The body of evidence of late-life depression: the complex relationship between depressive symptoms, movement, dyspnea and cognition.

Background: Physical symptoms play an important role in late-life depression and may contribute to residual symptomatology after antidepressant treatment. In this exploratory study, we examined the role of specific bodily dimensions including movement, respiratory functions, fear of falling, cognition, and physical weakness in older people with depression.

Methods: Clinically stable older patients with major depression within a Psychiatric Consultation-Liaison program for Primary Care underwent comprehensive assessment of depressive symptoms, instrumental movement analysis, dyspnea, weakness, activity limitations, cognitive function, and fear of falling.

Association of Clinician Denial of Patient Requests With Patient Satisfaction.

Importance: Prior studies suggesting clinician fulfillment or denial of requests affects patient satisfaction included limited adjustment for patient confounders. The studies also did not examine distinct request types, yet patient expectations and clinician fulfillment or denial might vary among request types.

Objective: To examine how patient satisfaction with the clinician is associated with clinician denial of distinct types of patient requests, adjusting for patient characteristics.

Reliability of Physician-Level Measures of Patient Experience in Primary Care.

Background: Patient experience measures are widely used to compare performance at the individual physician level.

Objective: To assess the impact of unmeasured patient characteristics on visit-level patient experience measures and the sample sizes required to reliably measure patient experience at the primary care physician (PCP) level.

Design: Repeated cross-sectional design.

Physical Exercise for Late-Life Depression: Customizing an Intervention for Primary Care.

Objectives: To identify which individual- and context-related factors influence the translation into clinical practice of interventions based on physical exercise (PE) as an adjunct to antidepressants (AD) for the treatment of late-life major depression (LLMD).

Design: Secondary analysis of a randomized controlled trial.

Setting: Primary care with psychiatric consultation-liaison programs (PCLPs)-organizational protocols that regulate the clinical management of individuals with psychiatric disorders.

Body mass index and health care utilization in diabetic and nondiabetic individuals.

Background: Although controversial, most studies examining the relationship of body mass index (BMI) with mortality in diabetes suggest a paradox: the lowest risk category is above normal weight, versus normal weight in nondiabetic persons. One proposed explanation is greater morbidity of diabetes in normal weight persons. If this were so, it would suggest a health care utilization paradox in diabetes, paralleling the mortality paradox, yet no studies have examined this issue.

Satisfaction with health care providers and preventive care adherence: a national study.

Background: Prior studies demonstrating associations between patient satisfaction with health care providers and preventive adherence were cross-sectional, limiting causal inferences. In cross-sectional and prospective analyses, we explored 3 hypotheses previously invoked to explain associations between satisfaction with providers and preventive adherence: (1) receiving preventive care increases satisfaction; (2) enhancing satisfaction increases preventive care; (3) satisfaction and adherence reflect patient characteristics, incompletely adjusted for in previous studies.

Methods: We conducted 3 sets of logistic regression analyses employing 2000-2010 Medical Expenditure Panel Survey data: 1 cross-sectional and 2 prospective (baseline preventive care/follow-up year satisfaction, and baseline satisfaction/follow-up year preventive care), each set cumulatively adjusting for patient demographics, socioeconomics, morbidity, health care access, and medical skepticism.

Short-term stability and spread of the U.S. News & World Report primary care medical school rankings.

Purpose: The annual U.S. News & World Report (USN&WR) Primary Care Medical School (PCMS) ranking attracts considerable attention, but its measurement properties have not been published.

Gender of physician as the usual source of care and patient health care utilization and mortality.

Background: Practice styles differ by provider gender, but whether provider gender influences health care utilization and mortality is unknown. The objective of this study was to examine associations of the gender of a patient's usual source of health care (USOC) with health care utilization and mortality.

Methods: This was a prospective observational study employing data from respondents aged ≥18 years entering the 2002 to 2008 United States Medical Expenditure Panel Surveys, reporting a USOC at entry, and participating for 2 years (N = 21,365).

Extended office hours and health care expenditures: a national study.

Purpose: A key component of primary care improvement efforts is timely access to care; however, little is known regarding the effects of extended (evening and weekend) office hours on health care use and outcomes. We examined the association between reported access to extended office hours and both health care expenditures and mortality.

Methods: We analyzed data from individuals aged 18 to 90 years responding to the 2000-2008 Medical Expenditure Panel Surveys reporting access or no access to extended hours via a usual source of care in 2 successive years (year 1 and year 2; N = 30,714).

Does applicant personality influence multiple mini-interview performance and medical school acceptance offers?

Purpose: To examine relationships among applicant personality, Multiple Mini-Interview (MMI) performance, and medical school acceptance offers.

Method: The authors conducted an observational study of applicants who participated in the MMI at the University of California, Davis, School of Medicine during the 2010-2011 admissions cycle and responded to the Big Five Inventory measuring their personality factors (agreeableness, conscientiousness, extraversion, neuroticism, openness). Individuals' MMI performance at 10 stations was summarized as a total score.

The cost of satisfaction: a national study of patient satisfaction, health care utilization, expenditures, and mortality.

Background: Patient satisfaction is a widely used health care quality metric. However, the relationship between patient satisfaction and health care utilization, expenditures, and outcomes remains ill defined.

Methods: We conducted a prospective cohort study of adult respondents (N = 51,946) to the 2000 through 2007 national Medical Expenditure Panel Survey, including 2 years of panel data for each patient and mortality follow-up data through December 31, 2006, for the 2000 through 2005 subsample (n = 36,428).

Patient-centered care: the influence of patient and resident physician gender and gender concordance in primary care.

Background: Patient-centered care (PCC) is thought to significantly influence the process of care and its outcomes and has been identified as part of a comprehensive strategy for improving our nation's healthcare delivery system. Patient and physician gender, as well as gender concordance, may influence the provision of PCC.

Methods: Patients (315 women, 194 men) were randomized to care by primary care resident physicians (48 women, 57 men).

Patient-provider sex and race/ethnicity concordance: a national study of healthcare and outcomes.

Background: Increasing patient-provider sex and race/ethnicity concordance has been proposed to improve healthcare and help mitigate health disparities, but the relationship between concordance and health outcomes remains unclear.

Objective: To examine associations of patient-provider sex, race/ethnicity, and dual concordance with healthcare measures.

Research Design And Participants: Analyses of data from adult respondents indicating a usual source of healthcare (N=22,440) in the 2002 to 2007 Medical Expenditure Panel Surveys (each a 2-year panel).

Patient-centered care is associated with decreased health care utilization.

Purpose: This article uses an interactional analysis instrument to characterize patient-centered care in the primary care setting and to examine its relationship with health care utilization.

Methods: Five hundred nine new adult patients were randomized to care by family physicians and general internists. An adaption of the Davis Observation Code was used to measure a patient-centered practice style.

Patient gender differences in the prediction of medical expenditures.

Aims: The prediction of individuals' use of medical services and associated costs is crucial for medical systems. We modeled a risk assessment equation that included patient sociodemographic characteristics and health risk behaviors (obesity, smoking, and alcohol abuse) to strengthen the power of self-reported health status to predict healthcare resource use. We also sought to uncover gender-specific differences in the predictive value of the models.

Determinants and outcomes of patient-centered care.

Objective: This paper defines an interactional analysis instrument to characterize patient-centered care and identify associated variables.

Methods: In this study, 509 new adult patients were randomized to care by family physicians and general internists. An adaption of the Davis Observation Code was used to measure a patient-centered practice style.

Attributes affecting the medical school primary care experience.

Purpose: Favorable primary care (PC) experiences might encourage more medical students to pursue generalist careers, yet academicians know little about which attributes influence the medical school PC experience. The authors sought to identify such attributes and weight their importance.

Method: Semistructured interviews with 16 academic generalist leaders of family medicine, general internal medicine, and general pediatrics led to the development of a Web-based survey, administered to a national sample of 126 generalist faculty.

The influence of gender on the doctor-patient interaction.

Objective: This paper discusses the research focused on gender issues in healthcare communication.

Methods: The majority of papers discussed here are based on a research study in which 509 new adult patients were prospectively and randomly assigned to family practice or internal medicine clinics at a university medical center and followed for one year of care.

Results: There are significant differences in the practice style behaviors of female and male doctors.

Patient-centered communication in primary care: physician and patient gender and gender concordance.

Background: Physicians' use of patient-centered communication (PCC) affects important outcomes of care. Although there is evidence that both patient and physician gender affect the process of care, there is limited information about their impact on PCC. Our objective was to investigate the influence of patient and physician gender, as well as gender concordance between patient and physician, on the patient centeredness of primary care visits.

A qualitative study of the barriers to chronic pain management in the ED.

Purpose: This qualitative study sought to identify perceived barriers to diagnosing and treating patients with chronic pain in the emergency department (ED).

Basic Procedure: Semistructured interviews were conducted with 24 ED physicians from 4 hospitals to elucidate their experiences of managing chronic pain in the ED.

Main Findings: Time limitations and a low triage priority were major barriers to caring for patients with chronic pain.

Chronic pain management in the emergency department: a survey of attitudes and beliefs.

Objective: The emergency department (ED) can be a particularly challenging environment in which to offer care for chronic pain. This study tried to determine if beliefs held by patients and providers about noncancer-related chronic pain affect evaluation and management of pain in ED.

Intervention: We surveyed 103 patients presenting to the ED with chronic pain, 34 ED physicians, and 44 ED nurses to assess the influence of 15 possible barriers to managing chronic pain in the ED.

Determinants of physician discussion regarding tobacco and alcohol abuse.

The U.S. Preventive Services Task Force recommends that clinicians screen adults for tobacco and alcohol abuse and provide appropriate interventions.

Patient gender and physician practice style.

Background: Patient and physician gender may impact the process of medical care and its outcomes. Our objective was to investigate the influence of patient gender on what takes place during initial primary care visits while controlling for other variables previously demonstrated to affect the physician-patient interaction, such as physician gender and specialty, patient health status, pain, depression, obesity, age, education, and income.

Methods: New patients (315 women, 194 men) were randomized for care by 105 primary care physicians.

Association between obesity and patient satisfaction.

Objective: To examine the relationship between BMI and patient satisfaction with health care providers using a nationally representative survey.

Research Methods And Procedures: This analysis examined the 9914 adult patients who completed the 2000 Medical Expenditure Panel Survey and had visited a health care provider within 12 months of the survey. Linear regression models were employed with patient satisfaction as the dependent variable.