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Primary Care Pearls | Page 2

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Ashok Reddy, Craig E Pollack, David A Asch, Anne Canamucio, Rachel M Werner
IMPORTANCE: Primary care provider (PCP) turnover is common and can disrupt patient continuity of care. Little is known about the effect of PCP turnover on patient care experience and quality of care. OBJECTIVE: To measure the effect of PCP turnover on patient experiences of care and ambulatory care quality. DESIGN, SETTING, AND PARTICIPANTS: Observational, retrospective cohort study of a nationwide sample of primary care patients in the Veterans Health Administration (VHA)...
July 2015: JAMA Internal Medicine
Michael Tanner
No abstract text is available yet for this article.
May 19, 2015: Annals of Internal Medicine
(no author information available yet)
No abstract text is available yet for this article.
May 15, 2015: American Family Physician
Kristin Parker, Karen Dohr, Jon O Neher, Gary Kelsberg, Leilani St Anna
Statin therapy produces a small increase in the incidence of diabetes: one additional case per 255 patients taking statins over 4 years.
April 2015: Journal of Family Practice
Vari M Drennan, Mary Halter, Louise Joly, Heather Gage, Robert L Grant, Jonathan Gabe, Sally Brearley, Wilfred Carneiro, Simon de Lusignan
BACKGROUND: Physician associates [PAs] (also known as physician assistants) are new to the NHS and there is little evidence concerning their contribution in general practice. AIM: This study aimed to compare outcomes and costs of same-day requested consultations by PAs with those of GPs. DESIGN AND SETTING: An observational study of 2086 patient records presenting at same-day appointments in 12 general practices in England. METHOD: PA consultations were compared with those of GPs...
May 2015: British Journal of General Practice: the Journal of the Royal College of General Practitioners
Robin S Gotler
No abstract text is available yet for this article.
May 2015: Annals of Family Medicine
Steven S Fu, Michelle van Ryn, Scott E Sherman, Diana J Burgess, Siamak Noorbaloochi, Barbara Clothier, Brent C Taylor, Carolyn M Schlede, Randy S Burke, Anne M Joseph
IMPORTANCE: Current tobacco use treatment approaches require smokers to request treatment or depend on the provider to initiate smoking cessation care and are therefore reactive. Most smokers do not receive evidence-based treatments for tobacco use that include both behavioral counseling and pharmacotherapy. OBJECTIVE: To assess the effect of a proactive, population-based tobacco cessation care model on use of evidence-based tobacco cessation treatments and on population-level smoking cessation rates (ie, abstinence among all smokers including those who use and do not use treatment) compared with usual care among a diverse population of current smokers...
May 2014: JAMA Internal Medicine
Jay S Balachandran, Sanjay R Patel
This issue provides a clinical overview of Obstructive Sleep Apnea focusing on prevention, diagnosis, treatment, practice improvement, and patient information. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including ACP Smart Medicine and MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic from these primary sources in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of science writers and physician writers...
November 4, 2014: Annals of Internal Medicine
Ben Darlow, Sarah Dean, Meredith Perry, Fiona Mathieson, G David Baxter, Anthony Dowell
BACKGROUND: Low back pain (LBP) is a significant health problem and common reason to visit the GP. Evidence suggests GPs experience difficulty applying evidence-based guidelines. OBJECTIVE: Explore GPs' underlying beliefs about acute LBP and how these influence their clinical management of patients. METHODS: Eleven GPs from one geographical region within New Zealand were recruited by purposive sampling. Audio recordings of semi-structured qualitative interviews were transcribed verbatim...
December 2014: Family Practice
Kurt Kroenke
Physical symptoms account for more than half of all outpatient visits, yet the predominant disease-focused model of care is inadequate for many of these symptom-prompted encounters. Moreover, the amount of clinician training dedicated to understanding, evaluating, and managing common symptoms is disproportionally small relative to their prevalence, impairment, and health care costs. This narrative review regarding physical symptoms addresses 4 common epidemiologic questions: cause, diagnosis, prognosis, and therapy...
October 21, 2014: Annals of Internal Medicine
Peter J Gill, Nia W Roberts, Kay Yee Wang, Carl Heneghan
BACKGROUND: Identifying articles relevant to primary care is challenging for busy clinicians. Setting specific search strategies can be used to help clinicians find pertinent studies in a timely fashion. OBJECTIVES: To develop search filters for identifying research studies of relevance to primary care in MEDLINE (OvidSP). METHODS: We conducted a search of MEDLINE (OvidSP) for articles published in five core medical journals at five yearly intervals...
December 2014: Family Practice
Mark H Ebell, Roland Grad
In 2013, we performed monthly surveillance of more than 110 English-language clinical research journals, and identified approximately 250 studies that had the potential to change the practice of family physicians. Each study was critically appraised and summarized by a group of primary care clinicians with expertise in evidence-based medicine. Studies were evaluated based on their relevance to primary care practice, validity, and likelihood that they could change practice. These summaries, called POEMs (patient-oriented evidence that matters), are e-mailed to subscribers, including members of the Canadian Medical Association...
September 15, 2014: American Family Physician
Kira L Ryskina, Deborah Korenstein, Arlene Weissman, Philip Masters, Patrick Alguire, Cynthia D Smith
BACKGROUND: Although high-value care (HVC) that balances benefits of tests or treatments against potential harms and costs has been a recently emphasized competency for internal medicine (IM) residents, few tools to assess residents' knowledge of HVC are available. OBJECTIVE: To describe the development and initial results of an HVC subscore of the Internal Medicine In-Training Examination (IM-ITE). DESIGN: The HVC concepts were introduced to IM-ITE authors during question development...
November 18, 2014: Annals of Internal Medicine
Steven H Woolf, Russell P Harris, Doug Campos-Outcalt
In 2013, the US Preventive Services Task Force (USPSTF) recommended low-dose computed tomographic (CT) screening for high-risk current and former smokers with a B recommendation (indicating a level of certainty that it offered moderate to substantial net benefit). Under the Affordable Care Act, the USPSTF recommendation requires commercial insurers to fully cover low-dose CT. The Centers for Medicare & Medicaid Services (CMS) is now considering whether to also offer coverage for Medicare beneficiaries. Although the National Lung Screening Trial (NLST) demonstrated the efficacy of low-dose CT, implementation of national screening may be premature...
December 2014: JAMA Internal Medicine
Helen P Booth, Toby A Prevost, Alison J Wright, Martin C Gulliford
BACKGROUND: Overweight and obesity have negative health effects. Primary care clinicians are best placed to intervene in weight management. Previous reviews of weight loss interventions have included studies from specialist settings. The aim of this review was to estimate the effect of behavioural interventions delivered in primary care on body weight in overweight and obese adults. METHODS: The review included randomized controlled trials (RCTs) of behavioural interventions in obese or overweight adult participants in a primary care setting, with weight loss as the primary outcome, and a minimum of 12 months of follow-up...
December 2014: Family Practice
Carrie H Colla
Efforts to reduce overuse of health care services run counter to the dominant financial incentives in our fee-for-service system, challenge the cultural assumption that more is better, and raise concerns about stinting on necessary care. Given the evidence that as much as one third of U.S. health..
October 2, 2014: New England Journal of Medicine
Caroline Sayer, Thomas H Lee
Conventional wisdom holds that the redesign of health care requires stepping back from the issues of individual patients and analyzing patterns of outcomes and costs for large patient populations. As practicing primary care physicians, we think a useful, complementary perspective might result from..
October 2, 2014: New England Journal of Medicine
Samuel T Edwards, Julia C Prentice, Steven R Simon, Steven D Pizer
IMPORTANCE: Primary care services based at home have the potential to reduce the likelihood of hospitalization among older adults with multiple chronic diseases. OBJECTIVE: To characterize the association between enrollment in Home-Based Primary Care (HBPC), a national home care program operated by the US Department of Veterans Affairs (VA), and hospitalizations owing to an ambulatory care-sensitive condition among older veterans with diabetes mellitus. DESIGN AND SETTING: Retrospective cohort study...
November 2014: JAMA Internal Medicine
Yi Huang, Xiaoyan Cai, Peisong Chen, Weiyi Mai, Hongfeng Tang, Yuli Huang, Yunzhao Hu
BACKGROUND: Reports on the association of prediabetes with all-cause mortality and cardiovascular mortality are inconsistent. Objective. To evaluate the risk of all-cause and cardiovascular mortality in association with impaired fasting glucose (IFG) and impaired glucose tolerance (IGT). METHODS: Prospective cohort studies with data on prediabetes and mortality were included. The relative risks (RRs) of all-cause and cardiovascular mortality were calculated and reported with 95% confidence intervals (95% CIs)...
December 2014: Annals of Medicine
Sophia Zoungas, John Chalmers, Bruce Neal, Laurent Billot, Qiang Li, Yoichiro Hirakawa, Hisatomi Arima, Helen Monaghan, Rohina Joshi, Stephen Colagiuri, Mark E Cooper, Paul Glasziou, Diederick Grobbee, Pavel Hamet, Stephen Harrap, Simon Heller, Liu Lisheng, Giuseppe Mancia, Michel Marre, David R Matthews, Carl E Mogensen, Vlado Perkovic, Neil Poulter, Anthony Rodgers, Bryan Williams, Stephen MacMahon, Anushka Patel, Mark Woodward
BACKGROUND: In the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) factorial trial, the combination of perindopril and indapamide reduced mortality among patients with type 2 diabetes, but intensive glucose control, targeting a glycated hemoglobin level of less than 6.5%, did not. We now report results of the 6-year post-trial follow-up. METHODS: We invited surviving participants, who had previously been assigned to perindopril-indapamide or placebo and to intensive or standard glucose control (with the glucose-control comparison extending for an additional 6 months), to participate in a post-trial follow-up evaluation...
October 9, 2014: New England Journal of Medicine
2014-09-25 03:43:21
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