The American journal of managed care
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Patients and relatives have varying preferences for genetic testing and interventions related to hereditary cancer syndromes. We examined how the impact of these services on quality of life (QoL) affects the cost-effectiveness of screening for Lynch syndrome among probands newly diagnosed with colorectal cancer and their relatives. ⋯ Screening for Lynch syndrome in the population is likely to yield long-term gains in life expectancy that outweigh any short-term decreases in QoL, at acceptable costs. Counseling for individuals should aim to mitigate potential negative impact of genetic testing and risk-reducing interventions on QoL.
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Relative to more abundant neoplasms, endocrine cancers have been historically neglected, yet their incidence is increasing. We therefore sought to build interest in endocrine cancers, improve physician experience, and develop innovative approaches to treating patients with these neoplasms. ⋯ The development of subspecialty tumor groups for uncommon malignancies represents an effective approach to building experience, increasing patient volumes and referrals, and fostering development of increased therapeutic options and clinical trials for patients afflicted with otherwise historically neglected cancers.
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There are over 12 million ambulatory care visits for acute pharyngitis annually in the United States. Current guidelines recommend diagnosis through culture or rapid antigen detection test (RADT) and relatively straightforward treatment. Community pharmacists may provide cost-effective care for disease states such as group A streptococcus (GAS) pharyngitis. ⋯ This model suggests that pharmacists may be able to provide a cost-effective alternative for the treatment of pharyngitis caused by GAS in adult patients.
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The identification of patients most likely to benefit from care management programs-case finding-is a crucial determinant of their effectiveness regarding improved health outcomes and reduced costs. Until now, research has mainly focused on claims data-based case finding. This study aimed to explore how primary care physicians (PCPs) select patients for practice based care management and how risk prediction may complement their case finding. ⋯ Case finding for care management programs in primary care may benefit from a structured approach combining clinical judgment by PCPs and claims data-based risk modeling. However, further research is needed to identify the optimal case-finding strategy for practice based care management.
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To examine patient and physician factors affecting utilization of diagnostic imaging in primary care. ⋯ Both patient and physician factors have a substantial effect on primary care outpatient diagnostic imaging utilization. Several of these significantly influence both the probability that any images will be ordered and the intensity (number) of imaging.