Christopher Duffrin

Factors associated with placement of rural primary care physicians in North Carolina.

Objectives The objective of this study was to determine what factors influence primary care physicians to choose rural practice locations to better develop the rural workforce in North Carolina. To better recruit and retain physicians, residents, and medical students for rural practice, we must understand what factors positively influence their choice of practice location. Methods A survey was sent to all primary care physicians licensed in the state of North Carolina (N = 2829), with 975 usable (return rate 34.5%). Results were analyzed using basic descriptive statistics and &khgr;2 automatic interaction detection analysis. Results Findings indicated that solo practice, critical access hospital, community health center, or federally qualified health center sites were strongly associated with rural practice. Pay as a factor in choosing a work site, financial support from a hospital, and medical school loan repayment also was correlated with rural practice. Seventy-two percent of rural physicians reported being raised in a town of ⩽11,000, which was found to be highly associated with working in a rural area. This single point is highly indicative of rural practice and by defining this new level it roughly doubles the predictive value previously defined by other researchers. Conclusions Incentives such as loan repayment, salary guarantees, and practice assistance for rural physicians currently provided under several federal and state programs should continue to assist in attracting primary care physicians to rural areas. Having been raised in an area of ⩽11,000 was highly predictive of future rural medical practice and could be used in the recruitment of physicians and residents to increase the ultimate yield for rural areas. With these new data, North Carolina medical schools and practices serving rural areas may be able to better recruit and retain physicians with a predilection to rural practice.

Workaholism, Exercise, and Stress-Related Illness

The purpose of this study was to examine whether workaholism is associated with an increased risk of stress-related illness and if exercise is linked to a reduced risk of stress-related illness. Data were collected through administration of an online survey. The sample consisted of 266 employees in a medical school, 69% women, with a mean age of 47 years. Logistic regression analysis demonstrated that workaholism was significantly associated with the presence of stress-related illness (odds ratio [OR] = 1.47, p = .009) and exercise with absence of stress-related illness (OR = 1.68, p = .003), even after controlling for age, family history, gender, income, and hours worked. The authors concluded that workaholism is a significant risk factor for stress-related illnesses and that physical exercise mitigates the negative effects of workaholism.

Creating a New Paradigm for Premedical Undergraduate Studies: Physicians’ Perceptions of Subjects and Skills Critical for Success in Medical School and Practice

Background/Purpose: The purpose of this study is to determine subjects and skills that are perceived by practicing physicians as essential for success in medical training and practice. Previous studies suggest that better premedical preparation for a future career as a physician may reduce the need for expanded study of non-clinical subjects and skills in the graduate medical curriculum. Methods: The study was performed with a random sample of licensed physicians in Ohio (n=2,100), who were queried utilizing a survey instrument of 54 questions including demographics and perceptions on eight subjects and sixteen skills essential for success in medical school and practice. Completed surveys (n=356) were found to be representative of the national demographics of practicing physicians, including similar age, education, gender, type of practice, and specialty. Results: Respondents indicated that the subjects of business, communications, and technology were rated as most important for physician success, while communications, natural sciences and technology were most important for students. Skills identified as most essential to both training and practice included the ability to utilize technology, being honest and truthful, ability to explore, self-educate and research, and ability to communicate orally. Conclusions: The findings of the study support previous research and indicate that some students entering medical school may not have the breadth of study that practitioners identify as best preparing them for success as a student and practitioner.

Validation of a dietary intake tool for african-american dialysis patients with low literacy.

BACKGROUND This study analysed the validity and reliability of a food frequency questionnaire designed for African-American patients with low literacy. This instrument was designed specifically to meet the need for a tool that was short, easy to understand, and met clinical reliability and validity standards. OBJECTIVES Assessing patient nutritional status and dietary intake is crucial to the care of patients in end stage kidney disease. The development of a quick and reliable nutritional assessment tool for patients with low literacy could increase nutritional counselling effectiveness and improve patient outcomes. DESIGN The renal food frequency questionnaire (RFF) and a standard 24-hour recall were administered to a general population of African-American patients undergoing dialysis. Registered Dieticians and statistical analyses were used to validate the content and structural validity and reliability of the RFF to adequately measure dietary intake. PARTICIPANTS The study sample consisted of 30 African-American patients who received dialysis treatment at a regional teaching hospital facility. RESULTS The RFF was found to be a simple, easy to understand instrument with low reading complexity (grade level 4.4). Inter-rater reliability was found to be high (.81-1.00), and statistical analysis determined a high level of clinical validity. CONCLUSION The RFF was found to be a valid dietary recall tool that is appropriate for patients with limited literacy. It was found to have acceptable reliability and validity when compared with a standard 24-hour recall and has potential for use as a dietary intake and monitoring tool in patients undergoing dialysis.

The effect of primary care fellowship training on career satisfaction, happiness and perceived stress

Purpose This study was designed to measure the impact of primary care fellowship training on the subsequent happiness, career satisfaction and perceived stress levels of fellowship-trained physicians as compared to a general population of Family Medicine physicians in North Carolina. Methods A written survey instrument was completed by fellowship graduates of the Brody School of Medicine (n=53) and general population of Family Medicine physicians in North Carolina (n=203) in 2011. The survey included general demographic and practice variables, and validated psychological scales on subjective happiness, satisfaction with life, and perceived stress. Results Fellowship graduates (n=50), and non-fellowship graduates (n=203), exhibited similar levels of satisfaction with life (fellows=27.36 SD 5.45, FM physicians=26.91, SD 5.99 on a 5–35 scale), statistically higher levels of perceived stress (fellows=5.92, SD 3.03, FM physicians=4.98, SD 2.70 on a 0–16 scale), and significantly higher levels of subjective happiness (fellows=5.61SD 83, FM physician=4.75 SD 1.00 on a 1–7 scale). Female fellow response was significantly higher on the Satisfaction with Life and Subjective Happiness Scores, and lower on the Perceived Stress Scale. Male fellowship graduates presented with a reverse relationship, with higher perceived stress and lower satisfaction with life and subjective happiness. Conclusions Fellowship training exhibited a positive psychological effect on the graduate respondents versus the general physician population. Scores on various well-being scales were higher than the general Family Medicine physician population as a whole, although stress levels were also higher. Female physicians seem to garner a much larger gain in satisfaction than male fellowship graduates, who score slightly worse than the general family medicine population on the satisfaction with life and Perceived Stress Scales.

Perceptions of community health center impact on private primary care physician practice.

CONTEXT Community health centers (CHCs) were created in the mid-1960s to expand access to care in impoverished and underserved areas. The number of CHC sites has more than tripled in eastern North Carolina from 28 primary care centers in 2000 to 89 in 2010. OBJECTIVE This study determined the perceptions of physicians on the impact of CHC expansion on the local practice environment. DESIGN Descriptive statistics and correlations were used to compare responses regarding perceptions and differences between practice characteristics as well as physician ratios by year. Both CHC and private practice physician addresses were mapped using ArcGIS. SETTING AND PARTICIPANTS Surveys were sent to 1422 (461 returns/32.5% response rate) primary care physicians residing in 43 predominantly rural eastern North Carolina counties. RESULTS A large percentage of the respondents (82.7%) affirmed that they felt neutral or did not view CHCs to be competitors, whereas a minority (17%) did view them to be difficult to compete against. Forty-two percent of private practice respondents disagreed that CHCs offer a wider range of services despite significantly more CHC physicians than private practice respondents indicating that their facility provided basic services. CONCLUSION The CHCs were perceived to offer a wider range of services, employ more staff, and have more practice locations than private practices. However, private practice physicians did not perceive CHCs to have a competitive advantage or to unfairly impact their practices, possibly due to inconsistent population growth in relation to the physician retention during the last 10 years.

ACE inhibitors and potassium foods – nurses' knowledge

PURPOSE According to Joint Commission standards, patients should be educated about drug-nutrient interactions. Because nurses are well-suited to educating patients, this paper aims to assess their knowledge of ACE inhibitor drugs, nutrient interactions and high- and low-potassium foods. DESIGN/METHODOLOGY/APPROACH Licensed nurses from a teaching hospital in the US south eastern Atlantic region completed a self-administered questionnaire (n = 83). Means, standard deviations and 95 percent confidence intervals were calculated for continuous data and frequency and percentage distribution for discrete data. Students t-test was used to evaluate responses by ACE inhibitor patient load and nursing education. FINDINGS Mean nurse knowledge of ACE inhibitors and potassium was 62 +/- 16 percent and identifying high- and low-potassium foods was 32 +/- 23 percent. Most identified five from 12 high-potassium foods and did not know the designation of six, one from 14 low-potassium foods and did not know the designation of 11. Knowledge scores and identifying high- and low-potassium foods were similar regardless of ACE inhibitor patient load and nursing education. PRACTICAL IMPLICATIONS ACE inhibitors are the fourth most commonly used drug class in the USA. Nurses are well positioned to recognize potential drug-nutrient interactions owing to changing or adding a drug, dose delivery method, dietary change or a patients physical or clinical status that may indicate nutrient deficiency. The findings suggest that the nurses surveyed were proficient in identifying ACE inhibitors pharmacology, but that most were unable to identify foods that increase drug-nutrient interaction risk, and thus this is an area in which additional training might be beneficial. ORIGINALITY/VALUE Case menus were used to portray real-life scenarios in which healthcare practitioners can provide patient education about ACE inhibitor drug and dietary potassium interactions.