Journal of general internal medicine
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Pragmatic Clinical Trial
Electronic Pill Bottles or Bidirectional Text Messaging to Improve Hypertension Medication Adherence (Way 2 Text): a Randomized Clinical Trial.
Poor medication adherence contributes to inadequate control of hypertension. However, the value of adherence monitoring is unknown. ⋯ Despite good measured adherence, neither feedback with electronic pill bottles nor bidirectional text messaging about medication adherence improved blood pressure control. Adherence to prescribed medications was not improved enough to affect BP control or it was not the primary driver of poor control.
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One increasingly popular strategy for addressing avoidable healthcare costs is to couple "hotspotting" with interventions that deliver expanded, more intense primary care services to high-cost patient populations. While there is rationale for such intensive primary care programs, early results have been lackluster. Geoffrey Rose's preventive medicine strategy provides insight about a potential explanation: that the narrow scope of these initiatives on small groups of high-cost patients may inherently prevent them from achieving overall cost reductions across entire patient populations. While additional work and results from innovative non-healthcare-based interventions are needed, healthcare organizations may benefit from instead investing in broader interventions that impact patients across cost levels, including average- or low-cost patients.
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Observational Study
Predicting Outcomes of In-Hospital Cardiac Arrest: Retrospective US Validation of the Good Outcome Following Attempted Resuscitation Score.
Providers should estimate a patient's chance of surviving an in-hospital cardiac arrest with good neurologic outcome when initially admitting a patient, in order to participate in shared decision making with patients about their code status. ⋯ The GO-FAR score can estimate, at time of admission to the hospital, the probability that a patient will survive to discharge with good neurologic outcome after an in-hospital cardiac arrest. This prognostic information can help providers frame discussions with patients on admission regarding whether to attempt cardiopulmonary resuscitation in the event of cardiac arrest.
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Many approaches to burnout and compassion fatigue in medicine do not focus on the reason most physicians went into practice, namely love. And we do not explicitly think of our daily work in these terms. If we believe our job is to help others in a very task-oriented sense and we are not able to succeed or a patient has a poor outcome, we can miss the fact that often our simply being present is what is needed. Refocusing on our love of others in our work whether they are patients, colleagues, or administrators can reinvigorate our experience and make us happier people in the process.