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Biomedical subjects

H E Freeman

Publications and source records attributed to H E Freeman.

At least 37 records · Page 2Linked to original sources
PubMed1987

AIDS-related competence of California's primary care physicians.

We conducted a telephone survey of a random sample of primary care physicians practicing throughout the State of California to determine their AIDS-related experiences and competencies. Interviews were completed early in 1986 with 1,000 family and general practitioners and internists, 60 per cent of those eligible. Data on practice experiences reflect the increased incidence of AIDS (acquired immunodeficiency syndrome) in Los Angeles and San Francisco. The proportion of practitioners in rural areas who evaluated possible cases (17 per cent), and counseled patients at risk (50 per cent) indicated the generalized nature of the problem. Compared to similar data obtained in 1984, levels of competency in diagnosing and counseling persons with AIDS-related disorders increased in Los Angeles. However, on a statewide basis, a majority of those interviewed lack the AIDS-related knowledge and skills required to carry out their roles in dealing with AIDS. Competency was associated with physicians' personal and professional characteristics and their level of discomfort in dealing with homosexuals.

Acquired Immunodeficiency Syndrome↗
PubMed1987

A content analysis of dental capitation plan grievances.

As the health care system becomes more impersonal, competitive, and cost conscious, there is a potential for increased dissatisfaction with health care providers. This paper describes the use of content analysis to examine aspects of patient dissatisfaction with delivery of health services in a capitated dental plan. All written complaints from three regions of California from June 1984 to June 1986 were collected, and a content analysis was performed on these letters. The rates of grievances differ substantially across regions; however, three regions were similar in their grievance patterns. Access to care was the single largest category of concern, and these grievances were registered because patients had to wait for an appointment (35 percent) or had to wait in the office (32 percent) to receive care. Provider technical competence was the second largest category. Significant variables from a logistic regression that predicts complaint status of an eligible member are (1) years covered, (2) age, and (3) income. The grievance rate and grievance categories described in this study can help define new strategies and policies in the overall mission of a dental capitation organization.

Adult↗
PubMed1987

The sexual history-taking and counseling practices of primary care physicians.

As part of a statewide survey of experiences related to the acquired immunodeficiency syndrome and competencies of a random sample of primary care physicians in California done in early 1986, we interviewed 1,000 internists, family and general practitioners about their sexual history-taking and counseling practices. Less than 4% have patients complete a history form that includes questions about sexual orientation or practices, and only 10% ask new patients questions specific enough to identify those at high risk of exposure to the human immunodeficiency virus. Internists, women and younger physicians and those expressing little discomfort in dealing with gay men more often took adequate sexual histories and gave appropriate advice. Among those physicians with patients at risk of becoming infected, only half recommended the use of condoms and 60% advised a reduction in the number of partners. More than 15% recommended abstention from sexual intercourse, and 8% suggested these patients should switch to a heterosexual life-style.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Uncompensated care by hospitals or public insurance for the poor. Does it make a difference?

Results from two recent surveys of access to medical care, one nationwide and the other in Arizona, were analyzed to determine the consequences of reductions in Medicaid coverage for low-income Americans and the accompanying shift of responsibility for their health care to clinics and hospitals that provide uncompensated or subsidized care. The analysis indicated that in 1982, low-income persons received substantially less care from physicians if they resided in states without Medicaid programs or with only limited programs. In Arizona, the only state at the time without a Medicaid program, poor children saw physicians 40 percent less often, and poor rural residents saw physicians 22 percent less often, than poor residents of states with Medicaid programs; the proportion of poor Arizona residents refused care for financial reasons was almost double that in states with Medicaid programs. In addition, poor residents of states with the highest proportions of their low-income populations covered by Medicaid fared better than those in states with less extensive coverage. Moreover, poor elderly Americans were found to have comparable access to health care, regardless of where they lived, as a result of almost universal coverage under Medicare. Thus, this analysis suggests that the growing reliance on uncompensated care provided by hospitals and clinics may not be an effective substitute for public insurance and may adversely affect the health care received by the poor.

Adolescent↗
PubMed1985

Health care under AHCCCS: an examination of Arizona's alternative to Medicaid.

In late 1982, as an alternative to Medicaid, Arizona implemented a prepaid, competitively bid medical care program--the Arizona Health Care Cost Containment System (AHCCCS). Before its introduction, the poor had been cared for primarily by a network of county-supported centers. Impact of the AHCCCS initiative was examined by surveying comparable samples of poor persons in pre-AHCCCS 1982, and in 1984, after the program was in place. Both before and since AHCCCS, Arizona has had very restrictive eligibility requirements; to examine the program's impact on both eligible persons and the so-called "notch" group, the samples consist of individuals with family incomes within 200 percent of the program's financial criterion. Telephone surveys revealed that overall a lower proportion of the poor were enrolled in AHCCCS in 1984 than participated in county programs in 1982. However, access to care increased for AHCCCS enrollees in 1984, compared to county patients in 1982--and a greater proportion of 1984 AHCCCS enrollees than their 1982 counterparts in the county programs had at least one medical encounter in the 12 months preceding the surveys. For its enrolled population, then, AHCCCS may be a viable alternative to conventional Medicaid programs and to previous efforts at providing care at county sites. But the poor financially ineligible for AHCCCS are experiencing decreased opportunities for health services. The conclusions address the policy implications of the findings.

Adolescent↗
PubMed1982

Comparison of surveillance and control activities of infection control nurses and infection control laboratorians in United States hospitals, 1976-1977.

To study the impact of the professional background of infection control personnel, we compared the characteristics and activities of 107 infection control nurses (ICNs) with those of 13 infection control laboratorians (ICLs), all in hospitals with 300 beds or more. Although the two groups performed similarly in many respects. ICNs spent more time teaching, whereas ICLs spent more time and appeared more proficient in investigating outbreaks. Staff nurses at hospitals with ICNs found the infection control person more visible on the wards and more available for discussing infection control matters. ICNs appeared less hesitant to speak up to personnel not following correct handwashing techniques. ICNs and ICLs appear to offer different skills that should be considered when filling different infection control positions.

Analysis of Variance↗
PubMed1982

Telephone sampling bias in surveying disability.

Results of the California Disability Survey indicate that telephone interviewing is well suited for undertaking disability studies that provide (1) estimates of subgroups of the disabled population, including those that are statistically rare: (2) information on current and anticipated areas of policy concern; and (3) information for geographic areas important in rehabilitation program planning. Although these objectives necessitated a large sample size and a complex instrument, the costs and timeliness of telephone interviewing enabled the survey objectives to be reached. This paper discusses the advantages of telephone interviewing, as well as biases inherent in its use. The magnitude of the bias from the omission of nontelephone households is assessed, and the results confirm that the omission of nontelephone households introduces only minor biases into estimates for the total working-age population. A method of weighting is developed and illustrated.

Adolescent↗
PubMed1982

Evaluating drug use behavior.

Evaluations of drug use behavior can be described as an emerging activity. There are a variety of stakeholders, a number of different activities, and a multitude of purposes for which evaluations have utility. A tentative codification of drugs use evaluations is offered that takes into account stakeholders, activities, and purposes. Summaries of completed and on-going studies are provided to illustrate the value of undertaking drug use evaluations.

Delivery of Health Care↗
PubMed1980

The SENIC Project. Study on the efficacy of nosocomial infection control (SENIC Project). Summary of study design.

With the emergence of nosocomial infections as a serious problem among US hospitals, the Center for Disease Control undertook in 1974 a nationwide study to evaluate approaches to infection control. The three-phased project, now known as the Study on the Efficacy of Nosocomial Infection Control, or SENIC Project, was designed with three primary objectives: 1) to determine whether (and, if so, to what degree) the implementation of infection surveillance and control programs (ISCPs) has lowered the rate ofnosocomi al infection, 2) to describe the current status of ISCPs and infection rates, and 3) to demonstrate the relationships among characteristics of hospitals and patients, components of ISCPs, and changes in the infection rate. With data collection completed in a nationally representative sample of hospitals, analysis is underway to identify approaches to infection control that are most effective for the least cost to hospitals and to point out additional specific questions to be answered by future research.

Centers for Disease Control and Prevention, U.S.↗
PubMed1980

Nutrition and cognitive development among rural Guatemalan children.

Women and children from four Guatemalan villages participated in a voluntary food supplementation program for seven years. In two of the villages, they received a vitamin and mineral fortified, high-protein calorie supplement. In the other two villages, the vitamin-mineral fortified supplement contained no protein and a relatively small number of calories. Cognitive tests were administered regularly to children ages three to seven, and anthropometric measures obtained. In addition, measures of families' social milieu were collected at several points in time. Using multiple regression analysis, we find that both nutritional and social environmental measures are related to various dimensions of cognitive competence. The results suggest that nutritional intake, independent of social factors, affects cognitive development. There is also some evidence that the children who receive the high-protein calorie supplement (and whose mothers received it during pregnancy and lactation) are more likely to score high in cognitive performance. Our results, while not diminishing social environmental explanations of differences in cognitive function, suggest benefits from nutrition intervention programs in rural areas of lesser-developed countries.

Anthropometry↗
PubMed1977

Relations between nutrition and cognition in rural Guatemala.

The nutritional status of three and four year old children, as measured by height and head circumference, is related to cognitive performance in four rural Guatemalan villages. The relationships persist when social factors are taken into account. Families in two of the villages participate in a voluntary, high protein-calorie supplementation program. In the other two villages, the families receive a vitamin and mineral supplement with one-third of the calories. Although the longitudinal study still is ongoing there is some evidence that the children who receive the higher calorie supplement (or whose mothers received it during pregnancy and lactation) are most likely to score high in cognitive performance. The results support other animal and human studies that report an association between nutrition and cognitive development. The findings, while not diminishing social environmental explantions of differences in cognitive function, suggest the worth of nutrition intervention programs in rural areas of lesser-developed countries.

Child Development↗