Improving preventive health care in a medical resident practice.

BACKGROUND: The ambulatory care resident practice is an opportunity to enhance the skills, knowledge, and attitudes for effective provision of preventive health services (PHS). OBJECTIVE: To determine whether a required intervention at a university medical resident practice would lead to improved performance of 6 secondary PHS. METHODS: A sequentially randomized chart analysis was performed at 2 clinics, a collaborative nurse practitioner practice (NP) and a resident practice (RP) to determine performance rate of secondary PHS (pelvic, prostate, and breast examinations, stool guaiac testing, mammography, and prostate-specific antigen determination). A significantly lower (36.9%) PHS performance rate was noted in the RP compared with 84.5% in NP for all 6 secondary PHS studied. An intervention was implemented in the RP: following every resident-patient clinic encounter a discussion and documentation of the patient's PHS status was required as part of the assessment and plans of management. At the end of 1 year the effect of this intervention on performance rates of the 6 PHS in the RP was analyzed. RESULTS: There was a statistically significant difference (P < .001) between the PHS performance rates of NP and RP at the beginning. The intervention resulted in improved PHS performance rates in the RP; compared with the NP at the end of the study no statistical difference was noted between the groups. CONCLUSIONS: Despite various task force recommendations, PHS performance rates are generally suboptimal in varied clinic settings, including those of resident practices in teaching hospitals. Physicians and residents believe in the importance of health maintenance but fall short of their ideal in practice. Interventions to improve performance rates have been described; we are detailing a simple, inexpensive, and practical method that achieved positive results.

Thyrotoxicosis in Ugandan Africans.

A retrospective 5 year study of thyrotoxicosis at Mulago Hospital, Uganda is presented. 30 cases were analysed and features pertaining to the clinical pattern are described. Comment is made on 5 cases which had associated cardiovascular abnormalities. The increased incidence of the condition in Uganda and other parts of Africa is noted. It is suggested that this may provide the opportunity for workers to follow up larger series, and assess the clinical, epidemiological and immunological aspects of the disease which could provide important clues as regards the genesis of thyrotoxicosis.

Delivery of preventive healthcare to older African-American patients: a performance comparison from two practice models.

While there is an increasing recognition by primary care providers of the importance of preventive health services (PHS), the delivery of such services has in general been substandard in many ambulatory care settings. Patient sociodemographic status and the structural and operational procedures of different clinic models are all believed to affect delivery of PHS. We conducted a 2-year, retrospective, sequentially randomized chart analysis of African-American patients above age 50, comparing primary, secondary, and tertiary PHS performance rates in two practice models: a medicine resident/faculty physician clinic (MR) and a nurse practitioner/faculty physician clinic (NP). Sociodemographics, disease profile, and PHS completion rates from 132 NP and 111 MR patient charts were abstracted. Apart from age, sociodemographic features were similar in both patient groups. While there were differences between clinics with regards to disease profiles (P < 0.05), and the higher number of diseases per patient (P < 0.0001) in the MR population, the NP collaborative practice had significantly better PHS performance. Rates of immunization (influenza/pneumococcal), pelvic/pap and prostate examinations, stool-guaiac testing, mammography, and functional assessment (activities of daily living, instrumental activities of daily living, and mental status testing) were > 90% in the NP and < 60% in MR patients. Although lower completion rates were found for dietary counseling (60%), auditory screening (36%), dental examination (41%), and obtaining advanced directives (24%) in the NP clinic, the rates were higher than those for the MR clinic. In this NP collaborative model, a high level of preventive health services was delivered while providing primary care to an older, inner city, African-American population of low socioeconomic means.

The ethics of information disclosure in HIV disease and cancer: a study of medical residents attitudes.

The study analyzes medical residents (MRs) attitudes on the ethics of information disclosure in two case scenarios--HIV disease and cancer. A purposeful sample of 120 MRs took part in a self-completion questionnaire administered. Responses were factor analyzed and three factors (17 statements) protecting rights of (1) spouse/family, (2) patient and (3) society, were retained for study. Analysis revealed that: (1) MRs perceived greater justification (P < 0.0001) in protecting family rights in HIV disease and patient rights (P < 0.0001) in cancer; (2) male MRs were significantly more inclined to protect spouse/family rights (P < 0.01) in HIV disease, when compared to female MRs; and (3) international MRs were significantly more inclined to protect spouse/family (P < 0.05) and societal rights (P < 0.01) in HIV disease, compared with United States MRs. Perception differences by MRs on ethics of information disclosure in HIV disease and cancer are based on MRs gender and their cultural background. It is important to document and address these attitudes during residency training.

Thyroid disease in Uganda.

A five-year retrospective study of thyroid disease in an Uganda hospital shows that about 67% of cases are due to goitrous hyperplasia, with colloid diffuse goitre twice as common as nodular goitre. It also notes that goitre rates in neighbouring countries are high, and suggests that a survey to assess its prevalence in Uganda is necessary. I deficiency as an etiological factor and the advantage of a national salt iodization programme are discussed. The rising incidence of thyrotoxicosis (11.4%) is in keeping with its increasing frequency elsewhere in Africa. The incidence of neoplastic diseases of the thyroid is low. Chronic thyroiditis was not seen.