Biomedical subjects

Daniel Lessler

Publications and source records attributed to Daniel Lessler.

4 recordsLinked to original sources

PubMed2006

In search of mixed anxiety-depressive disorder: a primary care study.

The diagnosis of mixed anxiety-depressive disorder, as proposed in DSM-IV, is intended to be useful in settings such as primary care, where low-level anxiety and depressive symptoms may cause clinically significant impairment but are undiagnosable using current criteria. Evidence of the prevalence of this diagnosis is, however, lacking, particularly since the publication of the proposed diagnostic criteria in DSM-IV. Our study examined symptoms of anxiety and depression in 65 primary care patients screened for anxiety and depression while visiting their doctor. Results indicated that of the 37 patients without a diagnosable anxiety or depressive disorder, none had symptoms of depression and anxiety accompanied by interference that the patient deemed significant and attributable to his or her symptoms. These data dispute the need for a mixed anxiety-depression category (beyond mood and anxiety syndromes currently in DSM-IV) in future editions of the DSM.

Anxiety↗

PubMed2003

Colorectal cancer screening among African Americans: the importance of physician recommendation.

INTRODUCTION: African Americans have higher colorectal cancer incidence and mortality rates than whites. They are also more likely to be diagnosed with late-stage disease and less likely to survive for at least five years after diagnosis. Lack of adherence to colorectal cancer screening recommendations has previously been found to be associated with lower income, lower educational level, and racial/ethnic minority status. METHODS: One hundred-fifty African-American patients (aged 50-79 years) of an inner city hospital, were surveyed by mail and telephone in early 2002. Seventy-six patients completed the survey, and data from 74 surveys were analyzed. RESULTS: Approximately one-half (55%) of the respondents reported having received a fecal occult blood test (FOBT) in the last 12 months, sigmoidoscopy in the last five years, or colonoscopy in the last 10 years. Thirty-nine percent of the survey participants reported never having received a physician recommendation for FOBT, 60% reported never having received a recommendation for sigmoidoscopy, and 57% reported never having received a recommendation for colonoscopy. Previous physician recommendation was strongly associated (p < 0.001) with levels of FOBT, sigmoidoscopy, and colonoscopy use. DISCUSSION: Future studies should examine factors that influence primary care physicians' decision-making about ordering colorectal cancer screening tests, as well as patients' decision-making regarding adherence to physician recommendations.

Black or African American↗

PubMed2001

Utilization management: issues, effects, and future prospects.

Utilization management encompasses a diverse set of activities designed to influence the use of health care services and thereby constrain health care resource consumption. Utilization management, which has become one of the most widely used cost-containment approaches, has engendered debate and controversy. Physicians have been outspoken critics of utilization management because it has limited their clinical autonomy and has contributed to an intolerable administrative burden. Insurance carriers, managed care plans, and third-party payers have defended the use of utilization management as an imperfect-but necessary-practice that is needed to reduce consumption of unnecessary or inappropriate health care services. This review examines the operation and effects of three widely used utilization management procedures: prospective utilization review, case management, and physician gatekeeping programs. In addition, it explores the future role of utilization management in the health care system and outlines a set of principles that we believe should be used to guide the development of utilization management strategies in the future.

Cost Control↗

PubMedDate not supplied

Undertreatment of panic disorder in primary care: role of patient and physician characteristics.

BACKGROUND: In contrast with many studies describing the usual care for major depression in the primary care setting, there are few data on treatment received by primary care patients with panic disorder. METHODS: This prospective cohort study describes the self-reported medication use, at 3-month intervals for 1 year, of 58 patients with panic disorder and predictors of the use of appropriate (type, dose, and duration) medication. RESULTS: Approximately one half the patients received some type of antipanic medication at each interval, with selective serotonin reuptake inhibitors (SSRIs) the most common. Pharmacy records indicate that about 40% of patients not taking medication had received an initial physician prescription. Adequacy of dose and duration was achieved in only two thirds of the medication trials, usually with an SSRI. Patient characteristics (agoraphobia and low neuroticism) but not physician characteristics (eg, specialty, level of training, or years in practice) predicted those patients who had an adequate trial during at least one time interval. The relation between adequacy of medication and outcome was minimal. CONCLUSION: These findings highlight the continued undertreatment of panic disorder in primary care but suggest that focused efforts at physician education about diagnosis and treatment are less likely to increase rates of treatment compared with efforts to educate patients and improve the care process with more frequent visits and monitoring.

Adult↗