The American journal of managed care
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Many patients experience difficulty in adhering to medication for both physical and mental health. Our objective was to compare selfreported adherence and electronic monitoring of adherence to oral hypoglycemic agents and antidepressants and to examine the relationship of adherence with clinical outcomes. ⋯ Compared with electronic monitoring of adherence, self-reported adherence tended to overestimate medication adherence. Electronic monitoring of adherence to oral hypoglycemic agents predicted glycemic control, but self-reported adherence did not predict clinical outcomes.
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To examine patient, hospital, and geographic characteristics influencing variation in computed tomography (CT) scan use in inpatients in New York State. ⋯ After controlling for patient and hospital characteristics, significant geographic variation remained at the level of the county, which indicates that additional research investigating the use of CT scans is necessary to understand the reasons behind small-area variation. Understanding the distribution and practice patterns of specific physician specialties may be helpful in curtailing underuse and overuse.
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To determine patient, clinical, and hospital factors associated with receiving total hip arthroplasty (THA) and hemiarthroplasty (HA) in the United States. ⋯ Similarities and differences in patient, clinical, and hospital factors associated with surgical treatments of hip fracture warrant the attention of providers and payers.
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Fortification of cereal products with folic acid is not mandatory in Israel, yet folate deficiency remains rare and is usually associated with poor diet, malabsorption, alcoholism, or use of certain drugs. A retrospective review of all folate level determinations performed between January 2004 and January 2007 in the central district of Clalit Health Services in Israel revealed that only 4.3% of the 43,176 tests ordered were below the norm (5.6 nmol/L). ⋯ Neither laboratory parameters nor clinical findings in patients' charts were capable of distinguishing folate-deficient patients from controls. It seems that folate determinations in patients without known risk factors for folate deficiency are of little clinical significance.