The targeted literature search included evidence related to the effectiveness of 5 U.S. Food and Drug Administration-approved pharmacologic therapies for dementia for outcomes in the domains of cognition, global function, behavior/mood, and quality of life/activities of daily living. RECOMMENDATION 1: Clinicians should base the decision to initiate a trial of therapy with a cholinesterase inhibitor or memantine on individualized assessment. (Grade: weak recommendation, moderate-quality evidence.) RECOMMENDATION 2: Clinicians should base the choice of pharmacologic agents on tolerability, adverse effect profile, ease of use, and cost of medication. The evidence is insufficient to compare the effectiveness of different pharmacologic agents for the treatment of dementia. (Grade: weak recommendation, low-quality evidence.) RECOMMENDATION 3: There is an urgent need for further research on the clinical effectiveness of pharmacologic management of dementia.
The primary goal of medical education is to produce physicians who deliver high-quality health care. Recent calls for greater accountability in medical education and the development of outcomes research methodologies should encourage a new research effort to examine the effects of medical training upon clinical outcomes. The authors offer a research agenda that links medical education and quality of health care and give specific examples of potential research projects that would begin to examine that relationship. A proposed model of patient outcomes research in medical education recognizes the contributory effects of health care system-level factors as well as the continuum of medical education, process measures, and individual training and preparedness to deliver high-quality care. There exists an opportunity to create a research agenda in medical education outcomes research that is multidisciplinary, broad based, and focused on patient-centered outcomes.
PURPOSE Few studies have attempted to link patients' beliefs about racism in the health care system with how they use and experience health care.METHODS Using telephone survey data from a national sample of 1,479 whites, 1,189 African Americans, and 983 Latinos, we explored patients' beliefs about racism, their preferences for the race and ethnicity of their physician, and their satisfaction with that physician. A scale was developed to refl ect patients' beliefs about racism. Race-stratifi ed analyses assessed associations between patients' beliefs, racial preferences for physicians, choice of physician, and satisfaction with care.RESULTS Among African Americans, stronger beliefs about racial discrimination in health care were associated with preferring an African American physician (P <.001). Whereas only 22% of African Americans preferred an African American physician, those who preferred a African American physician and had an African American physician were more likely to rate their physician as excellent than did African Americans who preferred a African American physician but had a non-African American physician (57% vs 20%, P <.001). Latinos with stronger beliefs about discrimination in health care were more likely to prefer a Latino physician (P <.001). One third of Latinos preferred a Latino physician. Though not statistically signifi cant, those who preferred and had a Latino physician rated their physician higher than Latinos who preferred a Latino physician but had a non-Latino physician (40% vs 29%).CONCLUSIONS Many African Americans and Latinos perceive racism in the health care system, and those who do are more likely to prefer a physician of their own race or ethnicity. African Americans who have preferences are more often satisfi ed with their care when their own physicians match their preferences. INTRODUCTIONR acial and ethnic disparities are a major problem in the US health care system. 1 Racial differences have been documented in access to care, receipt of needed medical care, preventive services, and lifesaving technologies. [2][3][4][5][6][7] There is, however, considerable uncertainty around the factors that contribute to racial disparities in health care.8 Although disparities can be explained in part by differences in access to care, socioeconomic conditions, or even bias from health care physicians, the role of patients' beliefs and preferences remains unclear. 9,10 What is the connection between patients' racial beliefs and biases and their preferences for the race of their health caregivers? Shared language, social experiences, and cultural beliefs may drive some preferences. 4,11,12 At the same time, the dubious experience of American medical research in minorities has fostered racial suspicions among some groups. 13 14-16 Although some have documented patients' preferences for clinicians of the same race and a subsequent association with patient satisfaction, the factors that contribute to patients' preferences remain unclear. [15][16][17][18][19][20][21][22] Using a nat...
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