Biomedical subjects

Elizabeth C Clark

Publications and source records attributed to Elizabeth C Clark.

4 recordsLinked to original sources

PubMed2005

Hepatitis C identification and management by family physicians.

BACKGROUND AND OBJECTIVES: Many people with hepatitis C receive all or most of their care from primary care physicians, yet little information exists about the practice patterns, knowledge, and beliefs and attitudes of family physicians related to hepatitis C. METHODS: We mailed a written survey to a random sample of active members of the American Academy of Family Physicians. RESULTS: Nearly all respondents (94%) reported at least one patient with hepatitis C in their practice, and 66% had diagnosed at least one new case of hepatitis C in the past year. While most respondents (85%) correctly identified common hepatitis C risk factors, only 63% reported routinely asking patients about those risk factors. Respondents (74%) preferred to involve specialists in the care of hepatitis C patients, but half (50%) reported barriers to referral. A small number (5%) of respondents have prescribed antiviral medication within the past year. Most respondents think family physicians should screen (94%), diagnose (98%), and provide general care (69%) for hepatitis C patients. CONCLUSIONS: Family physicians know how to identify high-risk people and test for hepatitis C. Most prefer to refer patients with hepatitis C to specialists for workup and treatment but report frequent barriers to those referrals.

Adult↗

PubMed2004

Screening for hepatitis C virus infection: a review of the evidence for the U.S. Preventive Services Task Force.

BACKGROUND: Hepatitis C virus (HCV) is the most common bloodborne pathogen in the United States and is an important cause of patient morbidity and mortality, but it is unclear whether screening to identify asymptomatic infected persons is appropriate. PURPOSE: To synthesize the evidence on risks and benefits of screening for HCV infection. DATA SOURCES: MEDLINE (through February 2003), Cochrane Clinical Trials Registry (2002, Issue 2), reference lists, and experts. STUDY SELECTION: Controlled studies of screening and antiviral therapy and observational studies on other interventions, risk factors, accuracy of antibody testing, work-up, harms of biopsy, and long-term outcomes. DATA EXTRACTION: Using preset criteria, the authors assessed the quality of included studies and abstracted information about settings, patients, interventions, and outcomes. DATA SYNTHESIS: There are no published trials of screening for HCV infection. Approximately 2% of U.S. adults have HCV antibodies, with the majority having chronic infection. Risk factor assessment could identify adults at substantially higher risk. Antiviral treatment can result in a sustained virologic response rate of 54% to 56%, but no trials have been done specifically in asymptomatic patients likely to be identified by screening. Data are insufficient to determine whether treatment improves long-term outcomes. There are no data to estimate the benefit from counseling or immunizations. Although risks of biopsy and treatment appear minimal or self-limited, data on other adverse effects of screening, such as labeling or anxiety, are sparse. CONCLUSIONS: Antiviral treatment can successfully eradicate HCV, but data on long-term outcomes in populations likely to be identified by screening are lacking. Although the yield from targeted screening, particularly in intravenous drug users, would be substantially higher than in the general population, data are inadequate to accurately weigh the overall benefits and risks of screening in otherwise healthy asymptomatic adults.

Adult↗

PubMedDate not supplied

Abnormal uterine bleeding: a management algorithm.

Abnormal uterine bleeding is a common problem, and its management can be complex. Because of this complexity, concise guidelines have been difficult to develop. We constructed a concise but comprehensive algorithm for the management of abnormal uterine bleeding between menarche and menopause that was based on a systematic review of the literature as well as the actual management of patients seen in a gynecology clinic. We started by drafting an algorithm that was based on a MEDLINE search for relevant reviews and original research. We compared this algorithm to the actual care provided to a random sample of 100 women with abnormal bleeding who were seen in a university gynecology clinic. Discrepancies between the algorithm and actual care were discussed during audiotaped meetings among the 4 investigators (2 family physicians and 2 gynecologists). The audiotapes were used to revise the algorithm. After 3 iterations of this process (total of 300 patients), we agreed on a final algorithm that generally followed the practices we observed, while maintaining consistency with the evidence. In clinic, the gynecologists categorized the patient's bleeding pattern into 1 of 4 types: irregular bleeding, heavy but regular bleeding (menorrhagia), severe acute bleeding, and abnormal bleeding associated with a contraceptive method. Subsequent management involved both diagnostic and treatment interventions, which often occurred simultaneously. The algorithm in this article is designed to help primary care physicians manage abnormal uterine bleeding using strategies that are consistent with the evidence as well as the actual practice of gynecologists.

Algorithms↗

PubMedDate not supplied

Factors influencing cessation of pregnancy care in Oregon.

BACKGROUND AND OBJECTIVES: Anecdotal evidence suggests that many providers who previously delivered babies are no longer doing so, both in Oregon and nationally. This study determined the proportion of pregnancy care providers who have stopped or are planning to stop providing this care in Oregon and identified the important factors influencing such practice changes. METHODS: We mailed a survey in October and November 2002 to all obstetrician-gynecologists, family physicians, general practitioners, and certified nurse midwives practicing in Oregon. The survey inquired about whether they currently perform deliveries. If they did not do so, or if they did so but planned to stop, further questions were asked about reasons for not providing this care. RESULTS: A total of 2,158 surveys were mailed; 1,232 were returned (58% adjusted response rate), and 1,069 had sufficient information to be included in our analysis. Of respondents, 511 (47.8%) currently perform deliveries. Of these, 157 (30.7%) indicated that they planned to stop doing so in 1 to 5 years, with cost of professional liability insurance (59%) and fear of lawsuits (43%) most frequently cited as major reasons. A total of 367 (34%) respondents had previously stopped performing deliveries. Providers who stopped providing this care since 1999 were significantly more likely to cite cost of medical liability insurance and low reimbursement as major reasons, compared to providers who stopped earlier. CONCLUSIONS: Our study suggests that as many as half of clinicians who previously performed or currently perform deliveries in Oregon are planning to stop or have already stopped providing this service, raising concern about access to pregnancy care services for women in the state.

Cross-Sectional Studies↗