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Biomedical subjects

A John Orzano

Publications and source records attributed to A John Orzano.

6 recordsLinked to original sources

Recruiting minority primary care practices into practice-based research.

BACKGROUND: A potentially fruitful strategy for increasing enrollment of minority patients in research is to engage minority clinicians. However, little attention has been paid to unique challenges and effective strategies for engaging practices with minority physicians. OBJECTIVE: The objective of this study was to provide a model for recruiting community-based primary care practices with minority physicians into research studies. RESEARCH DESIGN: Practices were recruited using a 3-step process that included telephone contact, on-site meetings, and follow-up discussions. Strategies used to recruit 18 New Jersey community-based primary care practices with minority physicians for a quality improvement intervention study were assessed. RESULTS: Twelve of 18 practices (67%) were successfully recruited into the study. Effective recruitment strategies included building rapport using a multiethnic/multidisciplinary team led by a minority physician recruiter and stressing study benefits for the practice. We attempted to match recruiters and key practice members by race, underrepresented minority status of the lead recruiter, gender, career stage, experience in urban practice, and experience in clinical instruction. Practices that were successfully recruited had more characteristics in common between recruiters and key practice members than unsuccessfully recruited practices (mean number of characteristic matches = 3.75 vs. 1.83, P = 0.020). Study benefits cited by participants as motivators for participation included a general desire to provide good patient care by understanding their practices' strengths and challenges (92%) and improving their practice (85%). CONCLUSIONS: Our experience suggests that a staged, tailored, and iterative recruitment process emphasizing communication and relationship building can be successful in recruiting community-based primary care minority physicians into practice-based research.

Clinical Trials as Topic↗

Speaking of weight: how patients and primary care clinicians initiate weight loss counseling.

BACKGROUND: Obesity is epidemic in the US and other industrialized countries and contributes significantly to population morbidity and mortality. Primary care physicians see a substantial portion of the obese population, yet rarely counsel patients to lose weight. METHODS: Descriptive field notes of outpatient visits collected as part of a multimethod comparative case study were used to study patterns of physician-patient communication around weight control in 633 encounters in family practices in a Midwestern state. RESULTS: Sixty-eight percent of adults and 35% of children were overweight. Excess weight was mentioned in 17% of encounters with overweight patients, while weight loss counseling occurred with 11% of overweight adults and 8% of overweight children. In weight loss counseling encounters, patients formulated weight as a problem by making it a reason for visit or explicitly or implicitly asking for help with weight loss. Clinicians did so by framing weight as a medical problem in itself or as an exacerbating factor for another medical problem. CONCLUSIONS: Strategies that increase the likelihood of patients identifying weight as a problem, or that provide clinicians with a way to "medicalize" the patient's obesity, are likely to increase the frequency of weight loss counseling in primary care visits.

Adult↗

Are attributes of organizational performance in large health care organizations relevant in primary care practices?

Are organizational attributes associated with better health outcomes in large health care organizations applicable to primary care practices? In comparative case studies of two community family practices, it was found that attributes of organizational performance identified in larger health care organizations must be tailored to their unique context of primary care. Further work is required to adapt or establish the significance of the attributes of management infrastructure and information mastery.

Efficiency, Organizational↗

Social network analysis as an analytic tool for interaction patterns in primary care practices.

PURPOSE: Social network analysis (SNA) provides a way of quantitatively analyzing relationships among people or other information-processing agents. Using 2 practices as illustrations, we describe how SNA can be used to characterize and compare communication patterns in primary care practices. METHODS: Based on data from ethnographic field notes, we constructed matrices identifying how practice members interact when practice-level decisions are made. SNA software (UCINet and KrackPlot) calculates quantitative measures of network structure including density, centralization, hierarchy and clustering coefficient. The software also generates a visual representation of networks through network diagrams. RESULTS: The 2 examples show clear distinctions between practices for all the SNA measures. Potential uses of these measures for analysis of primary care practices are described. CONCLUSIONS: SNA can be useful for quantitative analysis of interaction patterns that can distinguish differences among primary care practices.

Decision Making↗

Diagnosis and treatment of obesity in adults: an applied evidence-based review.

BACKGROUND: Obesity is epidemic and leads to substantial morbidity/mortality. Effective strategies exist for managing obesity yet are rarely used by physicians. This applied evidence-based review provides a rationale for the diagnosis and treatment of obesity in adults by providing test characteristics for the body mass index (BMI) and number needed to treat (NNT) for relevant treatments. METHODS: We integrated evidence supporting recommendations from scientific bodies addressing obesity in adults, including: the National Heart, Lung, and Blood Institute, the World Health Organization, the Canadian Task Force on Preventive Health Care, and the US Preventive Task Force. In addition, pertinent studies were identified from MEDLINE, Database of Abstracts of Reviews of Effectiveness, and the Cochrane Database. RESULTS: (1) manage obesity as a chronic relapsing disease; (2) use BMI as a vital sign to screen for overweight/obese patients and to decide treatment (positive predictive value of 97%); (3) modest weight loss (10%) positively affects prevention/treatment of hypertension (NNT = 3), diabetes (NNT = 9), and hyperlipidemia; (4) effective treatments exist for overweight/obese patients and a combination of diet and exercise provides the best results (NNT = 7); (5) counsel patients to achieve a goal of 10% reduction in weight (500 to 800 kcal/day decrease to affect 1- to 2-pound loss/week); (6) counsel patients to exercise to achieve a goal of any increased energy expenditure. CONCLUSIONS: Weight loss has an impact on important disease states and risk factors. Effective strategies exist for the management of obesity when viewed as a chronic relapsing disease.

Anti-Obesity Agents↗