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Shared decision-making key in treating advanced heart failure

Patients with advanced heart failure often prefer to receive treatment from the doctors who know them best — their primary care physicians, said the lead author of a scientific statement on managing the chronic condition. But too often, doctors delay critical conversations about a patient’s preferences and expectations until emergency situations, when the individual’s decision-making might be impaired, said Larry A. Allen, MD, MHS, lead author of the American Heart Assn. statement, which was published online March 5 in Circulation. Part of the problem is that physicians often have insufficient time during office visits to thoroughly discuss with patients the unpredictable nature of the disease and the benefits and downfalls of the complex treatments available, Dr. Allen said. Doctors often have limited training in shared decision-making, which is required for appropriate care of patients with advanced heart failure, he added. The American Heart Assn. statement urges phys ...

Hospitals find success in slashing health disparities

A coalition of health care organizations is highlighting how collecting patients' demographic data, expanding cultural competency training and diversifying health leadership can help reduce care disparities. For example, New York-Presbyterian Hospital started an initiative to improve care for patients in the largely Hispanic neighborhoods of Washington Heights and Inwood in New York City. The effort included a four-hour training program for health professionals to help address patients' cultural, language and literacy needs. "The cultural competency training provides background information in terms of the various ethnicities and religions and groups that we see predominantly," said J. Emilio Carrillo, MD, MPH, vice president for community health at New York-Presbyterian. "However, we are making it very clear that we ascribe to a patient-centered, cross-cultural approach." Whatever ethnic or racial background a patient is from, "people are trained to respond to them as an indiv ...

Guidelines focus on newly diagnosed HIV patients

Worried that too few people with HIV receive the care they need, infectious diseases experts have issued guidelines calling on physicians to ensure that newly diagnosed patients start treatment and adhere to life-long drug regimens. The recommendations were developed by a panel of 31 HIV experts on behalf of the International Assn. of Physicians in AIDS Care. They were published online March 5 in Annals of Internal Medicine. The guidelines urge health professionals to monitor the entry of patients they diagnose with HIV into treatment programs. After the initial visit for such programs, nurses or other staff members periodically should call patients to ensure that they are properly taking their medications. Adherence also can be monitored through systems that alert physicians when a patient does not pick up his or her prescriptions, said Larry W. Chang, MD, MPH, co-author of the guidelines and an assistant professor of Medicine at Johns Hopkins University School of Medicine in ...