Arch Intern Med
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Randomized Controlled Trial Multicenter Study
A trial of disclosing physicians' financial incentives to patients.
Concern regarding financial conflict of interest for physicians has led to calls for disclosure of financial incentives to patients. However, limited data on the outcomes of disclosure exist to guide policy. ⋯ Among diverse patient populations, a single mailed disclosure letter from physician groups was associated with improved knowledge of physicians' compensation models. Patients' trust in their physicians was unharmed, and their loyalty to their physician group was strengthened. For physician groups with similar compensation programs, disclosure to patients should be considered an effective method to enhance the patient-physician relationship.
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Comparative Study
Management of acute pharyngitis in adults: reliability of rapid streptococcal tests and clinical findings.
How to use clinical score, the rapid streptococcal antigen test (RSAT), and culture results is uncertain for efficient management of acute pharyngitis in adults. ⋯ The RSAT we used is a valid test for diagnosis of pharyngitis in adults. A clinical approach combining this RSAT and clinical findings efficiently reduces inappropriate antibiotic prescription in adult patients with acute pharyngitis. Empirical therapy in patients with 3 or 4 clinical symptoms or signs results in antibiotic overuse.
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The Cambridge Risk Score (CRS) was developed to screen for type 2 diabetes mellitus risk. We assessed the ability of the CRS to predict glycosylated hemoglobin (HbA(1c)) levels and determined whether the CRS was better than body mass index (BMI) at predicting HbA(1c) levels in midlife. ⋯ For a population in mid-adult life, the CRS identified individuals with elevated HbA(1c) levels reasonably well. However, the CRS had no advantage compared with BMI alone in identifying diabetes risk.
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Racial disparities in care are well documented; information regarding solutions is limited. We evaluated whether generic quality improvement efforts were associated with changes in racial disparities in diabetes care. ⋯ Racial disparities were diminished in some aspects of diabetes care following variably successful quality improvement, but differences in the use of statins and glycemic level control persisted. Reducing disparities may require a focus on minority health.