Index by author
The Issue in Brief
Jul/Aug 2011
Consumption of Tea and Coffee and MRSA Nasal Carriage
Eric M. Matheson, and colleagues
Background Infection with MRSA (methicillin-resistant Staphylococcus aureus) is a major source of illness and death, and nasal carriage of MRSA may increase the risk of MRSA infection. This study examines the relationship between drinking tea and coffee and MRSA nasal carriage.
What This Study Found Drinking hot tea or coffee is associated with a decreased likelihood of MRSA nasal carriage.
Implications
- Drinking coffee or hot tea may modify the risk of MRSA nasal carriage and, potentially, the risk of MRSA infection.
Severity of Depression and Magnitude of Productivity Loss
Arne Beck, and colleagues
Background Depression is related to lowered work functioning, including absence from work, less productivity, and difficulty retaining a job. This article reports on the relationship between severity of depression symptoms and functioning at work.
What This Study Found As depression symptoms become more severe, productivity loss increases. Even minor levels of depression are associated with lost productivity at work.
Implications
- Employers may find it beneficial to invest in depression management programs for employees at all levels of depression severity.
Placebo Effects and the Common Cold: A Randomized Controlled Trial
Bruce Barrett, and colleagues
Background This study investigates how simulated real-life conditions (not taking a pill vs taking a named known pill) compares with the conditions of a conventional randomized controlled research trial. In particular, the study assesses 2 kinds of pill-related placebo effects in treating common cold (no pill vs blinded placebo and blinded vs open-label treatment), as well as potential effects of doctor-patient interaction.
What This Study Found There are modest and nuanced effects related to receiving pills regardless of their content, especially among those who believe in a particular therapy. The 4-armed trial (no pill, placebo, echinacea blinded and echinacea unblinded), which included 719 randomized participants aged 12 to 80 years, revealed that patients randomized to the no-pill group had longer and more severe illnesses than those who received pills, regardless of the pills' content. Among those who believed in the efficacy of echinacea and received pills, illnesses were shorter and less severe, regardless of whether the pills contained echinacea.
Implications
- Based on these findings, which suggest small but meaningful effects related to expectation and pill allocation, the authors conclude that patients' beliefs and feelings about treatments should be taken into consideration when making medical decisions.
Patient-Reported Care Coordination: Associations With Primary Care Continuity and Specialty Care Use
David T. Liss, and colleagues
Background There is a growing need to coordinate medical care between primary care clinicians and specialists, patients, payers, and professional organizations. This study investigates the association between primary care continuity (the concentration of visits to primary care clinicians) and coordination by primary care clinicians.
What This Study Found When elderly patients with chronic conditions receive large amounts of outpatient specialty care, the ability of primary care clinicians to coordinate care in the traditional office setting seems to diminish. Analyzing data on 2,051 Medicare enrollees with select chronic conditions, researchers find a positive association between continuity and coordination for patients with low levels of specialty care use, but not for patients who utilize specialty care at high levels.
Implications
- Coordinating care for an aging population with high levels of specialty care use entails additional work for primary care practices and strains their ability to effectively coordinate patient care.
- The authors call for new methods of care provision that preempt gaps in continuity and coordination that may result from high specialty use.
Effect of e-Learning and Repeated Performance Feedback on Spirometry Test Quality in Family Practice: A Cluster Trial
Tjard R. Schermer, and colleagues
Background Spirometry, a tool for measuring lung function, can be used to diagnose and monitor chronic respiratory conditions. This study investigates whether e-learning, followed by bimonthly performance feedback, improves the quality of spirometry tests in family practices.
What This Study Found In the course of 1 year, a combination of e-learning and repeated feedback had a small and late effect on the quality of spirometry tests performed by family medicine nurses.
Implications
- This intervention does not seem to compensate for a lack of rigorous training and experience in performing spirometry tests. The authors suggest exploring other models to provide family medicine practices with good-quality spirometry tests.
Childhood Nonspecific Abdominal Pain in Family Practice: Incidence, Associated Factors, and Management
Marieke J. Gieteling, and colleagues
Background Abdominal pain is a common complaint in children and is not usually associated with disease. Little is known about primary care treatment of nonspecific abdominal pain (NSAP, that is, abdominal pain unrelated to disease). This study examines treatment of childhood NSAP by family physicians.
What This Study Found This common complaint is usually resolved in 1 to 2 visits without diagnostic tests or referral to a specialist. Despite the lack of evidence for effectiveness, family physicians frequently prescribe laxatives and antidepressants for these patients. Analyzing data from the Second Dutch National Survey of General Practice, researchers found NSAP has an incidence rate of 25 per 1,000 person years, making it 1 of the 10 most commonly seen complaints of children in Dutch family practice. In the study's 1,480 children with newly diagnosed NSAP, less than 7% consulted more than twice for the problem. Family physicians referred these patients to specialist care in only 5% of visits, and they prescribed medication in 21%.
Objective Measurement of Sociability and Activity: Mobile Sensing in the Community
Ethan M. Berke, and colleagues
Background Health behavior data are often collected in laboratory settings or through surveys or self-reports, but these measures have a number of limitations. Mobile sensing of health behavior in the patient's natural environment over extended periods of time holds promise for clinicians, patients, and researchers. This study tests an automated behavioral monitoring system for sensing, recognizing, and presenting a range of physical, social, and mental indicators of well-being in natural everyday settings in older adults.
What This Study Found The study offers a provocative glimpse into the possibilities of wireless mobile technology to measure elderly patients' physical activity and social interactions and improve detection of changes in their health. Sensors on a waist-mounted wireless mobile device worn by 8 patients aged 65 years and older continuously measured patients' time spent walking level, up or down an elevation, and stationary (sitting or standing), and time spent speaking with one or more other people. Data from the mobile sensors correlated highly with results obtained using four established questionnaires. Moreover, study participants found the device easy to use, comfortable to wear, and more convenient than written questionnaires, which rely on recall and are more prone to biases.
Implications
- Automated inference of behavior using commonly available mobile devices is potentially feasible and valid in older populations.
- Data obtained through mobile sensing could potentially link to patients' electronic health records, providing clinicians a rich source of information that could alert them of changes in a patient's behavior before it is identified by family or caregivers.
Electronic Health Records vs Medicaid Claims: Completeness of Diabetes Preventive Care Data in Community Health Centers
Jennifer E. DeVoe, and colleagues
Background Measuring rates of receipt of recommended services is an important part of health care quality assessment efforts. This study examines the congruence between Medicaid insurance claims and electronic health record (EHR) data in a network of community health centers.
What This Study Found In this study, EHR data provide a more comprehensive picture of preventive services delivery than Medicaid claims data. The following services were documented in EHRs but not in Medicaid claims: 49% of cholesterol screenings, 50% of influenza vaccinations, 50% of nephropathy screenings, and 48% of glycated hemoglobin tests.
Implications
- Medicaid claims data are likely to substantially underestimate the quality of care.
- The authors call for researchers, policy makers, and payers to combine EHR and claims data sources to get the most complete picture of health services delivery, especially for populations who are not continuously insured.
COOP/WONCA Charts as a Screen for Mental Disorders in Primary Care
Joao Mazzoncini de Azevedo-Marques, and colleagues
Background Questionnaires can be used to facilitate the screening of mental disorders in the primary care setting. This study evaluates the validity and feasibility of the COOP/WONCA Charts, a brief 6-item pictorial assessment for routine screening of mental disorders, by comparing it with other validated questionnaires and the assessment of a mental health specialist using structured diagnostic interview.
What This Study Found The COOP/WONCA Charts is valid and feasible for use by primary health care teams in screening for mental disorders. When administered to 120 primary care patients, the tool had accuracy, sensitivity, specificity, and predictive values ranging between 0.77 and 0.92 compared with previously validated questionnaires. Clinicians who administered the questionnaires rated its understandability, ease of use, and clinical relevance as satisfactory.
Implications
- Because the tool is friendly, brief, easily understood and can be administered and scored by all team members, it is a useful screening tool for the primary care setting, where there are many competing demands and time constraints.
Personalized Medicine and Tobacco-Related Health Disparities: Is There a Role for Genetics?
Chris Carlsten, and colleagues
What This Study Found Genetic approaches have been proposed as a means to improve the effectiveness of interventions to stop smoking. This essay argues that although genetics offers opportunities to tailor drug treatment and provide risk prediction, the most promising approaches for stopping smoking include efforts to improve smokers' access to health care and to tools that are known to help them quit. This is particularly true, according to the authors, among disadvantaged populations, who constitute the majority of smokers. Methods of personalizing health care using existing community- and individual-based tools are more likely than genetics to yield greater benefit for decreasing smoking-related health disparities.