Journal of general internal medicine
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Randomized Controlled Trial Multicenter Study Comparative Study
Cost-effectiveness of a disease management program for major depression in elderly primary care patients.
Major depression is common in older adults and is associated with increased health care costs. Depression often remains unrecognized in older adults, especially in primary care. ⋯ This disease management program for major depression in elderly primary care patients had no statistically significant relationship with clinical outcomes, costs, and cost-effectiveness. Therefore, based on these results, continuing usual care is recommended.
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Randomized Controlled Trial Comparative Study
Improving depression care in patients with diabetes and multiple complications.
Depression is common in patients with diabetes, but it is often inadequately treated within primary care. Competing clinical demands and treatment resistance may make it especially difficult to improve depressive symptoms in patients with diabetes who have multiple complications. ⋯ Patients with depression and diabetes who have multiple complications may benefit most from collaborative care for depression. These findings suggest that with appropriate intervention depression can be successfully treated in patients with diabetes who have the highest severity of medical problems.
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Randomized Controlled Trial Multicenter Study Comparative Study
Impacts of evidence-based quality improvement on depression in primary care: a randomized experiment.
Previous studies testing continuous quality improvement (CQI) for depression showed no effects. Methods for practices to self-improve depression care performance are needed. We assessed the impacts of evidence-based quality improvement (EBQI), a modification of CQI, as carried out by 2 different health care systems, and collected qualitative data on the design and implementation process. ⋯ Evidence-based quality improvement had perceptible, but modest, effects on practice performance for patients with depression. The modest improvements, along with qualitative data, identify potential future directions for improving CQI research and practice.
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Randomized Controlled Trial
Factors associated with the hospitalization of low-risk patients with community-acquired pneumonia in a cluster-randomized trial.
Many low-risk patients with pneumonia are hospitalized despite recommendations to treat such patients in the outpatient setting. ⋯ Hospital admission appears justified for one-third of low-risk inpatients based upon the presence of one or more contraindications to outpatient treatment. At least one-fifth of low-risk inpatients did not have a contraindication to outpatient treatment or an identifiable risk factor for hospitalization, suggesting that treatment of a larger proportion of such low-risk patients in the outpatient setting could be achieved without adversely affecting patient outcomes.
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Randomized Controlled Trial
Predictors of quitting among African American light smokers enrolled in a randomized, placebo-controlled trial.
To examine the predictors of quitting among African American (AA) light smokers (<10 cigarettes per day) enrolled in a smoking cessation trial. ⋯ Individual characteristics may decrease the likelihood of quitting; however, the provision of directive, advice-oriented counseling focused on the addictive nature of nicotine, health consequences of smoking, benefits of quitting, and development of a concrete quit plan may be an important and effective facilitator of quitting among AA light smokers.