Abstract
Welcome to the debut issue of the Journal of Primary Care and Community Health. We are pleased to release this set of articles, the first to appear in our new journal. The journal is intended to offer a forum for exchanging findings and methods about generating evidence on effective practices in primary care and community health. To this end, we include several different types of articles.
The first article is a commentary authored by the editor. In it, I lay out some ideas about practical impact evaluations of primary care and community health programs. This is not intended to discourage submission of other types of program evaluations, including case reports or other qualitative studies. Instead, the paper points out that quantitative analysis of program outcomes is possible, even with limited resources. Some short-term outcomes (ie, “impacts”) are important and, in fact, managers might be held accountable for short-term outcomes by senior executives. Using the same performance indicators for both management and evaluation makes research very relevant to practice.
The first original research paper included in this issue was contributed by a team of investigators from the Albert Einstein College of Medicine at Yeshiva University in New York. Clinicians in 36 primary care pediatric practices were studied to examine how organizational culture and job satisfaction affect clinician turnover. Two dimensions of organizational culture were found to be particularly important determinants of job satisfaction and, indirectly, of turnover. Whether these dimensions of organizational culture can be changed, and if so, how they can be changed, is likely to provoke some debate.
The second original research paper is from Weill Cornell Medical College and Hamad Medical Corporation in Qatar. This study investigated somatic symptoms in a large sample of primary care patients. The results reinforce what our field is beginning to recognize. Many problems and issues in primary care have cross-cultural relevance.
A team from Beth Israel Deaconess Medical Center reported the results of a quality improvement study performed in a community health center in Boston. The purpose was to learn how to increase uptake of human papilloma virus (HPV) vaccination by investigating knowledge and attitudes about HPV in a sample of adult women. One interesting finding was that women seeking vaccination usually were not motivated by perceived risk for HPV infection.
A colon cancer screening program was the focus of a study from the University of Iowa. The target population consisted of uninsured or underinsured patients aged 50 to 64 years, some of whom attended the University of Iowa and others the Iowa City Free Medical Clinic. The intervention involved mailings, posters, personal recruitment, and having clinic receptionists hand eligible patients a research packet. The 297 eligible patients received a free fecal immunochemical test (FIT) and those with positive FITs were provided with a colonoscopy at no cost to them. No colon cancers were identified, but 49 individuals tested positive and were offered colonoscopies. Twenty individuals had a least 1 polyp biopsied. The costs and benefits of this type of population-based screening make for an interesting discussion.
Four pilot studies are offered in this issue. Angstman and Williams, from the Mayo Clinic Departments of Family Medicine and Psychiatry, evaluated the differences in outcomes and cost of a collaborative care model (CCM) for depression in comparison to usual care using a quasi-experimental design. They found a modest short-term increase in costs in the CCM with significantly more patients being symptom-free after 6 months.
A team from East Carolina University and St. Judes Children’s Research Hospital in Memphis pilot-tested a 12-week obesity intervention for children aged 8 through 12. The intervention was based on the transtheoretical model. In comparison to a control group, the children in the intervention group experienced a greater reduction in body mass index (BMI), more increases in daily vigorous physical activity, and movement toward the action/maintenance stage of change.
Investigators from the Mayo Clinic Department of Internal Medicine studied the relationship between the frequency of no-shows (missed appointments) and the number of emergency department visits, comparing the residents practice to the faculty practice. At first glance, the faculty practice appeared to result in fewer emergency department visits. However, after adjustment for other variables, including no-shows, no significant difference between the faculty and the residents remained.
Finally, atrial fibrillation cases seen in primary care were the focus of a study of patients seen in a health center in Chrisoupolis, Greece. The study identifies opportunities for improvement in patient care. Once again, the similarities and differences in health care system problems that appear internationally are of interest.
This issue contains 2 review articles. The purpose of these reviews are not to present the editorial positions of the journal, but to offer readers a view of the landscape pertaining to an issue. Investigators from the University of Texas (MD Anderson and the School of Public Health) were led to some provocative conclusions about what would constitute “rational” medication policies by their review of the literature. An investigator from Eli Lilly and Company reviewed the evidence on the relationship between depression and diabetes and concluded that depression is a modifiable risk factor for diabetes burden.
A briefer review is offered in the form of a research letter by Lori Sanderson, a public health doctoral student in Walden University. Ms Sanderson reported on the dearth of evidence-based interventions for promoting lifestyle change in children and adolescents with diabetes or kidney disease.
Taken together, this set of articles provides an interesting snapshot of the kinds of studies being conducted in primary care and community health, both in the United States and around the world. We hope our readers will find them interesting. We also invite submissions of evidence-based papers on any topics of relevance to primary care and community health. These papers can be based on studies which had small budgets. We are eager to publish pilot studies as well as full-length research papers.