Annals of family medicine
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Annals of family medicine · May 2012
Randomized Controlled Trial Comparative StudyTypical electronic health record use in primary care practices and the quality of diabetes care.
Recent efforts to encourage meaningful use of electronic health records (EHRs) assume that widespread adoption will improve the quality of ambulatory care, especially for complex clinical conditions such as diabetes. Cross-sectional studies of typical uses of commercially available ambulatory EHRs provide conflicting evidence for an association between EHR use and improved care, and effects of longer-term EHR use in community-based primary care settings on the quality of care are not well understood. ⋯ Consistent use of an EHR over 3 years does not ensure successful use for improving the quality of diabetes care. Ongoing efforts to encourage adoption and meaningful use of EHRs in primary care should focus on ensuring that use succeeds in improving care. These efforts will need to include provision of assistance to longer-term EHR users.
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Annals of family medicine · May 2012
Review Meta AnalysisIntranasal corticosteroids in management of acute sinusitis: a systematic review and meta-analysis.
Acute sinusitis is a common condition in ambulatory care, where it is frequently treated with antibiotics, despite little evidence of their benefit. Intranasal corticosteroids might relieve symptoms; however, evidence for this benefit is currently unclear. We performed a systematic review and meta-analysis of the effects of intranasal corticosteroids on the symptoms of acute sinusitis. ⋯ Intranasal corticosteroids offer a small therapeutic benefit in acute sinusitis, which may be greater with high doses and with courses of 21 days' duration. Further trials are needed in antibiotic-naïve patients.
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Annals of family medicine · May 2012
Randomized Controlled TrialHealth coaching to improve hypertension treatment in a low-income, minority population.
Poor blood pressure control is common in the United States. We conducted a study to determine whether health coaching with home titration of antihypertensive medications can improve blood pressure control compared with health coaching alone in a low-income, predominantly minority population. ⋯ Blood pressure control in a low-income, minority population can be improved by teaching patients to monitor their blood pressure at home and having nonprofessional health coaches assist patients, in particular, by counseling them on medication adherence. The improved blood pressure control can be achieved while reducing the time spent by physicians.
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Annals of family medicine · May 2012
Intraclass correlation coefficients typical of cluster-randomized studies: estimates from the Robert Wood Johnson Prescription for Health projects.
Researchers who conduct cluster-randomized studies must account for clustering during study planning; failure to do so can result in insufficient study power. To plan adequately, investigators need accurate estimates of clustering in the form of intraclass correlation coefficients (ICCs). ⋯ ICCs for patient behaviors and intent to change those behaviors were generally less than 0.1. Though small, such ICCs are not trivial; if cluster sizes are large, even small levels of clustering that is unaccounted for reduces the statistical power of a cluster-randomized study.
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Annals of family medicine · May 2012
Involving the health care system in domestic violence: what women want.
PURPOSE Domestic violence is prevalent among women using primary health care services in Lebanon and has a negative effect on their health, yet physicians are not inquiring about it. In this study, we explored the attitudes of these women regarding involving the health care system in domestic violence management. METHODS We undertook a qualitative focus group study. ⋯ Additionally, they recommended mass media and community awareness campaigns focusing on family relationships to address domestic violence. CONCLUSIONS Addressing domestic violence through the health care system, if done properly, may be socially acceptable and nonoffensive even to women living in conservative societies such as Lebanon. The women in this study described characteristics of health professionals that would be conducive to screening and that could be extrapolated to the health care of immigrant Arab women.