***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background : We conducted a prospect i ve trial r and omizing 75 physicians to either a control or intervention arm to evaluate the impact of providing patient-reported information on anxiety and other mental health symptoms and disorders to primary care physicians . Methods : Five hundred seventy-three patients of the study physicians who met entry criteria were r and omized to either usual care or usual care supplemented with feedback of patient-reported mental health information to physicians . This mental health information was derived from initial patient-reported question naires completed in waiting rooms of physicians contracted to a mixed-model health maintenance organization in Colorado . Main outcome measures included impact of intervention on rates of ( 1 ) chart notation of anxiety , depression , or other mental health diagnoses or symptoms ; ( 2 ) referral to mental health specialists ; ( 3 ) prescription of psychotropic medications ; ( 4 ) hospitalization ; and ( 5 ) office visits during a 5-month observation period . Results : Physicians receiving feedback on previously unrecognized and untreated anxiety patients were more likely to make chart notations ( adjusted odds ratio [ AOR ] = 2.51 , 95 percent confidence interval [ CI ] = 1.62 - 3.87 ) , to make referrals to mental health specialists ( AOR = 3.86 , 95 percent CI = 1.63 - 9.16 ) , and to see patients for more frequent outpatient visits ( AOR = 1.73 , 95 percent CI = 1.11 - 2.70 ) . Use of psychotropic medications and rate of hospitalizations did not differ significantly . Conclusions : Providing patient-reported mental health information to primary care physicians result ed in increased recognition and referral rates for previously unrecognized and untreated anxiety patients , plus an increase in primary care visits , without concomitant increases in the use of psychotropic medications or rate of hospitalizations Background Only approximately half of patients with hypertension have their blood pressure controlled , due in large part to the tendency of primary care providers ( PCPs ) not to intensify treatment when blood pressure values are elevated . Objective This study tested the effect of an intervention design ed to help patients ask questions at the point of care to encourage PCPs to appropriately intensify blood pressure treatment . Methods PCPs and their patients with hypertension ( N=500 ) were recruited by letter and r and omized into 2 study groups : ( 1 ) intervention condition in which patients used a fully automated website each month to receive tailored messages suggesting questions to ask their PCP to improve blood pressure control  , and ( 2 ) control condition in which a similar tool suggested questions to ask about preventive services ( eg , cancer screening ) . The Web-based tool was design ed to be used during each of the 12 study months and before scheduled visits with PCPs . The primary outcome was the percentage of patients in both conditions with controlled blood pressure . Results Of 500 enrolled patients ( intervention condition : n=282 ; control condition : n=218 ) , 418 ( 83.6 % ) completed the 12-month follow-up visit . At baseline , 289 ( 61.5 % ) of participants had controlled blood pressure . Most ( 411/500 , 82.2 % ) participants used the intervention during at least 6 of 12 months and 222 ( 62.5 % ) reported asking questions directly from the Web-based tool . There were no group differences in asking about medication intensification and there were no differences in blood pressure control after 12 months between the intervention condition ( 201/282 , 71.3 % ) and control condition ( 143/218 , 65.6 % ; P=.27 ) groups . More intervention condition participants discussed having a creatinine test ( 92 , 52.6 % vs 49 , 35.5 % ; P=.02 ) and urine protein test ( 81 , 44.8 % vs 21 , 14.6 % ; P<.001 ) , but no group differences were observed in the rate of testing . The control condition participants reported more frequent discussion s about tetanus and pneumonia vaccines and reported more tetanus ( 30 , 13.8 % vs 15 , 5.3 % ; P=.02 ) and pneumonia ( 25 , 11.5 % vs 16 , 5.7 % ; P=.02 ) vaccinations after 12 months . Conclusions The use of an interactive website design ed to overcome clinical inertia for hypertension care did not lead to improvements in blood pressure control . Participant adherence to the intervention was high . The control intervention led to positive changes in the use of preventive services ( eg , tetanus immunization ) and the intervention condition led to more discussion s of hypertension-relevant tests ( eg , serum creatinine and urine protein ) . By providing patients with individually tailored questions to ask during PCP visits , this study demonstrated that participants were likely to discuss the questions with PCPs . These discussion s did not , however , lead to improvements in blood pressure control . Trial Registration Clinical Trials.gov NCT00377208 ; http:// clinical trials.gov/ct2/show/NCT00377208 ( Archived by WebCite at http://www.webcitation.org/6IqWiPLon ) The aim of the review was to assess the effect of patient education in ischaemic heart disease . Thirteen r and omised controlled trials of moderate to good quality including 68,556 patients were selected . The effect on mortality , cardiac morbidity , hospitalisation and health-related quality of life was assessed and only non-significant tendencies of effect were found . The authors of the review nevertheless conclude that the review supports current rehabilitation programmes that include patient education . Further research in patient education , especially concerning the most effective methods of education delivery , is needed BACKGROUND To compare three approaches for improving compliance with breast cancer screening in older women . METHODS R and omized controlled trial using three parallel group practice s at a public hospital . Subjects included women aged 65 years and older ( n = 803 ) who were seen by residents ( n = 66 ) attending the ambulatory clinic from October 1 , 1989 , through March 31 , 1990 . All provider groups received intensive education in breast cancer screening . The control group received no further intervention . Staff in the second group offered education to patients at their visit . In addition , flowsheets were used in the " Prevention Team " group and staff had their tasks redefined to facilitate compliance . RESULTS Medical records were review ed to determine documented offering/receipt of  clinical breast examination and mammography .  A subgroup of women without previous clinical breast examination ( n = 540 ) and without previous mammography ( n = 471 ) were analyzed to determine the effect of the intervention . During the intervention period , women without a previous clinical breast examination were offered an examination significantly more often in the Prevention Team group than in the control group , adjusting for age , race , and comorbidity and for physicians ' gender and training level . The patients in the Prevention Team group were offered  clinical breast examination  ( 31.5 % ) more frequently than those in the patient education or control groups , but this was not significant after adjusting for the above covariates . Likewise ,  mammography  was offered more frequently to patients in the Prevention Team and in the patient education group than to patients in the control group , after adjusting for the factors above using logistic regression . CONCLUSIONS The results provide support for patient education and organizational changes that involve nonphysician personnel to enhance breast cancer screening among older women , particularly those without previous screening CONTEXT For patients with cancer-related pain and their physicians , routine oncology visits are an opportunity to adjust the analgesic regimen and secure better pain control . However , treatment intensification occurs haphazardly in practice . OBJECTIVES To estimate the effect of patient-centered tailored education and coaching ( TEC ) on the likelihood of analgesic treatment adjustment during oncology visits , and in turn , the influence of treatment adjustment on subsequent cancer pain control , we studied patients enrolled in a r and omized trial of TEC . METHODS Just before a scheduled oncology visit , 258 patients with at least moderate baseline pain received TEC or control ;  just after the same visit , they reported on whether the physician recommended a new pain medicine or a change in dose of an existing medicine .  Pain severity and pain-related impairment were measured two , six , and 12 weeks later . RESULTS Patients assigned to TEC were more likely than controls to report a change in the analgesic treatment regimen ( 60 % vs. 36 % , P<0.01 ) ; significant effects persisted after adjustment for baseline pain , study site , and physician ( adjusted odds ratio 2.61 , 95 % confidence interval 1.55 , 4.40 , P<0.01 ) . In a mixed-effects repeated measures regression , analgesic change ( but not TEC itself ) was associated with a sustained decrease in pain severity ( P<0.05 ) . CONCLUSION TEC increases the likelihood of self-reported , physician-directed adjustments in analgesic prescribing , and treatment intensification is associated with better cancer pain outcomes Introduction This study evaluated the impact of a waiting room-administered , low-literacy , computer multimedia diabetes education program on patient self-management and provider intensification of therapy . Methods In this r and omized , controlled trial , 129 participants either viewed a computer multimedia education program ( intervention group ) or read an educational brochure ( control group ) while in the waiting room . Participants were uninsured , primarily ethnic minority adults with type 2 diabetes receiving care from a county clinic in Chicago , Illinois . Wilcoxon test , t-test , and linear mixed model analyses evaluated changes in diabetes knowledge , self-efficacy , behaviors , medications prescribed , hemoglobin A1c ( HbA1c ) , and blood pressure levels over 3 months . Results During the study period , there was an increase in the number of oral diabetes medications prescribed over three months to multimedia users compared with those in the control group ( P=0.017 ) . HbA1c declined by 1.5 in the multimedia group versus 0.8 in the control group ( P=0.06 ) . There were no differences between groups in changes in blood pressure levels , self-efficacy , and most diabetes-related behaviors . Self-reported exercise increased in the control group compared with the multimedia group ( 0.9 days/week vs. 0.1 days/week , P=0.016 ) . Conclusion Multimedia users received a greater intensification of diabetes therapy , but demonstrated no difference in self-management in comparison with those receiving educational brochures . The availability of a computer multimedia program in the waiting room appears to be a novel and acceptable approach in providing diabetes education for underserved population BACKGROUND Hypertension is generally poorly controlled in primary care . One possible intervention for improving control is the harnessing of patient expertise through education and encouragement to challenge their care . AIM To determine whether encouraging patients to manage their hypertension in an ' expert ' manner , by providing them with information in a clear clinical guideline , coupled with an explicit exhortation to become involved in and to challenge their own care if appropriate , would improve their care . DESIGN OF STUDY Single blind r and omised controlled trial of detailed guideline versus st and ard information . SETTING Single urban general practice over 1 year . METHOD Patient-held guideline with written explicit exhortation to challenge care when appropriate . Two hundred and ninety-four of 536 eligible patients on the practice hypertension register were recruited , all of whom were r and omised into one of two groups . Two hundred and thirty-six patients completed the study . RESULTS PRIMARY OUTCOME average systolic blood pressure . SECONDARY OUTCOMES proportion of patients with blood pressure < 150 mmHg systolic and < 90 mmHg diastolic , average cholesterol , proportion of patients prescribed statins and aspirin according to guideline , hospital anxiety and depression score . No clinical ly , or statistically significant differences were found between intervention and control with respect to all parameters or in anxiety and depression levels . Statin and aspirin use improved throughout the course of the study in both groups . Statin use showed a trend ( P = 0.02 ) in favour of control . CONCLUSION In this study there was no clinical ly significant perceived benefit to patients as a result of providing them with a hypertension guideline . Patient guidelines are currently planned for many chronic illnesses . It is important to determine the utility of such interventions before scarce re sources are applied to them Background : Too few patients with nonvalvular atrial fibrillation ( NVAF ) receive appropriate antithrombotic therapy . We tested the short-term ( primary outcome ) and long-term ( secondary outcome ) effect of a patient decision aid on the appropriateness of antithrombotic therapy among patients with NVAF . Methods : We conducted a cluster r and omized trial with blinded outcome assessment involving 434 NVAF patients from 102 community-based primary care practice s. Patients in the intervention group received a self-administered booklet and audiotape decision aid tailored to their personal stroke risk profile . Patients in the control group received usual care . The primary outcome measure was change in antithrombotic therapy at 3 months . Appropriateness of therapy was defined using the American College of Chest Physicians ( ACCP ) recommendations . Results : The mean patient age was 72 years , and the median duration of NVAF was 5 years . In the control group , there was a 3 % decrease over 3 months in the number of patients receiving therapy appropriate to their risk of stroke ( 40 % [ 85/215 ] at baseline v. 37 % [ 79/215 ] at 3 months ) . In the intervention group , the number of patients receiving therapy appropriate to their stroke risk increased by 9 % ( 32 % [ 69/219 ] at baseline v. 41 % [ 89/219 ] at 3 months ) . Although the proportion of patients whose therapy met the ACCP treatment recommendations did not differ between study arms at baseline ( p = 0.11 ) or 3 months ( 
    Output:
    
We found that patient-reported health information interventions and patient education interventions probably improve healthcare professionals ' adherence to recommended clinical practice ( moderate certainty evidence ) .
We also found that patient information interventions may improve healthcare professionals ' adherence to recommended clinical practice ( low certainty evidence ) .
Patient decision aids may make little or no difference to the number of healthcare professionals ' adhering to recommended clinical practice ( low-certainty evidence ) .
Our findings strengthen the belief that patient-mediated interventions have the potential to improve professional practice , especially patient-reported health information interventions and patient education interventions .
PRACTICE IMPLICATION S Our findings show that patient-reported health information interventions and patient education interventions are relevant approaches to improve professional practice .
Thus , it seems reasonable to conclude that these types of patient-mediated interventions can contribute to improving the quality of healthcare services