Office-based Primary Care Physicians Research Articles

Lung Cancer Screening Knowledge and Perceived Barriers Among Physicians in the United States

IntroductionLung cancer remains the leading cause of cancer death in the United States and has historically been detected late in its course. Low-dose computed tomography scan (LDCT) reduces lung cancer mortality by 20% and is currently recommended by clinical practice guidelines. However, compared with other cancer screening modalities, LDCT utilization remains low. This study surveyed office-based primary care physicians across the United States to better understand LDCT utilization. MethodsA total of 1500 family and internal medicine physicians selected from the American Medical Association’s physician master file were surveyed between April and July 2019 regarding LDCT practices, eligibility, clinical scenarios, and perceived barriers. ResultsThe American Association for Public Opinion Research response rate 3 was 59% (652 respondents); 599 completed supplemental questions regarding lung cancer screening. A total of 88% of respondents discussed LDCT in the previous year, and 78% had ordered at least one LDCT. Most (59%) knew the tobacco exposure criteria for LDCT and correctly identified appropriate clinical scenarios (49%–86% responded correctly). Less than half of respondents correctly identified the age eligibility criteria (44%–45% responded correctly). In general, male physicians, those who graduated after 1990, and family medicine physicians were more likely to report accurate knowledge regarding LDCT eligibility. The top perceived barriers to LDCT were cost to the patient (48% identified as a major barrier), insurance not covering screening (46% major), and patients being unaware of lung cancer screening (40% major). ConclusionKnowledge and practices about lung cancer screening are improving, though remain suboptimal. The most common barriers remain cost or insurance-based and suggest the need for a systems-based response to increase awareness and reduce the underutilization of LDCT.

QuickStats: Distribution* of Hours per Day That Office-Based Primary Care and Specialist Care Physicians Spent Outside Normal Office Hours Documenting Clinical Care in Their Medical Record System† - United States, 2019.

QuickStats: Distribution* of Hours per Day That Office-Based Primary Care and Specialist Care Physicians Spent Outside Normal Office Hours Documenting Clinical Care in Their Medical Record System† - United States, 2019.

Alcohol Screening and Brief Intervention: Office-Based Primary Care Physicians, U.S., 2015–2016

In 2013, the U.S. Preventive Services Task Force again recommended alcohol misuse screening and provision of brief behavioral counseling interventions to those engaged in risky drinking for all adults aged ≥18 years in primary care. This report presents national estimates of the provision of alcohol screening and brief intervention by U.S. primary care physicians, the screening methods, and the resources they identified as helpful in implementing alcohol/substance screening and intervention in primary care settings. Data included 876 self-identified primary care physicians from the Physician Induction Interview portion of the 2015-2016 National Ambulatory Medical Care Survey, an annual nationally representative sample survey of nonfederal, office-based physicians in the U.S., encompassing all the 50 states and the District of Columbia. Descriptive estimates (annualized percentages) of alcohol misuse screening were generated for selected primary care physician characteristics. Estimates of how primary care physicians reported screening, the frequency of brief intervention, and resources identified as helpful in the implementation of screening/intervention procedures were also generated. Two-tailed significance tests were used to determine the differences between the compared groups. Data analyses were conducted in 2019-2021. In total, 71.7% of office-based primary care physicians reported screening patients for alcohol misuse. Statistically significant differences in screening were observed geographically and by provider specialty. Less than 40% of primary care physicians who screened patients for alcohol misuse reported always intervening with patients who screened positive for risky alcohol use. Collection of data on resources that primary care physicians report as being helpful for alcohol/substance screening and intervention implementation may be useful in continuous improvement efforts.

Characteristics of Primary Care Physicians Associated With High Outpatient Antibiotic Prescribing Volume.

Our objective was to identify characteristics associated with high-volume antibiotic prescribing among office-based primary care physicians to target antibiotic stewardship efforts. Physicians aged 40 years and older who were male, located in the South, and in solo or 2-physician practices prescribed higher volumes of antibiotics than their peers by specialty.

QuickStats: Percentage* of Office-Based Primary Care Physicians Accepting New Patients, by Source of Payment Accepted — National Electronic Health Records Survey, 2015

<i>QuickStats</i>: Percentage* of Office-Based Primary Care Physicians Accepting New Patients, by Source of Payment Accepted — National Electronic Health Records Survey, 2015

Physician assessments of drug seeking behavior: A mixed methods study.

BackgroundPain complaints are common, but clinicians are increasingly concerned about overuse of opioid pain medications. This may lead patients with actual pain to be stigmatized as “drug-seeking,” or attempting to obtain medications they do not require medically. We assessed whether patient requests for specific opioid pain medication would lead physicians to classify them as drug-seeking and change management decisions.Methods and findingsMixed-methods analysis of interviews with 192 office-based primary care physicians after viewing video vignettes depicting patients presenting with back pain. For each presentation physicians were randomly assigned to see either an active request for a specific medication or a more general request for help with pain. The main outcome was assignment by the physician of “drug-seeking” as a potential diagnosis among patients presenting with back pain. Additional outcomes included other actions the physician would take and whether the physician would prescribe the medication requested.A potential diagnosis of drug-seeking behavior was included by 21% of physicians seeing a specific request for oxycodone vs. 3% for a general request for help with back pain(p<0.001). In multivariable models an active request was most strongly associated with a physician-assigned diagnosis of drug-seeking behavior(OR 8.10; 95% CI 2.11–31.15;p = 0.002); other major patient and physician characteristics, including gender and race, did not have strong associations with drug-seeking diagnosis. Physicians described short courses of opioid medications as a strategy for managing patients with pain while avoiding opioid overuse.ConclusionsWhen patients make a specific request for opioid pain medication, physicians are far more likely to suspect that they are drug-seeking. Physician suspicion of drug-seeking behavior did not vary by patient characteristics, including gender and race. The strategies used to assess patients further varied widely. These findings indicate a need for the development of better clinical tools to support the evaluation and management of patients presenting with pain.

Perspectives of Health-Care Providers Toward Advance Care Planning in Patients With Advanced Cancer and Congestive Heart Failure.

Advance care planning (ACP) discussions afford patients and physicians a chance to better understand patients' values and wishes regarding end-of-life care; however, these conversations typically take place late in the course of a disease. The goal of this study was to clarify attitudes of oncologists, cardiologists, and primary care physicians (PCPs) toward ACP and to identify persistent barriers to timely ACP discussion following a quality improvement initiative at our health system geared at improvement in ACP implementation. A 20-question, cross-sectional online survey was created and distributed to cardiologists, oncologists, PCPs, and cardiology and oncology support staff at the NorthShore University HealthSystem (NorthShore) from February to March 2015. A total of 117 individuals (46% of distributed) completed the surveys. The results were compiled using an online survey analysis tool (SurveyMonkey, Inc., Palo Alto, California, USA). Only 15% of cardiologists felt it was their responsibility to conduct ACP discussions with their patients having congestive heart failure (CHF). In contrast, 68% of oncologists accepted this discussion as their responsibility in patients with terminal cancer ( P < .01). These views were mirrored by PCPs, as 68% of PCPs felt personally responsible for ACP discussion with patients having CHF, while only 34% felt the same about patients with cancer. Reported documentation of these discussions in the electronic health record was inconsistent between specialties. Among all surveyed specialties, lack of time was the major barrier limiting ACP discussion. Perceived patient discomfort and discomfort of the patient's family toward these discussions were also significant reported barriers. Attitudes toward ACP implementation vary considerably by medical specialty and medical condition, with oncologists in this study tending to feel more personal responsibility for these discussions with patients having cancer than cardiologists with their patients having heart failure. Robust implementation of ACP across the spectrum of medical diagnoses is likely to require a true collaboration between office-based PCPs and specialists in both the inpatient and the ambulatory settings.

Variability of physician perspectives toward advance care planning for patients with incurable cancer and congestive heart failure.

12 Background: Advance Care Planning (ACP) discussions afford patients and physicians a chance to better understand patients’ values and wishes regarding end-of-life care; however these conversations typically take place late in the course of a disease, or not at all. The goal of this study was to understand attitudes of oncologists, cardiologists, and primary care physicians (PCPs) towards ACP. We also aimed to identify persistent barriers to timely ACP discussion following a quality improvement initiative at our health system aimed at improving ACP completion rate. Methods: A 23-question cross-sectional online survey was created and distributed to cardiologists, oncologists, primary care physicians and cardiology and oncology support staff at the NorthShore University Health System (NorthShore) from February-March 2015. A total of 117 individuals (46% of distributed) completed the surveys. The results were compiled using an online survey analysis tool. Results: Only 15% of cardiologists felt it was their responsibility to conduct ACP with their congestive heart failure (CHF) patients. In contrast, 68% of oncologists accepted responsibility for ACP in incurable cancer patients. Sixty-eight percent of PCPs felt personally responsible for conducting ACP discussions with CHF patients, while only 34% felt the same about cancer patients. Documentation of ACP in the electronic health record (EHR) was inconsistent among specialties. Among all surveyed specialties, lack of time was the major barrier limiting ACP discussion. Perceived patient discomfort and discomfort of the patient’s family towards these discussions were also significant reported barriers. Conclusions: Attitudes toward ACP implementation vary considerably by medical specialty and medical condition, with oncologists in this study feeling more personal responsibility for carrying out these discussions with cancer patients than cardiologists with their heart failure patients. Robust implementation of ACP across the spectrum of medical illnesses is likely to require a true collaboration between office-based PCPs and specialists in both the inpatient and ambulatory settings.

Quick Stats: Percentage* of Office-Based Primary Care Physicians Not Accepting New Patients, by Source of Payment — United States, 2013

Quick Stats: Percentage* of Office-Based Primary Care Physicians Not Accepting New Patients, by Source of Payment — United States, 2013

Efficacy of a CO2-releasing suppository in dyschezia: a double-blind, randomized, placebo-controlled clinical trial.

Constipation has a significant impact on quality of life. Aim of this study was to evaluate the safety and the efficacy for relieving dyschezia symptoms of a CO2-releasing suppository in a randomized, placebo-controlled, clinical trial. Fifty-three office-based primary care physicians and 24 gastroenterologists conducted the study in France, between November 2010 and January 2012. Patients (aged 18-75 years) with dyschezia were eligible. Patients were randomly allocated a once-a-day suppository (CO2-releasing suppository or placebo) for 21 days. Primary endpoint was the change, from Day 0 to Day 21, in the intensity of discomfort related to dyschezia based on a self-assessed 0-100 visual analogue scale. A total of 323 patients were randomized, i.e. 166 into the intervention group and 157 into the placebo group. Co-variance analysis showed a greater reduction in discomfort visual analogue scale score in the intervention group (-34.5mm; standard error of the mean: 1.8mm) than in the placebo group (-26.2mm; standard error of the mean: 1.9 mm; p<0.001). The greater efficacy of the CO2-releasing suppository was confirmed for all secondary efficacy parameters. No significant side effects for either treatment were observed. A CO2-releasing suppository is more effective than a placebo for the relief of symptoms of dyschezia. This efficacy is associated with a good safety profile.

Trends in Office-Based Mental Health Care Provided by Psychiatrists and Primary Care Physicians

To assess recent national trends in mental health care provided by office-based psychiatrists and primary care physicians. Trends in mental health-related visits to psychiatrists and primary care physicians are evaluated with the 1995-2010 National Ambulatory Medical Care Surveys. Rates and percentages of visits with mental health complaints, mental disorder diagnoses, psychotropic medications, and psychotherapy or mental health counseling were calculated for 1995-1998, 1999-2002, 2003-2006, and 2007-2010 by dividing the number of visits of a given type by intercensal population estimates. Between 1995-1998 and 2007-2010, a significant increase occurred in the rate per 100 population of primary care visits with mental health complaints (5.96 to 8.49) (OR = 0.45; 95% CI, 0.33-0.62, mental disorders (8.75 to 13.23) (OR = 1.40; 95% CI, 1.26-1.56), and psychotropic medications (11.08 to 26.74) (OR=3.43; 95% CI, 2.16-2.71). Significant corresponding increases occurred in psychiatrist visits with psychotropic medications (5.28 to 7.85) (OR = 2.25; 95% CI, 1.49-3.41), but not mental disorders (7.60 to 8.95) (OR = 0.87; 95% CI, 0.34-2.23), and the rate with mental health complaints significantly declined (5.87 to 5.20) (OR = 0.45; 95% CI, 0.33-0.62). During this period, the percentages of visits to primary care physicians that included prescriptions for antidepressants (interaction P = .0001), antipsychotics (interaction P = .03), and anxiolytics/hypnotics (interaction P = .0009) increased significantly faster than the corresponding percentages of visits to psychiatrists. A similar pattern occurred for visits that resulted in a bipolar disorder diagnosis (interaction P = .01). In recent years, office-based primary care physicians have significantly increased their involvement in providing mental health care. These trends underscore the importance of collaboration between primary care physicians and psychiatrists to help ensure provision of high quality outpatient mental health care.

Primary Care Visit Duration and Quality

It is unclear if increasing pressure on primary care physicians to be more efficient has affected visit duration or quality of care. We sought to describe changes in the duration of adult primary care visits and in the quality of care provided during these visits and to determine whether quality of care is associated with visit duration. We conducted a retrospective analysis of visits by adults 18 years or older to a nationally representative sample of office-based primary care physicians in the United States. Between 1997 and 2005, US adult primary care visits to physicians increased from 273 million to 338 million annually, or 10% on a per capita basis. The mean visit duration increased from 18.0 to 20.8 minutes (P < .001 for trend). Visit duration increased by 3.4 minutes for general medical examinations and for the 3 most common primary diagnoses of diabetes mellitus (4.2 minutes, P = .002 for trend), essential hypertension (3.7 minutes, P < .001 for trend), and arthropathies (5.9 minutes, P < .001 for trend). Comparing the early period (1997-2001) with the late period (2002-2005), quality of care improved for 1 of 3 counseling or screening indicators and for 4 of 6 medication indicators. Providing appropriate counseling or screening generally took 2.6 to 4.2 minutes. Providing appropriate medication therapy was not associated with longer visit duration. Adult primary care visit frequency, quality, and duration increased between 1997 and 2005. Modest relationships were noted between visit duration and quality of care. Providing counseling or screening required additional physician time, but ensuring that patients were taking appropriate medications seemed to be independent of visit duration.

Racial and Ethnic Disparities in Detection and Treatment of Depression and Anxiety Among Psychiatric and Primary Health Care Visits, 1995–2005

Recent evidence questions whether formerly documented disparities in care for common mental disorders among African Americans and Hispanics still remain. Also, whether disparities exist mainly in psychiatric settings or primary health care settings is unknown. To comprehensively examine time trends in outpatient diagnosis and treatment of depression and anxiety among ethnic groups in primary care and psychiatric settings. Analyses of office-based outpatient visits from the National Ambulatory Medical Care Study from 1995-2005 (n = 96,075). Visits to office-based primary care physicians and psychiatrists in the United States. Diagnosed with depression or anxiety, received counseling or a referral for counseling, received an antidepressant prescription, and any counseling or antidepressant care. In these analyses of 10-year trends in treatment of common mental disorders, disparities in counseling/referrals for counseling, antidepressant medications, and any care vastly improved or were eliminated over time in psychiatric visits. Continued disparities in diagnoses, counseling/referrals for counseling, antidepressant medication, and any care are found in primary care visits. Disparities in care for depression and anxiety among African Americans and Hispanics remain in primary care. Quality improvement efforts are needed to address cultural and linguistic barriers to care.

Unnecessary Antibiotic Use Continues for Children with Sore Throat

Many specialty societies have striven to reduce unnecessary use of antibiotics for sore throat. These authors evaluated U.S. trends in group A β-hemolytic streptococci (GABHS) testing and antibiotic prescribing in children aged 3 to 17 years who presented with sore throat to office-based primary care physicians, hospital outpatient facilities, and emergency departments from 1995 to 2003. Data were obtained from the National Ambulatory Medical Care Survey and National …

Prescription rates and diagnostic patterns are stable: A comparison of high-, medium- and low-prescribing primary care physicians treating community-acquired respiratory tract infections

The objective was to study prescription practices of primary care physicians in prescribing antibiotics for community-acquired respiratory tract infections. Design was time series analysis and cross-sectional survey. The setting was 30 community primary health care centres. A case report form was completed for 3478 patient consultations treated by 198 office-based primary care physicians. Main outcome measures were: classification of diagnoses of respiratory tract infections made by each physician; number of antibiotic prescriptions related to these diagnoses; each physician's mean weekly number of antibiotic prescriptions during 6 months before and after the survey. Patients' risk (odds ratio: OR) to receive an antibiotic prescription from the high and medium prescribers was 5.81 (95% confidence interval [CI] 4.85-6.96) and 2.41 (95% CI 2.04-2.86), compared to low prescribers. High and medium prescribers made more diagnoses of otitis media (OR 2.07, 95% CI 1.70-2.53 and 1.85, 95% CI 1.51-2.26, respectively) and fewer diagnoses of unspecified upper respiratory tract infection (OR 0.32, 95% CI 0.26-0.38 and 0.57, 95% CI 0.48-0.68, respectively) than low prescribers. The rank of the prescription rate of high, medium and low prescriber groups remained the same for all diagnoses except pneumonia. In addition, the annual rank between high, medium and low prescriber groups remained stable; high group prescribed more antibiotics during the year than medium group, which prescribed more than low prescriber group.

Fall-risk assessment and management in clinical practice: views from healthcare providers.

To determine the extent to which healthcare providers reportedly address evidence-based fall risk factors in older patients after exposure to an educational intervention and to determine barriers reportedly encountered when these healthcare providers intervene with or refer older patients with identified fall-risk factors. Cross-sectional study using a structured interview. Geographic area of Connecticut where the Connecticut Collaboration for Fall Prevention (CCFP) has been implemented. Emergency department (ED) physicians, hospital-based discharge planners or care coordinators (nurses or social workers), home health agency nurses, and office-based primary care physicians (total n=33) after exposure to the CCFP implementation team. Self-reported practices (direct intervention or referral) and barriers when addressing seven evidence-based risk factors for falls: gait and transfer impairments, balance disturbances, multiple medications, postural hypotension, sensory and perceptive deficits, foot and footwear problems, and environmental hazards. Respondents were most likely to report directly intervening with or referring older patients for gait and transfer impairments (85%) and balance disturbances (82%) and least likely to do so when encountering foot or footwear problems (58%) and sensory or perceptive deficits (61%). ED physicians reported lowest rates of direct intervention or referral for foot or footwear problems (20%), home health agency nurses for sensory or perceptive deficits (50%), and office-based primary care physicians for foot or footwear problems (50%). Patient compliance was the most commonly reported barrier to successful direct intervention across several risk factors, whereas inadequate availability of other healthcare providers and lack of Medicare reimbursement were the most commonly reported barriers to successful patient referrals. After exposure to the CCFP implementation team, the majority of healthcare providers reported directly intervening or referring patients when addressing all risk factors, but results pinpointed specific healthcare provider groups with room for improvement in assessment and management of specific risk factors. Patient education appears to be a necessary adjunct to healthcare provider training, because patient compliance was a reported barrier to optimal intervention by healthcare providers.

Association between antibiotic prescribing and visit duration in adults with upper respiratory tract infections

Background: Upper respiratory tract infections (URTIs) are the most common reason for individuals to seek health care in the United States. Inappropriate antibiotic use exposes patients unnecessarily to potential adverse events and increases the prevalence of antibiotic-resistant bacteria. One of the reasons physicians may prescribe an antibiotic inappropriately is to save time. Objective: The aim of this study was to determine whether there is an association between antibiotic use and a shorter visit duration in adults with URTIs. Methods: Visits to office-based primary care physicians made by adults aged 18 to 60 years from 1995 through 2000 were extracted from the National Ambulatory Medical Care Survey. Visits that resulted in a primary diagnosis of acute URTI; acute nasopharyngitis; acute bronchitis; sinusitis; streptococcal sore throat, acute pharyngitis, or acute tonsillitis; or otitis media were included in the study. Visits associated with >1 diagnosis were included in a separate category Visit duration was defined as the face-to-face time between the patient and physician. Results: There were 3764 visits that met the criteria for inclusion in this study, representing an estimated 27 million annual visits to office-based primary care physicians by adults with URTIs. Antibiotics were prescribed in 67% of visits. The mean visit duration associated with prescription of an antibiotic was 14.2 minutes, compared with 15.2 minutes without prescription of an antibiotic ( P = 0.007). In multivariable modeling, independent predictors of visit duration were calendar year (additional 0.3 minute per year; 95% CI, 0.1 to 0.6), internal medicine specialty (additional 2.2 minutes vs family practice; 95% CI, 1.3 to 3.1), covisit with a nurse-practitioner or physician assistant (6.6 minutes shorter; 95% CI, −2.7 to −10.6), and Midwestern location of practice (1.1 minutes shorter vs Northeast; 95% CI, −0.1 to −2.2). Antibiotic use was marginally associated with a shorter visit duration (0.7 minute shorter; 95% CI, 0.0 to −1.3; P = NS). Conclusions: In the present study, antibiotic use was marginally associated with a shorter visit duration for adults with URTIs. Any potential efficiencies gained by physicians through prescribing antibiotics for adults with URTIs are likely to be outweighed by increases in antimicrobial resistance and exposure of patients to unneeded medication.

Prevalence and physician awareness of symptoms of urinary bladder dysfunction.

To determine awareness of bladder dysfunction and attitudes towards its management among office-based physicians. A total of 211,648 patients consulting office-based primary care physicians (PCPs), gynaecologists (OBGs) or urologists (UROs) for any reason were given a questionnaire of four questions related to symptoms of bladder dysfunction. The physicians were asked to discuss the answers with their patients and to choose from a list of suspected diagnoses. They were also asked whether medical therapy would be initiated and/or the patient referred to a specialist. Patients (57%) had a least one symptom of bladder dysfunction, with increased frequency being most common (41.9%), and symptoms of stress incontinence (30.6%), urgency (24.3%) and urge incontinence (20.2%) less frequent. However, patients with symptoms of overactive bladder (OAB), mixed incontinence or stress incontinence according to the questionnaire remained undiagnosed by their physician in 57.5, 47.5 and 38.1% of cases, respectively. When a diagnosis was suspected by the physician, it often did not match what would be expected based on the questionnaire, and in half of all cases did not result in medical treatment. Bladder dysfunction is highly prevalent among patients consulting an office-based physician for any reason, but remains undiagnosed in many cases and untreated despite diagnosis in many others. Since various effective treatment options are available for bladder dysfunction, educational programs for patients and physicians appear necessary to improve the quality of diagnosis and treatment for this wide-spread condition.

Diagnosing depression and prescribing antidepressants by primary care physicians: the impact of practice style variations.

This study examined variations in the diagnosis of depressive disorders and prescription of antidepressant medications in primary care and the contribution of the physicians' practice styles to these variations. The analyses were based on visits to a representative sample of the U.S. office-based primary care physicians from the 1997 and 1998 National Ambulatory Medical Care Survey. In this sample, the propensities to give a diagnosis of depressive disorder and to prescribe antidepressants were operationalized as propensity variables. The association of these variables, obtained from a randomly selected subsample of visits to each physician, with the diagnoses and treatments of the other patients seen by the same physicians was examined. The results revealed considerable variations across practices in the percentages of patients who received diagnoses of depressive disorders (0-25%) and prescriptions for antidepressant medications (0-38%). Furthermore, the physicians' propensities to diagnose depressive disorders or to prescribe antidepressants were significantly associated with the diagnosis and treatment of individual patients. The large variations in diagnosis and treatment of depressive disorders and the significant impact of practice style variables on these variations highlight the need for implementation of uniform practice guidelines for diagnosis and treatment of depressive disorders in primary care settings.

Work interrupted: A comparison of workplace interruptions in emergency departments and primary care offices

Study Objective: We sought to determine the number of interruptions and to characterize tasks performed in emergency departments compared with those performed in primary care offices. Methods: We conducted an observational time-motion, task-analysis study in 5 nonteaching community hospitals and 22 primary care offices in 5 central Indiana cities. Twenty-two emergency physicians and 22 office-based primary care physicians (PCPs) were observed at work. The number of interruptions, tasks, simultaneous tasks, and patients concurrently managed were recorded in 1-minute increments during 150- to 210-minute observation periods. Results: Emergency physicians were interrupted an average of 9.7 times per hour compared with 3.9 times per hour for PCPs, for an average difference of 5.8 times per hour (95% confidence interval [CI] 4.2 to 7.4). PCPs spent an average of 11.4 minutes per hour performing simultaneous tasks compared with 6.4 minutes per hour for emergency physicians (average difference, 5.0 minutes; 95% CI 1.2 to 8.8). Emergency physicians spent an average of 37.5 minutes per hour managing 3 or more patients concurrently compared with 0.9 minutes per hour for PCPs. PCPs spent significantly more time performing direct patient care, and emergency physicians spent significantly more time in analyzing data, charting, and taking reports on patients. Conclusion: Emergency physicians experienced more interruptions and managed more patients concurrently than PCPs. PCPs spent more time performing simultaneous tasks than emergency physicians. Our study suggests there are important ergonomic differences between emergency medicine and office-based primary care work environments that may require different training approaches, design considerations, and coping strategies. [Chisholm CD, Dornfeld AM, Nelson DR, Cordell WH. Work interrupted: a comparison of workplace interruptions in emergency departments and primary care offices. Ann Emerg Med. August 2001;38:146-151.]