Abstract:
BACKGROUND:The growing number of primary care physicians (PCPs) reducing their clinical work hours has raised concerns about meeting the future demand for services and fulfilling the continuity and access mandates for patient-centered care. However, the patient's experience of care with part-time physicians is relatively unknown, and may be mediated by continuity and access to care outcomes. OBJECTIVE:We aimed to examine the relationships between a physicians' clinical full-time equivalent (FTE), continuity of care, access to care, and patient satisfaction with the physician. DESIGN:We used a multi-level structural equation estimation, with continuity and access modeled as mediators, for a cross-section in 2010. PARTICIPANTS:The study included family medicine (n = 104) and internal medicine (n = 101) physicians in a multi-specialty group practice, along with their patient satisfaction survey responses (n = 12,688). MAIN MEASURES:Physician level FTE, continuity of care received by patients, continuity of care provided by physician, and a Press Ganey patient satisfaction with the physician score, on a 0-100 % scale, were measured. Access to care was measured as days to the third next-available appointment. KEY RESULTS:Physician FTE was directly associated with better continuity of care received (0.172% per FTE, p < 0.001), better continuity of care provided (0.108% per FTE, p < 0.001), and better access to care (-0.033 days per FTE, p < 0.01), but worse patient satisfaction scores (-0.080% per FTE, p = 0.03). The continuity of care provided was a significant mediator (0.016% per FTE, p < 0.01) of the relationship between FTE and patient satisfaction; but overall, reduced clinical work hours were associated with better patient satisfaction (-0.053 % per FTE, p = 0.03). CONCLUSIONS:These results suggest that PCPs who choose to work fewer clinical hours may have worse continuity and access, but they may provide a better patient experience. Physician workforce planning should consider these care attributes when considering the role of part-time PCPs in practice redesign efforts and initiatives to meet the demand for primary care services.
journal_name
J Gen Intern Medjournal_title
Journal of general internal medicineauthors
Panattoni L,Stone A,Chung S,Tai-Seale Mdoi
10.1007/s11606-014-3104-6subject
Has Abstractpub_date
2015-03-01 00:00:00pages
327-33issue
3eissn
0884-8734issn
1525-1497journal_volume
30pub_type
杂志文章abstract::The fourth-year medicine clerkship was restructured at one of four sites. Teams consisting of one attending physician and three students cared for eight new patients per week. The overall experience of the restructured clerkship was rated significantly more positively than the experiences at all other sites and the te...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02600292
更新日期:1993-01-01 00:00:00
abstract:BACKGROUND:As children with diabetes transition to adulthood, they may be especially vulnerable to diabetic ketoacidosis (DKA). Cross-national comparisons may inform efforts to avoid this complication. OBJECTIVE:To compare DKA hospitalization rates in the USA and Manitoba, Canada, during the vulnerable years known as ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-019-05006-6
更新日期:2019-07-01 00:00:00
abstract:BACKGROUND:Chronic hepatitis B and hepatitis B-associated liver cancer is a major health disparity among Vietnamese Americans, who have a chronic hepatitis B prevalence rate of 7-14% and an incidence rate for liver cancer six times that of non-Latino whites. OBJECTIVE:Describe factors associated with hepatitis B testi...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-010-1285-1
更新日期:2010-07-01 00:00:00
abstract::This editorial, "Internal Medicine Point of Care Ultrasound: Indicators It's Here to Stay" (DOI: 10.1007/s11606-019-05268-0), was intended to accompany "Education Indicators for Internal Medicine Point-of-Care Ultrasound: a Consensus Report from the Canadian Internal Medicine Ultrasound (CIMUS) Group". ...
journal_title:Journal of general internal medicine
pub_type: 已发布勘误
doi:10.1007/s11606-020-05632-5
更新日期:2020-02-01 00:00:00
abstract:BACKGROUND:For patients with peripheral arterial disease (PAD), depression is associated with worse patency and recurrent symptoms in the treated leg, but its association with death or cardiovascular events in other vascular beds is unknown. OBJECTIVE:To assess the association between depression and mortality or cardi...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-008-0560-x
更新日期:2008-05-01 00:00:00
abstract:BACKGROUND:Many have called for ambulatory training redesign in internal medicine (IM) residencies to increase primary care career outcomes. Many believe dysfunctional, clinic environments are a key barrier to meaningful ambulatory education, but little is actually known about the educational milieu of continuity clini...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-010-1437-3
更新日期:2011-01-01 00:00:00
abstract:BACKGROUND:Obese women experience higher postmenopausal breast cancer risk, morbidity, and mortality and may be less likely to undergo mammography. OBJECTIVES:To quantify the relationship between body weight and mammography in white and black women. DATA SOURCES AND REVIEW METHODS:We identified original articles eval...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,meta分析,评审
doi:10.1007/s11606-009-0939-3
更新日期:2009-05-01 00:00:00
abstract::Polypharmacy occurs when a medical regimen includes at least one unnecessary medication. Factors that contribute to this problem include: patient characteristics of increasing age, multiple medical problems, therapy expectations, and decisions to self-treat; physician factors such as excessive prescribing; and system ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/BF02600099
更新日期:1993-05-01 00:00:00
abstract:BACKGROUND:In the 27 nursing homes located within the Veterans Affairs (VA) Central Region, the proportion of residents with pressure ulcers in 1986 varied from 2% to 16%. Three of these nursing homes were selected for study: nursing home A from the highest prevalence quintile, B from close to the median, and C from th...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02598281
更新日期:1993-12-01 00:00:00
abstract::This paper presents a case for careful consideration of theory in planning to implement evidence-based practices into clinical care. As described, theory should be tightly linked to strategic planning through careful choice or creation of an implementation framework. Strategies should be linked to specific interventio...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2006.00362.x
更新日期:2006-02-01 00:00:00
abstract:INTRODUCTION:Whether the clinical vignettes presented at the Society of General Internal Medicine (SGIM) annual meeting could be of educational value to third year students in the Internal Medicine clerkship has not been studied. OBJECTIVE:To explore the relevance and learning value of clinical vignettes from the SGIM...
journal_title:Journal of general internal medicine
pub_type:
doi:10.1111/j.1525-1497.2006.00596.x
更新日期:2006-11-01 00:00:00
abstract:BACKGROUND:Only half of hypertensive adults achieve blood pressure (BP) control in the United States, and it is unclear how BP control rates may be improved most effectively and efficiently at the population level. OBJECTIVE:We sought to compare the potential effects of system-wide isolated improvements in medication ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-015-3231-8
更新日期:2015-08-01 00:00:00
abstract:BACKGROUND:Prior studies have demonstrated how price transparency lowers the test-ordering rates of trainees in hospitals, and physician-targeted price transparency efforts have been viewed as a promising cost-controlling strategy. OBJECTIVE:To examine the effect of displaying paid-price information on test-ordering r...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.1007/s11606-016-3917-6
更新日期:2017-04-01 00:00:00
abstract:BACKGROUND:Due to a shortage of studies focusing on older adults, clinicians and policy makers frequently rely on clinical trials of the general population to provide supportive evidence for treating complex, older patients. OBJECTIVES:To examine the inclusion and analysis of complex, older adults in randomized contro...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-010-1629-x
更新日期:2011-07-01 00:00:00
abstract:OBJECTIVE:To determine whether the results of the Internal Medicine In-Training Examination (ITE) can predict subsequent performance on the American Board of Internal Medicine certifying examination (ABIMCE). DESIGN:Retrospective data review. SETTING:A mixture of six community hospital and university-based internal m...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599105
更新日期:1992-01-01 00:00:00
abstract:OBJECTIVE:Community physicians in the United States prescribe antibiotics to 80% to 90% of smokers with acute bronchitis. We performed a systematic review of the literature to determine the efficacy of antibiotics for smokers with acute bronchitis. DESIGN:A medline search was done using the keywords bronchitis, cough,...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1046/j.1525-1497.2002.10405.x
更新日期:2002-03-01 00:00:00
abstract:BACKGROUND:For adults who stutter, communication difficulties can impact many spheres of life. Previous studies have not examined how stuttering might impact patient's experiences with the medical system. OBJECTIVE:Our objective was to understand the range and depth of experiences with the medical system among adults ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-015-3302-x
更新日期:2015-11-01 00:00:00
abstract::Much of medical practice involves the exercise of such basic cognitive tasks as estimating probabilities and synthesizing information. Scientists studying cognitive processes have identified impediments to accurate performance on these tasks. Together the impediments foster "cognitive bias." Five factors that can detr...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/BF02596149
更新日期:1987-05-01 00:00:00
abstract:OBJECTIVE:Although hospitalization patterns have been studied, little is known about hospital readmission among HIV-infected patients in the era of highly active antiretroviral therapy. We explored the risk factors for early readmission to a tertiary care inner-city hospital among HIV-infected patients with pneumonia i...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.2003.20720.x
更新日期:2003-04-01 00:00:00
abstract::This article highlights the timely situation that resident physicians, faculty, and staff are facing after the recent highly publicized murders of Black Americans and its impact on our healthcare communities. We discuss our experiences of how the hospital can serve as a meeting place for anti-racism, as well as how an...
journal_title:Journal of general internal medicine
pub_type: 社论
doi:10.1007/s11606-020-06291-2
更新日期:2020-10-20 00:00:00
abstract:BACKGROUND:Decisions to forgo life-sustaining medical treatments in terminally ill patients are challenging, but ones that all doctors must face. Few studies have evaluated the impact of medical training on medical students' attitudes towards end-of-life decisions and none have compared them with an age-matched group o...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-008-0713-y
更新日期:2008-10-01 00:00:00
abstract:INTRODUCTION:With the increasing number of women Veterans enrolling in the Veterans Health Administration (VA), there is growing demand for reproductive health services. Little is known regarding the on-site availability of reproductive health services at VA and how this varies by site location and type. OBJECTIVE:To ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11606-012-2289-9
更新日期:2013-07-01 00:00:00
abstract:BACKGROUND:Quite often medical students or novice residents have difficulty in ruling out diseases even though they are quite unlikely and, due to this difficulty, such students and novice residents unnecessarily repeat laboratory or imaging tests. OBJECTIVE:To explore whether or not a carefully designed short trainin...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2004.30257.x
更新日期:2004-05-01 00:00:00
abstract:BACKGROUND:Studies have shown a mismatch between published cancer screening and genetic counseling referral recommendations and physician-reported screening and referral practices. Inaccurate cancer risk assessment is one potential cause of this mismatch. OBJECTIVE:To assess U.S. physicians' ability to accurately dete...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.1007/s11606-014-2768-2
更新日期:2014-05-01 00:00:00
abstract:OBJECTIVE:To determine the overdose rate of drugs that require renal dose adjustment and factors related with overdose. SUBJECTS:Total of 23,635,210 records of prescriptions and laboratory data of inpatients at a tertiary teaching hospital for the period from January 2002 to December 2005. METHODS:A clinical data mar...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-007-0336-8
更新日期:2008-04-01 00:00:00
abstract:BACKGROUND:Experts suggest an individualized approach to colon cancer screening to take into account variation in older adults' life expectancies and potential to benefit from screening. However, little is known about how physicians make decisions about colon cancer screening in adults age 75 and older. OBJECTIVE:To u...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-009-1006-9
更新日期:2009-07-01 00:00:00
abstract:BACKGROUND:Direct-to-consumer advertising (DTCA) remains a controversial issue, with concerns that it leads to unnecessary and inappropriate prescribing. Whether DTCA shifts prescribing from first-line (guideline-recommended) therapy to second-line drugs has not been studied. OBJECTIVE:The purpose of this study was to...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-014-3063-y
更新日期:2015-04-01 00:00:00
abstract:BACKGROUND:Residents demonstrate scholarly activity by presenting posters at academic meetings. Although recommendations from national organizations are available, evidence identifying which components are most important is not. OBJECTIVE:To develop and test an evaluation tool to measure the quality of case report pos...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-008-0860-1
更新日期:2009-03-01 00:00:00
abstract:OBJECTIVE:The presentation format of clinical trial results, or the "frame," may influence perceptions about the worth of a treatment. The extent and consistency of that influence are unclear. We undertook a systematic review of the published literature on the effects of information framing on the practices of physicia...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1046/j.1525-1497.1999.09038.x
更新日期:1999-10-01 00:00:00
abstract:BACKGROUND:National guidelines indicate that healthcare providers should routinely screen women of reproductive age for experience of intimate partner violence. We know little about intimate partner violence (IPV) screening and disclosure experience among women older than reproductive age. OBJECTIVE:To examine the per...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-020-05947-3
更新日期:2020-09-01 00:00:00