Role Of Primary Care Physicians Research Articles

Knowledge and attitudes of primary care physicians toward the nurse practitioner role in the Kingdom of Bahrain

The Kingdom of Bahrain is facing a number of challenges, including an escalating cost of health services, increasing incidence of chronic diseases, and shortage of primary care physicians (PCPs). Introducing the nurse practitioner (NP) specialty in the primary care setting is one way to meet these challenges. The purpose of this quasi-experimental study was to examine the knowledge and attitudes of PCPs about the NP role prior to and following an educational intervention. The modified Northern Emergency Nurse Practitioner Staff Survey was used to measure the PCPs' attitudes and knowledge. A total of 90 PCPs completed the pretest and posttest. The study findings showed that PCPs had poor understanding of the NP role. Their knowledge and attitudes changed significantly after the educational intervention. Also, posttest data indicated a positive correlation between knowledge and attitudes toward the NP role. More educational preparation and orientation to the NP role for PCPs and other healthcare professionals are needed before the implementation of the role in the primary care setting in Bahrain. There is a need for the role to be clearly defined prior to implementation to help gain understanding and acceptance.

Patient, Primary Care Physician and Specialist Expectations of Primary Care Physician Involvement in Cancer Care

In Canada, many health authorities recommend that primary care physicians (PCP) stay involved throughout their patients' cancer journey to increase continuity of care. Few studies have focused on patient and physician expectations regarding PCP involvement in cancer care. To compare lung cancer patient, PCP and specialist expectations regarding PCP involvement in coordination of care, emotional support, information transmission and symptom relief at the different phases of cancer. Canadian survey of lung cancer patients, PCPs and cancer specialists A total of 395 patients completed questionnaires on their expectations regarding their PCP participation in several aspects of care, at different phases of their cancer. Also, 45 specialists and 232 community-based PCP involved in these patients' care responded to a mail survey on the same aspects of cancer care. Most specialists did not expect participation of the PCP in coordination of care in the diagnosis and treatment phases (65% and 78% respectively), in contrast with patients (83% and 85%) and PCPs (80% and 59%) (p < 0.0001). At these same phases, the best agreement among the 3 groups was around PCP role in emotional support: 84% and more of all groups had this expectation. PCP participation in symptom relief was another shared expectation, but more unanimously at the treatment phase (p = 0.85). In the advanced phase, most specialists expect a major role of PCP in all aspects of care (from 81% to 97%). Patients and PCP agree with them mainly for emotional support and information transmission. Lung cancer patient, PCP and specialist expectations regarding PCP role differ with the phase of cancer and the specific aspect of cancer care. There is a need to reach a better agreement among them and to better define PCP role, in order to achieve more collaborative and integrated cancer care.

The primary care physician role in cancer genetics: a qualitative study of patient experience

Increased availability of genetic testing is changing the primary care role in cancer genetics. The perspective of primary care physicians (PCPs) regarding their role in support of genetic testing has been explored, but little is known about the expectations of patients or the PCP role once genetic test results are received. Two sets of open-ended semi-structured interviews were completed with patients (N=25) in a cancer genetic programme in Ontario, Canada, within 4 months of receiving genetic test results and 1 year later; written reports of test results were collected. Patients expected PCPs to play a role in referral for genetic testing; they hoped that PCPs would have sufficient knowledge to appreciate familial risk and supportive attitudes towards genetic testing. Patients had more difficulty in identifying a PCP role following receipt of genetic test results; cancer patients in particular emphasized this as a role for cancer specialists. Still, some patients anticipated an ongoing PCP role comprising risk-appropriate surveillance or reassurance, especially as specialist care diminished. These expectations were complicated by occasional confusion regarding the ongoing care appropriate to genetic test results. The potential PCP role in cancer genetics is quite broad. Patients expect PCPs to play a role in risk identification and genetics referral. In addition, some patients anticipated an ongoing role for their PCPs after receiving genetic test results. Sustained efforts will be needed to support PCPs in this expansive role if best use is to be made of investments in cancer genetic services.

Determinants of primary care physicians' referral pattern: a structural equation model approach.

This study examines patient referrals by primary care physicians (PCP) with nurse practitioners and physician assistants (NP-PA) in their medical practices as compared to practices without them. The study uses data from the Robert Wood Johnson Foundation community tracking study (CTS) Physician Survey, Round I (1996-97) and II (1998-99). Structural equations with binary dependent variables were used to examine the links among managed care, the use of NP-PA, the complexity of patient's conditions, and the number of referrals. PCP's with NP-PA were found to have a greater likelihood of treating patients with complex conditions instead of referring them to specialists. Managed care related variables (i.e., large group practice/HMO, the percentage of patients for whom PCPs acted as gatekeepers, and the percentage of managed care revenue from capitated/prepaid contracts) affected PCP' patient referrals, but only through the increased use of NP-PA. PCP's with NP-PA were also found to provide appropriate care to the complex patients. These findings indicate that NP-PA enable PCP to concentrate on patients with more complex conditions thus reducing the number of referrals. In addition, NP-PA is found to affect the gatekeeper role of PCPs.

The Role of Primary Care Physicians in Cancer Care

The demand for oncology services in the United States (US) is increasing, whereas a shortage of oncologists looms. There is the need for a better understanding of the involvement of primary care physicians (PCPs) in cancer care. To characterize the role of PCPs in cancer care, compare it with that of oncologists, and identify factors explaining greater PCP involvement in cancer care. National survey of physicians caring for cancer patients conducted by the Cancer Care Outcomes Research and Surveillance Consortium. 1694 PCPs; 1621 oncologists. Questionnaires mailed during 2005 and 2006 examined the participation of physicians in 12 aspects of care for cancer patients. Over 90% of PCPs fulfilled general medical care roles for patients with cancer such as managing comorbid conditions, chronic pain, or depression; establishing do-not-resuscitate status; and referring patients to hospice. Oncologists were less involved in these roles. Determining the treatment preferences of individual patients and deciding on the use of surgery were the only cancer care roles in which > or =50% of PCPs participated. Twenty-two percent of PCPs reported no direct involvement in cancer care roles while 19% reported heavy involvement. PCPs who were aged > or =50 years, were internists or geriatricians, taught medical students, saw more cancer patients, or experienced referral barriers fulfilled more roles. Rural practice location was not associated with greater PCP involvement in cancer care. PCPs across the US have an active role in cancer patient management. Determining the optimal interface between PCPs and oncologists in delivering and coordinating cancer care is an important area for future research.

Who’s in charge? Challenges in evaluating quality of primary care treatment for low back pain

Low back pain (LBP) is a common condition with frequent health care visits and work disability. Quality improvement efforts in primary care focused on guidelines adherence, provider selection and education, and feedback on appropriateness of care. Such efforts can only succeed if a health care provider is in charge of care over a substantial period. This study was conducted to provide insights about actual patterns of provider involvement in LBP care and implications for quality evaluation. Established primary care patients with occupational LBP and health care covered by a workers' compensation insurer were selected. Primary care physician (PCP) involvement was examined relative to overall health care utilization. Four methods of classifying PCP involvement were used to assess the association between PCP involvement and health care and work disability outcomes over a 2-year follow-up period. Primary care physician was rarely the sole provider during episodes of occupational LBP. PCP was the initial non-emergency room provider in 55% of cases, and was the most prevalent provider during at least one episode of care in 45% of cases. Different methods of classification led to different conclusions about the association between PCP involvement and work disability or number of health care visits. Multiple providers were involved throughout the clinical course of the small number of cases that accounted for most of the health care visits and work disability; in these cases, the role of PCP in care was difficult to determine. Administrative data alone are adequate for provider comparisons only in relatively simple cases. Provider comparisons based on initial treating provider likely overstate the importance of early care, particularly in more complex cases. For LBP, quality improvement models based on PCP-directed interventions or reinforcing guideline adherence may not impact outcomes. A patient-centred model may be necessary to achieve outcome improvements.

Evolving role of primary-care physicians in the US

Evolving role of primary-care physicians in the US

How Israeli primary care physicians perceive their role in the health care system.

In some Western European countries, primary care physicians (PCPs) play a major role in the health care system, but in Israel the health care system is in the process of being reformed and the role of PCPs has not yet been established. The purpose of the study described in this article was to determine the attitude of PCPs toward the role that they should play in the health care system in Israel and the formal training they need to fill this role. PCPs cited 12 primary functions that they should carry out, including coordinating patient care and counseling patients. Also, 60% of PCPs have undergone specialty training, and 94% think that this training is essential. Among the conclusions of the study are that a higher percentage of PCPs should undergo specialty training in order to enhance their professional status and that continued medical education should emphasize specific issues, such as the consideration of economic factors in patient management decisions, responsibility for patients' administrative issues, 24-hour responsibility for patients, and house calls.