Practice redesign to improve care for falls and urinary incontinence: primary care intervention for older patients.

BACKGROUND: In primary care, medical care for age-associated conditions, such as falls and urinary incontinence (UI), is inadequate. In collaboration with the American College of Physicians, we augmented the Assessing Care of Vulnerable Elders practice redesign intervention to improve falls and UI care. METHODS: We performed a controlled trial in 5 nonrandomly selected primary care intervention (26 physicians across sites) and control (18 physicians) practices from diverse communities. Patients 75 years and older who screened positive for falls or fear of falling and UI were included in the study. We conducted a multicomponent intervention between October 30, 2006, and December 31, 2007, that included efficient collection of data, medical record prompts, patient education materials, and physician decision support. Main outcome measures were quality of care for falls and UI comparing intervention and control sites. RESULTS: Of 6051 patients screened, 2847 (47.1%) screened positive for falls or UI (46.1% in the intervention group and 48.8% in the control group). Across the 5 practices, 1211 patient medical records were evaluated after stratified random selection. Intervention patients received 60.0% of recommended care for falls vs 37.6% provided by control health care professionals (P < .001). Similarly, intervention health care professionals provided more recommended care for UI (47.2% vs 27.8%, P < .001). Intervention health care professionals more often performed a falls history, orthostatic blood pressure measurement, gait and balance examination, and UI history and tried UI behavioral treatments first. Knowledge about falls and UI increased more among intervention than control group health care professionals. CONCLUSIONS: Practice redesign can improve the care that community-based primary care physicians provide for older patients with falls and UI. Outcomes of such care improvements require further evaluation.

Comparison of fingerstick versus venipuncture for antibody testing of measles and rubella.

The aim of this study was to determine whether the fingerstick method of obtaining blood is an acceptable alternative to venipuncture for measuring antibody levels. Blood specimens for antibody determination were obtained from healthy adult subjects by venipuncture with the serum separated from the clot by standard methodology. Fingerstick samples were also obtained by piercing the second or third finger and collected in Microtainer serum separator tubes. The serum was then separated by centrifugation, and all specimens were immediately stored at -80 degrees C until assayed. There was an excellent correlation between sera collected from fingerstick and venipuncture for both measles and rubella antibody assays. For the measles enzyme immunoassay (EIA), 85% of subjects were immune, and the correlation coefficient between the fingerstick and the venipuncture results was 0.98 using least squares linear regression. For the rubella EIA, 100% of subjects were immune, and the correlation coefficient was 0.83. Both methods showed the same number of immunopositive individuals; furthermore, there were no cases of immunity to either virus that were detected in only 1 fluid source. There was no significant difference in antibody levels from blood obtained by either method.