Table of Contents
The Issue in Brief
Christopher Millett , and colleagues
Background The United Kingdom (UK) has implemented a major quality improvement effort, which includes a goal of reducing inequalities in the management of chronic diseases. This study examines differences in the management of high blood pressure by patient ethnicity in the United Kingdom.
What This Study Found Black patients with high blood pressure are less likely to reach an established treatment target for blood pressure control than white or South Asian patients. South Asian patients with high blood pressure have more cardiovascular conditions than white or black patients. The presence of two or more other cardiovascular conditions was associated with better blood pressure control in white but not in black or South Asian patients. South Asian patients with poorly controlled blood pressure were prescribed fewer antihypertensive medications than black or white patients.
Implications
- Ethnic inequalities in the management of high blood pressure have continued in the United Kingdom despite major investment in quality improvement programs, including pay for performance.
- These disparities are particularly marked in patients with additional cardiovascular conditions.
- In universal quality improvement programs, such as pay for performance, additional efforts are required to improve the quality of care for high-risk individuals.
Racial Disparity in Hypertension Control: Tallying the Death Toll</a
Kevin Fiscella , and colleague
Background Hypertension (high blood pressure) contributes to cardiovascular disease. Among people being treated for hypertension, blacks have worse blood pressure control, and uncontrolled hypertension accounts for up to one-quarter of all deaths in black adults. This study looks at differences in blood pressure control among whites and blacks with hypertension and the effect of these differences on the rate of death among blacks.
What This Study Found In the United States, the average blood pressure among blacks with hypertension is higher than for whites with hypertension. A reduction in blood pressure among blacks would reduce the annual number of black deaths from heart disease by 5,590, and from stroke by 2,190.
Implications
- Eliminating racial disparity in blood pressure control among adults with hypertension would substantially reduce the number of black deaths from heart disease and stroke.
- Researchers need to better understand the causes of these inequalities and develop strategies to eliminate them.
Benjamin W. Van Voorhees , and colleagues
Background As many as 24% of adolescents will experience depression by the age of 24. Preventive approaches could help reduce the risk of depression and suicide in adolescents. In this study, researchers test a tool to help primary care doctors identify adolescents at future risk for depression who might benefit from early treatment.
What This Study Found The Chicago Adolescent Depression Risk Assessment (CADRA) predicts future depression and could help primary care doctors and families help adolescents who are at highest risk.
Implications
- The CADRA is one of the first depression prediction tools for use in community or primary care settings for either adults or children.
- A practical and reliable risk prediction index will increase awareness of the risk of depression and help in making decisions regarding care for at-risk adolescents and their families.
Margaret A. Handley , and colleagues
Background Diabetes is a widespread and costly condition. This study, conducted in publicly funded clinics, looks at costs and effectiveness of an automated telephone system with nurse care to support patients with type 2 diabetes in their self-management.
What This Study Found The automated telephone system with nurse care management is associated with improvements in quality of life and longevity related to patients' overall health. Using this system, a 10% increase in the number of patients meeting the American Diabetes Association's exercise guidelines can be achieved at a modest cost.
Implications
- This study is one of the first to examine the cost-effectiveness of a diabetes self-management support program that uses health communication technology to reach and involve a vulnerable population.
- Automated telephone self-management systems may help reduce inequalities in diabetes-related health in vulnerable populations.
Prognosis of Fatigue and Functioning in Primary Care: A 1-Year Follow-up Study
Iris Nijrolder , and colleagues
Background Fatigue (feeling tired or exhausted) is a common symptom, but there has been little study of it in primary care patients. This study looks at the course of fatigue in primary care patients whose main symptom is fatigue.
What This Study Found The study results suggest a relationship between the degree of fatigue, ability to function, psychological symptoms, and quality of sleep. Most patients with fatigue fall into one of four groups: those who are highly fatigued on an ongoing basis (26%), those who have a fast recovery from fatigue (17%), those who have a slow recovery (25%), and those whose fatigue comes and goes (32%).
Implications
- As fatigue becomes less severe over time, there is improvement in functioning, sleep, and psychological symptoms.
- Only 17% of patients recover quickly from fatigue, and more than one-half of patients (58%) have recurrent or ongoing fatigue over the course of a year.
- To identify patients with ongoing or repeated fatigue, doctors should pay attention to patients� general health or functioning, psychological symptoms, and sleep quality.
Characterizing Breast Symptoms in Family Practice
Margaret M. Eberl , and colleagues
Background Breast symptoms are common, but little is known about how often such symptoms occur in female primary care patients, how they are evaluated and treated, and how they are related to breast cancer. This study from the Netherlands examines the frequency and types of breast complaints in the family medicine setting and which breast-related symptoms and concerns are most related to a breast cancer diagnosis.
What This Study Found Breast symptoms are reported in about 3% of all family medicine visits by female patients; breast pain and breast mass are the most common complaints. Only a small group of patients with breast symptoms has breast cancer diagnosed, but the presence of a breast mass is related to a higher likelihood of the disease.
Implications
- Breast-related symptoms are not uncommon in the family medicine setting.
- Clinicians should aggressively follow-up on breast complaints, especially a breast mass or lump, regardless of patient age.
Off the Roadmap? Family Medicine's Grant Funding and Committee Representation at NIH
Sean C. Lucan , and colleagues
Background Although family medicine has a strong framework for clinical practice, it has long struggled to develop its research base. The National Institutes of Health (NIH), the leading source of support for medical research in the United States, does not focus on primary care research, and new programs relevant to primary care may not fit well with family medicine. This study aims to determine the numbers of family physicians serving on NIH advisory committees, and assess the level and distribution of NIH grants to departments of family medicine from 2002-2006.
What This Study Found Departments of family medicine and family physicians in particular receive an extremely small amount of NIH grant funding and have correspondingly little representation on standing NIH advisory committees.
Implications
- Family medicine's low involvement with NIH weakens the potential for translating medical knowledge into community practice and advancing knowledge to improve health care and health for the US population.
- To strengthen family medicine's connection to NIH, the authors suggest increased research training, learning from family medicine departments that have successful relationships with NIH, establishing research partnerships, and encouraging practicing family physicians to serve on NIH advisory committee public seats, while family medicine researchers serve on scientific seats.
What Latina Patients Don't Tell Their Doctors: A Qualitative Study
Kell Julliard , and colleagues
Background Many studies have explored barriers to communication between patients and physicians, but Latina women were not well represented in such studies. A better understanding of barriers to information disclosure could improve health care outcomes. The goal of this study is to identify conditions that create barriers to disclosure of health information in Latina patients' medical visits.
What This Study Found Full disclosure of health issues between Latina patients and physicians is more likely to occur in the context of a warm, trusting, compassionate relationship in which the patient feels respected and truly heard. Barriers to disclosure include the presence of translators and time constraints. Sexual issues represent the most sensitive topic. Many women are more willing to fully disclose health issues to a female physician.
Implications
- Staff training in techniques for building rapport can foster better communication, increase empathy and compassion, and lead to the establishment of trusting relationships in which disclosure is more likely.
- Clinicians should be aware of the difficulties some Latinas experience in disclosing sensitive information when a translator is present.
Percentage Change in Antenatal Body Mass Index as a Predictor of Neonatal Macrosomia
Chad A. Asplund , and colleagues
Background Macrosomia, a condition in which a fetus grows unusually large, affects between 3% and 15% of all pregnancies and can cause health problems for both infant and mother. This study examines whether a percentage change in the mother's body mass index, or BMI, (a measurement of body fat) during pregnancy predicts macrosomia.
What This Study Found During pregnancy, an increase in the mother's BMI of 25% or more is highly predictive of macrosomia, regardless of her initial BMI or absolute weight gain.
Implications
- This is the first published study showing that change in BMI during pregnancy is a sensitive predictor of fetal macrosomia, regardless of initial weight.
- This method of predicting macrosomia is easy to use without any special equipment or expert clinical skills and is more sensitive and specific than other methods.
- This method may allow clinicians to tailor pregnancy weight gain recommendations to women's individual needs.
Tool to Assess Likelihood of Fasting Glucose ImpairmenT (TAG-IT)
Richelle J. Koopman , and colleagues
Background Fifty-four million people in the United States have impaired fasting glucose (IFG), a condition in which blood sugar levels are higher than normal but not high enough for a diagnosis of diabetes. Those with IFG are at higher risk for developing type 2 diabetes. In this study, researchers develop and test a tool to identify adults who are likely to have undetected high blood sugar levels.
What This Study Found The Tool to Assess likelihood of fasting Glucose ImpairmenT (TAG-IT) is an efficient method to identify those most likely to have high fasting blood sugar. It can be used in the medical setting to help screen patients for prediabetes and diabetes, and as a tool to identify potential participants for research.
Implications
- A tool to efficiently identify adults most likely to have high fasting blood sugar can help clinicians make decisions about screening and assessment of patients at risk for diabetes.
- The TAG-IT is more useful than a list of risk factors in assessing prediabetes in young adults, and provides clinicians and researchers with a way to assess combinations of risk factors.