Journal of general internal medicine
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Randomized Controlled Trial Multicenter Study Comparative Study
Reducing the prescribing of heavily marketed medications: a randomized controlled trial.
Prescription drug costs are a major component of health care expenditures, yet resources to support evidence-based prescribing are not widely available. ⋯ Computerized decision support is an effective tool to reduce the prescribing of heavily marketed hypnotic medications in ambulatory care settings.
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Comparative Study
Comparison of medicine resident diabetes care between Veterans Affairs and academic health care systems.
Although others have reported national disparities in the quality of diabetes care between the Veterans Affairs (VA) and private health care delivery systems, it is not known whether these differences persist among internal medicine resident providers in academic settings. ⋯ In spite of similar resident providers and practice models, there were substantial differences in the diabetes quality of care delivered in the VA and AHS. Understanding how these factors influence subsequent practice patterns is an important area for study.
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Comparative Study
Characteristics of uninsured Americans with chronic kidney disease.
In the United States, public health insurance is available for nearly all persons with end-stage renal disease (ESRD). Little is known about the extent of health insurance coverage for persons with non-dialysis dependent chronic kidney disease (CKD). ⋯ Uninsured persons with non-dialysis dependent CKD are at higher risk for progression to ESRD than their insured counterparts but are less likely to receive recommended interventions to slow disease progression. Lack of public health insurance for patients with non-dialysis dependent CKD may result in missed opportunities to slow disease progression and thereby reduce the public burden of ESRD.
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Comparative Study
Population-based fracture risk assessment and osteoporosis treatment disparities by race and gender.
Undertreatment of osteoporosis has been recognized as a common problem in selected patient subgroups. However, primary prevention has been hampered by limited risk assessment tools that can be applied to large populations. ⋯ A substantial gap exists between 2008 NOF treatment guidelines based on fracture risk and the receipt of prescription osteoporosis medications. This gap was particularly notable for African Americans and men. FRAX is likely to be useful to assess risk at a population level and identify high-risk persons in need of additional evaluation.
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Comparative Study
Understanding their options: determinants of hospice discussion for older persons with advanced illness.
Clinicians' discussions about hospice with patients and families are important as a means of communicating end-of-life options. ⋯ Clinicians' discussion of hospice for patients with advanced illness, and, ultimately, patients' use of hospice, relies largely on clinician estimates of patient life expectancy and the predictability of disease course. Many clinicians whose patients might benefit from learning about hospice are not having these discussions.