Primary care physicians' decisions about discharging patients from their practices.
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ABSTRACT:
SUBMITTER: Farber NJ
PROVIDER: S-EPMC2359473 | biostudies-other | 2008 Mar
REPOSITORIES: biostudies-other
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Project description:BackgroundExperienced and anticipated regret influence physicians' decision-making. In medicine, diagnostic decisions and diagnostic errors can have a severe impact on both patients and physicians. Little empirical research exists on regret experienced by physicians when they make diagnostic decisions in primary care that later prove inappropriate or incorrect. The aim of this study was to explore the experience of regret following diagnostic decisions in primary care.MethodsIn this qualitative study, we used an online questionnaire on a sample of German primary care physicians. We asked participants to report on cases in which the final diagnosis differed from their original opinion, and in which treatment was at the very least delayed, possibly resulting in harm to the patient. We asked about original and final diagnoses, illness trajectories, and the reactions of other physicians, patients and relatives. We used thematic analysis to assess the data, supported by MAXQDA 11 and Microsoft Excel 2016.Results29 GPs described one case each (14 female/15 male patients, aged 1.5-80 years, response rate < 1%). In 26 of 29 cases, the final diagnosis was more serious than the original diagnosis. In two cases, the diagnoses were equally serious, and in one case less serious. Clinical trajectories and the reactions of patients and relatives differed widely. Although only one third of cases involved preventable harm to patients, the vast majority (27 of 29) of physicians expressed deep feelings of regret.ConclusionEven if harm to patients is unavoidable, regret following diagnostic decisions can be devastating for clinicians, making them 'second victims'. Procedures and tools are needed to analyse cases involving undesirable diagnostic events, so that 'true' diagnostic errors, in which harm could have been prevented, can be distinguished from others. Further studies should also explore how physicians can be supported in dealing with such events in order to prevent them from practicing defensive medicine.
| S-EPMC7079478 | biostudies-literature
Project description:To assess knowledge, attitudes, and practices of primary care physicians (PCPs) toward topical corticosteroids (TCs). Methods: A cross-sectional, 53-item questionnaire based study on TCs was conducted among PCPs in Riyadh, Kingdom of Saudi Arabia between January and March 2015. A maximum score of 30 was calculated for the knowledge portion. Results: Out of 420 PCPs, 336 responded (80%). Most participants (89.6%) reported prescribing TCs. The mean knowledge score was 17.14 (SD=5.48). Only 39% PCPs correctly identified that there are 7 or 4 TCs potency groups (2 different classification systems). The MBBS/MD and diploma-certified physicians scored lower than board-qualified PCPs (p less than 0.05). Family medicine physicians scored higher than general practitioners (GPs) (p less than 0.05). Hospital-based PCPs scored better than private practice PCPs (p less than 0.05). Moreover, those who felt somewhat comfortable (32.5%) in treating dermatology patients were more knowledgeable (p less than 0.05). Lastly, 76.5% of physicians were interested in attending courses on dermatologic therapies. Conclusion: Knowledge of TCs among PCPs was inadequate. Targeted educational interventions delivered by dermatologists are recommended.
| S-EPMC5541192 | biostudies-other
Project description:We examined the knowledge, attitudes, and practices of primary care doctors in Ulaanbaatar, Mongolia using a recently developed World Hypertension League survey. The survey was administered as part of a quality assurance initiative to enhance hypertension control. A total of 577 surveys were distributed and 467 were completed (81% response rate). The respondents had an average age of 35 years and 90.1% were female. Knowledge of hypertension epidemiology was low (13.5% of questions answered correctly); 31% of clinical practice questions had correct answers and confidence in performing specific tasks to improve hypertension control had 63.2% "desirable/correct" answers. Primary care doctors mostly had a positive attitude toward hypertension management (76.5% desirable/correct answers) and highly prioritized hypertension management activities (85.7% desirable/correct answers). Some important highlights included the majority (> 80%) overestimating hypertension awareness, treatment, and control rates; 78.2% used aneroid blood pressure manometers; 15% systematically screened adults for hypertension in their clinics; 21.8% reported 2 or more drugs were required to control hypertension in most people; and 16.1% reported most people could be controlled by lifestyle changes alone. 55% of respondents were not comfortable prescribing more than 1 or 2 antihypertensive drugs in a patient and the percentage of desirable/correct responses to treating various high-risk patients was low. Most (53%-74%) supported task shifting to nonphysician health care providers except for drug prescribing, which only 13.9% supported. A hypertension clinical education program is currently being designed based on the specific needs identified in the survey.
| S-EPMC8030928 | biostudies-literature
Project description:BackgroundThe Centers for Disease Control and Prevention recommends routine HIV testing in all healthcare settings, but it is unclear how consistently physicians adopt the recommendation. Making the most of each interaction between black physicians and their patients is extremely important to address the HIV health disparities that disproportionately afflict the black community. The goal of this survey-based study was to evaluate the perceptions and practices of black, primary care physicians regarding HIV testing.MethodsA physician survey was administered at the 2010 National Medical Association Annual Convention, via online physician panels, and by email. Physician eligibility criteria: black race; practicing at least 1 year in the US; practice comprised of at least 60% adults and 20% black patients. Contingency tables and ordinary least squares regression were used for comparisons and statistical analyses. A Chi-square test compared percentages of physicians who gave a particular response and a t-test compared the means of values provided by physicians.ResultsPhysicians over-estimated HIV prevalence and believed that HIV is a crisis in the black community, yet reported that only 34% of patients were HIV tested in the past year. Physicians reported that 67% of those patients tested did so due to a physician recommendation. Physicians who were younger, female, obstetricians/gynecologists, and had a higher proportion of black, low-socioeconomic status, and Medicaid patients reported higher testing rates. Most testing was risk-based rather than routine, and three of the five most commonly reported barriers to testing were related to disease stigma and perceived value judgments. Physicians reported that in-office patient informational materials, increased media attention, additional education and training on HIV testing, government mandates requiring routine testing, and accurate pre-packed tests would most help them test more frequently for HIV.ConclusionsIn this sample of black, primary care physicians, HIV testing practices differed according to physician characteristics and practice demographics, and overall reported testing rates were low. More physician education and training around testing guidelines is needed to enable more routine testing, treatment, and long-term management of patients with HIV.
| S-EPMC3599058 | biostudies-literature
Project description:INTRODUCTION:Primary care practices are essential settings for Advance Care Planning (ACP) conversations with patients. We hypothesized that such conversations occur more routinely in Advanced Primary Care/Patient Centered Medical Home (APCP/PCMH) Practices using practice transformation strategies. METHODS:We analyzed characteristics of physician respondents and their practices associated with ACP discussions in older and sicker patients using US data from the 2015 Commonwealth Fund International Survey of Primary Care Physicians in 10 Nations. The primary outcome was how routinely these ACP conversations are reported. We developed an index of APCP/PCMH features as a practice covariable. RESULTS:Respondents (N = 1001) were predominantly male (60%) and ≥45 years old (74%). Multivariable analyses showed that suburban practice location was associated with fewer ACP conversations; working in a practice commonly seeing patients with multiple chronic conditions or who have palliative care needs, and working in a practice from which home visits are made, were associated with more ACP conversations. Physicians compensated in part by capitation were more likely to report ACP conversations. No association was found between a single item asking if the practice was an APCP/PCMH and having ACP conversations. However, higher scores on an index of APCP/PCMH features were associated with more ACP conversations. CONCLUSIONS:In this sample of US primary care physicians, the types of patients seen, practice location, and physician compensation influenced whether physicians routinely discuss ACP with patients who are older and sicker. Practices demonstrating more features of APCP/PCMH models of primary care are also associated with ACP discussions.
| S-EPMC7406384 | biostudies-literature
Project description:BACKGROUND:Burnout among primary care physicians, advanced practice clinicians (nurse practitioners and physician assistants [APCs]), and staff is common and associated with negative consequences for patient care, but the association of burnout with characteristics of primary care practices is unknown. OBJECTIVE:To examine the association between physician-, APC- and staff-reported burnout and specific structural, organizational, and contextual characteristics of smaller primary care practices. DESIGN:Cross-sectional analysis of survey data collected from 9/22/2015-6/19/2017. SETTING:Sample of smaller primary care practices in the USA participating in a national initiative focused on improving the delivery of cardiovascular preventive services. PARTICIPANTS:10,284 physicians, APCs and staff from 1380 primary care practices. MAIN MEASURE:Burnout was assessed with a validated single-item measure. KEY RESULTS:Burnout was reported by 20.4% of respondents overall. In a multivariable analysis, burnout was slightly more common among physicians and APCs (physician vs. non-clinical staff, adjusted odds ratio [aOR]?=?1.26; 95% confidence interval [CI], 1.05-1.49, APC vs. non-clinical staff, aOR?=?1.34, 95% CI, 1.10-1.62). Other multivariable correlates of burnout included non-solo practice (2-5 physician/APCs vs. solo practice, aOR?=?1.71; 95% CI, 1.35-2.16), health system affiliation (vs. physician/APC-owned practice, aOR?=?1.42; 95%CI, 1.16-1.73), and Federally Qualified Health Center status (vs. physician/APC-owned practice, aOR?=?1.36; 95%CI, 1.03-1.78). Neither the proportion of patients on Medicare or Medicaid, nor practice-level patient volume (patient visits per physician/APC per day) were significantly associated with burnout. In analyses stratified by professional category, practice size was not associated with burnout for APCs, and participation in an accountable care organization was associated with burnout for clinical and non-clinical staff. CONCLUSIONS:Burnout is prevalent among physicians, APCs, and staff in smaller primary care practices. Members of solo practices less commonly report burnout, while members of health system-owned practices and Federally Qualified Health Centers more commonly report burnout, suggesting that practice level autonomy may be a critical determinant of burnout.
| S-EPMC6258608 | biostudies-literature
Project description:BackgroundThe essence of humanism in medicine and health care is relationships-caring relationships between clinicians and patients. While raising concerns regarding professional-patient boundaries has positively contributed to our understanding and prevention of potentially harmful boundary violations, there is controversy about which types of relationships, caring acts, and practices are acceptable versus cross boundary lines.ObjectiveTo examine primary care physicians' practices and attitudes regarding acts that have been questioned as potentially "inappropriate" or "unethical" crossing of professional-patient boundaries.DesignSurveys conducted via in-person polling or electronic and mailed paper submissions from April 2016 to July 2017. We calculated descriptive statistics and examined associations with practices and attitudes using logistic regression.ParticipantsRandom sample of all US primary care physicians who treat adult patients; convenience sample of attendees at medicine grand rounds presentations.Main measuresOutcomes were self-reported practices and attitudes related to giving patients rides home, paying for patients' medication, helping patients find jobs, employing patients, going to dinner with patients, and providing care to personal friends.Key resultsAmong 1563 total respondents, 34% had given a ride home, 34% had paid for medications, 15% helped patients find a job, 7% had employed a patient, 10% had dinner with patients, and 59% provided care to personal friends. A majority disapproved of dinner with a patient (75%) but approved of or were neutral on all other scenarios (61-90%).ConclusionsThe medical profession is quite divided on questions related to drawing lines about appropriate boundaries. Contrary to official and widespread proscriptions against such practices (with exception of dinner dates), many have actually engaged in such practices and the majority found them acceptable.
| S-EPMC7018879 | biostudies-literature
Project description:BACKGROUND/AIM:Early diagnosis of chronic illnesses and cancers mainly occurs at primary health care centers (PHCs) by primary health care physicians (PHPs). The incidence of colorectal cancer (CRC) in the Kingdom of Saudi Arabia (KSA) is rising and this has been attributed to many factors. The increasing incidence of CRC is compounded by nonadherence to screening recommendations. Therefore, evaluating PHPs knowledge, attitudes, and practices of screening for CRC is clinically important. We aimed to evaluate the knowledge, attitudes, and practices of PHPs regarding CRC screening and to identify the factors associated with nonadherence of PHPs to screening recommendations. MATERIALS AND METHODS:PHPs working at three tertiary care centers and PHCs across the city of Jeddah were randomly recruited. Participants were surveyed using a comprehensive questionnaire that recorded data on demographics, qualifications, and knowledge of various modalities and guidelines related to CRC screening. Perspectives about effectiveness of, or adherence to, factors that influence physicians' perspectives or recommendations for CRC screening were also assessed. Logistic regression analysis was used to identify physician characteristics associated with PHPs perspectives and nonadherence to CRC screening. RESULTS:A total of 127 PHPs were recruited. The average age of participants was 34 (±8.4) years, 86.6% were native Saudi's and 56.7% were females. The majority of surveys (66.9%) were completed at 24 PHCs and the remaining at hospital-based family medicine clinics. Most of the PHPs (55%) had a bachelor's degree and 31.5% were board-certified or carried a PhD in family medicine; 95% of participants believed that CRC screening in general was effective, but as much as 55% reported that they did not practice screening. The male physicians [odds ratio (OR) = 0.44, 95% confidence interval (CI) = 0.19-0.99, P = 0.048)] and PHPs with only a bachelor degree or less (OR = 0.72, 95% CI = 0.55-0.93, P = 0.011) were less likely to recommend screening for CRC. CONCLUSIONS:A considerable proportion of PHPs do not adhere to CRC screening recommendations despite a wide belief that screening is effective. Male PHPs with lower qualifications appear to be less likely to recommend screening.
| S-EPMC5738794 | biostudies-literature
Project description:BackgroundCongenital cytomegalovirus (cCMV) affects 1 in every 200 United States infants, at present there are 9 states which mandate newborn cCMV screening. With more infants being diagnosed, more children will need continuing care from providers who are knowledgeable about cCMV.ObjectivesTo examine pediatric provider knowledge, practices, and beliefs around cCMV.MethodsPrimary care and newborn hospitalist pediatricians (N = 103) from Michigan, who "regularly care for infants" were invited to participate in a survey about their cCMV-related knowledge, clinical practices, and beliefs.ResultsRespondents had low knowledge of typical cCMV presentation and sequelae, with mixed knowledge of screening and testing standards. Most (68%) reported rarely/never screening for cCMV, though 71% strongly agreed/agreed that primary care providers should test for cCMV. Most (90%) strongly agreed/agreed that infants who fail/refer on their newborn hearing screen should be tested for cCMV, yet 81% expressed not being comfortable diagnosing and managing cCMV. Most (72%) felt that cCMV was not sufficiently covered in their medical training; almost all respondents endorsed interest in learning more.ConclusionsPrimary care and newborn hospitalists in this study expressed mixed knowledge about, infrequent practice of and low comfort with screening and caring for children with cCMV. This may present a prime opportunity for education and clinician support by professional organizations.
| S-EPMC9244937 | biostudies-literature
Project description:Introduction: Lifestyle medicine (LM) uses therapeutic lifestyle behavior change to address the root causes of chronic diseases. The purpose of this study was to assess family physicians' perceptions and utilization of LM principles in their primary care practices, as well as identify reported barriers to implementation. Methods: A survey was administered to 5770 family physicians registered with the American Academy of Family Physicians (AAFP). The survey questions assessed the gap between perception and practice of LM core competencies and the 6 domains of LM. Results: The responses from 447 family physicians were included in the study. Respondents' perceived importance and reported practice was higher for clinical skills compared to the community partnerships and advocacy. There was a substantial gap in the reported comfort with and practice of certain LM domains, such as sleep (47%) and relationships (39.4%). However, LM board-certified physicians had a significantly higher frequency of practice in these domains. The majority of participants identified both difficulty with changing patient behavior (89%) and having limited time (81%) as major barriers to incorporate LM into their practice. Conclusion: Lifestyle medicine concepts resonate strongly with family physicians although gaps exist surrounding engaging in community partnerships, advocacy, and certain domains of LM. This study assesses family physicians' perceptions and utilization of LM principles in their primary care practices, and identifies reported barriers to implementation.
| S-EPMC10498979 | biostudies-literature