Describing Primary Care Encounters: The Primary Care Network Survey and the National Ambulatory Medical Care Survey

Abstract

PURPOSE The purpose of this study was to describe clinical encounters in primary care research networks and compare them with those of the National Ambulatory Medical Care Survey (NAMCS).METHODS Twenty US primary care research networks collected data on clinicians and patient encounters using the Primary Care Network Survey (PRINS) Clinician Interview (PRINS-1) and Patient Record (PRINS-2), which were newly developed based on NAMCS tools. Clinicians completed a PRINS-1 about themselves and a PRINS-2 for each of 30 patient visits. Data included patient characteristics; reason for the visit, diagnoses, and services ordered or performed. We compared PRINS data with data obtained from primary care physicians during 5 cycles of NAMCS (1997)(1998)(1999)(2000)(2001). Data were weighted; PRINS refl ects participating networks and NAMCS provides national estimates.RESULTS By discipline, 89% of PRINS clinicians were physicians, 4% were physicians in residency training, 5% were advanced practice nurses/nurse-practitioners, and 2% were physician's assistants. The majority (53%) specialized in pediatrics (34% specialized in family medicine, 9% in internal medicine, and 4% in other specialties). All NAMCS clinicians were physicians, with 20% specializing in pediatrics. When NAMCS and PRINS visits were compared, larger proportions of PRINS visits involved preventive care and were made by children, members of minority racial groups, and individuals who did not have private health insurance. A diagnostic or other assessment service was performed for 99% of PRINS visits and 76% of NAMCS visits (95% confi dence interval, 74.9%-78.0%). A preventive or counseling/education service was provided at 64% of PRINS visits and 37% of NAMCS visits (95% confi dence interval, 35.1%-38.0%).CONCLUSIONS PRINS presents a view of diverse primary care visits and differs from NAMCS in its methods and fi ndings. Further examinations of PRINS data are needed to assess their usefulness for describing encounters that occur in primary care research networks. 2007;5:39-47. DOI: 10.1370/afm.620. Ann Fam Med INTRODUCTIONP ractice-based research networks (PBRNs) are groups of practices affi liated for the purposes of research and quality improvement. PBRNs have increased in number and diversity over the past decade and are a prime environment for needed research.1,2 Primary care-focused PBRNs use the experience and insight of clinicians to identify and frame research questions for primary care settings, 3 which are the key sites for health care delivery in the United States. 4 A wide scope of research is conducted in primary care PBRNs, including clinical trials, epidemiologic studies, translational research, and health services research. At the same time, many of the 111 primary care PBRNs now known to be active in the United States Helen J. Binns, MD PR IM A RY C A R E ENCOUNT ER Sreport that the lack of adequate information systems in offi ce practices is a major barrier to research.5 Many PBRNs do not have accurate, up-to-date data describing th...

A Method for Obtaining an Unbiased Sample of Family Medicine Patients for Research Purposes

“…A formal evaluation of the alternative sampling methods, associated data collection costs, and the final sample size that can be obtained for a given design is standard procedure for well funded large-scale surveys. 12,13 These issues are beyond the scope of this paper. Sampling textbooks and review papers address these issues in more detail.…”

“…[2][3][4][5][6][7][8][9][10][11][12][13] Our study adds to this sparse literature on the pros and cons of alternative ways of sampling patients from primary care. More experience with practical but valid hybrid samples in primary care is needed, especially in the context of a greater emphasis on evidence-based primary care.…”

“…Compromises between practicality, costs, statistical power, and a tolerable level of (selection) bias are usually made. 12,13 The ultimate success of any sampling approach depends not only on sampling mechanics but also on inherent study risk, study appeal, the complexity of the consent process, the length or content of any research interviews, patient compensation, and the clinical context within which the data collection occurs. Thus, we have described the clinical context around data collection for our study in sufficient detail so that readers can draw their own interferences.…”

“…A dozen reports over a 16-year period were found. [2][3][4][5][6][7][8][9][10][11][12][13] Four studies compare probability and nonprobability sampling. 2,6,10,11 The research of Cumming supports the proposition that a systematic sample can yield valid results, but the reported study was done in shopping centers rather than in primary care.…”

“…7 Other literature addresses issues peripheral to this paper. [3][4][5]8,9,12,13 This relatively sparse literature does not adequately address hybrid sampling techniques in primary care. We illustrate a practical hybrid systematic and multistage patient sampling and recruiting scheme that adds to this sparse literature on sampling in primary care.…”