Annals of family medicine
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Annals of family medicine · Mar 2013
Comparative StudyRisks and benefits associated with antibiotic use for acute respiratory infections: a cohort study.
Antibiotics are frequently prescribed for acute nonspecific respiratory infections (ARIs), presumably to avoid small risks of progression to serious bacterial illness. However, even low risks of associated adverse drug events could result in many such events at the population level. Our objective was to assess the risks and benefits of antibiotic use in a cohort of patients with ARIs, comparing outcomes of patients who were prescribed antibiotics with outcomes of patients not receiving antibiotics. ⋯ Compared with patients with ARI who were not treated with antibiotics, patients who were treated with antibiotics were not at increased risk of severe adverse drug events and had a small decreased risk of pneumonia hospitalization. This small benefit from antibiotics for a common ambulatory diagnosis creates persistent tension; at the societal level, physicians are compelled to reduce antibiotic prescribing, thus minimizing future resistance, whereas at the encounter level, they are compelled to optimize the benefit-risk balance for that patient.
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Annals of family medicine · Mar 2013
Controlled Clinical TrialImproved outcomes in diabetes care for rural African Americans.
Rural low-income African American patients with diabetes have traditionally poorer clinical outcomes and limited access to state-of-the-art diabetes care. We determined the effectiveness of a redesigned primary care model on patients' glycemic, blood pressure, and lipid level control. ⋯ Redesigning care strategies in rural fee-for-service primary care practices for African American patients with established diabetes results in significantly improved glycemic control relative to usual care.
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Annals of family medicine · Mar 2013
Screening for hypertension annually compared with current practice.
Hypertension is the most common diagnosis in ambulatory care, yet little evidence exists regarding recommended screening intervals or the sensitivity and specificity of a routine office-based blood pressure measurement, the most common screening test. Screening for hypertension is usually performed by measuring blood pressure at every outpatient visit, which often results in transiently elevated findings among adults who do not have a diagnosis of hypertension. We hypothesize that a more limited annual screening strategy may increase specificity while maintaining sensitivity. ⋯ A limited annual screening strategy for hypertension can improve specificity without sacrificing sensitivity when compared with routine screening at every visit in previously normotensive adults.
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Annals of family medicine · Jan 2013
Review Comparative StudyHow long does a cough last? Comparing patients' expectations with data from a systematic review of the literature.
We hypothesized that antibiotic overuse for acute cough illness (ACI) is in part due to a mismatch between patients' expectations and the natural history of ACI. ⋯ There is a mismatch between patients' expectations regarding the duration of ACI and the actual duration based on the best available evidence. Efforts to reduce inappropriate antibiotic use should target this discrepancy.