J Fam Pract. 2008 May;57(5):298
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Family Medicine Update
Important Medical news for family physicians and primary care providers
Aten Primaria. 2008 May;40(5):235-9
OBJECTIVE: To determine the validity of Spirometry tests done in primary care in our province and to find in what parts of the test errors are committed. DESIGN: Transversal, descriptive study. SETTING: All the primary care units in the province of Gipuzkoa, Spain. PARTICIPANTS: Thirty of the 44 existing units took part, contributing the last 10 spirometry tests conducted in November, 2005. MAIN MEASUREMENTS: Two primary care doctors who were skilled in spirometry analysed the acceptability, reproducibility, possible utility of invalid tests and their spirometric patterns. They also looked at aspects of the curve that were not sufficient. Tests were considered acceptable, reproducible and possibly useful when the 2 doctors coincided. Where they did not coincide, these characteristics were determined by a pneumologist. The validity criteria of the ATS were followed. RESULTS: Of the 44 units in our province, 30 took part. They contributed 300 spirometry tests, of which 12 were excluded as illegible. A total of 48% were considered acceptable, 78% met reproducibility criteria and 38.5% met both characteristics. The most common error was the scant length of exhalation, insufficient in 38.19% of cases. The most usual pattern found was the normal one with 58%, followed by the restrictive with 18%, the obstructive with 13%, and the mixed one, with 11%. CONCLUSIONS: Quality of spirometry tests in primary care is deficient. The most common error is that exhalation is too brief. We think this is why we find a predominance of restrictive patterns over obstructive ones. Just by prolonging the spirometry operation, we would manage to increase markedly the number of valid tests.
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Residency footprints: assessing the impact of training programs on the local physician workforce and communities.
29 June 2008
Fam Med. 2008 May;40(5):339-44
BACKGROUND AND OBJECTIVES: National workforce models fail to capture the regional effect of residency programs, despite local control over decisions to open or close training sites. In the last 5 years, 37 (nearly 8% of total) family medicine residency programs have closed. We report on a novel approach to measuring the regional effect of residency training programs closures using a combination of quantitative and spatial methods. METHODS: American Medical Association Physician Masterfile records and residency graduate registries for 22 of 37 family medicine residency programs that closed between 2000–2006 were analyzed to determine regional patterns of physician practice, as well as the effect of graduates from closed programs on areas that otherwise would be Health Professional Shortage Areas (HPSAs). Program graduate data from two sampled programs were mapped using geographic information system software to display the distribution “footprint” of graduates regionally. RESULTS: Of the 1,545 graduates of the 22 programs, 21% of graduates practice in rural locations, and 68% are in full-county or partial-county HPSAs. Without the graduates of these programs, there would have been 150 additional full HPSA counties in 15 states. The spatial distribution of the graduates of two closed programs demonstrates their effect across multiple counties and states. CONCLUSIONS: The effect of closing family medicine residency programs is likely to go undetected for many years. Decisions regarding the fate of family medicine programs are often made without benefit of a full assessment. Local and regional effects on physician access are often recognized only after the fact. Novel approaches to analysis and display of local effects of closures are essential for policy decisions concerning physician workforce training.
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