Patient age, number and type of clinical encounters, and provider advice to quit smoking. BRFSS 2000

The purpose of this study was to determine how often smoking patients receive quit advice and if patient age, and number and type of clinical encounters are associated with odds of receipt. Behavioral Risk Factor Surveillance System (BRFSS) 2000 data were used to study 10,582 smokers (aged ≥ 18) having ≥ 1 of three types of clinical encounters in the past year: routine checkups, other physician encounters, or dental visits. Multivariate-adjusted odds ratios (ORs) for quit advice by patient age, encounter type, and number of doctor\u27s visits were calculated. Almost 55% of patients were advised to quit smoking. There was a 4-23% chance of receiving quit advice at any given doctor\u27s visit. Odds of receiving advice did not increase with increasing number of visits. With advancing age, men were more likely, women less likely, to receive quit advicebut only significantly for White men. Compared to those having dental visits, ORs for receiving quit advice for patients having checkups and other physician encounters were 3.35 (95% CI 2.ll, 5.31) and 3.03 (95%CI 1.32, 6.97) respectively. These cross-sectional data suggest that whereas a small majority of smoking patients are advised to quit at some clinical encounter, smoking patients are not advised to quit at the majority of encounters. Being young and male, or seeing dentists rather than doctors made patients less likely to receive quit adviceas did having lower education or BMI, no insurance or coverage other than military or private, not having asthma, or not having breast exams or follow-up Papanicolaou smears if female. Based on a previously-reported absolute quit difference of 1.9%, if smoking patients received quit advice just once at any of their encounters with physicians in a year, at least 800,000 more U.S. smokers would quit at an economic savings of $2.4 billion

When food isn't medicine - A challenge for physicians and health systems

Food can be powerful medicine. Good nutrition helps promote health and prevent and treat disease. Yet nutrition is not often part of a physician's training or clinical practice. Food might not be medicine when it's importance is under-recognized and healthful eating is under-prescribed. Moreover, food cannot be medicine when it is not available to patients (or when available only in the form of unhealthful fare). This paper considers evolving thinking about when food isn't medicine by chronicling the experience of one physician—from college coursework to providing patient care and conducting research. The paper is framed around the experience of a representative patient struggling with diet-related chronic conditions, and describes some community-focused initiatives to help address issues related to food access in challenged communities. A principal focus is the over-abundance of foods from ‘plants’ (the industrial processing kind) and the low availability of food from ‘plants’ (the living botanical kind). Physicians and health systems can support access to healthier food and healthier eating, and the idea of food as medicine, through a variety of approaches that extend beyond hospital and clinic walls. Examples of such physician and health-system approaches are provided. Keywords: Food, Nutrition, Public health, Medicine, Community health, Physicians, Hospitals, Health systems, Accountable care organization

Family Medicine Research in the United States – from the Late 1960s into the Future

When the new field of family medicine research began a half century ago, multiple individuals and organizations emphasized that research was a key mission. Since the field’s inception, there have been notable research successes for which family medicine organizations, researchers, and leaders – assisted by federal and state governments and private foundations - can take credit. Research is a requirement for family medicine residency programs but not individual residents, and multiple family medicine departments offer research training in various forms for learners at all levels, including research fellowships. Family physicians have developed practice-based research networks (PBRNs) to conduct investigations and generate new knowledge. The field of family medicine has seen the creation of new journals to support the publication of research relevant to practicing family physicians. Nonetheless, in spite of much growth and many successes, family physicians and their research have been underrepresented in research funding. Clinical presentations in family medicine are often complex, poorly-differentiated, and often exist as one of several patient complaints and diagnoses, and are not well-covered by the narrow basic-science and specialty research that defines most of the biomedical research enterprise. Overall health in the United States would benefit from a more robust research participation and greater support for family medicine research

Family Medicine Research in the United States – from the Late 1960s into the Future

When the new field of family medicine research began a half century ago, multiple individuals and organizations emphasized that research was a key mission. Since the field’s inception, there have been notable research successes for which family medicine organizations, researchers, and leaders – assisted by federal and state governments and private foundations - can take credit. Research is a requirement for family medicine residency programs but not individual residents, and multiple family medicine departments offer research training in various forms for learners at all levels, including research fellowships. Family physicians have developed practice-based research networks (PBRNs) to conduct investigations and generate new knowledge. The field of family medicine has seen the creation of new journals to support the publication of research relevant to practicing family physicians. Nonetheless, in spite of much growth and many successes, family physicians and their research have been underrepresented in research funding. Clinical presentations in family medicine are often complex, poorly-differentiated, and often exist as one of several patient complaints and diagnoses, and are not well-covered by the narrow basic-science and specialty research that defines most of the biomedical research enterprise. Overall health in the United States would benefit from a more robust research participation and greater support for family medicine research