Annals of family medicine
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Annals of family medicine · Nov 2005
How experiencing preventable medical problems changed patients' interactions with primary health care.
We wanted to explore how patients' experiences with preventable problems in primary care have changed their behavioral interactions with the health care system. ⋯ Understanding how patients react to their experiences with preventable problems can assist health care at both the physician-patient and system levels. We propose an association of mistrust with the behaviors of avoidance and advocacy, and suggest that further research explore the potential impact these patient behaviors have on the provision of health care.
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Annals of family medicine · Nov 2005
The break-even point: when medical advances are less important than improving the fidelity with which they are delivered.
Society invests billions of dollars in the development of new drugs and technologies but comparatively little in the fidelity of health care, that is, improving systems to ensure the delivery of care to all patients in need. Using mathematical arguments and a nomogram, we demonstrate that technological advances must yield dramatic, often unrealistic increases in efficacy to do more good than could be accomplished by improving fidelity. ⋯ The misalignment of priorities is driven partly by the commercial interests of industry and by the public's appetite for technological breakthroughs, but health outcomes ultimately suffer. Health, economic, and moral arguments make the case for spending less on technological advances and more on improving systems for delivering care.
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Annals of family medicine · Nov 2005
Randomized Controlled TrialPhysicians answer more clinical questions and change clinical decisions more often with synthesized evidence: a randomized trial in primary care.
Clinicians need evidence in a format that rapidly answers their questions. DynaMed is a database of synthesized evidence. We investigated whether primary care clinicians would answer more clinical questions, change clinical decision making, and alter search time using DynaMed in addition to their usual information sources. ⋯ Using DynaMed, primary care clinicians answered more questions and changed clinical decisions more often, without increasing overall search time. Synthesizing results of systematic evidence surveillance is a feasible method for meeting clinical information needs in primary care.
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Annals of family medicine · Nov 2005
Quick assessment of literacy in primary care: the newest vital sign.
Current health literacy screening instruments for health care settings are either too long for routine use or available only in English. Our objective was to develop a quick and accurate screening test for limited literacy available in English and Spanish. ⋯ NVS is suitable for use as a quick screening test for limited literacy in primary health care settings.