Annals of family medicine
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Annals of family medicine · May 2007
Randomized Controlled TrialHome visiting for adolescent mothers: effects on parenting, maternal life course, and primary care linkage.
Adolescent mothers are at risk for rapidly becoming pregnant again and for depression, school dropout, and poor parenting. We evaluated the impact of a community-based home-visiting program on these outcomes and on linking the adolescents with primary care. ⋯ This community-based home-visiting program improved adolescent mothers' parenting attitudes and school continuation, but it did not reduce their odds of repeat pregnancy or depression or achieve coordination with primary care. Coordinated care may require explicit mechanisms to promote communication between the community program and primary care.
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Annals of family medicine · May 2007
Competing demands or clinical inertia: the case of elevated glycosylated hemoglobin.
This study aimed to examine the contribution of competing demands to changes in hypoglycemic medications and to return appointment intervals for patients with type 2 diabetes and an elevated glycosylated hemoglobin (A1c) level. ⋯ The concept of clinical inertia is limited and does not fully characterize the complexity of primary care encounters. Competing demands is a principle for constructing models of primary care encounters that are more congruent with reality and should be considered in the design of interventions to improve chronic disease outcomes in primary care settings.
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Annals of family medicine · May 2007
Sufficiently important difference for common cold: severity reduction.
We undertook a study to estimate the sufficiently important difference (SID) for the common cold. The SID is the smallest benefit that an intervention would require to justify costs and risks. ⋯ Depending on treatment specifics, people want an on-average 25% to 57% reduction in overall illness severity to justify costs and risks of popular cold treatments. Randomized trial evidence does not support benefits this large. This model and these methods should be further developed for use in other disease entities.
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The purpose of this article is to produce a relatively simple conceptual framework for guiding and studying practice improvement. ⋯ This framework may provide a guide to those in the front lines of care who would like to make the care transformations that are needed to greatly improve care. It may also be helpful to those who are developing or testing interventions and recruiting medical practices for such change efforts.
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Annals of family medicine · May 2007
A national survey of primary care practice-based research networks.
Increasing numbers of primary care practice-based research networks (PBRNs) are being developed in the United States to perform research relevant to everyday practice. To assess the current status and potential value of this resource, we surveyed US primary care PBRNs in operation from late 2003 to early 2004. ⋯ American primary care PBRNs are mainly young, diverse, and pursuing a variety of research foci. Most have university links and provide a dynamic town-gown relationship that could be a vital national resource for improving primary care, translating research into practice, and meeting the National Institutes of Health Roadmap goals. PBRNs merit further attention from both private and public funding agencies and researchers interested in studying the delivery of primary care.