The Ecology of Medical Care Revisited

Green, Larry A.; Fryer, George E.; Yawn, Barbara P.; Lanier, David; Dovey, Susan

doi:10.1056/nejm200106283442611

Cited by 696 publications

(541 citation statements)

References 15 publications

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“…This spectrum of chronicity, severity and healthcare use results in a healthcare system gradient: individuals from general population samples report the fewest symptoms and least severe illness on average, whereas patients from samples of specialty care clinics report the most health problems and individuals from primary care samples report intermediate levels of ill health (Green et al 2001).…”

Section: The Conceptual Basis Of Population-based Carementioning

confidence: 99%

Managing future Gulf War Syndromes: international lessons and new models of care

Engel

Hyams

Scott

2006

Phil. Trans. R. Soc. B

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After the 1991 Gulf War, veterans of the conflict from the United States, United Kingdom, Canada, Australia and other nations described chronic idiopathic symptoms that became popularly known as 'Gulf War Syndrome'. Nearly 15 years later, some 250 million dollars in United States medical research has failed to confirm a novel war-related syndrome and controversy over the existence and causes of idiopathic physical symptoms has persisted. Wartime exposures implicated as possible causes of subsequent symptoms include oil well fire smoke, infectious diseases, vaccines, chemical and biological warfare agents, depleted uranium munitions and post-traumatic stress disorder. Recent historical analyses have identified controversial idiopathic symptom syndromes associated with nearly every modern war, suggesting that war typically sets into motion interrelated physical, emotional and fiscal consequences for veterans and for society. We anticipate future controversial war syndromes and maintain that a population-based approach to care can mitigate their impact. This paper delineates essential features of the model, describes its public health and scientific underpinnings and details how several countries are trying to implement it. With troops returning from combat in Afghanistan, Iraq and elsewhere, the model is already getting put to the test.

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Section: The Conceptual Basis Of Population-based Carementioning

confidence: 99%

Managing future Gulf War Syndromes: international lessons and new models of care

Engel

Hyams

Scott

2006

Phil. Trans. R. Soc. B

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“…Given their relationship with patients and repeated contact with them, PCPs may be instrumental in ensuring that patients with positive FIT/FOBT tests complete follow-up colonoscopy. 14,15 Thus far, however, this relationship has not been explored.…”

Section: Introductionmentioning

confidence: 99%

Association Between Primary Care Visits and Colorectal Cancer Screening Outcomes in the Era of Population Health Outreach

et al. 2016

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BACKGROUND: Population outreach strategies are increasingly used to improve colorectal cancer (CRC) screening. The influence of primary care on cancer screening in this context is unknown. OBJECTIVE: To assess associations between primary care provider (PCP) visits and receipt of CRC screening and colonoscopy after a positive fecal immunochemical (FIT) or fecal occult blood test (FOBT). DESIGN: Population-based cohort study. PARTICIPANTS: A total of 968,072 patients ages 50-74 years who were not up to date with CRC screening in 2011 in four integrated healthcare systems (three with screening outreach programs using FIT kits) in the PopulationBased Research Optimizing Screening through Personalized Regimens (PROSPR) consortium. MEASURES: Demographic, clinical, PCP visit, and CRC screening data were obtained from electronic health records and administrative databases. We examined associations between PCP visits in 2011 and receipt of FIT/ FOBT, screening colonoscopy, or flexible sigmoidoscopy (CRC screening) in 2012 and follow-up colonoscopy within 3 months of a positive FIT/FOBT in 2012. We used multivariable logistic regression and propensity score models to adjust for confounding. RESULTS: Fifty-eight percent of eligible patients completed a CRC screening test in 2012, most by FIT. Those with a greater number of PCP visits had higher rates of CRC screening at all sites. Patients with ≥1 PCP visit had nearly twice the adjusted-odds of CRC screening (OR = 1.88, 95 % CI: 1.86-1.89). Overall, 79.6 % of patients with a positive FIT/FOBT completed colonoscopy within 3 months. Patients with ≥1 PCP visit had 30 % higher adjusted odds of completing colonoscopy after positive FIT/FOBT (OR = 1.30; 95 % CI: 1.22-1.40). CONCLUSIONS:Patients with a greater number of PCP visits had higher rates of both incident CRC screening and colonoscopy after positive FIT/FOBT, even in health systems with active population health outreach programs. In this era of virtual care and population outreach, primary care visits remain an important mechanism for engaging patients in cancer screening.KEY WORDS: primary care; colorectal cancer screening; population health outreach.

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“…Im deutschen Gesundheitssystem stehen Allgemeinärzte als erste ärztli-che Ansprechpartner zur Verfügung. Sie können mehrheitlich die Beratungsanlässe, weswegen Patienten in die Praxis kommen, ohne andere Ärzte hinzuziehen zu müssen, erfolgreich lösen [13,14,32]. Weitere Kennzeichen der hausärzt-lichen Tätigkeit sind die Kontinuität der Versorgung und die damit einhergehende Langzeitversorgung [12].…”

Section: Hinführung Zum Themaunclassified