Family Medicine Update

Odds of having a regular physician and perceptions of care: ethnic patterns for women ages 25–45.

Fam Med. 2009 Apr;41(4):271-6

Authors: Shreffler KM, McQuillan J, Greil AL, Lacy NL, Ngaruiya C

BACKGROUND AND OBJECTIVES: This study’s purpose was to simultaneously investigate demographic, socioeconomic status, health status, and access-to-care factors to see if they could explain racial/ethnic differences in the odds of reproductive-aged women having a regular physician and perceptions of those women about their care. METHODS: Data come from a nationally representative sample of 4,520 women ages 25–45. We used logistic regression models to ascertain the odds of having a regular doctor and feeling cared for among black, Hispanic, and Asian women as compared to non-Hispanic white women. Models contained controls for factors found significant in prior research and interaction terms. RESULTS: Hispanic women have significantly lower odds of having a regular doctor than white non-Hispanic women, a gap primarily explained by differences in language and insurance status. Asian and Hispanic women have significantly lower odds of reporting feeling cared for by their doctor, and black women have higher odds of reporting feeling cared for by their doctor than white women. Significant interaction terms of race/ethnicity by economic level, residence, and health status show that the associations between race/ethnicity and having a regular doctor, and feeling cared for by that doctor, depend on other characteristics. CONCLUSIONS: The odds that women of reproductive age will have a regular doctor and report feeling cared for by that doctor differ by race/ethnicity and socioeconomic characteristics. Black women have higher odds, and Spanish-speaking women have lower odds of having a regular doctor than white women, and Hispanic and Asian women have lower odds of feeling cared for.

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Designing an RCT of acupuncture for depression–identifying appropriate patient groups: a qualitative study.

Fam Pract. 2009 Apr 7;

Authors: Schroer S, Macpherson H, Adamson J

BACKGROUND: Acupuncture is a popular complementary therapy choice for depression in the UK but the evidence base lags behind its usage. Further effectiveness trials are required; however, these need based on appropriate design for a complex intervention on a heterogeneous group of people. Aim. To identify subgroups of patients with depression who could be the focus of effectiveness trials. METHODS: Qualitative research using in-depth interviews in UK primary care. In-depth interviews with 30 participants from three stakeholder groups: 10 acupuncture patients and 10 acupuncturists-to examine the reasons why acupuncture is used for depression and 10 physicians-to elicit who would be acceptable to refer into a trial of acupuncture for depression. Interviews were transcribed and analysed using a Framework approach. RESULTS: The data have highlighted that the acceptability of particular treatments for depression is influenced by the individuals’ illness career within their social context. In addition, the plausibility and associated acceptability of depression treatments are also closely tied to an individuals’ explanatory model of their condition. Seven patient subgroups were identified who could potentially find acupuncture of particular interest and on which effectiveness trials could be focused. CONCLUSIONS: We have identified the main reasons why people seek acupuncture for depression and the circumstances in which physicians would be willing to refer for depression were it to prove effective. We have also set out a number of potential patient subgroups who may be particularly interested participating in a randomized controlled trail of acupuncture for depression.

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Teaching First-year Medical Students to Apply Evidence-based Practices to Patient Care.

Fam Med. 2009 May;41(5):332-6

Authors: Nieman LZ, Cheng L, Foxhall LE

BACKGROUND AND OBJECTIVES: Our objective was to describe and evaluate an educational intervention for teaching preclinical medical students enrolled in a family medicine preceptorship to use evidence-based medicine (EBM) techniques. METHODS: In a brief workshop, 94 preclinical students, enrolled in a 4?week family medicine preceptorship, learned an EBM approach to clinical decision making. Students were responsible for completing four patient case summaries to document that they had searched selected databases and obtained feedback from their preceptors. We then evaluated (1) the percent of students documenting EBM processes, (2) the students’ perceived self?efficacy, (3) the level of the students’ EBM learning, and (4) preceptors’ attitudes toward using the EBM project as the focus of their feedback. RESULTS: All students succeeded in identifying the factual knowledge that they had used to convert information from patient encounters into searchable clinical questions. The preceptors provided case?specific, written feedback to all students. Students gave lesser ratings of importance to EBM and self?efficacy in using EBM after the preceptorship as compared to after the brief introductory workshop. Preceptors acknowledged that the project helped them to focus their feedback and to reconsider patient management practices. CONCLUSIONS: Students learned to use an EBM process and became more familiar with and more realistic about their self?efficacy in using EBM. Preceptors and preclinical medical students can learn and hone EBM skills together.

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