Optimal training in communication model (OPTiCOM): A programmatic roadmap.

OBJECTIVES: Teaching primary care residents patient communication skills is essential, complex, and impeded by barriers. We find no models guiding faculty how to train residents in the workplace that integrate necessary system components, the science of physician-patient communication training and competency-based medical education. The aim of this project is to create such a model. METHODS: We created OPTiCOM using four steps: (1) communication educator interviews, analysis and theme development; (2) initial model construction; (3) model refinement using expert feedback; (4) structured literature review to validate, refine and finalize the model. RESULTS: Our model contains ten interdependent building blocks organized into four developmental tiers. The Foundational value tier has one building block Naming relationship as a core value. The Expertize and resources tier includes four building blocks addressing: Curricular expertize, Curricular content, Leadership, and Time. The four building blocks in the Application and development tier are Observation form, Faculty development, Technology, and Formative assessment. The Language and culture tier identifies the final building block, Culture promoting continuous improvement in teaching communication. CONCLUSIONS: OPTiCOM organizes ten interdependent systems building blocks to maximize and sustain resident learning of communication skills. Practice Implications Residency faculty can use OPTiCOM for self-assessment, program creation and revision.

Effects of team care of frequent attenders on patients and physicians.

Frequent clinic attenders consume a large portion of health care resources while feeling underserved. At the same time, physicians are frustrated trying to adequately care for these patients. Previous trials of team care in primary care have rarely included control groups. Adults with eight or more clinic visits in the past year were nonrandomly assigned to usual care or team care. For the latter group, a Care Team met to review each case and create a care plan. Changes in patient health care use, well-being, and satisfaction from baseline to 6 months were compared between team care and usual care patients. In addition, Care Team members' perceptions of team care were assessed by quantitative and qualitative methods. Study patients were medically complex. Self-reported overall well-being and overall care satisfaction improved in the 12-patient team care group, but remained unchanged in the 8 patient usual care group. Median 6-month visits fell by 3 visits among team care patients and increased by 1.5 among usual care patients. Most Care Team members rated team care as positive and as improving quality of care. Members were divided on its effect on care efficiency and workload. Team care is feasible within a family medicine residency practice and may improve care.

Premenstrual exacerbation of depressive disorders in a community-based sample in the United States.

OBJECTIVE: No published epidemiologic study has examined premenstrual exacerbation of depressive disorders (PME-DD) in a representative sample. Knowledge gained should indicate the burden of illness, suggest whom to monitor, and facilitate diagnosis. The objectives were to 1) ascertain the prevalence and predictors of PME-DD; and 2) test competing hypotheses that PME-DD is related to a) severity or history of depression, b) menstrual cyclicity in females in general, or c) a methodological artifact. METHODS: Menstruating females (N = 900) from ages 13 to 53 living in urban or rural Illinois completed semi-structured psychiatric diagnostic interviews and rated symptoms of depression daily for two menstrual cycles; 58 had major depressive, dysthymic, or subclinical depressive disorders, and the remaining 842 were the non-depressed portion of the representative sample. RESULTS: Depressed females had 1.34 (95% confidence interval, 1.02-1.66) symptoms exacerbated premenstrually. The best model for predicting exacerbation contained only age. Older women more often had symptoms worsen. Symptoms during the follicular phase were most severe for clinically depressed, intermediate for subclinically depressed, and least severe for non-depressed participants, ps < 0.001. Consistent with the hypothesis that exacerbation is related to cyclicity in all females, the number of symptoms that became worse did not differ between groups, ps < 0.46. Given no symptoms in one cycle, the odds of having symptoms in the next cycle were 0.91. Only 56% of non-depressed females taking antidepressants were asymptomatic all month long; the remaining 44% still had symptoms premenstrually. CONCLUSIONS: Premenstrual exacerbation of depressive disorders is associated with deteriorated functioning over and above that already experienced by depressed females. Patients may be susceptible regardless of severity of depression, number of episodes, or remission status.

Breast cancer risk and screening: a comparison of lesbian and heterosexual women.

OBJECTIVES: Using data collected as part of the Multisite Women's Health Study, we examined the differences between lesbians and heterosexual women on objective breast cancer risk calculations using the Gail Model. Health risk behaviors and screening behaviors for breast cancer were also examined. It was hypothesized that lesbians would have higher objective cancer risk estimates and report more behavioral and screening risk factors for breast cancer than heterosexual women. METHODS: Secondary data analyses were conducted using data from a study of women's health conducted from 1994 to 1996. Using a cross sectional design, a convenience sample of lesbian (n = 550) and heterosexual (n = 279) women was recruited from Chicago, New York City and Minneapolis-St. Paul. Data were collected using a self-administered questionnaire. RESULTS: Estimates of 5-year and lifetime breast cancer risk were higher for lesbians compared to heterosexual women. Groups did not differ in self-perceptions of being overweight, but more lesbians reported heavier drinking and more reported abstinence from alcohol. Group differences in adherence to breast cancer screening were not significant. CONCLUSIONS: Findings suggest a small but statistically significant difference in the calculated breast cancer risk estimates of lesbian and heterosexual women, which seem to be largely accounted for by differences in reproductive risk factors.

Correlates of underutilization of gynecological cancer screening among lesbian and heterosexual women.

BACKGROUND: Study aims were to examine cervical cancer risk factors, screening patterns, and predictors of screening adherence in demographically similar samples of lesbian (N=550) and heterosexual women (N=279). METHODS: Data are from a multisite survey study of women's health conducted from 1994 to 1996. RESULTS: Differences in sexual behavior risk factors for cervical cancer were observed with lesbians reporting earlier onset of sexual activity (P<0.05), more sexual partners (P<0.001), and lower use of safer sex activities (P<0.01). Lesbian and heterosexual women were equally likely to have ever had a Pap test; however, lesbians were less likely to report annual (P<0.001) or routine (P<0.001) testing. Multivariate analyses were used to determine the associations between demographics, health care factors, health behaviors, and worry about health and screening behaviors. Individual predictors of never screening included younger age, lower income, and lack of annual medical visits. Independent predictors of both recent and annual screenings included history of an abnormal Pap test, being heterosexual, and annual medical visits. CONCLUSION: Data indicate that lesbians are at risk for cervical cancer, yet underutilize recommended screening tests. Findings have implications for research, education, and cancer control among lesbians.

Incorporating a Psychological Counselor in a Cancer Risk Assessment Program: Necessity, Acceptability, and Potential Roles.

Evidence suggests that cancer risk assessment may be associated with increased psychological distress. This exploratory study assessed the necessity and acceptability of incorporating psychological counseling into routine clinic procedures at a cancer risk program. Following a visit to a university-based cancer risk clinic, patients (N = 102) completed an anonymous self-report instrument. Participants reported experiencing current stress and anxiety (41%), depression (29%), and suicidal ideation (2%). Patients with a history of cancer were more likely to be experiencing current emotional difficulties. Sixty-nine percent of the participants found the visit with the psychological counselor to be helpful, while 41% of the participants reported interest in follow-up psychological services. Interest in receiving future psychological services was positively correlated with levels of anxiety, depression, and cancer worry. This pilot study demonstrates the acceptability and potential role for psychological counselors in increasing adjustment in high-risk patients undergoing genetic counseling for inherited cancers.