Band 94, Heft 10

Human immunodeficiency virus (HIV) testing and pretest/posttest counseling are central components in prevention efforts in the United States. Yet, not all persons return for their test results and posttest counseling. Based on an exploratory study at four community health centers in South Florida, the authors determined the percentage of patients who returned to these clinics. They also examined those sociodemographic and HIV antibody test-related factors that predicted patient return. Less than 50% of those patients tested returned. Younger, urban, minority group patients whose HIV serostatus was likely to be negative were the least likely to return for test results. The authors describe a direction of future research to address these disturbing findings.

Although hypertension was defined more than 100 years ago, it remains the leading cause of office visits and use of prescription drugs. Because hypertension is one of the major risk factors for premature death and disability, the medical community continues to strive toward more aggressive detection, follow-up, and treatment. The Fifth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure provides an excellent guide for all health practitioners. This publication, along with several recent articles, have provided a comprehensive approach to the hypertensive patient. Although cerebrovascular events have been dramatically reduced by the treatment of hypertension, results regarding cardiac morbidity and mortality have been disappointing. Therefore, from a cardiologist's standpoint, the concept of cardioprotection has evolved into an important component in the treatment of the hypertensive patient.

Policymakers agree that cost-containment in healthcare delivery cannot be attained unless the incentives for providers, patients, and payers can be changed. The authors review the existing incentives that have led to escalating costs and conflicting interests for providers, patients, employers, third-party payers and taxpayers. They examine the current incentives for each group and explore the changing incentives that the new integrated healthcare systems and managed care present. They conclude that the new systems are not a simplistic solution to the ''healthcare crisis" in cost, access, and quality, but they emphasize that these new systems have already introduced new incentives for provider collaboration and cooperation. The traditional ties of the osteopathic medical profession allow a quick response to creating new integrated systems, but require collaboration to add tertiary care to the profession's strong primary care and community hospital base.