The American journal of managed care
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We assessed whether Medicare Part D reduced disparities in access to medication. ⋯ We found that the Part D coverage gap is particularly disruptive to minorities and those living in low-income areas. The implications of this work suggest that protecting the health of vulnerable groups requires more than premium subsidies. Patient education may be a first step, but more substantive improvements in adherence may require changes in healthcare delivery.
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Comparative Study Observational Study
Decision aids for benign prostatic hyperplasia and prostate cancer.
To examine the relationships among implementing decision aids (DAs) for benign prostatic hyperplasia (BPH) and prostate cancer (PRCA), and treatment rates and costs. ⋯ Implementing patient DAs was associated with lower rates of elective surgery for previously treated BPH and active treatment for localized PRCA; however, implementation of these DAs was not associated with lower costs of care.
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Comparative Study Observational Study
Race/ethnicity, personal health record access, and quality of care.
To estimate the impact of race/ethnicity and written language preference on registration for a personal health record (PHR) that included emailing providers, viewing lab results, refilling prescriptions, and other functionalities, and the impact of PHR use on quality across racial/ethnic groups with comparable access. ⋯ Nonwhite race/ethnicity and Spanish language preference independently predict poor PHR adoption. PHR use is associated with higher quality healthcare, and when PHR use is equivalent across racial/ethnic groups, so is quality of care.
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There are various interventions for guideline implementation in clinical practice, but the effects of these interventions are generally unclear. We conducted a systematic review to identify effective methods of implementing clinical research findings and clinical guidelines to change physician practice patterns, in surgical and general practice. ⋯ Active forms of continuing medical education and multifaceted interventions were found to be the most effective methods for implementing guidelines into general practice. Additionally, active approaches to changing physician performance were shown to improve practice to a greater extent than traditional passive methods. Further primary research is necessary to evaluate the effectiveness of these methods in a surgical setting.
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Observational Study
Prognostic factors of mortality among patients with severe hyperglycemia.
Severe hyperglycemia is associated with increased morbidity and mortality in a variety of patients. We undertook this study to identify prognostic factors of mortality among patients experiencing severe hyperglycemia in the emergency department (ED). ⋯ The 90-day mortality rate among patients with severe hyperglycemia in the ED was 14.6%. Sepsis, renal impairment with electrolyte imbalance, and lower blood pressure were independent prognostic factors.