Environmental health concerns in urban and rural family practice.

OBJECTIVE: To describe environmental health problems encountered in some Ontario family practices and to describe differences between the environmental concerns of urban (small and large) and rural physicians. DESIGN: A self-completed questionnaire was mailed to 536 family physicians with hospital affiliations in three areas of Ontario. SETTING: Family practices (rural, small urban, and large urban) in Ontario. PARTICIPANTS: Of 521 eligible community family physicians with hospital affiliations, 214 returned usable questionnaires for a 41% response rate. MAIN OUTCOME MEASURES: Environmental health problems encountered in practice were measured using questions about physician concerns, reported patient questions, physician-identified high-risk groups, problems related to environmental exposure, self-rated knowledge, and current and preferred sources of information on environmental health effects. RESULTS: Physicians were highly concerned and reported many patient questions about the health effects of environmental exposures. Pregnant women, agricultural workers, and children were considered important at-risk groups. Self-ratings of knowledge were generally very low. Rural physicians were concerned about agricultural pesticide exposure and their patients about moldy hay. Urban physicians had different concerns about lead and reported patient concerns about exposure to Great Lakes fish. All groups used similar sources of current environmental health information. CONCLUSIONS: Family physicians who participated in this study identified important patient and professional concerns about environmental health issues and reported a lack of resources to meet those concerns. This study provides information to family medicine residency programs and continuing medical education providers to help them enhance their focus on environmental health.

Applying total quality management to a pharmacist intervention program.

Intervention documentation continues to be a valuable tool for both documenting pharmacist impact on patient care and justifying new clinical pharmacy services. Utilizing TQM principles to improve documentation has yielded many long-term benefits. Not only has intervention documentation been streamlined, but pharmacists at the staff level were an integral part of the changes that were made and the improvements to come. Their familiarity with the pitfalls of the former system provided solutions to the problems that might have been overlooked without their input.

Pharmacists' perceptions and practices regarding the purchase of multisource pharmaceuticals.

This article describes the results of a survey of the perceptions and practices of pharmacists towards the purchase of multisource pharmaceuticals. A questionnaire was mailed to 1,000 randomly selected hospital pharmacists, 670 managed-care pharmacy directors, and 900 consultant pharmacists in June, 1991. Recipients were asked to provide educational background data, information on pertinent aspects of their work setting, and responses to a variety of questions about multisource pharmaceuticals. Of the 2,570 surveys mailed, 531 (20.7%) usable responses were received. Although not completely satisfied, pharmacists perceive the quality of multisource products to be better than 2 years ago. A variety of factors were found to influence purchasing decisions. Differences among the three groups were evident in several areas including: the importance of purchasing groups, institutional criteria, and patient preference. Overall, pharmacists made their decisions based on a number of issues, and attitudes among the three groups regarding the purchase of multisource products were quite similar.

FDA drug classification system.

The purpose and use of the FDA's classification system for new drug products are described. Investigational new drug applications (INDs) and new drug applications (NDAs) are submitted to the FDA's Center for Drug Evaluation and Research. To establish the priority of the product in the review process, expert reviewers classify each product according to chemical type and therapeutic potential. Drug products that receive a high therapeutic rating (e.g., 1AA or 1A) are reviewed for approval more quickly than drugs that receive a lower therapeutic rating (e.g., 1B or 1C). Because this system is the only national therapeutic rating system for drug products, it has been used in legislation, in clinical evaluation of new drug products as they are approved, and in formulary decisions. However, caution is needed because the therapeutic rating assigned at the time of the product's approval may not reflect its importance relative to all agents available at a later date. The FDA classification system was designed to guide new drug products through the application process and should be used only with caution for other purposes.

Obesity in family practice: is treatment effective?

Obesity is a common condition which has important effects on health status and longevity. This review examines the efficacy of treatments for both moderate and severe obesity. A plan of treatment combining diet, exercise, and behavioral strategies is outlined. Surgery and its complications are reviewed. Eight management issues, including rate of weight loss, self-help groups, and fringe therapies, are presented. Management recommendations are based on a critical review of the weight loss literature.

Religious affiliation and adolescent drinking.

Of high-school students who attend church, fundamental Protestants are less likely to drink than are liberal Protestants and Roman Catholics; nonattenders are more likely than churchgoers to be heavy drinkers.