Physician Dual Practice: Access Enhancement or Demand Inducement?

In many developing countries, the majority of physicians employed in government clinics also have a private practice. We develop a simple model to show that allowing dual practice helps low-income governments retain skilled physicians to assure patient access. If dual-practice providers differentially refer higher-income patients to private practice, public funding becomes more effectively targeted on the poor. Yet dual practice physicians may also skimp on effort, pilfer supplies, and induce demand. Patterns of care-seeking in Indonesia, especially disproportionate use of private providers by the urban poor, are consistent with exacerbated incentive for physician self-referral to private practice in urban areas.

Gaston Memorial Hospital: Driving Quality Improvement With Data, Guidelines, and Real-Time Feedback

Describes efforts to reduce variance in provider practice patterns through data analysis and benchmarking of process-of-care measures. Discusses strategies such as sharing data, feedback, and best practices in ways physicians can utilize them immediately

Rural Idaho Family Physicians’ Scope of Practice

Context: Scope of practice is an important factor in both training and recruiting rural family physicians. Purpose: To assess rural Idaho family physicians’ scope of practice and to examine variations in scope of practice across variables such as gender, age and employment status. Methods: A survey instrument was developed based on a literature review and was validated by physician educators, practicing family physicians and executives at the state hospital association. This survey was mailed to rural family physicians practicing in Idaho counties with populations of less than 50,000. Descriptive, bivariate and multivariate analyses were employed to describe and compare scope of practice patterns. Results: Responses were obtained from 92 of 248 physicians (37.1% response rate). Idaho rural family physicians reported providing obstetrical services in the areas of prenatal care (57.6%), vaginal delivery (52.2%) and C-sections (37.0%) and other operating room services (43.5%), esophagogastroduodenoscopy (EGD) or colonoscopy services (22.5%), emergency room coverage (48.9%), inpatient admissions (88.9%), mental health services (90.1%), nursing home services (88.0%), and supervision to midlevel care providers (72.5%). Bivariate analyses showed differences in scope of practice patterns across gender, age group and employment status. Binomial logistic regression models indicated that younger physicians were roughly three times more likely to provide prenatal care and perform vaginal deliveries than older physicians in rural areas. Conclusion: Idaho practicing rural family physicians report a broad scope of practice. Younger, employed and female rural family medicine physicians are important subgroups for further study

Primary care physician practices in the diagnosis, treatment and management of men with chronic prostatitis/chronic pelvic pain syndrome.

To describe practice patterns of primary care physicians (PCPs) for the diagnosis, treatment and management of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), we surveyed 556 PCPs in Boston, Chicago, and Los Angeles (RR=52%). Only 62% reported ever seeing a patient like the one described in the vignette. In all, 16% were 'not at all' familiar with CP/CPPS, and 48% were 'not at all' familiar with the National Institutes of Health classification scheme. PCPs reported practice patterns regarding CP/CPPS, which are not supported by evidence. Although studies suggest that CP/CPPS is common, many PCPs reported little or no familiarity, important knowledge deficits and limited experience in managing men with this syndrome

Clinical use of probiotics: A survey of physicians’ beliefs and practice patterns

Background: Probiotics have the potential to be used as a preventive agent or adjuvant therapy for various medical conditions, and recent research is beginning to illuminate some of the associated benefits. Some clinicians currently prescribe probiotics in practice. Understanding physicians’ beliefs and practice patterns regarding the use of probiotics will help identify current practices, barriers preventing their acceptance, and the sources of information that impact clinical practice. Objective: To identify and describe physicians’ beliefs and practice patterns regarding the use of probiotics. Methods: A cross-sectional online questionnaire was administered to 130 physicians employed by or affiliated with Danville Regional Medical Center, a 350- bed, acute care facility located in Danville, VA. Data were analyzed using descriptive frequencies, Pearson’s chi-square, and the Student’s t-test. Results: Of the 27 valid responses (20.8%), 55.6% of physicians reported using probiotics in clinical practice (n = 15). Those who used probiotics were significantly more likely to agree that probiotics have clinically beneficial effects (p \u3c 0.017) and pose minimal risk (p \u3c 0.003) than those who don’t use probiotics (n = 12, 44.4%). Physicians using probiotics were also less likely to agree that more clinical evidence is needed to support the benefits of probiotics for their specialty (p \u3c 0.012), and more likely to indicate “peer practice patterns” (p \u3c 0.032) as prompting their use, whereas those not using probiotics were more likely to choose “original research ii i articles” (p \u3c 0.006) as a source of information that would potentially change their practice with regard to probiotics. Conclusions: Physicians’ beliefs regarding the use of probiotics differ between those who recommend their use in clinical practice and those who do not. Physicians not using probiotics feel that more evidence-based research is needed to support their use in clinical practice

How Physicians React to Cost-Effectiveness Information

Since 1998, the growth of health care spending has accelerated to levels not seen since the 1980s. This growth has renewed pressures on physicians to practice “cost-effective” care, since physicians’ decisions account for the vast majority of all health care spending. But little is known about what physicians think about cost containment, and how they incorporate cost-effectiveness information into their practice patterns. This Issue Brief summarizes three related studies that describe primary care physicians’ attitudes toward considering costs in their clinical decisions, and the effects of providing cost-effectiveness information on physicians’ recommendations

Teaching Physicians Procedural Skills at a National Professional Meeting

Background: Practicing physicians often wish to improve their procedural skills but have limited educational opportunities to do so. Description: To summarize the effects of two procedural workshops on participants’ confidence, proficiency, and practice patterns. Evaluation: Following completion of a skin biopsy or arthrocentesis workshop, participants completed a post-course and an 8-month follow up evaluation. Recipients of this training rated it highly and reported that following training they performed more procedures, referred less, and noted an increase in their confidence that was still evident eight months after the workshop. Conclusion: Skin biopsy and arthrocentesis/joint injection skills can be taught to practicing physicians in a workshop setting at national professional meetings. Key Words: clinical competence; internal medicine; teaching; educational measuremen

Patterns of ambulatory care in internal medicine: the national ambulatory medical care survey, United States, January 1980-December 1981

Data on the ambulatory medical care provided during visits to office-based internists are presented. Individual practice profiles are drawn for female and male physicians and for different age groups of physicians. Patterns of care are described for physicians in solo or other practices and for those in the four major geographic regions and in metropolitan and nonmetropolitan areas. Descriptors of practice include patient demographic characteristics, prior visit status, and patient condition. Data are also presented on the patient management techniques utilized, including diagnostic services, medication therapy, and nonmedication therapy. Comparisons are made between practice patterns of internists and other specialists.Includes bibliographical references (p. 16)