BACKGROUND Improving the cost-effectiveness of health care requires an understanding of the genesis of health care costs and in particular the sources of cost variation. Little is known about how multiple physicians, caring collaboratively for patients, contribute to costs. OBJECTIVE To explore the effect of collaborative care by physicians on variation in discretionary costs in an intensive ...

OBJECTIVE To assess quality of life of adults with Duchenne muscular dystrophy in the Netherlands and to identify domains and major problems influencing quality of life. DESIGN Cross-sectional. SUBJECTS Seventy-nine men aged ≥ 20 years with Duchenne muscular dystrophy. METHODS The Medical Outcome Study Short Form-36 (SF-36), World Health Organization Quality of Life - BREF (WHOQOL-BREF) a...

Resistance increases with the use and abuse of antibiotics. Since physicians are primarily responsible for the decision to use antibiotics, ascertaining the attitudes and knowledge that underlie their prescribing habits is thus a prerequisite for improving prescription. Three-year follow-up cohort study (2008-2010) targeting primary-care physicians (n = 2100) in Galicia, a region in NW Spain. W...

BACKGROUND Continual improvements in diagnostic processes are needed to minimise the proportion of patients with cancer who experience diagnostic delays. Clinical audit is a means of achieving this. AIM To characterise key aspects of the diagnostic process for cancer and to generate baseline measures for future re-audit. DESIGN AND SETTING Clinical audit of cancer diagnosis in general pract...

BACKGROUND Survival from breast cancer remains lower in Estonia than in most other European countries. More advanced stage and larger tumors that have impact on survival may be a result of delay in seeking help for breast cancer symptoms. The aim of this study was to identify determinants of delayed presentation among breast cancer patients in Estonia. METHODS The study population included wo...

CONTEXT Patients' perspectives of posttransplant self-management tasks have not been explored.OBJECTIVE-To explore the concept and the presence of self-management tasks mastered by patients in the early phase after kidney transplant. DESIGN Mixed-method study using semistructured interviews and a structured questionnaire.Setting-Outpatient Division of Nephrology at University Hospital Zurich,...

BACKGROUND The clinical value of teledermatology in the primary care setting remains relatively unknown. OBJECTIVE We sought to determine the impact of teledermatology on outpatient diagnosis, management, and access to dermatologic care in a resource-poor primary care setting. METHODS We performed a prospective study of store-and-forward teledermatology consults submitted between January an...

OBJECTIVE To estimate the proportion of cervical screening non-attenders presenting to general practice (GP) primary care over one year. SETTING 137 practices in East London, UK. METHODS Anonymous primary care records were downloaded using EMIS web (clinical software). Cervical screening nonattendance was defined as no recorded smear in the last 3.5 years (women aged 25-49) or 5.5 years (wo...

BACKGROUND Prohibiting falls and fall-related injuries is a major challenge for health care systems worldwide, as a substantial proportion of falls occur in older adults who are previously known to be either frail or at high risk for falls. Hence, preventive measures are needed to educate and minimize the risk for falls rather than just minimize older adults' fall risk. Health apps have the pot...

OBJECTIVE To examine whether walk-in centres contribute to shorter waiting times for a general practice appointment. DESIGN Ecological study. SETTING 2509 general practices in 56 primary care trusts in England; 32 walk-in centres within 3 km of one of these practices. MAIN OUTCOME MEASURE Waiting time to next available general practitioner appointment (April 2003 to December 2004), from n...