Faculty Bibliography

BACKGROUND:Telephone consultation is widely used in primary care and can provide an effective and efficient alternative for the in-person visit. Gouverneur Health, a safety-net primary care practice in New York City serving a predominately immigrant population, evaluated the feasibility and physician and patient acceptability of a telephone visit initiative in 2015. MEASURES/METHODS:Patient and physician surveys, and physician focus groups. RESULTS:Though only 85 of 270 scheduled telephone visits (31%) were completed, 84% of patients reported being highly satisfied with their telephone visit. Half of physicians opted to participate in the pilot. Among participating physicians, all reported they were able to communicate adequately and safely care for patients over the telephone. CONCLUSIONS:Participating patients and physicians in a linguistically and culturally diverse urban safety-net primary care clinic were highly satisfied with the use of telephone visits, though completion of the visits was low. Lessons learned from this implementation can be used to expand access and provision of high-quality primary care to other vulnerable populations.

Despite a rapid growth of Type 2 diabetes mellitus in Chinese Americans, the management of diabetes in this population is yet understudied. This pilot study attempts a first step in seeking solutions to decrease demand for health services in this population by improving patients' self-care. Focus groups were conducted in well-controlled (HbA1c < 7) and poorly-controlled (HbA1c > 8) Chinese Americans with Type 2 DM who were asked about their knowledge and self-care skills of diabetes as well as experience of living with the disease. Well-controlled had more insights in their illness and were more inquisitive, while poorly-controlled were more fixated on symptoms and side effects of treatments. Common themes for both groups included interest in diet and Traditional Chinese Medicine. The findings provide valuable information to design a survey instrument to more definitively assess self-care skills differentiating levels of control, suggest that changing attitudes and behaviors need to be a stronger focus in care and identify needs to provide more culturally appropriate materials to care for this population.

We studied 63 randomly selected third-year students who split their 10-week medicine clerkship between ambulatory and inpatient components. Compared with their inpatient experience, during the ambulatory rotation, the 63 students felt more like doctors, more responsible for patients, and more able to know and help their patients. Students reported that ambulatory attending staff appeared happier and less stressed, and did not embarrass them as frequently. Compared with their 619 "inpatient" classmates, these 63 "ambulatory" students scored as well on the medicine examination, and were as likely to receive honors (44% vs 41%), and to choose internal medicine residencies (35% vs 34%). In conclusion, students experienced better relationships with their patients and teachers during the ambulatory rotation, which was academically comparable to the inpatient experience.