Kathleen Klink

Direct Primary Care: Practice Distribution and Cost Across the Nation

Direct primary care (DPC) is an emerging practice alternative that (1) eliminates traditional third-party fee-for-service billing and (2) charges patients a periodic fee for primary care services. We describe the DPC model by identifying DPC practices across the United States; distinguish it from other practice arrangements, such as the “concierge” practice; and describe the models pricing using data compiled from existing DPC practices across the United States. Lower price points and a broad distribution of DPC practices were confirmed, but data about quality are lacking.

Are a Speculum Examination and Wet Mount Always Necessary for Patients With Vaginal Symptoms? A Pilot Randomized Controlled Trial

Purpose: The suggested evaluation of vaginal symptoms is based on the wet mount diagnosis of candidiasis, trichomoniasis, and bacterial vaginosis. We wondered if patients with vaginal symptoms could be managed initially based solely on symptoms. Methods: This pilot randomized controlled trial was conducted in 2 urban family practice clinics and enrolled 46 premenopausal, nonpregnant women with acute vaginal symptoms. In the control arm, women were managed based on a speculum examination and wet mount. In the intervention arm, women were managed based on symptoms. Women were tested for gonorrhea, chlamydia, and trichomoniasis and called 2 weeks later to assess symptom resolution, adverse medication effects, need for revisit, and satisfaction with care. Results: Forty-one of 44 women (93%) felt better 2 weeks after the visit; 28 (64%) had complete resolution of symptoms. The intervention arm had slightly better resolution of symptoms (P = .046); there were other no differences between the 2 arms. Three women were diagnosed with sexually transmitted diseases (trichomoniasis, chlamydia, and gonorrhea). Conclusions: Our pilot study suggests that in selected women it may be reasonable to initially manage vaginal complaints based on symptoms. These results should be confirmed in other larger trials. Testing for sexually transmitted diseases is important in our population.

Who is Using Telehealth in Primary Care? Safety Net Clinics and Health Maintenance Organizations (HMOs)

Despite rapid advancements in telehealth services, only 15% of family physicians in a 2014 survey reported using telehealth; use varied widely according to the physicians practice setting or designation. Users were significantly more likely than nonusers to work in federally designated “safety net” clinics and health maintenance organizations (HMOs) but not more likely than nonusers to report working in a patient-centered medical home (PCMH) or accountable care organization.

Urgent and emergency family physicians in rural communities.

Health reform and the Affordable Care Act have triggered a renewed interest in strengthening access to primary care services, with a focus on ensuring that the nation has appropriately trained physicians practicing where they are needed. There are about 80 primary care physicians per 100,000 people

Changes in Primary Care Graduate Medical Education Are Not Correlated With Indicators of Need: Are States Missing an Opportunity to Strengthen Their Primary Care Workforce?

Purpose Federal and state graduate medical education (GME) funding exceeds

Sponsoring Institutions with Five or Fewer Residency Programs Produce a Larger Proportion of General Internists and Family Physicians

15 billion annually. It is critical to understand mechanisms to align undergraduate medical education (UME) and GME to meet workforce needs. This study aimed to determine whether states’ primary care GME (PCGME) trainee growth correlates with indicators of need. Method Data from the American Medical Association Physician Masterfile, the Association of American Medical Colleges, the American Association of the Colleges of Osteopathic Medicine, and the U.S. Census were analyzed to determine how changes between 2002 and 2012 in PCGME trainees—a net primary care physician (PCP) production estimate—correlated with state need using three indicators: (1) PCP-to-population ratio, (2) change in UME graduates, and (3) population growth. Results Nationally, PCGME trainees declined by 7.1% from the net loss of 679 trainees (combined loss of 54 postgraduate year 1 trainees in internal medicine, family medicine, and pediatrics and addition of 625 fellowship trainees in those specialties). The median state PCGME decline was 2.7%. There was no correlation between the percent change in states’ PCGME trainees and PCP-to-population ratio (r = −0.06) or change in UME graduates (r = 0.17). Once adjusted for population growth, PCGME trainees declined by 15.3% nationally; the median state decline was 9.7%. Conclusions There is little relationship between PCGME trainee growth and state need indicators. States should capitalize on opportunities to create explicit linkages between UME, GME, and population need; strategically allocate Medicaid GME funds; and monitor the impact of workforce policies and training institution outputs.

Evaluation of vaginal complaints.

Policymakers are increasingly interested in addressing the US primary care physician shortage and achieving measurable accountability for the products of the nations

Family Physicians Report Considerable Interest in, but Limited Use of, Telehealth Services

15 billion investment in graduate medical education (GME). Using one such measure, we found that sponsoring institutions (SIs) with ≤5 residency programs produce a higher percentage of general internists and family physicians than larger SIs.