The patient perspective on overactive bladder: a mixed-methods needs assessment.

BACKGROUND: While overactive bladder is often managed in the primary care setting, a number of barriers including embarrassment, poor communication, and low patient adherence contribute to the under-treatment of patients with burdensome urinary symptoms. In order to address these challenges, it is crucial to have a fundamental understanding of patient perspectives toward OAB and urinary symptoms. To meet this aim, researchers designed and conducted a study to identify patients' knowledge, experiences and attitudes, barriers to treatment adherence, and desires and tendencies regarding patient/clinician communications. METHODS: A mixed-methods qualitative/quantitative needs assessment of patients with overactive bladder and/or urinary symptoms. Researchers conducted in-depth qualitative interviews via telephone with 40 patients. Interview results informed the design and dissemination of a quantitative survey, which was completed by 200 self-selected respondents who had previously identified themselves as having overactive bladder or bladder problems. Statistical and qualitative analysis of results were conducted. RESULTS: Among survey respondents, an average of 3.5 years elapsed between symptom onset and seeking diagnosis by a physician. In the long term most patients do not experience improvement in symptoms. Medication non-adherence is common and is related to therapy effectiveness and adverse effects. Patients clearly indicate that communication and patient/physician relationships are important to them and they would prefer the clinician initiate the conversation on overactive bladder. Patient experiences, perspectives, and attitudes toward their bladder symptoms differ in many ways from clinicians' assumptions. CONCLUSIONS: The significant time gap between symptom onset and diagnosis indicates ongoing need for screening and diagnosis of overactive bladder. Contrary to guideline recommendations, urinalysis and physical examination are not widely used in clinical practice. Many patients experience no improvement in symptoms over time. Patients indicate that clinician/patient relationships and communication regarding their condition are important.

Bioterrorism--a health emergency: do physicians believe there is a threat and are they prepared for it?

OBJECTIVE: To determine whether bioterrorism training provided increased awareness and understanding of bioterrorism and to assess physicians' beliefs about the threat of bioterrorism and how it impacts on preparedness. DESIGN: This is a retrospective review of data obtained from a bioterrorism training grant. Data were obtained from a postevaluation form completed by trainees with an 80 percent return rate. The Institutional Review Board approved this study. Informed consent was not required as data were deidentified and demographic information regarding study subjects was not used. SETTING: The Department of Family Medicine within the University of Medicine and and Dentistry of New Jersey, School of Osteopathic Medicine in Stratford, NJ, conducted the training and follow-up study. PARTICIPANTS: The bioterrorism preparedness training was targeted to physicians, residents, and third- and fourth-year medical students in New Jersey. There were 578 trainees; however, responses to each question were varied. OUTCOME MEASURES: Trainees were asked to complete an evaluation form. Specific questions were selected from the form. Frequency statistics were used to describe responses to the questions. RESULTS: Ninety-four percent of the respondents agreed that the bioterrorism training increased their awareness and/or understanding of bioterrorism; however, only 49 percent believe there is a high probability that a bioterrorism event or other health emergency will occur in the near future in New Jersey, and 42 percent considered themselves prepared to respond as a healthcare professional to a bioterrorism event. CONCLUSIONS: Physicians in New Jersey increased their awareness and understanding of bioterrorism through training. However, concerns remain that a physician's belief in a low threat of bioterrorism translates into a low need for bioterrorism preparedness training.

Potential for pregabalin abuse or diversion after past drug-seeking behavior.

Pregabalin, primarily used to manage neuropathic pain and fibromyalgia, is categorized as a Schedule V drug (ie, lowest potential for abuse) in the US Drug Enforcement Administration's Controlled Substances Act. Because pregabalin is not recognized as a drug with high-abuse potential, data on pregabalin abuse and addiction are lacking. The authors report a case of a 35-year-old woman with a history of opioid-seeking behavior who was prescribed pregabalin for pain control. The patient requested an increase in her medication 2 months after beginning treatment and, after her physician denied her request, subsequently obtained pregabalin from other sources. Over a 28-day period, the patient received a total of 88,500 mg of pregabalin. After learning of the other prescriptions, the patient's physician became suspicious of pregabalin abuse or diversion. In accordance with state medical board guidelines, the patient was discharged from the practice and referred to a local detoxification center.

Eliminating barriers for patients with limited English proficiency.

The increasing number of patients with limited English proficiency (LEP) in the United States is an important issue for patients, physicians, federal and state government agencies, and insurance carriers. Physicians can actively address this healthcare barrier by becoming familiar with established state and federal guidelines and determining when appropriate linguistic services are required for their LEP patient populations. Physicians can ensure that appropriate care is administered to LEP patients by developing and monitoring plans that include training staff to identify and work with LEP patients, providing language assistance to LEP patients, and notifying LEP patients of special services.

Patient knowledge and perception of upper respiratory infections, antibiotic indications and resistance.

BACKGROUND AND OBJECTIVE: The misuse of antibiotics is not a harmless practice; rather, it can render future antibiotic treatments ineffective. This study looked to determine patient knowledge and perception of upper respiratory infections and indicated treatment. METHODS: The authors developed and administered a questionnaire to 98 patients visiting affiliated family medicine clinical sites. Participants were selected randomly, either while sitting in the waiting room, or after being seen by the clinician. RESULTS: While more than half the respondents recognized that treatment for colds did not require antibiotics, 70% erroneously indicated that viruses require antibiotic treatment. Additionally, almost 90% of respondents thought that yellow nasal discharge or coughing up yellow mucous requires antibiotic treatment. It was interesting to note that 95% of patients reported satisfaction when advised by their physician that antibiotic treatment wasn't necessary, even if they initially thought they needed antibiotics. CONCLUSIONS: Primary care providers have the greatest opportunity to curb inappropriate antibiotic use by both prescribing appropriately and educating their patients about proper antibiotic use when indicated.

The effectiveness of a first-year clinical preceptorship on the data collection and communication skills of second-year medical students.

BACKGROUND: Evidence suggests that effective physician communication strongly correlates with patient satisfaction and treatment outcome. Unfortunately, teaching these skills has been challenging because of 2 major barriers: (a) medical students are often too preoccupied with the technical and scientific aspects of their curriculum, and (b) it is difficult to expand curricular time. DESCRIPTION: To overcome these barriers, an educational intervention that has not required additional classroom time was implemented. This first-year preceptorship focused on improving data gathering and interpersonal/communication skills. EVALUATION: Analysis of the data for the 2 test groups revealed that interpersonal and communication skills were modestly higher in the preceptorship group. There was no significant difference in data collection in each of the two groups. CONCLUSIONS: Combining formal communication skills instruction with an early clinical experience may prove to be the most effective approach to improving interpersonal, communication, and data gathering skills.