The provider-patient relationship in academic health centers: the movement toward patient-centered care.
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Academic Medical Centers↗
Biomedical subjects
B Gerbert
Publications and source records attributed to B Gerbert.
Risk perception and risk communication: benefits of dentist-patient discussions.
Experts in risk communication have encouraged dentists to initiate discussions about dental office-related risks with their patients. However, little is known about how often these discussions occur--and even less about their consequences. A survey of 4,061 dental patients explored patients' concerns, the frequency of risk-related discussions and their correlates. Patients who discussed concerns were less fearful about dentistry and more likely to receive dental care often. The study findings highlight the complexities of risk communication.
Chi-Square Distribution↗
Dental hygienists' perceptions of preparation and importance of curriculum topics.
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Adult↗
Dentists and the patients who love them: professional and patient views of dentistry.
Dentistry has long been identified with the bizarre or sadistic in books, movies and sitcoms. But how do dentists see themselves? How do patients view their dentists? Professional qualities of the ideal dentist, the surveyed dentist and the dentists of surveyed patients are discussed.
Clinical Competence↗
Addressing the public's concerns about human immunodeficiency virus transmission in health-care settings.
BACKGROUND: The 1990 report of a cluster of patients infected with the human immunodeficiency virus (HIV) associated with a Florida dentist with acquired immunodeficiency syndrome attracted considerable media coverage and legislative attention. A number of polls found that the public favored mandatory HIV-antibody testing of health-care workers. The Centers for Disease Control and Prevention, Atlanta, Ga, conducted a two-phase study to understand how public concerns regarding potential HIV transmission in health-care settings can be addressed by the medical and public health communities. METHODS: Sixteen focus group discussions in nine US cities were conducted to explore the public's perceptions, concerns, and behavioral responses regarding HIV transmission in health-care settings. Using this information, a questionnaire was developed and administered to a nationwide probability telephone sample of 1150 adults. RESULTS: Concern about contracting HIV in health-care settings was highest for emergency department treatment and lowest for treatment by a personal physician. Two factors directly related to patient care, ie, the health-care professional's willingness to discuss acquired immunodeficiency syndrome and the presence of acquired immunodeficiency syndrome educational materials in the waiting room, were considered useful factors for determining potential risk of transmission of HIV in a health-care setting. CONCLUSIONS: Public concern about the potential for HIV transmission in health-care settings remains high. Active steps on the part of health-care professionals, such as providing educational materials and initiating discussions about infection control procedures and about HIV and acquired immunodeficiency syndrome, could likely have positive effects in terms of alleviating these concerns.
Adolescent↗
HIV-infected health care professionals. Public opinion about testing, disclosing, and switching.
BACKGROUND: We wanted to know what the public believes about the risks of human immunodeficiency virus (HIV) transmission in health care settings, and what opinions the public holds regarding HIV-infected health care professionals. We also wanted to uncover the correlates and predictors of those opinions. METHODS: A telephone survey of a nationwide random probability sample of adults was conducted in summer 1991. Thirteen hundred fifty adults completed the survey. The response rate was approximately 63%. We assessed (1) public opinion about whether HIV-infected physicians, surgeons, and dentists should quit working, and (2) the public's self-reported intention to remain in the care of an HIV-infected professional or to switch to another provider. RESULTS: Public concern about HIV transmission in health care settings has increased from 19% in 1988 to 38% in 1991. More of the public now believes that transmission from HIV-infected physicians is likely (up from 33% in 1988 to 46% in 1991). Yet, fewer respondents believe that HIV-infected physicians should not be allowed to work (45% vs 39%). Only 5% would deprive HIV-infected physicians of their livelihood as physicians. Fewer would switch from HIV-infected physicians now than in 1988 (56% vs 37%). Knowing someone with HIV infection was related to less concern and to less belief in likelihood of transmission as well as to increased support of HIV-infected health professionals' right to work. CONCLUSIONS: Although the public is more concerned about HIV transmission in health care settings since 1988, fewer would not allow HIV-infected health care professionals to work now than in 1988. Personalizing the epidemic, by using personal physicians and people with acquired immunodeficiency syndrome as educators, might help continue the trend toward improved attitudes toward HIV-infected health care professionals.
Adolescent↗
Is anybody talking to physicians about acquired immunodeficiency syndrome and sex? A national survey of patients.
OBJECTIVE: We wanted to know what proportion of the US population had spoken with a physician about sex and the acquired immunodeficiency syndrome (AIDS). In particular, we wanted to know whether patients who were at risk for sexually transmitted diseases, including human immunodeficiency virus (HIV), had had such discussions. DESIGN: A telephone survey of a US nationwide random probability sample of adults was conducted in the summer of 1991. PATIENTS: The survey was completed by 1350 adults; of these, 1312 were patients, defined as those who reported that they had been to a physician within the last 5 years. MAIN OUTCOME MEASURE: We assessed whether patients reported having had discussions about sex and AIDS with physicians. RESULTS: Only 259 (20%) of patients in our survey reported that they had talked with a physician about AIDS. Fifty-five (21%) of those who had talked with a physician about AIDS reported that the physician started the discussion. Few patients reported that they had spoken with a physician even when it appeared vital that they do so: 46 (26%) of those who reported that their chances of getting the AIDS virus were "high" or "medium" and 25 (23%) of those who reported being at behavioral risk for AIDS had spoken to a physician about AIDS. CONCLUSIONS: Few patients reported having discussed sex and AIDS with a physician, even if the patients considered themselves to be at risk for contracting HIV or another sexually transmitted disease. More of these discussions must take place to prevent the spread of sexually transmitted diseases and AIDS and to facilitate testing and early treatment of HIV-infected individuals.
Acquired Immunodeficiency Syndrome↗
AIDS in the public eye: is the epidemic viewed as a crisis?
To determine public opinion about the importance of AIDS as a social and policy issue, we conducted a telephone survey of a nationwide random probability sample of adults in the United States, summer 1991. Thirteen hundred and fifty adults completed the survey. The response rate was 63%. We found that 93% of respondents believe that AIDS is a crisis, and 90% believe that AIDS in the US is out of control. In addition, most people reported believing that the government should spend as much as necessary to solve the AIDS epidemic and that AIDS is a problem for everyone in society, not just those who have the disease. Respondents who had a personal connection to the AIDS epidemic (e.g., knew someone infected with HIV) and those who did not have such a connection equally believe that AIDS is an important social and political issue. In conclusion, we found that AIDS is being accorded great importance by the majority of the US public, regardless of demographic group membership and individual personal connection to the epidemic. However, AIDS scientists must be mindful of potential shifts in public opinion when considering strategies to disseminate research findings.
Acquired Immunodeficiency Syndrome↗
CPR requirements for dental schools and state licensure.
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Cardiopulmonary Resuscitation↗
Compliance with infection control procedures among California orthodontists.
We conducted a survey of a random sample of California orthodontists and of general dentists to compare their infection control procedures. Questionnaires were returned by 124 orthodontists (56% response rate) and 126 general dentists (61% response rate). Eighteen questions were asked covering practice profile, perception of risk from hepatitis B virus (HBV) and human immunodeficiency virus (HIV), exposure to blood, barrier protection used, and sterilization and disinfection procedures. Gloves always were worn by 80% of the orthodontists sampled, 63% always wore glasses, and 59% changed gloves between patients. Orthodontists sterilized their instruments 66% of the time and pliers 49% of the time. Compared with general dentists, orthodontists' perception of risk, use of barrier protection, and sterilization and disinfection procedures were lower in all areas. Our data suggest that poorer performance may be because orthodontists: (1) perceive their younger population of patients at less risk for HBV and HIV; (2) treat 2.5 times as many patients, which increases the costs of infection control; (3) do not use invasive procedures; and (4) perceive that glove use decreases dexterity. Orthodontists should follow the American Dental Association/Council on Dental Therapeutics infection control guidelines for universal precautions. To meet these guidelines, orthodontists still need improvement in all aspects of their infection control procedures.
Adolescent↗
Risks of the "big three": what dentists and patients believe about dental amalgam, fluoride and HIV.
Dental professionals have seriously considered the risks to the public from dental amalgam, fluoridated water and HIV transmission in the dental office. These issues are important to the public, who typically rely on practicing dentists for information about just how serious the risks are.
Attitude of Health Personnel↗
How dentists see themselves, their profession, the public.
The public traditionally has held dentistry in high regard as a profession. But some recent evidence suggests a decline in public confidence--a fact that may be affecting the way dentists view themselves. What should and can be done?
Attitude of Health Personnel↗
Primary care physicians and AIDS. Attitudinal and structural barriers to care.
OBJECTIVE: To explore the extent to which primary care physicians are providing health care for people with human immunodeficiency virus (HIV) infection and to document barriers to HIV care giving. DESIGN: National random-sample mailed survey. PARTICIPANTS: Population-based random sample of 2004 US general internists, family physicians, and general practitioners in 1990. Response rate was 59%. MAIN OUTCOME MEASURES: HIV treatment experience, willingness to treat HIV-infected patients, negative attitudes toward homosexuals and intravenous drug users, fear of contagion of the acquired immunodeficiency syndrome (AIDS), perceived lack of information about AIDS, and time demands of HIV care. RESULTS: Most physicians (75%) had treated one or more patients with HIV infection. A majority (68%) believed that they had a responsibility to treat people with HIV infection, yet half (50%) indicated that they would not, if given a choice. Over 80% of respondents believed that they lacked information about AIDS and that caring for people with AIDS is time consuming. Further, 35% of respondents agreed that they "would feel nervous among a group of homosexuals" and 55% expressed discomfort about having intravenous drug users in their practice. Physicians who had treated 10 or more HIV-infected patients expressed less negativity toward members of these stigmatized groups who are likely to be HIV infected. CONCLUSIONS: These data suggest that many primary care physicians are responding professionally to the AIDS epidemic but that attitudinal barriers may be hindering some physicians from providing treatment to HIV-infected patients.
Acquired Immunodeficiency Syndrome↗
Possible health care professional-to-patient HIV transmission. Dentists' reactions to a Centers for Disease Control report.
On July 27, 1990, the Centers for Disease Control reported possible transmission of the human immunodeficiency virus (HIV) from a dentist to a patient as a result of patient care. We surveyed a random national probability sample of 300 dentists with a 26-item survey in August and September 1990 to assess reactions to the report (response rate, 59%). Respondents tended not to believe the report (mean was 3.2, median 3.0, where 1 indicated "do not believe" and 7 indicated "believe"). Our sample also tended to believe that transmission of HIV from dentists to patients was unlikely in the future (mean was 2.0, median 2.0, where 1 indicated "not at all likely" and 7 indicated "very likely"). Fifty-one percent of our sample recommended that dentists infected with HIV should discontinue practice, while 38% recommended continuing practice with changes in procedures. Seventy-four percent believed patients should be told if their dentist was infected with HIV. In summary, dentists doubted the possibility of dentist-to-patient transmission of HIV and did not believe the Centers for Disease Control case report, but they did believe infected dentists should refrain from clinical work or modify their practice.
American Dental Association↗
The impact of who you know and where you live on opinions about AIDS and health care.
We hypothesized that public attitudes towards AIDS and the safety of health care in the era of HIV would be more positive for people who knew someone with AIDS. We believed, moreover, that living in areas with high AIDS prevalence would result in more favorable attitudes. To test these hypotheses, we conducted telephone interviews with a random sample of 2000 U.S. adults (response rate = 75%) in summer 1988. Overall 19.5% of respondents said that they knew someone with AIDS or the AIDS virus. Thirteen percent of people who lived in low prevalences areas reported knowing someone with AIDS, compared with 27% of those in areas of high prevalence. Of the total sample, 38% reported knowing someone they believed was at risk. People who knew someone with AIDS were less likely to say they would change physicians or dentists if their provider was HIV infected or was known to be treating people who were infected. Knowing someone with AIDS was also associated with greater tolerance for those with AIDS to continue to work if they were able and with lower perception of risk of transmission in health care settings. Multivariate regression analyses indicated that personal contact was related to more positive attitudes. Counter to our hypothesis, living in a high prevalence area had no independent effect on attitudes. This surprising finding suggests that, after controlling for personal contact with someone with AIDS, where one lives does not influence attitudes. Because bringing people with AIDS into contact with others may have positive outcomes, we suggest implementation of interventions using this strategy.
Acquired Immunodeficiency Syndrome↗
Public perception of risk of AIDS in health care settings.
Our nationwide telephone survey conducted in 1988 (n = 2,000) reveals that the public perceives a considerable risk of contracting AIDS during routine transactions in health care settings. In addition to previously noted public concerns about getting infected with the AIDS virus through blood transfusions and blood donations, respondents also think that AIDS can be transmitted through contact with HIV-infected health care workers during routine treatment in medical or dental offices and in hospital emergency rooms. Effective education programs must be developed to address these public concerns.
Acquired Immunodeficiency Syndrome↗
Issues in the dental care management of patients with bloodborne infectious diseases: an opinion survey of dental school seniors.
This study revealed some significant findings concerning the views of dental school seniors. Through a series of questions, we determined the opinions that seniors had about treating patients with bloodborne infections and the way they regarded their professional responsibility to provide care to these patients. We were able to identify that the majority of seniors had knowingly treated patients with one of these diseases, and believed that they had a professional obligation to do so. The study showed that these future professionals were aware of the risks related to disease transmission and they had real concerns about those risks; nevertheless, they were prepared to accept their professional obligation to provide care to these individuals. More than half of the survey population was fearful of treating patients with these diseases, and over half indicated that they would not treat these patients given the choice. This fear was compounded by their presumption that other patients would not want to be treated by a dentist who provides care to HBV/HIV patients, and by the presumption of increased cost of infection control. More than three fourths of these dental seniors agreed that treatment of infected patients would place them at higher risk. Nevertheless, in the face of this perceived danger, 62 percent indicated that they were willing to treat these patients, 79 percent said that they were capable of treating them, and 76 percent acknowledged the responsibility of the profession to treat. Another finding of note involves the treatment of infected patients and the effect that treatment experience had on the seniors' attitudes.(ABSTRACT TRUNCATED AT 250 WORDS)
Attitude of Health Personnel↗
Planning, implementation, and evaluation of AIDS education programs for dentists.
Because many dentists were trained before HIV disease was recognized and its implications for dentistry understood, there is a need for effective continuing education programs about the disease for health professionals. Unfortunately, much of the continuing professional education about AIDS in the last few years has been poorly evaluated and the value of continuing education itself has increasingly been called into question. In order to clarify how continuing educational efforts can be designed and evaluated, we report on our continuing educational projects and research which culminated in research on a nationwide educational intervention about AIDS for dentists. We outline and evaluate the steps taken in designing both the intervention and the research. The strengths and weaknesses of the design are discussed and suggestions made about how the design could be improved.
Acquired Immunodeficiency Syndrome↗