November/December 2013 Annals of Family Medicine tip sheet

November 11, 2013

Patients Report High-Quality Care in Federally Supported Health Centers

Patients seen in federally supported community health centers in the United States generally report high quality of care, according to data from a nationally representative survey of more than 4,500 patients. Eight-four percent of patients surveyed reported excellent or very good overall quality of services; 81 percent reported excellent or very good quality of clinician care; and 84 percent were very likely to refer friends and relatives. Examining which attributes of care were associated with patients' perceptions of higher quality, researchers found higher patient ratings of access to care and patient-centered communication were associated with higher odds of positive ratings of care. They conclude that clinicians seeking to improve patients' overall perceptions of health care experiences should focus on improving patients' experience in getting access to care before and during the visit and on promoting clinician and support staff communication skills.

Effects of Patient-Centered Medical Home Attributes on Patients' Perceptions of Quality in Federally Supported Health Centers
By Lydie A. Lebrun- Harris, PhD, MPH, et al
US Department of Health and Human Services

What Health Care Professionals Say to Patients Consulting With Low Back Pain Has Significant and Enduring Influence on Their Beliefs

Although people with low back pain consult with the Internet, family and friends for information and understanding of their symptoms, health care professionals appear to have the strongest influence on patients' attitudes and beliefs, with messages to "protect the back" having long-term negative effects, and messages of reassurance and encouragement of activity having long-term positive effects. Through interviews with 23 people with acute or chronic low back pain, researchers found information and advice from clinicians had the most significant and enduring influence on patients' attitudes, with such information often impacting their beliefs for many years. Notably, they found messages from clinicians that were interpreted as meaning the back is vulnerable and needed to be protected could result in increased vigilance, worry, frustration and guilt for patients. These findings, the authors write, paint a discouraging picture of the role clinicians unwittingly play in the management of low back pain. They call on clinicians to provide reassurance to patients in an effort to increase confidence and to offer clear advice that will empower patients and positively influence their approach to movement and activity.

The Enduring Impact of What Clinicians Say to People With Low Back Pain
By Ben Darlow, et al
University of Otago, Wellington, New Zealand

Multimorbidity is Common in Australian Primary Care, With Prevalence and Severity Increasing With Age

Examining the pattern and prevalence of multimorbidity among patients attending two large Australian primary care practices, researchers find the coexistence of multiple chronic conditions is very common in both men and women and its prevalence and severity increases steadily with age. Analyzing medical records data on 7,247 patients seen over a six month period, researchers found 52 percent of all patients had two or more chronic illness, 35 percent had three or more and 15 percent had five or more. Musculoskeletal illness was the most common morbidity domain, followed by psychiatric, respiratory and vascular. The prevalence of multimorbidity increased with age (44 percent of patients aged 25 to 44, 76 percent of patients aged 45 to 64, 88 percent of patients aged 65 to 74, and 97 percent of patients aged 75 years and older). Overall, 58 percent of patients had mild, 49 percent had moderate and 14 percent had severe severity index scores. Severity index scores also increased with age, with moderate scores showing the greatest increase.

Multimorbidity in Patients Attending 2 Australian Primary Care Practices
By Tom Brett, MD, MRCGP, FRACGP, et al
The University of Notre Dame Australia, Fremantle

Government-Owned Health Centers in South China Have Better Patient-Reported Primary Care Experiences Than Hospital-Owned or Privately-Owned Centers

Evaluating the effect of various models of community health center ownership and management on patients' experience of primary care in southern China, researchers find government-owned and -managed community health centers have better patient-reported first-contact care and coordination of care than health centers managed by hospitals or by private and social entities. The survey of 1,440 patients of community health centers in China's Pearl River Delta found government-owned and -managed centers had the highest overall scores when compared with centers either managed by hospitals (95.2 vs. 90.8) or owned by private and social entities (95.2 vs. 90.7) as a result of better first-contact care and coordination of care, using a validated Mandarin Chinese version of the Primary Care Assessment Tool. The authors conclude the findings suggest that government-owned and -managed centers may be better able to solve one of the key challenges facing health care reform efforts in China - the problem of underutilization of the community health centers as the first-contact point of care.

Patients' Experiences in Different Models of Community Health Centers in Southern China
By Samuel Y.S. Wong, MD, FCFPC, et al
The Chinese University of Hong Kong SAR, China

New Scale Measures the Quality of Work Relationships in Primary Care and Offers Preliminary Evidence That Staff and Clinician Relationships Impact Patients' Health Care Experience

Recognizing that the quality of work relationships among clinicians and staff may be an essential component to improving health care delivery, researchers develop and validate a new 15-item Work Relationships Scale to assess the quality of relationships in primary care settings. Working with 17 Department of Veterans Affairs primary care clinics, researchers analyze data from 457 clinician and staff surveys and 247 patient interviews and find evidence to support the scale's validity as well as preliminary evidence that relationship quality within clinics influences patients' experience of health care. Specifically, researchers found patients' "overall rating of health care," which reflects their perceptions of their care as a whole and "overall rating of doctor/nurse," which reflects their perception of individual clinicians, were both significantly associated with WRS scores, with lower WRS-scoring clinics receiving poorer patient quality ratings for both individual clinicians and overall health care. Given these findings, authors assert that primary care quality improvement efforts should include the assessment of work relationships.

Relationship Quality and Patient-Assessed Quality of Care in VA Primary Care Clinics: Development and Validation of the Work Relationships Scale
By Erin P. Finley, PhD, MPH, et al
South Texas Veterans Health Care System, San Antonio

Community Intervention to Increase Colon Cancer Screening Has Modest Success

Researchers describe a multicomponent community-based intervention to increase colon cancer screening in the rural northeast Colorado. The program, which included educational and motivational materials disseminated through local newspapers and other very targeted outlets (auction flyers, community organizations, etc.), successfully engaged community members and resulted in a modest, though not statistically significant, increase in overall colon cancer screening. Analyzing data from more than 1,000 pre- and post-intervention survey responses, researchers with the High Plains Research Network found a 5 percent increase in the proportion of respondents who reported ever having had any test in the intervention communities (from 76 percent to 81 percent) compared with no increase among control counties in southeast Colorado (77 percent at both points). They also found the extent of exposure to intervention materials was associated with a significant and cumulative increase in screening. Community members who reported seeing five or more products were significantly more likely to report having ever been tested or being up to date for colon cancer screening than those who had seen only one component (87 percent vs. 78 percent). The authors conclude that although they did not find any statistically significant differences, the findings are consistent with an intervention-related increase in screening and provide preliminary evidence for the effectiveness of a multicomponent community approach to improve colon cancer screening.

Testing to Prevent Colon Cancer: Results From a Rural Community Intervention
By John M. Westfall, MD, MPH, et al
University of Colorado Denver School of Medicine

Community Members Provide a Personal Perspective on Working Together to Improve the Health and Health Care of Their Community

A companion essay by the community-based advisory council who collaborated with the High Plains Research Network to develop and implement the colon cancer screening intervention describes the process through the voices of the community participants. They assert that their experience attests to the power of participatory research in the implementation of interventions to improve population health outcomes. A video that will post with the essay tells the story in their own words

Testing to Prevent Colon Cancer: How Rural Community Members Took on a Community-Based Intervention
By John M. Westfall, MD, MPH, et al
University of Colorado Denver School of Medicine

New Concept for Measuring the Impact of Information from Electronic Knowledge Resources

Researchers describe a new conceptualization and measure of the impact of information gleaned from electronic knowledge resources. They define the "number needed to benefit from information" as the number of patients for whom clinical information is retrieved for one patient to benefit. This number, they hope, can be used in future experimental research to compare the impact of information derived from different electronic knowledge resources.

Number Needed to Benefit From Information (NNBI): Proposal From a Mixed Methods Research Study With Practicing Family Physicians
Pierre Pluye, MD, PhD, et al
McGill University, Montreal, Quebec, Canada

Cultivating a Cycle of Trust is Critical to Engaging Minority Populations in Practice-Based Research Studies

With minority populations traditionally underrepresented in clinical research studies, researchers identify strategies for recruiting and retaining patients from diverse racial and ethnic communities into practice-based research studies. Interviews with 18 researchers experienced in recruiting participants from minority communities and 172 patients from those communities revealed the critical importance of trust to successful recruitment and retention. Participants emphasized that establishing and maintaining trusting relationships that extend beyond the enrollment and data collection phases are essential to enhance the participation of diverse populations in PBRN clinical research. Participants identified a set of flexible strategies within each stage of the research process and called for close engagement with the clinic and community partners. The findings from this study, conducted in five distinct minority communities within a national network of PBRNs, offer the PBRN community a guide toward achieving the important goal of engaging diverse communities in research.

Cultivating a Cycle of Trust With Diverse Communities in Practice-Based Research: A Report From PRIME Net
By Christina M. Getrich, PhD, et al
University of New Mexico, Albuquerque

Family Physician Posits Six Habits for Better Patient Encounters

A family physician explores the effect of health care expectations, which he asserts lie at the heart of the health care crisis, and identifies six habits of mind and practice that he believes are associated with healthier, happier encounters with patients and their illness. These habits include identifying, listening, touching, looking, planning and following up.

What Do You Expect from a Doctor? Six Habits for Healthier Patient Encounters
By David Loxterkamp, MD
Belfast, Maine

Pharmacist Reflects on the Meaning of Community After Hurricane Sandy Relief Experiences

A pharmacist in Hoboken, N.J., reflects on how she rediscovered the meaning of community while working with colleagues, health care professionals and non-health care volunteers in the days immediately following Hurricane Sandy.

Rediscovering Community-Reflections After Hurricane Sandy
By Sharon See, PharmD, FCCP, BCPS
Jamaica, N.Y.
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. Launched in May 2003, Annals is sponsored by seven 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, the North American Primary Care Research Group, and the College of Family Physicians of Canada. 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 website,

American Academy of Family Physicians

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