Index by author
The Issue in Brief
May/June 2012
Health Coaching to Improve Hypertension Treatment in a Low-Income, Minority Population
Thomas Bodenheimer, and colleagues
Background Home blood pressure monitoring has been shown to improve control of hypertension (high blood pressure). This study examines whether, in a low-income population, health coaching with in-home adjustment of antihypertensive medications can improve blood pressure control compared to health coaching alone.
What This Study Found Blood pressure control in a low-income population can be improved by teaching patients to monitor their blood pressure at home and having nonprofessional health coaches assist patients, in particular by counseling them on medication adherence. More coaching visits are associated with greater reduction in blood pressure.
Implications
- Improved blood pressure control can be achieved while reducing the time spent by physicians.
- These findings add to the evidence that team-based interventions can improve hypertension control.
Healthy Steps Trial: Pedometer-Based Advice and Physical Activity for Low-Active Older Adults
Gregory S. Kolt, and colleagues
Background In New Zealand, the Green Prescription is a nationally supported intervention to increase physical activity, encouraging participants to take part in 30 minutes of moderate activity per day. This study compares the effectiveness of a pedometer-based Green Prescription with the current time-based program.
What This Study Found A recommendation for physical activity with pedometer monitoring results in a greater increase in leisure walking among older adults than a Green Prescription that relies only on time-based goals. Among 330 older adults with low levels of physical activity, leisure walking increased by 50 minutes a week among the pedometer-based Green Prescription group compared with 28 minutes a week among the standard Green Prescription group. For both groups, there were significant increases in physical activity that were largely maintained throughout the 12-month study period. Body mass index did not change in either group, but significant improvements in blood pressure were observed for both groups.
Implications
- Pedometers may improve the efficacy of the activity prescription by providing regular objective monitoring and feedback to assist motivation.
Involving the Health Care System in Domestic Violence: What Women Want
Jumana Antoun, and colleagues
Background Despite increasing interest in addressing domestic violence in the Arab world, research is limited. This study explores Lebanese women's opinions and attitudes about the role of primary health care clinics in addressing domestic violence.
What This Study Found Most participants encourage the health care system's involvement in managing domestic violence and consider it to be a socially acceptable way to break the silence around the issue. Participants do not believe that the health care system alone can reduce or end domestive violence and recommend community interventions, such as public awareness and media campaigns to change knowledge, attitudes, beliefs, and social norms.
Implications
- This study breaks new ground by reflecting Arab women's voices about the health care system's role in identifying and intervening with domestic violence.
Typical Electronic Health Record Use in Primary Care Practices and the Quality of Diabetes Care
Jesse C. Crosson, and colleagues
Background It is widely expected that use of electronic health records (EHRs) will lead to improvements in health care safety, quality, and efficiency. This study analyzes diabetes care outcomes in practices that use an EHR compared with those using paper records.
What This Study Found Over a 3-year period, practices using an EHR did not make more rapid quality improvements than practices using paper records and, after 2 years, had poorer diabetes care quality.
Implications
- Having an EHR as opposed to a paper-based record keeping system does not guarantee better care.
- Adopting an EHR requires corresponding changes in work processes and ways of thinking about care that lead to improvements in chronic illness management.
Effect of a UK Pay-for-Performance Program on Ethnic Disparities in Diabetes Outcomes: Interrupted Time Series Analysis
Riyadh Alshamsan, and colleagues
Background The Quality and Outcomes Framework (QOF) is a UK pay-for-performance program that rewards general practitioners for achieving preset targets. This study examines the QOF's impact over time on ethnic disparities in diabetes outcomes.
What This Study Found When the QOF was introduced, there were initial accelerated improvements in systolic blood pressure in white and black patients, but these improvements were sustained only in black patients. Initial improvements in diastolic blood pressure in white patients and in cholesterol levels in black and white patients were not sustained after QOF was introduced. There was no beneficial impact of QOF on hemoglobin A1c levels in any ethnic group, and existing disparities in risk factor control remained largely intact at the end of the study period.
Implications
- Targeted quality improvement strategies may be required to address disparities in chronic disease management.
Intraclass Correlation Coefficients Typical of Cluster-Randomized Studies: Estimates From the Robert Wood Johnson Prescription for Health Projects
David M. Thompson, and colleagues
Background Research conducted in practice-based research networks often randomizes interventions, not by individuals, but according to a natural clustering unit, such as the physician or the practice in which patients receive care. Researchers who conduct cluster-randomized studies must explicitly account for clustering at every stage of design and analysis to avoid underpowered studies. This requires good estimates of clustering effects in the form of intraclass correlation coefficients (ICCs). This study uses data from the Robert Wood Johnson Foundation's Prescription for Health program to estimate ICCs for demographic and behavioral variables and for physician and practice characteristics.
What This Study Found The authors analyzed data from 5,042 patients in 61 practices and 8 practice-based research networks. They found that ICCs for certain measures of health behavior and intent to change those behaviors are small, generally less than 0.1. Clustering is less evident for outcome variables than for other independent and process variables.
Implications
- Though small, the ICCs in this report are not trivial; if cluster sizes are large, even small levels of clustering, if unaccounted for, can reduce a study's statistical power.
Intranasal Corticosteroids in Management of Acute Sinusitis: A Systematic Review and Meta-Analysis
Gail Hayward, and colleagues
Background Acute sinusitis is often treated with antibiotics, although there is little evidence for their benefit. This analysis of existing research examines the effects of intranasal corticosteroids on acute sinusitis symptoms.
What This Study Found After 14 to 21 days of intranasal corticosteroid use, patients show a small increase in the resolution or improvement of symptoms; the most consistently significant benefits are relief of face pain and congestion. The effect is most marked when patients are given longer durations of treatment (21 days) and higher doses of medication.
Implications
- The authors call for additional research comparing intranasal corticosteroids with placebo and without antibiotics to clarify the time-course of clinical benefit and the impact on work and quality of life.
Communities of Solution: The Folsom Report Revisited
Kim S. Griswold, and colleagues
Background The fragmented US health system lacks a policy blueprint for systematic implementation of integrated, community health services. The 1967 Folsom Report, which called for more comprehensive health care, can help guide reform efforts and maximize the potential of health information technology.
What This Study Found The Folsom Report suggested that the boundaries of communities be those "within which a problem can be defined, dealt with, and solved" and referred to this concept as a Community of Solution. From the Folsom Report's original 14 positions, the authors have produced an updated series of 13 grand challenges to facilitate nationwide integrated patient-centered community health services. The renewal of the Folsom Report's Community of Solution concept serves as the anchor point for improving overall health, decreasing health costs, and focusing on local decision making.
Implications
- The authors call for health care professionals, public health organizations, community groups, and policy makers to actively partner with communities to transform personal and population health.
Rewarding Healthy Behaviors�Pay Patients for Performance
Joanne Wu
Background This essay calls for a pay-for-performance program that rewards patients directly for achieving evidence-based health goals. Rewards in the form of discounts towards co-payments for doctor's visits, procedures, and medications could reduce cost and compliance issues, foster a stronger partnership between doctors and patients, and improve health outcomes. Funding for the program would come from insurance companies, employers, pharmaceutical companies, and the government. The author asserts that the current system, which places the responsibility and reward for quality of care on physicians, is paternalistic and neither cost-effective nor sustainable. Patients deserve a greater role in improving their wellness and reaping the rewards from it.
The Joy of Family Practice
William Ventres
Background In this essay, the author explores his fulfillment as a family physician. He reflects on the roles of love, faith, mystery, place, dance, and medicine in the personal joys he has received from family medicine.