Open-access appointment scheduling in family practice: comparison of a demand prediction grid with actual appointments.

BACKGROUND: Inadequate access to their primary care physician remains a major reason for patient dissatisfaction in ambulatory care. The concept of open-access appointment scheduling has been found to accommodate patients' urgent health care needs while providing continuous, routine care. We describe the development of a demand prediction grid for future appointments, compare it with one developed by Kaiser Permanente, and compare the predictions with actual appointments made and held in our clinic. METHODS: Using adjusted 1999 appointments based on historical data for the Scott & White Killeen Clinic (> 75,000 annual appointments; 13 family physicians), we computed appointment predictions for calendar year 2000 by day of the week and by month of the year. We then compared our predictions with those of Kaiser and actual appointments for the first half of 2000. RESULTS: Our data and the Kaiser data agreed on the day of week, but they were different for the summer and winter months. Overall, actual appointments made and held at our clinic for January through June 2000 were within 6% of the predictions. Appointments for January and February were 18% and 4% more than the predictions, respectively, while appointments for March were 3% less than the predictions. Appointments for April through June were 3% to 7% more than the predictions. Few daily variations were observed between actual appointments and predictions. CONCLUSIONS: We conclude that the Kaiser data might be tempered by a different climate, underscoring the need for each practice to develop its own demand prediction grid. That our actual appointments were 6% more than predicted overall but fluctuated month by month reemphasizes the need for continuous monitoring of the adjustment factor for prediction.

Family practice incidence rates.

BACKGROUND: It is difficult for practicing physicians to understand the annual incidence of disease in terms that are directly relevant to their practices. A simple calculation, called the family practice incidence rate (FPIR), has been developed to assist family physicians in applying epidemiological information to their own patient population. METHODS: By multiplying the annual incidence of a disease by the practice panel size and dividing by the population, it is possible to determine the number of cases a family physician will see in 1 year. When the answer is a fraction, that fraction can be divided into 1 year to determine the number of years required to encounter one case. This formula can be adjusted for panel size, specific percentages of the practice panel and regional variations in incidence rates. RESULTS AND CONCLUSIONS: The FPIR is a convenient model to make the incidence of disease, mortality data, and demographic data immediately available to the practicing physician. Using this calculation will help physicians better understand the patient population they serve.

Use effectiveness of the Cytobrush in the primary care setting.

BACKGROUND: Numerous studies indicate that Papanicolaou smears contain better cellular material when the technique for collecting the sample employs the Zelsmyn Cytobrush. Few studies, however, have examined its ability to increase the percentage of abnormal Papanicolaou smear results in actual clinical practice. METHODS: This study looked at 7999 Papanicolaou smears done by 46 primary care physicians to determine the percentage of abnormal results during two different periods. The Cytobrush technique was then implemented; and after 6029 Papanicolaou smears, the percentage of smears with abnormal findings was recalculated. RESULTS: The proportion of Papanicolaou smears demonstrating significantly abnormal cells remained constant during the three observation periods: 1.81 percent during the first period, 1.96 percent during the second period (before the Cytobrush technique was implemented), and 1.96 percent during the third period (after the Cytobrush technique was implemented). CONCLUSIONS: It seems logical that Papanicolaou smears containing better cellular material from the squamocolumnar junction would increase the yield of Papanicolaou smears with cancerous and precancerous cells. Our study, however, did not confirm this supposition. While evaluation of Papanicolaou smear technique based on quantity and quality of cellular material is important, we believe the effectiveness of any technique must be evaluated from another perspective--the actual practice setting.

The house call in current medical practice.

There is currently a resurgence of interest in house calls in American primary care. Studies have shown that at least 53 percent of family physicians still do house calls, although younger physicians may be less likely to do house calls than their older colleagues. To gain a deeper insight into the house call, one must appreciate the types of house calls: (1) the emergency house call, (2) the acute illness house call, (3) the chronic illness house call, (4) the dying patient house call, (5) the house call to pronounce death, (6) the grief house call, (7) home management vs hospitalization house call, and (8) the home visit house call. The chronic illness house call is by far the most common type, but all can become important ingredients in comprehensive family practice. The training environment should emphasize the home visit type of house call, since one must learn to appreciate this type of encounter.