Highlights of this issue
Lost opportunities for preventive care
Patients admitted to hospital who had missed out on preventive care did not get it during their stay
See also:
- Evidence: Missed opportunities for prevention in general internal medicine
- Editorial: Incorporating preventive care recommendations into clinical practice: How do we bridge the gap?
Richard Brull and colleagues at the University of Calgary reviewed the hospital records of 100 consecutive patients admitted to their general internal medicine service and interviewed them about preventive health examinations. Opportunities for preventive care were identified from among 10 interventions recommended by the Canadian Task Force on the Periodic Health Examination. For each patient a mean of 3.8 preventive manoeuvres applied; perhaps unsurprisingly, only 46.5% of these had been addressed before admission, and by discharge this percentage had risen to only 55.2%. The most commonly overlooked interventions were influenza and pneumococcal vaccination. In an accompanying editorial James Douketis provides some perspective on the neglect of preventive care and suggests remedial strategies.
Post-term pregnancy
Rates are dramatically lower with elective labour induction
See also:
- Evidence: Effect of labour induction on rates of stillbirth and cesarean section in post-term pregnancies
Randomized clinical trials show that post-term pregnant women and their babies are better off if labour is induced before 42 weeks. Andrea Sue-A-Quan and colleagues at the University of Toronto and Dalhousie University reviewed the Canadian experience between 1980 and 1995. As the figure shows, there was a marked increase in the proportion of total births at 41 weeks' gestation (from 11.9% in 1980 to 16.3% in 1995) and a corresponding decrease in the proportion at 42 or more weeks (from 7.1% in 1980 to 2.9% in 1995).
Substituting home care for acute hospital care
Does home care work, and is it cheaper?
See also:
Lee Soderstrom and colleagues reviewed 148 papers published between 1975 and early 1998 and found 14 that compared home care with hospital care for 8 specific health conditions (hip fracture, hip replacement, knee replacement, hysterectomy, antibiotic treatment, chronic obstructive pulmonary disease, stroke and pressure sores) as well as mixed medical and surgical problems. They found no convincing evidence that patients admitted to home care had better or worse health outcomes than patients who stayed in hospital. The effects on health system costs were mixed: for hip fracture there appeared to be overall cost savings, whereas for hip and knee replacement, home care resulted in higher overall costs.
The importance of being rural
What factors induce young physicians to practise in rural areas?
See also:
- Evidence: Rural background and clinical rural rotations during medical training: effect on practice location
- Editorial: Recruiting rural doctors: ending a Sisyphean task
Queen's is one of several excellent Canadian medical schools attempting to provide exposure to rural practice during undergraduate and residency training. The hope is that young physicians, given an opportunity to experience rural practice, might discover an affinity for it. As similar programs have shown, this strategy does not work, or at least not very well. Mark Easterbrook and colleagues surveyed 159 physicians who had graduated from the Family Medicine program at Queen's University between 1977 and 1991. Only 45 of the physicians reported that they chose a rural practice location after residency training. The survey findings indicate, however, that the most salient influence on these physicians' choice of a rural practice location was not an exposure to rural practice during medical training but, rather, having a rural background. Those who came to medical school from communities of fewer than 10 000 people were almost 5 times more likely than their colleagues from nonrural communities to practise in a rural area.
In an accompanying editorial, Joshua Tepper, a resident in family medicine at the University of Toronto, and James Rourke, Director of the Southwestern Ontario Rural Medicine Education, Research and Development Unit, comment on the study.
