Primary care physicians' awareness and adherence to cervical cancer screening guidelines in Texas.

BACKGROUND: Cervical cancer screening guidelines were created to help healthcare professionals in appropriate screening utilizing the PAP test. However, significant variation in cervical cancer screening among primary care physicians has been noted. Knowledge of the awareness of and adherence to cervical cancer screening guidelines by primary care physicians will help determine how best to disseminate and educate these physicians regarding the guidelines in hopes of reducing unnecessary screening and improving screening for under screened populations. METHODS: A cross-sectional, mailed survey involving Family Medicine (FP), Community Internal Medicine (CIM), and Obstetrics/Gynecology (OB) physicians practicing in a large University-affiliated, multi-specialty group practice associated with an 186,000-member HMO in Central Texas (n = 177) was conducted in 2001-2002. RESULTS: Most physicians performed PAP testing (50.4%). PAP screening was noted to vary significantly by specialty (P < 0.0001). All OBs were aware of at least one published guideline, compared to 96% of FPs and 91% of CIMs (P < 0.05). A wide variation was reported regarding adherence to published guidelines. In addition, there was significant intraspecialty variation regarding adherence to the physicians' own specialty's guidelines. CONCLUSIONS: While most physicians in the primary care setting perform PAP tests and are aware of published guidelines for PAP screening, adherence to the published guidelines varies considerably even in the same clinical setting.

E-mail communications in primary care: what are patients' expectations for specific test results?

OBJECTIVES: The objectives of this study were to assess patients' willingness to use e-mail to obtain specific test results, assess their expectations regarding response times, and identify any demographic trends. METHODS: A cross-sectional survey of primary care patients was conducted in 19 clinics of a large multi-specialty group practice associated with an 186,000-member Health Maintenance Organization. The outcome measures were proportion of patients with current e-mail access, their willingness to use it for selected general clinical services and to obtain specific test results, and their expectations of timeliness of response. RESULTS: The majority of patients (58.3%) reported having current e-mail access and indicated strong willingness to use it for communication. However, only 5.8% reported having ever used it to communicate with their physician. Patients were most willing to use e-mail to obtain cholesterol and blood sugar test results, but less willing to use it to obtain brain CT scan results. Patients' expectations of timeliness were generally very high, particularly for high-stakes tests such as brain CT scan. Significant differences of willingness and expectations were found by age group, education, and income. CONCLUSIONS: These findings indicate that most patients are willing to use e-mail to communicate with their primary care providers even for specific test results and that patients will hold providers to high standards of timeliness regarding response. The implication is that integration of e-mail communications into primary care ought to assure prompt and accurate patient access to a plethora of specific clinical services.

Teaching medical students complementary and alternative medicine using evidence-based principles.

OBJECTIVES: Introducing new ideas such as complementary and alternative medicine (CAM) and evidence-based medicine (EBM) to medical students early in their education may help to nurture their interest. This study evaluated the effectiveness of teaching CAM using EBM principles and assessed changes in student perceived knowledge, attitudes, and skills following a new curriculum on CAM. DESIGN: A before-and-after evaluation using a one-page, anonymous questionnaire. SETTING AND SUBJECTS: All third year students of a state, public medical school in Texas. INTERVENTION: A new curriculum comprising interactive sessions on CAM, EBM, and basic principles of epidemiology and biostatistics. OUTCOME MEASURES: Changes in student-perceived knowledge, attitudes, and skills. RESULTS: Of 67 students, complete data were obtained for 54 (81%). The majority reported that the new instruction in CAM (98%), EBM (96%), biostatistics (91%), and epidemiology (87%) would be of some benefit in their future work. Significant changes were reported in the areas of appraising a clinical trial (p < 0.0001), critiquing the medical literature (p < 0.01), and the appropriateness of integrating EBM and CAM in the medical school curriculum (p < 0.05). There were modest increases in the mean responses on their skill level in reading/understanding the medical literature (3.40-3.52), comfort level in reading the medical literature (3.53-3.67), and preparedness in designing a research study (2.12-2.39) based on a five-point Likert scale, although not statistically significant. CONCLUSIONS: Medical students could be effectively taught CAM using EBM principles. In addition, a short, interactive curriculum on an important topic has a positive impact on medical students' desires to acquire new knowledge. This should be a good motivational message to family medicine educators regarding the contribution to new knowledge such as CAM.