Index by author
The Issue in Brief
Diagnostic Value of Oral Prednisolone Test for Chronic Obstructive Pulmonary Disorders
Berna D. L Broekhuizen , and colleagues
Background A patient�s response to oral prednisolone, a corticosteroid drug, is sometimes used to help diagnose chronic obstructive pulmonary disorders. This study examined the added value of using oral prednisolone for this diagnostic purpose.
What This Study Found A response to oral prednisolone is suggestive of chronic obstructive pulmonary disease (COPD), but, when added to other diagnostic information, does not have relevant value for diagnosing or excluding COPD. Of 233 patients complaining of cough who were given a 14-day test treatment with oral prednisolone, researchers found those who responded to the treatment were more likely to have COPD than asthma. After adjusting for age, sex and smoking status, however, the association between prednisolone and COPD was no longer statistically significant.
Implications
- In light of the unwillingness of many patients to undergo the prednisolone test, the authors recommend against using it in the diagnostic workup when COPD is suspected.
Randomized Trial of Bulb Syringes for Earwax: Impact on Health Service Utilization
Richard Coppin , and colleagues
Background Millions of people seek medical care, including ear irrigation procedures, for problems with earwax, representing a significant health cost. Bulb syringes, a tool for self-treatment, are not widely available in the United Kingdom. In this UK study, researchers compared two treatment options�self-treatment with a bulb syringe and treatment in the clinic�and their effects on utilization of health services.
What This Study Found Of patients presenting with ears blocked with wax and subsequently cleared, those given a bulb syringe for self-use had about 50 percent fewer clinic visits for irrigation compared to the other group of patients.
Implications
- Self-treatment with drops and self-irrigation may offer a feasible alternative to clinic visits, saving time and cost. The authors estimate that, in the UK, encouraging the initial use of bulb syringes could, in the following two years, reduce the number of clinic irrigations by around 0.9 million.
Patients With Type 2 Diabetes at Risk for Major Depressive Disorder Over Time
Diana M. Naranjo , and colleagues
Background Depression is common among patients with type 2 diabetes. This study set out to identify characteristics that predict the onset of major depressive disorder (MDD) among primary care patients with diabetes.
What This Study Found Among 338 adult patients with type 2 diabetes, researchers found prior MDD and negative affect were the primary predictors of subsequent MDD. When stratified by negative affect, negative life events, elevated body mass index, and poor control of glycated hemoglobin also predicted MDD.
Implications
- Negative life events and patients� disease-related concerns are important when understanding what predicts MDD. The authors conclude that these variables combine to yield the negative emotional symptoms that predict MDD over time.
- When patients have moderate levels of increased depressive symptoms, it may be helpful to inquire about other life stressors and chronic disease management. Devoting attention to these factors may have a positive impact on patients' emotional status as well as their disease management.
Patients' Preferences for Ways to Communicate Benefits of Cardiovascular Medication
Felicity Goodyear-Smith , and colleagues
Background This study examined patient preferences for ways in which doctors communicate the benefits of taking medication to prevent cardiovascular disease.
What This Study Found Patients prefer a doctor give his or her opinion about the medication rather than explain the risks using numbers or pictures. Moreover, patients prefer visual depictions to words. Specifically, the study of 934 patients in Auckland, New Zealand, found 62 percent preferred to know what their doctor thinks about the medication, and 55 percent preferred pictorial presentations to numbers. Patients showed a strong preference for relative risk as a means of encouraging them to take preventive medication.
Implications
- Patients� willingness to take preventive cardiovascular medication depends more on the way in which treatment benefit is communicated than on their cardiovascular disease risk score or level of concern about a future cardiovascular episode.
- It is not possible to predict which mode of communication individual patients will prefer. As a result, the authors recommend clinicians use several methods and formats to communicate risk, matching information to the needs of individuals.
Mark C. Van der Wel , and colleagues
Background Office blood pressure measurement can be inaccurate as a result of white-coat effect (in which patients have high blood pressure in a clinical setting but not in other settings, perhaps resulting from anxiety) or other biases. Twenty-four hour blood pressure monitoring is often more accurate, but can be costly, difficult to implement, and not suitable for all patients. This study examined a new method of measuring office blood pressure through a series of automated measurements taken with the patient sitting alone in a quiet room.
What This Study Found Sitting for 30 minutes in a quiet room with automated blood pressure measurements is as useful in detecting white-coat hypertension as is 24-hour continuous blood pressure monitoring.
Implications
- The authors conclude that the automated 30-minute blood pressure measurement technique is a valid, useful, office-based alternative to 24-hour blood pressure monitoring, allowing physicians to overcome such problems as observer bias and the white-coat effect, while saving patients from the hassle of 24-hour monitoring.
Barbara T. Do , and colleagues
Background This study provides an update on US progress toward three objectives for arthritis management as part of the Healthy People 2010 initiaitive. These objectives encourage self-management education and clinician counseling for weight loss and physical activity among adults with doctor-diagnosed arthritis.
What This Study Found Clinicians have made significant progress in weight loss counseling of overweight and obese adults with arthritis. There has been no change, however, in the proportion of adults with arthritis who have taken a self-management education class or been counseled to engage in physical activity.
Implications
- The authors call for additional research to fully understand the obstacles and barriers faced by primary care physicians in meeting objectives for physical activity counseling and encouraging self-management education among patients with arthritis.
It�s Easier Said Than Done': Perspectives on Mammography for Women With Intellectual Disabilities
Joanne E. Wilkinson , and colleagues
Background Women with intellectual disabilities have equal rates of breast cancer compared with women in the general population but lower rates of mammography. This study explores the perceptions and understanding of mammography in women with intellectual disabilities.
What This Study Found Women with intellectual disabilities perceive mammography differently from women in the general population, and their perception is shaped by inadequate knowledge, anxiety, and inadequate preparation. In-depth interviews with 27 intellectually disabled women revealed that they feel poorly prepared for the procedure, not understanding its purpose or what to expect during the test. The latter was particularly upsetting to those interviewed and contributed to their negative perceptions of mammography. Participants reported feeling singled out for being unprepared despite their desire to have at least one mammogram like other women their age.
Implications
- The authors assert that women with intellectual disabilities need more time and explanation to understand and process elements of the experience. The women want to be perceived as competent, not disabled, which compounds the anxiety of unfamiliar situations. Increased familiarity with the test may facilitate the women's ability to complete mammography successfully and to return for subsequent screenings.
- The authors offer several recommendations for preparing intellectually disabled women for mammography, including allowing for extra time during the appointment so medical providers can describe the procedure, including details about where it occurs, how long it takes, and what the experience will be like, as well as a brief explanation of why it is necessary.
Catherine Hudon , and colleagues
Background Patient-centered care is widely acknowledged as a core value in family medicine. This systematic review examines existing research to identify and compare instruments, subscales, or items assessing patient perceptions of patient-centered care in family medicine.
What This Study Found Thirteen instruments measuring patients� perceptions of patient-centered care are available. Two of the instruments are dedicated to patient-centered care but are visit-based, limiting their applicability for the study of care processes over time, such as chronic illness management. The 11 remaining instruments provide only partial coverage of patient-centered care.
Implications
- As valid measures of perceptions of patient-centered care are applied within the patient-centered medical home organizing framework, researchers will be better able to determine how systems-level dimensions, such as accessibility and coordination of care, fit and whether they should be considered in a model of patient-centered care.
- Future research, including qualitative interviews with primary care patients, could help refine this conceptual model to better understand which dimensions are really patient centered, are most meaningful for patients, and may have an impact on long-term outcomes.
Physician Trust in the Patient: Development and Validation of a New Measure
David H. Thom , and colleagues
Background Although there are several measures of patient trust in the physician, this study describes the development and validation of the first measure of physician trust in the patient.
What This Study Found Developed as part of a community-based study of prescription opioid use for chronic pain in HIV-infected patients, the final 12-item scale demonstrated high internal consistency, a distinct 2-factor pattern, and both convergent and discriminant validity. The final measure, which is consistent with the limited published qualitative work on physician trust of patients, includes items asking about expectations that patients will behave in ways that fulfill their roles in providing accurate and complete histories, asking questions, following a treatment plan, and following up. It also includes respecting the physician�s boundaries and not manipulating the relationship for personal gain.
Implications
- The authors suggest that the new measure will provide a better understanding of the relationship between mutual trust and processes and outcomes of care leading to improvements in the quality of care and both patient and physician satisfaction.
Progress of Ontario's Family Health Team Model: A Patient-Centered Medical Home
Jack M. Colwill , and colleagues
Background In this special report, Canadian researchers detail the progress of Ontario�s Family Health Team (FHT) model, which serves nearly 2 million Ontarians, making it North America�s largest example of a patient-centered medical home.
What This Study Found Implemented in 2005, the FHT model is based on multidisciplinary teams and an innovative incentive-based funding system. Preliminary observations suggest high satisfaction among patients, higher income and more gratification for primary care physicians, and trends toward more medical students selecting careers in family medicine. Popular demand is resulting in expansion from 170 FHTs today to 200 FHTs in the near future.
Implications
- The authors suggest that the FHT model should be part of the solution for health system reform in both Canada and the United States.