Journal of general internal medicine
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Comparative Study
Older patients perceptions of "unnecessary" tests and referrals: a national survey of Medicare beneficiaries.
Unnecessary exposure to medical interventions can harm patients. Many hope that generalist physicians can limit such unnecessary exposure. ⋯ When faced with new symptoms, many older patients report that they would want a diagnostic test or specialty referral that their generalist thought was unnecessary. Generalists striving to provide patient-centered care while at the same time limiting exposure to unnecessary medical interventions will need to address their patients' perceptions regarding the need for these services.
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Randomized Controlled Trial Comparative Study
Quality of care for cardiovascular disease-related conditions in patients with and without mental disorders.
We compared the quality of care for cardiovascular disease (CVD)-related risk factors for patients diagnosed with and without mental disorders. ⋯ Quality of care for major chronic conditions associated with premature CVD-related mortality is suboptimal for VA patients with SMI, especially for procedures requiring care by a specialist.
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Randomized Controlled Trial Comparative Study
The impact of consumer-directed health plans and patient socioeconomic status on physician recommendations for colorectal cancer screening.
Consumer-directed health plans are increasingly common, yet little is known about their impact on physician decision-making and preventive service use. ⋯ Patient SES and deductible-level affect physician recommendations for preventive care. Coverage of preventive services and funds in medical savings accounts may help to mitigate the impact of high-deductibles and SES on inappropriate recommendations.
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Comparative Study
Providers' perceptions of relationships and professional roles when caring for patients who leave the hospital against medical advice.
Patients who leave hospitals against medical advice (AMA) may be at risk for adverse health outcomes. Their decision to leave may not be clearly understood by providers. This study explored providers' experiences with and attitudes toward patients who leave the hospital AMA. ⋯ Our study revealed that patients who leave AMA influence providers' perceptions of their patients' insight, and their own patient-provider communication, empathy for patients, and professional roles and obligations. Future research should investigate educational interventions to optimize patient-centered communication and support providers in their decisional conflicts when these challenging patient-provider discussions occur.
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Comparative Study
Contents of general practitioner-patient consultations in the treatment of depression.
Counseling of patients is an indispensable part of any drug treatment and even more so in the treatment of depression. ⋯ Counseling plays an important part in day-to-day encounters of general practitioners. Pharmacotherapy is embedded in comprehensive psychological care. Training programs for general practitioners should be specific in respect to different tasks and parts of the physician-patient encounter (e.g., building a therapeutic alliance, support for life problems or change of cognitions).