Does Provider Gender Affect the Quality of Primary Care?

Quantifying EHR and Policy Factors Associated with the Gender Productivity Gap in Ambulatory, General Internal Medicine

BACKGROUND

The gender gap in physician compensation has persisted for decades. Little is known about how differences in use of the electronic health record (EHR) may contribute.

OBJECTIVE

To characterize how time on clinical activities, time on the EHR, and clinical productivity vary by physician gender and to identify factors associated with physician productivity.

DESIGN, SETTING, AND PARTICIPANTS

This longitudinal study included general internal medicine physicians employed by a large ambulatory practice network in the Northeastern United States from August 2018 to June 2021.

MAIN MEASURES

Monthly data on physician work relative value units (wRVUs), physician and practice characteristics, metrics of EHR use and note content, and temporal trend variables.

KEY RESULTS

The analysis included 3227 physician-months of data for 108 physicians (44% women). Compared with men physicians, women physicians generated 23.8% fewer wRVUs per month, completed 22.1% fewer visits per month, spent 4.0 more minutes/visit and 8.72 more minutes on the EHR per hour worked (all p < 0.001), and typed or dictated 36.4% more note characters per note (p = 0.006). With multivariable adjustment for physician age, practice characteristics, EHR use, and temporal trends, physician gender was no longer associated with productivity (men 4.20 vs. women 3.88 wRVUs/hour, p = 0.31). Typing/dictating fewer characters per note, relying on greater teamwork to manage orders, and spending less time on documentation were associated with higher wRVUs/hour. The 2021 E/M code change was associated with higher wRVUs/hour for all physicians: 10% higher for men physicians and 18% higher for women physicians (p < 0.001 and p = 0.009, respectively).

CONCLUSIONS

Increased team support, briefer documentation, and the 2021 E/M code change were associated with higher physician productivity. The E/M code change may have preferentially benefited women physicians by incentivizing time-intensive activities such as medical decision-making, preventive care discussion, and patient counseling that women physicians have historically spent more time performing.

Knowledge and practices of sickle cell disease among healthcare providers in Kinshasa, Democratic Republic of the Congo

BACKGROUND

 In Kinshasa, Democratic Republic of Congo, there is a low evocation of the diagnosis of sickle cell disease (SCD) by first-level healthcare providers (HCPs), most likely because of poor knowledge of the disease.

AIM

 To assess the levels of knowledge and practices of SCD and to identify determinants of the practices among primary HCPs.

SETTING

 Healthcare facilities in Selembao health zone in Kinshasa, Democratic Republic of the Congo.

METHODS

 A cross-sectional study of HCPs randomly selected through a two-stage sampling design. Data were collected using a pre-tested interviewer-administered questionnaire. Univariate and bivariate analysis were done to describe the levels of knowledge and practices of SCD. Factors associated with better practices on SCD were determined using multiple linear regression. The threshold for statistical significance was p ˂ 0.05.

RESULTS

 A total of 318 HCPs, which included 80 physicians and 238 nurses, participated in the study. The participants showed different scores on the components of the knowledge. All the participants showed poor practices on SCD. Multiple linear regression retained overall knowledge of SCD as a significant predictor of better practice for physicians. Knowledge of SCD and duration of work experience were significant predictors of better practices among nurses.

CONCLUSION

 The practices of healthcare providers on SCD were far from optimal. These practices were significantly associated with knowledge and experience of healthcare providers.Contribution: This study highlighted the need for continuing professional education to enhance the management of SCD in the setting.

Exploring the Demographic and Professional Characteristics of Physicians and Nurse Practitioners Associated With Providing Medication-Assisted Treatment: A Retrospective Observational Study

Integration of medication-assisted treatment (MAT) for opioid use disorder in primary care settings is an emerging health care delivery model that supports increased access to specialized care but requires primary care provider engagement. Examining the characteristics of providers who provide this service is key to informing targeted recruitment. Using administrative and supplemental data collected during license renewal, this study aimed to identify the characteristics of primary care physicians and nurse practitioners (NPs) associated with greater odds of providing MAT in their practice. A retrospective observational study was conducted using a descriptive correlational design. The analysis included 5259 physicians and 3486 NPs who renewed their licenses electronically in 2021 and specialized in primary care or psychiatry. Chi-square and logistic regression analyses were conducted to identify the demographic and clinical characteristics of physicians and NPs associated with MAT participation in their practice. Physicians had a higher odds ratio (OR) of providing MAT if they were younger than 35 years (OR = 1.334; P = .0443), practiced in a federally qualified health center (OR = 3.101, P < .0001), and offered a sliding fee scale in their practice (OR = 2.046; P < .0001). Likewise, NPs had higher odds of providing MAT if they practiced in a public or community health center (OR = 3.866; P < .0001). The results of this study highlight the personal and professional characteristics of physicians and NPs associated with higher odds of providing MAT. These findings may have implications for the recruitment and sustainability of MAT integration in primary care.

Psychometric assessment of pharmacists' counseling in dementia

OBJECTIVE

This study aimed to explore pharmacists' counseling for dementia by developing a measurement tool based on the Theory of Planned Behavior.

METHODS

A survey was applied online to community pharmacists; in total, 190 community pharmacists participated in the study. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and Mann-Whitney U test were performed.

RESULTS

A six-factor structure was obtained from the EFA, and the CFA confirmed the structure. These factors explained 71.294% of the total variance. The Cronbach's alpha coefficients for the factors ranged from 0.728 to 0.913. In addition, the pharmacists rated themselves as having positive attitudes and intentions toward counseling for dementia. Differences in these factors were found between the groups based on their participation in vocational training on dementia.

CONCLUSION

The developed measurement tool had a satisfactory construct and convergent and discriminant validities and reliabilities.

PRACTICE IMPLICATIONS

The developed measurement tool can be used to investigate pharmacists' self-reported counseling for dementia and can also be applied to the counseling behavior of pharmacists in various health conditions.

Impact of a training program on hospital pharmacists' patient-centered communication attitudes and behaviors

Background

Effective communication that integrates the value of patient-centered care is important in healthcare encounters. Communication skills training (CST) has been indicated as effective in improving patient-centered communication behaviors. However, there is a paucity of studies on the impact of CST among Malaysian hospital pharmacists.

Objective

This study aimed to evaluate the effects of a patient-centered CST program on patient-centered communication scores, communication self-efficacy, and attitudes toward concordance among pharmacists in public hospitals.

Methods

A communication skills training (CST) program was conducted among hospital pharmacists. This training intervention was developed based on patient-centered communication frameworks and techniques, namely the Four Habits Model and motivational interviewing. A pre-test/post-test quasi-experimental design was implemented for the evaluation. Pharmacists underwent pre-test/post-test audiotaped simulated consultations and completed questionnaires, including the Revised United States-Leeds Attitudes Toward Concordance scale (RUS-LATCon) and Communication Self-Efficacy scale. The Four Habits Coding Scheme (FHCS) was used to evaluate patient-centered communication scores from the audiotapes, and the Wilcoxon signed-rank test was used to analyze for differences in the pre- and post-intervention scores.

Results

A total of 38 pharmacists from four tertiary hospitals participated in this study and completed the pre-test. However, due to the impact of COVID-19, only 23 pharmacists completed the post-test data collection. Improvements were noted in the FHCS scores post-training, including items related to exploring patients' concerns, acceptability, and barriers to treatment. Based on the questionnaire, there was an improvement in recognizing patients' needs and potential medication uncertainty and an increase in the overall communication self-efficacy scores after the training.

Conclusions

CST may help improve the adoption of patient-centered communication in pharmacists' consultations with patients.

Use of seven types of medical jargon by male and female primary care providers at a university health center

OBJECTIVES

The purposes of this study were to investigate extent and type of jargon use among primary care providers at a university health center, to evaluate the association of jargon use with patient outcomes, and to identify differences in jargon use between male and female providers.

METHOD

The study employed a causal comparative design. Audio recordings of 87 primary care interviews were transcribed and coded using Pitt and Hendrickson's seven-category medical jargon classification framework.

RESULTS

Nearly 80% of appointments included at least one instance of unexplained jargon, with an average of more than four uses of jargon per visit. The most frequently used types of jargon were technical terminology and medical vernacular. Acronyms and abbreviations, medicalized English, and unnecessary synonyms were also regularly used. Just under half of distinct jargon terms were explained. Male providers used nearly 50% more jargon per minute than female providers, and they used more technical jargon than did their female colleagues. However, they explained that jargon just as frequently as female providers.

CONCLUSIONS

Whereas previous studies have frequently limited the operational definition of jargon to two or three types, the comprehensive typology proposed by Pitt and Hendrickson provides a useful tool for identifying a wide range of jargon usage. Future research should examine the outcomes of this range of jargon types in more varied, less educated patient populations, and across different types of healthcare providers.

PRACTICE IMPLICATIONS

With jargon used on average more than once every four minutes in our sample, and only half of jargon terms explained, medical jargon may be more of a problem even in primary care contexts than providers themselves realize. Male providers especially may want to make efforts to become more conscious of their jargon use and take care to explain terms, in an effort to facilitate more effective patient-provider communication and improved patient outcomes.