Table of Contents
The Issue in Brief
Having a Personal Health Care Provider and Receipt of Colorectal Cancer Testing
Roberto Cardarelli , and colleagues
Background Although colorectal cancer is 1 of the top 3 causes of cancer deaths, screening for the disease occurs at low rates. The purpose of this study is to assess the relationship between having a personal health care provider and being up-to-date on testing for colorectal cancer.
What This Study Found Having a personal health care provider is the greatest predictor of up-to-date colorectal cancer testing regardless of race/ethnicity, education, income, and health insurance status.
Implications
- Increasing and supporting the primary care workforce can increase colorectal cancer screening rates.
- Policy initiatives are needed to ensure that all people have access to a personal health care provider. This could help improve colorectal cancer screening rates as well as other aspects of health.
Masahito Jimbo , and colleagues
Background The fecal occult blood test (FOBT) is an effective method of screening patients for colorectal cancer. To be effective at preventing colon cancer, positive FOBT tests must be followed up with further testing, such as colonoscopy. However, in practice, follow-up of positive FOBT results does not always occur. This study examines reasons for this low rate of complete diagnostic evaluation following a positive FOBT.
What This Study Found For a majority of patients, primary care doctors' reported reasons for not performing a complete diagnostic evaluation are appropriate. A common reason for not performing a complete diagnostic evaluation is that one had been completed within 3 years before the FOBT-positive result. Further analysis, however, shows that a significant proportion of decisions not to perform a complete evaluation are not compatible with established guidelines.
Implications
- Because decision making by primary care doctors appears to have a major effect on whether a complete diagnostic evaluation is performed after a positive FOBT result, colorectal screening programs should include guidance for doctors on this issue.
- These findings will shed light on potential strategies to help doctors improve rates of complete diagnostic evaluation in FOBT-positive patients.
Michael B. Potter , and colleagues
Background Only about one-half of eligible adults aged 50 years and older report being up-to-date on screening for colorectal cancer. The home fecal occult blood test (FOBT) is the least expensive screening method, but there are often educational, linguistic, ethnic, social, or cultural barriers to its use. This study examines whether offering home FOBT tests during annual flu shot clinics is an effective way to increase rates of colorectal cancer screening.
What This Study Found Offering home FOBT to eligible patients at a primary care-based annual flu shot clinic dramatically increases colorectal cancer screening rates among those in attendance. In this study of 514 patients at an annual flu shot clinic, screening rates increased by almost 30 percentage points among those offered an FOBT compared with an insignificant increase of 4 percentage points in screening among those who weren't offered the test.
Implications
- Annual flu shot activities provide an opportunity for nonphysician staff to offer FOBT to patients older than 50 years who need it at a time when they are already thinking about illness prevention.
- Combining annual FOBT and flu shot activities could become an effective way to promote colorectal cancer screening in primary care settings, especially in communities and clinics where FOBT remains the primary screening option.
Kelly Marvin Jeppesen , and colleagues
Background Health literacy, or the ability to obtain and understand health information, is related to one's health and ability to manage medical conditions. Knowing what questions to ask about a patient's learning styles could help clinicians personalize health education for their patients. The purpose of this study is to determine questions and patient characteristics that indicate that a patient may have low health literacy.
What This Study Found Researchers identify 5 screening questions and demographic characteristics that predict whether a patient has limited health literacy: (1) self-rated reading ability, (2) the result of the Single-Item Literacy Screener (a 1-question test that asks, "How often do you need to have someone help you when you read instructions, pamphlets, or other written material from your doctor or pharmacy?"), (3) highest education level attained, (4) sex, and (5) race.
Implications
- The authors suggest that clinicians ask questions to identify patients who may need assistance with navigating the health care system or understanding health-related materials.
- Asking patients about self-rated reading ability and their highest educational level and the Single-Item Literacy Screener can help in developing strategies to assist patients with low health literacy levels.
What Drives Prescribing of Asthma Medication to Children? A Multilevel Population-Based Study
Mira G. P. Zuidgeest , and colleagues
Background Asthma in children is a major clinical and public health problem. Because diagnosing and treating the condition is a challenge, there are differences in the prescribing of asthma medication. The aim of this study is to investigate how and to what degree patient, family, and doctor characteristics influence the prescribing of asthma medication in children.
What This Study Found The patient, family, and doctor have a significant influence on prescribing asthma medication in children. Prescribing is strongly related to children's asthma and symptoms and to other respiratory diseases, such as bronchitis. The presence of asthma in the parents is also associated with prescribing asthma medication to children. In addition, in this study, every extra family contact with the doctor led to a 10% extra chance of receiving asthma medication. There is more variation between doctors in prescribing for children younger than the age of 6 years compared with older children. This may be due to the complexities in diagnosing asthma in young children.
Implications
- Uncertainties in diagnosing asthma may result in more prescribing that is influenced by family and doctors.
- Despite the ongoing search for better ways to diagnose asthma in children, there is still a diagnostic gap, especially in preschool children. This gap contributes to differences between doctors in prescribing asthma medication, based on personal preferences and general attitudes toward prescribing.
Bennett Parnes , and colleagues
Background Proponents of direct-to-consumer pharmaceutical advertising (DTCA) suggest it can inform consumers, motivate them to seek care, and help them weigh treatment options. Critics argue that DTCA provides incomplete and biased information, leads to inappropriate prescribing, and consumes time in the medical visit. This study examines the rate of patient medication inquires and their influence on primary care doctor visits.
What This Study Found In this study, patient inquiries for prescription medications were uncommon (3.5% of visits) and inquiries for advertised products were even lower (2.6%). Clinicians did not usually feel that these requests had a negative effect on the medical visit.
Implications
- The study included a large proportion of patients in lower income groups, who because of cost may be less inclined to request specific medications. Even among private practices in the study, however, the rate of medication inquiries was 7.2%, less than one-half the rate in a previous report.
- Patients and doctors may be growing accustomed to medication requests and DTCA.
- DTCA may have less effect on lower income groups.
Intimate Partner Violence and Comorbid Mental Health Conditions Among Urban Male Patients
Karin V. Rhodes , and colleagues
Background There has been a great deal of research about intimate partner violence (IPV) against women, but few studies have examined such violence against men. This article focuses on the relationship between mental health symptoms and IPV in men. In particular, it looked at men who visited an urban emergency department for nonacute conditions and were in an intimate relationship in the past year.
What This Study Found Thirty-seven percent of men in the study were victims of IPV, or perpetrated IPV, or both. The amount of IPV was associated with mental health symptoms, including symptoms of depression, posttraumatic stress disorder, suicidality, and substance abuse. Smoking, drinking, and use of street drugs were also higher in men involved with IPV.
Implications
- New methods of identifying IPV and classifying risk of violence need to account for the severity and frequency of occurrences, as well as other health and mental health conditions.
- At least some of the negative health effects associated with violence may be due to unhealthy behaviors, such as smoking, drinking, and drug use.
- Improving our understanding of the interactions between mental health and violence is important if we are to develop new methods of addressing these issues outside the criminal justice system.
Screening Colonoscopies by Primary Care Physicians: A Meta-Analysis
Thad Wilkins , and colleagues
Background Colonoscopy is recommended as a method for screening patients for colorectal cancer. In the US, however, there are not enough clinicians trained in providing colonoscopies to implement a full-scale national screening program. This study systematically examines existing data on the quality and safety of screening colonoscopies performed by primary care doctors.
What This Study Found Colonoscopies performed by trained primary care doctors are safe and effective. They compare favorably in terms of quality to colonoscopies performed by specialists, according to published standards and reports of specialist practice.
Implications
- Primary care doctors trained in colonoscopy can play an important role in providing access to colonoscopy for colorectal cancer screening.
Postpartum Depression Screening at Well-Child Visits: Validity of a 2-Question Screen and the PHQ-9
Dwenda Gjerdingen , and colleagues
Background Postpartum depression affects up to 22% of women who have recently given birth. Most mothers are not screened for postpartum depression, and an ideal screening tool has not been identified. This study tests the effectiveness of 2 postpartum depression screening tools and the feasibility of screening for postpartum depression during well-child visits.
What This Study Found A 2-step screening procedure may be an effective way to identify women with postpartum depression. Women would first complete a 2-item screening test, and those who test positive would complete a longer (9-item) questionnaire to confirm the results. Those who test positive for the second step would be advised to get further evaluation and treatment. The study finds that the 2-item screen is highly sensitive for identifying those with postpartum depression, meaning it did not miss any cases. The longer questionnaire is highly specific for identifying postpartum depression.
Implications
- This 2-stage approach could be easily administered in the primary care setting, especially compared with other screening approaches that require specialized training.
AAFP Guideline for the Detection and Management of Post-Myocardial Infarction Depression
Post-Myocardial Infarction Depression Clinical Practice Guideline Panel
Background As many as 65% of patients who have had a heart attack (or myocardial infarction) report symptoms of depression, and major depression is present in 15%-22% of these patients. A panel of the American Academy of Family Physicians systematically reviewed recent research on the effect of depression after a heart attack.
What This Study Found There is strong evidence for screening patients for depression after heart attack using a standardized symptom checklist. There is moderate to strong evidence for treatment to improve depression symptoms using selective serotonin reuptake inhibitors (SSRIs) and psychotherapy.
Implications
- The authors identify a need for further research to distinguish the symptoms and issues that are most related to depression after heart attack.
- In addition, research is needed to study treatment and results of depression in specific groups of heart attack patients, as well as the effect of depression on whether patients take medications and make recommended lifestyle changes following a heart attack.
Something in Nothing: Negative Space in the Clinician-Patient Relationship
Stephen A. Buetow
Background Negative space is an art term that refers to the space between or around subjects: if we ignore negative space, we risk seeing only what we expect to see, rather than what is there. Similarly, clinicians can easily miss the importance of how what is not present gives depth, perspective, and clues in patient visits. Being aware of negative space and looking carefully and without preconceptions can help clinicians strengthen their relationships with patients.