Annals of family medicine
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Annals of family medicine · Nov 2004
Randomized Controlled Trial Multicenter Study Clinical TrialImproving test ordering in primary care: the added value of a small-group quality improvement strategy compared with classic feedback only.
We wanted to evaluate the added value of small peer-group quality improvement meetings compared with simple feedback as a strategy to improve test-ordering behavior. Numbers of tests ordered by primary care physicians are increasing, and many of these tests seem to be unnecessary according to established, evidence-based guidelines. ⋯ Compared with only disseminating comparative feedback reports to primary care physicians, the new strategy of involving peer interaction and social influence improved the physicians' test-ordering behavior. To be effective, feedback needs to be integrated in an interactive, educational environment.
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Annals of family medicine · Nov 2004
Race, rural residence, and control of diabetes and hypertension.
African Americans are at increased risk for diabetes mellitus and hypertension, and rural residents have historically had decreased access to care. It is unclear whether living in a rural area and being African American confers added risks for diagnosis and control of diabetes and hypertension. The purpose of this study was to examine the prevalence of diagnosed diabetes and hypertension, as well as control of both conditions, among rural and urban African Americans and whites. ⋯ In this nationally representative sample, rural African Americans are at increased risk for a lack of control of diabetes and hypertension.
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Annals of family medicine · Nov 2004
Comparative StudyHealth care seeking among urban minority adolescent girls: the crisis at sexual debut.
We wanted to explore the context of help seeking for reproductive and nonreproductive health concerns by urban adolescent girls. ⋯ Adolescent girls attempt to meet reproductive health needs within a context shaped by values of privacy and close mother-daughter relationships. Difficulty balancing these values often results in inadequate support and care.
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Annals of family medicine · Nov 2004
The biopsychosocial model 25 years later: principles, practice, and scientific inquiry.
The biopsychosocial model is both a philosophy of clinical care and a practical clinical guide. Philosophically, it is a way of understanding how suffering, disease, and illness are affected by multiple levels of organization, from the societal to the molecular. ⋯ We propose a biopsychosocial-oriented clinical practice whose pillars include (1) self-awareness; (2) active cultivation of trust; (3) an emotional style characterized by empathic curiosity; (4) self-calibration as a way to reduce bias; (5) educating the emotions to assist with diagnosis and forming therapeutic relationships; (6) using informed intuition; and (7) communicating clinical evidence to foster dialogue, not just the mechanical application of protocol. In conclusion, the value of the biopsychosocial model has not been in the discovery of new scientific laws, as the term "new paradigm" would suggest, but rather in guiding parsimonious application of medical knowledge to the needs of each patient.