Journal of general internal medicine
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Randomized Controlled Trial Multicenter Study Clinical Trial
Improving depression outcomes in community primary care practice: a randomized trial of the quEST intervention. Quality Enhancement by Strategic Teaming.
To determine whether redefining primary care team roles would improve outcomes for patients beginning a new treatment episode for major depression. ⋯ In practices without onsite mental health professionals, brief interventions training primary care teams to assume redefined roles can significantly improve depression outcomes in patients beginning a new treatment episode. Such interventions should target patients who report that antidepressant medication is an acceptable treatment for their condition. More research is needed to determine how primary care teams can best sustain these redefined roles over time.
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Randomized Controlled Trial Clinical Trial
The effect of discussions about advance directives on patients' satisfaction with primary care.
Discussions of end-of-life care should be held prior to acute, disabling events. Many barriers to having such discussions during primary care exist. These barriers include time constraints, communication difficulties, and perhaps physicians' anxiety that patients might react negatively to such discussions. ⋯ Elderly patients with chronic illnesses were more satisfied with their primary care physicians and outpatient visits when advanced directives were discussed. The improvement in visit satisfaction was substantial and persistent. This should encourage physicians to initiate such discussions to overcome communication barriers might result in reduced patient satisfaction levels.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Perceived access problems among patients with diabetes in two public systems of care.
We examined the prevalence of access problems among public clinic patients after participating in trials of automated telephone disease management with nurse follow-up. ⋯ Many of these public sector patients with diabetes reported that they failed to obtain health services because they perceived financial and nonfinancial access problems. Automated telephone disease management calls with telephone nurse follow-up improved patients' access to care. Despite the impact of the intervention, county clinic patients were more likely than VA patients to report access problems in several areas.
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Randomized Controlled Trial Clinical Trial
Randomized, controlled trial of an interactive videodisc decision aid for patients with ischemic heart disease.
To determine the effect of the Ischemic Heart Disease Shared Decision-Making Program (IHD SDP) an interactive videodisc designed to assist patients in the decision-making process involving treatment choices for ischemic heart disease, on patient decision-making. ⋯ There was no significant difference in satisfaction with decision-making process scores between the IHD SDP and usual practice groups. The IHD SDP patients were more knowledgeable, underwent less revascularization (interventional therapies), and demonstrated increased patient decision-making autonomy without apparent impact on quality of life.
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Randomized Controlled Trial Clinical Trial
Cervical cancer screening in the urgent care setting.
To determine the feasibility of cervical cancer screening in an urgent care clinic. ⋯ Urgent care clinic visits can be used as opportunities to perform Pap test screening in women who are unlikely to adhere to cervical cancer screening recommendations. However, to accrue the full potential benefit from this intervention, an improved process to ensure patient follow-up must be developed.