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A study was designed to investigate the status of obstetric practice by Pennsylvania family physicians and its relationship to family practice residency training. A 50% probability sample of all family and general physicians and of all graduates of Pennsylvania family practice residency programs was surveyed by mail. Ten percent of Pennsylvania family physicians and general practitioners reported currently practicing obstetrics, 44% of whom said they planned to stop within 3 years. Telephone survey information from nonresponders suggests that even fewer (5%) of the state's family physicians may actually be practicing obstetrics. Family practice residency training, postresidency obstetric training, and small community size were the best predictors of current obstetric practice. Family physicians in the smallest communities, however, were also those most likely to be planning to stop, and graduates of residency programs were increasingly choosing not to practice obstetrics. Cost of liability insurance and fear of lawsuits were primary reasons cited for stopping obstetrics. Family physicians have been major providers of obstetric care in the nation's rural areas. Now, increasingly firm evidence that fewer family physicians are practicing obstetrics signals increasing shortages in obstetric care for women in rural communities. Changes in the practice climate and obstetric training programs for family physicians seem essential to help reverse these trends.

Recent studies have documented that physician compliance with recommended periodic health screening improves with reminders to physicians. These reminders, however, are often costly to maintain and modify. This study investigates the influence of a microcomputer tickler system on the ordering of mammograms. All women (N = 1262) aged 40 years and older who made visits to an outpatient office during a 6-month period were randomly assigned to one of two groups. For the experimental group, the date of the last mammogram ordered and recorded in the clinical database was printed on the encounter form generated for each patient visit. No information regarding previous mammograms was printed for patients in the control group. Women in the experimental group were more likely to have a mammogram ordered during the study period (19% compared with 12%, P = .001) and, as a result, were more likely to be in compliance with mammography guidelines at the study's completion (27% compared with 21%, P = .011). Microcomputerized data storage and retrieval systems may help increase physicians' attention to preventive health screening recommendations.

This study examined the presence of depressive symptoms in an adult outpatient population. Through review of 100 randomly selected patient charts, it was found that a diagnosis of depression was recorded in 31 percent, with an additional 31 percent having symptoms and diagnoses suggestive of depression noted. Data collection on a sample of 123 patients in a second study phase designed to assess agreement among alternative methods for identifying depression included patient interviews (using the Beck Depression Inventory, the Zung Self-Rating Depression Scale, and a visual analog), physician interviews, and chart abstracts. The proportion of patients considered depressed using each of the measures ranged from 21 percent to 38 percent. The patient-reported measures were more closely correlated with each other than with the physician-reported measures. The finding that depressive symptoms are highly prevalent in this population supports the need for training physicians in recognition, treatment, and documentation of depression. Future research imperatives should include differentiating between depressive symptoms and diagnoses, investigating the use of interviewer-administered measures of depression as screening tools, and investigating the relationships between depression, physiologic disease, and use of health services.

A home visit program was established by a large urban family practice in an academic setting. At the program's inception, 198 patients were randomly assigned to either an experimental group, to be eligible for home visits, or a control group, to continue receiving only office-based care. Two years after this randomization, follow-up data were obtained on 194 of the 198 subjects to assess the program's effectiveness. Fifty-one of the subjects had died. There were an increased number of deaths in the experimental group (30 percent) compared with the control group (21 percent), although this difference was not statistically significant. No statistically significant differences were found between the remaining 143 experimental and control group patients in function or well-being. Patients in the experimental group had a significantly higher number of hospitalizations, although there was no difference in the number of days spent in the hospital. Although methodologic considerations limit the ability to draw policy conclusions from this follow-up study, this home visit program did not have a measurable sustained impact on health outcomes or utilization of health services.