Primary care physician: Difference between revisions

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imported>Robert Badgett
imported>Robert Badgett
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* Regarding the treatment of pain in general, two studies found specialists were more likely to adopt [[cyclooxygenase 2 inhibitors|cyclooxygenase 2 inhibitor]] drugs before the drug [[rofecoxib]] was withdrawn by its manufacturers because of its unanticipated adverse effects <ref name="pmid15755796">{{cite journal |author=Rawson N ''et al.'' |title=Factors associated with celecoxib and rofecoxib utilization |journal=Ann Pharmacother |volume=39 |pages=597-602 |year=2005 |pmid=15755796}}</ref><ref name="pmid16808768">{{cite journal |author=De Smet BD ''et al.'' |title=Over and under-utilization of cyclooxygenase-2 selective inhibitors by primary care physicians and specialists: the tortoise and the hare revisited |journal=J Gen Intern Med |volume=21 |pages=694-7 |year=2006 |pmid=16808768 |doi=10.1111/j.1525-1497.2006.00463.x}}</ref>. One of the studies went on to state:
* Regarding the treatment of pain in general, two studies found specialists were more likely to adopt [[cyclooxygenase 2 inhibitors|cyclooxygenase 2 inhibitor]] drugs before the drug [[rofecoxib]] was withdrawn by its manufacturers because of its unanticipated adverse effects <ref name="pmid15755796">{{cite journal |author=Rawson N ''et al.'' |title=Factors associated with celecoxib and rofecoxib utilization |journal=Ann Pharmacother |volume=39 |pages=597-602 |year=2005 |pmid=15755796}}</ref><ref name="pmid16808768">{{cite journal |author=De Smet BD ''et al.'' |title=Over and under-utilization of cyclooxygenase-2 selective inhibitors by primary care physicians and specialists: the tortoise and the hare revisited |journal=J Gen Intern Med |volume=21 |pages=694-7 |year=2006 |pmid=16808768 |doi=10.1111/j.1525-1497.2006.00463.x}}</ref>. One of the studies went on to state:
::"''using COX-2s as a model for physician adoption of new therapeutic agents, specialists were more likely to use these new medications for patients likely to benefit but were also significantly more likely to use them for patients without a clear indication''".<ref name="pmid16808768"/>  
::"''using COX-2s as a model for physician adoption of new therapeutic agents, specialists were more likely to use these new medications for patients likely to benefit but were also significantly more likely to use them for patients without a clear indication''".<ref name="pmid16808768"/>  
* Primary care physicians, as compared to specialists, may obtain [[vaginal smear]]s at rates more concordant with [[U.S. Preventive Services Task Force]] [[clinical practice guideline]]s.<ref name="pmid20548011">{{cite journal| author=Saraiya M, Berkowitz Z, Yabroff KR, Wideroff L, Kobrin S, Benard V| title=Cervical cancer screening with both human papillomavirus and Papanicolaou testing vs Papanicolaou testing alone: what screening intervals are physicians recommending? | journal=Arch Intern Med | year= 2010 | volume= 170 | issue= 11 | pages= 977-85 | pmid=20548011
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20548011 | doi=10.1001/archinternmed.2010.134 }} </ref>
* Similarly, primary care physicians may be more critical of new research than are specialist physicians.<ref name="pmid16622142">{{cite journal| author=Haynes RB, Cotoi C, Holland J, Walters L, Wilczynski N, Jedraszewski D et al.| title=Second-order peer review of the medical literature for clinical practitioners. | journal=JAMA | year= 2006 | volume= 295 | issue= 15 | pages= 1801-8 | pmid=16622142  
* Similarly, primary care physicians may be more critical of new research than are specialist physicians.<ref name="pmid16622142">{{cite journal| author=Haynes RB, Cotoi C, Holland J, Walters L, Wilczynski N, Jedraszewski D et al.| title=Second-order peer review of the medical literature for clinical practitioners. | journal=JAMA | year= 2006 | volume= 295 | issue= 15 | pages= 1801-8 | pmid=16622142  
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=16622142 | doi=10.1001/jama.295.15.1801 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref>
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=16622142 | doi=10.1001/jama.295.15.1801 }}</ref>


Factors associated with quality of care by primary care physicians include:
Factors associated with quality of care by primary care physicians include:

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A primary care physician is the doctor who is predominantly responsible for a patient's health. One of the tasks of the primary care physician is coordinating the many facets of a patient's health care and chronic diseases.[1]

Studies of the quality of care provided by primary care physicians

Studies that compare the knowledge base and quality of care provided by generalists versus specialists usually find that the specialists are more knowledgeable and provide better care. [2][3][4] However, these studies examine the quality of care in the domain of the specialists. In addition, these studies need to account for clustering of patients and physicians. [5]

Studies of the quality of preventive health care find the opposite results - primary care physicians perform best. An analysis of elderly patients found that patients seeing generalists, as compared to patients seeing specialists, were more likely to receive influenza vaccination. [6] In health promotion counseling, a studies of self-reported behavior found that generalists were more likely than internal medicine specialists to counsel patients [7] and to screen for breast cancer. [8]

Exceptions may be diseases that are so common that primary care physicians develop their own expertise:

  • A study of patients with acute low back pain found the primary care physicians provided equivalent quality of care, but at lower costs that orthopedic specialists. [9] Another study found that orthopedics surgeons may be less aware of current knowledge than primary care physicians.[10]
  • Regarding the treatment of pain in general, two studies found specialists were more likely to adopt cyclooxygenase 2 inhibitor drugs before the drug rofecoxib was withdrawn by its manufacturers because of its unanticipated adverse effects [11][12]. One of the studies went on to state:
"using COX-2s as a model for physician adoption of new therapeutic agents, specialists were more likely to use these new medications for patients likely to benefit but were also significantly more likely to use them for patients without a clear indication".[12]

Factors associated with quality of care by primary care physicians include:

  • The more experience the primary care physician has with a specific disease. [15]
  • Physician group affiliation with networks of multiple groups.[16]

Job satisfaction

A qualitative survey of internal medicine doctors in the United States found three sources of satisfaction from medical practice:[17]

  1. realizing a fundamental change in perspective via an experience with a patient
  2. making a difference made in someone's life
  3. connecting with patients

Part-time practice is associated with increased satisfaction.[18]

Difficulties

The increasing number of items to discuss during a patient visit is a problem[19] in spite of the increasing length of visits[20]. Longer visits are associated with greater quality.[20]

Collapse of primary care in the United States

The number of physicians entering primary care in the United States is dropping, probably in part due to making less income for the amount on time spend with patients.[21] Alternative financial compensation models have been proposed.[22] These models include the medical home[23], ambulatory intensive caring unit, and retainer model of compensation has been proposed to solve this problem (also called concierge medicine).[24]

References

  1. ↑ Bodenheimer, T. (2008). Coordinating care -- a perilous journey through the health care system, N Engl J Med, 358(10), 1064-1071. DOI:10.1056/NEJMhpr0706165.
  2. ↑ Majumdar S, Inui T, Gurwitz J, Gillman M, McLaughlin T, Soumerai S (2001). "Influence of physician specialty on adoption and relinquishment of calcium channel blockers and other treatments for myocardial infarction". J Gen Intern Med 16 (6): 351-9. PMID 11422631.
  3. ↑ Fendrick A, Hirth R, Chernew M (1996). "Differences between generalist and specialist physicians regarding Helicobacter pylori and peptic ulcer disease". Am J Gastroenterol 91 (8): 1544-8. PMID 8759658.
  4. ↑ George S, et al. A prospective randomised comparison of minor surgery in primary and secondary care. The MiSTIC trial. Health Technol Assess. 2008 May;12(23):1-58. PMID 18505669
  5. ↑ (2002) "Summaries for patients. Comparing the quality of diabetes care by generalists and specialists". Ann Intern Med 136 (2): I42. PMID 11928735.
  6. ↑ Rosenblatt R, Hart L, Baldwin L, Chan L, Schneeweiss R (1998). "The generalist role of specialty physicians: is there a hidden system of primary care?". JAMA 279 (17): 1364-70. PMID 9582044.
  7. ↑ Lewis C, Clancy C, Leake B, Schwartz J (1991). "The counseling practices of internists". Ann Intern Med 114 (1): 54-8. PMID 1983933.
  8. ↑ Turner B, Amsel Z, Lustbader E, Schwartz J, Balshem A, Grisso J. "Breast cancer screening: effect of physician specialty, practice setting, year of medical school graduation, and sex". Am J Prev Med 8 (2): 78-85. PMID 1599724.
  9. ↑ Carey T, Garrett J, Jackman A, McLaughlin C, Fryer J, Smucker D (1995). "The outcomes and costs of care for acute low back pain among patients seen by primary care practitioners, chiropractors, and orthopedic surgeons. The North Carolina Back Pain Project". N Engl J Med 333 (14): 913-7. PMID 7666878.
  10. ↑ Finestone AS, Raveh A, Mirovsky Y, Lahad A, Milgrom C (2009). "Orthopaedists' and family practitioners' knowledge of simple low back pain management.". Spine (Phila Pa 1976) 34 (15): 1600-3. DOI:10.1097/BRS.0b013e3181a96622. PMID 19564770. Research Blogging.
  11. ↑ Rawson N et al. (2005). "Factors associated with celecoxib and rofecoxib utilization". Ann Pharmacother 39: 597-602. PMID 15755796.
  12. ↑ 12.0 12.1 De Smet BD et al. (2006). "Over and under-utilization of cyclooxygenase-2 selective inhibitors by primary care physicians and specialists: the tortoise and the hare revisited". J Gen Intern Med 21: 694-7. DOI:10.1111/j.1525-1497.2006.00463.x. PMID 16808768. Research Blogging.
  13. ↑ Saraiya M, Berkowitz Z, Yabroff KR, Wideroff L, Kobrin S, Benard V (2010). "Cervical cancer screening with both human papillomavirus and Papanicolaou testing vs Papanicolaou testing alone: what screening intervals are physicians recommending?". Arch Intern Med 170 (11): 977-85. DOI:10.1001/archinternmed.2010.134. PMID 20548011. Research Blogging.
  14. ↑ Haynes RB, Cotoi C, Holland J, Walters L, Wilczynski N, Jedraszewski D et al. (2006). "Second-order peer review of the medical literature for clinical practitioners.". JAMA 295 (15): 1801-8. DOI:10.1001/jama.295.15.1801. PMID 16622142. Research Blogging.
  15. ↑ Kitahata M, Koepsell T, Deyo R, Maxwell C, Dodge W, Wagner E (1996). "Physicians' experience with the acquired immunodeficiency syndrome as a factor in patients' survival". N Engl J Med 334 (11): 701-6. PMID 8594430.
  16. ↑ Friedberg et al., “Does Affiliation of Physician Groups with One Another Produce Higher Quality Primary Care?,” Journal of General Internal Medicine 22, no. 10 (October 21, 2007): 1385-1392, http://dx.doi.org/10.1007/s11606-007-0234-0 (accessed September 28, 2007).
  17. ↑ Horowitz C, Suchman A, Branch W, Frankel R (2003). "What do doctors find meaningful about their work?". Ann Intern Med 138 (9): 772-5. PMID 12729445.
  18. ↑ Mechaber HF, Levine RB, Manwell LB, et al (2008). "Part-time physicians...prevalent, connected, and satisfied". J Gen Intern Med 23 (3): 300-3. DOI:10.1007/s11606-008-0514-3. PMID 18214623. Research Blogging.
  19. ↑ Abbo, Elmer; Qi Zhang, Martin Zelder, Elbert Huang (2008-12-01). "The Increasing Number of Clinical Items Addressed During the Time of Adult Primary Care Visits". Journal of General Internal Medicine 23 (12): 2058-2065. DOI:10.1007/s11606-008-0805-8. Retrieved on 2008-12-18. Research Blogging.
  20. ↑ 20.0 20.1 Chen LM, Farwell WR, Jha AK (2009). "Primary care visit duration and quality: does good care take longer?". Arch Intern Med 169 (20): 1866-72. DOI:10.1001/archinternmed.2009.341. PMID 19901138. Research Blogging.
  21. ↑ Singer, N (3/19/2008). For Top Medical Students, an Attractive Field. New York Times. Retrieved on 2008-03-31.
  22. ↑ Baron, R. J., & Cassel, C. K. (2008). 21st-Century Primary Care: New Physician Roles Need New Payment Models. JAMA, 299(13), 1595-1597. DOI:10.1001/jama.299.13.1595.
  23. ↑ Anonymous (2008). ACP: Medical Homes & Patient-Centered Care. American College of Physicians. Retrieved on 2008-04-02.
  24. ↑ Centor RM, Vega CP (03/20/2008). The Retainer Model or Single Payer -- What Will Save Primary Care?. Medscape. Retrieved on 2008-03-31.

See also

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