Speciality
Spotlight

 




 


Family Practice


 

 




Health
Policy And Economics

            
 


  • Rosenblatt RA, Hart LG, Baldwin L-M, et al (Univ of Washington, Seattle; Health Care Financing Administration, Region X, Seattle)

    The Generalist Role in Specialty Physicians: Is There a Hidden System of Primary Care?

    JAMA 279: 1364-1370, 1997

          


    This paper inquires into the generalists’ role that a specialist can perform. In a study of over 370,000 Medicare beneficiaries it is pointed out that most specialist physicians or specialist surgeons are unable to function as generalists.

           


    The authors make an example of immunizations e.g. against influenza. This was highest with generalists, and lowest with surgical specialists; exceptions were rheumatologists and pulmonary specialists.

          


  • Bertakis KD, Callahan EJ, Helms LJ, et al (Univ of California, Davis)

    Physician Practice Styles and Patient Outcomes: Differences Between Family Practice and General Internal Medicine 

    Med Care 36: 879-891, 1998

           


    This paper compares the relationship between patients and attending physicians in the styles of practice involving family practice and a general medicine clinic.

           


    Patient satisfaction was better with counseling, patient activation and physician behavior rather than style of practice. Technical practice had a negative impact.

            

  • Franks P, Fiscella K
    (Univ of Rochester, NY)

    Primary Care Physicians and Specialists as Personal Physicians: Health Care Expenditures and Mortality Experience

    J Fam Pract 47: 105-109, 1998

            


    This large study brings out the importance of managed care in terms of cost and mortality in patients being treated by a primary care physician versus a specialist personal physician.

          


    Rural female white patients preferred the primary care physician and came up with less number of medical problems.

          


    The authors conclude that primary care physicians had a lower mortality and less medical problems, thus were cost effective. More research in the field is suggested.

          


    Conclusion : Seriousness of problems faced by the two groups is likely to be different. If referrals are made late results would be altered against the specialist physician. A balance between the two is suggested.

          


  • Conrad DA, Maynard C, Cheadle A, et al (Univ of Washington, Seattle) 

    Primary Care Physician Compensation Method in Medical Groups: Does It Influence the Use and Cost of Health Services for Enrollees in Managed Care Organizations?

    JAMA 279: 853-858, 1998

           


    This article analyses compensation methods for primary care physicians (PCP) and expenses involved in provisions for enrolled patients in managed care organizations
    (MCOs).

          


    The study involved over 200,000 subjects and 865 PCPs. Taking into consideration hospital stay visits and others there was no significant relation between compensation and use of services offered.

           


    These findings are clear in the case of practice in a group. The authors suggest more studies along these lines.

            


  • Health System Issues


    Halm EA, Causino N, Blumenthal D (Harvard Med School, Boston)

    Is Gatekeeping Better Than Traditional Care? A Survey of Physician’s Attitudes

    JAMA 278: 1677-1681, 1997

           


    The primary care physician (PCP) plays the role of gatekeeping thus coordinating cost reduction and improving quality care.

           


    The 330 physicians involved in this work gave varied opinions. The negative effects included increasing telephone calls, paperwork, poorer physician-patient relations and a variety of other observed facts. 

           


    The authors conclude that gatekeeping may be better or equal to traditional ways of working.

           


    Comment : Wherever a doctor is converted into a clerk clinical work and patient care suffer. In the management jargon doctors have been denigrated to providers and patients to consumers.

           


  • Schulz R, Scheckler WE, Moberg DP, et al (Univ of Wisconsin-Madison)

    Changing Nature of Physician Satisfaction With Health Maintenance Organization and Fee-for-Service Practices

    J Fam Pract 45: 321-330, 1997

            


    Health maintenance organizations (HMOs) and fee-for-service
    (FFS) systems are compared for expressions of satisfaction in physicians thus involved.

           


    Primary care physicians were more satisfied with HMO practice because of autonomy, resources and independence in clinical work. The hospital based subspecialists felt FFS to be better.

           


  • Hurst J, Nickel K, Hilborne LH (Univ of California, Los Angeles; RAND, Santa Monica,
    Calif)

    Are Physicians’ Office Laboratory Results of Comparable Quality to Those Produced in Other Laboratory Settings?

    JAMA 279: 468-471, 1998

           


    A proficiency testing (PT) score was introduced consequent to legal requirement in California since 1995.

           


    Tests were performed in various laboratories including those in physicians’ offices
    (POLs).

          


    Results indicated that unsuccessful results were greater in POLs than non POLs and POLs using qualified medical technicians.

          


  • Longo DR, Land G, Schramm W, et al (Univ of Missouri, Columbia; Missouri, Dept of Health, Jefferson City)

    Consumer Reports in Health Care: Do They Make a Difference in Patient Care?

    JAMA 278: 1579-1584, 1997

           


    Gathering data from consumers on health care provided by several provider hospitals especially those in a competitive field is looked into. The success of competitive ventures depends on the increasing nature of amenities provided to the consumer. 

           


    Hospitals with low patient satisfaction had to alter their policies or add new methods of treatment or investigations.

           


    Comment : Consumer complaint rather than acting as an irritant or criticism needs to be looked into as a way of improvement. Withdrawal of useful facilities have often to be revaluated.

          


  • Smith MA, Atherly AJ, Kane RL, et al (Univ of Minnesota, Minneapolis)

    Peer review of the Quality of Care: Reliability and Sources of Variability for Outcome and Process Assessments

    JAMA 278: 1573-1578, 1997

           


    This paper deals with older frail individuals constituting a population. Their medical records of 1 year were subjected to evaluation by 8 specialists and 6 expert nurses.

           


    The authors conclude that elderly subjects suffer from many chronic illnesses. They can be easily undertreated when cost reduction takes precedence over medical management.

          


    Comment : Maturity in those looking after a gerratric group is often a factor tilting the balance in favor of the
    latter.

                




 

 

Speciality Spotlight

 

 

Health Policy And Economics
              

  • Rosenblatt RA, Hart LG, Baldwin L-M, et al (Univ of Washington, Seattle; Health Care Financing Administration, Region X, Seattle)
    The Generalist Role in Specialty Physicians: Is There a Hidden System of Primary Care?
    JAMA 279: 1364-1370, 1997
          
    This paper inquires into the generalists’ role that a specialist can perform. In a study of over 370,000 Medicare beneficiaries it is pointed out that most specialist physicians or specialist surgeons are unable to function as generalists.
           
    The authors make an example of immunizations e.g. against influenza. This was highest with generalists, and lowest with surgical specialists; exceptions were rheumatologists and pulmonary specialists.
          

  • Bertakis KD, Callahan EJ, Helms LJ, et al (Univ of California, Davis)
    Physician Practice Styles and Patient Outcomes: Differences Between Family Practice and General Internal Medicine 
    Med Care 36: 879-891, 1998
           
    This paper compares the relationship between patients and attending physicians in the styles of practice involving family practice and a general medicine clinic.
           
    Patient satisfaction was better with counseling, patient activation and physician behavior rather than style of practice. Technical practice had a negative impact.
            

  • Franks P, Fiscella K (Univ of Rochester, NY)
    Primary Care Physicians and Specialists as Personal Physicians: Health Care Expenditures and Mortality Experience
    J Fam Pract 47: 105-109, 1998
            
    This large study brings out the importance of managed care in terms of cost and mortality in patients being treated by a primary care physician versus a specialist personal physician.
          
    Rural female white patients preferred the primary care physician and came up with less number of medical problems.
          
    The authors conclude that primary care physicians had a lower mortality and less medical problems, thus were cost effective. More research in the field is suggested.
          
    Conclusion : Seriousness of problems faced by the two groups is likely to be different. If referrals are made late results would be altered against the specialist physician. A balance between the two is suggested.
          

  • Conrad DA, Maynard C, Cheadle A, et al (Univ of Washington, Seattle) 
    Primary Care Physician Compensation Method in Medical Groups: Does It Influence the Use and Cost of Health Services for Enrollees in Managed Care Organizations?
    JAMA 279: 853-858, 1998
           
    This article analyses compensation methods for primary care physicians (PCP) and expenses involved in provisions for enrolled patients in managed care organizations (MCOs).
          
    The study involved over 200,000 subjects and 865 PCPs. Taking into consideration hospital stay visits and others there was no significant relation between compensation and use of services offered.
           
    These findings are clear in the case of practice in a group. The authors suggest more studies along these lines.
            

  • Health System Issues
    Halm EA, Causino N, Blumenthal D (Harvard Med School, Boston)
    Is Gatekeeping Better Than Traditional Care? A Survey of Physician’s Attitudes
    JAMA 278: 1677-1681, 1997
           
    The primary care physician (PCP) plays the role of gatekeeping thus coordinating cost reduction and improving quality care.
           
    The 330 physicians involved in this work gave varied opinions. The negative effects included increasing telephone calls, paperwork, poorer physician-patient relations and a variety of other observed facts. 
           
    The authors conclude that gatekeeping may be better or equal to traditional ways of working.
           
    Comment : Wherever a doctor is converted into a clerk clinical work and patient care suffer. In the management jargon doctors have been denigrated to providers and patients to consumers.
           

  • Schulz R, Scheckler WE, Moberg DP, et al (Univ of Wisconsin-Madison)
    Changing Nature of Physician Satisfaction With Health Maintenance Organization and Fee-for-Service Practices
    J Fam Pract 45: 321-330, 1997
            
    Health maintenance organizations (HMOs) and fee-for-service (FFS) systems are compared for expressions of satisfaction in physicians thus involved.
           
    Primary care physicians were more satisfied with HMO practice because of autonomy, resources and independence in clinical work. The hospital based subspecialists felt FFS to be better.
           

  • Hurst J, Nickel K, Hilborne LH (Univ of California, Los Angeles; RAND, Santa Monica, Calif)
    Are Physicians’ Office Laboratory Results of Comparable Quality to Those Produced in Other Laboratory Settings?
    JAMA 279: 468-471, 1998
           
    A proficiency testing (PT) score was introduced consequent to legal requirement in California since 1995.
           
    Tests were performed in various laboratories including those in physicians’ offices (POLs).
          
    Results indicated that unsuccessful results were greater in POLs than non POLs and POLs using qualified medical technicians.
          

  • Longo DR, Land G, Schramm W, et al (Univ of Missouri, Columbia; Missouri, Dept of Health, Jefferson City)
    Consumer Reports in Health Care: Do They Make a Difference in Patient Care?
    JAMA 278: 1579-1584, 1997
           
    Gathering data from consumers on health care provided by several provider hospitals especially those in a competitive field is looked into. The success of competitive ventures depends on the increasing nature of amenities provided to the consumer. 
           
    Hospitals with low patient satisfaction had to alter their policies or add new methods of treatment or investigations.
           
    Comment : Consumer complaint rather than acting as an irritant or criticism needs to be looked into as a way of improvement. Withdrawal of useful facilities have often to be revaluated.
          

  • Smith MA, Atherly AJ, Kane RL, et al (Univ of Minnesota, Minneapolis)
    Peer review of the Quality of Care: Reliability and Sources of Variability for Outcome and Process Assessments
    JAMA 278: 1573-1578, 1997
           
    This paper deals with older frail individuals constituting a population. Their medical records of 1 year were subjected to evaluation by 8 specialists and 6 expert nurses.
           
    The authors conclude that elderly subjects suffer from many chronic illnesses. They can be easily undertreated when cost reduction takes precedence over medical management.
          
    Comment : Maturity in those looking after a gerratric group is often a factor tilting the balance in favor of the latter.
                

 

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