Group Health's initiative to avert opioid misuse and overdose among patients with chronic noncancer pain.

Increased opioid prescribing for chronic pain that is not due to cancer has been accompanied by large increases in abuse and overdose of prescription opioids. This paper describes how Group Health, a Seattle-based nonprofit health care system, implemented a major initiative to make opioid prescribing safer. In the initiative's first nine months, clinicians developed documented care plans for almost 6,000 patients receiving long-term opioid therapy for chronic pain.

Physician support for diabetes patients and clinical outcomes.

Background: Physician practical support (e.g. setting goals, pro-active follow-up) and communicative support (e.

Gaps in depression care: why primary care physicians should hone their depression screening, diagnosis, and management skills.

Objective: To highlight the potential role that occupational and environmental physicians can play in providing high quality depression care by describing: the profound impact that depression can have on development and persistence of unexplained medical symptoms such as pain; the impact of depression on social and occupational functioning; the adverse effect of comorbid depression in patients with chronic medical illness on self-care and medical outcomes; and the significant direct and indirect costs associated with depression.

Method: Literature review.

Results: Despite evidence-based treatment guidelines, suboptimal depression care persists.

Availability of gynecologic services in the department of veterans affairs.

Purpose: The optimum approach to providing the Congressionally mandated gender-specific services for which women veterans are eligible is unknown. We evaluated onsite availability of gynecologic services, clinic type and staffing arrangements, and the impact of having a gynecology clinic (GYN) and/or an obstetrician gynecologist (OBGYN) routinely available.

Methods: We analyzed data from the 2001 national VHA Survey of Women Veterans Health Programs and Practices (n = 136 sites; response rate, 83%).

Determinants of physician unwillingness to offer medical abortion using mifepristone.

Purpose: We sought to identify factors associated with contemplating versus not contemplating offering medical abortion with mifepristone among physicians not opposed to it.

Methods: We analyzed data from a Kaiser Family Foundation survey of a nationally representative sample of 790 American obstetrician/gynecologists and primary care physicians. Our study sample consisted of 419 physicians who were not personally opposed to medical abortion and could be classified as not actively considering (precontemplation) or actively considering (contemplation) offering mifepristone.