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Biomedical subjects

C J Henke

Publications and source records attributed to C J Henke.

30 records · Page 2Linked to original sources
PubMed1991

Polypharmacy among patients attending an AIDS clinic: utilization of prescribed, unorthodox, and investigational treatments.

The objective of this study was to describe the utilization and characteristics associated with the use of prescribed, over-the-counter, investigational, and unorthodox treatments among AIDS clinic patients. This report is derived from cross-sectional data obtained using structured telephone surveys. Study participants (n = 197) were recruited from the University of California, San Francisco, Medical Center AIDS clinic. One hundred eighty-nine participants (96%) received 1-24 prescription medications during the 3 months prior to interview. Those with an AIDS diagnosis received a relatively greater number of prescription drugs (p = 0.0001); an average of 5.6 prescribed medications were used by AIDS patients versus 4.8 among AIDS-related complex and 2.3 among asymptomatic patients. Thirty-one percent participated in drug trials during the 3 months before interview, including 18% who were in multiple studies. Twenty-nine percent used unorthodox treatments. Seventy-five (40%) received prescription medication from a provider other than their primary provider. A more advanced stage of illness was associated with the use of unorthodox treatments (p = 0.003): users of these treatments had a greater educational attainment than nonusers (p = 0.03) and were significantly less likely to report that their primary provider was aware of all the treatments they used (odds ratio = 2.1, p less than 0.03). We conclude that use of polypharmacy among some AIDS clinic patients is common, could create an increased risk for adverse drug reactions, and may affect clinical drug trials. Despite having decided to obtain care at a university-based clinic, many of the participants of this study also chose to receive unorthodox therapies and care from nonprimary medical providers.(ABSTRACT TRUNCATED AT 250 WORDS)

AIDS-Related Complex↗
PubMed1986

Work disability among persons with musculoskeletal conditions.

We examined the question of what distinguishes persons with musculoskeletal disease who continue working after onset of illness from those who do not. We also investigated why persons with musculoskeletal disease have high rates of work disability relative to those with other chronic conditions of comparable activity limitation. Data regarding 3,100 persons with limitations in activities and chronic disease who were respondents to the 1978 Social Security Administration Survey of Disabled and Non-Disabled Adults were used. Persons with musculoskeletal disease who stopped working had poorer overall health status and physical function, and different work attitudes and working conditions than did those who continued to work. Symptoms of the musculoskeletal condition were poor predictors of whether work disability would result. Persons with musculoskeletal conditions had high rates of work disability, relative to those with other chronic conditions, primarily because of their age, level of comorbidity, and the interaction of the physical limitations imposed by their illness and the requirements of their jobs. They had similar levels of commitment to work and a similar proclivity to seek alternative sources of income as did those with other chronic diseases.

Attitude↗
PubMed1986

Risk factors for hospitalization and surgery in patients with rheumatoid arthritis: implications for capitated medical payment.

Risk factors for hospitalization in patients with rheumatoid arthritis were analyzed to determine if factors proposed for use in adjusting Medicare capitation payments to prepaid health plans are, in fact, associated with use of costly medical care for this illness. Participating physicians from a random sample of half the rheumatologists in northern California provided us with the names of all patients with rheumatoid arthritis presenting during a 1-month period. We surveyed 754 (89%) of these patients in both 1982-83 and 1984 to obtain information about health care use in the previous 12 months. We found that baseline functional status and prior-year admissions (proposed Medicare adjustment factors), as well as disease-specific severity measures, predicted subsequent admissions. The association of prior with subsequent admissions was independent of disease severity and physician characteristics. Adjusting capitation payments for both health status and prior use will increase incentives for prepaid health plans to enroll patients with rheumatoid arthritis who have high expected medical costs.

Arthritis, Rheumatoid↗
PubMed1985

A comparison of the treatment of rheumatoid arthritis in health maintenance organizations and fee-for-service practices.

This study compares the use of health care services (hospital and ambulatory) by patients with rheumatoid arthritis who were under the care of rheumatologists in prepaid and fee-for-service arrangements. Participating physicians from a random sample of half the rheumatologists in northern California maintained a log of all their patients with well-established diagnoses of rheumatoid arthritis. We interviewed 822 of their patients, using a structured, validated phone survey to obtain information about health care use. Patients in prepaid plans had about the same number and type of hospitalizations and the same rate of surgery as those receiving fee-for-service care. However, fee-for-service patients made more ambulatory visits. We conclude that the use of expensive services (hospital admissions and surgery) for the care of patients with rheumatoid arthritis is not different in fee-for-service and prepaid settings.

Ambulatory Care↗
PubMed1981

The nature of U.S. rheumatology practice, 1977.

A description of academic and community rheumatologist practice activities in the United States has been assembled from 826 responses to a 1977 survey of American Rheumatism Association members. Reported work hours and patient load are similar to other medical subspecialists, and three-fourths of the clinical time is devoted to persons with predominantly rheumatic disease problems. Significant differences in activities occur between academic and community practices and among rheumatologists with different training backgrounds. Few characteristics vary significantly across geographic regions containing divergent rheumatologist-population ratios. Descriptive productivity measures such as these are necessary for planning; they provide part of the empirical analysis required to give reality to manpower policies.

Academic Medical Centers↗
PubMed1977

The university rheumatic disease clinic: provider and patient receptions of cost.

A medical school based rheumatic disease clinic provides patient services and educational activities and conducts clinical research. The patient population and routes of access to one such clinic are described, and the effect of direct and indirect costs influencing patient compliance are analyzed. It was found that the program cost of such a facility greatly exceeds the administrative cost. Alternatives to such high-cost facilitities are considered.

Adult↗
PubMed1977

Rheumatology manpower in California. Approaches to assessment of quantitative sufficiency.

Californian specialists in the treatment of rheumatic diseases were surveyed to determine the spatial distribution of rheumatologic services in the state, the amount of patient care time available for the rhematic diseases in each county, the physicians' capacity to treat all rhemmatic disease patients who seek their care, and their perception of the need for more specialists in their area. The data resulting from the survey are analyzed by four methods to assess the sufficiency of medical manpower resoruces.

Attitude of Health Personnel↗
PubMedDate not supplied

The costs of rheumatoid arthritis. A patient-oriented study of chronic disease costs.

To detail the cost for one year of a chronic disease, 50 patients with Stage III rheumatoid arthritis were surveyed. Direct medical costs for this group were three times the national average, and 58% of these costs were covered by insurance. Indirect costs due to lost income were at least three times the direct medical costs, and transfer payments covered only 42% of these costs. Fifty-eight percent of the study group also sustained a major psychosocial loss. Uncovered income losses were the greatest economic burden for individuals with chronic rheumatoid arthritis. This striking ratio of indirect to direct medical costs has important implications for medical practice and health policy.

Adult↗
PubMedDate not supplied

The economic impact of the tacrine in the treatment of Alzheimer's disease.

Alzheimer's disease is a progressive neurodegenerative disorder that results in tremendous economic and quality-of-life burdens. This paper presents estimates of the impact of tacrine use on the costs of caring for patients with Alzheimer's disease. This study presents a cost analysis, based on a decision-analytic model constructed around the milestones in the progression of Alzheimer's disease. Clinical data concerning the effectiveness of tacrine came from published results of an open-label follow-up study of 663 patients originally enrolled in a placebo-controlled clinical trial of tacrine. Data concerning longevity, nursing home time, and costs of community and nursing home care are taken from several reports based on prospective cohorts of patients. The use of tacrine was associated with a cost savings of $9,250 (7.5%) over the patient's lifetime from diagnosis to death, even when averaged over data from patients who discontinued tacrine treatment or took only low doses. Most of the savings were due to reduced time in nursing homes. Patients who continued higher doses of tacrine experienced a cost saving of more than $36,500 over 5 years. Model results persisted over a wide range of sensitivity analysis variations. The use of tacrine for patients with mild-to-moderate Alzheimer's disease reduces the costs of medical and social services required for care, and it increases functioning and delays nursing home placement for up to 433 days. New treatments that can both improve clinical outcomes and save costs should be given serious consideration by clinicians and administrators.

Alzheimer Disease↗
PubMedDate not supplied

Correlates of fatigue in older adults with rheumatoid arthritis.

The purposes of this study were to describe the prevalence of fatigue, examine the association between fatigue and doctor visits, and identify correlates of fatigue in rheumatoid arthritis (RA). On average, a high degree of fatigue was reported to occur every day, to remain constant during the course of a week, and to most often affect walking and household chores. When controlling for disease severity and insurance coverage, respondents who reported more fatigue made more visits to the rheumatologist than those reporting less fatigue. A regression model with fatigue as the dependent variable revealed that the following variables explained a significant amount of variance: pain rating, functional status, sleep quality, female gender, comorbid conditions, and duration of disease.

Aged↗