Journal of general internal medicine
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To describe the medical care use and costs associated with migraine. ⋯ By combining validated telephone survey information to identify migraine cases and controls with comprehensive claims data, we found migraine cases incur higher medical care costs compared to controls. These increased costs are associated with the presence of psychiatric symptoms and other comorbidities.
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While patient-centered care (PCC) is desirable for many reasons, its relationship to treatment outcomes is controversial. We evaluated the relationship between PCC and the provision of preventive services. ⋯ Improved communication between patients and providers, and continuity of care are associated with increased provision of preventive services, while other aspects of PCC are not strongly related to delivery of preventive services.
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Comparative Study
Race/ethnicity and patient satisfaction. Using the appropriate method to test for perceived differences in care.
To determine whether an established patient satisfaction scale commonly used in the primary care setting is sufficiently sensitive to identify racial/ethnic differences in satisfaction that may exist; to compare a composite indicator of overall patient satisfaction with a 4-item satisfaction scale that measures only the quality of the direct physician-patient interaction. ⋯ Measurements of patient satisfaction that use multi-item, composite indicators should also include focused comparisons of satisfaction directly with the care provided by the physician. In measurements of patient satisfaction, patient race/ethnicity should be included as an explanatory variable. The results also confirm earlier findings that factors external to the direct physician-patient interaction can have substantial effects on patients' perceptions of that interaction.
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Despite the explosion of online communication in the community, its use between patients and their health care providers remains low. However, rapidly growing patient and provider interest in using online communication has motivated organizations to consider options for deploying these new tools in clinical practice. ⋯ Finally, we provide a roadmap for developing and deploying these new tools in clinical practice. Health care providers and their organizations will need to consider issues related to technology, data management, operations, communication management, and financial support in order to successfully deploy online services and communication for patients in clinical settings.
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Multicenter Study Clinical Trial
Promoting advance directives among elderly primary care patients.
To determine efficient ways of promoting advance directives among heterogeneous populations of elderly ambulatory patients. ⋯ A replicable intervention largely targeting doctors achieved a modest increase in advance directives among elderly ambulatory patients. Future interventions may need to target lower-income patients, "younger" elderly, and more specifically address doctors' attitudes and comfort discussing advance directives.