The Journal of family practice
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Comparative Study
The do-not-resuscitate order: outpatient experience and decision-making preferences.
Do-not-resuscitate (DNR) orders have become a widespread part of modern medical practice. This study examined patient experience and decision-making preferences regarding cardiopulmonary resuscitation. A random sample of 800 outpatients (one half aged over 70 years) was surveyed by questionnaire, with a 51% response rate. ⋯ When asked who they would have help them with DNR decisions, physicians were most often selected, while spouses were the most valued advisors. In a series of scenarios such factors as dementia, drug or alcohol use, age, and pain had a significant effect on a patient's decision about resuscitation. Discussions about DNR issues in the outpatient setting should be encouraged, as patient interest is strong, and greater physician awareness of patients' values and preferences can prevent unwanted resuscitation in the acute setting.
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Review Comparative Study
The gap between patient reading comprehension and the readability of patient education materials.
Patient education materials and hospital forms are given to patients with little regard for their ability to read them. Nationwide sampling and data from the 1980 census suggest that a high proportion of patients cared for in public hospitals are functionally illiterate. In this study, 151 adult primary care patients in five different ambulatory care settings were tested for reading comprehension. ⋯ The average reading comprehension of public clinic patients was 6th grade 5th month. Most tested patient education materials required a reading level of 11th to 14th grade, and standard institutional consent forms required a college-level reading comprehension. In the public clinics there was a gap of more than 5 years between patient reading levels and the comprehension levels required by written patient materials.
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The ratio of primary care physicians to subspecialists is of major importance to the future of American medicine. This study examined the output of primary care physicians by a state-supported medical school that has a goal of placing 50% of its graduates in primary care. Data were obtained from alumni office questionnaires and published board-certification listings for 1102 graduates of the University of Kentucky College of Medicine from 1973 through 1983. ⋯ Of all 1102 graduates, 37% are categorized as practicing primary care physicians; 29% of the total are board certified in a primary care discipline. Attrition from primary care as an initial career choice at entry into residency was 26%. With declining medical student interest in primary care and a shortage of primary care physicians, new initiatives in medical education and in the practice of medicine are necessary to balance the specialty distribution of physicians more favorably toward primary care.
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One of the primary benefits of continuity of care is its influence upon patient and physician satisfaction. This prospective pilot study involved a cohort of 14 second- and third-year family practice residents and 4 full-time faculty at a community hospital-based family practice residency in Cleveland, Ohio. Rates of continuity that physicians experience were calculated using the usual provider continuity (UPC) measure of continuity, and were correlated with physician satisfaction with outpatient care using a practice satisfaction scale (PSS) developed specifically for this purpose. ⋯ The average continuity rates were 59% for second-year residents, 54% for third-year residents, and 82% for faculty. The UPC continuity measure correlated highly with the PSS scores (corrected r2 = .55; P less than .001). The data support the hypothesis that continuity of care with patients is an important determinant of resident and faculty physician satisfaction with their outpatient experience.