Journal of general internal medicine
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Multicenter Study Comparative Study
Low use of opioid risk reduction strategies in primary care even for high risk patients with chronic pain.
Experts recommend close oversight of patients receiving opioid analgesics for chronic non-cancer pain (CNCP), especially those at increased risk of misuse. We hypothesized that physicians employ opioid risk reduction strategies more frequently in higher risk patients. ⋯ Primary care physicians' adoption of opioid risk reduction strategies is limited, even among patients at increased risk of misuse.
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Randomized Controlled Trial Multicenter Study Comparative Study
Relationship between literacy, knowledge, self-care behaviors, and heart failure-related quality of life among patients with heart failure.
We sought to examine the relationship between literacy and heart failure-related quality of life (HFQOL), and to explore whether literacy-related differences in knowledge, self-efficacy and/or self-care behavior explained the relationship. ⋯ Low literacy was associated with worse HFQOL and lower HF-related knowledge, self-efficacy, and self-care behaviors, but differences in knowledge, self-efficacy and self-care did not explain the relationship between low literacy and worse HFQOL.
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Comparative Study
The case for synergy between a usual source of care and health insurance coverage.
In 2010, the United States (US) passed health insurance reforms aimed at expanding coverage to the uninsured. Yet, disparities persist in access to health care services, even among the insured. ⋯ Amidst ongoing health care reform, these findings suggest the important role that both health insurance coverage and a usual source of care may play in facilitating individuals' access to care.
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Multicenter Study Comparative Study
Now what should I do? Primary care physicians' responses to older adults expressing thoughts of suicide.
Many older adults who die by suicide have had recent contact with a primary care physician. As the risk-assessment and referral process for suicide is not readily comparable to procedures for other high-risk behaviors, it is important to identify areas in need of quality improvement (QI). ⋯ The physicians in this sample recognized and implicitly acknowledged suicide risk in their older patients, but all seemed unable to go beyond mere assessment. The absence of clearly articulated treatment plans may reflect a lack of a coherent framework for managing suicide risk, insufficient clinical skills, and availability of mental health specialty support required to address suicide risk effectively. To respond to suicide's numerous challenges to the primary care delivery system, QI strategies will require changes to physician education and may require enhancing practice support.