Annals of family medicine
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Annals of family medicine · Jan 2014
ReviewSystems and complexity thinking in the general practice literature: an integrative, historical narrative review.
Over the past 7 decades, theories in the systems and complexity sciences have had a major influence on academic thinking and research. We assessed the impact of complexity science on general practice/family medicine. ⋯ This historical review describes the development of general practice/family medicine in relation to complex adaptive systems theories, and shows how systems sciences more accurately reflect the discipline's philosophy and identity. Analysis suggests that general practice/family medicine first embraced systems theories through conscious reorganization of its boundaries and scope, before applying empirical tools. Future research should concentrate on applying nonlinear dynamics and empirical modeling to patient care, and to organizing and developing local practices, engaging in community development, and influencing health care reform.
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Indicators of prognosis should be considered to fully inform clinical decision making in the treatment of depression. This study examines whether self-rated health predicts long-term depression outcomes in primary care. ⋯ Self-rated health offers family physicians an efficient and simple way to identify patients at risk of poor long-term depression outcomes and to inform therapeutic decision making.
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Annals of family medicine · Jan 2014
Randomized Controlled TrialTargeted melanoma prevention intervention: a cluster randomized controlled trial.
Targeted interventions to reduce the risk and increase the early detection of melanoma have the potential to save lives. We aimed to assess the effect of such an intervention on patient prevention behavior. ⋯ The combination of use of the SAMScore and general practitioner examination and counseling during consultations is an efficient way to promote patient behaviors that may reduce melanoma risk. Extending the duration of follow-up and demonstrating an impact on morbidity and mortality remain major issues for further research.
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Annals of family medicine · Jan 2014
Family physicians' quality interventions and performance improvement through the ABFM diabetes performance in practice module.
Practice performance assessment is the fourth requirement of Maintenance of Certification for Family Physicians (MC-FP). American Board of Family Medicine (ABFM) diplomates have many options for completing Part 4 requirements, including Web-based Performance in Practice Modules (PPMs) developed by the ABFM. Our objective was to describe the actions and outcomes of family physicians who completed the ABFM diabetes PPM. ⋯ Family physicians participating in MC-FP implemented improvement projects and showed quality improvements in caring for patients with diabetes. Emphasis on quality of care by payers will increasingly require physicians to embrace quality measurement and improvement.
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Annals of family medicine · Jan 2014
Managing expectations of antibiotics for upper respiratory tract infections: a qualitative study.
Communication experts have suggested that it is good practice to ask patients' directly whether they expect to receive antibiotics as part of asking about the triad of ideas, concerns, and expectations for health care. Our aim was to explore the views and experiences of family physicians about using this strategy with their patients, focusing the interview on the problem of eliciting expectations of antibiotics as a possible treatment for upper respiratory tract infections. ⋯ Real-world family physicians use indirect methods to explore expectations for treatment and, on the basis of their physical examination, build an argument for reassuring the patient or parent. In contrast to proposed models in the communication literature, interventions to promote appropriate antibiotic prescribing might include a focus on training in communication skills that (1) integrates these indirect methods as part of building collaborative physician-patient relationships and (2) uses the running commentary of examination findings to facilitate participation in clinical decisions.