Journal of general internal medicine
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Clinical Trial
Tracking abnormal cervical cancer screening: evaluation of an EMR-based intervention.
System level barriers have been associated with inadequate follow-up of abnormal cervical cytology. ⋯ Our study cannot demonstrate that with follow up, we directly avoided cases of invasive cervical cancer. However, we show that in an at-risk urban population, an automated, EMR-based tracking system reduced the time to resolution, and increased the number of women who achieved diagnostic resolution.
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Randomized Controlled Trial
Cost-effectiveness of strategies to improve HIV testing and receipt of results: economic analysis of a randomized controlled trial.
The CDC recommends routine voluntary HIV testing of all patients 13-64 years of age. Despite this recommendation, HIV testing rates are low even among those at identifiable risk, and many patients do not return to receive their results. ⋯ In a primary-care population, nurse-initiated routine screening with rapid HIV testing and streamlined counseling increased rates of testing and receipt of test results and was cost-effective compared with traditional HIV testing strategies.
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Socioculturally relevant measures of medical mistrust are needed to better address health disparities, especially among Black men, a group with lower life expectancy and higher death rates compared to other race/gender groups. ⋯ The present findings provide strong additional evidence that the GBMMS is a valid and reliable measure that may be used among urban Black men.
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Some Medicare Part D enrollees whose drug expenditures exceed a threshold enter a coverage gap with full cost-sharing, increasing their risk for reduced adherence and adverse outcomes. ⋯ Certain chronically ill MAPD enrollees are at high risk of gap entry and exposure to unsubsidized medication costs. Clinically vulnerable populations should be counseled on how to best manage costs through drug substitution or discontinuation of specific, non-essential medications.