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News From The Annals Of Family Medicine: July/August 2013

Examine the Causes of Potentially Avoidable Hospitalizations

Exploring the causality hospitalizations for illnesses that can typically be managed effectively on an outpatient basis, researchers found primary care physicians deemed most to be potentially avoidable, attributing the causes to five possible categories: system-related, physician-related, medical, patient-related and/or social. Interviews with 12 German primary care physicians regarding 104 hospitalizations of 81 patients with ambulatory care-sensitive conditions revealed participating physicians rated 41 percent of the hospitalizations as potentially avoidable. During the interviews, the cause of hospitalization fell into one or more of five principal categories: system-related (e.g., unavailability of outpatient services), physician related (e.g., suboptimal monitoring), medical (e.g., medication side effects), patient-related (e.g., delayed help-seeking) and social (e.g., lack of social support). System-related causes were attributed to 30 hospitalizations (29 percent), physician-related causes to 32 (31 percent), medical causes to 101 (97 percent), patient-related causes to 83 (80 percent) and social causes to 20 (19 percent). Based on these findings, the authors posit strategies to avoid such hospitalizations, including after-hours care, optimal use of outpatient services, intensified monitoring of high-risk patients and initiatives to improve patients’ willingness and ability to seek timely help as well as patients’ medication adherence.

Strategies for Reducing Potentially Avoidable Hospitalizations for Ambulatory Care-Sensitive Conditions

By Tobias Freund, MD, et al

University Hospital Heidelberg, Germany

Most Pregnant Women in the United States Receive Care from Multiple Types of Clinicians, Number Seeing Remains Stable Over Past Decade

Approximately one-third of pregnant women report having seen or talked to a for during the prior year, a percentage that has remained stable over the past decade. Analyzing nationally representative data on 3,204 women from 2000 to 2009, researchers found a substantial and steady proportion of pregnant women (36 percent) received some care from family physicians, with most reporting receiving care from multiple types of clinicians, including family physicians, obstetrician-gynecologists, midwives, nurse practitioners and physicians assistants. The authors conclude these findings underscore the importance of care coordination for this patient population. The researchers also identify regional differences in trends in care, with pregnant women in the North Central United States increasingly reporting care from family physicians and women in the South reporting a decline (7 percent annual increase vs. 5 percent annual decrease).

Care From Family Physicians Reported By Pregnant Women in the United States By Katy Backes Kozhimannil, PhD, MPA, and Patricia Fontaine, MD, MS University of Minnesota School of Public Health, Minneapolis-St. Paul and Health Partners Institute for Education and Research, Minnesota

Safety Climate in German Family Practices Generally Positive

Evaluating the impact of different individual and practice features on perceptions of the safety climate – the shared employee perceptions of the priority of safety at an organization – in German primary care practices, researchers find though the safety culture is positive overall, professionals’ use of incident reporting and a systems approach to errors was fairly rare. The researchers’ analysis of more than 2,100 questionnaires revealed the safety climate as perceived by doctors and assistants was not significantly influenced by individual and practice team characteristics. They also found participation of the whole practice team in the survey had a positive influence on safety climate, and doctors had more positive perceptions of four of the seven climate factors evaluated than assistants. Because measurement of a safety climate aims to detect areas of deficiencies to improve patient safety, the authors assert these findings should prompt German primary care doctors and assistants to learn more about error causation and adopt a systems approach toward patient safety incidents as a method to develop a memory for past errors and to learn from them. They call for assistants, in particular, to contribute more to incident reporting and participate in an open and fair safety culture.

Impact of Individual and Team Features of Patient Safety Climate: A Survey in Family Practices By Barbara Hoffmann, MD, MPH, et al Goethe University, Frankfurt, Germany

The Consequences of Postponing Motherhood in the Pursuit of a Career in Medicine

Two female physicians reflect on the consequences of postponing motherhood in the pursuit of successful medical careers. They share their personal stories of difficulty conceiving, miscarriages and stillbirth, reflecting on how their intense career focus led them to gamble away their fertility. Because delayed childbearing can result in unintended childlessness, the need for assisted reproductive techniques, adoption and having smaller than desired family size, the authors call for training programs and employers to provide more information and support to women in medicine, and adopt policies that are consistent with today’s trainees’ and physicians’ complex lives. They caution men and women in medicine to carefully consider how medical school, residencies and fellowships can impinge on family planning.

Women in Medicine and the Ticking Clock

By Lisa N. Miura, MD and Rebecca S. Boxer, MD, MS

Legacy Emanuel Medical Center, Portland, Oregon

Source

American Academy of Family Physicians