Family Physicians Improve Patient Health Care Quality and Outcomes

Abstract

This issue exemplifies family physicians' ability to provide great care and to continuously improve. For example, beyond other specialty care, the care provided by family physicians is associated with improved melanoma diagnosis and outcomes and improved preventive services for those with a history of breast cancer. Electronic health records are providing new avenues to both assess outcomes and influence care. However, to truly reward quality care, simplistic and readily measurable items such as laboratory results or assessment of the provision of preventive services must be adjusted for risk. Health insurance influences classic preventive care services more than personal health behaviors. The care provided at federally qualified health centers throughout the nation is highly appreciated by the people they serve and is not plagued by the types of disparities in other settings. (J Am Board Fam Med 2013; 26:617-619.)Maly et al 1 show the positive impact of family physicians on recommended preventive services in the follow-up care of underserved female breast cancer survivors. The disparity between specialities was dramatic for colonoscopy in particular, where only a quarter of patients seeing only surgeons/ cancer specialists for follow-up received the recommended screening.Related to another cancer-melanoma-Roetzheim et al 2 showed that visiting a family physician compared with only a dermatologist before the diagnosis of melanoma was associated with a diagnosis of more thin melanomas and possibly a lower rate of mortality. To improve the accuracy of detection of skin cancers, Eide et al 3 tested an intriguing intervention using a readily available, 1-to 2-hour, interactive web-based course. In addition to evaluations after the course, this study considered referrals to dermatology before and after the course and diagnoses after the course. Most of the providers had trained in internal medicine. The evaluations immediately and after 6 months found improved scores, and the later practice patterns found fewer referrals to dermatology but no obvious change in the rate of diagnosis of skin cancers. The physicians reporting no past dermatology training had the greatest improvement. Effects of Insurance on Preventive Services and Health BehaviorsJerant et al 4 reported that patients who newly obtained health insurance after being uninsured clearly receive more recommended preventive care that are based on the health system (eg, Papanicolaou tests, mammograms, and immunizations); the opposite is also true: losing insurance decreases these services. Yet patients' personal health behaviors did not improve or worsen with changes in health insurance. Unfortunately, this questions the ability of the health care system to either recognize negative patient behaviors, assist patients in changing them, or both. Perhaps follow-up longer than 1 year would change these outcomes since behavior changes often take repeated efforts over multiple years.

Analysis on the relationship between effort-reward imbalance and job satisfaction among family doctors in China: a cross-sectional study

“…In 2011, the Chinese government proposed the Guiding Opinions of the State Council on the Establishment of the General Practitioner System as a national indicator of family doctor services [ 3 ]. Family doctor contract services which are established by signing the contract of the service aimed to build a long-term and better medical cooperation between family doctors and the residents, so as to meet with the diversified healthcare needs and improve the residents’ health status [ 4 , 5 ] have been available in Sichuan Province since 2016. However, due to the short-term development of family doctor primary care systems in China, primary care is a relatively new discipline in the medical field and a sequence of prominent defects and problems come to manifest, including an increased workload at community health service centres, an inadequate contract service rate, family doctor shortages, and the absence of supporting policies [ 6 – 8 ], unnecessary and tortuous paperwork, skimpy wages and salaries.…”

Family Doctor Contract Services and Health-Related Quality of Life Among Patients With Chronic Diseases in Rural China: What Is the Role of Socioeconomic Status?

“…As a developing country, China has been in the process of establishing family doctor contract services (FDCS) system in health care since 2009. The long-term medical cooperation between family doctors and the residents is established by signing the contract of the service, so as to better understand the healthcare needs of the residents and improve the health status of the residents through the formulation of personalized intervention plans [7,8]. In 2016, the Chinese government fully implemented the family doctor signing system to carry out contract services.…”

Activities of daily living limitations and family doctor contract services among overweight and obese older adults: is there a rural-urban difference?

“…As a primary care service model, family doctor contract services have obvious advantages in terms of health management, disease prevention and control, rationalizing health resources, and lowering medical costs [ 13 , 14 ]. As a developing country, China has been establishing a system of contracted family doctor services since 2009 [ 15 ]. In May 2016, the State Council issued the Guiding Opinions on Promoting Family Doctor Contract Services, marking the official implementation of family doctor contract services in China [ 16 ].…”