Pathfinding on the Frontier.

OVERVIEW: In rural settings, referrals to specialists from primary care providers can be difficult for patients and families to follow up on, sometimes requiring that patients travel great distances. Patient care coordination has been shown to decrease the number of ED visits and hospitalizations, but little is known about its effectiveness in assisting with referrals in rural primary care. This article presents three case studies showing how a nurse care coordinator at a rural primary care practice resolved complex issues involving medications, specialists, and diagnoses.

Evaluating family medicine residency COPC programs: meeting the challenge.

BACKGROUND AND OBJECTIVES: We conducted a review of the evaluation literature and outcomes from community-oriented primary care (COPC) programs in US family medicine residencies since 1969. METHODS: We used a Medline and ERIC search for "community-oriented primary care" in English from 1969-2005. RESULTS: Twenty-two articles were found that concerned US family medicine residency COPC. Six surveys over 25 years reported stable rates of COPC teaching (approximately 40%). Eight descriptive and eight evaluative papers described 14 residency COPC programs. Teaching and learning methods included block and longitudinal rotations and COPC projects. Evaluation methodologies included one quasi-experimental control group study, pretests and posttests of knowledge and attitudes, focus groups, and semi-structured interviews. Reported outcomes included changes in residents' knowledge, attitudes, and behaviors; effect on graduates' career choice and future practice; and impact on patient care and community health. CONCLUSIONS: Few studies have evaluated residency COPC programs. Evaluation has been less than rigorous, with variable results, but at least one study indicates positive outcomes at each evaluation level. More residency programs must evaluate and disseminate outcomes from their COPC projects to determine the value of COPC to residents, colleagues, community partners, and funding agencies.

Cameras and community health.

Photography projects are an alternative teaching method that can be easily integrated into community programs with adolescents and children. This article provides a brief review of the use of photography in documenting social and health issues. Two examples of community photography projects with easily ignored populations are described. These projects gave a voice to participants and allowed them to demonstrate their creativity with cameras. An implementation guide is presented to provide concrete suggestions for implementing community photography projects.

Beyond the rhythm and routine: adjusting to life in assisted living.

In Western countries, demographic trends indicate an increase in the aging population well into the next century. Because of declining health, many older adults will benefit from residence in assisted living (AL). The purpose of this qualitative study was to explore the experience and contextual influences in everyday decision-making of four older adults in AL using a case study method. Several themes emerged as significant in older adult satisfaction with everyday decision-making (i.e., trigger event, level of physical functioning, inside and outside support systems, past patterns of decision-making). Strategies for assessing and strengthening these contextually relevant factors are discussed.

Knowledge, attitudes, and beliefs about end-of-life care among inner-city African Americans and Latinos.

OBJECTIVE: This project explored end-of-life care preferences and barriers among low-income, urban African Americans and Latino/Hispanic Americans (Latinos) to uncover factors that may influence hospice utilization. METHODS: Focus groups were conducted separately for African Americans (4 groups, n = 26) and Latinos (4 groups, n = 27). Transcripts were coded and analyzed using consensus and triangulation to identify primary themes. RESULTS: Four preference themes and four barriers were identified. Results were largely similar across the two groups. Both preferred having families provide care for loved ones but expressed desire to reduce caretaker burden. Groups emphasized spirituality as the primary means of coping and valued the holistic well-being of the patient and family. Barriers reported were closely tied to access to care. Participants reported low hospice utilization because of lack of awareness of hospice and the prohibitive cost of health care. Latinos were more likely to report language barriers, while African Americans were more likely to report mistrust of the system. CONCLUSIONS: African Americans and Latinos in this study were highly receptive to end-of-life care that would provide relief for patients and caregivers and emphasize spirituality and family consensus. Improving awareness of hospice services would likely increase utilization.