Annals of Family Medicine articles from November 2005

Annals of Family Medicine archives from November 2005

In this issue: trade-offs, time use, depression care.(EDITORIAL)
November 1, 2005... DOI: 10.1370/afm.415. In this issue, we feature an essay (1) and 2 editorials (2,3) that debate the appropriate balance between investing in developing new technologies vs devoting resources toward improving systems of care to deliver...

Doing things better vs doing better things.(EDITORIAL)
November 1, 2005... DOI: 10.137/afm.407 The United States spends approximately $1.5 trillion on health care each year (about $5,700 per person), yet we have relatively little to show for it. Population health statistics (eg, years of healthy life expectancy)...

Misaligned incentives in America's health: who's minding the store?(EDITORIAL)
November 1, 2005... DOI: 10.1370/afm.408. We share Woolf and Johnson's pain. (1) The American health care system simply fails to deliver the health benefits commensurate with our investment. We have no one to blame but our collective selves, however. Each...

Time spent in face-to-face patient care and work outside the examination room.
November 1, 2005... ABSTRACT PURPOSE Contrary to physicians' concerns that face-to-face patient time is decreasing, data from the National Ambulatory Medical Care Survey (NAMCS) indicate that between 1988 and 1998, durations of primary care outpatient visits...

Physician activities during time out of the examination room.
November 1, 2005... ABSTRACT PURPOSE Comprehensive medical care requires direct physician-patient contact, other office-based medical activities, and medical care outside of the office. This study was a systematic investigation of family physician...

Quality of work life of independent vs employed family physicians in Wisconsin: a WReN study.
November 1, 2005... ABSTRACT PURPOSE Family physicians in Wisconsin who are mainly employed by large health care organizations have voiced concerns regarding the quality of their work lives. We explored the quality of work life and its relationship to...

Physicians answer more clinical questions and change clinical decisions more often with synthesized evidence: a randomized trial in primary care.
November 1, 2005... ABSTRACT PURPOSE Clinicians need evidence in a format that rapidly answers their questions. DynaMed is a database of synthesized evidence. We investigated whether primary care clinicians would answer more clinical questions, change...

Quick assessment of literacy in primary care: the newest vital sign.
November 1, 2005... ABSTRACT PURPOSE Current health literacy screening instruments for health care settings are either too long for routine use or available only in English. Our objective was to develop a quick and accurate screening test for limited literacy...

Suicidal ideation and risk levels among primary care patients with uncomplicated depression.
November 1, 2005... ABSTRACT PURPOSE We investigated the prevalence, severity, and course of passive and active suicidal ideation occurring in primary care patients with an uncomplicated depressive disorder. METHODS We studied suicidal ideation...

Improving detection of suicidal ideation among depressed patients in primary care.
November 1, 2005... ABSTRACT PURPOSE Primary care clinicians have difficulty detecting suicidal patients. This report evaluates the effect of 2 primary care interventions on the detection and subsequent referral or treatment of patients with depression and...

How experiencing preventable medical problems changed patients' interactions with primary health care.
November 1, 2005... ABSTRACT PURPOSE We wanted to explore how patients' experiences with preventable problems in primary care have changed their behavioral interactions with the health care system. METHODS We conducted semistructured interviews with 24...

The break-even point: when medical advances are less important than improving the fidelity with which they are delivered.(REFLECTIONS)
November 1, 2005... ABSTRACT Society invests billions of dollars in the development of new drugs and technologies but comparatively little in the fidelity of health care, that is, improving systems to ensure the delivery of care to all patients in need. Using...

To care is to coprovide.(REFLECTIONS)
November 1, 2005... ABSTRACT Although primary care, including family medicine, recognizes different types of clinician-patient interaction, I argue that only interactions characterized by coprovision define care. By coprovision I mean that clinicians and...

Practical and contextual issues.(ON TRACK)
November 1, 2005... DOI: 10.1370/afm.416. The Annals online discussion has brought out practical and contextual concerns about articles in the last issue. PRACTICAL ISSUES The cost-effective analysis of expanded testing for primary HIV infection...

Correction.(ON TRACK)(Correction Notice)
November 1, 2005... An error has been reported in the article by James E. Aikens, PhD, Donald E. Nease, Jr, MD, David P. Nau,PhD, Michael S. Klinkman,MD, MS, and Thomas L. Schwenk, MD. Adherence to maintenance-phase antidepressant medication as a function of...

The current status of medical student education in Family Medicine.(Family Medicine Updates)
November 1, 2005... To assure safe, effective, patient-centered, timely, efficient, and equitable health care for all Americans, the Future of Family Medicine Project concluded that family physicians should practice evidence-based care over a continuum, utilize...

Scholarly activity and residency training: seeking strategic partnerships.(FAMILY MEDICINE UPDATES)
November 1, 2005... The American Academy of Family Physicians (AAFP) and the Accreditation Council for Graduate Medical Education's (ACGME) program requirements for residency education in family practice acknowledge the importance of research and other scholarly...

UK lessons for US primary care.(FAMILY MEDICINE UPDATES)
November 1, 2005... Primary care is now acknowledged to be a foundation of effective, sustainable health care for populations, with favorable effects on access to care, comprehensiveness, continuity, efficiency, and equity. (1) In addition, variation in health...

Shaping the future of pay-for-performance programs.(FAMILY MEDICINE UPDATES)
November 1, 2005... Whether it's driven by private insurers or the federal government, pay-for-performance (P4P), a concept that offers health care providers payment for meeting certain performance measures, is here to stay. Recognizing the potential impact P4P...

2005 Pisacano scholars.(FAMILY MEDICINE UPDATES)(Pisacano Leadership Foundation)
November 1, 2005... The Pisacano Leadership Foundation, the philanthropic arm of the American Board of Family Medicine (ABFM), recently selected its 2005 Pisacano Scholars. These 5 medical students follow in the footsteps of 53 scholar alumni who are practicing...

STFM launches vision-driven academic fund-raising workshop and fellowship.(FAMILY MEDICINE UPDATES)(Society of Teachers of Family Medicine)
November 1, 2005... The Society of Teachers of Family Medicine (STFM) is launching an academic fund-raising workshop, Vision-Driven Fund-Raising 101 on December 2-3, 2005, in Indianapolis, Ind. The workshop is jointly sponsored by the STFM and the Family Medicine...

Primary care practice-based research networks: working at the interface between research and quality improvement.
November 1, 2005... ABSTRACT PURPOSE We wanted to describe the emerging role of primary care practicebased in research, quality improvement (QI), and translation of research into practice (TRIP). METHODS We gathered information from the published...

Primary care practice-based research comes of age in the United States.(PREFACE)
November 1, 2005... DOI: 10.1370/afm.338. The enormous potential of practice-based research networks (PBRNs) to expand the knowledge base of primary care and to integrate research into practice (and practice into research) was recognized in the United States...

Electronic data collection options for practice-based research networks.
November 1, 2005... ABSTRACT PURPOSE We wanted to describe the potential benefits and problems associated with selected electronic methods of collecting data within practice-based research networks (PBRNs). METHODS We considered a literature review,...

Human subjects issues and IRB review in practice-based research.(institutional review board)
November 1, 2005... ABSTRACT PURPOSE This article explores the challenges that practice-based research networks (PBRNs) face with respect to the regulatory requirements for institutional review board (IRB) review and the protection of human subjects in...

Practice-based research network studies in the age of HIPAA.(Health Insurance Portability and Accountability Act)
November 1, 2005... ABSTRACT PURPOSE We wanted to explore potential effects of the Health Insurance Portability and Accountability Act (HIPAA) on research activities of practice-based research networks (PBRNs). METHODS To understand the approaches PBRNs...

Longitudinal research and data collection in primary care.
November 1, 2005... ABSTRACT PURPOSE This article reviews examples of and experience with longitudinal research in family medicine. The objective is to use this empirical information to formulate recommendations for improving longitudinal research. ...

Infrastructure requirements for practice-based research networks.
November 1, 2005... ABSTRACT BACKGROUND The practice-based research network (PBRN) is the basic laboratory for primary care research. Although most PBRNs include some common elements, their infrastructures vary widely. We offer suggestions for developing and...

Multilevel modeling and practice-based research.
November 1, 2005... ABSTRACT PURPOSE The health care system in the United States is inherently hierarchical. Patients are "nested" within physicians who in turn are "nested" within practices. Much of the research data gathered in practice-based research...

Implementing health behavior change in primary care: lessons from prescription for health.
November 1, 2005... ABSTRACT PURPOSE Our objective was to identify themes that emerged from the evaluation of 17 interventions funded by the Robert Wood Johnson Foundation's Prescription for Health that aimed to enhance adherence to healthy behaviors in the...

Putting it together: finding success in behavior change through integration of services.
November 1, 2005... ABSTRACT PURPOSE The purpose of this analysis and commentary was to explore the rationale for an integrated approach, within and outside the office, to help patients pursue healthy behaviors. METHODS We examined the role of...

Prescription for health: round 1 initial results.(PREFACE)
November 1, 2005... DOI: 10.1370/afm.333. Our genetic endowment, social circumstances, environmental conditions, and health care are recognized to be important determinants of health, but our behavior is estimated to have a larger impact than any of these....

Practice-based research in primary care: facilitator of, or barrier to, practice improvement?
November 1, 2005... ABSTRACT PURPOSE In what ways is primary care practice-based research a facilitator of practice improvement vs a barrier to practice change? This article aims to alert investigators to the pitfalls they may face in undertaking the dual...

Integrating a health coach into primary care: reflections from the Penn State ambulatory research network.
November 1, 2005... PURPOSE In our Promoting Healthy Behaviors in Primary Care project, we proposed to (1) develop a health coach model of behavior change, integrated into primary care practices to improve diet and increase physical activity among obese...

Wellness for a lifetime: improving lifestyle behaviors of low-income, ethnically diverse populations.
November 1, 2005... PURPOSE Eight community nursing centers (CNCs) belonging to the Midwest Nursing Centers Consortium, a practice-based research network, implemented a community-based, multidimensional strategy to promote behavior changes among high-risk,...

Parent perspectives on messages to be delivered after nutritional assessment in pediatric primary care practice.
November 1, 2005... PURPOSE Guidelines for the prevention of childhood overweight and obesity call for annual assessment of nutritional status and counseling on healthy lifestyles. (1) This pilot study tested an office systems change approach (2) to engage...

The action plan project: discussing behavior change in the primary care visit.
November 1, 2005... PURPOSE Often, clinicians fail to discuss health-related behaviors during ambulatory visits. (1) An action plan is a structured tool that may assist clinicians in initiating such discussions. An action plan is an agreement between a...

Practice extenders and PDA-based counseling for smoking and unhealthy diet.
November 1, 2005... PURPOSE Members of the Alabama Practice Based Research Network (APBRN) explored the feasibility of using personal digital assistants (PDAs) as a means of integrating into routine clinical practice brief, evidence-informed interventions...

Bringing the Behavioral Health Improvement Program (BeHIP) to Rural Kentucky.
November 1, 2005... PURPOSE Cost-effective strategies for assisting patients in behavior change are needed at the primary care level. The purpose of this project was to determine the feasibility and effectiveness of linking rural practices with an established...

Establishing a family-based intervention for overweight children in pediatric practice.
November 1, 2005... PURPOSE We performed a pilot study in 2 pediatric practices to (1) increase the identification of overweight children by the primary care clinician and encourage their referral to an "in-office" family-based intervention, and (2) test the...

It takes a partnership: the value of collaboration in developing and promoting a Web site for primary care patients.
November 1, 2005... PURPOSE The purpose of our project was to develop a specialized Web site that helps patients pursue healthy eating, physical activity, smoking cessation, and moderation of alcohol consumption, and to integrate use of the Web site into...

Changing organizational constructs into functional tools: an assessment of the 5 A's in primary care practices.
November 1, 2005... PURPOSE Primary care clinicians have a unique opportunity to identify health risks in their patients and to encourage healthy behaviors, such as smoking cessation, physical activity, proper nutrition, and moderation in the use of alcohol....

LEAP--a brief intervention to improve activity and diet: a report from CaReNet and HPRN.(Leaders in Effective Activity Planning )
November 1, 2005... PURPOSE The purpose of our project was to test a practice-level intervention to increase use of evidence-based strategies for promoting physical activity and healthy diet by primary care patients. The intervention is based on the premise...

Mutual learning and the transformation of study intervention tools.
November 1, 2005... PURPOSE We planned a multicomponent intervention to increase primary care practices' provision of health behavior advice and patients' access to resources for health behavior change. The intervention included 2 tools: (1) a Web-based...

Minnesota clinicians motivating health improvement (MINIT) study: motivating healthy habits.
November 1, 2005... PURPOSE The MINIT (Minnesota Clinicians Motivating Health Improvement) Study was designed to target 4 risk behaviors that are strongly linked to a variety of negative health outcomes in the United States: (1) cigarette smoking, (2)...

Reducing tobacco use and risky drinking in underserved populations: the need for better implementation models.
November 1, 2005... PURPOSE The prevalence of many health behavior risk factors (eg, smoking, risky drinking, physical inactivity) are highest among uninsured and Medicaid-eligible populations. (1) Screening and brief behavioral counseling in high-volume...

Collaborative goal setting to improve lifestyle behaviors: lessons learned from NOPCRN.
November 1, 2005... PURPOSE We examined the effectiveness of a multicomponent lifestyle activity intervention for overweight or obese patients with impaired fasting glucose (prediabetes). The physician-directed counseling intervention included collaborative...

The healthy teen project: tools to enhance adolescent health counseling.
November 1, 2005... PURPOSE The leading causes of preventable disease, disability, health care burden, and premature death in the United States are related to 4 health risk behaviors: sedentary lifestyle, unhealthy diet, tobacco use, and risky drinking. These...

Modular lifestyle intervention tool: a handheld tool to assist clinicians in providing patient-tailored counseling.
November 1, 2005... PURPOSE Although proven health promotion interventions exist for effecting health behavior change, most physicians rarely go beyond simple advice or education when discussing health risk behaviors. (1) The primary goal of our project was...

Prescription for health: changing primary care practice to foster healthy behaviors.
November 1, 2005... ABSTRACT PURPOSE The leading causes of premature death in the United States are linked to 4 behaviors: smoking, unhealthy diet, physical inactivity, and risky alcohol use. We report lessons from 17 exploratory projects funded under...