Explaining the de-prioritization of primary prevention: Physicians' perceptions of their role in the delivery of primary care

BACKGROUND: While physicians are key to primary preventive care, their delivery rate is sub-optimal. Assessment of physician beliefs is integral to understanding current behavior and the conceptualization of strategies to increase delivery. METHODS: A focus group with regional primary care physician (PCP) Opinion Leaders was conducted as a formative step towards regional assessment of attitudes and barriers regarding preventive care delivery in primary care. Following the PRECEDE-PROCEED model, the focus group aim was to identify conceptual themes that characterize PCP beliefs and practices regarding preventive care. Seven male and five female PCPs (family medicine, internal medicine) participated in the audiotaped discussion of their perceptions and behaviors in delivery of primary preventive care. The transcribed audiotape was qualitatively analyzed using grounded theory methodology. RESULTS: The PCPs' own perceived role in daily practice was a significant barrier to primary preventive care. The prevailing PCP model was the "one-stop-shop" physician who could provide anything from primary to tertiary care, but whose provision was dominated by the delivery of immediate diagnoses and treatments, namely secondary care. CONCLUSIONS: The secondary-tertiary prevention PCP model sustained the expectation of immediacy of corrective action, cure, and satisfaction sought by patients and physicians alike, and, thereby, de-prioritized primary prevention in practice. Multiple barriers beyond the immediate control of PCP must be surmounted for the full integration of primary prevention in primary care practice. However, independent of other barriers, physician cognitive value of primary prevention in practice, a base mediator of physician behavior, will need to be increased to frame the likelihood of such integration

Pregnancy and Mental Health of Young Homeless Women

Pregnancy rates among women in the U.S. who are homeless are much higher than rates among women who are housed (Greene & Ringwalt, 1998). Yet little research has addressed mental health, risk and resilience among young mothers who are homeless. This study utilizes a sample of women from the Midwest Longitudinal Study of Homeless Adolescents (MLSHA) to investigate pregnancy and motherhood over three years among unaccompanied homeless young mothers. Our data are supplemented by in-depth interviews with a subset of these women. Results show that almost half of sexually active young women (n = 222, μ age = 17.2) had been pregnant at baseline (46.4%), and among the longitudinal subsample of 171 women (μ age = 17.2), almost 70.0% had been pregnant by the end of the study. Among young mothers who are homeless, only half reported that they helped to care for their children consistently over time, and one-fifth of the women reported never seeing their children. Of the young women with children in their care at the last interview of the study (Wave 13), almost one-third met criteria for lifetime major depressive episode (MDE), lifetime posttraumatic stress disorder (PTSD), and lifetime drug abuse, and onehalf met criteria for lifetime antisocial personality disorder (APD). Twelve-month diagnoses are also reported. The impacts of homelessness on maternal and child outcomes are discussed, including the implications for practice, policy, and research

A Randomized Controlled Trial Comparing Internet and Video to Facilitate Patient Education for Men Considering the Prostate Specific Antigen Test

BACKGROUND: Little is known about the relative advantages of video versus internet-based decision aids to facilitate shared medical decision making. This study compared internet and video patient education modalities for men considering the prostate specific antigen (PSA) test. METHODS: Two hundred and twenty-six men, aged 50 years or older, and scheduled to complete a physical examination at an HMO Health Appraisal Clinic were randomly assigned to access a website (N = 114) or view a 23-minute videotape in the clinic (N = 112) prior to deciding whether they wanted to be screened for prostate cancer. RESULTS: There were no between-groups differences in participants’ ratings of convenience, effort, or satisfaction following exposure to the decision aid. Participants assigned to the video group were more likely to review the materials than individuals assigned to the internet group (98.2% vs 53.5%). Participants in the video group showed significantly greater increases in PSA knowledge and were more likely to decline the PSA test than individuals assigned to the internet group. However, participants in the internet group who reviewed the entire online presentation showed similar increases in PSA knowledge as video participants. Only 5% of all participants visited other websites to inform themselves about the PSA test. CONCLUSIONS: Overall, the video was significantly more effective than the Internet in educating participants about benefits and risks of PSA screening

Ascertaining consumer perspectives of medication information sources using a modified repertory grid technique

Objective To establish the range of medicine information sources used by consumers and their perception of the reliability of these, using the repertory grid technique. Method Consumers visiting three community pharmacies in Brisbane, Australia, were interviewed using the repertory grid technique. During the interview, consumers were asked to name up to three medicine information sources that they used for a supermarket medicine, an over-the-counter medicine and a prescription medicine. They were then presented with their named information sources in groups of three and asked to discriminate between these in terms of their perceived reliability of the information source. The descriptors used by the consumer to discriminate between the information sources are known as constructs and these were recorded. The consumer was then asked to rate each of their information sources against each generated construct. Main outcome measure The range of information sources generated was determined along with the perceived reliability of these from the calculated median score of each information source when rated on each generated construct. Results A total of 110 consumers were interviewed and identified 648 information sources that they would use. The most frequent information sources cited by the 110 consumers were their doctor (83%), written information (90%) and the pharmacist (78%). There were a total of 299 constructs generated by 88 of the consumers and these were themed into 16 discrete categories. The most common generated constructs themes were “good knowledge” (15%), “training” (14%) and “trustworthiness” (13%). The consumer perception of their information sources were that the doctor and pharmacist have good knowledge (median score 1) and are trained (median score 1) and were perceived to be trustworthy (median score 3 and 2, respectively). Conclusion The repertory grid technique was successful in identifying the information sources consumers accessed to find out about their medicines and in identifying the perception of these sources in terms of their reliability. The repertory grid technique offers a novel method for future research into consumer preferences for different treatment options