Practice-Based Research Networks Answer Primary Care Questions

PURPOSE Guidelines encourage primary care clinicians to document smoking status when obtaining patients' blood pressure, temperature, and pulse rate (vital signs), but whether this practice promotes cessation counseling is unclear. We examined whether the vital sign intervention infl uences patient-reported frequency and intensity of tobacco cessation counseling. METHODSThis study was a cluster-randomized, controlled trial conducted in the Virginia Ambulatory Care Outcomes Research Network (ACORN). At intervention practices, nurses and medical assistants were instructed to assess the tobacco use status of every adult patient and record it with the traditional vital signs. Control practices did not use any systematic tobacco screening or identifi cation system. Outcomes were the proportion of smokers reporting clinician counseling of any kind and the frequency of 2 counseling subcomponents: simple quit advice and more intensive discussion.RESULTS A total of 6,729 adult patients (1,149 smokers) at 18 primary care practices completed exit questionnaires during a 6-month comparison period. Among 561 smokers at intervention practices, 61.9% reported receiving any counseling, compared with 53.4% of the 588 smokers at control practices, for a difference of 8.6% (P = .04). The effect was largely restricted to simple advice, which was reported by 59.9% of intervention patients and 51.5% of control patients (P = .04). There was no signifi cant increase in more extensive discussion, with 32.5% and 29.3% of patients at intervention and control practices, respectively, reporting this type of counseling (P = .18). CONCLUSIONSThe vital sign intervention promotes tobacco counseling at primary care practices through a modest increase in simple advice to quit. When implemented as a stand-alone intervention, it does not appear to increase intensive counseling.

Section: Settingmentioning

confidence: 99%

Effect on Cessation Counseling of Documenting Smoking Status as a Routine Vital Sign: An ACORN Study

Rothemich¹,

Woolf²,

Johnson³

et al. 2008

“…Most of the available medical evidence has come from the laboratory or hospital, which is often not applicable to the primary care context. 2,17,[27][28][29][30][31] An audit on antithrombotic treatment for patients with atrial fi brillation in our family practice in Hong Kong showed that all doctors in the clinic were against the use of warfarin in our setting because immediate laboratory support was not available, even though warfarin was highly recommended by hospital specialists. Thirty-three patients with atrial fi brillation were found: fewer than one half (16) were taking aspirin; 4 had spontaneous remission; 3 were older than 90 years, for whom the evidence of treatment is not clear; and 10 were eligible but not taking aspirin.…”

Section: The Health Care Environment Is Most Suitable For Family Medimentioning

confidence: 99%

“…32 As Mant et al have indicated, there is a need for more research in the primary care setting to provide evidence for the improvement of primary care services. 29 Family medicine is the leading discipline in primary care research and can contribute a great deal in the following areas 15,16,22,29,30 : the pathogenesis and natural history of common illnesses [13][14][15]33,34 ; the effectiveness of clinical care in relation to diagnostic tests and interventions in the real patient context 17,32,35 ; the impact of the doctor-patient relationship and communication on the process and outcome of care 19,20,36,37 ; health care services that are cost-effective in meeting the needs of the local community, in relation to epidemiology, help-seeking behavior, and organization of care 21,[38][39][40] ; and medical education and training that can infl uence practice and improve quality of care. [41][42][43][44] …”

Section: The Health Care Environment Is Most Suitable For Family Medimentioning

confidence: 99%

The 21st Century: The Age of Family Medicine Research?

Lam¹

2004

Family medicine has matured as an academic and scientifi c discipline with its own core concepts, knowledge, skills, and research domains. It has acquired much expertise in studying common illnesses; the integration of medical, psychological, social, and behavioral sciences; patient-centered care; and health services delivery. Many health care challenges in the 21st century will place a great demand on primary care, which can serve its purpose only if it is of high quality and evidence based. Family medicine research can contribute to many areas of primary care, ranging from the early diagnosis to equitable health care. Stakeholders, such as the World Health Organization, governments, and funding agencies, are becoming more supportive to family medicine research because they recognize its key importance in improving the quality of primary care and bridging the gap between biomedical research and clinical practice. Family medicine can play a leading role in shifting the paradigm of medical research from the laboratory to the person.The 21st century should be a golden age of family medicine research because the time is right for the discipline, the health care environment is most suitable, and stakeholders are supportive. Family medicine must prepare for it by building up its research track record and capacity.

“…[14][15][16] Another example of new research strategies has been the advent of practice-based research networks that, when combined with electronic health records, provide a laboratory for rapidly addressing certain types of clinical research issues. Large-scale multipractice trials allow the investigation of issues, such as mild hypertension in the elderly, 17 that can be addressed only in a primary care setting.…”

Section: Contribution Of Family Medicine To Research Culturementioning

confidence: 99%

“…17,23 In 1974 EGPRW was established as a starting point for the development of family medicine research in Europe. 24 Although individual research projects had been undertaken before then, this organization has added a new dimension to family medicine research.…”

Section: European General Practice Research Workhopmentioning

confidence: 99%

Changing Research Culture

Švab

2004

Although there is general agreement that family medicine has a lot to offer to the health care system, the academic dimension is still not widely understood. There are two main reasons why family medicine needs to develop its scientifi c potential: to address the true nature of the discipline, and to help in its recognition. The academic establishment benefi ts from academic family medicine by gaining new questions that are necessary to be answered and by gaining new research approaches.Many problems are encountered when introducing family medicine into the academic arena. Two main strategies for developing family medicine research can be identifi ed. The fi rst is to adapt to the existing structure of the academic world by claiming equal rights with the developed disciplines, collaborating with other university departments in their research projects, publishing articles in established journals, and participating in established faculty development programs. The other, more demanding, strategy is to introduce changes to the academic arena by developing specifi c research questions, by collaborating on research within family medicine, and by developing family medicine's own success criteria for academic excellence. The two approaches are not mutually exclusive.The World Organization of Family Doctors plays an important role in supporting both approaches through its international affi liations and contacts with policy makers.