Journal of general internal medicine
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Comparative Study
Do physicians with self-reported non-English fluency practice in linguistically disadvantaged communities?
Language concordance between physicians and patients may reduce barriers to care faced by patients with limited English proficiency (LEP). It is unclear whether physicians with fluency in non-English languages practice in areas with high concentrations of people with LEP. ⋯ Physicians who are fluent in Spanish or an Asian language are more likely to practice in geographic areas where their potential patients speak the corresponding language.
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Comparative Study
Health care utilization and unhealthy behaviors among victims of sexual assault in Connecticut: results from a population-based sample.
In the United States, 1 in 6 women report a lifetime prevalence of sexual assault. Few population-based studies have examined the association between sexual assault victimization on health care utilization and unhealthy behaviors. ⋯ For Connecticut adults, sexual assault victimization was associated with infrequent usage of some primary care health services and higher risks of unhealthy behaviors. Increased community-level interventions and public health outreach programs are needed to provide health-care services to this high-risk group.
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Aggressive weight-based dosing guidelines help achieve prompt therapeutic anticoagulation in patients with venous thromboembolism (VTE). While obese patients with VTE face an increased risk of recurrence, physicians typically resist prescribing doses two to three times the usual dose because of concern about bleeding complications. ⋯ A substantial proportion of obese patients treated with unfractionated heparin experienced a delay >24 h in achieving adequate anticoagulation, and the vast majority received an inadequate heparin bolus or initial continuous infusion (or both) according to current dosing guidelines.
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In Massachusetts, physician groups' performance on validated surveys of patient experience has been publicly reported since 2006. Groups also receive detailed reports of their own performance, but little is known about how physician groups have responded to these reports. ⋯ Despite statewide public reporting, physician groups' use of patient experience data varied widely. Integrated organizational models were associated with greater engagement, and efforts to enhance clinicians' interpersonal skills were uncommon, with groups predominantly focusing on office workflow and support staff.
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Randomized Controlled Trial Comparative Study
A video-intervention to improve clinician attitudes toward patients with sickle cell disease: the results of a randomized experiment.
Clinician attitudes toward patients are associated with variability in the quality of health care. Attitudes are typically considered difficult to change, and few interventions have attempted to do so. Negative attitudes toward adults with sickle cell disease have been identified as an important barrier to the receipt of appropriate pain management for this patient population. ⋯ Our results suggest that the attitudes of clinicians toward sickle cell patients may be improved through a short and relatively easy to implement intervention. Whether the attitudinal differences associated with our intervention are sustainable or are linked to clinical outcomes remains to be seen.