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Shared Medical Visit

Jaeyong Shin, Young Choi, Sang Gyu Lee, Tae Hyun Kim, Eun-Cheol Park
Unnecessary use of high-quality resources in general hospitals hinders treatment of patients with urgent and complicated conditions. Thus, the Korean Government has sought to reduce general hospital visiting of patients with 52 mild diseases, including hypertension. The higher cost sharing for medical expenses and medications from general hospitals were enacted in 2009 and 2011, respectively.We determined whether these regulations were effective through evaluating changing trends in first-visited healthcare organizations and defined the first visiting healthcare organization level (primary clinics, hospital, and general hospital) as an outcome measure...
October 2016: Medicine (Baltimore)
Daniel Petras, Louis-Félix Nothias, Robert A Quinn, Theodore Alexandrov, Nuno Bandeira, Amina Bouslimani, Gabriel Castro-Falcón, Liangyu Chen, Tam Dang, Dimitrios J Floros, Vivian Y H Hook, Neha Garg, Nicole Hoffner, Yike Jiang, Clifford A Kapono, Irina Koester, Rob Knight, Christopher A Leber, Tiejun Ling, Tal Luzzatto-Knaan, Laura-Isobel McCall, Aaron Philip McGrath, Michael J Meehan, Jonathan K Merritt, Robert H Mills, Jamie Morton, Sonia Podvin, Ivan Protsyuk, Trevor Purdy, Kendall Satterfield, Stephen Searles, Sahil Shah, Sarah Shires, Dana Steffen, Margot White, Jelena Todoric, Robert Tuttle, Aneta Wojnicz, Valerie Sapp, Fernando Vargas, Jin Yang, Chao Zhang, Pieter C Dorrestein
The cars we drive, the homes we live in, the restaurants we visit, and the labs and offices we work in are all a part of the modern human habitat. Remarkably, little is known about the diversity of chemicals present in these environments and to what degree molecules from our bodies influence the built environment that surrounds us and vice versa. We therefore set out to visualize the chemical diversity of five built human habitats together with their occupants, to provide a snapshot of the various molecules to which humans are exposed on a daily basis...
October 12, 2016: Analytical Chemistry
R Allan Jhagroo, Stephen Y Nakada, Kristina L Penniston
INTRODUCTION: Shared medical appointments (SMAs) have decreased patients' wait time to initial stone clinic appointment, standardized education, and increased exposure to nutrition therapy. We assessed the effectiveness of SMAs in reducing patients' urinary stone risk factors. METHODS: Patients who established care in our stone clinic in a SMA between 3/2012 and 8/2015 were sequentially identified. After eliminating those without follow-up urine collections or whose urinary creatinine excretion between the 2 collections varied by >40%, 113 patients were included (M:F 63:50; 54±15 y; BMI 30...
September 27, 2016: Journal of Endourology
Kaina Zhou, Hengxin Li, Xiaoli Wei, Xiaomei Li, Guihua Zhuang
OBJECTIVES: To identify medication adherence and its influencing factors among patients of 14 methadone maintenance treatment (MMT) clinics in Xi'an, China. METHODS: Data were obtained from the National AIDS Information System-Community Methadone Maintenance Treatment. All patients registered in the system were not permitted to take methadone at home without professionals' supervision. Medication adherence was assessed using categorical (ie, dropout or retained) and continuous (ie, treatment time, methadone use time, and percentage of methadone use days) variables...
September 19, 2016: Journal of Addiction Medicine
Anita H Clayton, Suresh Durgam, Dayong Li, Changzheng Chen, Laishun Chen, Maju Mathews, Carl P Gommoll, Armin Szegedi
The aim of this study is to evaluate the effects of vilazodone on sexual functioning in healthy, sexually active adults and assess the impact of medication nonadherence in this type of trial. Participants were randomized to vilazodone (20 or 40 mg/day), paroxetine (20 mg/day), or placebo for 5 weeks of double-blind treatment. The primary endpoint was change from baseline to day 35 in Change in Sexual Functioning Questionnaire (CSFQ) total score in the intent-to-treat (ITT) population. Post-hoc analyses were carried out in modified intent-to-treat (mITT) populations that excluded participants in the active-treatment groups with undetectable plasma drug concentrations at all visits (mITT-I) or at least one visit (mITT-II)...
September 16, 2016: International Clinical Psychopharmacology
Masha G Jones, Linda V DeCherrie, Yasmin S Meah, Cameron R Hernandez, Eric J Lee, David M Skovran, Theresa A Soriano, Katherine A Ornstein
Nurse practitioner (NP) comanagement involves an NP and physician sharing responsibility for the care of a patient. This study evaluates the impact of NP comanagement for clinically complex patients in a home-based primary care program on hospitalizations, 30-day hospital readmissions, and provider satisfaction. We compared preenrollment and postenrollment hospitalization and 30-day readmission rates of home-bound patients active in the Nurse Practitioner Co-Management Program within the Mount Sinai Visiting Doctors Program (MSVD) (n = 87) between January 1, 2012, and July 1, 2013...
September 13, 2016: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
Shyam Prabhakaran, Jungwha Lee, Kathleen O'Neill
BACKGROUND: Reduction in door-to-needle (DTN) times in patients with acute ischemic stroke treated with tissue-type plasminogen activator is associated with improved outcomes. We hypothesized that a learning collaborative would rapidly reduce DTN times at Chicago's primary stroke centers. METHODS AND RESULTS: We analyzed data from all adult patients with out-of-hospital ischemic stroke hospitalized between January 1, 2010 and March 31, 2015 and who received tissue-type plasminogen activator in the emergency department at 15 primary stroke centers in Chicago and 15 primary stroke centers in St...
September 2016: Circulation. Cardiovascular Quality and Outcomes
Kebede Beyene, Trudi Aspden, Janie Sheridan
BACKGROUND: Prescription medicine sharing has been defined as the lending of medicines (giving prescription medicines to someone else) or borrowing of medicines (being given and using a medicine prescribed for another person). This qualitative study explored the views of patients, to elicit information regarding factors influencing medicine sharing behaviours, their experiences of the consequences of prescription medicine sharing, and their risk assessment strategies when deciding to share...
2016: Journal of Pharmaceutical Policy and Practice
Ronald M Epstein, Paul R Duberstein, Joshua J Fenton, Kevin Fiscella, Michael Hoerger, Daniel J Tancredi, Guibo Xing, Robert Gramling, Supriya Mohile, Peter Franks, Paul Kaesberg, Sandy Plumb, Camille S Cipri, Richard L Street, Cleveland G Shields, Anthony L Back, Phyllis Butow, Adam Walczak, Martin Tattersall, Alison Venuti, Peter Sullivan, Mark Robinson, Beth Hoh, Linda Lewis, Richard L Kravitz
Importance: Observational studies demonstrate links between patient-centered communication, quality of life (QOL), and aggressive treatments in advanced cancer, yet few randomized clinical trials (RCTs) of communication interventions have been reported. Objective: To determine whether a combined intervention involving oncologists, patients with advanced cancer, and caregivers would promote patient-centered communication, and to estimate intervention effects on shared understanding, patient-physician relationships, QOL, and aggressive treatments in the last 30 days of life...
September 9, 2016: JAMA Oncology
Vinuta Mohan, Robert Lind
Graves' disease is the most common cause of hyperthyroidism. If left untreated, patients may have multiple systemic complications such as cardiac, reproductive, and skeletal disease. Thionamides, such as methimazole and propylthiouracil, and I(131) iodine ablation are the most commonly prescribed treatment for Graves' disease. Total thyroidectomy is often overlooked for treatment and is usually only offered if the other options have failed. In our case, we discuss a patient who was admitted to our medical center with symptomatic hyperthyroidism secondary to long-standing Graves' disease...
2016: Journal of Community Hospital Internal Medicine Perspectives
Kai Yeung, Anirban Basu, Ryan N Hansen, John B Watkins, Sean D Sullivan
BACKGROUND: Value-based benefit design has been suggested as an effective approach to managing the high cost of pharmaceuticals in health insurance markets. Premera Blue Cross, a large regional health plan, implemented a value-based formulary (VBF) for pharmaceuticals in 2010 that explicitly used cost-effectiveness analysis (CEA) to inform medication copayments. OBJECTIVE OF THE STUDY: The objective of the study was to determine the impact of the VBF. DESIGN: Interrupted time series of employer-sponsored plans from 2006 to 2013...
August 30, 2016: Medical Care
Jannik B Bertelsen, Jens Refsgaard, Helle Kanstrup, Søren P Johnsen, Ina Qvist, Bo Christensen, Kent L Christensen
AIM: To investigate whether phase II cardiac rehabilitation (CR) conducted by a community model of shared care CR (SC-CR) including health care centres and general practice was feasible and provided acceptable results and to compare SC-CR to hospital-based CR (H-CR) in a randomised controlled trial. METHODS: Patients were randomised to H-CR or SC-CR after admission for acute coronary syndrome. In SC-CR, the general practitioner took over the responsibility of the remaining rehabilitation, pharmacological treatment and risk factor management after the initial visit to the hospital outpatient clinic...
August 26, 2016: European Journal of Cardiovascular Nursing
Robyn Preston, Sarah Larkins, Judy Taylor, Jenni Judd
BACKGROUND: This paper presents a conceptual framework developed from empirical evidence, to guide medical schools aspiring towards greater social accountability. METHODS: Using a multiple case study approach, seventy-five staff, students, health sector representatives and community members, associated with four medical schools, participated in semi-structured interviews. Two schools were in Australia and two were in the Philippines. These schools were selected because they were aspiring to be socially accountable...
2016: BMC Medical Education
Leslie Rittenmeyer, Dolores Huffman, Michael Alagna, Ellen Moore
BACKGROUND: "Watchful waiting" or "active surveillance" is an alternative approach in the medical management of certain diseases. Most often considered appropriate as an approach to treatment for low-risk prostate cancer, it is also found in the literature in breast cancer surveillance, urinary lithiasis, lymphocytic leukemia, depression and small renal tumors. OBJECTIVES: This systematic review sought to:Identify and synthesize the best available international evidence on the experience of adults who choose watchful waiting or active surveillance as an approach to medical treatment...
February 2016: JBI Database of Systematic Reviews and Implementation Reports
Benjamin D Sommers, Robert J Blendon, E John Orav, Arnold M Epstein
Importance: Under the Affordable Care Act (ACA), more than 30 states have expanded Medicaid, with some states choosing to expand private insurance instead (the "private option"). In addition, while coverage gains from the ACA's Medicaid expansion are well documented, impacts on utilization and health are unclear. Objective: To assess changes in access to care, utilization, and self-reported health among low-income adults in 3 states taking alternative approaches to the ACA...
October 1, 2016: JAMA Internal Medicine
Shireen Madani Sims, James W Lynch
INTRODUCTION: The College of Medicine at our institution underwent a major curricular revision in order to develop a patient-centered context for learning. The admission process was revised to reflect this change, adopting a holistic review process, with the hope of attracting students who were particularly well suited to a patient-centered curriculum and learning culture. METHODS: Patients from a single practitioner, who were accustomed to working with medical students, were asked if they would like to select the next generation of physicians...
2016: Medical Education Online
John R Scheel, Daniel S Hippe, Linda E Chen, Diana L Lam, Janie M Lee, Joann G Elmore, Habib Rahbar, Savannah C Partridge, Christoph I Lee
OBJECTIVE: The purpose of this study is to determine whether primary care physicians were influenced by their own specialty society's mammography screening recommendations after the 2009 U.S. Preventive Services Task Force's (USPSTF) revised recommendations were released. MATERIALS AND METHODS: We performed an analysis of cross-sectional nationally representative data for 2007-2012 from the National Ambulatory Medical Care Survey (NAMCS). All office-based preventive services visits for women 40 years old or older were included...
November 2016: AJR. American Journal of Roentgenology
Jennifer L Wolff, Jonathan D Darer, Andrea Berger, Deserae Clarke, Jamie A Green, Rebecca A Stametz, Tom Delbanco, Jan Walker
We examined the acceptability and effects of delivering doctors' visit notes electronically (via OpenNotes) to patients and care partners with authorized access to patients' electronic medical records. Adult patients and care partners at Geisinger Health System were surveyed at baseline and after 12 months of exposure to OpenNotes. Reporting on care partner access to OpenNotes, patients and care partners stated that they had better agreement about patient treatment plans and more productive discussions about their care...
August 7, 2016: Journal of the American Medical Informatics Association: JAMIA
Alex D Federman, Angela Sanchez-Munoz, Lina Jandorf, Christopher Salmon, Michael S Wolf, Joseph Kannry
OBJECTIVE: We explored patients' and clinicians' perspectives on electronic health record (EHR)-generated outpatient after-visit summaries (AVSs) to inform efforts to maximize the document's utility. MATERIALS AND METHODS: This qualitative study involved focus groups and semistructured interviews with patients (n = 39) and clinicians (n = 56) in adult primary care practices serving socioeconomically diverse communities in New York City; Long Island, New York; and Chicago, Illinois...
August 7, 2016: Journal of the American Medical Informatics Association: JAMIA
Carolyn L Turvey, Dawn M Klein, Matthew Witry, J Stacey Klutts, Elaine L Hill, Bruce Alexander, Kim M Nazi
OBJECTIVES: Consumer-mediated health information exchange (HIE) is one of the three types of HIE designated by the Office of the National Coordinator. HIE is intended to improve the quality of care while reducing cost, yet empirical support for this claim is mixed. Future research should identify the contexts whereby HIE is most effective. METHODS: This study was conducted as a pilot two-arm randomized controlled trial. In the intervention arm, 27 veterans were taught how to generate a Continuity of Care Document (CCD) within the Blue Button feature of their VA patient portal and were then asked to share it with their community non-VA provider...
2016: Applied Clinical Informatics
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