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At which drinking level to advise a patient?: General practitioners' views

ALCOHOL AND ALCOHOLISM 2001年第5期36卷 431-433页

作者： Aalto, M Seppä, K Tampere Univ Hosp Dept Psychiat Tampere Finland Univ Tampere Sch Med FIN-33101 Tampere Finland

This study examined the views of 64 general practitioners (GPs) on how much a patient has to drink to be advised by them and compared the results to the recommended Finnish threshold values of heavy drinking. The levels stated by GPs were not too high to prevent early-phase intervention in heavy drinking;rather, they were so low that numerous moderate drinkers were also included. The mean (SD) level was 15.5 (6.5) drinks for male and 11.0 (4.6) drinks for female patients per week. These are about two-thirds of the Finnish threshold values of heavy drinking. Attempting to advise such high proportions of patients, including both heavy and moderate drinkers, might mean a discouraging burden for GPs. However, there may be a discrepancy between GPs' statements about when to advise and when they actually do so.

关键词：饮酒/流行病学饮酒/预防和控制芬兰/流行病学健康知识态度实践病人教育(主题)/统计学和数值数据医师家庭/统计学和数值数据统计学非参数成年人女(雌)性人类男(雄)性中年人

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Sample allocation for overlapping domains in a physician survey with a limited population

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STATISTICS IN MEDICINE 1999年第8期18卷 935-946页

作者： Zaslavsky, AM Williams, TV Cleary, PD Harvard Univ Sch Med Dept Hlth Care Policy Boston MA 02115 USA US Dept Def Tricare Management Act Falls Church VA 22041 USA

We consider an analytic survey in which each survey unit can respond with respect to one or more domains to which it belongs. In this situation, the optimal sample allocation is constrained by the number of available units in each stratum defined by a set of domains. We present optimal sample allocation rules for this situation, and other rules that apply when there are additional constraints on sample sizes or variances by domain. We apply these rules to our motivating example, the design of a survey of physicians on their experiences with health plans, in which each physician can only be asked about her experience with one plan regardless of her number of affiliations. Copyright (C) 1999 John Wiley & Sons, Ltd.

关键词：算法数据收集/方法数据收集/统计学和数值数据管理医疗规划马萨诸塞医师家庭/统计学和数值数据样本大小抽样研究人类

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Complementary medicine and general practice: an urban perspective

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COMPLEMENTARY THERAPIES IN MEDICINE 2000年第2期8卷 71-75页

作者： Perry, R Dowrick, CF Univ Liverpool Dept Primary Care Liverpool L69 3BX Merseyside England

Background: Complementary medicine appears to be an increasingly popular option amongst both doctors and patients. General practitioners in more affluent parts of Britain have showed considerable interest in its use. Objectives:To ascertain use of and attitudes towards complementary medicine, amongst general practitioners working in a socioeconomically deprived urban area. Methods: A postal questionnaire survey of all general practice principles in Liverpool, using freepost envelopes and one reminder after 3 weeks. With respect to eight common complementary therapies, respondents were asl(ed whether they treat with, refer to or endorse each therapy;for their views on NHS funding, effectiveness, adverse reactions, training needs, and theoretical validity, for each therapy. Results:The response rate was 131/252 (52%), higher amongst women and doctors aged under 40. During the previous week 74 (56%) of respondents had been involved in complementary medical activity with their patients: 13% had treated directly, 31% had referred to and 38% had endorsed one or more complementary therapies. Acupuncture was most popular as an NHS option, and along with osteopathy and chiropractic was the therapy most highly regarded by respondents in terms of effectiveness. Homeopathy and hypnotherapy received a mixed reaction,while medical herbalism, aromatherapy and reflexology were viewed more sceptically. Sixty-two per cent of respondents reported successful outcomes of complementary treatments, compared with 21% reporting adverse reactions. Knowledge and training desires were highest for homeopathy and acupuncture. Respondents were generally uncertain about the theoretical validity of these therapies: 50% though acupuncture had a valid basis, compared with only 23% for homeopathy and 8% for reflexology. Conclusions:The degree of support for complementary medicine therapies amongst general practitioners in this socioeconomically deprived urban area was similar to that found elsewhere i

关键词：医务工作者的态度补充疗法/利用英格兰卫生服务研究医师家庭/心理学医师家庭/统计学和数值数据问卷调查转诊和会诊公费医疗市区人口人类

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Rural physician satisfaction: Its sources and relationship to retention

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JOURNAL OF RURAL HEALTH 1996年第5期12卷 366-377页

作者： Pathman, DE Williams, ES Konrad, TR [*] Research Fellow Cecil G. Sheps Center for Health Services Research University of North Carolina at Chapel Hill CB#7590 Chapel Hill NC 27599.

This study uses survey data to identify areas of satisfaction and dissatisfaction for primary care physicians working in rural areas across the country. It also identifies the specific areas of satisfaction associated with longer retention within a given rural practice, as well as the characteristics of individuals, practices, jobs, and communities associated with the areas of satisfaction that predict retention. Study subjects comprised a sample of 1,600 primary care physicians who moved to nonmetropolitan counties nationwide during the years 1987 through 1990, with oversampling of those who moved to federally designated health professional shortage areas (HPSAs). Physicians serving in the National Health Service Corps (NHSC) were excluded. Sixty-nine percent of the eligible subjects returned completed mail questionnaires in 1991. Analyses for this study were limited to the 620 primary care physicians who worked more than 20 hours per week in towns of fewer than 35,000 population;who were neither in the military nor the NHSC;and who were not in urgent care, emergency room, or full-time teaching positions. Analyses revealed that the areas of rural physicians' greatest satisfaction were their relationships with patients, clinical autonomy, the care they provided to medically needy patients, and life in small communities. Physicians were least satisfied with their access to urban amenities and the amount of time they spent away from their practices. Retention was independently associated only with physicians' satisfaction with their communities and their opportunities to achieve professional goals. Retention was also marginally related to physicians' satisfaction with their earnings. Among the areas of satisfaction not related to retention were satisfaction with autonomy, access to medical information and consultants, and the quality of doctor-patient relationships. In a subsequent series of analyses of the factors that predict the three areas of satisfaction that wer

关键词：数据收集职业满意缺医地区多元分析医师诊疗模式医生病人关系医师家庭/心理学医师家庭/统计学和数值数据职业自主权专业场所乡村卫生服务/人力社会经济因素美国人类

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The attitudes of rural Minnesota family physicians toward nurse practitioners and physician assistants

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JOURNAL OF RURAL HEALTH 1997年第3期13卷 196-205页

作者： Bergeson, J Cash, R Boulger, J Bergeron, D UNIV MINNESOTA SCH MEDMINNEAPOLISMN 55455 UNIV MINNESOTA SCH MEDDULUTHMN 55812 MINNESOTA CTR RURAL HLTH DULUTHMN

Increased use of nurse practitioners and physician assistants has been promoted as a possible solution to the shortage of primary care providers in rural locations. If the use of nonphysician providers is to be optimized in these areas, awareness and acceptance of their capabilities by rural family physicians is essential. This study surveyed the attitudes of rural Minnesota family physicians toward the use of physician assistants and nurse practitioners. Forty-six percent of the 600 rural family physicians surveyed responded to the questionnaire. Approximately 90 percent of responding physicians indicated a high degree of confidence in the abilities of nonphysician providers in the areas of preventive and routine care;some concern was expressed about the proficiency of nonphysician providers taking call, covering the emergency room, and doing hospital rounds-activities that involve a broader base of clinical knowledge and diagnostic skills. Other concerns were an increased workload for physicians due to their assumed supervisory roles, an increase physician liability, job competition between nonphysician providers and physicians, and the lack of educational opportunities and supervisory guidelines for physicians regarding collaborative relationships. Appropriate roles for family physicians, nurse practitioners and physician assistants are not well-defined in the minds of respondents, and it appears future acceptance and practice patterns will depend on how these roles are established and accepted.

关键词：医务工作者的态度临床工作能力卫生保健调查职务说明缺医地区明尼苏达开业护士/利用医师助理/利用医师家庭/心理学医师家庭/统计学和数值数据乡村卫生服务/人力人类

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Practice and attitudes of primary care physicians in a rural southern state concerning HIV/AIDS patients

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Journal of Health and Social Policy 1993年第3期4卷 65-78页

作者： Strahan, N. Gandy, M. Thompson, F.E. Page, M.D. Phillips, D.M. Replogle, W.H. Bureau of Preventive Health Services Mississippi State Dept of Health MS United States

In preparing for the development of a plan of care for persons with AIDS and other HIV related conditions, the HIV Services Planning Program, a joint effort of the Department of Family Medicine of the University of Mississippi Medical Center and the Bureau of Preventive Health of the Mississippi State Department of Health, conducted a survey of all primary care physicians throughout the state of Mississippi. The purpose of the survey was to determine health care services provided to persons with HIV/AIDS. Specific areas of interest included: (a) type of medical specialty;(b) location of primary practice;(c) services provided for persons with HIV/AIDS;and (d) utilization of universal blood and body fluid precautions, i.e., barrier techniques. Descriptive statistics were utilized in analyzing responses.

关键词：获得性免疫缺陷综合征/流行病学获得性免疫缺陷综合征/治疗获得性免疫缺陷综合征/传播医务工作者的态度临床工作能力/统计学和数值数据 HIV感染/流行病学 HIV感染/治疗 HIV感染/传播密西西比/流行病学医生病人关系医师家庭/心理学医师家庭/统计学和数值数据防护服/统计学和数值数据防护服/利用问卷调查转诊和会诊/统计学和数值数据地区卫生计划综合预防/统计学和数值数据女(雌)性人类男(雄)性

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Medicaid claims data comparisons for nurse practitioners, physician assistants, and primary care physicians in New Mexico.

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Journal of the American Academy of Nurse Practitioners 1999年第1期11卷 3-10页

作者： Birkholz, G. Viens, D.C. College of Nursing University of New Mexico Albuquerque United States

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Two decades of experience in the University of Washington Family Medicine Residency Network: Practice differences between graduates in rural and urban locations

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Journal of Rural Health 1995年第1期11卷 60-72页

作者： Baldwin, L.-M. Hart, L.G. West, P.A. Norris, T.E. Gore, E. Schneeweiss, R. Department of Family Medicine School of Medicine University of Washington Seattle WA 98195 United States

This study describes how graduates of the University of Washington Family Medicine Residency Network who practice in rural locations differ from their urban counter-parts in demographic characteristics, practice organization, practice content and scope of services, and satisfaction. Five hundred and three civilian medical graduates who completed their residencies between 1973 and 1990 responded to a 27-item questionnaire sent in 1992 (84% response rate). Graduates practicing outside the United States in a specialty other than family medicine or for fewer than 20 hours per week in direct patient care were excluded from the main study, leaving 116 rural and 278 urban graduates in the study. Thirty percent of graduates reported practicing in rural counties at the time of the survey. Rural graduates were more likely to be in private and solo practices than urban graduates. Rural graduates spent more time in patient care and on call, performed a broader range of procedures, and were more likely to practice obstetrics than urban graduates. Fewer graduates in rural practice were women. A greater proportion of rural graduates had been defendants in medical malpractice suits. The more independent and isolated private and solo practice settings of rural graduates require more practice management skills and support. Rural graduates' broader scope of practice requires training in a full range of procedures and inpatient care, as well as ambulatory care. Rural communities and hospitals also need to develop more flexible practice opportunities, including salaried and part-time positions, to facilitate recruitment and retention of physicians, especially women.

关键词：卡方分布卫生服务研究实习医师和住院医师职务医疗事故医师家庭/统计学和数值数据医师女/统计学和数值数据专业业务/统计学和数值数据专业场所/统计学和数值数据问卷调查农村卫生/统计学和数值数据城市卫生/统计学和数值数据华盛顿女(雌)性人类

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Childrens immunizations: The gap between parents and providers

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Health Marketing Quarterly 1999年第4期16卷 7-14页

作者： Mack, Rhonda W. Darden, Paul M. The College of Charleston Charleston SC 29424-0001 9 Liberty Street United States Medical University of South Carolina Charleston SC 29425 United States

Childrens immunizations have been a part of our health care practice for many years. While immunizations have reached record highs in recent years, there is a fear that complacency may cause a drop in immunization rates and thus increases in disease rates. This study explored immunizations from two perspectives. First, focus groups with parents examined immunization information acquisition, practices, and barriers. Next, a physician survey examined immunization provider perceptions of parents information acquisition, barriers and immunization practices. Several gaps were discovered between these two groups controlling the immunization of our children. Suggestions are made as to possible paths to begin addressing these gaps in order to increase immunization rates. © 1999 by The Haworth Press, Inc. All rights reserved.

关键词：临床工作能力数据收集集中研讨小组健康教育健康知识态度实践免疫法/利用动机双亲/心理学病人依从医生病人关系医师家庭/心理学医师家庭/统计学和数值数据美国儿童学龄前人类

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The limits of leadership: Opinion leaders in general practice

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Journal of Health Services Research and Policy 1998年第4期3卷 197-202页

作者： Flottorp, S. Oxman, A. Bjorndal, A. Health Services Research Unit National Institute of Public Health Torshov 0403 Oslo Post Box 4404 Norway

Objective: To explore the importance and characteristics of opinion leaders in general practice, particularly in relationship to the use of laboratory tests. Design: Focus group discussions and a mailed survey. Subjects: Five focus groups (n = 29 participants) in four different municipalities and a random sample of 85 general practitioners (GPs) in Norway. Results: While Norwegian GPs recognised colleagues who were influential in determining how they practised, they found it difficult to identify opinion leaders specifically with respect to the use of laboratory tests. Opinion leaders were thought to be less important in influencing the use of laboratory tests than continuing medical education activities and practice guidelines, but more important than industry, patients or personal financial interests. Norwegian GPs recognised and characterised opinion leaders in much the same way as physicians in the USA. Influential colleagues were characterised as being good conveyers of information and willing to take time, as well as being up-to-date and having a high level of clinical expertise. GPs expressed a negative attitude towards 'super-specialists' who give advice without knowing the epidemiology of general practice, people who are arrogant and people who do not show respect towards GPs. Conclusions: The potential to identify and use opinion leaders to improve the use of laboratory tests by GPs in Norway appears to be limited.

关键词：医务工作者的态度教育医学继续集中研讨小组卫生服务研究职业间关系实验室技术和方法/利用领导挪威劝导交谈医师诊疗模式医师的作用医师家庭/教育医师家庭/心理学医师家庭/统计学和数值数据问卷调查人类

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