November/December 2006 Annals of Family Medicine tip sheet

NOVEMBER/DECEMBER 2006 ANNALS OF FAMILY MEDICINE TIP SHEET
With the cold and flu season upon us, the November/December issue of Annals of Family Medicine features several studies that cover the following topics:

  • Impact of the 2004 influenza vaccine shortage on continuity of care
  • Improving influenza vaccination of high-risk children
  • Proper use of antibiotics to treat upper respiratory infections, sinusitis and sore throat


INFLUENZA VACCINE

The flu vaccine shortage of 2004 appears to have had a negative impact on continuity of care according to an analysis of Medicare data in West Virginia. Medicare claims for flu vaccinations in West Virginia dropped by more than 50 percent from more than 92,000 in 2003 to approximately 44,000 in 2004. The shortage severely affected the ability of physicians to provide influenza vaccination to their patients and therefore some patients received vaccines from sources other than their regular doctors, most often from a mass immunizer, or did not receive vaccine at all. The percentage of Medicare recipients who received flu vaccine from the same clinician as the year before fell from 54 percent in 2002-2003 to 3 percent in 2003-2004. The authors suggest that the disruption of continuity of care is concerning because continuity of care in the ambulatory care setting has important benefits including improved health and reduced health care costs.

A second study looks at ways to help inner-city health centers raise vaccination rates among high-risk children and finds that when a menu of tailored interventions (such as flu vaccines on a walk-in basis or reminder e-mails for clinicians) is implemented in inner-city health centers, the result is a modest rise in flu vaccination rates for children aged 2 to 17 years. Influenza vaccination rates improved modestly from baseline (10.4 percent) to 13.1 percent during the first year of the intervention implementation and to 18.7 percent during the second year. A variety of strategies were used based on the health centers’ specific needs and their office and patient cultures.
Impact of the 2004 Influenza Vaccine Shortage Impact on Repeat Immunization Rates
By Charles P. Schade, M.D., M.P.H., et al
Improving Influenza Vaccination Rates of High-Risk Inner-City Children Over 2 Intervention Years
By Richard K. Zimmerman, M.D., et al


USE OF ANTIBIOTICS TO TREAT UPPER RESPIRATORY INFECTIONS

Millions of people suffer from sinusitis, making it a common ailment of the cold and flu season. The best policy for patients who might have sinusitis and do not have signs of complications or severe infection is to wait for natural recovery, rather than utilize antibiotics finds this study. A secondary analysis of 300 patients who participated in a randomized controlled trial finds that signs and symptoms of sinusitis and abnormal sinus x-rays do not help physicians predict the course of the illness or whether the patient will benefit from antibiotics. Although antibiotics are not generally effective in treating this condition, they are effective in treating a bacterial type of sinusitis that affects a minority of patients.

Another study about the use of antibiotics finds that patients with sore throat, who hope for antibiotics, may in fact be more concerned about receiving pain relief. In this study of 298 sore throat patients, the three most common reasons for consulting their physician were to find out the cause of the symptoms, pain relief and information about the course of the illness. Additionally, a patients’ desire for pain relief was a strong predictor for their hope of receiving an antibiotic. The authors suggest that physicians should address patients’ expectations and needs for managing pain when treating sore throat, rather than prescribing antibiotics.

In an accompanying editorial, the author, a family physician researcher of respiratory infections and antibiotic use, reflects upon the two studies above and how their findings might reframe his approach to management of acute respiratory infections. He states that he will focus more on symptom relief than on explanations of the differences between viruses and bacteria for all patients with common acute respiratory infections. Predicting Prognosis and Effect of Antibiotic Treatment in Acute Rhinosinusitis
By An De Sutter, M.D., Ph.D., et al
Are Sore Throat Patients Who Hope for Antibiotics Actually Asking for Pain Relief"
By Mieke L. van Driel, M.D., M.Sc., et al
A New Look at an Old Problem: Inappropriate Antibiotics for Acute Respiratory Infections
By John Hickner, M.D., M.Sc.


OTHER STUDIES IN THIS ISSUE

MATERNAL INVOLVEMENT IN ADOLESCENT DAUGHTERS’ REPRODUCTIVE HEALTH CARE

An in-depth qualitative study finds that mothers of urban minority adolescent girls have a low awareness of their adolescent daughters’ sexual activity but are strongly committed to protecting their daughters’ reproductive outcomes. Many mothers believe that confidential care promotes risky behavior and undermines mothers’ efforts to protect girls. Furthermore, adolescent girls express considerable discomfort around reproductive health care and negotiating maternal involvement, and fear breaches of confidentiality. The authors suggest that consistently including a confidential component to visits in early adolescence, with preparation for both mothers and daughters, may reduce feelings of distrust and discomfort. Perspectives on Confidential Health Care for Adolescent Girls
By M. Diane McKee, M.D., M.S., et al

HOW INTERVAL BREAST CANCER IS DETECTED

This epidemiological study finds that, of the 143 women studied with breast cancer that occurs between regularly scheduled mammograms, approximately half of the cancers were in women who seeking health care for a breast complaint, especially when a lump was accompanied by a personal and family history of breast cancer. Seventeen percent of the cancers were found by the patients’ primary care doctor conducting a routine breast exam and the remaining were picked up by a follow-up mammogram. The authors assert that women at highest risk for breast cancer may need closer surveillance than the general population of women and need to be encouraged to seek care from their primary care doctor if they develop breast symptoms, rather than taking reassurance from a negative screening mammogram. Discovery of Breast Cancers That Occur Within 1 Year of a Normal Screening Mammogram: How Are They Found"
By Patricia A. Carney, Ph.D., et al

DOCTORS’ SATISFACTION WITH THEIR WORK IS RELATED TO MAINTAINING RELATIONSHIPS

General practictioners’ satisfaction with patient visits is related to developing and maintaining relationships with their patients, rather than to technical aspects of diagnosis and treatment, finds this qualitative study of 19 general practitioners in Scotland. What Do General Practioners Find Satisfying in Their Work: Implications for Health Care System Reform
By Karen Fairhurst, Ph.D., et al

HEADACHES AND ABDOMINAL PAIN CLUSTER IN FAMILIES

Ailments, such as headaches and abdominal pain, tend to cluster in families, especially in mothers and children, according to this analysis of national survey data from more than 30,000 families in the Netherlands. The authors conclude that when primary care doctors understand patients’ family context, they can better diagnose and care for them. All in the Family: Headaches and Abdominal Pain as Indicators for Consultation Patterns in Families
By Mieke Cardol, Ph.D., et al

DEPRESSED PATIENTS THINK “SUPPORTIVE TALK” HELPS

Hispanic patients’ perceptions of the efficacy of depression treatment do not match current treatment guidelines that emphasize diagnosis and technical care. This study of 121 depressed Hispanic patients finds that most think their primary care physician could be helpful in treating their depression and that “supportive talk” with their doctor is an effective treatment. Three quarters thought that medication could be helpful, or were not sure. Conceptual Models of Treatment in Depressed Hispanic Patients
By Alison Karasz, Ph.D., et al

A NEW MEASURE OF CONTINUITY OF CARE

An experience-based measure of continuity of care (ECC-DM) proved to be reliable and a valid tool that is suitable for use in different care settings. This tool can increase physicians’ understanding of factors that improve or harm patients’ experiences of continuity of care and can be completed by the patient or in an interview format. Measuring Continuity of Care in Diabetes Mellitus: An Experience-Based Measure
By Martin C. Gulliford, F.R.C.P., et al

ASSESSMENT OF A RACE-BASED PHARMACEUTICAL DRUG

BiDil is the first drug approved by the Food and Drug Administration marketed for a single racial-ethnic group, African-Americans, in the treatment of congestive heart failure. This analysis discusses background issues to help prepare physicians to counsel patients about this controversial drug. BiDil: Assessing a Race-Based Pharmaceutical
By Howard Brody, M.D., Ph.D., et al

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Annals of Family Medicine is a peer-reviewed, indexed research journal that provides a cross-disciplinary forum for new, evidence-based information affecting the primary care disciplines. Annals is sponsored by six family medical organizations, including the American Academy of Family Physicians, the American Board of Family Medicine, the Society of Teachers of Family Medicine, the Association of Departments of Family Medicine, the Association of Family Medicine Residency Directors and the North American Primary Care Research Group. Annals is published six times each year and contains original research from the clinical, biomedical, social and health services areas, as well as contributions on methodology and theory, selected reviews, essays and editorials. Complete editorial content and interactive discussion groups for each published article can be accessed free of charge on the journal’s Web site, www.annfammed.org.


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