Journal of general internal medicine
-
Comparative Study
Prevalence of interpersonal abuse in primary care patients prescribed opioids for chronic pain.
Interpersonal abuse is associated with clinical problems including chronic pain disorders. ⋯ This study reports prevalence of abuse in both men and women prescribed opioids for chronic pain in primary care settings. Subjects who report experiencing interpersonal abuse also report significantly higher rates of suicide attempts and score higher on the ASI psychiatric scale. Screening patients taking opioids for chronic pain for interpersonal abuse may lead to a better understanding of contributors to their physical and mental health.
-
Residency programs involve trainees in quality improvement (QI) projects to evaluate competency in systems-based practice and practice-based learning and improvement. Valid approaches to assess QI proposals are lacking. ⋯ This method for assessing resident physician QI proposals is supported by content and internal structure validity evidence. QIPAT-7 is a useful tool for assessing resident QI proposals. Future research should determine the reliability of QIPAT-7 scores in other residency and fellowship training programs. Correlations should also be made between assessment scores and criteria for QI proposal success such as implementation of QI proposals, resident scholarly productivity, and improved patient outcomes.
-
Randomized Controlled Trial Multicenter Study Comparative Study
Screening for posttraumatic stress disorder in VA primary care patients with depression symptoms.
Unrecognized posttraumatic stress disorder (PTSD) is common and may be an important factor in treatment-resistant depression. Brief screens for PTSD have not been evaluated for patients with depression. ⋯ Most depressed VA primary care patients report a history of trauma, and one third may have comorbid PTSD. Our 4-item screen has useful LRs for scores of 0 and 3. Modifying item rating options may improve screening characteristics.
-
Multicenter Study Comparative Study
Effect of health-related quality of life on women and men's Veterans Affairs (VA) health care utilization and mortality.
Although women will account for almost 11% of veterans by 2040, we know little about their health and functioning, particularly compared to men. ⋯ Compared to men, women veterans receiving VA health care in the upper Midwest catchment area had better HRQOL and used fewer health services. Although VA health care utilization was similar across gender after adjusting for HRQOL, poorer mental or physical health was associated with fewer primary care stops for selected subgroups of women.
-
Comparative Study
Patient, physician, pharmacy, and pharmacy benefit design factors related to generic medication use.
Increased use of generic medications conserves insurer and patient financial resources and may increase patient adherence. ⋯ Physician and patient factors have an important influence on generic drug initiation, with the patients who live in the poorest zip codes paradoxically receiving generic drugs least often. While tiered pharmacy benefit designs and mail-order pharmacies helped steer patients towards generic medications once the first prescription has been filled, they had little effect on initial prescriptions. Providing patients and physicians with information about generic alternatives may reduce costs and lead to more equitable care.