Effective clinical practice : ECP
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Previous workforce analyses by the Council on Graduate Medical Education (COGME) have concluded that the United States has too few, or just enough, generalists. However, recent trends suggest that more physicians are entering primary care, raising the possibility of a future surplus. ⋯ At current levels of training, the supply of generalists will grow substantially and soon exceed several benchmarks for generalist requirements.
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For patients with chronic disease, there is growing interest in "self-management" programs that emphasize the patients' central role in managing their illness. A recent randomized clinical trial demonstrated the potential of self-management to improve health status and reduce health care utilization in patients with chronic diseases. ⋯ We replicated the results of our previous clinical trial of a chronic disease self-management program in a "real-world" setting. One year after exposure to the program, most patients experienced statistically significant improvements in a variety of health outcomes and had fewer ED visits.
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Comparative Study
A practice-based approach for converting from proton pump inhibitors to less costly therapy.
Projected cost for lansoprazole, the formulary proton pump inhibitor (PPI) at our institution, was $1.8 million in 1999. While some patients require PPI therapy, many could control their symptoms with a histamine H2-receptor antagonist blocker (H2 blocker) at a much lower cost. ⋯ The number of PPI prescriptions decreased during the intervention and was sustained at least three quarters afterward. This low-intensity, practice-based intervention may serve as a model for other health care systems.
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Editorial Comment
Finding undiagnosed type 2 diabetes: is it worth the effort?