Preferred Physicians Research Articles

Perspectives on telemedicine across urban, rural and remote areas in the Philippines during the COVID-19 pandemic

ObjectivesThis study explored attitudes, subjective norms, and perceived behavioural control of participants across urban, rural and remote settings and examined intention-to-use telemedicine (defined in this study as remote patient–clinician consultations)...

Qualityof life in the digital age: young adult hematopoietic stem cell transplantation patients and healthcare providers' views of telehealth.

The COVID-19 pandemic shifted the healthcare field from in-person clinic visits to virtual-based telehealth appointments. This study explored young adult (YA) hematopoietic stem cell transplantation (HSCT) patient and physician communication preferences and quality of life. One researcher conducted semi-structured interviews with n = 10 YA HSCT patients and n = 10 healthcare providers (HPs). HPs included physicians (n = 5) and advanced practice provider (APP) (nurse practitioners and physician assistants) (n = 5). Interviews lasted approximately 10-15min, were held over Zoom®, and were audio-recorded. Interviews were professionally transcribed verbatim, and two independent researchers conducted a thematic analysis using Dedoose®. Common themes included the following: (1) convenience, (2) improved communication, (3) technology issues, and (4) quality of life for patients and physicians. In general, most patients (n = 7; 70%) preferred in-person visits over telehealth for initial appointments, stating they chose the "social connection" and "engagement" associated with in-person visits. For "check-ins" and follow-up appointments (n = 5; 50%), patients preferred hybrid appointments. Physicians (n = 4; 80%) preferred telehealth stating it was "convenient," "timesaving," and improved "compliance." In contrast, all APP staff (n = 5; 100%) preferred in-person visits, stating in-person improved "relationships" with patients and was more "convenient" than using electronic devices for telehealth. Providers differed in preference. APP personnel preferred in-person visits and HSCT physicians preferred telehealth appointments. YA HSCT patients preferred in-person for initial appointments and hybrid clinic visits for follow-up appointments.

A153 IMPLEMENTATION OF THE CHAMPLAIN REGION GASTROINTESTINAL ENDOSCOPY CENTRAL INTAKE (GICI) PROGRAM

Abstract Background The Champlain region of Ontario is implementing a regional central intake triage program for screening colonoscopy services (FIT+, screening and surveillance indications). The aim of this program is to improve the delivery of regional endoscopy services, so that access to resource-intensive endoscopy procedures can be equitable, timely and evidence-based. We characterized the first phase of implementation of the Champlain Regional GI Central Intake (GICI). Aims The primary objective of this study is to identify program strengths and opportunities for quality improvement. Methods Prospective data was collected from August 1, 2022 to August 31, 2023. Descriptive statistics were analyzed. Discrete data were presented in terms of counts, percentages and means where appropriate. Results 1942 CIP referrals were received during the period of study. 1478(76.1%) referrals were submitted by fax, and 571(29.4%) were for positive FITs. 703(36.2%) referrals were declined, with 374(19.3%) not meeting Cancer Care Ontario (CCO) referral indications, 84(4.3%) being duplicates and 56(2.9%) being symptomatic. Prior to a policy change in March 2023, 23(1.2%) referrals were declined due to incomplete referral forms. 581(29.9%) referrals indicated a preferred physician or hospital site. On average, triage decisions were made within 11.4 hours of receipt of referrals for positive FIT, and 6.8 days for other indications. The average time from FIT positivity to referral receipt at CIP was 20.0 days. In the first quarter of 2023, 75th percentile wait times for colonoscopy were 35 days for FIT positivity, 150 days for symptoms, and 346 days for other screening indications. Conclusions GICI and the use of CCO evidence-based guidance reduces the need for colonoscopy in nearly 20% of referrals. It also decreases physician administrative burdens by eliminating duplicate referrals. Referrals should not be declined due to incomplete forms. Measures to improve timely access to colonoscopy for symptomatic patients should be explored. Most referred patients do not have a preferred physician or hospital site. Further primary care support and engagement is needed to encourage the use of the GICI as well as immediate referral for FIT+ colonoscopy. Funding Agencies None

Patient preferences in chronic immune-mediated inflammatory diseases potentially treated with biological drugs: discrete choice analysis using real-world data analysis

ABSTRACT Objectives Immune-mediated inflammatory diseases (IMIDs) represent a high burden due to their chronicity, high prevalence, and associated comorbidities. Chronic patients’ preferences must be considered in IMIDs treatment and follow-up. The objective of this study was to further understand patient’s preferences in private settings. Methods A literature review was performed to choose the most relevant criteria for patients. A D-efficient discrete choice experiment was designed to elicit preferences of adult patients with IMIDs and potential biological treatment prescription. Participants were collected from private practices (rheumatology, dermatology, and gastroenterology) from February to May 2022. Patients chose between option pairs, characterized by six health-care attributes, as well as monthly out-of-pocket drug price. Responses were analyzed through a conditional logit model. Results Eighty-seven patients answered the questionnaire. The most frequent pathologies were Rheumatoid Arthritis (31%) and Psoriatic Arthritis (26%). The most relevant criteria were choosing the preferred physician (OR 2.25 [SD0.26]); reducing time until visit with specialist (OR 1.79 [SD0.20]), access through primary care (OR 1.60 [SD0.08]), and an increase in monthly out-of-pocket price from 100€ to 300€ (OR 0.55 [SD0.06]) and to 600€ (OR 0.08 [SD0.02]). Conclusions Chronic IMIDs patients showed a preference toward a faster, personalized service, even with a trade-off in terms of out-of-pocket price

Primary Care Delivery Perceptions and Their Associations with Physician and Patient Gender.

We aim to survey patients' opinions on perceived differences in patient care delivered by male and female physicians. Patients of primary care practices at Mayo Clinic, Arizona completed a survey sent through the electronic health record. The survey evaluated opinion regarding their primary care physician (PCP)'s overall healthcare provision capabilities and any perceived differences based on gender. 4983 patients' responses were included in final analysis. Compared to male patients, most female patients preferred to have a female PCP (78.1% vs. 32.7%, p < 0.01). Having a preference for female physicians was correlated with higher overall opinion of female physicians. The majority of male patients did not hold a difference in opinion regarding male versus female physicians (p < 0.01). Male patients were half as likely to have a better opinion and nearly 2.5 times more likely to have a worse opinion of female physicians (p < 0.01) compared to female patients. Patients preferring female physicians were nearly 3 times more likely to have a better opinion of female physicians compared to patients with no preference (p < 0.01). In a primary care setting, majority of female patients compared to male patients preferred female physicians as their PCP and had higher opinion of the care delivery of female physicians. These findings may influence how practices should assign primary care physicians to new patients and add underlying context to patient satisfaction ratings.

Survey of patients and physicians on shared decision-making in treatment selection in relapsed/refractory multiple myeloma.

Shared decision-making (SDM) is a key component of patient-centered healthcare. SDM is particularly pertinent in the relapsed and/or refractory multiple myeloma (RRMM) setting, in which numerous treatment options can present challenges for identifying optimal care. However, few studies have assessed the extent and relevance of SDM and patient-centered communication (PCC) in RRMM. To describe treatment decision-making patterns between physicians and patients in the RRMM setting, we conducted online surveys of patients and physicians in the USA to compare their perspectives on the process of treatment decision-making. We analyzed the surveys descriptively. Two hundred hematologists/oncologists and 200 patients with RRMM receiving second-line (n = 89), third-line (n = 65), and fourth-line (n = 46) therapy participated. Top treatment goals for physicians and patients included extending overall survival (among 76% and 83% of physicians and patients, respectively) and progression-free survival (among 54% and 77% of physicians and patients, respectively), regardless of the number of prior relapses. Thirty percent of physicians believed patients preferred a shared approach to treatment decision-making, while 40% of patients reported most often preferring a shared role in treatment decision-making. One-fourth of patients most often preferred physicians to make the final treatment decision after seriously considering their opinion. Thirty-two percent of physicians and 16% of patients recalled ≥3 treatment options presented at first relapse. Efficacy was a primary treatment goal for patients and physicians. Discrepancies in their perceptions during RRMM treatment decision-making exist, indicating that communication tools are needed to facilitate SDM and PCC.

Communication skills utilized by physicians in the pediatric outpatient setting

BackgroundEffective communication has been shown to increase patient satisfaction. The objective of this study was to describe communication strategies employed by physicians, and determine if physician communication strategies affect caregiver perception of quality or satisfaction with physician communication in a pediatric ambulatory setting.MethodsThis observational study was conducted at the Children’s Hospital of Philadelphia and consisted of video recordings of visits that were reviewed by research assistants for physician utilized communication strategies. Caregivers completed surveys on their preferred physician communication qualities, perception of communication quality, and satisfaction with communication. Correlation was performed between types of communication strategy and caregiver satisfaction with communication or perceived quality of communication. T-tests were run to see if there was a significant difference in patient perceived communication and satisfaction scores based on the communication strategies utilized during visits.ResultsThere were five universally used communication strategies across the 84 clinic visits recorded, including: eye contact, good posture, speaking concisely, providing thorough explanations, and providing summary of next steps. The average number of communication strategies used was 15.95 (σ = 1.50) with physicians using at least 16 of the 18 communication strategies in 62% of the clinic visits. There was no correlation between the number of communication strategies physicians utilized and either the caregiver perception of communication quality score (CPCQ) or communication satisfaction (CS) score. Caregivers who preferred an authoritative approach but perceived a collaborative approach reported lower average CPCQ and CS scores compared to caregivers who had their communication expectations met.DiscussionThere are numerous tools designed to help the physician facilitate an effective working relationship with the patient. In our study, the universally used verbal communication strategies are generally recognized as components of an effective communication repertoire. Another part of effective communication is meeting communication expectations with the CS scores suggesting that caregivers felt their communication needs were being met. Dedicating clinical time to understanding this need may help improve the overall clinical experience.ConclusionPhysicians utilize many of the suggested communication strategies to help facilitate an effective clinical encounter. Further studies on caregiver communication requirements and meeting caregiver communication expectations are needed.

Physician eye contact in telemedicine video consultations: A cross-cultural experiment

IntroductionEye contact is generally considered a beneficial non-verbal behavior in patient-physician communication. Physicians are advised to simulate eye contact during video consultations by gazing at the camera, although we lack evidence that doing so is beneficial. This work is a cross-cultural experiment that aims to answer: “Are physicians who gaze at the camera during video consultations perceived as making eye contact, and are their communication skills rated higher?” Methods43 Japanese and 61 Lebanese participants watched videos of physicians providing the same video consultations while gazing at the camera and screen. After watching each video, they rated the physicians’ communication skills using six items from the GCRS and the MAAS-G scales. They also picked and justified their preferred physician gaze direction. ResultsWhen physicians gazed at the camera, they were perceived as making more eye contact and received higher communication and interpersonal skills ratings, both in Japan and Lebanon. The effect of gazing at the camera was consistently positive but varied by country and consultation content. In Japan, simulating eye contact improved the ratings of the attentive and caring physician, whereas in Lebanon, it improved the ratings of the tired and inattentive physician. When asked to choose their preferred gaze direction, 88.4% of Japanese and 90.2% of Lebanese participants chose camera gaze over screen gaze due to its positive effect on patient feelings and physician perception. Participants who chose screen gaze noted the unnaturalness of gazing at the camera and its potential negative impact on care quality. ConclusionPhysicians providing video consultations can simulate eye contact by gazing at the camera. Doing so improves their communication and interpersonal skills ratings and could potentially enhance their communication with their patients. Mainstream video conferencing platforms could implement gaze correction methods to simulate eye contact without affecting the physicians’ experience and capacity to provide quality care.

RealSelf Social Media Analysis of Rhinoplasty Patient Reviews

BackgroundSocial media has become increasingly important for patients when deciding whether they should undergo rhinoplasty. The purpose of this study is to analyze patient satisfaction of rhinoplasty procedures through RealSelf social media reviews. MethodsWe collected data from 583 rhinoplasty reviews published on the RealSelf portal. In posts dated between 2016 and 2020, we included those which were labeled as “Worth It” and “Not Worth It.” Posts that were labeled as “Unsure” or were left unlabeled were excluded from the study. In addition, posts not including the cost of their rhinoplasty were excluded. Taking into account patient demographics and cost of the procedure, we analyzed reasons for choosing to undergo surgery, reasons for choosing surgeons, and reasons for liking or disliking their procedure. ResultsOf the 583 reviews analyzed, most (45.4%) were categorized from the 18-24 years age group and there was an overall 93.8% satisfaction rate. While there was no statistically significant difference in the cost of rhinoplasty surgeries between “Worth It” and “Not Worth It” groups, the average cost of recorded rhinoplasties was US$ 8043 with a standard deviation ± $3296. According to our analysis, younger patients aged 18-24 years relied more on social media to choose their surgeons and desired a more natural appearance to their nose while older ones preferred compatible physician personalities and increased self-esteem for rhinoplasty. ConclusionThis study offers a unique perspective into the distinguishing characteristics of different age groups and the values they place in pursuing rhinoplasty, choosing their surgeons, and why they like/dislike their surgical outcomes.

Concordant physician-patient characteristics lose importance for Arab American women and their healthcare- cross-sectional study

SummaryBackgroundArab American women have preferred women physicians of their own culture in the past. The primary aim of this study is to determine the current influence of religion/culture among MENA women and their preferences for physicians of same sex, culture, and religion on the avoidance and uncomfortableness of routine and women’s health exams.MethodsA cross sectional community survey including religiosity and the importance of physician matched sex, culture, and religion was completed. Outcome measures were avoidance of a routine physical exam, or a women’s health exam because of religious/cultural issues; and the uncomfortableness of the women’s health exam. Linear regression modeling was used to evaluate the association between outcomes and potential predictors, with significance assessed using a bootstrap method.FindingsThe responses of 97 MENA women 30–65 years old showed that MENA women agreed that they would avoid routine health exams because of religious/cultural issues if their physician was of the same religion or culture as they were (p < 0.001, p < 0.05, respectively) or they had less education (p < 0.05). MENA women also avoided women’s health exams due to religious/cultural issues if her physician was of the same religion as she (p < 0.01).InterpretationMENA women 30–65 years old may no longer be bound to a female physician of their same religion/culture for their health exams.

Assessment of the Influence of Physicians' Attire on Surgical Patients' Perception. Across-Sectional Study in Aabet Hospital, AddisAbeba, Ethiopia, 2021.

BackgroundIn Ethiopia, physicians commonly wear formal attire, surgical scrubs, casual attire, or business attire during patient care, but there is no evidence to show which attire is preferred within the patients. So this study aims to assess the influence of physicians’ attire on patients’ perceptions.MethodologyAfter ethical approval, a cross-sectional study was conducted with written informed consent; data were collected and checked for its completeness, later entered into SPSS version 25 for statistical analysis. Descriptive statistics was presented with frequency, percentage, tables, graphs, and texts based on the nature of the data. All the four attires were compared using the Friedman test and pair wise comparisons were conducted with Bonferroni correction for multiple comparisons, and Mann–Whitney U-test was used to know the preferred attire on patients’ perception about physicians’ skill, with 95% confidence and a p-value of less than 0.05 were considered as statistically significant.ResultsIn this study, out of the total respondents 66.7% are males and 71.9%, 50.3% of the respondents were degree or diploma holders, and aged 18–34 years respectively. Among participants’ 77.1% and 55.9% preferred formal attire and surgical scrub respectively. For male surgeons, formal attire and surgical scrub have an equal preference in surgical patients (p<0.001), but business and casual attire have no statistically significant difference. The patients’ preference in male formal physician attire in surgeon’s confidence, willingness to discuss confidential information and safeties of the surgeon were 76.2%, 75.7%, and 70.5% respectively, and for female surgeons, formal attire on surgical patients’ confidence in the surgeon, safety, and willingness to discuss confidential information were 74.9%, 73.8%, and 71.8% respectively.ConclusionPhysician attire is one of the important factors that inspire surgical patient confidence, smartness, surgical skill, discussion of confidential information, and caring ability in physicians. Formal attire and surgical scrub were the most preferred physician’s outfits.

Acceptance evaluation of urine self-sampling, vaginal self-sampling and physician sampling in cervical cancer screening

Objective: To compare the acceptance of urine self-sampling, vaginal self-sampling and physician sampling in cervical cancer screening. Methods: Questionnaire surveys were conducted in women attending cervical cancer screening in Xiangyuan County and Yangcheng County in Shanxi Province from July to November 2015 and from October to December 2018. Both surveys included the following three parts: feelings and acceptance of women in urine self-sampling, vaginal self-sampling and physician sampling, and the ease evaluation of two self-samplings. Results: There were 3 485 questionnaires were collected finally. The proportions of women felt embarrassed in urine self-sampling, vaginal self-sampling and physician sampling were 2.3% (81/3 472), 7.1% (247/3 472) and 8.6% (299/3 472), and 1.3% (46/3 472), 9.7%(3 37/3 472) and 14.9% (518/3 472) of women felt uncomfortable, and 1.0% (35/3 469), 8.5% (295/3 469) and 15.3% (531/3 469) felt pain, and 98.3% (3 334/3 393), 96.3% (3 267/3 393) and 99.0% (3 360/3 393) thought that the sampling were conducted properly (P<0.05). Based on the feeling during sample collection, 61.2% (1 876/3 064), 39.1% (1 199/3 064) and 66.5% (2 037/3 064) women were willing to use the corresponded sampling methods in cervical cancer screening, respectively (P<0.05). If the accuracy was the same, there were 31.8% (1 109/3 485) women preferred self-sampling and 68.2% (2 376/3 485) preferred physician sampling for cervical cancer screening. Meanwhile, 23.5% (820/3 482) preferred vaginal self-sampling in comparison with 76.5% (2 662/3 482) for urine self-sampling in cervical cancer screening. 86.5% (3 007/3 478) of the women thought urine self-sampling was very easy, comparing 40.9% (1 423/3 478) for vaginal self-sampling. Conclusions: The bad feeling of women during urine self-sampling is less common and less serious than those during physician sampling and vaginal self-sampling, and the acceptance for physician sampling is highest, following by urine self-sampling and vaginal self-sampling. Urine self-sampling is much easier than vaginal self-sampling.

Using conjoint analysis to study health policy changes: An example from a cohort of persons who use drugs.

Historically, persons who use drugs (PWUDs) in the United States have often lacked health insurance, as Medicaid did not cover low-income adults. The Affordable Care Act of 2010 (ACA) increased access to insurance in states, such as Kentucky, that expanded their Medicaid programs. A cohort study of PWUDs in Kentucky found the prevalence of being insured increased from 34% pre-ACA to 87% post-ACA. However, changes to Medicaid were proposed that intended to restrict access to this program. This manuscript describes the feasibility and utility of conjoint analysis, an innovative method for studying decision-making, to identify potential impacts of health policy changes on PWUDs. IBM SPSS's "orthogonal design" command was used to construct 12 policy profiles that presented varying combinations of the proposed policy changes to Kentucky's Medicaid plan. Each policy profile presented information on (1) monthly premium costs, (2) penalties for not paying monthly premiums, (3) weekly work requirements, and (4) if their preferred physician accepted the plan for payment. Readability of the policy profiles was analyzed using the Readable.io application. The policy profiles were included in a recent follow-up of a longitudinal cohort of PWUDs in Appalachian Kentucky (n = 355). Participants rated the likelihood of enrolling in each policy profile's Medicaid plan, using a scale ranging from 0=not at all likely to 10=extremely likely. Data were analyzed using SPSS's conjoint analysis commands. Readability results indicated the policy profiles required a 3rd grade education. Nearly all participants responded to each of the 12 policy profiles. Across the policy profiles, the mean response for willingness to enroll was 3.43 (SD = 3.61), indicating relatively low willingness to enroll. Conjoint analysis revealed the two most influential factors on willingness to enroll were work requirements (importance score, IS = 77.63) and monthly premium costs (IS = 17.76). Penalties for nonpayment (IS = 0.43) and physician acceptance (IS = 4.13) had minimal influence. This research demonstrates the feasibility of using conjoint analysis to study the impacts of potential policy changes on PWUDs.

Knowledge, Attitude, and Performance of Pregnant Women Regarding General Anesthesia Neurotoxicity in Children under Three: A Report from an Academic Hospital.

BackgroundRecently, concerns about general anesthesia (GA)-related neurotoxicity has been growing in societies. Parents’ information obviously plays an important role to make right decision for elective surgeries on children aged under three years old.ObjectivesThe aim of this survey was to evaluate the knowledge, attitude, and performance of pregnant women about the GA-related neurotoxicity in children aged under three years old.MethodsThis descriptive study was conducted at Alzahra Teaching Hospital in Guilan, Iran, during 2020. The eligible pregnant women admitted to this center were interviewed, and a questionnaire containing 10 items was filled out by the responsible resident of anesthesiology.ResultsIn this research, a total of 361 pregnant women were enrolled and underwent a face-to-face interview. The mean age of the participants was 31.4 ± 7 years, 64.5% were living in urban areas, 82.5% were housewives, and 65.7% were multipara. Moreover, 83.7% of participants believed that receiving information in this regard was crucial, and 81.7% preferred physicians as the source of information. Only 8% of mothers had received information regarding the issue. A significant correlation was observed between the habitat, employment, the level of education, knowledge, and attitude status, and the source of receiving information.ConclusionsAccording to our results, the knowledge, attitude, and performance of pregnant women were not optimal and needed to be improved through practical strategies.

Oncology patients' perception of physicians who use an integrated electronic health record (EHR) during clinic visits: PRIME-EHR double-blind, randomized controlled trial.

Patients with cancer prefer and positively perceive physicians who communicate face-to-face without the use of a computer. However, the use of electronic health records (EHRs) in the examination room remains a practical necessity. On the basis of existing literature, the authors developed and tested an integration model, PRIME-EHR, that focuses on the best-practice guidelines. To their knowledge, no randomized controlled trials (RCTs) have been conducted to test the effectiveness of such models. In this double-blind, crossover RCT, 120 eligible patients with cancer were enrolled between April 1, 2019 and February 15, 2020 at The University of Texas MD Anderson Cancer Center. The objectives were to compare patients' perceptions of physicians' skills and their overall preference after they watched 2 standardized, scripted video vignettes of physicians: 1 portraying the use of a standard EHR and the other portraying the use of a PRIME-EHR. Actors and patients were blinded to the purpose of the study. Investigators were blinded to the sequence of videos watched by the patients. Validated questionnaires to rate physicians' compassion (0=best, 50=worst), communication skills (14=poor, 70=excellent), and professionalism (4=poor, 20=very good) were used. PRIME-EHR, compared with the standard EHR, resulted in better scores for physician compassion (median score, 5 [interquartile range, 0-10] vs 12 [interquartile range, 4-25]; P=.0009), communication skills (median score, 69 [interquartile range, 63-70] vs 61 [interquartile range, 50-69]; P=.0026), and professionalism (median score, 20 [interquartile range, 18-20] vs 18 [interquartile range, 14-20]; P=.0058). The majority of patients preferred physicians who used PRIME-EHR (n=70 [77%] vs n=21 [23%]; P<.0001). The PRIME-EHR approach significantly improved patients' perceptions of and preference for the physicians. This integrated model of health care delivery has the potential to improve communication and compassion in cancer care.

668 Qualitative assessment of patient values in decision making for alopecia areata: Preliminary results

Alopecia areata (AA) is a common disease of hair loss with no FDA-approved therapies. While many treatments are available to patients, each have their own benefits and risks. Clarifying patient values is an important step to help patients choose the treatment that best fits their unique needs. A qualitative study using semi-structured interviews was conducted with 10 patients recruited from Brigham and Women’s Hospital dermatology clinic. Interviews were split and independently coded among two pairs of researchers. Codes were determined by consensus. Coding reliability and frequency were determined using NVIVO software. Interrater reliability ratings were κ =.77 (% agreement: 99%) and κ=.69 (% agreement: 98%) for the two coding teams, indicating good-excellent agreement. Key themes emerged: 100% of patients considered treatment efficacy, safety profile, and convenience of use when choosing an AA treatment. 90% of patients reported barriers to receiving appropriate treatment for various reasons, such as lack of local experts in hair loss, other time commitments, and health insurance coverage. The majority of patients considered physician recommendations (80%) and information found on the internet (70%) when choosing a treatment. 60% of patients sought dermatologists with qualifications such as affiliations with teaching hospitals and specialization in hair loss. Patients preferred physicians that reviewed treatment options comprehensively with good bedside manner (50%). Understanding patient values and barriers to treatment is important in the shared-decision making process. This study demonstrates that patients highly value information on treatment risks and benefits, which they obtain from multiple sources including physicians and online-based materials. These findings are important to discuss to help patients make higher quality decisions that align with their treatment preferences.

After COVID-19: Improving the Patient's Outpatient Appointment Experience.

As the COVID-19 pandemic diminishes, it is expected that patients will seek more outpatient appointments resulting in adverse patient and clinic experiences if there is a corresponding increase in missed appointments. This study's purpose was to determine if there was an association between advanced access scheduling, also known as open access or same day scheduling, and missed appointment rates for patients scheduled with preferred primary care physicians vis-a-vis nonpreferred primary care physicians. Patients prescheduled with primary care providers and over the age of 18 years were included in the study, which totaled 4815 visits. Study results demonstrated a statistically significant mean proportion difference between the national no-show rate and the study's no-show rate as well as a significant association between physician type and visit status. The results suggested the potential for improving the patient experience with advanced access scheduling if patients are scheduled with their preferred primary care physician. This study may promote positive patient experiences by providing patients and clinicians with an understanding of the significance surrounding advanced access scheduling thus decreasing missed appointments.

US, Russian and Indian physician perspectives regarding end of life care

Aim. To compare US, Russian and Indian primary care physicians attitudes, comfort and experiences providing palliative care.&#x0D; Design. Cross sectional survey.&#x0D; Settings. Iowa, USA; Leningrad Oblast, Russia; Mangalore, India.&#x0D; Participants. Primary care physicians.&#x0D; Methods. Chi-squared testing for dichotomous variables and t-tests for mean scores.&#x0D; Results. 66 US, 81 Russian and 95 Indian physicians completed the survey. More US physicians preferred end of life care at home (83% v 56% Russian and 29% Indian) p 0.001 and Indian physicians preferring hospitals (36% v 0% US and 1% Russian) p 0.001. 94% percent of US physicians preferred patient make their own decisions, 57% of Russian sample preferred physicians as decision makers, and Indian physicians preferred family members to patients themselves (44%) p 0.001. Patient should be informed (US vs Russia vs India) of terminal illness Always (74% vs 31% vs 33%) p 0.001, If Asked (9% vs 64% vs 12%) p 0.001 or Physicians Judgement (15%, 5%, 54%) p 0.001. US physicians reported higher comfort rates with managing symptoms at the end of life. In the last 6 months US physicians were more satisfied with provided care Often or Always (63% vs 36% Russian v 21% Indian) p 0.001.&#x0D; Conclusions. US sample was more concerned with patient autonomy and had more comfort and satisfaction in providing end of life care compared to Russian and Indian samples.

Physician Assistant Utilization in Inpatient Psychiatry: A Qualitative Study.

ObjectiveThere is a national shortage of psychiatric care providers, with approximately 1% of physician assistants (PAs) working in psychiatry. The study aimed to understand the utilization of PAs in inpatient psychiatry.MethodsA qualitative study was performed utilizing semi-structured interviews focusing on PA autonomy, reimbursement, specialized certifications, training structure, and overall satisfaction with PAs in inpatient psychiatric care.ResultsOf the nine locations interviewed, four are currently using PAs, and five have never utilized PAs. All facilities utilizing PAs reported a decrease in physician workload with varying structures for training and billing, and required specialized certifications.ConclusionMost facilities surveyed do not utilize PAs and either preferred physicians or were unaware of the qualifications of PAs. Of the facilities utilizing PAs, there is wide variation in their utilization and reimbursement models; however, they reported a high level of satisfaction, reinforcing that PAs can provide high-quality care in inpatient psychiatric settings.

Impact of physician attire on patients’ impression of their gynecologist: Results from a large single-center survey analysis

ObjectiveTo assess the impact of physician attire in a gynecology office setting on a patient’s level of trust and perception regarding medical advice, performing vaginal exams, and physician’s ability to perform major and minor procedures. Study designCross sectional anonymous survey at a large academic medical center. The survey was distributed to 200 patients of a single-physician gynecology office, between January 1st 2018 and March 31st 2018. The survey contained an image depicting a hypothetical gynecologist and hypothetical questions regarding clinical situations. Participants were asked to answer which doctor from the image shown they preferred for a given scenario. ResultsWhite coat was reported to be preferred physician attire in almost every clinical situation (p < 0.05). There were only two clinical scenarios, a gynecologic emergency (p < 0.01) and in the setting of major surgery (p < 0.07), in which patients did not have a preference for the gynecologist wearing a white coat. Attire did not have a significant effect on respondent’s perception of the gynecologist’s knowledge, level of compassion, authority, or ability to communicate. ConclusionThe majority of patients preferred a physician wearing a white coat in the presented gynecologic scenarios, with the exception of gynecologic emergencies and gynecologic surgery, in which surgical scrubs were preferred.