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Am Fam Physician. 2000;62(12):2665-2666

Family Support Is Strongest Indicator of Self-Care Compliance

(52nd Annual Scientific Assembly of the American Academy of Family Physicians) According to results of a cross-sectional study of 357 consecutive adults with type 2 diabetes (formerly known as non–insulin-dependent diabetes) who presented to six family residency practice programs in San Antonio, social context (specifically family support) appears to be a more accurate predictor of self-care behaviors among patients with type 2 diabetes than patient demographics, stress or physician-patient relationship. Results of a patient-completed survey showed the following results regarding compliance in the following self-care behaviors: taking medication (63.5 percent), exercising (62 percent), testing blood sugar (33 percent) and following a diabetic diet (30 percent). The social context, which was indicated by response to the statement “My family understands my diabetes,” was strongly associated with patient adherence to diet, exercise and medication. Patient characteristics such as language preference, education level, marital status and satisfaction with the physician-patient relationship were not associated with any self-care behaviors; however, men were more likely than women to report that they exercised according to their physician's instructions. The researchers recommend that attempts by family physicians (who often provide care to multiple family members) to improve self-care behavior should include family members of the patient with diabetes.—teresa l. albright, m.d., Christas Spohn Memorial Hospital, Corpus Christi, Texas.

Majority of Pregnant Women Want Prenatal Ultrasound

(American Academy of Family Physicians) According to results of a study conducted at a large military care center, 98 percent of women want an average of 2.5 prenatal ultrasounds during their pregnancy, many are willing to pay for the examination out-of-pocket, and their reasons for wanting an ultrasound are similar across demographic groups (including age, race, rank and duty status). The study consisted of 137 of 150 consecutive routine prenatal patients at a military care center who agreed to participate. Of the 137 women, 135 wanted a prenatal ultrasound. The most commonly cited reasons for wanting an ultrasound were to determine the sex of the fetus; to ensure the health of the fetus; general maternal reassurance; and to ensure that there was adequate fetal growth. Thirty-seven percent of respondents indicated a willingness to pay out-of-pocket for the ultrasound examination. Currently, as many as 70 percent of women undergo ultrasonography during their pregnancy at an annual cost of more than $1 billion, but the medical utility of routine prenatal ultrasound examinations is debatable.—mark b. stephens, m.d., m.s., Uniformed Services University of Health Services, Bethesda, Maryland.

Study Reveals Perceptions of Smoking in a Specific Population

(American Academy of Family Physicians) The smoking prevalence among a population of male patients 12 years or older in Saudi Arabia is quite high, and those who are smokers are aware of the dangers smoking poses to themselves and others, want to or have tried to quit smoking but have failed for a variety of reasons, and think that a physician intervention would improve their chances of quitting. This is according to results of a questionnaire study of all male patients 12 years or older presenting to family and community medicine clinics at Alkharj Military Hospital in Saudi Arabia for any reason during a 30-day period. Of the 634 patients, 218 (34.4 percent) were current smokers, 104 (16.4 percent) were ex-smokers and 312 (49.2 percent) were non-smokers. Of the 162 (74.3 percent of current smokers) patients who had considered quitting, 121 (74.7 percent) had actually attempted to stop. The most common reasons cited for failed cessation included lack of willpower (34.0 percent), no precise reason for restarting (27.0 percent) and social problems (14.4 percent). A total of 144 of the current smokers (66.0 percent) listed friends' influence as the primary reason for starting to smoke. Most smokers (97.2 percent) acknowledged that smoking was harmful to them, and 84.9 percent knew that their second-hand smoke negatively affected other people. Eighty percent of patients agreed that special smoking clinics would be helpful for quitting smoking. The researchers conclude that opportunistic intervention by general practitioners can improve the success rates of their patients' efforts to quit smoking. —saima siddiqui, m.d., Alkharj Military Hospital, Saudi Arabia.

Revised PPIP Flow Sheet Improves Physician Use and Satisfaction

(American Academy of Family Physicians) Use of a revised version of the “Put Prevention into Practice” (PPIP) preventive care flow sheet significantly improved physician completion rates and satisfactions levels. This is according to results of a convenience sample of 200 outpatient records before and after a performance improvement intervention and a written satisfaction survey of participating physicians in an urban, Midwestern, community-based family practice residency program. The participants were faculty and resident physicians and outpatient staff of the residency program. Completion by physicians of the preventive care flow sheets improved from a baseline of 9.4 percent to 58.4 percent after revision of the form. Seventy-three percent of physicians found the revised form easier to use than the original PPIP format. The format of the PPIP preventive care flow sheet was simplified to more clearly express age-specific recommendations. PPIP is a preventive care program of the Agency for Healthcare Research and Quality, formerly the Agency for Health Care Policy and Research.—tana l. goering, m.d., University of Kansas School of Medicine, Wichita, Kansas.

High-Risk Asthma Patients Need to Be Identified in Hawaii

(American Academy of Family Physicians) Populations at high-risk of asthma mortality are prevalent in Hawaii and the continental United States, but the magnitude of high-risk asthma is much greater in Hawaii among older age groups, females, minorities (including Polynesians/Hawaiians, Pacific Islanders, Filipinos and others), and in certain regions (such as Central Oahu and Windward Oahu). This is according to an analysis of Hawaii's state and federal asthma mortality and populational raw data from 1879 to the 1990s. Researchers state that these findings have led them to recommend that physicians identify patients who are at higher risk and consider the following therapeutic actions: lower the threshold for use of steroids or referral if appropriate; take more time to assess and educate the patient; have closer follow-up; acknowledge cultural barriers; simplify medication regimens; administer pneumococcal and influenza vaccines; and refer to pulmonologist or allergist for desensitization. They also recommend that patients with asthma be made aware of possible asthma exacerbations when visiting Hawaii.—bradley e. hope, m.d., Waialua, Hawaii.

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