Annals of family medicine
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Annals of family medicine · Nov 2005
Quick assessment of literacy in primary care: the newest vital sign.
Current health literacy screening instruments for health care settings are either too long for routine use or available only in English. Our objective was to develop a quick and accurate screening test for limited literacy available in English and Spanish. ⋯ NVS is suitable for use as a quick screening test for limited literacy in primary health care settings.
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Annals of family medicine · Nov 2005
Time spent in face-to-face patient care and work outside the examination room.
Contrary to physicians' concerns that face-to-face patient time is decreasing, data from the National Ambulatory Medical Care Survey (NAMCS) indicate that between 1988 and 1998, durations of primary care outpatient visits have increased. This study documented how physicians spend time during the workday, including time outside the examination room, and compared observed face-to-face patient care time with that reported in NAMCS. ⋯ Nearly one half of a primary care physician's workday is spent on activities outside the examination room, predominately focused on follow-up and documentation of care for patients not physically present. National estimates of visit duration overestimate the combination of face-to-face time and time spent on visit-specific work outside the examination room by 41%.
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Annals of family medicine · Nov 2005
Quality of work life of independent vs employed family physicians in Wisconsin: a WReN study.
Family physicians in Wisconsin who are mainly employed by large health care organizations have voiced concerns regarding the quality of their work lives. We explored the quality of work life and its relationship to employment by health care organizations. ⋯ Independent physicians have significantly more positive ratings of several aspects of the quality of their work life compared with physicians employed by health care organizations. Health care organizations need to address these issues if they are to have a satisfied and stable workforce.
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Annals of family medicine · Nov 2005
The break-even point: when medical advances are less important than improving the fidelity with which they are delivered.
Society invests billions of dollars in the development of new drugs and technologies but comparatively little in the fidelity of health care, that is, improving systems to ensure the delivery of care to all patients in need. Using mathematical arguments and a nomogram, we demonstrate that technological advances must yield dramatic, often unrealistic increases in efficacy to do more good than could be accomplished by improving fidelity. ⋯ The misalignment of priorities is driven partly by the commercial interests of industry and by the public's appetite for technological breakthroughs, but health outcomes ultimately suffer. Health, economic, and moral arguments make the case for spending less on technological advances and more on improving systems for delivering care.
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Annals of family medicine · Sep 2005
Meta Analysis Comparative StudyEfficacy and tolerability of tricyclic antidepressants and SSRIs compared with placebo for treatment of depression in primary care: a meta-analysis.
Depression is common in primary care. There are no systematic reviews of depression treatment comparing antidepressants with placebo; hence, we do not know whether these medications are effective in primary care. ⋯ This systematic review is the first comparing antidepressants with placebo for treatment of depression in primary care. Both TCAs and SSRIs are effective. This review is also the first to show that low-dose TCAs are effective in primary care. Prescribing antidepressants in primary care is a more effective clinical activity than prescribing placebo.