Journal of general internal medicine
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Patients with chronic obstructive pulmonary disorder (COPD) frequently have co-occurring depressive disorders and are often seen in multiple-care settings. Existing research does not assess the impact of care setting on delivery of evidence-based depression care for these patients. ⋯ Most VA patients with COPD and an acute depressive episode receive suboptimal depression management. Improvements in depression treatment may be particularly important for those patients seen exclusively in primary care settings.
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Comparative Study
Does affiliation of physician groups with one another produce higher quality primary care?
Recent reports have emphasized the importance of delivery systems in improving health care quality. However, few prior studies have assessed differences in primary care quality between physician groups that differ in size and organizational configuration. We examined whether larger physician group size and affiliation with networks of multiple groups are associated with higher quality of care. ⋯ Physician group affiliation with networks of multiple groups was associated with higher quality, and for measures of diabetes care the quality advantage of network-affiliation was most evident among smaller physician groups.
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Efforts to promote medical professionalism often focus on cognitive and technical competencies, rather than professional identity, commitment, and values. The Healer's Art elective is designed to create a genuine community of inquiry into these foundational elements of professionalism. ⋯ In legitimizing humanistic elements of professionalism and creating a safe community, the Healer's Art enabled students to uncover the underlying values and meaning of their work--an opportunity not typically present in required curricula. Attempts to teach professionalism should address issues of emotional safety and authentic community as prerequisites to learning and professional affiliation.
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Financial compensation for participating in research is controversial, especially when participants are recruited from economically disadvantaged and/or marginalized populations such as drug users. Little is known about these participants' own views regarding payment for research participation. ⋯ Research regulators should consider participants' views of their desires and capacity for autonomous decisions about financial compensation for research rather than assume participants' diminished capacity due to poverty and/or drug use. Payment for research participation appears to be part of the "informal economy" that has been observed in underserved communities.
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Universal pain screening with a 0-10 pain intensity numeric rating scale (NRS) has been widely implemented in primary care. ⋯ The most commonly used measure for pain screening may have only modest accuracy for identifying patients with clinically important pain in primary care. Further research is needed to evaluate whether pain screening improves patient outcomes in primary care.