Study Examines Delivery of Reproductive Health Services to Adolescents

(52nd Annual Scientific Assembly of the American Academy of Family Physicians) Family physicians are more likely to provide reproductive preventive health services and counseling to their adolescent patients if they also regularly discuss confidentiality with those patients, are female, have more positive attitudes toward the recommendations of the American Academy of Family Physicians, have read preventive care guidelines and have recently graduated from medical school. This is according to results of a survey of a stratified random sample of 354 family practice physicians in three northwestern New York metropolitan areas. On average, family physicians reported asking 79 percent of their adolescent patients (ages 15 to 18) about contraceptive use, 73 percent about condom use, 72 percent about their sexual relationships and 61 percent about sexual behaviors. Only 36 percent of physicians asked their adolescent patients about their attitudes of when sexual activity is appropriate and only 30 percent asked them about sexual orientation. Physicians discussed the risk of human immunodeficiency virus (HIV) infection with 76 percent of adolescent patients, advised 78 percent to use condoms, gave handouts about HIV to 21 percent, and gave condoms to 9 percent of adolescent patients. Overall, physicians reported providing 5.5 of eight recommended reproductive health screening interventions to their adolescent patients during their most recent preventive visits.—elizabeth a. kelts, m.d., University of Rochester/Highland Hospital Family Practice Residency Program, Rochester, New York.

Some Physicians May Need Education to Manage Alzheimer's Disease

(American Academy of Family Physicians) Primary care physicians do not routinely conduct mental health status examinations, make referrals to community services, or address caregiver stress in their evaluation and management of patients with Alzheimer's disease. This is according to results from a survey of 50 persons who are caregivers to patients with Alzheimer's disease. Caregivers were 28 to 79 years of age, with the majority being children (48 percent) or spouses (42 percent) of the patient. Also, 82 percent of the caregivers had at least some college education, 36 percent were professionals and 74 percent of the caregivers were female. According to the care-givers, 58 percent of primary care physicians performed a medical work-up for the symptoms of dementia, 26 percent conducted mental status examinations and less than one half referred the patient for additional evaluation. Fewer than 25 percent of caregivers were informed by the physician about the availability of community services or respite care, and only 46 percent were asked if they had caregiver-related stress. Among the caregivers with whom the physician discussed caregiver stress, 91.3 percent were female. The authors recommend further studies to determine if primary care physicians are not conducting mental status examinations, making referrals to community services or addressing caregiver stress because of a lack of time or a lack of education of the physicians.—gerald d. karetnick, Berlin, New Jersey.

Multidisciplinary Education Is Helpful for Medical Students

(American Academy of Family Physicians) An experimental, four-week clerkship, titled Surgical Oncology for the Generalized Physician, for 24 fourth-year medical students entering family practice or general internal medicine was found to increase the oncology knowledge and retention levels of these students compared with peers who were not enrolled in the clerkship. The students who participated in the clerkship at a regional cancer center were given a pretest, posttest and a six-month follow-up examination. The students' knowledge rose significantly from pretest to posttest with an improvement of 40 percent compared with only a 10 percent increase of knowledge among peers. Evaluation at six months showed a 90 percent retention rate among the clerkship students and a return to a pretest level of knowledge among the peer group. The four components of the clerkship were: ambulatory multidisciplinary experiences in breast, dermatology, gastrointestinal, thoracic, endoscopy, and soft tissue and melanoma with multidisciplinary conferences; practical skill stations on breast, testicular, skin and prostate examination; supervised objective structured clinical education sessions with physician audit and immediate feedback; and problem-based learning sessions in small group setting. The researchers contend that multidisciplinary education, crossing the traditional barriers of medicine, surgery, pathology, radiology and others, is feasible and effective in student education.—judy lynn smith, m.d., Roswell Park Cancer Institute, Buffalo, New York.

Physician Compliance with Asthma Guidelines Is Less Than Optimal

(American Academy of Family Physicians) According to results of a retrospective chart review, compliance with the asthma guidelines from the 1997 National Institute of Health's Expert Panel Report 2 by family practice residents and faculty in an urban university family practice residency program was less than optimal. Researchers reviewed charts from 119 patients with 334 clinic visits for asthma (diagnosed by the ICD-9 code) over a one-year period. Classification of asthma severity according to the 1997 revised clinical guidelines was done in 17 percent of patients at some point during the year. Frequency of beta-agonist use per day or week, one of the clinical features used to determine asthma severity classification, was mentioned in 29 percent of clinic visits, and documentation of use of a home peak flow meter occurred in 32 percent of patients. Action plans were documented in 2 percent of patient charts. Mention of inhaled corticosteroids in the medication list or as prescribed for intended future use occurred in 68 percent of patient charts, and use of meter dose inhaled spacer was mentioned in 21 percent of patient charts. Faculty members were significantly less likely than residents to document use of the amount of beta agonists (28 versus 42 percent) and to use the asthma severity classification system (4 versus 16 percent of visits). The investigators believe that formal education of the guidelines as well as a systematic implementation of those guidelines is needed.—jeffrey p. alpert, m.d., Overland Park, Kansas.

Study Elucidates Health Care Concerns of Low-Income Persons

(American Academy of Family Physicians) Results of a sample of low-income residents in Minnesota showed that the percentage of residents who were uninsured for part or all of the year was five times the 7 percent reported by the state of Minnesota. A total of 727 low-income persons who lived at 200 percent or less of federal poverty guidelines (FPG) were recruited through agencies that serve low-income and homeless people, neighborhood businesses, churches, and subsidized housing units, and were interviewed. The sample group ranged in age from 18 to older than 80 years; 62 percent were white, 71 percent were female, and 54 and 30 percent of the females and males, respectively, had children living with them. Thirty-seven percent of respondents reported being without insurance for at least part of the previous year. The primary concerns were access to care (21 percent), costs of care (13 percent) and costs of medications (15 percent). These concerns differed depending on their amount of health coverage, age, health care needs and whether they were at 100 percent or less of FPG. Low-income elderly people with Medicare were choosing between paying for their medication or buying food. The main concern for people with mental health issues was finding a health care provider who would care for them.—barbara a. elliott, ph.d., University of Minnesota, Duluth, Minnesota