RESUMEN
BACKGROUND: The potential of primary care practice settings to prevent disease and morbidity through health habit counseling, screening for asymptomatic disease, and immunizations has been incompletely met. This study was designed to test a practice-tailored approach to increasing preventive service delivery with particular emphasis on health habit counseling. DESIGN: Group randomized clinical trial and multimethod process assessment. SETTING/PARTICIPANTS: Seventy-seven community family practices in northeast Ohio. INTERVENTION: After a 1-day practice assessment, a nurse facilitator met with practice clinicians and staff and assisted them with choosing and implementing individualized tools and approaches aimed at increasing preventive service delivery. MAIN OUTCOME MEASURE: Summary scores of the health habit counseling, screening and immunization services recommended by the U.S. Preventive Services Task Force up to date for consecutive patients during randomly selected chart review days. RESULTS: A significant increase (p=0.015) in global preventive service delivery rates at the 1-year follow-up was found in the intervention group (31% to 42%) compared to the control group (35% to 37%). Rates specifically for health habit counseling (p=0.007) and screening services (p=0.048) were increased, but not for immunizations. CONCLUSIONS: An approach to increasing preventive service delivery that is individualized to meet particular practice needs can increase global preventive service delivery rates.
Asunto(s)
Atención a la Salud/organización & administración , Medicina Familiar y Comunitaria/organización & administración , Visita a Consultorio Médico , Pautas de la Práctica en Medicina/estadística & datos numéricos , Servicios Preventivos de Salud/estadística & datos numéricos , Atención Primaria de Salud/organización & administración , Adulto , Consejo/estadística & datos numéricos , Estudios Transversales , Femenino , Investigación sobre Servicios de Salud , Humanos , Inmunización/estadística & datos numéricos , Masculino , Tamizaje Masivo/estadística & datos numéricos , Análisis Multivariante , Ohio , Evaluación de Procesos y Resultados en Atención de Salud/organización & administración , Guías de Práctica Clínica como Asunto , Servicios Preventivos de Salud/provisión & distribución , Evaluación de Programas y Proyectos de SaludRESUMEN
Growing evidence suggests that advance directives (ADs) are often ineffective. Further explanation of how these documents are viewed by the public, the expectations of how decisions about treatment are made, and, in particular, patients' understanding of how ADs are actually used in the clinical setting, are warranted. This article details a descriptive study in which patients were interviewed, during hospital stays, about their beliefs and understanding of advanced directives, as well as the processes used in completing them. The study was undertaken in a community hospital located in a rural area in the Midwest. Findings show that many patients were able to clearly articulate what an AD means in terms of making their choices known. However, misconceptions were found in patients' understanding of ADs and only 46% reported discussing their ADs with a physician. Strategies for effective implementation of education programs related to ADs are detailed here.