Chaperone Use by Family Physicians During the Collection of a Pap Smear

BACKGROUND We wanted to determine whether variations exist in use of a chaperone during the performance of a pelvic examination by family physicians. METHODS A self-administered questionnaire was mailed to 5,000 randomly selected active members of the American Academy of Family Physicians. RESULTS There were 3,551 survey responses (71% response rate) and 2,748 useable questionnaires. Most respondents (75.4%) reported routinely using a chaperone in the room during the collection of a Papanicolaou (Pap) smear. Significantly (P < .00001) more male physicians (84.1%) than female physicians (31.4%) reported using a chaperone. Physicians reporting routine use of a chaperone were significantly younger (P = .01) and did fewer Pap smears per month (P < .00001). Regional reporting of chaperone use varied significantly (P < .00001), with 71.6% reporting use in the Northeast, 89.0% in the South, 65.7% in the Midwest, and 72.4% in the West. CONCLUSION Family physicians vary considerably in the reported use of a chaperone during the collection of a Pap smear. The variation could reflect different regional or local norms, efficiency or resource issues in high-volume clinical settings, or other interpersonal factors. These issues need to be explored in more depth

Controlling Hypertension through Education and Coaching in Kidney Disease (CHECK-D): protocol of a cluster randomised controlled trial

Introduction Chronic kidney disease (CKD) affects 30 million Americans. Early management focused on blood pressure (BP) control decreases cardiovascular morbidity and mortality. Less than 40% of patients with CKD achieve recommended BP targets due to many barriers. These barriers include a lack of understanding of the implications of their diagnosis and how to optimise their health.This cluster randomised control trial hypothesises that the combination of early primary care CKD education, and motivational interviewing (MI)-based health coach support, will improve patient behaviours aligned with BP control by increasing patient knowledge, self-efficacy and motivation. The results will aid in sustainable interventions for future patient-centric education and coaching support to improve quality and outcomes in patients with CKD stages 3–5. Outcomes in patients with CKD stages 3–5 receiving the intervention will be compared with similar patients within a control group. Continuous quality improvement (CQI) and systems methodologies will be used to optimise resource neutrality and leverage existing technology to support implementation and future dissemination. The innovative approach of this research focuses on the importance of a multidisciplinary team, including off-site patient coaching, that can intervene early in the CKD care continuum by supporting patients with education and coaching.Methods and analysis We will test impact of BP control when clinician-delivered education is followed by 12 months of MI-based health coaching. We will compare outcomes in 350 patients with CKD stages 3–5 between intervention and control groups in primary care. CQI and systems methodologies will optimise education and coaching for future implementation and dissemination.Ethics and dissemination This study was approved by the University of Michigan Institutional Review Boards (IRBMED) HUM00136011, HUM00150672 and SITE00000092 and the results of the study will be published on ClinicalTrials.gov, in peer-reviewed journals, as well as conference abstracts, posters and presentations.Trial registration number NCT04087798