MEDICAL-PRACTICE WITH NURSING-HOME RESIDENTS - RESULTS FROM THE NATIONAL PHYSICIAN PROFESSIONAL ACTIVITIES CENSUS

OBJECTIVE: The study describes the prevalence of medical nursing home practice. Further, it examines the extent to which physician character istics and local county health care resources predict nursing home inv olvement. This information is relevant to evaluating and devising stra tegies that address the future provision of medical care in institutio nalized long-term care. DESIGN: A cross-sectional survey. SETTING: A n ational sample of all licensed practicing physicians was obtained from a special Professional Activities (PPA) survey conducted by the Ameri can Medical Association (AMA) in 1991. PARTICIPANTS: Respondents were 21,578 physicians involved in direct patient care. MEASURES: The typic al number of hours spent weekly caring for nursing home patients was o btained from the PPA survey, and physician demographics were obtained from the AMA Masterfile. County health care resources were obtained fr om the National Institutes of Health Area Resources File. RESULTS: Mos t (77%) physicians reported spending no measurable time caring for nur sing home patients. In all disciplines, a majority of physicians with a nursing home practice spent less than 2 hours per week with patients . Logistic regressions indicted that family practitioners and internis ts were most likely to have a nursing home practice, but general pract itioners were most likely to spend more time in practice. Only 15% of specialists reported having a nursing home practice. Prevalence of pra ctice was greatest among solo practitioners and physicians in partners hips and least among academic and hospital-based physicians and physic ians in group practice or employed by the government. Most county of p ractice resources were not associated or were modestly associated with nursing home practice, but having a nursing home practice became much more likely as the number of nursing home residents increased and hos pital beds decreased. A pattern was found for nursing home practice to be slightly less likely as the county's per capita income and the pro portion of proprietary nursing facilities increased. CONCLUSIONS: With increasing numbers of older and frailer residents, nursing homes will continue to be integral components of the future healthcare system. H owever, physicians currently spend minimal time caring for nursing hom e patients, with physician characteristics best predicting involvement . Questions remain about the future of nursing home medical practice a nd how to best recruit, staff, and train future cadres of physicians t o provide sufficient quality care for nursing home patients in an evol ving health care system.