Abstract:
OBJECTIVE:To examine the knowledge of, counseling about, and use of prior directives among patients with HIV-related disease. DESIGN:Cross-sectional survey with personal interviews that was part of the evaluation of a multi-site AIDS Health Services Program. SETTING:Outpatient clinics and AIDS community-based organizations. PATIENTS/PARTICIPANTS:To be eligible for the survey, subjects had to be at least 18 years of age and enrolled in the AIDS Health Services Program for at least one month. 1,031 clients were interviewed in nine communities. MEASUREMENTS AND MAIN RESULTS:Of those surveyed, 61% had thought a moderate or great amount about naming a proxy for health care decisions. The majority (68%) of the patients knew about prior directives, yet only 35% had been counseled and only 28% had a prior directive. Of those counseled, physicians had counseled only 11% (38/359). Gay/bisexual men were more likely to have been counseled and to have executed a prior directive than were others. Counseling was associated with having obtained a prior directive. Counseled subjects were 3.5 times more likely to have obtained a prior directive than were those not counseled. CONCLUSIONS:A gap exists between subjects' knowledge and implementation of prior directives. To help bridge this gap, the authors recommend that physicians not only attend to the technical aspects of patient care, but also determine patient values concerning life-sustaining therapy and counsel patients on prior directives.
journal_name
J Gen Intern Medjournal_title
Journal of general internal medicineauthors
Teno J,Fleishman J,Brock DW,Mor Vdoi
10.1007/BF02600877subject
Has Abstractpub_date
1990-11-01 00:00:00pages
490-4issue
6eissn
0884-8734issn
1525-1497journal_volume
5pub_type
杂志文章abstract::African Americans and Latinos use services that require a doctor's order at lower rates than do whites. Racial bias and patient preferences contribute to disparities, but their effects appear small. Communication during the medical interaction plays a central role in decision making about subsequent interventions and ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.2003.20532.x
更新日期:2003-02-01 00:00:00
abstract:BACKGROUND:Quite often medical students or novice residents have difficulty in ruling out diseases even though they are quite unlikely and, due to this difficulty, such students and novice residents unnecessarily repeat laboratory or imaging tests. OBJECTIVE:To explore whether or not a carefully designed short trainin...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2004.30257.x
更新日期:2004-05-01 00:00:00
abstract::This Perspective discusses 12 key facts derived from 50 years of health services research and argues that this knowledge base can stimulate innovative thinking about how to make health care systems safer, more efficient, more cost effective, and more patient centered, even as they respond to the needs of diverse commu...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-015-3298-2
更新日期:2015-10-01 00:00:00
abstract:BACKGROUND:Differences among hospitals in the use of inpatient consultation may contribute to variation in outcomes and costs for hospitalized patients, but basic epidemiologic data on consultations nationally are lacking. OBJECTIVE:The purpose of the study was to identify physician, hospital, and geographic factors t...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-015-3216-7
更新日期:2015-07-01 00:00:00
abstract::Over the past several decades, and particularly during the last 10 to 15 years, there has been a rapid increase in the accessibility of legalized gambling in the United States and other parts of the world. Few studies have systematically explored the relationships between patterns of gambling and health status. Existi...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1046/j.1525-1497.2002.10812.x
更新日期:2002-09-01 00:00:00
abstract:BACKGROUND:For adults who stutter, communication difficulties can impact many spheres of life. Previous studies have not examined how stuttering might impact patient's experiences with the medical system. OBJECTIVE:Our objective was to understand the range and depth of experiences with the medical system among adults ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-015-3302-x
更新日期:2015-11-01 00:00:00
abstract:OBJECTIVE:In 1996, the Health Care Financing Administration (HCFA) introduced new evaluation and management (E&M) guidelines mandating more intensive supervision and documentation by attending physicians. We assessed the effects of the guidelines on inpatient teaching. DESIGN:Pretest-posttest, nonequivalent control gr...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1046/j.1525-1497.2000.07001.x
更新日期:2000-07-01 00:00:00
abstract:OBJECTIVE:To evaluate patient-provider agreement on whether weight and related behaviors were discussed during routine visits. DESIGN:Post-visit survey assessments of patients and providers. PARTICIPANTS:Obese patients make up the majority of all patients seen in primary care (PC). The patients and physicians were re...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-008-0553-9
更新日期:2008-05-01 00:00:00
abstract:BACKGROUND:Depression is common among older patients yet is often inadequately treated. Patient beliefs about antidepressants are known to affect treatment initiation and adherence, but are often not expressed in clinical settings. OBJECTIVE:To explore attitudes toward antidepressants in a sample of depressed, communi...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2005.00296.x
更新日期:2006-02-01 00:00:00
abstract:BACKGROUND:Patient-centered care--including the domains of access and communication--is an important determinant of positive clinical outcomes. OBJECTIVE:To explore associations between race and HIV-infected patients' experiences of access and communication. DESIGN:This was a cross-sectional survey. PARTICIPANTS:Nin...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11606-008-0788-5
更新日期:2008-12-01 00:00:00
abstract:OBJECTIVE:To determine whether internists in the United States and China have different ideas and behaviors regarding informing patients of terminal diagnoses and HIV/AIDS, the role of the family in end-of-life decision making, and assisted suicide. DESIGN:Structured questionnaire of clinical vignettes followed by mul...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.1999.06318.x
更新日期:1999-08-01 00:00:00
abstract:BACKGROUND:Data on patients with coronavirus disease 2019 (COVID-19) who return to hospital after discharge are scarce. Characterization of these patients may inform post-hospitalization care. OBJECTIVE:To describe clinical characteristics of patients with COVID-19 who returned to the emergency department (ED) or requ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11606-020-06120-6
更新日期:2020-10-01 00:00:00
abstract:BACKGROUND:Thirty-day readmission penalties implemented with the Hospital Readmission Reduction Program (HRRP) place a larger burden on safety-net hospitals which treat a disproportionate share of racial minorities, leading to concerns that already large racial disparities in readmissions could widen. OBJECTIVE:To exa...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-019-04841-x
更新日期:2019-06-01 00:00:00
abstract:BACKGROUND:Many primary care physicians (PCPs) are ill-equipped to provide screening and counseling for inherited breast cancer. OBJECTIVE:To evaluate the outcomes of an interactive web-based genetics curriculum versus text curriculum for primary care physicians. DESIGN:Randomized two-group design. PARTICIPANTS:121 ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.1007/s11606-014-3113-5
更新日期:2015-03-01 00:00:00
abstract:BACKGROUND:Although experts recommend that healthcare organizations create forums for honest dialogue about race, there is little insight into the physician perspectives that may influence these conversations across the healthcare workforce. OBJECTIVE:To identify the range of perspectives that might contribute to work...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-008-0709-7
更新日期:2008-09-01 00:00:00
abstract::We designed a questionnaire survey to study internal medicine residents' plans to use a chaperone during the pelvic, breast, rectal, and testicular examinations. We found chaperone use by male and female residents differed markedly, and neither group planned to use chaperones universally. When examining female patient...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.2000.10006.x
更新日期:2000-08-01 00:00:00
abstract:OBJECTIVE:To evaluate the effects of an intensive intervention to implement guidelines for cost-effective management of hypertension on medication use and cost, blood pressure control, and other resource use. DESIGN:Retrospective cohort trial based on the Cleveland Veterans' Affairs Medical Center Firm System. SETTIN...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02600265
更新日期:1996-03-01 00:00:00
abstract:OBJECTIVES:To evaluate the comparative effectiveness of antiviral drugs in adults with chronic hepatitis B monoinfection for evidence-based decision-making. METHODS:A systematic review of randomized controlled clinical trials (RCTs) published in English. Results after interferon and nucleos(t)ides analog therapies wer...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-010-1569-5
更新日期:2011-03-01 00:00:00
abstract::The American Board of Internal Medicine suggests use of a standard form to rate residents on nine dimensions (such as clinical judgment and overall clinical competence) on a scale of 1 to 9. The authors examined the psychometric evidence for reliability and validity of 1,039 ratings of 85 residents by 135 attendings i...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02600537
更新日期:1990-05-01 00:00:00
abstract:BACKGROUND:Conflicting data exists regarding the effect of continuity on diabetes care. Resident physicians frequently treat patients with diabetes in their continuity clinics; however, maintaining continuity in a resident clinic can be very challenging. OBJECTIVE:To determine if resident continuity is associated with...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-008-0654-5
更新日期:2008-07-01 00:00:00
abstract:OBJECTIVE:To assess, from the patient's perspective, selected aspects of the quality of inpatient hospital care in the United States. DESIGN:A cross-sectional survey, using telephone interviews of patients discharged from the medical services of a probability sample of 62 public and private, nonprofit, nonfederal acut...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02602763
更新日期:1995-12-01 00:00:00
abstract:OBJECTIVES:To examine the extent and type of discordance between personal and medical classifications of weight status, and to examine the influence of sociodemographic factors on the misclassification of weight status. DESIGN/SETTING:The 1991 Health Promotion and Disease Prevention Supplement of the National Health I...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.2001.016008538.x
更新日期:2001-08-01 00:00:00
abstract:BACKGROUND:Enhancing the cultural competency of students is emerging as a key issue in medical education; however, students may perceive that they are more able to function within cross-cultural situations than their teachers, reducing the effectiveness of cultural competency educational efforts. OBJECTIVE:The purpose...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-009-1245-9
更新日期:2010-05-01 00:00:00
abstract:OBJECTIVES:To assess the prevalence and persistence of depression in patients with acute myocardial infarction (AMI) and the relationship between assessment modality and prevalence. DATA SOURCES:MEDLINE, Cochrane, CINAHL, PsycINFO, and EMBASE. REVIEW METHODS:A comprehensive search was conducted in March 2004 to ident...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1111/j.1525-1497.2005.00269.x
更新日期:2006-01-01 00:00:00
abstract:BACKGROUND:The health and healthcare of sexual minorities have recently been identified as priorities for health research and policy. OBJECTIVE:To compare the health and healthcare experiences of sexual minorities with heterosexual people of the same gender, adjusting for age, race/ethnicity, and socioeconomic status....
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-014-2905-y
更新日期:2015-01-01 00:00:00
abstract:OBJECTIVE:To determine whether physicians at a general internal medicine clinic spend more time with non-English-speaking patients. DESIGN:A time-motion study comparing physician time spent with non-English-speaking patients and time spent with English-speaking patients during 5 months of observation. We also tested p...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.1999.00338.x
更新日期:1999-05-01 00:00:00
abstract:BACKGROUND:Patients who leave hospitals against medical advice (AMA) may be at risk for adverse health outcomes. Their decision to leave may not be clearly understood by providers. This study explored providers' experiences with and attitudes toward patients who leave the hospital AMA. OBJECTIVE:To explore providers' ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-008-0728-4
更新日期:2008-10-01 00:00:00
abstract:OBJECTIVE:To compare specialist and primary care physician participation in California's Medicaid fee-for-service and managed care programs. DESIGN:Cross-sectional survey. PARTICIPANTS:A probability sample stratified by county and by race of 962 specialist physicians and 713 primary care physicians practicing in the ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:
更新日期:2001-12-01 00:00:00
abstract::Reflective capacity has been described as an essential characteristic of professionally competent clinical practice, core to ACGME competencies. Reflection has been recently linked to promoting effective use of feedback in medical education and associated with improved diagnostic accuracy, suggesting promising outcome...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-010-1347-4
更新日期:2010-07-01 00:00:00
abstract:OBJECTIVE:To develop a patient-based classification system to describe the clinical content of ambulatory medicine practices. DESIGN:A system of 100 diagnosis clusters was developed based on retrospective review of computerized problem lists of patients from a university practice, and then applied to the problem lists...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599394
更新日期:1991-01-01 00:00:00