Search

Background. The purpose of this study was to develop and evaluate a computer system that would translate patient diagnoses noted by a physician into appropriate International Classification of Diseases, 9th [...]

Background. Inexpensive reminder systems are needed to ensure that primary care physicians consistently provide health maintenance services to their patients. The purpose of this study was to determine the effectiveness of a simple, inexpensive health assessment form in place of the standard chart note to increase physician compliance with mammography recommendations. Methods. A health assessment form with a reminder for screening mammography was implemented in a family practice in 1987 and was to be used as the official chart record for health maintenance visits. The charts of all women 50 years of age and older with two or more office visits during the years 1985 through 1988 were audited to determine how many mammograms were completed. Results were compared with mammography completion rates at a similar practice that did not use a health assessment form. Results. The study group showed a significant increase in mammography completion after implementation of the form, with compliance increasing from 7.3% to 32.0% (P < .001). The comparison group had an increase in mammogram completion from 12.0% to 17.8% (P < .001). The difference between the changes in rates of mammography in the two practices was statistically significant (P < .001). Among women in the study group who had a scheduled health maintenance visit during the study period the average rate of mammography completion increased from 21.2% to 65.2% (P < .001). Conclusion. The addition of a health assessment form with a mammography reminder at the health maintenance visit is an effective and inexpensive method to increase compliance with mammography., For the past 10 years, the American Cancer Society, the National Cancer Institute, and other groups have recommended screening procedures to detect cancer in its early and presumably more curable [...]

Background. State and federal statistics describe a lower incidence of rape and child abuse than is suggested by community prevalence rates. Victims of sexual assault may experience numerous short-term and long-term effects on psychosocial and physical health. They tend to use medical services more than nonvictims and are also more likely to seek medical care than mental health services. This study seeks to determine the prevalence of sexual victimization in a family practice setting. Methods. Women 18 years of age or older presenting to a combined family practice and university student health center for a routine Papanicolaou smear or a health maintenance visit voluntarily completed an anonymous sexual experiences questionnaire of 28 close-ended items. Results. Of 416 consecutive women, 405 agreed to participate. Of 147 family practice patients, 47.6% reported some type of contact sexual victimization during their lifetimes; 25.2% reported rape or attempted rape. Of 258 student health service patients, 57% had experienced contact sexual victimization, and 28.7% reported rape or attempted rape. Of those who reported unwanted sexual contact, 30% of the family practice patients felt they would not be comfortable discussing the experience with medical personnel, and 44.9% of the student health service patients would not feel comfortable doing so. Conclusions. Women with a history of unwanted sexual contact may be common in family practice and student health settings. Although treatment can be beneficial, many of these patients are not comfortable discussing their experiences with medical personnel. These findings suggest that there is potential benefit in obtaining a sexual victimization history as part of routine care, but further research will be necessary to assess the clinical benefit of such an approach. Key words. Child abuse, sexual; rape; sex offenses; primary care; women. J Fam Pract 1992; 35:511-516., Rape and childhood sexual assault are associated with numerous short-term and long-term effects on psychosocial and physical health including depression, anxiety, interpersonal problems, self-destructive behaviors,[1-5] sexually transmitted diseases,[6,7] chronic pelvic [...]

Tricyclic antidepressants (TCAs) are a group of drugs used to treat a number of psychiatric conditions, but may also be useful in treating nonpsychiatric disorders. They have been recently reported to be useful in treating peptic ulcer disease and insomnia as well as anxiety and depression. A number of studies have reported that almost half of all TCA prescriptions written by primary care physicians are not for diagnosed psychiatric disorders. Some researchers doubt that prescriptions for nonpsychiatric disorders that are responsive to therapy with TCAs could account for the remaining half of TCA prescriptions. The implication has been that primary care physicians often prescribe these drugs indiscriminately. This study examined the TCA prescribing patterns of primary care physicians along with those of other groups of physicians. Data from a national survey that included a physician questionnaire were obtained and analyzed. Results showed that primary care physicians only prescribed TCAs in 1 percent of all patient visits and in 24 percent of visits where a mental disorder was diagnosed. Psychiatrists prescribed these drugs for 21 percent of all visits and for 23 percent of visits where a mental disorder was diagnosed. Fifty percent of the TCA prescriptions written by primary care physicians were for psychiatric disorders and 15 percent were for nonpsychiatric disorders for which TCA usage is believed to be effective. Prescribing patterns were similar for all groups of physicians except for psychiatrists. These results indicate that 65 percent of TCA prescriptions prescribed by primary care physicians have appropriately documented reasons, a rate much higher than expected. The circumstances under which the other 35 percent of TCA prescriptions were written are unclear and need further study. (Consumer Summary produced by Reliance Medical Information, Inc.), Background. Primary care physicians often do not document a psychiatric diagnosis when prescribing psychotropic medications. Recent literature suggests the potential benefit of tricyclic antidepressants (TCAs) in a number of nonpsychiatric conditions (low back pain, peptic disease, fibrositis, headache, peripheral neuropathy, rheumatoid disease, and irritable colon). Methods. Data from the 1985 National Ambulatory Medical Care Survey (NAMCS) were used to categorize the primary diagnoses given during office visits in which tricyclic antidepressants were prescribed. Comparisons were made across specialties. Results. Primary care physicians prescribed tricyclic antidepressants in 1% of all visits (an estimated 2,891,000 visits per year). Whereas 50% of these visits at which TCAs were prescribed were for documented psychiatric illnesses or conditions, 15% were for nonpsychiatric TCA-responsive conditions. The majority of visits by patients with these disorders were to primary care physicians. The pattern of TCA prescribing for these disorders by primary care physicians parallels that of other medical specialties except that primary care physicians prescribed TCAs for nonpsychiatric TCA-responsive disorders less frequently than did other medical specialists. Conclusions. When nonpsychiatric TCA-responsive disorders are included, primary care physicians document with appropriate diagnoses 15% more of their TCA prescriptions than previous studies have indicated. An undstanding of the 35% of TCA prescriptions that do not show proper documentation will require further study and information not available from the NAMCS., Although tricyclic antidepressants (TCAs) were first synthesized in the latter part of the 19th century, it was not until the late 1940s that their pharmacologic properties were investigated, and only [...]

While many would agree that the social support of a patient with cancer, or any serious disease, is important, it is difficult to state how important it is and how to measure its effects. Some theoretical models of social support have been elaborated, however. Such models may make a distinction between main effects and stress reduction. Main effects, as their name implies, involve a direct effect of the support, for example pressure to quit smoking or encouragement to see a physician and take medication regularly. Stress reduction effects, as their name implies, reduce the stress associated with cancer, and may therefore improve not only coping with the disease, but also provide a better internal environment with better immune system function and reduction of the neuroendocrine responses normally associated with stress. The authors argue that cancer research should not limit itself to outcome measures such as mortality, tumor recurrence or psychosocial adaptation. They advocate including measures of the quality of life of the patient in cancer studies as well. Of course, many cancer studies do include the quality of life in their research, but to the authors quality of life includes philosophical and religious aspects as well as coping with the tasks of day-to-day living. They suggest that cancer research should incorporate questions involving how the social support of the patient deals with philosophical and religious issues. (Consumer Summary produced by Reliance Medical Information, Inc.)