Index by author
The Issue in Brief
Training Residents in Community Health Centers: Facilitators and Barriers
Carl G. Morris , and colleagues
Background The ability of community health centers (CHCs) to care for of the underserved is limited by a shortage of family physicians. Training family medicine residents in community health centers may provide one solution to this shortage. This study set out to identify benefits and facilitators that contribute to affiliations between CHCs and family medicine residency programs, as well as solutions that would facilitate improvement in future partnerships.
What This Study Found The affiliation between CHCs and family medicine residencies is a complex relationship that includes a shared mission of service to the underserved, a need to improve financial stability, and improved educational and clinical quality; it is hindered by governing institutional regulations and administrative challenges. A successful partnership relies on the development of a shared mission of education and service, as well as innovation and flexibility by the organizations that govern them.
Implications
- The affiliation between CHCs and family medicine residencies may continue to provide excellent training for physicians interested in caring for the underserved. Without changes in governance and financing, however, the workforce needs of safety net settings are unlikely to be met.
Cost to Primary Care Practices of Responding to Payer Requests for Quality and Performance Data
Jacqueline R. Halladay , and colleagues
Background Primary care practices are increasingly required to participate in quality improvement (QI) programs. This study set out to determine the cost to practices of participation in programs requiring them to gather and report data on care quality indicators.
What This Study Found Responding to payer requests for quality and performance data can be costly for primary care practices, with estimated costs of implementation ranging from less than $1,000 to $11,100 per practitioner, and maintenance from less than $100 to $4,300 per year. Researchers found substantial variation among the four reporting programs studied in the way measurement data elements are defined, gathered, and transmitted. Major expenses included personnel time for planning, training, registry maintenance, visit coding, data-gathering, and entry.
Implications
- The authors recommend that quality improvement programs choose their performance measures judiciously.
- QI programs should consider offering financial incentives that allow practices to at least recoup their costs, as well as other motivators such as computer skills training, assistance with electronic system challenges, and quality improvement training for staff.
A Medical Assistant-Based Program to Promote Healthy Behaviors in Primary Care
Robert L. Ferrer , and colleagues
Background Most primary care patients have at least one of four major health risk behaviors: smoking, risky drinking, low physical activity, or unhealthy diet. This study sought to determine the effectiveness of a medical assistant-driven program to screen for the unhealthy behaviors, arrange appropriate interventions, and ultimately reduce unhealthy behaviors.
What This Study Found The medical assistant program was much more effective than usual care at linking patients with interventions, more than doubling the proportion of patients referred. Despite the process improvement, however, the program did not succeed in changing any of the four health behaviors.
Implications
- The study results underscore the difficulties in changing health behaviors.
- The authors call for more professional development for medical assistants taking on expanded roles, as well as further work in developing systems to support long-term improvements in patients� behaviors.
Jochen Gensichen , and colleagues
Background With health care assistants (HCAs) playing an increasingly prominent role in primary care practices, researchers in Germany sought to understand how HCAs who provide case management for depressed patients felt about their new and expanded roles.
What This Study Found HCAs found their case management work personally and professionally enriching. They also, however, experienced limited capacity for the increased workload and the challenges that came with working with depressed patients.
Implications
- Before shifting depression case management to HCAs, practices should appropriately train future case managers for the job, clearly define case management tasks to prevent overburdening, acknowledge the increased workload associated with these tasks, and provide additional financial compensation for the new responsibilities.
A Community Intervention to Decrease Antibiotics Used for Self-Medication Among Latino Adults
Arch G. Mainous III , and colleagues
Background Recent findings from Latino communities suggest that self-medication using antibiotics obtained without a prescription is common. The goal of this study was to implement and evaluate a culturally sensitive educational program to decrease self-medication with antibiotics in the Latino community.
What This Study Found A year-long multimedia campaign was not effective in decreasing the high incidence of acquiring antibiotics without a prescription among Latinos in a South Carolina community. Although most of the 250 adults surveyed had read or heard something on the radio about the appropriate use of antibiotics, this did not lead to differences in attitudes toward nonprescription antibiotics or having bought them in the last 12 months. Immigrants who had previously purchased antibiotics without prescription in their home country indicated they were likely to continue this practice in the United States.
Implications
- These results suggest that usual forms of health education may not be adequate to overcome the strong influence of past behavior. Successful programs may need to incorporate education about the reasons why antibiotics are regulated in the United States.
Early Abortion in Family Medicine: Clinical Outcomes
Ian M. Bennett , and colleagues
Background There has been little research assessing early abortion outcomes in family medicine. This study aims to determine success rates of abortion procedures by family physicians, identify the nature and severity of adverse outcomes/complications, and assess the ability to manage complications on site.
What This Study Found The rates of complications of first-trimester abortion care in family medicine clinical sites are very low and within the range of outcomes published for obstetric-gynecology and specialty abortion sites. Assessing the outcomes of 1,309 medication and 1,149 aspiration abortion procedures among family physicians in four residency training programs and one private practice, researchers found 96.5 percent of the medication and 99.1 percent of the aspiration abortions were successful. Less than 4 percent of either the medication or aspiration abortions had any related complications, and most complications were minor and managed within the family medicine practices without reliance on emergency services or those of specialists.
Implications
- The authors suggest that family physicians who provide early abortion care can promote continuity of care within the context of the medical home and may help to ameliorate abortion provider shortages across the United States.
- The study calls for initiatives to bring first-trimester abortion training into family medicine settings.
Mary Patricia Nowalk , and colleagues
Background Vaccination rates are relatively low in disadvantaged urban populations. This study was designed to (1) examine physician characteristics and office systems that are associated with vaccination rates among the elderly; and (2) account for variation in vaccination levels among physicians.
What This Study Found Analyzing data for 2,021 patients aged 65 years and older receiving care in 17 different practices, researchers found that PPV (pneumococcal polysaccharide vaccine) and influenza vaccination rates varied widely across individual physicians. Longer reported well-visits and enhanced vaccine documentation were associated with vaccination for PPV. The use of standing orders and average physician examination room time were associated with vaccination for influenza.
Implications
- The authors conclude that given the difficulty in increasing physician visit time, particularly in health professional shortage areas that often occur in disadvantaged urban communities, enhanced vaccination documentation using flow sheets or electronic medical records, and standing orders may be the most feasible ways to increase vaccination rates.
Undisclosed Changes in Outcomes in Randomized Controlled Trials: An Observational Study
Robert Ewart , and colleagues
Background Changing the outcomes of a clinical trial, without explanation, calls its validity into question. This study examines how often outcomes are changed between trial registration and final publication.
What This Study Found Authors frequently change the outcomes of clinical trials between trial registration and publication without explanation or disclosure. Analyzing 110 randomized controlled trials published in consecutive issues of five major medical journals in a six-month period and their associated trial registry entries, researchers found that a primary outcome had been changed in 34 (31 percent) of the articles and a secondary outcome was changed in 77 (70 percent) without disclosure.
Implications
- The authors assert that allowing researchers to change their outcomes without reason or disclosure threatens the underpinnings of the scientific enterprise and the ability of practicing physicians to apply published research to patient care.
James M. Galliher , and colleagues
Background The most systematic studies concerning primary care have been conducted in practice-based research networks. This study examined the extent to which physicians in the American Academy of Family Physicians National Research Network (AAFP NRN) are representative of the larger population of family physicians with respect to their self-reported clinical practices, behaviors, knowledge and beliefs about selected clinical issues.
What This Study Found Based on the results of three separate surveys, the study finds that physician members of the American Academy of Family Physicians National Research Network are representative of family physicians at large in terms of self-reported practice patterns, knowledge and clinical beliefs.
Implications
- This study helps support the potential generalizability of PBRN findings.
Accuracy of Monofilament Testing to Diagnose Peripheral Neuropathy: A Systematic Review
Jacquelien Dros , and colleagues
Background This systematic review evaluates monofilament testing for diagnosis of peripheral neuropathy of the feet, a condition that causes numbness or a complete loss of sensation.
What This Study Found Despite frequent recommendations for use of the test, researchers conclude that existing data are limited in their ability to draw conclusions about its accuracy because of a lack of diagnostic studies with adequate methods.
Implications
- The authors recommend against the sole use of microfilament testing to diagnose peripheral neuropathy.