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Biomedical subjects

E C Rich

Publications and source records attributed to E C Rich.

At least 37 records · Page 2Linked to original sources
PubMed1996

Physicians, pharmaceutical sales representatives, and the cost of prescribing.

OBJECTIVE: To evaluate the influence of primary care physicians' attitudes toward and use of information provided by pharmaceutical representatives on prescribing costs in ambulatory practice. DESIGN: A mailed questionnaire collected information about physician demographic and practice characteristics and attitudes toward and use of information provided by pharmaceutical representatives. PARTICIPANTS: Kentucky physicians practicing primary care adult medicine (family medicine, general practice, general medicine; n = 1603). MAIN OUTCOME MEASURE: Relative cost of prescribing, based on physician responses to treatment choices for ambulatory clinical scenarios in primary care. A multivariable regression model assessed predictive relationships between independent variables and prescription costs. RESULTS: Four hundred forty-six returned questionnaires were suitable for analysis. No significant differences were noted in age, gender, days worked per week, or years since graduation between responders and a sample of nonresponders. A significant positive correlation was found between physician cost of prescribing and perceived credibility, availability, applicability, and use of information provided by pharmaceutical representatives (P < .01, Pearson's Product-Moment Correlation Coefficient). Physicians in academic or hospital-based practice settings had significantly lower prescribing costs than physicians in nonacademic and nonhospital practices (P = .001, analysis of variance). Frequency of use of information provided by pharmaceutical representatives (P = .01, multiple linear regression) and the group practice setting (P = .02, multiple linear regression) remained significant, independent positive predictors of cost in the multivariable regression model. CONCLUSIONS: Frequency of use of information provided by pharmaceutical representatives and the group practice, nonacademic and nonhospital setting may be associated with increased primary care physician prescribing costs.

Attitude of Health Personnel↗
PubMed1996

Housestaff experience, workload, and test ordering in a neonatal intensive care unit.

BACKGROUND: Little is known of how the inexperience or the clinical workload of housestaff affects the decisions they make in the neonatal intensive care unit (NICU). The authors hypothesized that less experienced interns would order more tests per infant than more experienced residents, especially under conditions of heavy workload. METHOD: The NICU at the University of Kentucky A. B. Chandler Medical Center has either an intern or a resident on call by himself or herself at night, a natural setting to compare test ordering by interns and residents. The authors counted the numbers of X rays, analyses of arterial blood gases (ABGs), and electrolyte determinations ordered by the house officers on call for 321 infants from July through November 1993. Data for nine interns and seven residents were compared using multivariate linear regression. RESULTS: When workload became heavier (about five NICU patients), the interns increased their ordering of ABGs per infant to a significantly greater degree than did the residents (p = .01), with the difference being even greater on weekends when the housestaff were under less supervision (p = .004). CONCLUSION: As workload becomes greater in the NICU, interns order more ABGs per infant than do more experienced residents, especially when the interns are less supervised.

Academic Medical Centers↗
PubMed1996

Hills, ridges, mountains, and roads: geographical factors and access to care in rural Kentucky.

Access to health care remains an important issue facing many individuals. Barriers to health care include financial factors, characteristics of the individuals and of the health care delivery system, as well as geographical factors. Using a telephone survey of Kentucky residents, this study investigated the relationship between the road quality and county elevation and access to health care for individuals in rural and urban areas of the state. Controlling the comparison for known individual characteristics, community characteristics, and medical infrastructure characteristics, this study uncovered that worse road conditions, measured by a road "rideability" index, were associated with longer times to reach medical care. It also found an association between higher county elevations and shorter times to reach medical care.

Catchment Area, Health↗
PubMed1996

Housestaff social history knowledge. Correlation with evaluation of interpersonal skills.

It was hypothesized that internal medicine housestaff who inquire into their hospital patients' social histories would be rated by nurses and attendings as having better interpersonal skills. Thirty-seven internal medicine housestaff were asked to answer a questionnaire regarding the social history of up to three of their hospital patients. The score on these questionnaires was then compared to evaluations by nurses and attendings of housestaffs' interpersonal skills. We found that nurses' evaluations of housestaff interpersonal skills correlated with performance on the social history questionnaire, while attendings' evaluations did not. Social history inquiry by housestaff may be a marker for housestaff humanistic and interpersonal skills.

Adult↗
PubMed1995

Patient perceptions of physician acceptance of gifts from the pharmaceutical industry.

OBJECTIVE: To examine patient perceptions of professional appropriateness and the potential impact on health care of physician acceptance of gifts from the pharmaceutical industry. DESIGN: A random-digit dialing telephone survey. SETTING AND PARTICIPANTS: A sample of 649 adults (> or = 18 years old) living in Kentucky. MAIN OUTCOME MEASURES: Patient awareness of office-use gifts (eg, pens, notepads) and personal gifts to physicians from the pharmaceutical industry, patient exposure to office-use gifts, and attitudes toward physician acceptance of both office-use and personal gifts. RESULTS: The survey had a response rate of 55%. Eighty-two percent of the respondents were aware that physicians received office-use gifts, while 32% were aware that physicians received personal gifts. Seventy-five percent reported receiving free samples of medication from their physicians. Compared with office-use gifts, more respondents believed that personal gifts to physicians have a negative effect on both health care cost (42% vs 26%) and quality (23% vs 13%). After controlling for demographic variables, as well as awareness and exposure to physician gifts, individuals with at least a high school education were 2.4 times as likely to believe that personal gifts have a negative effect on the cost of health care and 2.3 times as likely to believe that personal gifts would have a negative effect on the quality of health care. CONCLUSIONS: These results suggest that the public is generally uninformed about personal gifts from pharmaceutical companies to physicians. If public perception regarding the objectivity of the medical profession is to serve as a guide, these findings suggest a reevaluation may be in order for guidelines regarding physician acceptance of gifts from the pharmaceutical industry.

Adult↗
PubMed1995

Knowledge and experience with Alzheimer's disease. Relationship to resuscitation preference.

BACKGROUND: Previous studies suggest that 20% to 67% of patients would desire cardiopulmonary resuscitation (CPR) even if they had advanced Alzheimer's disease. These preferences were not affected by education about CPR. We hypothesized that CPR preferences in scenarios involving Alzheimer's disease are influenced more by knowledge of or experience with Alzheimer's disease than by knowledge of CPR and its outcomes. METHODS: We performed a random digit-dialing telephone survey of adult Kentuckians in June 1993. A total of 661 persons responded. We asked respondents whether they have had a friend or family member with Alzheimer's disease and whether they had cared for that person at home. We then assessed basic knowledge of Alzheimer's disease and CPR. We read to one half of respondents an educational paragraph describing CPR and its outcomes. Finally, we asked respondents their CPR preference if they were to develop Alzheimer's disease. RESULTS: Overall, 22% of respondents would probably or definitely want CPR if they had Alzheimer's disease. With the use of simultaneous multiple linear regression, predictors of refusing CPR in scenarios involving Alzheimer's disease included knowledge of or experience with Alzheimer's disease (P < .001), older age (P < .001), greater income (P < .004), female sex (P < .01), and nonwhite race (P < .04). Baseline knowledge of CPR did not affect CPR preferences, nor did being read the educational paragraph. CONCLUSIONS: Cardiopulmonary resuscitation preferences in scenarios involving Alzheimer's disease are strongly associated with knowledge of or experience with Alzheimer's disease more so than with knowledge of CPR. These findings suggest that in eliciting patients' CPR preferences in an advanced directive, care must be taken that patients understand the condition presented in the scenario (eg, Alzheimer's disease).

Adult↗
PubMed1995

Housestaff's knowledge of their patients' social histories.

PURPOSE: To assess the extent to which house officers know the social histories of their hospital patients, and to examine the factors that influence social history knowledge. METHOD: In October-November 1992, all 31 internal medicine housestaff rotating on the hospital inpatient services at the University of Kentucky A. B. Chandler Medical Center completed questionnaires regarding the social histories of up to three of their patients. Responses were analyzed using simultaneous multiple linear regression analysis. RESULTS: Standard questions about social history were answered correctly only 29% of the time (two of seven items). The overall knowledge of patients' social histories was significantly less for supervising residents than for interns (p = .03) and, independently, for housestaff with greater patient loads (p = .04). Knowledge of a patient's social history was not related to the particular inpatient service, time the patient was admitted, or other characteristics of the patients or residents. CONCLUSION: The internal medicine residents' knowledge of their hospital patients' social histories was limited, particularly when the residents had relatively heavy patient loads or supervisory roles in patient care. The data suggest that patients' social histories may have been underemphasized during the residents' training.

Adult↗
PubMed1995

Interactions with colleagues and their effects on the satisfaction of rural primary care physicians.

Physician work satisfaction is related to several aspects of practice organization, including work group or colleagues, job content, work hours, and future opportunities. Practice location is an important determinant of practice organization and personal life satisfaction. This study compared the professional satisfaction of physicians in rural and urban settings to determine how practice setting, practice type, work hours, and interactions with colleagues influenced satisfaction. Surveys focusing on professional satisfaction were mailed to community-based, primary care physicians in Kentucky. Overall, physicians were satisfied with their practices, with physicians in larger communities being more satisfied than those from smaller communities. Professional satisfaction was associated with practice location, practice type, number of years since graduation from medical school, number of colleagues identified, and the quality of professional interactions with colleagues. The study concluded that collegial support for physicians is important in creating work environments that promote professional satisfaction.

Female↗
PubMed1994

The role of clinical workload and satisfaction with workload in rural primary care physician retention.

OBJECTIVE: To examine the relationship between clinical workload and workload satisfaction in rural primary care physician retention. DESIGN: Data from a survey, "Practice Patterns of Young Physicians, 1987: United States," were analyzed. PARTICIPANTS: Data on rural primary care (general or family practice, general internal medicine, or pediatrics) physicians working full time (> 35 h/wk) in clinical care were analyzed (n = 373). MAIN OUTCOME MEASURES: Self-reported likelihood of leaving the current practice within the next 2 years. RESULTS: Twenty-five percent of the physicians indicated that they were somewhat or very likely to leave the practice within the next 2 years. The modal reason for the likelihood of leaving was working too many hours (21%). Forty-nine percent of the respondents were dissatisfied with their workload. Those who were dissatisfied with their workload reported a greater likelihood of leaving (P = .0005). However, a quantitative measure of workload was not significantly related to the likelihood of leaving. The results of a multiple regression indicated that employees and those dissatisfied with their workload were most likely to leave the practice within the next 2 years. CONCLUSIONS: Satisfaction with clinical workload is an important factor in the likelihood of retaining rural primary care physicians.

Adult↗
PubMed1994

Preparing generalist physicians: the organizational and policy context.

A combination of financial, regulatory, and professional factors have led to a gradual but pronounced decline in generalist training and practice in the United States. This trend is likely to undergo dramatic reversal, however, as reflected by the diverse range of health care reform proposals incorporating incentives to promote generalist education and primary care practice. Considerable consensus has been reached by a number of professional organizations and public policy groups regarding the broad details of reform of generalist physician training, but key areas of controversy remain with important implications for academic medical centers. In addition, the generalist professional organizations, particularly those of family practice, general internal medicine, and general pediatrics, are being challenged to reconcile historic differences in the definitions and training of generalist competence. In this, the cell for "retraining subspecialists" with both offer an opportunity and entail a risk. Finally, academic medical centers will need new organizational structures that can combine the distinctive intellectual traditions and the expertise of the generalist medical disciplines to develop new approaches to the education and practice of primary care.

Academic Medical Centers↗
PubMed1994

The effects of scheduled intern rotation on the cost and quality of teaching hospital care.

We studied the effect of scheduled intern rotations on the cost and quality of inpatient care at one teaching hospital. For all discharges from the internal medicine service between 1980 and 1986, we identified 1,705 rotation patients and 3,141 no-rotation patients. Using linear or logistic regression analysis to control for baseline differences, we evaluated for the effect of rotation. We found that rotation was significantly related to longer length of hospital stay, b = 0.341 days, p = 0.001, and higher hospital charges (for log charges, b = 0.053, p = 0.016. Hospital deaths, nursing home placements, and 30-day readmissions were not significantly related to rotation, p > 0.1. These results suggest that the systematic discontinuity induced by scheduled intern rotations may be another source of increased health care costs experienced at teaching hospitals.

Continuity of Patient Care↗
PubMed1993

The shortage of generalist physicians and federal funding of graduate medical education.

Graduate Medical Education (GME) payments through the Health Care Financing Administration (HCFA) represent the largest portion of federal funding in direct support of training for health professionals. Whatever the benefits of these funds, they clearly have not served as a positive factor in addressing the emerging shortfall of generalist physicians. Therefore, a variety of options are being discussed for restructuring the incentives associated with HCFA GME funds. Seven principal alternatives that have been proposed to address these problems are the following: modification of hospital GME payments, GME payments to medical schools, GME payments to residency programs, GME transfers through Medicare part B, GME transfers to the Health Resources and Service Administration, GME transfers to states through block grants, and GME payments to academic consortia. Unfortunately, each of these approaches offers substantial disadvantages and faces important opposing constituencies. To address these weaknesses, combined strategies and "all payor" federal mechanisms of GME financing have recently been proposed. These compromise approaches have their own administrative and political liabilities as well. Revisions in current HCFA GME payments may be preferable as a first step, but more comprehensive approaches involving all payor financing with mechanisms that reconnect medical school training with primary care practice will likely be required to ensure efficient and effective reform. Such major shifts in the federal funding of GME will not be quick in coming, however, and will doubtless be characterized by a compromise of policy effectiveness with political feasibility.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1993

Resident recognition of open-angle glaucoma: effects of an educational intervention.

To test an educational intervention's effect on improving detection of glaucoma by direct ophthalmoscopy, 14 medicine residents examined five patients, two with ophthalmoscopic changes of glaucoma and three with normal fundi. The residents observed a standardized slide/narrative educational intervention reviewing glaucomatous ophthalmoscopic changes and then re-examined the same patients eight to 12 weeks later. The intervention's odds of improving residents' diagnostic impression were significant (OR = 2.2; 95% CI = 1.3-3.6), with significant improvement in sensitivity (p = 0.02) and a trend toward improved specificity. These findings confirm that the diagnosis of glaucomatous ocular changes on eye examinations by medicine residents can be improved with a brief educational intervention.

Clinical Competence↗