Monday, December 17, 2012

The most popular posts of 2012

- Kenny Lin, MD

Although page views are only a surrogate measure of reader engagement, in a year that saw American Family Physician review the "Top 20 Research Studies of 2011 for Primary Care Physicians," I thought it appropriate to share the top 10 most popular AFP Community Blog posts of 2012. The top post, on screening intervals for osteoporosis, has been viewed more than 600 times.

1. How often should you screen for osteoporosis? (January 25)

Armed with this new information, family physicians and other primary care clinicians can now work to redirect testing resources to where they are needed most.

Since 80 percent of patients and family physicians perceive religion to be important, acknowledging and supporting spiritual beliefs is a key component of holistic, patient-centered care.

3. Curbing overuse of CT scans (January 11)

Use computed tomography only when it is likely to enhance patient health or change clinical care.

4. Prescribing opioids for chronic pain: avoiding pitfalls (August 22)

National surveys show that chronic pain is undertreated, but opioids often have serious adverse effects and can lead to dependence, addiction, and abuse.

What drives doctors to order tests that, in their hearts, they must know have a remote chance of being helpful?

6. Electronic health records may improve preventive care (July 11)

After 4 months, colorectal, breast, and cervical cancer screening rates had increased by an impressive 13 to 19 percent among personal health record users.

7. Rhythm or rate control for atrial fibrillation? (June 28)

Management of newly diagnosed atrial fibrillation should be individualized, and the risks and benefits of different strategies discussed in detail before making treatment decisions.

How long will take to change both of these practices to reflect the best evidence?

9. The state of family medicine is ... ? (February 13)

There aren't nearly enough of us to handle the projected millions of new patients who will be seeking primary care as the result of health reform.

Is it possible that patient satisfaction is driven by receiving more care, but not better care?

Sunday, December 2, 2012

Live from NAPCRG: how long does a cough last?

- Kenny Lin, MD

Although American Family Physician focuses on providing readers with clinical reviews and features that synthesize evidence into guidance for practice, our medical editors wear a variety of hats. In addition to serving as Deputy Editor of Evidence-Based Medicine at AFP, Dr. Mark Ebell is also an accomplished primary care researcher. Earlier today, at the annual meeting of the North American Primary Care Research Group (NAPCRG), he presented the findings from a study that provided an original take a seemingly simple question: how long does a cough last? This study compared patient expectations with a systematic review of the medical literature.

Dr. Ebell and his colleagues surveyed a sample of patients and consulted "Dr. Google" to determine public perceptions of how long a cough from an acute upper respiratory infection is supposed to last. Although estimates varied, the most common answer was one to two weeks. His team then proceeded to review the medical literature for studies of the natural history of acute cough, using the control groups from randomized trials testing an intervention such as an antibiotic. The weighted mean duration of cough in these patients was actually 17.8 days.

Since antibiotics are prescribed for at least 50 percent of patients who visit doctors for acute cough, Dr. Ebell suggested that the substantial discrepancy between patients' expectations and the actual duration of acute cough caused by respiratory infections may be a driver of excessive antibiotic prescribing. If more patients knew that a cough could normally last for two weeks or more, perhaps fewer of them would seek medical care for self-limited illness. An article in the November 1st issue of AFP provides evidence-based guidance on appropriate antibiotic use in upper respiratory tract infections.