Journal of general internal medicine
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Randomized Controlled Trial Multicenter Study Comparative Study
Cost-effectiveness of a disease management program for major depression in elderly primary care patients.
Major depression is common in older adults and is associated with increased health care costs. Depression often remains unrecognized in older adults, especially in primary care. ⋯ This disease management program for major depression in elderly primary care patients had no statistically significant relationship with clinical outcomes, costs, and cost-effectiveness. Therefore, based on these results, continuing usual care is recommended.
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Comparative Study
Middle-aged and mobility-limited: prevalence of disability and symptom attributions in a national survey.
Lower limb mobility disabilities are well understood in older people, but the causes in middle age have attracted little attention. ⋯ Mobility (walking) disabilities in the middle-aged are relatively common. The symptoms reported as causes in this age group differ little from those reported by older groups, and are dominated by lower limb pain and shortness of breath. More clinical attention paid to disabling symptoms may lead to disability reductions in later life.
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Comparative Study
Four physician communication styles in routine Japanese outpatient medical encounters.
Few studies have explored how physicians approach medical encounters in Japan. ⋯ Results suggest the need for a multiprovider-patient model of medical communication among physician, nurse, and patient. Further research is needed to establish the applicability of this model to the communication styles of physicians in other countries.
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Randomized Controlled Trial Multicenter Study Comparative Study
Impacts of evidence-based quality improvement on depression in primary care: a randomized experiment.
Previous studies testing continuous quality improvement (CQI) for depression showed no effects. Methods for practices to self-improve depression care performance are needed. We assessed the impacts of evidence-based quality improvement (EBQI), a modification of CQI, as carried out by 2 different health care systems, and collected qualitative data on the design and implementation process. ⋯ Evidence-based quality improvement had perceptible, but modest, effects on practice performance for patients with depression. The modest improvements, along with qualitative data, identify potential future directions for improving CQI research and practice.