Journal of general internal medicine
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This report examines alternative methods of paying for clinical preventive care services. First, the extent of coverage of preventive health care services in public and private health insurance plans is reviewed. Included in this review are Medicare, Medicaid, health maintenance organizations, and private health insurance plans. ⋯ These options are: 1) fee-for-service; 2) a periodic preventive health visit fee; 3) capitation; and 4) a preventive services account. The report concludes with recommendations for constructing an equitable system for increasing access to preventive services. A multi-pronged approach is recommended involving improvements in public and private coverage of these services; development of a periodic preventive health visit fee payment mechanism; initiation of additional research and demonstration efforts designed to determine cost-effectiveness of services and payment approaches; and modifications to the current coding system that would lead to a more appropriate method for reimbursement of preventive care services.
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Multicenter Study Clinical Trial
Impact of the availability of a prior electrocardiogram on the triage of the patient with acute chest pain.
To determine whether information from a prior electrocardiogram (ECG) improves diagnostic accuracy in the emergency department (ED) evaluation of patients with acute chest pain. ⋯ When the current ECG is consistent with ischemia or infarction, the availability of a prior ECG for comparison to determine whether the ECG changes are old or new improves diagnostic accuracy and triage decisions by reducing the admission of patients without AMI or acute ischemic heart disease (increased specificity) without reducing the admission of patients with these diagnoses (unchanged sensitivity).
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Clinical preventive services have always been recognized by clinicians as an important part of primary care medicine, but for many years there has been some uncertainty as to the effectiveness of these maneuvers in preventing disease and exactly how and when they should be performed. The recent report of the U. ⋯ The recommendations provide guidance on how to design an appropriate package of services based on the medical history and risk profile of each patient. This article describes the historical background behind the formation of the task force, its methodology and rationale, and the format of the final report, the "Guide to Clinical Preventive Services." The potential implications of this report and its limitations are also discussed.
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Pharmaceutical representatives in academic medical centers: interaction with faculty and housestaff.
To determine the nature, frequency and effects of internal medicine housestaff and faculty contacts with pharmaceutical representatives (PRs). ⋯ Academic housestaff and faculty have frequent PR contact; such contact is related to changes in behavior. The potential for influence of PRs in academic medical centers should be recognized, and their activities should be evaluated accordingly.