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This study explores the relationship between practicing physicians' cognitive skill and the delivery of evidenced-based processes of care for Medicare beneficiaries using the maintenance of certification examination of the American Board of Internal Medicine, a validated examination of clinical knowledge. Using hierarchical multivariate models, Holmboe et al examined associations between examination scores and a composite diabetes measure, mammography, and lipid testing in patients with cardiovascular disease. Physicians scoring in the top quartile on the examination were more likely to perform processes of care for diabetes and mammography screening, but not lipid screening for cardiovascular disease, than physicians in the lowest physician quartile, even after adjustment for multiple factors. This study suggests that physician cognitive skill is associated with higher rates of processes of care for Medicare patients.
In this study of 174 patients 65 years and older with severe osteoarthritis of the hip or knee, 29% had joint replacement surgery during 12 months of follow-up. Postoperative pain lasting longer than 4 weeks was common, and postoperative functional recovery took several weeks. At 12 months, patients who underwent surgery had substantial improvement in pain and function. Patients 75 years and older experienced similar recovery and benefits from surgery as patients aged between 65 and 74 years. Among patients who did not undergo surgery, pain and function did not improve, and 45% reported that surgery was not offered as a potential treatment option.
Little is known about how to combine effective relationship development and communication skills with time management to make the best use of time in face-to-face medical encounters. Mauksch et al reviewed the literature between 1973 and 2006 and report 3 skill domains that may enhance communication efficiency: rapport building, up-front agenda setting, and acknowledging social or emotional clues. Building on these findings, the authors present a model blending the quality enhancing and time management features of selected communication and relationship skills.
Bernstein et al examined the proportion of men who have sex with men (MSM) recruited from gay venues who disclosed their same-sex attraction to their medical providers. Among the 452 MSM respondents, 175 (39%) did not disclose to their providers. Black and Hispanic MSM were significantly less likely to have disclosed to their providers, and none of the MSM who reported male and female sex partners had disclosed. Those who did not disclose their same-sex attraction to their provider were significantly less likely to have ever been tested for human immunodeficiency virus (HIV) (adjusted odds ratio, 2.10; 95% confidence interval, 1.01-4.38). Among this population of MSM who were recruited from gay venues, a significant proportion had not disclosed to their provider and may in turn have not been offered HIV testing. Risk-based HIV testing models may miss high-risk individuals.
Based on analysis of more than 12 000 respondents to the 2004 Medicare Current Beneficiary Survey, this study describes the experiences of community-dwelling older adults in routine medical visits and examines whether accompaniment status of beneficiaries, or functions assumed by visit companions, have a bearing on beneficiaries' satisfaction with physician care. Nearly 40% of the community-dwelling older adults were typically accompanied to routine medical visits by a companion. Accompanied individuals were older, less educated, in worse health, and incurred Medicare expenditures that were twice as high as their unaccompanied counterparts. More than 60% of patient companions actively facilitated visit communication by recording physician instructions (44.1%), providing information regarding patients' medical conditions or needs (41.6%), asking questions (41.1%), or explaining physicians' instructions (29.7%). After controlling for sociodemographic and health differences, individuals who were accompanied were more highly satisfied with their physician's technical skill, information giving, and interpersonal skill compared with individuals who were unaccompanied.
Patient ratings of physician information giving and companion's engagement in visit communication.
In This Issue of Archives of Internal Medicine. Arch Intern Med. 2008;168(13):1364. doi:10.1001/archinte.168.13.1364