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Federally Qualified Health Centers and Private Practice Performance on Ambulatory Care Measures

July 11, 2012 Comments off

Federally Qualified Health Centers and Private Practice Performance on Ambulatory Care Measures (PDF)

Source: American Journal of Preventive Medicine

Background:

The 2010 Affordable Care Act relies on Federally Qualifıed Health Centers (FQHCs) and FQHC look-alikes (look-alikes) to provide care for newly insured patients, but ties increased funding to demonstrated quality and effıciency.

Purpose:

To compare FQHC and look-alike physician performance with private practice primary care physicians (PCPs) on ambulatory care quality measures.

Methods:

The study was a cross-sectional analysis of visits in the 2006 –2008 National Ambulatory Medical Care Survey. Performance of FQHCs and look-alikes on 18 quality measures was compared with private practice PCPs. Data analysis was completed in 2011.

Results:

Compared to private practice PCPs, FQHCs and look-alikes performed better on six measures (p 0.05); worse on diet counseling in at-risk adolescents (26% vs 36%, p 0.05); and no differently on 11 measures. Higher performance occurred in ACE inhibitors use for congestive heart failure (51% vs 37%, p 0.004); aspirin use in coronary artery disease (CAD) (57% vs 44%, p 0.004); -blocker use for CAD (59% vs 47%, p 0.01); no use of benzodiazepines in depression (91% vs 84%, p 0.008); blood pressure screening (90% vs 86%, p 0.001); and screening electrocardiogram (EKG) avoidance in low-risk patients (99% vs 93%, p 0.001). Adjusting for patient characteristics yielded similar results, except that private practice PCPs no longer performed better on any measures.

Conclusions:

FQHCs and look-alikes demonstrated equal or better performance than private practice PCPs on select quality measures despite serving patients who have more chronic disease and socioeconomic complexity. These fındings can provide policymakers with some reassurance as to the quality of chronic disease and preventive care at Federally Qualifıed Health Centers and look-alikes, as they plan to use these health centers to serve 20 million newly insured individuals.

See: When Public Beats Private: Community Clinics That Keep Costs Down and Do a Better Job, Too (The Atlantic)

Categories: American Journal of Preventive Medicine, health and health care, health care providers, health care reform

Obesogenic Neighborhood Environments, Child and Parent Obesity: The Neighborhood Impact on Kids Study

April 18, 2012 Comments off
Source:  American Journal of Preventive Medicine
Background: Identifying neighborhood environment attributes related to childhood obesity can inform environmental changes for obesity prevention. Purpose: To evaluate child and parent weight status across neighborhoods in King County (Seattle metropolitan area) and San Diego County differing in GIS-defıned physical activity environment (PAE) and nutrition environment (NE) characteristics.
Methods: Neighborhoods were selected to represent high (favorable) versus low (unfavorable) on the two measures, forming four neighborhood types (low on both measures, low PAE/high NE, high PAE/low NE, and high on both measures). Weight and height of children aged 6–11 years and one parent (n 730) from selected neighborhoods were assessed in 2007–2009. Differences in child and parent overweight and obesity by neighborhood type were examined, adjusting for neighborhood-, family-, and individual-level demographics.
Results: Children from neighborhoods high on both environment measures were less likely to be obese (7.7% vs 15.9%, OR 0.44, p 0.02) and marginally less likely to be overweight (23.7% vs 31.7%, OR 0.67, p 0.08) than children from neighborhoods low on both measures. In models adjusted for parent weight status and demographic factors, neighborhood environment type remained related to child obesity (high vs low on both measures, OR 0.41, p 0.03). Parents in neighborhoods high on both measures (versus low on both) were marginally less likely to be obese (20.1% vs 27.7%, OR 0.66, p 0.08), although parent overweight did not differ by neighborhood environment. The lower odds of parent obesity in neighborhoods with environments supportive of physical activity and healthy eating remained in models adjusted for demographics (high vs low on the environment measures, OR 0.57, p 0.053).
Conclusions: Findings support the proposed GIS-based defınitions of obesogenic neighborhoods for children and parents that consider both physical activity and nutrition environment features.
Categories: American Journal of Preventive Medicine, children and families, housing and real estate, obesity, public health, social and cultural issues, sports, recreation, leisure

Developing Consumer-Centered, Nonprescription Drug Labeling

May 5, 2011 Comments off

Developing Consumer-Centered, Nonprescription Drug Labeling (PDF)
Source: American Journal of Preventive Medicine

Despite regulations in place since 1999, which require active ingredient information to be listed first in Drug Facts on all OTC products,6 the present study found that few participants knew acetaminophen is the active ingredient in Tylenol. Poor recognition of which products, both OTC and prescription, contain acetaminophen is not uncommon and has been found in other studies17,18 among patients seeking medical attention for a complaint of pain. Americans commonly identify OTC pain relievers by brand name rather than generic (or active ingredient) name.19 Recognition of the brand name instead of the active ingredient has the potential for serious consequences for consumers with the large number of products containing acetaminophen available today yet marketed under different brand names.

The finding that many individuals self-reported failing to routinely look at OTC labeling presents a challenge to OTC manufacturers in communicating risks and instructions to ensure the safe use of their products. Several participants offered prior experience with the medicine as a reason for failing to read labeling, indicating that new information appearing on the label has to be unique or appear different to draw their attention. Icons, in particular, may hold promise as visual aids to attract consumer attention to key active ingredient, risk, and maximum dose information located on text-heavy product labels.
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Categories: American Journal of Preventive Medicine, consumer issues, health and health care, public safety
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