Journal of general internal medicine
-
While patient-centered care (PCC) is desirable for many reasons, its relationship to treatment outcomes is controversial. We evaluated the relationship between PCC and the provision of preventive services. ⋯ Improved communication between patients and providers, and continuity of care are associated with increased provision of preventive services, while other aspects of PCC are not strongly related to delivery of preventive services.
-
To examine changes in the quality of primary care experienced and reported by Medicare beneficiaries from 1998 to 2000. ⋯ Over a 2-year period, the quality of seniors' interactions with their primary physicians declined significantly, as did other hallmarks of primary care such as continuity, integration of care, and financial access. This decline is in sharp contrast to the marked improvements in technical quality that have been measured over this period. In an era marked by substantial national investment in quality monitoring, measures of these elements of care are notably absent from the nation's portfolio of quality indicators.
-
Multicenter Study Clinical Trial
Promoting advance directives among elderly primary care patients.
To determine efficient ways of promoting advance directives among heterogeneous populations of elderly ambulatory patients. ⋯ A replicable intervention largely targeting doctors achieved a modest increase in advance directives among elderly ambulatory patients. Future interventions may need to target lower-income patients, "younger" elderly, and more specifically address doctors' attitudes and comfort discussing advance directives.
-
To use spatial and epidemiologic analyses to understand disparities in mammography use and to formulate interventions to increase its uptake in low-income, high-recent immigration areas in Toronto, Canada. ⋯ We found marked variation in mammography rates by area, with the lowest rates associated with low income and high immigration. Spatial patterns identified areas with low mammography and low physician visit rates appropriate for outreach and public education interventions. We also identified areas with low mammography and high physician visit rates appropriate for interventions targeted at physicians.
-
Physician self-disclosure has been viewed either positively or negatively, but little is known about how patients respond to physician self-disclosure. ⋯ Physician self-disclosure is significantly associated with higher patient satisfaction ratings for surgical visits and lower patient satisfaction ratings for primary care visits. Further study is needed to explore these intriguing findings and to define the circumstances under which physician self-disclosure is either well or poorly received.