Study objective: We sought to determine the number of interruptions and to characterize tasks performed in emergency departments compared with those performed in primary care off ices. Methods: We conducted an observa...
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Study objective: We sought to determine the number of interruptions and to characterize tasks performed in emergency departments compared with those performed in primary care off ices. Methods: We conducted an observational time-motion, task-analysis study in 5 nonteaching community hospitals and 22 primary care offices in 5 central Indiana cities. Twenty-two emergency physicians and 22 office-based primary care physicians (PCPs) were observed at work. The number of interruptions, tasks, simultaneous tasks, and patients concurrently managed were recorded in 1-minute increments during 150- to 210-minute observation periods. Results: Emergency physicians were interrupted an average of 9.7 times per hour compared with 3.9 times per hour for PUS, for an average difference of 5.8 times per hour (95% confidence interval [Cl] 4.2 to 7.4). PCPs spent an average of 11.4 minutes per hour performing simultaneous tasks compared with 6.4 minutes per hour for emergency physicians (average difference, 5.0 minutes;95% Cl 12 to 8.8). Emergency physicians spent an average of 37.5 minutes per hour managing 3 or more patients concurrently compared with 0.9 minutes per hour for PCPs. PCPs spent significantly more time performing direct patient care, and emergency physicians spent significantly more time in analyzing data, charting, and taking reports on patients. Conclusion: Emergency physicians experienced more interruptions and managed more patients concurrently than PCPs. PCPs spent more time performing simultaneous tasks than emergency physicians. Our study suggests there are important ergonomic differences between emergency medicine and off ice-based primary care work environments that may require different training approaches, design considerations, and coping strategies.
Over the past decade, the US health-care system has fallen into crisis. The nation□s health expenditures have increased 57.5%, from $699.4 billion in 1990 to an estimated $1.2 trillion in 1999 (1). Despite these incr...
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Over the past decade, the US health-care system has fallen into crisis. The nation□s health expenditures have increased 57.5%, from $699.4 billion in 1990 to an estimated $1.2 trillion in 1999 (1). Despite these increases, a growing number of Americans lack health insurance. In 1999, nearly 46 million US citizens (about 20% of the population) were uninsured (2). Because the health-care system has four distinct financers of care—employers, government, individuals, and providers—few, if any, Americans benefit from a coordinated continuum of care.
PURPOSE: To determine the association between cigarette smoking and the incidence of type 2 diabetes mellitus. SUBJECTS AND METHODS: We studied 21,068 US male physicians aged 40 to 84 years in the Physicians' Heal...
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PURPOSE: To determine the association between cigarette smoking and the incidence of type 2 diabetes mellitus. SUBJECTS AND METHODS: We studied 21,068 US male physicians aged 40 to 84 years in the Physicians' Health Study who were initially free of diagnosed diabetes mellitus, cardiovascular disease, and cancer. Information about cigarette smoking and other risk indicators was obtained at baseline. The primary outcome was reported diagnosis of type 2 diabetes mellitus. RESULTS: During 255,830 person-years of follow-up, 770 new cases of type 2 diabetes mellitus were identified. Smokers had a dose-dependent increased risk of developing type 2 diabetes mellitus: compared with never smokers, the age-adjusted relative risk was 2.1 (95% confidence interval [CI]: 1.7 to 2.6) for current smokers of greater than or equal to 20 cigarettes per day, 1.4 (95% CT: 1.0 to 2.0) for current smokers of <20 cigarettes per day, and 1.2 (95% CI: 1.0 to 1.4) for past smokers. After multivariate adjustment for body mass index, physical activity, and other risk factors, the relative risks were 1.7 (95% CI: 1.3 to 2.3) for current smokers of 20 cigarettes per day, 1.5 (95% CI: 1.0 to 2.2) for current smokers of <20 cigarettes per day, and 1.1 (95% CI: 1.0 to 1.4) for past smokers. Total pack-years of cigarette smoking was also associated with the risk of type 2 diabetes mellitus (P for trend <0.001). CONCLUSIONS: These prospective data support the hypothesis that cigarette smoking is an independent and modifiable determinant of type 2 diabetes mellitus. Am J Med. 2000;109: 538-542. (C) 2000 by Excerpta Medica, Inc.
PURPOSE: Although infections associated with indwelling urinary catheters are common, costly, and morbid, the use of these catheters is unnecessary in more than one-third of patients. We sought to assess whether atten...
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PURPOSE: Although infections associated with indwelling urinary catheters are common, costly, and morbid, the use of these catheters is unnecessary in more than one-third of patients. We sought to assess whether attending physicians, medical residents, and medical students are aware if their hospitalized patients have an indwelling urinary catheter, and whether physician awareness is associated with appropriate use of these catheters. METHODS: The physicians and medical students responsible for patients admitted to the medical services at four university-affiliated hospitals were given a list of the patients on their service. For each patient, the provider was asked: "As of yesterday afternoon, did this patient have an indwelling urethral catheter?" Respondents' answers were compared with the results of examining the patient. RESULTS: Among 288 physicians and students on 56 medical teams, 256 (89%) completed the survey. Of 469 patients, 117 (25%) had an indwelling catheter. There were a total of 319 provider-patient observations among these 117 patients. Over all, providers were unaware of catheterization for 88 (28%) of the 319 provider-patient observations. Unawareness rates by level of training were 21% for students, 22% for interns, 27% for residents, and 38% for attending physicians (P = 0.06). Catheter use was inappropriate in 36 (31%) of the 117 patients with a catheter. Providers were unaware of catheter use for 44 (41%) of the 108 provider-patient observations of patients who were inappropriately catheterized. Catheterization was more Likely to be appropriate if respondents were aware of the catheter (odds ratio = 3.7;95% confidence interval, 2.1 to 6.7, P<0.001). CONCLUSION: Physicians are commonly unaware that their patients have an indwelling urinary catheter. Inappropriate catheters are more often "forgotten" than appropriate ones. System-wide interventions aimed at discontinuing unnecessary catheterization seem warranted. Am J Med. 2000;109: 476-480. (
Colorectal cancer ranks fourth in incidence and second in cause of death from cancer in the United States (1). Although virtually every study has reported a positive association between cigarette smoking and adenomato...
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Colorectal cancer ranks fourth in incidence and second in cause of death from cancer in the United States (1). Although virtually every study has reported a positive association between cigarette smoking and adenomatous polyps, the evidence regarding smoking and colorectal cancer is less clear, probably because of a long induction period (2). We, therefore, examined lifetime smoking history and incidence of colorectal cancer in a large cohort of men followed for more than 12 years. In 1982, a total of 22 071 U.S. male physicians, 40–84 years of age, who did not have a history of myocardial infarction, stroke, cancer, liver or renal disease, gout, peptic ulcer, or contraindications to aspirin were randomly assigned in the Physicians' Health Study I, after written informed consent was obtained from them (3,4). The study was approved by the institutional review board of the Brigham and Women's Hospital, Boston, MA. Twice in the first year and once yearly thereafter, the participants completed a short questionnaire that asked about the occurrence of relevant health outcomes. The analysis is based on all self-reported and confirmed reports of colorectal cancer until December 31, 1995. At baseline, 22 011 (99.7%) physicians reported whether they had ever smoked cigarettes regularly (never, past only, or current), and current smokers were asked how many cigarettes per day they smoked. In the 5-year questionnaire, former smokers were asked for the ages at which they started smoking (also current smokers) and stopped smoking and the number of packs of cigarettes smoked per day. Pack-years of smoking were defined as the number of years of smoking during different age and time periods multiplied by the average number of packs of cigarettes smoked daily. Current and former cigarette smoking was reported by 2436 and 8666 physicians, respectively (Table 1). Former smokers were older than current and never smokers. Daily alcohol consumption was more prevalent in current smokers th
This study was conducted to ascertain the vaccination beliefs and practices of physicians who provide care for low income children. Sixty-two (56.9%) of a sample of 109 physicians in suburban Cook County, Illinois res...
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This study was conducted to ascertain the vaccination beliefs and practices of physicians who provide care for low income children. Sixty-two (56.9%) of a sample of 109 physicians in suburban Cook County, Illinois responded to a mail survey. A majority of physicians reported a willingness to immunize during well child care, follow-up, and chronic illness visits;yet, a substantial lack of willingness to immunize given certain acute mild illnesses was reported. Twenty-six percent of providers did not routinely identify children who were behind in immunizations and only 16% had completed a chart audit in the past three years. Seventy-four percent were willing to provide all shots needed at a single visit. Misconceptions regarding true contraindications was found among the group. Missed well child visits were identified as the greatest barrier to complete immunization. Improvements in vaccination rates are expected if physicians utilize all types of medical encounters to monitor the immunization status of patients and provide vaccines using only true medical contraindications.
One of the more dramatic changes in the healthcare industry has been the movement of physicians, particularly younger professionals, from private practice to some type of healthcare organization. In this study we exam...
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One of the more dramatic changes in the healthcare industry has been the movement of physicians, particularly younger professionals, from private practice to some type of healthcare organization. In this study we examine the importance attached to specific incentives by physicians in making an affiliation decision and healthcare administrators. Our results suggest significant differences between the importance placed on certain recruiting incentives by physicians and healthcare administrators. Further, they suggest distinct differences in importance ratings by different types of physicians. Implications of this study argue for developing different compensation packages to appeal to different segments of physicians.
This paper reports the results of an analysis of the American Medical Association Masterfile. The purpose of this study was to examine changes in health care accessibility in rural Colorado from 1992 to 1995, and to d...
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This paper reports the results of an analysis of the American Medical Association Masterfile. The purpose of this study was to examine changes in health care accessibility in rural Colorado from 1992 to 1995, and to describe the pattern of in-migration of physicians to nonmetropolitan statistical area counties of the state during that period. The number of direct patient care providers increased from 532 to 700 (31.6%) during the three-year period vs. a growth of 11.2 percent in the general population of nonmetropolitan statistical area counties. Of the 700 physicians serving residents of Colorado's 52 rural counties, 308 (44%) had been practicing in their community since 1992. The rate of departure from nonmetropolitan statistical area practice sites in 1992 was 26.4 percent (140 of 532). Physicians new to their rural practice locations were younger and proportionally more female, but they were similar in primary medical specialty to doctors who had remained in their 1992 sites. Population to physician and to primary care physician ratios were much more favorable for 1995 than for 1992. Accessibility to care was most improveed in counties with fewer than 10,000 inhabitants.
This research examined the prevalence of second offices and hospital consulting practices of physicians in Missouri, the characteristics of physicians participating in such practices, the change in availability of ser...
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This research examined the prevalence of second offices and hospital consulting practices of physicians in Missouri, the characteristics of physicians participating in such practices, the change in availability of services through these practices, the characteristics of counties and hospitals involved, and the practice organization of participating physicians. The assessment of the factors was conducted within the conceptual framework of community and physician characteristics, practice form and organization, and health system resources. In 1993, 64 of the 93 nonmetropolitan counties in Missouri, gained, on average, 1.3 full-time equivalent physicians through second office and hospital consulting practices. Eighteen nonmetropolitan counties lost, on average, 0.4 full-time equivalent physicians through these practices;11 nonmetropolitan counties were not affected. The majority of physicians engaged in these two types of practices are nonprimary care specialists. Consequently, in addition to the net contribution to total physician service availability, many nonmetropolitan counties gained access locally to a wider variety of specialty services. This change in availability of physician services, not generally incorporated in decisions, needs to be considered when policy efforts are undertaken to change the spatial and specialty distribution of physicians.
This paper aims to review the role of private practitioners and their interactions with public health services in developing countries, focusing largely on the Asian region. Evidence on the distribution of health faci...
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This paper aims to review the role of private practitioners and their interactions with public health services in developing countries, focusing largely on the Asian region. Evidence on the distribution of health facilities. manpower, health expenditures and utilization rates shows that private practitioners are significant health care providers in many Asian countries. Limited information has been published on interactions between public and private providers despite their co-existence. Issues related to enforcement of regulations, human resources, patient referrals and disease notifications, are examined.
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