Antibiotics for the common cold.
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Anti-Bacterial Agents↗
Biomedical subjects
A G Mainous
Publications and source records attributed to A G Mainous.
Current management of acute bronchitis in ambulatory care: The use of antibiotics and bronchodilators.
OBJECTIVE: To examine the treatment regimens for acute bronchitis in adults in a Medicaid population seen in ambulatory care settings. DESIGN: Cross-sectional sample of Kentucky Medicaid claims (July 1, 1993, through June 30, 1994). PARTICIPANTS: Individuals 18 years old or older seen in an ambulatory setting for acute bronchitis. Anyone with a primary diagnosis of asthma or chronic obstructive pulmonary disease within the time frame was excluded. Twelve hundred ninety-four individuals accounted for 1635 separate outpatient and emergency department encounters for acute bronchitis. Outpatient visits accounted for 89% (n=1448) of the encounters. RESULTS: In 22% (n=358) of the encounters, no medication was prescribed; in 61% (n=997), antibiotics alone were prescribed, in 3% (n=43), bronchodilators alone were prescribed; and in 14% (n=237), both antibiotics and bronchodilators were prescribed. Some type of medication was more likely to be prescribed in emergency departments than in outpatient settings (P=.04), and antibiotic/bronchodilator combination therapy was more likely to be prescribed in rural practices than in urban practices (P<.001). Broad-spectrum were more likely than narrow-spectrum antibiotics to be used in combination with a bronchodilator (P=.001). Penicillins were the most widely used antibiotics (37%), but broad-spectrum agents, such as second- and third-generation cephalosporins (10%) and fluoroquinolones (5%), were also prescribed. CONCLUSIONS: Although evidence suggests that antibiotic treatment is not usually indicated for treatment of acute bronchitis, these results indicate that antibiotics are still the predominant treatment regimen in ambulatory care. Furthermore, the evidence suggesting that bronchodilators are effective symptomatic treatments has not been widely adopted. These results have significant implications for the production of antibiotic-resistant bacteria and suggest investigation into why physicians have not used this information in their treatment of acute bronchitis.
Acute Disease↗
Rural human immunodeficiency virus health service provision. Indications of rural-urban travel for care.
We studied the travel of rural individuals positive for human immunodeficiency virus (HIV) to urban areas for HIV diagnosis and for ambulatory and inpatient HIV-related health services. We surveyed all (N = 84) identified HIV-positive adults (aged 18 years or older) residing in rural central and eastern Kentucky. Sixty-three individuals completed the survey, for a response of 75%. Although 60 respondents (95%) were living in a rural area at 18 years of age, 23 (37%) of the survey sample lived in urban areas at the time of their initial HIV diagnosis. Of the respondents, 13 (21%) traveled from rural areas to urban areas for their initial diagnosis of HIV. Forty-seven respondents (74%) traveled outside their county for HIV-related ambulatory care, with 40 respondents (64%) traveling to an urban area. The mean travel time required to obtain care for those who traveled to an urban area was almost 2 hours. Primary reasons for travel for ambulatory care include confidentiality concerns, belief that their physician was not knowledgeable enough about HIV, and referral to an outside physician. Increased training of rural primary care physicians regarding the psychosocial and biomedical aspects of HIV is suggested.
Adult↗
Practice patterns of rural family physicians based on the American Diabetes Association standards of care.
The purpose of this study was to examine practice patterns of rural family physicians in the care of non-insulin-dependent diabetes mellitus based on the standards of care of the American Diabetes Association (ADA). One hundred patient charts were randomly chosen, twenty for each physician, from the practices of five family physicians in rural Ohio. A standardized collection protocol was used, based upon the ADA recommendations. The charts were reviewed for compliance with the ADA parameters. The patients' records demonstrated 66% compliance with dietary counseling and 33% with counseling about exercise. Moreover, there was low compliance with physical examination guidelines. Specifically, 66% of the patients had fundoscopic examination and 64% had a complete foot examination done. With respect to the laboratory guidelines, 70% of the charts reviewed had a urinalysis ordered and 45% annual lipids measured. However, glycosylated hemoglobin was performed in only 15% of the patients. The results suggest that rural family physicians do not consistently follow the ADA standards of care.
Adult↗
Teaching conferences in family practice residencies.
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Family Practice↗
Streptococcal diagnostic testing and antibiotics prescribed for pediatric tonsillopharyngitis.
BACKGROUND: This study examined a 1-year cross-sectional sample of Kentucky Medicaid claims for the use of streptococcal diagnostic tests for pediatric tonsillopharyngitis and the empiric use of antibiotics. METHODS: Subjects were individuals older than 3 and younger than 18 years old seen in an ambulatory setting for tonsillopharyngitis; 3478 individuals accounted for the 5067 separate outpatient and emergency room encounters for pediatric tonsillopharyngitis; 849 encounters coded as streptococcal sore throat were also examined. RESULTS: Diagnostic tests for group A streptococcal tonsillopharyngitis were performed in only 22% (n = 1130) of the tonsillopharyngitis encounters and 36% (n = 306) of the streptococcal sore throat encounters. Urban physicians were more likely than rural physicians to use a diagnostic test (P = 0.0001). Emergency room encounters and outpatient encounters were not significantly different in the likelihood of having a diagnostic test (P = 0.16). In encounters for tonsillopharyngitis antibiotics were prescribed in 72% of the total encounters and in 73% of the encounters without a diagnostic streptococcal test. In encounters for streptococcal sore throat, antibiotics were prescribed for 68% of the total encounters and 69% of the encounters without a diagnostic streptococcal test. CONCLUSIONS: Current practices in the Kentucky Medicaid program do not follow the American Academy of Pediatrics guidelines for streptococcal tonsillopharyngitis.
Adolescent↗
Is health status related to residence in medically underserved areas? Evidence and implications for policy.
This study sought to compare the health status of adult residents of medically underserved areas (MUAs) with adult residents of nonshortage areas (non-MUAs). A random digit dialing telephone survey was used. Respondents were subsequently classified by their county of residence as residing in an MUA or non-MUA. A sample of 421 adults (aged 18 years or older) residing in Kentucky during 1993 were included in the analysis. Health status was measured by the Medical Outcomes Study 20-item Short-Form Health Survey's (SF-20) six subscales. After controlling in the multiple regression for demographic variables there were no significant differences between residents of MUAs and non-MUAs for the physical functioning, role functioning, general mental health, self-perception of health, or pain subscales. The social functioning subscale was significantly related to the residence in an MUA. The demographic variable "education" was a consistent predictor of each of the health status subscales. Excepting the social functioning subscale, residents of MUAs do not have significant differences in health status when compared to residents of non-MUAs. Future policy may need to focus on other health services shortage area designators that are more highly associated with the health status of residents. Consideration should be given to including the education demographics of areas or populations in health services shortage designation criteria.
Adult↗
Patients with personality disorders: functional status, health care utilization, and satisfaction with care.
BACKGROUND: Personality disorders are believed to occur in approximately 10% of the adult population, yet they are rarely diagnosed in primary care settings. This study compares the functional status, health care utilization, and satisfaction with care for patients who were at high risk for a personality disorder with those who were at low risk. METHODS: Patients at high risk for personality disorders were identified using a standardized psychometric instrument, the Structured Clinical Inventory for DSM-III Axis II (SCID-II). After assigning patients to risk categories, responses were compared on the Medical Outcomes Study Short Form-36, the Beck Depression Inventory, the CAGE alcohol use questionnaire, and an adapted version of the RAND Patient Satisfaction Questionnaire. RESULTS: Patients who were at high risk for any personality disorder had lower functional status, higher risk for depression or alcohol abuse, and lower levels of satisfaction with care. These differences could not be explained by demographic or socioeconomic differences between high- and low-risk patients. Being at high risk for specific personality disorders, such as borderline, schizoid, and dependent disorders, was associated with higher degrees of functional impairment and greater risk for depression and alcohol abuse. Patients at high risk for other disorders, such as obsessive-compulsive, narcissitic, and schizotypal, consistently showed no appreciable degree of impairment as compared with patients at low risk for any personality disorder. Medical care utilization was no higher when personality disorders were examined in aggregate, but a marked increase in utilization was noted among patients at high risk for histrionic and dependent disorders. CONCLUSIONS: Among primary care patients, having a personality disorder is associated with lower functional status, lower satisfaction with health care, and higher risk for depression and alcohol abuse.
Adult↗
How often are preoperative electrodiagnostic studies obtained for carpal tunnel syndrome in a Medicaid population?
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Adult↗
Antibiotics and upper respiratory infection: do some folks think there is a cure for the common cold.
BACKGROUND: Symptomatic treatment is the only recommended therapy for the uncomplicated "common cold." The purpose of this study was to examine the use of antibiotics and other prescription medications for the common cold in a Medicaid population seen in ambulatory care settings. METHODS: A cross-sectional sample of Kentucky Medicaid claims from July 1, 1993, through June 30, 1994, was analyzed. Subjects were patients seen in an ambulatory setting for the common cold, defined as acute nasopharyngitis. A total of 1439 individuals were seen for 2171 separate outpatient and emergency department encounters for the common cold. Outpatient visits accounted for 99% (2144) of the encounters. RESULTS: Patients in 35% (752) of the encounters did not fill a prescription for medication, 6% (129) filled a prescription for an antihistamine or other symptomatic medication, and 60% (1290) filled a prescription for an antibiotic for the common cold. Nineteen different antibiotics, 54% of which were amoxicillin, were prescribed for the common cold. Less than 2% of the encounters had a secondary diagnosis of either acute sinusitis or otitis media. These encounters were not more likely than the total sample to receive antibiotics. Adults were more likely than children to receive an antibiotic (P<.001), and urban physicians were more likely than rural physicians to prescribe antibiotics (P=.02). A conservative estimate of the annual cost of antibiotic prescribing for the common cold in the United States was $37.5 million. CONCLUSIONS: A majority of persons receiving medical care for the common cold are given prescriptions for an unnecessary antibiotic. Unchecked, this practice may lead to greater antibiotic resistance and unnecessary use of health care resources. Future research should focus on the ability to institute behavioral changes for treatment of the common cold in both closed systems (eg, managed care) and open systems (eg, general community of physicians).
Adolescent↗
Family medicine research in the community setting: what can we learn from successful researchers?
BACKGROUND: There is little information describing family physician researchers who work outside academic medical centers. This report describes the motivating factors and resources used by community residency faculty and nonfaculty family physicians who perform research. METHODS: We sent a questionnaire to community residency faculty and nonfaculty family physicians who published at least one paper in the family medicine literature from 1992 through 1994. The survey focused on previous research experience, training, and collaboration with university colleagues, and included an open-ended question about motivations and obstacles to research. RESULTS: The majority (60%) of community faculty and nonfaculty family physicians surveyed reported previous research experience on the undergraduate, medical school, or residency level. Research training received during residency was evaluated as poor. Sixty-nine percent of the respondents reported being successful at acquiring research funding, and 60% reported receiving funding from foundations. Reported keys to success included mentoring, a supportive infrastructure, and an inherent enjoyment in doing research. These factors did not differ between community residency faculty and nonfaculty physicians. CONCLUSIONS: For community-based family physicians, success at conducting and publishing research is enhanced by the availability of mentoring, support from local or national foundations, and previous research experience. Respondents identified research training during residency as one area that needs improvement.
Ambulatory Care↗
Substance use among adolescents: fulfilling a need state.
A factor that has received little investigation concerns the feeling state of need fulfillment and how this may relate to the significant public health problem of adolescent substance use. A survey of 823 students was conducted at a suburban public high school in the Southeastern United States. The questionnaire contained a scale focusing on fulfillment of adolescent needs, the Children's Depression Inventory, and items on current substance use. The results of t-tests indicated that the higher the adolescent is on the Need scale, the greater the likelihood of engaging in substance use (p < .05). Further, results indicated that cigarette smoking, drinking alcohol, and smoking marijuana are associated with significantly higher scores on the Need scale for both males and females. Although the Need scale was significantly positively correlated with the Children's Depression Inventory (r = .45, p = .0001), the two feeling states were not collinear. However, the Need scale was not significantly correlated with age, indicating that the need state is not simply a developmental process (r = .04, p = .11). The results suggest that a feeling state of unfulfilled needs may propel adolescents into the destructive behavior of substance use. A state of high wants and needs that cannot be gratified simply in a complex society may be a precursor of substance use.
Adolescent↗
Frequency of human immunodeficiency virus testing among rural US residents and why it is done.
OBJECTIVE: To examine the frequency with which rural residents' undergo human immunodeficiency virus (HIV) antibody testing and the reasons why. DESIGN: Data are from the 1991 National Health Interview Survey's supplemental questions on knowledge and attitudes about acquired immunodeficiency syndrome. SUBJECTS: The respondents were 42,725 adults (aged > or = 18 years), representing a nationwide sample of the civilian, noninstitutionalized population of the United States. Rural (n = 9903) and urban (n = 32,822) respondents were compared. RESULTS: Although 7.1% of rural and 7.9% of urban respondents are at high risk for contracting HIV (P = .06), 25.2% of rural and 33.0% of urban respondents had been tested for HIV (P = .001). Excluding blood donations, 10.7% of rural and 17.2% of urban respondents had been tested for HIV (P = .001). The primary reason between the two groups for not getting tested was a belief of being at low risk for contracting HIV. Rural respondents were less likely than urban respondents (6.6% vs 10.4%) (P = .001) to be tested for HIV in the next 12 months. Rural respondents were less informed about HIV risks than were urban respondents. Urban residence is a significant predictor of having had an HIV test even after controlling for actual risk status, perceived risk status, age, education, income, sex, perceived health status, and a scale of knowledge of acquired immunodeficiency syndrome risk factors (odds ratio, 1.54; 95% confidence interval, 1.37 to 1.73). CONCLUSIONS: Rural residents are less knowledgeable about HIV risk factors and are less likely to have been tested for HIV. With the increasing rates of infection in rural areas, specific and focused efforts for counseling and testing for HIV antibodies in rural areas might prevent and control HIV infection and acquired immunodeficiency syndrome.
Adult↗
Patient perceptions of physician acceptance of gifts from the pharmaceutical industry.
OBJECTIVE: To examine patient perceptions of professional appropriateness and the potential impact on health care of physician acceptance of gifts from the pharmaceutical industry. DESIGN: A random-digit dialing telephone survey. SETTING AND PARTICIPANTS: A sample of 649 adults (> or = 18 years old) living in Kentucky. MAIN OUTCOME MEASURES: Patient awareness of office-use gifts (eg, pens, notepads) and personal gifts to physicians from the pharmaceutical industry, patient exposure to office-use gifts, and attitudes toward physician acceptance of both office-use and personal gifts. RESULTS: The survey had a response rate of 55%. Eighty-two percent of the respondents were aware that physicians received office-use gifts, while 32% were aware that physicians received personal gifts. Seventy-five percent reported receiving free samples of medication from their physicians. Compared with office-use gifts, more respondents believed that personal gifts to physicians have a negative effect on both health care cost (42% vs 26%) and quality (23% vs 13%). After controlling for demographic variables, as well as awareness and exposure to physician gifts, individuals with at least a high school education were 2.4 times as likely to believe that personal gifts have a negative effect on the cost of health care and 2.3 times as likely to believe that personal gifts would have a negative effect on the quality of health care. CONCLUSIONS: These results suggest that the public is generally uninformed about personal gifts from pharmaceutical companies to physicians. If public perception regarding the objectivity of the medical profession is to serve as a guide, these findings suggest a reevaluation may be in order for guidelines regarding physician acceptance of gifts from the pharmaceutical industry.
Adult↗
The relationship of health professional shortage areas to health status. Implications for health manpower policy.
OBJECTIVE: To compare the health status of adult residents of health professional shortage areas (HPSAs) with adult residents of non-HPSAs. DESIGN: A random-digit dialing telephone survey. Respondents were subsequently classified by their county of residence as residing in an HPSA or non-HPSA. PARTICIPANTS: A sample of 470 adults (18 years or older) living in Kentucky. MAIN OUTCOME MEASURES: Health status was measured by the Medical Outcomes Study 20-Item Short-Form Health Survey's six subscales. RESULTS: Controlling for demographic variables in the multiple regression analysis, there were significant differences between HPSAs and non-HPSAs for the social, mental health, and pain subscales. An interaction between age and HPSAs in relation to health status was observed for the physical, social, mental health, health perception, and pain subscales. After stratification by age (18 to 44 years, 45 to 64 years, or 65 years or older), HPSA-designated areas were associated with poorer health status in all but the youngest age strata. Elders in HPSAs had the poorest health status. CONCLUSIONS: Health professional shortage areas are associated with poorer health status in the older segments of the adult population. Future policy may need to focus on increasing access not only to primary care services but also to specific types of services that may promote better health status of elderly residents of HPSAs.
Adult↗
A comparison of health status between rural and urban adults.
The objective of the study was to examine and compare health status between rural and urban adults. The data are from a 1993 statewide probability-based telephone survey of adult Kentuckians (n = 662). Metropolitan Statistical Area (MSA) residents (n = 264) and nonMSA residents (n = 398) were compared using the Medical Outcomes Study, Short Form Health Survey (SF-20). Self-perceived urban (n = 406) and rural (n = 256) residents were also compared. Additional analyses were stratified by the age categories of 18-44, 45-64, and > or = 65 years of age. Few differences in health status existed between rural and urban adults. However, rural elders (> or = 65 years) had significantly poorer health status than urban elders. After controlling for demographic variables in multiple regressions, rural elders had significantly poorer functioning (all p < .05) than urban elders as measured by the SF-20 subscales of a) physical functioning, b) role functioning, c) social functioning, d) general mental health, and e) general health perceptions. No differences between rural and urban residents were noted for the pain subscale. Although the health status of rural and urban adults is generally similar, the rural elderly have significantly worse health status than their urban counterparts.
Adult↗
Not everybody likes problem-based learning in a clerkship.
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Attitude↗