NURSE PRACTITIONERS WORKING IN PRIMARY CARE

Nurse Practitioners Working in Primary Care

Abstract

To determine the proportion of primary care physicians who screen sexually active teenage women for chlamydia and to determine demographic factors, practice characteristics, and attitudes associated with chlamydia screening. We obtained a random sample of 1600 Pennsylvania physicians from the American Medical Association masterfile, stratified to include at least 40% women and equal numbers of family physicians, internists, obstetricians/gynecologists, and pediatricians. In January 1998, physicians received mailed questionnaires; nonrespondents received two follow-up mailings. Physician characteristics associated with chlamydia screening were determined using bivariate and logistic regression analyses. Only one-third of physicians responded that they would screen asymptomatic, sexually active teenage women for chlamydia during a routine gynecologic examination. In multivariate analysis, physicians were significantly (p < .05) more likely to screen if they were female (43% vs. 24%), worked in a clinic versus solo practice (60% vs. 18%), worked in a metropolitan location (46% vs. 26%), or had a patient population =20% African-American (54% vs. 25%). Attitudes associated with screening included the belief that most 18-year-old women in their practice were sexually active (36% vs. 12%), feeling responsible for providing information about the prevention of sexually transmitted diseases to their patients (42% vs. 21%), or knowing that screening for chlamydia prevents pelvic inflammatory disease (37% vs. 13%). Physicians were less likely to screen if they believed that the prevalence of chlamydia was low (10% vs. 41%). A majority of physicians do not adhere to recommended chlamydia screening practices for teenage women. Interventions to improve chlamydia screening might target physicians who are male, in private practice, or who practice in rural areas, and should focus on increasing awareness of the prevalence of chlamydia and benefits of screening.



Table of Content

CHAPTER ONE5

INTRODUCTION5

CHAPTER TWO6

SYSTEMATIC REVIEW6

Web-based interventions14

Intensive educational interventions15

Brief interventions16

Simulated patient instructor17

CHAPTER THREE20

METHODOLOGY20

Identification of studies21

Assessment of study quality21

Data analysis22

CHAPTER FOUR23

DISCUSSION AND ANALYSIS23

Results23

Patient satisfaction24

Health status25

Process measures25

Limitations of the review26

Policy implications27

Unresolved issues28

CHAPTER FIVE30

CONCLUSION30

Strengths and weaknesses of study30

Comparison with other studies31

Meaning of the study32

Implications for policy and practice33

REFERENCES41

Chapter One

Introduction

Recent policy developments in the National Health Service, including NHS walk-in centres, NHS Direct, and nurse led personal medical services schemes, have been based on nurses rather than doctors acting as first point of contact with the health service. 1 2 Several factors have led to this expansion in the role of nurses, including issues of cost, the need to increase provision of care to improve access, the availability of doctors, and the skills and expertise of nurses. Particular interest has been shown in the concept of nurse practitioners providing front line care in general practice and in emergency departments. In this way they may potentially substitute for doctors, particularly in the management of patients with acute illness. Nurse practitioners have undergone further training, often at graduate level, to work autonomously, making independent diagnoses and treatment decisions.3 It is important to consider whether the evidence supports the notion that nurse practitioners can substitute for doctors by providing safe, effective, and economical front line management of ...