Annals of family medicine
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Annals of family medicine · Nov 2004
Randomized Controlled Trial Multicenter Study Clinical TrialImproving test ordering in primary care: the added value of a small-group quality improvement strategy compared with classic feedback only.
We wanted to evaluate the added value of small peer-group quality improvement meetings compared with simple feedback as a strategy to improve test-ordering behavior. Numbers of tests ordered by primary care physicians are increasing, and many of these tests seem to be unnecessary according to established, evidence-based guidelines. ⋯ Compared with only disseminating comparative feedback reports to primary care physicians, the new strategy of involving peer interaction and social influence improved the physicians' test-ordering behavior. To be effective, feedback needs to be integrated in an interactive, educational environment.
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Annals of family medicine · Nov 2004
Comparative StudyHealth care seeking among urban minority adolescent girls: the crisis at sexual debut.
We wanted to explore the context of help seeking for reproductive and nonreproductive health concerns by urban adolescent girls. ⋯ Adolescent girls attempt to meet reproductive health needs within a context shaped by values of privacy and close mother-daughter relationships. Difficulty balancing these values often results in inadequate support and care.
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Annals of family medicine · Nov 2004
Depression and comorbid illness in elderly primary care patients: impact on multiple domains of health status and well-being.
Our objective was to examine the relative association of depression severity and chronicity, other comorbid psychiatric conditions, and coexisting medical illnesses with multiple domains of health status among primary care patients with clinical depression. ⋯ Recognition and treatment of depression has the potential to improve functioning and quality of life in spite of the presence of other medical comorbidities.
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Annals of family medicine · Nov 2004
Review Meta AnalysisLay understanding of familial risk of common chronic diseases: a systematic review and synthesis of qualitative research.
Although the family history is increasingly used for genetic risk assessment of common chronic diseases in primary care, evidence suggests that lay understanding about inheritance may conflict with medical models. This study systematically reviewed and synthesized the qualitative literature exploring understanding about familial risk held by persons with a family history of cancer, coronary artery disease, and diabetes mellitus. ⋯ Persons with a family history of a common chronic disease develop a personal sense of vulnerability that is informed by the salience of their family history and interpreted within their personal models of disease causation and inheritance. Features that give meaning to familial risk may be perceived differently by patients and professionals. This review identifies key areas for health professionals to explore with patients that may improve the effectiveness of communication about disease risk and management.
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Annals of family medicine · Nov 2004
Race, rural residence, and control of diabetes and hypertension.
African Americans are at increased risk for diabetes mellitus and hypertension, and rural residents have historically had decreased access to care. It is unclear whether living in a rural area and being African American confers added risks for diagnosis and control of diabetes and hypertension. The purpose of this study was to examine the prevalence of diagnosed diabetes and hypertension, as well as control of both conditions, among rural and urban African Americans and whites. ⋯ In this nationally representative sample, rural African Americans are at increased risk for a lack of control of diabetes and hypertension.