Table of Contents

In Brief

Integration of Depression and Hypertension Treatment: A Pilot, Randomized Controlled Trial

Hillary R. Bogner , and colleagues

Background Past research suggests the importance of coordinating the management of depression with management of other medical conditions, especially cardiovascular disease. An integrated approach to care might also be more acceptable to patients than managing depression alone. In this study, researchers examine whether a single program to treat depression and care for high blood pressure improves older patients' depression symptoms, blood pressure control, and willingness to take depression and blood pressure medications.

What This Study Found Compared with other patients, primary care patients who receive an integrated approach to care have lower blood pressure and fewer depressive symptoms, and they take their depression and blood pressure medications at higher rates.

Implications

• Integrated programs may be especially valuable in medical practices where there are competing demands for limited resources.
• Further research is needed to evaluate an integrated care approach in a larger sample of patients with longer periods of follow-up.

Self-Rated Cardiovascular Risk and 15-Year Cardiovascular Mortality

Robert Gramling , and colleagues

Background Many people believe they have a low risk of cardiovascular disease, but little is known about the long-term results of such optimistic beliefs. In this study, researchers evaluate whether lower self-ratings of cardiovascular disease risk are related to lower rates of death from cardiovascular disease.

What This Study Found Men (but not women) who rate their 5-year risk of having a stroke or heart attack as "low" go on to have a lower-than-expected rate of death from cardiovascular disease in the next 15 years. Analyzing data from 2,816 adults, researchers found that men who rated their cardiovascular disease risk as lower than other men of their age had nearly a three times lower incidence of death from cardiovascular disease compared with all others.

Implications

• For men, optimistic perceptions of health risk leads to health benefits.
• A message about cardiovascular disease risk from a trusted doctor is likely to have a more long-lasting effect on patients� self-ratings of risk of cardiovascular disease than messages from less trusted sources.

Healing In Primary Care: A Vision Shared by Patients, Physicians, Nurses, and Clinical Staff

Clarissa Hsu , and colleagues

Background There has been little published research on how patients in primary care define healing, how healing might be improved, and how doctors and other members of primary health care teams see their roles in healing. This study explores what healing means to patients, doctors, nurses, and other members of the primary care team.

What This Study Found Patients and health care team members share a vision of healing and agree on ways to enhance the healing process in primary care. According to this definition, healing is a dynamic process of recovering from a trauma or illness by working toward realistic goals, restoring function, and regaining a personal sense of balance and peace. There are physical, emotional, and spiritual dimensions to healing.

Implications

• This study provides new information about healing by asking patients and clinicians what they think. There is strong agreement about healing among patients and clinicians in primary care settings.
• According to this definition of healing, medical care, though important, is only one contributor to healing, and healing is only one element of what goes on in medical care.

Understanding Healing Relationships in Primary Care

John G. Scott , and colleagues

Background There are few systematic studies about the experience of healing and how it occurs between clinicians and patients. This study set out to create a model that identifies how healing relationships are developed and maintained.

What This Study Found Patients and clinicians define healing as being cured when possible, reducing suffering when cure is not possible, and finding meaning beyond the illness experience. Clinicians help foster healing relationships by creating an emotional, nonjudgmental bond with patients; increasing patients' power; and showing a commitment to caring for patients over time. For patients, these processes can result in trust, hope, and a sense of being known. Clinicians can facilitate healing through self-confidence, emotional self-management, mindfulness, and clinical knowledge.

Implications

• Clinician-patient healing relationships have an identifiable structure and can lead to important patient-centered results.
• This model may apply to a range of healing relationships, not just relationships between patients and clinicians.
• Healing relationships seem to have an effect on both patients and clinicians.

Perceived Accessibility as a Predictor of Youth Smoking

Chyke A. Doubeni , and colleagues

Background Youths who believe they have easy access to illegal substances are more likely to get and experiment with those substances. This study looks at whether young people's perception of access to cigarettes predicts future patterns of smoking.

What This Study Found The perception that cigarettes are easy to obtain increases the risk for starting and continuing to smoke. Teens who perceive easy access and have friends who smoke are more likely to smoke regularly than those exposed to either factor alone.

Implications

• The perception among teens that cigarettes are easy to obtain is an important factor in starting and continuing to smoke.
• The authors suggest that clinicians routinely ask teens about their perceptions of accessibility to tobacco and their exposure to peers who smoke.

Evaluative Criteria for Qualitative Research in Health Care: Controversies and Recommendations

Deborah J. Cohen , and colleagues

Background Qualitative research methods are increasingly used in clinical and health care research. This article identifies standards of good qualitative research as described in the health care literature, as well as lessons the authors learned during this process.

What This Study Found The authors identified 7 criteria for good qualitative research: (1) carrying out ethical research; (2) importance of the research; (3) clarity and coherence of the research report; (4) use of appropriate and rigorous methods; (5) importance of reflexivity or attending to researcher bias; (6) importance of establishing validity or credibility; and (7) importance of verification or reliability. Points 5 through 7 should not be applied generically, but should take into account the approach used by the author or researcher.

Implications

• Researchers need to learn about the criteria appropriate for evaluating qualitative research based on the theoretical and methodological framework from which it emerges.

Using Multiple Sources of Knowledge to Reach Clinical Understanding of Chronic Fatigue Syndrome

Carolyn A. Chew-Graham , and colleagues

Background Chronic fatigue syndrome (CFS) is a condition that is not well understood. In addition to other symptoms, people with CFS feel too tired to do all of their normal, daily activities. This study explores how patients with CFS, as well as family physicians, view and understand the condition, and how their understanding might affect the primary care visit.

What This Study Found Interviews with 24 patients and 14 family physicians in the United Kingdom find that family physicians feel unprepared by their medical training and education to diagnose and manage CFS. As a result, they seek information through other sources, such as the media, observations of patients outside the office, and personal experience. Patients are aware of doctors' limited understanding of CFS and sometimes feel their concerns are dismissed.

Implications

• Family physicians need evidence-based knowledge about CFS.
• Training and continuing medical education for CFS could make use of the rich base of knowledge that patients with CFS possess.

Skin Diseases in Family Medicine: Prevalence and Health Care Use

Elisabeth W. M. Verhoeven , and colleagues

Background This study examines the rate at which skin diseases occur and the use of health care facilities by patients with skin diseases. Data were collected in a network of family practices in the Netherlands with a practice population of 12,000 people.

What This Study Found Skin diseases account for 12% of all diseases seen by family physicians. Most patients' skin diseases are treated by their family physician. Patients with more severe skin disease and a lower quality of life seek more treatment.

Implications

• Paying extra attention to patients� physical and psychosocial conditions might have beneficial consequences for dermatological treatment, for example, by increasing patient satisfaction with and adherence to treatment.
• More research is needed to better understand health care use and the effectiveness of health care facilities in treating specific skin diseases.

The Development of an Instrument for Measuring Healing

James Peter Meza , and colleagues

Background Healing is increasingly recognized as an important concept in medicine. There are, however, few tools available to researchers to measure healing. This project describes healing and tests a new scale to measure healing qualities.

What This Study Found The Self-Integration Scale is a valid and reliable measurement scale for attributes of healing.

Implications

• The Self-Integration Scale is one of the first attempts to measure healing in Western medical practice.
• The scale offers new possibilities for research in humanistic health care.

Community Care of North Carolina: Improving Care Through Community Health Networks

Beat D. Steiner , and colleagues

Background The United States leads the world in health care costs but ranks low in quality of care. This article describes Community Care of North Carolina, a partnership between practicing community doctors, hospitals, health departments, social services departments, and Medicaid to increase health care quality and reduce costs.

What This Study Found Community Care of North Carolina has improved health care quality and reduced costs since it began 10 years ago. The program is now saving the State of North Carolina at least $160 million per year.

Implications

• This program provides a model of care that could be implemented across the United States.
• Lessons learned from the North Carolina experience can be useful to others seeking to establish effective systems of care for patients with chronic illness.

Dinosaurs, Hospital Ecosystems, and the Future of Family Medicine

Cherie Glazner

Background This essay states that patients and family physicians suffer when fewer family physicians choose to provide hospital care. Family physicians' absence from the patient's bedside creates the very extinction they fear. Family medicine should focus on making the work of the family physician, including continued involvement in the hospital setting, financially and emotionally sustainable.