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Biomedical subjects

J E Ware

Publications and source records attributed to J E Ware.

At least 145 records · Page 8Linked to original sources
PubMed1984

Physicians' attitudes in counseling patients about smoking.

Attitudes of physicians toward counseling patients about their smoking habits may influence whether and how counseling occurs. In this paper, the authors develop and test a conceptual model of these attitudes. The model includes four attitude dimensions: physicians' motivations to counsel, perceived health risk of smoking, perceived skills in counseling, and perceived costs and benefits to the physician of counseling. A self-report questionnaire including a 40-item measure of these attitudes was delivered to a random sample of male general practitioners, internists, surgeons, and obstetrician-gynecologists who were members of a western county medical society in 1978. The response rate was 76%. Based on factor analyses, 10 subscales and 3 global scales were formed by summing items. The item contents of scales are consistent with the authors' model, and reliability and item-discriminant validity are excellent. The authors' model may be useful in understanding the factors that affect the process and outcomes of physician counseling about smoking.

Attitude of Health Personnel↗
PubMed1984

The sensitivity of mental health care use and cost estimates to methods effects.

The authors determined the sensitivity of estimates of the use and cost of outpatient mental health care to two methods effects: the definition of a mental health visit and strategies for allocating mental health care costs. They use data from the Rand Health Insurance Study, which has a random sample of the nonaged noninstitutionalized civilian population in six United States sites. Estimates of the use of mental health specialists are insensitive to alternative methods. However, estimates of the use and cost of the mental health care delivered by nonpsychiatrist physicians (e.g., internists) are quite sensitive to methods effects. Nevertheless, the cost of care from nonpsychiatrist physicians is so low that the total cost of outpatient mental health care is not meaningfully affected by methods effects.

Community Mental Health Services↗
PubMed1983

Does free care improve adults' health? Results from a randomized controlled trial.

Does free medical care lead to better health than insurance plans that require the patient to shoulder part of the cost? In an effort to answer this question, we studied 3958 people between the ages of 14 and 61 who were free of disability that precluded work and had been randomly assigned to a set of insurance plans for three or five years. One plan provided free care; the others required enrollees to pay a share of their medical bills. As previously reported, patients in the latter group made approximately one-third fewer visits to a physician and were hospitalized about one-third less often. For persons with poor vision and for low-income persons with high blood pressure, free care brought an improvement (vision better by 0.2 Snellen lines, diastolic blood pressure lower by 3 mm Hg); better control of blood pressure reduced the calculated risk of early death among those at high risk. For the average participant, as well as for subgroups differing in income and initial health status, no significant effects were detected on eight other measures of health status and health habits. Confidence intervals for these eight measures were sufficiently narrow to rule out all but a minimal influence, favorable or adverse, of free care for the average participant. For some measures of health in subgroups of the population, however, the broader confidence intervals make this conclusion less certain.

Adolescent↗
PubMed1983

Defining and measuring patient satisfaction with medical care.

This paper describes the development of Form II of the Patient Satisfaction Questionnaire (PSQ), a self-administered survey instrument designed for use in general population studies. The PSQ contains 55 Likert-type items that measure attitudes toward the more salient characteristics of doctors and medical care services (technical and interpersonal skills of providers, waiting time for appointments, office waits, emergency care, costs of care, insurance coverage, availability of hospitals, and other resources) and satisfaction with care in general. Scales are balanced to control for acquiescent response set. Scoring rules for 18 multi-item subscales and eight global scales were standardized following replication of item analyses in four field tests. Internal-consistency and test-retest estimates indicate satisfactory reliability for studies involving group comparisons. The PSQ well represents the content of characteristics of providers and services described most often in the literature and in response to open-ended questions. Empirical tests of validity have also produced generally favorable results.

Consumer Behavior↗
PubMed1983

Behavioral consequences of consumer dissatisfaction with medical care.

The effects of consumer dissatisfaction with doctors and medical care services on intentions to seek care and subsequent behavior were estimated using data from four general population studies. Satisfaction was linked to reported intentions regarding care-seeking behavior (choices between self-care and seeking care from a regular doctor or emergency room) in response to both minor and serious medical problems. These results were replicated in two populations with diverse sociodemographic characteristics. Satisfaction scales also predicted subsequent changes in medical care providers and disenrollments from prepaid health plans independent field tests. These results suggest that the behavioral consequences of individual differences in satisfaction with doctors and health care services are noteworthy from both clinical and social perspectives.

Consumer Behavior↗
PubMed1983

Patient satisfaction and change in medical care provider: a longitudinal study.

Longitudinal data from The Rand Corporation's Health Insurance Experiment were used to test the hypothesis that provider continuity can be modeled as one behavioral consequence of patient satisfaction. Bivariate and multivariate analyses (controlling for sociodemographic characteristics, prior use of services, health status, and health insurance plan) supported our hypotheses. A multivariate linear probability function indicated that a 1-point decrease on a general satisfaction scale was associated with a 3.4 percentage-point increase in the probability of provider change. The relationship between satisfaction scores and continuity during the following year appears to be roughly linear; we observed no "threshold" satisfaction level at which the probability of provider change increased markedly. We discuss needed improvements in the measurement of provider continuity and the need for further study of other behavioral consequences of patient satisfaction.

Consumer Behavior↗
PubMed1982

Psychosocial problems in chronically ill children: physician concern, parent satisfaction, and the validity of medical records.

This study concerns the psychosocial aspects of treatment for chronically ill children. The English-speaking parents of 44 children 5-13 years of age being seen at five specialty clinics at a large county hospital in Los Angeles, and their attending physicians, were the subjects in this study. The parents were interviewed concerning their expectations for the current visit, and the doctor-patient interaction was tape-recorded. Identical categories of information were abstracted from the tape recording and from a chart review of the patients' medical records. Although parents expected 76% of the psychosocial aspects of care to be covered by the doctor, only one fourth were actually discussed in the visit. These unfulfilled expectations were associated with lower satisfaction with medical care received (r = .47, p less than 0.01). Finally, while doctors recorded about 80% of discussions of symptoms and physical examinations in the patient's medical record, they recorded only 25% of discussion of psychosocial problems.

Adolescent↗
PubMed1982

Effects of physical and mental health on health-state preferences.

Studies concerned with measuring values and preferences for health states and health status components have typically employed "direct" scaling techniques that require conclusions to be based on definition. Problems and limitations of direct scaling are discussed. The algebraic modeling approach is new to health services research; it emphasizes testing models of how respondents combine stimulus information. The model specifies the causal relationship between the stimulus information and the responses. Subjective stimulus and response scales are derived from the model when the data satisfy the model's predictions. Thus, the validity of the subjective scale values rests on the validity of the model. In the present research, university students judged preferences between health states, each described by a physical (degree of physical activity) and mental (level of happiness/depression) component. The object of the research was to determine the subjective trade-offs between physical and mental health values in these preference judgments. For all respondents, preference judgments were consistent with the predictions of a preference model that yielded interval scales of the health states. Also, there were systematic interactions between physical and mental values, so that when a health state was bad on one component (e.g., poor physical health), the other component had less of an effect. However, results revealed individual differences in emphasis placed on the physical and mental health components. Advantages of replacing presently used measurement techniques with the algebraic modeling approach in general population studies are discussed.

Adolescent↗
PubMed1981

How sophisticated are consumers about the medical care delivery system?

A 10-item questionnaire was administered to non-elderly persons (N = 4,976) to measure their sophistication or knowledgeability about the medical care delivery system. Such sophistication seems germane to views about the appropriate role consumers might play in decisions affecting resource allocation, especially whether competition or cost-sharing strategies should be pursued or whether certain regulatory strategies are more promising. Analyses of individual items suggest that consumers are knowledgeable about some matters and uninformed about others. If a pro-competitive strategy is pursued, efforts at educating consumers about board certification, staff privileges and other information pertinent to choosing a regular source of care seems warranted. Factor analyses indicated that a substantial amount of the information contained in item responses can be summarized in a multi-item scale score. The reliability and validity of this scale as a measure of patient sophistication was supported.

Attitude to Health↗
PubMed1981

Advances in the measurement of functional status: construction of aggregate indexes.

This article summarizes tests of the appropriateness of aggregating specific categories of physical capacities and limitations into aggregate functional status indexes. Self-administered questionnaires were used to gather data from 4,603 people between 14 and 66 years of age. Cumulative indexes defining ranked levels of functional status were derived for two global constructs of functioning (personal and role functioning). Each index is scored to define chronic limitations and those of shorter duration. Personal functioning includes self-care, mobility and physical activity categories. Role functioning includes role and general activity categories. An index that aggregated personal and role limitations did not satisfy the assumptions of cumulative scaling.

Activities of Daily Living↗
PubMed1981

Choosing measures of health status for individuals in general populations.

This paper offers suggestions to adi the selection of appropriate instruments and data gathering methods for studies that require measures of personal health status applicable in general populations. Before selecting measures, the reason for studying health status must be identified. Next, definitional issues arise when attempting to specify the components of health that are to be studied. Evidence supports restriction of the definition of personal health status to its physical and mental components, rather than including social circumstances as well. In evaluating the suitability of available measures, three features must be considered: 1) practicality in terms of administration, respondent burden, and analysis; 2) reliability in terms of the study design and group or individual comparisons; 3) validity, in terms of providing information about the particular health components of interest to the study. Evaluating validity will be difficult for most available measures; careful attention to item content will be helpful in choosing appropriate measures. Despite problems in development and interpretation, overall health status indicators will prove useful to many studies and should be considered, as should both subjective and objective measures of health status. Given that the reasons to measure health have been identified, the aspects of health to be measured specified, and attention paid to their suitability, appropriate measures may often be found among those now available.

Data Collection↗
PubMed1980

Factors associated with relief from chest pain following emergency care.

A preliminary study was conducted to explore a range of factors that may be associated with relief from chest pain. Nonhospitalized ambulatory patients (N = 150) were interviewed in their homes shortly after seeking care at one of two hospital emergency rooms. Bivariate and multivariate analyses identified four factors positively correlated with symptom relief: whether someone accompanied the patient to the emergency room; whether the patient feared a heart attack or heart problem; whether the patient believed that providers are able to help their patients; and whether the patient was told that he had not had a heart attack. A fifth factor, the number of history and examination items recorded in the medical record, was found to be inversely related to pain relief. It is suggested that in addition to sociodemographic characteristics of patients and measures of medical care process which are frequently studied, social and psychologic factors be considered as important explanatory variables in studies of health status outcomes.

Adult↗
PubMed1979

Measuring components of children's health status.

Measures of physical, mental and social components of health status and general health ratings were studied for children ages 0-4 (N = 679) and 5-13 (N = 1473). Questionnaires were completed by adult proxies (usually mothers) in three generally healthy populations. Hypothesized multi-item scales were tested; reliability was estimated and preliminary attempts at validation were undertaken. Items in ten scales pertaining to mental health (Anxiety, Depression, Positive Well-Being, Mental Health Index), social health (Social Relations), general health ratings (Current Health, Prior Health, Resistance/Susceptibility to Illness, General Health Rating Index), as well as parental satisfaction with child development satisfied Likert-type and discriminant validity criteria. Because functional limitation items were endorsed for very few children, scales to measure physical health could not be tested. Almost all scales were sufficiently reliable for group comparisons; reliability coefficients were lower in the most disadvantaged population. Interrelationships among scales and validity variables generally supported their construct validity and supported a multi-component model of children's health status.

Analysis of Variance↗