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Primary Care

Research Findings

Research Activities, August 2008:
Enhancing the cultural competence of both clinicians and clinics may work synergistically to reduce care disparities
Family medicine physicians suggest ways to improve management of chronic pain in primary care patients
Physicians should empathize with patients who are worried that their symptoms may indicate something serious
Changing one word in a question from the doctor can dramatically reduce patients' unmet concerns in primary care
Studies examine effectiveness and cost-effectiveness of depression quality improvement programs in primary care

Research Activities, July 2008:
Primary care doctors miss diagnosing two-thirds of people suffering from depression

Research Activities, June 2008:
Antidepressants and therapy may be cost-effective for patients with medically unexplained symptoms
Primary care practices can perform very well in several quality areas

Research Activities, May 2008:
Medication monitoring advice and feedback to physicians modestly improves outpatient medication safety
Use of a visual medication schedule and brief physician counseling can reduce time to anticoagulation control
Nurses can facilitate quality improvement in primary care practices with electronic medical records
Managing knowledge in family practices takes more than technology
Patients with diabetes have better glucose control when they receive care at primary care clinics that adhere to the chronic care model

Research Activities, April 2008:
Modest health care quality gains outpaced by spending
Children from lower income families are not as likely to visit a dentist after a care provider's referral
The best way to communicate uncertainty to patients about the harms and benefits of treatments remains unidentified
Despite lack of evidence of benefit, PSA testing for prostate cancer screening has increased dramatically
Cost-effectiveness of primary care treatment of sinusitis depends on individual, societal, and payer's perspectives
Individuals will use Web-based data about physician characteristics and performance to choose a doctor
Poverty-related factors rather than frequency of primary care visits underlie racial disparities in preventive care

Research Activities, March 2008:
Care quality is not necessarily better with electronic health records
Pediatricians often do not pursue answers to questions that arise during medical visits
Sensitization to indoor allergens is not linked to increased asthma problems among inner-city adults

Research Activities, February 2008:
Children with special health care needs seem to benefit from Medicaid managed care programs with case managers
Managed care helps the elderly avoid preventable hospitalizations more than traditional Medicare

Research Activities, January 2008:
Antibiotics to prevent children's recurrent urinary tract infections have unclear benefits and potential risks
Internal medicine physicians find it more difficult to apply clinical guidelines to patients with multiple medical conditions
Possible problematic drug interactions are not always reported in medical records

Research Activities, December 2007:
Many underinsured U.S. children are not getting needed vaccines due to the current vaccine financing system
Family-centered, high quality primary care is linked to fewer nonurgent emergency department visits by children
A pharmacy alert system plus physician-pharmacist collaboration can reduce inappropriate drug prescribing among elderly outpatients
Use of simple clinical information systems can improve outcomes of patients with diabetes
Primary care practices face competing demands, not clinical inertia, in providing quality care to patients with diabetes
Colorectal cancer screening can be improved at primary care practices
Doctors should advise Latino families about the safety, low cost, and dental health benefits of drinking tap water
Despite their robust physical health and general optimism, a host of issues trouble young adults with depression

Research Activities, November 2007:
Caregivers of children with special health care needs rate Medicaid managed care as having better care access than fee-for-service
A skin condition may identify young patients at risk for developing type 2 diabetes
Postdischarge care management that integrates medical and social care can improve outcomes of the low-income elderly
Electronic data collection can greatly improve recruitment of primary care patients into clinical trials
Late diagnosis of HIV is a problem for older patients, many of whom aren't diagnosed until they've already developed AIDS
Diagnosing coronary heart disease prior to a heart attack improves the chance of lowering the risk of future coronary events
Mexicans' access to primary care is limited overall, but worse in nonmetropolitan areas

Research Activities, October 2007:
Primary care practice-based research networks are a young diverse group vital to translating research into practice
Studies funded by AHRQ's Primary Care Practice-Based Research Networks (PBRNs) identify ways to improve patient care and report medical errors
Studies examine dispensing of sample medications and preventing medication errors in primary care practices
Primary care doctors should encourage colorectal cancer screening and clarify that screening is not just for those with symptoms
Strategies to improve health literacy for diverse populations should address literacy, language, and cultural barriers
Barriers to timely diagnosis and treatment of prostate cancer in black men arise from lower socioeconomic status
Studies examine medication adherence and group medical visits among persons with high blood pressure

Research Activities, September 2007:
Elderly black men are less likely than white men to seek and receive care for lower urinary tract symptoms
Women in Medicare and private managed care plans receive worse care than men for cardiovascular disease and diabetes
A multipronged quality improvement strategy can markedly improve the quality of diabetes care and patient outcomes
Exam room reminders and physician feedback can improve screening for chlamydia in young women during preventive care visits
Physicians seem to manage potential conflicts with managed care financial arrangements to retain patient trust

Research Activities, August 2007:
The gender of both the child and parent affect a child's participation during visits to the doctor
Pertussis vaccination in adults can be cost-effective depending on incidence rates
Socioeconomically disadvantaged patients with lupus have less access to and use of health care
Education, income, and wealth all affect medical care expenditures among Medicare managed care members

Research Activities, July 2007:
Greater access to physician services may narrow mortality differences among the black and white elderly
Family physicians manage skin conditions well

Research Activities, June 2007:
Multidisciplinary programs increase patient access to comprehensive melanoma care
Certain medical education programs may reinforce physicians' goals to practice in disadvantaged communities

Research Activities, May 2007:
The shortage of pediatric rheumatologists limits residency training in pediatric rheumatology among general pediatricians
Parents who explore a preventive health Web site before well-child visits discuss more prevention topics with doctors
Pediatricians with more knowledge of and confidence in identifying and managing child abuse are more likely to identify abuse

Research Activities, April 2007:
Use of asthma care guidelines reduces emergency visits and improves asthma care in children
Visits to pediatric practice-based research network offices are representative of national pediatric outpatient visits Primary care doctors consider several factors when deciding whether to counsel a patient about obesity
Poor communication between patients taking warfarin and their doctors may place them at risk for stroke and bleeding
Primary care clinicians often fail to follow practice guidelines when treating patients with sore throats

Research Activities, March 2007:
Efforts to improve chronic disease management quality yield better care delivery but not better intermediate outcomes
Substantially delaying the first dose of hepatitis B vaccine may lead to underimmunization of children
Children are more likely to attend a weight management program if location and time are convenient for parents
Some pediatric offices may not be prepared to handle emergencies such as seizures or severe asthmatic episodes
Specific primary care office systems and quality improvement strategies may substantially affect the cost of diabetes care
HIV-infected women receive worse quality of care than HIV-infected men

Research Activities, February 2007:
Diagnostic errors that harm outpatients are typically the result of multiple individual and system breakdowns
Physician, patient, and pharmacy outreach reminders can improve recommended laboratory monitoring for certain medications
Many children do not receive recommended well-child visits during the year, especially disadvantaged children
Primary care patients with pain and psychosocial problems benefit from nurse telephone calls
Demand for primary care internists has decreased, while demand for hospital-based internists has increased

Research Activities, January 2007:
Depression worsens the health and quality of life of people with diabetes
Overprescribing of lipid-lowering agents is associated with several physician and practice characteristics

Research Activities, December 2006:
Direct-to-consumer drug advertising on television may have led to increased prescribing of Vioxx® and Celebrex®
Study raises doubts about the usefulness of emergency department diagnosis as a criteria for medically unnecessary EMS transports
Lack of health care options in rural communities poses substantial barriers to care for rural disabled adults

Research Activities, November 2006:
Studies examine influence of patient race on primary care quality and hospital discharge against medical advice
Computerized drug alerts when ordering medications reduce inappropriate prescribing for the elderly
Faxed pharmacy alerts to doctors when patients miss their antidepressant prescription refill does not improve compliance
Pay-for-performance incentives were adopted by half of U.S. HMOs, but their use depends on health plan type and physician payment arrangements

Research Activities, October 2006:
Elderly patients whose physicians are white or have urban practices are more likely to use antidepressants
Severity of illness and rural location affect the willingness of elderly people to travel longer distances to the hospital

Research Activities, September 2006:
Diabetes screening practices in children vary widely among pediatric clinicians

Research Activities, August 2006:
Pharmacists help identify patient safety and quality issues by clarifying prescriptions
Studies examine the practice of prescribing medications to outpatients that can dangerously interact with one another
Only half of older people with diabetes receive ACE inhibitors or angiotensin receptor blockers to prevent cardiac problems
Primary care physicians often prescribe antiviral medications inappropriately or fail to prescribe them when needed

Research Activities, July 2006:
Primary care of patients with type 2 diabetes can be improved
Reductions in primary and preventive care use under Medicaid primary care case management are more dramatic for minority children

Research Activities, June 2006:
Primary care assessment of intimate partner violence and referrals may prevent its recurrence
A year after leaving jail, half of women lack health insurance or use primary care
Interventions for primary care providers improve management of diabetes
Interventions that improve asthma outcomes in clinical trials may not translate to the practice level
Clinicians may need to balance recommendations with patient preferences for anticoagulant medication to treat atrial fibrillation
Diagnosis of a seriously ill patient misses the link between a type of hepatitis and Hodgkin's disease
Primary care physician and health care system characteristics influence the likelihood of referral to specialists
Communication between primary care patients and their doctors does not necessarily result in shared decisionmaking
A practice-based research cohort of patients may have advantages over the traditional PBRN model

Research Activities, May 2006
Electronic medication alerts reduce inappropriate prescribing of warfarin with interacting drugs
Computerized prescribing alerts can be designed to be widely accepted by primary care clinicians
Many primary care doctors still do not use electronic antibiotic prescribing for acute infections
Nurse-anchored practice-based research centers help address health disparities
One of every five medications approved for certain diagnoses are prescribed by office-based physicians for other conditions
Primary care doctors often fail to prescribe "controller medications" for asthma patients after an emergency room visit
Disadvantaged groups infected with hepatitis C can be effectively treated when health care providers collaborate

Research Activities, April 2006
Studies examine ways to improve the quality of diabetes care

Research Activities, March 2006
Frequent potential medication dosing errors occur during outpatient pediatric visits
Doctors still prescribe antibiotics for over half of children with sore throats
Adding cognitive behavioral therapy to treatment plans reduces depressive symptoms among adolescents
Better communication and coordination of care could reduce frustration experienced by patients with chronic diseases
Obese patients are treated differently during primary care visits

Research Activities, February 2006:
Changes in the delivery of care are needed to reduce the burden of diabetes among ethnic minorities
Study details differences in physician and nonphysician acupuncture treatment for chronic low back pain
Clinical setting and physician communication style predict patient participation during medical consultations
Varied use of physical therapists by people with back and neck pain suggests overuse by some patients and underuse by others

Research Activities, January 2006:
Having a usual source of care increases wellness visits among children with asthma
Insurance status influences patients' access to urgent followup appointments after emergency department care
State-subsidized health insurance programs provide both benefits and difficulties for low-income children

Research Activities, December 2005:
Long waits for providers and lack of access are the most common frustrations among urban primary care patients
Neither patient HMO membership nor physician HMO participation is greatly associated with racial disparities in primary care
Clinical inertia in primary care contributes to poor diabetes control

Research Activities, November 2005:
Younger women are more satisfied with their healthcare when a reproductive health specialist is their primary provider
Diagnosing dementia is difficult and expensive for primary care practices
Educating patients with asthma on avoiding allergens is suboptimal
Generalist physicians with appropriate experience and expertise can provide high-quality care to patients with HIV

Research Activities, October 2005:
White patients are more likely than black patients to receive opioids to relieve chronic nonmalignant pain
Parents are more satisfied when doctors prescribe antibiotics for their child's cough or cold symptoms
Greater access to primary care may reduce emergency department use

Research Activities, September 2005:
Use of nurse case managers and physician peer leaders can reduce children's asthma symptoms but at a price
Studies reveal variations in preventive care and parental guidance among pediatric and family medicine practices
Adolescents underuse and receive little preventive health counseling during primary care visits
Medical groups want to improve chronic disease care but many feel constrained by limited resources and lack of financial incentives
Improving physician knowledge of psychiatric problems and relevant medications could improve quality of care
Many rural primary care providers seek information to support patient care, but most still prefer print over online sources

Research Activities, August 2005:
Certain managed care organization characteristics can increase specialty care use among chronically ill low-income children
Study explores physician job satisfaction and quality of care and outcomes for managed care patients with pain and depression
It will be difficult to achieve strict cholesterol goals in many patients with diabetes and cardiovascular disease

Research Activities, July 2005:
Patient education may reduce unnecessary use of antibiotics by adults
Clinician training and charting tools can improve primary care screening and counseling of adolescents about risky behaviors

Research Activities, June 2005:
More than 13 percent of primary care patients do not know why they are taking at least one of their prescription medications
Herbal use is common among urban primary care patients and often is not disclosed to doctors
Primary care physician specialty influences use of screening mammography and Pap smears in gatekeeper plans

Research Activities, May 2005:
Researchers examine effects of quality improvement on depression care for adolescents and adults
Missing clinical information during primary care visits is commonplace and can adversely affect patient care
Researchers assess breast cancer risk and the effects of tamoxifen prophylaxis among women in primary care practices
Homeless youths have numerous health and access to care problems that vary between street and shelter-based youths

Research Activities, March 2005:
Preventing diabetes complications could save $2.5 billion annually
Primary care providers miss opportunities during office visits for adult preventive care
Family doctors and patients tend to agree on what constitutes competent patient communication
Limited direct evidence supports the many recommendations for preventive care during well-child care visits
Race appears to be a factor in how doctors communicate with their patients during primary care visits

Research Activities, January 2005:
Use of comprehensive QI program in primary care can improve delivery of preventive services for heart disease and stroke
Clinicians value medication safety alerts and welcome small-group training to make better use of them
Involving all staff members in guideline-recommended care can improve oversight and coordination of patient care
Patients are more trusting of doctors who spend more time with them and discuss the impact of their illness
Centers specializing in primary care for women consistently deliver preventive services and have high patient satisfaction
Shortages of rural generalist physicians may be due to poor recruitment rather than retention problems
Primary care doctors demonstrated restraint in prescribing antibiotics following the 2001 anthrax attacks

Research Activities, December 2004:
Many primary care errors stem from problems with access to clinicians and doctor/patient interaction
Physicians who feel confident in delivering preventive services to adolescents are more likely to screen them for risky behaviors
Patients with Alzheimer's disease and their caregivers need a comprehensive care program that addresses problem behaviors
Evidence-based care for depression is clinically effective for minority patients

Research Activities, November 2004:
Prehypertension is a considerable health risk, particularly in people aged 45 and older
Addressing multiple factors for certain diseases rather than just one may promote healthier lifestyles
Volume and intensity of physicians' services used by FFS Medicare enrollees jumped over 30 percent in the mid-1990s

Research Activities, October 2004:
Doctors can use conversational techniques during an illness visit to create an opportunity to deliver preventive care
Participants in a community-based mind-body training program report moderate improvements in quality of life after 3 months
Very little of the variation in quality of diabetes care is explained by practice factors

Research Activities, September 2004:
Study finds that some pregnant women are prescribed drugs that may be considered unsafe during pregnancy
Use of rofecoxib at 50 mg for more than 5 days for osteoarthritis should be discouraged due to dose-related problems
Although muscle relaxants are often prescribed for acute low back pain, they do not appear to speed recovery of function
Many diabetes patients at high risk for kidney failure are not receiving medication to slow its development
Interference of diabetes with social activities may be an early warning sign of subsequent disability
Half of doctors in State-sponsored financial support-for-service programs stay in underserved areas over 8 years, most working happily
Diagnosis of pain by primary care doctors is influenced by pain severity, patient sex, and physician practice style
Even when primary care patients receive recommended treatment for their depression, nearly half remain depressed
Children with special health care needs in Medicaid managed care plans receive more needed care than those in Medicaid FFS plans

Research Activities, August 2004:
Hypertension control is greater in U.S. primary care practices than usually reported
Immunization rates in New Mexico have fallen significantly since the introduction of Medicaid managed care

Research Activities, July 2004:
Researchers focus on primary care for diabetes and use of a rapid-turnaround test to measure blood glucose
A pain in the neck could mean Lemierre's syndrome
Improved access to medication and therapy for depressed primary care patients improves 5-year outcomes
Disparities in use of preventive care may be reduced by requiring Medicare HMO enrollees to select a primary care doctor

Research Activities, June 2004:
Physician prescribing preference plays a greater role than patient risk factors in prescribing COX-2 inhibitors
Primary care of adults with chronic acid-related disorders could be improved if more doctors followed treatment guidelines
Relief of symptoms from proton-pump inhibitor treatment does not necessarily confirm diagnosis of GERD
Patients are more likely to stop smoking if they are advised by their doctors to do so
Radical new approaches to taking a thorough family history will be needed to meet the challenges of genetic testing

Research Activities, May 2004:
More frequent visits to the doctor are associated with increased safety monitoring for toxicity among chronic NSAID users
Continued staff education and improved processes in physicians' offices can enhance preventive care for children
National survey reveals how primary care doctors identify and manage young children with developmental delays
Referrals for physical therapy for musculoskeletal conditions vary and may indicate problems with access to care
Practices that allot more time for acute care visits and promote immunization have higher adult vaccination rates
Researchers find New York SCHIP improves health care access, continuity, and quality

Research Activities, March 2004:
Relying on clinical guidelines to treat young infants with fevers may not improve outcomes
EXCEED projects focus on prevention and treatment of cardiovascular disease
Studies show low physician adherence to clinical guidelines for managing pneumonia and heart disease

Research Activities, February 2004:
Better communication of disease-specific and general health information can improve diabetes self-care
Task Force working group encourages patient-provider partnership in making decisions about preventive care
Computerized physician order entry needs further refinement to substantially reduce medication errors in primary care

Research Activities, January 2004:
South Carolina's initiative to reduce hypertension rates trains hypertension specialists and provides advice to doctors
Racial differences exist in parents' opinions about the quality of primary care provided to their children

 

AHRQ Advancing Excellence in Health Care