Family Medicine Abstracts
Volume 41 Issue 3
March 2009
Abstracts
March 2009
Abstracts
Teaching Culturally Effective Diabetes Care: Results of a Randomized Controlled Trial
BACKGROUND AND OBJECTIVES: Increased cultural competence is a tool in the fight to eliminate health disparities in people with diabetes. However, questions remain regarding the best cultural competence teaching, evaluation, and dissemination methods. An Internet-based approach requires less facilitator time and provides greater ease of dissemination. We developed and tested a skills-focused, Internet-based course on cultural competence in the context of type 2 diabetes. METHODS: To test the effectiveness of the course, a randomized controlled trial was conducted on a national sample of 122 family medicine residents. The primary outcome was measured by changes in score on the Cultural Competence Assessment Tool (CCAT), a new self-assessment tool developed for this study. RESULTS: Total CCAT score increased significantly after the completion of the Internet course for 58 residents in the experimental group (83.55 before the course, 192.09 after the course) but did not change for the 64 residents in the control group (177.58 at baseline, 177.84 at end of study). On multivariate analysis, the only significant predictor of total CCAT score change was having taken the online course. CONCLUSIONS: A skills-based course on cultural competence, delivered via the Internet, is an effective educational strategy. It has potential for dissemination of standardized content.
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First-year Medical Students' Perspectives on Continuity of Care
BACKGROUND AND OBJECTIVES: The objective of this research was to obtain and describe medical students' perspectives about continuity of care while they are participating in a preclinical practice-based preceptorship. METHODS: Within the context of a preclinical preceptorship, students completed directed readings, conducted patient and physician interviews, and wrote reflections about continuity of care. Two coders independently analyzed a randomly selected subset of de-identified reflections (78 of 170) to describe predominant themes. RESULTS: During preceptorship, students interacted with patients affected by wide-ranging diseases, from diabetes to multiple sclerosis, within primary care and specialty clinical settings located in geographically diverse regions. Drawing on personal experience and interviews with patients and physicians, students reported benefits of continuity of care for patients and physicians concordant with claims from the literature, including improved medical management, better interpersonal communication, increased patient compliance, and higher levels of trust. Students also offered perspectives regarding challenges of and impediments to providing continuity of care, including managed care and work hour constraints, lack of comprehensive coordinated services, and specialty-driven care. CONCLUSIONS: Preclinical medical students are able to identify both benefits and barriers to continuity of care. These topics can provide a foundation for a future curriculum and may need to be explicitly addressed as students choose careers in medicine.
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Antimicrobial Prescribing for Upper Respiratory Infections and Its Effect on Return Visits
BACKGROUND AND OBJECTIVES: Antibiotic resistance is a growing problem that complicates the treatment of various illnesses. This study analyzes Medicaid encounter data to (1) determine antibiotic prescribing rates for common respiratory tract infections in Oregon and (2) assess the effect of receiving an antibiotic at an index visit on whether there was a return visit within 30 days. METHODS: Subjects included in this study were Medicaid patients in Oregon between 2001--2003 who were enrolled in Medicaid for a full year and were diagnosed with an upper respiratory tract infection, including bronchitis, sinusitis, acute otitis media (AOM), pharyngitis, and upper respiratory infections (URIs). Claims data were analyzed to determine receipt of an antibiotic within 3 days of the initial visit and if there was a return visit within 30 days. RESULTS: During 2001--2003, the proportion of patients receiving antibiotics for bronchitis and sinusitis decreased, from 70% to 61%, and from 78% to 74%, respectively, while antibiotic prescribing for AOM, URI, and pharyngitis changed little. After controlling for age, gender, race/ethnicity, Medicaid plan type, and location, we determined that patients who had received antibiotics during the index visit for AOM, URI, and pharyngitis were more likely to return with a respiratory tract infection during the subsequent 30 days than patients who did not receive antibiotics. CONCLUSIONS: Antibiotic prescribing among Medicaid patients in Oregon has decreased. Receiving an antibiotic does not decrease the rate of subsequent return visits.
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Family Medicine, the NIH, and the Medical-Research Roadmap: Perspectives From Inside the NIH
BACKGROUND AND OBJECTIVES: Family medicine has had little engagement with the National Institutes of Health (NIH), and it is unclear what NIH officials think about this. METHODS: Purposive sampling identified 13 key informants at NIH for open-ended, semi-structured interviews. Evaluation was by content analysis. RESULTS: NIH officials expressed the perception that family physicians have strong relationships with patients and communities and focus on interdisciplinary collaboration but that they do limited research and have weak research infrastructure. They also indicated that NIH has repackaged its stated focus, to include areas of research that might be applicable to family medicine, but whether this represents real change is questionable; NIH still emphasizes basic science and exclusionary trials. While NIH officials suggested that family physicians still have no obvious NIH home, they also suggest that family physicians are well-poised to recruit patients and inform questions, if not lead research. Family physicians have opportunity with Clinical and Translational Science Awards (CTSAs) but need areas of expertise and additional formal research training to succeed with greater research participation. CONCLUSIONS: NIH key informants generally appreciated family medicine clinically but viewed family medicine research as underdeveloped. Some identified opportunities for family medicine to lead, particularly CTSAs. Greater self-advocacy, research training, and developing areas of expertise may improve family medicine's engagement with NIH.
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Push, Pull, and Plant: The Personal Side of Physician Immigration to Alberta, Canada
BACKGROUND AND OBJECTIVES: The global migration of physicians has led many international physicians to enter practice in Alberta, Canada. The study was designed to explore the personal side of migration and transition experiences of these international medical graduates (IMGs). METHODS: A qualitative study using telephone interviews and a semi-structured interview guide was used to interview 19 IMGs who are currently practicing and have held Part V, restricted or temporary practice licenses for less than 7 years. RESULTS: Three major themes were identified. The first was the "push" from their own country of origin and their perception that moving to Alberta would be better for them. Professional opportunities in their home country had been affected by changing policies, lack of infrastructure, and personal/family safety issues culminating in highly stressful work environments. The second was "pull." An improvement in the quality of personal life was associated with geographical, educational, recreational, and spiritual aspects of daily living for participants and their families in their new environment. The third theme was "plant"ie, factors that encouraged them to stay in Alberta. CONCLUSIONS: This study demonstrates the continued relevance of push and pull theory in understanding IMG physician migration. Our findings in this study indicate that remaining in place, or "being planted" is conditional on political, social, and economic aspects.
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Organizational Culture Influences Health Care Workers' Influenza Immunization Behavior
BACKGROUND AND OBJECTIVES: Low rates of influenza immunization among health care workers (HCWs) pose a potential health risk to patients in primary care practices. Despite previous educational efforts and programs to reduce financial barriers, HCW influenza immunization rates remain low. Variation in practice-level organizational culture may affect immunization rates. To explore this relationship, we examined organizational cultures and HCWs' influenza immunization behaviors in three family medicine practices. METHODS: We used a multi-method comparative case study. A field researcher used participant observation, in-depth interviews, and key informant interviews to collect data in each practice in November-December 2003. A diverse team used grounded theory to analyze text data. RESULTS: Organizational culture varied among practices and differing HCW immunization rates were observed. The most structured and business-like practice achieved immunization of all HCWs, while the other two practices exhibited greater variation in HCW immunization rates. Physicians in the practices characterized as chaotic/disorganized or divided were immunized at higher rates than other members of the practices. CONCLUSIONS: In these practices, organizational culture was associated with varying rates of influenza immunization for HCWs, especially among nonphysicians. Addressing elements of organizational culture such as beliefs regarding influenza immunization and office policies may facilitate the immunization of all staff members.
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Five Easy Answers: Where the ABFM Cognitive Exam Has Gone Wrong
The American Board of Family Medicine Maintenance of Certification (MOC) Exam of Cognitive Expertise is a rite of passage for the board-certified family physician. This year is the author's turn, and he looks at what the test includes, omits, and says about our professional posture. He questions the reader for five easy answers to the quagmires of everyday practice.
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