ObjectivesTo quantify the time spent by family physicians (FP) on tasks other than direct patient contact, to evaluate job satisfaction, to analyse the association between time spent on tasks and physician characteristics, the association between the number of tasks performed and physician characteristics and the association between time spent on tasks and job satisfaction.DesignCross-sectional, using time-and-motion techniques. Two workdays were documented by direct observation. A significance level of 0.05 was adopted.SettingMulticentric in 104 Portuguese family practices.ParticipantsA convenience sample of FP, with lists of over 1000 patients, teaching senior medical students and first-year family medicine residents in 2012, was obtained. Of the 217 FP invited to participate, 155 completed the study.Main outcomes measuredTime spent on tasks other than direct patient contact and on the performance of more than one task simultaneously, the number of direct patient contacts in the office, the number of indirect patient contacts, job satisfaction, demographic and professional characteristics associated with time spent on tasks and the number of different tasks performed, and the association between time spent on tasks and job satisfaction.ResultsFP (n=155) spent a mean of 143.6 min/day (95% CI 135.2 to 152.0) performing tasks such as prescription refills, teaching, meetings, management and communication with other professionals (33.4% of their workload). FP with larger patient lists spent less time on these tasks (p=0.002). Older FP (p=0.021) and those with larger lists (p=0.011) performed fewer tasks. The mean job satisfaction score was 3.5 (out of 5). No association was found between job satisfaction and time spent on tasks.ConclusionsFP spent one-third of their workday in coordinating care, teaching and managing. Time devoted to these tasks decreases with increasing list size and physician age.
Objectivos: Caracterizar as mensagens de correio electrónico entre uma médica de família (MF) e os seus pacientes durante os primeiros 14 meses de acesso. Estudo: Transversal descritivo Local: Centro de Saúde da Senhora da Hora População: Mensagens de e-mail trocadas entre os pacientes e a sua MF. Métodos: Uma amostra aleatória de 20% das mensagens recebidas foi estudada quanto a: sujeito da mensagem, dimensão, número e tipo de assuntos abordados, existência de resposta do MF e dimensão desta, intervalo de tempo até à resposta, hora de envio e resultado das mensagens. Fez-se a caracterização sócio-demográfica e familiar de todos os utilizadores. Determinou--se o tempo gasto com o e-mail numa semana. Na análise estatística descritiva usou-se o programa Excel 2003. Resultados: Foram recebidas 504 mensagens, de 92 utilizadores diferentes, com idade média de 37,1 anos, sendo 73% do sexo feminino e 65% com escolaridade superior. Foram enviadas pela MF 462 mensagens.As 100 mensagens estudadas visavam 112 sujeitos (mais frequentemente o próprio, filhos menores, idosos dependentes ou cônjuge).As mensagens tinham em média 57,1 palavras e abordavam 1,3 assuntos (mais frequentemente questões médicas, de exames complementares, administrativas e de enfermagem e de medicação).A MF respondeu a 69% das mensagens e em 94,2% dos casos fê-lo em menos de 48 horas, usando em média 58,2 palavras. Das mensagens recebidas, 22% foram escritas fora do horário do CS. A MF enviou 58% das suas mensagens em horas não assistenciais. Os resultados mais frequentes da troca de mensagens ABSTRACT E-MAIL USE BETWEEN A FAMILY PHYSICIAN AND HER PATIENTS: A FOURTEEN MONTH EXPERIENCEObjectives: To evaluate message exchange, between a family physician and her patients, during the first fourteen months of e-mail access. Study Design: Observational cross-sectional. Setting: A family practice in Senhora da Hora, Matosinhos, Portugal. Population: E-mail messages exchanged between physician and patients. Methods: A random sample of 20% of patient messages was evaluated for: person the message was written about, size, number and type of subjects mentioned, whether or not it elicited a reply from the family physician and, if so, the reply message size and time between initial message and reply, time of day messages were sent and message results. Socio-demographic and familiar data were collected for every patient using e-mail. The amount of time spent by family physician adressing e-mail during a whole week was measured. For descriptive statistical analysis the author used Excel 2003. Results: A total of 504 messages were received from 92 different patients, whose mean age was 37.1, being 73% of which female and 65% with higher education. The family physician herself sent 462 messages. Messages studied (n = 100) from patients were written about 112 persons (most often the one who wrote the message, children, dependent elderly or spouse). Mean message size was 57.1 words and mentioned a mean of 1.3 subjects (most often medical questions, test results, nursing o...
WHAT KEEPS FAMILY PHYSICIANS SO BUSY? A DESCRIPTION OF MEDICAL WORK BEYOND PATIENT ENCOUNTERSObjectives: Measuring the amount of time family physicians (FP) spend on direct patient encounters and other medical tasks, determining the number of direct patient encounters and indirect contacts, and describing the range of medical tasks performed. Design: Observational study. Setting: Family practices in the Unidade Local de Saúde de Matosinhos (ULSM), Portugal. Population: Family physicians working in ULSM Methods: A convenience sample of 46 family physicians was invited to record their activities during 2 to 5 working days, in June and July, 2010. They measured the time spent in practice, on breaks and on medical tasks aside from direct patient encounters, the numbers of direct and indirect patient contacts, and the types of medical tasks performed. The characteristics of the study participants and the characteristics of their tasks were analyzed using descriptive statistics. Results: Of the 46 family physicians invited, thirteen participated in the study (28% response rate). The activities of 52 working days were recorded, including 986 direct patient encounters, 514 indirect patient contacts and 100 hours of activities. Of the total daily working time, 23% was spent on non-contact medical tasks (on average one hour and 57 minutes per day), with an average of 10 indirect patient contacts per doctor per day. A mean of six hours and 31 minutes were spent on 19 direct patient contacts per doctor per day. The indirect contact tasks most often reported were: telephone calls, e-mails, medical record keeping, evaluation of laboratory and other tests, prescription refills, completing forms, interactions with other members of the team, referrals and staff meetings. Conclusions: This sample of family physicians spends an average of one hour and 57 minutes per day on non-contact patient related tasks, accounting for 23% of their workload. This is similar to the findings from North American studies. There are several likely biases in this study related to sample selection and data collection. This study illustrates the range of tasks that family physicians perform, as well as the amount of time required to perform them. This may contribute to improve the recognition of the workload created by these tasks as well as indicating their importance, with potential effects on professional satisfaction.
Background Second-line treatments boost overall survival in advanced gastric cancer (AGC). However, there is a paucity of information as to patterns of use and the results achieved in actual clinical practice.
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