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ABSTRACTS
Editor's
Special Report
Publications by Family Medicine Faculty in the Biomedical
Literature: 1989–1999
Barry
D. Weiss, MD
Editor, Family Medicine
Background
and Objectives: Concern has been expressed about a possible
decrease in publication productivity of family medicine
faculty. This study measured trends in publication productivity
by family medicine faculty from 1989 to 1999 and determined
the journals in which these individuals published their
work. Methods: A sample of Society of Teachers of Family
Medicine (STFM) members was identified from the STFM
membership roster. The sample included 900 members from
1980, 1,801 members from 1994, and 1,524 members from
1999. A MEDLINE search was performed to determine how
many articles each individual published during those
years and in what journals the articles were published.
An estimate was made of the total publication productivity
of all STFM members. Results: The percentage of STFM
members publishing at least one article in 1989, 1994,
and 1999 was 16%, 16.3%, and 8.5%, respectively. The
estimated total number of publications by all STFM members
in all journals was 729 in 1989, 1,040 in 1994, and
669 in 1999. The journals in which STFM members most
frequently published were the Journal of Family Practice,
Family Medicine, and Academic Medicine; 32% of all publications
appeared in those three journals. The number of publications
in high-profile interdisciplinary journals was very
small. Conclusions: Based on a MEDLINE search of a large
sample of STFM members’ publication records, it
appears that the publication productivity of the STFM
membership is decreasing. (Fam
Med 2002;34(1):10-6.)
Residency
Education
Put
Prevention Into Practice (PPIP): Evaluating PPIP in
Two Family Practice Residency Sites
Mark
W. Yeazel, MD, MPH; Scott H. Bunner, MPH; Phillip M.
Kofron, MD, MPH; Pamela J. Weiss, PhD, MPH
Background
and Objectives: The Put Prevention Into Practice (PPIP)
office system is a set of office tools designed to address
physician, patient, and system barriers to the provision
of clinical preventive services. This study evaluated
the effect of using PPIP on the delivery of clinical
preventive services at two family practice residency
sites. Methods: After a careful planning process at
each clinic, a 1-year trial was conducted with implementation
of PPIP at two residency sites compared to two control
residency sites. The subjects included adults age 19
and older. Data were collected via chart extraction
on 300 randomly selected patients per clinic for the
following three outcomes: health risk factor assessment
(for limited physical activity, poor nutrition habits,
and tobacco use), health promotion/counseling (for nutrition,
physical activity, and tobacco use), and screening rates
(clinical breast exam, cholesterol, fecal occult blood
test, mammography, and Pap smear). Results: Only inconsistent
or sporadic differences in risk factor assessment, health
promotion counseling, and screening were seen when comparing
implementation and control sites. Conclusions: PPIP
had little effect on the delivery of clinical preventive
services. Future research should include a careful analysis
of the users of PPIP and the environments in which they
practice. (Fam
Med 2002;34(1):17-22.)
Improving Family
Practice Residents’ Compliance With Asthma Practice
Guidelines
Adrienne
Z. Ables, PharmD; Mark T. Godenick, MD, MPH; Stuart
R. Lipsitz, PhD
Objectives:
This study primarily determined the effect of an educational
and system intervention on residents’ documentation
of the severity classification of asthma. Secondarily,
the study assessed the effect of classification on pharmacologic
treatment, as outlined by national asthma treatment
guidelines. Methods: We reviewed the charts of all patients
with asthma seen by the residents in the Center for
Family Medicine (CFM) between October 1, 1998, and March
31, 1999. Data gathered from each chart included, but
was not limited to, disease severity classification
and medication regimen. Between July 1999 and October
1999, efforts at increasing residents’ knowledge
of asthma severity classification were made via formal
and informal teaching. A post-intervention chart review
was performed on all patients with asthma seen by the
residents in the CFM between October 1, 1999, and March
31, 2000. Results: A total of 8.5% of 198 and 51% of
271 patient visits were classified with respect to asthma
severity in the pre- and post-intervention periods,
respectively. Classified patients were treated appropriately
100% of the time in the pre-intervention period and
76% of the time in the post-intervention period. Conclusions:
A comprehensive protocol significantly improved compliance
with national asthma treatment guidelines with respect
to severity classification but not pharmacologic treatment.
(Fam
Med 2002;34(1):23-8.)
Clinical
Research and Methods
Factors Influencing Immunization
Status in Primary Care Clinics
David
Page, MD, MPH; Jan Meires, ARNP, MN, EdD; Amy Dailey,
MPH
Background
and Objectives: National standards and goals for childhood
immunization rates are well established. Yet, despite
clear standards and goals, physicians do not achieve
the desired rate (90%) for immunization coverage. This
study examined factors related to immunization status
for 2-year-old children in pediatric and family practice
settings. Methods: Specially trained personnel used
computer software to audit 2,552 records from 42 practices
in Northeast Florida throughout 1997–1999. Immunization
records were judged as either complete or incomplete,
and factors related to immunization status were studied.
Clinic type and 18 immunization practice standards were
reviewed for effect on immunization status. Results:
The probability of complete immunization status for
children in pediatric clinics was greater than for those
in family practice clinics. Multivariate logistic regression
revealed that use of semiannual audits (odds ratio [OR]=2.00,
confidence interval [CI]=1.65–2.42) was the most
important factor for immunization completion. This was
followed by availability of discounted immunizations
(OR=.44, CI=.27–.73) and the use of an immunization
tracking system (OR=1.48, CI=1.18–1.70). Factors
that were not found to contribute included clinic type
and the remaining 15 practice standards. Conclusions:
Considering the significant factors, immunization status
was not affected by the type of clinic providing immunizations.
Based on this analysis, family physicians should implement
tracking systems and should perform semiannual audits
to match the success of pediatricians in immunizing
children. Neither group met nationally established goals
for administration of immunizations for 2-year-old children.
(Fam
Med 2002;34(1):29-33.)
Faculty
Development
Measuring
Academic Production
Dewey
C. Scheid, MD, MPH; Robert M. Hamm, PhD; Steven A. Crawford,
MD
Background:
The entire academic medical community is under increasing
pressure to define and measure its activities. Previous
relative value-based systems to measure research, teaching,
administration, and patient care share several features
that threaten their acceptability and validity. Using
a bottom-up approach, our academic family medicine department
attempted to develop a measurement system that avoided
some of the flaws of the earlier systems. Methods: The
system was developed in two phases. In the first phase,
faculty members were invited to submit lists of all
their professional activities. In the second phase,
the faculty rated the relative value of a comprehensive
list of academic activities using an unbounded ratio
scale and indicated how many times a year they did each
activity. Results: Phase One resulted in a list of 96
academic activities. The activity rated in Phase Two
as having the greatest relative value was principal
investigator of a funded grant (relative value=30.23),
followed by sole author of a book (relative value=28.25).
The activity with the smallest relative value was attending
a faculty meeting (relative value=.36). A half-day clinic
session had a relative value of 1.08. The department’s
annual production, measured in relative value units,
was 5,764 units of administration, 5,702 units of clinical
activities, 5,480 units of teaching, and 4,401 units
of scholarly activities. Conclusions: Overall, the process
efficiently produced relative value measures for a large
number of faculty activities using a process in which
most of the faculty participated. Problems with internal
coherence, face validity, and inconsistencies in estimation
suggest it would be premature to use such estimates
of relative value to quantify individuals’ productivity
as a basis for budgetary decisions. (Fam
Med 2002;34(1):34-44.)
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