Biomedical subjects

A Ghadiri

Publications and source records attributed to A Ghadiri.

4 recordsLinked to original sources

PubMed1996

A randomized trial of a telecommunications network for pregnant women who use cocaine.

OBJECTIVES: The authors describe computer services designed to make patients better informed and more motivated to participate in treatment. Patients use these services through their touch-tone telephone; access to a home computer or a modem is not needed. METHODS: The authors tested the impact of these computer services on the management of 179 pregnant women who had used cocaine during pregnancy or 1 month before pregnancy (as reported by the woman). Patients were randomly assigned to control and experimental groups; only the experimental group had access to the computer services. Patients were enrolled during the prenatal period and followed for 6 months after the birth of a live child. Self-reported data on the subjects' participation in drug treatment programs, health status (using the SF-36), and addiction severity (using the addiction severity index) were collected. The computer collected data on the frequency of the use of the service. The dependent variables were participation in formal treatment during the course of the project, and drug and alcohol use at exit interview. Multiple and logistic regressions were used to identify the effects of the intervention after controlling for demographic and baseline variables. RESULTS: Data showed that poor, pregnant, undereducated clients who use drugs and lived in multiple residences could use the services; about one-third of clients used the services more than three times a week. Access to the service did not lead to significant change in patients' health status, drug use, or utilization of services. Use of the services did lead to significant changes in participation in drug treatment: subjects who used the service more than three times a week were 1.5 times more likely to participate in formal drug treatment than subjects who used the service less often. Participation in formal drug treatment, however, was not effective in reducing the drug or the alcohol use. CONCLUSIONS: Almost all patients used the computer services to some extent, but there seems to be a threshold after which the use of the services had a more positive impact.

Adolescent↗

PubMed1996

Electronic self-help and support groups.

OBJECTIVES: The authors examined the impact of a voice bulletin board on the following: (1) participation in self-help efforts, (2) expression of emotional support, (3) development of solidarity within the group, (4) utilization of health-care services, and (5) health status of subjects. METHODS: Subjects were 53 pregnant women who abused drugs. A quasi-experimental design with matched control group and observations before and after intervention were carried out. Clients in the control group were asked to participate in biweekly face-to-face meetings. Clients in the experimental group participated in the voice bulletin board. Experimental subjects had previous experience with computer services. Subjects reported their level of drug use, health status, and utilization of health services. They also reported on their symptoms, attitudes toward use of physician services, loneliness, willingness to disclose information in groups, and sense of solidarity with their group. The content of the communication among the experimental group was recorded and the utterances were classified as to the type of communication. Exit interviews were done 4 months after baseline interviews were conducted. Clients were paid to complete the baseline and the exit questionnaires, and 94% completed the exit questionnaires. The dependent variables were utilization or health status at exit; the co-variate was utilization or health status at baseline; and the independent variable was the group in which the subject participated. RESULTS: Clients were eight times more likely to participate in the voice bulletin board than in the face-to-face meeting (alpha < 0.01). The majority of the comments left on the bulletin board (54.6%) were for emotional support of each other; no "flaming" or overt disagreements occurred. The more clients participated in the voice bulletin board, the more they felt a sense of solidarity with each other (alpha < 0.001). Members of the experimental group reported significantly lower rates of visiting outpatient clinics than members of the control group (alpha < 0.05). Lower utilization did not lead to poor health status or more drug use: There were no statistically significant differences in the health status and drug use between the experimental and the control groups. CONCLUSIONS: Voice bulletin boards may be an effective method of providing support to mothers who have a history of drug use. Use of these services may lead to lower cost without worsening patients' health.

Adult↗

PubMed1996

Computer reminders improve on-time immunization rates.

OBJECTIVES: This study examines the effectiveness of computer-generated telephone reminders in improving infants receiving on-time immunizations. A computer called parents at home, reminded them of their child's visit, and asked if they could keep the appointment. If parents either canceled or failed to honor the appointment, the computer called back a few days later and asked them to reschedule. METHODS: A medical assistant recruited 124 consecutive mothers to receive automated computer reminders. These mothers' infants were younger than 6 months, were being seen at an outpatient clinic for a first visit, and were patients of three attending physicians and three nurse practitioners. These infants were compared to 89 infants from the same clinic, in the same age range, who were being seen for the first time during the same period by the same providers but not contacted by the medical assistant. Subjects were selected from mothers who brought their infants for their first visit in an outpatient urban clinic that serves predominantly minority clients. A research assistant reviewed patients' medical records and collected the infants' birthday, mothers' age, race, source of payments, and the immunization record of the infants. Immunization was considered to be late if, at the time of the first visit, it was more than 30 days past due for any of the recommended immunizations of the American Academy of Pediatrics, except for Hepatitis B vaccine which was not recommended at the time of the study. The dependent variable was on-time immunization. The independent variables were age of the mother at baseline, age of the child at baseline, and membership in either the comparison or the experimental group. Chi-square tests and logistic regression were used to analyze the data. RESULTS: The participation rate for appointments for the experimental group was 82%, as compared to a 69% overall participation rate for the clinic providers. The on-time immunization rate for experimental subjects was 67.8%, whereas the comparison group had an on-time immunization rate of 43.4% (differences were significant at alpha levels less than 0.01). CONCLUSIONS: Computerized reminders sent to the parents led to an increase in participation rate at the clinic and an increase in on-time immunization for their infants.

Adult↗

PubMedDate not supplied

Automated monitoring of outcomes: application to treatment of drug abuse.

This paper suggests a new approach for lowering follow-up costs, improving the delivery of health care, and monitoring treatment outcomes. An automated telephone follow-up system that calls, identifies, and interviews clients is an alternative method for monitoring patients that may be both reliable and cost-effective. To test the viability of such a system, the authors monitored a patient population that has historically been shown to be difficult to follow: recovering drug users and alcoholics. Forty-two subjects were asked to call the computer and complete interviews on a weekly basis for five months. Clients answered 25 recorded questions by pressing the keys on their telephone pads. The computer automatically analyzed the clients' answers and estimated a probability of relapse for each client. In addition, the computer automatically called subjects who failed to complete interviews at the scheduled times. The study showed that self-reported data collected by a computer are as reliable as data obtained through a written questionnaire and that clients are more willing to respond to computer interviews than to mailed written questionnaires. This study also provides preliminary data on the predictive ability of a questionnaire for predicting relapse.

Adult↗