Vexing visits: Variables correlating with physician perceptions of patients as “difficult” and overall enjoyment of their delivery of primary ambulatory care

2021 ◽  
pp. 009121742110320
Author(s):  
Timothy Eugene Spruill
Keyword(s):  
Professional Growth ◽  
Work Group ◽  
Work Satisfaction ◽  
Psychosocial Problems ◽  
Patient Characteristics ◽  
Negative Attitudes ◽  
Group Loyalty ◽  
Physician Characteristics ◽  
Patient Variables ◽  
Clinic Practice

All physicians experience some patients described as “difficult.” Their prevalence negatively impacts work satisfaction. Prior research identified factors present when physicians perceive patients as difficult. Numerous variables are unrelated to vexing patient visits. Three additive patient characteristics predict difficult encounters: 1) depressive or anxiety comorbidity, 2) polysymptomatic patients, and 3) high symptom severity. The sole physician variable was their score on the Physician Belief Scale (PBS) which quantifies negative attitudes towards psychosocial problems. When all three patient predictors exist, high PBS scorers judge twice as many patients as difficult. Five clinic milieu variables correlated weakly with clinic satisfaction among primary care residents. They are: 1) minimal role conflict, 2) autonomy, 3) collegiality, 4) encouragement of professional growth, and 5) work group loyalty. “Positive affect” was among the strongest physician variables but the author labeled it a confounding variable. Finally, a small “n” QI study conducted in this author’s residency explored the role of physician affectivity and identified additional physician characteristics and clinic milieu factors correlating with overall enjoyment of ambulatory clinic practice. Surprisingly, none of the five previously identified clinic milieu variables correlated directly with resident clinic satisfaction. “Supportive staff cohesion” was one milieu variable that correlated significantly with clinic satisfaction. Resident affective characteristics that significantly reduced clinic satisfaction were “hostility” and “negative affectivity.” “Joviality” was positively related to clinic satisfaction. While patient variables are uncontrollable, it is plausible that by physicians changing their beliefs and affectivity the percentage of vexing visits could be cut in half improving work satisfaction.

Physician Characteristics and EMR Attitudes

2011 ◽  
pp. 138-149
Author(s):  
David Meinert ◽  
Dane K. Peterson
Keyword(s):  
Primary Care ◽  
Medical Records ◽  
Primary Care Physicians ◽  
Medical Profession ◽  
Successful Implementation ◽  
Negative Attitudes ◽  
Specialty Clinic ◽  
Medical Specialists ◽  
Positive Attitudes ◽  
Physician Characteristics

Despite the numerous purported benefits of Electronic Medical Records (EMR), the medical profession has been extremely reluctant to embrace the technology. One of the barriers believed to be responsible for the slow adoption of EMR technology is resistance by many physicians who are not convinced of the advantages of using EMR systems. This study examined potential characteristics of physicians that might help identify those individuals that are most likely to pose a threat to the successful implementation of an EMR system in a multi-specialty clinic. The results demonstrated that older physicians and physicians with only minimal computer skills are more likely to have negative attitudes regarding EMR technology. Medical specialists were most likely to have positive attitudes with respects to the use of EMR systems, while primary care physicians were most likely to have doubts regarding the purported benefits of EMR technology. [Article copies are available for purchase from InfoSci-on-Demand.com]

Variations in health services utilization by primary care patients

2002 ◽  
Vol 15 (2) ◽  
pp. 116-125 ◽  
Author(s):  
Victoria Bolaños-Carmona ◽  
Ricardo Ocaña-Riola ◽  
Alexandra Prados-Torres ◽  
Pilar Gutiérrez-Cuadra
Keyword(s):  
Primary Care ◽  
Health Service ◽  
Primary Care Physicians ◽  
Service Use ◽  
Patient Characteristics ◽  
Important Variable ◽  
Services Utilization ◽  
Care Groups ◽  
Physician Characteristics ◽  
Primary Care Patients

This study analyses how both ambulatory care groups (ACGs) and physician characteristics explain the variability in health-service use among primary care patients in Spain. During the period 1996-1997, data derived from 52 152 patients and their 38 respective primary care physicians were collected. The response variables were as follows: number of visits; diagnostic tests requested; and referrals to a specialist. ACGs are an important variable that should be taken into account in order to explain health-service utilization. As for professionals, age and the post they hold are essential factors. Most of the unexplained variability is caused by patient characteristics.

Predictors of Job Satisfaction Among Rural Emergency Medical Technicians

1990 ◽  
Vol 5 (3) ◽  
pp. 217-223 ◽  
Author(s):  
Theodore W. Whitley ◽  
Dennis A. Revicki ◽  
E. Jackson Allison ◽  
Sandra S. Landis
Keyword(s):  
Job Satisfaction ◽  
Occupational Stress ◽  
Communication Networks ◽  
Professional Growth ◽  
Work Group ◽  
The United States ◽  
Emergency Medical Technicians ◽  
Group Cohesiveness ◽  
Emergency Medical ◽  
Using Data

AbstractThis study investigated the capacity of selected personal and work environment characteristics, in combination with occupational stress, to predict job satisfaction for 495 emergency medical technicians (EMTs) who provided emergency medical services in a rural area in the United States. Using data obtained during a three-year survey, multiple regression analysis identified work group cohesiveness and effective supervisory behavior as the best predictors of job satisfaction. The perceived level of occupational stress and years of experience as an EMT were inversely related to job satisfaction, but EMTs who responded to the survey as they were preparing to enroll in advanced training programs were more satisfied with their jobs than were other subgroups. These results suggest that job satisfaction can be enhanced by reinforcing cooperation and cohesiveness within EMS work groups, by establishing and maintaining effective communication networks between EMS administrators and EMTs, and by providing opportunities for professional growth and development for EMTs.

Overuse and underuse of pegfilgrastim for primary prophylaxis of febrile neutropenia

2018 ◽  
Vol 25 (6) ◽  
pp. 1357-1365
Author(s):  
Andrew R Zullo ◽  
Uvette Lou ◽  
Sarah E Cabral ◽  
Justin Huynh ◽  
Christine M Berard-Collins
Keyword(s):  
Febrile Neutropenia ◽  
Palliative Chemotherapy ◽  
Chemotherapy Regimen ◽  
Multivariable Analysis ◽  
Patient Characteristics ◽  
Primary Prophylaxis ◽  
Cancer Center ◽  
Cancer Type ◽  
Prescribing Practices ◽  
Physician Characteristics

Introduction Guidelines recommend pegfilgrastim for primary prophylaxis of febrile neutropenia after highly myelosuppressive chemotherapy. While deviations from guidelines could result in overuse and increased costs, underuse is also a concern and could compromise quality of care. Our objectives were to evaluate guideline adherence and quantify the extent to which physician heterogeneity may influence pegfilgrastim use. Methods We randomly sampled 550 patients from a retrospective cohort of those who received infusions at an academic cancer center between 1 September 2013 and 1 September 2014. Electronic medical and drug dispensing records provided information on patient characteristics, chemotherapy characteristics, prescribing physician, and pegfilgrastim administration. Results We included 154 patients treated by 25 physicians. About half of patients were male and mean age was 61.3 years. Forty (26.1%) patients had no febrile neutropenia risk factors, 62 (40.5%) had one, and 51 (33.3%) had two or more. Thirty patients (19.5%) received pegfilgrastim, of which 12 (40%) received palliative chemotherapy. Nine (60%) of 15 patients on a regimen with a febrile neutropenia risk  ≥ 20% received pegfilgrastim. Pegfilgrastim use significantly varied by cancer type (p < 0.01), chemotherapy regimen (p < 0.001), and regimen febrile neutropenia risk (p < 0.001). Multivariable analysis reaffirmed the association between chemotherapy regimen febrile neutropenia risk ≥ 20% and pegfilgrastim use (odds ratio (OR) = 10.1, 95% confidence interval (CI): 1.6–62.7) and suggested that 31% (95% CI: 8%–71%) of the variation in use was attributable to physician characteristics. Conclusion Pegfilgrastim was potentially overused for palliative chemotherapy and underused for chemotherapy regimens with febrile neutropenia risk ≥ 20%. Successful interventions to modify prescribing practices likely require an understanding of the relationship between specific physician characteristics and pegfilgrastim use.

scholarly journals Psychosocial Impact of COVID-19: Stigma and Xenophobia

2021 ◽  
Author(s):  
Dogancan Sonmez ◽  
Cicek Hocaoglu
Keyword(s):  
Mental Health ◽  
Social Cohesion ◽  
Psychosocial Problems ◽  
The Novel ◽  
Negative Effects ◽  
Psychosocial Effects ◽  
Negative Attitudes ◽  
Economic Problems ◽  
Existing Problems ◽  
Stigmatizing Attitudes

The novel type of coronavirus (COVID-19) pandemic, which affected the whole world and resulted in the death of many people, caused problems in various fields in societies. The effects of the pandemic, especially on health and the economy, have reached important points and studies in these areas have intensified. It is also a known fact that the pandemic causes psychosocial problems in humans. Existing problems have also had negative effects on mental health. Measures, restrictions, and quarantine practices are taken to control the epidemic have caused psychological, social, and economic problems. The spread of the disease and changes in living conditions have led to an increase in negative attitudes among people. The pandemic has also caused discriminatory and stigmatizing attitudes among people. In addition, xenophobic attitudes, defined as fear, hatred, and prejudice against foreigners, have become widespread during the pandemic process. People exposed to stigma and xenophobic attitudes due to the pandemic have experienced social and economic inequalities. It is important to prevent stigmatizing and xenophobic attitudes during the pandemic process in order to ensure social cohesion in society. In this section, the psychosocial effects of stigma and xenophobia associated with COVID-19 will be discussed in light of literature.

scholarly journals Behavioral Science Rounds: Identifying and Addressing the Challenging Issues That Residents Face on a Family Medicine Inpatient Service

2019 ◽  
Vol 51 (7) ◽  
pp. 603-608
Author(s):  
George W. Saba ◽  
Teresa Villela ◽  
Ronald H. Goldschmidt
Keyword(s):  
Professional Growth ◽  
Behavioral Science ◽  
Critical Time ◽  
Psychosocial Problems ◽  
Emotional Reactions ◽  
Inpatient Service ◽  
Training Methods ◽  
Leadership Roles ◽  
Teaching Resources ◽  
Developmental Issues

Background and Objectives: Training residents in the care of hospitalized patients offers an opportunity to integrate behavioral science education with medical care and to foster professional growth, given the severity of coexisting medical and psychosocial problems and the formation of intense transient relationships. Rarely do residents have the time or guidance to reflect on how these experiences and relationships affect them. Weekly behavioral science rounds (BSR) provide dedicated time to reflect on and discuss challenging clinical and professional developmental issues arising during inpatient training. Methods: To understand the range of issues that learners experience, we analyzed facilitator notes of 45 consecutive BSR discussions. Through open coding analysis we identified the common topics and recurring themes raised by residents. Results: The most common topics related to residents’ emotional responses, clinical challenges, and interpersonal conflicts. We identified frequently recurring themes, including understanding the power and limitations of the physician, defining roles and responsibilities, and articulating personal beliefs and values. Early first-year residents had difficulty acclimating to increased responsibility and worried about competence; later, they experienced strong emotional reactions, feared becoming cynical, and were apprehensive about future leadership roles. Conclusions: Inpatient BSR can serve as an important educational intervention and professional development tool at a critical time in training. BSR requires a commitment of teaching resources, an assurance that they will occur regularly, and a culture of safety in which residents trust their discussions will be confidential and that they will be treated with respect and caring.

Abstract 228: Variation in Results of Coronary Angiography Among Referring Providers

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Jason H Wasfy ◽  
Robert W Yeh ◽  
Andrea Litvak ◽  
Eugene V Pomerantsev ◽  
G William Dec ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Massachusetts General Hospital ◽  
Diagnostic Yield ◽  
Patient Characteristics ◽  
F Test ◽  
Logistic Regression Models ◽  
Preliminary Results ◽  
Physician Characteristics ◽  
History Of ◽  
Diagnostic Coronary Angiography

Background: Nationally, the diagnostic yield of coronary angiography is low. Little is understood about how referring providers vary in propensity to refer for coronary angiography. Understanding these sources of variation and improving the yield of coronary angiography has the potential to reduce costs and enhance value. Methods: We identified all cases of diagnostic coronary angiography performed at the Massachusetts General Hospital from January 1, 2012 until June 30, 2013 (Analysis A). We then identified all positive angiograms, as defined as at least one epicardial coronary stenosis greater or equal than 50%. We excluded angiograms for STEMI, NSTEMI and excluded angiograms in patients with cardiomyopathy, LVEF < 50%, valve disease, history of cardiac transplantation, prior PCI, or prior CABG (Analysis B). For both Analysis A and Analysis B, we calculated proportions of positive angiograms for each referring provider and calculated variance, medians, and standard deviations of those proportions among providers. Referring providers with fewer than 10 included angiograms (Analysis B) over the 18 month period were excluded for both analyses. We compared the variances of the two analyses with an F-test. Logistic regression models were developed using both characteristics of referring physician and characteristics of patients. Results: 5186 total coronary angiograms were performed, of which 1334 met inclusion criteria. 117 physicians ordered at least one angiogram, and 34 physicians ordered at least 10 angiograms. The positivity rate for Analysis A was greater than the positivity rate for Analysis B (64.3% versus 50.9%, p < 0.0001). The variance of the positivity rates for Analysis A was 0.0099, and the variance of the positivity rates for Analysis B was 0.0201 (F-test = 0.045). Preliminary results suggest that more variance is due to patient factors (R-squared = 0.46) than physician factors (R-squared = 0.04). The distribution of positivity rates by referring physician for Analysis B is shown in Figure 1. Conclusions: Variation among referring providers increases after cases with clearer guidelines are excluded. Preliminary results suggest this variance is related to different patient characteristics (case mix) rather than referring physician characteristics.

Physician Characteristics and EMR Attitudes

2011 ◽  
pp. 1491-1502
Author(s):  
David Meinert ◽  
Dane K. Peterson
Keyword(s):  
Primary Care ◽  
Medical Records ◽  
Primary Care Physicians ◽  
Medical Profession ◽  
Successful Implementation ◽  
Negative Attitudes ◽  
Specialty Clinic ◽  
Medical Specialists ◽  
Positive Attitudes ◽  
Physician Characteristics

Despite the numerous purported benefits of Electronic Medical Records (EMR), the medical profession has been extremely reluctant to embrace the technology. One of the barriers believed to be responsible for the slow adoption of EMR technology is resistance by many physicians who are not convinced of the advantages of using EMR systems. This study examined potential characteristics of physicians that might help identify those individuals that are most likely to pose a threat to the successful implementation of an EMR system in a multi-specialty clinic. The results demonstrated that older physicians and physicians with only minimal computer skills are more likely to have negative attitudes regarding EMR technology. Medical specialists were most likely to have positive attitudes with respects to the use of EMR systems, while primary care physicians were most likely to have doubts regarding the purported benefits of EMR technology.

scholarly journals Loneliness and Burden Perceived by Family Caregivers of Patients With Alzheimer Disease

2020 ◽  
Vol 35 ◽  
pp. 153331752091778
Author(s):  
Verena Bramboeck ◽  
Korbinian Moeller ◽  
Josef Marksteiner ◽  
Liane Kaufmann
Keyword(s):  
Alzheimer Disease ◽  
Neuropsychiatric Symptoms ◽  
Patient Characteristics ◽  
Model Fit ◽  
Diagnostic Tools ◽  
Regression Analyses ◽  
Additional Consideration ◽  
Improve Model ◽  
Patient Variables ◽  
Living Circumstances

Background: The present study aimed at investigating loneliness and burden experienced by family members caring for relatives diagnosed with Alzheimer disease. Methods: Participants were 40 caregivers of inpatients with Alzheimer disease. Correlation and multiple regression analyses were conducted to investigate whether caregivers’ loneliness (uni- and multidimensional) and burden are associated with and predicted by (1) specific caregiver characteristics and/or (2) patients’ dementia severity and neuropsychiatric symptoms. Results: Loneliness was significantly correlated with caregivers’ sex, age, and living circumstances, while burden was significantly correlated with caregivers’ education solely. Regression analyses revealed that caregivers’ sex and living circumstances contributed significantly to variance explanation of loneliness (but not burden), while the additional consideration of patient variables did not improve model fit. Conclusions: Loneliness reported by caregivers of relatives diagnosed with dementia is significantly modulated by caregiver (but not patient) characteristics. Notably, both uni- and multidimensional loneliness scales seem to be sensitive diagnostic tools.

scholarly journals Factors associated with physician prescribing behavior of dipeptidyl peptidase-4 inhibitors for type 2 diabetes in the US outpatient population

2017 ◽  
Vol 6 (2) ◽  
pp. 59
Author(s):  
Xiaojing Ma ◽  
Chanhyun Park ◽  
Hsien-Chang Lin ◽  
Sweta Andrews ◽  
Jongwha Chang
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care Physicians ◽  
Patient Characteristics ◽  
Prescribing Pattern ◽  
Dipeptidyl Peptidase 4 ◽  
Prescribing Behavior ◽  
Factors Associated ◽  
Physician Characteristics ◽  
Physician Prescribing

Objective: Although the use of dipeptidyl peptidase-4 (DPP-4) inhibitors has been increasing after their first approval in 2006, little is known about their prescribing pattern. Therefore, the objective of this study is to evaluate the prescribing pattern of the DPP-4 inhibitors for the treatment of type 2 diabetes mellitus (T2DM) and examine sociological factors associated with physician prescribing behavior in the U.S. outpatient setting.Methods: This cross-sectional study was conducted utilizing data from the 2006-2010 National Ambulatory Medical Care Survey (NAMCS) and employed the Eisenberg model that explains physician decision making in the context of sociologic influences. For independent variables, the following characteristics were determined based on the Eisenberg model: patient characteristics, physician characteristics, the physician-health care system interaction, and the physician-patient relationship. The dependent variable was the use of DPP-4 inhibitors. Multivariate logistic regressions were used for analyses.Results: The estimated population size was 535,158,796 patients during five years, and 3.85% of them were prescribed DPP-4 inhibitors. Among the patient characteristic-related factors, the odds of the use of DPP-4 inhibitors was 73% lower in patients with Medicaid compared to patients with private insurance (OR = 0.27; 95% CI, 0.08-0.88; p = .030). For the physician characteristic-related factor, the odds of prescribing DPP-4 inhibitors for primary care physicians are about 86% higher than the odds for non-primary care physicians (OR = 1.86; 95% CI, 1.17-2.95; p = .008). In addition, physicians in private offices were 3.01 times more likely to prescribe DPP-4 inhibitors than physicians in the health maintenance organizations (HMO) (OR = 3.01; 95% CI, 1.03-8.78; p = .043).Conclusions: Patient characteristics, physician characteristics, and the physician’s relationship with the health care system were associated with an increased use of DPP-4 inhibitors. However, the physician’s relationship with the patient was not associated with an increased use of DPP-4 inhibitors.

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