[Show abstract][Hide abstract] ABSTRACT: Purpose:
The purpose of this study was to examine associations between the number and types of patients' chronic diseases and being up to date for breast, cervical, and colorectal cancer screening.
Data were abstracted from medical charts at 4 primary care clinics located in 2 rural Oregon communities. Eligibility criteria included being at least 55 years old and having at least 1 clinic visit in the past 2 years.
Of 3433 patients included, 503 (15%) had no chronic illness, 646 (19%) had 1, 786 (23%) had 2, and 1498 (44%) had ≥3 chronic conditions. Women with asthma/chronic lung disease and with cardiovascular disease were less likely to be up o date for mammography screening (odds ratio [OR], 0.59; 95% confidence interval [CI], 0.43-0.80), and those with chronic digestive disorders were more likely to be up to date for mammography (OR, 1.31; 95% CI, 1.03-1.66) compared with those without chronic conditions. Women with arthritis, diabetes mellitus, and hypertension were less likely to be up to date for cervical cancer screening (OR, 0.38; 95% CI, 0.21-0.68) compared with those without chronic conditions. Men with cardiovascular disease were less likely to be up to date for colorectal cancer screening (adjusted OR, 0.59; 95% CI, 0.44-0.80), and women with depression were less likely to be up to date (OR, 0.71; 95% CI, 0.56-0.91) compared with men and women without chronic conditions.
Specific chronic conditions were found to be associated with up-to-date status for cancer screening. This finding may help practices to identify patients who need to receive cancer screening.
The Journal of the American Board of Family Medicine 09/2014; 27(5):669-81. DOI:10.3122/jabfm.2014.05.140005 · 1.98 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose:
Community engagement (CE) and community-engaged research (CEnR) are increasingly recognized as critical elements in research translation. Process models to develop CEnR partnerships in rural and underserved communities are needed.
Academic partners transformed four established Community Health Improvement Partnerships (CHIPs) into Community Health Improvement and Research Partnerships (CHIRPs). The intervention consisted of three elements: an academic-community kickoff/orientation meeting, delivery of eight research training modules to CHIRP members, and local community-based participatory research (CBPR) pilot studies addressing childhood obesity. We conducted a mixed methods analysis of pre-/postsurveys, interviews, session evaluations, observational field notes, and attendance logs to evaluate intervention effectiveness and acceptability.
Forty-nine community members participated; most (78.7%) attended five or more research training sessions. Session quality and usefulness was high. Community members reported significant increases in their confidence for participating in all phases of research (e.g., formulating research questions, selecting research methods, writing manuscripts). All CHIRP groups successfully conducted CBPR pilot studies.
The CHIRP process builds on existing infrastructure in academic and community settings to foster CEnR. Brief research training and pilot studies around community-identified health needs can enhance individual and organizational capacity to address health disparities in rural and underserved communities.
[Show abstract][Hide abstract] ABSTRACT: Objective:
Remote monitoring technology (RMT) may enhance healthcare quality and reduce costs. RMT adoption depends on perceptions of the end-user (e.g., patients, caregivers, healthcare providers). We conducted a systematic review exploring the acceptability and feasibility of RMT use in routine adult patient care, from the perspectives of primary care clinicians, administrators, and clinic staff.
Materials and methods:
We searched the databases of Medline, IEEE Xplore, and Compendex for original articles published from January 1996 through February 2013. We manually screened bibliographies of pertinent studies and consulted experts to identify English-language studies meeting our inclusion criteria.
Of 939 citations identified, 15 studies reported in 16 publications met inclusion criteria. Studies were heterogeneous by country, type of RMT used, patient and provider characteristics, and method of implementation and evaluation. Clinicians, staff, and administrators generally held positive views about RMTs. Concerns emerged regarding clinical relevance of RMT data, changing clinical roles and patterns of care (e.g., reduced quality of care from fewer patient visits, overtreatment), insufficient staffing or time to monitor and discuss RMT data, data incompatibility with a clinic's electronic health record (EHR), and unclear legal liability regarding response protocols.
This small body of heterogeneous literature suggests that for RMTs to be adopted in primary care, researchers and developers must ensure clinical relevance, support adequate infrastructure, streamline data transmission into EHR systems, attend to changing care patterns and professional roles, and clarify response protocols. There is a critical need to engage end-users in the development and implementation of RMT.
Telemedicine and e-Health 04/2014; 20(5). DOI:10.1089/tmj.2013.0166 · 1.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To determine the expected duration of symptoms of common respiratory tract infections in children in primary and emergency care.
Systematic review of existing literature to determine durations of symptoms of earache, sore throat, cough (including acute cough, bronchiolitis, and croup), and common cold in children.
PubMed, DARE, and CINAHL (all to July 2012).
Randomised controlled trials or observational studies of children with acute respiratory tract infections in primary care or emergency settings in high income countries who received either a control treatment or a placebo or over-the-counter treatment. Study quality was assessed with the Cochrane risk of bias framework for randomised controlled trials, and the critical appraisal skills programme framework for observational studies.
Individual study data and, when possible, pooled daily mean proportions and 95% confidence intervals for symptom duration. Symptom duration (in days) at which each symptom had resolved in 50% and 90% of children.
Of 22,182 identified references, 23 trials and 25 observational studies met inclusion criteria. Study populations varied in age and duration of symptoms before study onset. In 90% of children, earache was resolved by seven to eight days, sore throat between two and seven days, croup by two days, bronchiolitis by 21 days, acute cough by 25 days, common cold by 15 days, and non-specific respiratory tract infections symptoms by 16 days.
The durations of earache and common colds are considerably longer than current guidance given to parents in the United Kingdom and the United States; for other symptoms such as sore throat, acute cough, bronchiolitis, and croup the current guidance is consistent with our findings. Updating current guidelines with new evidence will help support parents and clinicians in evidence based decision making for children with respiratory tract infections.
[Show abstract][Hide abstract] ABSTRACT: Previous research on ascertainment of cancer family history and cancer screening has been conducted in urban settings.
To examine whether documented family history of breast or colorectal cancer is associated with breast or colorectal cancer screening.
Medical record reviews were conducted on 3,433 patients aged 55 and older from four primary care practices in two rural Oregon communities. Data collected included patient demographic and risk information, including any documentation of family history of breast or colorectal cancer, and receipt of screening for these cancers.
A positive breast cancer family history was associated with an increased likelihood of being up-to-date for mammography screening (OR 2.09, 95% CI 1.45-3.00 relative to a recorded negative history). A positive family history for colorectal cancer was associated with an increased likelihood of being up-to-date with colorectal cancer screening according to U.S. Preventive Services Task Force low risk guidelines for males (OR 2.89, 95% CI 1.15-7.29) and females (OR 2.47, 95% CI 1.32-4.64) relative to a recorded negative family history. The absence of any recorded family cancer history was associated with a decreased likelihood of being up-to-date for mammography screening (OR 0.70, 95% CI 0.56-0.88 relative to recorded negative history) or for colorectal cancer screening OR 0.75, 95% CI 060-0.96 in females, 0.68, 95% CI 0.53-0.88 in males relative to recorded negative history).
Further research is needed to determine if establishing routines to document family history of cancer would improve appropriate use of cancer screening.
Preventive Medicine 09/2013; 57(5). DOI:10.1016/j.ypmed.2013.08.031 · 3.09 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background Respiratory tract infections (RTIs) in children are common and often result in antibiotic prescription despite their typically self-limiting course. Aim To assess the effectiveness of primary care based interventions to reduce antibiotic prescribing for children with RTIs. Design and setting Systematic review. Method MEDLINE(®), Embase, CINAHL(®), PsycINFO, and the Cochrane library were searched for randomised, cluster randomised, and non-randomised studies testing educational and/or behavioural interventions to change antibiotic prescribing for children (<18 years) with RTIs. Main outcomes included change in proportion of total antibiotic prescribing or change in 'appropriate' prescribing for RTIs. Narrative analysis of included studies was used to identify components of effective interventions. Results Of 6301 references identified through database searching, 17 studies were included. Interventions that combined parent education with clinician behaviour change decreased antibiotic prescribing rates by between 6-21%; structuring the parent-clinician interaction during the consultation may further increase the effectiveness of these interventions. Automatic computerised prescribing prompts increased prescribing appropriateness, while passive information, in the form of waiting room educational materials, yielded no benefit. Conclusion Conflicting evidence from the included studies found that interventions directed towards parents and/or clinicians can reduce rates of antibiotic prescribing. The most effective interventions target both parents and clinicians during consultations, provide automatic prescribing prompts, and promote clinician leadership in the intervention design.
British Journal of General Practice 07/2013; 63(612):445-54. DOI:10.3399/bjgp13X669167 · 2.29 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives:
The Agency for Healthcare Research and Quality (AHRQ) Effective Health Care Program conducts systematic reviews of health-care topics nominated by stakeholders. Topics undergo refinement to ensure relevant questions of appropriate scope and useful reviews. Input from key informants, experts, and a literature scan informs changes in the nominated topic. AHRQ convened a work group to assess approaches and develop recommendations for topic refinement.
Study design and setting:
Work group members experienced in topic refinement generated a list of questions and guiding principles relevant to the refinement process. They discussed each issue and reached agreement on recommendations.
Topics should address important health-care questions or dilemmas, consider stakeholder priorities and values, reflect the state of the science, and be consistent with systematic review research methods. Guiding principles of topic refinement are fidelity to the nomination, relevance, research feasibility, responsiveness to stakeholder inputs, reduced investigator bias, transparency, and suitable scope. Suggestions for stakeholder engagement, synthesis of input, and reporting are discussed. Refinement decisions require judgment and balancing guiding principles. Variability in topics precludes a prescriptive approach.
Accurate, rigorous, and useful systematic reviews require well-refined topics. These guiding principles and methodological recommendations may help investigators refine topics for reviews.
01/2013; Agency for Healthcare Research and Quality.
[Show abstract][Hide abstract] ABSTRACT: The current study was performed to determine, in rural settings, the relation between the type and status of insurance coverage and being up-to-date for breast, cervical, and colorectal cancer screening. Four primary care practices in 2 rural Oregon communities participated. Medical chart reviews that were conducted between October 2008 and August 2009 assessed insurance coverage and up-to-date status for breast, cervical, and colorectal cancer screening. Inclusion criteria involved having at least 1 health care visit within the past 5 years and being aged ≥ 55 years. The majority of patients were women aged 55 years to 70 years, employed or retired, and who had private health insurance and an average of 2.5 comorbid conditions. The overall percentage of eligible women who were up-to-date for cervical cancer screening was 30%; approximately 27% of women were up-to-date for clinical breast examination, 37% were up-to-date for mammography, and 19% were up-to-date for both mammography and clinical breast examination. Approximately 38% of men and 35% of women were up-to-date for colorectal cancer screening using any test at appropriate screening intervals. In general, having any insurance versus being uninsured was associated with undergoing cancer screening. For each type of screening, patients who had at least 1 health maintenance visit were significantly more likely to be up-to-date compared with those with no health maintenance visits. A significant interaction was found between having health maintenance visits, having any health insurance, and being up-to-date for cancer screening tests. Overall, the percentage of patients who were up-to-date for any cancer screening, especially cervical cancer screening, was found to be very low in rural Oregon. Patients with some form of health insurance were more likely to have had a health maintenance visit within the previous 2 years and to be up-to-date for breast, cervical, and/or colorectal cancer screening. Cancer 2012.
Cancer 12/2012; 118(24). DOI:10.1002/cncr.27635 · 4.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Adults with physical disabilities are less likely than others to receive cancer screening. It is not known, however, whether commonly used measures assess elements of physical ability necessary for successful screening. The objective of this exploratory study was to determine whether patients who reported limitations in activities of daily living (ADLs) or instrumental ADLs (IADLs) are perceived by their primary care clinicians to have physical limitations that may impede cancer screening.
Patients at 2 rural primary care clinics were surveyed about ADLs and IADLs and about their up-to-date status for breast, cervical, and/or colorectal cancer screening. Clinicians and office staff were asked whether they believed each patient had a physical limitation that might impede screening. The agreement between patient and clinician assessments was evaluated.
Clinicians believed that 43% of patients with severe disability (ADLs) and 30% of patients with moderate disability (IADLs) had limitations that might affect screening. Agreement between patient and clinician assessments was low according to the kappa statistic (κ = 0.355), but had a high percentage of negative agreement (92.3%) and a low percentage of positive agreement (42.7%). Patients with ADL/IADL-related disability were less likely than nondisabled patients to be current for cervical and breast cancer screening. Patients who were viewed by clinicians as having limitations relevant for screening were less likely to be current for cervical cancer screening.
These results indicate that a common measure of general disability may not capture all factors relevant for cancer screening. An instrument designed to include these factors may help identify and accommodate patients who have disabilities that may impede screening.
Cancer 03/2012; 118(5):1345-52. DOI:10.1002/cncr.26393 · 4.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To assess the efficacy of an intervention to promote mammography and Papanicolaou (Pap) testing among women with mobility impairments overdue for screenings.
Randomized controlled trial.
Urban and suburban Oregon.
Women aged 35 to 64 with mobility impairments who reported not receiving a Pap test in the past 3 years and/or mammogram (if age >40 years) in the last 2 years were eligible. A total of 211 women were randomized, and 156 completed the study (26% attrition). The majority were not employed and reported annual income <$10,000.
The Promoting Access to Health Services (PATHS) program is a 90-minute, small-group, participatory workshop with 6 months of structured telephone support, based on the health belief model and social cognitive theory.
Perceived susceptibility to breast and cervical cancer, perceived benefits of and self-efficacy for screening, intention to be screened, and self-reported receipt of mammography and Pap testing. ANALYSIS . Chi-square tests to examine the proportion of women obtaining screening; analysis of covariance to examine change in theoretical mediators.
The intervention group received more Pap tests than the control group at posttest (intervention 61%, control 27%, n = 71, p < .01). No significant group effect was observed for mammography (intervention 49%, control 42%, n = 125, p = .45).
Findings indicate that the PATHS intervention promotes Pap testing but not mammography among women with mobility impairments.
American journal of health promotion: AJHP 03/2012; 26(4):212-6. DOI:10.4278/ajhp.100701-ARB-226 · 2.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Respiratory tract infections (RTIs) are common in children and generally self-limiting, yet often result in consultations to primary care. Frequent consultations divert resources from care for potentially more serious conditions and increase the opportunity for antibiotic overuse. Overuse of antibiotics is associated with adverse effects and antimicrobial resistance, and has been shown to influence how patients seek care in ensuing illness episodes.
We conducted a systematic review and meta-analysis to assess the effectiveness of interventions directed towards parents or caregivers which were designed to influence consulting and antibiotic use for respiratory tract infections (RTIs) in children in primary care. Main outcomes were parental consulting rate, parental knowledge, and proportion of children subsequently consuming antibiotics. Of 5,714 references, 23 studies (representing 20 interventions) met inclusion criteria. Materials designed to engage children in addition to parents were effective in modifying parental knowledge and behaviour, resulting in reductions in consulting rates ranging from 13 to 40%. Providing parents with delayed prescriptions significantly decreased reported antibiotic use (Risk Ratio (RR) 0.46 (0.40, 0.54); moreover, a delayed or no prescribing approach did not diminish parental satisfaction.
IN ORDER TO BE MOST EFFECTIVE, INTERVENTIONS TO INFLUENCE PARENTAL CONSULTING AND ANTIBIOTIC USE SHOULD: engage children, occur prior to an illness episode, employ delayed prescribing, and provide guidance on specific symptoms. These results support the wider implementation of interventions to reduce inappropriate antibiotic use in children.
PLoS ONE 01/2012; 7(1):e30334. DOI:10.1371/journal.pone.0030334 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background. Promoting Access to Health Services (PATHS) is a theory-based intervention program designed to increase receipt of clinical preventive services by women with mobility impairments. The results of a previous randomized control trial to examine the efficacy of PATHS indicated that the intervention group was more likely to have received a Pap test, with no significant group effect observed for mammography. Objectives. To improve the 90 minute PATHS workshop, the present study identified the barriers and concerns expressed narratively by women in regards to obtaining mammogram screening and cervical cancer screening. Targeted population. Eligibility criteria included: being a woman between 35 and 64 years old; having a mobility limitation; having health insurance; no recent experience of either cervical cancer screening or mammography. Workshop participants were recruited via a Medicaid managed care organization and a durable medical equipment vendor in Oregon. Of the 197 workshop participants, 75 completed phone interviews to discuss barriers. Analysis. Phone transcripts were reviewed and the most frequent barriers and concerns to obtain cancer screenings were organized by the Transtheoretical Model (TTM). Results. Qualitative results indicated that physical secondary conditions and affordability were the most frequent barriers and concerns related to obtaining cancer screenings across TTM stages. Of note, women who were in the action stage indicated a lack of knowledge about the cancer screenings as their barrier to maintain their performance. Implication. Efforts to improve clinical preventive screening rates among women with disabilities need to address the barriers and concerns that they encounter.
139st APHA Annual Meeting and Exposition 2011; 10/2011
[Show abstract][Hide abstract] ABSTRACT: Background/context Systematic evidence reviews (SERs) identify knowledge gaps in the literature, a logical starting place for prioritizing future research. Varied methods have been used to elicit diverse stakeholders' input in such prioritization. Objective To pilot a simple, easily replicable process for simultaneously soliciting consumer, clinician and researcher input in the identification of research priorities, based on the results of the 2009 SER on screening adults for depression in primary care. Methods We recruited 20 clinicians, clinic staff, researchers and patient advocates to participate in a half-day event in October 2009. We presented SER research methods and the results of the 2009 SER. Participants took part in focus groups, organized by profession; broad themes from these groups were then prioritized in a formal exercise. The focus group content was also subsequently analysed for specific themes. Results Focus group themes generally reacted to the evidence presented; few were articulated as research questions. Themes included the need for resources to respond to positive depression screens, the impact of depression screening on delivery systems, concerns that screening tools do not address comorbid or situational causes of depression and a perceived 'disconnect' between screening and treatment. The two highest-priority themes were the system effects of screening for depression and whether depression screening effectively leads to improved treatment. Conclusion We successfully piloted a simple, half-day, easily replicable multi-stakeholder engagement process based on the results of a recent SER. We recommend a number of potential improvements in future endeavours to replicate this process.
Health expectations: an international journal of public participation in health care and health policy 08/2011; 16(4). DOI:10.1111/j.1369-7625.2011.00716.x · 3.41 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To describe a systematic approach for identifying, reporting, and synthesizing information to allow consistent and transparent consideration of the applicability of the evidence in a systematic review according to the Population, Intervention, Comparator, Outcome, Setting domains.
Comparative effectiveness reviews need to consider whether available evidence is applicable to specific clinical or policy questions to be useful to decision makers. Authors reviewed the literature and developed guidance for the Effective Health Care program.
Because applicability depends on the specific questions and needs of the users, it is difficult to devise a valid uniform scale for rating the overall applicability of individual studies or body of evidence. We recommend consulting stakeholders to identify the factors most relevant to applicability for their decisions. Applicability should be considered separately for benefits and harms. Observational studies can help determine whether trial populations and interventions are representative of "real world" practice. Reviewers should describe differences between available evidence and the ideally applicable evidence for the question being asked and offer a qualitative judgment about the importance and potential effect of those differences.
Careful consideration of applicability may improve the usefulness of systematic reviews in informing practice and policy.
[Show abstract][Hide abstract] ABSTRACT: Recommended screening can improve cancer detection and diagnosis, resulting in lower cancer mortality. The purpose of this study was to assess the efficacy of a theory-based program to promote regular mammography and Papanicolou (Pap) testing among women with mobility impairments who are overdue for screenings. Promoting Access to Health Services (PATHS) is an intervention designed to increase receipt of mammography and Pap tests among women with mobility impairments. PATHS is based on the Health Belief Model and Social Cognitive theory. It consists of a 90-minute participatory small-group workshop, followed by six months of structured telephone support. We evaluated the efficacy of PATHS through a randomized controlled trial. Women aged 35 64 with mobility impairments were recruited through a Medicaid managed care organization and a durable medical equipment vendor in Oregon during 2008 and 2009. Women who reported not receiving a Pap test in the past three years and/or a mammogram (if age >40 years) in the last two years were eligible. Of 211 women randomized, 156 completed the study (26% attrition). We used chi-square testing to compare the intervention and control groups for self-reported receipt of screenings at six-month follow-up. The intervention group was more likely to have received a Pap test (n=71, X2=8.2, p<.01). No significant group effect was observed for mammography (n=125, X2 = 0.6, p=.45). Intervention influences on theoretical mediators (e.g. self-efficacy) will also be presented. We will discuss potential explanations for differences in mammography and Pap test effects, and implications for health promotion programs.
138st APHA Annual Meeting and Exposition 2010; 11/2010
[Show abstract][Hide abstract] ABSTRACT: Women with physical disabilities (WPD) are a group of women at even greater risk than the general population of not obtaining clinical preventive screenings. Health behavior models provide theoretical frameworks for understanding variables that relate to likelihood of obtaining clinical preventive services. The purpose of this study was to investigate the relationship of key theoretical constructs from the Health Belief Model (HBM) and Social Cognitive Theory to the intention and the receipt of Pap tests among WPD. The participants were recruited through the enrollee rosters of a Medicaid provider and durable medical equipment vendor in Oregon during 2008 and 2009. Eligibility criteria included 35≤ age ≤ 64; having health insurance; no recent experience of cervical cancer screening, mammogram screening and/or being weighed at clinics. The PATH analyses on the M-plus was utilized to examine the mediational relationship of specific constructs (e.g., perceived risk, perceived benefits, self-efficacy, perceived barriers, cue to action) and demographic characteristics (e.g., income, education, chronic conditions) to the self-reported Pap test behavior. Most of the 230 participants were Caucasian (71%), with low education levels (21% less than high school), divorced or separated (49%) and not employed (90%). In the HBM framework, self-efficacy (β = .12, p<.05) and provider's communications (β =.74, p<.05) predicted increased Pap test history. The interactions of other theoretical constructs and demographic variables were not significant. The importance of the intervention programs targeting clinics about communication with clients will be discussed.
138st APHA Annual Meeting and Exposition 2010; 11/2010
[Show abstract][Hide abstract] ABSTRACT: This article describes the development of Promoting Access to Health Services (PATHS), an intervention to promote regular use of clinical preventive services by women with physical disabilities. The intervention was developed using intervention mapping (IM), a theory-based logical process that incorporates the six steps of assessment of need, preparation of matrices, selection of theoretical methods and strategies, program design, program implementation, and evaluation. The development process used methods and strategies aligned with the social cognitive theory and the health belief model. PATHS was adapted from the workbook Making Preventive Health Care Work for You, developed by a disability advocate, and was informed by participant input at five points: at inception through consultation by the workbook author, in conceptualization through a town hall meeting, in pilot testing with feedback, in revision of the curriculum through an advisory group, and in implementation by trainers with disabilities. The resulting PATHS program is a 90-min participatory small-group workshop, followed by structured telephone support for 6 months.
Health Promotion Practice 11/2010; 13(1):106-15. DOI:10.1177/1524839910382624 · 0.55 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of the Rural Older Adult Memory (ROAM) pilot study was to evaluate the feasibility of screening and diagnosing dementia in patients aged 75 years or older in 6 rural primary care practices in a practice-based research network.
Clinicians and medical assistants were trained in dementia screening using the ROAM protocol via distance learning methods. Medical assistants screened patients aged 75 years of age and older. For patients who screened positive, the clinician was alerted to the need for a dementia work-up. Outcomes included change in the proportion of patients who were screened and diagnosed with dementia or mild cognitive impairment, clinician confidence in diagnosing and managing dementia, and response to the intervention.
Results included a substantial increase in screening for dementia, a modest increase in the proportion of patients who were diagnosed with dementia or mild cognitive impairment, and improved clinician confidence in diagnosing dementia. Although clinicians and medical assistants found the ROAM protocol easy to implement, there was substantial variability in adherence to the protocol among the 6 practices.
This study demonstrated the complex issues that must be addressed in implementing a dementia screening process in rural primary care. Further study is needed to develop effective strategies for overcoming the factors that impeded the full uptake of the protocol, including the logistic challenges in implementing practice change and clinicians' attitudes toward dementia screening and diagnosis.
The Journal of the American Board of Family Medicine 07/2010; 23(4):486-98. DOI:10.3122/jabfm.2010.04.090225 · 1.98 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: For clinicians, using opioid therapy for chronic noncancer pain (CNCP) often gives rise to a conflict between treating their patients' pain and fears of addiction, diversion of medication, or legal action. Consequent stresses on clinical encounters might adversely affect some elements of clinical care. We evaluated a possible association between chronic opioid therapy (COT) for CNCP and receipt of various preventive services.
We conducted a retrospective cohort study in 7 primary care clinics within the Oregon Rural Practice-based Research Network (ORPRN). Using medical records of 704 patients, aged 35 to 85 years, seen during a 3-year period, we compared the receipt of 4 preventive services between patients on COT for CNCP and patients not on chronic opioid therapy (non-COT). We used multivariate log-binomial regression analyses to estimate the relative risk of receipt of each preventive service.
After adjustment for plausible confounders, we found that patients using COT had a statistically significantly lower relative risk (RR) of receipt of cervical cancer screening (RR = 0.60; 95% confidence interval [CI], 0.47-0.76) and colorectal cancer screening (RR = 0.42; 95% CI, 0.22-0.80) when compared with non-COT patients. The RR was reduced, without statistical significance, for lipid screening (RR = 0.77; 95% CI, 0.54-1.10), and not notably reduced for smoking cessation counseling (RR = 0.95; 95% CI, 0.78-1.15).
Patients using COT for CNCP were less likely to receive some preventive services. Research is needed to better understand barriers to and improved methods for providing preventive services for these patients.
The Annals of Family Medicine 05/2010; 8(3):237-44. DOI:10.1370/afm.1114 · 5.43 Impact Factor