Annals of family medicine
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Annals of family medicine · Mar 2005
ReviewLiability implications of physician-directed care coordination.
Various public and private initiatives encourage physicians to coordinate care for patients who have multiple chronic conditions, but physicians may resist doing so for fear of liability. This article assesses the extent of liability risk. ⋯ Physicians' perceptions about the liability risks of coordinating care for patients with multiple chronic conditions do not match evidence about the factors actually driving liability. It appears from many informed sources that there is no strong basis for physicians who perform these functions to have serious concerns about liability; instead, care coordination done well may lower liability risks.
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Annals of family medicine · Jan 2005
Randomized Controlled Trial Comparative StudyRCT of a care manager intervention for major depression in primary care: 2-year costs for patients with physical vs psychological complaints.
Depression care management for primary care patients results in sustained improvement in clinical outcomes with diminishing costs over time. Clinical benefits, however, are concentrated primarily in patients who report to their primary care clinicians psychological rather than exclusively physical symptoms. This study proposes to determine whether the intervention affects outpatient costs differentially when comparing patients who have psychological with patients who have physical complaints. ⋯ Depression intervention for a 2-year period produced observable clinical benefit with decreased outpatient costs for depressed patients who complain of psychological symptoms. It produced limited clinical benefit with increased costs, however, for depressed patients who complain exclusively of physical symptoms, suggesting the need for developing new intervention approaches for this group.
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The risk of an injury increases exponentially with alcohol consumption on a given occasion, but the conclusion that alcohol-related injuries are attributable primarily to heavy drinking may or may not be correct. The prevention paradox states that a large number of people at small risk may contribute more cases of a particular condition than a smaller number of people who are individually at greater risk. We sought to determine the extent to which the prevention paradox applies in the relationship between alcohol consumption and injury. ⋯ Injury is associated more with an occasion of alcohol consumption than with alcohol dependence. A substantial proportion of the PAF that is due to an occasion of alcohol consumption is from what are usually considered low-risk quantities.
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Annals of family medicine · Jan 2005
Changes in age at diagnosis of type 2 diabetes mellitus in the United States, 1988 to 2000.
The prevalence of diabetes in the United States is increasing. There is also concern that diabetes may be occurring at a greater frequency in youth and in young adults. We describe US population trends in self-reported age at diagnosis of type 2 diabetes mellitus. ⋯ The age at diagnosis of type 2 diabetes mellitus has decreased with time. This finding likely represents a combination of changing diagnostic criteria, improved physician recognition of diabetes, and increased public awareness. Younger age at diagnosis may also reflect a true population trend of earlier onset of type 2 diabetes.
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Annals of family medicine · Jan 2005
The recognition of depression: the primary care clinician's perspective.
The purpose of this study was to explore the responses of primary care clinicians to patients who complain of symptoms that might indicate depression, to examine the clinical strategies used by clinicians to recognize depression, and to identify the conditions that influence their ability to do so. ⋯ The likelihood of accurately diagnosing depression and the timeliness of the diagnosis are highly influenced by the conditions within which clinicians practice. Productivity expectations in primary care will continue to undermine the identification and treatment of depression if they fail to take into consideration the factors that influence such care.