NAPCRG ANNUAL MEETING DISTINGUISHED PAPERS

Jill Haught

doi:10.1370/afm.2011

NAPCRG’s Annual Meeting is a forum for primary care researchers from across the globe to gather and present their research, collaborate for new research, and foster growth for up-and-coming researchers. The 2016 Annual Meeting was held in Colorado Springs, Colorado, November 12–16, 2016.

Three papers were selected and given the special designation of “distinguished paper” for excellence in research based on the following factors: overall excellence, quality of research methods, quality of the writing, relevance to primary care clinical research, and overall impact of the research on primary care and/or clinical practice.

Below are brief summaries of this year’s distinguished papers; complete abstracts are available on the NAPCRG website.

The Correlation Between Family Physicians’ Work and Reportable Current Procedural Terminology Codes: A Residency Research Network of Texas Study

Richard A. Young, MD; Sandra K. Burge, PhD; Kaparaboyna Ashok Kumar, MD, FRCS, FAAFP

The US Center for Medicare and Medicaid Services (CMS) states that codes submitted by physicians for payment must be medically necessary, which is guided by the American Medical Association’s Current Procedural Terminology (CPT) coding system and CMS guidelines. The objective of this study was to characterize the issues addressed and treatments offered by family physicians and to count the number of visits in which the family physicians addressed issues that are reportable by available CPT codes. The study results indicated that family physicians performed cognitive work in a majority of their patient encounters that was not reportable under the CPT system. This was most often explained by numerous issues addressed by the physician.

“Pretty Radical From What I’ve Known”: The Dissonance and Distance Underlying Patients’ Cognitive Engagement With Educational Health Information

Gayle Halas; Beverley Temple

Patient education often aims to activate behaviors for health management. Assumptions of a fundamental desire for information and learning as prerequisite for self-management are countered by the fact that some patients refuse or selectively attend to health information. The complex and emotional context surrounding illness and disease may reduce the patient’s openness or willingness to engage with information. Perception of non-compliant, resistant, and even difficult patients is a common occurrence with little understanding of the underlying factors. The objective of this study was to explore the cognitive and emotional factors underlying the patient’s readiness to learn or cognitively engage with information regarding diabetes management. Throughout the study 3 main themes emerged: underlying incongruence in knowledge, thoughts, and beliefs; relational talking; and negotiating control. Themes converged on the essence of ‘distance’ between the patient’s lifeworld and the disease and its management. When considered in relation to cognitive dissonance and psychological distance theories psychological adjustment and relational challenges were revealed. Adjustment involved reconciling difference and dissonance at various points during diabetes management. It also threatened adjustment and in some cases generated defensive reactions. Differentiating the message according to concrete and abstract information may be more conducive to a staged learning process and offer a more tangible understanding of ‘finding common ground’ within patient-centered communication. In conclusion, adjustment and relational challenges have a bearing on the early stages of the learning process. These factors underlying readiness to learn have been reported by patients with diabetes and require further consideration for tailoring communication and education that supports person-centered care and self-management.

Predicting Adverse Outcome From LRTI: The 3C Cohort S of Lower Respiratory Tract Infection in Primary Care

Michael Moore, FRCGP; Beth Stuart; Sue Smith; Kyle Knox; Ann Van den Bruel, MD, PhD; Matthew J. Thompson, MD, MPH, DPhil; Mark Lown; Paul S. Little, MD, MBBS, MCRP, MRCP; David Mant

Lower respiratory tract infection (LRTI) is one of the most common acute infections presenting in primary care. Antibiotics are frequently prescribed and 1 of the drivers of continued prescribing is concern over adverse outcome and hospital admission. The goal of this study was to assess predictors of worse outcome in LRTI presenting in routine primary care. Preliminary analysis suggests there are 10 variables that predict hospitalization or death with a RR of 1.5 or higher: age 60+, comorbidity, shortness of breath, chest pain, crackles, higher severity score, high pulse, high temperature, low oxygen saturation and low blood pressure. These 10 items can be combined into a total score which ranges from 0 (none of these) to 10 (all of these). The AUC of this score is 0.73 (Bootstrapped 95% CI, 0.70–0.76). The concluded clinical implications were that hospitalization and death is uncommon following LRTI presentation in primary care. The prediction model shares many features of that predicting pneumonic infiltrates.