Urban Family Practice Research Articles

Increasing Medicare Annual Wellness Visit Utilization: An RN-Led Model of Care Pilot.

Annual wellness visits (AWVs) are an important component of primary care as they provide preventive services and an opportunity to identify safety and health risk factors for Medicare beneficiaries. However, primary care practices are facing unprecedented demands with high patient volumes, multimorbidity, a rapidly growing aging population, and primary care provider (PCP) shortages. RN-led models of care are increasingly recognized as a major key to providing quality care while relieving PCP demands. This article describes the implementation of an RN-led model of care pilot in an urban family practice to increase Medicare AWV completion and alleviate PCP burden.

Assessment of the Status of Urban Family Practice Program in Iran from the Perspective of Experts: A Qualitative Study

Assessment of the Status of Urban Family Practice Program in Iran from the Perspective of Experts: A Qualitative Study

Clinician Decisions After Notification of Elevated Blood Pressure Measurements From Patients in a Remote Monitoring Program

Guidelines recommend using telehealth for hypertension management, but insufficient evidence is available to guide strategies for incorporating telehealth data into clinical practice. To describe how primary care teams responded to elevated remote blood pressure (BP) alerts in the electronic health record (EHR) in a randomized clinical trial of BP telemonitoring conducted in routine practice settings. This retrospective cohort study reviewed EHR documentation from May 8, 2018, to August 9, 2019, in a single urban academic family practice site. Primary care teams comprising 28 attending physicians and nurse practitioners, residents, and nurses cared for 162 patients in a text-based clinical trial of remote BP monitoring remote BP monitoring. Data were analyzed from October 21, 2019, to April 30, 2021. Clinicians received a direct message in their EHR inbox when patients submitted at least 3 elevated BP readings. Categories and frequencies of clinician action, created via review of EHR-documented clinician responses to EHR alerts by 2 physicians. Patients in this study (n = 162) were predominantly female (111 [68.5%]) and Black or African American (146 [90.1%]), whereas attending physicians (n = 21) were predominantly female (13 [61.9%]) and non-Hispanic White (19 [90.5%]) with a mean (SD) age of 51.6 (11.1) years. Five hundred fifty-two alerts fell into 12 categories of clinical actions. Clinicians acted on 343 alerts (62.1%). Common remote activities were to reconcile medications and assess adherence (120 of 552 alerts [21.7%]) and verify BP measurement technique (65 of 552 alerts [11.8%]). Clinicians also commonly requested appointments (120 of 552 alerts [21.7%]) and/or saw the patient in a subsequent office visit (114 of 552 alerts [20.7%]). Ninety-six alerts (17.4%) resulted in medication changes; half of these changes were remote (48 of 96 [50.0%]), and the other half were visit-based. For 209 of 552 alerts (37.9%), no changes were made to the care plan, typically without documenting clinical rationale (196 of 209 instances [93.8%]). Exploratory EHR review was used to infer potential clinical rationale for 106 (54.1%) of such cases, but there was insufficient information for the remaining 90 (45.9%). These findings suggest that EHR alerts for elevated BP during remote monitoring were effective in prompting a mix of remote and office-based management. It was also common for the plan of care to remain unchanged, possibly suggesting need for more refined alerts and improved clinician support.

Legal needs of patients attending an urban family practice in Hamilton, Ontario, Canada: an observational study of a legal health clinic

BackgroundIndividuals living in poverty often visit their primary care physician for health problems resulting from unmet legal needs. Providing legal services for those in need may therefore improve health outcomes. Poverty is a social determinant of health. Impoverished areas tend to have poor health outcomes, with higher rates of mental illness, chronic disease, and comorbidity. This study reports on a medical-legal collaboration delivered in a healthcare setting between health professionals and lawyers as a novel way to approach the inaccessibility of legal services for those in need.MethodsIn this observational study, patients aged 18 or older were either approached or referred to complete a screening tool to identify areas of concern. Patients deemed to have a legal problem were offered an appointment at the Legal Health Clinic, where lawyers provided legal advice, referrals, and services for patients of the physicians. Fisher’s exact test was used to compare populations. Binary logistic regression was used to determine the factors predicting booking an appointment with the clinic.ResultsEighty-four percent (n = 648) of the 770 patients screened had unmet legal needs and could benefit from the intervention, with an average of 3.44 (SD = 3.42) legal needs per patient screened. Patients with legal needs had significantly higher odds of attending the Legal Health Clinic if they were an ethnicity that was not white (OR = 2.48; 95% CI 1.14–5.39), did not have Canadian citizenship (OR = 4.40; 95% CI 1.48–13.07), had housing insecurity (OR = 3.33; 95% CI 1.53–7.24), and had difficulty performing their usual activities (OR = 2.83; 95% CI 1.08–7.43). As a result of the clinic consultations, 58.0% (n = 40) were referred to either Legal Aid Ontario or Hamilton Community Legal Clinic, 21.74% (n = 15) were referred to a private lawyer; one case was taken on by the clinic lawyer.ConclusionThe Legal Health Clinic was found to fulfill unmet legal needs which were abundant in this urban family practice. This has important implications for the future health of patients and clinical practice. Utilizing a Legal Health Clinic could translate into improved health outcomes for patients by helping overcome barriers in accessing legal services and addressing social causes of adverse health outcomes.

Exploring the experiences of people in Ontario, Canada who have trouble affording medicines: a qualitative concept mapping study

ObjectivesThe experiences of people who report cost-related medicine non-adherence are not well documented. We aimed to present experiences relating to accessing medicines reported by the participants in a randomised controlled...

Examining patterns in medication documentation of trade and generic names in an academic family practice training centre

BackgroundStudies in the United States have shown that physicians commonly use brand names when documenting medications in an outpatient setting. However, the prevalence of prescribing and documenting brand name medication has not been assessed in a clinical teaching environment. The purpose of this study was to describe the use of generic versus brand names for a select number of pharmaceutical products in clinical documentation in a large, urban academic family practice centre.MethodsA retrospective chart review of the electronic medical records of the St. Michael’s Hospital Academic Family Health Team (SMHAFHT). Data for twenty commonly prescribed medications were collected from the Cumulative Patient Profile as of August 1, 2014. Each medication name was classified as generic or trade. Associations between documentation patterns and physician characteristics were assessed.ResultsAmong 9763 patients prescribed any of the twenty medications of interest, 45% of patient charts contained trade nomenclature exclusively. 32% of charts contained only generic nomenclature, and 23% contained a mix of generic and trade nomenclature. There was large variation in use of generic nomenclature amongst physicians, ranging from 19% to 93%.ConclusionsTrade names in clinical documentation, which likely reflect prescribing habits, continue to be used abundantly in the academic setting. This may become part of the informal curriculum, potentially facilitating undue bias in trainees. Further study is needed to determine characteristics which influence use of generic or trade nomenclature and the impact of this trend on trainees’ clinical knowledge and decision-making.

Characteristics, types and causes of chest pain in an urban family practice secondary care center in South India

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA G.S. Y, Honest P, Subramanian A, et al. Characteristics, types and causes of chest pain in an urban family practice secondary care center in South India. Family Medicine & Primary Care Review. 2017;19(4):377-381. doi:10.5114/fmpcr.2017.70810. APA G.S., Y., Honest, P., Subramanian, A., Abraham, R., Velaga, S., & Pricilla, R. et al. (2017). Characteristics, types and causes of chest pain in an urban family practice secondary care center in South India. Family Medicine & Primary Care Review, 19(4), 377-381. https://doi.org/10.5114/fmpcr.2017.70810 Chicago G.S., Yeshvanth Kumar, Prince Christopher Rajkumar Honest, Apoorva Subramanian, Ranjit Abraham, Saran Teja Velaga, Ruby Angeline Pricilla, and Kirubah Vasandhi David et al. 2017. "Characteristics, types and causes of chest pain in an urban family practice secondary care center in South India". Family Medicine & Primary Care Review 19 (4): 377-381. doi:10.5114/fmpcr.2017.70810. Harvard G.S., Y., Honest, P., Subramanian, A., Abraham, R., Velaga, S., Pricilla, R., David, K., and Abraham, S. (2017). Characteristics, types and causes of chest pain in an urban family practice secondary care center in South India. Family Medicine & Primary Care Review, 19(4), pp.377-381. https://doi.org/10.5114/fmpcr.2017.70810 MLA G.S., Yeshvanth Kumar et al. "Characteristics, types and causes of chest pain in an urban family practice secondary care center in South India." Family Medicine & Primary Care Review, vol. 19, no. 4, 2017, pp. 377-381. doi:10.5114/fmpcr.2017.70810. Vancouver G.S. Y, Honest P, Subramanian A, Abraham R, Velaga S, Pricilla R et al. Characteristics, types and causes of chest pain in an urban family practice secondary care center in South India. Family Medicine & Primary Care Review. 2017;19(4):377-381. doi:10.5114/fmpcr.2017.70810.

Development and evaluation of a customizable electron-ic medical record for clinical outcomes research and patient engagement

Background: Electronic Medical Records (EMRs) provide a database to support clinical information needs. However, it is often difficult to access EMR-generated data to answer specific clinical-based questions. Furthermore, EMR is not designed to complete the circle of care by interacting and communicating directly with patients. The problem is even greater in rural practices, with limited resources, and with providers inexperienced in research, who are doing well to meet the daily requirements of keeping their practice doors open.Objective: Design and evaluate a customizable EMR-Reporting Tool (EMR-RT) that can be used as an adjunct to an existing EMR or as a sole-standing EMR-RT for clinical outcome's research and patient engagement.Methods: Two rural and two urban family practice clinics participated in the design and beta testing of a customizable EMR-RT for clinical effectiveness research and for patient engagement. The EMR-RT was implemented in each clinic for a 6-month clinical trial.Results: The EMR-RT used in each clinic was simplistic enough that community health workers could handle patient data entry, data management, and data extraction independently. Each clinic could incorporate clinic-specific measurement variables into the EMR-RT database with minimal effort. Changes to the EMR-RT database capabilities could be performed off-site through the Internet.Conclusions: A customizable EMR-RT was successfully designed and implemented in two rural and two urban family practice clinics. The EMR-RT was robust enough to congregate clinical research data, but flexible enough and simplistic enough that workers who were previously untrained in EMR use could quickly utilize the system.

Cancer Screening Among Patients Who Self-Identify as Muslim: Combining Self-Reported Data with Medical Records in a Family Practice Setting.

Cancer screening is a core component of family medicine but screening inequalities are well documented in Canada for foreign-born persons. Although people of Muslim faith and culture are the fastest growing immigrant population in Canada, there is little information in the literature about their cancer screening practices. Determining screening gaps could inform practice-based quality improvement initiatives. We conducted a retrospective chart review combining patient-level medical record data with self-reported religious affiliation to examine the relationship between religion and cancer screening in a large multi-site urban family practice. Religious affiliation was classified as Muslim, other affiliation, or atheist/no religious affiliation. 5311 patients were included in the study sample. Muslim patients were significantly less likely to prefer English for spoken communication than the other two groups, less likely to be Canadian-born, more likely to have a female family physician, and were over-represented in the lowest income quintile. Muslim women were most likely to be up-to-date on breast cancer screening (85.2 vs. 77.5 % for those with other religions vs. 69.5 % for those with no religious affiliation). There were no significant differences in cancer screening by physician sex. In this pilot study conducted within a primary care practice, we used self-reported data on religious affiliation to examine possible inequities in cancer screening and observed intriguing variations in screening by self-identified religious affiliation. Future efforts to collect and use similar patient-level data should incorporate non-official languages and intensively outreach to patients with less health system contact. Regardless, the family medicine context may be the ideal setting to collect and act on patient-level sociodemographic data such as religious affiliation.

Measuring quality of life of old type 2 diabetic patients in primary care in Portugal: a cross-sectional study.

BackgroundWith the increasing prevalence of diabetes in patients aged over 75, the task of ensuring a good quality of life became even greater. This study aimed to evaluate quality of life of the very elderly (≥75 years) type 2 diabetic primary care patient, in an urban family practice setting.MethodsA cross sectional study was conducted. Quality of life (QoL) was assessed with the Portuguese version of EASY-Care. Descriptive and inferential analyses were performed.ResultsEighty three elderly type 2 diabetics were included in the study, with a mean age of 80.9 ± 4.3 years old. Most were women, widowed or married, with low educational levels, living with family members in urban areas and presented medium/low incomes. Participants were diagnosed with diabetes for 11.2 ± 10.1 years. Most of them were treated with oral antidiabetic agents, presented complications of diabetes and had good glycemic control. Despite that, excess weight, uncontrolled blood pressure and poor lipid management were noticed.In general, the participants perceived a positive quality of life. The worst perceived domain was “mental health and well-being”. Within the sociodemographic variables, gender, monthly income, and living arrangements interfered the most with the quality of life domains. Studied clinical variables affected quality of life very modestly.ConclusionsIn an urban primary care setting, when treating very elderly type 2 diabetic patients, and despite good glycemic control, attention should be paid to the QoL of women, the low income diabetics, their living arrangements and thoroughly evaluate the mental health and well-being of these patients.

Predictors of Low Colorectal Cancer Screening in an Urban Academic Family Practice

Purpose: The primary objective was to describe the specific socio-demographic variables that are associated with colorectal cancer (CRC) under-screening in an urban, inner city population. The secondary objective was to determine the overall proportion of eligible patients who are not appropriately screened. Methods: A retrospective chart review of patients eligible for average-risk CRC screening as per Ontario’s ColonCancerCheck program guidelines was conducted at an academic, inner city family health practice associated with St. Michael’s Hospital in Toronto, Ontario. Simple measures of association, including t-tests and chi-square tests, were used to determine the relationships between screening and demographic characteristics. Based on a type I error rate of 0.05 and an appropriate sample size, the calculated power for this study was 0.82. Results: A total of 200 patients were randomly selected; 54% were male; the majority were non-immigrants (77.5%) and were employed or retired (76.5%). Fifty-five percent of screened patients were up to date as per guidelines; 29.5% and 31% were up to date with a fecal occult blood test or a colonoscopy respectively. Individuals with psychiatric illness (p = 0.0005), with no history of prior cancer screening for other cancers (p = 0.0001), on disability or unemployed (p = 0.0010), or who were younger (p = 0.0062) were significantly less likely to undergo CRC screening. Conclusion: Colorectal cancer screening rates at this academic, urban family practice were very similar to province wide screening rates. Future studies should focus on group specific interventions to increase CRC screening uptake in low CRC screened populations.

Prescription errors in family practice in Menoufia governorate

Objective The aim of this study was to improve drug prescriptions in family practice through assessment of the types and frequency of prescription errors in family practice. Background Prescription is a written directive, as for the compounding or dispensing and administration of drugs, or for other services to a particular patient. Prescriptions should be clear, legible, and written in plain English. A prescription has three components: superscription (patient and prescriber data, diagnosis, and date), inscription: the body of the prescription (Rx symbol, drug data, and instructions for drug intake), and subscription (refills and prescriber signature). Prescribing faults and prescription errors are major problems among medication errors; although they are rarely fatal, they can affect patients' safety and quality of healthcare. Patients and methods A retrospective study of all available prescriptions (No. 691) during the period of the study (323 prescriptions from the Menouf family health center and 368 prescriptions from Monshaat Soltan family health unit) was carried out. The site of the study was selected using a stratified multistage random sampling technique to select a family health center and unit representing the urban and rural family practice sites in Menoufia governorate. These prescriptions were examined according to the ideal prescription writing mentioned in the article. Results Only 33.3% prescriptions were dated, whereas patients' weight, height, and address were absent in all of the prescriptions studied. Prescriber information was present in 64.3% and prescriber signature was present in 98.6%. The generic name of the drugs was mentioned in only 31.3% of the prescriptions. Only about one-third of the prescriptions were complete. Conclusion Prescribing errors contribute significantly toward adverse drug events. The frequency of drug prescription errors is high. Physicians should be trained more rigorously to learn the art of prescription writing.

Nonmydriatic Fundus Photography for Teleophthalmology Diabetic Retinopathy Screening in Rural and Urban Clinics

To evaluate the relative diagnostic value of nonmydriatic fundus photography (nFP) among patients screened for diabetic retinopathy in remote rural medical clinics and an urban academic medical center for nonadherence to recommended annual dilated eye examination. A retrospective cross-sectional study was performed among diabetic patients seen in primary outpatient clinics between 2006 and 2011 who were screened for diabetic retinopathy with nFP for history of nonadherence to recommended annual dilated eye examination. A single nonstereoscopic, 45°, 10-megapixel digital image of the disc and macula of both eyes was obtained locally and transmitted electronically to a retinal specialist for remote review. The results from remote rural Native American Indian reservations were compared with those from an urban academic family practice clinic. The proportion of subjects diagnosed with diabetic retinopathy and the quality of fundus images were compared. Among 872 patients (1,744 eyes) screened from rural sites and 517 subjects (1,034 eyes) screened from an urban site, images were of good quality for evaluation in 82.4% and 85.7% of subjects, respectively. Diabetic retinopathy was noted in 12.6% of rural subjects and 29.6% of urban subjects (p<0.001). nFP can be a useful tool in both rural and urban settings to screen for diabetic retinopathy in patients who are nonadherent to the recommended dilated annual eye exam. In our study population, a surprisingly higher percentage of diabetic subjects screened from the urban clinic had retinopathy compared with subjects screened in rural clinics.

Instrumental and socioemotional communications in doctor-patient interactions in urban and rural clinics

BackgroundLocation of practice, such as working in a rural or urban clinic, may influence how physicians communicate with their patients. This exploratory pilot study examines the communication styles used during doctor-patient interactions in urban and rural family practice settings in Western Canada.MethodsWe analyzed observation and interview data from four physicians practicing in these different locations. Using a grounded theory approach, communications were categorized as either instrumental or socioemotional. Instrumental communication refers to “cure-oriented interactions” and tends to be more task-oriented focusing on the patient’s health concerns and reason for the appointment. In contrast, socioemotional communication refers to more “care-oriented interactions” that may make the patient feel comfortable, relieve patient anxiety and build a trusting relationship.ResultsThe physicians in small, rural towns appear to know their patients and their families on a more personal level and outside of their office, and engage in more socioemotional communications compared to those practicing in suburban clinics in a large urban centre. Knowing patients outside the clinic seems to change the nature of the doctor-patient interaction, and, in turn, the doctor-patient relationship itself. Interactions between urban doctors and their patients had a mixture of instrumental and socioemotional communications, while interactions between rural doctors and their patients tended to be highly interpersonal, often involving considerable socioemotional communication and relationship-building.ConclusionsDespite the different ways that doctors and patients communicate with each other in the two settings, rural and urban doctors spend approximately the same amount of time with their patients. Thus, greater use of socioemotional communication by rural doctors, which may ease patient anxiety and increase patient trust, did not appear to add extra time to the patient visit. Research suggests that socioemotional communication may ultimately lead to better patient outcomes, which implies that health differences between rural and urban settings could be linked to differences in doctor-patient communication styles.

Healthy Weight Gain in Pregnancy: A Clinicians Tool for Individualized, Patient‐Focused Collaboration

Poster Presentation Purpose for the Program The purpose of this poster presentation is to share a tool developed by the Washington State Department of Health for prenatal clinicians to use to engage patients in developing goals and healthy behaviors, and provide individualized resources for healthy weight gain during pregnancy. Proposed Change Five obstetric (OB) practices were presented with the tool as a way to address healthy weight gain during the first prenatal (intake) exam. Previously, one of these practices did not formally address weight gain and the other four did not have a patient‐based tool. The goal was to get each clinic to use the tool. Implementation, Outcomes, and Evaluation In a pilot, five OB practices throughout the Southwest Region of Washington State were presented with the “Healthy Weight Gain in Pregnancy” tool, along with a “Clinician's Tool for Healthy Weight Gain in Pregnancy” to help clinicians with assessment, dialog, and monitoring. Represented were one urban, underserved OB access clinic; one urban family practice and residency practice; one urban OB practice; one suburban OB practice; and one rural OB practice. The clinician tools and patient tools were given to each practice (in laminated pad form) in three languages: English, Spanish, and Russian. After 3 months, each practice was queried regarding whether healthcare providers were using the tool, the patient interaction and success in engagement, and plans to continue the use of the tool. Of the five practices, only the rural practice did not embrace the tool—probably because of significant changes in staff, healthcare providers, and management. All others incorporated the tool in their OB intake process. The OB access clinic used the tool in their Centering/Group visit program and the other practices used the tool as part of their OB intake interview. Most successful in embracing the tool was the suburban practice, which used the tool and resources within the tool to develop plans that were incorporated into their electronic medical record (EMR) and monitor weight gain based on the goals developed. Implications for Nursing Practice The purpose of presenting this poster is genuinely to share this tool with others. Many healthcare providers are seeking a tool that will help engage patients and are eager to find something that has already been developed and can be used in their practices. This tool is a tangible, readily accessible way to involve patients and have them participate in healthy behaviors for healthy pregnancies and healthy birth outcomes.

Level of hypertension control: comparison of a rural and urban family practice centre in South Croatia

Arterial hypertension is a serious public health problem because of its frequency and poor management. We compared hypertension control between rural and urban environment over 5 years. Initial hypothesis: arterial pressure control is better in urban (Split) than in rural (Trilj) environment. Historic prospective study was conducted in two family medicine outpatient clinics. Data for the years 2005, 2006, and 2010 were analyzed. One hundred and seventeen subjects diagnosed with arterial hypertension in 2005 were examined: 66 in a rural and 51 in urban outpatient clinic. Their average age was 60.92 ± 10.03 (range 30-82 years). Blood pressure records at the onset of the study, the first, and fifth year of treatment, risk factors, and therapy were analyzed. T-test and χ(2)-test were used in statistical data analysis. In the urban clinic, more subjects were smokers, had positive family history, were overweight, and had registered hyperlipidemia. Initial mean arterial pressure readings were similar in both the clinics. Decrease was recorded in the following 5 years. During this study the use of ACE inhibitors (ACEI) (Split by 45 %, Trilj by 133 %) and calcium channel blockers (CCB) (Split by 76.9 %, Trilj by 525 %) was increased. The number of patients receiving monotherapy was reduced. Better arterial pressure control was recorded in the urban clinic, where, after 5 years, despite increased frequency of additional risk factors, the number of normotensive patients was higher than that in the rural one. Hypertension control in both settings was still poor. Hypertensive patients should participate actively in the treatment.

615 Comparison of the 2010 and 2012 Canadian Cardiovascular Society Atrial Fibrillation Guidelines in a Large Urban Family Practice

615 Comparison of the 2010 and 2012 Canadian Cardiovascular Society Atrial Fibrillation Guidelines in a Large Urban Family Practice

The Effects of a Group Visit Program on Outcomes of Diabetes Care in an Urban Family Practice

Diabetes mellitus is a prevalent chronic health condition associated with significant morbidity and mortality. Those with diabetes must acquire self-efficacy in the tasks necessary for them to successfully manage their disease. In this study, a controlled pre- and post-design was used to determine the effect of an adult support and education group visit program embedded in an urban academic family medicine practice on weight and the achievement of treatment goals for hemoglobin A1C, low-density lipoprotein (LDL) blood concentration, and blood pressure (BP) several months after it was implemented. Participants in the program were matched to a comparison group based on age, gender, race/ethnicity, and zip code group, a surrogate marker for socioeconomic status. The distribution of demographic characteristics and co-morbidities was similar between the groups. Significant increases occurred in the proportion of participants achieving both an A1C concentration <7% (CMH=4.6613, p = 0.0309) while controlling for baseline AIC concentration, and a BP<140/90mm Hg (CMH=5.61, p = 0.018) controlling for baseline BP compared to the comparison group. The hemoglobin A1C concentration declined in 76.9% of the participants in the group visit program compared to 54.3% in the comparison group (CMH=8.9911, p = 0.0027). The increase in the proportion of group visit participants achieving the target LDL concentrations did not achieve statistical significance. The proportion of participants who lost weight was similar to that in the comparison group. Early experience with the program was encouraging and suggested it may improve patients' management of their diabetes mellitus in an urban, predominantly African American population.

The roles of self‐efficacy and pretest counseling in type 2 herpes simplex virus screening in asymptomatic adults

To evaluate the role of counseling for patients undergoing screening for type 2 herpes simplex virus (HSV-2). Using pre- and post-screening questionnaires, we evaluated correlations between demographic factors, measures of self-efficacy and follow-through with the screening test, and willingness to take antiviral medication and share results with sexual partners. Subjects (N= 115) were recruited as part of usual care at a private, urban family practice. A total of 111 subjects completed pre-screening questionnaires, and 38 completed post-screening questionnaires. The overwhelming majority of participants were (a) willing to undergo screening; (b) take suppressive antiviral medication if necessary; (c) share their results with sexual partners; and (d) consider safer sexual practices as a consequence of screening. Older patients were less willing to consider daily antiviral medication. Men who have sex with men (MSM) had lower perceived susceptibility to HSV-2 but were more likely to undergo and report screening. Future research should include predictive models for determining the most appropriate patients to screen for HSV-2 and best practices for those who test positive. Shared decision making between patients and advanced practice nurses regarding the risks and benefits of screening for HSV-2 should be a component visits that include sexually transmitted disease screening. Particular attention should be paid to those at higher risk for contracting the virus, including patients with HIV and MSM.

What factors affect patients' recall of general practitioners' advice?

BackgroundIn order for patients to adhere to advice, provided by family doctors, they must be able to recall it afterwards. However, several studies have shown that most patients do not fully understand or memorize it. The aim of this study was to determine the influence of demographic characteristics, education, amount of given advice and the time between consultations on recalled advice.MethodsA prospective survey, lasting 30 months, was conducted in an urban family practice in Slovenia. Logistic regression analysis was used to identify the risk factors for poorer recall.Results250 patients (87.7% response rate) received at least one and up to four pieces of advice (2.4 ± 0.8). A follow-up consultation took place at 47.4 ± 35.2 days. The determinants of better recall were high school (OR 0.4, 95% CI 0.15-0.99, p = 0.049) and college education (OR 0.3, 95% CI 0.10-1.00, p = 0.050), while worse recall was determined by number of given instructions three or four (OR 26.1, 95% CI 3.15-215.24, p = 0.002; OR 56.8, 95% CI 5.91-546.12, p < 0.001, respectively) and re-test interval: 15-30 days (OR 3.3, 95% CI 1.06-10.13, p = 0.040), 31-60 days (OR 3.2, 95% CI 1.28-8.07, p = 0.013) and more than 60 days (OR 2.5, 95% CI 1.05-6.02, p = 0.038).ConclusionsEducation was an important determinant factor and warrants further study. Patients should be given no more than one or two instructions in a consultation. When more is needed, the follow-up should be within the next 14 days, and would be of a greater benefit to higher educated patients.