Annals of family medicine
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Annals of family medicine · Mar 2008
Randomized Controlled TrialBeyond fighting fires and chasing tails? Chronic illness care plans in Ontario, Canada.
Recent work has conceptualized new models for the primary care management of patients with chronic illness. This study investigated the experience of family physicians and patients with a chronic illness management initiative that involved the joint formulation of comprehensive individual patient care plans. ⋯ Although the experiences of the enthusiastic family physicians were encouraging, we found important individual-level barriers to chronic illness management in primary care. These issues seemed to transcend existing organizational and resource constraints.
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Annals of family medicine · Jan 2008
Randomized Controlled TrialEffect on cessation counseling of documenting smoking status as a routine vital sign: an ACORN study.
Guidelines encourage primary care clinicians to document smoking status when obtaining patients' blood pressure, temperature, and pulse rate (vital signs), but whether this practice promotes cessation counseling is unclear. We examined whether the vital sign intervention influences patient-reported frequency and intensity of tobacco cessation counseling. ⋯ The vital sign intervention promotes tobacco counseling at primary care practices through a modest increase in simple advice to quit. When implemented as a stand-alone intervention, it does not appear to increase intensive counseling.
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Annals of family medicine · Sep 2007
Randomized Controlled Trial Comparative StudyRandomized comparison of 3 methods to screen for domestic violence in family practice.
We undertook a study to compare 3 ways of administering brief domestic violence screening questionnaires: self-administered questionnaire, medical staff interview, and physician interview. ⋯ Domestic violence is common, and we found that most patients and clinicians are comfortable with domestic violence screening in urban family medicine settings. Patient self-administered domestic violence screening is as effective as clinician interview in terms of disclosure, comfort, and time spent screening.
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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 · Mar 2007
Randomized Controlled Trial Comparative StudyPatient education on prostate cancer screening and involvement in decision making.
Many clinicians lack resources to engage patients in shared decision making for prostate cancer screening. We sought to evaluate whether previsit educational decision aids facilitate shared decision making. ⋯ Patients in the decision aid groups were more informed and more engaged in the screening decision than their control counterparts. Exposure did not promote shared decision-making control, however. Whether shared decision making is the ideal model and how to measure its occurrence are subjects for further research.