Journal of general internal medicine
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Multicenter Study
Primary care provider concerns about management of chronic pain in community clinic populations.
Chronic pain is a common patient complaint in primary care, yet providers and patients are often dissatisfied with treatment processes and outcomes. ⋯ A substantial proportion of adult primary care appointments involve patients with chronic pain complains. Dissatisfaction with training and substantial concerns about patient self-management and about opioid prescribing suggest areas for improving medical education and postgraduate training. Emphasis on patient-centered approaches to chronic pain management, including skills for assessing risk of opioid abuse and addiction, is required.
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Many people display omission bias in medical decision making, accepting the risk of passive nonintervention rather than actively choosing interventions (such as vaccinations) that result in lower levels of risk. ⋯ Treatment preferences may be substantially influenced by a decision-making role. As certain roles appear to reinforce "big picture" thinking about difficult risk tradeoffs, physicians and patients should consider re-framing treatment decisions to gain new, and hopefully beneficial, perspectives.
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Patient-centeredness, originally defined as understanding each patient as a unique person, is widely considered the standard for high-quality interpersonal care. The purpose of our study was to examine the association between patient perception of being "known as a person" and receipt of highly active antiretroviral therapy (HAART), adherence to HAART, and health outcomes among patients with HIV. ⋯ We found that a single item measuring the essence of patient-centeredness-the patients' perception of being "known as a person"-is significantly and independently associated with receiving HAART, adhering to HAART, and having undetectable serum HIV RNA. These results support the hypothesis that the quality of patient-physician relationship is directly related to the health of patients.
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Disparities in survival for black patients with HIV in the United States have been reported. The VA is an equal access health care system. ⋯ Survival during and after first hospitalization with HIV in the VA did not significantly differ for white and black patients, possibly indicating similar effectiveness of care for HIV. Further research is needed to understand the reasons for the lack of disparities for VA patients with HIV and whether the VA's results could be replicated.
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Editorial Comparative Study
Race, ethnicity, culture, and disparities in health care.