Primary Care Physician Perspectives Research Articles

Physician perspectives on the ethics of sex selection: a comparison of the attitudes of primary care providers and sex selection technology providers

OBJECTIVE: The use of reproductive technology for the purpose of sex selection is controversial. This pilot study contrasts the perspectives of primary care physicians (PCPs) and physician sex-selection technology providers (SSTPs) about the ethics of sex selection.

Physician Perspectives Regarding Annual Influenza Vaccination Among Children With Asthma

National guidelines have historically varied for influenza vaccination of children with asthma, depending on asthma severity. This study aims to explore perspectives of primary care physicians regarding influenza vaccination practices for children with persistent versus intermittent asthma. A cross-sectional survey was mailed to general pediatricians (n = 300) and family physicians (n = 300) in primary care offices in Michigan in 2006. The main outcome measures included physicians' influenza vaccination recommendations and reasons for nonadministration of influenza vaccine to children with asthma for the 2005-2006 influenza season. Ninety-six percent of respondents (N = 320) reported routinely recommending influenza vaccination for children with persistent asthma; fewer (82%) reported routinely recommending influenza vaccination for those with intermittent asthma. The adjusted odds of recommending influenza vaccination for intermittent asthma patients was significantly higher among pediatricians versus family physicians (adjusted odds ratio 3.49, 95% confidence interval, 1.68-7.22), controlling for other practice characteristics. Regardless of specialty, physicians with more than 25 asthma patients were more likely than those with fewer asthma patients to routinely recommend influenza vaccination. Physicians who do not routinely recommend influenza vaccination to children with intermittent asthma were more likely to cite overlooking discussion of influenza vaccine during the visit (50% vs 13%, respectively; P < .0001) as a reason for lack of vaccination. Influenza vaccination practices of primary care physicians reflect the inconsistencies historically found in national recommendations. Further research is warranted to determine whether the recent clarification of recommendations of the National Asthma Education and Prevention Program (NAEPP) to remove distinctions by asthma severity is associated with a reduction in missed opportunities to vaccinate.

Primary Care Physician's Attitude Towards the GERMAN e-Health Card Project—Determinants and Implications

In Germany e-health cards will be distributed nationwide to over 80 million patients. Given the impending mandatory introduction of the e-health technology, the objective of this study was to examine the determinants of primary care physicians' acceptance of the technological innovation. The study was conducted prior to the introduction of the e-health cards. A questionnaire survey was carried out addressing primary care physicians from different fields. The reduction of medication error rates and the improvement of communication between medical caregivers are central aspects of the perceived usefulness. Primary care physicians rate their involvement in the process of the development of the technology and their own IT expertise concerning the technological innovation as rather low. User involvement and IT expertise can explain 46 % of the variance of perceived usefulness of the e-health card. User involvement plays a crucial role in the adoption of the German e-health card. Primary care physician's perspective should be represented in the process of developing and designing the technology.

Improving the Quality and Capacity of Canada's Health Services: Primary Care Physician Perspectives

This study set out to identify the perspectives of family physicians (FP/GPs) on the quality and capacity of the services they provide and of the system in which they work, to assess their responsiveness to potential changes and to determine their suggestions for future directions to enhance primary care services. Thematic results from prior focus groups with FP/GPs provided direction for a questionnaire sent to practitioners in the urban study area. Seventy-four questions, most using a five-point Likert scale, were grouped into 10 sections: physician issues (based on themes from the focus groups), access to specialist services, workload, scope of practice, primary care physician networks, interdisciplinary collaborative practice, complexities and challenges of family practice, future directions, comments and demographics. Five hundred and eighty-three FP/GPs were surveyed, and 300 responses (52%) were analyzed for frequencies and comparisons using SPSS. In addition to informative responses to the various survey sections noted above, specific physician suggestions for future directions to improve quality and capacity were identified. These included access to specialists/consultants, teamwork/collaborative practice, access to diagnostics, electronic records/technology, time and remuneration. The identified suggestions by FP/GPs to enhance the quality and capacity of health services contribute to a framework for policy development at national, provincial/territorial and regional levels and can be used as a reference point for the progress of primary care reform initiatives.

Accounting for the effect of GERD symptoms on patients’ health-related quality of life: supporting optimal disease management by primary care physicians

AimTo review, from a primary care physician (PCP) perspective, the use of patient-reported outcome (PRO) instruments for assessment of gastro-oesophageal reflux disease (GERD) symptoms, their impact on health-related quality of life (HRQL) and the effectiveness of therapy.ResultsWhile generic and disease-specific PRO instruments have been used in the assessment of GERD, the latter can be considered to be more appropriate as they focus only on problems relevant to the disease in question (and therefore tend to be more responsive to change). Such instruments include the Quality of Life in Reflux and Dyspepsia (QOLRAD) questionnaire and the Gastrointestinal Symptom Rating Scale and the Reflux Disease Questionnaire (RDQ). Their use indicates that GERD symptoms are troublesome and significantly reduce patients’ HRQL, and that effective treatment of GERD improves HRQL. The GERD Impact Scale (GIS) questionnaire, primarily developed for use within primary care, can also help to determine the impact of symptoms on patients’ everyday lives and, in turn, the benefit of appropriately targeted therapy. Notably, these PRO instruments were developed from focus groups of GERD patients, and only aspects rated of highest importance are used in the final instruments. Consequently, PCPs can feel confident that these questionnaires encompass the most relevant points that they are likely to ask in terms of how symptoms affect patients’ everyday lives.ConclusionsPrimary care physicians are encouraged to make wider use of PRO instruments within routine practice to improve communication with their GERD patients that, in turn, could lead to improved clinical outcomes and greater patient satisfaction.Review CriteriaWe conducted a review of validated patient-reported outcome (PRO) instruments used in gastro-oesophageal reflux disease (GERD), based on the authors’ expertise in the field and a supplementary MEDLINE search with the terms ‘health-related quality of life’, ‘quality of life questionnaire’, ‘patient-reported outcomes’, ‘patient satisfaction’ and ‘gastro-oesophageal reflux disease’.We reviewed papers reporting health-related quality of life (HRQL) data in patients with GERD, including the effect of GERD on HRQL, treatment efficacy and HRQL, patient satisfaction and physician-patient agreement, to help primary care physicians to incorporate PRO instruments into their day-to-day management of patients with GERD.Message for the ClinicAn evidence-based review shows that PRO instruments can accurately assess the nature of GERD symptoms, their impact on HRQL and the efficacy of treatment.Primary care physicians are encouraged to make wider use of PRO instruments as part of their management of patients with GERD, given that such questionnaires can facilitate patient communication and help physicians understand and satisfy the therapeutic needs of their patients.Among validated PRO instruments, the GERD Impact Scale represents a practical tool that is easy for primary care physicians to incorporate into their everyday practice.

Specialty Referral Completion Among Primary Care Patients: Results From the ASPN Referral Study

This study describes referral completion from the perspectives of patients and primary care physicians and identifies predictors of adherence to the referral recommendation. We observed a cohort of 776 referred patients from the offices of 133 physicians in 81 practices and 30 states. Referring physicians and patients completed self-administered questionnaires at the time of the referral decision and 3 months later. Physicians reported that 79.2% of patients referred had a specialist visit, and 83.0% of patients indicated they completed the referral. The most common reasons for not completing the referral were "lack of time" and patient belief that the "health problem had resolved." The kappa statistic for patient-physician agreement on referral completion was 0.34, indicating only fair concordance. Patients in Medicaid plans were less likely than others to complete the referral, and more likely to experience a health plan denial. A longer duration of the patient relationship with the primary care physician and physician/staff scheduling of the specialty appointment were both positive predictors of referral completion. About 8 in 10 patients referred from primary care complete a specialty referral within 3 months. Findings from this study suggest that referral completion rates may be increased by assisting patients with scheduling their specialty appointments and promoting continuity of care.

Adult outpatient tracheostomy care: Practices and perspectives

To determine the attitudes, opinions, and current practice of adult outpatient tracheostomy care from the surgeon and primary care physician's perspective. Multidisciplinary physician survey. Found 53.4% (667 of 1250) and 28.9% (404 of 1400) of otolaryngologists and internists responded, respectively; 47% of otolaryngologists lack standardized tracheostomy discharge protocols. General ward nurses most commonly (33%) provide discharge education. A total of 64% of otolaryngologists felt primarily responsible for tracheostomy care and follow-up; 48% expect the primary physician to provide some or all tracheostomy care. Ninety-seven percent of internists received little or no residency training in tracheostomy care, which was significantly associated with decreased comfort (P<0.0001) and willingness (P<0.0001) to care for these patients. Tracheostomy care is a concerted effort between the patient, surgeon, primary physician, and interdisciplinary team. Otolaryngologists should strive to standardize tracheostomy discharge, education, and follow-up practices. Disparities are highlighted between disciplines in their comfort, willingness, and knowledge of outpatient tracheostomy care.

Anticipating clinical integration of genetically tailored tobacco dependence treatment: Perspectives of primary care physicians

Emerging research will likely make it possible to tailor pharmacological treatment for individuals with tobacco dependence by genotype. This study explored primary care physicians' attitudes about the strengths of and barriers to using genetic testing to match patients to optimal nicotine replacement therapy. Four focus groups (n=27) were conducted, and data were analyzed using thematic content analysis. Physicians reported how likely they would be to offer patients a genetic test to tailor smoking treatment in response to three different scenarios that described characteristics of the genetic test based on published research. Respondents were on average 36 years of age; 59% were male and 67% were white. Physicians believed genetically tailored treatment may offer new hope to smokers trying to quit, yet they also noted several potential barriers to clinical integration. Barriers included erroneous assumptions by patients regarding the meaning of genetic test results, possible misinterpretation of information regarding racial differences in the prevalence of certain risk alleles, and potential discrimination against patients undergoing testing. Concerns increased dramatically when physicians were told that the same genotypes that would be identified to tailor smoking treatment also have been associated with increased risk of becoming addicted to nicotine, as well as other addictions and psychiatric disorders. Physicians were interested in the possibility of realizing improved smoking cessation outcomes through pharmacogenetic developments, but they also raised many concerns. Primary care physicians will need additional educational inputs and system support prior to integrating genetic testing for a common trait into their routine clinical practice.

The Impact of Exercise on Activities of Daily Living and Quality of Life: A Primary Care Physician's Perspective

Evaluation of the environment of patients is an important function of the primary care physician and assists the caregiver in providing an improved quality of life for one's patients. In addition to data collection and therapy, assessment of both the basic and instrumental activities of daily living is a primary concern, especially in patients with chronic diseases such as chronic obstructive pulmonary disease. This article presents the perspective and observation of a primary care physician's management of chronic obstructive pulmonary disease and will give examples of how combined pulmonary rehabilitation and medication improved the quality of life for three patients and show how activities of daily living and quality of life may be seen as a continuum in chronic obstructive pulmonary disease.

Physician Perspectives to Inform a New Recommendation for Meningococcal Conjugate Vaccine (MCV4)

Purpose In January 2005, the U.S. Food and Drug Administration licensed a new tetravalent meningococcal conjugate vaccine (MCV4). Before any policy decisions by the U.S. Advisory Committee on Immunization Practices (ACIP) related to MCV4, the Centers for Disease Control and Prevention requested a study to explore the perspective of primary care physicians regarding different recommendation scenarios for use of MCV4. Methods Cross-sectional mail survey of a national random sample of pediatricians (PDs) and family physicians (FPs), conducted January 2005. Respondents chose from four MCV4 recommendation scenarios in terms of ability to implement, perceived patient/parent preferences, scientific evidence, and overall best fit. Results Response rate to the single-mailing survey was 57%. In terms of ability to implement, respondents generally preferred an MCV4 recommendation targeted to middle-school entry (11–12 years old) or with the Td booster at any age, but on the basis of scientific evidence they favored MCV4 at high school completion. For “overall best fit,” relatively equal proportions of respondents favored a recommendation at middle school entry and one linked to Td booster administration (whenever it occurred); there were no significant differences between PDs and FPs. Major influences on willingness to recommend MCV4 were vaccine safety/side effects and insurance coverage/reimbursement. Conclusions Support for an MCV4 recommendation at middle school entry is common but not universal among primary care providers. Data suggest that respondents appreciate the potential discrepancy between practical aspects of vaccine delivery and the need to protect those adolescents at greatest risk of disease. Respondents’ preferences for the overall best fit appear to prioritize ease of implementation over epidemiologic patterns.

Understanding the Headache Patient With Complex Comorbidities: A Primary Care Physician's Perspective

Understanding the Headache Patient With Complex Comorbidities: A Primary Care Physician's Perspective

Primary care physician perspective on management of patients with depression.

To discuss the relationship between the primary care physician and other health care professionals and best practice strategies in the management of depression. Useful chronic clinical models can transform a visit between a patient with depression and the primary care provider from an unfocused encounter to one that is anticipated, planned, and productive. With the proper decision and organizational support to manage their patients with depression, primary care providers will have the increased confidence to treat these patients and have more knowledge about the treatment plan, whether that is a referral or continuation of treatment in the provider.s office. The primary care provider must recognize that he or she cannot work alone. In addition to decision support and clinical information systems, there needs to be a delivery system that supports a depression care manager and identifies the patient as the key player in the system. Participation and cooperation by the entire health care system will determine the success of such depression care models.

How treatment priorities influence triptan preferences in clinical practice: perspectives of migraine sufferers, neurologists, and primary care physicians

ABSTRACTBackground: In treating migraine sufferers, physicians can choose from among seven triptans with different attributes.Objective: To develop a system for selecting an oral triptan based on treatment priorities of migraine sufferers, neurologists, and primary care physicians (PCPs) in the United States, and evidence-based performance of triptans in clinical trials.Methods: The TRIPSTAR project combines data on the treatment preferences of migraineurs and physicians with results from a meta-analysis of individual triptans, which evaluated their effectiveness on various clinical endpoints. Telephone interviews with migraine sufferers, neurologists, and PCPs were conducted to elicit individual views on the relative importance of a prespecified set of acute treatment outcomes. Four hundred and fifteen migraine sufferers, both triptan-experienced and triptan-naive, were interviewed. Also, 200 board-certified neurologists and 200 PCPs provided information on migraine patients from their clinical practice. A multi-attribute decision model for selecting an oral triptan was constructed using attribute importance weights collected at telephone interview and the meta-analysis data, which were drawn from 53 clinical trials of 6 oral triptans.Results: Efficacy attributes were rated significantly more important than tolerability or consistency in selecting an oral triptan, according to migraine sufferers and physicians. Freedom from cardiovascular adverse events was the most important tolerability attribute, according to migraine sufferers and physicians alike. Pain free at 1 h was the most important lower-level efficacy attribute for migraine sufferers, while sustained pain free was most important for physicians. When weighted treatment attributes were combined with meta-analysis data in a multi-attribute decision model, almotriptan 12.5 mg, eletriptan 80 mg, and rizatriptan 10 mg were significantly closer to the hypothetical ideal triptan than was sumatriptan 100 mg. Triptans selected by the model were generally closer to the patient-specific ideal triptan than were the triptans prescribed by physicians.Conclusions: Almotriptan, eletriptan, and rizatriptan were the three triptans closest to the ideal, from the perspectives of migraine sufferers, PCPs, and neurologists alike. The TRIPSTAR model may be a potentially useful decision-support tool to help physicians select the triptan most likely to produce a successful outcome in migraine sufferers.

Providing Care to Children and Youth With Behavioral and Emotional Problems: The Primary Care Physician's Perspective

Providing Care to Children and Youth With Behavioral and Emotional Problems: The Primary Care Physician's Perspective

A primary care physician perspective survey on the limited use of handwriting and pen computing in the electronic medical record

Empirical research has demonstrated that simple design modifications in the electronic medical record (EMR) can improve user acceptance. Changes, such as pagination, the use of wireless pen slate computers and the use of digital ink (the graphic representation of the pen across the computer screen), can make dramatic differences in user performance, reduce uncertainty and increase acceptability. No survey has asked primary care physicians (PCPs) their preference of computer type for use during a consultation. Neither has any investigation determined whether or not physicians believed they could benefit from the use of handwriting (in the entry form of digital ink) as a supplement to the EMR. A survey was prepared to see if a group of PCPs in private practice was receptive to the use of digital ink, and what type of computer - desktop or wireless pen slate - would be preferred for use during a consultation. A wireless pen slate computer was described as having a screen large enough to display the same image seen on a desktop computer. Screen captures were used to demonstrate digital ink for handwriting and drawing. One-hundred-and-fifty-six of the 411 physicians responded (37.95%). Five physicians (3.2%) used a computer during a consultation. Ninety-nine (63.46%) would be willing to use a computer during a consultation. One-hundred-and-twenty-one (77.56%) indicated that digital ink would be useful as a supplement to the EMR. Of those who would use a computer during a consultation, 91/99 (91.09%) preferred a wireless pen slate computer to a desktop computer. Subgroup analysis indicated that those physicians who had been in practice more than 25 years or those who had low volume practices were less likely to desire a computer for use during a consultation. No subgroup showed less than 73% support for the use of handwriting in the EMR. Lack of standards (47.68%) and costs (40.40%) were chosen as the major reasons for not purchasing an EMR. Sixty-one PCPs (36.42%) indicated that a lack of typing skills was an issue and 39 (25.83%) said they had no time to learn. The use of handwriting in the EMR was broadly supported by this group of PCPs in private practice. Likewise, wireless pen computers were the overwhelming choice of computer for use during a consultation. In this group, older and lower volume physicians were less likely to desire a computer for use during a consultation. User acceptance of the EMR may be related to how closely it resembles the processes that are being automated. More surveys are required to determine the needs and expectations of physicians. The data also support other research studies that demonstrate the preference for handwriting and wireless computers, and the need for a limited, standardised and controlled vocabulary.

The Primary Care Physician's Perspective

The Primary Care Physician's Perspective

Shared Vision: Concordance Among Fathers, Mothers, and Pediatricians About Unmet Needs of Children With Chronic Health Conditions

These analyses were undertaken to investigate the number and types of services and assistance believed to be useful to children with a chronic health condition and their families. The perspective of mothers, fathers, and primary care physicians were sought separately and compared. Families that include at least 1 child with a chronic health condition were selected from pediatric practices in Central Massachusetts. All 3 respondents completed a questionnaire describing their own perspective of current needs and of the severity of the child's condition. The 3 perspectives are compared statistically and areas of agreement/disagreement are described. Mothers, fathers, and physicians described children's and families' needs with a surprising degree of concordance. On the other hand, pediatricians identified fewer needs, despite rating the severity of children's illnesses as greater than did parents. Mothers and fathers agreed substantially about the level of severity of their child's condition and about their unmet needs. It is important that pediatric practice systems include effective mechanisms to assess parents' opinions regarding the unmet needs of their child/family in the face of a child with a chronic health condition. Without input from families, pediatricians are aware of only some of the needs that parents identify.

Diagnosing dementia: perspectives of primary care physicians.

As few as 50% of dementia cases are diagnosed by physicians. This study investigated how primary care physicians assess patients for dementia and identified barriers to dementia diagnosis in the primary care setting. Seventy-eight physicians in three geographic areas participated in 18 focus groups. Barriers identified included: (a) the failure to recognize and respond to symptoms of dementia; (b) a perceived lack of need to determine a specific diagnosis; (c) limited time; and (d) negative attitudes toward the importance of assessment and diagnosis. These barriers keep physicians from diagnosing dementia and, consequently, from offering concrete help for patients experiencing symptoms of dementia or for the families who care for them.

Physicians' Perspectives of a Therapeutic Conversion within a Staff-model HMO

OBJECTIVE: To identify perspectives of primary care physicians in a staff-model health maintenance organization (HMO) concerning a therapeutic conversion program conducted for the drug class HMG-CoA reductase inhibitors. DESIGN: Multi-site, observational study. SETTING: 11 ambulatory care medical practices within a staff-model HMO serving 100,000 patients in the midwestern United States. PARTICIPANTS: 25 adult medicine physicians specializing in internal medicine or family practice. MAIN OUTCOME MEASURES: Physicians' perspectives of 13 components of the Lescol (fluvastatin) therapeutic conversion program as measured by a Likerttype scale. RESULTS: Means were used to quantify the overall response for each item. Findings indicated that the program rationale was clear, the supporting communications were useful, the inconveniences were slight, the patient feedback was neutral, and, on average, any clinical concerns about Lescol were insignificant. CONCLUSION: The responding physicians were not displeased with the Lescol therapeutic conversion program, which increased the prescribing of preferred and alternative agents from 20.6% within this class at the close of 01 1994 to 69.2% at the close of 01 1995, resulting in a 26.5% reduction in average ingredient costs over the 12-month period. Nevertheless, the vast majority of physicians (96%) strongly agreed that practicing physician opinion should be solicited prior to the implementation of future therapeutic conversion programs.

Challenges in Personal and Public Health Promotion: The Primary Care Physician Perspective

I develop an analytical framework for understanding the effectiveness of health promotion in primary care, applying the health belief and social learning models to health activities. Although the importance of prevention is widely recognized, strategies to implement preventive health care are not always obvious. I examine attitudes of both patients and physicians toward prevention activities, along with strategies for increasing health promotion. Physicians are often caught up in screening high-risk populations based on the health belief model, when they should instead focus on health prevention activities for the entire population. Primary care physicians should practice preventive medicine by providing recommendations for preventive measures to patients in the workplace, in schools, and in community centers and by making prevention a part of every patient visit.