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Biomedical subjects

D E Stehr

Publications and source records attributed to D E Stehr.

4 recordsLinked to original sources
PubMed1991

Emergency department return visits in chronic obstructive pulmonary disease: the importance of psychosocial factors.

STUDY OBJECTIVES: Relapses are common after treatment of decompensated chronic obstructive pulmonary disease (COPD) in the emergency department. The purpose of this study was to identify psychosocial and pulmonary function variables that distinguish patients who relapse from those who do not. DESIGN: Retrospective case analysis. A relapse was defined as an unscheduled return to the ED within two weeks of treatment. SETTING: 475-bed Veterans Administration Medical Center. TYPE OF PARTICIPANTS: 33 male veterans with COPD who used the ED. MEASUREMENTS: Demographic profile, a Likert-scaled questionnaire about illness beliefs, and physiologic data obtained by chart review. MAIN RESULTS: Patients who relapsed at least once (R patients) were more likely to be widowed, separated, or divorced than patients who did not relapse at any time (N patients) (52.4% vs 8.3%; P = .011). R patients were more likely to have lost a first-order relative within three years (57.1% vs 8.3% P = .006). Stepwise logistic regression showed that the loss of a first-order relative, a negative attitude about prognosis, and a higher forced vital capacity distinguished R from N patients. Stepwise linear regression showed that six specific illness beliefs, distance of the home from the hospital, and baseline bronchodilator response correlated with the number of relapses (multiple r2 = 0.82; P less than .001). CONCLUSION: Social and psychological parameters are closely correlated with relapse in patients with decompensated COPD.

Aged↗
PubMed1981

Predicting the need for primary care specialists: the example of a southwestern state.

Because of a need to project the requirements for the training of primary care practitioners in the state of New Mexico, we reviewed available means of determining health manpower needs. Combining several of these methods, we constructed a three-tiered model, taking into account different patterns of care-seeking in areas of various population densities. These methods may be applicable in other states like New Mexico where densely populated cities contrast with sparsely settled rural areas. All such methods, however, are confounded by the state of balance of many factors, including immigration and emigration of physicians, use of nonphysician providers, and patient movement across boundaries for care. This report contributes to the growing literature on health manpower needs by recognizing and attempting to account for differences between urban and rural patterns of care-seeking.

Forecasting↗