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Biomedical subjects

D L Patrick

Publications and source records attributed to D L Patrick.

At least 145 records · Page 8Linked to original sources
PubMed1988

A comparison of patient, family, and physician assessments of the value of medical intensive care.

Medical ethics suggest that physicians incorporate patient preferences when making life-sustaining treatment decisions. This study therefore examines how closely physicians' assessments of the usefulness of intensive care agree with their patients' willingness to receive intensive care. Former intensive care patients, at least 55 yr old (or family members of nonsurviving patients), and their physicians were interviewed (n = 76 pairs of interviews) to determine how valuable each believe intensive care would be to the patient (on a scale of 0 to 100%) under actual and ideal life circumstances. Little correlation was found between individual patient or family member and physician responses (Kendall's Tau ranged from -.14 to .22 depending on how long life was prolonged). Physicians' evaluations of intensive care for patients under ideal life circumstances were strongly correlated with physicians' personal preferences for intensive care (Kendall's Tau, .41 to .65, p less than .02). Because physicians and patients may not agree regarding the value of intensive care, physicians must explicitly discuss patients' preferences in order to reconcile wishes and justifiable needs for critical care.

Aged↗
PubMed1988

Poverty, health services, and health status in rural America.

Access to health services for everyone has been a major policy goal in the United States: inequitable access is assumed to lead to inequitable health status, particularly for low-income groups. A sophisticated model of the relation between poverty, health care needs, service use, and health outcomes is used to analyze cross-sectional data on 7,823 adults from 36 rural communities. Improved access and use are helpful, but evidence clearly indicates that combined health and social initiatives will be necessary to reduce inequalities in health status.

Cross-Sectional Studies↗
PubMed1987

A comparison of patient, family, and nurse evaluations of the usefulness of intensive care.

As patient advocates, critical care nurses need to be cognizant of which treatments the patients and their families prefer. Therefore, we conducted a study to compare how nurses, their critically ill patients, and their families evaluate the usefulness of intensive care. A group of former medical intensive care patients (n = 72), or their family members if the patient had died, were asked how willing they would be to undergo (or to subject their relative to) intensive care again, if necessary. All nurses (n = 15) caring for these patients were asked a parallel, hypothetical question about the usefulness of intensive care to these patients and to themselves, were they to become sick. Analysis of matched pairs of patient (or family member) and nurse questionnaires (n = 38) revealed that: nurses underestimate the usefulness of intensive care as evaluated by their patients and families; and patients believe that quality of life is a less important factor in judging the usefulness of intensive care than do their nurses.

Attitude↗
PubMed1986

Psychosocial support and change in the health status of physically disabled people.

Evidence is presented on the relationship between psychosocial support (social contact and emotional intimacy) and changes in health status (physical, psychosocial and emotional functioning) experienced by 583 adults age 45-75 years living at home with a preexisting physical illness. Data were used from a panel study of physically disabled adults in London, England to provide a test of the buffer and direct effects hypotheses concerning social support and adverse life events. Controlling for age, sex and initial level of health status, the analyses showed that a low level of social contact was associated significantly with deterioration in psychosocial and emotional functioning only in the presence of adverse life events. A similar but non-significant pattern existed for physical functioning. A high level of social contact had a more protective effect on the physical functioning of respondents with arthritis or heart trouble who also reported depression, except among women age 45-64. Level of emotional intimacy was not a significant influence on reported health status change. Confiding relationships do not appear important for adults with preexisting illnesses who are not at significant risk of developing stress-related conditions. Social participation outside the home would help to reduce deterioration in psychosocial and emotional functioning, important outcomes for improving and maintaining quality of life.

Aged↗
PubMed1985

A cross-cultural comparison of health status values.

The extent to which the values attached to health states are similar in different cultures or social groups is important for understanding health and illness behaviors and for developing standardized health status measures. A cross-cultural study was conducted to compare the health status values obtained in a United States population (Seattle, Washington) with those from another English-speaking culture (London, England) on the Sickness Impact Profile, a standardized measure composed of 136 items. London judges rated the severity of dysfunction described in each item on an equal interval scale using the same methods of scaling and analysis employed in the Seattle study. A regression of English mean item values on US mean values yielded a slope of 1.00 and an intercept of -0.07, indicating that judges gave strikingly similar ratings to most items. Agreement was higher at the more severe end of the dysfunction continuum than at the least severe end, a finding consistent with the notion that what constitutes health is more difficult to define than what constitutes illness. While a universal conception of dysfunction may exist in English-speaking societies, the social and cultural determinants of health status values deserve more systematic study.

Activities of Daily Living↗
PubMed1984

Social networks and psychosocial support among disabled people.

Analysis of the network characteristics and nature of social ties among physically disabled people living in an inner London borough showed network size rather than network type was related to the availability of psychosocial support, reflecting the important role of both related and non-related people in the provision of this form of support. The study also questioned three commonly held assumptions. Firstly, in contrast to the image of physically disabled people as lacking social ties, those with a high level of disability, although having a lower level of social contact outside the household than other groups, did not differ significantly in other aspects of their network structures and support. Secondly, in contrast to the characterisation of inner city areas as relatively homogeneous and as lacking locally based ties, the inner London area studied comprised a variety of network types with a large proportion of respondents deriving support from people living in close proximity. Thirdly, whereas the presence of household members, and especially a spouse, tend to be equated with the availability of strong emotional support, considerable numbers of married people lacked such support. This suggests measures to promote psychosocial support need to be fairly broadly based and cautions against using marital status as a proxy measure of support.

Adolescent↗
PubMed1983

Disability and patient satisfaction with medical care.

The effect of patients' health status on their satisfaction with medical care should be well understood before individual providers of care are evaluated using patient satisfaction as a criterion. This paper examines how disability is associated with patients' dissatisfaction with medical care services provided by doctors in primary care. Measures of patient satisfaction developed by Roghmann and his colleagues using multidimensional scaling (MDS) were included in a survey of 1,245 respondents living in the London Borough of Lambeth. The measures included attitudes toward the medical profession (general satisfaction) and satisfaction with patients' own provider or regular source of care (specific satisfaction). Disability was assessed using a British version of the Sickness Impact Profile. Consistent with findings from other studies, the majority of respondents expressed satisfaction with most aspects of care, except for doctor availability in an emergency, preventive teaching, and aspects of communication. Replication of the MDS analysis on this study population yielded an overall measure of general satisfaction, and three submeasures of specific satisfaction labelled access, quality, and recent experience. These dimensions also emerged from a content analysis of responses to an open-ended question. Respondents with a higher level of disability were more likely to be dissatisfied with all three aspects of specific satisfaction. Other social and medical factors, such as sex, social class, medical conditions, self-rating of health, social support, and adverse life events, were significantly related to one or more measures of specific satisfaction. Because disability can influence satisfaction with medical care received from specific doctors or practice settings, attempts to use satisfaction measures for evaluating specific services or providers should distinguish between patient groups with different physical and psychosocial disabilities. Multidimensional satisfaction measures with both positively and negatively worded items anchored to recent and specific consultations would prove more reliable, valid, and useful in future studies.

Adolescent↗
PubMed1983

Use of multivariate measures of disability in health surveys.

It has been claimed that the aggregation of information from several areas of life into a small set of global measures has certain advantages for describing disability. Global measures of disability were constructed from a modified version of an existing health survey instrument and the sickness impact profile (SIP) and their properties were tested. The disability items grouped satisfactorily into five global measures (physical, psychosocial, eating, communication, and work). All disability measures (global and original category scores) were poor predictors of service use by individuals but were related as expected to age and number of medical conditions. The global measures generally had lower standard errors and better repeatability. All scores exhibit J-shaped distributions for cross sectional data but the change in global measures over time was consistent with the normal distribution. Preferably, both global and category measures should be used for comparing changes over time between groups of individuals.

Activities of Daily Living↗
PubMed1982

Disablement and care: a comparison of patient views and general practitioner knowledge.

A questionnaire was used to assess general practitioners' knowledge of handicaps and service use among disabled patients in a group practice. The disabled patients were identified by a postal screening questionnaire. Sixty-eight were subsequently interviewed to assess the severity of restrictions on their activities and to collect information about informal support and use of community or hospital services. The areas of life in which the disabled were most affected by their medical conditions were sleep and rest, household management, emotion and mood. Relatives assisted the disabled considerably with all daily activities but more help was requested. Most disabled patients had consulted their general practitioner or attended casualty and outpatient clinics, but only a minority had used other community services. Prescription of drugs was considered the most important service the doctor provided. A second questionnaire, which the general practitioners completed with the help of their records, revealed that they knew of only 50 per cent of the difficulties with daily living reported by the disabled and even less of the aids, appliances and services used. A better awareness of these facilities among general practitioners might lead to a more effective distribution of resources among their patients.

Activities of Daily Living↗
PubMed1981

Screening for disability in the inner city.

A 10% sample of private households on the electoral register of the London borough of Lambeth was screened for disable persons aged 16 and over, using a postal questionnaire. After three mailings and individual follow-up of non-responders, 87% of the sample households returned questionnaires. Disability was defined in the screening questionnaire as functional limitations or activity restrictions consequent upon disease or impairment. The overall point prevalence of disability was estimated at 15.4% and the most frequently reported impairments were those of the sense organs, bones, central nervous, circulatory, and respiratory systems. Hearing difficulties were the single most frequently reported functional limitation. A log-linear modelling procedure identified age, marital status, and working status as the factors most strongly associated with disability for both men and women. In addition, men aged 50-64 and not working, and men in manual occupations and living alone, were more likely to report disability. These findings indicate that some population groups are disable by functional limitations and activity restrictions not included in office criteria of identification and assessment. These criteria might be broadened, and serves planned for those population groups with higher rates of reported disability.

Adolescent↗
PubMed1981

Estimating the prevalence of disability in the community: the influence of sample design and response bias.

An estimate of the prevalence of physical disability in the community based upon a sample survey may be influenced by the sample design and the response to the method of data collection employed. In this paper we describe a postal survey of a sample of households in the London borough of Lambeth and the procedures used for calculating the influence of these factors on the estimate produced. These procedures can be used to adjust the estimate to take account of the relative chance of households falling into the sample and to correct for non-response bias.

Adolescent↗
PubMed1981

[Quasi experimental evaluation of public health interventions (author's transl)].

The classic experiment, the randomised controlled trial, is the best known and most revered of evaluation research methods. Randomization in community-based intervention trials, however, is not always possible because of ethical problems arising from with holding the experimental treatment from the control groups or the difficulties in conducting experiments in field settings which do not approach controlled laboratory conditions. In such circumstances, quasi-experimental or observational designs must be used. Two major principles are involved in using quasi-experimental methods: (1) the logic for establishing causality between treatment and effect is the same as that for randomised experiments, but the problems of assessing causality or internal validity are greater, and (2) assessment of the external validity or generalizability of quasi-experimental findings crucial to the interpretation of results. Selected quasi-experimental designs using time series and comparison groups are described with examples from public health intervention trials where threats to internal validity have been assessed by using different analytic techniques or gathering additional evidence. Quasi-experimental evaluations are most useful when opportunities exist for testing rival hypotheses concerning the internal and external validity, or the findings can be used to complement true experiments.

Epidemiologic Methods↗
PubMed1980

Evaluation of a postal screening questionnaire to identify the physically disabled.

In this study a postal screening questionnaire was compared with an interviewer-administered questionnaire for identifying disabled persons living in the community. Disability was defined as difficulty with specified activities of daily living, specified medical problems which often cause disablement, and frequent use of a formal health or social service. A 91 per cent response rate to the screening questionnaire was obtained from a random sample of 793 adults in a general practice; 89 were classified as "disabled". Seventy-eight per cent of those subsequently interviewed changed their response to at least one item; this figure fell to 29 per cent when frequent use of formal services was excluded from the definition of disability. None of the persons classified as disabled from the postal survey were considered to be non-disabled after interview. Interviews with a sample of persons who did not report disability on the postal questionnaire resulted in no changes in classification. General practitioners (GPs) who completed screening questionnaires on respondents with the help of practice records were aware of only 79 of 206 disability items reported. The GPs were more aware of respondents' difficulties with activities of daily living than of their medical problems.

Disability Evaluation↗
PubMed1979

Collaboration, consultation and referral in an integrated health-mental health program at an HMO.

The paper describes interactions between primary care physicians (PCP's) and mental health clinicians (MHC's) in a "team collaborative model." A study of the interactions showed there were about two consultations a day with PCP's for each MHC, that they were largely unscheduled, took place mostly in PCP or MHC offices or in corridors, and increased in frequency over a two-year period. Role definition was a continuing process; PCP's and MHC's each learned through repeated discussions what to expect from the other in patient care. It is found that a model with close working arrangements between PCP's and MHC's is of therapeutic value for that large population of emotionally disturbed patients seen often by PCP's much less often by MHC's.

Community Mental Health Services↗
PubMed1978

Primary care treatment of emotional problems in an HMO.

Integrating mental health services into primary care should improve the availability, access, and delivery of psychiatric care to the whole population. Health maintenance organizations (HMOs) are settings for the development of integrated medical-mental health services. This paper reports findings of a project to evaluate a team collaborative model in an HMO. In this model, primary care clinicians carry major responsibility for emotional problems of their patients, and mental health clinicians collaborate with and support primary care clinicians as well as treat referred patients. Over a two-year study period, 15.7 per cent of all patients who visited the HMO presented a mental or emotional difficulty. When psychotropic drug prescriptions were used as an unobtrusive measure for estimating underenumeration, this prevalence figure rose to 19 per cent. Primary care clinicians treated an increasing proportion of the emotional problem demand, although this increase could not be attributed only to the establishment of the team collaborative model. Findings concerning the psychiatric problems treated and psychotropic drugs prescribed by primary care clinicians are also presented. We conclude that the primary care clinicians did assume major responsibility for emotional problem treatment when encouraged and supported through the team collaborative process and other organizational arrangements.

Affective Symptoms↗