Does vocational training in family medicine have an impact on general practice patterns?

Abstract

Context: The focus of health care system around the world is shifting toward primary care and better primary care systems have better health outcomes. Vocational training (VT) in family medicine has advanced over the last decade, but little is known about the practice patterns of such vocationally trained doctors. Objective: To determine whether VT of family doctors have any effect on their practice patterns. Design: Territory-wide morbidity and management survey in primary care. Setting: Community-based primary care practices in Hong Kong. Participants: Members of the Hong Kong College of Family Physicians were invited and 101 out of 1500 family doctors participated. Instrument: Standardized data collection forms for prospective recording of all health problems and management activities occurred within one designated week of every month. Main Outcome Measures: Health problems coded by ICPC and management activities in terms of prescribing, investigation, referrals and preventive care. Results: Between July 2007 and March 2008, 101 family doctors of whom 59 received VT, recorded 44,289 health problems. Compared with non-VT doctors using multivariate logistic regression, VT had an independent effect on lower prescribing rate of antibiotics (OR 0.406), benzodiazepines (OR 0.695) and the non-benzodiazepine hypnotics (OR 0.438), higher investigation rate (OR 2.33), higher referral rate (OR 1.562), higher rate of preventive activities in terms of lifestyle habit (OR 1.195) and vaccination advice (OR 2.375), but lower rate on cancer screening advice (OR 0.796). Among the top ten most commonly occurred health problems, VT doctors encountered more chronic diseases (26%) than non-VT doctors (11.7%). Conclusion: The survey suggested that family doctors with vocational training were more vigilant in prescribing, focused more on health promotion and took care of more patients with chronic diseases. Vocational training in family medicine should be supported and the family doctor concept promoted to help strengthen the primary care system.