Index by author
The Issue in Brief
Testing to Prevent Colon Cancer: Results From a Rural Community Intervention
John M. Westfall , and colleagues
Background Colon cancer is the second leading cause of cancer death in the United States, but rates of colon cancer screening are low. This study examined a community-based participatory approach to increase colon cancer screening in rural northeast Colorado.
What This Study Found The program, which included educational and motivational materials disseminated through local newspapers and other targeted outlets (eg, auction flyers and community organizations), successfully engaged community members and resulted in a modest, though not statistically significant, increase in overall colon cancer screening. Researchers with the High Plains Research Network found a 5 percent increase in the proportion of respondents who reported ever having had any test in the intervention communities compared with no increase among control counties in southeast Colorado. They also found the extent of exposure to intervention materials was associated with a significant and cumulative increase in screening. Community members who reported seeing five or more products were significantly more likely to report having ever been tested or being up to date for colon cancer screening than those who had seen only one component.
Implications
- The authors conclude that the findings provide preliminary evidence for the effectiveness of a multicomponent community approach to improve colon cancer screening.
Lydie A. Lebrun-Harris , and colleagues
Background The patient-centered medical home (PCMH) is a team-based approach to patient care. Several PCMH transformation projects are underway in US federally supported community health centers to improve quality of care. This study assesses patient ratings of PCMH attributes and overall quality of care within health centers.
What This Study Found Patients in community health centers generally report high quality of care, according to data from a nationally representative survey of more than 4,500 patients. Eighty-four percent of patients surveyed reported excellent or very good overall quality of services; 81 percent reported excellent or very good quality of clinician care; and 84 percent said they were very likely to refer friends and relatives. Higher patient ratings of access to care and patient-centered communication were associated with higher odds of positive ratings of care.
Implications
- Clinicians seeking to improve patients' overall perceptions of health care experiences should focus on improving patients' access to care before and during the visit and on promoting clinician and support staff communication skills, according to the authors.
Patients' Experiences in Different Models of Community Health Centers in Southern China
Harry H. X. Wang , and colleagues
Background China is developing and expanding primary care networks based on community health centers (CHCs). In urban areas, different models of ownership and management of CHCs have emerged. This study evaluated the relationship between three different models of CHCs and the quality of primary care services provided with regard to key attributes of primary care.
What This Study Found Government-owned and -managed community health centers have better patient-reported first-contact care and coordination of care than health centers managed by hospitals or by private and social entities. The survey of 1,440 patients of community health centers in China's Pearl River Delta found government-owned and -managed centers have the highest overall scores when compared with centers either managed by hospitals or owned by private and social entities as a result of better first-contact care and coordination of care.
Implications
- Government-owned and managed centers may be better able to solve one of the key challenges facing health care reform efforts in China -- the problem of underutilization of community health centers as the first-contact point of care.
The Enduring Impact of What We Say to People With Low Back Pain
Ben Darlow , and colleagues
Background Psychosocial factors are important in the development of low back pain and disability. Depression, passive coping strategies, fear avoidance, and expectations of low recovery are associated with poor low back pain outcomes. This study explores the formation and impact of attitudes and beliefs among people with low back pain.
What This Study Found Although patients with low back pain consult the Internet, family, and friends for information and understanding of their symptoms, health care professionals appear to have the strongest influence on patients' attitudes and beliefs, with messages to "protect the back" having long-term negative effects, and messages of reassurance and encouragement of activity having long-term positive effects. Through interviews with 23 patients with acute or chronic low back pain, researchers found information and advice from health care professionals had the most significant and enduring influence on patients' attitudes, with such information often affecting their beliefs for many years. Notably, messages from clinicians that were interpreted as meaning the back and spine are vulnerable and needed to be protected resulted in increased vigilance, worry, frustration, and guilt for patients.
Implications
- These findings, the authors suggest, paint a discouraging picture of the role clinicians unwittingly play in the management of low back pain. They call on clinicians to provide reassurance to patients in an effort to increase confidence and offer clear advice that will empower patients and positively influence their approach to movement and activity.
Multimorbidity in Patients Attending 2 Australian Primary Care Practices
Tom Brett , and colleagues
Background Multimorbidity, the co-existence of multiple chronic conditions in one person, is a major health priority. This study examined the pattern and prevalence of multimorbidity among patients at two large Australian primary care practices.
What This Study Found The coexistence of multiple chronic conditions is very common in both men and women and its prevalence and severity increase steadily with age. In this study, 52 percent of all patients had two or more chronic illnesses, 35 percent had three or more, and 15 percent five or more. Musculoskeletal illness was the most common type of morbidity, followed by psychiatric, respiratory and vascular. The prevalence of multimorbidity increased with age. Overall, 58 percent of patients had mild, 49 percent had moderate, and 14 percent had severe severity index scores. Severity index scores also increased with age with moderate scores showing the greatest increase.
Implications
- Multimorbidity is significant in men and women and increases steadily with age.
Erin P. Finley , and colleagues
Background High-quality relationships among clinicians and staff is an essential component of improving delivery of primary care. This study set out to develop and validate a scale to assess staff and clinician relationships in primary care settings.
What This Study Found A 15-item Work Relationships Scale (WRS) was developed. The WRS has excellent internal reliability and identified significant variation in relationship quality across participating practices. Practices with lower WRS scores received poorer patient quality ratings for both individual clinicians and overall healthcare.
Implications
- This is one of the first studies to demonstrate that relationships within a care organization affect patient satisfaction.
- Relationships between primary care staff and clinicians appear to have a significant impact on patient perceptions of care and should be assessed in efforts to improve health care delivery.
Christina M. Getrich , and colleagues
Background Minority populations are traditionally underrepresented in clinical research studies. In this study, researchers identified strategies for recruiting and retaining patients from diverse racial and ethnic communities into practice-based research studies.
What This Study Found Interviews with 18 researchers experienced in recruiting participants from minority communities and 172 patients from those communities revealed the critical importance of trust to successful recruitment and retention. Participants emphasized that establishing and maintaining trusting relationships that extend beyond the enrollment and data collection phases are essential to enhance the participation of diverse populations in clinical research in practice-based research networks. Participants identified a set of flexible strategies within each stage of the research process and called for close engagement with the clinic and community partners.
Implications
- These findings provide guidance on culturally sensitive procedures for research recruitment and retention of diverse minority groups and offer practice-based research networks a guide for achieving this important goal.
Pierre Pluye , and colleagues
Background Electronic resources help physicians find answers to clinical questions, but the wealth of information available to guide primary care practice is not used to its full potential. In this study, researchers describe a new concept about the impact of information gleaned from electronic knowledge resources.
What This Study Found The "number needed to benefit from information" (NNBI) suggests how frequently patients may benefit when their physicians search for information in electronic knowledge resources. The NNBI will vary depending on the type of electronic resource and the clinician's characteristics, such as information seeking skills, knowledge, and behavior in specific clinical situations.
Implications
- This construct might be useful in experimental research to compare resources, identify kinds of clinical questions difficult to answer, and measure benefits of specific searches for information.
Testing to Prevent Colon Cancer: How Rural Community Members Took on a Community-Based Intervention
Ned Norman , and colleagues
Background Although participatory research and community engagement in health research have gained momentum in recent years, there are few first-hand descriptions of this process from participating community members. This essay describes a collaboration between community members, primary care practices, and academic researchers to increase colon cancer prevention.
What This Study Found In 2003, the High Plains Research Network convened a Community Advisory Council (CAC) to provide advice, relevance, and community engagement. The CAC quickly became an active group providing input, feedback, innovation, and dissemination efforts. As part of a study to increase colorectal cancer screening in rural Colorado, CAC members participated in training on colon cancer prevention. They spent 6 months developing a locally relevant intervention for rural agricultural communities and a year implementing the intervention. The intervention components included group talks on colon cancer prevention, newspaper articles, and print materials delivered by community members. CAC members participated in all aspects of the research including intervention messaging, survey design, recruitment, implementation, analysis and interpretation of data, and dissemination of results including presentations at national venues and co-authoring manuscripts.
Implications
- Engaging the CAC allowed the intervention to grow from and into the community. Many volunteers became advocates for the intervention and extended the reach and depth of the message. CAC members can be seen in an accompanying video.
Rediscovering Community: Reflections After Hurricane Sandy
Sharon See
Background Despite a focus on emergency preparedness, Hoboken, New Jersey, did not have contingencies in place to facilitate and assess the medication needs of the community when Hurricane Sandy struck. In this essay, the author--a pharmacist--describes how she volunteered and found meaning in the days after the hurricane.
What This Study Found Community was fostered in unpredictable environments, including patients' homes, where the author was regaled with stories, and an emergency shelter, where she helped neighbors with their medication needs. The author describes extraordinary acts of kindness, patience, and tireless effort.
What Do You Expect From A Doctor? Six Habits for Healthier Patient Encounters
David Loxterkamp
Background Patients should expect competency and a moral compass from their doctor. In this essay, the author describes additional simple habits that might assure that doctor visits are satisfying for both patient and physician.
What This Study Found These these six habits can lead to a healthier, more satisfying practice for the doctor and patient alike.
Identify: Patients need to know their health professional?s level of training and responsibility.
Listen: Patients want their doctors to listen.
Touch: A careful physical exam can provide clues for a diagnosis and create a connection that invites communication.
Look: To get to know patients and earn their trust, the doctor must look at the patient and not at the computer.
Plan: The doctor should outline specific steps that will lead to the patient?s recovery.
Follow-up: Doctors should prepare patients with a prognosis, provide test results, and guide them through their illness.
Implications
- Rather than perfection or cure, most patients desire a plan that connects them to another human being--their doctor.