Provider satisfaction in army primary care clinics

The job satisfaction of physicians, nurse practitioners, and physician assistants was assessed during the course of a multicenter study of Army primary care clinics. All providers in nine clinics at three medical centers who were engaged in adult or family care were invited to participate in the study. Questionnaires on job satisfaction and other practice style variables were completed by 26 physicians, 19 nurse practitioners, and 13 physician assistants (46, 76, and 41% of eligible providers, respectively). Analysis revealed a broad range of job satisfaction in the sample. However, average levels of job satisfaction were not significantly different across the three groups of primary care providers. Autonomy and collaboration were significant predictors of job satisfaction. It is clear that changes in health care systems that reduce, or appear to reduce, the primary care provider's autonomy in clinical matters are likely to reduce provider satisfaction as well.     

Open access appointing in Army primary care clinics

The open access model, also referred to as advanced or same-day appointments, is a new concept in managing patient appointments. More than 70% of the Army's primary care clinics currently use an antiquated system that inherently provides for a delay of medical services and lacks continuity of care. Although many providers and administrators believe delay and the lack of continuity of care are associated with a lack of resources, many studies prove otherwise. Open access is predicated on the principal that providers do today's work today. Patients calling to schedule an appointment with their provider are offered a same-day appointment. To achieve this, clinic chiefs and administrators must conduct an in-depth analysis of their true demand and current resources. Clinic staffs who have a strong commitment to change will be able to convert to an open access model whereby they are able to increase patient and provider satisfaction.     

Evaluating delivery of primary health care to military personnel during low-intensity conflict using a patient satisfaction survey

The delivery of medical health care to soldiers serving in active front units in the Israeli Defense Forces requires the ability to adjust to different military activity settings. This study was conducted to compare patient satisfaction, as a tool for assessing quality of care, in different activity settings: training and Low-intensity conflict setting. A patient satisfaction survey was conducted simultaneously in battalions during low-intensity conflict and training activities. Data analysis showed that patients' perception of the quality of care they received and of medical staff attitude was higher in the conflict setting. Correlation analysis revealed that patients during conflict perceived outcome of care and accessibility as most important in evaluating overall satisfaction. We suggest that perception of high-quality medical care can be obtained during conflict conditions. Interestingly, in the conflict setting, the physical environment of the clinics appears to be less crucial to patient satisfaction than physician availability and medical outcome. These results may serve as a basis for changing health delivery systems by health policy makers.     

A comparison of patient populations between two types of military primary care health clinics

A cross-sectional survey was conducted of 993 patients treated at either a Primary Care for the Uniformed Services health clinic or a nearby free-standing primary care health clinic operated directly by the Army Medical Department. The study found the clinics significantly different in terms of the patients' age, race and the sponsors' ranks. The clinics were not significantly different in terms of the patients' sex, medical diagnosis, and visit status. This study recommends that the location, capabilities, staffing, and operations of primary health care clinics be contingent on the characteristics of the patient population. Also, additional research should be conducted to identify other significant patient characteristics.     

Draft registration of health care personnel

A chronic shortage of health care personnel in the active and reserve forces continues to be of concern, particularly in planning for national emergencies or war. Congress has authorized the Selective Service System to establish a system to register and classify health care personnel rapidly in the event a national emergency requires implementation of a draft for the armed services. This paper describes the creation of the Health Care Personnel Delivery System. It provides a brief history of previous military drafts for health care personnel and describes the principal differences in the way a draft registration program may operate in the future.     

Organizational characteristics associated with the availability of women's health clinics for primary care in the Veterans Health Administration

OBJECTIVE: Women's health clinics (WHCs) offering integrated primary care (PC) and gender-specific services reduce fragmentation and improve quality of care for women. Our objective was to understand organizational influences on the development of WHCs for PC delivery in Veterans Health Administration (VA) facilities. METHODS: We surveyed PC directors at 219 VA facilities about the presence of separate WHCs for PC and evaluated organizational characteristics (e.g., authority, staffing, and resources) associated with their development. RESULTS: One hundred thirty-three VA medical centers (61%) have established WHCs for PC. VA facilities with WHCs for PC were significantly more likely to have PC leadership distinct from subspecialty care (odds ratio = 3.62; 95% confidence interval, 1.45-9.05). Local PC staff mix, team structure, and resource characteristics were not associated with WHCs. CONCLUSIONS: With the growth of women in the military and, in turn, in the VA, autonomy of PC leadership may drive VA-based innovations in women's health.     

Effect of a computerized online grading system on patient satisfaction in a military primary health care setting

Patient satisfaction is gaining recognition as an important determinant of the quality of medical care. We conducted an analysis to evaluate the effect of a computerized online system that comparatively displays grades of patient satisfaction among primary care military infirmaries. Fifteen Israel Air Force primary care infirmaries served as the intervention group, and 130 Israel Defense Force infirmaries were the control group. Baseline patient satisfaction was surveyed in all infirmaries. In the intervention group only, infirmaries were resurveyed at 3-month intervals during a 1-year period. Satisfaction scores were continuously displayed on an intranet site in a comparative graphical manner by using the computerized system, available only to the intervention group. At the endpoint, patient satisfaction improved in both groups. However, the magnitude of improvement in the intervention group was significantly greater, in comparison with the control group. The most pronounced improvement was noted in availability of service (intervention group, 57.9% at baseline vs. 66.0% at endpoint, p < 0.001; control group, 67.5% vs. 69.6%, p < 0.025). We conclude that the use of this computerized system in conjunction with promotional efforts resulted in significant improvements in patient satisfaction.     

A systematic review of physical activity promotion in primary care office settings

OBJECTIVE: To assess the efficacy of physical activity promotion in primary care office settings. DESIGN: Systematic review of clinical trials in which the efficacy of physical activity promotion was investigated in a primary care office setting with at least one month of follow up. SUBJECTS: A total of 13,981 adults, aged 17-85+, were included from 203 practices in eight trials assessing physical activity promotion in primary care office settings. MAIN OUTCOME MEASURES: Odds ratios and 95% confidence intervals were calculated comparing the number of participants who increased their physical activity or were active at follow up in the intervention group with a control group for each study. RESULTS: Five of eight trials where positive with statistically significant results (range 0.91-6.56), but significant biases or limited clinical relevance of the outcomes were found in all trials. Short term trials of less than one year (four of four were positive), single-risk-factor trials (three of three were positive), randomised clinical trials (two of three were positive), and those assessing moderate levels of physical activity (three of four were positive) were most likely to find benefit. Only one of four trials lasting longer than a year were positive. CONCLUSION: There is limited evidence from well designed trials that office based physical activity promotion in primary care settings is efficacious in promoting changes in physical activity that could conceivably have lasting clinical benefits.


     

Evaluation of dermatologic conditions by primary care providers in deployed military settings

Dermatologic illnesses have historically been a significant source of morbidity and resource utilization in fielded military forces. The impact of cutaneous diseases during U.S. military conflicts is reviewed, and recent data from Craig Joint Theater Hospital at Bagram Air Field in Afghanistan are presented, confirming previous experience. A discussion of the difficulties of diagnosing and treating dermatologic conditions for deployed primary care providers is provided, including recommendations to improve patient care and military unit readiness.     

Simulation in health care provider education at Brooke Army Medical Center

The teaching and assessment of clinical skills are critical components of health care provider education, and clinical skill proficiency is essential for safe and successful health care delivery. Medical simulation is being increasingly recognized in health care education as an extremely valuable mechanism for training and assessing clinical skills. As in other high-stakes professions, the use of simulation can enhance the proficiency and efficiency of training while maximizing safety and minimizing risk. Located within Brooke Army Medical Center, the Trauma Simulation Training Center is a multifaceted, full-service, medical simulation facility. In an effort to improve and to expand the role of simulation, we collected data on utilization of the facility and the level of overall satisfaction among our users. Results showed that the primary users were graduate medical education physicians-in-training. In addition, survey results demonstrated that users favored simulation-based learning because of the realism of simulated scenarios. The Trauma Simulation Training Center embraces the simulation-based medical education philosophy by actively inviting training program participation, and we realize that more research is needed to determine the effectiveness of this teaching and assessment modality.     

Early pregnancy confirmation--the role of urine pregnancy test in military primary care clinics

Pregnancy detection is a common procedure in primary care and can be challenging in the setting of military primary care clinics. The objective of this study was to determine whether the introduction of urine pregnancy tests to military primary care clinics is associated with earlier pregnancy detection. We conducted a cross-sectional study using data from female soldiers, aged 18 to 20 years. Pregnancy was diagnosed using urine pregnancy tests. Ultrasonographic gestational age at presentation was compared between pregnant soldiers diagnosed in primary care clinics and pregnant soldiers diagnosed in gynecology secondary care clinics. A total of 150 female soldiers performed urine pregnancy tests in 5 different primary care clinics, from which 28 (19%) were pregnant. Mean gestational age at diagnosis was significantly lower among patients diagnosed in primary care clinics as compared with patients diagnosed in gynecology secondary care clinics (41.07 days (SD, 6.72) vs. 48.42 days (SD, 21.94), p < 0.001). In conclusion, the availability of urine pregnancy tests in the setting of military primary care clinics was strongly associated with early pregnancy detection at a time point in which presentation for both antenatal care and abortion services potentially improve maternal and neonatal health.     

Sudden cardiac deaths in young British Army personnel

Much attention has been paid to sudden cardiac death in young athletes which has led to the implementation of tighter screening controls in many sports at various levels. Less attention has been paid to this subject in young army recruits. We describe three cases of sudden cardiac death in young UK soldiers. The scale of the problem in the UK is unknown. We highlight issues regarding diagnostic testing to identify risk factors for sudden cardiac death and suggest potential additions to the current screening programme for new recruits to help increase the sensitivity of detecting cardiac pathology and reducing the rates of sudden cardiac death in this group.     

Total quality management and the Army health care system.

Total quality management (TQM) is the newest in a long line of magic formulas which have been touted as saviors for American industry and medicine. The author discusses the basic concepts of TQM and notes that much of it resembles philosophical beliefs long held by the medical community. TQM does offer many opportunities to refine old concepts and further those goals of quality care to which health care providers have always aspired. If, however, it becomes simply another codified bureaucracy, then a great deal of time and money will be invested for very little gain.     

The association between obesity related health risk and fitness test results in the British Army personnel

Objective

In the British Army, fitness is assessed by a load carriage test (Annual Fitness Test, AFT) and by a three event Personal Fitness Assessment (PFA). Body composition based on body mass index (BMI) and abdominal circumference (AC) is also part of a mandatory annual assessment. This study examined the influence of BMI and AC on fitness test results within a comprehensive sample of British Army personnel.

Outsourcing of primary care: satisfaction level in the Israeli Defense Forces

OBJECTIVE: To examine the effect of outsourcing primary care services on satisfaction levels among career soldiers in the Israeli Defense Forces (IDF). METHODS: Data were acquired via self-administered satisfaction questionnaires during the visits of soldiers and civilians to primary care clinics in military bases, hospitals, and HMO settings. Multivariable analyses (GLM) used the SAS statistical program. RESULTS: Two hundred thirty civilians and 618 soldiers (200 in hospital clinics, 277 in military clinics, and 141 in HMO clinics) completed 848 questionnaires. Gender did not influence satisfaction level (alpha < 0.05). Age and rank influenced two parameters: surroundings (p = 0.0277) and availability of the medical service (p = 0.0368). Location (hospital clinic, HMO clinic, and military clinic) was the primary variable influencing and predicting satisfaction level (11.6%). "Quality of medical care" predicts only 4% of satisfaction level. Soldiers in HMO settings expressed a higher degree of satisfaction particularly in availability of service, quality of service, general satisfaction, and courtesy. CONCLUSIONS: Career soldiers in Israel value all aspects of primary care given by a civilian HMO and are willing to accept a change (outsourcing primary care to a civilian provider). As a result, decision makers should expand the provision of these services to all career soldiers in Israel. Outsourcing of medical services can serve as a model to military corps worldwide.