Table of Contents
The Issue in Brief
Causes of Persistent Dizziness in Elderly Patients in Primary Care
Otto R. Maarsingh , and colleagues
Background Although dizzy patients are usually seen in primary care settings, most diagnostic studies of dizziness have been performed in secondary or tertiary care settings. This study assesses causes and types of dizziness in elderly primary care patients.
What This Study Found Cardiovascular disease was the most common major cause of dizziness, followed by peripheral vestibular disease and psychiatric illness. The most common minor contributory cause of dizziness was an adverse drug effect. In a large proportion of patients, there was more than one cause of dizziness.
Implications
- Primary care clinicians should consider multiple causes when treating dizzy patients.
Psychosocial Effects of Physical and Verbal Abuse in Postmenopausal Women
Charles P. Mouton , and colleagues
Background Although researchers have examined the physical effects of abuse on older women, there has been little research into the psychological effects of abuse. This study examines the psychological effects of physical and verbal abuse on older women.
What This Study Found Older women who have been exposed to abuse have worse mental health than nonabused women. In this study, abused women had more symptoms of depression, greater social strain, and lower optimism. Exposure to verbal abuse only, without physical abuse, had greater psychological effects than physical abuse alone.
Implications
- Detecting and alleviating abusive situations may have significant beneficial effects on the mental health and quality of life of older women.
- Clinicians should consider possible exposure to abuse in older female patients with depression.
Ngaire Kerse , and colleagues
Background Both poor physical functioning and low levels of social contact can contribute to depression in older people. This study tested a home-based physical activity program that included social visits.
What This Study Found Social visiting was just as successful as a home-based physical activity program at improving mood and quality of life. The study involved 193 people aged 75 and older with depressive symptoms recruited from primary care practices in Auckland, New Zealand. Those who received an individualized physical activity program as well as those who received social visits showed improvements in quality-of-life measures related to mood and mental health.
Implications
- Social contact may be as effective as physical activity in improving mood and quality of life for those with depressive symptoms.
Reinvention of Depression Instruments by Primary Care Clinicians
Seong-Yi Baik , and colleagues
Background Many instruments have been developed to help diagnose depression and evaluate its treatment. This study looks at how and why primary care clinicians use depression screening instruments in their practices.
What This Study Found Primary care clinicians report using depression-screening instruments when they need to persuade a patient to accept a diagnosis of depression, when they lack time, or when they do not fully understand the patient�s social and relational life. They rarely use depression instruments for screening purposes or for monitoring the treatment of depression.
Implications
- Clinicians have reinvented depression screening instruments to deal with a real-world problem: convincing patients, believed to be depressed, that they are depressed and developing a shared agenda for treatment. This negotiation process is overlooked by current guidelines for depression, yet primary care clinicians see it as one of the greatest burdens they face.
- Additional research is needed to help foster efficient depression care processes for real-world primary care practice.
Managing Depression Among Ethnic Communities: A Qualitative Study
John Furler , and colleagues
Background This study reports on how family physicians experience working with patients from different ethnic minority communities in recognizing and caring for depression.
What This Study Found Working across cultural differences--with both biomedical and social models of depression and at both the community and individual levels--is not a barrier to high-quality care, but rather a central element of that care. Family physicians in this study negotiated across differences in ethnicity, culture, and language using a sensitive, implicit process.
Implications
- Family physicians provide a unique form of depression care that includes dealing with difference.
- Future research should explore the process of negotiating difference as part of depression care and its relationship to clinical outcomes and physician and patient characteristics.
David I. Buckley , and colleagues
Background Opioid medication is a controversial treatment for chronic noncancer pain. Prescribing opioids can be time consuming and may detract from other aspects of clinical care. This study examines whether patients who receive opioid therapy for noncancer pain are less likely than other patients to receive preventive services during primary care office visits.
What This Study Found Patients receiving chronic opioid therapy for noncancer pain are less likely to receive some preventive services, particularly screening for cervical or colorectal cancer.
Implications
- Providing appropriate preventive services for patients with chronic pain may present particular challenges.
- Future research should explore the relationships between chronic noncancer pain, chronic opioid therapy, and preventive care to help ensure that patients with chronic pain receive preventive services.
Trends in Well-Child Visits to Family Physicians by Children Younger Than 2 Years of Age
Donna Cohen , and colleagues
Background There was a significant decline in the provision of prenatal services by U.S. family physicians between 1995 and 2004. Did family physicians care for fewer children as a result of this decline? This study sought to answer that question.
What This Study Found Family physicians continued to provide a stable share of well-child care in the first 2 years of life, despite a decline in prenatal services. Between 1995 and 2007, the percentage of well-child visits to family physicians for children younger than 2 years of age remained stable at 15%.
Implications
- This finding challenges the longstanding belief that a reduction in maternity care is associated with a reduction in care for children.
M. Diane McKee , and colleagues
Background Obesity in children is a growing public health concern. This study evaluates parents' reactions to a program that addresses risk behaviors for obesity among urban preschool children. In the program, doctors incorporate family lifestyle change and goal setting into pediatric preventive care visits.
What This Study Found Parents welcome doctors� efforts to address family lifestyle change to prevent obesity in their childrens' preventive visits. Study participants welcomed family-centered goal setting for obesity-related risk behaviors, and were accepting of referral to a health educator for behavior change counseling. The study found sometimes overwhelming barriers to change in the low-income urban setting, such as complex family dynamics around control of resources and generational conflict and cultural beliefs about food. Parents expressed frustration with doctors for offering advice about changing behavior but not how to achieve it, for dismissing concerns about picky eating or undereating, and in some cases for labels of overweight, which they believe were inappropriately applied.
Implications
- Doctors may need help to deliver some health behavior change messages effectively.
- The authors suggest that behavior change messages should focus on raising healthy children rather than preventing obesity.
Julie A. Schmittdiel , and colleagues
Background Translational research is the application of research findings to medical treatment or daily clinical practice. This essay proposes that translational research can be strengthened by applying principles of community-based participatory research, which emphasizes partnership between community members and researchers. Participatory research methods, such as engaging in collaborative partnerships, building on existing community strengths, investing in long-term relationships, and engaging in research as a cyclical, iterative process, increases the likelihood that research questions will be relevant, interventions will be sustainable, and research findings will be translated into systematic action.
Beneficent Persuasion: Techniques and Ethical Guidelines to Improve Patients� Decisions
J.S. Swindell , and colleagues
Background Patients often make choices that work against their long-term goals (such as smoking) or that run counter to evidence and the clinician�s best judgment. Using concepts from behavioral economics, this essay argues that it is often ethical for physicians to rebias patients in ways that promote their health or other long-term goals.
Journey During Acute Ischemic Stroke: A Physician�s Experience
Vijay K. Sharma , and colleagues
Background A practicing radiologist in Singapore relates his experience as a patient undergoing treatment for acute ischemic stroke and reflects on how that experience changed him and his attitude toward his practice and his patients. He concludes that while effective treatment requires great aptitude and appropriate use of high-tech diagnostic treatment tools, it also requires talking with patients and families, sharing and showing emotions, and offering words of encouragement.