Annals of family medicine
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Annals of family medicine · May 2005
Breast and cervical cancer screening: impact of health insurance status, ethnicity, and nativity of Latinas.
Although rates of cancer screening for Latinas are lower than for non-Latina whites, little is known about how insurance status, ethnicity, and nativity interact to influence these disparities. Using a large statewide database, our study examined the relationship between breast and cervical cancer screening rates and socioeconomic and health insurance status among foreign-born Latinas, US-born Latinas, and non-Latina whites in California. ⋯ Breast and cervical cancer screening rates vary by ethnicity and nativity, with foreign-born Latinas experiencing the highest rates of never being screened. After accounting for socioeconomic factors, differences by ethnicity and nativity are reversed or eliminated. Lack of health insurance coverage remains the strongest predictor of cancer screening underutilization.
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The health care system in the United States is inherently hierarchical. Patients are "nested" within physicians who in turn are "nested" within practices. Much of the research data gathered in practice-based research networks (PBRNs) also have similar patterns of nesting (clustering). When research data are nested, statistical approaches to the data must account for the multilevel nature of the data or risk errors in interpretation. We illustrate the concept of multilevel structure and provide examples with implications for practice-based research. ⋯ Recognizing and accounting for multilevel structure when analyzing data from PBRN studies can lead to more accurate conclusions, as well as offer opportunities to explore contextual effects and differences across sites. Accommodating multilevel structure in planning research studies can result in more appropriate estimation of required sample size.
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Annals of family medicine · May 2005
COGME's 16th Report to Congress: too many physicians could be worse than wasted.
Departing from past reports, the latest Council on Graduate Medical Education (COGME) report warns of a physician deficit of 85,000 by 2020 and recommends increases in medical school and residency output. COGME notes that contributions of other clinicians and changes in how medical care is delivered in the future would likely offset physician deficits but chose not to modify their recommendations. ⋯ Producing a physician surplus could be far worse than wasted, because the investment required and resulting rise in health care cost may harm, not help, the health of people in the United States. Instead, these resources could be applied in ways that improve health.
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Medicine is traditionally considered a healing profession, but it has neither an operational definition of healing nor an explanation of its mechanisms beyond the physiological processes related to curing. The objective of this study was to determine a definition of healing that operationalizes its mechanisms and thereby identifies those repeatable actions that reliably assist physicians to promote holistic healing. ⋯ Healing may be operationally defined as the personal experience of the transcendence of suffering. Physicians can enhance their abilities as healers by recognizing, diagnosing, minimizing, and relieving suffering, as well as helping patients transcend suffering.
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Annals of family medicine · May 2005
Is there time for management of patients with chronic diseases in primary care?
Despite the availability of national practice guidelines, many patients fail to receive recommended chronic disease care. Physician time constraints in primary care are likely one cause. ⋯ Current practice guidelines for only 10 chronic illnesses require more time than primary care physicians have available for patient care overall. Streamlined guidelines and alternative methods of service delivery are needed to meet recommended standards for quality health care.