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Marjorie S Rosenthal

Publications and source records attributed to Marjorie S Rosenthal.

5 recordsLinked to original sources
PubMed2005

A randomized trial of practice-based education to improve delivery systems for anticipatory guidance.

BACKGROUND: Communication between physicians and patients is an important component of medical encounters and has been identified by the Institute of Medicine as a point of intervention to increase quality of care. In pediatric health maintenance visits, substantial recommended communication, in the form of anticipatory guidance, is not provided. OBJECTIVE: To examine the effectiveness of an intervention of continuing medical education and process improvement methods to implement "office systems" to improve the delivery of anticipatory guidance for parents of young children. METHODS: We performed a randomized controlled trial of a practice-based quality improvement intervention among 44 pediatric practices in North Carolina. In the 22 intervention practices, project staff coached practice staff in auditing performance and identifying, testing, and implementing new care processes to improve delivery of anticipatory guidance. We surveyed parents of 1-month-olds and 6-month-olds regarding their recollection of anticipatory guidance as well as parent knowledge and parent behaviors and used cluster analysis to determine the effects of the intervention. RESULTS: The proportion of parents of 1-month-olds who reported that they received all age-appropriate anticipatory guidance changed from 15.9% (95% confidence interval [CI], 8.9%-26.7%) to 10.0% (95% CI, 5.1%-18.8%) in the control practices and from 7.3% (4.1%-12.9%) to 24.0% (95% CI, 14.6%-36.9%) in the intervention practices (difference between 2 differences, P = .002). The proportion of parents of 6-month-olds who reported that they received all age-appropriate anticipatory guidance changed from 8.2% (95% CI, 3.6%-17.8%) to 5.4% (95% CI, 2.8%-10.2%) in the control practices and from 2.2% (95% CI, 0.8%-5.9%) to 18.1% (95% CI, 10.3%-29.9%) in the intervention practices (difference between 2 differences, P = .001). There were no differences in self-reported parent knowledge and parent behavior. CONCLUSION: An office system intervention improved parent reports of quantity of anticipatory guidance but did not change parent knowledge or parent behavior. Future research should examine how to use systems improvement methods to improve the impact of anticipatory guidance.

Adult↗
PubMed2004

Pregnancy prevention in adolescents.

Although the pregnancy rate in adolescents has declined steadily in the past 10 years, it remains a major public health problem with lasting repercussions for the teenage mothers, their infants and families, and society as a whole. Successful strategies to prevent adolescent pregnancy include community programs to improve social development, responsible sexual behavior education, and improved contraceptive counseling and delivery. Many of these strategies are implemented at the family and community level. The family physician plays a key role by engaging adolescent patients in confidential, open, and nonthreatening discussions of reproductive health, responsible sexual behavior (including condom use to prevent sexually transmitted diseases), and contraceptive use (including the use of emergency contraception). This dialogue should begin before initial sexual activity and continue throughout the adolescent years.

Adolescent↗
PubMed2004

The effect of a literacy training program on family medicine residents.

BACKGROUND AND OBJECTIVES: Pediatric literacy promotion programs carried out in the primary care setting, such as Reach Out and Read (ROR), have been associated with improved language skills for preschool children. Primary care physicians have frequent contact with young families and may be well situated for a literacy promotion program for both children and adults. We examined whether introducing ROR and an adult literacy intervention improves family medicine residents' literacy knowledge, attitudes, and practices. METHODS: We conducted a single group pretest/posttest evaluation design study of residents in a family medicine residency program serving low-income families. Residents completed self-administered questionnaires assessing literacy knowledge, attitudes, and practice. Then, through educational conferences, precepting, and ROR, residents were trained to assess and counsel patients about literacy. The same questionnaire was readministered 8 months later. RESULTS: All 24 (100%) residents completed both the pre- and post-intervention questionnaires. Literacy knowledge mean scores increased from 74.5% to 83.1%. After the intervention, residents reported a greater sense of comfort in counseling about childhood and adult literacy. After the intervention, a greater proportion of residents reported usually or always asking about literacy milestones (30.2% to 79.2%) and parent-child reading (65.2% to 97.8%) during well-child visits. CONCLUSIONS: A family literacy promotion program improved family medicine residents' self-reported literacy knowledge, attitudes, and practices. Such interventions can be incorporated into the education of family medicine residents with meaningful results.

Adult↗