Journal of general internal medicine
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The impact of national efforts to limit antibiotic prescribing has not been fully evaluated. ⋯ During the study period, outpatient antibiotic prescribing for respiratory infections where antibiotics are rarely indicated has declined, while the proportion of broad-spectrum antibiotics prescribed for these diagnoses has increased significantly. This trend resulted in a 15% decline in the total proportion of outpatient visits in which antibiotics were prescribed. However, because outpatient visits increased 17% over this time period, the population burden of outpatient antibiotic prescriptions changed little.
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To report rates of cost-related skipping of medications and other treatments, assess correlates of skipping, examine changes in skipping between 1998 and 2000, and identify factors associated with changes in skipping. ⋯ Cost-related skipping was associated with several factors, including drug coverage, poverty, poor health, and physician-patient relationship quality. The important role of physician-patient relationships in cost-related skipping has not been shown previously. Physicians should be aware of these risk factors for cost-related skipping, and initiate dialogue about problems paying for prescription medications and other treatments.
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Comparative Study
Quality of ambulatory care for women and men in the Veterans Affairs Health Care System.
Gender differences in inpatient quality of care are well known. However, whether men and women receive equivalent ambulatory care is less well understood. ⋯ In this large national health care system that predominantly serves men, the quality of ambulatory care is equivalent for women and men on numerous measures.
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Little guidance is available for health care providers who try to communicate with patients and their families in a culturally sensitive way about end-of-life care. ⋯ The groups differed broadly in their preferences for both the content and structure of end-of-life discussions and on the values that influence those preferences. Further research is necessary to help practitioners engage in culturally sensitive end-of-life discussions with patients and their families by considering varying preferences for the goals of end-of-life care communication.