We conducted a qualitative study to elicit attitudes, attributions, and self-efficacy related to diabetes self-care in both English- and Spanish-speaking Hispanic men. Transcripts from six focus groups (three in English and three in Spanish) were reviewed by the authors to extract principal and secondary themes. Participants could describe their medication and lifestyle regimens and were aware of whether they were adherent or nonadherent to physician recommendations. Lack of skills on how to incorporate diet and regular physical activity into daily living, lack of will power, and reluctance to change culturally rooted behaviors emerged as significant barriers to diabetes self-management. Medication adherence is for some men the principal diabetes self-care behavior. Nonadherence appeared to fit two profiles: 1) intentional, and 2) nonintentional. In both instances low self-efficacy emerged as a significant influence on attainment and maintenance of diabetes self-care goals. Participants also expressed a strong sense of fatalism regarding the course of their disease, and seemed to have little motivation to attempt long-term dietary control. Educational and counseling messages should stress that a diagnosis of diabetes is not a death sentence, and full functional capacity can be maintained with good control.

Most colon cancer patients at a major VA medical center receive recommended therapy. Among rectal cancer patients, those presented at tumor board are most likely to receive recommended therapy.

Default options in health information technology exert a powerful effect on user behavior, an effect that can be leveraged to optimize decision making.

Objective: Most electronic health record (EHR) systems have the capability of generating a printed after-visit summary (AVS), but there has been little research on optimal content. We conducted a qualitative study and a randomized trial to understand the effect of AVS content on patient recall and satisfaction.Methods: Adult primary care patients (n ‫؍‬ 272) with at least 1 chronic condition were randomly assigned to 4 AVS content conditions: minimum, intermediate, maximum, or standard AVS. Demographics and health literacy were measured at an index clinic visit. Recall and satisfaction were measured by telephone 2 days and 2 to 3 weeks after the clinic visit.Results: Average age was 52 years; 75% of patients were female, 61% were Hispanic, and 21% were African American, and 64% had adequate health literacy. Average medication recall accuracy was 53% at 2 days and 52% at 3 weeks, with no significant difference among groups at either time. Satisfaction with AVS content was high and did not differ among groups. Recall of specific content categories was low and unrelated to group assignment. Health literacy was unrelated to recall and satisfaction. Supplying patients with printed instructions and information when they leave a medical encounter has become common practice. Before the availability of electronic health records (EHRs), patient educational materials often took the form of handouts and pamphlets and sometimes videos or interactive computer programs. Most EHRs enable clinicians to supply patients with individualized information in the form of an after visit summary (AVS) based on data available in patients' medical records. Recent legislation has all but required this feature to be included in the EHR for eligibility for financial incentives by meeting the Centers for Medicare and Medicaid Services' (CMS) Meaningful Use (MU) guidelines for the AVS.1 Core Measure 13 describes the objective to provide to patients clinical summaries about each office visit. According to §495.6(d)(13)(ii), the expectation is for, "Clinical summaries provided to patients for more than 50% of all office visits within 3 business days." 2The minimum set of elements recommended by CMS to achieve stage 1 of MU includes patient The EHR-generated AVS represents a potentially efficient and effective tool to support a variety of objectives for optimal patient outcomes in primary care. The majority of adult patients are followed for chronic conditions, such as hypertension and type 2 diabetes, which require long-term adherence to self-management behaviors. The concept of patient activation as a central factor in effective chronic disease self-management underlies many current behavioral interventions to improve outcomes. 3,4 In this conceptualization, the activated patient is provided with useful information about his or her condition(s), uses this information to undertake the recommended treatment plan, and engages with the provider in shared decision making to achieve desired health outcomes. The AVS can be viewed as a communication cha...