Academic General Practice Research Articles

How to launch a career in academic general practice

Dharani Yerrakalva explains how a special interest in academia can add a new dimension to a GP career

International primary care snapshot: academic primary care in Italy.

Family medicine (also known as general practice or primary health care) has undergone substantial growth accompanied by academic development in Western countries during recent years. In Europe, however, the situation is not uniform: although in Northern European countries family medicine is established in both the national health system (NHS) and the universities, and academic general practice looks promising in post-Communist Eastern European countries, in Southern European counterparts it is still considered a minor medical discipline. Even within Southern Europe the pattern of family medicine is not homogeneous, because several countries such as Croatia, Portugal, and Greece do include some academic curricula in family medicine. Yet this is not the case in Italy, where general practice is completely devoid of any academic features. In fact, Italian universities have no primary care departments at all, and general practice is not even included in the undergraduate curriculum of Italian medical schools. Only private foundations conduct primary care research in Italy. Italian GPs do not have the opportunity to pursue a PhD programme in family medicine, nor …

Status and trends of general otolaryngology in academia.

This article focuses on the hiring trends of academic general otolaryngology practices to clarify the status of academic general otolaryngology in the face of today's changing medical landscape. Cross-sectional study. We conducted a survey to evaluate past, present, and projected hiring issues in academic otolaryngology, specifically related to general otolaryngology. Surveys were sent via e-mail to all academic chairpersons of accredited otolaryngology residency programs in the United States. Data included faculty appointments, work hours, clinical and research roles, academic productivity, patient load, promotions, and criteria for future hires. The response rate was 34.3%. On average, general otolaryngologists (generalists) represented 17% of otolaryngology faculty in academic practices. Whereas most generalists were employed as assistant professors (65%), nearly half of promotions in recent years were given to generalists (49%). Between 2009 and 2014, there was an average of six new hires per academic otolaryngology practice (range: 1-13); of these new hires, 21% were generalists. Chairpersons estimated that in the next 5 years they would hire an average of three new otolaryngologists per practice (range: 0-7), of whom 39% would be generalists. Although 82% of chairpersons reported an increase in subspecialty hires, 94% reported that they would also require the same or increasing numbers of generalists. Despite the increase in subspecialization in academic otolaryngology, the role of general otolaryngologists in academic practices will continue to be important and perhaps will increase. N/A. Laryngoscope, 126:1995-1998, 2016.

Rapid infant weight gain and early childhood obesity in low-income Latinos and non-Latinos.

To examine the growth of infants and toddlers in a population that is both under-represented in the literature and at high risk for childhood obesity. Weight and height measurements were extracted from all visits for a sample of 0-4-year-old, low-income, Latino and non-Latino patients of an urban, academic general paediatric practice. Early growth was characterized as change in weight-for-length Z-score (WLZ) from birth to 3 years. The outcome of interest was BMI Z-score (BMIZ) at age 3 years. Mixed-effects models and multivariate linear regression were used to analyse the association between infant growth and early childhood obesity. Baltimore, MD, USA. Latino (n 210) and non-Latino (n 253) children, born in 2003-2004. An increase in WLZ from birth to 2 years was observed for this cohort as well as a high incidence of overweight and obesity. WLZ at birth and change in WLZ from birth to 2 years were both significantly and positively associated with increases in BMIZ at 3 years of age. The effect of the change in WLZ was twofold higher than the effect of WLZ at birth. An increase in WLZ during the first 2 years of life increased the risk of early childhood obesity. Latino children had a higher incidence of early childhood obesity than non-Latino children in this low-income sample.

Academic general practice: a viewpoint on achievements and challenges.

Service general practice is supported by three academic systems: the Royal College of General Practitioners (RCGP), university general practice, and the GP deaneries. Having been privileged to hold senior posts in all three branches of academic general practice simultaneously, I offer a highly personal, helicopter view of its achievements and challenges and the big questions of our day. #### Service general practice Service general practice has evolved in one lifetime from a singlehanded, untrained service, like my grandfather’s and father’s, working from home, into a vocationally-trained, multidisciplinary service mainly in purpose planned premises, with world-class computing. No British profession has evolved faster while retaining such high patient/client satisfaction. ### RCGP The College turned general practice from a craft into a discipline. RMS McConaghey, a service GP, established the College Journal as the first scientific journal of general practice in 1961,1 before there was a professor of general practice in the world. The College still edits and publishes the British Journal of General Practice . The College Council crossed the boundary into universities, providing the first professor of general practice in the world,2 the first GP professor in Canada, England, Ireland, and the first in a postgraduate university department. It created vocational training, steering it into law. It established the Scientific Foundation Board, a rare GP/primary care-focused research fund. College leadership identified four young GPs, who, 30 years later included the first GP president of the GMC and the first GP Chairman of the Academy of Medical Royal Colleges (AMRC). Is this happening today? The College established the first patient group in any British medical institution. Initially, salaried academic GPs were excluded from the NHS distinction award scheme, through blatant discrimination. GP professors complained bitterly, but were helpless. I solved this problem with the help of the Joint Consultants Committee (JCC) and the AMRC, only …

Endoscopy services and training: a national survey of general surgeons.

Delivering high-quality endoscopy services depends largely on the competence of endoscopists. General surgery residency training in endoscopy and the associated quality of endoscopy services being delivered by general surgeons have been the subject of considerable controversy. In conjunction with the Canadian Association of General Surgeons (CAGS) executive board, we formulated a survey to evaluate the general state of endoscopy practice and training among general surgeons in Canada. The study was designed as a cross-sectional survey. General surgeons who are members of CAGS were selected to participate in the study and were emailed a link to the online questionnaire regarding the importance of endoscopy. They were asked to compare their training to resident training today. Sixty-nine surveys were completed. The majority of general surgeons (95.7%) indicated that endoscopy was an important skill to possess, and more than 85.5% used endoscopy in their own practices. However, nearly half (46.4%) felt that general surgery endoscopy training in Canada is currently inadequate to produce competent endoscopists. The main qualitative themes emerging from the survey were the inadequacy of current postgraduate endoscopy training (37.5%) and the absence of standardization in training (25.0%). Endoscopy is considered integral to academic and community general surgeons' practices; however, the adequacy of training seems to be questioned. Postgraduate training in endoscopy needs to be formalized and standardized, with a greater emphasis placed on teaching endoscopy.

A framework for developing rural academic general practices: a qualitative case study in rural Victoria

There is increasing pressure for Australian rural general practices to engage in educational delivery as a means of addressing workforce issues and accommodating substantial increases in learners. For practices that have now developed a strong focus on education, there is the challenge to complement this by engaging in research activity. This study develops a rural academic general practice framework to assist rural practices in developing both comprehensive educational activity and a strong research focus thus moving towards functioning as mature academic units. A case study research design was used with the unit of analysis at the level of the rural general practice. Purposively sampled practices were recruited and individual interviews conducted with staff (supervisors, practice managers, nurses), learners (medical students, interns and registrars) and patients. Three practices hosted 'multi-level learners', two practices hosted one learner group and one had no learners. Forty-four individual interviews were conducted with staff, learners and patients. Audio recordings were transcribed for thematic analysis. After initial inductive coding, deductive analysis was undertaken with reference to recent literature and the expertise of the research team resulting in the rural academic general practice framework. Three key themes emerged with embedded subthemes. For the first theme, organisational considerations, subthemes were values/vision/culture, patient population and clinical services, staffing, physical infrastructure/equipment, funding streams and governance. For the second theme, educational considerations, subthemes were processes, clinical supervision, educational networks and learner presence. Third, for research considerations, there were the subthemes of attitude to research and research activity. The framework maps the development of a rural academic practice across these themes in four progressive stages: beginning, emerging, consolidating and established. The data enabled a framework to be constructed to map rural general practice activity with respect to activity characteristic of an academic general practice. The framework offers guidance to practices seeking to transition towards becoming a mature academic practice. The framework also offers guidance to educational institutions and funding bodies to support the development of academic activity in rural general practices. The strengths and limitations of the study design are outlined.

Book Review

Depending on the reader's perspective, this treasury of a book is aimed at multiple audiences or is intended as the type of reference that can be taken off the shelf and consulted at many points in an individual general practitioner's (GP's) career. Advice on what kinds of intercalated BSc medical students might consider is followed by consideration of different paths within the speciality, whether based on the type of employment (partner versus salaried versus locum) or the content of the job (e.g. what does being a GP with specialist interest involve?). In the chapter on international primary care, Pettigrew and Heath even offer international work as option for partnership sabbaticals and retirement projects. Hutt and Park have assembled a knowledgeable ‘Who's who’ of authors (including two RCGP presidents) to cover key elements of a developing general practice career, including chapters on academia, teaching and international primary care. In the foreword, Roger Neighbour claims that the book will help new doctors and students decide whether general practice is the right career and that it will provide those with teaching and mentoring roles ‘with a persuasive ally.’ Does the book deliver, and is there balance between the wisdom of the GP glitterati and street cred? Does this book capture enough of the essence of a career in general practice? Arguably, it does – and in a way that does not waste too many words! Roger Neighbour's forward begins an implicit thread that runs through this book, namely that of professional identity. He describes the controversial 1958 statement of Lord Moran, President of the Royal College of Physicians, who suggested that GPs should not be paid the same as hospital doctors because they had fallen off ‘the ladder’ of a hospital career. Neighbour goes to describe the subsequent movement by GPs: to prove that clinical generalism and clinical competence were not mutually exclusive, to clarify the defining characteristics of good general practice and to pioneer the UK's system of GP vocational training. Neighbour defines general practice as the open-ended and unconditional medical care of the uniquely individual patient and in the chapter on professional development Dicker echoes Neighbour's definition of good practice when he describes how GP trainees have to unlearn hospital-based history taking habits in favour of an ‘ethical conversation’. He defines this as what happens in a meeting between patient and doctor. It is devoid of judgementalism and attempts to place the patient's problem in the wider context of their life, using a systematic approach, and sharing an understanding of both the patient's and the doctor's perspective. Neighbour generously concedes, ‘… many good specialists try to remember that the patient is a complex and multidimensional individual. It's just that a true generalist can never forget it and wouldn't want to.’ Does this mean that GPs who concentrate on the biomedical aspects of practice are not ‘true’ generalists? The triumphalism of good general practice is sometimes challenged in the book by personal reflections on practice. Steve Iliffe, for example, states, ‘The claim by general practice to be biopsychosocial medicine is exaggerated. Most GPs know little about either the “psycho-” or the “socio-” parts of the job as this is squeezed out of the curriculum …’ and describes his own academic career as ‘… a belated attempt to catch up’. The manner in which such reflections can illustrate situations that are not ideal serves as a reality check for aspiring GPs – and just because senior colleagues might not value or be aware of ethical conversations and psychosocial aspects of practice does not mean that these aspects are not important or should be abandoned. In the chapter on academic general practice, Raymond argues that qualitative research can lead to a better understanding of health beliefs that affect patient health outcomes in diseases such as diabetes (a point of note even for the cynical among us). Raymond also rightly asserts, however, that primary care academia has more recently evolved to meet demands of chronic disease and acute disease management, which have moved from the hospital into community settings. Accordingly, there is major emphasis on quantitative approaches to research which can incorporate pharmaceutical research as well as public health, clinical trials and bio-bank research. This book is for aspiring GPs and for anyone who would like to attempt to understand what current practice involves for GPs. Foundation-year doctors, GP trainees and qualified GPs may find the constant references to opportunities for medical students annoying at times, unless they are one of those precocious medical students who refer back to their old well-thumbed copy in years to come!

Measurement of ECG abnormalities and cardiovascular risk classification: a cohort study of primary care patients in the Netherlands.

GPs need accurate tools for cardiovascular (CV) risk assessment. Abnormalities in resting electrocardiograms (ECGs) relate to increased CV risk. To determine whether measurement of ECG abnormalities on top of established risk estimation (SCORE) improves CV risk classification in a primary care population. A cohort study of patients enlisted with academic general practices in the Netherlands (the Utrecht Health Project [UHP]). Incident CV events were extracted from the GP records. MEANS algorithm was used to assess ECG abnormalities. Cox proportional hazards modelling was applied to relate ECG abnormalities to CV events. For a prediction model only with SCORE variables, and a model with SCORE+ECG abnormalities, the discriminative value (area under the receiver operator curve [AUC]) and the net reclassification improvement (NRI) were estimated. A total of 2370 participants aged 38-74 years were included, all eligible for CV risk assessment. During a mean follow-up of 7.8 years, 172 CV events occurred. In 19% of the participants at least one ECG abnormality was found (Lausanne criteria). Presence of atrial fibrillation/flutter (AF) and myocardial infarction (MI) were significantly related to CV events. The AUC of the SCORE risk factors was 0.75 (95% CI = 0.71 to 0.79). Addition of MI or AF resulted in an AUC of 0.76 (95% CI = 0.72 to 0.79) and 0.75 (95% CI = 0.72 to 0.79), respectively. The NRI with the addition of ECG abnormalities was small (MI 1.0%; 95% CI = -3.2% to 6.9%; AF 0.5%; 95% CI = -3.5% to 3.3%). Performing a resting ECG in a primary care population does not seem to improve risk classification when SCORE information - age, sex, smoking, systolic blood pressure, and total cholesterol/HDL ratio - is already available.

Development and Validation of the Comprehensive Health Activities Scale: A New Approach to Health Literacy Measurement

Current health literacy measures have been criticized for solely measuring reading and numeracy skills when a broader set of skills is necessary for making informed health decisions, especially when information is often conveyed verbally and through multimedia video. The authors devised 9 health tasks and a corresponding 190-item assessment to more comprehensively measure health literacy skills. A sample of 826 participants between the ages of 55 and 74 years who were recruited from an academic general internal medicine practice and three federally qualified health centers in Chicago, Illinois, completed the assessment. Items were reduced using hierarchical factor analysis and item response theory resulting in the 45-item Comprehensive Health Activities Scale. All 45 items loaded on 1 general latent trait, and the resulting scale demonstrated high reliability and strong construct validity using measures of health literacy and global cognitive functioning. The predictive validity of the Comprehensive Health Activities Scale using self-reported general, physical, and mental health status was comparable to or better than widely used measures of health literacy, depending on the outcome. Despite comprehensively measuring health literacy skills, items in the Comprehensive Health Activities Scale supported 1 primary construct. With similar psychometric properties, current measures may be adequate, depending on the purpose of the assessment.

Integrated disease management programs in the academic general practice; the role of ict

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 2.913 (2021 JCR, received in June 2022)The IJIC 20th Anniversary Issue was published in 2021.

Clinical drug trials in general practice: a 10-year overview of protocols

BackgroundDrugs predominantly prescribed in general practice should ideally be tested in that setting; however, little is known about drug trials in general practice. Our aim was to describe drug trials in Norwegian general practice over the period of a decade.MethodsThe present work concerns a 10-year retrospective study of protocols submitted to the Norwegian national medicines agency (1998 to 2007) identifying all studies involving general practitioners (GPs) as clinical investigator(s). We analyzed the number of trials, drug company involvement, patients, participating doctors, payment, medications tested and main diagnostic criteria for inclusion. We also analyzed one trial in greater detail.ResultsOut of 2,054 clinical drug trials, 196 (9.5%) were undertaken in general practice; 93% were multinational, 96% were industry funded and 77% included patients both from general practice and specialist care. The trials were planned to be completed in the period 1998 to 2012. A total of 23,000 patients in Norway and 340,000 patients internationally were planned to be included in the 196 trials. A median of 5 GPs participated in each trial (range 1 to 402). Only 0.7% of 831 GP investigators had general practice university affiliations. Median payment for participating investigators was €1,900 (range €0 to 13,500) per patient completing the trial. A total of 30 pharmaceutical companies were involved. The drugs most commonly studied were antidiabetics (21%), obstructive airway disease medications (12%), agents acting on the renin-angiotensin system (10%), and lipid modifying agents (10%). One trial, presented in more detail, had several characteristics of a seeding or marketing trial.ConclusionsOnly one in four drug trials involving general practice were solely general practice trials and almost all were industry initiated without input from academic general practice. There was a large variation in the number of patients, participating doctors, and economic compensation for trial investigators, with some investigators receiving substantial payments.

Overuse and underuse of calcium and vitamin D in women with osteoporosis: A survey in a primary care setting

Introduction: Optimal calcium and vitamin D intake is important components of the treatment of osteoporosis. The national average calcium and vitamin D intake for women over age 50 is below the recommended levels for optimal bone health. The aim of this study was to assess whether deficiencies in calcium and vitamin D intake exist in women with osteoporosis in a general medicine practice, as well as evaluate whether physicians accurately document calcium and vitamin D supplementation in the health record. Methods: Using the Electronic Health Record (EHR), we identified all female patients age 50 and older with the diagnosis of osteoporosis who were seen at the study site clinic, an urban academic general medicine practice, between January 1st, 2010 and December 1st, 2010. Women were randomly selected to receive an invitation to participate in a telephone survey on osteoporosis treatment. Results: One hundred and sixteen women completed the telephone survey. The mean calcium intake was 1524 mg per day. Forty-nine percent of women surveyed reported taking less than 1200 mg/day of supplemental calcium. When considering reported calcium intake from diet, 33% percent consumed less than 1200 mg/day and 52% percent consumed more than 1500 mg/day. Twenty eight percent of patients were taking less than 800 IU/day of vitamin D; only four percent were taking more than 4000 IU/day. Agreement between patients’ self-reported intake of calcium, vitamin D and multivitamin supplements and physicians’ documentation of these supplements was 52% for calcium, 53% for vitamin D and 61% for multivitamin. Conclusion: Among women with osteoporosis getting regular care in a general medicine practice, approximately a third are getting less than the recommended daily amount of calcium and a quarter less than the recommended amount of vitamin D. In addition, a significant proportion of women are getting excessive daily amounts of calcium, which may also be a quality concern. Rates of agreement between self-reported calcium and vitamin D supplements and chart documentation of these supplements were low.

Academic General Practice Training: A Trainee's Perspective

Academic General Practice Training: A Trainee's Perspective

General practice-based clinical trials in Germany - a problem analysis.

BackgroundIn Germany, clinical trials and comparative effectiveness studies in primary care are still very rare, while their usefulness has been recognised in many other countries. A network of researchers from German academic general practice has explored the reasons for this discrepancy.MethodsBased on a comprehensive literature review and expert group discussions, problem analyses as well as structural and procedural prerequisites for a better implementation of clinical trials in German primary care are presented.ResultsIn Germany, basic biomedical science and technology is more reputed than clinical or health services research. Clinical trials are funded by industry or a single national programme, which is highly competitive, specialist-dominated, exclusive of pilot studies, and usually favours innovation rather than comparative effectiveness studies. Academic general practice is still not fully implemented, and existing departments are small. Most general practitioners (GPs) work in a market-based, competitive setting of small private practices, with a high case load. They have no protected time or funding for research, and mostly no research training or experience. Good Clinical Practice (GCP) training is compulsory for participation in clinical trials. The group defined three work packages to be addressed regarding clinical trials in German general practice: (1) problem analysis, and definition of (2) structural prerequisites and (3) procedural prerequisites. Structural prerequisites comprise specific support facilities for general practice-based research networks that could provide practices with a point of contact. Procedural prerequisites consist, for example, of a summary of specific relevant key measures, for example on a web platform. The platform should contain standard operating procedures (SOPs), templates, checklists and other supporting materials for researchers.ConclusionAll in all, our problem analyses revealed that a substantial number of barriers contribute to the low implementation of clinical research in German general practice. Some issues are deeply rooted in Germany’s market-based healthcare and academic systems and traditions. However, new developments may facilitate change: recent developments in the German research landscape are encouraging.

Comparative effects of non-steroidal anti-inflammatory drugs (NSAIDs) on blood pressure in patients with hypertension

BackgroundNonsteroidal anti-inflammatory drugs (NSAIDs) may disrupt control of blood pressure in hypertensive patients and increase their risk of morbidity, mortality, and the costs of care. The objective of this study was to examine the association between incident use of NSAIDs and blood pressure in patients with hypertension.MethodsWe conducted a retrospective cohort study of adult hypertensive patients to determine the effects of their first prescription for NSAID on systolic blood pressure and antihypertensive drug intensification. Data were collected from an electronic medical record serving an academic general medicine practice in Indianapolis, Indiana, USA. Using propensity scores to minimize bias, we matched a cohort of 1,340 users of NSAIDs with 1,340 users of acetaminophen. Propensity score models included covariates likely to affect blood pressure or the use of NSAIDs. The study outcomes were the mean systolic blood pressure measurement after starting NSAIDs and changes in antihypertensive therapy.ResultsCompared to patients using acetaminophen, NSAID users had a 2 mmHg increase in systolic blood pressure (95% CI, 0.7 to 3.3). Ibuprofen was associated with a 3 mmHg increase in systolic blood pressure compared to naproxen (95% CI, 0.5 to 4.6), and a 5 mmHg increase compared to celecoxib (95% CI, 0.4 to 10). The systolic blood pressure increase was 3 mmHg in a subgroup of patients concomitantly prescribed angiotensin converting enzyme inhibitors or calcium channel blockers and 6 mmHg among those prescribed a beta-adrenergic blocker. Blood pressure changes in patients prescribed diuretics or multiple antihypertensives were not statistically significant.ConclusionCompared to acetaminophen, incident use of NSAIDs, particularly ibuprofen, is associated with a small increase in systolic blood pressure in hypertensive patients. Effects in patients prescribed diuretics or multiple antihypertensives are negligible.

Current Indications and Outcomes of the Adult Tonsillectomy

Objective: While there have been numerous studies on tonsillectomies for the pediatric population, there are few studies focused on tonsillectomies performed on adult patients. We sought to determine the current indications for adult tonsillectomy and to examine factors associated with postoperative complications. Method: Medical records of 184 patients aged >18 years who underwent tonsillectomy in an academic general otolaryngology practice from 2006 to 2011 were retrospectively reviewed. There were 185 tonsillectomies performed (149 total tonsillectomies [TT] and 36 partial intracapsular tonsillectomies [PIT]); 1 patient underwent primary and revision tonsillectomy. Results: Indications for TT were 58.4% infection (71.3% recurrent, 9.2% tonsilliths/halitosis, and 19.5% recurrent and tonsilliths/halitosis), 34.2% upper airway obstruction, 3.4% obstruction/infection, and 4.0% other medical. Indications for PIT were 77.8% infection (28.6% recurrent, 50.0% tonsilliths/halitosis, and 21.4% recurrent and tonsilliths/halitosis), 19.4% upper airway obstruction, and 2.8% obstruction/infection. Complication rates were 16.5% for infection, 6.9% for upper airway obstruction, 16.7% for obstruction and infection, and 0% for other medical reasons. Complications occurred in 14.8% of TT (72.7% hemorrhage, 27.3% dehydration) and in 5.6% PIT (hemorrhage). No significant difference in complication rate was noted for technique ( P = .17) or indication ( P = .21). Conclusion: While recurrent infection remains the most common indication for adult tonsillectomy, there is a growing rate of tonsillectomies performed for upper airway obstruction. Complication rates varied according to indication for surgery and surgical technique (total versus partial intracapsular); however, neither was found to significantly increase risk of postoperative complications.

Why should you care about academic general practice?

Faraz Mughal explains the importance of academic general practice for the ongoing improvement of primary care

Risk of Unintentional Overdose with Non-Prescription Acetaminophen Products

There is increasing concern over the risk of consumer unintentional misuse of non-prescription (a.k.a. 'over-the-counter') medications containing acetaminophen, which could lead to acute liver failure. To determine the prevalence of potential misuse and overdose of over-the-counter medications containing acetaminophen, either alone or in combination. Cross-sectional, structured interviews with literacy assessment. One academic and one community-based general internal medicine practice in Chicago, IL, and one academic general internal medicine practice and a public hospital clinic in Atlanta, GA. Five hundred adults seeking primary care, ages 18-80. Demonstration of how and when patients would take over-the-counter medications containing acetaminophen, alone or in combination with one another, over a 24-hour period. Overall, 23.8 % of participants demonstrated they would overdose on a single over-the-counter acetaminophen product by exceeding a dose of four grams in a 24-hour period; 5.2 % made serious errors by dosing out more than six grams. In addition, 45.6 % of adults demonstrated they would overdose by 'double-dipping' with two acetaminophen-containing products. In multivariable analyses, limited literacy (Relative Risk Ratio (RR) 1.65, 95 % Confidence Interval (CI) 1.03-2.66) and heavy acetaminophen use in the past six months (RR 1.70, 95 % CI 1.10-2.64) were independently associated with overdosing over-the-counter products. Misunderstanding of the active ingredient and proper instructions for over-the-counter medications containing acetaminophen is common. The potential for errors and adverse events associated with unintentional misuse of these products is substantial, particularly among heavy users of acetaminophen and those with limited literacy.

Literacy, Cognitive Function, and Health: Results of the LitCog Study

Emerging evidence suggests the relationship between health literacy and health outcomes could be explained by cognitive abilities. To investigate to what degree cognitive skills explain associations between health literacy, performance on common health tasks, and functional health status. Two face-to-face, structured interviews spaced a week apart with three health literacy assessments and a comprehensive cognitive battery measuring 'fluid' abilities necessary to learn and apply new information, and 'crystallized' abilities such as background knowledge. An academic general internal medicine practice and three federally qualified health centers in Chicago, Illinois. Eight hundred and eighty-two English-speaking adults ages 55 to 74. Health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM), Test of Functional Health Literacy in Adults (TOFHLA), and Newest Vital Sign (NVS). Performance on common health tasks were globally assessed and categorized as 1) comprehending print information, 2) recalling spoken information, 3) recalling multimedia information, 4) dosing and organizing medication, and 5) healthcare problem-solving. Health literacy measures were strongly correlated with fluid and crystallized cognitive abilities (range: r=0.57 to 0.77, all p<0.001). Lower health literacy and weaker fluid and crystallized abilities were associated with poorer performance on healthcare tasks. In multivariable analyses, the association between health literacy and task performance was substantially reduced once fluid and crystallized cognitive abilities were entered into models (without cognitive abilities: β= -28.9, 95 % Confidence Interval (CI) -31.4 to -26.4, p; with cognitive abilities: β= -8.5, 95 % CI -10.9 to -6.0). Cross-sectional analyses, English-speaking, older adults only. The most common measures used in health literacy studies are detecting individual differences in cognitive abilities, which may predict one's capacity to engage in self-care and achieve desirable health outcomes. Future interventions should respond to all of the cognitive demands patients face in managing health, beyond reading and numeracy.