In This Issue: From Communities of Solution to Joy

COMMUNITIES OF SOLUTION

In a report proposing communities of solution, a group of rising family medicine leaders, calling themselves the Folsom Group, revitalize and modernize the grand challenges from the landmark 1967 Folsom Report.^1,2 This proposal for vitalizing community-centered approaches to improving health calls on the best traditions of local action, public health, and primary health care. A recent Institute of Medicine report³ recommends both federal and local efforts that will support the Community of Solution vision. And around the country and in whole systems around the world varied partners and multistakeholder groups are working together to address problems and create opportunities to improve the health of their communities. The Annals editors encourage readers to share your experiences of communities of solution and develop ideas for realizing even a portion of this expansive vision: log on to the TRACK discussion of articles at http://www.AnnFamMed.org. The Annals Journal Club⁴ provides questions to guide group discussion.

UNDERSTANDING AND IMPROVING CARE FOR VULNERABLE PEOPLE

A randomized clinical trial by Margolis and colleagues⁵ finds that home blood pressure monitoring and weekly health coaching are associated with reduced blood pressure in low-income minority patients with poorly controlled hypertension, but it finds no effect of home titration of blood pressure medications.

For older adults with low levels of physical activity, Kolt and colleagues⁶ assess the effect of a “green prescription”—a recommendation for physical activity with pedometer monitoring. In a clinical trial of 330 adults older than 65 years, they find that a green prescription increases leisure walking without an effect on overall activity levels.

In a qualitative study of women in Lebanon, Usta et al find that even in a conservative society, most women want their clinicians to assess the possibility of domestic violence, and they want their health care system to address what is uncovered.⁷

Pay-for-performance schemes have been touted as a route to reducing health care inequalities. In a study in the UK’s Quality and Outcomes Framework (QOF), Alshamsan et al find that introduction of QOF had no effect on health care inequalities in 29 general practices.⁸

CONTROVERSIAL TOPICS

As evidence and clinical policy recommendations move away from antibiotic use for acute sinusitis,⁹ a helpful meta-analysis by Hayward and colleagues finds a small therapeutic benefit from intranasal corticosteroids.¹⁰ The effect is not apparent until 2 to 3 weeks, however, and most studies also included antibiotics, making it difficult to tease out the independent effect of steroids. An editorialist¹¹ is skeptical about anything but limited use of intranasal steroids for selected patients with sinusitis.

An essay by Wu proposes paying patients for performance by rewarding them for achieving evidence-based health goals.¹² An editorial by Christiansen¹³ supports the concept of reinforcing positive behavior but argues that the literature on incentives does not yet justify such a proposal.