The authors review why the gulf between clinical medicine and public health has existed since the first schools of public health were established in 1916. They emphasize that academic health centers (AHCs) have the potential to bring together these two perspectives--as well as the health services perspective--to clarify what they offer and to find creative ways to build upon their combined strengths. The authors describe institutional approaches that can be taken to narrow the gulf, with examples from the initiatives of this type that are under way at The George Washington University Medical Center in Washington, D.C. For example, the authors state and discuss in detail that an AHC's medical, public health, and health services institutions should be physically and institutionally close; that collaboration between them requires well-structured interaction; that institutional structures are needed to ensure cooperation when internal competition is likely; and that collaboration is fostered by new opportunities and the potential for new resources. The authors conclude by stating that the future will require that the health education and prevention perspective of public health, the treatment perspective of medicine, and the financial and management perspective of health services be developed and integrated into the work of AHCs, and give examples of specific activities that would be possible with such integration.
Women and men with alcohol use disorders differ in many respects. A retrospective medical record review of 132 patients was performed to determine outpatient clinic utilization, presentation patterns and physician actions related to patient gender and lifetime DIS-status. Women, irrespective of DIS-status, utilized out-patient health care services more often than did DIS-positive or negative men. Of 16 specific alcohol-related complaints, gender differences were only detected for trauma. DIS-positive men were more likely to have had an alcohol history taken during the preceding 12 months than were DIS-positive women. Sedatives/minor tranquilizers were most often prescribed to DIS-positive women. This study supports the need in primary care settings for more screening to detect and diagnose alcohol-abusing patients, particularly women. Physicians should routinely screen for alcohol abuse before prescribing sedatives or minor tranquilizers.
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