PubMed Health⌕ Search

Biomedical subjects

Steven A Schroeder

Publications and source records attributed to Steven A Schroeder.

17 recordsLinked to original sources
PubMed2005

What to do with a patient who smokes.

Despite the reality that smoking remains the most important preventable cause of death and disability, most clinicians underperform in helping smokers quit. Of the 46 million current smokers in the United States, 70% say they would like to quit, but only a small fraction are able to do so on their own because nicotine is so highly addictive. One third to one half of all smokers die prematurely. Reasons clinicians avoid helping smokers quit include time constraints, lack of expertise, lack of financial incentives, respect for a smoker's privacy, fear that a negative message might lose customers, pessimism because most smokers are unable to quit, stigma, and clinicians being smokers. The gold standard for cessation treatment is the 5 As (ask, advise, assess, assist, and arrange). Yet, only a minority of physicians know about these, and fewer put them to use. Acceptable shortcuts are asking, advising, and referring to a telephone "quit line" or an internal referral system. Successful treatment combines counseling with pharmacotherapy (nicotine replacement therapy with or without psychotropic medication such as bupropion). Nicotine replacement therapy comes in long-acting (patch) or short-acting (gum, lozenge, nasal spray, or inhaler) forms. Ways to counter clinicians' pessimism about cessation include the knowledge that most smokers require multiple quit attempts before they succeed, that rigorous studies show long-term quit rates of 14% to 20%, with 1 report as high as 35%, that cessation rates for users of telephone quit lines and integrated health care systems are comparable with those of individual clinicians, and that no other clinical intervention can offer such a large potential benefit.

Antidepressive Agents↗
PubMed2003

Primary care in a new era: disillusion and dissolution?.

The current dilemmas in primary care stem from 1) the unintended consequences of forces thought to promote primary care and 2) the "disruptive technologies of care" that attack the very function and concept of primary care itself. This paper suggests that these forces, in combination with "tiering" in the health insurance market, could lead to the dissolution of primary care as a single concept, to be replaced by alignment of clinicians by economic niche. Evidence already exists in the marketplace for both tiering of health insurance benefits and corresponding practice changes within primary care. In the future, primary care for the top tier will cater to the affluent as "full-service brokers" and will be delivered by a wide variety of clinicians. The middle tier will continue to grapple with tensions created by patient demand and bureaucratic systems but will remain most closely aligned to primary care as a concept. The lower tier will become increasingly concerned with community health and social justice. Each primary care specialty will adapt in a unique way to a tiered world, with general internal medicine facing the most challenges. Given this forecast for the future, those concerned about primary care should focus less on workforce issues and more on macro health care financing and organization issues (such as Medicare reform); appropriate training models; and the development of a conception of primary care that emphasizes values and ethos, not just function.

Forecasting↗
PubMed2002

Primary care at a crossroads.

The author explains why primary care is especially beleaguered today (e.g., growth in specialization and widening income gaps between specialists and generalists, growth of managed care, cutbacks in Medicare and Medicaid payments to academic medical centers, and pro-technology biases in fee-for-service payment). Medical students sense primary care's troubles; primary care residency matches continue to decline. Attempts to encourage generalist practice cannot compete with such forces as pro-specialist reimbursement policies, the way research is funded, the dominance of specialist role models, and the daunting knowledge demands of the generalist mandate. Can generalists find a niche in the current health care marketplace? How will the under-65 population influence the future of primary care practice? (The author predicts a scenario based on patients' degrees of affluence.) Will consumers be willing to pay for the services that primary care is uniquely well positioned to offer? The author explains why increasingly important issues of cost, quality, and convenience could help create a niche for primary care. He also maintains that academic medicine must rededicate itself to producing well-trained generalists, despite all the pressures not to, and discusses the challenges that family practice, internal medicine, and pediatrics must face if they are to flourish. He concludes that if generalism fails the market test, something very precious will be lost-and that generalist physicians would be so badly missed that they might have to be reinvented.

Humans↗
PubMedDate not supplied

Intensity, not prices.

Explore the source record for details and available documents.

Developed Countries↗
PubMedDate not supplied

An agenda to combat substance abuse.

Despite their huge health toll, substance abuse disorders remain underappreciated and underfunded. Reasons include stigma, tolerance of personal choices, acceptance of youthful experimentation, pessimism about treatment efficacy, fragmented and weak leadership, powerful tobacco and alcohol industries, underinvestment in research, and difficult patients. Positive signs include declining prevalence rates, successful counter-marketing campaigns, changing public attitudes, new scientific discoveries that could yield new treatments, and effective new organizations. Further progress will require better treatment, more research, better education of health professionals, more nongovernmental support, and stronger leadership. Policy changes regarding each of the three substance groups are indicated, as are reforms in the criminal justice and educational systems.

Alcoholism↗