PURPOSE We undertook a study to assess the impact of comparative feedback vs general reminders on practice-based referrals to a tobacco cessation quit line and estimated costs for projected quit responses.
METHODSWe conducted a group-randomized clinical trial comparing the impact of 6 quarterly (18 months) feedback reports (intervention) with that of general reminders (control) on practice-based clinician referrals to a quit-line service. Feedback reports were based on an Achievable Benchmark of Care approach using baseline practice, clinician, and patient survey responses, and referrals per quarter. Comparable quit responses and costs were estimated.RESULTS Three hundred eight clinicians participated (171 family medicine, 88 internal medicine, 49 obstetrics-gynecology) from 87 primary care practices in Michigan. After 18 months, there were more referrals from the intervention than from the control practices (484 vs 220; P <.001). Practice facsimile (fax) referrals (84%, n = 595) exceeded telephone referrals (16%, n = 109), but telephone referrals resulted in greater likelihood of enrollment (77% telephone vs 44% fax, P <.001). The estimated number of smokers who quit based on the level of services utilized by referred smokers was 66 in the feedback and 36 in the gentle reminder practices.CONCLUSION Providing comparative feedback on clinician referrals to a quit-line service had a modest impact with limited increased costs.
INTRODUCTIONS moking cessation interventions have proved to be effective in primary care settings according to the systematic reviews of controlled clinical trials that resulted in Clinical Practice Guidelines on Smoking Cessation by the Public Health Service.1,2 Clinicians report various reasons for not following the guidelines, such as focusing on acute or chronic care rather than preventive care, having little training in giving brief advice to quit smoking, and not being subject to accountability or feedback. 3,4 Survey fi ndings show that physicians understand the importance of smoking cessation and espouse its value, but they often do not implement the key elements of offi ce-based methods. 3,4 Physicians rarely schedule smokers for follow-up visits or arrange referrals for support services.1,3-5 Several community-based and health-system-based studies have shown fairly high rates of long-term smoking cessation (20% to 36%) by combining physician identifi cation, advice, and referral for follow-up care with telephone support counseling. [6][7][8][9][10][11] Telephone counseling services for smoking cessation (quit lines) have become widely available through health plans and state or national services, 12 but they are often underutilized. Methods to enhance clinician referrals to quit-line services are needed.
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TOBACCO C ES S AT ION QUI T L INEFeedback on clinical performance has been studied in numerous randomized clinical trials and reported in systematic reviews to have modest effects.13 Comparing personal performance with peer performance should be a powerful motivator ...
Study Design
A case-control study
Objective
To determine whether parity and abdominal surgeries are associated with degenerative spondylolisthesis (DS).
Summary of Background Data
DS is considered to be a major cause of low back pain (LBP) in the older population, with greater prevalence of DS among women. Because LBP and impaired abdominal muscle function are common during pregnancy and post-partum, parity-related abdominal muscle deficiency, resulting in poor spinal mechanics, could be a factor in the development of DS in women. Indeed a relationship between the number of pregnancies and DS was reported in one study.
Methods
322 women between the ages of 40 and 80 (149 with DS and 173 controls) filled out a questionnaire providing information about their demographics, the number of full-term pregnancies, the number and types of abdominal surgeries (including cesarean section (CS) and hysterectomies), and age at menopause among other items. A binary logistic regression was used as a multi-variate model to identify the variables associated with DS.
Results
Along with age and body-mass-index as co-variates, the number of full-term pregnancies and the hysterectomy were significant predictors of DS. Other abdominal surgeries, CS or the number of years post-menopause were not significant predictors of DS in this regression model after adjusting for all other significant variables.
Conclusions
Each full-term pregnancy seems to be associated with the 22% increase in odds of developing DS. Hysterectomy nearly doubles the odds of DS as compared to women who did not have hysterectomy.
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