Family practice research journal最新文献

This paper describes a study of biomedical and psychosocial risks and the perinatal outcome. Two hundred nineteen pregnant women completed three instruments to identify their biomedical and psychosocial risk: anxiety, family function, life events. Biomedical risk was assessed through analyses of self-reported health histories. Information on complications of pregnancy, labor, and delivery was obtained from the hospital delivery records. In the sample studied, biomedical risk alone was not substantially related to perinatal complications. Four psychosocial items were the best psychosocial predictors of perinatal complications: emotional tension; depressive humor; neurovegetative symptoms of anxiety; and dissatisfaction with the time, space, and money shared with the family (p < 0.05). The interaction between these critical psychosocial items and biomedical risk also reliably predicted complications (p < 0.00001). The results of this study suggest that psychosocial risk assessment alone and in interaction with biomedical risk assessment may significantly improve the ability to identify women who may experience perinatal complications.

Use of a standard prescription pad, although it adequately meets the needs of drug delivery, requires the physician to document prescribed medications separately in the medical record. Failure to do so may lead to under-recognition of problems of potential drug interactions and adverse drug reactions, delays in prescription refills, and other areas of quality of care, especially in a setting where multiple physicians may be involved in the care of a patient. Of 83 prescriptions written in a primary care clinic, only 11 (13%) were noted on the chart medication form when physicians used prescription pads. Implementation of a "one-write" noncarbon prescription form that generated an instant copy increased prescription documentation to 83% (49 of 59 prescriptions) (x2 = 68.86; p < 0.005) over a one-week period. In a follow-up study conducted approximately 3.5 years after the initial intervention, use of the "one-write" form had maintained at 82% prescription documentation (32 of 39) prescriptions) (x2 = 52.05; p < 0.005). A "one-write" copy system could improve clinical care by improving medication documentation in the medical record.

The Family Profile is a new self-report family assessment instrument that is grounded in family theory and designed following a construct validation approach to instrument design that integrated theoretical concepts with test construction and empirical analysis. Development consisted of three component phases: rational theoretical design, empirical structural analysis, and psychometric validation. The first theoretical design phase resulted in a 231-item instrument with 13 construct scales. Structural analysis data were collected from a pilot sample of 160 patients selected from 6 family practice clinics in urban, suburban, and rural locations. After revision based on item and scale analysis, a 129-item instrument was administered to a random sample of 876 patients from family practices throughout Minnesota. Responses were analyzed for item- and scale-distribution characteristics, item-scale and scale-scale correlations, correlation with social desirability, factor analysis to confirm or disconfirm the existence of the theoretical dimensions, internal consistency reliability, and test-retest reliability. This analysis reduced the instrument to 90 items from all 13 postulated constructs that cluster into 6 main factors--Family Concordance, Family Discordance, Marital Strength, Active Involvement, Religiosity, and Parental Leadership. The Family Profile is also temporally stable and free from social desirability bias. Validation (construct and criterion) and normative data studies of various populations are in progress.

Depression is a common but underrecognized disorder in family practice. The purpose of this study was to determine the relationship between physician attitudes toward psychosocial aspects of care and psychiatric knowledge and recognition of depression in a family practice residency clinic. Adult patients (n = 582) presenting to 16 family practice residents were screened for depression using the short form of the Beck Depression Inventory. A regression model was created with the rate of recognition of depression for each physician as the dependent variable. Independent variables included in the model were resident scores on the Physician Belief Scale and the psychiatric subsection of the in-training exam scores, patient familiarity, and whether the attending physician was consulted. Orientation toward psychosocial aspects of medical care was found to be significantly related to recognition of patients at risk for depression. In-training examination psychiatric subsection scores were unrelated to a resident's clinical recognition of depression risk. This study suggests that physician attitude is a significant factor in successful recognition of depression by family practice residents.

Background: Prior studies suggest a gender-based difference in the management of myocardial ischemia in nonacute settings. We examined whether there was a gender difference in the emergency department evaluation and management of patients with acute chest pain.

Methods: A record review from 10 St. Louis metropolitan emergency departments was done on all patients over 35 years old who presented with acute nonpleuritic, nontraumatic chest pain. We reviewed for the presence of cardiac risk factors, prior cardiac disease, time to physician evaluation, and time to initial electrocardiogram. In the patient subgroup admitted from the emergency department with a diagnosis of myocardial infarction or unstable angina, disposition was noted.

Results: Women waited longer than men for an initial physician evaluation and an initial electrocardiogram. In the patient subgroup with acute myocardial ischemia, a smaller percentage of women than men (56.0% vs 82.8%) were admitted to an intensive care unit.

Conclusion: In patients with acute nonpleuritic, nontraumatic chest pain, women were evaluated and managed less aggressively than men.

The characteristics of those with phobic anxiety--anxiety with or without avoidance of specific fear-provoking situations--seen in family practice have not been previously described. However, patients with agoraphobia--extreme avoidance of fear-provoking situations--are frequently seen in the general health sector. In addition, panic attacks, which are spontaneous episodes of intense anxiety associated with at least four autonomic symptoms that build rapidly in intensity, are believed to be antecedent to phobic anxiety. This secondary analysis used 29 patients with panic attacks. During a structured interview, these patients completed a phobic anxiety questionnaire and the Health Locus of Control questionnaire. Of the 21 patients with phobic anxiety, 16 (76%) reported that they avoided at least one situation. Although patients frequently left home during the week (mean = 10.8 times), 11 (58%) felt that their fears controlled their lives. Patients' responses generally supported the model of fear causing anticipatory anxiety that in turn causes avoidance; however, panic attacks frequently began after phobic anxiety but before the fear was reported by patients to control their lives. Recognition and early intervention with those with phobic anxiety may minimize its severity and pervasiveness.

A hypothesis-generation study was conducted to examine risk factors for bacterial vaginosis recurrences among women participating in a randomized controlled trial of male sexual partner treatment. Of the 140 women enrolled in the trial, 72 had a normal vaginal gram-stained slide at the first follow-up visit and were included in this analysis. Nineteen of the 72 (26.2%) women developed a bacterial vaginosis recurrence documented by a vaginal gram-stained slide during the 6-week follow-up period. Of the 19 women, 4 of 6 sponge users (66%) developed a bacterial vaginosis recurrence (RR 2.93, 95% CI: 1.43-6.02). Logistic regression analysis supported the association between sponge use and bacterial vaginosis recurrences (adjusted RR 2.71, 95% CI: 1.06-6.99) but revealed that an apparent protective effect of diaphragm use was due to the confounding effect of sexual partner treatment. Our hypothesis is that bacterial vaginosis recurrences may be due to factors other than sexual transmission, such as sponge use. Further studies are needed to examine risk factors for bacterial vaginosis recurrences. In the interim, physicians might suggest another form of contraception to their sponge-using patient with frequent bacterial vaginosis infections.