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To explore colorectal cancer risk perceptions among Latinos. Focus groups discussions among Spanish-speaking Latinos conducted between February and July 2007 with 37 men and women who were age-eligible for colorectal cancer screening. Predominant themes of perceived colorectal cancer risk included: general cancer risks, risks related to nutrition and the digestive tract, and risks related to sexual practices. Participants frequently referred to the role of diet in keeping the colon 'clean,' suggesting that retained feces increase colorectal cancer risk. Among both men and women, rectal sex was commonly associated with increased colorectal cancer risk. Some Latinos may hold misperceptions about colorectal cancer risks, including an association between rectal sex and colon cancer, that may impact their screening behaviors. Clinicians and public health officials should consider these potential risk misperceptions and explore for other risk misperceptions when counseling and educating patients about colorectal cancer screening. [ABSTRACT FROM AUTHOR]

Objective: To determine the impact of interpretation method on outpatient visit length.Design: Time-motion study.Setting: Hospital-based outpatient teaching clinic.Participants: Patients presenting for scheduled outpatient visits.Measurements and Main Results: Over a 6-week study period, a research assistant recorded the following information for consecutive patient visits: patient age, gender and insurance type; type of interpreter used (none, hospital interpreter, telephone interpreter or patient-supplied interpreter); scheduled visit length; provider type (nurse practitioner; attending physician; resident in postgraduate year 1, 2 or 3, or medical student); provider gender; amount of time the patient spent in the examination room with the provider (provider time); and total time the patient spent in the clinic from check-in to checkout (clinic time). When compared to patients not requiring an interpreter, patients using some form of interpreter had longer mean provider times (32.4 minutes [min] vs 28.0 min, P <.001) and clinic times (93.6 min vs 82.4 min, P =.002). Compared to patients not requiring an interpreter, patients using a telephone interpreter had significantly longer mean provider times (36.3 min vs 28.0 min, P <.001) and clinic times (99.9 min vs 82.4 min, P =.02). Similarly, patients using a patient-supplied interpreter had longer mean provider times (34.4 min vs 28.0 min, P <.001) and mean clinic times (92.8 min vs 82.4 min, P =.027). In contrast, patients using a hospital interpreter did not have significantly different mean provider times (26.8 min vs 28.0 min, P =.51) or mean clinic times (91.0 min vs 82.4 min, P =.16) than patients not requiring an interpreter.Conclusion: In our setting, telephone and patient-supplied interpreters were associated with longer visit times, but full-time hospital interpreters were not. [ABSTRACT FROM AUTHOR]

Early exposure to health careers has the potential to improve diversity in the health professional workforce and reduce health provider shortages in Rhode Island and across the United States. Rhode Island alone has 13 federally designated Primary Care Health Professional Shortage Areas (PCHPSA) and 12 Medically Underserved Areas (MUA). To help increase healthcare access for individuals residing in these areas and promote diversity within the RI health workforce, The Warren Alpert Medical School of Brown University established and/or supports multiple pathway programs to provide early health career exposure to students. This approach empowers and supports students from various backgrounds to see themselves as future healthcare professionals. These programs work to create a more well-rounded healthcare workforce equipped to serve the state's diverse patient population. [ABSTRACT FROM AUTHOR]

Background: Little is known about whether internal medicine residents find pain management agreements (PMAs) useful or whether PMA use is associated with more positive attitudes toward patients with chronic noncancer pain (CNCP)., Methods: We surveyed all internal medicine residents at Rhode Island Hospital regarding whether they found PMAs useful, what percentage of their patients taking chronic opioids had a signed PMA, and their attitudes toward and experiences with managing CNCP., Results: Survey response rate was 89% (110/124). Ninety percent of respondents reported finding PMAs useful. A majority of respondents reported that PMAs were at least somewhat helpful for reducing multiple prescribers (76%), reducing requests for early refills (67%), reducing calls and pages from patients (57%), making it easier to discuss potential problems associated with chronic opioid use (73%), and making it easier to identify patients who are abusing pain medications (66%). Residents who reported greater use of PMAs reported a greater sense of preparation (r=0.20, P=0.04), greater confidence (r=0.18, P=0.06), and a greater sense of reward (r=0.24, P=0.02) for managing CNCP. In a multivariate analysis, PMA use was significantly associated with greater sense of preparation and greater sense of reward for managing CNCP., Conclusions: Among internal medicine residents, PMA use was associated with more positive attitudes toward CNCP management.

Background: Millions of people use the Internet as a source for health information yet little is understood about how the use of the Internet for health information is related to the doctor-patient relationship., Objective: We conducted the present study to understand the association between one's interest in using the Internet for general and quality-oriented health information and attitudes about one's communications with health care provider(s)., Design: Cross-sectional survey., Setting: Four community-based primary care practices in Rhode Island., Measurements: A single self-administered survey included items to measure: interest in using the Internet to look for general and quality-oriented information and a patient's perceptions of the degree to which their doctors over the previous year have: (1) given them information and (2) engaged them in the decision-making process., Results: A total of 300 patients completed the survey. Among patients without Internet access, interest in using the Internet for health related activities was less among patients who felt that their doctor gave less information: Odds ratio 0.83 (95% CI, 0.70-0.98) and greater among patients who felt that their doctor engaged them more in decision making: Odds ratio 1.3 (95% CI, 1.1-1.6). Among patients with Internet access, we found no relationship between interest in using the Internet for health related activities and measures of patient-physician communication or patient-physician decision making., Conclusions: Interest in using the Internet for health information is greater for those who (1) felt their doctors provided less information and (2) felt their doctors engaged them more in the decision-making process, but this is true only for those without access to the Internet.

Background: Millions of people use the Internet as a source for health information yet little is understood about the use of the Internet for other health-related activities., Objective: We conducted the present study to understand, among primary care patients, the interest in and experience with using the Internet for a variety of health-related activities., Methods: Cross-sectional survey in the setting of 4 community-based primary care practices in Rhode Island. A single self-administered questionnaire included the following: 14 items measuring interest in using the Internet for a variety of health-related purposes, demographics, self-reported health status, and self-reported health care quality., Results: The survey was completed by 300 patients, 109 without access to the Internet and 191 with access to the Internet. Experiences with and attitudes about each of the health-related activities on the Internet varied widely across each activity. Regardless of access, patients were most interested in using the Internet for finding information about diseases and medications. However, patients with Internet access were more interested, compared to those without access, in each of the health-related activities on the Internet. Among patients with access to the Internet, the largest gap between interest and experience (the opportunity gap) was in using the Internet to investigate the quality of their care (eg, "find out if your health care provider was giving you all of the tests and treatments that you are due to have?") and administrative functions (eg, "schedule an appointment with your doctor?")., Conclusions: Much opportunity remains for developing health-related Internet Web sites to address the unmet needs of primary care patients.

Background: The aim of this study was to examine the acceptability of point of care computerized prompts to improve health services delivery among a sample of primary care patients., Methods: Primary data collection. Cross-sectional survey. Patients were surveyed after their visit with a primary care provider. Data were obtained from patients of ten community-based primary care practices in the spring of 2001., Results: Almost all patients reported that they would support using a computer before each visit to prompt their doctor to: "do health screening tests" (92%), "counsel about health behaviors (like diet and exercise)" (92%) and "change treatments for health conditions" (86%). In multivariate testing, the only variable that was associated with acceptability of the point of care computerized prompts was patient's confidence in their ability to answer questions about their health using a computer (beta = 0.39, p =.001). Concerns about data security were expressed by 36.3% of subjects, but were not related to acceptability of the prompts., Conclusions: Support for using computers to generate point of care prompts to improve quality-oriented processes of care was high in our sample, but may be contingent on patients feeling familiar with their personal medical history.