J Am Board Fam Med
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Randomized Controlled Trial Multicenter Study
Validation of the Insomnia Severity Index in primary care.
Although insomnia is a prevalent complaint with significant consequences on quality of life, health, and health care utilization, it often remains undiagnosed and untreated in primary care settings. Brief, reliable, and valid instruments are needed to facilitate screening for insomnia in general practice. This study examined psychometric indices of the Insomnia Severity Index (ISI) to identify individuals with clinically significant insomnia in primary care settings. ⋯ These findings suggest that the ISI is a valid screening instrument for detecting insomnia among patients consulting in primary care settings.
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Multicenter Study
Chronic abdominal wall pain misdiagnosed as functional abdominal pain.
The abdominal wall is often neglected as a cause of chronic abdominal pain. The aim of this study was to identify chronic abdominal wall pain syndromes, such as anterior cutaneous nerve entrapment syndrome (ACNES), in a patient population diagnosed with functional abdominal pain, including irritable bowel syndrome, using a validated 18-item questionnaire as an identification tool. ⋯ A clinically relevant portion of patients previously diagnosed with functional abdominal pain syndrome in a primary care environment suffers from an abdominal wall pain syndrome such as ACNES.
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Multicenter Study Comparative Study Observational Study
Risk-adjusted comparison of blood pressure and low-density lipoprotein (LDL) noncontrol in primary care offices.
Population-level control of modifiable cardiovascular disease (CVD) risk factors is suboptimal. The objectives of this study were (1) to demonstrate the use of electronically downloaded electronic health record (EHR) data to assess guideline concordance in a large cohort of primary care patients, (2) to provide a contemporary assessment of blood pressure (BP) and low-density lipoprotein (LDL) noncontrol in primary care, and (3) to demonstrate the effect of risk adjustment of rates of noncontrol of BP and LDL for differences in patient mix on these clinic-level performance measures. ⋯ We demonstrated that the use of electronic collection of data from a large cohort of patients from fee-for-service primary care clinics is feasible for the audit of and feedback on BP and LDL noncontrol. Rates of noncontrol for most clinics are substantially higher than those achievable. Risk adjustment of noncontrol rates results in a rank-order of clinics very different from that achieved with nonadjusted data.
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Health care reimbursement is increasingly based on quality. Little is known about how clinic-level patient characteristics affect quality, particularly in community health centers (CHCs). ⋯ Clinic variability in delivery rates of preventive services correlates with differences in clinics' patient panel characteristics, particularly the percentage of patients with continuous insurance coverage. Quality scores that do not account for these differences could create disincentives to clinics providing diabetes care for vulnerable patients.
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The declining number of family physicians providing pregnancy care is of concern because they are an important source of pregnancy care in underserved communities. Innovative approaches might reinforce family physician participation in pregnancy care for the underserved. Since group prenatal visits have been shown to improve patient education, support, and satisfaction, we implemented and evaluated a group prenatal visit program for Japanese women in Michigan, an underserved population because of their limited proficiency with English. ⋯ This research demonstrates the feasibility and cultural acceptability of prenatal group visits for Japanese women. Prenatal group visits provided education and social support for Japanese women during the perinatal and postpartum periods that were not otherwise accessible in Japanese. This study confirms the feasibility of family physicians providing prenatal group visits and extends the literature of the applicability of prenatal group visits for patients with limited English skills.