ABSTRACT
BACKGROUND: Achieving cancer early-detection goals remains a challenge, especially among low-income and minority populations. DESIGN/SETTING: A randomized trial based in 62 community health centers for the underserved in New York, New Jersey, and western Connecticut. Family physicians were on staff at most of the centers. INTERVENTION: Workshops, materials, and ongoing advice for center leaders promoted implementation of a preventive services office system to identify patients in need of services at each visit through use of medical record flow sheets, other tools, and staff involvement. EVALUATION END POINTS: The proportion of randomly selected patients by center who were up to date for indicated services at baseline (n = 2645) and follow-up (n = 2864) record review. RESULTS: Only 1 service (breast self-examination advice) increased more in intervention centers. Seven of 8 target services increased significantly for the 62 centers overall. During the study, the medical director changed in 26 centers (42%). Keeping the same medical director at intervention centers was associated with improvements in services. CONCLUSIONS: Cancer early-detection services are improving in community health centers, but the intervention had only a small impact, as determined by record review. To have an impact, the intervention required that there be no change in medical director. The relationship of changes in the practice environment to services delivered is complex and deserves more study.
Subject(s)
Medically Underserved Area , Neoplasms/prevention & control , Preventive Health Services/statistics & numerical data , Aged , Connecticut , Female , Humans , Male , Middle Aged , New Jersey , New York , Socioeconomic FactorsABSTRACT
Throughout STFM's 25th anniversary year, we illustrated the dynamic history of family medicine using the personal narratives of some of the discipline's founders and early leaders. We have attempted to take the energy of their spoken words and put it on paper for clinician educators to learn from and lead by. For us, as authors, this process has been enriching and has caused us to reexamine and confirm the meanings of our roles as teachers in family medicine. In this final installment, we present five new voices: individuals from succeeding generations of academic family physicians. Like the many others we interviewed but have not included here, these five individuals were identified by colleagues for their demonstrated leadership in the discipline. They and others will help mold the future of family medicine well into the 21st century.
Subject(s)
Physicians, Family/psychology , Career Choice , Family Practice/education , Female , Humans , MaleSubject(s)
Community Health Centers/organization & administration , Community-Institutional Relations , Family Health , Primary Health Care/organization & administration , Community Health Centers/economics , Ethnicity , Female , Financing, Government/methods , Health Services Needs and Demand/organization & administration , Humans , Managed Care Programs/organization & administration , New York City , Pregnancy , Prenatal Care/organization & administration , Primary Health Care/economicsABSTRACT
Women in communities with a high rate of adverse birth outcomes benefit from early prenatal care. The Montefiore Medical Center Department of Family Medicine has developed a Low Birth-weight Prevention Program at a community health center, which encourages early prenatal care, surveillance of all pregnancies for existing or emergent risk factors, and case management of high-risk pregnancies by family medicine faculty, residents, and nurse practitioners.
Subject(s)
Family Practice/organization & administration , Medically Underserved Area , Outcome Assessment, Health Care , Prenatal Care/organization & administration , Preventive Medicine/organization & administration , Female , Humans , New York , Pregnancy , Urban HealthSubject(s)
Acquired Immunodeficiency Syndrome/epidemiology , Community Health Centers , Family/psychology , Physicians, Family , Acquired Immunodeficiency Syndrome/congenital , Acquired Immunodeficiency Syndrome/psychology , Female , Humans , Infant , Male , Middle Aged , New York City/epidemiology , PovertyABSTRACT
Psychologic and social factors have been implicated in the aetiology of dyspepsia. In this study these factors were investigated in relation to flatulent dyspepsia, a symptom complex that has traditionally been associated with gallbladder disease. Subjects completed the Middlesex Hospital Questionnaire and the Life Events Inventory and were interviewed in detail, using a semi-structured format. Three groups of patients with flatulent dyspepsia--those with and without gallbladder disease and post-cholecystectomy--all had significantly more associated somatic symptoms than non-dyspeptic subjects with gallbladder disease or normal controls, thus indicating greater emotional upset amongst dyspeptic patients. There was little evidence that symptoms were related to stressful life events.
Subject(s)
Dyspepsia/psychology , Adult , Biliary Tract Diseases/complications , Cholecystectomy/adverse effects , Cholecystitis/complications , Colic/complications , Dyspepsia/diagnosis , Dyspepsia/etiology , Female , Humans , Male , Middle Aged , Psychophysiologic Disorders/diagnosis , Socioeconomic FactorsABSTRACT
Health has improved in Cuba and China during the past quarter of a century. Some of the improvements in health occurred as economic conditions improved in both countries, but there are other similarities of health care delivery in China and Cuba. Collective activity plays an important role in health care in both nations; both do health planning centrally, but local communities control the daily activities of the health services that they use. Techniques that have improved health in underdeveloped nations might be applied in underserved areas of the United States.
