 and 2016, describing CME initiatives using SP encounters as practice for participants compared with those which did not. Studies assessing virtual patients or mannequins or employing SPs for assessment only were excluded. Learning outcomes were characterized according to the Kirkpatrick framework for determining the effectiveness of training programs. Four hundred eighty-eight studies were identified, but only five were eligible for analysis. Most were conducted with small numbers of primary care physicians in North America. CME topics related to opioid prescribing, breast cancer examination and cancer screening, smoking cessation, and chronic asthma management. In the two studies testing knowledge, no difference was found between intervention and control groups (Kirkpatrick level 2). Improved behaviors were demonstrated in breast cancer patient examination and interview and decreased opioid-prescribing rates among selected participants in two studies (Kirkpatrick level 3). Only one study investigated patient outcomes and found reduced rates of uncontrolled asthma in practices of physicians who were assigned to SP practice encounters in the CME training (Kirkpatrick level 4). There is little rigorous outcome study of CME programs incorporating SPs. Given the necessary human and fiscal resources associated with their use, our review highlights the need to reconsider the SP role in CME unless further purposeful evaluation to determine participant behavior change and related patient outcomes is pursued.

Transgender Dependent Adolescents in the U.S. Military Health Care System: Demographics, Treatments Sought, and Health Care Service Utilization.

Transgender and gender-diverse (TGD) youth are at greater risk for mental health and medical conditions than their cisgender peers; however, poor health outcomes and identity-based discrimination can be minimized in the context of optimal support. Approximately 1.7 million youth may be eligible for care covered by the Military Health System, which includes mental health and gender-affirming medications. The purpose of the current study is to identify sociodemographic characteristics, the psychosocial and behavioral risk profile, and health care utilization patterns of TGD dependent youth cared for in the U.S. military system to inform provider training and resource allocation. We performed a retrospective chart review by searching all medical records between July 1, 2014 and July 1, 2017 for diagnoses suggesting visits for TGD-services at a regional referral-based adolescent medicine clinic which cares for dependent children of active duty, activated selected reserve, and retired military service members between the ages of 9 and 24 years for a wide range of health care needs. Fifty-three participants were included in this study. Sixty-four percent reported a transmasculine identity, 21% a transfeminine identity, and 15% a non-binary or undecided identity. The mean age at first gender-related visit was 14.5 years (SD 3.2). The mean number of primary care physicians and specialists seen by a given individual in a military treatment facility for any visit type since the implementation of the medical record system in 2005 was 12 (SD 6.8) and 10.2 (SD 7.8), respectively. Thirty-three percent of all patients assigned as female at birth were on testosterone therapy and 23% of all patients assigned as male at birth were on estrogen therapy at their most recent clinic visit. Twelve patients were undergoing pubertal suppression with an injectable or implantable gonadotropin-releasing hormone agonist. Seventy percent reported a history of suicidal ideation, 42% self-harm, 21% at least one suicide attempt, and 33% psychiatric hospitalization. Having strongly supportive parents was significantly associated with recognizing, disclosing and seeking treatment for gender nonconformity at an earlier age (ps ≤ 0.03) and marginally associated with less likelihood of current suicidal ideation (p = 0.06) compared to those with less supportive parents. This study elucidated the sociodemographic and behavioral risk profile of a sample of TGD youth in the MHS. Military and non-military health care providers across a broad spectrum of specialties should be knowledgeable about the unique psychosocial and medical needs, requisite sensitivity, and available referral options in the care of TGD youth. Assumptions about one's gender identity, sexual orientation, gender expression, or behaviors cannot be made based on birth-assigned sex. Further research is needed to investigate the health and wellbeing of TGD military-affiliated youth over time and to determine quality transgender-related services in support of this vulnerable and underserved population.

Performance of Hospitalists and Inpatient Clinical Outcomes

Use of the hospitalist model has reduced the number of primary care physicians taking care of inpatients. Physician shortages in primary care has forced many healthcare systems to use locum physicians as part of their delivery system and physician practice plan. With value-based purchasing and new payment models, measuring quality and patient-satisfaction with the hospitalist model is important. Hospital administrators need to carefully monitor the use of locum hospitalists, especially around quality of care and clinical outcomes.

Climate Change and Public Health through the Lens of Rural, Eastern North Carolina.

BACKGROUND Recognizing that health outcomes are associated with climate threats is important and requires increased attention by health care providers and policymakers. The primary goal of this report is to provide information related to the public health threats of climate change, while identifying climate-sensitive populations primarily in rural, Eastern North Carolina.METHODS Publicly available data was used to evaluate regional (eg, Eastern, Piedmont, and Western) and county level socio-vulnerability characteristics of population groups in North Carolina, including: percent of persons living in poverty, percent of non-white persons, percent of persons under 18 years living in poverty, percent of elderly people living in poverty, percent of persons with a disability, and number of primary care physicians. One-way ANOVA was used to calculate and compare mean value estimates of population socio-vulnerability variables in Eastern North Carolina with Piedmont and Western regions.RESULTS Across all regional categories, the eastern part of the state had considerably higher averages than the state for percent of persons living in poverty (17.2%), percent of non-white persons (13.3%), percent of persons under 18 years old living in poverty (24.9%), percent of elderly people living in poverty (10.0%), and percent of persons with a disability (13.3%). Overwhelmingly, more counties in Eastern North Carolina had fewer primary care physicians (per 10,000 persons) than the state average (8.6 per 10,000 persons).CONCLUSION Eastern North Carolina has a disproportionally higher percent of population groups that are vulnerable to the threats of climate change. The need for health care providers to understand and communicate the challenges faced by rural, vulnerable population groups is of great public health importance. Communicating these health risks to policy makers is of equal importance.

Authentic general practice placements for medical students

There have been calls to increase both the quantity and quality of undergraduate General Practice (GP) placements to provide an increased number of primary care physicians for the 21st century [1,2...

HCAHPS Scores and Community Factors.

The objective was to examine associations between patient experience, as measured by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, and the sociodemographic, cultural, and access-to-care factors of the surrounding community. Using an empty model, this study found that 27% of the variation in HCAHPS scores was at the level of the county in which the hospital was located. The county factors examined explained about half of this county-level variation. Among community factors most strongly associated with increased HCAHPS scores were higher numbers of primary care physicians per capita, fewer specialists per capita, and smaller percentages of African Americans and Hispanics in the county. A number of community factors beyond the hospitalization experience may influence HCAHPS scores. As HCAHPS gains importance as a measure of quality of care and is linked to higher payments over time, it will be essential to understand the possible effects of community factors.

How confident are physicians in deprescribing for the elderly and what barriers prevent deprescribing?

Deprescribing is the process of discontinuing or reducing the dosage of medications that are no longer appropriate or aligned with goals of care, which is paramount in elderly patients with multiple comorbidities and polypharmacy. The objective of this study was to assess the perceptions of primary care physicians on deprescribing for elderly patients and potential barriers to deprescribing that physicians experience in the Local Health Authority (LHA) of Parma, Emilia-Romagna, Italy. One hundred and sixty physicians (57% of the total number of primary care physicians in Parma) attended an educational session related to deprescribing and were asked to anonymously complete a paper survey. Participants were asked to assess their level of agreement on nine questions about their perception of deprescribing and potential factors affecting the deprescribing process using a seven-point Likert-type scale. A correlation coefficient was calculated to assess the association between physicians' confidence in deprescribing and attitudes or barriers associated with deprescribing. Many physicians (72%) reported general confidence in their ability to deprescribe. Most respondents (78%) reported they were comfortable deprescribing preventive medications, yet only half (53%) were comfortable deprescribing guideline-recommended therapies. Lack of evidence on discontinuing preventive medicines and concern about withdrawal side effects were reported to impede deprescribing by more than one-third of physicians. When medications were initially prescribed by another physician, 40% of physicians reported hesitance in deprescribing them. About half of physicians (45%) did not feel comfortable deprescribing when patients/caregivers believed that continuation of the medication was needed. Lack of time and difficulty engaging patients/caregivers in the deprescribing process were cited as barriers by about one in four physicians. There was no strong correlation between physicians' confidence and attitudes or barriers associated with deprescribing. The study results show that physicians believe they are generally comfortable with deprescribing, although there are still several factors that hamper their ability to engage in the process. An improved understanding of physicians' views on deprescribing may help guide further research, and policies to help patients remain healthy while streamlining their medication regimen.

A system dynamics approach to planning and evaluating interventions for chronic disease management

Studies have been reported on the applications of systems science to chronic disease management, but few, if any, have concentrated on chronic kidney disease (CKD). We examined the impact of a system dynamics approach to the evaluation of interventions in care of patients with CKD. We developed a stock flow simulation model and a multi-objective goal programming model. After calibrating the model, eight scenarios were analysed to measure intervention effects. Physician education (PE) had the most significant impact on reducing disease progression rate (DPR) from Stage 3 to Stage 4, while care coordination had a substantial impact on decreasing DPR Stage 4 to Stage 5. The addition of either CME or primary care team building to PE led to significant reductions in DPR for patients with Stage 3 CKD. The goal programming model indicated that a growing number of primary care physicians and care managers are needed to manage CKD patients overtime. This study showed that the stock flow model is a potentially powerful tool for supporting informed decision-making for planning and implementing interventions at various phases.

Improvement in the implementation of Helicobacter pylori management guidelines among primary care physicians following a targeted educational intervention

BackgroundConsensus guidelines recommend that in regions with a high rate of clarithromycin resistance, Helicobacter pylori (H. pylori) infection be treated with 4 drugs. Compliance with this recommendation among primary care physicians (PCPs) is low. We aimed to examine whether PCP compliance with H. pylori treatment recommendations increased following a targeted educational intervention.MethodsA questionnaire assessing H. pylori treatment was sent to >2000 PCPs in June 2015 and June 2018. In the interim, 3 interventions were performed: distribution of printed materials, educational outreach visits, and education over a social media platform.ResultsA total of 635 PCPs returned questionnaires, including 314 in 2015 and 321 in 2018 (148 [46.3%] male, age 44.7±10.9 years). The number of PCPs who recommended a 4-drug treatment protocol increased from 12 (3.8%) in 2015 to 119 (37.1%) in 2018 (P<0.001). The number of PCPs who recommended bismuth- or levofloxacin-based therapy for second-line treatment increased from 95 (30.3%) in 2015 to 247 (77.1%) in 2018 (P<0.001). Independent predictors for a 4-drug treatment protocol included central clinic location (odds ratio [OR] 2.78, 95% confidence interval [CI] 1.38-5.60; P<0.003), exposure to printed educational materials (OR 1.64, 95%CI 0.99-2.72; P=0.04) and exposure to the social media platform (OR 6.60, 95%CI 3.08-14.13; P<0.001. There were no independent predictors of compliance with second-line treatment.ConclusionsPCP compliance with H. pylori guidelines remains suboptimal. Educational initiatives may be effective in increasing PCPs’ knowledge and compliance with guidelines. Direct web-based interaction between PCPs and gastroenterologists may be particularly effective.

Choosing Primary Care as a Profession: A Systematic Review

The importance of primary care as a means toward individual and community health is unchallenged. However, with the number of primary care physicians (PCPs) entering the field on the decline in the United States, a clear view of the career pipeline becomes crucial, especially with regard to the role of medical education. The literature posits a number of predictive variables as important determinants of career selection. Much of the research focused on career decisions is based upon preclinical ideation rather than occupational outcomes. We conducted a synthesis of the literature to explore factors most influential when selecting primary care as a profession. CINAHL, Web of Science, Ovid MEDLINE, and PubMed MEDLINE were explored from January 2008 to December 2017 to identify salient factors associated with a career decision to follow a primary care pathway. This review yielded 226 publications with 27 meeting our inclusion and quality criteria. Our analysis generated five overarching categories that best represent salient influences toward primary care as a career: general academic experiences, pipeline programs, student debt, characteristics of the educational institution, and student characteristics. We found that career decisions toward primary care were best supported by sound medical educational practice, remunerative expectations, and individual qualities such as familial background and preferred lifestyle. Our findings are congruent with earlier analyses in that academic experiences play an important role in career development toward primary care. However, our study did not capture rural experiences or demographic factors, both reported in previous studies in which preclinical students were queried. For medical educators, administrators, and students themselves, these outcomes represent largely modifiable factors when addressing the looming physician shortage.

Primary Care Teams and Pharmacist Staffing Ratios: Is There a Magic Number?

Primary care physician (PCP) shortages are predicted for 2025, and many workforce models have recommended the expanded integration of nurse practitioners and physician assistants. However, there has been little consideration of incorporating clinical pharmacists on primary care teams to address the growing number of patient visits that involve medication optimization and management. This article summarizes various estimates of pharmacist staffing ratios based on number of PCPs, patient panel size, or annual patient encounters. Finally, some steps are offered to address the practice- and policy-based implications of expanding primary care pharmacist activities at the local and state levels.

Mobility of US Rural Primary Care Physicians During 2000-2014.

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 these key factors to more effectively target retention policies and to take into account the additional support needed by these more vulnerable communities.

Understanding the barriers and improving care in type 2 diabetes: Brazilian perspective in time to do more in diabetes

BackgroundType 2 diabetes mellitus (T2DM) is a complex disease, particularly in a continental country like Brazil. We attempted to understand and evaluate the perceptions and routines of Brazilians with T2DM and physicians, compared with other countries.MethodsWe compared the results from a 20-min online survey in Brazil with simultaneously collated data from India, Japan, Spain, UK and USA.ResultsIn total, 652 adults with T2DM and 337 treating physicians were enrolled, of whom 100 patients and 55 physicians were from Brazil. The numbers of primary care physicians from the five countries were 221 versus 43 in Brazil, diabetes specialists were 61 versus 12. There was disconnect between the opinions of physicians and people with diabetes globally. Further, there were differences between clinical practices in Brazil versus the rest of the world, in many areas Brazilians were performing better.ConclusionsCommunication between patients and physicians should be clearer. There is an urgent need to identify the deficits in education, in order to address the clinical inertia within the diabetes management team. There is a necessity to understand the specific requirements of the Brazilian population in order to contextualise international guidelines and implement local changes in practice.

Territorial variation in mortality from causes amenable to medical care in Poland.

This study examines the geographical variation of amenable mortality in Poland, focusing primarily on the role of health care resources at the level of administrative districts and regions, and selected area socioeconomic characteristics as explanatory factors. The concept was used of amenable mortality, based on the assumption that deaths from certain causes should not occur in the presence of timely and effective health care. Standardized death rates (SDR) from causes considered amenable to health care and, separately, for ischaemic heart disease (IHD), were calculated for each of 379 districts (NUTS 4 level) in Poland in 1991-1995 and 2006-2010, using unit mortality data from the National Causes of Death Register. The analytical procedure involved spatial analysis of the distribution of amenable mortality rates, selection of explanatory variables and fitting multilevel regression models using area-level and regional-level characteristics. The results indicate that mortality from conditions which have become amenable to medical intervention has generally decreased in all districts of Poland in the past two decades. Considerable territorial variation in mortality can be observed. Since the 1990s, these differences have been reduced for IHD-related mortality and have increased for amenable mortality. The presented analysis only partly confirms the correlation between variables reflecting the infrastructure of health care resources and the territorial variation in mortality from these two categories of causes of death. Significant correlations with variation in mortality are revealed for the number of primary care physicians (at district level) and the number of specialist practitioners (at regional level). However, after controlling for socioeconomic variables, such as education and low income, the effect of the health care infrastructure-related variables was considerably reduced. The multi-level models also revealed a substantial variation at the regional level, which implies that there are other unobserved contextual influences on amenable mortality at this level.

Expanded roles of registered nurses in primary care delivery of the future

BackgroundPrimary care in the United States is changing: practice size is increasing, there is a growing shortage of primary care practitioners, and there is a heightened prevalence of chronic disease. Given these trends, it is likely that registered nurses will become important members of the primary care team. PurposeThis paper explores the challenges and opportunities in primary care delivery in the 21st century and examines the likelihood of expanded roles for RNs to improve quality and add capacity to the primary care workforce. MethodsWe searched the peer-reviewed and gray literature for publications on primary care, primary care workforce projections, the future of nursing, and team-based care. DiscussionThe number of primary care physicians is expected to decrease in relation to the US population while the number of nurse practitioners is increasing, with the result that more and more patients will see nurse practitioners as their primary care practitioner. However, the primary care practitioner (physicians, nurse practitioners and physician assistants) to population ratio is dropping. As a result, other professionals will be needed to deliver primary care. As the nation’s largest health profession, registered nurses (RNs) are in sufficient supply and have been shown to improve the care of patients with chronic conditions. It is likely that primary care practices of the future will include an enhanced role for RNs, particularly in chronic disease management. ConclusionFor RNs to assume an expanded role in primary care, several barriers need to be overcome: (1) the widespread introduction of payment reform that reimburses RNs to independently provide care for patients, and (2) nursing education reform that includes primary care nursing skills (3) scope of practice clarification for non-advance practice RNs working under standardized procedures.

The Effect of Volunteering at a Student-Run Free Healthcare Clinic on Medical Students' Self-Efficacy, Comfortableness, Attitude, and Interest in Working with the Underserved Population and Interest in Primary Care.

IntroductionThe number of primary care physicians in the United States continues to lag behind the number of uninsured people. There has been a growing demand for medical students to improve their self-efficacy, comfortableness, attitude, and interest in working with the underserved and in primary care. This study aims to discern whether volunteering at a student-run, free healthcare clinic has a positive impact on these five variables of interest or not.MethodsA 95-item survey was distributed through Qualtrics Survey Software (Qualtrics, Provo, UT, USA) to medical students from the Class of 2018 and Class of 2019 at the University of Central Florida College of Medicine. They were recruited via emails, Facebook, and in-classroom announcements. Mean responses on a Likert-like scale to different survey items were collected and compared between two study cohorts: Keeping Neighbors In Good Health Through Service (KNIGHTS) Clinic volunteers and non-volunteers.ResultsResults from 128 students showed no significant differences in the means between the two cohorts (p-values were not significant). When volunteers were asked the survey item, “KNIGHTS Clinic positively influenced my attitude towards working with underserved patients,” 62% strongly agreed, 26% agreed, 10% were neutral, and 2% disagreed.DiscussionBased on the results, volunteering at KNIGHTS Clinic may not have a positive impact on the five variables of interest. However, the lack of significance may also be due to certain limitations of this study addressed elsewhere in this paper. With the majority of KNIGHTS Clinic volunteers agreeing that “KNIGHTS Clinic positively influenced […their] attitude towards working with underserved patients,” there may be a positive impact of volunteering on volunteers’ attitude towards working with the underserved.