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Biomedical subjects

G Underbakke

Publications and source records attributed to G Underbakke.

11 recordsLinked to original sources
PubMed2000

Improving prevention systems in primary care practices: the Health Education and Research Trial (HEART)

BACKGROUND: The Health Education and Research Trial (HEART) was a multicenter clinical trial designed to test methods to improve primary care practice systems for heart disease prevention services. We present the trial methodology, the practices' use of medical record tools, and changes in documentation of cardiovascular risk factor screening and management. METHODS: Primary care practices were recruited from 4 Midwestern states. The factorial design resulted in 4 study groups: conference only, conference and quality improvement consultations, conference and prevention coordinator, and all interventions combined. Medical record audits and physician, staff, and patient surveys assessed practice change in cardiovascular disease risk factor documentation. RESULTS: Practices participated fully in this project, set goals to improve preventive services, and implemented recommended medical record tools. The number of goals set and the increase in the use of medical record tools were greatest in the combined intervention group, with improvements noted in all groups. The use of patient history questionnaires, problem lists, and flow sheets was significantly higher in the combined intervention group when compared with the conference-only group. Documentation of risk factor screening in a recommended-medical record location improved in all intervention groups, with significant sustained improvements in the practices that received the combined intervention. Documented risk factor management significantly improved in all intervention groups compared with the conference-only control. CONCLUSION: Primary care practices are interested in improving prevention systems and can change these systems in response to supportive external interventions. Promoting organizational change to produce sustained improvement in preventive service clinical outcomes is a complex process that requires further research.

Adult↗
PubMed1998

Primary care practice adherence to National Cholesterol Education Program guidelines for patients with coronary heart disease.

BACKGROUND: Clinical trials demonstrate significant benefit from cholesterol management for patients with cardiovascular disease (CVD). National guidelines recommending goals for screening and treatment were published in 1993 and widely disseminated. This study examines cholesterol screening and management by primary care physicians after the guidelines were released. METHODS: Medical records and patient surveys provided data for 603 patients with CVD, aged 27 to 70 years, from 45 practices in 4 states during 1993 to 1995. Physician surveys measured estimated performance and other variables. Physician and patient factors associated with adherence, or lack of adherence, to national guidelines were examined using univariate and multivariate analyses. RESULTS: A total of 199 patients (33%) with CVD were not screened with lipid panels, 271 patients (45%) were not receiving dietary counseling, and 404 (67%) were not receiving cholesterol medication. Only 84 patients (14%) with CVD had achieved the recommended low-density lipoprotein level of less than 2.58 mmol/L (100 mg/dL) and 302 (50%) had triglyceride levels lower than 2.26 mmol/L (200 mg/dL). Patients with a revascularization history and higher low-density lipoprotein and/or triglyceride levels were more likely to receive treatment, but other patient factors, including CVD risk factors, did not predict treatment. Physician specialty was not associated with differences in treatment, but physicians in practice for fewer years ordered more lipid panels. CONCLUSIONS: Most patients with CVD in primary care were not receiving cholesterol screening and management as recommended by the National Cholesterol Education Program guidelines in the 2 years after their release. Increasing cholesterol screening and treatment should be a priority for practice quality improvement and could result in significant reductions in CVD events for high-risk patients.

Adult↗
PubMed1998

Physician attitudes toward research study participation: a focus group.

The Wisconsin Research Network (WReN) and the UW Health Education And Research Trial (HEART) sponsored a focus group to explore the attitudes of primary care physicians toward research in their practices. Physicians, representing a variety of practice groups, emphasized that research is a low priority in their organizations. All had participated in some form of research, are philosophically committed to research as important to primary care, but are hesitant to commit themselves to participation in further research. They emphasized that academic researchers need to understand the constraints of primary care practice, propose research ideas that are practical and interesting to care providers, provide relevant feedback to participating practices, and do the majority of the research work themselves so impositions on the practice are minimal. The traditional barriers to practice-based research, such as the cost of physician and staff time and diversion from other tasks, continue to be of concern when physicians consider participation in research projects.

Adult↗
PubMed1996

Recruitment of private practices for primary care research: experience in a preventive services clinical trial.

BACKGROUND: Recruitment of community primary care practices for studies to improve health service delivery is important to many health care organizations. Prior studies have focused on individual physician recruitment or academic settings. METHODS: This descriptive study evaluated the efficiency and utility of three different recruitment methods to encourage community practice participation in a preventive services research trial. Primary care practices in four midwestern states were recruited using different sources for initial mailings (physician lists, practice lists, and a managed care organization's primary care network) and different recruiting methods. Outcome measures included response rates, participation rates, and comparative costs of each method. RESULTS: Of the 86 eligible practices contacted, 52 (60%) consented to participate. Mailing to individual physicians was the most cumbersome and expensive method and had the lowest response rate. Initial contacts with practice medical directors increased the participation rate substantially, and practice recruitment meetings improved both study participation and practice-project communication. CONCLUSIONS: Experience with these three methods suggests that the most efficient way to recruit practices for participation in a preventive services research trial involves targeted mailings and phone calls to medical directors, followed by on-site practice meetings.

Adult↗
PubMed1993

A survey of dietetics professionals' knowledge of and attitudes toward cholesterol management.

Dietetics professionals in Wisconsin (n = 687) were surveyed to assess their knowledge, attitudes, practices, experience, and educational interests regarding cholesterol management. The survey, conducted to guide the development of cholesterol education programming in the state, found that most dietetics professionals are familiar with and support the guidelines of the National Cholesterol Education Program (NCEP). Ninety-three percent of dietetics professionals responding to the survey believe that reducing serum cholesterol levels will reduce the risk of heart disease; the same percentage of respondents were familiar with NCEP guidelines for detecting and treating blood cholesterol levels and knew which cholesterol levels should be treated. Seventy-three percent were familiar with the American Heart Association step 1 diet, and 69% were familiar with the step 2 diet. On average, survey respondents defined a cholesterol level of 6.12 mmol/L as "high risk"; this value is almost identical to the NCEP definition. Respondents were optimistic about patients' ability to reduce their blood cholesterol levels through dietary modifications. Dietetics professionals are interested in education on cholesterol management, although individual educational interests vary depending on the respondent's area of practice.

Aged↗
PubMedDate not supplied

Smoking screening and management in primary care practices.

OBJECTIVES: To describe the screening and management of patients who smoke by primary care physicians and to review practice factors associated with smoking services. DESIGN AND METHODS: A descriptive study based on physician and patient questionnaires and medical record retrospective reviews. SETTING AND SUBJECTS: Forty-five nonacademic primary care practices, including 160 physicians (whose subspecialty is family practice, internal medicine, or general practice) in 4 Midwest states and 4879 adult patients who completed questionnaires and consented for medical record review. MAIN OUTCOME MEASURES: The a priori hypothesis was that screening by physicians would detect most persons who smoke, but that the lack of systematic methods to screen, intervene, or follow-up would limit the provision of smoking cessation services. RESULTS: Eighty-one percent of all patients and 93% of patients who smoked in the past 2 years reported being asked if they smoked. Patients who smoked reported being told to quit (78%), discussing a quit data (60%), receiving a nicotine prescription (20%) or referral (25%) at higher rates than prior reports. Patients with coronary heart disease (CHD) or CHD risk factors, who smoked more, visited the physician more, or who wanted help were more likely to receive smoking cessation services. Few practices had developed systems to routinely provide services, and a lack of systems was associated with fewer interventions. CONCLUSIONS: Physician screening and management of their practice patients is higher than reported in population surveys. Most patients who smoke report that they were asked whether they smoke, but smoking status is not routinely documented or updated. Significant variability is noted between physicians in smoking-related screening and interventions, and proved methods to improve services are infrequently used.

Adult↗