J Am Board Fam Med
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Daily opioid therapy is widely used in the treatment of chronic noncancer pain, yet there is limited empirical evidence on the relationship of opioid dosing and health-related quality of life (HRQoL) in primary care settings. ⋯ Use of low- to moderate-dose opioid therapy provides an improvement in HRQoL scores for chronic noncancer pain patients compared to no opioid therapy, while high-dose opioids have a smaller positive effect that is limited to mental health quality of life and patient satisfaction, and that may not justify treatment.
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Heterogeneity in management of diabetes mellitus among Latino ethnic subgroups in the United States.
Recent debate suggests that general racial/ethnic categories may obscure potentially important subgroup differences within minority groups. The purpose of this study was to examine the quality of diabetes care among ethnic subgroups of the Latino population in the United States while accounting for aspects of acculturation and access to care. ⋯ Differences in diabetes management exist between Latino ethnic subgroups; treating Latinos in the United States as one homogenous category may be a barrier to the appropriate provision of care.
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Immunization rates are static in the United States. Risk factors for not being up to date (UTD) include ethnicity and lower socioeconomic status. Reminder cards increase immunization rates in urban settings. Their effect in poor, Latino, and rural children is unknown. ⋯ In poor, rural, and Latino populations, language-appropriate reminder/order cards increase immunization rates.
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Global health provides a special challenge for primary care and general practice, which will become increasingly important in the future as the prevalence of multimorbidity increases with increasing likelihood of survival from acute manifestations of illness, as populations age, and as costs of care increase with increasing availability of technologic interventions. World organizations of primary care physicians need to take up the challenge before it becomes a crisis.
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Multicenter Study
Why hasn't this patient been screened for colon cancer? An Iowa Research Network study.
Less than half of eligible Americans have been screened for colorectal cancer (CRC). The objective of this study was to describe physicians' reasons for screening or not screening specific patients for CRC and their approach to CRC testing discussions. ⋯ Reasons many patients remain unscreened for CRC include (1) factors related to the health care system, patient, and physician that impede or prevent discussion; (2) patient refusal; and (3) the focus on diagnostic testing. Strategies to improve screening might include patient and physician education about the rationale for screening, universal coverage for health maintenance exams, and development of effective tracking and reminder systems. The words physicians choose to frame their recommendations are important and should be explored further.