Journal of general internal medicine
-
Randomized Controlled Trial Multicenter Study
Community-partnered cluster-randomized comparative effectiveness trial of community engagement and planning or resources for services to address depression disparities.
Depression contributes to disability and there are ethnic/racial disparities in access and outcomes of care. Quality improvement (QI) programs for depression in primary care improve outcomes relative to usual care, but health, social and other community-based service sectors also support clients in under-resourced communities. Little is known about effects on client outcomes of strategies to implement depression QI across diverse sectors. ⋯ Community engagement to build a collaborative approach to implementing depression QI across diverse programs was more effective than resources for services for individual programs in improving mental HRQL, physical activity and homelessness risk factors, and shifted utilization away from hospitalizations and specialty medication visits toward primary care and other sectors, offering an expanded health-home model to address multiple disparities for depressed safety-net clients.
-
Randomized Controlled Trial
A social psychological approach to improving the outcomes of racially discordant medical interactions.
Medical interactions between Black patients and non-Black physicians are less positive and productive than racially concordant ones and contribute to racial disparities in the quality of health care. ⋯ An intervention used to reduce intergroup bias successfully produced greater Black patient trust of non-Black physicians and adherence. These findings offer promising evidence for a relatively low-cost and simple intervention that may offer a means to improve medical outcomes of racially discordant medical interactions. However, the sample size of physicians and patients was small, and thus the effectiveness of the intervention should be further tested in different settings, with different populations of physicians and other health outcomes.
-
Randomized Controlled Trial
Changing interactions between physician trainees and the pharmaceutical industry: a national survey.
Increasingly, medical school policies limit pharmaceutical representatives' access to students and gifts from drugmakers, but little is known about how these policies affect student attitudes toward industry. ⋯ Despite recent policy changes, a substantial number of trainees continue to receive gifts from pharmaceutical representatives. We found no relation between these outcomes and a school's policies concerning interactions with industry.
-
Randomized Controlled Trial
Gender differences among veterans deployed in support of the wars in Afghanistan and Iraq.
The changing scope of women's roles in combat operations has led to growing interest in women's deployment experiences and post-deployment adjustment. ⋯ Although there are important gender differences in deployment stressors-including women's increased risk of interpersonal stressors-and post-deployment adjustment, there are also significant similarities. The post-deployment adjustment of our nation's growing population of female Veterans seems comparable to that of our nation's male Veterans.
-
Randomized Controlled Trial
PTSD risk and mental health care engagement in a multi-war era community sample of women veterans.
Post-traumatic stress disorder (PTSD) is common in women veterans (WVs), and associated with significant co-morbidity. Effective treatment is available; however, PTSD is often unrecognized. ⋯ More than one in eight WVs screened positive for PTSD. Though a majority of VA-users received MHC, low income predicted nonuse. Only a minority of VA-nonusers received MHC. The majority of WVs use non-VA healthcare providers, who may be unaware of their veteran status and PTSD risk. VA outreach to educate VA-nonusers and their healthcare providers about WVs' PTSD risk and available evidence-based VA treatment options is one approach to extend the reach of VA MHC. Research to characterize barriers to VA MHC use for VA-nonusers and low income VA-users is warranted to better understand low service utilization, and to inform program development to engage more WVs in needed MHC.