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Improving Communication Between Doctors and Breast Cancer Patients
Moira Stewart, PhD , and colleagues
Background This study tests a new continuing medical education (CME) program aimed at improving communication between doctors and breast cancer patients. The program, based on needs described by patients, is 6 hours long and includes a discussion of patients' perspectives and a videotape review with individual feedback. It is compared with a traditional, 2-hour CME program that shows and discusses a videotaped patient-doctor visit.
What This Study Found There were no significant differences between the communication scores of 51 doctors (family physicians, surgeons, and oncologists) exposed to a traditional 2-hour CME program, compared with a new 6-hour intensive version. Among family physicians, however, those exposed to the longer program had higher communication scores than those exposed to the traditional 2-hour program. Patients of surgeons and oncologists who participated in the new 6-hour program were more satisfied and felt better than patients whose doctors participated in the 2-hour program.
Implications
Barriers to Self-Management and Quality of Life Outcomes in Seniors With Multimorbidities
Elizabeth A. Bayliss, MD, MSPH , and colleagues
Background In this study, seniors with chronic diseases were surveyed about barriers that prevent them from caring for themselves and that contribute to a sense of worse health.
What This Study Found Three-hundred fifty-two seniors completed the survey questionnaire and had an average of 8.7 chronic diseases. The following barriers to self-care, which were identified by the participants, are related to worse health: more chronic health conditions, lower level of physical functioning, less knowledge about medical conditions, less social activity, ongoing depression, financial difficulties, and male sex. These barriers could be addressed by identifying and treating depression, educating patients about their medical conditions; increased physical therapy and other support, ensuring that symptoms and treatments for separate conditions do not interfere with each other, and coordinating patient care while taking into account patients’ financial resources.
Implications
Psychosocial Factors and Progression From Prehypertension to Hypertension or Coronary Heart Disease
Marty S. Player, MD , and colleagues
Background There is increasing evidence that people with prehypertension (systolic blood pressure of 120 to 139 mm Hg and diastolic blood pressure of 80 to 89 mm Hg) are at greater risk for developing high blood pressure or cardiovascular disease. This study investigates whether psychosocial factors are associated with the progression from prehypertension to hypertension and prehypertension to heart disease.
What This Study Found Middle-aged men with prehypertension who have high levels of trait anger (a tendency to experience anger across a range of situations) have a higher risk of developing hypertension and coronary heart disease. Men with high trait anger scores have 1.7 times greater odds for developing hypertension than those with low or moderate scores, and high trait anger scores are associated with a 90 percent increase in the risk of progression to coronary heart disease in prehypertensive men. Long-term stress is associated with greater risk of coronary heart disease in both women and men.
Implications
Let's Not Talk About It: Suicide Inquiry in Primary Care
Mitchell D. Feldman, MD, MPhil, and colleagues
Background The primary care setting presents an excellent opportunity for detecting and addressing suicide risk. This study examines whether characteristics of doctors, patient symptoms, or patient behavior influence whether doctors explore the topic of suicide with their patients.
What This Study Found Primary care doctors do not consistently ask patients about suicide. Among 152 doctors who saw patient actors portraying depression symptoms, suicide was explored in 36 percent of visits. Doctors were more likely to explore the possibility of suicide when the patient actors portrayed major depression (compared with adjustment disorder) and when they asked for antidepressant medication, especially when the medication request was general (as opposed to requesting a particular brand). Exploration of suicide was also more common in academic primary care offices and among doctors who had personal experience with depression (whether in themselves, family members, or close friends).
Implications
Patient Satisfaction With Care for Urgent Health Problems: A Survey of Family Practice Patients
Michelle Howard, MSc , and colleagues
Background The goal of this study is to better understand patients’ satisfaction with care for urgent health problems provided in different settings. The study is based on a survey mailed to family practice patients.
What This Study Found Patients’ satisfaction with after-hours care for an urgent problem is higher if provided by their own family doctor or their doctor’s after-hours clinic, compared with a walk-in clinic, the emergency department, and telephone health advisory services. According to a survey of 1,227 patients from 36 practices in Thunder Bay, Ontario, who were asked to rate their satisfaction on a 7-point scale, patients reported highest satisfaction when care was received from their own family doctor (6.1), followed by an after-hours clinic affiliated with their doctor (5.6). Those who received care at a walk-in clinic or who used more than one service reported the lowest satisfaction rating (4.7).
Implications
Assessing Risk for Development of Diabetes in Young Adults
Arch G. Mainous III, PhD , and colleagues
Background As diabetes is increasingly diagnosed in young adults and adolescents, it is important to identify those who are at high risk for the disease. The purpose of this study is to evaluate whether a risk score for the development of diabetes in middle-aged people is useful in young adults.
What This Study Found A risk score for the development of diabetes created from a middle-aged population is less successful in predicting the development of diabetes in a younger population.
Implications
Randomized Comparison of 3 Methods to Screen for Domestic Violence in Family Practice
Ping-Hsin Chen, PhD , and colleagues
Background This study compares 3 ways of asking women about domestic violence during visits to their family doctor’s office: (1) a self-administered questionnaire, which the patient answers by herself; (2) questions asked by a medical staff member; and (3) questions asked by the doctor.
What This Study Found All 3 methods are equally effective in terms of rates at which women disclose information about domestic violence, comfort with the method of questioning, and time spent. In this study, 1 in 7 women in intimate relationships had experienced domestic violence.
Implications
Differences Among International Pharyngitis Guidelines: Not Just Academic
Jan Matthys, MD , and colleagues
Background This study compares recommendations and reported evidence in guidelines for managing sore throat in adults. Four North American and 6 European guidelines were included in the study.
What This Study Found The recommendations differ from one another in terms of testing for and treating sore throat. In France, North America, or Finland, a diagnostic test will be performed and the treatment depends on its result. In England, Scotland, Belgium, or the Netherlands, doctors will not use a test, and the decision to prescribe penicillin depends mainly on the severity of the patient’s illness. The evidence used to support these guidelines is different in North America and Europe. North American guidelines cite more North American references than do European guidelines.
Implications
Ina U. Park, MD , and colleagues
Background Racial and ethnic minority communities have high rates of hypertension (high blood pressure). Racial or ethnic differences in response to drugs intended to lower blood pressure may contribute to differences in cardiovascular disease or high blood pressure between racial or ethnic minorities and whites. This study examines previous research to (1) identify racial differences in the effectiveness of drugs to lower high blood pressure and (2) determine the number and proportion of Asians, blacks, Hispanics, and Native Americans participating in previous research studies.
What This Study Found Of the 28 studies examined, 8 reported results by racial subgroup, and 5 made comparisons between ethnic groups. Four of these 5 studies found similar effectiveness of treatment in whites and minorities.
Implications
John Zweifler, MD, MPH
Background This essay encourages primary care offices to add staff dedicated to working with chronically ill patients. According to the author, chronic disease management workers can improve the quality of care for patients with chronic diseases and increase the satisfaction of both doctors and patients by offering self-management support, maintaining disease registries, and monitoring patients’ compliance with their treatment programs. They also can provide the missing link by connecting patients, families, and doctors with disease management services available through health plans or in the community. California’s well-established Comprehensive Perinatal Services Program offers a payment model for reimbursing primary care offices for defined chronic disease management services.
The Teamlet Model of Primary Care
Thomas Bodenheimer, MD , and colleagues
Background The 15-minute doctor visit must be eliminated as the standard in primary care, according to this essay. The authors propose that it be replaced by a teamlet (little team) model, which has 2 main features: (1) the patient visit involves 2 caregivers--a clinician (doctor, nurse-practitioner, or physician’s assistant) and a health coach--rather than only the clinician; and (2) the 15-minute visit is expanded to include a previsit by the coach, a visit by the clinician together with the coach, a postvisit by the coach, and between-visit care by the coach. According to the authors, the teamlet model is a blueprint for addressing some of the serious problems facing primary care: inadequate visit time to provide all recommended acute, chronic, and preventive care; doctor and patient dissatisfaction with the rushed atmosphere of many visits; and inadequate quality of care that may be provided by stressed primary care practices. Pilot projects are underway to test whether this model of care is practical.
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