Index by author

The Issue in Brief

Overstimulated Consumers or Next-Generation Learners? Parent Tensions About Child Mobile Technology Use

Jenny S. Radesky , and colleagues

Background With the growing use of mobile devices by young children, researchers interviewed a diverse sample of mothers, fathers and grandmothers to better understand their views about child mobile technology use.

What This Study Found The 35 caregivers interviewed reported feeling uncertain about whether mobile technologies are beneficial or harmful to their children's development, how to use digital devices beneficially when their rapid evolution seems out of control, and the important purposes media serve in their families despite displacing family time. In particular, caregivers identified three conflicting viewpoints: 1) effects on the child -- fear of missing out on the benefits of mobile devices vs. concerns about their effects on children's thinking and behavior; 2) loss of control -- wanting to use mobile technology in educational ways vs. feeling that rapidly evolving technologies are beyond their control; and 3) family stress -- the necessity of mobile device use in stressed families vs. its interference with high-quality family time. The authors propose a framework with which clinicians can respectfully and realistically discuss mobile technology use with caregivers so they can make informed and empowered decisions.

Implications

• The authors assert that their findings present opportunities for influencing behavior change. Tensions in the unknowns surrounding new technologies may be an effective entry point into clinicians' conversations with parents.

A Qualitative Study of How Health Coaches Support Patients in Making Health-Related Decisions and Behavioral Changes

David H. Thom , and colleagues

Background Despite the growing use of coaches to help patients make health-related decisions and behavioral changes, there is little research about the ways in which health coaches support patients.

What This Study Found Analyzing focus group and individual interviews with patients, family members, health coaches and clinicians, this study identifies several core features of successful coaching and develops a model to describe how health coaches and patients work together. Themes identified by respondents include shared characteristics between health coaches and patients, availability of health coaches to patients, development of a strong relationship based on trust, educational role of the health coach, providing personal support for patients, providing support for decision making, and bridging between the patient and clinician.

Implications

• The resulting model, which attempts to characterize how health coaches and patients can work together, can be used in training and supporting health coaches in practice.

Those Left Behind From Voluntary Medical Home Reforms in Ontario, Canada

Tara Kiran , and colleagues

Background Seeking to improve health outcomes and reduce costs, more than three-quarters of family physicians in Ontario, Canada, voluntarily transitioned from traditional fee-for-service practices to medical homes over the past decade. However, approximately one in six Ontarians are still enrolled in fee-for service practices. This study seeks to understand the characteristics and quality of care of patients who did not participate in the voluntary transition to medical homes.

What This Study Found Patients who did not participate in the voluntary transition to medical homes, are more likely to be poor, urban, and have immigrated in the last 10 years, and less likely to receive recommended screening services, compared to patients in medical homes. Those patients with a fee-for-service physician are less likely to receive recommended testing for diabetes and less likely to receive screening for cervical, breast, and colorectal cancer, compared to patients with a medical home physician. (The authors note these differences in quality of care preceded medial home reforms.) Physicians who chose not to transition to a medical home were more likely to be older, to be international medical graduates and have smaller panel sizes.

Implications

• The authors call for strategies to improve care for patients left behind by medical home reforms in Ontario through improved connection to primary care or improved services with their existing physician.

Subclinical Peroneal Neuropathy: A Common, Unrecognized, and Preventable Finding Associated With a Recent History of Falling in Hospitalized Patients

Susan E. Mackinnon , and colleagues

Background Identifying risk factors for falling is key to reducing the incidence of falls. Subclinical peroneal neuropathy (SCPN), a condition which causes foot drop that can lead to tripping and falling, is preventable and treatable. This study examines the prevalence of SCPN in hospitalized adults and its association with falling.

What This Study Found In this study of 100 hospital inpatients, nearly one-third of patients at risk for falling have subclinical peroneal neuropathy (SCPN). Patients with SCPN are nearly five times as likely to have fallen in the past year than those without the condition.

Implications

• Screening for SCPN, implementing preventive measures, and treating the disorder may help reduce the incidence of falls in hospitalized and recently discharged patients.

Disease Course of Lower Respiratory Tract Infection With a Bacterial Cause

Jolien Teepe , and colleagues

Background In cases of acute cough, it is often assumed that bacterial pathogens cause a different illness course than non-bacterial causes, but little is actually known about this. This study compares the illness course of lower respiratory tract infection (LRTI) in primary care patients with and without a bacterial pathogen.

What This Study Found The illness course of lower respiratory tract infection with a bacterial cause is generally mild, uncomplicated and similar to that of nonbacterial lower respiratory tract infection and does not warrant immediate prescribing of antibiotics. Among 834 adults with acute cough, 162 of whom were diagnosed with a bacterial infection, patients with acute bacterial LRTI had only slightly worse symptoms at day two to four after the first office visit and returned more often for a second consultation than those without bacterial LRTI, however, the differences were small and not clinically meaningful. There was no difference in resolution of symptoms rated moderately bad or worse between the groups.

Implications

• The authors conclude that because there appears to be no meaningful difference in the illness course of bacterial LRTIs, physicians can reassure patients that LRTI, even if bacterial, is a self-limiting condition. Rather than immediately prescribing an antibiotic, they recommend following a strategy of watchful waiting.

Peer Support Interventions for Adults With Diabetes: A Meta-Analysis of Hemoglobin A1C Outcomes

Sonal J. Patil , and colleagues

Background Peer support is a promising approach to improving and sustaining diabetes self-management. This study analyzes existing research to assess the effectiveness of peer-support interventions on improving glycemic control in adult patients with diabetes as measured by HbA1C, compared to patients who received similar care except for peer delivered interventions.

What This Study Found Peer support interventions delivered by people affected by diabetes are associated with a small but statistically significant reduction in glycosylated hemoglobin, with larger effects among minority (particularly Hispanic) participants. There was an overall 0.24 percent improvement in HbA1c. Studies with predominantly Hispanic participants showed an HbA1c improvement of 0.48 percent in the peer support intervention group compared with the control group. In contrast, the pooled effect size from studies with predominantly white, non-Hispanic participants showed no improvement in HbA1c level with peer support interventions.

Implications

• Peer health coaches might be providing more culturally appropriate health education in ethnic minority populations, particularly in the Latino population. The authors call for future research to assess the effect of peer interventions on long-term patient-centered outcomes.

Prevalence of Atypical Pathogens in Patients With Cough and Community-Acquired Pneumonia: A Meta-Analysis

Mark H. Ebell , and colleagues

Background In most primary care patients with cough, the cough is caused by a virus. In about 5% of cases, patients with cough have community-acquired pneumonia. In addition, some coughs are caused by an atypical bacterial infection, which has the potential to cause serious complications. This study analyzes existing research to describe the prevalence of atypical pathogens among two groups: 1) patients with cough, acute bronchitis, or lower respiratory tract infection in the ambulatory setting and 2) patients with community-acquired pneumonia.

What This Study Found The study found high rates of atypical bacterial pathogens in patients with acute lower respiratory tract diseases, including cough, bronchitis and community-acquired pneumonia (CAP). Among adults with CAP, 14 percent had an atypical pathogen: 7 percent had mycoplasma pneumoniae, 4 percent had Chlamydophila pneumoniae, and 3 percent had Legionella pneumophila. Among children with CAP, 18 percent had Mycoplasma pneumoniae, only 1 percent had Chlamydophila pneumoniae, and Legionella pneumophila was extremely rare (only one case in 1,765 patients). Among patients with prolonged cough, 9 percent of adults and 18 percent of children had Bordetella pertussis.

Implications

• The findings suggest these conditions are underreported, underdiagnosed and undertreated in current clinical practice.
• The authors call for future research to help clinicians more accurately diagnose these pathogens and determine if and when antibiotic treatment is helpful.

Prevalence of Group C Streptococcus and Fusobacterium Necrophorum in Patients With Sore Throat: A Meta-Analysis

Mark H. Ebell , and colleagues

Background Although most cases of sore throat are viral, some are caused by Group A beta-hemolytic streptococci bacteria. Two other bacteria may also cause sore throat: Group C beta-hemolytic streptococcus and Fusobacterium necrophorum. This analysis of existing research evaluates the prevalence of these two pathogens in the outpatient primary care setting.

What This Study Found Group C beta-hemolytic streptococcus and Fusobacterium necrophorum are common in patients with sore throat. Analysis of 16 studies reveals overall prevalences of Group C streptococcus and F necrophorum were 6 percent and 19 percent, respectively, in patients presenting with sore throat in primary care.

Implications

• Future research is needed to determine whether these bacteria cause disease in patients with sore throat and whether antibiotics reduce the duration of symptoms, the likelihood of complications, or the spread to others.

Discussing Opioid Risks With Patients to Reduce Misuse and Abuse: Evidence From 2 Surveys

Joachim Hero , and colleagues

Background Recently published guidelines for prescribing opioids for chronic pain recommend that clinicians discuss the risks and benefits of opioid therapy with patients. Based on two population-representative surveys, this study examines the effectiveness of such patient education efforts.

What This Study Found The high-risk behavior of saving opioid pills for later use is substantially less likely among patients who report having been counseled by their physicians about the risks of prescription painkiller addiction. The study included 385 respondents who reported they had been prescribed strong prescription painkillers within the last two years. There was a 60 percent relative reduction in self-reported saving of pills among respondents who said they talked with their physicians about the risks of prescription painkiller addiction.

Implications

• Patient education efforts may have positive behavioral consequences that could lower the risks of prescription painkiller abuse.
• The authors call for future research to test the effectiveness of physician-patient discussions about addiction risk and related safety measures in promoting appropriate use, storage and disposal of prescription pain killers.

Are We the Walking Dead? Burnout as Zombie Apocalypse

Benjamin R. Doolittle

Background Reflecting on physicians' struggles in medicine, in particular the high prevalence of burnout and the challenge to cultivate compassion and meaning, this essay, asks, "Are we the walking dead?"

What This Study Found The plot and themes of the popular television show "The Walking Dead" and the zombie apocalypse metaphor could shed light on the state of medicine in 2016 as physicians struggle to survive. The author challenges physicians to reclaim their central purpose -- to promote life, to focus on patients' healing and the flourishing of their own lives -- in order to avoid becoming the walking dead.