Do physicians address other medical problems during preventive gynecologic visits?

Background: The patient-centered medical home model may be a strategic approach to improve delivery of women's health care and consistently provide women with accessible and comprehensive care. We examined whether primary care physicians (family medicine, internal medicine, and hospital general medicine clinics) and obstetrician-gynecologists differ in scope and the number of medical issues addressed during preventive gynecologic visits.

Methods: We analyzed data from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey to characterize visits with a primary diagnosis of gynecological examination or routine cervical Papanicolaou test between 1999 and 2008.

Use of antidepressant medication in the United States during pregnancy, 2002-2010.

Objective: The authors analyzed prescribing for antidepressant medications during 27,328 prenatal visits in ambulatory settings in the United States between 2002 and 2010.

Methods: Data from the 2002-2010 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey were used to compare prescribing for antidepressant medication during visits for outpatient prenatal care between 2002-2006 and 2007-2010.

Results: Prenatal visits associated with a prescription for an antidepressant increased from .

Increased emergency department computed tomography use for common chest symptoms without clear patient benefits.

Objective: The aim of this study was to examine changes in the utilization of computed tomography (CT) in the evaluation of common chest symptoms and the rate of clinically significant diagnoses in emergency departments after 2004.

Methods: This study analyzed the National Hospital Ambulatory Medical Care Survey, comparing 1997 to 1999 and 2005 to 2007. Set in US emergency departments, individuals older than 14 years old were eligible.

Trends in the provision of preventive women's health services by family physicians.

Background And Objectives: Family medicine has experienced variations in scope and comprehensiveness of care in recent years. To investigate whether these changes in practice have impacted women's health services, we measured trends in the proportion of preventive women's health visits provided by family physicians nationally.

Methods: We analyzed the National Ambulatory Medical Care Survey to identify the trend in the proportion of preventive women's health visits to family physicians and obstetrician-gynecologists and others between 1995 to 2007.

Trends in well-child visits to family physicians by children younger than 2 years of age.

Purpose: Provision of prenatal visits by family physicians decreased by 50% from 1995 to 2004. To determine the impact of this trend on the provision of well-child visits by these professionals, we measured trends in and factors associated with well-child visits by children younger than 2 years of age to family physicians and pediatricians.

Methods: Using the National Ambulatory Medical Care Survey, we identified well-child visits made in the first 2 years of life to family physicians and pediatricians between 1995 and 2007.

Management of acute otitis media after publication of the 2004 AAP and AAFP clinical practice guideline.

Objectives: Observation without initial antibiotic therapy was accepted as an option for acute otitis media (AOM) management in the 2004 American Academy of Pediatrics and American Academy of Family Physicians clinical practice guideline. The guideline also recommended amoxicillin as the first-line treatment for most children, and analgesic treatment to reduce pain if it was present. Our objective was to compare the management of AOM after publication of the 2004 guideline.

A randomized trial of increased intravenous hydration in labor when oral fluid is unrestricted.

Background And Objectives: Increased intravenous (IV) hydration is associated with decreased labor duration and oxytocin augmentation in nulliparous women when oral fluid is restricted. The objective of this study was to determine the effect of increased IV hydration on the duration of labor when access to oral fluid was unrestricted.

Methods: Term, nulliparous women with uncomplicated singleton pregnancies were randomly assigned to receive lactated ringers at 250 ml per hour (IV fluid group) throughout active labor or usual care.

Observing the spread of common illnesses through a community: using Geographic Information Systems (GIS) for surveillance.

Background: The recent implementation of electronic medical record systems allows for the development of systems to track common illness across a defined community. With the threats of bioterrorism and pandemic illness, syndromic surveillance methodologies have become an important area of study. There has been limited study of the application of syndromic surveillance techniques to communities for tracking common illnesses to improve health system resource allocation and inform communities.

Trends in prenatal cares settings: association with medical liability.

Background: Medical liability concerns centered around maternity care have widespread public health implications, as restrictions in physician scope of practice may threaten quality of and access to care in the current climate. The purpose of this study was to examine national trends in prenatal care settings based on medical liability climate.

Methods: Analysis of prenatal visits in the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, 1997 to 2004 (N = 21,454).

Improving maternal care with a continuous quality improvement strategy: a report from the Interventions to Minimize Preterm and Low Birth Weight Infants through Continuous Improvement Techniques (IMPLICIT) Network.

Background: Maternal medical care (prenatal and postpartum) involves a set of clinical interventions addressing risk factors associated with important maternal and infant outcomes. Programs to increase the rate of delivery of these interventions in clinical practice have not been widely implemented.

Methods: A practice-based research network focused on developing continuous quality improvement (CQI) processes for maternal care among 10 family medicine residency training sites in the northeastern United States (the IMPLICIT Network) from January 2003 through September 2007.

Trends in broad-spectrum antibiotic prescribing for children with acute otitis media in the United States, 1998-2004.

Background: Overuse of broad-spectrum antibiotics is associated with antibiotic resistance. Acute otitis media (AOM) is responsible for a large proportion of antibiotics prescribed for US children. Rates of broad-spectrum antibiotic prescribing for AOM are unknown.

How often do physicians address other medical problems while providing prenatal care?

Purpose: It is unknown to what extent physicians address multiple problems while providing prenatal care. The objective of this study was to determine the percentage of prenatal encounters with 1 or more secondary and tertiary nonobstetric diagnoses and compare rates between family physicians and obstetricians.

Methods: Using the National Ambulatory Medical Care Survey, 1995-2004, I analyzed prenatal visits to family physicians' and obstetricians' offices.

Declining trends in the provision of prenatal care visits by family physicians.

Purpose: We wanted to measure trends in the proportion of prenatal visits provided by family physicians nationally for a 10-year period and determine characteristics of prenatal visits made to family physicians compared with visits made to obstetricians.

Methods: We analyzed the National Ambulatory Medical Care Survey to identify prenatal visits made to family physicians and obstetricians between 1995 and 2004. The primary outcome measure was the trend in proportion of prenatal visits seen by family physicians.

Efficiency of a two-item pre-screen to reduce the burden of depression screening in pregnancy and postpartum: an IMPLICIT network study.

Objective: Systems for efficient case finding of women with major depression during pregnancy and postpartum are needed. Here we assess the diagnostic accuracy of a modified 2-item patient health questionnaire (PHQ-2) as a pre-screen in assessing depression.

Methods: Cross-sectional assessments at 15 weeks' gestation (n = 414), 30 weeks' gestation (n = 334), and 6 to 16 weeks postpartum (n = 193) among women from a diverse set of races/ethnicities, participating in the IMPLICIT maternal care quality improvement network.

Cost-effectiveness analysis of treatment options for acute otitis media.

Purpose: This study evaluated the costs and utility of observation and routine antibiotic treatment options for children with acute otitis media.

Methods: The cost-effectiveness analysis was performed among children aged 6 months to 12 years seen in primary care offices. The interventions studied were watchful waiting as practiced in the Netherlands, delayed prescription, 5 days of amoxicillin, and 7 to 10 days of amoxicillin.

Relation of time spent in an encounter with the use of antibiotics in pediatric office visits for viral respiratory infections.

Objective: To examine the relationship between the time a physician spends in an office encounter with the prescribing of antibiotics for pediatric patients with presumed viral respiratory infections.

Design And Setting: Cross-sectional analysis of the 2000 National Ambulatory Medical Care Survey in physician offices in the United States.

Participants: Children and adolescents (aged < or = 18 years) with a diagnosis of upper respiratory infections or bronchitis.

Prevalence of primary HIV infection in symptomatic ambulatory patients.

Purpose: Recognizing primary human immunodeficiency virus (HIV) infection is important for public health. The prevalence in outpatient settings is largely unknown but would be useful in developing testing guidelines. The objective of this study is to estimate the national prevalence of primary HIV infection in symptomatic ambulatory patients regardless of risk factors.

The cost-effectiveness of expanded testing for primary HIV infection.

Purpose: Primary infection with the human immunodeficiency virus (HIV) is a major factor in the HIV epidemic. Most patients become symptomatic and seek care, but seldom are they tested or is their condition diagnosed. The objectives of this study are to determine whether it is cost-effective to expand testing for primary HIV infection to a larger cohort of patients, and, if so, which diagnostic assay is most cost-effective.

Knowledge of structured treatment interruption and adherence to antiretroviral therapy.

We conducted a survey of 106 HIV-infected patients on antiretroviral therapy at a community hospital in Lancaster, Pennsylvania, to determine the extent of patient knowledge and attitudes about structured treatment interruption (STI) and whether these were factors in adherence to antiretroviral regimens. Thirty-six percent of patients possessed knowledge of STI as a treatment option and four patients reported that they had stopped taking antiretroviral therapy without specific recommendation from their physician based on information they had heard or read about STI. There was no difference in median adherence based on whether a patient was aware of STI, however, in the group who had heard of STI, attitude that STI is very beneficial was correlated with greater adherence to medication.

Comparison of two prevention strategies for neonatal group B streptococcal disease.

Background: Neonatal group B streptococcal disease is a serious infection, causing more than 2,000 cases of sepsis annually. The Centers for Disease Control and Prevention has recommended two alternative strategies to prevent infection, but few data directly compare the two in terms of intrapartum antibiotic administration, protocol feasibility, newborn laboratory evaluation, and costs.

Methods: We collected data on intrapartum antibiotic administration, protocol compliance, newborn laboratory evaluation, and maternal-newborn length of stay for 347 mother-infant pairs in a family practice residency maternity service.