What Patients Want Most from Their Doctor’s Visit: A Thorough Examination
Although patient-centered care is important to patients, they appear to place a higher priority on the technical quality of the care they receive. According to a survey of 1,193 patients from the United Kingdom, patients value the thoroughness of the primary care consultation most highly, followed by seeing a physician who knows them well, seeing a physician with a warm and friendly manner, having a reduction in waiting time for an appointment, and having flexibility in selecting appointment times. Specifically, patients were willing to pay the most for a thorough examination ($40.87), followed by seeing a physician who knew them well ($12.18), seeing a physician with a friendly manner ($8.50), having a one day reduction in waiting time for an appointment ($7.22) and having flexibility in selecting appointment times ($6.71). Patients placed similar value on the different aspects of patient centered care ($12.06-$14.82).
The authors assert these results can inform policy discussions about issues such as pay for performance and the balance between incentives for technical and nontechnical aspects of care.
What Patients Want From Primary Care Consultations: A Discrete Choice Experiment to Identify Patients’ Priorities
By Sudeh Cheraghi-Sohi, B.Sc., et al
Daily Psyllium Fiber Supplement Not Effective in Reducing Inflammation Associated With Cardiovascular Disease in Overweight Adults
Daily psyllium fiber supplementation by overweight or obese adults does not appear to significantly reduce the levels of inflammatory markers that play a role in cardiovascular risk. These findings contrast with previous research, which demonstrated lower levels of inflammatory markers in people who consume greater than 20 grams of fiber daily. In this new trial involving 158 participants, researchers found no significant differences between the treatment groups (28 grams per day or 21 grams a day of total daily fiber on average) and the control group in the amount of change in C-reactive protein concentration, interleukin-6 levels, fibrinogen levels or white blood cell counts. The authors point out that these findings do not negate the epidemiologic evidence that dietary fiber is a factor in reducing inflammation or the risk of cardiovascular disease, but the data do suggest that fiber supplementation with psyllium does not replicate the results seen with a diet naturally high in fiber.
Effect of Psyllium Fiber Supplementation on C-Reactive Protein: The Trial to Reduce Inflammatory Markers (TRIM)
By Dana E. King, M.D., et al
Large Number of Rural Residents Seek Medical Care Outside Their Local Communities
Approximately one third of patients living in rural areas bypass their local health care professionals and facilities and obtain medical care elsewhere, in part because of perceptions of limited local services and specialty care. According to a telephone survey of 1,264 adults living in rural areas, 32 percent bypassed local primary care. Notably, the researchers observed a wide variation in bypass rates in the 25 rural areas sampled, ranging from 9.4 percent to 66 percent. Compared with those who use services in their local community, bypassers were younger, had higher incomes, were more likely to have had inpatient care in the past year and were less satisfied with their local hospital. When asked why people might bypass local care, respondents cited lack of services or specialty care (50 percent), referral out of the community by their physician (19 percent), poor quality of care (15 percent) and poor reputation of local facilities (14 percent). Bypassers suggested measures their local hospitals could take to keep patients locally: add more specialty services (24 percent), add more physicians and services (17 percent), get better physicians (17 percent) and provide better customer service (11 percent).
The authors assert the wide variation in bypass rates suggest the need for local communities and facilities to develop tailored strategies that fit their unique circumstances and needs. They conclude that changing rural residents’ perception of their local care, helping them gain a better understanding of the function of primary care, and increasing the number of primary care physicians might help retain patients and keep rural communities healthy.
Bypass of Local Primary Care in Rural Counties: Effect of Patient and Community Characteristics
By Jiexin (Jason) Liu, Ph.D., M.B.A., M.S., et al
Adopting an American Diet Undesirable for Diabetic Latinos
Contrary to the common assumption that ethnic minority populations always benefit from acculturation to mainstream U.S. society, this study finds that acculturation among diabetic Latinos to the general U.S. culture is associated with adoption of some less desirable dietary habits. Analyzing nationally representative data on 467 Latino adults from the 1999-2004 National Health and Nutrition Examination Survey, researchers found more-acculturated Latinos were less likely to have diets high in fiber (9.4 vs. 35.4 percent) and lower in saturated fat (17.2 vs. 46.5 percent) than their less-acculturated counterparts. Acculturation, however, appeared to positively influence leisure time exercise habits, with more-acculturated individuals more likely to report leisure time exercise (59.2 vs. 19.3 percent). The proportion of those who smoked did not differ. The researchers conclude that when developing culturally sensitive health care programs, it is important to understand the complex process of acculturation and encourage patients to maintain healthy traditional behaviors while simultaneously adopting beneficial aspects of the mainstream culture.
Acculturation and Healthy Lifestyle Among Latinos with Diabetes
By Arch G. Mainous III, Ph.D., et al
OTHER STUDIES IN THIS ISSUE
U.S. Preventive Services Task Force Reaffirms Recommendations for Two Newborn Screenings
In the March/April issue of Annals, the U.S. Preventive Services Task Force provides two updated statements, reaffirming their previous recommendations for phenylketon (PKU) and congenital hypothyroidism screening in newborns. Both statements, which are based on new evidence, are available on the Annals of Family Medicine Web site, www.annfammed.org.
Screening for Phenylketonuria (PKU): US Preventive Services Task Force Reaffirmation Recommendation
Screening for Congenital Hypothyroidism: US Preventive Services Task Force Reaffirmation Recommendation
By U.S. Preventive Services Task Force
Redesigning Primary Care Practice: National Pilot Project Update
At the pilot project’s halfway point, two participants in the American Academy of Family Physicians’ multimillion dollar practice redesign initiative reflect on the crisis in primary care and offer insights from their own experience with practice transformation. They propose necessary ingredients for practice change and conclude that relationships remain the centerpiece of family medicine.
Changing Horses Midstream: The Promise and Prudence of Practice Redesign
By David Loxterkamp, M.D. and Louis A. Kazal, Jr., M.D.
Study Suggests Ways to Organize Primary Care Practices for Better Accessibility and Continuity
A study of patients and physicians in 100 primary care clinics in Quebec identifies the organizational and professional characteristics of primary care practice that are associated with patient accessibility, continuity and coordination of care. Among those features are offering after-hours care and telephone advice and having operational agreements with other health care establishments.
Practice Features Associated With Patient-Reported Accessibility, Continuity, and Coordination of Primary Health Care
By Jeannie L. Haggerty, Ph.D., et al
Physician Support Groups Help Swedish Primary Care Doctors Avoid Burnout
In an era in which primary care physician burnout is a major concern, researchers find that long-term participation in a Balint group, in which physicians meet regularly to discuss follow-up cases from their everyday work, can enhance the joy of being a doctor. Qualitative interviews with nine Swedish physicians revealed that Balint group participation increased physicians’ competence in patient encounters and enabled them to endure in their job and find joy and challenge in their patient relationships.
Balint Groups as a Means to Increase Job Satisfaction and Prevent Burnout Among General Practitioners
By Dorte Kjeldmand, G.P., Ph.D. and Inger Holström, R.N., Ph.D.
Paper Versus PDA, Which is Better for Data Collection?
Comparing the completeness of survey data gathered using handheld computers or paper forms in the practice setting, researchers find that while handheld computers produce more complete data, they were not necessarily superior because of the large amount of missing data due to technical difficulties and stolen or lost handheld computers.
Data Collection Outcomes Comparing Paper Forms with PDA Forms in an Office-Based Patient Survey
By James M. Galliher, Ph.D., et al
Barriers to Implementing Chronic Care Management in Ontario, Canada
Examining both the patient and the physician experience with chronic illness care management in Ontario, Canada, researchers find the approach is difficult to implement within the traditional biomedical framework of physicians and is generally not noticed by patients. The authors conclude that pervasive individual barriers combined with a lack of system-based support suggest that this approach is unlikely to have a major impact on the Ontario health care system at this time.
Beyond Fighting Fires and Chasing Tails? Chronic Illness Care Plans in Ontario, Canada
By Grant Russell, M.B.B.S., F.R.A.C.G.P., M.F.M, Ph.D., et al
Narrative Reports: A Useful Tool for Evaluating Implementation Research
Analyzing an intervention to integrate pharmacists into group family practices, researchers found that narrative reports can be effective qualitative tools for tracking and evaluating the early stages of implementation research in which process evaluation plays an important role in the interpretation of findings.
Narrative Reports to Monitor and Evaluate the Integration of Pharmacists Into Family Practice Settings
By Kevin Pottie, M.D., C.C.F.P., M.C.I.Sc., F.C.F.P., et al
One Family Physician’s Reflections on the Fundamental Aspects of Healing Relationships
In this personal essay, a family physician recalls a child’s spontaneous desire to help her mother during an office visit and how that prompted her to reflect upon the multidimensional nature of healing.
Healing With the Needles
By Mary P. Guerrera, M.D.
A New Generation of Physicians, a New Respect for Work-Life Balance
Inspired by a conversation with his personal physician, this family physician reflects on the challenges facing physicians today as they struggle to strike the proper balance between career and personal life.
Success, Regret, and the Struggle for Balance
By Joseph A. Carrese, M.D., M.P.H.
Journal
The Annals of Family Medicine