Rationale, aims and objectivesIn 2005, the US Preventive Services Task Force issued recommendations for one-time abdominal aortic aneurysm (AAA) screening using abdominal ultrasonography in men aged 65 to 75 years with a history of smoking. However, despite a mortality rate of up to 80% for ruptured AAAs, providers order the screening for a minority of patients. We examined AAA screening rates among providers and investigated the role of visit duration and other factors in whether patients received screening. We also looked for potential interventions to improve compliance.MethodsWe retrospectively reviewed the records of patients who visited our clinic over a 4-month period and met the US Preventive Services Task Force criteria for AAA screening when our practice had a real-time decision support tool implemented to identify patients due for the screening. We also surveyed our clinic's providers about their knowledge and attitudes regarding AAA screening.ResultsDespite the use of physician reminders, providers ordered screening for only 12.9% of eligible patients. Screening was more likely to be ordered during longer visits versus shorter ones (24% vs. 6%). When surveyed, most providers (70.6%) indicated that a nurse-directed ordering system would improve compliance.ConclusionsThis study illustrates that physician reminders alone are not sufficient to improve care and that more time is needed for preventive services. This provides additional support for the use of a multidisciplinary approach to preventive screening, as in a patient-centred medical home. In a patient-centred medical home, a care team of physicians, nurses and office staff use technology such as clinical decision support to provide comprehensive, coordinated patient care.

Virtual consultations (VCs) are being ordered by primary care physicians in 1 large multispecialty clinic, replacing face-to-face visits with specialists. Virtual consultations involve electronic communication between physicians, including exchanging medical information. The purpose of this study was to assess provider satisfaction with VCs via e-mail survey. Although approximately 30% of the 56 family medicine providers had not tried the VC system after it had been in place for over a year or said that they often forgot that VCs were an option, most of the providers surveyed (73%) felt that VCs provided good medical care. A majority felt that VCs are a cost-effective and efficient tool for our department (65%). Most specialists (81%) reported that VCs were an efficient use of their time, and 67% said that VCs were less disruptive than contacts by telephone or pager. Only 5% felt that VCs do not provide good medical care. Although several of our primary care providers have been enthusiastic about VCs, others have been reluctant to adopt this innovation. Specialists providing VCs tended to be supportive. This illustrates both the difficulty of incorporating e-health innovations in primary care practice and the potential for increased efficiency.

Purpose:The demand for comprehensive primary health care continues to expand. The development of team-based practice allows for improved capacity within a collective, collaborative environment. Our hypothesis was to determine the relationship between panel size and access, quality, patient satisfaction, and cost in a large family medicine group practice using a team-based care model.Methods: Data were retrospectively collected from 36 family physicians and included total panel size of patients, percentage of time spent on patient care, cost of care, access metrics, diabetic quality metrics, patient satisfaction surveys, and patient care complexity scores. We used linear regression analysis to assess the relationship between adjusted physician panel size, panel complexity, and outcomes.Results: The third available appointments (P < .01) and diabetic quality (P ‫؍‬ .