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M A Morehead

Publications and source records attributed to M A Morehead.

18 recordsLinked to original sources

Lead screening.

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Child

A model for evaluating the delivery of pediatric primary care services.

This evaluation model describes the components used to assess the functioning of Pediatric Resource Centers which provide primary care to high risk children in New York City. These centers are administered by the Medical and Health Research Association of New York City and are funded by the State through the New York City Department of Health. Measurements are made of: accessibility, availability, accountability, productivity and patient volumes, continuity, coordination, and comprehensiveness. Data is collected from the PRC data reporting system, site visits, chart reviews, and fiscal reports. The findings vary considerably among the different centers with compliance to the various assessments, differing not only within a given center but between centers. In spite of some methodological limitations, it is felt that these measurements are effective in pointing out problem areas in the centers and are helpful to the funding agency in focusing on program areas in need of greater support.

Child

Medication costs in different provider settings.

Comparison was made of the cost of medications between Shared Health Facilities (SHFs) or Medicaid Mills and a Neighborhood Health Center (NHC) for nine conditions in fields of adult medicine, pediatrics, and gynecology. A total of 10 cases from SHF reviews were matched by diagnosis, age, and length of time under care with those in the NHC. For otitis media and pharyngitis in children and questionable urinary tract infection and vaginitis in adult women, the average costs were significantly higher in the SHFs. Average costs for family planning services and vaginal bleeding were higher in the SHFs but not significantly so. Medication costs for children with asthma and adults with bronchitis and hypertension were approximately the same in both settings. The reasons for higher costs included greater use of more expensive antibiotics, concurrent use of decongestants and antihistamines for infectious conditions of childhood, and dispensing of medications on "shot-gun" basis without adequate diagnostic studies. The most striking difference was the additional average cost of $798 for hospitalization of the SHF patients with vaginal bleeding when D & C and surgery were performed. The NHC women had no hospitalizations as the recommended procedure of endocervical biopsy in the office was Center policy. Other quality inferences noted in the NHC, but not in SHFs, were routine performance of throat cultures for pharyngitis, wet smears for vaginitis, and deferral of treatment until cultures were received for urinary tract infection. The small number of cases for each condition and the large intersample variability were limiting factors in this study, but the findings do suggest that higher standards of care contribute to lower therapy costs.

Adult

Utilization and cost of ambulatory care services of Medicaid recipients, Bronx.

The Bronx Professional Standards Review Organization (BPSRO) analyzed 1979-80 ambulatory claims for South Bronx Medicaid recipients. An estimated 87 per cent of Medicaid eligibles were users of care with an average of 11.2 visits a year, compared to an average of 9.8 visits for the Bronx Medicaid population. Shared Health Facilities (Medicaid Mills) were the principle providers of care. Two-thirds of the costs were generated by one-fourth of the patients who made more than 10 visits each a year. PBSRO concluded the South Bronx does not lack health care resources for the Medicaid recipient and that public policy and patients would benefit by concentrating reforms on high utilizers and provision of care for the near poor.

Adolescent

Activation by selegiline (Eldepryle) of REM sleep behavior disorder in parkinsonism.

Abnormal sleep-wake organization is frequently seen in idiopathic parkinsonism (PD) and other parkinsonism syndromes. A 1993 article in The Annals of Neurology first described the high rate of REM behavior disorder (RBD) in non-demented PD patients (1). In this article, we present the case reports of three non-demented PD patients who manifested RBD while on recommended doses of selegiline (Eldepryle). None of them had problems severe enough to suggest RBD while they were being treated with varying doses of other dopaminergic agents (carbidopa/L-dopa, pergolide) unaccompanied by selegiline.

Aged