Annals of family medicine
-
Annals of family medicine · Jan 2006
Randomized Controlled TrialEffects of enhanced depression treatment on diabetes self-care.
Among patients with diabetes, major depression is associated with more diabetic complications, lower medication adherence, and poorer self-care of diabetes. We reported earlier that enhanced depression care reduces depression symptoms but not hemoglobin A1c level. This study examined effects of depression interventions on self-management among depressed diabetic patients. ⋯ In general, diabetes self-management did not improve among the enhanced depression treatment group during a 12-month period, except for small between-group differences of limited clinical importance. Research needs to assess whether self-care interventions tailored for specific conditions, in addition to enhanced depression care, can achieve better diabetes and depression outcomes.
-
Annals of family medicine · Jan 2006
Quality of preventive care for diabetes: effects of visit frequency and competing demands.
We sought to determine the association between timely receipt of diabetes-related preventive services and the longitudinal pattern of outpatient service use as characterized by a novel taxonomy that prioritized visits based on the Oregon State Prioritized Health Services List. ⋯ Patients who attend relatively few outpatient visits or who attend more frequent visits for predominantly lower-priority conditions are more likely to receive substandard preventive care for diabetes.
-
Annals of family medicine · Jan 2006
Comparative StudyEffect of improved primary care access on quality of depression care.
We wanted to determine whether a major improvement in access to primary care during 2000 was associated with changes in the quality of care for patients with depression. ⋯ Marked improvement in access to primary care for 1 year was associated with some improvement in primary care for patients with depression, but the mechanism appeared to be improved continuity. Those planning to implement advanced access to care need to do so in such a way that continuity of care is enhanced rather than harmed by the change.
-
We undertook this study to examine the symptoms, clinical events, and types of health care encounters that preceded the diagnosis of diabetes mellitus in adults, and to examine changes in glycemic control and cardiovascular risk factors in the first year after a diabetes diagnosis. ⋯ Primary care practices may improve detection of undiagnosed diabetes in primary care and improve 1-year outcomes by being vigilant for symptoms of diabetes, by evaluating those at high risk for this disorder, and by instituting appropriate treatments at the time of diagnosis.
-
Physician narratives in family medicine have the potential to convey the vibrant spirit of our field and provide meaningful insights into disease, illness, suffering, and the nature of healing. They may also complement empirical research, education, and practice through their integrative, expressive nature. ⋯ An example of a family medicine physician-and-self drama, this piece takes the reader beyond the basic medical facts into the experience and sensations of the event. It also provides a stark contrast to the usual medical description and emphasizes the importance of stories as reflective opportunities for improving health care, sustaining ourselves as practitioners, and maintaining the vitality of our field.