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Racial & Ethnic Disparities in CAD

Previous research has shown that there appears to be disparate care among different racial and ethnic populations, especially in the treatment of coronary artery disease (CAD). Clinical studies also suggest that there are differences in the use of evidence-based medicine among these different racial and ethnic groups. According to published data, minorities with acute coronary syndromes are more likely to receive sub-standard care. It has been shown throughout the medical literature that racial and ethnic minorities often receive evidence-based treatments less frequently than Caucasians. Other studies show that minorities are often treated at facilities that are not as adept at adhering to composite performance measures. The Get With the Guidelines-CAD (GWTG-CAD) quality improvement program, provided by the American Heart Association and American Stroke Association, is designed to enhance hospital adherence to guidelines when managing CAD patients. The program employs a set of performance, quality, and reporting measures to track the quality of care at an institution, and it has been proven to improve adherence to evidence-based care of patients hospitalized with CAD. A part of the GWTG-CAD program is directed toward improving ethnic and racial disparities among CAD patients to the point where care is defect-free. The concept of defect-free care is a critical component in the GWTG-CAD program. At its core, defect-free care is intended to ensure that every patient receives all of the interventions for which they’re eligible. These interventions are also known as performance measures because their use in CAD patients is supported by well-grounded scientific evidence. Therefore, performance measures are well-suited for public reporting to compare hospitals and pay-for-performance initiatives. Quality Improvement Programs Work In...

A Guideline Update for Major Depressive Disorder

The impact of major depressive disorder (MDD) on patients and their families is substantial. MDD adversely affects the patient as well as others, with the most serious complication of a major depressive episode being suicide. The disorder has also been associated with significant medical comorbidity. It can complicate recovery from other medical illnesses. Furthermore, MDD affects patients’ marital, parental, social, and vocational functioning. The disorder is unremitting in about 15% of patients and recurrent in another 35%. Compounding the problem is that treatment is often delayed. These factors highlight the need for changes in the delivery of mental health services to enhance timeliness and quality of care in MDD. With treatment, however, the prognosis associated with MDD is generally good. Most patients will respond to acute treatment, and continuation and maintenance therapy with acutely active treatments has been shown to lower the risk and severity of relapses into depression. Revisiting Previous Guidelines In 2010, the American Psychiatric Association (APA) released a new clinical practice guideline for the treatment of patients with MDD. This document (available online at www.psych.org/guidelines/mdd2010), the third since guidelines were originally created by the APA for MDD, revises a previous version that was published about a decade ago. “It includes new evidence-based recommendations on the use of antidepressant medications, depression-focused psychotherapies, and somatic treatments, such as electroconvulsive therapy,” says Alan J. Gelenberg, MD, who chaired the workgroup that developed the recommendations. “The guideline also addresses other topics, such as alternative and complementary treatments, treating depression during pregnancy, and strategies for treatment-resistant depression.” It took approximately 5 years to update the APA guidelines, Dr. Gelenberg says. “The update...
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