Trends in Adult Visits to Primary Care Physicians in the United States

Stafford, Randall S.; Saglam, Demet; Causino, Nancyanne; Starfield, Bárbara; Culpepper, Larry; Marder, William D.; Blumenthal, David

doi:10.1001/archfami.8.1.26

Cited by 55 publications

(44 citation statements)

References 12 publications

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“…This is a concerning finding because not only is the complexity of health care increasing, 30 but this is particularly true of primary care. 31 In fact, by its very nature, primary care is more complex than specialty care. 32 To deal with this rise in the perceived complexity of expected care, the PCP must be able to respond with flexible decision making 33 and creativity.…”

Section: Discussionmentioning

confidence: 99%

Perceived Complexity of Care, Perceived Autonomy, and Career Satisfaction Among Primary Care Physicians

Katerndahl

Parchman

Wood

2009

The Journal of the American Board of Family Medicine

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Background: The purpose of this study was to examine relationships of both perceived autonomy and perceived complexity of care with career satisfaction.Methods: This secondary analysis used 3 consecutive surveys of family physicians, internists, and pediatricians from the Community Tracking Survey. Two-way analysis of variance assessed interaction effects of perceived complexity of care and perceived autonomy on satisfaction. Logistic regression analysis identified physician characteristics, practice characteristics, practice improvement strategies, perceived complexity, and perceived autonomy that accounted for variance in career satisfaction among physicians.Results: Although 24% to 27% of physicians felt perceived complexity of care expected was greater than it should be, 83% to 86% felt free to make clinical decisions. Approximately 80% of physicians were satisfied with their careers. Differences in probability of career satisfaction were highly significant (P < .001) for both perceived complexity of care and perceived autonomy as well as their interaction. A multiphysician practice; the ability to obtain high quality ancillary services (such as physical therapy, home health care, and nutritional counseling); managed care revenue, lower levels of perceived complexity of expected care; and perceived autonomy were consistently associated with satisfaction.Conclusion: Higher perceived autonomy and lower perceived patient complexity as higher than desirable were associated with high career satisfaction among primary care physicians.

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Section: Discussionmentioning

confidence: 99%

Perceived Complexity of Care, Perceived Autonomy, and Career Satisfaction Among Primary Care Physicians

Katerndahl

Parchman

Wood

2009

The Journal of the American Board of Family Medicine

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“…[33][34][35][36] One way to increase the reach of these services is to harness the health care system to refer smokers to them proactively. 35 Because younger adults do not seek primary care as frequently as older adults, 37 referral in this setting may represent the best way to use the health care system to offer a quit smoking program for this population group.…”

Section: Figurementioning

confidence: 99%

Using the Postpartum Hospital Stay to Address Mothers' and Fathers' Smoking: The NEWS Study

et al. 2010

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OBJECTIVE: The objective of this study was to test the feasibility and acceptability of introducing an intervention to address mothers' and fathers' smoking during the postpartum hospitalization. METHODS: During a 14-month period (February 2005 to April 2006), we assessed the smoking status of both parents of all newborns who were delivered at a hospital child birth center. Parents who were current smokers (1 cigarette, even a puff, in past 30 days) or recent quitters (smoked since 1 month before conception) were eligible for the study. Parents were assigned to intervention or usual care control condition on the basis of day of study enrollment. Smoking outcomes were assessed at 3 months by telephone survey and cotinine confirmation; quitline use was assessed at 3 months by using quitline database. RESULTS: A total of 101 (64%) of 159 eligible parents enrolled in the study (n = 53 control subject, n = 48 intervention), including 72 (71%) current smokers and 29 (29%) recent quitters. All parents in the intervention group received the in-hospital counseling session, 94% had a fax sent to a provider, and 36 (75%) accepted quitline enrollment. In an intention-to-treat analysis that included both current smokers and recent quitters, self-reported 7-day abstinence decreased from 31% to 25% among intervention parents versus 38% to 23% among control subjects (effect size 9.4%; nonsignificant). Among current smokers at baseline who were reached at follow-up (n = 36), self-reported 24-hour quit attempts were higher in the intervention group versus control group (64% vs 18%; P = .005), whereas the cotinine-confirmed 7-day abstinence rates at follow-up were 9% in the intervention group and 3% in the control group (nonsignificant). CONCLUSIONS: Enrolling mothers and fathers into tobacco treatment services during the immediate postpartum hospital stay is feasible and seems to stimulate quit attempts. The birth of an infant presents a teachable moment to reach both parents and to provide cessation assistance.

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“…1 Although there may be a benefit to using antimicrobials in selected acute bronchitis patients with chronic obstructive pulmonary disease and asthma, 2,3 systematic reviews have concluded that current evidence supports the existence of no, or at best limited, clinical benefit of antimicrobials in otherwise healthy patients. 4 Antimicrobial use and overuse results in adverse drug reactions, 5,6 unnecessary drug expenditures, 7,8 and contributes to the development of antimicrobial drug resistance and risk of antimicrobial-resistant infections.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Interventions in Reducing Antibiotic Use for Upper Respiratory Infections in Ambulatory Care Practices

Vinnard

Linkin

Localio

et al. 2013

Population Health Management

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The objective was to evaluate the effect of separate interventions on antimicrobial prescribing for uncomplicated upper respiratory tract infections. The authors conducted a quasi-experimental pre-post study with concurrent control groups for each intervention. Academic detailing led to a significant reduction in unnecessary antibiotic prescribing. However, there was no significant change in antibiotic prescribing in response to educational mailings to providers or to provider involvement in patient mailings. Organizations that seek to reduce inappropriate use of antibiotics should use proven approaches, even when they are more expensive. (Population Health Management 2013;16:22-27)

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Trends in Adult Visits to Primary Care Physicians in the United States

Cited by 55 publications

References 12 publications

Perceived Complexity of Care, Perceived Autonomy, and Career Satisfaction Among Primary Care Physicians

Perceived Complexity of Care, Perceived Autonomy, and Career Satisfaction Among Primary Care Physicians

Using the Postpartum Hospital Stay to Address Mothers' and Fathers' Smoking: The NEWS Study

Effectiveness of Interventions in Reducing Antibiotic Use for Upper Respiratory Infections in Ambulatory Care Practices

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