Suburban Primary Care Research Articles

Out-of-hours primary care and the patients who die: A survey of deaths after contact with a suburban primary care out-of-hours service

Objective - To assess how and to what extent out-of-hours primary care facilities care for patients who die shortly afterwards, and whether information about deaths and causes of deaths are fed back to doctors who treated the deceased persons. Design - An observational prospective study of patients who die. Setting - An out-of-hours primary care facility providing services to a population of 78000. Subjects - 531 patients who died in the 1-year study period. Main outcome measures - Extent of reporting back about deaths to the out-of-hours primary care facility and description of contacts with out-of-hours primary care prior to death. Results - 134 of 531 deceased patients had been treated by an out-of-hours primary care physician within the last 4 weeks of life. The physicians had received information about the cause of death in only 9 of the cases (6%). Six dead patients (5%) had their condition misinterpreted by the out-of-hours primary care physicians, with a possible delay in appropriate care. Conclusion - Prompt feedback of causes of death to primary care physicians represents an important, but mostly unexploited, potential for quality improvement.

Patient Notification and Follow-up of Abnormal Test Results

To investigate physician practices in the handling of patients' test results from the time the test was ordered until the time any required follow-up was completed. Survey of 161 attending physicians and 101 residents in family practice and internal medicine practicing at a large urban teaching hospital and 21 suburban primary care practices in Southeastern Michigan. The survey included questions about physician demographics, and whether physicians have methods for ensuring that (1) the results of all tests ordered are received, (2) all patients are notified of results, (3) all patient notification is documented, and (4) all required follow-up is done. Physicians were also asked to self-rate the reliability of their methods and the importance of various steps in the handling of patients' test results. The response rate was 79% for both attending physicians and residents. Approximately 17% to 32% of physicians reported having no reliable method to make sure that the results of all tests ordered are received. One third of physicians do not always notify patients of abnormal results. The most common reasons reported for not notifying patients were that the results were trivial and that the patient was expected to return to the clinic soon. Residents were significantly less likely to document notifying patients of abnormal results (P < .001). Only 23% of physicians reported having a reliable method for identifying patients overdue for follow-up. Lack of methods to ensure that the results of tests ordered were received, dependence on follow-up visits to inform patients of results, and lack of documentation were relatively common among physicians surveyed. These could lead to an increased risk of malpractice litigation and suboptimal patient care.