In This Issue: Health Care Policy Affects the Lives of Real People

This issue of Annals provides insights into how policies affect the health care and lives of diverse peoples. The issue also includes a new measure of the depth of the patient-doctor relationship, an analysis that debunks a long-standing tradition of using first-void urine samples for Chlamydia testing, and a poignant essay on saying good-bye to patients.

Three policy articles^1–3 and an accompanying editorial by Phillips,⁴ call for US health care to stand up where currently we fall down. Mainous et al find worrisome differences in length of stay for ambulatory care–sensitive conditions associated with patients’ insurance and hospital ownership.¹ The association of a parent’s usual source of care with children’s access to care is examined by DeVoe and colleagues,² and the primary care problems that stem from closing a safety-net hospital are examined by Odom Walker and colleagues.³

An editorial by Roberts presents policy lessons about how to deal with complaints against physicians.⁵ It is based on an analysis of the Dutch disciplinary law system that allows patients to file complaints against physicians outside a legal malpractice system.⁶

An essay by Saxe⁷ presents a pathway by which greater physician advocacy for environmental change can help to assuage the epidemic of childhood obesity.

Policy lessons can also be drawn from multiple other articles in this issue.

Solberg and colleagues examine changes in performance of technical quality and patient experience among practices changing into level III patient-centered medical homes.⁸ They find that recognition as a level III patient-centered medical home does not necessarily mean that transformative improvements have occurred.

Eaton and colleagues use a cluster randomized trial design to examine a patient activation and decision support tool intervention designed to improve the translation of National Cholesterol Education Program guidelines into practice.⁹ Despite the overall null findings, higher rates in subgroups of practices using patient activation kiosks and clinicians using decision support tools point the way for further investigation.

A methodology piece by Ridd et al uses qualitative methods to develop a measure of the depth of patient-physician relationship and quantitative methods to assess the measure’s psychometric properties.¹⁰ They find good reasons to further test and use this measure in studies that assess the effect of relationship on patient care processes and outcomes.

This issue’s Annals Journal Club selection builds on prior research¹¹ (and a prior Annals Journal Club)¹² showing the effects of Balint groups among practicing physicians. In this issue, an essay by Shorer and colleagues depicts how Balint group involvement leads a physician to recognize her conflicted feelings about leaving her practice, and to proactively plan her departure.¹³ For residents and practicing physicians leaving their practices, what efforts are important to take to deal with the many resulting transitions?

Please join the ongoing discussion of these articles and their implications at http://www.AnnFamMed.org.

• © 2011 Annals of Family Medicine, Inc.