Index by author
The Issue in Brief
Patients' Commitment to Their Primary Physician and Why it Matters
Leonard L. Berry, PhD , and colleagues
Background The patient-doctor relationship is an important part of high-quality health care. This study explores patients' commitment to and trust in the relationship with their doctor. The study also looks at whether commitment and trust are related to patients' attitudes toward following their doctors' medical suggestions and healthy eating.
What This Study Found An analysis of 869 patient questionnaires found that patients' trust in and commitment to their family physician strengthen the patient-doctor relationship. Trust and commitment are also associated with following the doctor's suggestions and healthy eating.
Implications
- The patient-doctor relationship is based not only on doctors� medical competence but also on their interpersonal communication skills.
- One way patients might invest in the relationship with their doctor is through positive, healthy behavior.
- To invest in stronger patient relationships while managing the pressures of time, doctors need to develop time-effective, financially-efficient approaches for educating patients.
Pamela A. Ohman-Strickland, PhD , and colleagues
Background Growing numbers of nurse-practitioners (NPs) and physician's assistants (PAs) are providing care in primary care practices. This study examines the effect of NPs and PAs on the quality of care delivered in the primary care setting. In particular, the study focuses on the care of diabetes patients.
What This Study Found Family medicine practices with NPs perform better at providing some types of diabetes care (primarily monitoring tests) than practices with doctors only, and they perform especially better than practices using physician's assistants.
Implications
- The reasons for these results are not yet clear. Additional research needs to explore whether the results are due to NPs and PAs or the practices that hire them.
- Future research should also aim to find the best roles for different clinicians working in teams, so that they can have the greatest impact on patient care.
Explaining Patients' Beliefs About the Necessity and Harmfulness of Antidepressants
James E. Aikens, PhD , and colleagues
Background More than one-half of patients who are prescribed antidepressants either discontinue their medication early or take it too inconsistently to gain any medical benefit. This appears to increase the risk of relapse and recurrence of depression. To help with this problem, researchers set out to explore patients' beliefs about the necessity and harmfulness of antidepressants.
What This Study Found Patients with major depression who are younger, have never taken antidepressants, view their symptoms as mild and temporary, and are unclear about the causes of their depression are most likely to be skeptical about antidepressants.
Implications
- This group of patients might benefit from educational efforts focused on their beliefs about antidepressants, thus promoting a greater willingness to take their medication and better results in treating their depression. Because negative treatment attitudes might be based on patients' experiences, however, it might not always be appropriate to try to change their beliefs about taking medications.
Care Management for Depression in Primary Care Practice: Findings From the RESPECT-Depression Trial
Paul A. Nutting, MD, MSPH , and colleagues
Background Care management has been shown to be effective in treating depression. Care management for depression includes assessing and monitoring the patient's condition; determining the patient's preferences, barriers, and progress in treatment; providing education and developing treatment and self-management plans; coordinating care among caregivers; and encouraging patients to follow recommended treatment. Primary care doctors have been hesitant to adopt this model, and researchers set out to examine the reasons why.
What This Study Found Primary care clinicians see value in care management for their depressed patients and believe it improves the quality of care. Through interviews with 42 primary care clinicians, researchers also found that primary care practices are slow to adopt care management for depression because of lack of financial compensation and the competing time demands of primary care practice.
Implications
- The major barriers to more widespread use of care management in depression are largely economic and less related to attitudes and preferences of primary care clinicians.This underscores the urgency of reimbursement policies that include coverage of depression care management.
Primary Care After Psychiatric Crisis: A Qualitative Analysis
Kim S. Griswold, MD, MPH , and colleagues
Background Primary care is of value to patients with mental health conditions, but getting connected to a primary care doctor may be difficult for patients with serious mental illness who are emerging from psychiatric crisis. The goals of this study were (1) to determine whether care managers (who coordinate medical care and link patients to necessary resources) improve patients' access to primary care, and (2) to understand patients' experiences with health care after a psychiatric crisis.
What This Study Found Among patients who have experienced a psychiatric crisis, those assigned a care manager have easier access to primary care and feel it is of benefit to them compared with those who are not. Seventy-one percent of those with a care manager report that having someone to assist them in making primary care connections is beneficial. Additionally, at 6 months, patients with a care manager report better physical and mental function than their counterparts. At 1 year, however, differences in physical function are no longer significant.
Implications
- Care management is effective in helping patients gain access to primary care after a psychiatric crisis and, for some, it makes the difference between finding a regular doctor or going without care.
Intimate Partner Violence, Depression, and PTSD among Pregnant Latina Women
Michael A. Rodriguez, MD, MPH , and colleagues
Background Among Latinas in the United States, approximately 6% experience intimate partner violence (IPV) during pregnancy and 5% experience IPV in the period just before or after giving birth. This study describes factors related to depression or posttraumatic stress disorder (PTSD) among pregnant Latinas in Los Angeles, California, with and without exposure to IPV.
What This Study Found Pregnant Latinas who are exposed to IPV are more than twice as likely to report high levels of symptoms of depression or posttraumatic stress disorder compared with other pregnant Latinas. They also report being exposed to more trauma (such as child abuse), social undermining (anger, criticism, insults), and stress with less social support. Despite such adversity, Latinas exposed to IPV report similar levels of resilience and mastery as their counterparts, and they engage in more active coping behaviors.
Implications
- These results affirm the link between mental health and trauma and emphasize the importance of screening Latina patients for violence and mental health status.
- Focusing on how Latinas can utilize their own strengths to confront these complex issues may result in strategies that are culturally appropriate and effective in powerfully personal ways.
Influence of Patients' Socioeconomic Status on Clinical Management Decisions: A Qualitative Study
Susannah M. Bernheim, MD, MHS , and colleagues
Background Patients' socioeconomic status (SES) has been shown to influence their health and the quality of their health care. This study looks at doctors' perspectives on how patients' SES influences the care they provide.
What This Study Found Doctors change their management plans to make care more affordable, feasible, or comprehensible for patients with low socioeconomic status. Although these changes are intended for the patient's best interest, doctors have concerns about maintaining a standard of consistent care for all patients.
Implications
- Patients� socioeconomic status affects doctors� day-to-day clinical management decisions.
- Helping patients accommodate their financial needs by altering care may contribute to differences in health care based on socioeconomic status.
- Recognizing the role of socioeconomic factors in clinical decision making may be an important contribution in developing standards to ensure high-quality care and a physician workforce willing to care for vulnerable populations.
Effect on Cessation Counseling of Documenting Smoking Status as a Routine Vital Sign: An ACORN Study
Stephen F. Rothemich, MD, MS , and colleagues
Background Smoking is the leading cause of death in the United States. Advice from doctors, even brief and simple advice, has been shown to increase the rates at which patients quit smoking. This study examines whether documenting patients' smoking status along with other vital signs (such as blood pressure) makes a difference in the amount of advice patients receive about stopping smoking.
What This Study Found Asking about smoking status as a routine vital sign in primary care practice results in a modest increase in simple advice to quit but not in more extensive counseling about smoking. The study found an 8.6 % increase in counseling that consisted mainly of simple advice to quit, with little discussion of how to do so.
Implications
- Asking about smoking status as a routine vital sign in primary care practices can modestly increase the rates at which patients stop smoking.
- To offer more intensive counseling about quitting smoking, practices and health plans must redesign management systems and reimbursement plans, and work with other community resources.
A Meta-Analysis of Pedometer-Based Walking Interventions and Weight Loss
Caroline R. Richardson, MD , and colleagues
Background People who walk more tend to be thinner than those who walk less. This study examines the effects of walking programs for overweight adults that use pedometers (small devices worn at the waist that count every step taken during the day).
What This Study Found Walking programs that use a pedometer as a motivational tool result in a moderate amount of weight loss in overweight or obese sedentary adults. The average participant in a pedometer-based walking program without dietary change can expect to lose about 1 pound every 10 weeks, or about 5 pounds per year. Longer programs are associated with greater weight loss.
Implications
- The amount of weight loss from pedometer-based walking programs is small but significant from a clinical perspective.
- Walking programs that use pedometers can have health benefits that are associated with both a modest weight loss and increased physical activity.
Peter A. Selwyn, MD, MPH
Background An inner-city family physician describes a chance encounter on a New York subway that prompts him to reflect on the nature of doctors' interactions with their patients and others they come across in their lives. These everyday interactions offer a string of opportunities to witness the lives of others, see things differently, and learn about their patients and themselves.
Richard E. Allen, MD, MPH
Background A family physician reflects on his experience caring for Native American patients on a reservation in Montana. As he tells of rescuing a teenage girl in labor, he describes his search for meaningful purpose while struggling with his own preconceptions and expectations.