Choosing Wisely: AFP Helps Physicians Put Recommendations into Practice

Physicians now have a new tool to help them incorporate nearly 180 recommendations from the Choosing Wisely campaign into their practices. The editors of American Family Physician (AFP) have identified and organized the recommendations that are particularly relevant to primary care clinicians. Users can search those recommendations by keyword, topic area, sponsoring organization, or source on the AFP website (https://www.aafp.org/afp/recommendations/search.htm) and choose which related information to display (topic areas, rationale, sponsoring organizations, and sources). A table of the recommendations is also available as a PDF. The search function and table will be updated as more recommendations are released. In addition, articles in AFP with topics related to Choosing Wisely recommendations will include a table of best practices that highlights the relevant recommendations. For more information, go to https://www.aafp.org/journals/afp/authors/ebm-toolkit/resources/choosing-wisely.html.

Patients Value Communication and Access to Physicians Offered in PCMH Model

New research indicates that patients appreciate the quality of care they receive at health centers invested in the patient-centered medical home (PCMH) model of care. More than 4,500 patients were interviewed between September and December 2009 to determine the relationship between patient perceptions of the PCMH and the quality of care they received in federally supported health centers. Researchers were interested in patients' opinions about access to care, their communication with health care professionals and support staff, self-management support for chronic conditions and behavioral risks, and preventive care. By a large majority, survey participants reported high-quality care in the PCMH and said they were likely to refer others to the health care site. A total of 83.5% reported excellent or very good overall quality of services, 81.3% reported excellent or very good quality of physician advice and treatment, and 84.3% said they were very likely to refer friends and relatives to the health care site. Such high patient ratings are notable given that low-income and uninsured patients generally rate their care much lower. The results were highlighted in the November/December 2013 issue of Annals of Family Medicine. For more information, go to https://www.aafp.org/news-now/practice-professional-issues/20140108ptpcmhstudy.html.

Health Care for Children Varies by Location

The health care children receive varies greatly depending on where they live, according to a recent report from the Dartmouth Atlas Project. The report raises questions about whether some children are missing out on recommended care while others receive unnecessary treatments. The report, which is based on data from all-payer claims databases in northern New England from 2007 to 2010, examined three categories: health care proven to be effective; preference-sensitive care, for which benefits and risks are less clear; and supply-sensitive care, which often is tied to availability of services. Among other findings, the report states that the rate of children who received appropriate testing for pharyngitis ranged from 41% to 92%; the rate of lead screening among children insured by Medicaid varied more than tenfold, from 8% to 86%; and the 30-day follow-up rate for children receiving medication for attention-deficit/hyperactivity disorder varied from 17% to 70%. For more information, go to https://www.aafp.org/news-now/health-of-the-public/20140108dartmouthatlas.html.

Patients with Chronic Diseases Seek Primary Care Physicians Over Subspecialists

Patients seeking care for high-cost chronic conditions, such as asthma and diabetes mellitus, more often turn to primary care physicians rather than subspecialists, according to research from the Robert Graham Center for Policy Studies in Family Medicine and Primary Care. Researchers used data from the 2008 National Ambulatory Medical Care Survey to track outpatient visits for 14 chronic conditions to determine whether patients were seen by a primary care physician or a subspecialist. Out of more than 10 million patient visits for asthma, 85.5% were to a primary care physician. In addition, primary care physicians handled 84.5% of visits for chronic obstructive pulmonary disease; 77.9% of visits for hyperlipidemia; 68.9% of visits for hypertension; 66.8% of visits for osteoporosis; and 63.6% of visits for chronic kidney disease. Of the 14 chronic conditions for which data were reviewed, patients sought subspecialist care for only arthritis, atrial fibrillation, and ischemic heart disease. For more information, go to https://www.aafp.org/news-now/practice-professional-issues/20140115chronic-primcare.html.

—AFP and AAFP NEWS staff