Patient and provider satisfaction with medical care.

BACKGROUND: This study compares patient and provider satisfaction with medical care and waiting time in a large family medicine residency program. Few published studies have dealt with both patient and provider perceptions. METHODS: Telephone interviews were conducted with 156 adult, English-speaking patients who were randomly selected from daily appointment schedules. The patients were asked to rate their satisfaction with 10 aspects of medical care and to estimate the length of time they waited to see their physicians. Sixty-five family health care providers responded to the same survey items through a self-administered questionnaire. RESULTS: In general, 97% of patients and 89% of providers were satisfied with the overall medical care provided at the family health center. Approximately 8% of patients and 22% of providers were dissatisfied with waiting time, and 11% of patients and nearly 60% of providers were dissatisfied with appointment scheduling. Patients' estimates of waiting time for care (mean = 16.1 minutes) were significantly shorter than providers' estimates (mean = 27.5 minutes). Patients who were dissatisfied with the length of waiting time estimated waiting 41.8 minutes, while satisfied patients estimated waiting 13.3 minutes (P less than .001). CONCLUSIONS: Family medicine patients reported higher levels of satisfaction with medical care than did providers. Both groups were the least satisfied with access to care.

AIDS in California family medicine. Changing experiences, knowledge, and geographic distribution.

Information regarding practice patterns specific to acquired immunodeficiency syndrome (AIDS) was obtained in 1988 from 1774 family physicians in California using a mail survey. Data were analyzed across the following county groupings: Los Angeles County, other counties in standard metropolitan statistical areas, and counties outside standard metropolitan statistical areas. Comparisons were made with the data from a telephone survey conducted in 1986. Differences over time were analyzed. By 1988, the percentage of physicians treating or referring patients for possible AIDS had more than doubled in counties outside standard metropolitan statistical areas. The percentage of physicians reporting one or more diagnosed cases of AIDS had tripled, a finding that suggests the importance of AIDS in family medicine is increasing at a rapid rate. In addition, survey results indicate that a majority of those surveyed still lack the AIDS-related knowledge and competency necessary to effectively deal with AIDS.

Perinatal outcomes in obstetric and family medicine services in a county hospital.

The relations between perinatal outcomes and physician specialty were examined in a retrospective study. Data pertaining to demographics, labor and delivery events, and maternal and neonatal outcomes were examined for 125 family medicine and 125 obstetric patients. Bivariate analyses showed no differences between the groups for demographics. Significant differences were found for two of 13 labor and delivery events: episiotomy and degree of lacerations. However, when multivariate analyses were conducted to control for possible confounding effects, differences between the groups for episiotomy or degree of lacerations were no longer significant. The only significant difference between the groups on perinatal outcomes was that family medicine newborns had a significantly higher mean birth weight (3364.9 grams) than obstetric newborns (3147.1 grams). Stepwise multiple regression analysis showed that smoking and specialty account for approximately 10 percent of the variance in birth weight. Overall, the results suggest that, regardless of physician specialty, obstetric and family medicine patients had similar outcomes.

Satisfaction of continuity patients in a family medicine residency--validation of a measurement tool.

Patient satisfaction with resident physicians and patient satisfaction with faculty physicians was investigated in three clinical centers of a county hospital-based family medicine residency. Only patients in a continuity relationship (minimum 5 visits) were studied. Utilizing a previously validated Patient Satisfaction Questionnaire (PSQ), the dimensions of access, availability, continuity, finances, physician humaneness, and physician quality/competence were measured. Although there was little discriminant power between the measures of physician humaneness and quality/competence of care, overall internal validity was high. Availability and finances created the most dissatisfaction. Residents' care was reported to be as satisfying as that delivered by faculty physicians. Differentiation between system dependent factors and physician-dependent factors may be difficult among patients with a demonstrated continuity relationship. Nevertheless this study demonstrated a high internal validity for the short form of the PSQ in yet another practice setting. This instrument is available for further investigation in clinical settings.

A contractual model for accountability and financial stability in a community-based family practice residency.

A contractual model is described that defines the relationship between the hospital and the Department of Family Practice. The model provides institutions supporting graduate training in family practice with a method that is accountable and cost effective. Application of this model at a community hospital over a five-year period is presented. The model resulted in expansion of the family practice residency, increased faculty numbers, increased income for the faculty, and control of the institution's cost of graduate medical education.

Second-generation video sigmoidoscopy.

A newly developed 60-cm video sigmoidoscope has no image bundle or eyepiece. During scope manipulation, the instrument provides a real-time color endoscopic image on a video monitor as well as a permanent videotape record of the procedure. In a series of examinations performed by residents in family medicine, no complications occurred and patient acceptance was good. Consultations can be obtained using the videotapes. The video recording format overcomes many of the teaching limitations of conventional fiberoptic sigmoidoscopy and may play a role in documentation of procedures as well as certification of competence.

A structured experiential curriculum in community medicine.

In order to provide experimental training in community medicine, a structured curriculum has been developed. Specific methodological skills in community medicine are identified and nine content areas are presented in seminar form during the three-year training program. Each resident is expected to participate in a community health care project and demonstrate one or more of the methodological skills identified. The experiences of two residents are reported. One involved a community health needs assessment and one, the development of a mechanism to ensure continuing consumer/provider communication.

Chronic pain: a review for the family physician.

The challenge of effective management of chronic pain frequently confronts the family physician. Successful management relies on the physician's skill in integrating fundamental concepts in the pathophysiology, psychodynamics, and diagnostic and therapeutic modalities associated with chronic pain syndromes. The use of time-contingent rather than pain-contingent therapy in the prevention of the chronic pain state is advocated.

A university/community hospital family practice residency program.

A residency program associated with a major university has many obvious advantages. On the other hand, a residency program located in an area of health manpower shortage is a major advantage to that community. This paper describes the development of a university affiliated family practice residency in the Mojave Desert of Southern California. It reports that it is possible to form a successful alliance between a medical center and a rural community, bringing increased primary care to the community, upgrading the quality of medicine practiced in the community and augmenting the staff of the local hospital without sacrificing training for the family practice residents. Furthermore, the residency program can become financially self-sufficient.

A competency-based curriculum in business practice management.

Business management skills are an essential part of an efficient medical practice, but they are largely neglected or ignored in residency training programs. In order to realistically prepare physicians for their future community practices, the Family Practice Residency Training Program at the University of California, Los Angeles, includes a business practice management curriculum based on 12 behavioral objectives. Through observation, seminars, consultation, and practice design, the resident becomes competent in the skills and behaviors necessary for effective management. Over the three-year period, the resident completes a handbook with research findings, and designs elements of his/her own future practice. The instructor's manual is included to illustrate and clarify methods of implementation and evaluation of the curriculum.

The CR Alpha Diagnostic Coding System for ambulatory care.

A three-digit code system for patient encounters in ambulatory care was constructed to meet the criteria of integrity, retrievability, flexibility, and acceptability. The system is distinguished from other comparable codes by the use of an alphabetical letter as a category designator, the provision of "open" areas within each category for the addition of new rubrics in appropriate sequence, and the availability of "open" categories for use in research or expansion. The system has the capacity to expand from 22 primary categories to 97 subheadings and to a maximum of 3,200 rubrics. The system uses both diagnostic and symptom-oriented rubrics. The diagnostic terms are adopted from the International Classification of Diseases, Adapted, Eighth Revision (ICDA-8) and the symptoms from the National Ambulatory Medical Care Survey Symptom Classification.