Operationalizing a Data to Care Strategy in Michigan Through Cross-Agency Collaborations.

Background: For persons with HIV infection (PWH), viral load suppression is essential to maintaining health and reducing the likelihood of HIV transmission. Data to Care (D2C) is an important strategy for improving HIV outcomes but may be resource-intensive to execute.

Setting: In 2016, Michigan joined the HIV Health Improvement Affinity Group to strengthen D2C partnerships between its Medicaid and HIV program.

The pursuit of preventive care for chronic illness: turning healthy people into chronic patients.

Preventive health care has become prominent in clinical medicine in the US, emphasising risk assessment and control, rather than addressing the signs and symptoms of pathology. Current clinical guidelines, reinforced by evidence-based decision aids and quality of care assessment, encourage clinicians to focus on maintaining rigid test thresholds that are based on population norms. While achieving these goals may benefit the total population, this may be of no benefit or even harmful to individual patients.

Genes, race, and culture in clinical care: racial profiling in the management of chronic illness.

Race, although an unscientific concept, remains prominent in health research and clinical guidelines, and is routinely invoked in clinical practice. In interviews with 58 primary care clinicians we explored how they understand and apply concepts of racial difference. We found wide agreement that race is important to consider in clinical care.

Changing Diagnostic and Treatment Criteria for Chronic Illness: A Critical Consideration of their Impact on Low-Income Hispanic Patients.

Low-income Hispanics are often identified as especially at risk for common chronic conditions like diabetes, and targeted for aggressive screening and treatment. Anthropologists and other social scientists have extensively explored barriers and facilitators to chronic illnesses management in minority populations, but have not yet considered the impact of recently lowered diagnostic and treatment thresholds on such groups. In this paper, we critically review recent changes in diabetes, hypertension and high cholesterol diagnostic and treatment standards which have dramatically increased the number of people being treated for these conditions.

Pharmacogenetics in primary care: the promise of personalized medicine and the reality of racial profiling.

Many anticipate that expanding knowledge of genetic variations associated with disease risk and medication response will revolutionize clinical medicine, making possible genetically based Personalized Medicine where health care can be tailored to individuals, based on their genome scans. Pharmacogenetics has received especially strong interest, with many pharmaceutical developers avidly working to identify genetic variations associated with individual differences in drug response. While clinical applications of emerging genetic knowledge are becoming increasingly available, genetic tests for drug selection are not as yet widely accessible, and many primary care clinicians are unprepared to interpret genetic information.

The changing face of chronic illness management in primary care: a qualitative study of underlying influences and unintended outcomes.

Purpose: Recently, there has been dramatic increase in the diagnosis and pharmaceutical management of common chronic illnesses. Using qualitative data collected in primary care clinics, we assessed how these trends play out in clinical care.

Methods: This qualitative study focused on management of type 2 diabetes and hypertension in 44 primary care clinics in Michigan and was based on interviews with 58 clinicians and 70 of their patients, and observations of 107 clinical consultations.

Delivering diversity: newly regulated midwifery returns to Manitoba, Canada, one community at a time.

Through its publicly funded health care system, Canada is committed to offering accessible, quality maternity health services to all its citizens, yet this remains a challenge in its First Nations, rural and immigrant communities. With the implementation of midwifery as a self-regulating health profession in Manitoba, Canada, in 2000, initiatives were incorporated into the structure of the profession to try to address this issue. This qualitative investigation documents and explores these initiatives through a case study combining semistructured interviews and documentary sources.