Annals of family medicine
-
Annals of family medicine · May 2021
Shared Medical Appointments and Prediabetes: The Power of the Group.
Shared medical appointments, which allow greater access to care and provide peer support, may be an effective treatment modality for prediabetes. We used a retrospective propensity-matched cohort analysis to compare patients attending a prediabetes shared medical appointment to usual care. ⋯ The shared medical appointments group lost more weight (2.88 kg vs 1.29 kg, P = .003), and achieved greater reduction in hemoglobin A1c (-0.87% vs +0.87%, P = .001) and systolic blood pressure (-4.35 mmHg vs +0.52 mmHg, P = .044). The shared medical appointment model can be effective in treating prediabetes.
-
The Trial of Aggregate Data Exchange for Maintenance of Certification and Raising Quality was a randomized controlled trial which first had to test whether quality reporting could be a by-product of clinical care. We report on the initial descriptive study of the capacity for and quality of exchange of whole-panel, standardized quality measures from health systems. ⋯ The secure transfer of standardized, physician-level quality measures from 4 health systems with mature measure processes proved difficult. There were many errors that required human intervention and manual repair, precluding full automation. This study reconfirms an important problem, namely, that despite widespread health information technology adoption and federal meaningful use policies, we remain far from goals to make clinical quality reporting a reliable by-product of care.
-
Annals of family medicine · May 2021
Culture That Facilitates Change: A Mixed Methods Study of Hospitals Engaged in Reducing Cesarean Deliveries.
Large-scale efforts to reduce cesarean deliveries have shown varied levels of impact; yet understanding factors that contribute to hospitals' success are lacking. We aimed to characterize unit culture differences at hospitals that successfully reduced their cesarean rates compared with those that did not. ⋯ Successful hospitals' culture and context was measurably different from nonresponders. Leveraging these contextual factors may facilitate success.
-
Annals of family medicine · May 2021
Improving Smoking and Blood Pressure Outcomes: The Interplay Between Operational Changes and Local Context.
We undertook a study to identify conditions and operational changes linked to improvements in smoking and blood pressure (BP) outcomes in primary care. ⋯ There was no magic bullet for improving smoking or BP outcomes. Multiple combinations of operational changes led to improvements, but only in specific contexts of practice size and ownership, or dose of external facilitation.
-
Annals of family medicine · May 2021
Psychologic Treatment of Depression Compared With Pharmacotherapy and Combined Treatment in Primary Care: A Network Meta-Analysis.
Most patients with depression are treated by general practitioners, and most of those patients prefer psychotherapy over pharmacotherapy. No network meta-analyses have examined the effects of psychotherapy compared with pharmacotherapy, combined treatment, care as usual, and other control conditions among patients in primary care. ⋯ Psychotherapy is likely effective for the treatment of depression when compared with care as usual or waitlist, with effects comparable to those of pharmacotherapy. Combined treatment might be better than either psychotherapy or pharmacotherapy alone.