Journal of general internal medicine
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Little is known about patients who skip doses or otherwise avoid using their medications because of cost. We sought to identify which elderly patients are at highest risk of restricting their medications because of cost, and how prescription coverage modifies this risk. ⋯ Medication restriction is common in seniors who lack prescription coverage, particularly among certain vulnerable groups. Seniors in these high-risk groups who have prescription coverage are much less likely to restrict their use of medications.
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To examine initiation of newer antiretroviral treatments across sociodemographic subgroups during the 3 years following the introduction of these treatments, and explore persistence on treatment and its association with patient characteristics. ⋯ Results suggest that consistent longitudinal use is difficult for many patients. Persistence of use was lower for minority beneficiaries despite comparable coverage for pharmacy and other health services through Medicaid. Our findings suggest the need to examine nonfinancial barriers to appropriate use of highly active antiretroviral therapy, and to develop and test programmatic strategies for supporting patients in remaining on these regimens consistently.
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To examine whether patients' experiences with nontechnical aspects of care such as patient education and discharge planning are associated with long-term outcomes. ⋯ Patients' experiences with nontechnical processes of AMI hospital care are associated with long-term outcomes; however the association between a negative hospital experience and subsequent chest pain may be offset by more positive outpatient experiences.
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A prospective pilot study was undertaken to assess a protocol to educate primary care residents in how to personally perform ultrasonography for abdominal aortic aneurysm screening. Resident exams were proctored by a primary care physician trained in ultrasonography and were scored on the level of competence in doing the examination. Patients had ultrasound performed by a resident, followed by repeat examination by the vascular lab. ⋯ There were 75 normal examinations; resident ultrasonography results were consistent with the results of the vascular lab. Ten residents achieved an abdominal aortic ultrasound-independent competence level after an average of 3.4 proctored exams. The main outcome of this study is that a primary care resident, with minimal training in ultrasonography imaging, is able to rapidly learn the technique of ultrasonography imaging of the abdominal aorta.
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Editorial Comment
Processes and outcomes in acute myocardial infarction.