J Am Board Fam Med
-
Randomized Controlled Trial
Training to use motivational interviewing techniques for depression: a cluster randomized trial.
The goal of this study was to assess the effects of training primary care providers (PCPs) to use Motivational Interviewing (MI) when treating depressed patients on providers' MI performance and patients' expressions of interest in depression treatment ("change talk") and short-term treatment adherence. ⋯ MI training resulted in improved MI performance, more depression-related patient change talk, and better short-term adherence.
-
Demographics, mental illness, substance use, and prior family violence are associated with perpetration of intimate partner violence (IPV) among male patient populations as well as court-based and community samples. However, few studies have identified health services use and physical symptoms associated with IPV perpetration among men. This study assesses the prevalence of IPV perpetration in a nationally representative sample of men and examines the associations of IPV perpetration with demographics, health services use, physical symptoms, mental illness, substance abuse, and prior family violence. ⋯ Nearly 1 in 5 men in the United States reported lifetime IPV perpetration toward their current intimate partner. Physical symptoms from irritable bowel syndrome and insomnia, substance use disorders, and prior family violence are associated with IPV perpetration by men. Understanding these associations may aid primary care physicians in identifying male patients who perpetrate IPV.
-
Comparative Study
Comparing chronic pain treatment seekers in primary care versus tertiary care settings.
Patients frequently seek treatment for chronic nonmalignant pain in primary care settings. Compared with physicians who have completed extensive specialization (eg, fellowships) in pain management, primary care physicians receive much less formal training in managing chronic pain. While chronic pain represents a complicated condition in its own right, the recent increase in opioid prescriptions further muddles treatment. It is unknown whether patients with chronic pain seeking treatment in primary care differ from those seeking treatment in tertiary care settings. This study sought to determine whether patients with chronic pain in primary care reported less pain, fewer psychological variables related to pain, and lower risk of medication misuse/abuse compared with those in tertiary care. ⋯ It seems that primary care physicians care for a complicated group of patients with chronic pain that rivals the complexity of those seen in specialized tertiary care pain management facilities.
-
In this commentary we describe our experience developing a "gentle cesarean" program at a community hospital housing a family medicine residency program. The gentle cesarean technique has been popularized in recent obstetrics literature as a viable option to enhance the experience and outcomes of women and families undergoing cesarean delivery. ⋯ By sharing our experience, we hope to help other hospitals develop gentle cesarean programs. Family physicians should play an integral role in this process.
-
There is an extensive literature on how physicians can best educate their patients about living healthier-one might call it a "pedagogy of living." In this essay, I suggest that physicians develop a "pedagogy of dying" for their adult patients: educating them about how they can approach death with some measure of grace and dignity, as consistent with their wants as possible, and cognizant of the final reality we all face. This process happens in the ambulatory settings as part of ongoing care and precedes any serious illness or the crisis of hospitalization. I draw on known models for communicating effectively, my own practice experience, and the disciplines of palliative care and bioethics in asking physicians to consider developing such a "pedagogy of dying," a kind of anticipatory guidance toward aging, infirmity, and, ultimately, death [corrected].