Biomedical subjects

Kurt Kroenke

Publications and source records attributed to Kurt Kroenke.

75 records · Page 5Linked to original sources

PubMedDate not supplied

Gender and symptoms in primary care practices.

The authors sought to explore gender differences among patients with physical symptoms who came to see internists. The women were younger, more likely to report stress, endorsed more "other, currently bothersome" symptoms, were more likely to have a mental disorder, and were less likely to be satisfied with their care. The men were slower to improve, but there was no difference between the sexes after 3 months. There were no differences in the number, type, duration, or severity of symptoms or in the expectation of care, costs of visits, intervention received, use of health care services, or likelihood of being considered difficult by their physician. The gender of the clinician had no effect on any outcome.

Adult↗

PubMedDate not supplied

Somatic symptoms in primary care: etiology and outcome.

Although somatic complaints are the predominant reason for seeking general medical care, their etiology and prognosis remain poorly understood. In a random sample of the records of all patients visiting an urban primary care clinic during four 1-month periods, 289 patients had one or more somatic symptoms, a total of 433 symptoms. Using explicit criteria, physician raters classified nearly half (48%) of the symptoms as either psychiatric or idiopathic in etiology. Reviewing follow-up notes for 12 months after the index visit, raters found that at least one-fourth of the symptoms persisted. Independent predictors of symptom persistence were prior visits for the same symptom, symptom type (i.e., headache or back pain), male gender, and greater medical comorbidity (i.e., seven or more medical diagnoses). Developing better management strategies for prevalent, medically unexplained, persistent somatic symptoms is a health care priority.

Adult↗

PubMedDate not supplied

Going to scale: re-engineering systems for primary care treatment of depression.

BACKGROUND: Recent trials have shown improved depression outcomes with chronic care models. We report the methods of a project that assesses the sustainability and transportability of a chronic care model for depression and change strategy. METHODS: In a randomized controlled trial (RCT), a clinical model for depression was implemented through a strategy supporting practice change. The clinical model is evidence based. The change strategy relies on established quality improvement programs and is informed by diffusion of innovations theory. Evaluation will address patient outcomes, as well as process of care and process of change. RESULTS: Five medical groups and health plans are participating in the trial. The RCT involves 180 clinicians in 60 practices. All practices assigned to the clinical model have implemented it. Participating organizations have the potential to disseminate this clinical model of care to 700 practices and 1,700 clinicians. CONCLUSIONS: It is feasible to implement the clinical model and change strategy in diverse practices. Follow-up evaluation will determine the impact, sustainability, and potential for dissemination. Materials are available through http://www. depression-primarycare.org; more in-depth descriptions of the clinical model and change strategy are available in the online-only appendixes to this article.

Cooperative Behavior↗