Journal of general internal medicine
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Comparative Study
Home buprenorphine/naloxone induction in primary care.
Buprenorphine can be used for the treatment of opioid dependence in primary care settings. National guidelines recommend directly observed initial dosing followed by multiple in-clinic visits during the induction week. We offered buprenorphine treatment at a public hospital primary care clinic using a home, unobserved induction protocol. ⋯ Home buprenorphine induction was feasible and appeared safe. Induction complications occurred at expected rates and were not associated with short-term treatment drop-out.
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There are few population-based studies of cardiovascular risk factors, knowledge, and related behaviors among Vietnamese Americans. ⋯ There are significant disparities in risk factors and knowledge of symptoms of cardiovascular diseases among Vietnamese Americans. Culturally appropriate studies and interventions are needed to understand and to reduce these disparities.
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Comparative Study
Patient experiences with coordination of care: the benefit of continuity and primary care physician as referral source.
Coordination across a patient's health needs and providers is important to improving the quality of care. ⋯ Facilitating visit continuity between the patient and PCP, and encouraging the use of the PCP as the referral source would likely enhance care coordination.
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Comparative Study
Readiness for the Patient-Centered Medical Home: structural capabilities of Massachusetts primary care practices.
The Patient-Centered Medical Home (PCMH), a popular model for primary care reorganization, includes several structural capabilities intended to enhance quality of care. The extent to which different types of primary care practices have adopted these capabilities has not been previously studied. ⋯ Larger and network-affiliated primary care practices are more likely than smaller, non-affiliated practices to have adopted several recommended capabilities. In order to achieve PCMH designation, smaller non-affiliated practices may require the greatest investments.
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Comparative Study
High prevalence of stage 3 chronic kidney disease in older adults despite normal serum creatinine.
Serum creatinine is commonly used to diagnose chronic kidney disease (CKD), but may underestimate CKD in older adults when compared with using glomerular filtration rates (eGFR). The magnitude of this underestimation is not clearly defined. ⋯ Use of serum creatinine underestimates the presence of advanced (stage 3 or greater) CKD among older adults in the US. Automated eGFR reporting may improve the accuracy of risk stratification for older adults with CKD.