Researchers from Dartmouth offer a provocative glimpse into the possibilities of wireless mobile technology to measure elderly patients' physical activity and social interactions and improve detection of changes in their health. Sensors on a waist-mounted wireless mobile device worn by eight patients aged 65 and older continuously measured patients' time spent walking level, up or down an elevation, and stationary (sitting or standing), and time spent speaking with one or more other people. Researchers found that data from the mobile sensors correlated highly with results obtained using four established questionnaires, the 36-Item Short Form Health Survey, the Yale Physical Activity Survey, the Center for Epidemiologic Studies-Depression scale, and the Friendship Scale. Moreover, study participants found the device easy to use, comfortable to wear and more convenient than written questionnaires, which rely on recall and are more prone to biases. The authors conclude this quantitative robustness, combined with qualitative acceptance of the technology make automated inference of behavior using commonly available mobile devices potentially feasible and valid in older populations. They point out the resulting data could potentially link to patients' electronic health records, providing clinicians a rich, objective source of information that could alert them of changes in a patient's behavior before it is identified by family or caregivers.
An accompanying editorial examines the future applications of sensor-based monitoring as a tool for clinical care and medical research, and the roadblocks leading to its widespread adoption. The authors conclude ubiquitous sensing systems can provide important health insight with unprecedented fidelity and scope to both individuals and physicians.
Objective Measurement of Sociability and Activity: Mobile Sensing in the Community
By Ethan M. Berke, M.D., M.P.H., et al
The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, N.H., et al
The Potential of Sensor-Based Monitoring as a Health Care, Health Promotion, and Research Tool
By Kevin G. Stanley, Ph.D. and Nathaniel D. Osgood, Ph.D.
University of Saskatchewan, Canada
Even Minor Levels of Depression Associated with Reduced Employee Productivity
Depression is associated with lowered work function and loss of productivity among employees, and the degree of impairment increases the more severe depression symptoms are. Analyzing data on 771 employed patients with diagnosed depression, researchers found a strong linear relationship between depression symptom severity and productivity impairment, with even minor symptoms associated with considerable loss of productivity. Specifically, they found that for every one-point increase in patients' scores on the Patient Health Questionnaire 9-item screen, patients experienced an additional mean productivity loss of 1.65 percent. To reduce work loss and productivity impairment, the authors advise employers to promote evidence-based depression management programs to employees experiencing even minor depression.
Severity of Depression and Magnitude of Productivity Loss
By Ann Beck, Ph.D., et al
Kaiser Permanente, Denver, Colo.
Tea and Coffee Consumption Associated with Reduced MRSA Nasal Carriage
Researchers report an association between the consumption of hot tea or coffee and a decreased likelihood of methicillin-resistant Staphylococcus aureus nasal carriage, which studies have suggested may significantly increase the risk of systemic MRSA infection. Analyzing nationally representative data from the 2003-2004 National Health and Nutrition Examination Survey, researchers found that individuals who reported consuming hot tea were one-half as likely to have MRSA nasal carriage relative to individuals who drank no hot tea. Similarly, individuals who reported consuming coffee had about a one-half reduction in the risk of MRSA nasal carriage relative to individuals who drank no coffee. They conclude these findings raise the possibility of a new method of decreasing MRSA nasal carriage and potentially MRSA infection that is safe, inexpensive and easily accessible. While the mechanism behind the possible effect of coffee and tea is not completely understood, they point to increasing evidence to suggest that both coffee and tea have antimicrobial characteristics.
Tea and Coffee Consumption and MRSA Nasal Carriage
By Eric M. Matheson, M.D., M.S., et al
Medical University of South Carolina, Charleston
Researchers Find Modest Placebo Effects in Treatment of the Common Cold
Investigating placebo effects in treatment of the common cold, researchers find modest and nuanced effects related to receiving pills regardless of their content, especially among those who believe in a particular therapy. The four-armed trial (no pill, placebo, Echinacea blinded and Echinacea unblinded), which included 719 randomized participants aged 12 to 80 years, revealed that patients randomized to the no-pill group had longer and more severe illnesses than those who received pills, regardless of the pills' content. Specifically, those randomly assigned pills reported colds that were on average 0.16 to 0.69 days shorter and 8 to 17 percent less severe than those who didn't receive pills. Among those who believed in the efficacy of Echinacea and received pills, illnesses were substantively shorter and less severe, regardless of whether the pills contained the Echinacea. Specifically, those who received pills and rated Echinacea's effect highly had illnesses that were 1.31 to 2.58 days shorter and 26 to 29 percent less severe. The authors conclude these findings, which suggest small but meaningful effects related to expectation and pill allocation, support the idea that patients' beliefs and feelings about treatments should be taken into consideration when making medical decisions.
Placebo Effects and the Common Cold: A Randomized Controlled Trial
By Bruce Barrett, M.D., Ph.D., et al
University of Wisconsin, Madison
High Use of Specialty Care Strains Primary Care Physicians' Ability to Coordinate Care
When elderly patients with chronic conditions receive large amounts of outpatient specialty care, the ability of primary care clinicians to coordinate care in the traditional office setting seems to diminish. Analyzing data on 2,051 Medicare enrollees with select chronic conditions, researchers find a positive association between continuity and coordination for those patients with low levels of specialty care use (an increase of one standard deviation in continuity was associated with an increase of 2.71 in the Ambulatory Care Experiences Survey coordination scale), but not for patients who utilize specialty care at high levels. These findings provide evidence that coordinating care for an aging population with high levels of specialty care use entails additional work for primary care practices. The authors call for new methods of care provision that preempt gaps in continuity and coordination that may result from high specialty care use.
Patient-Reported Care Coordination: Associations With Primary Care Continuity and Specialty Care Use
By David T. Liss, M.A., et al
University of Washington, Seattle
Electronic Health Record Data More Complete Than Medicaid Claims Data
Analyzing data on more than 2,100 Medicaid patients from a network of 50 community health centers, researchers find electronic health record data provide a more comprehensive picture of preventive services delivery than Medicaid claims data. Notably, the following services were documented in EHRs but not in Medicaid claims: 49 percent of cholesterol screenings, 50 percent of influenza vaccinations, 50 percent of nephropathy screenings, and 48 percent of glycated hemoglobin tests. Medicaid claims data, they conclude, are likely to substantially underestimate the quality of care. They call for researchers, policy makers and payers to combine EHR and claims data sources to get the most complete picture of health services delivery, especially for populations who are discontinuously insured.
Electronic Health Records vs Medicaid Claims: Completeness of Diabetes Preventive Care Data in Community Health Centers
By Jennifer E. DeVoe, M.D., D.Phil., et al
Oregon Health and Science University, Portland
Nonspecific Abdominal Pain Common Complaint of Children Seen in Primary Care
Investigating nonspecific abdominal pain in children, researchers find that this common complaint is usually resolved in one to two visits without diagnostic tests or referral to a specialist. They also find that despite the lack of evidence for effectiveness, family physicians frequently prescribe laxatives and antidepressants for these patients. Analyzing data from the Second Dutch National Survey of General Practice, researchers found NSAP has an incidence rate of 25 per 1,000 person years, making it one of the 10 most commonly seen complaints of children in Dutch family practice. In the study's 1,480 children with newly diagnosed NSAP, less than 7 percent consulted more than twice for the problem. Family physicians referred these patients to specialist care in only 5 percent of visits, and they prescribed medication in 21 percent.
Childhood Nonspecific Abdominal Pain in Family Practice: Incidence, Associated Factors, and Management
By Marieke J. Gieteling, M.D., et al
Erasmus MC-University Medical Center, Rotterdam, The Netherlands
Intervention Unsuccessful in Improving Quality of Spirometry Tests by Family Practice Nurses
Investigating whether a combined intervention of e-learning and bimonthly performance feedback was able to improve the quality of spirometry tests by practice nurses in Dutch family practice, researchers found a small and late effect. Analysis of 1,135 tests found the average rate of adequate tests was only 33 percent in intervention and 30 percent in control group practices. In the intervention group, the adequacy of the tests tended to increase over time with rates of adequate tests in the fifth and final study period of 43 and 34 percent for the intervention and control groups, respectively. The authors conclude while there was a trend toward improved quality at the end of the observation period, this intervention does not appear to be able to compensate for the practice nurses' lack of rigorous training and experience in performing spirometry tests.
Effect of e-Learning and Repeated Performance Feedback on Spirometry Test Quality in Family Practice: A Cluster Trial
By Tjard R. Schermer, M.Sc., Ph.D., et al
Radboud University Nijmegen Medical Center, The Netherlands
Genetic Testing, Though Promising, Not the Best Way to Decrease Smoking-Related Health Disparities
Researchers weigh in on the potential of smoking-related genetic testing to increase smoking cessation rates. They conclude that although genetics offers increasing opportunities to tailor drug treatment and may in some cases provide useful risk prediction, reducing the prevalence of cigarette smoking, particularly amongst disadvantaged populations who constitute the majority of smokers, is an unlikely context for such added value. They assert there are other methods of personalizing health care using existing community- and individual-based tools that are more likely than genetics to yield greater benefit for decreasing smoking-related health disparities.
Personalized Medicine and Tobacco-Related Health Disparities: Is There a Role for Genetics?
By Chris Carlsten, M.D., M.P.H., et al
University of British Columbia, Vancouver, Canada
Researchers Validate New Screen for Mental Disorders in Primary Care
Researchers validate the COOP/WONCA Charts, a brief 6-item pictorial assessment for routine screening of mental disorders in primary care. When administered to 120 primary care patients, the tool had accuracy, sensitivity, specificity and predictive values ranging between 0.77 and 0.92 compared with previously validated questionnaires. Clinicians who administered the questionnaires rated its understandability, ease of use and clinical relevance as satisfactory. The authors conclude because the screen is friendly, brief, easily understood and can be administered and scored by all team members, it is a useful screening tool for the primary care setting where there are many competing demands and time constraints.
COOP/WONCA Charts as a Screen for Mental Disorders in Primary Care
By Joao Mazzoncini de Azevedo-Marques, et al
University of San Paulo, Brazil
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Annals of Family Medicine is a peer-reviewed, indexed research journal that provides a cross-disciplinary forum for new, evidence-based information affecting the primary care disciplines. Launched in May 2003, Annals is sponsored by seven family medical organizations, including the American Academy of Family Physicians, the American Board of Family Medicine, the Society of Teachers of Family Medicine, the Association of Departments of Family Medicine, the Association of Family Medicine Residency Directors, the North American Primary Care Research Group, and the College of Family Physicians of Canada. Annals is published six times each year and contains original research from the clinical, biomedical, social and health services areas, as well as contributions on methodology and theory, selected reviews, essays and editorials. Complete editorial content and interactive discussion groups for each published article can be accessed free of charge on the journal's Web site, www.annfammed.org.
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