Ethics, Support for Care, Prevention, and What’s Important
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* Kurt C. Stange

This issue of the *Annals* addresses ethical issues,1,2 the effects of implementing new models of care support,3,4 prevention,5 screening,6–8 and patients’ health information-seeking behaviors.9 It closes with a new approach for calculating the complexity of patient visits10,11 and a community celebration of the life of a personal physician.12

An essay by bioethicist and family physician Howard Brody1 argues the ethical issues surrounding the American Academy of Family Physicians (AAFP) receipt of a corporate donation from Coca-Cola to fund patient education. AAFP President Lori Heim presents a counterargument. We look forward to a thoughtful dialogue of this issue in the *Annals’* online discussion and at state chapter meetings of the Academy around the country this summer preceding the AAFP’s fall Congress of Delegates.

The *Annals* Journal Club selection13 examines the effects of implementing a new model of support for care of chronically ill older adults. In a cluster-randomized trial,3 this Guided Care model shows promising outcomes from the physician’s point of view.

A qualitative study by Shield et al examines a different change in care processes—implementation of an electronic medical record in a residency-training practice.4 The authors find both expected and unanticipated effects on the process of care and on relationships with patients and among practice members.

A cluster of articles addresses disease prevention and early detection.

Abramson and colleagues help us to proactively plan for the next influenza season with a clinical trial evaluation of a multifaceted but feasible intervention to increase staff influenza vaccination rates.5

Another study takes a longitudinal perspective on the use of colorectal cancer screening. Doubeni and colleagues identify a constellation of factors associated with colorectal cancer screening in Medicare beneficiaries.6

The population prevalence of cardiovascular risk factors and cholesterol screening in young adults is examined by Kuklina et al, with the surprising finding of no difference in screening rates for those with and without risk factors.7

The largest exclusively primary care validation study of the Patient Health Questionnaire (PHQ) 2- and 9-item measures provides helpful and actionable information on the use of these measures to screen for depression in primary care.8

A qualitative study by Longo and colleagues examines how people with diabetes seek and use health information, identifying the interaction of both active and passive information receipt.9

In an article with important policy implications, Katerndahl and colleagues10 elucidate a new approach for calculating the complexity of patient visits. An editorial by Lee Green puts this work into context and draws out the implications.11

Finally, a moving essay by Larry Green and Bill Phillips12 helps us to focus on what is important about family medicine by witnessing the effect of a family doctor’s life through the eyes of his community.

Please join the online discussion of these articles at [http://www.AnnFamMed.org](http://www.AnnFamMed.org).

*   © 2010 Annals of Family Medicine, Inc.

## REFERENCES

1.  Brody H. Professional medical organizations and commercial conflicts of interest: ethical issues. Ann Fam Med. 2010;8(4):354–358.
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiOC80LzM1NCI7czo0OiJhdG9tIjtzOjIyOiIvYW5uYWxzZm0vOC80LzI5MC5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

2.  Heim L. Identifying and addressing potential conflict of interest: a professional medical organization’s code of ethics. Ann Fam Med. 2010;8(4):359–361.
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiOC80LzM1OSI7czo0OiJhdG9tIjtzOjIyOiIvYW5uYWxzZm0vOC80LzI5MC5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

3.  Marsteller JA, Hsu YJ, Reider L, et al. Physician satisfaction with chronic care processes: a cluster-randomized trial of Guided Care. Ann Fam Med. 2010;8(4):308–315.
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiOC80LzMwOCI7czo0OiJhdG9tIjtzOjIyOiIvYW5uYWxzZm0vOC80LzI5MC5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

4.  Shield RR, Goldman RE, Anthony DA, Wang N, Doyle RJ, Borkan J. Gradual electronic health record implementation: new insights on physician and patient adaptation. Ann Fam Med. 2010;8(4):316–326.
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiOC80LzMxNiI7czo0OiJhdG9tIjtzOjIyOiIvYW5uYWxzZm0vOC80LzI5MC5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

5.  Abramson ZH, Avni O, Levi O, Miskin IN. Randomized trial of a program to increase staff influenza vaccination in primary care clinics. Ann Fam Med. 2010;8(4):293–298.
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiOC80LzI5MyI7czo0OiJhdG9tIjtzOjIyOiIvYW5uYWxzZm0vOC80LzI5MC5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

6.  Doubeni CA, Laiyemo AO, Young AC, et al. Primary care, economic barriers to health care, and use of colorectal cancer screening tests among Medicare enrollees over time. Ann Fam Med. 2010;8(4):299–307.
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiOC80LzI5OSI7czo0OiJhdG9tIjtzOjIyOiIvYW5uYWxzZm0vOC80LzI5MC5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

7.  Kuklina EV, Yoon PW, Keenan NL. Prevalence of coronary heart disease risk factors and screening for high cholesterol levels among young adults, United States, 1999–2006. Ann Fam Med. 2010;8(4):327–333.
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiOC80LzMyNyI7czo0OiJhdG9tIjtzOjIyOiIvYW5uYWxzZm0vOC80LzI5MC5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

8.  Arroll B, Goodyear-Smith F, Crengle S, et al. Validation of PHQ-2 and PHQ-9 to screen for major depression in the primary care population. Ann Fam Med. 2010;8(4):348–353.
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiOC80LzM0OCI7czo0OiJhdG9tIjtzOjIyOiIvYW5uYWxzZm0vOC80LzI5MC5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

9.  Longo DR, Schubert SL, Wright BA, LeMaster J, Williams CD, Clore JN. Health information seeking, receipt, and use in diabetes self-management. Ann Fam Med. 2010;8(4):334–340.
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiOC80LzMzNCI7czo0OiJhdG9tIjtzOjIyOiIvYW5uYWxzZm0vOC80LzI5MC5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

10. Katerndahl DA, Wood R, Jaén CR. A method for estimating relative complexity of ambulatory care. Ann Fam Med. 2010;8(4):341–347.
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiOC80LzM0MSI7czo0OiJhdG9tIjtzOjIyOiIvYW5uYWxzZm0vOC80LzI5MC5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

11. Green LA. The implications of measuring complexity. Ann Fam Med 2010;8(4):291–292.
    
    [FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiOC80LzI5MSI7czo0OiJhdG9tIjtzOjIyOiIvYW5uYWxzZm0vOC80LzI5MC5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

12. Phillips WR, Green LA. A public celebration of a personal doctor. Ann Fam Med. 2010;8(4):362–365.
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiOC80LzM2MiI7czo0OiJhdG9tIjtzOjIyOiIvYW5uYWxzZm0vOC80LzI5MC5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

13. Guided Care. *Annals* Journal Club. Ann Fam Med. 2010;8(4):iii.
    
    [FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiOC8xL2lpaSI7czo0OiJhdG9tIjtzOjIyOiIvYW5uYWxzZm0vOC80LzI5MC5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=)