Background: Functional status differs among populations of elderly, although the extent of differences in types of functions among groups has not been closely examined. This study identifies and compares characteristics among different populations of elderly, using a screening test that measures self-assessment of multiple areas of function. The screening tool used was the Dartmouth COOP Charts, developed for and primarily tested in office medical practices. It has not been used to systematically compare office patients with other groups of elderly.

Methods: Dartmouth COOP Charts were administered to five groups of elderly drawn from convenience samples of individuals age 65 and older, including elderly living in senior apartments, those attending community activities, mentally oriented nursing home patients, office patients, and elderly patients not visiting the doctor within the past 6 months. Demographic data, as well as COOP chart results, were obtained.

Results: There were multiple differences in COOP chart scores among the samples of elderly individuals. The greatest differences were in self-reported physical fitness and in the level of difficulty in performing daily activities. Medical office patients not visiting in 6 months had the highest fitness levels. On the other hand, the "social support" availability scale showed no differences among groups. Results from other scales were intermediate among these extremes. Conclusions: Different samples of elderly yield varying results on several measures of reported physical and emotional health. All convenience samples of the elderly may have somewhat poorer health than the average person age 65 and older. Of the groups studied, those with the poorest function were either older adults in nursing homes or those visiting the doctor's office for treatment.

Background and Objectives: Impaired cognition is a determinant of poor recovery following a hip fracture. Because of the risk of poorer outcomes, individuals with impaired cognitive function may be refused admission into a rehabilitation program. This study considered the impact of cognitive status on functional ability over time for older adults who participate in a rehabilitation program.

Methods: We studied a convenience sample of 200 consecutive patients who participated in an inpatient rehabilitation program following an orthopedic event. We obtained complete follow-up data on 181 participants. Baseline data were collected within 48 hours of admission and included demographics, rehabilitation diagnosis, living location prior to admission, the Mini-mental State Examination, and the Barthel Index (BI). Telephone follow-up was made at 3, 6, and 12 months after discharge from rehabilitation, and we obtained information about demographic data and functional status (BI).

Results: There were no differences in the demographic characteristics of the two groups except for race; a larger percentage of African-Americans were in the impaired group. There was a statistically significant main effect of time with functional ability of all participants, increasing over the 12-month follow-up period.

Conclusions: This study suggests that rehabilitation of the older adult, both with and without cognitive impairment, can result in improvement in functional ability that is sustained over a 12-month period. Although the findings indicate that those with cognitive impairment have lower functional perfomance at each testing period, these individuals improved functionally during the course of rehabilitation and maintained their discharge level of functioning for 1 year after discharge.

Background and Objectives: To facilitate resident training in the ambulatory setting, a few family practice residency programs use a partnership system to train residents. Partnerships are pairs of residents from the same year that rotate together on inpatient services. We identified and characterized the advantages and disadvantages of partnership programs in family practice residencies.

Methods: We conducted a national survey of family practice residencies, followed by phone interviews with residency directors of programs with partnerships.

Results: A total of 305 of 407 (75%) residencies responded; 10 programs fit our definition of partnership. Program directors were positive about resident partnerships. Benefits included improved outpatient continuity, enhanced medical communication skills, and emotional and intellectual support. Disadvantages were decreased inpatient exposure and difficulty coordinating residentsÍ schedules.

Conclusions: Directors were favorable about partnerships, which seem to be an underutilized technique to improve residency training.

Background and Objectives: Many strategies have been used by academic institutions to address the shortage of rural family physicians. Fellowship training in rural family medicine represents one approach.

Methods: Tacoma Family Medicine developed a fellowship program of this type. Five years of operations are described, including applicants, educational outcomes, rural outcomes, and adverse outcomes.

Results: An adequate applicant pool does exist, composed of both applicants from residency and from practice. A curriculum of advanced obstetrics, electives, and a rural experience has been successful. Unforeseen problems included a strained relationship with family practice residents in the program and competition for community preceptors.

Conclusions: Family practice residencies with a mission of rural training are encouraged to consider the strategy of a rural fellowship.

Background and Objectives: It has been suggested that medical students who attend schools known for graduating prospective primary care physicians may enter primary care residencies, rather than non-primary care residencies, because they are unable to compete for subspecialty residencies due to poorer academic performance. This study determined if performance on standardized examinations conducted by the National Board of Medical Examiners (NBME) could differentiate between students who selected primary care and those who selected non-primary care specialties at a medical school in the southeastern United States committed to graduating primary care physicians.

Methods: We examined initial scores on NBME examinations and subsequent residency selections by 780 students over a 14-year period to determine if there were differences in the kind of residency placements of students who passed and those who failed the examinations.

Results: Data analysis indicated that medical students who entered primary care and non-primary care residencies were not distinguishable on the basis of standardized examination performance. Conclusions: These results may help to refute negative stereotypes about students who enter primary care residencies and about medical schools known for promoting careers in primary care.

Background and Objectives: We designed a qualitative case study to ascertain whether attitudes and views of diabetes differ between patients with diabetes who do and do not respond well to a diabetes care intervention.

Methods: Prospective epidemiological data were used to classify and sample graduates from an outpatient diabetes care program into one of two groups: 1) positive responders (n=18) who had a 20% or greater improvement in glycemic control 6 months after the care program and 2) negative responders (n=16) who had less than a 20% improvement in glycemic control 6 months after the care program. We collected data using depth interviews and focus groups. Transcriptions were summarized and analyzed using an editing approach. The themes from these two groups were summarized and compared to ascertain similarities and differences in attitudes and views of diabetes.

Results: Four major themes emerged from the analysis. Positive and negative responders differed a) in their views of diabetes and its treatment, b) on how they incorporated diabetes care into their daily routines, c) in "conversion experiences" in which some patients became suddenly much more aware of the serious threat of diabetes to their health, and d) in their views of their medical care providers.

Conclusions: The conversion experiences observed in many of these subjects are not consistent with stage-of-change models of health-related behavior change. These data advance our understanding of patients' diabetes-related attitudes and behaviors and may be used by clinicians to monitor change in patientsÍ attitudes and expectations over time and by researchers to develop and target novel patient-centered clinical interventions to improve patient satisfaction and clinical outcomes.

Background and Objectives: Family physicians are responsible for the health and illness care of individuals with mental retardation (MR) in many community practices. Therefore, it is important to determine the special disease patterns for this group. This study determined if individuals with MR are at increased risk for selected chronic diseases.

Methods: We analyzed 366 individuals, living in the community, with a primary diagnosis of MR. The two comparison groups without MR were 427 individual Medicaid recipients and 746 privately insured individuals.

Results: Individuals with MR had higher rates of neurophysical conditions (eg, seizures, central nervous system conditions, and sensory loss) compared to the other two groups. However, they had lower rates of some chronic conditions and health behaviors (eg, hypertension, migraines/chronic headaches, diabetes, depression or anxiety, obesity, substance abuse, and smoking) compared to other Medicaid and insured patients.

Conclusions: Individuals with MR have lower rates of many chronic conditions, compared with other Medicaid recipients. This finding should reduce concerns among family physicians that treatment of this special population involves higher rates of chronic illness.

Background: The development of family medicine in Latin America is inhibited by limited resources. Successful strategies to promote the specialty include academic exchanges between countries. Short-term faculty development opportunities are needed for foreign academic family physicians.

Methods: After 2 years of unstructured visits by Latin American physicians planning to teach family medicine, we designed a faculty development course, in Spanish, that continues to evolve through constructive feedback. This includes workshops in project planning, computer training, clinical decision making, family systems, clinical teaching, problem-based learning, and clinical epidemiology. Each fellow designs a project to be implemented subsequently in the country of origin.

Results: Since 1991, we have trained 37 physicians from nine Latin American countries, 27 since 1993 in the structured course. A full schedule encourages fellows to complete course objectives within 8 weeks. All participating physicians have rated highly the course content and quality. Twenty-five of the 27 course participants are or will soon begin teaching in family practice residency programs in their home countries.

Conclusions: This faculty development course for Latin American physicians is perceived as an effective way to enhance academic skills. Ongoing evaluation will show how the fellowship impacts the physiciansÍ teaching effectiveness and the development of family medicine in their countries.