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Biomedical subjects

A G Mainous

Publications and source records attributed to A G Mainous.

113 records · Page 7Linked to original sources
PubMedDate not supplied

Why are antibiotics prescribed for patients with acute bronchitis? A postintervention analysis.

BACKGROUND: Despite the findings in controlled trials that antibiotics provide limited benefit in the treatment of acute bronchitis, physicians frequently prescribe antibiotics for acute bronchitis. The aim of this study was to determine whether certain patient or provider characteristics could predict antibiotic use for acute bronchitis in a system where antibiotic use had already been substantially reduced through quality-improvement efforts. METHODS: A retrospective chart review was performed in an academic family medicine training center that had previously instituted a quality-improvement project to reduce antibiotic prescribing for acute bronchitis. Patients who had acute bronchitis diagnosed during an 18-month period and who had no other secondary diagnosis for respiratory distress or a condition that would justify antibiotics were selected from a computerized-record database and included in the study (n = 135). Charts were reviewed to document patient symptoms, physical findings, provider and patient characteristics, and treatment. RESULTS: Thirty-five (26%) patients received antibiotics for their acute bronchitis. Adults were more likely to receive antibiotics than children (34% vs 3%, P < .001). Analysis of 20 different symptoms and physical findings showed that symptoms and signs were poor predictors of antibiotic use. Likewise, no significant differences were found based on prescribing habits of individual providers or provider level of training. CONCLUSION: In a setting where antibiotic use for acute bronchitis had been decreased through an ongoing quality-improvement effort, it did not appear that providers selectively used antibiotics for patients with certain symptoms or signs. Other factors, such as nonclinical cues, might drive antibiotic prescribing even after clinical variation is suppressed.

Acute Disease↗
PubMedDate not supplied

Physician extenders: who is using them?

BACKGROUND: Nurse practitioners and physician assistants (physician extenders) are playing an increased role in medical care. The purpose of this research was to determine the proportion of adults who have received health care from physician extenders. METHODS: This study used the subject population of the 1990 Kentucky Health Survey, a probability survey of all households in Kentucky. Study personnel contacted subjects using random digit telephone dialing. Subjects were then interviewed to ascertain whether subjects had received health care from physician extenders and whether they were satisfied with that care. RESULTS: Of 687 participating subjects, 25% had received care from physician extenders during the previous two years, primarily for minor problems and routine checkups. More than 90% of these subjects reported satisfaction with the care they received. Users of physician extenders did not differ from nonusers with respect to income, education, insurance status, self-assessment of health status, or rural versus urban location. Men used physician extenders more frequently than women. CONCLUSIONS: A substantial proportion of the population has used physician extenders. Patient satisfaction with physician extenders is high. Use of physician extenders may be an effective strategy for improving delivery of primary care.

Adult↗
PubMedDate not supplied

Survey sampling issues in primary care research.

Survey research methods are often used to answer questions in primary care medicine. Consequently, investigators must understand and address sampling issues. Probability sampling designs have particular utility for questions that seem most appropriate for survey research. These designs provide each member of the population with a known probability of selection, and if performed properly with an appropriate sample size, they provide a sample with essentially no selection bias. Examples of random and stratified sampling designs are presented. These two probability designs, along with nonprobability sampling techniques (convenience, purposive, quota), are discussed in terms of bias, error, and possible limitations.

Humans↗
PubMedDate not supplied

Public awareness of prostate cancer and the prostate-specific antigen test.

Prostate cancer and prostate-specific antigen (PSA) testing have been the focus of significant media attention. This study examines the public's knowledge of prostate cancer, knowledge of the PSA test, and among men, the use of the test. The data are from the 1993 Kentucky Health Survey, an annual probability-based statewide telephone survey of adult (18 years of age and older) Kentucky residents (n = 661). Although 92% of the sample reported hearing of prostate cancer, the respondents were basically uninformed about the outcomes of prostate cancer. Men 50 years of age and older were no more informed than was the rest of the sample about prostate cancer or PSA testing. However, 94% of the men who had the test recommended by their physician had undergone the test. These findings indicate that adults remain poorly informed about prostate cancer and possible case-finding strategies. If the American Cancer Society's (ACS) early detection recommendations are to succeed, attention should focus on improving the public's awareness of currently available methods for early detection of prostate cancer.

Health Knowledge, Attitudes, Practice↗