Table of Contents
The Issue in Brief
Principles of the Patient-Centered Medical Home and Preventive Services Delivery
Jeanne M. Ferrante , and colleagues
Background The patient-centered medical home (PCMH) is being promoted as a means of making primary care practice, as well as US health care, more effective, efficient, and economical. PCMH principles include an ongoing relationship with a personal physician, care by a physician-directed team, whole-person orientation, coordinated care, quality and safety, enhanced access, and payment reform. This study examines the relationship between PCMH principles and receipt of preventive services in community primary care practices.
What This Study Found Patient-centered medical home principles, particularly relationship-centered aspects, are associated with higher rates of preventive services delivery in community primary care practices. Having more primary care visits and a well visit in the past 5 years had the greatest impact on the number of preventive services received. The only high-tech indicator that was significantly associated with receipt of preventive services was use of clinical decision-support tools.
Implications
- The authors suggest that PCMH demonstration projects and measurement tools focus more on "high-touch," relationship-centered qualities, which are shown to improve health care, rather than high-tech aspects of care.
Physician Office vs Retail Clinic: Patient Preferences in Care Seeking for Minor Illnesses
Arif Ahmed , and colleagues
Background Retail clinics are a new and fast-growing health care option in the US, offering cheaper and convenient alternatives to doctors' offices for minor illness and wellness care. This study examines the effects of cost of care and appointment wait time on patients' decisions about whether to seek care at retail clinics or doctors' offices.
What This Study Found Time and cost savings offered by retail clinics are attractive to patients, and patients are likely to visit them for care of minor illnesses if there are sufficient cost savings. Although patients prefer receiving care from a doctor at a private office, they will consider other options in order to save a sufficient amount of money. Appointment wait time is the most important factor in patients� care-seeking decisions.
Implications
- Because of the importance that patients place on appointment wait time, the authors suggest that primary care practices consider patient convenience features such as same-day scheduling, walk-in clinics and extended hours.
Jochen W.L Cals , and colleagues
Background Antibiotics are often overprescribed for patients with respiratory infections and rhinosinusitis. Measuring C-reactive protein, which increases quickly when an inflammation is present, can help determine which patients will benefit from antibiotic treatment. This study looks at whether C-reactive protein testing during patient visits for respiratory infections and rhinosinusitis helps clinicians make better prescribing decisions.
What This Study Found Testing for C-reactive protein during patient visits for respiratory infections and rhinosinusitis led to reduced antibiotic use and did not have a negative effect on patients' recovery. Patient satisfaction with care was higher when C-reactive protein testing was used.
Implications
- C-reactive protein testing during patient visits for respiratory infection and rhinosinusitis may be a useful strategy to decrease antibiotic use and increase patient satisfaction without compromising patient health.
Miranda A. L van Tilburg , and colleagues
Background Research has shown that adults who were abused as children are more likely to have unexplained gastrointestinal symptoms.This study investigated whether there is a relationship between abused children and development of gastrointestinal symptoms.
What This Study Found There is a high prevalence of unexplained abdominal pain and nausea/vomiting among children?both boys and girls?who have been abused. The study findings suggest that any type of abuse (sexual, psychological, and physical) has the potential to increase the risk of suffering from unexplained gastrointestinal problems.
Implications
- When treating at-risk children, clinicians should consider prior abuse when unexplained gastrointestinal symptoms are present.
Navkiran K. Shokar , and colleagues
Background Colorectal cancer is the second leading cause of cancer-related deaths in the United States. Discussing colorectal cancer screening is challenging, however, because multiple tests are recommended, and the tests are very different and complex. This study set out to better understand patient preferences and decision making about colorectal cancer screening options.
What This Study Found Patients are clear about the qualities that they prefer in a colorectal cancer screening test, but no one test has them. Preferences vary across individuals and are not predictable. When making decisions about colorectal cancer screening, patients consider test accuracy, scientific evidence of effectiveness, amount of colon examined, and need for sedation.
Implications
- Because patient preferences for colorectal cancer screening tests vary and are not predictable, clinicians should discuss all available screening tests with patients. They should be sure to address test accuracy, since this is an important element in patient decision making.
James M. Galliher , and colleagues
Background The Ask Me 3 health communication program encourages patients to ask specific questions during office visits in order to improve understanding of their health conditions and adherence to treatment recommendations. This study evaluates whether Ask Me 3 improves patients� question-asking behavior and increases adherence to prescription medications and lifestyle recommendations.
What This Study Found In this study, the Ask Me 3 program showed no effect on either questioning by patients or adherence to advice. The authors suggest this finding may be because participating patients already asked questions at high rates and had fairly high levels of adherence to treatment recommendations.
Implications
- Further study of Ask Me 3 may be useful in practices with lower rates of question-asking and adherence to treatment.
Bradley N. Gaynes , and colleagues
Background Mood and anxiety disorders are the most common psychiatric conditions seen in primary care, yet they remain underdetected and undertreated. This study tests the M-3 checklist, a new 1-page, patient-rated, 27-item tool developed to screen for multiple psychiatric disorders in primary care.
What This Study Found A 1-page, 27-item checklist that can be completed in a few minutes accurately indicates whether a patient has any of 4 common psychiatric illnesses, including major depression, bipolar disorder, anxiety disorder, and post-traumatic stress disorder. Testing showed the checklist was as accurate as currently used screening instruments that test for single disorders.
Implications
- Primary care clinicians need to consider multiple psychiatric disorders among their patients, rather than just depression or anxiety alone. The M-3 potentially can reduce missed psychiatric diagnoses and facilitate proper treatment of identified cases.
Hassan Soubhi , and colleagues
Background Caring for patients with multiple chronic health conditions is complex and challenging. In this article, researchers propose a primary care practice model for caring for patients with multiple chronic illnesses.
What This Study Found In the proposed model, practices form open, constructive communities of practice in which they define common goals and concrete care plans and engage in reflective cased-based learning and practice. The model is based on (1) the importance of relationships among clinicians in delivering effective patient-centered care and (2) the flexibility gained from constant assessment and case-based learning.
Implications
- Caring for patients with multiple chronic conditions is an opportunity to improve on existing care models based on ongoing learning and continual evaluation. Research is needed to test the added value of communities of practice in primary care.