High Volume Portal Usage Impacts Practice Resources.

Patient portals have both patient-centered benefits and substantial impacts on practices. Successful implementation of a patient portal can be achieved with a comprehensive team approach. Increased portal usage results in high-volume patient secure messaging. We describe the impact of high patient message volume on our fee-for-service academic family medicine practice. Practice adaptations are necessary to manage volume, length, and complexity of messages. Dedicated staff with specialized training to handle patient messages and ample protected time for providers are important to minimize clerical burden associated with patient portal use.

The benefits of a standardized approach to opioid prescribing.

This initiative increased patient acceptance of controlled substance agreements and random urine drug screening, and it led many patients to discontinue opioid therapy.

Family Medicine Panel Size with Care Teams: Impact on Quality.

PURPOSE: The demand for comprehensive primary health care continues to expand. The development of team-based practice allows for improved capacity within a collective, collaborative environment. Our hypothesis was to determine the relationship between panel size and access, quality, patient satisfaction, and cost in a large family medicine group practice using a team-based care model. METHODS: Data were retrospectively collected from 36 family physicians and included total panel size of patients, percentage of time spent on patient care, cost of care, access metrics, diabetic quality metrics, patient satisfaction surveys, and patient care complexity scores. We used linear regression analysis to assess the relationship between adjusted physician panel size, panel complexity, and outcomes. RESULTS: The third available appointments (P < .01) and diabetic quality (P = .03) were negatively affected by increased panel size. Patient satisfaction, cost, and percentage fill rate were not affected by panel size. A physician-adjusted panel size larger than the current mean (2959 patients) was associated with a greater likelihood of poor-quality rankings (≤25th percentile) compared with those with a less than average panel size (odds ratio [OR], 7.61; 95% confidence interval [CI], 1.13-51.46). Increased panel size was associated with a longer time to the third available appointment (OR, 10.9; 95% CI, 1.36-87.26) compared with physicians with panel sizes smaller than the mean. CONCLUSIONS: We demonstrated a negative impact of larger panel size on diabetic quality results and available appointment access. Evaluation of a family medicine practice parameters while controlling for panel size and patient complexity may help determine the optimal panel size for a practice.

Directors Recognize Difficulties in Providing Medical Care to Residents But Few Implement Policies to Address Them.

BACKGROUND AND OBJECTIVES: Residents find it difficult to access medical care. Some seek care within their own program. Our objectives were to (1) determine whether family medicine program directors see their own resident physicians as patients, (2) describe whether they perceive the residency culture as actively encouraging of this practice, and (3) assess perceptions about reasons to encourage or discourage this. METHODS: We used a paper-based self-administered survey November 2013--January 2014. A stratified random sample of family medicine residencies based on administrative type was used. Participants were directors of sampled programs. The main outcome measure was provision of medical care to resident physicians. RESULTS: A total of 137/250 directors (55%) responded. Thirty (22%) reported seeing residents as patients in their family medicine clinic while 107 did not (78%). Some directors who do see resident patients expressed discomfort in doing so (24%). Participants reported that other faculty physicians were significantly more likely to see residents (56%). Eighty-eight percent (114/129) agreed that "Having a doctor-patient relationship with a resident makes a supervisory relationship more difficult." Significant differences in attitudes were noted between directors who do and do not provide resident medical care. Few directors (10 %) agreed that their residency culture actively encouraged residents to establish doctor-patient relationships with faculty physicians. Only 16 (12%) had created written policies. CONCLUSIONS: It is uncommon for directors to see residents as patients, but most who do feel comfortable with it. Other faculty physicians provide care more frequently. Directors acknowledge potential difficulties with this practice, but few have addressed these issues by creating specific policies.