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ABSTRACTS
Special
Article
Indirect
Institutional Revenue Generated From an Academic Primary
Care Clinical Network
JW Saultz; G McCarty; B Cox; D Labby; R Willams;
SA Fields
Background
and Objectives: As the financial performances of
US academic health centers have faltered under managed
care and the Balanced Budget Act of 1997, increasing
attention has been paid to the costs and benefits of
operating primary care networks. This study examines
the indirect revenues to a university hospital and faculty
group practice that result from such a primary care
network using a method of abstracting billing data.
Methods: A primary care patient cohort was identified
by selecting all patients who generated at least one
charge in any of the 10 primary care clinics in the
network over a 15-month period. All charges from the
hospital and the faculty practice group for this cohort
were then examined during a 6-month period, and the
total charges generated in the primary care setting
were compared with charges generated elsewhere in the
health system. Results: The primary care patient
cohort included 56,459 patients and generated a total
of $7,243,312 in charges for primary care services,
$43,559,741 of charges in the hospital billing system
for non-primary care services, and $8,825,611 of charges
for services from specialty faculty. This cohort accounted
for 18.5% of the gross charges for hospital care and
17.6% of charges generated by the specialty physicians.
Conclusions: Using a simple and replicable methodology,
this study estimates a substantial financial benefit
to the hospital and specialty practices from a primary
care network.
(Fam Med 2001;33(9):668-71.)
Residency
Education
The
Current Status of Balint Groups in US Family Practice
Residencies: A 10-year Follow-up Study, 1990-2000
AH Johnson; CD Brock; G Hamadeh; R Stock
Background
and Objectives: In 1990, the first and, to date,
only objective study of Balint groups in US family practice
residencies was conducted to measure their prevalence,
composition, leadership, and function. The study reported
here collected similar information about Balint groups.
Methods: Surveys were sent to all 464 US family
practice residency program directors, with a 1-month
follow-up to nonrespondents. The survey included questions
about the existence, leadership, meeting frequency,
and objectives of Balint training. Results: A
total of 298 (64%) residencies responded. Almost half
(48%) of US responding residences reported conducting
Balint groups, and 40% of those residencies have more
than one group. The frequency of Balint group meetings
has shifted in the past 10 years. In 1990, 55% of groups
met weekly; in 2000, only 15% of groups met weekly.
Sixty-five percent of residencies require Balint participation.
One third of Balint groups are conducted without a coleader,
and the number of physicians leading groups is 22%,
a decrease of 10% from 10 years ago. Forty-four percent
of groups are led by psychologists, an increase of 19%
from 10 years ago. Respondents indicated uncertainly
about whether their groups were true Balint groups or
simply resident support groups. Conclusions:
About half of US family practice residencies operate
groups described as Balint groups. They meet less frequently
then 10 years ago and are less likely to have a physician
involved in group leadership. Some of the groups may
actually be support groups rather than Balint groups.
(Fam Med 2001;33(9):672-7.)
Job
Satisfaction of Family Practice Residents
S Weaver; TL Mills; C Passmore
Background and Objectives: As new market forces
and expanding responsibilities strongly influence our
specialty, it is vital to understand issues that affect
resident recruitment, retention, and performance. This
study evaluated family practice residents' satisfaction
with their chosen careers, their individual programs,
and many of the other factors that potentially influence
and contribute to job satisfaction. Methods:
Data were collected using a 56-item questionnaire that
included demographic information and specific questions
regarding residency job satisfaction. The questionnaire
was mailed to all 28 Texas family practice residency
programs. Results: We received results from 75%
of surveyed residents. "Overall satisfaction with family
practice as a specialty" received the highest satisfaction
ranking. Satisfaction with 25 various aspects of family
practice residency training was significantly higher
in community-based programs, compared with university-based
programs, and satisfaction increased with year level
of training. Items that were ranked higher by community-based
residents included satisfaction with their specific
residency program, obstetrics experience, overall learning
environment, degree of autonomy, and relationship with
specialists. Conclusions: This report demonstrates
a strong degree of overall job satisfaction among family
practice residents. In general, residents in community-based
programs have a higher level of job satisfaction, compared
with residents in university-based programs, and satisfaction
increases with year level of training.
(Fam Med 2001;33(9):678-82.)
Medical
Student Education
Quality
of a Family Medicine Preceptorship Is Significantly
Associated With Matching Into Famly Practice
BT
Levy; A Hartz; ML Merchant; BT Schroeder
Objectives:
This study tested whether clinical experiences in family
practice are associated with matching into family practice.
Methods: We conducted a prospective cohort study
of 913 medical students who completed the Family Practice
Preceptorship (FPP) at the University of Iowa from 1990*1996.
Using univariate techniques and logistic regression,
we compared the background and experiences of those
who matched into family practice with those who chose
other specialties. Results: Twenty-nine percent
(n=267) matched into family practice. Positive independent
predictors of family practice match were hometown size
less than 10,000 (odds ratio [OR] 1.8), anticipating
choosing family practice at matriculation (OR 4.2),
and liking to help others (OR 4.1). Negative independent
predictors included parental income of at least $120,000
(OR .61), desiring to perform technical procedures (OR
.51), and liking the scientific method and research
(OR .54). The effect of an early summer clinical experience
at a community hospital varied depending on the level
of student interest in family practice at matriculation.
Students who rated the educational value of the FPP
as high or very high were significantly more likely
to go into family practice (OR 2.9), even after adjusting
for all other student characteristics. Conclusions:
A number of student characteristics and preferences,
early clinical experiences, and the perceived quality
of a required family medicine preceptorship were significantly
and independently associated with students matching
into family practice.
(Fam Med 2001;33(9):683-90.)
Clinical
Research and Methods
Maternal
Ratings of Child Behavior Improve With Treatment of
Maternal Depression
JD
Modell; JG Modell; J Wallander; B Hodgens; L Duke
Background
and Objectives: Maternal reports of child behavior
are often the sole criterion by which childhood psychiatric
disorders are diagnosed and treated, even though maternal
distress or psychopathology may influence the accuracy
of these reports. This study examines the effect of
maternal depression and the impact of its treatment
on reported behavior in the depressed women's children.
Methods: A total of 24 women with newly diagnosed
major depressive disorder completed a self-rated Beck
Depression Inventory (BDI) and a Conners' Parent Rating
Scale (CPRS) of child behavior prior to and after 1*2
months of antidepressant treatment. Results:
During antidepressant treatment, mean maternal BDI declined
by 53%, while mean CPRS score decreased by 20%; these
improvements were significantly correlated. Changes
in the conduct, learning problem, and impulsive-hyperactive
CPRS-subscale scores accounted for 89% of the rated
behavioral change. Conclusions: Reported behavior
problems in the children of depressed mothers improved
with treatment of the maternal depression, and the degree
of reported behavioral improvement was highly correlated
with the degree of improvement in depressive symptoms.
Maternal depression must therefore be considered in
the differential diagnosis of any child being evaluated
for behavior or emotional problems.
(Fam Med 2001;33(9):691-5.)
International
Family Medicine
Bringing
A Family Practice Model of Health to the People's Republic
of China
LZ
Nieman; J Kvale; X Fu; Y Gu; HW Strobel
The
health care system in the People's Republic of China
(PRC) is undergoing a major transition that has made
the government revise its approach to how medicine is
taught and practiced. Family medicine, which provides
a generalist approach to medical care, is at the forefront
of this transition. This article reviews the recent
history of medical education in the PRC, including the
establishment of the discipline of family medicine in
the mid 1980s, and factors promoting development of
family medicine. These include the movement away from
government-subsidized health care in hospital settings,
the aging population, increased urbanization, increasing
incidence of infectious diseases, and rising health
care costs. We conclude from observations made in the
PRC and from a review of secondary sources that family
medicine in China is in its infancy. The value of understanding
the role that family medicine plays within China's changing
health care system is that we gain a broader perspective
of the variety and growing international importance
of family practice as a profession.
(Fam Med 2001;33(9):696-701.)
On
the Biopsychosical Model: The Example of Political Economic
Causes of Diabetes in the Marshall Islands
S
Yamada; NA Palafox
Biomedical
reductionism, the unwritten theory underlying the practice
of medicine, is being supplanted by the biopsychosocial
model. The explanatory power of the biopsychosocial
model, however, is hampered by an inadequate mechanism
to account for the social production of disease. We
examine diabetes in the Marshall Islands to explore
a conceptual approach that incorporates ecology, history,
and political economy into the biopsychosocial model.
The use of the Marshall Islands by the United States
as testing grounds for nuclear war has led to ecological
destruction, population displacement, and economic dependency.
The consequence at the biological level has been an
epidemic of weight gain, altered metabolism, and diabetes.
A political economic perspective reveals that such outcomes
are the result of decisions made by those who do not
live with these decisions. Such a perspective points
the way for social engagement and political work toward
justice and health.
(Fam Med 2001;33(9):702-4.)
Innovations
in Family Medicine Education
Colposcopy
101: A Didactic Curriculum to Complement the Clinical
Experience
John E. Delzell, Jr, MD, MSPH; Susan L. Pereira,
MD; Jacqueline Ruplinger, MD
The
family medicine faculty who perform colposcopy at the
University of Missouri-Columbia have developed an innovative
didactic curriculum that is used as an adjunct to the
clinical experience in teaching family practice residents
about colposcopy. The curriculum is taught weekly during
a colposcopy conference that is held in the family practice
center and includes core topic lectures, pathology-correlate
lectures, and a journal club. The core lecture series
has 26 topics that range from basic to advanced colposcopy.
Pathology-correlate lectures combine pathologic evaluation
with the clinical colposcopic examination. The journal
club systematically reviews and evaluates the colposcopy
literature.
(Fam Med 2001;33(9):658-60.)
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