The Journal of family practice
-
Lower extremity amputations are increasing among patients with diabetes in the United States. Evidence-based reviews suggest that many of these tragic events may be preventable within the framework of existing health care services. Known benefits for high-risk patients result from the coordination of proven care strategies, such as screening, prophylactic foot care, self-care management education, and protective footwear. Organizational changes in practice settings, including provider education, team coordination, patient registries, appointment systems, flowsheets, and chart reminders, improve both patient and provider participation in the behaviors required to interrupt the cascade of events leading to amputation.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Is either sotalol or amiodarone more effective than digoxin for converting patients with new-onset atrial fibrillation (AF) to sinus rhythm within 48 hours?
-
In recent years much has been written about the overuse of antibiotics, especially for common respiratory illnesses. One approach to this issue is the use of a back-up prescription, only to be filled if a patient's condition deteriorates or fails to improve. The purpose of our study was to determine patient satisfaction, prescription fill rates, and correlates of these outcomes among patients receiving back-up antibiotic prescriptions. ⋯ Our findings indicate that patients were very satisfied with a back-up antibiotic prescription. The fact that half of the patients chose not to fill these prescriptions suggests a potential health care cost savings.
-
Standard obstetrical practice has included iron therapy for patients with anemia without requiring the determination of iron deficiency. However, the proportion of pregnant women with anemia who have such a deficiency may be relatively modest. We instituted a practice protocol using serum ferritin levels to determine the proportion of women undergoing prenatal care who had both anemia and iron deficiency. ⋯ In our population of prenatal patients with anemia, only approximately half had an iron deficiency. Diagnostic and therapeutic approaches to screening for anemia in pregnancy should be reconsidered and further evaluated.
-
Randomized Controlled Trial Clinical Trial
The impact of patient-centered care on outcomes.
We designed this observational cohort study to assess the association between patient-centered communication in primary care visits and subsequent health and medical care utilization. ⋯ Patient-centered communication influences patients' health through perceptions that their visit was patient centered, and especially through perceptions that common ground was achieved with the physician. Patient-centered practice improved health status and increased the efficiency of care by reducing diagnostic tests and referrals.