Evaluating family counselling skills training for family practice.

Educational programmes for family practice should develop family counselling skills of students to moderate levels of competence. Few specific training programmes are part of the regular curriculum and of these few are evaluated. Twenty-three residents enrolled in a 2-year family practice programme in Toronto, Canada participated in a non-randomized control intervention study to assess a specific training programme. Pre-training counselling skills, and ability were assessed using two types of generally recognized measurement instruments, the Carkhuff Stems of Communication Skills and the Carkhuff Discrimination Index. The treatment group entered the training programme which involved supervised family counselling 8 half-days each week for one month as part of their usual rotations. They completed a second set of instruments following this course to assess immediate within-group change and then both they and the control group completed a set about one year later to measure differences. Initial scores for all residents showed a less than 'minimally facilitative' level of counselling response on both empathy and warmth dimensions. Following the course, the treatment group scored above this level and significantly better than the control group. Furthermore, the former showed a 20% improvement in ability to discriminate between effective and ineffective helping responses which was sustained over one year, while the control group's scores became worse. Teaching of counselling skills can be effective.

Referrals in primary care: is the family physician a "gatekeeper"?

The increasing financial restraints on the use of health care resources make it important to examine the appropriateness of present usage patterns. The authors studied referral patterns for a group of academic family physicians practising in a health service organization in Ontario. They found that for all consultant encounters, the family physician directly controlled 65% of these consultations, whereas 13% were continuing consultations with the specialist without direct family physician referral. The remainder were either unknown or referred from other sources, for example, emergency room or specialist-to-specialist referrals. The family physician made the exact same diagnosis as the consultant in 73.4% of cases for which data were available, and the patient was referred to an inappropriate specialist in only 2.7% of cases.

The effects of learners on waiting times and patient satisfaction in an ambulatory teaching practice.

Data regarding waiting times and times with nurses and physicians were recorded for 656 patients visiting a large family practice unit. Patients also provided estimates of their own waiting times and ratings of the acceptability of these waits. The data were analyzed to assess whether any differences exist in terms of waiting times, times with providers, and waiting time satisfaction for patients seen by clinical clerks (medical students), resident physicians, and attending physicians. Consultation times were longer for patients seen by learners, but waiting times were shorter for these patients. Importantly, there were no significant differences in terms of patient satisfaction with consultation time or waiting time satisfaction. Thus, while learners made a noticeable impact on consultation time, the overall effect on the patient booking system was marginal, and there was no negative impact on patient wait time satisfaction. To control for unevenness of type of providers assigned to the different services, only intermediate assessments are included in this study. The conclusions should not be generalized for other types of services.

Satisfaction and wait time of patients visiting a family practice clinic.

Data relating to wait times and time spent with nurses and physicians were recorded for 656 patients visiting a large family-practice unit. Patients were asked to provide estimates of their wait times and ratings of the acceptability of these wait intervals. Actual wait times were usually longer than those estimated by the patient, and total wait times were considered reasonable. The results of the study show high levels of patient satisfaction and indicate that few patients are dissatisfied until total wait time exceeds forty-five minutes. Different age groups appear to have different expectations, however, and younger patients are more likely to be dissatisfied with their wait times.

Left-vs. Right-Handedness: A Preliminary Survey of Health Status and Health Care Utilization.

Left-handedness has been linked to dyslexia, migraines, autoimmune disease and early-onset dementia. A pilot study to investigate further the association among handedness, health status and health-care utilization was carried out in a group family practice setting. Variables included frequency of types of medical problems, frequency of visits to the physician, number of referrals to specialists, and number of laboratory and radiographical investigations. A short questionnaire assessing handedness was distributed to 613 randomly selected patients visiting the family practice clinic over a one-month period. Twenty-eight left-handers were identified among 520 patients. These were matched with 28 controls, after which charts for all subjects were reviewed to evaluate the study variables. No statistical differences were found between the two groups. Methodological problems included determining true handedness (as distinct from mixed), reviewing of charts for data, and coding and assessing the data. Suggestions are made for improving and facilitating further research in this area for family practice.

Referrals and investigation patterns in a family physician group: questions for teaching cost containment.

Analysis of laboratory use and referrals within a family practice teaching group showed large differences in physicians' behavior. There were three- to four-fold differences between physicians, both for the number and the costs of laboratory use and X-ray services. There were equally large variations in the types of referrals (to medical, dermatologic, obstetric and gynecologic, surgical, ophthalmological and psychological services). There was no consistent pattern for any physician: that is, if a physician used laboratory investigations often, that physician might seldom use X-ray services or might refer fewer patients to specialists. These results have major implications for teachers and for teaching cost containment.