Journal of general internal medicine
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Randomized Controlled Trial Multicenter Study Comparative Study
Impacts of evidence-based quality improvement on depression in primary care: a randomized experiment.
Previous studies testing continuous quality improvement (CQI) for depression showed no effects. Methods for practices to self-improve depression care performance are needed. We assessed the impacts of evidence-based quality improvement (EBQI), a modification of CQI, as carried out by 2 different health care systems, and collected qualitative data on the design and implementation process. ⋯ Evidence-based quality improvement had perceptible, but modest, effects on practice performance for patients with depression. The modest improvements, along with qualitative data, identify potential future directions for improving CQI research and practice.
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Comparative Study
Simultaneous control of intermediate diabetes outcomes among Veterans Affairs primary care patients.
Guidelines recommend tight control of hemoglobin A1c (HbA1c), low-density lipoprotein cholesterol (LDL-C), and blood pressure (BP) for patients with diabetes. The degree to which these intermediate outcomes are simultaneously controlled has not been extensively described. ⋯ While the proportion of patients who achieved minimal levels of control of HbA1c and LDL-C was high, these data indicate a low level of simultaneous control of HbA1c, LDL-C, and BP among patients with diabetes.
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To explore the effect of race on primary care quality and satisfaction among women in the Department of Veterans Affairs (VA). ⋯ While demographics and health experiences vary by race among veterans, race had no effect on primary care ratings. Future studies need to determine whether this racial equity persists in health outcomes among women veterans.
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Randomized Controlled Trial Multicenter Study Comparative Study
Cost-effectiveness of a disease management program for major depression in elderly primary care patients.
Major depression is common in older adults and is associated with increased health care costs. Depression often remains unrecognized in older adults, especially in primary care. ⋯ This disease management program for major depression in elderly primary care patients had no statistically significant relationship with clinical outcomes, costs, and cost-effectiveness. Therefore, based on these results, continuing usual care is recommended.
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Randomized Controlled Trial Comparative Study
Improving depression care in patients with diabetes and multiple complications.
Depression is common in patients with diabetes, but it is often inadequately treated within primary care. Competing clinical demands and treatment resistance may make it especially difficult to improve depressive symptoms in patients with diabetes who have multiple complications. ⋯ Patients with depression and diabetes who have multiple complications may benefit most from collaborative care for depression. These findings suggest that with appropriate intervention depression can be successfully treated in patients with diabetes who have the highest severity of medical problems.