Does family practice at residency teaching sites reflect community practice?

Journal of Family Practice, Dec, 1993 by Valerie Gilchrist, Rebecca S. Miller, William R. Gillanders, Dewey C. Scheid, Everett E. Logue, Donald C. Iverson, Allison M. Oprandi, David L. Weldy, Mark A. Krell

When excluding blood pressure measurement, the percentage of office visits in each survey in which diagnostic services were ordered or provided was similar (Table 5). The variety of services provided or offered was different. More mammograms, Pap smears, and cholesterol tests were offered or provided to our patients than to those in the NAMCS. The FPs and GPs in the NAMCS ordered more chest radiographs.

Overall, more therapeutic services were provided at our residency teaching sites than in the practices of FPs and GPs surveyed nationally (56.6% vs 40.8%, respectively, P [less than] .01). Our residency teaching sites had a higher percentage of visits for patient education than reported by FPs and GPs in the NAMCS (53.0% vs 32.7%, respectively, P [less than] .01) and about the same percentages for other counseling (18.0% and 20.9%, respectively) and psychotherapy (1.7% and 1.5%, respectively), but fewer referrals for physiotherapy (0.9% vs 2.7%, respectively, P [less than] .01, respectively). Our physicians provided almost twice the amount of counseling for cholesterol reduction as the FPs and GPs in the NAMCS (5.9% vs 3.4%, respectively, P [less than] .01), and almost three times the amount of counseling for smoking cessation (8.5% vs 3.0%, respectively, P [less than] .01).

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The physicians at the residency teaching sites recorded more medications per patient than the FPs and GPs in the NAMCS; this is true both for the mean number of medications recorded per visit (1.6 vs 1.2, respectively) and the lower percentage of visits for which there were no medications recorded (22.2% vs 30.9%, respectively, P [less than] .01). Although the percentages of visits during which physicians recorded one and two medications were similar, the percentage of visits for which they recorded three or more medications was higher among physicians at the residency teaching sites than among FPs and GPs in the NAMCS (P [less than] .01). The increased number of older patients in our sample did not account for the increase in medication noted.

The disposition of patient visits differed between the two surveys. Physicians scheduled patients to return at a specific time in 77.4% of the office visits to our practices, but in only 53.7% of those made to FPs and GPs in the NAMCS. Either the patient was told to return as needed (12.8% vs 29.1%, respectively, P [less than] .01) or no follow-up visit was planned (5.0% vs 12.3%, respectively, P [less than] .01) much less often in our practices than in those of FPs and GPs in the NAMCS. Our practices made more follow-up telephone calls than practices of FPs and GPs in the NAMCS (3.6% vs 2.7%, respectively, P [less than] .05), but fewer referrals (3.2% vs 4.2%, respectively, P [less than] .05). The rate of hospitalizations (0.6%) was the same in both.

The mean duration of visits found in our survey and those of practices in the NAMCS differed by only 1 minute (16 minutes vs 15 minutes, respectively). There were more 10-minute visits to the FPs and GPs in the NAMCS, whereas there were more visits lasting 15 minutes or longer to the physicians at our residency teaching sites (Figure). The modal visit duration for both populations was 15 minutes, whereas the median visit duration was 13 minutes for our patients and 12 minutes for patients visiting practices in the national survey.