Journal of general internal medicine
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Randomized Controlled Trial Comparative Study
Academic Detailing Compared with Group Meetings to Change Drug Prescribing for Type 2 Diabetes-A Randomized Controlled Trial.
Academic detailing (AD) is a one-on-one educational outreach with the goal to improve prescribing. There is insufficient evidence on the difference in impact between AD and group visits to facilitate behavior change among general practitioners (GPs). ⋯ Short educational visits of 20-45 min impact the prescribing of drugs for T2D, either the education is given one-on-one as AD or in a group setting.
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Multicenter Study
Patient and Physician Perspectives on Discussing Addiction Recovery and Spirituality in the Primary Care Setting.
Spirituality is an important component of recovery for many individuals with substance use disorder (SUD). However, few studies have compared patient and physician attitudes on spirituality in SUD recovery. ⋯ Spirituality can have diverse effects on an individual's SUD recovery. Physicians endorsed the benefits of discussing spirituality in the context of their patients' recovery, while patients expressed reservations about engaging in these conversations with their physicians. This variation in perspectives highlights the need for additional research to understand the individual and structural factors that contribute to it, as well as best practices for engaging in effective, non-judgmental conversations about spirituality in recovery.
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Health care systems are increasingly partnering with community-based organizations to address social determinants of health (SDH). We established a program that educates and connects patients with SDH needs at a primary care clinic to community services and facilitated referrals. ⋯ Our findings suggest that screening clinic patients for SDH, and educating and connecting them to community services during post-hospital care may be associated with reductions in hospital readmissions.
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Patterns of Care Following a Positive Fecal Blood Test for Colorectal Cancer: A Mixed Methods Study.
Multilevel barriers to colonoscopy after a positive fecal blood test for colorectal cancer (CRC) are well-documented. A less-explored barrier to appropriate follow-up is repeat fecal testing after a positive test. We investigated this phenomenon using mixed methods. ⋯ Among patients in this cohort, 7.4% repeated fecal testing after an initial positive test. Of those, over half did not go on to receive a colonoscopy within 1 year. Efforts to improve CRC screening must address repeat fecal testing after a positive test as a barrier to completing colonoscopy.
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The available data on anticoagulation therapy in real-world primary care settings for atrial fibrillation (AF) patients at high risk of stroke is limited. ⋯ AF with high stroke risk adult patients are more likely to be on an oral anticoagulant if they are older, having BMI ≥ 25, or taking more than five medications. Medicare as the sole coverage, male gender, worse renal function, and higher CHA2DS2-VASc scores are factors associated with greater warfarin usage, while patients taking over five daily medications are more likely to be prescribed DOACs.