Physician activities during time out of the examination room.
Adult; Female; Humans; Male; Middle Aged; Ohio; Aged; *Family Practice; *Patient Care; Task Performance and Analysis; Time and Motion Studies; Medical; *Practice Management
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.
Gilchrist Valerie; McCord Gary; Schrop Susan Labuda; King Bridget D; McCormick Kenelm F; Oprandi Allison M; Selius Brian A; Cowher Michael; Maheshwary Rishi; Patel Falguni; Shah Ami; Tsai Bonny; Zaharna Mia
Annals of family medicine
2005
2005-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1370/afm.391" target="_blank" rel="noreferrer noopener">10.1370/afm.391</a>
The consultation and referral process.
PATIENTS; PRIMARY care; PRACTICE of medicine; MEDICAL care; MEDICAL consultation; PHYSICIANS (General practice)
BACKGROUND. Consultation and referral are essential components of the practice of primary care. Despite this, little is known about the factors that contribute to the success of a referral. We examined the short-term outcomes of communication between family physicians and consultants during the referral process. METHODS. The study setting was six family practice centers in northeastern Ohio. All eligible physicians at each center participated in data collection by means of a card study. Data was recorded on any patient who received a referral to a physician or nonphysician provider during the month of July 1994. One year later, referrals were followed up by physician questionnaire. RESULTS. Three hundred nine of 5172 total patients were referred (5.97 referrals per 100 office visits). At follow-up, the family physicians reported that 63% of patients had visited the consultant, 14% had not, and the physician had no knowledge of the actions taken by the other 23%. The referring physician received feedback from the consultant regarding 55% of the patients referred. Receipt of feedback was strongly related to communication by the family physician to the consultant at the time of referral. Physicians who received feedback were the most satisfied with communication from the consultant and the care their patient had received. CONCLUSIONS. Primary care physicians can influence the likelihood of receiving feedback from a consultant by initiating communication with the consultant. A referral wherein the physicians involved do not communicate with one another results in physician dissatisfaction. Primary care physicians must practice strategies to improve the referral process. [ABSTRACT FROM AUTHOR]
Bourguet Claire; Gilchrist Valerie; McCord Gary
Journal of Family Practice
1998
1998-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).