In This Issue: Policy and Practice
==================================

* Kurt C. Stange

This issue presents a wide variety of topics, from policy to practice, from mental health to multimorbidity, from the early years of life to the final year.

A pair of Point-Counterpoint articles argue the question: is a strategy focused on super-utilizers equal to the task of health care system transformation?1,2

A pair of systematic reviews and an accompanying editorial3 provide a wealth of information on the effectiveness of different pharmacological treatments4 and different psychological treatments5 for patients with depression seen in primary care.

The study featured in this issue’s *Annals* Journal Club examines the diagnostic usefulness of different combinations of lung function measures and finds that the combination of a fixed ratio of FEV1/FVC or lower limit of normal cut-offs, plus a low FEV1, is more strongly associated with clinical outcomes than other measures.6 Another clinical study finds that the combination of laryngeal height measurement and a lung function questionnaire is useful for screening for COPD.7

In a prospective case series, ultrasound imaging appears to be useful in diagnosing acute shoulder pain and potentially for providing tailored treatment for people seen in family practice.8

A health care policy study shows a substantial decline in the percent of uninsured patients seen in community health centers since the Medicaid expansion supported by the Affordable Care Act.9

A careful examination of the resources needed to maintain viable health information technology identifies deficiencies in community health centers and rural practices.10

Across 6 European countries, a large study compares the rate of identification of patients with alcohol dependence by general practitioners versus a structured interview.11 Interestingly, these 2 methods discover about the same number of alcohol dependent people, but there is little overlap between the people identified.

An important study by Gill and colleagues discovers 5 different clinical trajectories of disability for people in the year before hospice.12 The findings have implications for better meeting the palliative care needs of people in the year before death.

A clinical practice guideline summary from the American Academy of Family Physicians offers evidence-based recommendations and guidelines for good clinical practice for labor and planned vaginal birth after a prior Cesarean delivery.13

An essay identifies potential impending shifts in both physician-directed and direct-to-consumer advertising due to new federal “Sunshine” regulations that require disclosure of certain marketing and industry payments to physicians.14

This issue contains a disquieting study that delineates the limited availability of physicians in rural areas who can prescribe buprenorphine for opioid use disorder.15 The study addresses issues of rural health care delivery, opioid addiction, and creating a rational and effective health care workforce, that have been addressed with rigor and perspective over many years by the lead author, Roger Rosenblatt.

We were deeply saddened to learn of Dr Rosen-blatt’s death on December 12, 2014. Roger was a major contributor of relevant new knowledge and insights, and a leader in rural health care, since shortly after the rebirth of family medicine in the United States more than 4 decades ago. He trained several generations of family medicine leaders and investigators. Recently he expanded his broad vision to work on preserving intact ecosystems, open space, and wildlife habitat, gaining a forestry degree, educating children and adults, and preserving a forest in the process. We will miss, but continue to be sustained by, his warmth and wisdom.

We welcome your reflections at [http://www.AnnFamMed.org](http://www.AnnFamMed.org).

*   © 2015 Annals of Family Medicine, Inc.

## References

1.  Emeche U. Is a strategy focused on super-utilizers equal to the task of health care system transformation? Yes. Ann Fam Med. 2015;13(1):6–7.
    
    [FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NjoiMTMvMS82IjtzOjQ6ImF0b20iO3M6MjE6Ii9hbm5hbHNmbS8xMy8xLzIuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

2.  Newton WP, Lefebvre A. Is a strategy focused on super-utilizers equal to the task of health care system transformation? No. Ann Fam Med. 2015;13(1):8–9.
    
    [FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NjoiMTMvMS84IjtzOjQ6ImF0b20iO3M6MjE6Ii9hbm5hbHNmbS8xMy8xLzIuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

3.  deGruy FV. Treatment of depression in primary care. Ann Fam Med. 2015;13(1):3–5.
    
    [FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NjoiMTMvMS8zIjtzOjQ6ImF0b20iO3M6MjE6Ii9hbm5hbHNmbS8xMy8xLzIuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

4.  Linde K, Kriston L, Rücker G, et al. Efficacy and acceptability of pharmacological treatments for depressive disorders in primary care: systematic review and network meta-analysis. Ann Fam Med. 2015;13(1):69–79.
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiMTMvMS82OSI7czo0OiJhdG9tIjtzOjIxOiIvYW5uYWxzZm0vMTMvMS8yLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

5.  Linde K, Sigterman K, Kriston L, et al. Effectiveness of psychological treatments for depressive disorders in primary care: systematic review and meta-analysis. Ann Fam Med. 2015;13(1):56–68.
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiMTMvMS81NiI7czo0OiJhdG9tIjtzOjIxOiIvYW5uYWxzZm0vMTMvMS8yLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

6.  van Dijk W, Tan W, Li P, et al. Clinical relevance of fixed ratio vs lower limit of normal of FEV1/FVC in COPD: patient-reported outcomes from the CanCOLD cohort. Ann Fam Med. 2015;13(1):41–48.
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiMTMvMS80MSI7czo0OiJhdG9tIjtzOjIxOiIvYW5uYWxzZm0vMTMvMS8yLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

7.  Casado V, Navarro SM, Alvarez AE, Villafañe M, Miranda A, Spaans N. Laryngeal measurements and diagnostic tools for diagnosis of chronic obstructive pulmonary disease. Ann Fam Med. 2015;13(1):49–52.
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiMTMvMS80OSI7czo0OiJhdG9tIjtzOjIxOiIvYW5uYWxzZm0vMTMvMS8yLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

8.  Ottenheijm RPG, Cals JWL, Weijers R, Vanderdood K, de Bie R, Dinant G-J. Ultrasound imaging for tailored treatment of patients with acute shoulder pain. Ann Fam Med. 2015;13(1):53–55.
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiMTMvMS81MyI7czo0OiJhdG9tIjtzOjIxOiIvYW5uYWxzZm0vMTMvMS8yLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

9.  Angier H, Hoopes M, Gold R, et al. An early look at rates of uninsured safety net clinic visits after the Affordable Care Act. Ann Fam Med. 2015;13(1):10–16.
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiMTMvMS8xMCI7czo0OiJhdG9tIjtzOjIxOiIvYW5uYWxzZm0vMTMvMS8yLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

10. Green LA, Potworowski G, Day A, et al. Sustaining “meaningful use” of health information technology in low-resource practices. Ann Fam Med. 2015;13(1):17–22.
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiMTMvMS8xNyI7czo0OiJhdG9tIjtzOjIxOiIvYW5uYWxzZm0vMTMvMS8yLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

11. Rehm J, Allamani A, Della Vedova R, et al. General practitioners recognizing alcohol dependence: a large cross-sectional study in 6 European countries. Ann Fam Med. 2015;13(1):28–32.
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiMTMvMS8yOCI7czo0OiJhdG9tIjtzOjIxOiIvYW5uYWxzZm0vMTMvMS8yLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

12. Stabenau HF, Morrison L, Gahbauer E, Leo-Summers L, Allore H, Gill TM. Functional trajectories in the year before hospice. Ann Fam Med. 2015;13(1):33–40.
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiMTMvMS8zMyI7czo0OiJhdG9tIjtzOjIxOiIvYW5uYWxzZm0vMTMvMS8yLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

13. King VJ, Fontaine PL, Atwood LA, et al. Clinical practice guideline executive summary: labor after cesarean/planned vaginal birth after cesarean. Ann Fam Med. 2015;13(1):80–81.
    
    [FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiMTMvMS84MCI7czo0OiJhdG9tIjtzOjIxOiIvYW5uYWxzZm0vMTMvMS8yLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

14. Mackey TK, Liang BA. It’s time to shine the light on direct-to-consumer advertising. Ann Fam Med. 2015;13(1):82–85.
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiMTMvMS84MiI7czo0OiJhdG9tIjtzOjIxOiIvYW5uYWxzZm0vMTMvMS8yLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

15. Rosenblatt RA, Andrilla CA, Catlin M, Larson EH. Geographic and specialty distribution of physicians trained to provide office-based treatment of opioid use disorder in the United States. Ann Fam Med. 2015;13(1):23–26.
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiMTMvMS8yMyI7czo0OiJhdG9tIjtzOjIxOiIvYW5uYWxzZm0vMTMvMS8yLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==)