Is respite care available for chronically ill seniors?
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OBJECTIVE: To determine family physicians' perceptions of how available respite care is and how easy it is to refer chronically ill older people to it, and to examine their opinions of respite care. DESIGN: Mailed survey to family physicians on the Thames Valley Family Practice Research Unit's mailing list. SETTING: London, Ont, and surrounding area. PARTICIPANTS: Of the 448 surveys mailed to eligible physicians, 288 were completed and returned for a response rate of 64.3%. MAIN OUTCOME MEASURES: Respondents' perceptions of how available respite care is and how easy it is to refer chronically ill older people to it and their opinions on the effectiveness of respite care. RESULTS: More than half the respondents reported that outpatient respite care is always available, but how available depended on practice location. Inpatient respite care was reported as less available. More than half the respondents found referral to respite care difficult. Respondents were very positive about the role of respite services in long-term care and in lowering caregiver stress. Respondents' perceptions varied according to where they had attended medical school. Their perceptions of respite care's role in long-term care and in helping patients remain at home were influenced by whether they thought respite care was available. CONCLUSION: Family physicians need education in the value of respite services for their chronically ill older patients and their families. Physicians also need information on the respite services available and strategies for accessing them. Our findings suggest a need for greater attention to regional discrepancies in availability of services. (+info)
HMO growth and the geographical redistribution of generalist and specialist physicians, 1987-1997.
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OBJECTIVE: To assess the impact of the growth in HMO penetration in different metropolitan areas on the change in the number of generalists, specialists, and total physicians, and on the change in the proportion of physicians who are generalists. DATA SOURCES/STUDY SETTING: The American Medical Association Physician Masterfile, to obtain the number of patient care generalists and specialists in 1987 and in 1997 who were practicing in each of 316 metropolitan areas in the United States. Additional data for each metropolitan area were obtained from a variety of sources, and included HMO penetration in 1986 and 1996. STUDY DESIGN: We estimated multivariate regression models in which the change in the number of physicians between 1987 and 1997 was a function of HMO penetration in 1986, the change in HMO penetration between 1986 and 1996, population characteristics and physician fees in 1986, and the change in population characteristics and fees between 1986 and 1996. Each model was estimated using ordinary least squares (OLS) and two-stage least squares (TSLS). PRINCIPAL FINDINGS: HMO penetration did not affect the number of generalist physicians or hospital-based specialists, but faster HMO growth led to smaller increases in the numbers of medical/surgical specialists and total physicians. Faster HMO growth also led to larger increases in the proportion of physicians who were generalists. Our best estimate is that an increase in HMO penetration of .10 between 1986 and 1996 reduced the rate of increase in medical/surgical specialists by 10.3 percent and reduced the rate of increase in total physicians by 7.2 percent. CONCLUSIONS: The findings of this study support the notion that HMOs reduce the demand for physician services, particularly for specialists' services. The findings also imply that, during the past decade, there has been a redistribution of physicians-especially medical/surgical specialists-from metropolitan areas with high HMO penetration to low-penetration areas. (+info)
Urban-rural differences in total hip replacements: the next stage.
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BACKGROUND: The aim of this study was to explore the differences in the incidence of primary elective total hip replacements between urban and rural communities and different age and sex groups in Northern Ireland, and to use this information to develop an equitable method for the allocation of surgical capacity among groups of general practices, in a system where referrals are matched to the contracted capacity. METHODS: A retrospective review was performed of all cases of primary elective total hip replacement between 1 April 1994 and 31 March 1997. Incidence rates were calculated using direct standardization. Age, sex, and urban and rural specific rates for Northern Ireland were calculated and applied to each general practice population giving that practice's annual expected number of total hip replacements. RESULTS: A total of 4,147 cases were analysed. The age and sex standardized incidence of primary elective total hip replacement for the total population was 87.6 per 100,000. The incidence was significantly greater in rural populations (101.3 per 100,000), than in urban ones (77.6 per 100,000), p < 0.001. The overall standardized ratio of males to females was 1:1 although it was 1:1.2 in urban and 1:0.9 in rural populations. Using a 3 year commissioning cycle, commissioning for a population of 130,000 allows a 10 per cent margin of error in the numbers of procedures required. CONCLUSIONS: A system of calculating the expected need for a total hip replacements was developed based on the demography and rurality of individual general practices. This system allowed a method of commissioning to be instituted that could significantly reduce in-patient waiting lists for this procedure. (+info)
The intersection of race, gender, and primary care: results from the Women Physicians' Health Study.
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The Women Physicians' Health Study is a nationally distributed mailed questionnaire survey of a random sample of 4501 female physicians. We examined differences in the professional characteristics and personal health habits of minority women physicians compared to other women physicians, with regard to the choice of primary care specialties, type or location of practice site, and career satisfaction. Most women physicians were self-described as non-Hispanic white (77.4%), with 13% Asians, and few blacks (4.3%) or Hispanics (5.2%). Blacks and Hispanics were more likely to choose primary care specialties (61.6% and 57.9%, respectively, vs. 49.3% of whites, p < 0.05). Black and Hispanic physicians were most likely to practice in urban areas (71.8% and 72.2%, respectively, p < 0.001). Minority physicians were most likely to report spending some time each week on clinical work for which they did not expect compensation. Black physicians were least likely to report high levels of work control and were least likely to be satisfied with their careers. While most physicians were compliant with the examined recommendations of the U.S. Preventive Services Task Force, we did find significant differences by ethnicity in compliance with clinical breast exams, mammograms, and pap smears. In conclusion, there continues to be fewer blacks and Hispanics in the U.S. physician workforce than in the general population. Minority women physicians are more likely to provide primary care services in communities that have been traditionally underserved and may also report higher rates of career dissatisfaction. (+info)
Attitudes and practices regarding varicella vaccination among physicians in Minnesota: implications for public health and provider education.
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OBJECTIVES: This study sought to determine physicians' attitudes and practices regarding varicella vaccine. METHODS: A sample of Minnesota family physicians and pediatricians was surveyed in January 1997. RESULTS: Of 255 physicians surveyed, 108 (42%) reported routinely offering varicella vaccine. Physicians who perceived their professional organization's recommendations as "very important" were more likely to routinely offer varicella vaccine. Physicians who preferred natural disease over vaccination and those concerned about waning immunity were less likely to routinely offer vaccine. CONCLUSIONS: Recommendations of professional organizations have encouraged varicella vaccine use and may further enhance future use. Differences in pediatricians' and family physicians' attitudes and practices regarding this vaccine suggest that education of providers by specialty may be needed to increase acceptance of newly licensed vaccines. (+info)
A profile of PMS salaried GP contracts and their impact on recruitment.
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BACKGROUND: Personal medical services (PMS) pilot sites aim to use salaried GP schemes to improve GP recruitment and retention and enhance the quality of service provision, particularly in underserved areas. OBJECTIVES: Our objectives were to (i) compare the work incentives of salaried compared with standard GP contracts; (ii) assess recruitment success to salaried posts; and (iii) describe the types of GPs attracted to these new posts. METHOD: All first wave PMS pilot sites with salaried GP posts known to be 'live' in October 1998 were included in the analysis of employment contracts and job descriptions. Information on recruitment was obtained by a questionnaire survey of PMS sites that were intending to recruit a salaried GP. RESULTS: The mean full-time equivalent salary was 43,674 pounds sterling with additional benefits in terms of sick leave, maternity leave and paid expenses. Eighty-nine percent of posts were eligible for the NHS pension scheme. Posts were mainly full time (40.8 hours per week). GPs were responsible for providing services equivalent in scope to general medical services. One-fifth of contracts freed GPs from out-of-hours responsibility and most freed them from practice management. Forty-three of the pilot sites actively recruited to fill 63 salaried posts, which involved a total of 51 recruitment 'rounds', with some pilots advertising more than once. There were 291 applications. The median number of applicants per post was three and the median time to recruitment was 6 weeks. Eighty-five percent of sites were satisfied with the quality of their applicants and 64% with the quantity. Eighty-five percent of applicants previously had been working in general practice, most in locum or salaried posts. Applicants tended to be young and male. Sixty posts were filled. CONCLUSIONS: Salaried contracts offer positive incentives to recruitment in terms of reduced hours of work and freedom from administrative responsibility. Recruitment success was similar to that achieved by inner city practices generally. This modest achievement might be enhanced by the addition of professional development schemes and increased flexible/part-time working. (+info)
Do residents in a northern program have better quality lives than their counterparts in a city?
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OBJECTIVE: To determine whether McMaster University's family medicine residents training in the Family Medicine North (FMN) program have better quality lives than those based in Hamilton, Ont (urban). DESIGN: Residents at both sites were simultaneously given the Quality of Life Questionnaire, a standardized measurement tool. They were asked to complete the questionnaire anonymously and to provide demographic data. SETTING: Family practice residencies in Ontario. PARTICIPANTS: McMaster University's family medicine residents. Of 66 residents living in Hamilton, 36 completed the questionnaire; five respondents were ineligible. Of 25 residents living in Thunder Bay, Ont, 24 completed the questionnaire; none were ineligible. MAIN OUTCOME MEASURES: Total quality-of-life score. Score was divided into five major domains, each with several subdomains: general well-being (material, physical, and personal growth), interpersonal relations (marital, parent-child, extended family, and extramarital), organizational activity (altruistic and political behaviour), occupational activity (job characteristics, occupational relations, and job satisfiers), and leisure and recreational activity (creative/esthetic behaviour, sports activity, vacation behaviour). RESULTS: The FMN residents scored significantly higher than the Hamilton-based residents on overall quality of life (124.7 vs 112.5, P < .05) and tended to score higher in the five major domains. The trend reached statistical significance in general well-being and occupational activity; it was also apparent in various subdomains, with statistically significant differences in material well-being, marital relations, job characteristics, job satisfiers, and vacation behaviour. CONCLUSION: Family Medicine North residents enjoy better quality of life than their urban counterparts based on responses to a standardized questionnaire. (+info)
Physicians certified in family medicine. What are they doing 8 to 10 years later?
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OBJECTIVE: To determine field of medicine and location of a cohort of physicians certified in family medicine between 1989 and 1991 and residing in Ontario in 1993 and to gather information on the scope of practice of family physicians in the cohort in 1999. DESIGN: Responses to a mailed questionnaire sent in 1999 were compared with responses to a 1993 survey of this group. SETTING AND PARTICIPANTS: All family physicians in Ontario in 1993 who received certification in 1989, 1990, or 1991 after completing a family medicine residency. Seven of 557 respondents to the 1993 survey were ineligible; 293 physicians (53%) responded to the 1999 survey. MAIN OUTCOME MEASURES: Field, location, and scope of practice. RESULTS: About 91% of the cohort were still practising family medicine, although 11% of these had restricted their practices to certain areas within family medicine. Physicians migrated from Ontario (6%) in nearly equal numbers to other provinces and other countries, predominantly the United States. More family physicians offered counseling, shared antenatal care, and newborn care in 1999 than in 1993. Those with restricted family practices provided fewer types of services and were less likely to provide antenatal or intrapartum care or to provide in-hospital services. CONCLUSION: Receiving certification in family medicine does not guarantee that physicians will remain in family practice 8 to 10 years later. Loss from general family medicine to restricted practices within family medicine and specialization was greater than loss from migration. (+info)