Patient Care Outside of Office Visits: A Primary Care Physician Time Study.
J Gen Intern Med. 2010 Sep 2;
Authors: Chen MA, Hollenberg JP, Michelen W, Peterson JC, Casalino LP
BACKGROUND: Patient care provided by primary care physicians outside of office visits is important for care coordination and may serve as a substitute for office visits. OBJECTIVES: To describe primary care physicians’ ambulatory patient care activities outside of office visits (“AOVs”) and their perceptions of the extent to which AOVs substitute for visits and may be performed by support staff. DESIGN: Cross-sectional direct observational study. PARTICIPANTS: Thirty-three general internists in 20 practices in two health care systems (one public, one private) in the New York metropolitan area. MAIN MEASURES: Duration of AOVs by type of activity and whether they pertain to a patient visit on the study day (visit specific) or not (non-visit specific). Physician perceptions of the: (1) extent that non-visit-specific AOVs substitute for visits that would have otherwise occurred, (2) extent that visits that occurred could have been substituted for by AOVs, and (3) potential role of support staff in AOVs. KEY RESULTS: Physicians spent 20% of their workday performing AOVs, 62% of which was for non-visit specific AOVs. They perceived that a median of 37% of non-visit-specific AOV time substituted for visits, representing a potential five visits saved per day. They also perceived that 15% of total AOV time (excluding charting) could be performed by support staff. Forty-two percent of physicians indicated that one or more visits during the study day could be substituted for by AOVs. CONCLUSIONS: Though time spent on AOVs is generally not reimbursed, primary care general internists spent significant time performing AOVs, much of which they perceived to substitute for visits that would otherwise have occurred. Policies supporting physician and staff time spent on AOVs may reduce health care costs, save time for patients and physicians, and improve care coordination.
20811956
– Patient Care Outside of Office Visits: A Primary Care Physician Time Study.
Experiences and attitudes of nurse specialists in primary care regarding their role in care for patients with urinary incontinence.
Scand J Caring Sci. 2010 Aug 27;
Authors: Albers-Heitner PC, Lagro-Janssen TA, Venema PP, Berghmans BL, Winkens RR, de Jonge AA, Joore MM
Scand J Caring Sci; 2010 Experiences and attitudes of nurse specialists in primary care regarding their role in care for patients with urinary incontinence Aim: To explore experiences and attitudes of nurse specialists in primary care regarding their role in care for patients with urinary incontinence (UI), thereby identifying facilitators and barriers for wider implementation. Background: Currently, primary care for patients with UI lacks sufficient adherence to existing guidelines on UI and is far from optimal. Studies in various countries show that involving nurse specialists may offer a solution to the inadequate care for UI. As qualitative studies on experiences of nurses with this type of intervention are lacking, we performed this study with a qualitative approach and data collection method within the course of a randomized controlled trial (RCT). Method: A focus group study was conducted in 2007 with six nurse specialists who were trained in caring for patients with UI in our pragmatic RCT. The focus group interview was audio-taped and transcribed verbatim. The data were analysed using qualitative content analysis to identify themes. To understand obstacles and incentives for change, we relied on an existing ‘implementation model’. Findings: Nurse specialists feel competent to provide advice and information, to offer possible solutions and to give attention and guidance to the process of care of people with UI. They feel appreciated by patients and feel they offer an added value to the usual care of general practitioners (GPs). Nurses sometimes notice that GPs lack interest in UI. Personal contact with the GPs, availability of enough time, adequate equipment and financial resources are important preconditions for effective nurse specialist care. Nurse specialists value continuous education and feedback in daily care for patients with UI. Conclusion: Trained nurse specialists appeared to feel competent and satisfied to support GPs in care for patients with UI. They feel highly appreciated by both patients and GPs.
20804524
– Experiences and attitudes of nurse specialists in primary care regarding their role in care for patients with urinary…
Knowledge of vaccination of allergic children among Italian primary care pediatricians, hospital pediatricians and pediatric residents.
Vaccine. 2010 Aug 27;
Authors: Esposito S, Azzari C, Bartolozzi G, Fara GM, Giovanetti F, Giudice ML, Galeone C, Atti MC,
A cross-sectional survey of Italian pediatricians and pediatric residents was carried out between 15 September and 18 October 2008 in order to evaluate their knowledge concerning the administration of vaccines to children with suspected or proved allergies. Of the 750 physicians who accepted to participate (620 pediatricians and 130 residents), 630 (84.0%; 407 females; mean age 43.5+/-11.2 years) returned completed questionnaires: 268 primary care pediatricians (42.5%), 244 hospital pediatricians (38.8%), and 118 pediatric residents (18.7%). Knowledge concerning the vaccination of children with suspected or proved allergies was far from optimal, with the poorest knowledge being shown by the pediatric residents and no difference between the primary care and hospital pediatricians. Since pediatricians are the main parents’ advisors regarding vaccinations, these results indicate an urgent need for educational programmes (especially for residents) and evidence-based guidelines concerning vaccinations in children with suspected or proved allergies.
20804803
– Knowledge of vaccination of allergic children among Italian primary care pediatricians, hospital pediatricians and pediatric…
