Journal of general internal medicine
-
Multicenter Study
Factors associated with frequency of emergency department visits for chronic obstructive pulmonary disease exacerbation.
Little is known about the factors associated with frequency of emergency department visits (FEDV) in chronic obstructive pulmonary disease (COPD) patients with recurrent exacerbations. ⋯ Our results suggest that both disease and health care-related factors were associated with FEDV in COPD exacerbation. Multidisciplinary efforts through primary care provider follow-up should be assessed to test the effects on reducing the high morbidity and cost of recurrent COPD exacerbations.
-
Multicenter Study
Hypertensive patients' race, health beliefs, process of care, and medication adherence.
African Americans have higher rates of hypertension and worse blood pressure (BP) control than Whites, and poorer medication adherence may contribute to this phenomenon. We explored associations among patients' race, self-reported experiences with clinicians, attitudes and beliefs about hypertension, and ultimately, medication adherence, among a sample with no racial disparities in BP control, to determine what lessons we could learn from patients and providers in this setting. ⋯ When both physicians and patients take BP management seriously, disparities in BP adherence and control may be reduced.
-
The paper sets forth a set of evidence-based recommendations for interventions to combat unintentional bias among health care providers, drawing upon theory and research in social cognitive psychology. Our primary aim is to provide a framework that outlines strategies and skills, which can be taught to medical trainees and practicing physicians, to prevent unconscious racial attitudes and stereotypes from negatively influencing the course and outcomes of clinical encounters. ⋯ We emphasize the need for programs to provide a nonthreatening environment in which to practice new skills and the need to avoid making providers ashamed of having racial, ethnic, or cultural stereotypes. These recommendations are also intended to provide a springboard for research on interventions to reduce unintentional racial bias in health care.
-
Very little is known about complementary and alternative medicine (CAM) use in Asian Americans (AA), especially on a national level. To compare CAM use, reasons for use, and disclosure rates between Asian and non-Hispanic white Americans (NHW), and examine ethnic variations among AA. Data on CAM use in the past year (excluding prayer) were used from the 2002 National Health Interview Survey for 917 AA and 20,442 NHW. ⋯ Among AA, CAM use was associated with being female, having higher education, and having a chronic medical condition; foreign-birth was not associated with CAM use. Complementary and alternative medicine use is common among AA, and there are important ethnic variations in use. Asian Americans are less likely than NHW to disclose CAM use to conventional healthcare providers, suggesting that it is particularly important that physicians query AA patients about CAM use.
-
Oral anticoagulants (OAC) are effective and safe if the international normalized ratio (INR) is maintained within a narrow therapeutic range. Hospitalization is independently associated with poor anticoagulation control. The objective of this study is to describe how anticoagulation control changes in the peri-hospitalization period. ⋯ Following other hospitalization types, the proportion of patients with INR < 1.5 was significantly increased (daily increase 0.19%, P = .02). Patients admitted to the hospital for a variety of indications have significantly worse anticoagulation control in the peri-hospitalization period. Anticoagulated patients discharged after medical hospitalizations could be targeted for improved anticoagulation control.