Search PubMed⌕ Search

Biomedical subjects

F J Romm

Publications and source records attributed to F J Romm.

At least 19 recordsLinked to original sources
PubMed1996

Patterns of aspirin use in middle-aged adults: the Atherosclerosis Risk in Communities (ARIC) Study.

To determine correlates of and recent trends in aspirin use in middle-age men and women, we analyzed data from population-based samples selected in four U.S. communities. Aspirin use (during a 2-week period preceding the study examination) was more prevalent in whites than in blacks (30% vs 11%; p < 0.001) and in men than in women among whites (31% vs 28%; p < 0.002) but not blacks (10% in both sexes). In all four race and sex groups, there was a graded positive relation between estimated coronary heart disease (CHD) risk and age-adjusted prevalence of aspirin use. For example, 33% of CHD-free white men who reported diagnoses of hypercholesterolemia and hypertension and had ever smoked reported aspirin use as compared with 25% of their risk factor-free counterparts (p < 0.001). Among men with symptomatic CHD or at high risk for CHD, aspirin use increased by four percentage points between 1987 and 1989 in conjunction with the publication of results from the aspirin primary prevention trials. However, nearly 50% of participants reporting a history of myocardial infarction apparently did not take aspirin regularly.

Black or African American↗
PubMed1995

Population awareness and control of hypertension and hypercholesterolemia. The Atherosclerosis Risk in Communities study.

BACKGROUND: A national program for hypertension detection and control was implemented in the 1970s, whereas a similar program for control of hypercholesterolemia has been implemented in recent years. We studied the levels of awareness, treatment, and control of these conditions in US population samples during a 3-year period (1987 to 1989). METHODS: The levels of awareness, treatment (by medication), and adequate control of hypertension (systolic blood pressure, > or = 140 mm Hg; diastolic blood pressure, > or = 90 mm Hg; or antihypertensive medication) and hypercholesterolemia (serum cholesterol level, > or = 6.21 mmol/L [> or = 240 mg/dL], or lipid-lowering medication) were studied among participants in the baseline examination of the Atherosclerosis Risk in Communities Study, including 15,739 individuals aged 45 to 64 years. RESULTS: Eighty-four percent of the hypertensive subjects and 42% of the hypercholesterolemic subjects were aware of their conditions. Overall, 50% of the hypertensive subjects and only 4% of the hypercholesterolemic subjects had their conditions both treated and controlled. Rates of hypertension prevalence, awareness, and control remained stable during the 3-year study period. Hypercholesterolemia prevalence decreased from 30% in 1987 to 25% in 1989; its awareness increased from 31% to 50% during the same period. Hypertensive women were more likely than hypertensive men to be aware and treated, whereas hypercholesterolemia awareness was higher in men than in women. Hypertension awareness was highest in black women, but black hypertensive subjects were less likely than whites to be treated and to have their hypertension controlled. Black hypercholesterolemic subjects were less likely to be either aware or treated. CONCLUSIONS: After the recent implementation of the National Cholesterol Education Program, the levels of awareness, treatment, and control of hypercholesterolemia are improving at a high rate, although they are still substantially lower than those for hypertension. Further improvement is necessary, particularly among certain population groups, such as blacks.

Age Distribution↗
PubMed1991

Practical grantsmanship: the application process in health care research.

The creation of the Agency for Health Care Policy and Research presents expanded opportunities for research in primary care. This paper discusses the grant review process and includes section-by-section suggestions for successful proposal writing. Applicants should choose topics of their own interest, be aware of the funding agency's priorities, pick co-investigators who complement their own backgrounds and training, and perform at least some preliminary study of the topic which can be discussed in a proposal. Successful grantsmanship also requires patience, perseverance, and flexibility because several attempts may be necessary to receive funding.

Humans↗
PubMed1987

The periodic health examination in a family practice center: use, content, and results.

Records of 176 patients coming to a family practice center for complete physical examinations were reviewed to learn about the use, content and results of such examinations. The patients provided new or updated histories and were given full physical examinations. Blood pressures, breast, and rectal examinations were performed on at least 70 percent of the patients. Stool blood checks and mammograms were performed on 40 percent or less of the patients. Urinalyses, blood counts, and multichannel chemistry tests were performed as routine procedures for about one-half the patients. Most abnormalities found on these tests appeared relatively minimal; only about one-fourth of the abnormal results were repeated or commented upon in the record. Few diagnoses or changes in therapy resulted from routine laboratory testing. These studies should be used to screen only for preventable or treatable conditions, or to evaluate specific problems noted on history or physical examination.

Adult↗
PubMed1986

Low back pain and x-ray films of the lumbar spine: a prospective study in primary care.

We prospectively studied 96 men with low back pain to evaluate the association of x-ray findings with clinical diagnosis, treatment, functional outcome, and satisfaction with care. Degenerative joint disease (DJD) was the most common radiologic finding (70%). Making the diagnosis of spinal DJD has little effect on patient management, but patients with x-ray evidence of DJD were three times more likely than those with normal films to receive nonsteroidal anti-inflammatory drugs other than aspirin. Furthermore, patients given a "diagnostic label" of DJD were more likely to express satisfaction with medical care and less likely to seek care elsewhere than patients with similar x-ray results who were given nonspecific diagnoses. These factors will need to be considered in arriving at an estimate of the net benefits of x-ray examination of the lumbar spine.

Adult↗
PubMed1985

Periodic health examination: effect of costs on patient expectations.

The periodic health examination accounts for many visits to primary care practitioners and is a major source of preventive care. The purpose of this study was to compare our results with results of previous studies suggesting that patients desire periodic check-ups, including extensive laboratory studies. The effect of knowledge of cost of these procedures was determined by a randomized inclusion of this information in patient questionnaires. At Bowman Gray Family Practice Center, 91% of adult patients requested periodic examinations. The laboratory studies and other procedures selected by most patients were in excess of the recommendations of the Canadian Task Force on the Periodic Health Examination for adequate preventive care. Patients who were told the costs of these procedures selected them less frequently than those who were not told. Knowledge of personal risks as well as the effectiveness of studies to detect or prevent disease should be assessed to promote appropriate patient expectations of preventive care.

Adult↗
PubMed1985

The family and hypertension in family practice.

The influence of the family in the care of family practice patients has not been studied extensively. This study uses hypertension as an index condition to characterize the extent of involvement of family around family practice center (FPC) patients and to examine whether the presence of family members influences patient outcomes. Records of 366 hypertensive patients were reviewed for information about blood pressures, demographic characteristics, associated medical conditions, and treatment. Three hundred forty-three of these patients responded to questions about family members, including their use of the FPC and whether they also had hypertension. Twenty percent of patients lived alone. Of the rest, two thirds had some, and one half had all family members enrolled in the FPC. Seventy-three listed family with hypertension, and 42 said these relatives were treated at the FPC. At the time of the first visit to the FPC for hypertension, the mean diastolic blood pressure was 93 mmHg. At their most recent visit, the mean was 83 mmHg, and 69 percent were below 90 mmHg. There was no association between blood pressure control and family enrollment in the FPC.

Adult↗
PubMed1984

Veterans Administration and ambulatory care: the "low-priority" veteran.

We describe several consequences of an effort to reduce patient volume in a general medical clinic (GMC) by releasing "low-priority" veterans. With a before-after descriptive study, we determined what sources of medical care these veterans used and assessed changes in their medical status using hypertension as a tracer condition. Private providers were used exclusively by 35% of veterans, 33% continued to use VA medical services, 11% used a combination of VA and private care, and 16% used other miscellaneous sources of care. While most veterans (74%) paid cash for their care, 35% also used Medicare or Medicaid supplementally. In veterans with hypertension, the diastolic blood pressure distributions were ostensibly unchanged after release. These results suggest that a reduction in services provided to "low-priority" veterans is feasible without deleteriously affecting their medical status. With regard to blood pressure control, those veterans who obtained private sources of care did as well as those who remained in the GMC.

Adult↗
PubMed1984

Patients' expectations of periodic health examinations.

The periodic health examination is a major part of medical care in the United States, but has been infrequently studied. Adult family medicine center patients were surveyed to learn their expectations about the timing and content of preventive checkups. Over 90 percent desired such examinations, most often on an annual basis. At least 75 percent selected care items that added up to extensive physical examinations and use of laboratory and other procedures. Their choices usually exceeded those recommended by an expert group as most likely to detect or prevent disease. Other data showed that recorded practice by their physicians neither met their expectations nor was consistent with recommended care patterns. These findings suggest the need to align patients' and their physicians' expectations to allow more effective practice of preventive care.

Adult↗
PubMed1981

The validity of the medical record.

The medical record is the source of information for many purposes, including evaluation of the quality of care provided. Despite this reliance on the record, there have been few attempts to validate the recorded content against the verbal content of the interaction between patient and physician. In this study, we compared the record with verbatim transcripts of outpatient visits. Overall, 59 per cent of units of information present in either source were found in the record. Recording was more complete for the chief complaint (92 per cent) and information related to the patient's present illness (71 per cent) than for other medical history (29 per cent). Incomplete recording of elicited information may partially explain the often low levels of performance of recommended care items found in quality-of-care studies. We suggest that more attention be paid to improving communication about tests and therapies to patients.

Adolescent↗
PubMed1981

The periodic health examination: comparison of recommendations and internists' performance.

In this paper we bring together recommendations from three expert sources for preventive care by periodic health examination of adults. We compare these recommendations with care items considered essential for such examinations, and those actually performed by a panel of practicing internists. We found substantial differences among the expert groups and between the experts and the practicing internists in their perceptions of essential care items. Overall, 59% of items recommended by any of the expert groups were found in the internists' records. We suggest that the periodic examination serves a purpose in addition to screening for disease; that the screening function need not be performed annually; that awareness and practice of proven beneficial components of such examinations be increased among practitioners; and that a better consensus on recommendations for preventive care be developed.

Adult↗
PubMed1980

Internists' perceptions and performance in office practice.

Thirty-one internists in private practice chose items of care that they considered essential and likely to be recorded in the evaluation and management of diabetics, hypertensives, women with symptoms of dysuria or frequency, and patients requesting a general examination. Records of patients with these conditions, in those practices, were reviewed to determine which items of care were routinely performed and recorded. Overall, physical examination and laboratory evaluation items were more likely both to be considered essential and to be recorded than were history questions or management instructions. The lists of cure criteria and frequently performed components of the care process are presented for use by other peer review groups and for the interest of other practicing internists.

Ambulatory Care↗
PubMed1980

Peer review in diabetes and hypertension: the relationship between care process and patient outcome.

To assess the effect of physician performance on patient outcomes, we examined the relationship between performance of essential care items and several patient outcomes in hypertension and diabetes. A group of internists in private practice selected the criteria and allowed their records to be reviewed to ascertain their adherence to these criteria and their patients' outcome status. Among all physicians and patients, adherence to criteria was not associated with a composite measure of control status or with blood sugar level in diabetes, or with blood pressure control in hypertension. Peer review groups should recognize the limitations in measuring care process and patient outcomes, and that adequacy of physician performance does not necessarily predict how well the patient will do.

Adult↗
PubMed1979

Care process and patient outcome in diabetes mellitus.

The relationship between the process of medical care and patient outcome is a central issue in health services research. We examined this relationship in 244 patients with adult-onset diabetes mellitus, who were under the care of private internists and family physicians. Process measures included physician awareness of patients' concerns, communication of information from physician to patient, medication-taking behavior, physician adherence to minimum care criteria, and extent of patient utilization of services. Outcomes measured during and after a 6-month follow-up period, included diabetic control status and patient satisfaction with medical care. Potentially confounding variables included practice and physician characteristics, patient demographic characteristics, and measures of disease severity. There was a small statistically significant correlation between physician awareness and control status, but the association was not maintained when controlling for other variables. Communication of information from physician to patient was significantly (p less than .005) associated with satisfaction in the multiple regression analysis but explained only 4 per cent of the variance in patient satisfaction. Thus, in patients under treatment for diabetes, there was little association between certain measures of care process and patient outcome. We suggest that process and outcome assessments are distinct but complementary aspects of quality of care.

Adult↗
PubMed1979

Developing criteria for quality of assessment: effect of the Delphi technique.

We examined the effect of the Delphi iteration procedure in developing explicit criteria for ambulatory care assessment. Practicing internists chose items they believed to be essential with regard to the care of certain specified conditions. The initial responses were tabulated and "fed-back" to the participants. The second round of criteria selection, with the first-round summary available, produced few and relatively minor changes in the items chosen by group consensus.

Ambulatory Care↗