Abstract:
BACKGROUND:Depression is associated with poor chronic illness outcomes, but it is unknown whether depression influences the quality of communication during the clinical encounter. We investigated whether diabetes patients with depressive symptoms, compared with those without depressive symptoms, report worse clinician-patient communication, and which domains of communication are most affected. METHODS:We surveyed 231 ethnically diverse, English-speaking patients with diabetes to ascertain their experiences of communication with their primary care clinician. We selected measures from the interpersonal processes of care (IPC) instrument to assess communication and dichotomized the 7 subscales into "optimal" or "suboptimal" communication. We used the Clinical Epidemiologic Services for Depression (CES-D 10) to categorize patients as having no (CES-D 10 score <10), mild (CES-D 10 score 10-14), or severe (CES-D 10 score >14) depressive symptoms. We used multivariable logistic regression to evaluate the relationship between depressive symptoms and communication subscales. RESULTS:Thirty-five percent of subjects reported severe depressive symptoms. Compared with those with no depressive symptoms, the presence of severe depressive symptoms was independently associated with suboptimal communication in 4 of 7 subscales: elicitation of patient problems, concerns, and expectations (adjusted odds ratio [AOR], 2.94; 95% confidence interval [CI], 1.14-7.61); explanations of condition (AOR, 3.79; 95% CI, 1.41-10.21); empowerment (AOR, 2.98; 95% CI, 1.35-6.58); and decision-making (AOR, 2.56; 95% CI, 1.14-5.78). CONCLUSIONS:Diabetes patients with severe depressive symptoms are more likely than those without depressive symptoms to report suboptimal clinician-patient communication across multiple domains of communication, especially those that involve more interactive and "patient-centered" communication. Further investigation of this relationship may uncover explanatory mechanisms and help guide interventions for improving care for both conditions.
journal_name
Med Carejournal_title
Medical careauthors
Swenson SL,Rose M,Vittinghoff E,Stewart A,Schillinger Ddoi
10.1097/MLR.0b013e31816080e9subject
Has Abstractpub_date
2008-03-01 00:00:00pages
257-65issue
3eissn
0025-7079issn
1537-1948pii
00005650-200803000-00005journal_volume
46pub_type
杂志文章相关文献
MEDICAL CARE文献大全abstract:OBJECTIVES:Various individual characteristics increase a nursing home resident's likelihood of being mechanically restrained. However, there is not good information on the role played by facility characteristics and geographic area in determining the likelihood of physical restraint use. This study investigates the imp...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199611000-00008
更新日期:1996-11-01 00:00:00
abstract:BACKGROUND:Acute health shocks can reduce the ability to work and earn among working-age survivors. The full economic impact includes labor market effects on spouses/partners, but there is a knowledge gap in this area. OBJECTIVES:The objective of this study was to assess how 3 common health shocks, acute myocardial in...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000001249
更新日期:2020-02-01 00:00:00
abstract:BACKGROUND:To optimize the use of patient-reported outcomes (PROs) in clinical research, it is first necessary to review the current use of these outcomes in clinical trials to determine under what circumstances they are most useful, and to reveal current limitations. PURPOSE:To investigate current patterns of use of ...
journal_title:Medical care
pub_type: 杂志文章,评审
doi:10.1097/MLR.0b013e3182064aa2
更新日期:2011-04-01 00:00:00
abstract:BACKGROUND:Self-reported racial discrimination in healthcare has been associated with negative health outcomes, but little is known about its association with diabetes outcomes. METHODS:We used data from the Behavioral Risk Factor Surveillance System to investigate associations between self-reported healthcare discrim...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e318215d925
更新日期:2011-07-01 00:00:00
abstract:OBJECTIVES:This study examined factors that affect access to Veterans Administration mental health services. METHODS:Data from national Veterans Affairs databases and the 1990 Decennial Census were used to estimate rates of Veterans Affairs mental health service use in each US county (n = 3,156) among all US veterans ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199804000-00006
更新日期:1998-04-01 00:00:00
abstract:BACKGROUND:The Medicare Part D benefit is complicated and may be costly, especially for vulnerable low-income populations where lack of resources and limited English proficiency may be barriers to optimal plan selection. OBJECTIVES:To identify vulnerable Medicare beneficiaries and lower their expected annual out-of-po...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e318202a9f2
更新日期:2011-04-01 00:00:00
abstract:BACKGROUND:Assessing accuracy and completeness of data is an important component of conducting research. VA Healthcare System benefits from a highly developed electronic medical information system. The Immunology Case Registry was designed to monitor costs and quality of HIV care. The Decision Support System was develo...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e31817d69c2
更新日期:2009-01-01 00:00:00
abstract::This study compares health insurance payments and patient utilization patterns for episodes of care for common lumbar and low back conditions treated by chiropractic and medical providers. Using 2 years of insurance claims data, this study examines 6,183 patients who had episodes with medical or chiropractic first-con...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199603000-00001
更新日期:1996-03-01 00:00:00
abstract:BACKGROUND:Health plans commonly face the conflicting demands of trying to provide access to novel technologies, including new classes of medications, while trying to contain costs. These demands are particularly acute for California's Medicaid program, known as Medi-Cal, which is responsible for delivery of medical ca...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199904001-00005
更新日期:1999-04-01 00:00:00
abstract:BACKGROUND:There is growing attention given to the spiritual needs of dying patients and long-term care (LTC) facilities are common settings in which patients receive care as they approach death. OBJECTIVES:To describe the sources of support, the structure and processes of spiritual care in LTC, and examine the relati...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e3181468b5d
更新日期:2008-01-01 00:00:00
abstract:OBJECTIVE:Most Veterans Affairs (VA) Health Care System enrollees age 65+ also have the option of obtaining care through Medicare. Reliance upon VA varies widely and there is a need to optimize its prediction in an era of expanding choice for veterans to obtain care within or outside of VA. We examined whether survey-b...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000001155
更新日期:2019-08-01 00:00:00
abstract::This study analyzes the relationship between medical student participation in rural training programs, including preceptorships, and the decision to locate medical practice in rural areas. Data consist primarily of responses to questionnaires mailed in 1972 to all graduates of United States medical schools in 1965. St...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-197503000-00004
更新日期:1975-03-01 00:00:00
abstract:OBJECTIVES:The first objective of this study was to examine the prevalence of prescriptions that offer the opportunity for generic drug use (a prescription for a multisource drug product). The second objective was to examine the prevalence of generic drug use by examining the rate of generic drug prescribing for multis...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.MLR.0000020926.85284.8E
更新日期:2002-08-01 00:00:00
abstract:INTRODUCTION:Growing adoption of electronic health records and increased emphasis on the reuse and integration of clinical care and administration data require a robust informatics infrastructure to inform health care effectiveness in real-world settings. The Scalable Architecture for Federated Translational Inquiries ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e318259bff4
更新日期:2012-07-01 00:00:00
abstract:BACKGROUND:Clinical practice guidelines quickly become outdated. One reason they might not be updated as often as needed is the expense of collecting expert judgment regarding the evidence. The RAND-UCLA Appropriateness Method is one commonly used method for collecting expert opinion. We tested whether a less expensive...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.MLR.0000100583.76137.3E
更新日期:2003-12-01 00:00:00
abstract:BACKGROUND:In 2002 British Columbia, Canada began redistributing its hospital services. OBJECTIVE AND DESIGN:We used administrative data and interrupted time series analyses to determine how recent hospital closures affected patient outcomes. SUBJECTS:All adult acute myocardial infarction (AMI), stroke, and trauma ev...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000619
更新日期:2017-01-01 00:00:00
abstract:BACKGROUND:Increasing recognition of the failure to translate research findings into practice has led to greater awareness of the importance of using active dissemination and implementation strategies. Although there is a growing body of research evidence about the effectiveness of different strategies, this is not eas...
journal_title:Medical care
pub_type: 杂志文章
doi:
更新日期:2001-08-01 00:00:00
abstract::Broken appointments have been a major problem at the Anthony L. Jordan Health Center since it opened in 1968. In an earlier 6-month study of broken appointments at the center the authors found 48% of pediatric appointments and 43% of medicine appointments to be broken. Daily broken appointment rates were correlated be...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198409000-00005
更新日期:1984-09-01 00:00:00
abstract::There have been recent increases in asthma prevalence, morbidity, and mortality in the United States. There is substantial evidence that problems in health care delivery may be contributing to these recent trends. Because of these recent changes, a reduction in asthma-related morbidity has been identified as a new nat...
journal_title:Medical care
pub_type: 杂志文章,评审
doi:10.1097/00005650-199303001-00004
更新日期:1993-03-01 00:00:00
abstract:BACKGROUND:Methods to select physicians most likely to benefit from educational interventions to improve the outcome of depression have not been adequately developed. OBJECTIVE:The purpose of this study was to identify a combination of primary care provider (PCP) self-report questions to improve the precision of PCP e...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-200007000-00009
更新日期:2000-07-01 00:00:00
abstract:BACKGROUND:With rising health spending, predicting costs is essential to identify patients for interventions. Many of the existing approaches have moderate predictive ability, which may result, in part, from not considering potentially meaningful changes in spending over time. Group-based trajectory modeling could be u...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000623
更新日期:2017-01-01 00:00:00
abstract::There are various reasons why physicians order laboratory tests. Earlier studies have shown that in many cases test-ordering behavior lacks efficiency, resulting in excessive laboratory utilization. Throughout the years various attempts have been made to improve this situation. This review, based on the literature of ...
journal_title:Medical care
pub_type: 杂志文章,评审
doi:10.1097/00005650-199309000-00003
更新日期:1993-09-01 00:00:00
abstract:BACKGROUND:In Ontario, Canada, the 70/90 regulations were instituted in May 1993 to establish provincial government procurement prices for generic drugs. Accordingly, the first generic entrant's price could not exceed 70% of the incumbent's branded price. Subsequent entrants' prices could not exceed 90% of the first en...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-200301000-00015
更新日期:2003-01-01 00:00:00
abstract:BACKGROUND:The lack of quality-oriented organizational climates is partly responsible for deficiencies in patient-centered care and poor quality more broadly. To improve their quality-oriented climates, several organizations have joined quality improvement collaboratives. The effectiveness of this approach is unknown. ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e31826b1087
更新日期:2012-11-01 00:00:00
abstract:OBJECTIVES:The authors examined how the courts have responded to public and private insurers' use of medical appropriateness criteria to establish coverage and payment policies. METHODS:A structured review of all federal and state court health insurance cases decided between 1960 and June 1994 that involved a dispute ...
journal_title:Medical care
pub_type: 杂志文章,评审
doi:10.1097/00005650-199808000-00016
更新日期:1998-08-01 00:00:00
abstract:BACKGROUND:In 1999, the US Congress mandated the Agency for Healthcare Research and Quality (AHRQ), Department of Health and Human Services (DHHS), to report annually to the nation about healthcare quality. One chapter in the National Healthcare Quality Report (NHQR) is focused on patient safety. OBJECTIVES:The object...
journal_title:Medical care
pub_type: 杂志文章,评审
doi:10.1097/00005650-200503001-00007
更新日期:2005-03-01 00:00:00
abstract:BACKGROUND:Chinese Americans are one of the fastest growing ethnic groups in the United States; however, language and cultural obstacles have challenged health workers and policy makers seeking to understand the health status and needs of this population. OBJECTIVES:This study is the first to use a large-scale probabi...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-200005000-00010
更新日期:2000-05-01 00:00:00
abstract:BACKGROUND:Although cardiac procedures are commonly used to treat cardiovascular disease, they are costly. Administrative data sources could be used to track cardiac procedures, but sources of such data have not been validated against clinical registries. OBJECTIVES:To examine accuracy of cardiac procedure coding in a...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e3182329778
更新日期:2013-04-01 00:00:00
abstract::In a longitudinal, prospective study of patient's decisions about influenza vaccination, the stability of attitudes about the flu and flu shots, the stability of flu shot decisions, and the relationship of attitude shifts to compliance were studied. In both 1981 and 1982 for 216 patients at high risk for complications...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198506000-00002
更新日期:1985-06-01 00:00:00
abstract::A national sample of both hospital administrators and hospital review chair-persons (the two adversarial providers in the hospital regulatory milieu) were surveyed and asked to estimate the degree and kind of unnecessary hospital utilization taking place both in the U.S. and at their own institution. Both groups indic...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198101000-00006
更新日期:1981-01-01 00:00:00