Journal of general internal medicine
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Letter Observational Study
Improving Hepatitis C Screening Rates in an Ambulatory Clinic: an Observational Study.
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Randomized Controlled Trial
Short-Term VA Health Care Expenditures Following a Health Risk Assessment and Coaching Trial.
Short-term health care costs following completion of health risk assessments and coaching programs in the VA have not been assessed. ⋯ Compared to completing and receiving HRA results, working with health coaches to set actionable health behavior change goals following HRA completion did not reduce short-term health expenditures.
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When working with surrogate decision-makers, physicians often encounter ethical challenges that may cause moral distress which can have negative consequences for physicians. ⋯ Physician moral distress occurs more frequently when the physician is male, the patient is older or requires decisions about life-sustaining treatments. These findings may help target interventions to support physicians. Prior discussions about patient wishes is associated with lower distress and may be a target for patient-centered interventions.
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Heterogeneity of existing physician burnout studies impairs analyses of longitudinal trends, geographic distribution, and organizational factors impacting physician burnout. The Department of Veterans Affairs (VA) is one of the largest integrated healthcare systems in the USA, offering a unique opportunity to study burnout across VA sites and time. ⋯ VA physician burnout was lower than previously described in many non-VA studies and was relatively stable over time. These findings may be due to unique characteristics of the VA practice environment. Nonetheless, with over a third of VA physicians reporting burnout, organizational interventions are needed. Primary care physicians and those practicing at small, rural sites have higher rates of burnout and may warrant more focused attention. Our results can guide targeted interventions to promote VA physician well-being and inform efforts to address burnout in diverse clinical settings.
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Federally qualified health centers (FQHCs) serve diverse communities in the United States (U.S.) and could function as important venues to diagnose and treat hepatitis C virus (HCV) infections. ⋯ Fewer than 20% of individuals with identified OUD were tested for HCV. SVR was lower than findings in other real-world cohorts. Measures to improve outcomes should be considered with the expansion of HCV management into community clinics.