Annals of family medicine
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Annals of family medicine · Mar 2019
Randomized Controlled TrialAntibiotic Prescribing for Acute Respiratory Tract Infections 12 Months After Communication and CRP Training: A Randomized Trial.
C-reactive-protein (CRP) is useful for diagnosis of lower respiratory tract infections (RTIs). A large international trial documented that Internet-based training in CRP point-of-care testing, in enhanced communication skills, or both reduced antibiotic prescribing at 3 months, with risk ratios (RRs) of 0.68, 0.53, 0.38, respectively. We report the longer-term impact in this trial. ⋯ Internet-based training in enhanced communication skills remains effective in the longer term for reducing antibiotic prescribing. The early improvement seen with CRP training wanes, and this training becomes ineffective for lower RTIs, the only current indication for using CRP testing.
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Annals of family medicine · Mar 2019
Trends in Providing Out-of-Office, Urgent After-Hours, and On-Call Care in British Columbia.
Providing care in alternative (non-office) locations and outside office hours are important elements of access and comprehensiveness of primary care. We examined the trends in and determinants of the services provided in a cohort of primary care physicians in British Columbia, Canada. ⋯ Care provided in non-office locations and after office hours declined significantly during the study period. Jurisdictions where providing these services are not mandated, and where similar workforce demographic shifts are occurring, may experience similar accessibility challenges.
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Loneliness has important health consequences. Little is known, however, about loneliness in primary care patient populations. This study describes the prevalence of loneliness in patients presenting for primary care and associations with self-reported demographic factors, health care utilization, and health-related quality of life. ⋯ Our findings demonstrate that loneliness is common in primary care patients and is associated with adverse health consequences including poorer health status and greater health care utilization. Further work is needed to understand the value of screening for and using interventions to treat loneliness in primary care.
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Annals of family medicine · Jan 2019
Meta AnalysisManaging Antidepressant Discontinuation: A Systematic Review.
We aimed to determine the effectiveness of interventions to manage antidepressant discontinuation, and the outcomes for patients. ⋯ Cognitive behavioral therapy or mindfulness-based cognitive therapy can help patients discontinue antidepressants without increasing the risk of relapse/recurrence, but are resource intensive. More scalable interventions incorporating psychological support are needed.
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Annals of family medicine · Jan 2019
Practice Capacity to Address Patients' Social Needs and Physician Satisfaction and Perceived Quality of Care.
Recent studies have explored clinician impacts of health care-based interventions that respond to patients' social and economic needs. These studies were limited by available clinician data. ⋯ Results suggest that perceived capacity to address social needs is strongly associated with both clinician satisfaction and perceived medical care quality. Our findings add to a growing literature on the potential return on investment of clinical interventions to address social needs.