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Biomedical subjects

A G Mainous

Publications and source records attributed to A G Mainous.

At least 55 records · Page 3Linked to original sources
PubMed1999

Commitment to a regular physician: how long will patients wait to see their own physician for acute illness?

BACKGROUND: Continuity of care with a physician is associated with better health outcomes and greater patient satisfaction. Having a "regular doctor" could lead to greater continuity of care, but only if the patient consistently seeks care from this physician. How long will a patient wait for care if their usual physician is not available? Our study explored factors related to a patient's decision to seek care from another professional. METHODS: We analyzed the results of a statewide random digit dialing telephone survey of 658 Kentucky adults. Our study focused on the 466 adults who indicated they usually seek care from the same physician. Respondents were asked about seeing an alternate provider if they had an acute, non-life-threatening condition and their usual physician was not available. RESULTS: Of the respondents, 48.6% indicated they would seek care from another professional the same day, 41.6% would wait 1 day or more, and 9.8% would not see another professional. Patients with asthma were significantly more likely to wait for care from their regular physician (P <.05), as were patients who usually visited a physician's office instead of a clinic (P <.05). In a multivariate model, seeking alternate care the same day was significantly more likely among patients who were older, nonwhite, and who would seek alternate care at their usual site of care (P <.05). CONCLUSIONS: Maintaining continuity of care with their usual physician is important to patients. Patient and practice characteristics may influence the decision to wait for care in an effort to maintain continuity.

Acute Disease↗
PubMed1999

Antibiotic use for the treatment of upper respiratory infections in a diverse community.

BACKGROUND: Previous studies have not addressed whether cultural factors influence beliefs and practices related to the treatment of upper respiratory infections (URIs). The purpose of our project was to assess beliefs, care-seeking behavior, use of antibiotics, and means of obtaining antibiotics for the treatment of URIs among different ethnic groups in an urban community. METHODS: A total of 192 adults completed a self-administered questionnaire indicating their likelihood of seeking care, the perceived effectiveness of treatment methods, and their usual use of treatment regimens for 2 scenarios consistent with uncomplicated URIs. Respondents were also asked about their use of antibiotics not prescribed by a physician for a URI. RESULTS: A majority of subjects reported a belief in the effectiveness of antibiotics for URIs and indicated they are likely to seek care for URIs. Many (26%) had obtained antibiotics from sources other than a physician's prescription (e.g., directly from pharmacists or a supplier outside the United States). Many (31%) believed that antibiotics should be available over the counter. Individuals who reported using antibiotics for a URI were more likely than those who did not to obtain them without a prescription (35% vs. 11%, P = .001). Subjects with a cultural background from countries where antibiotics are available over the counter are more likely to use antibiotics not prescribed by a physician than those from countries with variably enforced regulations or the United States (40%, 30%, and 20%, respectively, P = .049). CONCLUSIONS: Members of an ethnically diverse community believe antibiotics are effective for colds, are very likely to seek care for colds, and often obtain antibiotics without a prescription. The ease of antibiotic access worldwide may influence their use in some communities in the United States.

Adult↗
PubMed1999

Retention of family medicine faculty development fellows in academic medicine.

OBJECTIVE: This study measured the retention of family medicine faculty development fellows in academic medicine. METHODS: Surveys were sent, in two stages, to 1) fellowship program directors and 2) fellows. These surveys were about full-time faculty development fellowships with new or continued Title VII funding during the interval of 1993-1996. Retention as faculty was the primary outcome. Likelihood of leaving academics and service in a federally designated medically underserved area were secondary outcomes. RESULTS: The fellowship program directors survey produced an 88% response rate and identified 105 alumni. The survey of fellows yielded a response rate of 73% (n = 77). The retention rate of these newly graduated family medicine fellows in academic positions was 75% (n = 58). A total of 37% (n = 21) of alumni in full- and part-time teaching positions reported being likely to leave their current position within the next 2 years. CONCLUSIONS: Retention rates of newly graduated family medicine fellows in academic positions are similar to rates reported in the 1980s. This group anticipates a high job turnover within the next 2 years.

Adult↗
PubMed1998

Acute bronchitis.

Acute bronchitis is a lower respiratory tract infection that causes reversible bronchial inflammation. In up to 95 percent of cases, the cause, is viral. While antibiotics are often prescribed for patients with acute bronchitis, little evidence shows that these agents provide significant symptomatic relief or shorten the course of the illness. In a few small studies, bronchodilators such as albuterol have been found to relieve some symptoms of acute bronchitis. Increased attention is being given to the role of Chlamydia species in acute bronchitis and adult-onset asthma. Studies in progress may help to clarify the importance of these organisms in acute bronchitis and to determine whether early treatment can prevent or ameliorate asthma.

Acute Disease↗
PubMed1998

The importance of continuity of care in the likelihood of future hospitalization: is site of care equivalent to a primary clinician?

OBJECTIVES: This study examined the effect of continuity with clinicians and health care sites on likelihood of future hospitalization. METHODS: Delaware Medicaid patient data were analyzed. Logistic regression models supplied adjusted effects of continuity on hospitalization. RESULTS: Patients in the high clinician continuity group had lower odds of hospitalization than patients in the high site/low clinician continuity group (odds ratio [OR] = 0.75, 95% confidence interval [CI] = 0.66, 0.87). The latter group did not differ from the low site/low clinician continuity group (OR = 0.93, 95% CI = 0.80, 1.08). CONCLUSIONS: A location providing health care without clinician continuity may not be sufficient to ensure cost-effective care.

Adolescent↗
PubMed1998

Patterns of antibiotic-resistant Streptococcus pneumoniae in children in a day-care setting.

BACKGROUND: Streptococcus pneumoniae is one of the primary causes of illness and death among young children, and evidence suggests that the prevalence of antibiotic-resistant S pneumoniae is increasing. The purpose of this study was to investigate the prevalence of antibiotic-resistant S pneumoniae in a sample of children in day-care facilities in a region that includes both rural and urban communities. METHODS: Nasopharyngeal cultures were obtained from 104 children in eight day-care centers located in rural and urban central Kentucky in April and May, 1997. Thirty-five of the children produced isolates positive for S pneumoniae. Each isolate was tested for susceptibility to penicillin, trimethoprim-sulfamethoxazole, erythromycin, tetracycline, vancomycin, and cefotaxime. RESULTS: Of the children with S pneumoniae isolates, 54% had isolates that were resistant to penicillin and 40% that were resistant to trimethoprim-sulfamethoxazole. Twenty-one (60%) of the isolates had resistance to at least one of the six tested antimicrobials, with 15 (43%) having resistance to more than one of the antimicrobials. The mean age of children with isolates resistant to penicillin was significantly less (2.7 + 1.6) than those with penicillin-susceptible isolates (3.7 + 1.1, P = .02). There was no relation between resistance and rural or urban day-care location. CONCLUSIONS: A substantial proportion of S pneumoniae isolates in young children are resistant to antibiotics. Limiting the effect of S pneumoniae drug resistance may require a reexamination of outpatient treatment strategies for childhood respiratory tract infections.

Child↗
PubMed1998

Antibiotics for colds in children: who are the high prescribers?

OBJECTIVE: To examine physician characteristics associated with being a high prescriber of antibiotics for pediatric upper respiratory tract infections (URIs). DESIGN AND SETTING: Analysis of 34624 episodes of care for URIs in children (younger than 18 years) in the Kentucky Medicaid program from July 1, 1995, to June 30, 1996. PARTICIPANTS: Primary care physicians with at least 25 episodes of care (n=205). The proportion of patients with URIs receiving antibiotics stratified the sample into low (< or =25th percentile) and high (> or =75th percentile) antibiotic prescribers. MAIN OUTCOME MEASURES: Bivariate analyses were computed comparing the high and low prescribers. A logistic regression model was computed for likelihood of being a high prescriber by number of URI episodes, proportion of patients receiving antibiotics that were broad spectrum, years since medical school graduation, physician gender, rural/urban practice, and specialty. RESULTS: The high prescriber group (n=52) included data from 11899 episodes of care, with a mean prescribing rate of 80%. The low prescriber group (n=55) included data from 5396 episodes, with a mean prescribing rate of 16%. High prescribers were significantly more years away from medical school graduation (27 vs 19 years; P<.001) and had managed significantly more URI episodes than low prescribers (229 vs 98; P=.001). In the logistic regression, compared with pediatricians, the odds ratios of being a high prescriber were 409 (95% confidence interval [CI], 29-7276) for family practitioners and 318 (95% CI, 17-6125) for other primary care physicians. CONCLUSION: With the rise of antibiotic-resistant bacteria, more focused training regarding treatment of URIs is warranted in residency and in continuing medical education forums.

Adolescent↗
PubMed1998

Criteria used by clinicians to differentiate sinusitis from viral upper respiratory tract infection.

BACKGROUND: Acute sinusitis and upper respiratory tract infections (URIs) share many common symptoms and signs. Objective criteria have been identified that are valid for distinguishing between these two clinical problems. The objective of this study was to determine how often clinicians use these validated criteria and how often they rely on clinical cues that are less valuable for differentiating sinusitis from URI. METHODS: We performed a retrospective review of 734 patients with a diagnosis of acute sinusitis (n = 367) or URI (n = 367) at a family practice residency training site over a 3-year period. Charts were reviewed to ascertain patient demographics, past history, current symptoms, physical findings, and treatment prescribed. RESULTS: Patients with sinusitis were likely to be older, female, smokers, have a history of allergic rhinitis, and have longer symptom durations. Complaints of sinus pressure or discolored nasal discharge and the finding of sinus tenderness were strongly associated with the diagnosis of sinusitis. In multivariate analysis, eight factors were independently associated with the diagnosis of sinusitis. Four clinical cues alone (sinus tenderness, sinus pressure, postnasal drainage, and discolored nasal discharge) were highly associated with the diagnosis of sinusitis and explained 60% of the variation in the diagnosis between sinusitis and URI. CONCLUSIONS: Physicians tend to rely on four factors to differentiate sinusitis from URIs. Only one of these has been shown to be a reliable predictor of acute sinusitis. This use of unreliable criteria may lead to misdiagnoses and inappropriate prescriptions for antibiotics.

Acute Disease↗
PubMed1998

Health care for Kentucky's uninsured indigents: the perspective of providers in the Kentucky Physicians Care program.

The pressing issue of providing care for the uninsured indigent has been addressed in Kentucky by a unique private sector program that depends on physician donation of services. The Kentucky Physicians Care (KPC) program which provides health care to uninsured indigent patients in Kentucky was evaluated from the perspective of the participating physicians through in-depth interviews with 22 randomly selected physicians. The results of the interviews suggested that the KPC program is generally viewed by participating providers as a successful and personally rewarding enterprise. Suggestions for improving services included strategies to increase awareness of the program for both patients and providers. As state and federal policy continues to focus on the uninsured as a vulnerable population, integration of this private sector program into a partnership with the public sector may be a worthwhile strategy.

Interviews as Topic↗
PubMed1997

Assessing residents' readiness for working in a managed care environment.

PURPOSE: A the pilot study to assess the state of residents' training for practice in a managed care environment. METHOD: In May and June 1996, all 178 residents at the University of Kentucky College of Medicine in six programs were approached to participate in the study. An instrument was created to assess the residents' knowledge of, attitudes toward, and exposure to managed care, as well as their perceptions of their residency experience. Attitudinal items were measured using a five-point Likert scale (1 = strongly agree, 5 = strongly disagree), as were the assessments of experience (1 = excellent, 5 = poor). Bivariate statistics were computed between the number of correct responses to the knowledge questions and both the year of training and reported exposure to managed care. The relationship between exposure and knowledge was analyzed using a two-tailed t-test. A Pearson product-moment correlation was computed between residents' knowledge and year of training. RESULTS: In all, 140 (79%) residents participated, 76% of whom were men. Seventy-three percent of the residents rated their experiences as fair or poor; the mean rating across all the residents was 3.8 (SD, 0.8). Among those reporting some exposure, attitudes toward the effectiveness of their exposure generally ranged from neutral to negative. Across all the residents, the mean number of correct responses to the five knowledge questions was 3.2 (SD, 1.1). No statistically significant relationship was found between year of training and the number of correct responses. The residents who reported some exposure to managed care had a significantly higher mean number of correct responses than did those with no reported exposure (3.4, SD, 1.1, vs 2.8, SD, 1.3, p = .04). CONCLUSION: The residents reported limited exposure to managed care and that their training experience did not prepare them for working in managed care; this was confirmed (in a limited way) by the responses to the knowledge questions. As managed care expands in the United States, the systematic incorporation of managed care instruction into training is necessary to appropriately prepare residents for future practice.

Attitude of Health Personnel↗
PubMed1997

A comparison of the numbers of pharmaceutical advertising pages in family medicine research journals and journals in other medical disciplines.

PURPOSE: To determine whether declines in pharmaceutical industry advertising have been greater for family medicine research journals than for journals in other disciplines. METHOD: Three family medicine research journals and eight randomly selected journals in other disciplines were chosen for this study. The number of advertising pages from the first issue of each journal from 1990 through 1995 were calculated by manually counting every journal page that contained all or part of an advertisement for a pharmaceutical product. Data were compared using Student's t-test. RESULTS: Overall, the mean number of pages of pharmaceutical advertising in all of the journals fell 41%, from 34 pages in 1990-1991 to 21 pages in 1994-1995. For the three family medicine journals the drop over the same six-year period was 55% (from 30 to 14, p = .01), compared with a 35% drop for the eight other journals (from 36 to 23, p < .001). CONCLUSION: Although advertising in medical research journals has dropped in all disciplines, it would appear that the decline for family medicine journals has been disproportionately large. The potential effect of this decline for the discipline of family medicine is a decrease in the outlets and opportunities for the publication of new knowledge.

Advertising↗
PubMed1997

Evaluation and treatment of respiratory infections: does managed care make a difference?

BACKGROUND: Primary care physicians frequently use antibiotics for nonindicated conditions and conditions for which antibiotics have not been shown to be effective. The intention of this study was to determine whether shifting the costs from the insurer to physicians in a staff model health maintenance organization (HMO) influenced antibiotic prescribing. METHODS: A random sample of patients in whom upper respiratory infections (URIs) (n = 334) or acute bronchitis (n = 218) were diagnosed within a 12-month period was selected from a large multispecialty group practice whose population was predominantly fee-for-service (FFS) and from a staff model HMO. Detailed chart reviews were performed to verify the diagnosis and note secondary diagnoses, identify whether an antibiotic or other medication was prescribed, assess whether diagnostic testing was performed, and determine the specialty of the clinician. RESULTS: After excluding patients seen with sinusitis, otitis media, or streptococcal pharyngitis, 334 patients with URIs and 218 patients with acute bronchitis remained for analysis. For URIs, antibiotic prescribing was higher in the HMO population than in the FFS group (31% vs 20%, P = .02). In patients with acute bronchitis, HMO patients were also more likely to have an antibiotic prescribed, but the difference was not statistically significant (82% vs 73%, P = .11). Further analyses showed that while HMO physicians were more likely to prescribe antibiotics, they were less likely to prescribe other medications for acute bronchitis or use diagnostic tests for evaluation of patients with URIs or bronchitis. CONCLUSIONS: Shifting costs from insurer to physicians through managed care appears to reduce diagnostic testing for URIs and acute bronchitis, but does not decrease excessive use of antibiotics and may actually increase antibiotic use for URIs.

Acute Disease↗
PubMed1997

Patient knowledge of upper respiratory infections: implications for antibiotic expectations and unnecessary utilization.

BACKGROUND: Upper respiratory infections (URIs) account for many of the visits in primary care and are commonly treated with ineffective antibiotic therapy. The purpose of this study was to examine patient beliefs in the effectiveness of antibiotics and the likelihood of seeking care for normal presentations of URIs. METHODS: We conducted a survey of 961 adults (> or = 18 years of age) from an undifferentiated patient population in a university-based family practice residency clinic in metropolitan Kentucky, a private internal medicine practice in nonmetropolitan Kentucky, and, in metropolitan Louisiana, an emergency department and a convenience sample from the community. RESULTS: Seventy-two percent of the sample reported that they would seek care with a condition of 5 days' duration with cough, sore throat, and discolored nasal discharge. Sixty-one percent of the sample expressed their belief that antibiotics are effective for a condition of 5 days' duration with cough, sore throat, and clear nasal discharge; 79% said that they believed antibiotics are effective when there is discolored discharge (P = .0001). Medicaid recipients were most likely to seek care across the symptom complexes. Higher education was related to a decreased belief in the effectiveness of antibiotics for the scenario with clear discharge (P .001), but to an increased belief in the effectiveness of antibiotics in the scenario with discolored discharge (P = .003). The strongest predictor of both likelihood of utilization and belief in effectiveness of antibiotics was usual use of antibiotics for the URI symptom complexes. CONCLUSIONS: Patients lack understanding of the normal presentation of a URI and the effectiveness of antibiotics as a treatment. A confusion about the meaning of discolored nasal discharge is particularly evident, and past antibiotic use may contribute to inappropriate utilization and expectations for antibiotics.

Adult↗
PubMed1997

Using other people's data: the ins and outs of secondary data analysis.

BACKGROUND AND OBJECTIVES: A variety of types of data ranging from administrative data sets to large-scale surveys have been collected for one purpose but can be accessed and used to address new questions of relevance to primary care. For many research questions, primary data collection isn't necessary because the data already exists. Although relatively few researchers consider analyzing existing data sets, there are a variety of advantages to secondary analysis. This paper introduces the practical aspects of performing secondary analysis. We review the types of questions that can addressed, where and how to access data, and the steps involved in preparing data for analysis.

Data Collection↗