Arch Intern Med
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Multicenter Study Comparative Study
"Are you at peace?": one item to probe spiritual concerns at the end of life.
Physicians may question their role in probing patients' spiritual distress and the practicality of addressing such issues in the time-limited clinical encounter. Yet, patients' spirituality often influences treatment choices during a course of serious illness. A practical, evidence-based approach to discussing spiritual concerns in a scope suitable to a physician-patient relationship may improve the quality of the clinical encounter. ⋯ Asking patients about the extent to which they are at peace offers a brief gateway to assessing spiritual concerns. Although these issues may be heightened at the end of life, research suggests they influence medical decision making throughout a lifetime of care.
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Multicenter Study Comparative Study
Depression and medication adherence in outpatients with coronary heart disease: findings from the Heart and Soul Study.
Depression leads to adverse outcomes in patients with coronary heart disease (CHD). Medication nonadherence is a potential mechanism for the increased risk of CHD events associated with depression, but it is not known whether depression is associated with medication nonadherence in outpatients with stable CHD. ⋯ Depression is associated with medication nonadherence in outpatients with CHD. Medication nonadherence may contribute to adverse cardiovascular outcomes in depressed patients.
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Multicenter Study Comparative Study
Justice at work and reduced risk of coronary heart disease among employees: the Whitehall II Study.
Justice is a fundamental value in human societies, but its effect on health is poorly described. We examined justice at work as a predictor of coronary heart disease (CHD). ⋯ Justice at work may have benefits for heart health among employees.
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Multicenter Study Comparative Study
Variation in the tendency of primary care physicians to intervene.
Research has documented dramatic variation in health care spending across the United States that has little relationship to health outcomes. Although high-spending areas have more physicians per capita, it is not known whether this disparity fully explains the differences in spending or whether individual physicians in high-spending regions have a greater tendency to intervene for their patients. We sought to measure the tendency of primary care physicians to intervene across regions that differ in their levels of local health care spending. ⋯ Varying rates of health care spending across the United States reflect the underlying tendency of local physicians to recommend interventions for their patients.
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Multicenter Study
The role of patient-physician trust in moderating medication nonadherence due to cost pressures.
Prescription drug costs constitute a burden for many chronically ill adults and are strongly related to patients' likelihood of using less medication than prescribed. We examined the extent to which patients' trust in their physicians may moderate the impact of economic constraints and other risk factors for cost-related adherence problems. ⋯ These findings suggest that a trusting physician relationship may moderate the impact of cost pressures on patients' medication adherence. More generally, addressing noncost barriers to adherence may reduce rates of cost-related medication underuse.