RESUMEN
PURPOSE: Understand how participation in service-learning activities in medical school influenced physicians' early careers. METHODS: Researchers conducted semi-structured interviews with physicians who had completed residency training and held leadership positions within an established medical-student-run, service-learning initiative. The research team analyzed the interviews iteratively, using an editing coding strategy to identify categories, and identified themes by prolonged data immersion. The team sought disconfirming evidence and conducted member-checking. Researchers stopped interviews after no new themes emerged (saturation). RESULTS: The research team identified four main themes: service-learning activities provided an outlet for individuals predisposed to service; participants reported actively seeking underserved populations in their practice; participants described increased sensitivity towards the underserved; and participants reported gaining leadership, organizational, and administrative skills. CONCLUSIONS: Physicians who participated in medical school service-learning activities indicated these experiences influenced their professional development and approach to practice. Future studies may consider these outcomes when evaluating service-learning projects.
Asunto(s)
Actitud del Personal de Salud , Área sin Atención Médica , Médicos/psicología , Facultades de Medicina/organización & administración , Clínica Administrada por Estudiantes/organización & administración , Adulto , Comunicación , Curriculum , Femenino , Procesos de Grupo , Accesibilidad a los Servicios de Salud/organización & administración , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Grupo de Atención al Paciente/organización & administración , Relaciones Médico-Paciente , Investigación CualitativaRESUMEN
Hypertension, particularly among African Americans, has been increasing in importance in the past 10 years. One aspect of this problem is poor disease management. This study examined illness beliefs, behaviors, and hypertension control among 102 African American outpatients. Participants were interviewed about their commonsense beliefs concerning hypertension and its management in accordance with Leventhal's commonsense model of self-regulation (CSM). Also assessed were medication adherence, stress-reducing behaviors, and lifestyle behaviors recommended for blood pressure control. Blood pressure was measured at about the time of interviewing. Results indicated that endorsement of a medical belief model of hypertension (i.e., caused and controlled by factors such as diet, age, and weight) was cross-sectionally associated with lower systolic blood pressure, a relationship that was statistically mediated by lifestyle behaviors (e.g., cut down salt, exercise). Endorsement of a stress belief model (i.e., stress is the main factor in hypertension cause and control) was associated with engagement in stress-related behaviors but not with blood pressure. These results further support the utility of the CSM for understanding patients' disease management behaviors.
Asunto(s)
Actitud Frente a la Salud , Negro o Afroamericano/psicología , Hipertensión/prevención & control , Cooperación del Paciente , Negro o Afroamericano/estadística & datos numéricos , Factores de Edad , Antihipertensivos/uso terapéutico , Índice de Masa Corporal , Grupos Control , Femenino , Conductas Relacionadas con la Salud , Conocimientos, Actitudes y Práctica en Salud , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/psicología , Estilo de Vida , Masculino , Persona de Mediana Edad , Modelos Psicológicos , Análisis de Regresión , Factores Sexuales , Factores Socioeconómicos , Estrés Psicológico/prevención & control , Estrés Psicológico/psicologíaRESUMEN
PURPOSE: Patients seeking care for medically unexplained physical symptoms pose a major challenge at primary care sites, and there are very few well-accepted and properly evaluated interventions to manage such patients. METHODS: We tested the effectiveness of a cognitive behavior therapy (CBT)-type intervention delivered in primary care for patients with medically unexplained physical symptoms. Patients were randomly assigned to receive either the intervention plus a consultation letter or usual clinical care plus a consultation letter. Physical and psychiatric symptoms were assessed at baseline, at the end of treatment, and at a 6-month follow-up. All treatments and assessments took place at the same primary care clinic where patients sought care. RESULTS: A significantly greater proportion of patients in the intervention group had physical symptoms rated by clinicians as "very much improved" or "much improved" compared with those in the usual care group (60% vs 25.8%; odds ratio = 4.1; 95% confidence interval, 1.9-8.8; P<.001). The intervention's effect on unexplained physical symptoms was greatest at treatment completion, led to relief of symptoms in more than one-half of the patients, and persisted months after the intervention, although its effectiveness gradually diminished. The intervention also led to significant improvements in patient-reported levels of physical symptoms, patient-rated severity of physical symptoms, and clinician-rated depression, but these effects were no longer noticeable at follow-up. CONCLUSIONS: This time-limited, CBT-type intervention significantly ameliorated unexplained physical complaints of patients seen in primary care and offers an alternative for managing these common and problematic complaints in primary care settings.
Asunto(s)
Instituciones de Atención Ambulatoria , Terapia Cognitivo-Conductual/métodos , Medicina Familiar y Comunitaria/métodos , Atención Primaria de Salud/métodos , Trastornos Somatomorfos/terapia , Centros Médicos Académicos , Adolescente , Adulto , Anciano , Ansiedad/etnología , Ansiedad/terapia , Depresión/etnología , Depresión/terapia , Femenino , Humanos , Entrevista Psicológica , Masculino , Servicios de Salud Mental , Persona de Mediana Edad , New Jersey , Psicoterapia Breve , Derivación y Consulta , Índice de Severidad de la Enfermedad , Trastornos Somatomorfos/etnología , Resultado del Tratamiento , Servicios Urbanos de SaludRESUMEN
BACKGROUND AND PURPOSE: To determine the recognition of sleep disorders in a community-based outpatient health setting following an educational intervention for health care professionals. Previously we have reported very low rates of recognition of sleep disorders in minority and medically indigent populations in a community-based setting. This omission is significant, since there is evidence of an increased number of sleep disorders among minority populations. PATIENTS AND METHODS: In-service training on sleep and sleep disorders was conducted over a 4-year period. Patients screened at the health center with suspected sleep disorders were referred to a hospital-based sleep laboratory. Rates of recognition and referral for sleep-related disorders were compared over the 4-year period using the sleep lab and health center databases and patient chart review at the health center. RESULTS: The intervention program was highly rated and well attended by staff. Rates of referral for sleep testing significantly increased from pre-intervention (0.06%) to the last year post-intervention (0.21%). Overall prevalence rate for sleep diagnoses increased similarly (0.11 vs. 0.26%). CONCLUSIONS: The educational intervention was effective in increasing rates of recognition and diagnosis, although the rate remains low compared to the estimated prevalence of sleep disorders in the general population. Despite broad coverage of sleep disorders during the training program, OSA was the primary diagnosis. Further examination of factors leading to the lack of recognition of other primary sleep disorders needs to be addressed in this patient group.