Assessing the impact on patient-physician interaction when physicians use personal digital assistants: a Northeastern Ohio Network (NEON) study.

BACKGROUND: The effects of the use of technological devices on dimensions that affect the physician-patient relationship need to be well understood. OBJECTIVES: Determine patients' perceptions of physicians' personal digital assistant (PDA) use, comparing the results across 8 physician-patient dimensions important to clinical interactions. RESULTS: Patients completed anonymous surveys about their perceptions of physician PDA use. Data were collected during 2006 and 2007 at 12 family medicine practices. Survey items included physician sex, patient demographics, if physicians explained why they were using the PDA, and Likert ratings on 8 dimensions of how a PDA can influence physician-patient interactions (surprise, confidence, feelings, comfort, communication, relationship, intelligence, and satisfaction). The survey response rate was 78%. Physicians explained to their patients what they were doing with the PDA 64% of the time. Logistic regression analyses determined that patients of male physicians, patients attending private practices and underserved sites, patients with Medicaid insurance, and patients who observed their physician using a PDA during both the index visit and at least one prior visit were more likely to receive an explanation of PDA use. Most importantly, physician-patient communication was rated significantly more positive if an explanation of PDA use was offered. CONCLUSION: Patients rate interactions with their physicians more positively when physicians explain their PDA use.

Awarding faculty rank to non-tenured physician faculty in a consortium medical school.

Many medical schools struggle to identify an appropriate system to award faculty rank to non-tenured physician faculty. A key element needs to be balanced recognition of teaching and scholarly activities. At the Northeastern Ohio Universities College of Medicine (NEOUCOM), clinical teaching is accomplished predominantly by volunteer physician faculty whose major responsibilities are patient care and teaching. In addition to our system for awarding rank to faculty in a tenure track, NEOUCOM devised a system for awarding faculty rank to volunteer, non-tenure physician faculty that equitably recognizes teaching, service, and scholarly activity with assigned "units" of accomplishment for each criterion. We now have an effective two-track system for our non-tenure physician faculty that objectively assesses and recognizes academic productivity in all three areas and standardizes requirements for promotion. This paper discusses 3 years of experience with this two-track system and its effect on the rank of physician faculty in the Department of Family Medicine.

Answering questions at the point of care: do residents practice EBM or manage information sources?

PURPOSE: To determine the types of information sources that evidence-based medicine (EBM)-trained, family medicine residents use to answer clinical questions at the point of care, to assess whether the sources are evidence-based, and to provide suggestions for more effective information-management strategies in residency training. METHOD: In 2005, trained medical students directly observed (for two half-days per physician) how 25 third-year family medicine residents retrieved information to answer clinical questions arising at the point of care and documented the type and name of each source, the retrieval location, and the estimated time spent consulting the source. An end-of-study questionnaire asked 37 full-time faculty and the participating residents about the best information sources available, subscriptions owned, why they use a personal digital assistant (PDA) to practice medicine, and their experience in preventing medical errors using a PDA. RESULTS: Forty-four percent of questions were answered by attending physicians, 23% by consulting PDAs, and 20% from books. Seventy-two percent of questions were answered within two minutes. Residents rated UptoDate as the best source for evidence-based information, but they used this source only five times. PDAs were used because of ease of use, time factors, and accessibility. All examples of medical errors discovered or prevented with PDA programs were medication related. None of the participants' residencies required the use of a specific medical information resource. CONCLUSIONS: The results support the Agency for Health Care Research and Quality's call for medical system improvements at the point of care. Additionally, it may be necessary to teach residents better information-management skills in addition to EBM skills.

The medically underserved: who is likely to exercise and why?

Adults who exercise regularly have better health, but only 15% of U.S. adults engage in regular exercise, with some social groups, such as people with lower incomes and women, having even lower rates. This study investigates the rate at which medically underserved patients receive exercise counseling from health care providers, characteristics of those who exercise, and barriers and motivations to exercise. The convenience sample was predominantly female and White and exclusively low-income and uninsured or underinsured. On average, participants were obese, by Federal Obesity Guidelines; 43% smoked. Although 60% of 126 patients reported that providers discussed exercise with them, the discussions had no relationship with patients' engagement in exercise. Women and those with lung problems, diabetes, or children in the home were less likely than others surveyed to exercise. The highest rated motivations included body image and health issues. The most important barriers were time, cost, and access to exercise facilities and equipment. In order for exercise counseling to be more effective, health care providers' interventions must consider patients' personal characteristics, health status, readiness to engage in an exercise program, and motivations and barriers to exercise.

Physician activities during time out of the examination room.

PURPOSE: Comprehensive medical care requires direct physician-patient contact, other office-based medical activities, and medical care outside of the office. This study was a systematic investigation of family physician office-based activities outside of the examination room. METHODS: In the summer of 2000, 6 medical students directly observed and recorded the office-based activities of 27 northeastern Ohio community-based family physicians during 1 practice day. A checklist was used to record physician activity every 20 seconds outside of the examination room. Observation excluded medical care provided at other sites. Physicians were also asked to estimate how they spent their time on average and on the observed day. RESULTS: The average office day was 8 hours 8 minutes. On average, 20.1 patients were seen and physicians spent 17.5 minutes per patient in direct contact time. Office-based time outside of the examination room averaged 3 hours 8 minutes or 39% of the office practice day; 61% of that time was spent in activities related to medical care. Charting (32.9 minutes per day) and dictating (23.4 minutes per day) were the most common medical activities. Physicians overestimated the time they spent in direct patient care and medical activities. None of the participating practices had electronic medical records. CONCLUSIONS: If office-based, medically related activities were averaged over the number of patients seen in the office that day, the average office visit time per patient would increase by 7 minutes (40%). Care delivery extends beyond direct patient contact. Models of health care delivery need to recognize this component of care.

Discussing spirituality with patients: a rational and ethical approach.

BACKGROUND: This study was undertaken to determine when patients feel that physician inquiry about spirituality or religious beliefs is appropriate, reasons why they want their physicians to know about their spiritual beliefs, and what they want physicians to do with this information. METHODS: Trained research assistants administered a questionnaire to a convenience sample of consenting patients and accompanying adults in the waiting rooms of 4 family practice residency training sites and 1 private group practice in northeastern Ohio. Demographic information, the SF-12 Health Survey, and participant ratings of appropriate situations, reasons, and expectations for physician discussions of spirituality or religious beliefs were obtained. RESULTS: Of 1,413 adults who were asked to respond, 921 completed questionnaires, and 492 refused (response rate = 65%). Eighty-three percent of respondents wanted physicians to ask about spiritual beliefs in at least some circumstances. The most acceptable scenarios for spiritual discussion were life-threatening illnesses (77%), serious medical conditions (74%) and loss of loved ones (70%). Among those who wanted to discuss spirituality, the most important reason for discussion was desire for physician-patient understanding (87%). Patients believed that information concerning their spiritual beliefs would affect physicians' ability to encourage realistic hope (67%), give medical advice (66%), and change medical treatment (62%). CONCLUSIONS: This study helps clarify the nature of patient preferences for spiritual discussion with physicians.

Stages of change analysis of smokers attending clinics for the medically underserved.

OBJECTIVE: To determine whether smokers at clinics providing care for the medically underserved can be characterized according to the transtheoretical stages of change model. STUDY DESIGN: Prospective, descriptive study. POPULATION: Smokers in the waiting rooms of clinics providing care for the medically underserved. OUTCOMES MEASURED: Standardized questionnaires that assessed stages of change, processes of change, decisional balance, and self-efficacy and temptation. RESULTS: The smoking rate of subjects interviewed at 4 clinics was 44%. Two hundred current smokers completed the questionnaires. Smokers claiming that they planned to quit within 6 months scored higher on experiential process statements that are consistent with quitting smoking than did smokers who claimed they were not planning to quit within 6 months. They also scored higher on behavioral statements related to quitting. Concerns about the negative aspects of smoking were more important to smokers planning to quit than to smokers not planning to quit, whereas the statements assessing positive aspects of smoking were rated the same. Fifty-five percent of the smokers were smoking a pack or more each day and reported smoking more during negative situations and from habit than did smokers who smoked less than a pack a day. CONCLUSIONS: Smokers planning to quit who still smoke at least a pack a day may benefit from counseling to decrease smoking for specific reasons or from pharmacologic aids. Smokers at the clinics who planned to quit smoking reported experiences and behaviors that were consistent with their stated desire to quit and should be counseled in the same fashion as smokers from more traditional practices.