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Biomedical subjects

A G Mainous

Publications and source records attributed to A G Mainous.

At least 109 records · Page 6Linked to original sources
PubMed1993

Public perceptions of radon risk.

Since 1984, a significant amount of media attention has focused on health threats from radon gas exposure. Using a probability telephone survey of adults (n = 685), we studied public perceptions of risk from radon exposure versus other environmental health risks. The results indicated that 92% of those individuals who had heard of radon believe radon to be a health risk, although only 4% believe they are currently exposed to high levels of radon gas. Perception of risk from radon was positively related to other perceptions of environmental risks. Younger and less educated individuals were more likely to perceive radon as a health risk. Women were three-and-one-half times as likely as men to perceive risk from radon. However, there was no significant relationship between perceived risk from radon and cigarette smoking. Media attention has apparently led to public awareness of radon hazards, but further attention is needed to improve smokers' awareness of their special risks from radon.

Adolescent↗
PubMed1993

Patient and physician characteristics associated with perceived quality of care.

This study was undertaken to describe patient and physician sociodemographic characteristics that might be associated with the patient's perception of the quality of care rendered by his or her physician. A random telephone survey of 685 adult Kentucky residents showed that self-health assessment correlated positively, while patient education correlated negatively, with perceived quality of care. Perceived physician origin was related to the respondent's perceptions of quality of care, with native-born physicians perceived as supplying higher quality of care than their foreign-born counterparts. Cultural and communication issues might explain differences in perceived quality of care.

Clinical Competence↗
PubMed1992

Clinical competence of family physicians. The patient perspective.

OBJECTIVE: This study examines the attitudes and perceptions of patients regarding the clinical competence of family physicians. DESIGN: Telephone survey employing probability sampling (random-digit dialing). SETTING: A sample of adults living in Kentucky. PARTICIPANTS: Data come from a sample of 650 completed calls (64% response rate). MEASUREMENTS/MAIN RESULTS: Ninety-three percent of the patients reported having a physician who provides primary health care. Only 1% of those with a physician listed a specialist as their source of care. Patients generally agree that family physicians are clinically competent to handle common medical problems. Of 11 investigated conditions, depression and heart disease were the conditions with the lowest reported patient confidence. A stepwise logistic regression model indicated that the quality of care provided by one's primary care physician was the only significant predictor of patient confidence in the competence of family physicians. CONCLUSIONS: These results suggest that patients believe family physicians are competent to treat a wide variety of common medical problems.

Aged↗
PubMed1992

Childhood immunization practices of primary care physicians.

OBJECTIVE: To assess if immunization utilization practices differ between rural and urban primary care physicians in Kentucky. DESIGN: Survey of 200 primary care physicians. PARTICIPANTS: Pediatricians, family physicians, and general practitioners in Kentucky. SELECTION PROCEDURES: Participants completed a 20-item questionnaire that surveyed selected demographics with regard to the physician and practice, immunizations offered to children, and reasons why the responding physicians did not offer immunizations and where they referred patients for this service. RESULTS: Physicians practicing in rural counties offered immunizations to their patients less frequently than did urban physicians (54% vs 77%). Rural and urban physicians cited immunization costs to patients as the chief reason that immunizations were not used more often and referred patients primarily to county health departments. CONCLUSIONS: Rising costs have limited physician use of immunizations in rural areas to a greater extent than that seen in urban areas. This may make access to immunizations more difficult for children living in rural areas.

Child↗
PubMed1992

Attitudes of medical school faculty toward gifts from the pharmaceutical industry.

The American Medical Association (AMA) has recently published guidelines for the receipt of gifts from industry representatives. To examine faculty members' attitudes toward that AMA policy as it pertains to gifts from the pharmaceutical industry, the authors surveyed the faculty of the University of Kentucky College of Medicine in 1991. Of 462 faculty members, 248 (54%) completed the questionnaires. The faculty generally agreed with the AMA guidelines. A majority of the faculty believed that personal relationships had the potential to influence prescribing patterns but that gifts, in general, did not greatly influence prescribing behaviors. Compared with the 169 M.D. faculty, the 69 Ph.D. faculty significantly favored more restrictive policies (p less than .001). The authors discuss both the ethical considerations and the utility of guidelines for physician-industry interactions.

American Medical Association↗
PubMed1991

Small rural hospitals: an example of market segmentation analysis.

In recent years, market segmentation analysis has shown increased popularity among health care marketers, although marketers tend to focus upon hospitals as sellers. The present analysis suggests that there is merit to viewing hospitals as a market of consumers. Employing a random sample of 741 small rural hospitals, the present investigation sought to determine, through the use of segmentation analysis, the variables associated with hospital success (occupancy). The results of a discriminant analysis yielded a model which classifies hospitals with a high degree of predictive accuracy. Successful hospitals have more beds and employees, and are generally larger and have more resources. However, there was no significant relationship between organizational success and number of services offered by the institution.

Bed Occupancy↗
PubMed1991

Hospital services as a tool in physician marketing.

The marketing of hospitals to physicians is of importance because of the latter's hypothesized primacy in health care buying decisions. The notion of marketing to physicians was investigated in terms of types of services offered by hospitals. The results indicated that successfully performing hospitals are more likely to offer high technology services for diagnostic and therapeutic tasks. Further, there was no significant difference between successfully and unsuccessfully performing hospitals in the provision of services marketed to the community. It was concluded that offering these high technology services may be an effective way of marketing hospitals to physicians.

Bed Occupancy↗
PubMedDate not supplied

The cost of antibiotics in treating upper respiratory tract infections in a medicaid population.

OBJECTIVE: To examine the use and cost of the nonindicated treatment regimens of antibiotics for nonspecific upper respiratory tract infections (URIs) in a Medicaid population. DESIGN: A cross-sectional sample of Kentucky Medicaid claims for 50000 people (July 1, 1993-June 30, 1994). SETTING: Episodes of care were created linking outpatient and emergency department visits for URIs to medications filled within a 5-day period. PARTICIPANTS: Individuals who were seen in ambulatory care for a URI as defined by the International Classification of Diseases, Ninth Revision, Clinical Modification codes 460 and 465. Of the 15706 episodes, 95% were outpatient office episodes. The outpatient episodes were accounted for by 8784 patients and 946 physicians. MAIN OUTCOME MEASURES: Use of antibiotics in URI episodes. Proportionate costs and costs per episode were computed based on claims paid by Medicaid. RESULTS: Sixty percent of outpatient episodes and 48% of emergency department episodes resulted in an antibiotic prescription being filled. In outpatient settings, episodes in which secondary diagnoses of either otitis media or acute sinusitis were found accounted for less than 6% of the episodes that resulted in an antibiotic prescription being filled. The most frequently filled antibiotic was amoxicillin, although second- and third-generation cephalosporins were the second most frequently occurring antibiotic class. Twenty-three percent and 9% of outpatient and emergency department episodes, respectively, resulted in a prescription filled for antihistamines. In outpatient episodes, antibiotics account for 23% of the total cost of care. In emergency department visits, antibiotics account for 8% of the cost of URIs. Antibiotics cost, on average, $9.91 for each episode of care in outpatient office visits. An estimate of the cost of antibiotics for URIs in a year for the Kentucky Medicaid program is $1.62 million. CONCLUSIONS: The results indicate that a substantial proportion of resources in Medicaid are being used for nonindicated and ineffective treatments for URIs. With the increase in antibiotic-resistant pathogens and shrinking public health care funding, the current treatment for URIs should be reexamined.

Aged↗
PubMedDate not supplied

The role of provider continuity in preventing hospitalizations.

OBJECTIVES: To examine the association between provider continuity and future hospitalization in a Medicaid population, and to determine if this association is greater for ambulatory care-sensitive conditions. DESIGN: Analysis of paid claims to the Delaware Medicaid program during a 2-year period (July 1, 1993, to June 30, 1995). Continuity with a single provider during year 1 of the study was computed for each participant. PARTICIPANTS: A total of 13,495 continuously enrolled fee-for-service Medicaid patients aged 0 to 64 years who had made at least 3 ambulatory physician visits during the first year of the study. MAIN OUTCOME MEASURE: Likelihood of hospitalization in year 2 of the study for all conditions and for ambulatory care-sensitive conditions. RESULTS: The mean continuity score was 0.50 in year 1 and 11.9% of patients were hospitalized in year 2. After controlling for demographics, number of ambulatory visits, and case mix, higher provider continuity was associated with a lower likelihood of hospitalization for any condition (odds ratio [OR] = 0.56; 95% confidence interval [CI], 0.46-0.69). For chronic ambulatory care-sensitive conditions there was a similar association between provider continuity and hospitalization (OR = 0.54; 95% CI, 0.34-0.88), but for acute ambulatory care-sensitive conditions there was no significant association (OR = 0.80; 95% CI, 0.48-1.34). CONCLUSIONS: Continuity of care with a provider is associated with a decreased future likelihood of hospitalization in the Delaware Medicaid population. This suggests that policies that encourage patients to concentrate their care with a single provider may lead to lower hospitalization rates and possibly lower health care costs. This study does not support the hypothesis that a certain set of conditions are particularly ambulatory care sensitive.

Adolescent↗
PubMedDate not supplied

Assessing quality of care via HEDIS 3.0. Is there a better way?

Patients, employers, and third-party payers are all calling for improved measures of health care quality. This has led to the development of "report cards," assessments that are many times applied not just to health plans but also to providers. One attempt at creating a standardized set of quality and effectiveness measures is the Health Plan Employer Data and Information Set (HEDIS). The HEDIS measures are based primarily on analyses of administrative data sets. Problems with HEDIS measures, including the probability that plans will use different data collection methods and a lack of risk adjustment, may result in incorrect conclusions about the quality of care delivered by various providers. An alternative method of standardized surveys is proposed that will overcome many of the limitations of the current HEDIS measures, provide outcome rather than process data, and provide data for developing interventions to improve quality.

Data Interpretation, Statistical↗
PubMedDate not supplied

Antibiotics for upper respiratory tract infections. Follow-up utilization and antibiotic use.

OBJECTIVES: To examine the effects of antibiotic prescribing during an initial visit for viral respiratory tract infections on future care seeking and the cost of care. MATERIALS AND METHODS: Retrospective analysis of recorded visits for viral respiratory tract infections (N = 49,862) between January 1, 1995, and December 31, 1997, to practices in a large network of affiliated practices that use the same electronic medical record. RESULTS: Patients receiving antibiotics at the initial visit were less likely to return for a second visit, but this difference was small (15.4% vs 17.4%, P < .001). When returning for the second visit, those who received an antibiotic on the initial visit were prescribed more expensive antibiotics than those who had not received an antibiotic on the initial consultation. Overall, cost from initial antibiotic use outweighed any benefit from reduced utilization in adults and children. CONCLUSIONS: Antibiotic prescribing at an initial contact for a viral respiratory tract illness may reduce the likelihood that an individual will return for a subsequent visit, but adds substantial costs to care for the initial antibiotic and for more expensive antibiotics used on subsequent visits.

Adolescent↗
PubMedDate not supplied

A comparison of family medicine research in research intense and less intense institutions.

BACKGROUND: Family medicine is a relatively new specialty that has been trying to develop a research base for 30 years. It is unclear how institutional research success and emphasis have affected the research productivity of family medicine departments. OBJECTIVE: To examine the research infrastructure, productivity, and barriers to productivity in academic family medicine in research intense and less intense institutions. DESIGN, SETTING, AND PARTICIPANTS: A survey of 124 chairs among institutional members of the Association of Departments of Family Medicine. Departments were categorized as being associated with research intense institutions (defined as the top 40 in National Institute of Health funding) or less intense institutions. MAIN OUTCOME MEASURES: Prioritization of research as a mission, number of funded research grants, total number of research articles published, and number of faculty and staff conducting research. RESULTS: The response rate was 55% (N = 68). Of 5 potential ratings on the survey, research was the fourth highest departmental priority in both categories of institutions. Departments in research intense institutions were larger, had more faculty on investigational tracks, and employed more research support staff (P<.05). Neither category of department published a large number (median = 10 in both groups) of peer-reviewed articles per year. Controlling for the number of full-time equivalent faculty, the departments in less intense institutions published a median of 0.7 articles, while the research intense institutions published 0.5 (P =.30). Departments in research intense institutions received more grant funding (P<.005) in both unadjusted and adjusted analyses. Chairs reported a scarcity of qualified applicants for research physician faculty openings. CONCLUSION: Future initiatives should focus on prioritizing research and creating a critical mass of researchers in family medicine. Arch Fam Med. 2000;9:1100-1104

Academic Medical Centers↗
PubMedDate not supplied

Does drug treatment of patients with acute bronchitis reduce additional care seeking? Evidence from the Practice Partner Research Network.

BACKGROUND: Considerable discussion has focused on treatment methods for patients with acute bronchitis. OBJECTIVE: To examine whether antibiotic or bronchodilator treatment is associated with differences in follow-up visit rates for patients with acute bronchitis. METHODS: A retrospective medical chart review was conducted for patients with a new episode of acute bronchitis over a 3-year period in the Practice Partner Research Network (29,248 episodes in 24,753 patients). Primary outcomes of interest were another visit in the next 14 days (early follow-up) or 15 to 28 days after initial treatment (late follow-up). RESULTS: Antibiotics were used more commonly in younger patients (<18 years), whereas older patients (>65 years) were more likely to receive no treatment. Younger patients treated with antibiotics were less likely to return for an early follow-up visit, but no differences were seen in adults and older patients. Late follow-up rates were not affected by the initial treatment strategy. When patients did return for a follow-up visit, no new medication was prescribed to most (66% of younger patients and 78% of older adults). However, compared with patients who did not receive an antibiotic at their first visit, patients initially treated with an antibiotic were about 50% more likely to receive a new antibiotic at their second visit. CONCLUSIONS: Initial prescribing of an antibiotic reduces early follow-up for acute bronchitis in younger patients but seems to have no effect in adults. However, reductions in future follow-up visits might be outweighed by increases in antibiotic consumption because patients who return for a follow-up visit seem to receive additional antibiotic prescriptions. Arch Fam Med. 2000;9:997-1001

Acute Disease↗
PubMedDate not supplied

The importance of fulfilling unmet needs of rural and urban adolescents with substance abuse.

PROBLEM: Because of the negative impact on health of drug and alcohol use, this study examined adolescent needs and substance use. METHODS: Subjects (N = 191) were adolescents aged 14 to 19 in a rural and an urban high school. A modified version of the Need Subscale from the Addiction Research Center Maturation Scale measured a feeling of satisfaction related to meeting basic needs, and an investigator's prepared questionnaire elicited current use of alcohol, nicotine, and marijuana. FINDINGS: Individuals with feelings of unmet needs were more likely to be current drinkers. Rural/urban residence was not a significant predictor in a multivariate analysis, but religiosity was. CONCLUSIONS: A feeling of unmet needs seems to be an important factor in adolescent substance use.

Adolescent↗