Comparison of obstetrician-gynecologists and family physicians regarding weight-related attitudes,communication, and bias

ObjectivesTo assess physician perceptions regarding weight-related communication, quality of care, and bias in obstetrics-gynecology (OBGYN) and family physician (FP) practices.MethodsA cross-sectional survey study based on a convenient sampling of OBGYN and FP was conducted. Physicians completed a 40-question survey assessing perceived obesity management and weight bias in caring for female patients with body mass index ≥25 kg/m².ResultsReponses from 51 physicians (25 OBGYN and 26 FP) were received. There was no difference between specialties in satisfaction with care or level of confidence in treating patients with obesity. However, OBGYNs reported more negative perceptions of patients with obesity (mean score 19.2 ± 3.3 vs. 15.0 ± 4.0, p < 0.001) and greater weight bias (11.8 ± 2.0 vs. 9.7 ± 2.5, p < 0.01) compared to FPs. OBGYNs were also more likely to expect less favorable treatment outcomes (13.3 ± 2.5 vs. 15.5 ± 2.8. p < 0.01). Physicians between 31?50 years old displayed a significantly higher perception of weight bias in their profession when compared to the reference 21?30 year olds, and for each unit increase in self-reported BMI there was a 0.18 average increase in the composite score for perceived weight bias.ConclusionsOBGYN physicians reported significantly higher levels of weight bias than FP physicians, indicating a need for improved education in OBGYN training.Clinical trial registrationN/A.     

Evidence-based medicine in primary care: qualitative study of family physicians

Background

The objectives of this study were: a) to examine physician attitudes to and experience of the practice of evidence-based medicine (EBM) in primary care; b) to investigate the influence of patient preferences on clinical decision-making; and c) to explore the role of intuition in family practice.

Method

Qualitative analysis of semi-structured interviews of 15 family physicians purposively selected from respondents to a national survey on EBM mailed to a random sample of Canadian family physicians.

Results

Participants mainly welcomed the promotion of EBM in the primary care setting. A significant number of barriers and limitations to the implementation of EBM were identified. EBM is perceived by some physicians as a devaluation of the 'art of medicine' and a threat to their professional/clinical autonomy. Issues regarding the trustworthiness and credibility of evidence were of great concern, especially with respect to the influence of the pharmaceutical industry. Attempts to become more evidence-based often result in the experience of conflicts. Patient factors exert a powerful influence on clinical decision-making and can serve as trumps to research evidence. A widespread belief that intuition plays a vital role in primary care reinforced views that research evidence must be considered alongside other factors such as patient preferences and the clinical judgement and experience of the physician.

Discussion

Primary care physicians are increasingly keen to consider research evidence in clinical decision-making, but there are significant concerns about the current model of EBM. Our findings support the proposed revisions to EBM wherein greater emphasis is placed on clinical expertise and patient preferences, both of which remain powerful influences on physician behaviour.

     

Knowledge and attitudes of health care social workers regarding advance directives

This cross sectional investigation describes the knowledge and attitudes of health care social workers regarding advance directives and explores factors that influence them. As major contributors to quality patient care, the level of knowledge and attitudes held by health care social workers regarding health care policy mandates are important. Mail survey methods were used to collect data from a systematic random sample (n = 324) of social workers throughout one mid-western state. Results indicate that the majority of health care social workers have high to moderate levels of knowledge about advance directives and hold positive attitudes regarding the policy. Social workers with more experience working with the elderly had higher levels of knowledge. Those employed in nursing homes and hospice settings had more positive attitudes than did those working in other health care facilities.     

Primary care in a post-communist country 10 years later Comparison of service profiles of Lithuanian primary care physicians in 1994 and GPs in 2004

OBJECTIVES: The study aimed, firstly, to assess changes in the service profile of primary care physicians between 1994, when features of the Soviet health system prevailed, and 2004, when retraining of GPs was completed. Secondly, to compare service profiles among current GPs, taking into account their positions before being retrained. METHODS: A cross-sectional repeated measures study was conducted among district therapists and district pediatricians in 1994 and GPs in 2004. A questionnaire was used containing identical items on the physicians' involvement in curative and preventive services. The response rates in both years were 87% and 73%, respectively. RESULTS: In 2004, physicians had much more office contacts with patients than in 1994. Modest progress was made with the provision of technical procedures. Involvement in disease management was also stronger in 2004 than in 1994, particularly among former pediatricians. Involvement in screening activities remained stable among former therapists and increased among former pediatricians. At present, GPs who used to be therapists provide a broader range of services than ex pediatricians. GPs from the residency programme hold an intermediate position. CONCLUSIONS: Lithuanian GPs have taken up new tasks but variation can be reduced. The health care system is still in the midst of transition.     

Health care barriers and interventions for battered women.

Family violence is a major public health problem. Battered women present with multiple physical injuries in hospital emergency rooms, clinics, and personal physicians'' offices. Yet, they are often not identified as battered and fail to receive appropriate treatment for the nonphysical effects of these events. Instead, only discrete physical injuries are identified. The authors explore the literature to identify barriers in recognizing and treating battered women. These barriers are viewed as a microcosm of the larger public health problem in which battered women fear identifying themselves and often are not recognized by public health professionals. Some barriers pertain to the victims themselves; others can be attributed to the attitudes of medical care providers in emergency rooms, clinics, and private physicians'' offices. The many faceted needs of victims require a variety of interventions including medical models, criminal justice intervention systems, and social models for change. Some intervention strategies that are currently being employed in various programs in the United States are described.     

Comparison of knowledge, attitudes and behaviour regarding smoking among Estonian and Finnish physicians

Summary. Objectives: To compare smoking behaviour, attitudes and opinions towards smoking and smoking cessation among Estonian and Finnish physicians. Methods: A cross-sectional postal survey using a self-administered questionnaire was carried out among 2 480 Estonian and 2 075 Finnish physicians. Results: Daily smoking prevalence was higher among Estonian physicians than among their Finnish counterparts in both male (18.6% and 6.7%) and female (6.6% and 3.6%). Compared to Estonia, physicians in Finland more often agreed that smoking is very harmful to their health, that trying to convince people to stop smoking is their responsibility and that smoking prevention should be part of the normal and special training of health professionals. In both countries, non-smoking physicians held more unfavourable attitudes towards smoking than those who were smoking. Conclusions: Physicians’ own smoking patterns and quitting behaviour are important because physicians serve as models for their patients and play a key role in the reinforcement of smoke-free health facilities. These results remain a challenge to medical educators, especially in Estonia. Estonia needs to improve medical education in terms of motivating physicians to ask about the smoking patterns of their patients and of training medical students and resident physicians to counsel their patients to stop smoking.

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Zusammenfassung. Vergleich der Kenntnisse, Einstellungen und des eigenen Verhaltens bezüglich des Rauchens zwischen der estnischen und der finnischen ?rzteschaft Fragestellung: Es werden die Unterschiede in den Rauchgewohnheiten, in der Einstellung und den Ansichten über das Rauchen und die Raucherentw?hnung zwischen estnischen und finnischen ?rzten untersucht. Methoden: Eine Querschnittsstudie mit selbstauszufüllendem Fragebogen wurde bei 2 480 estnischen und 2 075 finnischen ?rzten durchgeführt. Resultate: Die t?gliche Rauchpr?valenz war sowohl bei den ?rzten (18,6%) als auch bei den ?rztinnen (6,6%) in Estland h?her als bei ihren finnischen Kollegen (6,7%) und Kolleginnen (3,6%). Verglichen mit Estland, waren ?rzte in Finnland ?fters der Meinung, dass Rauchen sehr sch?dlich für ihre Gesundheit ist, dass sie dafür verantwortlich sind, ihre Patienten davon zu überzeugen, dass es wichtig ist, aufzuh?ren zu rauchen, und dass Tabakpr?vention ein Teil der normalen und speziellen Ausbildung von Gesundheitsfachleuten sein sollte. In beiden L?ndern hatten nichtrauchende ?rzte gegenüber dem Rauchen eine st?rker ausgepr?gte negative Haltung als die rauchenden. Schlussfolgerung: Dem Rauchverhalten der ?rzteschaft selbst kommt wegen deren Vorbildfunktion gegenüber den Patienten eine Schlüsselrolle bei der Erreichung von rauchfreien Gesundheitseinrichtungen zu. Diese Resultate zeigen, dass die medizinische Ausbildung vor allem in Estland betreffend Rauchen noch ein Verbesserungspotential hat. Estland muss die medizinische Ausbildung so verbessern, dass ?rzte mehr motiviert sind, mit ihren Patienten über das Rauchen zu sprechen. Zudem sollten Studierende der medizinischen F?cher aber auch bereits praktizierende ?rzte dahingehend geschult werden, dass sie ihre Patienten st?rker zur Raucherentw?hnung motivieren k?nnen.

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Résumé. Connaissances, attitudes et comportements des médecins estoniens et finlandais envers le tabagisme Objectifs: Comparer les habitudes de consommation de tabac, les attitudes et les opinions concernant le tabagisme et la cessation tabagique parmi les médecins estoniens et finlandais. Méthodes: Enquête par questionnaire auto administré, auprès de 2 480 médecins estoniens et de 2 075 médecins finlandais. Résultats: La prévalence du tabagisme était plus élevée parmi les médecins estoniens que parmi leurs collègues finlandais, tant pour les hommes (18,6% et 6,7%) que pour les femmes (6,6% et 3,6%). Les médecins en Finlande ont accepté plus souvent qu’en Estonie l’idée que le tabagisme est très nuisible pour leur santé, qu’il est de leur responsabilité de convaincre les gens de cesser de fumer et que la prévention du tabagisme devrait être un sujet normalement abordé dans la formation des professionnels de la santé. Dans les deux pays, les médecins non-fumeurs avaient une attitude plus défavorable envers le tabagisme que les médecins fumeurs. Conclusion: L’attitude des médecins concernant le tabagisme et la cessation tabagique est importante car ils servent de modèles pour leurs patients et ils jouent un r?le-clé pour assurer que le système de santé offre un environnement sans tabac. L’Estonie surtout a besoin d’améliorer la formation des médecins pour inciter ces derniers à interroger leurs patients sur leurs habitudes tabagiques et pour enseigner aux étudiants et aux internes comment informer leurs patients sur les programmes de cessation tabagique.

     

Comparison of knowledge, attitudes and behaviour regarding smoking among Estonian and Finnish physicians

Objectives: To compare smoking behaviour, attitudes and opinions towards smoking and smoking cessation among Estonian and Finnish physicians. Methods: A cross-sectional postal survey using a self-administered questionnaire was carried out among 2 480 Estonian and 2 075 Finnish physicians.     

Consultation between family physicians and specialists about the hospital admission of patients]

Consultation between GPs and specialists about patients' in-hospital treatment is to be expected from the claim of Dutch GPs that they are responsible for continuous care for the patients on their lists. Data were gathered in the Dutch National Survey of General Practice: registration concerning all patients hospitalized during a three-month period (n = 7815) by 161 GPs. GPs consult specialists most frequently about the decision to admit patients (15% of all admissions). Consultation during patient's stay in hospital (5%) and about the discharge decision and possible aftercare (4%) is less usual. Consultation results from practical circumstances, such as the GP's initiative in the admission and a contact between patient and GP about the admission. The results leave GPs to answer the question whether the little actual consultation about the patient's stay in hospital, discharge and aftercare accords with their task to provide continuous care.     

Effect of race on patient expectations regarding their primary care physicians

BACKGROUND: Fulfilment of patients' expectations has been associated with greater patient satisfaction with care and greater adherence to medical advice. However, little is know about how race influences patient expectations. OBJECTIVE: To determine the association between patient race and patient expectations of their primary care physician. METHODS: The design was a cross-sectional study. Setting and participants were sample of 709 primary care patients from four clinic sites at the Philadelphia Veterans Affairs Medical Center and the University of Pennsylvania Health System. The measures were an expectations instrument asking patients to rate the necessity of the physician performing 13 activities during the index visit, self-reported race, demographics, the Rapid Estimate of Adult Literacy in Medicine, the Charlson Comorbidity Index and SF-12. RESULTS: After adjusting for age, sex, education, clinic site, comorbidity, health literacy and health status, African Americans were more likely to report it was absolutely necessary for the physician to refer them to a specialist [AOR 1.55 (95% confidence interval, CI, 1.09-2.21), P = 0.01], order tests [AOR 1.59 (95% CI 1.11-2.27), P = 0.01] and conduct each of the six physical exam components. CONCLUSIONS: African American race is associated with greater expectations of the primary care physicians. More research is needed to confirm the differential expectations by race and determine the reasons for the differential expectations.     

Knowledge,attitudes and behavior of physicians regarding predictive genetic tests for breast and colorectal cancer

Background

Genetic testing for cancer susceptibility is an emerging technology in medicine. This study assessed the knowledge, attitudes and professional behavior of Italian physicians regarding the use of predictive genetic tests for breast and colorectal cancer, including the BRCA1/2 and APC tests.

Methods

A cross-sectional survey of a random sample of Italian physicians was performed in 2010 through a self-administered questionnaire.

Results

A response rate of 69.6% (1079 questionnaires) was achieved. A significant lack of knowledge was detected, particularly for APC testing. Less than half of the physicians agreed on the importance of efficacy and cost-effectiveness evidence in the selection of predictive genetic tests to be offered to the patients. Multiple logistic regression analyses showed that education had a positive influence on knowledge, attitudes and, to a lesser extent, professional use. The factor most strongly related to the physicians' use of genetic testing was patients requests for breast (odds ratio = 12.65; 95% confidence interval 7.77–20.59) or colorectal cancer tests (odds ratio = 7.02; 95% confidence interval 3.61–13.64). A high level of interest for specific training was reported by almost all physicians surveyed.

Conclusions

Targeted educational programs are needed to improve the expertise of physicians, and, ultimately, to enhance the appropriate use of genetic tests in clinical practice.     

Hospice and primary care physicians: attitudes,knowledge, and barriers

Underuse of hospice services is a significant problem in the United States. Primary care physicians constitute an increasing referral base and have been hypothesized to be important barriers to increased use. We conducted a mail survey of 131 primary care physicians (overall response rate of 72 percent), examining their attitudes toward, knowledge about, and perceived benefits and barriers to hospice care. Physicians demonstrated very favorable attitudes towards hospice. They had correct knowledge about most aspects of hospice, and, where they did not, they were far more likely to be uncertain than erroneous. Primary care physicians perceived many benefits to hospice care and identified patient and family readiness as the major barrier to earlier hospice referrals. A significant subgroup had concerns about problems in interacting with hospices. There were very few differences between family practitioners and general internists. These findings have many implications for directing collaborative efforts between primary care physicians and hospices to improve end-of-life care.     

Fragmentation of patient care between chiropractors and family physicians

BACKGROUND: Most patients using alternative practitioners also receive care from physicians. It is unclear, however, how well alternative practitioners and physicians communicate and coordinate the care of shared patients. OBJECTIVE: To describe the communication and coordination of care for shared patients between chiropractors and family physicians as well as potential barriers to effectively sharing care. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional national random sample survey of 400 chiropractors and 400 family physicians. MAIN OUTCOME MEASURES: Reports on shared patients including information on adverse events, treatment, and health status. Attitudes toward perceived expertise as well as perceived liability and economic competition involved in sharing care were also assessed. RESULTS: Surveys were completed by 360 (49%) of the 736 eligible practitioners, including 227 chiropractors and 133 family physicians. Although a high degree of interaction occurs between the practitioners, family physicians received information from chiropractors on 26.5% of referred patients while chiropractors received information from family physicians in 25.0% of cases (P = .73). Both groups believed that they did not receive enough information on adverse health outcomes or treatment plans for shared patients. Although neither group was particularly oriented toward wanting to share care, family physicians were much less likely than chiropractors to feel comfortable sharing care (P<.001). CONCLUSIONS: These findings indicate that care is fragmented between chiropractors and the general medical sector, with little information communicated between health care providers on issues with critical importance to quality of care. Further study is needed to identify ways to improve communication and coordination of care.     

Characteristics of women US family physicians.

CONTEXT: There have been no national studies comparing women family physicians (FPs) with other physicians; determining FP characteristics is useful in workforce and health systems planning and may also be of inherent interest to FPs and others. DESIGN AND PARTICIPANTS: A comparison of the FP (n = 347) and other (n = 4154) respondents to the Women Physicians' Health Study. MAIN OUTCOME MEASURES: Personal and clinical practices. RESULTS: Women FPs are more likely to be US-born and self-defined as politically liberal than were other women physicians. Those graduating from medical school in the 1950s through 1970s were less and those graduating in the 1980s were far more likely to be board certified than were other women physicians. Although their personal and household incomes were significantly lower, their professional satisfaction was similar to those of other women specialists, and they reported a lesser frequency of severe work stress. Personal health-related habits and health status of women FPs were similar to those of other women physicians. For all 14 counseling practices examined, the amount of counseling they reported performing, the clinical relevance they ascribed to those practices, their self-confidence in performing the practices, and the amount of training they received was as high as or higher than that of other women primary care practitioners and usually exceeded those of non-primary care physicians outcomes at the P < .001 level. CONCLUSIONS: Although women FPs resemble other women physicians in some respects, they are more liberal, are professionally well-satisfied, and are relatively avid preventionists.     

Patient attitudes towards self-report and biomarker alcohol screening by primary care physicians

AIMS: One of the many barriers to more frequent alcohol screening by primary care physicians is a reported concern that patients may be offended by questions about drinking. However, evidence suggests that patients do not object to alcohol screening and actually expect physicians to ask about lifestyle factors that influence their health. The aim of this study was to provide more detailed information on patient attitudes toward self-report and biomarker alcohol screening and to explore whether demographic variables were related to these attitudes. METHODS: We administered (i) a survey about attitudes towards alcohol screening, and (ii) the Alcohol Use Disorders Identification Test-C (AUDIT-C) to primary care outpatients at the time of their medical appointments. The survey contained 10 items on patient opinions about being screened for at-risk drinking by physicians. Participants rated their levels of agreement with each statement using a 5-point Likert scale. Participants also provided demographic information. RESULTS: The majority of patients reported that they were supportive of physician screening about alcohol use. Responses on 3 of the 10 statements were related to patient race, age, and/or AUDIT-C results. CONCLUSIONS: In general, results support the fact that patients are in favour of being screened for at-risk drinking by their physicians whether the screening instrument was a self-report measure or an alcohol biomarker laboratory test. In addition, the majority of patients are open to advice from physicians about their alcohol use.