A model for a standardized national family medicine graduate survey.

BACKGROUND AND OBJECTIVES: Accreditation requirements mandate that family medicine residency programs perform surveys of graduates. As part of the Preparing the Personal Physician for Practice (P4) Project, we developed a model for a standardized national graduate survey to be used to assess practice characteristics of graduates, including the implementation of features of the Patient-centered Medical Home (PCMH). METHODS: We conducted a content analysis of residency graduate surveys from the 14 programs involved in the P4 project to identify common elements of importance to residencies. We then designed a new graduate survey as a core measure of the P4 Project. It included practice characteristics, assessment of training, and the status of features of the PCMH. RESULTS: Categories of variables common to the graduate surveys of the P4 programs included physician and practice characteristics, work load, scope of practice, career satisfaction, and assessment of training. We found variability among programs in the number of procedures and residency content areas listed on any individual program survey, with the number of procedure ranging from 0--21, and the number of content areas ranging from 0-61. The only PCMH feature included on any P4 program survey was the status of an electronic medical record. CONCLUSIONS: Graduate surveys from individual residency programs vary widely. Using a standardized national survey instrument would provide important information to understand the national practice characteristics and scope of practice in family medicine as well as to track the implementation of PCMH features among residency graduates.

The influence of nurse home visits, including provision of 3 months of contraceptives and contraceptive counseling, on perceived barriers to contraceptive use and contraceptive use self-efficacy.

OBJECTIVE: To identify the influence of a community health nurse (CHN) home visit on perceived barriers to contraceptive access and contraceptive use self-efficacy. METHODS: We enrolled 103 women into two groups in a randomized trial evaluating the influence of contraceptive dispensing and family planning counseling during home visits on perceived barriers to accessing contraceptives and contraceptive use self-efficacy. Both groups received counseling by a CHN about sexually transmitted disease and pregnancy prevention, and a resource card listing phone numbers of family planning clinics. After randomization, the CHN dispensed three months of hormonal contraception to the intensive intervention group and advised the minimal intervention group to schedule an appointment at a family planning clinic. Data collection at baseline and 12 months included demographic, reproductive and other health-related information as well as quantitative assessments of information on perceived barriers to contraceptive access and contraceptive use self-efficacy. RESULTS: The mean age of participants was 24.7 years. Three-fourths had household incomes under $25,000. We found significant reductions in three perceived barriers to contraceptive access for both groups, as well as significant increases in two measures of contraceptive use self-efficacy at twelve months compared to baseline. CONCLUSION: Nurse home visits involving family planning counseling might be effective in reducing perceived barriers to contraceptive access and increasing contraceptive use self-efficacy.