The Impact of Change in Hospital Admissions When Primary Care Is Provided by a Single Primary Care Physician: A Cohort Study Among HMO Patients in Israel.

Objectives: An Israeli health maintenance organization (HMO) changed its policy from freedom of choice in choosing any primary care physician (PCP) to provide health care to one provider allocated to the patients. We examined outcome measures before and after the intervention in the study population.

Design: During a 2.

Does a policy that requires adherence to a regular primary care physician improve the actual adherence of patients?

Background: Continuity of care by the same personal physician is a key factor in an effective and efficient health care system. Studies that support the association between high adherence and better outcomes were done in settings where allocation to the same physician was a long-term policy.

Objectives: To evaluate the influence that changing organizational policy from the free choice of a primary care physician to a mandatory continuity of care by the same physician has on adherence to a personal physician.

[THE MISTAKE OF CUT AND PASTE FROM ACUTE PAIN TO CHRONIC PAIN].

What is a physician to do when the tools in his toolbox fail him? In the field of chronic pain, we are told that imaging studies are often so non-specific as to barely distinguish between symptomatic and asymptomatic individuals. "Advanced pain management techniques and off-label use of popular pain medicines do not withstand the rigors of controlled clinical trials and in many cases have been shown to be harmful. We are informed by the CDC that we are in the midst of a deadly "physician-driven" epidemic of prescribed opioid use disorder.

Changing electronic formats is associated with changes in number of laboratory tests ordered.

Objectives: To evaluate if changes in how laboratory test requests are presented in the electronic health record (EHR) would lead to less testing.

Study Design: Computerized laboratory data were used to compare the numbers of tests ordered before and after each change was introduced.

Methods: Leumit Health Services (a health maintenance organization [HMO] in Israel) has a central laboratory that serves HMO members in 340 clinics all over the country.

Blood levels of vitamin D and health-functional status in asymptomatic individuals: a cross sectional study.

Background: Recently issued guidelines do not recommend screening for vitamin D deficiency in asymptomatic adults. The large range of health effects that have been associated with vitamin D deficiency raises the possibility that vitamin D levels may be a marker of poor health status rather than a cause of it. We investigated an association between vitamin D level and health-functional status.

Vitamin B12 screening in metformin-treated diabetics in primary care: were elderly patients less likely to be tested?

Low serum B12 level is a common occurrence in patients with type 2 diabetes (T2DM) treated with metformin. There is lack of evidence concerning blood testing of vitamin B12 and current clinical guidelines make no recommendations on the detection or prevention of vitamin B-12 deficiency during metformin treatment. Our objective was to examine the current practice and clinical determinants of vitamin B12 testing in metformin treated T2DM patients.

Help-seeking preferences in the area of mild cognitive impairment: comparing family physicians and the lay public.

Background: Mild cognitive impairment (MCI) or mild neurocognitive disorder is a well-established clinical entity included in current diagnostic guidelines for Alzheimer's disease and in major psychiatric classifications. In all, a loosely defined concern obtained from conceptually different sources (the individual, a knowledgeable informant, or a clinician) regarding a decline in cognition and change in functioning constitutes a sine qua non for initiating diagnostics and providing therapy and support. This concern in practice may translate into complex proactive help-seeking behavior.

Standardized patient-based simulation training as a tool to improve the management of chronic disease.

Introduction: Patient education is a critical factor in the treatment of chronic disease because it reduces gaps in health care and disease management. We implemented different methods of physician training for patient education of asthma and compared the effects on patients' health.

Method: Four interventions were administered to groups of primary care physicians in one health care maintenance organization.

Familiarity, knowledge, and preferences of family physicians regarding mild cognitive impairment.

Background: Mild cognitive impairment (MCI) is a common condition among elderly persons. Its early identification is important because MCI can be a precursor of dementia. Since physicians' knowledge and preferences regarding MCI can be critical in its identification, this study assessed family physicians' familiarity, knowledge, and preferences regarding help-seeking, diagnosis, and treatment options for MCI.

Fatigue as a first-time presenting symptom: management by family doctors and one year follow-up.

Background: Fatigue is a common complaint in primary care and has a broad differential diagnosis, making the approach complex and often ineffective.

Objectives: To follow the course of adults without a significant known background disease who complain of fatigue for the first time, and to characterize the family physician's approach.

Methods: The study population comprised a random sample of 299 patients aged 18-45 who presented with fatigue as a first-time single complaint to their family physician.

[Workload, burnout and need to recover among female residents in internal medicine and family medicine].

Background: The Israeli medical residents' workload in hospitals is enormous, especially in the internaL wards, due to a severe lack of manpower and the demand to carry out many shifts. The workload of residents who practice in the community is rising as well: family physicians are required to achieve quality objectives in treating chronic diseases while the time dedicated to each patient is shortening. Creating a family usually parallels to this phase, causing home-work conflict among the residents.

Non-specific symptoms as clues to changes in emotional well-being.

Background: Somatic symptoms are a common reason for visits to the family physician. The aim of this study was to examine the relation between non-specific symptoms and changes in emotional well-being and the degree to which the physician considers the possibility of mental distress when faced with such patients.

Methods: Patients who complained of two or more symptoms including headache, dizziness, fatigue or weakness, palpitations and sleep disorders over one year were identified from the medical records of a random sample of 45 primary care physicians.

The tools of an evidence-based culture: implementing clinical-practice guidelines in an Israeli HMO.

Purpose: Although clinical-practice guidelines (CPGs) are implemented on the assumption that they will improve the quality, efficiency, and consistency of health care, they generally have limited effect in changing physicians' behavior. The purpose of this study was to design and implement an effective program for formulating, promulgating, and implementing CPGs to foster the development of an evidence-based culture in an Israeli HMO.

Method: The authors implemented a four-stage program of stepwise collaborative efforts with academic institutions composed of developing quantitative tools to evaluate prescribing patterns, updating CPGs, collecting MDs' input via focus groups and quantitative surveys, and conducting a randomized controlled trial of a two-stage, multipronged intervention.

Smoking prevention and primary physician's and patient's characteristics.

Objective: To describe relationships between primary physician and patient characteristics and the approach to prevention and quitting of smoking.

Methods: A questionnaire composed of descriptions of cases and clinic activities was given to primary physicians.

Results: Fewer smoking physicians use written materials, yet former smokers more often recommend smoking cessation groups.

[Physician incentives--an overview].

Physicians are the backbone of every medical system. Physician function and behavior have a major impact on the function and outcomes of medical systems. Physician behavior is influenced by sets of incentives that are an inherent part of the medical system.

Thirty years of family medicine publications in Israel (1975-2004): what, where, and how much?

Background: Departments of family medicine in Israel were established in the 1970s. Until now, little or no effort has been made to characterize the productivity of Israeli board-certified family medicine physicians in publishing peer-reviewed scientific articles.

Methods: Publications were identified by 2 methods.

[Impact of living in the West Bank and the Gaza Strip on chronic disease among the Jewish population].

Objective: To assess chronic physical morbidity in the terror-prone Jewish population of the West Bank and the Gaza Strip (WBGS).

Methods: We conducted a cross-sectional study based on electronic medical records. Included in the study were 24,551 members aged 26 years or older: 8,304 inhabitants of eleven Jewish settlements in the WBGS and 16,247 inhabitants of eleven settlements inside the 1967 borders of Israel.

Long-term adherence to antihypertensive therapy: a survey in four primary care clinics.

Background: Many hypertensive patients have suboptimal control of their blood pressure. One of the most common causes is poor adherence with treatment.

Aim: To identify factors associated with poorer adherence to antihypertensive treatment.

Web-based question-answering service of a family physician -- the characteristics of queries in a non-commercial open forum.

The use of the Internet is growing rapidly. Up to 70% of American Internet surfers use the Web for some kind of medical purpose. Only a few studies characterized the consulting population and their inquiries.

Pre-hypertension is a common phenomenon: national database study.

Background: Recently the Joint National Committee (7th report) introduced the term "pre-hypertension." Little is known on its prevalence in the general population.

Objectives: To assess the prevalence of pre-hypertension in a large national cohort.

Prescription of ocular beta-blockers in patients with obstructive pulmonary disease: Does a central electronic medical record make a difference?

Objectives: Topical beta-blockers are contraindicated in obstructive pulmonary diseases (OPDs). In this study we aimed to evaluate through central or local electronic medical records (EMRs) the prescription patterns for topical ocular beta-blockers for patients with glaucoma and OPD treated by ophthalmologists.

Methods: The study was carried out at the Leumit Health Maintenance Organisation (HMO) in Israel.

[The effects of violence and terrorism on chronic physical illness].

Over the past few years more than a thousand Israeli civilians were murdered and thousands were wounded in recurrent terrorist attacks. Many others had been exposed to the terrorists' attacks, either directly or indirectly. However, the impact of the terror on physical illness had not yet been explored.

Quality of diabetes care in the community: a cross-sectional study in central Israel.

Background: Good care of the diabetic patient reduces the incidence of long-term complications. Treatment should be interdisciplinary; in the last decade a debate has raged over how to optimize treatment and how to use the various services efficiently.

Objectives: To evaluate the quality of care of diabetic patients in primary care and diabetes clinics in the community in central Israel.