Abstract:
PURPOSE:There is currently too few endoscopists to enact a national colorectal cancer screening program with colonoscopy. Primary care physicians could play an important role in filling this shortage by offering screening colonoscopy in their practice. The purpose of this study was to examine the safety and effectiveness of colonoscopies performed by primary care physicians. METHODS:We identified relevant articles through searches of MEDLINE and EMBASE bibliographic databases to December 2007 and through manual searches of bibliographies of each citation. We found 590 articles, 12 of which met inclusion criteria. Two authors independently abstracted data on study and patient characteristics. Descriptive statistics were performed. For each outcome measure, a random effects model was used to determine estimated means and confidence intervals. RESULTS:We analyzed 12 studies of colonoscopies performed by primary care physicians, which included 18,292 patients (mean age 59 years, 50.5% women). The mean estimated adenoma and adenocarcinoma detection rates were 28.9% (95% confidence interval [CI], 20.4%-39.3%) and 1.7% (95% CI, 0.9%-3.0%), respectively. The mean estimated reach-the-cecum rate was 89.2% (95% CI, 80.1%-94.4%). The major complication rate was 0.04% (95% CI, 0.01%-0.07%); no deaths were reported. CONCLUSIONS:Colonoscopies performed by primary care physicians have quality, safety, and efficacy indicators that are comparable to those recommended by the American Society of Gastrointestinal Endoscopy, the American College of Gastroenterology, and the Society of American Gastrointestinal Endoscopic Surgeons. Based on these results, colonoscopy screening by primary care physicians appears to be safe and effective.
journal_name
Ann Fam Medjournal_title
Annals of family medicineauthors
Wilkins T,LeClair B,Smolkin M,Davies K,Thomas A,Taylor ML,Strayer Sdoi
10.1370/afm.939subject
Has Abstractpub_date
2009-01-01 00:00:00pages
56-62issue
1eissn
1544-1709issn
1544-1717pii
7/1/56journal_volume
7pub_type
杂志文章,meta分析,评审abstract:PURPOSE:Bacterial pathogens are assumed to cause an illness course different from that of nonbacterial causes of acute cough, but evidence is lacking. We evaluated the disease course of lower respiratory tract infection (LRTI) with a bacterial cause in adults with acute cough. METHODS:We conducted a secondary analysis...
journal_title:Annals of family medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1370/afm.1974
更新日期:2016-11-01 00:00:00
abstract:PURPOSE:Knowledge about the ways patients perceive their vulnerability to disease is important for communication with patients about risk and preventive health measures. This interview study aimed to explore how patients with a diagnosis of heterozygous familial hypercholesterolemia understand and perceive their vulner...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.529
更新日期:2006-05-01 00:00:00
abstract:PURPOSE:We hypothesized that antibiotic overuse for acute cough illness (ACI) is in part due to a mismatch between patients' expectations and the natural history of ACI. METHODS:We performed a population-based random digit dialing survey of 493 adults in Georgia to determine their expectations regarding the duration o...
journal_title:Annals of family medicine
pub_type: 杂志文章,评审
doi:10.1370/afm.1430
更新日期:2013-01-01 00:00:00
abstract:PURPOSE:Although screening with fecal occult blood testing (FOBT) reduces colorectal cancer (CRC) mortality, its effectiveness may diminish if patients do not adhere with repeated screenings. Among patients who had previously engaged in FOBT screening, we assessed subsequent adherence with FOBT screening. METHODS:We a...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.1133
更新日期:2010-09-01 00:00:00
abstract:PURPOSE:Automated office blood pressure monitoring during 30 minutes (OBP30) may reduce overtreatment of patients with white-coat hypertension in primary health care. OBP30 results approximate those of ambulatory blood pressure monitoring, but OBP30 is much more convenient. In this study, we compared OBP30 with routine...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.2041
更新日期:2017-03-01 00:00:00
abstract:PURPOSE:The health care system in the United States is inherently hierarchical. Patients are "nested" within physicians who in turn are "nested" within practices. Much of the research data gathered in practice-based research networks (PBRNs) also have similar patterns of nesting (clustering). When research data are nes...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.340
更新日期:2005-05-01 00:00:00
abstract::Behavioral change is at the heart of effective primary care, but when patients don't change, how do we account for our days? In this personal essay, I relate an encounter with a patient who wants to quit smoking, lose weight, and control her diabetes. I am discouraged when she deflects my recommendations, but a collea...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.1781
更新日期:2015-05-01 00:00:00
abstract:PURPOSE:We aimed to identify the strategies used to support patient behavior change by clinicians whose patients had an increase in patient activation. METHODS:This mixed methods study was conducted in collaboration with Fairview Health Services, a Pioneer Accountable Care Organization. We aggregated data on the chang...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.1904
更新日期:2016-03-01 00:00:00
abstract:PURPOSE:Describe the duration of symptoms, proportion of parents seeking primary care consultations, and costs for respiratory tract infections (RTIs) of children in the community. METHODS:Community-based, online, prospective inception cohort study. General practitioners from socioeconomically diverse practices posted...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.2327
更新日期:2019-01-01 00:00:00
abstract:PURPOSE:Practice transformation in primary care is a movement toward data-driven redesign of care, patient-centered care delivery, and practitioner activation. A critical requirement for achieving practice transformation is availability of tools to engage practices. METHODS:A total of 48 practices with 109 practice si...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.2382
更新日期:2019-08-12 00:00:00
abstract::Cultural values and beliefs about the primary care physician bolster the myth of the lone physician: a competent professional who is esteemed by colleagues and patients for his or her willingness to sacrifice self, accept complete responsibility for care, maintain continuity and accessibility, and assume the role of l...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.1353
更新日期:2012-03-01 00:00:00
abstract:PURPOSE:Multimorbidity is associated with adverse outcomes, yet research on the determinants of its incidence is lacking. We investigated which sociodemographic, health, and individual lifestyle (eg, physical activity, smoking behavior, body mass index) characteristics predict new cases of multimorbidity. METHODS:We u...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.2271
更新日期:2018-07-01 00:00:00
abstract:PURPOSE:Targeted interventions to reduce the risk and increase the early detection of melanoma have the potential to save lives. We aimed to assess the effect of such an intervention on patient prevention behavior. METHODS:We conducted a pilot clustered randomized controlled trial, comparing a targeted screening and e...
journal_title:Annals of family medicine
pub_type: 杂志文章,随机对照试验
doi:10.1370/afm.1600
更新日期:2014-01-01 00:00:00
abstract:PURPOSE:Whether patients with 1 or more chronic illnesses are more or less likely to receive recommended preventive services is unclear and an important public health and health care system issue. We addressed this issue in a large national practice-based research network (PBRN) that maintains a longitudinal database d...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.1502
更新日期:2013-07-01 00:00:00
abstract:PURPOSE:In specialist care, fecal calprotectin (FCal) is a commonly used noninvasive diagnostic test for ruling out inflammatory bowel disease (IBD) in children with chronic gastrointestinal symptoms. The aim of this study was to evaluate the diagnostic accuracy of FCal for IBD in symptomatic children in primary care. ...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.1949
更新日期:2016-09-01 00:00:00
abstract::Provider continuity is in need of an expanded definition that is not exclusively clinician centered. Currently, provider continuity is defined by visits over time to the same clinician. Many patients and informal caregivers, however, are co-providers of health care, not merely consumers. As a result, provider continui...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.115
更新日期:2004-09-01 00:00:00
abstract::Tobacco use, lack of physical activity and poor diet, and alcohol consumption are leading causes of death in the United States. We estimated screening and counseling rates by using a nationally representative sample of adults aged 35 years and older with a preventive care supplement to the 2014 Medical Expenditure Pan...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.2363
更新日期:2019-03-01 00:00:00
abstract:BACKGROUND:We wanted to identify differences between diabetic patients who smoke and those who do not smoke to design more effective strategies to improve their diabetes care and encourage smoking cessation. METHODS:A random sample of adult health plan members with diabetes were mailed a survey questionnaire, with tel...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.36
更新日期:2004-01-01 00:00:00
abstract:BACKGROUND:We wanted to determine the frequency of self-reported receipt of screening mammography and Papanicolaou (Pap) tests in older women and investigate important predictors of utilization, based on 2 national longitudinal surveys. METHODS:This cohort study includes participants from 4 waves (1994-2000) of the He...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.54
更新日期:2003-11-01 00:00:00
abstract:PURPOSE:Practice transformation is the cornerstone of the future of family medicine and health care reform, but little is known about how the process occurs. We sought to develop and test a model of the natural history of practice transformation. METHODS:We developed an outcomes-based model of how a practice moves thr...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.1497
更新日期:2013-05-01 00:00:00
abstract:PURPOSE:The purpose of this study was to characterize graduates of family medicine (FM) residencies from 1994 to 2017 and determine whether they continue to practice family medicine after residency. METHOD:We sampled physicians who completed FM residency training from 1994-2017 using 2017 American Medical Association ...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.2535
更新日期:2020-07-01 00:00:00
abstract:PURPOSE:Though evidence supports the value of community health workers (CHWs) in chronic disease self-management support, and authorities have called for expanding their roles within patient-centered medical homes (PCMHs), few PCMHs in Minnesota have incorporated these health workers into their care teams. We undertook...
journal_title:Annals of family medicine
pub_type: 杂志文章,多中心研究
doi:10.1370/afm.2171
更新日期:2018-01-01 00:00:00
abstract:PURPOSE:Although screening for unipolar depression is controversial, it is potentially an efficient way to find undetected cases and improve diagnostic acumen. Using a reference standard, we aimed to validate the 2- and 9-question Patient Health Questionnaires (PHQ-2 and PHQ-9) in primary care settings. The PHQ-2 compr...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.1139
更新日期:2010-07-01 00:00:00
abstract:PURPOSE:Peer health coaches offer a potential model for extending the capacity of primary care practices to provide self-management support for patients with diabetes. We conducted a randomized controlled trial to test whether clinic-based peer health coaching, compared with usual care, improves glycemic control for lo...
journal_title:Annals of family medicine
pub_type: 杂志文章,随机对照试验
doi:10.1370/afm.1443
更新日期:2013-03-01 00:00:00
abstract::Two voices tell the story of an evolving doctor-patient relationship. Seizures are the first indication of squamous cell lung cancer metastatic to the brain. Both doctor and patient describe the course of the illness, treatment, and remarkable recovery, each from his own perspective. The patient describes how the canc...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.9
更新日期:2003-05-01 00:00:00
abstract:PURPOSE:Unexplained gastrointestinal symptoms are more common in adults who recall abuse as a child; however, data available on children are limited. The aim of this study was to investigate the association of childhood maltreatment and early development of gastrointestinal symptoms and whether this relation was mediat...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.1053
更新日期:2010-03-01 00:00:00
abstract:PURPOSE:Up to 50% of urinary tract infections (UTIs) in young children are missed in primary care. Urine culture is essential for diagnosis, but urine collection is often difficult. Our aim was to derive and internally validate a 2-step clinical rule using (1) symptoms and signs to select children for urine collection;...
journal_title:Annals of family medicine
pub_type: 杂志文章,多中心研究
doi:10.1370/afm.1954
更新日期:2016-07-01 00:00:00
abstract::Patient-choice cesarean delivery is increasing in the United States. The American College of Obstetricians and Gynecologists supports this option, citing ethical premises of autonomy and informed consent, despite a lack of evidence for its safety. This increase in patient-choice cesarean delivery occurs during a time ...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.537
更新日期:2006-05-01 00:00:00
abstract:PURPOSE:Hot tea and coffee have been found to have antimicrobial properties. The purpose of this study was to determine whether the consumption of tea, coffee, or both is associated with less frequent nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA). METHODS:We performed a secondary analysis of dat...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.1262
更新日期:2011-07-01 00:00:00
abstract:PURPOSE:Patient ratings of physician's patient-centered communication are used by various specialty credentialing organizations and managed care organizations as a measure of physician communication skills. We wanted to compare ratings by real patients with ratings by standardized patients of physician communication. ...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.643
更新日期:2007-03-01 00:00:00