The Journal of the American Board of Family Practice / American Board of Family Practice
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Human brucellosis has a serious medical impact worldwide, and its eradication poses major difficulties. Although human brucellosis is relatively rare in the United States (approximately 100 cases per year), there is concern that this disease is largely underdiagnosed and underreported. Additionally, immigrants from endemic areas are arriving to this country, and Brucella species are considered to be biologic agents for terrorism. Human brucellosis affects all age-groups, and family physicians are not well versed in recognizing and treating this potentially life-threatening condition. ⋯ Appropriate antimicrobial therapy and duration of treatment of human brucellosis will reduce morbidity, prevent complications, and diminish relapses. Because of the nonspecific symptoms and rarity of human brucellosis in the United States, family physicians must acquire a detailed dietary and occupational history to diagnose the disease promptly. Family physicians must assume a responsible role in reporting this disease, as well as be aware of persons at high-risk for this disease and the potential sources of infection.
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J Am Board Fam Pract · Sep 2002
Effect of managed care and financing on practice constraints and career satisfaction in primary care.
The shift away from third party insurers to risk-sharing arrangements affecting care management and clinicians could be the most fundamental change in the health care system. Analysis was undertaken to study how managed care, practice setting, and financial arrangements affect physicians' perceived impact on their practice. ⋯ Physicians in solo and 2-physician practices were least satisfied with their careers and reported more constraints on their clinical freedom and income than physicians in other settings. Physicians in group practices or staff model HMOs are more likely to report time pressure than physicians in solo or 2-physician practices. Family practice falls between internal medicine (less satisfied, more practice constraints) and pediatrics (more satisfied, fewer practice constraints).
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J Am Board Fam Pract · Jul 2002
Accuracy of rapid strep testing in patients who have had recent streptococcal pharyngitis.
Some clinicians have questioned the accuracy of rapid diagnosis of group A streptococcal pharyngitis by commercial immunochemical antigen test kits in the setting of recent streptococcal pharyngitis, believing that the false-positive rate was increased because of presumed antigen persistence. ⋯ The findings of this study indicate that the rapid strep test is both sensitive and specific in the setting of recent group A beta-hemolytic streptococcal pharyngitis, and its use might allow earlier treatment in this subgroup of patients.
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J Am Board Fam Pract · May 2002
Impact of the limited generalist (no hospital, no procedures) model on the viability of family practice training.
Some doubt the desirability and cost-effectiveness of continuing to provide an expanded scope of primary care practice. Additionally, there has been concern about declining reimbursement from Medicaid and Medicare. Although an expanded scope of patient care services are required for training, we wanted to determine whether these services drain resources and time from other primary care activities. ⋯ Revenue was adequate for reimbursement of equipment, staff, and physician time in either case. For procedural activities in the office, there was a net gain of $372,974 in charges once opportunities for lost office visits were deducted. Even within the 40% net collection scenario, revenue was more than adequate to pay for overhead and equipment. For this practice with 84% Medicaid-Medicare accounts, projected collections of 40% underestimated slightly the actual net revenue.
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J Am Board Fam Pract · May 2002
The National Institute for Program Director Development: a school for program directors.
The role of residency program director is unique in medicine and medical education. Most program directors learn the job through trial and error, with a fortunate few benefiting from the wisdom and experience of their predecessors and mentors. In 1994, the Association of Family Practice Residency Directors (AFPRD) made the development of training and support resources for program directors a top priority. ⋯ Enhanced preparation for the job of residency program director results in a positive impact on both the director and the program.