Rural primary care

Article Abstract:

Internal medicine may need to share the burden of primary care in rural areas with family practice and pediatrics. The American College of Physicians has made six recommendations to improve access to care and delivery of primary care in rural areas. Universal health care coverage may make primary care more affordable for residents of rural areas. More primary care physicians may practice in rural areas if specialty and geographic differences in physician income are decreased. Medical education may assist in increasing the number of primary care providers in rural areas by emphasizing the selective admissions and training of students from rural backgrounds. The use of telecommunications to make continuing medical education available may reduce professional isolation of rural primary care physicians. State and federal funds may be needed to keep rural hospitals open, especially those providing tertiary care. Innovative delivery systems which include physicians and nonphysician primary care providers, and use all available medical and nonmedical resources, may be used to increase access to and delivery of primary care.

Standards, Medicine, Rural, Rural medicine

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The effects of organizational structure on primary care outcomes under managed care

Article Abstract:

Standard doses of adenosine commonly given in emergency departments to patients with heart palpitations may be dangerous when the patients have the Wolff-Parkinson-White syndrome. Two patients with the syndrome went to emergency departments and received adenosine for heart palpitations. Both patients experienced dangerously irregular heartbeats following adenosine administration. Regular heartbeat was restored with electrical shock to the heart. The Wolff-Parkinson-White syndrome is a type of rapid heartbeat (tachycardia) that affects the heart ventricles. Electrophysiologic studies of the patients' hearts showed that they had atrial fibrillation, irregular heartbeat involving the atrium of the heart, with rapid ventricular responses. Such a condition may compromise the flow of blood through the body because the heart beats incorrectly. Procainamide administered intravenously or synchronized electrical shock to the heart may be the best treatments for short-term management of patients with wide QRS complex tachycardias, such as are found in patients with the Wolff-Parkinson-White syndrome.

Research, Consumer confidence, Public opinion, Managed care plans (Medical care)

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Cross-Cultural Primary Care: A Patient-Based Approach

Article Abstract:

A curriculum is described to teach medical students and residents how to understand and care for patients from a different ethnic group. Different ethnic groups can have different health beliefs and behaviors. Knowledge of these cultural beliefs and attitudes is critical in today's multicultural society. The curriculum consists of five conceptual units taught in four 2-hour sessions.

Curricula, Intercultural education, Multicultural education, Medical education

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