Journal of general internal medicine
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The aim of this analysis was to create a parsimonious tool to screen for high social risk using item response theory to discriminate across social risk factors in adults with type 2 diabetes. ⋯ Based on these findings, crime and neighborhood rating discriminate best between individuals with type 2 diabetes who have high social risk and those with low social risk. These two questions can be used as a parsimonious social risk screening tool to identify high social risk.
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Effective shared decision-making (SDM) tools for use during clinical encounters are available, but, outside of study settings, little is known about clinician use of these tools in practice. ⋯ Patient factors, including race and sex, were associated with clinician use of Statin Choice; half the variation in use was attributable to individual clinicians.
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Increasing primary care's attractiveness as a career choice is an important task of socially accountable medical schools. Research has broadly studied influences on medical students' career choice. However, a deeper understanding of the processes behind career decision-making could support medical schools in their efforts to promote primary care careers. ⋯ This study's narrative approach illustrates the dynamic nature of career choice and refines elements of a conceptual framework previously developed by the authors. Its findings underline the importance of exploration, for which personal experiences and observations of physicians' work are crucial. To advance efforts to make primary care a more attractive career, students must be sufficiently exposed to primary care in a safe and individualized environment and should be supported in all stages of their career choice process.
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The number of older adults entering opioid treatment programs (OTPs) to treat opioid use disorder (OUD) is increasing. However, the lived experiences of aging in OTPs have not been examined. ⋯ Older adults with OUD reported increasing social isolation and declining health while experiencing multilevel stigma and discrimination. The US healthcare system must transform to deliver age-friendly care that integrates evidence-based geriatric models of care incorporated with substance use disorder treatment and addresses the intersectional stigma this population has experienced in healthcare settings.
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Clinicians can prescribe antibiotics inappropriately without coding the indication for antibiotics. Whether the prevalence of inappropriate antibiotic prescribing with or without a plausible indication differs between safety-net and non-safety-net populations is unknown. ⋯ Inappropriate antibiotic prescribing with or without a plausible antibiotic indication is common in all populations, highlighting the importance of broad-based antibiotic stewardship initiatives. However, targeted initiatives focused on improving coding quality in adult safety-net settings may be warranted.