Urban Primary Care Physicians Research Articles

A Comparison of Rural and Urban Primary Care Physicians’ Comfort Level of Providing Sexual Healthcare Practices to Adolescent Patients

A Comparison of Rural and Urban Primary Care Physicians’ Comfort Level of Providing Sexual Healthcare Practices to Adolescent Patients

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.
 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.
 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.
 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 <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 <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 <0.05).
 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.

When Do Primary Care Physicians Retire? Implications for Workforce Projections.

Retirement of primary care physicians is a matter of increasing concern in light of physician shortages. The joint purposes of this investigation were to identify the ages when the majority of primary care physicians retire and to compare this with the retirement ages of practitioners in other specialties. This descriptive study was based on AMA Physician Masterfile data from the most recent 5 years (2010-2014). We also compared 2008 Masterfile data with data from the National Plan and Provider Enumeration System to calculate an adjustment for upward bias in retirement ages when using the Masterfile alone. The main analysis defined retirement as leaving clinical practice. The primary outcome was construction of a retirement curve. Secondary outcomes involved comparisons of retirement interquartile ranges (IQRs) by sex and practice location across specialties. The 2014 Masterfile included 77,987 clinically active primary care physicians between ages 55 and 80 years. The median age of retirement from clinical activity of all primary care physicians who retired in the period from 2010 to 2014 was 64.9 years, (IQR, 61.4-68.3); the median age of retirement from any activity was 66.1 years (IQR, 62.6-69.5). However measured, retirement ages were generally similar across primary care specialties. Females had a median retirement about 1 year earlier than males. There were no substantive differences in retirement ages between rural and urban primary care physicians. Primary care physicians in our data tended to retire in their mid-60s. Relatively small differences across sex, practice location, and time suggest that changes in the composition of the primary care workforce will not have a remarkable impact on overall retirement rates in the near future.

Teledermatology perception differences between urban primary care physicians and dermatologists.

Teledermatology perception differences between urban primary care physicians and dermatologists.

Rural and Urban Primary Care Physician Professional Beliefs and Quality Improvement Behaviors

We evaluated whether primary care physicians (PCPs) from urban and rural practices differ on attitudes and behaviors related to quality improvement (QI) activities, patient relationships, and professionalism/self-regulation. Data from a national survey that assessed physician attitudes and behaviors based on the Physician Charter on Medical Professionalism were used. Of the 1,891 survey respondents, N = 840 were PCPs (n = 274 family medicine (response rate = 67.5%); n = 257 general internal medicine (60.8%); and n = 309 pediatricians (72.7%)). Using Rural-Urban Commuting Area (RUCA) codes, PCPs were classified as urban and rural according to their practice ZIP code. A total of n = 691 physicians were urban and n = 127 rural. Attitudes regarding participating in QI did not differ by practice location; however, rural PCPs were more likely to have reviewed an other physician's records for QI than urban PCPs (65.6% vs 48.0%, P < .001). Rural physicians were more likely to agree that physicians should talk with their patients about the cost of care than urban PCPs (40.5% vs 29.2%, P = .02). While all PCPs endorsed attitudes regarding the importance of professional behaviors (eg, reporting impaired/incompetent colleagues, disclosing medical errors) at generally similar levels, their behaviors differed. More rural physicians had a personal knowledge of an impaired/incompetent physician than urban physicians (20.7% vs 12.7%, P = .02). PCPs from rural and urban areas share similar attitudes regarding the importance of participating in QI and fulfilling professional responsibilities. However, certain behaviors (eg, knowledge of impaired colleagues) do differ. These results should be confirmed in larger studies of rural PCPs.

Urban Primary Care Physicians’ Perceptions About Initiation of Controller Medications During a Pediatric Emergency Department Visit for Asthma

This study aimed to identify the beliefs and attitudes of primary care providers (PCPs) regarding emergency department (ED) physicians' initiation of controller medications for children with persistent asthma symptoms during an immediate ED visit. We performed semistructured interviews and a focus group with a purposive sample of PCPs of asthmatic patients to assess attitudes toward the National Asthma and Education Prevention Program recommendations regarding ED-based initiation of controller medications. Interviews and a focus group were digitally recorded, transcribed, and entered into qualitative software for coding and analysis. A multidisciplinary team used content analysis to identify important themes. A total of 22 pediatricians and 1 nurse practitioner participated, and content saturation was achieved. Of all participants, 57% were from hospital-based practices and 43% were from non-hospital-based practices. All agreed with the new guideline recommendation that emergency medicine physicians should consider initiating controller medications during a short-term visit for asthma. Four major themes were identified: (1) the importance of communication and collaboration between primary care and ED practitioners, (2) patients must meet criteria for inhaled corticosteroids and provide a reliable history, (3) the ED visit offers a lost opportunity for education and may represent a teachable moment, and (4) the ED visit provides a chance to capture patients with frequent exacerbations who are noncompliant with follow-up visits. Primary care providers who participated in this study believed that the ED visit offers a valuable opportunity for the initiation of controller medications when ED providers use guideline-based criteria and communicate the intervention to the PCP.

A comparison of the workload of rural and urban primary care physicians in Germany: analysis of a questionnaire survey

BackgroundMany western countries are facing an existing or imminent shortage of primary care physicians especially in rural areas. In Germany, working in rural areas is often thought to be associated with more working hours, a higher number of patients and a lower income than working in urban areas. These perceptions might be key reasons for the shortage. The aim of this analysis was to explore if working time, number of treated patients per week or proportion of privately insured patients vary between rural and urban areas in Germany using two different definitions of rurality within a sample of primary care physicians including general practitioners, general internists and paediatricians.MethodsThis is a secondary analysis of pre-collected data raised by a questionnaire that was sent to a representative random sample of 1500 primary care physicians chosen by data of the National Association of Statutory Health Insurance Physicians from all federal states in Germany. We employed two different methods of defining rurality; firstly, level of rurality as rated by physicians themselves (urban area, small town, rural area); secondly, rurality defined according to the Organisation for Economic Co-operation and Development.ResultsThis analysis was based upon questionnaire data from 715 physicians. Primary care physicians in single-handed practices in rural areas worked on average four hours more per week than their urban counterparts (p < 0.05). Physicians' gender, the number of patients treated per week and the type of practice (single/group handed) were significantly related to the number of working hours. Neither the proportion of privately insured patients nor the number of patients seen per week differed significantly between rural and urban areas when applying the self-rated classification of rurality.ConclusionOverall this analysis identified few differences between urban and rural primary care physician working conditions. To counter future misdistribution of primary care, students should receive practical experience in rural areas to get more practical knowledge on working conditions.

Information needs and seeking behavior among primary care physicians in Saudi Arabia: Implications for policy and practice

This is an exploratory study conducted in Riyadh region, Saudi Arabia to determine information needs and information-seeking behavior among rural and urban primary health care physicians. The study employed self-administered questionnaires to collect data on demographic characteristics, types of medical and health information needed, sources sought and barriers encountered by physicians. The questionnaires were distributed to all primary health care physicians in Riyadh region between August and November 2010. The results indicated that physicians in rural areas were less likely to have access to medical and health information than their counterparts in urban areas, particularly for modern sources such as online databases, medical journals and the Internet websites. Physicians in both geographical locations reported similar individual and organizational barriers that hinder using information resources. Acquiring primary care physicians, particularly in rural areas with access to medical and health information is vital in the provision of primary health services. Efforts are needed to facilitate primary health care facilities with necessary information infrastructure that help develop the profession and provide quality of health care to a large segment of the population who use such health facilities. Key words: Primary health care, rural, urban, information-seeking behavior, Saudi Arabia.

Colorectal cancer screening by primary care physicians in Texas: a rural-urban comparison.

Little is known about colorectal cancer (CRC) screening practices of primary care physicians (PCPs) in rural versus urban locations. The authors surveyed 3,380 PCP members of the Texas Medical Association (TMA), stratified by specialty and rural/urban status. Factors associated with PCPs' self-reported practices of CRC screening by fecal occult blood test (FOBT) and/or flexible sigmoidoscopy (SIG) were examined using chi-square tests and multivariate regression. Over 80% of both rural and urban PCPs reported CRC screening with the FOBT, while 70% reported screening with SIG. Many reported doing FOBTs in the office versus using the take-home kit. Variations were found in recommended ages and screening intervals among all respondents. Geographic location was less important than knowledge and attitudes in predicting PCPs' CRC screening practices. More specific education regarding CRC screening guidelines needs to be directed towards all PCPs.

Health care provider attitudes and practices regarding adolescent immunizations: A qualitative study

Objective Assess health care providers’ attitudes and practices regarding adolescent immunizations, including factors that either impede or facilitate vaccination. Methods Focus groups—In 2005, 3 focus groups were conducted in Monroe County, NY for (1) urban primary care physicians (PCPs); (2) suburban PCPs; and (3) nurses from practices represented in PCP groups. Audiotaped discussions were transcribed and analyzed using Atlas.ti. Key informant interviews—We recruited knowledgeable informants (18 physicians, 6 nurses) from across the US. The authors conducted in-depth telephone interviews with the participants, typed their interview notes, and sent them to the participant for verification. Separately for nurses, urban physicians, and suburban physicians results for each question were listed and reviewed by the authors. Themes were added to those from the focus groups. Results Three overarching themes were identified: professional buy-in (e.g., reimbursement, professional organization recommendations, disease and vaccine characteristics, office consensus); parent/adolescent buy-in (e.g., school requirements, perception of MD recommendations, cost and insurance coverage, media reports, disease and vaccine characteristics, “vaccine fatigue”), and delivery factors (e.g., vaccine supply, ordering, timing and scheduling, consent). Conclusions Providers identified intertwined system issues that color their attitudes about adolescent immunization. Practice implications Buy-in and delivery factors must be addressed before high immunization rates will be achieved.

Abstract B15: HPV vaccinations among a multi-ethnic female outpatient clinic sample

Abstract B15 Background High risk types of HPV are necessary though not sufficient causes of the vast majority of cervical cancers. With the approval by FDA of the HPV vaccine among women age 9-26, dissemination is critical. Fewer than one-third of the US population has heard of HPV. Few know about its association with cervical cancer, and how to prevent its spread. Yet, physician recommendation is key to vaccination. Methods The study examines vaccination intentions and practices among a sample of 235 multi-ethnic/racial, urban primary care physicians who are enrolled in an RCT of an educational intervention. Intention was measured via self-report prior to FDA approval. Vaccination rates were assessed two years post-FDA vaccine approval, among their multi-ethnic female patients, age 18-26, using medical audit. Results Prior to the approval of the vaccine, findings revealed strong intention to vaccinate among physicians, at 92% extremely or somewhat likely to vaccinate. Multivariate analyses of primary care physicians revealed that those who regularly performed recto-pelvic examinations on asymptomatic women (β=0.21, p=0.03), and those who were more familiar with the ACS screening guidelines held stronger intentions to vaccinate (β=0.24, p=0.01) than did comparable others. Female primary care physicians had stronger intentions to vaccinate for HPV than male providers (β=0.21, p=0.03). Two years post-approval, 10% of multi-ethnic female patients age 18-26 have received at least one inoculation, 2% have received the entire 3-dose protocol. Major barriers are awareness, cost, and availability of the vaccine. Conclusions: The findings reveal stronger intentions to vaccinate than contemporaneous population-based surveys (80%), but similar predictors in gender and knowledge. The rate of vaccination is comparable to the 14% for the Hepatitis B vaccine among children one year post-approval, but much lower than among pediatricians in a Boston metropolitan hospital (57%) during a similar period of time. This is the first study to observe vaccination intentions among urban physicians working in under-resourced communities, and to systematically report the HPV vaccination uptake among their young adult female patients. Targeted dissemination strategies to urban primary care physicians in under-resourced areas, with tailored messages, are critical. In addition to exploring the pragmatic issues in disseminating the vaccine, we will examine the ethical, political, and social contexts for population-based HPV vaccine inoculations. Citation Information: Cancer Prev Res 2008;1(7 Suppl):B15.

HPV vaccinations one year post FDA approval

1513 Background: High risk types of HPV are necessary though not sufficient causes of the vast majority of cervical cancers. With the approval by FDA of the HPV vaccine among women age 9–26, dissemination is critical. Fewer than one-third of the US population has heard of HPV. Few know about its association with cervical cancer, and how to prevent its spread. Yet, physician recommendation is key to vaccination. Methods: The study examines vaccination intentions and practices among a sample of 235 multi-ethnic/racial, urban primary care physicians who are enrolled in an RCT of an educational intervention. Intention was measured via self-report prior to FDA approval, and vaccination rates were assessed one year later using medical audit. Results: Prior to the approval of the vaccine, findings revealed strong intention to vaccinate among physicians, at 92% extremely or somewhat likely to vaccinate. Multivariate analyses of primary care physicians revealed that those who regularly performed recto-pelvic examinations on asymptomatic women (β=0.21, p=0.03), and those who were more familiar with the ACS screening guidelines held stronger intentions to vaccinate (β=0.24, p=0.01) than did comparable others. Female primary care physicians had stronger intentions to vaccinate for HPV than male providers (β=0.21, p=0.03). One year post-approval, 10% of age-eligible girls and young women have been vaccinated. Major barriers are awareness, cost, and availability of the vaccine. Conclusions: The findings reveal stronger intentions to vaccinate than contemporaneous population-based surveys (80%), but similar predictors in gender and knowledge. The rate of vaccination is comparable to the 14% for the Hepatitis B vaccine among children one year post-approval, but much lower than among pediatricians in a Boston metropolitan hospital (57%) during a similar period of time. This is the first study to observe vaccination intentions among urban physicians working in under-resourced communities, and to systematically report the HPV vaccination practices among primary care physicians who are practicing in these same neighborhoods. Targeted dissemination strategies to urban primary care physicians in under-resourced areas are critical. No significant financial relationships to disclose.

Rural–Urban Differences in Primary Care Physicians' Practice Patterns, Characteristics, and Incomes

Low salaries and difficult work conditions are perceived as a major barrier to the recruitment of primary care physicians to rural settings. To examine rural-urban differences in physician work effort, physician characteristics, and practice characteristics, and to determine whether, after adjusting for any observed differences, rural primary care physicians' incomes were lower than those of urban primary care physicians. Using survey data from actively practicing office-based general practitioners (1,157), family physicians (1,378), general internists (2,811), or pediatricians (1,752) who responded to the American Medical Association's annual survey of physicians between 1992 and 2002, we used linear regression modeling to determine the association between practicing in a rural (nonmetropolitan) or urban (standard metropolitan statistical area) setting and physicians' annual incomes after controlling for specialty, work effort, provider characteristics, and practice characteristics. Rural primary care physicians' unadjusted annual incomes were similar to their urban counterparts, but they tended to work longer hours, complete more patient visits, and have a much greater proportion of Medicaid patients. After adjusting for work effort, physician characteristics, and practice characteristics, primary care physicians who practiced in rural settings made $9,585 (5%) less than their urban counterparts (95% confidence intervals: -$14,569, -$4,602, P < .001). In particular, rural practicing general internists and pediatricians experienced lower incomes than did their urban counterparts. Addressing rural physicians' lower incomes, longer work hours, and greater dependence on Medicaid reimbursement may improve the ability to ensure that an adequate supply of primary care physicians practice in rural settings.

A model of stage of change to recommend colonoscopy among urban primary care physicians.

Theory is little used in the prediction of physician cancer screening stage of change. Structural equation modeling was used to evaluate the theoretical predictors of stage of change to recommend colonoscopy among 235 urban physicians. Constructs from the theory of planned behavior, social-cognitive theory, and the transtheoretical model were systematically tested. As predicted, contextual factors, such as the physicians' ages, their race-ethnicities, patient race-ethnicity, and office-related barriers to preventive care were associated with stage of change through self-efficacy, normative beliefs, and negative behavioral beliefs. The findings demonstrate the relevance of these models to studying the behavior of physicians and support the development of interventions that are tailored to normative beliefs and specific physician cognitions for colonoscopy recommendation.

Rural and urban physicians' perceptions regarding the role and practice of the nurse practitioner, physician assistant, and certified nurse midwife.

There is a dearth of literature citing the differences in rural and urban physicians' perceptions of the role and practice of nurse practitioners, physician assistants, and certified nurse midwives (nonphysician providers). The purpose of this study was to investigate and compare differences, if any, between rural and urban primary care physicians' perceptions of the role and practice of nonphysician providers. Despite a 15.55% response rate using a mail-out survey in South Carolina, data from 681 rural and urban primary care physicians indicated that they perceived that nonphysician providers possess the necessary skills and knowledge to provide primary care to patients, are an asset to a physician's practice, free the physician's time to handle more critically ill patients, and increase revenue for the practice, but increase the risk of patient care mistakes and a physician's time in administrative duties. Urban physicians' mean scores were higher for perceiving that nonphysician providers are able to see as many patients in a given day as a physician but experience impediments in the delivery of patient care. Results will be used to clarify physicians' perceptions regarding the role and practice of nonphysician providers to reduce impediments to patient care access.

Cancer education among primary care physicians in an underserved community

Introduction: Urban minority groups, such as those living in north Manhattan, are generally underserved with regard to cancer prevention and screening practices. Primary care physicians are in a critical position to counsel their patients on these subjects and to order screening tests for their patients. Methods: Eighty-four primary care physicians in two intervention communities who received educational visits about cancer screening and prevention were compared with 38 physicians in a nearby community who received no intervention. With pre- and post-test interviews over an 18-month period, the physicians were asked about their attitudes toward, knowledge of (relative to American Cancer Society guidelines), and likelihood of counseling and screening for breast, cervical, colorectal, and prostate cancers. Results: Comparison of the two surveys of physicians indicated no statistically significant differences in knowledge of cancer prevention or screening. At post-test, however, intervention group physicians identified significantly fewer barriers to practice than control physicians ( p < 0.05). While overall, the educational visits to inner-city primary care physicians did not appear to significantly alter cancer prevention practices, there was a positive dose–response relationship among the subgroup of participants who received three or more project contacts. Conclusions: We uncovered significant changes in attitude due to academic detailing among urban primary care physicians practicing in north Manhattan. A significant pre-test sensitization effect and small numbers may have masked overall changes in cancer prevention and screening behaviors among physicians due to the intervention.

Medicaid participation among urban primary care physicians.

This article describes Medicaid participation among office-based primary care physicians in cities and examines its determinants. Data used in this study were collected through the 1993 and 1994 American Medical Association Socioeconomic Monitoring System telephone surveys. The sample includes 1,300 primary care physicians. Our multivariate model includes a variety of personal, practice, community, and policy factors thought to influence participation. Logistic regression was used to examine determinants of accepting any Medicaid patients and ordinary least square regression was used to examine determinants of the extent of participation among participants. The authors found that 19% of respondents did not participate in Medicaid and 62% had practices with 9% or fewer Medicaid patients. Multivariate analyses indicated that Medicaid payment levels were not associated with observed patterns of Medicaid participation. Community sociodemographic characteristics and demand from Medicaid-eligibles, by contrast, play a significant role in influencing observed levels of participation. Strategies other than raising Medicaid payment levels will be needed to achieve equitable access to office-based primary care for the poor residing in cities.