Practices Of Primary Care Physicians Research Articles

Primary care physician practice styles and quality, cost, and productivity.

To assess quality, cost, physician productivity, and patient experience for 2 primary care physician (PCP) practice styles: the focused, who typically address only the patient's acute problem, versus the max-packers, who typically address additional conditions also. Retrospective observational study using administrative data, electronic health record (EHR) data, and patient surveys. Data represent 285 PCPs (779 PCP-years) in a large, multispecialty group practice during 2011, 2012, and 2013. PCPs were ranked each year by their number of additional conditions addressed during acute care visits. The top one-third (max-packers) addressed 25.4% more"other problems" than expected, while focused PCPs (bottom one-third) addressed 20.3% fewer than expected. Outcomes were resource use, clinical quality metrics, patient-reported experience, physician time using the EHR, and physician productivity. All measures were risk-adjusted to account for patient mix. T tests were used to compare measures. Relative to a focused pattern of care, max-packing was associated with 3.4% lower overall resource use, consistently better scores for the available clinical quality metrics, and comparable patient experience (except for worse wait time ratings). Patients of focused PCPs used 7.3% more specialist services, in terms of costs, than patients of max-packers ($1218 vs $1136; P <.001). Max-packers spent 40 minutes more per clinical day using the EHR. PCPs with less appointment availability and who used a mix of appointment slots were more likely to be max-packers. Max-packing behavior yields desirable outcomes at lower overall cost but involves more conventionally uncompensated PCP time. Alternatives to compensation just for face-to-face visits and using more flexible scheduling may be needed to support max-packing.

Validation of the portable Bluetooth\xae Air Next spirometer in patients with different respiratory diseases

BackgroundChronic respiratory diseases constitute a considerable part in the practice of pulmonologists and primary care physicians; spirometry is integral for the diagnosis and monitoring of these diseases, yet remains underutilized. The Air Next spirometer (NuvoAir, Sweden) is a novel ultra-portable device that performs spirometric measurements connected to a smartphone or tablet via Bluetooth®.MethodsThe objective of this study was to assess the accuracy and validity of these measurements by comparing them with the ones obtained with a conventional desktop spirometer. Two hundred subjects were enrolled in the study with various spirometric patterns (50 patients with asthma, 50 with chronic obstructive pulmonary disease and 50 with interstitial lung disease) as well as 50 healthy individuals.ResultsFor the key spirometric parameters in the interpretation of spirometry, i.e. FEV1, FVC, FEV1/FVC and FEF25–75%, Pearson correlation and Interclass Correlation Coefficient were greater than 0.94, exhibiting perfect concordance between the two spirometers. Similar results were observed in an exploratory analysis of the subgroups of patients. Using Bland-Altman plots we have shown good reproducibility in the measurements between the two devices, with small mean differences for the evaluated spirometric parameters and the majority of measurements being well within the limits of agreement.ConclusionsOur results support the use of Air Next as a reliable spirometer for the screening and diagnosis of various spirometric patterns in clinical practice.

Leveraged Primary Care: Lessons From the Trenches.

To support primary care physicians (PCPs) in managing populations of patients requires a reengineering of PCP practices, and a new, disruptive model of care management, with the seamless integration of the 2. That is our conclusion, having watched 7 Accountable Care Organizations (ACOs) with direct employer contracts provide care to employed populations over a period of 6 years. We have seen dramatic improvement in outcomes when an ACO provides the needed resources, tears down the silos, and interweaves care management with PCP practices. That is leveraged primary care.

Primary care physician practice styles and patient care: Evidence from physician exits in Medicare

Primary care physicians (PCPs) provide frontline health care to patients in the U.S.; however, it is unclear how their practice styles affect patient care. In this paper, we estimate the long-lasting effects of PCP practice styles on patient health care utilization by focusing on Medicare patients affected by PCP relocations or retirements, which we refer to as “exits.” Observing where patients receive care after these exits, we estimate event studies to compare patients who switch to PCPs with different practice style intensities. We find that PCPs have large effects on a range of aggregate utilization measures, including physician and outpatient spending and the number of diagnosed conditions. Moreover, we find that PCPs have large effects on the quality of care that patients receive, and that all of these effects persist for several years. Our results suggest that switching to higher-quality PCPs could significantly affect patients’ longer-run health outcomes.

Knowledge, Attitudes and Practices of Primary Health Care Physicians Regarding Diabetes Management: A Cross Sectional Study in Gharbia Governorate, Egypt

Background: With increasing prevalence of diabetes mellitus worldwide, primary health care physicians are the main providers of diabetes care and their knowledge, attitudes and practices are important to achieve goals in diabetes management.&#x0D; Objectives: Assessment of the knowledge, attitude and practices (KAP) of primary health care physicians regarding management of diabetes. To find-out gaps between the practices of primary health care physicians and the already established national and international guidelines.&#x0D; Methods: This cross- sectional study was conducted on 144 primary health care physicians working in a randomly chosen primary health care centers in Al Garbia Governorate. Data collected concerning knowledge, attitudes and practices of primary care physicians regarding diabetes management.&#x0D; Results: The study included 144 primary health care physicians working in 38 primary health care centers in Gharbia governorate. About two thirds (95) of the studied physicians were working in rural areas and the rest (49) in urban ones. As regards years since graduation, fifty three of the studied physicians were graduated &lt;5 years and the rest (91) were graduated ≥5 years. Concerning relevant certifications or training courses, about three fourths (106) had relevant past experiences while one fourth (38) had no such experiences. Urban primary care physicians had higher percentage of correct knowledge than the rural ones as regards diagnosis, complications and managements of DM (p value &lt;0.05). Primary care physicians with increased years of practice and who attended relevant training courses had favorable attitude and practices as regards counseling and regular examination of diabetic patients (p value &lt;0.05).&#x0D; Conclusion: The current study revealed a shortage of knowledge, attitude and practices of primary health care physicians as regards management of diabetes. The defect in knowledge and unfavourability of attitude and inappropriateness of practices are obvious in family physicians working in the rural health care facilities, those without relevant experience and those graduated less 5 years.

Waterpipe smoking cessation: knowledge, barriers, and practices of primary care physicians- a questionnaire-based cross-sectional study

BackgroundWhile cigarette smoking has been considered the most relevant tobacco product worldwide, waterpipe tobacco smoking (WTS) has increased in prevalence globally and calls for more considerable attention now. However, little is known about WTS cessation knowledge and clinical practices among physicians, particularly in Lebanon. This study aims to examine the knowledge, barriers, and cessation practices of primary care practitioners towards WTS.MethodsA cross-sectional study where an anonymous self-reported questionnaire was completed by physicians attending the Annual Conference of the Lebanese Society of Family Medicine for family medicine physicians, general practitioners, and internists in Lebanon.ResultsOut of 180 attendees, 105 primary care practitioners (PCPs) responded to the questionnaire. Only 38.1% of the physicians think similar techniques are used for the cessation of smoking of both cigarette and waterpipe. Similarly, 30.5% of the physicians believe that nicotine replacement therapy works in the cessation of waterpipe smoking. There was a statistically significant difference between the percentage of physicians who counsel for cigarette smoking and those who counsel for waterpipe smoking cessation (p = 0.005) where 30% of the physicians tend to counsel against cigarette smoking more than waterpipe smoking.ConclusionsThis study shows a difference in the attitude and behavior of PCPs towards cigarette and waterpipe smoking cessation. Moreover, there is a lack of knowledge about water pipe smoking cessation techniques. There is a great room for continued medical education to PCPs in their private practice to improve their knowledge.

Exercise Counseling by Primary Care Physicians in Jordan-A Preliminary Study.

Despite the value of physical activity and exercise to patients, little is known about the perception and practices of Jordanian primary care physicians (PCPs) regarding counseling patients about exercise. This study was aimed at assessing counseling about exercise by PCPs in Jordan. A cross-sectional study targeting a random sample of physicians from family medicine, internal medicine and general practice in academic, public, and private sectors. Chi-square test of independence was used to assess the association of perceptions and practices of physicians regarding exercise counseling with their specialty. Logistic regression models were used to examine the association of demographic information with selected items of perception and practice. A total of 218 physicians participated in the study. They were mainly males (67%), family medicine physicians (42.2%), and had a mean age of 33.7 (±9.87) years. Most physicians believed that less than half of patients will start exercising (91.3%) or will continue exercising if they were repeatedly counseled at follow-up visits (85.4%). Family medicine physicians counseled more patients, more frequently, and their desire to counsel more patients was significantly higher than other physicians (P = .002).The Perceptions and practices of Jordanian PCPs toward exercise counseling for their patients were found positive; however the desire to counsel more patients was low. Lack of patients’ motivation to practice exercise, time constraint and limited resources were the most frequently reported barriers to counseling. Further investigation on how to overcome such barriers is recommended.

Obstructive Sleep Apnea Awareness among Primary Care Physicians in Africa.

Rationale: Obstructive sleep apnea (OSA) is a significant health problem among adults and children globally, resulting in decreased quality of life and increased costs of healthcare. For optimal clinical care, primary care physicians should be familiar with OSA and confident in their ability to screen, diagnose, and manage this condition.Objectives: To assess the knowledge, attitudes, and practices of primary care physicians in Kenya, Nigeria, and South Africa regarding OSA in adults and children.Methods: We conducted a multicenter cross-sectional survey in Kenya (Nairobi), Nigeria (Edo State), and South Africa (Cape Town) between April 2016 and July 2017. At least 40 participants were randomly selected from a register of primary care physicians at each site. Potential participants were contacted to receive online/paper-based, validated OSA Knowledge and Attitudes (OSAKA) and OSAKA in Children (OSAKA-KIDS) questionnaires related to adults and children, respectively. The median percentage knowledge scores and proportions of favorable attitude were computed and current diagnostic and referral practices were documented.Results: The median OSAKA knowledge scores were 83.3% (interquartile range [IQR], 77.8-88.9), 66.7% (IQR, 55.6-77.8), and 61.1% (IQR, 55.6-77.8) among South African, Kenyan, and Nigerian physicians, respectively. For OSAKA-KIDS, the median knowledge scores were 61.1% (IQR, 50.0-72.2), 64.2% (IQR, 35.3-93.2), and 58.3% (IQR, 44.4-66.7) among South African, Kenyan, and Nigerian physicians, respectively. Most physicians (90-94%) considered adult and pediatric OSA very/extremely important. Fewer physicians agreed/strongly agreed that they were confident about OSA diagnosis (55%), management (25%), and continuous positive airway pressure (18%) use in adults. Even fewer physicians agreed/strongly agreed that they were confident about pediatric OSA diagnosis (35%), management (21%), and continuous positive airway pressure use (18%). South African physicians mainly prescribed polysomnography (51%) and overnight oximetry (22%), whereas 49% of Nigerian physicians and 65% of Kenyan physicians commonly requested lateral cervical radiography.Conclusions: Primary care physicians in South Africa, Nigeria, and Kenya considered OSA to be important but had modest knowledge about OSA in adults and children, and had a low perceived confidence in adult and pediatric management. Focused educational interventions during undergraduate training and continuing professional development programs may improve primary physicians' knowledge about OSA and its diagnosis and management.

Primary care physicians' knowledge, attitudes, and practices related to diabetic retinopathy in Buraidah city, Qassim region, Saudi Arabia

Background: Diabetic retinopathy (DR) is one of the severe complications of diabetes that can result in complete blindness when it presents late in the course of the disease. The role of primary care physicians (PCPs) in the screening, prevention, and possibly referral of patients with this complication is of great importance. Materials and Methods: An analytic cross-sectional study was conducted in all primary care clinics in Buraidah city, Qassim region, Saudi Arabia. The sampling technique used is convenience sampling. The sample is PCPs (PCPs). Data were collected using a pretested, semi-structured questionnaire with sections for assessment of knowledge, attitudes, and practices toward DR in the PCPs. Results: Out of a total of 106 physicians, 100 have answered the questionnaire with a response rate of 94%, 75% have received postgraduate training. Eighty-seven percent of the PCPs have agreed that an ophthalmoscope is needed in their clinic while only (35%) have agreed that they can do an ophthalmoscopic examination confidently to detect DR in patients with diabetes. Around 23% have disagreed that diabetic patients can have DR despite having a good vision, and only 56% have agreed that pregnancy can actually worsen DR. Conclusions: The knowledge, attitudes, and practices of PCPs are sub-optimal. Dilated Fundus Examination using a slit-lamp ophthalmoscope is the best technique used in the screening of DR. Primary care centers should be equipped with more technologically advanced ophthalmic devices, and tele-screening should be utilized to precisely diagnose DR. Moreover, the communication with and referral to ophthalmology should be done on findings that are suggestive of DR. PCPs should stress the importance of screening to their diabetic patients. Finally, more efforts should be placed to increase knowledge in certain areas like DR effects in pregnant patients.

A Randomized Controlled Trial of a Motivational Interviewing Intervention to Improve Whole-Person Lifestyle.

The purpose of this randomized controlled trial was to examine the effects of a motivational interviewing intervention to improve whole-person lifestyle and reduce cardiovascular disease risk profile. A sample of 111 adults with type 2 diabetes and/or hypertension was recruited from a primary care physician practice. The intervention was facilitated by a program specialist trained in motivational interviewing. Outcomes included body mass index, cholesterol, hemoglobin A1c, blood pressure, waist circumference, wellness scores, and substance use. Differences in the changes in body mass index and waist circumference existed between the intervention and control groups after 6 months. In the intervention group, the proportion of high wellness scores increased after the program. A whole-person lifestyle intervention with motivational interviewing for patients with metabolic syndrome can improve one’s health in terms of components in the cardiovascular disease risk profile, as well as overall wellness. Efforts to improve the health of these patients may incorporate motivational interviewing to guide goal setting and address mental and spiritual health in addition to physical health.

Knowledge and practice of primary health care physicians about referral system in Baghdad

Knowledge and practice of primary health care physicians about referral system in Baghdad

Knowledge and practices of primary care physicians on the current referral system of diabetic retinopathy in Islamabad and Rawal-Pindi, Pakistan.

To assess the current knowledge and practices in diabetic eye care and referral system regarding diabetic retinopathy (DR) in health centers of Islamabad and Rawal-Pindi. A cross-sectional study was carried out in 4 government and private health centers in Rawalpindi-Islamabad from May 2018 to Oct. 2018. A total of 38 Primary Care Physicians (general practitioners, family physicians, and internists) were recruited out of which data for 2 were either not returned, or were missing partially. Data were collected through a 27-item consented & validated, multiple-choice questionnaire based on physician characteristics, knowledge and practice of diabetic eye care and challenges faced due current DR referral system. Descriptive analyses for all variables were performed including, mean and standard deviation. Analytical analyses were also conducted to study association between different study variables. Mean scores of knowledge for general practitioners, family physicians, and internists were 41.7%, 42.0% and 46.6% respectively. A lack of knowledge, and suboptimal practices were observed regarding signs, symptoms, screening, testing, evaluation and referral of DR regardless of physicians' specialty, or years in practice. Lack of expertise regarding direct ophthalmoscopy, interpretation of findings, and referral to an ophthalmologist were noted. Physicians who performed consultation and counselling according to patients' needs referred more patients to an ophthalmologist than those who restricted their consultation to a fixed amount of time and had more patients per unit time (P=0.01). Physicians who had taken care of less than 5 number of patients with DR marked less incorrect answers with no significantly greater number or correct answers compared to physicians who had taken care of more than 5 number of patients with DR (P=0.044). An association of more than 5 patients with DR taken care of with more need based patient consultation and counselling was also noted (P=0.017). An evaluation of the current referral system for DR revealed major loopholes in the health care infrastructure, proper guidelines, properly functioning equipment, check and balances, and lack of guidance to physicians regarding acquiring and updating knowledge regarding DR. Lack of updated and adequate knowledge, practices among primary care physicians, and suboptimal diabetic eye care and referral system have contributed to late presentation of DR. Interventions are needed to improve current diabetic eye care, and knowledge and practices of primary care physicians.

Rural Physician Shortages and Policy Intervention

Although fourteen percent of the U.S. population lives in rural areas, only ten percent of primary care physicians practice medicine there; populations in areas with physician shortages have measurably worse health outcomes. We analyze the effects of incentive programs intended to eliminate physician shortages. Using a differences-in-differences approach, we estimate that student loan forgiveness programs cause an increase of three physicians per rural county. We then estimate a model of physician location decisions and find that physicians are unresponsive to differences in compensation and prefer to live in their home state. Consequently, current programs are too small to eliminate shortages.

National Trends in Primary Care Visit Use and Practice Capabilities, 2008-2015.

Recent evidence shows a national decline in primary care visit rates over the last decade. It is unclear how changes in practice-including the use and content of primary care visits-may have contributed. We analyzed nationally representative data of adult visits to primary care physicians (PCPs) and physician practice characteristics from 2007-2016 (National Ambulatory Medical Care Survey). United States census estimates were used to calculate visits per capita. Measures included visit rates per person year; visit duration; number of medications, diagnoses, and preventive services per visit; percentage of visits with scheduled follow-up; and percentage of physicians with practice capabilities including an electronic medical record (EMR). Our weighted sample represented 3.2 billion visits (83,368 visits, unweighted). Visits per capita declined by 20% (-0.25 visits per person, 95% CI, -0.32 to -0.19) during this time, while visit duration increased by 2.4 minutes per visit (95% CI, 1.1-3.8). Per visit, PCPs addressed 0.30 more diagnoses (95% CI, 0.16-0.43) and 0.82 more medications (95% CI, 0.59-1.1), and provided 0.24 more preventive services (95% CI, 0.12-0.36). Visits with scheduled PCP followup declined by 6.0% (95% CI, -12.4 to 0.46), while PCPs reporting use of EMR increased by 44.3% (95% CI, 39.1-49.5) and those reporting use of secure messaging increased by 60.9% (95% CI, 27.5-94.3). From 2008 to 2015, primary care visits were longer, addressed more issues per visit, and were less likely to have scheduled follow-up for certain patients and conditions. Meanwhile, more PCPs offered non-face-to-face care. The decline in primary care visit rates may be explained in part by PCPs offering more comprehensive in-person visits and using more non-face-to-face care.

Pre-schoolers bronchial asthma in the primary health care centres: physicians' knowledge and practice in Jazan region Saudi Arabia

Background: The aim of this study was to assess the knowledge and practice of primary health care (PHC) physicians in the diagnosis and management of preschoolers’ bronchial asthma in Jazan region in Saudi Arabia.Methods: A survey of 106 primary care physicians practicing in Jazan region was conducted. Domains that assessed include asthma causes, diagnosis, management, and prognosis. Item formats included self-reports through online version questionnaire during the period December 2018 to February 2019.Results: Among 72% of participants were general practitioners, with about 60% were mid-level experience (1-10 years), overall PHC physician level of knowledge and practice was moderate level, and the knowledge was significantly affected by grade of specialty, years of experience, and the number of bronchial asthma patients seen in the last three months in the center. This study showed mis concepts and mal practices of PHC physicians as 57% of them considered prescribing antibiotics during asthma attacks, while 72% agreed that anti-cough therapy is helpful in asthma like symptoms.Conclusions: This study proves that PHC physician in Jazan region are moderately aware of preschoolers’ bronchial asthma if compared to studies done in other regions of Saudi Arabia. There are certain practices and concepts regarding preschooler’s asthma that need to be revised. Raising the awareness regarding adherence to guidelines of pediatrics bronchial asthma mandates more attention and advocacy.

241 A Care Model for Optimization of Colorectal Cancer Screening in Western Pennsylvania

INTRODUCTION: Our Health Network and insurance provider collaborated to focus on a Care Model for colorectal cancer (CRC) screening to address barriers to screening. This Care Model corresponds to a manner in which healthcare services are delivered while outlining best practices and services to patients as they progress through stages of colon cancer (Figure 1). Well-known barriers to CRC screening include lack of transportation, lack of primary care physician (PCP) involvement and education, apprehension about the prep and/or complications, and certain ethnicities. METHODS: Our Health Network and insurance provider worked together on the GI Care Model to address underutilization of CRC. The team interviewed PCP practices in the region to identify their processes for screening. The team performed a geographical analysis identifying screening rates for Western PA and the city of Pittsburgh by zip code and socioeconomic status. Transportation status, PCP status, age, and ethnicity as well as socioeconomic status were evaluated. The team then used this information to implement initiatives targeted at reducing and eliminating these barriers. RESULTS: PCPs expressed lack of updated knowledge regarding the latest colon cancer guidelines and challenges in scheduling a procedure. 122 healthcare professionals attended the webinar series in the first quarter. Feedback was overwhelmingly positive with requests for further education on a quarterly basis. Screening rates were higher if a patient had a PCP vs no PCP (Table 1). A Best Practices Alert was generated and sent by massmail to all healthcare practitioners across the region which outlined the latest recommendations with respect to screening. Difficulties in scheduling were optimized by providing flow diagrams of the scheduling process. We found that the strongest correlation to a lack of screening was lack of a vehicle (Table 2). The PALS (People Able to Lend Support) volunteer program was implemented for patients who had no vehicle. A patient education program (Doc Talks) was also offered to patients in the community at selective health insurance retail stores. Opportunity to answer questions and address fears of procedure were discussed. CONCLUSION: The GI Care Model has made significant progress in increasing awareness, education, access, and identification of common barriers which contribute to underutilization of CRC screening in our region. We will be addressing the barriers by ethnicity in future months as part of our Care Model.

Where are social workers co-located with primary care physicians?

ABSTRACTSocial workers are increasingly working in primary care clinics that provide Integrated Behavioral Healthcare (IBH) in which a patient’s physical, behavioral, and social determinants of health are addressed on a collaborative team. Co-location, where care is housed in the same physical space, is a key element of IBH. Yet, little is known about the rate of social workers co-located with primary care physicians (PCPs). To identify national rates of social worker co-location, data were drawn from the Centers for Medicare and Medicaid (CMS) National Plan and Provider Enumeration System (NPPES; n = 232,021 social workers, n = 380,690 PCPs). Practice addresses were geocoded and straight-line distances between practice locations of social workers and PCPs were calculated. More than 26% of social workers were co-located with a PCP. However, in rural settings only 21% were co-located (p < .001). Co-location also varied by PCP practice size, specialty, and state. This study serves as a benchmark of the growth of IBH and continued monitoring of co-location is needed to ensure social work workforce planning and training are aligned with changing models of care. Further, identifying mechanisms to support social work education, current providers, and health systems to increase IBH implementation is greatly needed.

National Survey of Primary Care Physicians' Knowledge, Practices, and Perceptions of Prediabetes.

Despite strong evidence and national policy supporting type 2 diabetes prevention, little is known about type 2 diabetes prevention in the primary care setting. Our objective was to assess primary care physicians' knowledge and practice regarding perceived barriers and potential interventions to improving management of prediabetes. Cross-sectional mailed survey. Nationally representative random sample of US primary care physicians (PCPs) identified from the American Medical Association Physician Masterfile. We assessed PCP knowledge, practice behaviors, and perceptions related to prediabetes. We performed chi-square and Fisher's exact tests to evaluate the association between PCP characteristics and the main survey outcomes. In total, 298 (33%) eligible participants returned the survey. PCPs had limited knowledge of risk factors for prediabetes screening, laboratory diagnostic criteria for prediabetes, and management recommendations for patients with prediabetes. Only 36% of PCPs refer patients to a diabetes prevention lifestyle change program as their initial management approach, while 43% discuss starting metformin for prediabetes. PCPs believed that barriers to type 2 diabetes prevention are both at the individual level (e.g., patients' lack of motivation) and at the system level (e.g., lack of weight loss resources). PCPs reported that increased access to and insurance coverage of type 2 diabetes prevention programs and coordination of referral of patients to these resources would facilitate type 2 diabetes preventive efforts. Addressing gaps in PCP knowledge may improve the identification and management of people with prediabetes, but system-level changes are necessary to support type 2 diabetes prevention in the primary care setting.

Correlates of physical activity counseling provided by physicians: A cross-sectional study in Eastern Province, Saudi Arabia

BackgroundPhysical inactivity is a major health issue in Saudi Arabia (SA). Being physically active can improve overall health and prevent the risk of noncommunicable diseases and their consequences. The objective of this study was to assess the knowledge, attitudes, and practices of primary health care physicians in SA toward physical activity (PA) and identify the correlates of PA counseling provided by physicians.MethodsA cross-sectional study was conducted in four main cities of Eastern Province, SA (Al-Khobar, Dammam, Qatif, and Safwa). A total of 147 physicians (44%) filled out self-reported surveys that were used in the assessment of the aims.ResultsOverall, 59.9% of the physicians believed that PA promotion to patients was their responsibility, and 53.7% of the physicians felt confident in their ability to provide PA counseling. However, the physicians indicated that lack of time, inadequate referral services for PA, and inadequate training in PA counseling are barriers to providing PA counseling to their patients. Only 5.4% of the physicians had excellent knowledge about PA recommendations. Female physicians were more likely to promote PA than male physicians (OR, 3.72; 95% CI, 1.10–12.58; P = .03) and more likely to assess PA in pediatric patients (OR, 2.61; 95% CI, 1.03–6.61; P = .04). Compared to other specialties, family physicians were more likely to provide general PA counseling to patients without chronic diseases (OR, 8.86; 95% CI, 1.86–42.13; P = .006). Physicians who saw fewer adult patients were more likely to systematically track/follow-up on the PA of patients (OR, 3.13; 95% CI, 1.14–8.58; P = .03) and to promote PA to pediatric patients (OR, 2.87; 95% CI, 1.37–6.00; P = .005).ConclusionsTraining medical staff in PA counseling and strengthening the health care workforce and infrastructure can help physicians improve their counseling practice.

Language-Concordant Primary Care Physicians for a Diverse Population: The View from California.

Purpose: The population with limited English proficiency (LEP) in California is growing. We sought to determine whether enough primary care physicians (PCPs) have the language skills to meet patient needs.Methods: The authors determined the number of PCPs who self-report proficiency in the five most common non-English languages spoken in California (Spanish, Cantonese, Mandarin, Tagalog, and Vietnamese) using Medical Board of California data from 2013 to 2015. The authors estimated LEP populations during 2011–2015 using Census data. They calculated PCP supply (the ratio of PCPs/100,000 LEP individuals) compared to a federal standard to judge adequacy. They performed a sensitivity analysis adjusting the percentage of LEP patients in a bilingual physicians' practice from 100% to the percentage of LEP individuals in California who spoke that language.Results: Of 19,310 PCPs in California, 15,933 (83%) provided information about languages they speak. There were 5,203 (33%) Spanish-, 486 (3%) Cantonese-, 986 (6%) Mandarin-, 956 (6%) Tagalog-, and 671 (4%) Vietnamese-speaking PCPs. PCP supply, compared to a federal standard, was adequate if we assumed that bilingual PCPs only care for LEP patients. However, if one assumes the number of LEP patients in a PCP's practice reflects the percentage in the general population, there is a large PCP undersupply for all languages.Conclusion: Estimates of access to language-concordant PCPs for LEP individuals are sensitive to assumptions about the percentage of LEP patients in a PCP's panel. Ensuring language-concordant access will require deliberate effort to match LEP patients with bilingual PCPs.