Practice Patterns Of Care Research Articles

Investigating spiritual care perceptions and practice patterns in Hong Kong nurses: Results of a cluster analysis

Nurses' spiritual care perceptions and practices are explored by identifying profiles of nurses studying in a part-time baccalaureate course in a local Hong Kong university. Relationships between nurses' spiritual care perceptions and their practices are explored. Hundred and ninety three nurses completed a structured questionnaire. Spiritual care perceptions and practices. Two-step cluster analysis yielded three clusters. Clusters A, B, and C consisted of 15.0% (n = 29), 44.6% (n = 86), and 40.4% (n = 78), respectively. Cluster A nurses were characterized by relatively negative spiritual care perceptions and practices. Cluster C nurses reported positive perceptions, but negative practices; they mainly chose 'uncertain' for most items on both scales. Cluster B was a large group of nurses holding both positive spiritual care perceptions and practices. Significant differences towards spiritual care were found among clusters. Nurses' perceptions were significant positively correlated with practices (r = 0.62). High positive correlations were found between the two scales (r = 0.83) for nurses in Cluster A, for nurses in Clusters B and C, low positive correlations (r = 0.37) were found. Three clusters of Hong Kong nurses were differentiated. They showed differences in the level of their spiritual care perceptions and practices. Despite their level of spiritual care perceptions, nurses seldom incorporated spiritual care practices into their daily nursing care, and the level of spiritual care awareness of some nurses was low. Findings may be used to improve support of nurses, to ensure sensitive spiritual care in their daily practices, and to enhance nursing curricula.

Emergency contraception: an intervention on primary care providers

Objective We studied whether a single educational intervention can change provider knowledge, attitudes and practice patterns with respect to emergency contraception (EC). Materials and Methods Primary care providers completed a preintervention survey prior to attending a lecture on EC, and again 6 months later. There were 50 physicians, 4 advanced practice nurses and 2 physician assistants in the final sample (internal medicine 48%, family medicine 34%, obstetrics-gynecology 9%, and pediatrics/adolescent medicine 9%). Results Following the intervention, providers were more likely to agree that advance prescriptions should be given, disagree that the number of times EC is dispensed should be restricted and disagree that repeated EC use poses health risks. The proportion of providers who had ever given an advance prescription increased from 18% to 41% (p=.007), and there was a trend toward a greater proportion of providers initiating counseling about EC from 36% to 54% (p=.057). Conclusions A simple educational intervention was associated with a change in primary care provider attitudes and practice patterns regarding EC.

Radiotherapy for Uterine Cervical Cancer: Results of the 1995-1997 Patterns of Care Process Survey in Japan

The aim of this study is to establish Japanese national practice patterns for uterine cervical cancer patients who received radiotherapy without surgery. The Japanese Patterns of Care Study (JPCS) conducted a national survey of 73 institutions using two-stage cluster sampling, and collected specific information on 591 patients with uterine cervical cancer treated by radiotherapy without planned surgery between 1995 and 1997. The median age of the patients was 70 years. Karnofsky performance status (KPS) was >/=90 for 37%. Most patients (95%) had histology of squamous cell carcinoma. Ten percent were stage I, 29% stage II, 48% stage III and 13% stage IVA. Photon beams of 10-14 MV were the most used for external beam radiotherapy (EBRT). The beam energy utilized varied significantly by institution strata. Midline block was used in approximately 70% of institutions. Intracavitary brachytherapy (ICBT) was performed in 77%. Institution strata correlated significantly with the ICBT application. The majority of patients (89%) were treated with high-dose-rate (HDR) ICBT. The median single point A dose of HDR-ICBT was 600 cGy. The median summated point A dose from EBRT and HDR-ICBT was 5800 cGy (range: 1196-8600). The median overall treatment time including ICBT was 49 days. Twenty-four percent of the patients received chemotherapy. Concurrent chemoradiation was performed in 5%. The JPCS established the Japanese national practice patterns of care for uterine cervical cancer patients treated with radiotherapy without planned surgery between 1995 and 1997. This survey demonstrated that the institutional strata significantly affected several practice patterns.

Management of Asthma Among Community-Based Primary Care Physicians

Background. Despite significant improvements in asthma treatment and the dissemination of national and international guidelines for asthma management, there are ongoing concerns that suboptimal care is being provided for patients with asthma. Objective. To determine the current practice patterns of asthma care among primary care physicians. Design. A cross-sectional study. Setting. Province of Alberta, Canada (population: 3 million people). Participants. Patients, 5 years of age or older, who had a physician's diagnosis of asthma, and had at least two visits for asthma between 1996 and 2001. Measurement and Results. Charts of 3072 distinct patients (from 45 unique primary care physicians) were reviewed. Previous emergency department visits or hospitalizations were experienced by 20% of the sample. A total of 25% of patients had documented evidence that they had performed spirometry. More than half of the patients had no documented evidence that they had received any form of asthma education; only 2% of the charts indicated that patients received a written action plan. Two thirds of the patients were prescribed an inhaled steroid within 6 months of the last clinic visit. Conclusions. Our study indicates a gap in the provision of asthma education, written action plans, and spirometric testing for patients diagnosed with asthma among primary care physicians.

The Use of an Electronic Patient Record System to Identify Advanced Cancer Patients and Antidepressant Drug Use

Psychiatric morbidity is common in cancer patients toward the end of life. In this study, we demonstrate the use of an electronic patient record system to identify patients with advanced cancer, and then analyze practice patterns regarding the use of antidepressants. Using electronic patient records from January 1986 to December 1996, we identified 17,476 patients with possible cancer. Patients were identified by virtue of having any one of eight markers. We used an iterative process to modify the specificity of these markers, and an advanced cancer cohort was assembled consisting of 1185 patients. A random sample of 200 written medical records were reviewed, of which 157 records (78.5%) were retrieved. Extracted information was reviewed by an oncologist, and patients were classified as follows: (1) no evidence of cancer; (2) evidence of cancer with an expected survival of less than or equal to 24 months; or (3) evidence of cancer with an expected survival of more than 24 months. Overall, 86% of the advanced cancer sample assembled from electronic records was correctly classified as advanced cancer by the review of the written records. Overall, 16% of all 1185 patients with advanced cancer were exposed to at least one antidepressant, with 3% of patients exposed to a selective serotonin-reuptake inhibitor, 10% exposed to a tricyclic antidepressant at a dose of greater than 25 mg, and 4% exposed to a low dose of a tricyclic antidepressant. The electronic patient record can be used to assemble an advanced cancer cohort for the purpose of studying palliative care practice patterns. Antidepressants are seldom part of the palliative management of this population.

Diabetes care for Medicare beneficiaries. Attitudes and behaviors of primary care physicians.

To obtain information related to primary care physician (PCP) attitudes, knowledge, and practice patterns, as well as perceptions about barriers to care and the use of materials to assist in the delivery of diabetes care for elderly patients in the office setting. A survey was mailed to a random sample (n = 900) of PCPs (internal medicine, family practice, and general practice physicians and endocrinologists) from the states of Alabama, Iowa, and Maryland who met selection criteria and provided diabetes care to > or = 25 Medicare beneficiaries during calendar year 1993. Respondents provided self-reported information regarding diabetes care for elderly patients. PCP respondents (n = 370) considered blood glucose control to be the most important treatment goal. Most respondents (92%) considered acceptable GHb values to be those < 8%. Blood pressure measurement and foot inspections for the detection of ulcers and infection were the most commonly reported routine procedures performed as part of an office visit. Laboratory tests reported to be frequently ordered included GHb, serum creatinine, and proteinuria tests. Patient nonadherence to the treatment regimen was reported to be the most common barrier to care. The majority of respondents reported using two treatment aids in caring for patients with diabetes. The results of this study provide some evidence that PCP self-reported attitudes, knowledge, and practice patterns in delivering diabetes care for elderly patients in the office setting more closely reflect current recommended practice than reported in previous physician surveys. Opportunities for improvement still exist.

Most nephrologists are primary care providers for chronic dialysis patients: results of a national survey

The medical care of end-stage renal disease (ESRD) patients includes not only dialysis-related medical care but preventive and general medical care as well as the care of minor acute illnesses. There is little information about nephrologists' interpretation of their potential role as a primary health care provider for the general medical needs of chronic dialysis patients. To characterize nephrologists' primary care practice patterns related to the care of chronic dialysis patients, we surveyed a randomly selected group of practicing nephrologists and asked questions about preventive medicine guidelines followed, treatment of minor acute illnesses, and management of chronic medical problems in ESRD patients. The results of 233 questionnaires (46% response rate) were analyzed. Most of the responding nephrologists were men (91%), were board certified in internal medicine (96%) and nephrology (83%), were out of nephrology practice for a mean of 16 years, had a mean age of 48 ± 7 years, and were in private practice (65%). The average percentage of time spent with chronic dialysis patients was reported as 30%; 38% of that time was devoted to the general medical care of those patients. Ninety percent of nephrologists reported that they provided primary care to their dialysis patients, and only 21% said a nurse practitioner or physician assistant worked with them. Age and number of years in practice were the only demographic factors increasing the likelihood of nephrologist-provided primary care, with older, more experienced practitioners more likely to be providing primary care to dialysis patients. Most nephrologists reported that they managed minor acute illnesses and comorbid conditions (diabetes mellitus, cardiac disease, and gastrointestinal disease) in their dialysis patients. Nephrology fellowship training programs and recertification programs may need to address issues of primary general health care of ESRD patients. Plans under development for health care programs and reimbursement criteria also need to recognize and consider the primary medical care role practiced by nephrologists caring for ESRD patients.

Ambulatory care groups and the profiling of primary care physician resource use

A variety of profiling models and tools is utilized by payers, providers, and regulators to evaluate physician work, performance, and resource utilization. In physician profiling, the provider's pattern of practice is expressed as a rate of service or outcome. The article by Tucker, Weiner, Honigfeld, and Parton (this issue) compares the practice-based norms of primary care physicians by adjusting for case mix using ambulatory care groups (ACGs), a population-based classification method. Once the case mix is adjusted, the actual use of resources, as measured by overall charges, is compared with the expected value of resource use. In the Center for Research in Ambulatory Health Care Administration (CRAHCA) Physician Profiling Project, funded by The Robert Wood Johnson Foundation, physicians learn which services other physicians in their specialties perform. Physicians are able to compare their profiles with state and national level medians. The profiling project is one of the first demonstration projects in the field to profile ambulatory care practice patterns and collect patient demographics. An aspect of the project is to test the ACG classification system to data selected from 130 nonacademic practices representing over 5,000 physicians.

Nurse Practitioner Practice Patterns Based on Standards of Medical Care for Patients With Diabetes

To determine to what extent nurse practitioner (NP) practice patterns of diabetes care are consistent with standards of care suggested by the American Diabetes Association (ADA). A descriptive study was conducted to examine practice patterns. A convenience sample of 78 charts was audited, representing a proportionate number of charts for each of the six masters-prepared, certified NPs employed in an ambulatory primary-care center. Practice patterns related to diabetes care revealed a discrepancy between established standards of care and the degree to which care was documented. All six NPs acknowledged that they became clinically competent to care for patients with diabetes on the job. Results of this small study suggest that NPs are not consistently following standards of care suggested by the ADA.

Physician staffing patterns correlates of nursing home care: an initial inquiry and consideration of policy implications.

To determine, post-OBRA 1987, medical organization in nursing facilities (ie, medical director and staff profile, closing of medical staff, use of physician contract); structural correlates of medical organization; and links between medical organization, especially closed staffing, and medical care. Mail survey of New York state nursing facility administrators (63% response). Survey consisted of open and closed end items that focused on facility and staff demographics, medical organization, and markers of medical care delivery, ie, physicians' daily presence, average response time to emergency calls, cross coverage for acute conditions and emergencies, attendance at care conferences, and offering of in-services. On average, facilities had 8.6 attending physicians, 32 residents per physician, 70% of residents cared for by non-staff physicians, no daily physician presence (60%), and no cross coverage. Most medical directors were from family (42%) or internal (55%) medicine, had a tenure of 7.5 years, did not have a certificate of added qualification in geriatrics (73%), and attended residents (66%). Forty-three percent of facilities had closed medical staffs, and 12% had physician contracts. Closed staffs were more likely in facilities that were larger, had more Medicaid residents, used physician extenders, and had more residents per nurse. Facilities with closed medical staffs had fewer physicians more residents per physician, and reported medical care practice patterns that would be associated with quality of care. These effects were independent of nursing and facility characteristics. Physician contract was unrelated to care. Medical organization and practice patterns emerge as important factors in considerations of nursing home quality. Results argue that, as in acute settings, limiting practice privileges in nursing homes may be a useful organizational strategy to improve quality of care.

The practice patterns of adult oncologists' care of pediatric oncology patients.

The role of the adult oncologists in the area of pediatric cancer treatment previously has been unmeasured. A questionnaire bearing regarding the practice of 447 adult oncologists was administered in June 1991. The membership list of the Association of Community Cancer Centers was used to identify contact oncologists. One hundred thirty-one questionnaires (29.3%) were returned for analysis. The data reveal that 204 patients younger than 21 years of age were treated during the last year in 63 adult oncology practices. Most of these patients were more than 15 years of age. Only a minority (53) were treated in rural practices. In addition, only a minority (27%) of these patients are reported to be enrolled in clinical trials. In addition, adult oncologists appear to regard physiologically mature adolescents (age 16-21 years) as adults. They do not seem to make a distinction between patients 16-21 years old and those older than 21 years.

Practice patterns of palliative care for the united states 1984–1985

This study reports the national averages for patterns of palliative radiation therapy observed in the United States for patients treated in 1984–1985 and compares those patterns to the pertinent literature. The data were collected in 1984–1985 by the Patterns of Care Study Survey of Palliative Care conducted in 49 institutions selected to provide valid national averages for the practice patterns reported. Data were collected from 784 patient records selected from five “strata” of practice. Demographic data and process data were tabulated and national averages were calculated from the data. Four metastatic sites were selected, weight bearing bones (401), non-weight bearing bones (102), brain metastasis (224), and lung-mediastinum (57). The median patient age was 63 years, equally divided by sex. In 52% of patients this was the first metastasis. Common Karnofsky performance scores ranged from 40 to 80%. Lung, breast, and prostate were the most common primaries. Two-thirds of the patients were treated by linear accelerators, one-third by cobalt. The median number of fractions was 10, median dose 3000 cGy, median fraction size 300 cGy, and median treatment duration 15 days. The goal of treatment was relief of pain (98%) and return of function (30%) for weight bearing bones, for brain metastasis it was preservation of function (68%), pain relief (330!0), and relief of compression (25%). All sites showed TDF values that ranged from 33–85, and a TDF of approximately 65 was most common for weight bearing bones and brain metastasis with no consistent pattern of TDF selection for the other sites. Compliance by strata of practice with work-up criteria was excellent with isolated poor compliance seen in several strata.

Practice patterns of palliative care for the United States — 1983

Practice patterns of palliative care for the United States — 1983

Inside the hidden mental health network: Examining mental health care delivery of primary care physicians

Mental disorder diagnoses among 51 patients, made by a group of 20 family physicians, were compared with diagnoses generated by the Diagnostic Interview Schedule (DIS). Processes of diagnosis, decision making, and treatment planning were then examined through structured physician interviews and chart audits. In this study, 75 of 94 DIS diagnoses (79%) were undetected. During interview and chart audit, the physicians were found to have consistently under-estimated, misinterpreted, or neglected psychiatric aspects of care among a majority of patients in the study. These physicians had all satisfactorily completed a psychiatry curriculum designed for family physicians. Analysis of these results suggests that a mental health role is often not integrated into primary care practice, regardless of physician performance during psychiatric training experiences. Assumption of this role appears to be state dependent on involvement with a psychiatric treatment setting. Primary care practice patterns do not seem to result in application of appropriate skills and therapeutic attitudes to detect, diagnose, and correctly manage the majority of mental disorders that occur. The need is reaffirmed for active collaboration between mental health professional and primary care providers in training and in incorporation of psychiatric skills into primary care practice.

Primary care practice patterns

An interview survey of the primary care practices of a class of dental school graduates was conducted in 1977 as a part of a longitudinal study that was begun 11 years earlier, when these individuals entered dental school. Primary care was defined by the variety of dental treatment procedures used by the dentist and by his or her participation in interdisciplinary aspects of health care. The study showed that: (1) the urban or rural location of the practice was not associated with primary care; (2) the dentists' position in the practice (sole practitioner, group owner, and so forth) was associated with the variety of treatment procedures used; (3) predental school values, dental aptitudes, and dental school achievement were significant predictors of primary care practices; and (4) the two measures of primary care were uncorrelated, and there were several patterns of primary care being practiced.