Journal of general internal medicine
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Multicenter Study Comparative Study
Ambulatory hypercholesterolemia management in patients with atherosclerosis. Gender and race differences in processes and outcomes.
To determine whether outpatient cholesterol management varies by gender or race among patients with atherosclerosis, and assess factors related to subsequent cholesterol control. ⋯ In this high-risk population with uncontrolled cholesterol, cholesterol management was less intensive for women than men but similar for black and white patients. Less intense cholesterol management accounted for some of the disparity in cholesterol control between women and men but not between black and white patients.
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To describe local health care market dynamics that support increasing use of hospitalists' services and changes in their roles. ⋯ These findings have important implications for patients, hospitalists, and their employers. Hospitalists may require changes in education and training, develop competing goals and priorities, and face new issues in their relationships with health plans, hospitals, and other physicians.
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Randomized Controlled Trial Multicenter Study
Brief physician and nurse practitioner-delivered counseling for high-risk drinking. Results at 12-month follow-up.
The objective of this study was to determine the effects of a brief primary care provider-delivered counseling intervention on the reduction of alcohol consumption by high-risk drinkers. The intervention was implemented as part of routine primary care medical practice. ⋯ Project Health provides evidence that screening and very brief (5-10 minute) advice and counseling delivered by a patient's personal physician or nurse practitioner as a routine part of a primary care visit can reduce alcohol consumption by high-risk drinkers.
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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.
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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.