North American Primary Care Research Group (NAPCRG)

NEW ORLEANS – Use of photo-aging software helped persuade young people to stop smoking in a small Australian study.

Oksana Burford, a lecturer and doctoral candidate in the School of Pharmacy at Curtin University in Perth, Western Australia, said that she and her colleagues were hoping to find a way to motivate young smokers to quit, as they are generally resistant to most messages. Previous studies have shown, however, that young people do respond to graphic imagery, she said at the annual meeting of the North American Primary Care Research Group.

Ms. Burford decided to test a software program that would show teens and young adults how they would look in their 50s and 60s if they continued to smoke. She used face-aging software – called April – which is marketed by Toronto-based Aprilage Inc.

That company was started in 1998 to help develop the software, which was created for an exhibit at the Ontario Science Center. The Roswell Park Cancer Institute in Buffalo, N.Y., also was very involved in developing the first version of April, and it has been used by many antismoking and substance abuse programs around the world, according to the company.

The photo-aging program is available to clinicians who want to use it in their offices, and individuals also can use the program on the web by visiting http://www.ageme.com/.

Ms. Burford conducted a randomized controlled study at eight pharmacy sites around Western Australia, targeting young smokers. About 1,500 were screened and 213 were deemed eligible for study. In the end, 160 participated – 80 in the control group and 80 in the intervention group. The participants were smokers, aged 18-30, and they had to give informed consent and be available for 6 months of telephone follow-up.

All participants were asked to complete a baseline questionnaire: 56 (70%) in the control group and 48 (60%) in the intervention group completed the form. All received a self-care guide on smoking. For the intervention group, Ms. Burford took a photo of each, downloaded it onto her laptop, and then showed them what they would look like as a smoker or a nonsmoker at age 55. They also were given the photo-aging results to have at home.

Ms. Burford and her colleagues followed up with all subjects by phone at 1, 3, and 6 months.

At 6 months, only 5 of the 80 people in the control group self-reported as nonsmokers. Only 1 of the 5 agreed to a breath test to confirm whether they had actually quit. Just 11 of the 22 in the intervention group who said they had quit agreed to the confirmatory test.

The researchers calculated a Fagerstrom score for all the participants at baseline and at 6 months. Most clinicians use a modified, six-question Fagerstrom quiz, which is a measure of physical dependence on nicotine. The higher the score, the more intense the dependence.

For the control group, 11 moved to a lower category (14%), 68 (85%) had no change, and 1 (1%) moved to a higher category. For the intervention group, 41 (51%) moved to a lower category (this was significant, with a P value of .0001), 39 (49%) had no change, and none moved to a higher group.

The researchers assumed that subjects who did not return follow-up calls continued to smoke, Ms. Burford said. Overall, one in seven smokers quit after viewing their photo-aged selves. Ms. Burford concluded that the software program is an effective motivator in getting young people to quit, but she noted some limitations of the study, including the lack of blinding for participants and researchers and the low number of breath-test verifications in the control group.

Ms. Burford reported no conflicts.

a.ault@elsevier.com

On Twitter @aliciaault

NEW ORLEANS – Use of photo-aging software helped persuade young people to stop smoking in a small Australian study.

Oksana Burford, a lecturer and doctoral candidate in the School of Pharmacy at Curtin University in Perth, Western Australia, said that she and her colleagues were hoping to find a way to motivate young smokers to quit, as they are generally resistant to most messages. Previous studies have shown, however, that young people do respond to graphic imagery, she said at the annual meeting of the North American Primary Care Research Group.

Ms. Burford decided to test a software program that would show teens and young adults how they would look in their 50s and 60s if they continued to smoke. She used face-aging software – called April – which is marketed by Toronto-based Aprilage Inc.

That company was started in 1998 to help develop the software, which was created for an exhibit at the Ontario Science Center. The Roswell Park Cancer Institute in Buffalo, N.Y., also was very involved in developing the first version of April, and it has been used by many antismoking and substance abuse programs around the world, according to the company.

The photo-aging program is available to clinicians who want to use it in their offices, and individuals also can use the program on the web by visiting http://www.ageme.com/.

Ms. Burford conducted a randomized controlled study at eight pharmacy sites around Western Australia, targeting young smokers. About 1,500 were screened and 213 were deemed eligible for study. In the end, 160 participated – 80 in the control group and 80 in the intervention group. The participants were smokers, aged 18-30, and they had to give informed consent and be available for 6 months of telephone follow-up.

All participants were asked to complete a baseline questionnaire: 56 (70%) in the control group and 48 (60%) in the intervention group completed the form. All received a self-care guide on smoking. For the intervention group, Ms. Burford took a photo of each, downloaded it onto her laptop, and then showed them what they would look like as a smoker or a nonsmoker at age 55. They also were given the photo-aging results to have at home.

Ms. Burford and her colleagues followed up with all subjects by phone at 1, 3, and 6 months.

At 6 months, only 5 of the 80 people in the control group self-reported as nonsmokers. Only 1 of the 5 agreed to a breath test to confirm whether they had actually quit. Just 11 of the 22 in the intervention group who said they had quit agreed to the confirmatory test.

The researchers calculated a Fagerstrom score for all the participants at baseline and at 6 months. Most clinicians use a modified, six-question Fagerstrom quiz, which is a measure of physical dependence on nicotine. The higher the score, the more intense the dependence.

For the control group, 11 moved to a lower category (14%), 68 (85%) had no change, and 1 (1%) moved to a higher category. For the intervention group, 41 (51%) moved to a lower category (this was significant, with a P value of .0001), 39 (49%) had no change, and none moved to a higher group.

The researchers assumed that subjects who did not return follow-up calls continued to smoke, Ms. Burford said. Overall, one in seven smokers quit after viewing their photo-aged selves. Ms. Burford concluded that the software program is an effective motivator in getting young people to quit, but she noted some limitations of the study, including the lack of blinding for participants and researchers and the low number of breath-test verifications in the control group.

Ms. Burford reported no conflicts.

a.ault@elsevier.com

On Twitter @aliciaault

NEW ORLEANS – Use of photo-aging software helped persuade young people to stop smoking in a small Australian study.

Oksana Burford, a lecturer and doctoral candidate in the School of Pharmacy at Curtin University in Perth, Western Australia, said that she and her colleagues were hoping to find a way to motivate young smokers to quit, as they are generally resistant to most messages. Previous studies have shown, however, that young people do respond to graphic imagery, she said at the annual meeting of the North American Primary Care Research Group.

Ms. Burford decided to test a software program that would show teens and young adults how they would look in their 50s and 60s if they continued to smoke. She used face-aging software – called April – which is marketed by Toronto-based Aprilage Inc.

That company was started in 1998 to help develop the software, which was created for an exhibit at the Ontario Science Center. The Roswell Park Cancer Institute in Buffalo, N.Y., also was very involved in developing the first version of April, and it has been used by many antismoking and substance abuse programs around the world, according to the company.

The photo-aging program is available to clinicians who want to use it in their offices, and individuals also can use the program on the web by visiting http://www.ageme.com/.

Ms. Burford conducted a randomized controlled study at eight pharmacy sites around Western Australia, targeting young smokers. About 1,500 were screened and 213 were deemed eligible for study. In the end, 160 participated – 80 in the control group and 80 in the intervention group. The participants were smokers, aged 18-30, and they had to give informed consent and be available for 6 months of telephone follow-up.

All participants were asked to complete a baseline questionnaire: 56 (70%) in the control group and 48 (60%) in the intervention group completed the form. All received a self-care guide on smoking. For the intervention group, Ms. Burford took a photo of each, downloaded it onto her laptop, and then showed them what they would look like as a smoker or a nonsmoker at age 55. They also were given the photo-aging results to have at home.

Ms. Burford and her colleagues followed up with all subjects by phone at 1, 3, and 6 months.

At 6 months, only 5 of the 80 people in the control group self-reported as nonsmokers. Only 1 of the 5 agreed to a breath test to confirm whether they had actually quit. Just 11 of the 22 in the intervention group who said they had quit agreed to the confirmatory test.

The researchers calculated a Fagerstrom score for all the participants at baseline and at 6 months. Most clinicians use a modified, six-question Fagerstrom quiz, which is a measure of physical dependence on nicotine. The higher the score, the more intense the dependence.

For the control group, 11 moved to a lower category (14%), 68 (85%) had no change, and 1 (1%) moved to a higher category. For the intervention group, 41 (51%) moved to a lower category (this was significant, with a P value of .0001), 39 (49%) had no change, and none moved to a higher group.

The researchers assumed that subjects who did not return follow-up calls continued to smoke, Ms. Burford said. Overall, one in seven smokers quit after viewing their photo-aged selves. Ms. Burford concluded that the software program is an effective motivator in getting young people to quit, but she noted some limitations of the study, including the lack of blinding for participants and researchers and the low number of breath-test verifications in the control group.

Ms. Burford reported no conflicts.

a.ault@elsevier.com

On Twitter @aliciaault

Primary care physicians’ assessments of the risks and benefits of cancer screening didn’t match with reality, based on the results of a survey of beliefs and behaviors around cancer risk.

"We were really surprised at the high percentage of physicians who were inaccurately estimating risk," said Dr. Laura-Mae Baldwin, professor of family medicine at the University of Washington, Seattle, who presented on behalf of her colleagues a slice of data from the survey of 3,200 physicians. "This has the potential for average-risk patients to receive unnecessary testing, and for high-risk patients to miss opportunities for prevention or early detection."

Alicia Ault/IMNG Medical Media

The cross-sectional national survey used the 2008 American Medical Association master file to randomly sample family physicians, general internists, and obstetrician-gynecologists. The physicians were all under age 65 and practiced in either a hospital or an office. They were contacted by mail, and given encouragement in the form of a $20 bill. In a second mailing, nonresponders received a written note from Dr. Baldwin. Overall, there was a 62% response rate: 591 family physicians, 414 general internists, and 569 ob.gyns. took part.

Survey participants were given a 12-page booklet with a particular patient vignette and a photo of the patient. The example included a medical and family history, along with age, race, sex, insurance status, and some other characteristics.

The researchers focused on ovarian cancer in particular because the Centers for Disease Control and Prevention, which funded the study, had a special interest in that cancer.

For instance, one vignette presented a 51-year-old white woman who came in because she wanted to be sure she was up to date on various tests. She had no medical problems, but had not seen a physician in 3 years. Her father had hypertension and her mother died of ovarian cancer at age 65. The other family history was negative, and there was an unremarkable physical exam.

The researchers had 258 variations for the different vignettes, varying age, race, insurance status, whether the patient asked for ovarian cancer screening, and family history. Physicians were asked to give their best estimate for this patient, and for other example patients, of risk for breast, ovarian, and colon cancer. They were asked to state whether the patient had a risk that was the same as that of the general population, somewhat higher, or much higher.

For a woman who was at the same risk as the general population for ovarian cancer, 72% of physicians were in agreement. However, 26% estimated the women were at somewhat higher risk and 1%, at much higher risk. For women at somewhat higher risk for ovarian cancer, however, 7% of physicians correctly assessed risk. Risk was assessed as somewhat higher or much higher by 90%, Dr. Baldwin reported at the annual meeting of the North American Primary Care Research Group.

For a woman at high risk for ovarian cancer, 35% of physicians correctly estimated that risk. Most physicians estimated risk as somewhat higher, but 11% thought her risk was the same as that for the general population.

The assessments of risk for colon cancer were similarly inaccurate. For the vignette of the woman at the same risk as the general population, 62% of physicians were on target, and 39% overestimated the risk.

There were no significant differences among the specialties, but ob.gyns. tended to be more accurate in their screening decisions, said Dr. Baldwin. An analysis showed that providers’ personal history with cancer influenced their recommended screening behaviors, said Dr. Baldwin. She did not present specific data on that issue.

The study did have some limitations in that physicians were given somewhat limited information about the patient’s risk. Dr. Baldwin said it’s important to study physician behaviors further, especially since so many in the survey underestimated risk in a woman who clearly was at high risk for ovarian cancer.

Primary care physicians’ assessments of the risks and benefits of cancer screening didn’t match with reality, based on the results of a survey of beliefs and behaviors around cancer risk.

"We were really surprised at the high percentage of physicians who were inaccurately estimating risk," said Dr. Laura-Mae Baldwin, professor of family medicine at the University of Washington, Seattle, who presented on behalf of her colleagues a slice of data from the survey of 3,200 physicians. "This has the potential for average-risk patients to receive unnecessary testing, and for high-risk patients to miss opportunities for prevention or early detection."

Alicia Ault/IMNG Medical Media

The cross-sectional national survey used the 2008 American Medical Association master file to randomly sample family physicians, general internists, and obstetrician-gynecologists. The physicians were all under age 65 and practiced in either a hospital or an office. They were contacted by mail, and given encouragement in the form of a $20 bill. In a second mailing, nonresponders received a written note from Dr. Baldwin. Overall, there was a 62% response rate: 591 family physicians, 414 general internists, and 569 ob.gyns. took part.

Survey participants were given a 12-page booklet with a particular patient vignette and a photo of the patient. The example included a medical and family history, along with age, race, sex, insurance status, and some other characteristics.

The researchers focused on ovarian cancer in particular because the Centers for Disease Control and Prevention, which funded the study, had a special interest in that cancer.

For instance, one vignette presented a 51-year-old white woman who came in because she wanted to be sure she was up to date on various tests. She had no medical problems, but had not seen a physician in 3 years. Her father had hypertension and her mother died of ovarian cancer at age 65. The other family history was negative, and there was an unremarkable physical exam.

The researchers had 258 variations for the different vignettes, varying age, race, insurance status, whether the patient asked for ovarian cancer screening, and family history. Physicians were asked to give their best estimate for this patient, and for other example patients, of risk for breast, ovarian, and colon cancer. They were asked to state whether the patient had a risk that was the same as that of the general population, somewhat higher, or much higher.

For a woman who was at the same risk as the general population for ovarian cancer, 72% of physicians were in agreement. However, 26% estimated the women were at somewhat higher risk and 1%, at much higher risk. For women at somewhat higher risk for ovarian cancer, however, 7% of physicians correctly assessed risk. Risk was assessed as somewhat higher or much higher by 90%, Dr. Baldwin reported at the annual meeting of the North American Primary Care Research Group.

For a woman at high risk for ovarian cancer, 35% of physicians correctly estimated that risk. Most physicians estimated risk as somewhat higher, but 11% thought her risk was the same as that for the general population.

The assessments of risk for colon cancer were similarly inaccurate. For the vignette of the woman at the same risk as the general population, 62% of physicians were on target, and 39% overestimated the risk.

There were no significant differences among the specialties, but ob.gyns. tended to be more accurate in their screening decisions, said Dr. Baldwin. An analysis showed that providers’ personal history with cancer influenced their recommended screening behaviors, said Dr. Baldwin. She did not present specific data on that issue.

The study did have some limitations in that physicians were given somewhat limited information about the patient’s risk. Dr. Baldwin said it’s important to study physician behaviors further, especially since so many in the survey underestimated risk in a woman who clearly was at high risk for ovarian cancer.

Primary care physicians’ assessments of the risks and benefits of cancer screening didn’t match with reality, based on the results of a survey of beliefs and behaviors around cancer risk.

"We were really surprised at the high percentage of physicians who were inaccurately estimating risk," said Dr. Laura-Mae Baldwin, professor of family medicine at the University of Washington, Seattle, who presented on behalf of her colleagues a slice of data from the survey of 3,200 physicians. "This has the potential for average-risk patients to receive unnecessary testing, and for high-risk patients to miss opportunities for prevention or early detection."

Alicia Ault/IMNG Medical Media

The cross-sectional national survey used the 2008 American Medical Association master file to randomly sample family physicians, general internists, and obstetrician-gynecologists. The physicians were all under age 65 and practiced in either a hospital or an office. They were contacted by mail, and given encouragement in the form of a $20 bill. In a second mailing, nonresponders received a written note from Dr. Baldwin. Overall, there was a 62% response rate: 591 family physicians, 414 general internists, and 569 ob.gyns. took part.

Survey participants were given a 12-page booklet with a particular patient vignette and a photo of the patient. The example included a medical and family history, along with age, race, sex, insurance status, and some other characteristics.

The researchers focused on ovarian cancer in particular because the Centers for Disease Control and Prevention, which funded the study, had a special interest in that cancer.

For instance, one vignette presented a 51-year-old white woman who came in because she wanted to be sure she was up to date on various tests. She had no medical problems, but had not seen a physician in 3 years. Her father had hypertension and her mother died of ovarian cancer at age 65. The other family history was negative, and there was an unremarkable physical exam.

The researchers had 258 variations for the different vignettes, varying age, race, insurance status, whether the patient asked for ovarian cancer screening, and family history. Physicians were asked to give their best estimate for this patient, and for other example patients, of risk for breast, ovarian, and colon cancer. They were asked to state whether the patient had a risk that was the same as that of the general population, somewhat higher, or much higher.

For a woman who was at the same risk as the general population for ovarian cancer, 72% of physicians were in agreement. However, 26% estimated the women were at somewhat higher risk and 1%, at much higher risk. For women at somewhat higher risk for ovarian cancer, however, 7% of physicians correctly assessed risk. Risk was assessed as somewhat higher or much higher by 90%, Dr. Baldwin reported at the annual meeting of the North American Primary Care Research Group.

For a woman at high risk for ovarian cancer, 35% of physicians correctly estimated that risk. Most physicians estimated risk as somewhat higher, but 11% thought her risk was the same as that for the general population.

The assessments of risk for colon cancer were similarly inaccurate. For the vignette of the woman at the same risk as the general population, 62% of physicians were on target, and 39% overestimated the risk.

There were no significant differences among the specialties, but ob.gyns. tended to be more accurate in their screening decisions, said Dr. Baldwin. An analysis showed that providers’ personal history with cancer influenced their recommended screening behaviors, said Dr. Baldwin. She did not present specific data on that issue.

The study did have some limitations in that physicians were given somewhat limited information about the patient’s risk. Dr. Baldwin said it’s important to study physician behaviors further, especially since so many in the survey underestimated risk in a woman who clearly was at high risk for ovarian cancer.

NEW ORLEANS – The cost of care may be more expensive at an internist’s office, but it appears that internists may do a better job than family physicians in offering preventive care services such as flu shots and cancer screenings.

That’s according to an observational study of some 30,000 adults who had an internist, family physician, or specialist as their usual source of care.

Alicia Ault/IMNG Medical Media

Dr. Joshua J. Fenton of the department of family and community medicine at the University of California, Davis, and his colleagues analyzed data from the Medical Expenditures Panel Survey from 2000 to 2008 and selected adults who responded that they had one of those physicians as a usual source of care in the previous year. Surgeons and ob.gyns were excluded because the authors wanted to study prostate cancer screening, in addition to other outcomes.

Previous research has consistently shown that internists and specialists have higher costs than family physicians, but there have been few data showing whether those higher costs are justified through the delivery of better care – specifically, better preventive care. The authors hypothesized that preventive care delivery would be similar across the three physician groups, Dr. Fenton said at the annual meeting of the North American Primary Care Research Group.

Of the 29,503 adults who were selected, 73% had a family physician as their usual source of care, 23% had an internist, and 4% a specialist. Those who received their care from an internist or specialist were slightly older, had a greater illness burden, had a higher income, and were more likely to live in urban areas, he said.

On an unadjusted basis, the annual care expenditures were $4,682 for those seeing an FP, $6,356 for an internist, and $9,147 for specialist. After adjusting for a variety of factors, including use of care in the previous year, the cost for internists was 10% more and for specialists was 33% more than the cost for family physicians.

People seeing an internist had significantly increased odds of receiving a flu shot in the study year, when compared with a family physician. The odds of getting a shot with a specialist were similar to those with a family physician.

For mammograms – 11,806 women had one during the study year – those with an internist were slightly more likely to get the screen. About 82% of those seeing an internist had a mammogram, compared with 79% of those seeing a family physician and 78% of those seeing a specialist. Pap smear screening rates were similar across the three physician groups, with about 82% getting the test.

Some 15,000 patients had an up-to-date colorectal screen – defined as a fecal occult test within the prior year or lower endoscopy within the previous 5 years. Rates were highest for internists, at 53%, compared with 48% of those seeing a family physician and 44% of those using a specialist.

Patients seeing an internist also had significantly increased odds of having a prostate-specific antigen test.

The study was limited by its cross-sectional and observational design, said Dr. Fenton, who also noted that it’s possible that some preventive care may have been delivered by providers other than the usual source of care.

The finding that internists delivered more preventive services, however, "raises some questions about cost-effectiveness and value," he said.

Dr. Fenton reported no conflicts.

NEW ORLEANS – The cost of care may be more expensive at an internist’s office, but it appears that internists may do a better job than family physicians in offering preventive care services such as flu shots and cancer screenings.

That’s according to an observational study of some 30,000 adults who had an internist, family physician, or specialist as their usual source of care.

Alicia Ault/IMNG Medical Media

Dr. Joshua J. Fenton of the department of family and community medicine at the University of California, Davis, and his colleagues analyzed data from the Medical Expenditures Panel Survey from 2000 to 2008 and selected adults who responded that they had one of those physicians as a usual source of care in the previous year. Surgeons and ob.gyns were excluded because the authors wanted to study prostate cancer screening, in addition to other outcomes.

Previous research has consistently shown that internists and specialists have higher costs than family physicians, but there have been few data showing whether those higher costs are justified through the delivery of better care – specifically, better preventive care. The authors hypothesized that preventive care delivery would be similar across the three physician groups, Dr. Fenton said at the annual meeting of the North American Primary Care Research Group.

Of the 29,503 adults who were selected, 73% had a family physician as their usual source of care, 23% had an internist, and 4% a specialist. Those who received their care from an internist or specialist were slightly older, had a greater illness burden, had a higher income, and were more likely to live in urban areas, he said.

On an unadjusted basis, the annual care expenditures were $4,682 for those seeing an FP, $6,356 for an internist, and $9,147 for specialist. After adjusting for a variety of factors, including use of care in the previous year, the cost for internists was 10% more and for specialists was 33% more than the cost for family physicians.

People seeing an internist had significantly increased odds of receiving a flu shot in the study year, when compared with a family physician. The odds of getting a shot with a specialist were similar to those with a family physician.

For mammograms – 11,806 women had one during the study year – those with an internist were slightly more likely to get the screen. About 82% of those seeing an internist had a mammogram, compared with 79% of those seeing a family physician and 78% of those seeing a specialist. Pap smear screening rates were similar across the three physician groups, with about 82% getting the test.

Some 15,000 patients had an up-to-date colorectal screen – defined as a fecal occult test within the prior year or lower endoscopy within the previous 5 years. Rates were highest for internists, at 53%, compared with 48% of those seeing a family physician and 44% of those using a specialist.

Patients seeing an internist also had significantly increased odds of having a prostate-specific antigen test.

The study was limited by its cross-sectional and observational design, said Dr. Fenton, who also noted that it’s possible that some preventive care may have been delivered by providers other than the usual source of care.

The finding that internists delivered more preventive services, however, "raises some questions about cost-effectiveness and value," he said.

Dr. Fenton reported no conflicts.

NEW ORLEANS – The cost of care may be more expensive at an internist’s office, but it appears that internists may do a better job than family physicians in offering preventive care services such as flu shots and cancer screenings.

That’s according to an observational study of some 30,000 adults who had an internist, family physician, or specialist as their usual source of care.

Alicia Ault/IMNG Medical Media

Dr. Joshua J. Fenton of the department of family and community medicine at the University of California, Davis, and his colleagues analyzed data from the Medical Expenditures Panel Survey from 2000 to 2008 and selected adults who responded that they had one of those physicians as a usual source of care in the previous year. Surgeons and ob.gyns were excluded because the authors wanted to study prostate cancer screening, in addition to other outcomes.

Previous research has consistently shown that internists and specialists have higher costs than family physicians, but there have been few data showing whether those higher costs are justified through the delivery of better care – specifically, better preventive care. The authors hypothesized that preventive care delivery would be similar across the three physician groups, Dr. Fenton said at the annual meeting of the North American Primary Care Research Group.

Of the 29,503 adults who were selected, 73% had a family physician as their usual source of care, 23% had an internist, and 4% a specialist. Those who received their care from an internist or specialist were slightly older, had a greater illness burden, had a higher income, and were more likely to live in urban areas, he said.

On an unadjusted basis, the annual care expenditures were $4,682 for those seeing an FP, $6,356 for an internist, and $9,147 for specialist. After adjusting for a variety of factors, including use of care in the previous year, the cost for internists was 10% more and for specialists was 33% more than the cost for family physicians.

People seeing an internist had significantly increased odds of receiving a flu shot in the study year, when compared with a family physician. The odds of getting a shot with a specialist were similar to those with a family physician.

For mammograms – 11,806 women had one during the study year – those with an internist were slightly more likely to get the screen. About 82% of those seeing an internist had a mammogram, compared with 79% of those seeing a family physician and 78% of those seeing a specialist. Pap smear screening rates were similar across the three physician groups, with about 82% getting the test.

Some 15,000 patients had an up-to-date colorectal screen – defined as a fecal occult test within the prior year or lower endoscopy within the previous 5 years. Rates were highest for internists, at 53%, compared with 48% of those seeing a family physician and 44% of those using a specialist.

Patients seeing an internist also had significantly increased odds of having a prostate-specific antigen test.

The study was limited by its cross-sectional and observational design, said Dr. Fenton, who also noted that it’s possible that some preventive care may have been delivered by providers other than the usual source of care.

The finding that internists delivered more preventive services, however, "raises some questions about cost-effectiveness and value," he said.

Dr. Fenton reported no conflicts.

NEW ORLEANS – Patients tend to underestimate how long a cough should last, leading to unnecessary and inappropriate use of antibiotics, according to a review of the evidence and a survey of patient beliefs.

Cough is the third most frequent reason for physician office visits, and yet doctors and patients don’t seem to have an understanding of the natural history of cough and the expected duration, said Dr. Mark Ebell of the department of epidemiology at the University of Georgia College of Public Health in Athens.

The National Ambulatory Medical Survey in 2007 showed that there were 27 million outpatient visits for cough that year. That constitutes 2%-3% of all family practice visits, said Dr. Ebell. Half of patients received an antibiotic for their cough, and half the time, it was a broad spectrum antibiotic.

"There are some real issues with how we manage cough," said Dr. Ebell. Cough can indicate a condition that needs medical attention and a prescription therapy, but often, it is treated without evidence for antibiotics because the patient or doctor is uncomfortable with its duration.

Before patients ask their doctor how long a cough should last, they are likely to ask Google, he said. In conducting his own Google search, he found estimates ranging from 7 days to 14 days.

To get a sense of what patients think, Dr. Ebell and his colleagues surveyed Georgia residents by adding questions to the Georgia Poll, which is conducted twice a year by the Survey Research Center at the University of Georgia. Potential participants – aged 18 years or older – are randomly selected and contacted by phone. Almost 500 participated; 63% were women. It was an older population because the survey is conducted through landlines.

Participants were asked about their beliefs concerning antibiotics and the effectiveness of these drugs when the main symptom was a cough. They were asked how long they think it would take for the cough to get better if they were not taking any medicine, in six different scenarios: dry cough, coughing up yellow mucus or green mucus, or any of those kinds of cough with a slight fever, or no fever.

Patients with self-reported chronic lung disease or asthma were excluded from the survey.

Some respondents thought they would be better in as few as 2 days. Some thought the cough would last several months, but almost everyone thought it would take less than 2 weeks. There was not much difference between the scenarios, except when the scenario involved green phlegm.

The participants who had previously used antibiotics thought the cough would last longer, as did women, whites, and those with less education.

To determine how long a cough actually does last, Dr. Ebell conducted a literature search. After combing through several 100,000 potential studies, excluding those in sinusitis or people with a clear bacterial diagnosis, and focusing on those in community-dwelling, otherwise healthy adults with undifferentiated acute cough or bronchitis, he and his colleagues were left with 18 studies. In the end, only 5 of those 18 provided useful data.

The mean duration was 17-18 days. "So now we know how long a cough lasts," said Dr. Ebell.

Although the cough usually improves significantly in 2 weeks, most patients think it should be over in a week. "And that’s a big driver, or may be a big driver, of antibiotic use," he said. It may also lead to patients seeking repeat visits after 4 days, or asking for a "better" antibiotic after 8 or 9 days, which results in more prescriptions for broad spectrum antibiotics.

And the next time around, they are likely to say that the only drug that works for them is a broad spectrum antibiotic.

Dr. Ebell and his colleagues said they are exploring the clinical issue further, researching what physicians believe about cough, how messages in the media influence behavior, and whether there might be a discrepancy between the reality of an acute illness – its natural history – and perception.

Most importantly, he said he hopes to determine whether his findings can be used "to educate patients, to educate physicians, and hopefully create more realistic expectations about the duration of a cough [and] the duration of an acute illness, and thereby, hopefully reduce the demand for antibiotics."

Dr. Ebell reported having no relevant financial conflicts.

NEW ORLEANS – Patients tend to underestimate how long a cough should last, leading to unnecessary and inappropriate use of antibiotics, according to a review of the evidence and a survey of patient beliefs.

Cough is the third most frequent reason for physician office visits, and yet doctors and patients don’t seem to have an understanding of the natural history of cough and the expected duration, said Dr. Mark Ebell of the department of epidemiology at the University of Georgia College of Public Health in Athens.

The National Ambulatory Medical Survey in 2007 showed that there were 27 million outpatient visits for cough that year. That constitutes 2%-3% of all family practice visits, said Dr. Ebell. Half of patients received an antibiotic for their cough, and half the time, it was a broad spectrum antibiotic.

"There are some real issues with how we manage cough," said Dr. Ebell. Cough can indicate a condition that needs medical attention and a prescription therapy, but often, it is treated without evidence for antibiotics because the patient or doctor is uncomfortable with its duration.

Before patients ask their doctor how long a cough should last, they are likely to ask Google, he said. In conducting his own Google search, he found estimates ranging from 7 days to 14 days.

To get a sense of what patients think, Dr. Ebell and his colleagues surveyed Georgia residents by adding questions to the Georgia Poll, which is conducted twice a year by the Survey Research Center at the University of Georgia. Potential participants – aged 18 years or older – are randomly selected and contacted by phone. Almost 500 participated; 63% were women. It was an older population because the survey is conducted through landlines.

Participants were asked about their beliefs concerning antibiotics and the effectiveness of these drugs when the main symptom was a cough. They were asked how long they think it would take for the cough to get better if they were not taking any medicine, in six different scenarios: dry cough, coughing up yellow mucus or green mucus, or any of those kinds of cough with a slight fever, or no fever.

Patients with self-reported chronic lung disease or asthma were excluded from the survey.

Some respondents thought they would be better in as few as 2 days. Some thought the cough would last several months, but almost everyone thought it would take less than 2 weeks. There was not much difference between the scenarios, except when the scenario involved green phlegm.

The participants who had previously used antibiotics thought the cough would last longer, as did women, whites, and those with less education.

To determine how long a cough actually does last, Dr. Ebell conducted a literature search. After combing through several 100,000 potential studies, excluding those in sinusitis or people with a clear bacterial diagnosis, and focusing on those in community-dwelling, otherwise healthy adults with undifferentiated acute cough or bronchitis, he and his colleagues were left with 18 studies. In the end, only 5 of those 18 provided useful data.

The mean duration was 17-18 days. "So now we know how long a cough lasts," said Dr. Ebell.

Although the cough usually improves significantly in 2 weeks, most patients think it should be over in a week. "And that’s a big driver, or may be a big driver, of antibiotic use," he said. It may also lead to patients seeking repeat visits after 4 days, or asking for a "better" antibiotic after 8 or 9 days, which results in more prescriptions for broad spectrum antibiotics.

And the next time around, they are likely to say that the only drug that works for them is a broad spectrum antibiotic.

Dr. Ebell and his colleagues said they are exploring the clinical issue further, researching what physicians believe about cough, how messages in the media influence behavior, and whether there might be a discrepancy between the reality of an acute illness – its natural history – and perception.

Most importantly, he said he hopes to determine whether his findings can be used "to educate patients, to educate physicians, and hopefully create more realistic expectations about the duration of a cough [and] the duration of an acute illness, and thereby, hopefully reduce the demand for antibiotics."

Dr. Ebell reported having no relevant financial conflicts.

NEW ORLEANS – Patients tend to underestimate how long a cough should last, leading to unnecessary and inappropriate use of antibiotics, according to a review of the evidence and a survey of patient beliefs.

Cough is the third most frequent reason for physician office visits, and yet doctors and patients don’t seem to have an understanding of the natural history of cough and the expected duration, said Dr. Mark Ebell of the department of epidemiology at the University of Georgia College of Public Health in Athens.

The National Ambulatory Medical Survey in 2007 showed that there were 27 million outpatient visits for cough that year. That constitutes 2%-3% of all family practice visits, said Dr. Ebell. Half of patients received an antibiotic for their cough, and half the time, it was a broad spectrum antibiotic.

"There are some real issues with how we manage cough," said Dr. Ebell. Cough can indicate a condition that needs medical attention and a prescription therapy, but often, it is treated without evidence for antibiotics because the patient or doctor is uncomfortable with its duration.

Before patients ask their doctor how long a cough should last, they are likely to ask Google, he said. In conducting his own Google search, he found estimates ranging from 7 days to 14 days.

To get a sense of what patients think, Dr. Ebell and his colleagues surveyed Georgia residents by adding questions to the Georgia Poll, which is conducted twice a year by the Survey Research Center at the University of Georgia. Potential participants – aged 18 years or older – are randomly selected and contacted by phone. Almost 500 participated; 63% were women. It was an older population because the survey is conducted through landlines.

Participants were asked about their beliefs concerning antibiotics and the effectiveness of these drugs when the main symptom was a cough. They were asked how long they think it would take for the cough to get better if they were not taking any medicine, in six different scenarios: dry cough, coughing up yellow mucus or green mucus, or any of those kinds of cough with a slight fever, or no fever.

Patients with self-reported chronic lung disease or asthma were excluded from the survey.

Some respondents thought they would be better in as few as 2 days. Some thought the cough would last several months, but almost everyone thought it would take less than 2 weeks. There was not much difference between the scenarios, except when the scenario involved green phlegm.

The participants who had previously used antibiotics thought the cough would last longer, as did women, whites, and those with less education.

To determine how long a cough actually does last, Dr. Ebell conducted a literature search. After combing through several 100,000 potential studies, excluding those in sinusitis or people with a clear bacterial diagnosis, and focusing on those in community-dwelling, otherwise healthy adults with undifferentiated acute cough or bronchitis, he and his colleagues were left with 18 studies. In the end, only 5 of those 18 provided useful data.

The mean duration was 17-18 days. "So now we know how long a cough lasts," said Dr. Ebell.

Although the cough usually improves significantly in 2 weeks, most patients think it should be over in a week. "And that’s a big driver, or may be a big driver, of antibiotic use," he said. It may also lead to patients seeking repeat visits after 4 days, or asking for a "better" antibiotic after 8 or 9 days, which results in more prescriptions for broad spectrum antibiotics.

And the next time around, they are likely to say that the only drug that works for them is a broad spectrum antibiotic.

Dr. Ebell and his colleagues said they are exploring the clinical issue further, researching what physicians believe about cough, how messages in the media influence behavior, and whether there might be a discrepancy between the reality of an acute illness – its natural history – and perception.

Most importantly, he said he hopes to determine whether his findings can be used "to educate patients, to educate physicians, and hopefully create more realistic expectations about the duration of a cough [and] the duration of an acute illness, and thereby, hopefully reduce the demand for antibiotics."

Dr. Ebell reported having no relevant financial conflicts.

NEW ORLEANS – Supply of primary care physicians is unlikely to meet demand when the Affordable Care Act is fully implemented in 2014 and shortages will be more acute in some regions that others.

Overall, the expansion of health insurance to a wider population is likely to mean that the United States will need an additional 8,000 primary care physicians over what is currently projected, or a 3% increase in the current workforce, by 2025, Stephen M. Petterson, Ph.D., reported at the annual meeting of the North American Primary Care Research Group.

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While that may not seem to be a huge increase, the nation will need 43,000 additional primary care doctors just to keep pace with population growth and the aging of that population.

Taking into account population growth, the aging of the population, and the impact of the ACA, the number of office visits in the United States will increase from 462 million in 2008 to 565 million in 2025 (Ann. Fam. Med. 2012;10:503-9). Dr. Petterson and his colleagues noted that their analysis is the first look at the ACA’s impact specifically on the primary care workforce and primary care services.

To get at that data, the authors used the Medical Expenditure Panel Survey (MEPS) to calculate the use of office-based primary care in 2008, U.S. Census Bureau projections for population estimates, and the American Medical Association Masterfile to calculate the number of primary care physicians and determine the number of visits per physician.

They determined that 46% of all physician office visits are to primary care physicians. MEPS data show that in 2008, there were 977 million office visits to physicians, 462 million of which were to primary care physicians. Women made more office visits than did men, older adults more than younger ones, and the insured more than the uninsured.

Previous studies have shown that when people gain insurance coverage, they tend to use more services, said Dr. Petterson, research director at the Robert Graham Center, a primary care think tank in Washington, D.C.

Based on their analysis, by 2025, an estimated 260,687 practicing primary care physicians will be needed – an increase of 51,880 from today. Most of the additional workforce can be built gradually, to accommodate aging and population growth, they said. But there will be a more urgent need in 2014 and 2015 when the ACA is fully implemented and there will be an additional 20 million primary care visits.

The ACA proposes to build the primary care workforce through expanding the number of primary care residents and increasing training for physician assistants and nurse practitioners. But that will only produce an estimated 500 additional physicians, said the authors, noting that "even if these positions were maintained for 10 years, only 5,000 additional primary care physicians would be trained."

The need for more primary care doctors varies geographically, Dr. Petterson said at the meeting.

Some states, those with a low number of uninsured, small populations, or a relatively high concentration of physicians, won’t need to bump up their numbers by much. Those states include Vermont, North Dakota, Wyoming, Delaware, the District of Columbia, South Dakota, Hawaii, Rhode Island, New Hampshire, and Montana.

The 10 states that will require the largest increase in the workforce are New Jersey, Pennsylvania, Ohio, North Carolina, Georgia, Illinois, New York, Florida, Texas, and California. These states have a high number of uninsured patients and a relatively low ratio of primary care physicians to the overall population, Dr. Petterson said. On the low end, New Jersey will need to increase its workforce by about 3%, or 200 or so new physicians. Texas and California are looking at a 7% and a 5% increase respectively, he said.

"The sudden influx of newly insured patients will exacerbate this situation," he said.

The authors had no relevant conflicts of interest; the study was funded in part by the Agency for Healthcare Research and Quality.

NEW ORLEANS – Supply of primary care physicians is unlikely to meet demand when the Affordable Care Act is fully implemented in 2014 and shortages will be more acute in some regions that others.

Overall, the expansion of health insurance to a wider population is likely to mean that the United States will need an additional 8,000 primary care physicians over what is currently projected, or a 3% increase in the current workforce, by 2025, Stephen M. Petterson, Ph.D., reported at the annual meeting of the North American Primary Care Research Group.

thinkstockphotos.com

While that may not seem to be a huge increase, the nation will need 43,000 additional primary care doctors just to keep pace with population growth and the aging of that population.

Taking into account population growth, the aging of the population, and the impact of the ACA, the number of office visits in the United States will increase from 462 million in 2008 to 565 million in 2025 (Ann. Fam. Med. 2012;10:503-9). Dr. Petterson and his colleagues noted that their analysis is the first look at the ACA’s impact specifically on the primary care workforce and primary care services.

To get at that data, the authors used the Medical Expenditure Panel Survey (MEPS) to calculate the use of office-based primary care in 2008, U.S. Census Bureau projections for population estimates, and the American Medical Association Masterfile to calculate the number of primary care physicians and determine the number of visits per physician.

They determined that 46% of all physician office visits are to primary care physicians. MEPS data show that in 2008, there were 977 million office visits to physicians, 462 million of which were to primary care physicians. Women made more office visits than did men, older adults more than younger ones, and the insured more than the uninsured.

Previous studies have shown that when people gain insurance coverage, they tend to use more services, said Dr. Petterson, research director at the Robert Graham Center, a primary care think tank in Washington, D.C.

Based on their analysis, by 2025, an estimated 260,687 practicing primary care physicians will be needed – an increase of 51,880 from today. Most of the additional workforce can be built gradually, to accommodate aging and population growth, they said. But there will be a more urgent need in 2014 and 2015 when the ACA is fully implemented and there will be an additional 20 million primary care visits.

The ACA proposes to build the primary care workforce through expanding the number of primary care residents and increasing training for physician assistants and nurse practitioners. But that will only produce an estimated 500 additional physicians, said the authors, noting that "even if these positions were maintained for 10 years, only 5,000 additional primary care physicians would be trained."

The need for more primary care doctors varies geographically, Dr. Petterson said at the meeting.

Some states, those with a low number of uninsured, small populations, or a relatively high concentration of physicians, won’t need to bump up their numbers by much. Those states include Vermont, North Dakota, Wyoming, Delaware, the District of Columbia, South Dakota, Hawaii, Rhode Island, New Hampshire, and Montana.

The 10 states that will require the largest increase in the workforce are New Jersey, Pennsylvania, Ohio, North Carolina, Georgia, Illinois, New York, Florida, Texas, and California. These states have a high number of uninsured patients and a relatively low ratio of primary care physicians to the overall population, Dr. Petterson said. On the low end, New Jersey will need to increase its workforce by about 3%, or 200 or so new physicians. Texas and California are looking at a 7% and a 5% increase respectively, he said.

"The sudden influx of newly insured patients will exacerbate this situation," he said.

The authors had no relevant conflicts of interest; the study was funded in part by the Agency for Healthcare Research and Quality.

NEW ORLEANS – Supply of primary care physicians is unlikely to meet demand when the Affordable Care Act is fully implemented in 2014 and shortages will be more acute in some regions that others.

Overall, the expansion of health insurance to a wider population is likely to mean that the United States will need an additional 8,000 primary care physicians over what is currently projected, or a 3% increase in the current workforce, by 2025, Stephen M. Petterson, Ph.D., reported at the annual meeting of the North American Primary Care Research Group.

thinkstockphotos.com

While that may not seem to be a huge increase, the nation will need 43,000 additional primary care doctors just to keep pace with population growth and the aging of that population.

Taking into account population growth, the aging of the population, and the impact of the ACA, the number of office visits in the United States will increase from 462 million in 2008 to 565 million in 2025 (Ann. Fam. Med. 2012;10:503-9). Dr. Petterson and his colleagues noted that their analysis is the first look at the ACA’s impact specifically on the primary care workforce and primary care services.

To get at that data, the authors used the Medical Expenditure Panel Survey (MEPS) to calculate the use of office-based primary care in 2008, U.S. Census Bureau projections for population estimates, and the American Medical Association Masterfile to calculate the number of primary care physicians and determine the number of visits per physician.

They determined that 46% of all physician office visits are to primary care physicians. MEPS data show that in 2008, there were 977 million office visits to physicians, 462 million of which were to primary care physicians. Women made more office visits than did men, older adults more than younger ones, and the insured more than the uninsured.

Previous studies have shown that when people gain insurance coverage, they tend to use more services, said Dr. Petterson, research director at the Robert Graham Center, a primary care think tank in Washington, D.C.

Based on their analysis, by 2025, an estimated 260,687 practicing primary care physicians will be needed – an increase of 51,880 from today. Most of the additional workforce can be built gradually, to accommodate aging and population growth, they said. But there will be a more urgent need in 2014 and 2015 when the ACA is fully implemented and there will be an additional 20 million primary care visits.

The ACA proposes to build the primary care workforce through expanding the number of primary care residents and increasing training for physician assistants and nurse practitioners. But that will only produce an estimated 500 additional physicians, said the authors, noting that "even if these positions were maintained for 10 years, only 5,000 additional primary care physicians would be trained."

The need for more primary care doctors varies geographically, Dr. Petterson said at the meeting.

Some states, those with a low number of uninsured, small populations, or a relatively high concentration of physicians, won’t need to bump up their numbers by much. Those states include Vermont, North Dakota, Wyoming, Delaware, the District of Columbia, South Dakota, Hawaii, Rhode Island, New Hampshire, and Montana.

The 10 states that will require the largest increase in the workforce are New Jersey, Pennsylvania, Ohio, North Carolina, Georgia, Illinois, New York, Florida, Texas, and California. These states have a high number of uninsured patients and a relatively low ratio of primary care physicians to the overall population, Dr. Petterson said. On the low end, New Jersey will need to increase its workforce by about 3%, or 200 or so new physicians. Texas and California are looking at a 7% and a 5% increase respectively, he said.

"The sudden influx of newly insured patients will exacerbate this situation," he said.

The authors had no relevant conflicts of interest; the study was funded in part by the Agency for Healthcare Research and Quality.