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Biomedical subjects

D Cherkin

Publications and source records attributed to D Cherkin.

At least 19 recordsLinked to original sources
PubMed1994

A brief introduction to the critical reading of the clinical literature.

Clinicians are bombarded by reports of new diagnostic tests or treatments for patients with spine problems. To provide the best possible patient care, clinicians need to be able to critically appraise the results of such studies for validity and relevance to patient care. Important questions to be asked of any description of diagnostic or treatment studies are the following questions: 1) Are the patients described in detail so that you can decide whether they are comparable to those that you see in your practice? 2) Are the treatments or assessments described well enough so that you could provide the same for your patients? 3) Was a clinically relevant endpoint measured? 4) Is there an appropriate comparison group? 5) Are potential sources of bias appropriately attended to? 6) Are the results clinically significant?

Humans↗
PubMed1994

Effects of practice style in managing back pain.

OBJECTIVE: To assess the effects of a practice style of back pain management consistent with self-care (infrequent prescribing of pain medications and bed rest) on long-term functional outcomes, costs of care, and patient satisfaction. DESIGN: A quasi-experimental observational study in which primary care physicians (n = 44) were categorized according to one of three practice style groups defined by a low, moderate, or high frequency of prescribing pain medications and bed rest for many patients (average, 24 patients per physician). SETTING: Primary care practices of a large, staff model health maintenance organization, Group Health Cooperative of Puget Sound. PATIENTS: Consecutive patients with back or neck pain of participating primary care physicians. Patients were interviewed 1 month (n = 1071) and 1 year and 2 years (n = 911) after their index visits. RESULTS: Patients in the three practice style groups rated similarly the quality of medical care received for back pain. Patients treated by physicians who infrequently prescribed pain medications and bed rest were more satisfied with education about back pain. On a scale of 0 to 10, the mean rating of agreement with the statement, "After your visit the doctor, you fully understood how to take care of your back problem," was 5.6 +/- 3.6 among patients of physicians who frequently prescribed medication and rest and was 6.6 +/- 3.5) among those who infrequently prescribed medication and bed rest. At 1 month, 30% of patients of physicians who infrequently prescribed medications and bed rest were graded as having moderate to severe activity limitation because of back pain, whereas 37% of patients in the moderate group had this grading, and 46% of patients of physicians who frequently prescribed were graded as having moderate to severe activity limitation. Differences in activity limitation by practice style group were no longer evident at 1 or 2 years of follow-up. The total 1-year costs of back care were higher among patients seen by physicians who frequently prescribed bed rest and pain medications (cost, $768 +/- $1592) than among those seen by physicians who infrequently prescribed (cost, $428 +/- $665), due largely to differences in inpatient and specialty care costs. The adjusted difference in costs, after controlling for case-mix variables, was $277 (95% Cl, $85.50 to $471.32). CONCLUSIONS: A practice style consistent with back pain self-care yielded similar long-term pain and functional outcomes at lower cost and was associated with higher satisfaction with patient education compared with a practice style characterized by more frequent prescribing of pain medications and bed rest.

Adult↗
PubMed1993

Back pain in primary care. Outcomes at 1 year.

Outcomes of primary care back pain patients (N = 1128) were studied at 1 year after seeking care. Changes in depression depending on outcome, and predictors of poor outcome were evaluated. Less than one back pain patient in five reported recent onset (first onset within the previous 6 months). One year after seeking care, the large majority of both recent and nonrecent-onset patients reported having back pain in the previous month (69% vs. 82%). A significant minority of both recent and nonrecent-onset patients had either a poor functional outcome (14% vs. 21%) or continuing high intensity pain without appreciable disability (10% vs. 16%). Predictors of poor outcome included pain-related disability, days in pain, lower educational attainment, and female gender. Among initially dysfunctional patients with persistent pain, one half were improved and one third had a good outcome at the 1-year follow-up. Among initially dysfunctional patients who experienced a good outcome, elevated depressive symptoms improved to normal levels at follow-up. The outcome of back pain was predicted by pain-related disability and days in pain rather than by recency of onset, so it may be more meaningful to distinguish characteristic levels of pain intensity, pain-related disability, and pain persistence than to classify patients as acute or chronic.

Adult↗
PubMed1993

The impact of physician attitudes on patient satisfaction with care for low back pain.

We wished to determine whether patient satisfaction was related to physicians' confidence in their abilities to effectively manage low back pain, and to examine their attitudes about patients with back pain. The confidence and attitudes of primary care providers were determined using self-administered questionnaires. Patient satisfaction with care was assessed during telephone interviews conducted 3 weeks after a clinic visit for low back pain. The study was conducted in a primary care clinic of a large health maintenance organization. Completed surveys were obtained from 21 primary care providers (18 physicians and three physician assistants) and 270 of their patients with low back pain. Three satisfaction scales specific to low back pain were used to measure patient satisfaction with regard to information received from provider, caring, and effectiveness of treatment. The results showed that the providers' attitudes about patients with low back pain were not associated with any of the patient satisfaction measures. However, patients of more confident providers were significantly more satisfied with the information they received than were patients of less confident providers. These differences could not be explained by years in practice, length of visit, patient demographics, or the severity and duration of low back pain. These findings suggest that providers who have more confidence in their abilities to effectively manage low back pain may in fact be more effective patient educators.

Adolescent↗
PubMed1991

Evaluation of a physician education intervention to improve primary care for low-back pain. I. Impact on physicians.

In an effort to improve the cost-effectiveness of primary care for low-back pain, we developed, implemented, and evaluated a physician education intervention. The program was designed to provide family physicians with specific information, tools, and techniques that our previous studies and the literature suggested should be associated with more satisfying and cost-effective care for low-back pain. The in-clinic educational intervention included feedback of the findings of our previous studies of care for back pain (comparing family physicians and chiropractors), an up-to-date summary of scientific knowledge relevant to the management of back pain in primary care, a videotape contrasting ineffective and effective patient encounters, and a clinical assessment form for low-back pain. The back pain-related beliefs, attitudes, and behaviors of 15 primary care providers in a large health maintenance organization clinic and of 14 family physicians in six group practices were assessed before and after the intervention. Significant increases were noted in the proportions of providers who felt confident they knew how to manage low-back pain, who believed their patients were satisfied, and who claimed they reassured patients that they did not have serious disease. The intervention, however, had little impact on the prevalence of negative feelings about patients with back pain or frustration with patients who wanted their doctor to "fix" their problem. The intervention had a similar impact on health maintenance organization and fee-for-service physicians.

Back Pain↗
PubMed1991

Evaluation of a physician education intervention to improve primary care for low-back pain. II. Impact on patients.

A physician education intervention was previously found to have significantly improved perceived physician knowledge, confidence, and patient-reassuring behavior in the treatment of low-back pain. This study examined whether this intervention, presented in a health maintenance organization clinic, had an effect on patient outcomes. Outcomes of care for 148 patients seen for low-back pain before the intervention were compared with outcomes of care for 157 patients seen after the intervention. Patients were telephoned 2-4 weeks after their back-pain visit and were asked about symptom improvement, amount of disability, and satisfaction with care. Satisfaction was measured with a three-dimensional instrument for low-back pain developed specifically for this study, which was found to be valid and reliable. The preintervention and postintervention patient cohorts were similar in terms of key baseline variables. Despite its apparent benefit to physicians, the intervention did not result in significant improvements in any patient outcomes, even for the subset of patients whose physicians had perceived the greatest benefit.

Back Pain↗
PubMed1989

Family physicians' views of chiropractors: hostile or hospitable?

Family physicians in the State of Washington were surveyed about their knowledge and views about chiropractors; 79 per cent (476) responded. Sixty-six per cent indicated discomfort with what they believed chiropractors do while acknowledging their effectiveness for some patients; 25 per cent viewed chiropractors as an excellent source of care for some musculoskeletal problems and only 3 per cent dismissed chiropractors as quacks that patients should avoid; 57 per cent admitted having encouraged patients to see a chiropractor. These views are less negative than those of organized medicine.

American Medical Association↗