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Biomedical subjects

M S Gerrity

Publications and source records attributed to M S Gerrity.

16 recordsLinked to original sources
PubMed2001

Interventions to improve physicians' well-being and patient care: a commentary.

Dr. Firth-Cozens begins her paper by reviewing a broad range of research related to physicians' stress, depression, and alcoholism (Firth-Cozens, 2001, Social Science and Medicine, 52, 215-222). She then argues that these psychological problems have a negative impact on patient care and describes the possible causes of these problems. Finally, she proposes a system of organizational and individual interventions to address these problems. Before accepting her conclusions and proposed system of interventions, an important issue should be considered. Is physicians' well-being an important goal in and of itself, or do we need strong evidence that physician stress, depression, and alcoholism lead to poor patient care and outcomes?

Evaluation Studies as Topic↗
PubMed2001

Identifying physicians likely to benefit from depression education: a challenge for health care organizations.

BACKGROUND: Few methods exist to identify physicians who might benefit from depression education. OBJECTIVES: To develop a measure of physicians' confidence or self-efficacy in caring for depressed patients and assess it's reliability and validity. RESEARCH DESIGN: A national sample of primary care physicians were surveyed and exploratory factor analysis (EFA) was used to identify factors underlying physicians' responses to 26 items. We named the factors, selected items with factor loadings > or = 0.50 for final scales, and tested a priori hypotheses about self-efficacy. SUBJECTS: 1) Random cross-sectional sample of family physicians, internists, obstetrician-gynecologists, and pediatricians (n = 5,369) and 2) 49 general internists and family physicians participating in a prepost evaluation of a depression workshop. RESULTS: In the national sample, 3,712 physicians were eligible and 2,104 responded. Forty-six percent were female, and 51% were family physicians and general internists. EFA identified 5 factors, the first of which was called Self-Efficacy (4 items, alpha = 0.86). More family physicians (64%) had confidence (self-efficacy) in caring for depressed patients compared with general internists (33%), obstetrician-gynecologists (16%), and pediatricians (6%) (P < 0.001). Few physicians intended to change their care of depressed patients (10%) or take CME on depression (24%). Of the 49 physicians attending a depression workshop, 76% reported high self-efficacy after the workshop versus 50% before it (P = 0.013). CONCLUSIONS: This study supports the reliability and validity of the Self-Efficacy scale as one method to identify physicians who might benefit from interventions. New approaches are needed because physicians are unlikely to change.

Cross-Sectional Studies↗
PubMed2000

Patients' knowledge of options at the end of life: ignorance in the face of death.

CONTEXT: Effectiveness of legislation promoting advance directives and legalizing physician-assisted suicide depends on patients' understanding their legal options about end-of-life care. However, outpatients' understanding of their legal options at the end of life has not been studied. OBJECTIVES: To estimate the percentage of outpatients who are informed about 4 areas relevant to end-of-life care: refusal and withdrawal of lifesaving treatments, physician-assisted suicide, active euthanasia, and double effect; and to determine whether authoring advance directives, experiencing illness, acting as a proxy for health care decisions, and caring for an ill loved one are associated with better knowledge in end-of-life care. DESIGN: Cross-sectional survey. SETTING AND PARTICIPANTS: One thousand consecutive English-speaking, adult patients attending 1 university-based internal medicine clinic and 3 community-based, university-affiliated, mixed internal medicine and family practice clinics in Oregon during May and June 1999. MAIN OUTCOME MEASURES: Percentage of correct responses in the 4 topic areas and total knowledge score, adjusted for demographic (eg, age, race, educational level, income level, marital status) and experiential (eg, health, proxy decision making, advance directives, and death of a loved one) factors. RESULTS: Of the 1000 patients invited to participate, 728 (73%) consented and completed the questionnaire and were included in the analysis. A total of 69% of respondents answered correctly regarding refusal of treatment, 46% for withdrawal of treatment, 23% for assisted suicide, 32% for active euthanasia, and 41% for double effect. Sixty-two percent of respondents did not distinguish between assisted suicide and euthanasia. After adjustment for other covariates, better knowledge was significantly associated with white race (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.3-4.2), having at least a college degree (OR, 3.0; 95% CI, 1.4-6.7), and having been a proxy for health care decisions (OR, 1.8; 95% CI, 1.2-2.6). Personal experience with illness (OR, 1.0; 95% CI, 0.6-1.5), death or illness of a loved one (OR, 1.6; 95% CI, 1.0-2.7), and authoring an advance directive (OR,1.3; 95% CI, 0.9-2.0) were not associated with better knowledge. CONCLUSIONS: A significant proportion of outpatients at university-affiliated clinics in Oregon appear to misunderstand options in end-of-life care. Our results suggest that greater public knowledge about end-of-life care is needed, and advance care planning must be preceded by education about options in end-of-life care. JAMA. 2000;284:2483-2488.

Adult↗
PubMed1999

Improving the recognition and management of depression: is there a role for physician education?

BACKGROUND: Many patients who visit primary care physicians suffer from depression, but physicians may miss the diagnosis or undertreat these patients. Improving physicians' communication skills pertaining to diagnosing and managing depression may lead to better outcomes. METHODS: We performed a randomized controlled trial involving 49 primary care physicians to determine the effect of the Depression Education Program on their knowledge of depression and their behavior toward depressed patients. After randomization, physicians in the intervention group completed the Depression Education Program, which consists of 2 4-hour interactive workshops that combine lectures, discussion, audiotape review, and role-playing. Between sessions, physicians audiotaped an interview with one of their patients. Two to 6 weeks following the intervention program, physicians completed a knowledge test and received office visits from 2 unannounced people acting as standardized patients with major depression. These "patients" completed a checklist and scales. Logistic and linear regression were used to control for sex, specialty, and suspicion that the patient was a standardized patient. RESULTS: For both standardized patients, more intervention physicians than control physicians asked about stresses at home, and they also scored higher on the Participatory Decision-Making scale. During the office visits of one of the standardized patients, more intervention physicians asked about at least 5 criteria for major depression (82% and 38%, P = .006), discussed the possibility of depression (96% and 65%, P = .049), scheduled a return visit within 2 weeks (67% and 33%, P = .004), and scored higher than control physicians on the Patient Satisfaction scale (40.3 and 35.5, P = .014). CONCLUSIONS: The Depression Education Program changed physicians' behavior and may be an important component in the efforts to improve the care of depressed patients.

Communication↗
PubMed1998

Evaluating change in medical school curricula: how did we know where we were going?

This chapter compares and contrasts the primary outcomes and methods used to evaluate the curricular changes at the eight schools participating in The Robert Wood Johnson Foundation "Preparing Physicians for the Future: Program in Medical Education." Each school evaluated its own program. The eight evaluators formed an ad hoc group to share information, but the schools did not use a common evaluation system. Although the evaluations were done without common standards, many of the measures were similar. The schools used such quantitative methods as measuring students' performances and their choices of specialties, as well as such qualitative methods as asking students to evaluate their courses and to participate in focus groups. The authors describe the ways in which evaluative data were collected and how evaluation drove curricular change. The authors conclude that program evaluation can sustain schools through the turbulence of curricular change, and that qualitative data and communicating the results of evaluations with faculty and students are essential to successful reform.

Curriculum↗
PubMed1993

What do applicants look for when selecting internal medicine residency programs? A comparison of rating scale and open-ended responses.

OBJECTIVE: To develop reliable scale measures of factors most important to applicants when they select internal medicine residencies and to assess their validity by comparing scores from these measures with responses to open-ended questions. DESIGN: All 353 applicants ranked by the University of North Carolina at Chapel Hill (UNC-CH) for the 1988 National Residency Match Program received a questionnaire after submitting their match lists. First, they listed the three most important factors considered in ranking residency programs and starred the single most important factor out of the three. Then, they rated 41 items on a five-point Likert scale ranging from 1 (not important) to 5 (extremely important). SETTING: Categorical internal medicine residency program at an academic medical center. MEASUREMENTS AND MAIN RESULTS: 315 (88%) applicants responded to the survey. Three reliable scales, Interpersonal Issues (7 items, alpha = 0.78), Reputation (5 items, alpha = 0.77), and Work Issues (11 items, alpha = 0.89), were developed using exploratory factor analysis of applicants' responses to the 41 items. Applicants felt interpersonal issues were very important (mean score = 4.2 +/- 0.5), academic reputation was important (3.3 +/- 0.8), and work issues were less important (2.8 +/- 0.7). The differences between these scores were significant (F = 3.76, p < 0.05). The ratings for the top five items not in these scales also indicated that education and location were very important. These results were corroborated by applicants' responses to the open-ended request to list the three most important factors in ranking residencies. CONCLUSION: These findings suggest that work issues are important, but greater emphasis is placed on interpersonal issues, education, location, and a program's reputation when applicants select residency programs. Furthermore, this study provides evidence supporting the reliability and validity of the three scales.

Adult↗
PubMed1993

Short versions of the Timed Manual Performance Test. Development, reliability, and validity.

The Timed Manual Performance test is gaining wider use as a measure of functional status in research and clinical settings. It is a rather lengthy 27-item test, however, requiring the use of a large cumbersome panel of doors. The authors, therefore, studied 1,286 community-dwelling elderly subjects recruited through their primary care provider to: 1) reduce the number of items in the Timed Manual Performance (TMP) test and 2) assess the reliability and validity of the shorter versions of the TMP compared with the 27-item TMP. Using principal components analysis, we identified two shorter measures, TMP (Doors) consisting of five board tasks and TMP (Table) consisting of six table tasks. Timed Manual Performance (Doors) and TMP (Table) involve less equipment than the original TMP and have higher rates of completion. Furthermore, not only are these tests reliable (alpha = 0.79 and 0.82 for TMP [Doors] and TMP [Table], respectively), they appear to be better measures of manual performance compared with the 27-item TMP.

Activities of Daily Living↗
PubMed1990

Written case simulations: do they predict physicians' behavior?

Written case simulations are often used to investigate physicians' decision making and clinical competence. Their use rests on the assumption that physicians' responses to written simulations closely agree with their responses to actual clinical encounters, yet this assumption of criterion validity has received little attention. To determine the ability of written case simulations to predict actual clinical behavior, we applied methodologic criteria to published articles that used written simulations. Only 11 (15%) of 74 articles included an assessment of the criterion validity of their written case simulations. Only 2 of those 11 studies were designed and executed in such a way that criterion validity could be fully interpreted. No clear consensus emerged from an examination on the 11 studies on how well responses to written case simulations perform as proxy measures of actual behavior. More work is needed before assuming that written case simulations measure actual behavior.

Clinical Competence↗
PubMed1990

Physicians' reactions to uncertainty in patient care. A new measure and new insights.

Although variations in physicians' practice patterns and use of resources are well documented, the reasons for these variations are less well understood. The uncertainty inherent in patient care may be one explanation. Existing measures of intolerance to uncertainty, developed in contexts outside of patient care, fail to explain these variations. To address this limitation, the Physicians' Reactions to Uncertainty scale was developed. A questionnaire containing an initial pool of 61 items was mailed to a random sample of 700 physicians in North Carolina and Oregon, stratified by specialty. The items covered nine areas of physicians' reactions to uncertainty derived from interviews with physicians and a definition of the concept affective reactions to uncertainity in patient care. Factor analysis of the 428 responses received yielded two primary factors that accounted for 58% of the common variance among the 61 items. Items with unambiguous loadings on these factors defined two reliable and readily interpretable subscales: Stress from Uncertainty (Cronbach's alpha = 0.90, 13 items) and Reluctance to Disclose Uncertainty to Others (alpha = 0.75, 9 items). By virtue of its clarity and good psychometric properties, this new measure promises insights into the role that uncertainty plays in physicians' resource utilization and practice patterns.

Adaptation, Psychological↗
PubMed1988

A comparison of patient, family, and physician assessments of the value of medical intensive care.

Medical ethics suggest that physicians incorporate patient preferences when making life-sustaining treatment decisions. This study therefore examines how closely physicians' assessments of the usefulness of intensive care agree with their patients' willingness to receive intensive care. Former intensive care patients, at least 55 yr old (or family members of nonsurviving patients), and their physicians were interviewed (n = 76 pairs of interviews) to determine how valuable each believe intensive care would be to the patient (on a scale of 0 to 100%) under actual and ideal life circumstances. Little correlation was found between individual patient or family member and physician responses (Kendall's Tau ranged from -.14 to .22 depending on how long life was prolonged). Physicians' evaluations of intensive care for patients under ideal life circumstances were strongly correlated with physicians' personal preferences for intensive care (Kendall's Tau, .41 to .65, p less than .02). Because physicians and patients may not agree regarding the value of intensive care, physicians must explicitly discuss patients' preferences in order to reconcile wishes and justifiable needs for critical care.

Aged↗
PubMedDate not supplied

The association of physician attitudes about uncertainty and risk taking with resource use in a Medicare HMO.

PURPOSE: To explore the association between the attitudes of primary care physicians toward uncertainty and risk taking, as measured by a validated survey, with resource use in a Medicare HMO. DESIGN: All primary-care internists (n=20) in a large, multi-specialty clinic were surveyed to measure their attitudes about uncertainty and risk taking using three previously developed scales. Results were linked with administrative data for 792 consecutive patients in a recently created Medicare HMO. The patients' index visits occurred between April 1, 1995, and November 30, 1995. ANALYSIS: Charges stemming from several claim types (primary care and subspecialty physician, laboratory, radiology, and ambulatory procedures) in the 30 days following the index visit were summed. The physician scales were dichotomized at the median to seek unadjusted associations with charges. Generalized estimation equations were used to account for the correlation of charges resulting from patients' being nested within physicians and adjusted for physician characteristics (age, sex, years in practice) and patient characteristics (age, sex, comorbidity). MAIN RESULTS: The physician response rate was 90%. Most physicians (90%) were male. The mean age of the patients was 74 years, and 69% were female. The mean cost (+/-SD) per patient was $621.61+/-1,737.31. From the unadjusted analysis, high "anxiety due to uncertainty" was associated with higher patient charges ($197.85 vs $158.21, p=0.01). From the multivariable analysis, each standard deviation increase in "anxiety due to uncertainty" (3.5 points) corresponded to a 17% increase in mean charges (p < 0.01) and each similar increase in "reluctance to disclose uncertainty to patients" (1.92 points) corresponded to a 12% increase (p=0.03). However, increasing "reluctance to disclose mistakes to physicians" and increasing physician risk-taking propensity were associated with decreased total charges [-10% per standard deviation (1.34 points), p=0.02, and -8% per standard deviation (3.26 points), p=0.02, respectively]. CONCLUSION: Physician attitudes toward uncertainty were significantly associated with patient charges. Further investigation may improve prediction of patient-care charges, offer insight into the medical decision-making process, and perhaps clarify the relationship between cost, uncertainty, and quality of care.

Aged↗
PubMedDate not supplied

Effectiveness of an intervention to improve primary care provider recognition of depression.

CONTEXT: Depression remains under-recognized and undertreated by primary care providers. While systematic screening has the potential to improve recognition, providers may overlook screening results because of barriers to accessing the information and the need to address multiple health care issues. OBJECTIVE: To determine whether limited follow-up of positive findings on depression screening improves provider recognition and initial management of depression. DESIGN: Before-after study. PATIENTS: Consecutive patients with positive findings on depression screening in a Veterans Affairs primary care clinic in Oregon during the 3 months before (n = 160) and the 3 months after (n = 97) the intervention began. INTERVENTION: Patients with positive findings on depression screening completed a self-administered questionnaire (Patient Health Questionnaire), which they turned in to their provider. A mental health nurse subsequently reviewed the records of patients who completed questionnaires and contacted providers when depression was not mentioned in the visit note. OUTCOME MEASURES: Documentation of depression or suicidal ideation and actions taken for depression (prescription of antidepressant medication, mental health referral, watchful waiting) at the clinic visit. RESULTS: The mental health nurse received questionnaires for only 39 (40%) postintervention patients. Documentation of depression symptoms (72% vs. 48%; P < 0.001) and suicidal ideation (36% vs. 14%; P < 0.001) significantly improved in the postintervention group compared with the preintervention group. Postintervention patients were also more likely to begin receiving antidepressants (23% vs. 12%; P < 0.05) and to be referred for mental health services (28% vs. 9%; P < 0.001). CONCLUSION: A limited intervention can improve provider recognition and initial management of depression in a Veterans Affairs primary care setting.

Depressive Disorder↗