Journal of general internal medicine
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Patient-centered care has received new prominence with its inclusion by the Institute of Medicine as 1 of the 6 aims of quality. Seven attributes of patient-centered primary care are proposed here to improve this dimension of care: access to care, patient engagement in care, information systems, care coordination, integrated and comprehensive team care, patient-centered care surveys, and publicly available information. ⋯ To bring about marked improvement will require a new system of primary care payment that blends monthly patient panel fees with traditional fee-for-service payment, and new incentives for patient-centered care performance. A major effort to test this concept, develop a business case, provide technical assistance and training, and diffuse best practices is needed to transform American health care.
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To determine whether a patient-physician agreement instrument predicts important health outcomes. ⋯ Agreement between physicians and patients regarding diagnosis, diagnostic plan, and treatment plan is associated with higher patient satisfaction and better health status outcomes in patients with back pain. Additional research is required to clarify the relationship between physician communication skills, agreement, and patient outcomes.
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Identify the incidence and prevalence of intimate partner violence (IPV) in women over 55 years of age in primary care offices. ⋯ Physical and sexual abuse by an intimate partner does occur in women over 55 years, but rates are lower than those of younger women. Health care providers are reminded to think about IPV in older women and to ask about abuse as disclosure is rare.
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Comparative Study Controlled Clinical Trial
Improvements in antimicrobial prescribing for treatment of upper respiratory tract infections through provider education.
Inappropriate use of antimicrobials to treat acute upper respiratory tract infections (URIs), which usually have a viral etiology, contributes to emergence and spread of antimicrobial resistance in Streptococcus pneumoniae and other human bacterial pathogens. ⋯ An interactive, case-based educational program for physicians and their staff proved effective for reducing unwarranted prescribing of antibiotics in the treatment of URIs by primary care physicians in a Medicaid HMO setting.
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Randomized Controlled Trial Comparative Study
Respiratory symptom relief related to reduction in cigarette use.
Many smokers reduce their cigarette consumption during failed attempts to quit. We report the impact of changes in consumption on smoking-related respiratory symptom severity (SRRSS). ⋯ Reduction in symptom severity increases as absolute reduction in daily smoking increases. This is the first study to demonstrate an association between subjective short-term health changes and reduction in smoking.