Primary Care / Health Services Research : South Florida Primary Care Practice-Based Research Network


The Newest Vital Sign Health Literacy Assessment

Status: Completed
Principal Investigator: J. Ryan, Dr. P.H.

Co-investigators: F. Leguen, MD, MPH; B. Weiss, MD; S. Albury; T. Jennings, Ph.D; F. Velez; N. Salibi, MPH; E. Armas, MD; A. Bryan, MD; R. Iglesias, MD; C. Larocca, MD; L. Marraccini, MD; N. Roche, MD; J. Rosen, MD; E. Smith, MD; N. Soto, MD; B. Wollschlaeger, MD.

Abstract: If health providers are aware of their patients’ literacy skills, they can more appropriately tailor their communication with patients. Few providers, however, assess patients’ literacy skills for fear of offending patients, but no research has ever determined if patients object to such assessments. Our objectives were to determine the percentage of patients seen for routine health care that would agree to undergo literacy assessment and if satisfaction of patients differs in practices that perform literacy assessments versus practices that do not. We randomized 20 private and public medical practices to an intervention group that implemented literacy assessments with the Newest Vital Sign and a control group that did not. For intervention practices, we noted the percentage of patients agreeing to undergo the assessment. For both intervention and control practices, we assessed patient satisfaction. We conclude that patients are willing to undergo literacy assessments during routine office visits and performing such assessments does not decrease patient satisfaction.

Ryan, JG; Leguen F; Weiss, BD; Albury, S; Jennings, T; Velez, F; Salibi, N. Will patients agree to have their literacy skills assessed in clinical practice? Health Education Research, Sept. 22, 2007.

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Quality of Diabetes Management at the United Health Foundation/ Jefferson Reaves, Sr. Health Center

Status: In progress
Principal Investigator: J. Ryan, Dr. P.H.

Co-investigators: D. Brown, MD; T. Jennings, Ph.D.; A. Escobar

Abstract: The standard of care for adult patients with Type 2 Diabetes Mellitus is achieved among a minority of patients in primary care settings. The purpose of this project is to determine the extent to which standard clinical recommendations for the management of diabetes is implemented at a community-based, primary care ambulatory office that serves a patient population that is at high risk for diabetes, in a major urban environment and that is affiliated with a major hospital system in South Florida. This project will contribute to an evaluation of the extent to which clinicians in this ambulatory practice incorporated diabetes standards of care into their diabetes management prior to implementation of an intervention designed to improve the quality of diabetes management in this practice.

United Health Foundation/ Jefferson Reaves, Sr. Health Center Preventive Healthcare Screening

Status: In progress
Principal Investigator: J. Ryan, Dr. P.H.

Co-investigators: D. Brown, MD; T. Jennings, Ph.D.

Abstract: The purpose of this project is to determine the prevalence of undiagnosed diabetes, mental health problems or access to healthcare problems among patients who receive their healthcare at the health center and to support resource management for providing targeted, necessary healthcare interventions. A consecutive sample of 1,000 patients presenting to Jefferson Reaves, Sr. Health Center were screened using validated items to assess their self-reported risk for diabetes, depression and problems related to accessing healthcare.

Diabetes Risk

Status: Completed.

Ryan, JG; Velez, F; Chung-Bridges, K; Lewis, J; Schwartz, R. Prevalence of Undetected High-Risk for Type 2 Diabetes Mellitus in Primary Care: A South Florida Primary Care Practice-Based Research Network Study. In review.

Ryan, JG; Velez, F; Chung, K; Lewis, J; Schwartz, R. Prevalence of Undetected High-Risk for Type 2 Diabetes Mellitus among Primary Care Patients. 38th Society of Teachers of Family Medicine Annual Spring Conference, New Orleans, LA: 2005.

The purpose of this study was to determine the prevalence of diabetes risk, measure risk awareness among primary care patients and identify differences related to key demographic variables. This was a cross-sectional study with an analytical component of primary care patients presenting to physicians participating in the South Florida Primary Care Practice-Based Research Network (SoFla-PBRN). We used a validated instrument to calculate diabetes risk based on body mass index, family history of diabetes, physical activity and obstetric history. We excluded self-reported diabetics and classified undiagnosed patients into two groups: those who recalled receiving information about their high risk and those who didn’t. A total of 2,836 patients were recruited, of whom 48% self-reported that they were non-diabetics and who were identified to have a high-risk for diabetes. Among high risk patients, 83% reported not having been informed by their doctors that they were at risk. Significant differences in diabetes risk were observed among ethnic groups (p=.01), but patient demographics were not associated with informed status among high risk patients. High BMI was strongly associated with informed status (p<.0001). Less than one in five patients at high risk reported having been informed of their elevated risk. This low rate of patient education, or retention of having been educated, may delay preventive measures and may contribute to the disproportionate effect of diabetes on ethnic groups in whom diabetes is more common.

Alternative Therapies Used by South Florida Primary Care Patients

Status: Completed.

Ryan, JG; Wollschlaeger, B. Complementary and Alternative Medicine Use by Primary Care Patients in South Florida: A Report from the South Florida Primary Care Practice-Based Research Network. Journal of the American Nutraceuticals Association 2004; 7(1): 6-10.

Ryan, JG; Hudson, K; SoFla-PBRN Physicians. Utilization of alternative therapies in South Florida: A South Florida Primary Care Practice-Based Research Network Study [Research Forum]. North American Primary Care Research Group, Amelia Island, Florida; November 2-5, 2000.

An increase in complementary and alternative medicine use and within the United States has been documented, along with its acceptability. Government agencies and managed care organizations have responded to consumer demand by integrating policies that recognize utilization of selected alternative therapies into policy and practices. Medical school curriculum committees and primary care physicians are increasingly understanding the significance that alternative therapies represent for patient care; however, patients appear reluctant to fully disclose their use of alternative therapies to their physicians for a variety of reasons, including fear of ridicule, suggesting a lack of trust in the doctor-patient relationship. Full disclosure of self-treatment is important to control for the potential of adverse interactions between conventional and alternative therapies. Effective communication regarding alternative therapies is also important for the physician to harness whatever positive benefits the patient may derive from alternative therapies to improve disease outcomes. The purpose of this study was several-fold and included identifying the prevalence of alternative therapy use among patients presenting to typical community-based family practice offices; comparing utilization patterns of alternative therapies between patient demographics; and to determine patient satisfaction with alternative therapies among patients presenting to family practices.