Journal of general internal medicine
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Little is known about how care is coordinated for patients with diseases requiring multidisciplinary treatments. How complex care is coordinated may affect a patient's chance of receiving the full complement of care provided by multiple physicians. We sought to describe approaches used to coordinate care for women with early-stage breast cancer, a disease often treated by multiple different disciplines in the outpatient setting. ⋯ Numerous coordination mechanisms exist. No site has the ability to systematically track care provided by multiple different specialists. The most valued mechanisms are under the hospital's aegis. Hospitals should consider implementing coordination mechanisms to improve delivery of multidisciplinary care.
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Multicenter Study
Quality of life is impaired in men with chronic prostatitis: the Chronic Prostatitis Collaborative Research Network.
Health-related quality of life (HRQOL) impairment may be a central component of chronic prostatitis for men afflicted with this condition. Our objective was to examine HRQOL, and factors associated with HRQOL, using both general and condition-specific instruments. ⋯ Men with chronic prostatitis experience impairment in the mental and physical domains of general HRQOL, as well as condition-specific HRQOL. To optimize the care of men with this condition, clinicians should consider administering HRQOL instruments to their patients to better understand the impact of the condition on patients' lives.
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To identify the preferences and concerns of seriously ill patients about discussing religious and spiritual beliefs with physicians. ⋯ Religion and spirituality are a source of comfort for many patients. Although not necessarily expecting physicians to discuss spirituality, patients want physicians to ask about coping and support mechanisms. This exploratory study suggests that if patients then disclose the importance of spiritual beliefs in their lives, they would like physicians to respect these values.
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Specific elements of health care process and physician behavior have been shown to influence disenrollment decisions in HMOs, but not in outpatient settings caring for patients with diverse types of insurance coverage. ⋯ Failure of physicians to acknowledge patient concerns, provide explanations of care, and spend sufficient time with patients may contribute to patients' decisions to discontinue care at their usual site of care.
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To distinguish the effects of drug abuse, mental disorders, and problem drinking on antiretroviral therapy (ART) and highly active ART (HAART) use. ⋯ Drug abuse-related factors were greater barriers to ART use in this national sample than mental disorders but once on ART, these factors were unrelated to type of therapy.