Primary Care: The Future for Pediatric Education

PEDIATRICS ◽  
1990 ◽  
Vol 86 (5) ◽  
pp. 653-659
Author(s):  
Joel J. Alpert
Keyword(s):  
Primary Care ◽  
Rural Areas ◽  
Primary Care Physicians ◽  
Geographic Location ◽  
Pediatric Care ◽  
Past Century ◽  
Inner Cities ◽  
Critical Issues ◽  
Definition Of ◽  
Care Problems

There is a continuing crisis in primary care, characterized by inadequate numbers of appropriately trained primary care physicians and the failure to mount an effective and consistent graduate educational program for primary care. This paper reviews the history of the primary care crisis; revisits the definition of primary care; and, through identification of critical issues, presents a primary care educational agenda for the 1990s. Pediatrics is at a crossroads regarding primary care, as powerful social and economic forces are impacting on today's major pediatric care problems. Before the second World War there were more than 300 primary care physicians available for each 100 000 of our population. Today the ratio is 75 for 100 000. This is despite the fact that a shortage of 50 000 physicians 10 years ago no longer exists. The majority view is that a physician surplus of 70 000 will be present by the early 1990s.1 Whether there is a surplus is subject to interpretation and the surplus may end up as nonexistent. Moreover, the availability of primary care physicians varies with geographic location, and even a single figure for this nation provides a distorted picture. The shortage is especially serious in inner cities and in many rural areas. In addition, the use of overall numbers assumes that all primary care physicians are appropriately trained in the general disciplines. For the past century, physicians have cared for patients usually as family physicians. Today, however, the generalist has been replaced by the specialist. Is this a function of financial rewards and society's needs and values or the educational experience?

scholarly journals The Differences in the Prevalence of Cardiovascular Disease, Its Risk Factors, and Achievement of Therapeutic Goals among Urban and Rural Primary Care Patients in Poland: Results from the LIPIDOGRAM 2015 Study

2021 ◽  
Vol 10 (23) ◽  
pp. 5656
Author(s):  
Krzysztof Studziński ◽  
Tomasz Tomasik ◽  
Adam Windak ◽  
Maciej Banach ◽  
Ewa Wójtowicz ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Rural Areas ◽  
Urban Areas ◽  
Primary Care Physicians ◽  
Primary Care Patient ◽  
Care Patient ◽  
Cross Sectional ◽  
Therapeutic Goals ◽  
Rural Primary Care

A nationwide cross-sectional study, LIPIDOGRAM2015, was carried out in Poland in the years 2015 and 2016. A total of 438 primary care physicians enrolled 13,724 adult patients that sought medical care in primary health care practices. The prevalence of hypertension, diabetes mellitus, dyslipidaemia, and CVD were similar in urban and rural areas (49.5 vs. 49.4%; 13.7 vs. 13.1%; 84.2 vs. 85.2%; 14.4 vs. 14.2%, respectively). The prevalence of obesity (32.3 vs. 37.5%, p < 0.01) and excessive waist circumference (77.5 vs. 80.7%, p < 0.01), as well as abdominal obesity (p = 43.2 vs. 46.4%, p < 0.01), were higher in rural areas in both genders. Mean levels of LDL-C (128 vs. 130 mg/dL, p = 0.04) and non-HDL-C (147 vs. 148 mg/dL, p = 0.03) were slightly higher in rural populations. Altogether, 14.3% of patients with CVD from urban areas and 11.3% from rural areas reached LDL <70 mg/dL (p = 0.04). There were no important differences in the prevalence of hypertension, diabetes, dyslipidaemia, and CVD, or in mean levels of blood pressure, cholesterol fractions, glucose, and HbA1c between Polish urban and rural primary care patient populations. A high proportion of patients in cities and an even-higher proportion in rural areas did not reach the recommended targets for blood pressure, LDL-C, and HbA1c, indicating the need for novel CVD-prevention programs.

scholarly journals Use of Heuristics during the clinical decision process in from family physicians in real conditions.

2021 ◽  
Author(s):  
Carmen Fernández Aguilar ◽  
José-Jesús Martín-Martín ◽  
Sergio Minué-Lorenzo ◽  
Alberto Fernández Ajuria
Keyword(s):  
Primary Care ◽  
Decision Process ◽  
Primary Care Physicians ◽  
Clinical Decision ◽  
Diagnostic Error ◽  
Operational Definition ◽  
Statistical Correlation ◽  
Diagnostic Process ◽  
Representativeness Heuristic ◽  
Definition Of

Rationale, aims and objectives: The available evidence on the existence and consequences of the use of heuristics in the clinical decision process is very scarce. The purpose of this study is to measure the use of the Representativeness, Availability and Overconfidence heuristics in real conditions with Primary Care physicians in cases of dyspnea and to study the possible correlation with diagnostic error. Methods: A prospective cohort study was carried out in 4 Primary Care centers in which 371 new cases or dyspnea were registered. The use of the three heuristics in the diagnostic process is measured through an operational definition of the same. Subsequently, the statistical correlation with the identified clinical errors is analyzed. Results: In 9.97% of the registered cases a diagnostic error was identified. In 49.59% of the cases, the physicians used the representativeness heuristic in the diagnostic decision process. The availability heuristic was used by 82.38% of the doctors and finally, in more than 50% of the cases the doctors showed excess confidence. None of the heuristics showed a statistically significant correlation with diagnostic error. Conclusion: The three heuristics have been used as mental shortcuts by Primary Care physicians in the clinical decision process in cases of dyspnea, but their influence on the diagnostic error is not significant. New studies based on the proposed methodology will allow confirming both its importance and its association with diagnostic error.

Induced Delusional Disorder in Rural Areas: A Case of Folie a Quatre

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
V. Peritogiannis ◽  
M. Lekka ◽  
N. Papavassiliou ◽  
C. Mantas ◽  
V. Mavreas ◽  
...  
Keyword(s):  
Primary Care ◽  
Rural Areas ◽  
Primary Care Physicians ◽  
Psychiatric Service ◽  
Delusional Disorder ◽  
Appropriate Treatment ◽  
Psychiatric Units ◽  
Close Relationship ◽  
Psychotic Exacerbation ◽  
Three Sisters

Background and aim:Induced delusional disorder or folie a deux is characterized by the presence of similar delusional ideas in two or more individuals. The delusional system develops as a result of a close relationship with a person with an established psychotic disorder. Most commonly the affected persons are members of a family.Methods:An unusual case of folie a famille involving four siblings, brother and three sisters, (folie a quatre) is presented. This case was detected in the context of a community-based psychiatric service in Greece, the Mobile Psychiatric Unit of the prefectures of Ioannina and Thesprotia.Results:A 46-year-old woman was referred from primary care physicians for the management of a psychotic exacerbation. On the examination it was revealed that she and her three older siblings were sharing the delusional idea of being affected by their neighbors with magic. These siblings had been living in social isolation for long and have been querulant and aggressive toward their neighbors, against whom they had undertaken a succession of lawsuits. None of the rest siblings accepted to be examined so it could not be determined who the inducer was or what the diagnoses were for each of the affected persons. The patient did not receive the prescribed medication and did not engage in follow-up.Conclusions:Cases of induced delusional disorder may be difficult to be detected and treated. Mobile psychiatric units in co-operation with primary care physicians may have an opportunity to provide appropriate treatment for such patients in rural areas.

scholarly journals Desirable Characteristics of Consulting Cardiologists for Sustained Referrals by Primary Care Physicians

2016 ◽  
Vol 6 ◽  
Author(s):  
Phillip Ribeiro ◽  
Swetal Patel ◽  
Krystal Carlos ◽  
Sumit Sehgal ◽  
Ramdas Pai ◽  
...  
Keyword(s):  
Primary Care ◽  
Rural Areas ◽  
Primary Care Physicians ◽  
Primary Care Providers ◽  
Team Work ◽  
Care Organization ◽  
Care Providers ◽  
Specialist Care ◽  
Little Rock ◽  
Potential Factors

<p>Accountable care organization and high quality affordable patient care requires impeccable team work between primary and specialist care physicians. Limited data exists on evaluation of factors that lead to termination of referrals between primary care physicians and cardiologists.  Using an 11 point questionnaire of potential factors for cause of termination of referrals to cardiologists, 103 primary care providers were interviewed. Out of 103 primary care providers interviewed in Little Rock, Arkansas and Chicago, Illinois, 84 providers were practicing in the city limits and 19 in the rural areas. The most important factors that result in termination of referrals between primary care physicians and cardiologists include cardiologist's bedside manners as perceived by the patient, poor feedback to the primary care provider from the cardiologist, and the patients not getting their questions fully answered by the cardiologist during the visit.</p>

Primary Care and Physician Extenders in Affluent Countries

1977 ◽  
Vol 7 (4) ◽  
pp. 545-555 ◽  
Author(s):  
Milton I. Roemer
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Rural Areas ◽  
Primary Care Physicians ◽  
Physician Assistants ◽  
The United States ◽  
Industrialized Countries ◽  
Major Response ◽  
Urban And Rural Areas ◽  
Physician Extenders

The worldwide growth of specialization in medicine has led to a perceived shortage of primary care. A major response in the United States has been the training of physician extenders (both physician assistants and nurse practitioners). Other industrialized countries have rejected this approach, in favor of strengthening general medical practice through continuing education, provision of ancillary personnel, use of health centers, and by other methods. Developing countries use doctor-substitutes as a reasonable adjustment to their lack of economic resources. All countries use ancillary personnel for selected procedures, such as midwifery, which involve only limited judgment and decision making. The American strategy on use of doctor-substitutes for primary care, however, follows from unwillingness to train greater numbers of primary care physicians and to require them to serve in places of need. This results in an inequitable concentration of doctor-substitutes on service to the poor in both urban and rural areas.

scholarly journals Effect of trust in primary care physicians on patient satisfaction: a cross-sectional study among patients with hypertension in rural China

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Wenqin Chen ◽  
Yingchao Feng ◽  
Jiyuan Fang ◽  
Jin Wu ◽  
Xianhong Huang ◽  
...  
Keyword(s):  
Primary Care ◽  
Patient Satisfaction ◽  
Rural Areas ◽  
Primary Care Physicians ◽  
Rural China ◽  
Hypertension Management ◽  
Technical Competence ◽  
Patient Trust ◽  
Clinical Behavior ◽  
Organization Of Care

Abstract Background In rural areas of China, hypertension is on the rise and it is drawing the Chinese government’s attention. The health outcomes of hypertension management can be positively impacted by patient satisfaction with primary care physicians (PCPs), and the influence of patient trust on satisfaction cannot be ignored. This study aimed to analyze the effect of trust in PCPs on patient satisfaction among patients with hypertension in rural China, and the influence of patients’ socio-demographic characteristics and hypertension-management-related factors. Methods A multi-stage stratified random sampling method was adopted to investigate 2665 patients with hypertension in rural China. Patient trust and satisfaction were measured using the Chinese version of the Wake Forest Physician Trust Scale and the European Task Force on Patient Evaluation of General Practice. Multiple linear regression was used to analyze the factors influencing patient satisfaction, and structural equation modeling was conducted to clarify the relationships among patient trust and patient satisfaction with PCPs. Results Patients’ trust in their PCPs’ benevolence had a positive main effect on all three satisfaction dimensions (clinical behavior: β = 0.940, p <  0.01; continuity and cooperation: β = 0.910, p <  0.01; and organization of care: β = 0.879, p <  0.01). Patients’ trust in their PCPs’ technical competence had a small negative effect on all three satisfaction dimensions (clinical behavior: β = − 0.077, p <  0.01; continuity and cooperation: β = − 0.136, p <  0.01; and organization of care: β = − 0.064, p <  0.01). Patient satisfaction was also associated with region, gender, insurance status, distance from the nearest medical/health-service institution, and number of visits to PCPs in the past year. Conclusions Patients focused more on physicians’ benevolence than on their technical competence. Hence, medical humanities and communication skills education should be emphasized for PCPs. Regarding region-based and health-insurance-based differences, the inequities between eastern, central, and western provinces, as well as between urban and rural areas, must also be addressed.

scholarly journals Producing Physicians for Rural Kansas

2020 ◽  
Vol 3 (1) ◽  
Author(s):  
William Cathcart-RAke
Keyword(s):  
Primary Care ◽  
Conflict Of Interest ◽  
Rural Areas ◽  
Primary Care Physicians ◽  
Physician Workforce ◽  
University Of Kansas ◽  
School Of Medicine ◽  
Early Success ◽  
Regional Medical ◽  
The University

Abstract             Physician workforce shortages in rural areas are well-documented problems. The University of Kansas School of Medicine (KUSM) established the Salina regional medical campus (RMC) in response to the need to train more physicians interested in primary care in rural Kansas. Since its founding in 2011, thirty-eight students have completed their training on the Salina RMC and received their M.D. Twenty-eight graduates (74%) matched in primary care residencies; eighteen (44%) in family medicine. Eleven of the first sixteen graduates have finished residency and entered practice; nine are in Kansas, and seven of those are in rural Kansas. The Salina RMC has had early success in producing primary care physicians to serve rural Kansas.   The author has no conflict of interest to report.

scholarly journals The Roles of Nature and Nurture in the Recruitment and Retention of Primary Care Physicians in Rural Areas

2002 ◽  
Vol 77 (8) ◽  
pp. 790-798 ◽  
Author(s):  
Robert G. Brooks ◽  
Michael Walsh ◽  
Russell E. Mardon ◽  
Marie Lewis ◽  
Art Clawson
Keyword(s):  
Primary Care ◽  
Rural Areas ◽  
Primary Care Physicians ◽  
Recruitment And Retention ◽  
Nature And Nurture

Letter to the Editor

PEDIATRICS ◽  
1978 ◽  
Vol 61 (4) ◽  
pp. 672-672
Author(s):  
R. J. H.
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Preventive Services ◽  
Institute Of Medicine ◽  
Letter To The Editor ◽  
Important Field ◽  
Definition Of

While we agree with the definition of primary care articulated by Dr. Rivara, even it does not fully describe this important field. The recent Institute of Medicine definition of primary care1 adds to his points of accessible, comprehensive, and preventive services those of coordination, continuity, and accountability. To have addressed all of these in one small supplement of Pediatrics is a tall order. We clearly could not. In addition we believe that competency in managing the content of such services is also a responsibility of primary care physicians.

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