No abstract

Predicting which caretakers are at risk for using the ED for nonurgent care when their children are sick provides the primary care physician a means of identifying specific patients who may benefit from interventions designed to promote a more cost-effective approach to using medical resources. Arch Fam Med. 2000;9:1086-1092

T mens for chronic disease has been well documented over the past 20 years or more. The rates have changed little over that time period (Dunbar-Jacob, Dwyer, & Dunning, 1991). Even today, up to 80% of patients will not follow their treatment program sufficiently to attain therapeutic benefit. Furthermore, the problem crosses age groups, diagnoses, and socioeconomic strata as well as various treatment regimens.The problem of nonadherence to therapeutic regimens concerns all practitioners in the health care arena. Every patient is at risk for nonadherent episodes of varying degree. Thus, the practitioner needs to advise patients and to prescribe health behaviors in ways that support adherence. For the clinical health psychology practitioner, the problem of nonadherence has relevance beyond the direct patient-provider in-313

Type 2 diabetes puts patients at risk for serious health consequences that they can prevent or delay by achieving glycemic control. However, glycemic control depends largely on self-management. Consequently, determining what physicians might do in medical appointments to improve patients' self-management is of utmost concern. Patients were asked to discuss, in focus groups, their illness experience and their goals for regularly scheduled appointments. Six interrelated themes emerged from the analysis of transcripts: complications and comorbidities, time, control, information, family influences, and the physician-patient encounter. These themes and their implications for diabetes appointments were explored, specifically considering how physicians might use information about patients' perspectives to improve patients' self-management and thereby their glycemic control.