The Issue in Brief

Effect of Psyllium Fiber Supplementation on C-Reactive Protein: The Trial to Reduce Inflammatory Markers (TRIM)

Dana E. King, MD , and colleagues

Background High levels of C-reactive protein (a protein in the blood that indicates inflammation) have been associated with increased risk of cardiovascular disease, whereas diets high in fiber have been shown to lower the risk of cardiovascular disease. This study examines whether supplementing the diet with psyllium, a form of fiber, affects levels of C-reactive protein and other indicators of inflammation in overweight or obese adults.

What This Study Found In overweight or obese adults, taking daily psyllium fiber supplements does not appear to significantly lower the levels of inflammation that play a role in cardiovascular risk. These findings contrast with previous research suggesting that dietary fiber is associated with levels of C-reactive protein.

Implications

• A diet naturally high in fiber is important; however, taking a psyllium supplement may not be an effective way to reduce inflammation and risk of cardiovascular disease.
• The authors call for further research with other types of fiber or with combinations of nutrients.

What Patients Want From Primary Care Consultations: A Discrete Choice Experiment to Identify Patients' Priorities

Sudeh Cheraghi-Sohi, BSc , and colleagues

Background What do patients consider important when they visit the doctor? This study assesses patient priorities in the doctor visit.

What This Study Found Although communication is important to patients, they place higher priority on technical care and continuity of care (an ongoing relationship with a clinician). Patients value the thoroughness of the primary care visit most highly, followed by seeing a doctor who knows them well, seeing a doctor with a warm and friendly manner, less waiting time for an appointment, and flexibility in selecting appointment times.

Implications

• In order to make decisions about their medical care, patients need information about both technical and relationship aspects of care. Little is known, however, about how patients assess technical care.
• The results of this study can inform discussions of health care policy and payment.

Practice Features Associated With Patient-Reported Accessibility, Continuity, and Coordination of Primary Health Care

Jeannie L. Haggerty, PhD , and colleagues

Background In this study in Quebec, Canada, researchers measure the organizational and professional characteristics of primary care practice that are associated with accessible care, continuity (an ongoing patient-doctor relationship), and coordination of care between different clinicians.

What This Study Found The way the medical practice is organized influences both continuity and accessible care. This includes offering care in the evenings, access to telephone advice, and establishing operational agreements with other health care establishments. Patients in this study have little confidence that they can get needed care from the clinician of their choice in a time frame that is appropriate to the urgency of the problem, but they have positive assessments of continuity and coordination between their family physician and specialists.

Implications

• The study suggests ways to organize and deliver primary health care for better accessibility and continuity, especially in the Canadian health care system.
• Telephone access for patients is an important feature.

Bypass of Local Primary Care in Rural Counties: Effect of Patient and Community Characteristics

Jiexin (Jason) Liu, PhD, MBA, MS , and colleagues

Background It is important for policy makers and medical professionals to know whether patients bypass their local hospitals for other facilities, yet few studies of this issue have focused on rural areas. This study looks at the frequency with which rural patients bypass local hospitals and clinicians, and solicits suggestions for what hospitals can do to keep local patients.

What This Study Found Approximately one-third of patients living in rural areas bypass local health care professionals and facilities and get medical care elsewhere. There is a wide variation in bypass rates in the 25 rural areas sampled, ranging from 9.4% to 66%. Compared with those who use services in their local community, bypassers are younger, have higher incomes, are more likely to have had inpatient hospital care in the past year, and are less satisfied with their local hospital. When asked why people might bypass local care, respondents cite lack of services or specialty care (50%), referral out of the community by their doctor (19%), poor quality of care (15%), and poor reputation of local facilities (14%). Bypassers suggest that hospitals could keep local patients by adding more specialty services (24%), adding more doctors and services (17%), getting better doctors (17%), and providing better customer service (11%).

Implications

• The wide variation in bypass rates suggests that local communities and facilities need to develop tailored strategies that fit their own circumstances and needs.
• Policies that promote networks of clinicians could benefit rural patients.
• Lower access to primary care physicians in health professional shortage areas (HPSAs) may contribute to bypass of local health care facilities and clinicians.

Acculturation and Healthy Lifestyle Among Latinos With Diabetes

Arch G. Mainous III, PhD , and colleagues

Background Latinos have higher rates of diabetes than non-Latino whites. Furthermore, diabetes is more common among Latinos who are less acculturated to the majority US culture. This study explores the relationship between acculturation and a healthy lifestyle in Latinos with diabetes in the United States.

What This Study Found Less acculturated Latinos with diabetes tend to have a healthier (high-fiber, low-fat) diet than their more acculturated counterparts. Acculturation appears to have a positive influence on exercise habits, with more-acculturated individuals more likely to report leisure time exercise.

Implications

• For Latinos, adopting an "American" diet may not be a desirable change in behavior.
• Understanding the process of acculturation is important when encouraging patients to maintain healthy traditional behaviors while adopting beneficial aspects of the mainstream culture.

Balint Groups as a Means to Increase Job Satisfaction and Prevent Burnout Among General Practitioners

Dorte Kjeldmand, GP, PhD, and Inger Holström, RN, PhD

Background Doctors can reduce or avoid burnout by joining groups (called Balint groups) in which they reflect on their relationships with patients and learn strategies for handling their work life. The aim of this study is to explore general practitioners' experience of Balint group participation and its influence on their work life.

What This Study Found Participants in this study describe Balint group participation as beneficial and essential to their working life as general practitioners. It strengthens their competence in patient visits, helps them remain in their jobs, and helps them find joy and enthusiasm in their patient relationships.

Implications

• Balint groups can help general practitioners handle a demanding work life and prevent burnout.
• Balint groups might not suit all general practitioners; additional ways to reduce stress and increase job satisfaction should be offered.

Beyond Fighting Fires and Chasing Tails? Chronic Illness Care Plans in Ontario, Canada

Grant Russell, MBBS, FRACGP, MFM, PhD , and colleagues

Background This study evaluates the impact of a holistic, patient-centered, and pragmatic approach to improve the management of chronic disease in Canadian family practices. In particular, it aims to understand the experience of family physicians and patients in an initiative in which they jointly develop patient care plans.

What This Study Found Participating doctors generally viewed the patient-centered, planned care initiative as time intensive and unrealistic for widespread implementation. Participants varied in their enthusiasm for the program.

Implications

• Implementing comprehensive, patient-centered chronic illness care management involves more than organizational change. Doctors’ attitudes and professional culture should be considered in attempts to improve the delivery of chronic illness care in primary care practices.
• Additional methods are needed to support both doctors and patients in transitioning to a collaborative and proactive approach to managing chronic illness.

Data Collection Outcomes Comparing Paper Forms With PDA Forms in an Office-Based Patient Survey

James M. Galliher, PhD , and colleagues

Background There are many challenges to collecting and managing research data in medical offices. A survey on immunizations provided an opportunity to look at the use of handheld computers for administering and transmitting patient survey data and compare the completeness of data gathered using paper forms vs handheld computers.

What This Study Found The overall survey return rate was better for paper forms than for electronic forms due to technical difficulties with electronic data collection and stolen or lost personal digital assistants (PDAs). There were more errors of omission on the paper forms.

Implications

• Although handheld computers produce more complete data than paper forms for survey data, these PDAs are not superior because of large amounts of missing data resulting from technical difficulties or their theft or loss.
• Other hardware solutions, such as tablet computers or cell phones linked via a wireless network directly to a Web site, may be better electronic solutions for the future.

Narrative Reports to Monitor and Evaluate the Integration of Pharmacists Into Family Practice Settings

Kevin Pottie, MD, CCFP, MClSc, FCFP , and colleagues

Background This article describes a practical method for qualitative research-the narrative report-and its role in evaluating a project involving the integration of pharmacists into group family practices.

What This Study Found Pharmacists' monthly narrative reports allowed the research team to document early learning from the project and make adjustments as needed. The reports helped the research team stay in tune with challenges that developed, helped build a sense of shared experience among participants, and facilitated the sharing of innovations.

Implications

• Narrative reports can serve as a qualitative tool to track and evaluate the early stages of a project in an evolving primary health care team.

Screening for Phenylketonuria (PKU): US Preventive Services Task Force Reaffirmation Recommendation Statement

US Preventive Services Task Force

Background Based on a targeted literature search for new and substantial evidence, the US Preventive Services Task Force (USPSTF) reaffirms its recommendation for screening for phenylketonuria (PKU) in newborns.

Screening for Congenital Hypothyroidism: US Preventive Services Task Force Reaffirmation Recommendation Statement

US Preventive Services Task Force

Background Based on a targeted literature search for new and substantial evidence, the US Preventive Services Task Force (USPSTF) reaffirms its recommendation for screening for congenital hypothyroidism in newborns.

Changing Horses Midstream: The Promise and Prudence of Practice Redesign

David Loxterkamp, MD, and Louis A. Kazal, Jr, MD

Background Two participants in the pilot project of TransforMED, the American Academy of Family Physicians' practice redesign initiative, reflect on the crisis in primary care and offer insights on practice change. These insights come from their own experience with practice transformation and a retreat for practices in the project's self-directed group. The authors conclude that relationships remain the centerpiece of family medicine.

Success, Regret, and the Struggle for Balance

Joseph A. Carrese, MD, MPH, and Michel A. Ibrahim, MD, PhD

Background Inspired by a conversation with his personal physician, a family physician reflects on the challenges facing doctors today as they struggle to strike the proper balance between career and personal life.

Healing With the Needles

Mary P. Guerrera, MD, FAAFP

Background A child's spontaneous desire to help her mother during an office visit prompts a family physician to reflect on the many dimensions of healing and the unique moments that occur in daily medical practice.