Hepatitis A.

Hepatitis A is a common viral illness worldwide, although the incidence in the United States has diminished in recent years as a result of extended immunization practices. Hepatitis A virus is transmitted through fecal-oral contamination, and there are occasional outbreaks through food sources. Young children are usually asymptomatic, although the likelihood of symptoms tends to increase with age. Most patients recover within two months of infection, although 10 to 15 percent of patients will experience a relapse in the first six months. Hepatitis A virus does not usually result in chronic infection or chronic liver disease. Supportive care is the mainstay of treatment. The Centers for Disease Control and Prevention and the American Academy of Pediatrics recommend routine vaccination of all children 12 to 23 months of age, as well as certain vulnerable populations. Hepatitis A vaccine is also recommended for most cases of postexposure prophylaxis, although immunoglobulin is an acceptable alternative in some situations.

Six-year update on the financial status of US Family Medicine Departments.

BACKGROUND: The financial climate for academic family medicine departments is increasingly threatened by reductions in federal funding and ever more competitive health care markets. OBJECTIVES: Our objective was to evaluate the financial status of US Departments of Family Medicine, comparing 1998 and 2004 data. METHODS: In 1999 and 2005, family medicine department chairs were surveyed for the Association of Departments of Family Medicine. Information reported about departments' financial status for 1998 and 2004 included department size, faculty compensation, revenue sources, expenditures, residents' salary support, payer mix, and department reserves. The 2005 survey data were compared to the 1999 survey reports. RESULTS: Eighty-five departments responded to the 2005 survey (69% of 124 departments). For 2004, the largest source of department revenue was clinical income; the median percent of revenue from clinical work increased from 32% in 1998 to 46% in 2004. The contributions of school/government support and hospital support decreased. Median expenditures for faculty salaries and fringe benefits increased (from 49% to 54%). Although the percentage of departments with reserves had increased (from 57% to 71%), 18% of departments reported debt in 2004. CONCLUSIONS: Family medicine departments increasingly rely on clinical income. They continue to be vulnerable to changes in support from government and hospital sources, since these sources constitute significant portions of department budgets but have declined in the past 6 years.

Toward Interdisciplinary Care: Bridging the Divide between Biomedical and Alternative Health Care Providers.

PURPOSE: Responding to suggestions that physicians are obligated to inquire fully about complementary and alternative medicine (CAM) use and its scientific evidence, to acknowledge patients' health beliefs and practices, and to accommodate diverse healing practices, our interdisciplinary CAM integration project created an advisory committee (AC) composed of CAM practitioners and institutional personnel to incorporate CAM- related information into health professions training. We report on the collaborative process and describe group members' perceptions of medicine and clinical teaching. METHODS: Information collected from the first two years' quarterly meetings, the first annual retreat, and other venues was analyzed in conjunction with semi-structured in-person interviews of 10 biomedical and CAM practitioner committee members. Data were analyzed using qualitative methodology and N5 software to identify themes and patterns. RESULTS: Analysis confirmed expectations that allopathic and CAM AC members held different views of health and healing. Member comments reflected points of tension that clustered into three intertwined themes: what constitutes evidence, interaction with the patient, and the relative importance of experience in learning. Recommendations for designing interdisciplinary CAM curricula are presented. CONCLUSION: Differences between CAM and allopathic providers were frequent but did not obviate common goals or collaboration. Results demonstrate the potential for collaboration between these groups and our activities may be useful to others seeking to implement interdisciplinary care, particularly between CAM and allopathic providers.

How and why to study the practice content of a practice-based research network.

BACKGROUND: We describe the rationale, methods, and important lessons learned from doing a practice content study in a new practice-based research network (PBRN). METHODS: We performed a modified replication of the National Ambulatory Medical Care Survey (NAMCS) in the Kentucky Ambulatory Network (KAN). Network clinicians had input into focused modifications of the NAMCS protocol, including addition of data fields of special interest to them. Cross-sectional sampling of patient visits was done for a 1-year period, with each practice collecting data during 2 separate weeks. We used selected results to illustrate lessons learned and the value of this endeavor. RESULTS: Twenty-three KAN clinicians helped recruit 33 of their colleagues, and these 56 community-based primary care clinicians collected data on 2,228 office visits. Patient demographics (except race) and the top 10 diagnoses were similar to US NAMCS data. One third of visits addressed 3 or more diagnoses, and one fourth of the visits involved 4 or more medications. The top 10 primary diagnoses represented only one third of all primary diagnoses. Seventy percent of adult patients were either overweight (30%) or obese (40%). Rates of counseling on diet or exercise rose with increases in body mass index. CONCLUSION: This study helped us establish and activate our new PBRN, increasing its membership in the process. The descriptive data gained will stimulate, guide, and support our future research activities.

The Future of Family Medicine: a collaborative project of the family medicine community.

BACKGROUND: Recognizing fundamental flaws in the fragmented US health care systems and the potential of an integrative, generalist approach, the leadership of 7 national family medicine organizations initiated the Future of Family Medicine (FFM) project in 2002. The goal of the project was to develop a strategy to transform and renew the discipline of family medicine to meet the needs of patients in a changing health care environment. METHODS: A national research study was conducted by independent research firms. Interviews and focus groups identified key issues for diverse constituencies, including patients, payers, residents, students, family physicians, and other clinicians. Subsequently, interviews were conducted with nationally representative samples of 9 key constituencies. Based in part on these data, 5 task forces addressed key issues to meet the project goal. A Project Leadership Committee synthesized the task force reports into the report presented here. RESULTS: The project identified core values, a New Model of practice, and a process for development, research, education, partnership, and change with great potential to transform the ability of family medicine to improve the health and health care of the nation. The proposed New Model of practice has the following characteristics: a patient-centered team approach; elimination of barriers to access; advanced information systems, including an electronic health record; redesigned, more functional offices; a focus on quality and outcomes; and enhanced practice finance. A unified communications strategy will be developed to promote the New Model of family medicine to multiple audiences. The study concluded that the discipline needs to oversee the training of family physicians who are committed to excellence, steeped in the core values of the discipline, competent to provide family medicine's basket of services within the New Model, and capable of adapting to varying patient needs and changing care technologies. Family medicine education must continue to include training in maternity care, the care of hospitalized patients, community and population health, and culturally effective and proficient care. A comprehensive lifelong learning program for each family physician will support continuous personal, professional, and clinical practice assessment and improvement. Ultimately, systemwide changes will be needed to ensure high-quality health care for all Americans. Such changes include taking steps to ensure that every American has a personal medical home, promoting the use and reporting of quality measures to improve performance and service, advocating that every American have health care coverage for basic services and protection against extraordinary health care costs, advancing research that supports the clinical decision making of family physicians and other primary care clinicians, and developing reimbursement models to sustain family medicine and primary care practices. CONCLUSIONS: The leadership of US family medicine organizations is committed to a transformative process. In partnership with others, this process has the potential to integrate health care to improve the health of all Americans.