In This Issue: New Model Finances, Systematic Reviews, Patients and Health Care
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* Kurt C. Stange

## THE FINANCIAL VIABILITY OF A NEW MODEL OF PRACTICE

The final report of an initiative to “develop a strategy to transform and renew the specialty of family medicine to meet the needs of people and society in a changing environment”1 is featured as an online supplement to this issue of *Annals.* The future of family medicine task force report on financing the New Model of family medicine2 assesses the fiscal implications of moving to the New Model of practice proposed in the original future of family medicine project reports.1,3 This new report asks whether the New Model is financially viable for the practices that must implement it, for the systems and society that must support it, and for the patients for whom its benefits are intended.

We look forward to a lively online discussion of this report. To submit a comment, open the online report at [http://www.annfammed.org/content/vol2/suppl\_3/S1](http://www.annfammed.org/content/vol2/suppl_3/S1), open the full-text version of the report, and click on TRACK Comments: Submit a response. We hope you will log on often to read and contribute to the discussion.

## SYSTEMATIC REVIEWS

This issue features 2 important systematic reviews. One continues the patient-clinician relationship theme of the last issue of *Annals* by assessing the health outcomes of interventions to alter interaction between patients and clinicians.4 The other systematic review assesses lay understanding of familial risk of common chronic diseases.5 The accompanying editorial6 explicates the importance of the study’s novel ethnographic meta-analysis method, and the importance of the resulting insights for providing health care in the emerging genetic era.

## RESEARCH THAT ENGAGES THE PATIENT PERSPECTIVE

Three studies bring out clinically relevant new insights from the perspective of patients. Two use qualitative methods among traditionally underserved populations. The study by Lacy et al7 should help identify reasons that patients miss appointments. Unmet needs for health information around the time of their first sexual activity is identified in a study of adolescent girls by McKee et al.8 A novel study that collected data from both patients and physicians in several European countries discovers an “emerging agenda” in nearly 1 out of 7 outpatient visits.9 This emerging agenda consists of issues not part of the patient’s or the physician’s expectations before the consultation.

## RESEARCH ABOUT PATIENTS AND HEALTH CARE

Other studies in this issue provide new insights about patients and their health care. One identifies characteristics of patients who call the practice frequently.10 In another study, Noël and colleagues find that depression has a dramatic effect on quality of life among older patients with comorbidities.11 In a study using a nationally representative data set, Mainous and colleagues find that living in a rural area and being African American combine to elevate the risk of poor control of diabetes and hypertension.12

A clinical trial from researchers in the Netherlands finds that peer interaction and social influence is more effective than comparative feedback in improving physician test-ordering behavior.13

A theory exposition identifies that the value of the biopsychosocial model is primarily in guiding the parsimonious application of medical knowledge to the needs of each patient.14

An essay depicts how the confluence of holding a beating heart and caring for a drunken driver profoundly influenced a resident physician.15

Many of these articles highlight the need to integrate diverse perspectives as part of any effort to understand and change a complex adaptive system such as health care. We invite you to contribute your perspective to the *Annals* online discussion.

*   © 2004 Annals of Family Medicine, Inc.

## REFERENCES

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    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6MTI6IjIvc3VwcGxfMS9zMyI7czo0OiJhdG9tIjtzOjIyOiIvYW5uYWxzZm0vMi82LzUzMC5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

2.  Spann SJ, for the members of Task Force 6 and the Executive Editorial Team. Task force report 6. Report on financing the new model of family medicine. Ann Fam Med. 2004;2(Suppl 3):S1–S21. Available at: [http://www.annfammed.org/cgi/content/full/2/suppl_3/S1](http://www.annfammed.org/cgi/content/full/2/suppl_3/S1).
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6MTI6IjIvc3VwcGxfMy9zMSI7czo0OiJhdG9tIjtzOjIyOiIvYW5uYWxzZm0vMi82LzUzMC5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

3.  Task Force 1 Writing Group, Green LA, Graham R, Bagley B, et al. Task Force 1. Report of the task force on patient expectations, core values, reintegration, and the new model of family medicine. Ann Fam Med. 2004; 2(Suppl 1):S33–S50. Available at: [http://www.annfammed.org/cgi/content/full/2/suppl_1/S33](http://www.annfammed.org/cgi/content/full/2/suppl_1/S33).
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6MTM6IjIvc3VwcGxfMS9zMzMiO3M6NDoiYXRvbSI7czoyMjoiL2FubmFsc2ZtLzIvNi81MzAuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

4.  Griffin SJ, Kinmonth A-L, Veltman MWM, Gillard S, Grant J, Stewart M. Effect on health-related outcomes of interventions to alter the interaction between patients and practitioners: a systematic review of trials. Ann Fam Med. 2004;2:595–608.
    
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5.  Walter FM, Emery J, Braithwaite D, Marteau TM. Lay understanding of familial risk of common chronic diseases: a systematic review and synthesis of qualitative research. Ann Fam Med. 2004;2:583–594.
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiMi82LzU4MyI7czo0OiJhdG9tIjtzOjIyOiIvYW5uYWxzZm0vMi82LzUzMC5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

6.  Acheson LS, Crabtree BF. How do people interpret their family histories of diabetes, coronary disease, or cancer? Ann Fam Med. 2004;2:532–533.
    
    [FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiMi82LzUzMiI7czo0OiJhdG9tIjtzOjIyOiIvYW5uYWxzZm0vMi82LzUzMC5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

7.  Lacy NL, Paulman A, Reuter MD, Lovejoy B. Why we don’t come: patient perceptions on no-shows. Ann Fam Med. 2004;2:541–545.
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiMi82LzU0MSI7czo0OiJhdG9tIjtzOjIyOiIvYW5uYWxzZm0vMi82LzUzMC5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

8.  McKee MD, Karasz A, Weber CM. Health care seeking among urban minority adolescent girls: the crisis at sexual debut. Ann Fam Med. 2004;2:549–554.
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiMi82LzU0OSI7czo0OiJhdG9tIjtzOjIyOiIvYW5uYWxzZm0vMi82LzUzMC5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

9.  Peltenburg M, Fischer JE, Bahrs O, van Dulmen S, van den Brink-Muinen A. The unexpected in primary care: a multicenter study on the emergence of unvoiced patient agenda. Ann Fam Med. 2004;2:534–540.
    
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10. Hildebrandt DE, Westfall JM, Nicholas RA, Smith PC, Stern J. Are frequent callers to family physicians high utilizers? Ann Fam Med. 2004;2:546–548.
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiMi82LzU0NiI7czo0OiJhdG9tIjtzOjIyOiIvYW5uYWxzZm0vMi82LzUzMC5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

11. Noël PH, Williams JW Jr, Unützer J, et al. Depression and comorbid illness in elder primary care patients: impact on multiple domains of health status and well-being. Ann Fam Med. 2004;2:555–562.
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiMi82LzU1NSI7czo0OiJhdG9tIjtzOjIyOiIvYW5uYWxzZm0vMi82LzUzMC5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

12. Mainous AG III, King DE, Garr DR, Pearson WS. Race, rural residence, and control of diabetes and hypertension. Ann Fam Med. 2004;2:563–568.
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiMi82LzU2MyI7czo0OiJhdG9tIjtzOjIyOiIvYW5uYWxzZm0vMi82LzUzMC5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

13. Verstappen WHJM, van der Weijden T, Dubois WI, et al. Improving test ordering in primary care: the added value of a small group quality improvement strategy over classic feedback only. A multicenter randomized trial. Ann Fam Med. 2004;2:569–575.
    
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14. Borrell-Carrió F, Suchman AL, Epstein RM. The biopsychosocial model 25 years later: principles, practice, and scientific inquiry. Ann Fam Med. 2004;2:576–582.
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiMi82LzU3NiI7czo0OiJhdG9tIjtzOjIyOiIvYW5uYWxzZm0vMi82LzUzMC5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

15. Glazer JL. Bag of worms. Ann Fam Med. 2004;2:609–610.
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiMi82LzYwOSI7czo0OiJhdG9tIjtzOjIyOiIvYW5uYWxzZm0vMi82LzUzMC5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=)