Journal of general internal medicine
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Randomized Controlled Trial Multicenter Study Clinical Trial
Improving depression outcomes in community primary care practice: a randomized trial of the quEST intervention. Quality Enhancement by Strategic Teaming.
To determine whether redefining primary care team roles would improve outcomes for patients beginning a new treatment episode for major depression. ⋯ In practices without onsite mental health professionals, brief interventions training primary care teams to assume redefined roles can significantly improve depression outcomes in patients beginning a new treatment episode. Such interventions should target patients who report that antidepressant medication is an acceptable treatment for their condition. More research is needed to determine how primary care teams can best sustain these redefined roles over time.
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Multicenter Study
Prevalence and determinants of intimate partner abuse among public hospital primary care patients.
To determine the prevalence, sociodemographic determinants, and depression correlates of intimate partner abuse among an ethnically diverse population of women patients. ⋯ Because a substantial proportion of women patients in primary care settings are abused, screening for partner abuse and depression is indicated. In contrast to other studies, lower socioeconomic status was not associated with partner abuse history.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Perceived access problems among patients with diabetes in two public systems of care.
We examined the prevalence of access problems among public clinic patients after participating in trials of automated telephone disease management with nurse follow-up. ⋯ Many of these public sector patients with diabetes reported that they failed to obtain health services because they perceived financial and nonfinancial access problems. Automated telephone disease management calls with telephone nurse follow-up improved patients' access to care. Despite the impact of the intervention, county clinic patients were more likely than VA patients to report access problems in several areas.
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Multicenter Study
Measuring compliance with preventive care guidelines: standardized patients, clinical vignettes, and the medical record.
To determine how accurately preventive care reported in the medical record reflects actual physician practice or competence. ⋯ These data indicate that physicians perform more preventive care than they report in the medical record. Thus, benchmarks of preventive care by individual physicians and institutions that rely solely on the medical record may be misleading, at best.
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Multicenter Study Comparative Study
Effects of the revised HCFA evaluation and management guidelines on inpatient teaching.
In 1996, the Health Care Financing Administration (HCFA) introduced new evaluation and management (E&M) guidelines mandating more intensive supervision and documentation by attending physicians. We assessed the effects of the guidelines on inpatient teaching. ⋯ Physicians reported a dramatic increase in overall time spent attending but a decrease in time spent teaching following implementation of the revised E&M guidelines. Yet, evaluations of their teaching effectiveness did not change.