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Biomedical subjects

L I Solberg

Publications and source records attributed to L I Solberg.

At least 19 recordsLinked to original sources
PubMed1992

A controlled trial to integrate smoking cessation advice into primary care practice: Doctors Helping Smokers, Round III.

BACKGROUND: Although most physicians believe that smoking cessation assistance is important for their patients, the majority of smokers report that they have not received smoking cessation advice from a physician. We therefore tested whether on-site recruitment, training, and organizational assistance in incorporating a smoking intervention system of documented efficacy into nonvolunteer primary care practices would result in higher rates of smoking cessation advice to patients. METHODS: This was a nonrandomized trial comparing all 10 primary care clinics in an intervention area to all 8 primary care clinics from a geographically separate control area. The evaluation was based on the smoking intervention activities of each of the clinics as reported on preintervention and postintervention mail surveys of cohorts of regular smokers seen in the clinics. RESULTS: Preintervention, 22.9% +/- 11.2% of the intervention clinic cohort and 21.9% +/- 9.6% (P = .84) of the control clinic cohort reported that they had been asked about tobacco during a clinic visit in the prior 6 months. Postintervention, the intervention clinic cohort was significantly more likely to report that someone had asked them if they smoked (39.8% +/- 12.3% vs 26.0% +/- 12.2%; P less than .05), that their physician asked them to quit if they were currently smoking (40.5% +/- 12.1% vs 26.4% +/- 14.6%; P less than .05), and that someone had commended them if they had recently quit smoking (28.2% +/- 19.8 vs 11.3% +/- 11.8%; P less than .05). CONCLUSIONS: The intervention significantly increased the rates at which a population of primary care clinics identified their patients who smoked, advised them to quit smoking, and commended those who had recently quit smoking.

Adult↗
PubMed1990

The Minnesota project: a focused approach to ambulatory quality assessment.

With national HMO quality assurance requirements pending for Medicare risk contracts, three HMOs in Minnesota established a working group with the state Department of Health to develop and test a new methodology proposed for quality of care review. A two-tiered system was developed for ambulatory chart review based on 15 hospitalization diagnoses having a potential for inadequate prehospital care. This system was applied to 796 cases from the HMOs (2% of admissions). Technical problems limited actual review to 673 of these cases. Although 304 (45%) of reviewed cases failed initial screening, physician review found only 22% of such failures (10% of reviewed cases) to represent probable quality of care problems. The approach appears to be feasible and unusually efficient. Although there is considerable variability that limits its potential use for interhealth plan comparison, the approach holds promise for quality assurance within an individual health plan.

Ambulatory Care↗
PubMed1990

Beyond efficacy testing: introducing preventive cardiology into primary care.

The interventions of documented efficacy that have been developed for the treatment of cardiovascular disease risk factors have been neither rapidly nor completely incorporated into clinical practice. This may be due to not recognizing that there is a fundamental conflict between the attributes of the ideal protocol for testing the efficacy of an intervention and the attributes of ideal patient care. For example, when testing an intervention for efficacy, benefit to the subject must be made secondary to the goal of increasing the community's fund of knowledge. When caring for patients, increasing the community's fund of knowledge must be secondary to the goal of benefiting the patient who is receiving care. Therefore, the ideal efficacy-testing program is minimally responsive to the needs of the individual subject; the ideal treatment program is maximally responsive to the needs of the individual patient. A second reason for the slow incorporation of preventive cardiology into patient care is the current lack of a supporting structure. An understanding of the attributes of good patient care and the need for a structure to support preventive cardiology interventions should further the incorporation of preventive cardiology interventions into routine patient care while allowing patient care systems to be scrutinized with efficacy-testing protocols.

Cardiology↗
PubMed1990

A systematic primary care office-based smoking cessation program.

There is a large discrepancy between apparent potential and actual practice of smoking cessation activities by physicians. This paper describes the 2-year results of an integrated system to support such physician activities with all of their tobacco-using patients. The system consists of organized identification, progress records, brief physician messages, follow-up, and assistance; it focuses on those most interested in quitting. Introduction of the system to one clinic was associated with an initial threefold to fivefold increase in quit rates of all clinic patients using tobacco. After 2 years, the overall quit rate was approximately 20%, rising to 33% for those tobacco users with more clinic contacts or at least 1 year from the first to the latest contact. Such a program has been well accepted by patients, physicians, and office staff and seems to provide the support needed for a feasible and effective long-term smoking cessation intervention in primary care practices.

Adult↗
PubMed1990

A comparison of two methods to recruit physicians to deliver smoking cessation interventions.

To address the problem of recruiting physicians to deliver smoking cessation interventions, Doctors Helping Smokers included a trial of physician recruitment strategies. In round 1 of Doctors Helping Smokers, three types of informational materials were mailed directly to 1110 family physicians. The physicians were asked to return a postcard if they were interested in participating in a 1-month trial of a smoking cessation intervention. Response did not differ among the three conditions; overall, 9.8% of physicians (95% confidence limits [CL], 8.0, 11.6) responded and 6.0% (95% CL, 4.6, 7.4) eventually participated in the intervention trial. The same procedure was repeated for round 2 of Doctors Helping Smokers with direct mailing to all general internists and cardiologists (n = 1108) on the mailing list of the Minnesota Medical Association. Five percent (95% CL, 3.7, 6.3) of the internists responded and 2.7% (95% CL, 1.7, 3.7) participated in the trial. Recruitment for round 3 made use of repeated face-to-face recruitment efforts at the physician's office through a managed-care organization that held contracts with the physician's clinic to provide care for its enrollees. Six months after the initiation of round 3, 59% (95% CL, 49%, 67%) of the 126 primary care physicians reported that they were giving their patients smoking cessation advice and completing the smoking intervention records. Eighteen months after the initiation of round 3, 56% (95% CL, 47%, 65%) of the 116 primary care physicians who remained in the practice reported continued activity in the project.

Attitude of Health Personnel↗
PubMed1989

A randomized trial to increase smoking intervention by physicians. Doctors Helping Smokers, Round I.

Sixty-six physicians were randomized to three groups to conduct a 1-month campaign to help their patients stop smoking. The workshop group received free patient education materials and a 6-hour training workshop. The materials group received free patient education materials, and the no-assistance group received nothing. A telephone interview was completed with 89% of the 6767 eligible adult patients seen during the month of the campaign. The brief training program and patient education materials marginally increased the smoking intervention activities of volunteer physicians in private practice. Both workshop and materials physicians asked 54% of their smoking patients to stop; no-assistance physicians asked 40%. One year later, 36% of patients who had not even been asked by their doctors if they smoked reported that they had tried to stop smoking. If the physician had asked the patient if he or she smoked, the probability of a quit attempt was 47%. Patients who had been asked if they smoked were more likely to claim to have stopped (13%) than patients who had not been asked (9%). However, the proportion of patients claiming continued abstinence (range, 12% to 14%) was not related to the group of the physician.

Adolescent↗
PubMed1989

Patient education by a family nurse as a model for training residents.

There is need for a practical model of patient education in the primary care setting that can also be used as a method for teaching primary care residents about patient education. This project modified a previously established and well-defined role for a family nurse in order to provide such a patient care-based learning experience for a family practice residency. Evaluation of the 18 month project showed that an average of 72 patient visits per month with charges of $482 were provided by this nurse at the same time that she was undertaking many improvements in the residency clinic's patient education system. Before and after surveys of the clinic staff and residents showed a rise in their perception of the quality of patient education (11% and 25% respectively thought it good or outstanding before, while 90% and 100% did so at the end of the project). There was also an increase in the residents' perceptions of having good personal patient education knowledge (from 50% to 88%) and skills (from 70% to 82%). The residents agreed that the family nurse role had been very valuable (76%) and that they would be interested (35%) or very interested (53%) in having such a person in their future practice, since it appeared to them to be cost-effective (69%). This model appears to be a feasible and acceptable way to deliver and teach patient education.

Cost-Benefit Analysis↗
PubMed1988

Smoking cessation strategies and evaluation.

The success of smoking cessation interventions appears to be most closely related to the amount of positive reinforcement that the smoker receives for not smoking (unpublished data). The goal of the clinic is to reinforce not smoking over the longest period of time. The program outlined focuses on helping the smoker who wants to stop smoking, it demands a minimal amount of time from the physician and it is self-supporting. If these guidelines are followed, the physician should find that helping the smokers who want help to stop smoking is a productive and rewarding experience.

Costs and Cost Analysis↗
PubMed1987

Smoking patterns among social contacts of smokers, ex-smokers, and never smokers: the Doctors Helping Smokers Study.

Smoking status of spouses/partners and other social contacts was examined among 5,241 adults who had recently visited a family physician. Associations between smoking status and proportion of social contacts who smoke among men and women of three different age groups were assessed by analysis of covariance, with age and education as covariates. The proportion of smoking contacts was found to be greatest for smokers, less for ex-smokers, and least for never smokers. Comparison of data across four types of social contacts by smoking groups suggests that, in general, the social contacts of ex-smokers more strongly resemble those of never smokers than those of current smokers. The results suggest that smokers desiring to become nonsmokers need to enlarge their social group to include more nonsmoking contacts, as well as to learn and use coping strategies to prevent relapse in the presence of smokers.

Adolescent↗
PubMed1987

Assessment by patients of their health education needs.

One hundred ninety-two patients of three family practice clinics were surveyed about their health information needs. The largest gaps between present and desired knowledge were in cardiopulmonary resuscitation and immunizations. Other major differences concerned mind/body relationships, health risk reduction, coverage of health care costs and nonprescription medications. There was little knowledge discrepancy with regard to the problem for which the patients saw their physicians. This technique is recommended as a way for clinics to target their patient education efforts more effectively.

Ambulatory Care Facilities↗