Journal of general internal medicine
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Review
Interactions between pharmaceutical representatives and doctors in training. A thematic review.
Medical school and residency are formative years in establishing patterns of prescribing. We aimed to review the literature regarding the extent of pharmaceutical industry contact with trainees, attitudes about these interactions, and effects on trainee prescribing behavior, with an emphasis on points of potential intervention and policy formation. ⋯ The pharmaceutical industry has a significant presence during residency training, has gained the overall acceptance of trainees, and appears to influence prescribing behavior. Training programs can benefit from policies and curricula that teach residents about industry influence and ways in which to critically evaluate information that they are given. Recommendations for local and national approaches are discussed.
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Comparative Study
Self-reported comorbidities, perceived needs, and sources for usual care for older and younger homeless adults.
While older individuals who are homeless tend to be in poorer health, it is less clear how they view their health care needs and whether their self-reported patterns for accessing health services differ from younger homeless counterparts. ⋯ Older homeless adults have a greater disease burden than their younger counterparts. However, it is unclear whether these needs are being appropriately identified and met. There is a need for specific and targeted outreach to connect them to appropriate services.
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Comparative Study
Quality of ambulatory care for women and men in the Veterans Affairs Health Care System.
Gender differences in inpatient quality of care are well known. However, whether men and women receive equivalent ambulatory care is less well understood. ⋯ In this large national health care system that predominantly serves men, the quality of ambulatory care is equivalent for women and men on numerous measures.
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To report rates of cost-related skipping of medications and other treatments, assess correlates of skipping, examine changes in skipping between 1998 and 2000, and identify factors associated with changes in skipping. ⋯ Cost-related skipping was associated with several factors, including drug coverage, poverty, poor health, and physician-patient relationship quality. The important role of physician-patient relationships in cost-related skipping has not been shown previously. Physicians should be aware of these risk factors for cost-related skipping, and initiate dialogue about problems paying for prescription medications and other treatments.
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Hepatitis C virus (HCV) infection is both prevalent and undertreated. ⋯ HCV treatment was infrequent in our cohort of outpatients. Barriers to treatment included patient factors (patient preference, alcohol use, missed appointments), provider factors (reluctance to treat past substance abusers), and system factors (referral-associated delays). Multimodal interventions may be required to increase HCV treatment rates.