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Biomedical subjects

H G Bloom

Publications and source records attributed to H G Bloom.

10 recordsLinked to original sources
PubMed1999

A managed care organization's attempt to increase influenza and pneumococcal immunizations for older adults in an acute care setting.

OBJECTIVE: Among the high risk groups for complications from influenza and pneumococcal disease, individuals aged 65 and older hospitalized within the previous year represent the group at highest risk. Studies have demonstrated that targeting hospitalized patients aged 65 and older for immunization before hospital discharge can be successful. This study addressed the efficacy of such a program within a managed care organization to immunize this highest risk group. DESIGN: A cross-sectional study. SETTING: Oxford Health Plans, a major managed care organization in New York serving a large Medicare population. PARTICIPANTS: A total of 106 Primary Care Physicians caring for 153 patients aged 65 and older, who were hospitalized in one of 10 high volume hospitals during October and November of 1996. Nine of these facilities were located in New York and one was in New Jersey. INTERVENTION: Patients aged 65 and older admitted to any of the 10 hospitals were identified daily. A fax was sent to each patient's primary care physician explaining the program and requesting that he/she administer influenza and/or pneumococcal vaccine to his/her patient before hospital discharge. Literature references citing past successful programs were included in the fax. MEASUREMENTS: Measurements included medical record documentation of influenza and pneumococcal immunization, both ordered and given, for the individual member before discharge; patient age; sex; and primary and secondary diagnoses. Physicians were sent follow-up questionnaires to determine reasons for not vaccinating. RESULTS: A total of 206 patients were admitted during the eligible time period. One hundred fifty-three hospitalized patients (average age = 74 years) participated. The median length of stay among this study population was 5 days (range, 1-63 days). The distribution of the median length of stay for the 25th and 75th percentiles was 3 and 9 days. The rate for influenza and pneumococcal immunization, both ordered and given, before hospital discharge was 1.96% for the influenza vaccine (n = 3) and .65% for the pneumococcal vaccine (n = 1), respectively. Results of a follow-up survey mailed to all physicians (n = 106) with eligible members in the study indicated that the most frequent reasons for not vaccinating included: patients were vaccinated before admission, patients were not stable enough to be vaccinated before discharge, and the acute care setting is not appropriate for vaccination. Response rate of 58% (n = 61) was achieved with an initial mailing and one follow-up telephone call to all previous nonresponders. Some physician survey responses do not correlate with data obtained from retrospective patients' claims analysis. CONCLUSION: Well-coordinated and timely attempts to encourage primary care physicians to immunize patients 65 years and older before hospital discharge were unsuccessful in our study. Rather than working with physicians, it may be that managed care organizations should work directly with hospitals to implement influenza and pneumococcal immunization programs.

Aged↗
PubMed1991

Factors differentiating hospital transfers from long-term care facilities with high and low transfer rates.

This paper examines the factors that account for differences among nursing homes in terms of the rates at which they transfer patients to hospitals. Data from nursing staff and charts were collected on the 286 most recent transfers from 10 nursing homes. Discriminant function analyses indicated that from relatively equivalent patient populations, high-rate facilities tended to transfer the more chronically ill, physically frail patients; patients with infection (a potentially treatable condition within the long-term care facility); and to make transfers because of lack of resources such as a lab and X-ray equipment. Lack of IV therapy, while a frequently cited primary nonmedical reason for transfer, did not discriminate between high- and low-transfer-rate facilities.

Female↗
PubMed1990

Aeromonas hydrophila diarrhea in a long-term care setting.

Infectious diarrheal diseases can be a serious problem in long-term care institutions. Aeromonas hydrophila, a facultative, anaerobic gram-negative rod, has not been implicated previously in an acute diarrheal outbreak in this setting. We report 17 patients with this disorder all characterized by the acute onset of painless, nonbloody diarrhea. Thirteen of 17 (76%) patients had two to four loose bowel movements and a duration of illness of less than 48 hours. Eleven of 17 (65%) patients were afebrile. Stool cultures were obtained in 11 patients; 4 (36%) were positive for A. hydrophila. The disease was fatal in one patient who experienced profuse diarrhea and developed fever, tachycardia, and hypotension. The original source of the A. hydrophila was not identified but transmission is known to be water- or food-borne. Although usually mild and self-limited, A. hydrophila infection as noted in one patient can be fulminant and severe. A. hydrophila diarrhea responds to antibiotic therapy; it is important to consider in the differential diagnosis of acute diarrheal illness among older persons in an institutional setting.

Aeromonas↗
PubMed1989

Obstacles to family practitioners' use of screening tests: determinants of practice?

The effect of nine obstacles on family physicians' screening practices is reported. Family physicians, responding to a survey of periodic health screening practices, were asked to check the obstacles that affected their use of the screening tests listed. In the survey, 129 members of the American Academy of Family Physicians and 146 members of the Society of Teachers of Family Medicine responded. The most frequently reported obstacles to screening were cost to the patient, patient refusal, inconvenience to the patient, and lack of facilities or equipment. The tests for which the most obstacles were reported were sigmoidoscopy, tonometry, and mammography. The Society of Teachers of Family Medicine physicians were more likely to list cost, patient reluctance, inconvenience to the patient, "the literature does not recommend to use the test," time to perform the tests, and high rate of false positives and negatives. American Academy of Family physicians were more likely to report two obstacles, lack of facilities or equipment and risk to the patient. An analysis of the relationship between obstacle report and test utilization indicated that for only five of the nine obstacles were physicians who listed the obstacle less likely to use the test than physicians who did not list the obstacle. Obstacles related with decreased test use were those that affected the physician's ability to perform the test or the efficacy of the test itself while "inactive" obstacles were those that more directly affected and emanated from patients.

Attitude of Health Personnel↗
PubMed1988

Increased utilization of influenza and pneumococcal vaccines in an elderly hospitalized population.

This study compared three interventions designed to increase acceptance of influenza and pneumococcal vaccines among elderly hospitalized patients. All individuals 65 and older able to give informed consent (73 patients) who were admitted to one medical floor of an acute care hospital were randomized to one of three groups. All groups received informational pamphlets explaining influenza and pneumococcal disease, their respective vaccines, and indications for their use. The first group received pamphlets only, the second received nursing follow-up, and the third received trained volunteer follow-up. Patients on another medical floor served as controls. The results showed a significant improvement in vaccine acceptance in all three study groups compared to controls for both influenza (78% vs 0%) and pneumococcal (75% vs 0%) vaccines. The differences among the three groups were not significant. No significant differences were found among patients accepting or refusing vaccination with regard to diagnosis, age, length of stay, sex, or having a private physician. We conclude that a simple educational program followed by offering vaccination before hospital discharge can be easily implemented, and dramatically increase immunization rates in this high risk group.

Aged↗
PubMedDate not supplied

Screening practices of family physicians: a comparison of STFM and AAFP members.

The screening practices of 146 members of the Society of Teachers of Family Medicine (STFM) and 129 members of the American Academy of Family Physicians (AAFP) are compared. The screening practices of physicians from the two organizations were generally similar for psychosocial and behavioral problems, many forms of cancer, and numerous other conditions considered for inclusion in the routine periodic screening of asymptomatic individuals. However, for numerous diseases and tests, the screening practices of physicians from the two groups were significantly different. AAFP physicians were more likely to screen for lung and skin cancer, thyroid dysfunction, diabetes, and anemia, AAFP physicians were more likely to utilize chest x-ray, ECG, urinalysis, and SMA 6/12. STFM physicians were more likely to perform gonoccocal culture and tetanus-diphtheria immunization as well as to inquire about seat belt use. Three variables were found to predict physician screening practices as well as to account for the differences found between physicians drawn from the two organizations: completion of a residency in family medicine, year of graduation from medical school, and number of patients seen per week. Physicians reported practices were compared with recommendations in the major critical reviews: Frame and Carlson, Breslow and Sommers, the Canadian Task Force, and the American Cancer Society. For a number of tests and diseases physicians' reported practices were divergent with recent recommendations.

Family Practice↗