Biomedical subjects

G Fairbrother

Publications and source records attributed to G Fairbrother.

29 records · Page 2Linked to original sources

PubMed1996

Benzodiazepine prescribing in a Sydney teaching hospital.

OBJECTIVES: To determine the pattern of benzodiazepine prescribing in hospital and at discharge in relation to prior benzodiazepine therapy. DESIGN: Patient interview within 48 hours of admission to determine benzodiazepine, alcohol and other psychotropic drug use before admission and review of medical records after discharge to document drugs prescribed in hospital and at discharge. SETTING: Tertiary teaching hospital, January to August 1995. RESULTS: 1453 patients (mean age, 60 [SD, 19] years; 52.7% female) were interviewed; 277 patients (19.1%) were taking benzodiazepines regularly (one or more doses per week) before admission. Of these, 28.5% did not have benzodiazepine therapy continued while in hospital and 63.9% did not receive benzodiazepines at the time of discharge. Of the remaining 1176 patients (those not previously taking benzodiazepines), 277 (23.6%) were prescribed them for the first time in hospital and 5.3% received benzodiazepines at the time of discharge. Older age, female sex, marital status (single, divorced or widowed) and the use of antidepressants and Schedule 8 narcotic analgesics were all statistically significant predictors of benzodiazepine use before admission, but alcohol consumption was not. CONCLUSIONS: A substantial number of patients do not have their benzodiazepine therapy continued in hospital and at the time of discharge, and are thus at risk of developing benzodiazepine withdrawal syndromes, including delirium. A small but clinically significant number of patients who do not usually take benzodiazepines receive them at the time of discharge and may be at risk of becoming long term users.

Anti-Anxiety Agents↗

PubMed1996

Matching needs to services: the quick response. Case study: St George Hospital and Community Health Services Best Practice Project.

A Quick Response Program (QRP) was developed and implemented at St George Hospital during 1995 and 1996. The program sought to improve the service provided to elderly people presenting to the emergency department by offering a new rapid response service pathway to community-based care. Emergency department discharge planning and crisis intervention evolved as important QRP functions during the program's life. Evaluation findings indicated that QRP penetration into the elderly sub-acute emergency department patient population was high, and that hospital admissions were avoided without affecting emergency department process times. Health outcomes were not compromised by the program, and patient and general practitioner satisfaction were high. The program grappled with the inherent conflict of interest between the aims of the hospital (acute care services) and those of the community service (support and maintenance). The program sought to bridge the gap between these service parameters in the name of meeting patient needs.

Aftercare↗

PubMed1996

Medicaid managed care in New York: problems and promise for childhood immunizations.

New York State is aggressively pursuing mandatory Medicaid managed care. Under managed care, physicians and plans have a defined population for which they are responsible, quality assurance monitoring emphasizes immunization rates along with other preventive services, and population-based incentives are possible. The literature does not offer compelling evidence, however, that immunization coverage is any better in managed care than under fee-for-service. If reimbursement is low and physician capacity insufficient, immunization rates may be considerably worse. In New York, care needs to be taken so that expansion does not outstrip the capacity of managed care plans to absorb additional enrollees.

Health Plan Implementation↗

PubMed1996

Markers for primary care: missed opportunities to immunize and screen for lead and tuberculosis by private physicians serving large numbers of inner-city Medicaid-eligible children.

OBJECTIVE: This study examines coverage levels for immunization, missed opportunities to immunize, and extent of lead and tuberculosis screening in inner-city storefront physician offices and then relates child, visit, and physician characteristics to missed opportunities. METHODOLOGY: With the use of a nested sampling strategy, 232 charts were selected for review in 31 physicians' offices. Charts selected were for children 0 to 35 months of age who had three or more visits in more than 3 months. Physicians were selected from those in specific low-income New York inner-city neighborhoods who submitted large volumes of Medicaid billing claims. Variables examined were missed opportunities to immunize, immunization coverage levels, lead, and tuberculosis screening. The outcome measure was missed opportunities to immunize. RESULTS: Only 26% of the children were up to date for their age for diphtheria, tetanus, pertussis (DTP), oral polio vaccine (OPV), and measles, mumps, rubella (MMR) compared with a city-wide coverage level of 49%. Children who were not up to date for immunization coverage were more likely not to be up to date for lead (RR = 1.24, CI 0.96 to 1.60) or tuberculosis (RR = 1.54, CI 1.14 to 2.08) screening. Physicians miss opportunities to immunize in 84% of the eligible visits. Opportunities to immunize are missed more frequently at sick care or follow-up visits (95% and 91% missed opportunities) than at well care visits (41% missed opportunities). CONCLUSIONS: The quality of pediatric primary care given by these inner-city storefront physicians is suboptimal. Sick and follow-up visits predominate; well care visits are infrequent. If care is to be improved, Medicaid reimbursement policies, which make delivery of well care unprofitable, will need to be changed. In addition, monitoring the quality of care will need to be more aggressive. In the near future children who receive Medicaid in New York will be in managed care. If reimbursement and monitoring policies that provide incentives for delivering pediatric primary care are to be in place, it will be the managed care plans that implement this.

Child, Preschool↗

PubMed1995

New York City's 1993 child immunization day: planning, costs, and results.

OBJECTIVES: This study evaluates New York City's Child Immunization Day (1993), with emphasis on the cost and effects of a mass campaign and the use of strategies from developing nations in an inner-city context. METHODS: The methodology was designed to (1) document the planning and implementation process, (2) analyze the number and characteristics of children in the target group, and (3) estimate costs. RESULTS: Neither the social mobilization nor the political will that characterize successful campaigns in developing nations occurred in New York City's campaign. Despite substantial time and effort from both private and public agencies, turnout for the event was low. In total, 2647 families and 5237 children were assessed for health care and insurance needs, 2949 children were immunized at a cost of about $279 per immunized child, and 7236 vaccines were administered. CONCLUSIONS: The differences between inner cities and developing nations have a bearing on strategies used in planning and implementing mass campaigns. New strategies need to be forged from a blending of these contexts to create effective campaigns in industrialized inner cities.

Child Health Services↗

PubMed1995

New York City physicians serving high volumes of Medicaid children: who are they and how do they practice?

This study examined, in 1993, the characteristics and practices of New York City physicians who submit large numbers of Medicaid claims for children. Of our sample of 33 physicians, more than 90% were educated outside the United States; fewer than half were board certified or had hospital staff appointments. These physicians saw a clientele who were 98% Medicaid; most visits (82%) were at a time of acute illness. With the rapid advent of mandatory, Medicaid managed care in New York City, and with the large estimated gap in primary care capacity in the inner city, policy questions arise as to whether these physicians should be integrated into managed care plans. If they are not, the question becomes: how will they be replaced?

Adolescent↗

PubMed1994

Influence of socioeconomic status, ethnicity and an educational brochure on compliance with a postal faecal occult blood test.

The study aimed to determine if socioeconomic status and ethnicity affect compliance with postal faecal occult blood test screening, and if compliance can be increased by adding an educational brochure. A pilot intervention study was used in socioeconomically defined postcodes and defined census collection districts of the Southern Sydney Area Health Service. The study population of men and women aged 45 to 75 years was selected from general practice lists in the defined postcodes. Samples were comparable for age, sex, and socioeconomic indices. Compliance, using a general practitioner letter alone, was: for the Australian middle-socioeconomic status sample, 65.8 per cent (95 per cent confidence interval (CI) 59.5 to 72.1), the Australian low-socioeconomic status sample, 63.9 per cent (CI 57.3 to 70.5), the Arabic low-socioeconomic status sample, 33.3 per cent (CI 27.2 to 39.4). With the general practitioner letter plus brochure, compliance was: Australian middle-socioeconomic status sample, 67.0 per cent (CI 60.5 to 73.5), Australian low-socioeconomic status sample, 62.1 per cent (CI 55.3 to 68.9) and Arabic low-socioeconomic status sample, 36.8 per cent (CI 30.6 to 43.0). Compliance was higher in all Australian samples than in Arabic samples. A brochure, designed to increase compliance with testing, had no significant effect in Australian samples. Australian samples of different socioeconomic status complied almost equally. Results suggest that advice from the local doctor is very effective in motivating patients to screen with faecal occult blood testing.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1992

Colorectal cancer screening: optimal compliance with postal faecal occult blood test.

Five approaches to postal faecal occult blood test (FOBT) were compared in a population sample of 966 subjects collected from three general practitioner patient lists in Southern Sydney. The highest compliance rate (59.8%) was achieved by a method using a general practitioner letter, with no dietary restrictions with FOBT. This was also the least expensive method. Compliance rates can be affected by incorrect address information and screenees not considering themselves to be current patients. An explanation from the family doctor addressed personally to the patient with an enclosed FOBT kit can achieve high compliance rates.

Aged↗

PubMedDate not supplied

The relative influence of personal and workplace descriptors on stress.

A survey canvassing self-reported workplace stress levels and personal/workplace demographics was conducted among a sample of Australian nurses. Stress ratings and demographics were cross-sectionally analysed. Quantitative and qualitative analyses of survey responses suggest that excessive workload is the likely dominant predictor of workplace stress. Personal and workplace demographics are shown to be relatively unimportant in comparison with workload-related factors. Regular exercise habit was shown to be correlated with reduced workplace stress ratings. The findings support a previously unreported view that nurses are unlikely to bring their personal stress with them to the workplace--rather the workload characteristics of the workplace itself are the principle stress determinants.

Adaptation, Psychological↗

PubMedDate not supplied

Impact of financial incentives on documented immunization rates in the inner city: results of a randomized controlled trial.

OBJECTIVE: This study determined the effect of 2 financial incentives---bonus and enhanced fee-for-service---on documented immunization rates during a second period of observation. METHODS: Incentives were given to 57 randomly selected inner-city physicians 4 times at 4-month intervals based on the performance of 50 randomly selected children. Coverage from linked records from all sources was determined for a subsample of children within physician offices. RESULTS: Up-to-date coverage rates documented in the charts increased significantly for children in the bonus group (49.7% to 55.6%; P <.05) and the enhanced fee-for-service group (50.8% to 58.2%; P <.01) compared with the control group. The number of immunizations given by these physicians did not change significantly, although the number of immunizations given by others and documented by physicians in the bonus group did increase (P <.05). Up-to-date coverage for all groups increased from 20 to 40 percentage points when immunizations from physician charts were combined with other sources. CONCLUSIONS: Both financial incentives produced a significant increase in coverage levels. Increases were primarily due to better documentation not to better immunizing practices. The financial incentives appeared to provide motivation to physicians but were not sufficient to overcome entrenched behavior patterns. However, true immunization coverage was substantially higher than that documented in the charts.

Child, Preschool↗

PubMedDate not supplied

Comparison of preventive care in Medicaid managed care and Medicaid fee for service in institutions and private practices.

OBJECTIVE: To compare preventive screening for children in Medicaid managed care (MMC) with children in Medicaid fee for service (M-FFS) in private and institutional settings. METHODS: The sample included randomly selected institutions and private practice physicians in New York City. Within setting, children in MMC and M-FFS were sampled randomly and charts reviewed for immunizations and lead and anemia screening. RESULTS: In both institutions and private practices, children enrolled in MMC appeared more likely to be up-to-date than their M-FFS counterparts for immunizations (institution, P <.01; private practice, P <.05), lead screening (institution, P <.01; private practice, P <.01), and anemia screening (institution, P <.01; private practice, P <.01). However, children in MMC had more visits (P <.01) and were followed up for a longer time (P <.01). After controlling for these variables, effects of MMC diminished and only remained significant for screening among private physicians. When considering 10 different attributes of managed care plans, no clear pattern of association with better preventive care services was observed. CONCLUSION: The positive effect of managed care on preventive care services was largely explained by more visits and longer follow-up time; however, there were differences between institutions and private practices, with enrollment in MMC associated with some positive effect on screenings in private practices.

Cross-Sectional Studies↗