Search Results
Medical and Economic Impact of a Free Student-Run Podiatric Medical Clinic
A Preliminary Analysis
Background
Data from the free student-run podiatric medical clinic at ClĂnica Tepati at the University of California, Davis, were used to analyze medical and economic impacts on health-care delivery and to extrapolate the economic impact to the national level. ClĂnica Tepati also provides an excellent teaching environment and services to the uninsured Hispanic population in the Greater Sacramento area.
Methods
In this analysis, we retrospectively reviewed patient medical records for podiatric medical encounters during 15 clinic days between November 2010 and February 2012. The economic impact was evaluated by matching diagnoses and treatments with Medicare reimbursement rates using International Classification of Diseases codes, Current Procedural Terminology codes, and the prevailing Medicare reimbursement rates.
Results
Sixty-three podiatric medical patients made 101 visits during this period. Twenty patients returned to the clinic for at least one follow-up visit or for a new medical concern. Thirty-nine different diagnoses were identified, and treatments were provided for all 101 patient encounters/visits. Treatments were limited to those within the clinic's resources. This analysis estimates that $17,332.13 worth of services were rendered during this period.
Conclusions
These results suggest that the free student-run podiatric medical clinic at ClĂnica Tepati had a significant medical and economic impact on the delivery of health care at the regional level, and when extrapolated, nationally as well. These student-run clinics also play an important role in medical education settings.
Background
Foot self-care is key in preventing morbidity in high-risk diabetic patients. Motivational interviewing (MI) is an approach to encourage behavior change by patients that can be used in medical settings. The goal was to explore how podiatric physicians promote self-care in such patients and whether they use MI techniques.
Methods
We conducted a 19-question online survey of US-based practicing podiatric physicians. Most answers were on a 5-point scale. The MI index was the sum of answers to five relevant questions.
Results
Of 843 podiatric physicians, 86% considered foot self-care to be very important for high-risk diabetic patients, and 90% felt that it was their role to discuss foot self-care with them; 49% felt that they had training and were successful in promoting behavior change, but most were definitely (38%) or possibly (46%) interested in learning more. Only 24% of respondents scored at least 15 of 20 on the MI index. Higher MI scores were associated with more face time and more time discussing foot self-care but were not related to podiatric physicians' age, sex, geographic location, percentage of time in surgery, or years in practice. Reported barriers to counseling were lack of reimbursed time and poor patient engagement.
Conclusions
Most podiatric physicians view self-care behavior among high-risk diabetic patients and their role in promoting it as very important; most feel already proficient, but only a few demonstrate MI skills; most are willing to learn more. Success in behavioral counseling, such as MI, is likely to require more time and may be encouraged by a move from fee-for-service to outcome-based reimbursement.
Background: Complementary and alternative medicine (CAM) is one of the fastest growing areas of health care. This has necessitated an increased awareness and understanding of CAM by conventional health professionals.
Methods: A questionnaire seeking information about use of and attitudes toward CAM was mailed to 1,365 Australian podiatric physicians.
Results: Ninety-one percent of Australian podiatric physicians surveyed have used at least one CAM therapy in the past 12 months, and 93% have treated patients with CAM or have recommended its use to patients. Overall, the respondents rated their knowledge of various CAM therapies as “average,” and responses on the CAM Health Belief Questionnaire indicated that respondents tended not to endorse CAM health beliefs, with statements about CAM therapies being seen as “a threat to public safety” and effects being “usually due to the placebo effect” producing the strongest responses.
Conclusions: Complementary and alternative medicine therapies are already being used in podiatric medical practice, and there are significant opportunities for further research into CAM education and clinical research relevant to podiatric medicine. (J Am Podiatr Med Assoc 99(2): 121–128, 2009)
Background
To identify the strengths and weaknesses in a given research area, it is necessary to analyze the published literature. International studies on podiatry research productivity are scarce. This study aimed to analyze scientific productivity in the area of podiatric medicine from 1965 to 2017.
Methods
This was a retrospective, observational, bibliometric study. The MEDLINE database was used to identify research published between 1965 and 2017. Literature searches were performed in 2010 and 2017 through RefWorks, and research production per year, author, document type, country, institution, journal, and language were calculated. Podiatry's contribution to global scientific production was measured by calculating the ratio of podiatry publications to total production, and Price's law was applied to analyze the temporal evolution. Author productivity index, coauthorship, geographic distribution, and the distribution by institution type and journal (Bradford's law) were analyzed.
Results
The MEDLINE search yielded 1,256 publications, representing 4.75 articles per 100,000 publications in global scientific research. The growth rate followed Price's law after linear adjustment. The 2,229 identified authors presented a transience index of 85.73%; 0.38% were highly productive authors. The coauthorship index increased from 1.40 in 1965 to 5.80 in 2017. The most common document type was the journal article, whereas 2.1% were clinical trials. Only one document reported a controlled clinical trial. The United States led scientific production, with 77.15% of the documents; 60.5% of the publications were concentrated in four journals.
Conclusions
Podiatry is still an emerging research field, and literature is concentrated in a small number of journals, categorized into different subjects.
This research project investigated the orthotic prescription habits of podiatric physicians in Australia and New Zealand. A 23-item questionnaire was distributed to all members of the Australian Podiatry Association and the New Zealand Society of Podiatrists. When asked what type of foot orthoses they prescribe most often, 72% of respondents reported functional foot orthoses; the next most common response was prefabricated orthoses (12%). A typical prescription for functional foot orthoses consisted of a modified Root style orthosis, balanced to the neutral calcaneal stance position, with the shell made from polypropylene and an ethyl vinyl acetate (EVA) rearfoot post applied. The majority of podiatric physicians surveyed used a commercial orthotic laboratory to fabricate their orthoses. However, New Zealand respondents were three times more likely to prescribe prefabricated foot orthoses, and males were twice as likely as females to manufacture the orthoses themselves rather than use a commercial orthotic laboratory. (J Am Podiatr Med Assoc 91(4): 174-183, 2001)
The Use of Rubrics in the Clinical Evaluation of Podiatric Medical Students
Objectification of the Subjective Experience
Background: We assessed the differences in podiatric medical students' clinical professionalism objective scores (CPOSs) by comparing a previous nonrubric evaluation tool with a more recently implemented objective-centered rubric evaluation tool. This type of study has never been performed or reported on in the podiatric medical education literature.
Methods: We conducted a retrospective analysis of 89 third-year podiatric medical students between academic years 2010-2011 and 2011-2012. A Pearson correlation coefficient analysis was performed to compare CPOSs from the students' first (CPOS1) and second (CPOS2) rotations. A correlation analysis was performed comparing students' grade point averages (GPAs) with each of the individual CPOSs to verify the validity of the rubric evaluation tool.
Results: The Pearson correlation coefficients for the relationship between 2012 CPOS1 and CPOS2 and GPA were r = 0.233 (P ≤ .093) and r = 0.290 (P < .035) and for the relationship between 2013 CPOS1 and CPOS2 and GPA were r = 0.525 (P = .001) and r = 0.730 (P < .001).
Conclusions: These findings suggest that the use of a rubric in the evaluation of podiatric medical students' CPOSs is correlated with their GPAs, and CPOS2 demonstrated a higher correlation than CPOS1. We believe that implementation of the rubric evaluation tool has increased the accuracy of the evaluation of podiatric medical students with respect to CPOSs.
Background:
The Kent State University College of Podiatric Medicine is negotiating with the College of Business Administration at Kent State University to establish a dual Doctor of Podiatric Medicine (DPM)/Master of Business Administration (MBA) degree. Of the nine colleges of podiatric medicine in the nation, there are two schools that have a joint DPM/MBA program listed in their catalogue, but no joint program was operational at the time this survey was conducted. A telephone survey of the other eight podiatric medical colleges was conducted to obtain that information. This survey was used to assess further data for the exploration of a dual DPM/MBA program at Kent State University College of Podiatric Medicine.
Methods:
A survey was sent out to 38 individuals who possessed both a DPM and an MBA degree. They responded to questions about why they obtained the business degree, how they are using their business degree, what courses in the MBA program are most relevant, and whether they would recommend that DPM students pursue a dual degree.
Results:
The majority of respondents indicated that they obtained an MBA degrees to gain a better understanding of the marketplace, to increase their income, and to better manage a podiatric medical practice. The respondents were generally very happy to have obtained their MBA degree and would encourage a dual-degree option. They admitted that a minor or series of courses with a business focus may be helpful to a DPM student who did not opt for an MBA degree.
Conclusions:
The positive survey results from respondents encourage continued research into a dual-degree DPM/MBA program. During research for a DPM/MBA degree, we feel a DPM with an MBA degree will allow our students to be better prepared for leadership roles within their community and administrative positions and to have a deeper understanding of the business of health care.
