Implementation of an Alcohol Medical Amnesty Policy at an Urban University With a Collegiate-Based Emergency Medical Services Agency.

PURPOSE: Medical amnesty policies (MAPs) at universities attempt to encourage students to seek emergency medical care by reducing disciplinary sanctions. This study analyzed how a MAP affected requests for emergency medical help to a collegiate-based emergency medical services (CBEMS) agency for alcohol-related issues. METHODS: This before-and-after study analyzed CBEMS call data for the 6 semesters prior to and after MAP implementation. Extracted data included patient demographics, dispatch time, and requests for advanced life support (ALS) resources. RESULTS: Following MAP introduction, increases were observed in alcohol-related calls/day in the fall semesters (0.84 vs. 0.93; p < 0.01). The median time of calls decreased; 1:20 a.m. versus 12:59 a.m. (median difference 21 minutes, p < 0.001). Finally, ALS was requested less often (9.0% vs. 3.7%; odds ratio 0.39; p < 0.01). CONCLUSIONS: MAP implementation at a university with a CBEMS is associated with a higher call volume, requests for service that occur earlier in the evening, and reduction in ALS requests for alcohol-related emergencies.

Electronic Medical Records, Medical Students, and Ambulatory Family Physicians: A Multi-Institution Study.

PURPOSE: Medical students commonly encounter electronic medical records (EMRs) in their ambulatory family medicine clerkships, but how students interact with this technology varies tremendously and presents challenges to students and preceptors. Little research to date has evaluated the impact of EMRs on medical student education in the ambulatory setting; this three-institution study aimed to identify behaviors of ambulatory family medicine preceptors as they relate to EMRs and medical students. METHOD: In 2015, the authors sent e-mails to ambulatory preceptors who in the preceding year had hosted medical students during family medicine clerkships, inviting them to participate in the survey, which asked questions about each preceptor's methods of using the EMR with medical students. RESULTS: Of 801 ambulatory preceptors, 265 (33%) responded. The vast majority of respondents used an EMR and provided students with access to it in some way, but only 62.2% (147/236) allowed students to write electronic notes. Of those who allowed students electronic access, one-third did so by logging students in under their own (the preceptor's) credentials, either by telling the students their log-in information (22/202; 10.9%) or by logging in the student without revealing their passwords (43/202; 21.3%). CONCLUSIONS: Ambulatory medical student training in the use of EMRs not only varies but also requires many preceptors to break rules for students to learn important documentation skills. Without changes to the policies surrounding student access to and use of EMRs, future physicians will enter residency without the training they need to appropriately document patient care.

STFM's National Clerkship Curriculum: CERA reveals impact, clerkship director needs.

BACKGROUND AND OBJECTIVES: Consistency is needed in family medicine clerkships nationwide. The Society of Teachers of Family Medicine's (STFM) National Clerkship Curriculum (NCC) and supporting NCC website have been developed to address this need. A survey was used to measure these tools' effect and guide future improvements. METHODS: The Council of Academic Family Medicine's (CAFM) Educational Research Alliance (CERA) 2012 survey of clerkship directors (CD) was used to answer two research questions: (1) To what extent are clerkships teaching the minimum core curriculum? and (2) What resources do clerkship directors identify as important in their role? RESULTS: The survey response rate was 66% (88/134). Ninety-two percent of these CDs are aware of the NCC, 74% report having visited the NCC website, and 71% plan to visit it more than once per year in the future. A total of 21.6% strongly agree that their clerkship content matches the NCC. CDs rate the quality of materials on the website as high and place greatest value on materials that can be downloaded and adapted to their clerkships. CONCLUSIONS: STFM's NCC website and materials are familiar to CDs although only one in five state their clerkship curriculum matches the NCC minimum core curriculum. The NCC editorial board needs to better understand why so few teach curriculum that closely matches the minimum core. Continued outreach to CDs can answer this question and improve our ability to support CDs as they incorporate the NCC into family medicine clerkships.

Do more hospital beds lead to higher hospitalization rates? a spatial examination of Roemer's Law.

BACKGROUND: Roemer's Law, a widely cited principle in health care policy, states that hospital beds that are built tend to be used. This simple but powerful expression has been invoked to justify Certificate of Need regulation of hospital beds in an effort to contain health care costs. Despite its influence, a surprisingly small body of empirical evidence supports its content. Furthermore, known geographic factors influencing health services use and the spatial structure of the relationship between hospital bed availability and hospitalization rates have not been sufficiently explored in past examinations of Roemer's Law. We pose the question, "Accounting for space in health care access and use, is there an observable association between the availability of hospital beds and hospital utilization?" METHODS: We employ an ecological research design based upon the Anderson behavioral model of health care utilization. This conceptual model is implemented in an explicitly spatial context. The effect of hospital bed availability on the utilization of hospital services is evaluated, accounting for spatial structure and controlling for other known determinants of hospital utilization. The stability of this relationship is explored by testing across numerous geographic scales of analysis. The case study comprises an entire state system of hospitals and population, evaluating over one million inpatient admissions. RESULTS: We find compelling evidence that a positive, statistically significant relationship exists between hospital bed availability and inpatient hospitalization rates. Additionally, the observed relationship is invariant with changes in the geographic scale of analysis. CONCLUSIONS: This study provides evidence for the effects of Roemer's Law, thus suggesting that variations in hospitalization rates have origins in the availability of hospital beds. This relationship is found to be robust across geographic scales of analysis. These findings suggest continued regulation of hospital bed supply to assist in controlling hospital utilization is justified.

Chlamydia trachomatis infections: screening, diagnosis, and management.

Chlamydia trachomatis is a gram-negative bacterium that infects the columnar epithelium of the cervix, urethra, and rectum, as well as nongenital sites such as the lungs and eyes. The bacterium is the cause of the most frequently reported sexually transmitted disease in the United States, which is responsible for more than 1 million infections annually. Most persons with this infection are asymptomatic. Untreated infection can result in serious complications such as pelvic inflammatory disease, infertility, and ectopic pregnancy in women, and epididymitis and orchitis in men. Men and women can experience chlamydia-induced reactive arthritis. Treatment of uncomplicated cases should include azithromycin or doxycycline. Screening is recommended in all women younger than 25 years, in all pregnant women, and in women who are at increased risk of infection. Screening is not currently recommended in men. In neonates and infants, the bacterium can cause conjunctivitis and pneumonia. Adults may also experience conjunctivitis caused by chlamydia. Trachoma is a recurrent ocular infection caused by chlamydia and is endemic in the developing world.

Clinical Inquiry. How best to diagnose asthma in infants and toddlers?

No reliable way exists to diagnose asthma in infants and toddlers. Recurrent wheezing, especially apart from colds, combined with physician-diagnosed eczema or atopic dermatitis, eosinophilia, and a parental history of asthma, increase the probability of a subsequent asthma diagnosis in the absence of other causes (strength of recommendation: B, 2 good-quality cohort studies).

Clinical inquiries. What are appropriate screening tests for infants and children?

There is adequate evidence for screening neonates for hemoglobinopathies, congenital hypothyroidism, phenylketonuria (strength of recommendation [SOR]: A), and cystic fibrosis (SOR: B). Vision screening should be done for those younger than age 5 years (SOR: B). High-risk children should be tested for tuberculosis (TB) (SOR: B) and lead toxicity (SOR: B). Few data exist to guide frequency and timing of these screening tests, so the following timing recommendations are based on consensus opinion (SOR: C): test for visual acuity yearly starting at age 3 years; test for TB and lead once between the ages of 9 and 12 months, and repeat for high risk or exposure.

The natural history of asthma in a primary care cohort.

BACKGROUND: We examined the natural history of asthma in a primary care cohort of patients 10 years after the cohort was stratified for asthma risk by responses to a questionnaire and bronchial hyperresponsiveness (BHR) testing. METHODS: Children and young adults who were born between 1967 and 1979 within 1 of 4 affiliated family practices of the Nijmegen Department of Family Medicine, The Netherlands, were asked to participate in an asthma study in 1989. Of 926 patients available, 581 (63%) agreed to participate. Their family physicians' diagnoses of upper and lower respiratory tract disease and asthma were prospectively collected during the next 10 years and were analyzed. RESULTS: BHR or the presence of asthma symptoms at screening did not result in a significantly disproportionate number of physician visits during the next 10 years for 4 or more upper or lower respiratory tract infections when compared with patients who did not have these findings at the beginning of the study. The presence of asthma symptoms correlated with an increased risk of an asthma diagnosis or allergic rhinitis in the group of patients who did not have asthma diagnosed at start of the study. One half of the known asthmatic patients at the onset of the study (21 of 44) had no further visits to their physicians for treatment of asthma during the next 10 years. CONCLUSIONS: In primary care, BHR testing has limited value in predicting subsequent respiratory tract disease for patients who have asthma diagnosed by a physician. The use of symptom questionnaires can be of clinical use in predicting asthma.