Index by author
The Issue In Brief
March-April 2004
Cumulative list of Issues In Brief
A
Community-Oriented Primary Care Demonstration Project: Refining Interventions
for Cardiovascular Disease and Diabetes
By
Marcus Plescia, MD, MPH, et al.
Community-oriented
primary care (COPC) applies public health principles in the primary care
setting. In this COPC project, community residents gathered and helped interpret
information about diet and exercise patterns in their community. The information
is being used to design programs to reduce cardiovascular disease and diabetes.
The Natural History
of Asthma in a Primary Care Cohort
By Vince
WinklerPrins, MD, et al.
In children and young
adults, a single test for overreactiveness of the airway does not help predict
whether the patient will develop respiratory tract illness, including asthma.
Questionnaires about symptoms were more successful at predicting asthma and may
be useful in practice.
Management of
Patients With Hepatitis C in a Community Population: Diagnosis, Discussions, and
Decisions to Treat
By Liliana Gazzoula Rocca,
MD, et al.
Chronic hepatitis C is a treatable
condition, but little is known about its treatment in the community practice
setting. In a Minnesota county, generalist physicians (general internists and
family physicians) diagnosed more cases of hepatitis C than any other group of
physicians. Generalist physicians may also have central roles in monitoring and
treating hepatitis C patients and referring them for specific therapies.
The Identification
of Medical Errors by Family Physicians During Outpatient Visits
By Nancy C. Elder, MD, MSPH, et al.
Fifteen practicing family physicians identified medical errors
and preventable problems in almost one quarter (23.6%) of their patient visits.
Office administration errors were most frequently identified. According to the
physicians� estimates, 23.7% of the errors and events led to minor patient harm,
especially increased emotional distress and wasted time for the patient. In this
and other studies, participants had different views of when an error is a
�nuisance� and when it is a �harm.� Future primary care research is needed to
clarify definitions for harm, refine a classification system for errors, and
estimate the occurrence of errors.
Family Physician
Self-Efficacy with Screening for Inherited Cancer Risk
By Robert Gramling, MD, et al.
Most family physicians believe it is important to screen
patients for an inherited risk of cancer. However, less than two thirds believe
that they are effective at this type of screening. This suggests that many
practicing family physicians would welcome strategies aimed at improving
effectiveness in screening patients for inherited cancer risk.
Elevated Serum
Transferrin Saturation and Mortality
By Arch
G. Mainous III, PhD, et al.
Excess iron and iron
overload can contribute to the occurrence of certain conditions and diseases.
Serum transferrin saturation can indicate a predisposition for iron overload.
This study found that elevated levels of serum transferrin saturation were
associated with a significantly higher risk of death from all causes. Further
research is needed to determine if measuring serum transferrin produces useful
information about the likely course and outcome of some diseases.
The Mortality Risk
of Elevated Serum Transferrin Saturation and Consumption of Dietary Iron
By Arch G. Mainous III, PhD, et al.
Serum transferrin saturation can indicate an overload of iron.
Among people with elevated levels of serum transferrin saturation, eating large
amounts of red meat and other iron-containing foods was associated with
increased death rates. Specifically, people with elevated transferrin saturation
who reported high dietary iron intake had a 2.9 times greater risk of death than
those who had normal transferrin saturation levels and reported low dietary iron
intake. People who had a high transferrin saturation and reported eating red
meat seven or more times per week had a risk of death 2.26 times greater than
those who had normal transferrin saturation and reported eating low amounts of
red meat. Simple dietary restrictions may help to reduce the risk of death
associated with high transferrin saturation.
Parental Attitudes
About a Pregnancy Predict Birth Weight in a Low-Income Population
By Robert D. Keeley, MD, MSPH, et al.
Low birth weight is the primary cause of illness and death in
newborns in the United States, and has risen steadily during the last 17 years
from 6.5% to 7.8% in 2002. In a low-income population, pregnant women who
reported that the father was happier than they were about the pregnancy were at
greater risk of having a low--birth-weight baby. If future research shows that
attitudes toward pregnancy predict birth weight in other populations, this
information may be useful in programs to reduce the occurrence of
low--birth-weight babies.
Powerlessness,
Control and Complexity: The Experience of Family Physicians in a Group Model HMO
By Linda Gask, MB, ChB, PhD, FRCPsych, et al.
More than half of the family physicians in a group
model health maintenance organization feel they lack power to change or control
their working environment, although some physicians have developed coping skills
to help retain a sense of control. The physicians value the variety and
complexity of family practice. The authors call for physicians and health care
organizations to work together to restore family physicians� professional
independence and involvement, and to incorporate these efforts in programs to
improve quality of medical care and reduce costs.
Screening for
Family and Intimate Partner Violence: Recommendation Statement
By the U.S. Preventive Services Task Force
Based on its examination of evidence about family and intimate
partner violence, the U.S. Preventive Services Task Force found insufficient
evidence to recommend for or against routine screening of parents or guardians
for the physical abuse or neglect of children, of women for intimate partner
violence, or of older adults or their caregivers for elder abuse.
Screening Children
for Family Violence: A Review of the Evidence for the U.S. Preventive Services
Task Force
By Peggy Nygren, MA, et al.
Nygren and colleagues conducted a systematic review
of relevant studies on screening children for family violence. They found that
despite the prevalence of child abuse and neglect and its impact on health,
there are few studies providing data on its detection and management to guide
physicians. These findings provided evidence for the U.S. Preventive Services
Task Force recommendation statement on Screening for Family and Intimate Partner
Violence.
Does Enhancing
Partner Support and Interaction Improve Smoking Cessation? A Meta-Analysis
By Eal-Whan Park, PhD, et al.
Starting and stopping smoking are influenced by other family
members. However, programs to quit smoking which involve increased support from
smokers� partners do not show higher long-term quit rates. Programs to enhance
partner support for stopping smoking might be most effective when they involve
live-in and married partners, and when they focus on increasing positive,
supportive behaviors by the partner and minimizing behaviors that are negative
and critical.
Getting the News
By Roger A. Rosenblatt, MD, MPH
In this essay, a family physician shares his personal
experience with cancer � and of cancer care in an academic medical center �
discussing how the lessons learned from the journey have reverberated through
his personal and professional life.
The Future of Family
Medicine: A Collaborative Project of the Family Medicine Community
By the Future of Family Medicine Project Leadership
Committee
In response to the flaws and fragmentation
of the US health care system, the leadership of seven family medicine
organizations have released a blueprint for improved, patient focused care. The
Future of Family Medicine Project report calls for large-scale changes to the US
health care system, medical education and clinical practice. It proposes a new
model of patient-centered care in which all Americans would have a "personal
medical home." Based on interviews and focus groups, the report offers an
objective understanding of what patients want and need from their personal
physicians and from America�s health care system, and it identifies challenges
and opportunities for the specialty of family medicine.