Biomedical subjects

Martin S Lipsky

Publications and source records attributed to Martin S Lipsky.

8 recordsLinked to original sources

PubMed2002

Screening for depression across the lifespan: a review of measures for use in primary care settings.

Depression is a common psychiatric disorder in children, adolescents, adults, and the elderly. Primary care physicians, not mental health professionals, treat the majority of patients with symptoms of depression. Persons who are depressed have feelings of sadness, loneliness, irritability, worthlessness, hopelessness, agitation, and guilt that may be accompanied by an array of physical symptoms. A diagnosis of major depression requires that symptoms be present for two weeks or longer. Identifying patients with depression can be difficult in busy primary care settings where time is limited, but certain depression screening measures may help physicians diagnose the disorder. Patients who score above the predetermined cut-off levels on the screening measures should be interviewed more specifically for a diagnosis of a depressive disorder and treated within the primary care physician's scope of practice or referred to a mental health subspecialist as clinically indicated. Targeted screening in high-risk patients such as those with chronic diseases, pain, unexplained symptoms, stressful home environments, or social isolation, and those who are postnatal or elderly may provide an alternative approach to identifying patients with depression.

Adolescent↗

PubMed2002

Content and design attributes of antivaccination web sites.

CONTEXT: Individuals searching the Internet for vaccine information may find antivaccination Web sites. Few published studies have systematically evaluated these sites. OBJECTIVES: To examine antivaccination Web site attributes and to delineate the specific claims and concerns expressed by antivaccination groups. DESIGN AND SETTING: In late 2000, using a metasearch program that incorporates 10 other search engines, we reviewed and analyzed 772 links to find 12 Web sites that promulgated antivaccination information. Analyzing links from these 12 sites yielded another 10 sites, producing a total of 22 sites for study. Using a standardized form, 2 authors (R.M.W., L.K.S.) systematically evaluated these sites based on specific content and design attributes. MAIN OUTCOME MEASURES: Presence or absence of 11 Web site content attributes (antivaccination claims) and 10 Web site design attributes. RESULTS: The most commonly found content claims were that vaccines cause idiopathic illness (100% of sites), vaccines erode immunity (95%), adverse vaccine reactions are underreported (95%), and vaccination policy is motivated by profit (91%). The most common design attributes were the presence of links to other antivaccination sites (100%of sites), information for legally avoiding immunizations (64%), and the use of emotionally charged stories of children who had allegedly been killed or harmed by vaccines (55%). CONCLUSION: Antivaccination Web sites express a range of concerns related to vaccine safety and varying levels of distrust in medicine. The sites rely heavily on emotional appeal to convey their message.

Health Education↗

PubMed2002

Expert agreement in Current Procedural Terminology evaluation and management coding.

BACKGROUND: Available data suggest that physicians are accurate in approximately 55% of Current Procedural Terminology (CPT) evaluation and management (E/M) coding for their services. This accuracy is relative to observers' or auditors' assigned codes for these services, a group that has not been studied for their consistency in application of the CPT E/M coding guidelines. The purpose of this study was to determine the level of agreement of certified coding specialists in their application of CPT E/M coding guidelines. METHODS: Three hundred certified professional coding specialists randomly selected from the active membership of the American Health Information Management Association were sent 6 hypothetical progress notes of office visits along with a demographic survey. The study group assigned CPT E/M codes to each of the progress notes and completed the demographic survey. RESULTS: Coding specialists agreed on the CPT E/M codes for 57% of these 6 cases. The level of agreement for the individual cases ranged from 50% to 71%. Relative to the most common or consensus code, undercoding of established patients occurred more commonly than overcoding. In contrast, for new patient progress notes, overcoding relative to the consensus code was more common than undercoding. CONCLUSIONS: There is substantial disagreement among coding specialists in application of the CPT E/M coding guidelines. The results of this study are similar to results of prior studies assessing physician coding accuracy, suggesting that the CPT coding guidelines are too complex and subjective to be applied consistently by coding specialists or physicians.

Adult↗

PubMed2002

Continuing medical education and attitudes of health care providers toward treating diabetes.

INTRODUCTION: Continuing medical education (CME) is an important tool in improving the care provided to patients with type 2 diabetes. Health behavior models suggest that attitudes are important factors in changing behavior. The aim of this study was to evaluate the immediate and 3-month impact of a diabetes educational program on the attitudes of health care providers toward treating diabetes. METHODS: Health care providers (including physicians, physician assistants, nurse practitioners, and nurses) were attending a 7-hour CME program on type 2 diabetes in one of eight states in the United States between May and September 1999. Attitudes were assessed using the Diabetes Attitudes Scale-3 (DAS-3), which was given immediately before the program, immediately after the program, and 3 months after the program. A convenience sample of 315 providers completed pre- and post-CME measurement. Three-month follow-ups were completed by 146 (46%) of the 315 providers. RESULTS: Following the CME program, physicians had significantly more positive attitudes on two of five DAS subscales. At 3 months, the change persisted on one subscale that measured beliefs related to type 2 being a serious disease. Allied professionals had significantly more positive attitudes on five subscales following the program; however, the change did not persist at 3 months. DISCUSSION: This CME program resulted in different patterns of attitude change for physicians as compared to allied professionals. In both groups, more positive attitudes toward treating diabetes were detected following the CME; however, the change tended to diminish by 3 months after the program. These findings mimic much of the research on knowledge retention following CME.

Attitude of Health Personnel↗

PubMed2002

Atherosclerotic risk factor reduction in peripheral arterial diseasea: results of a national physician survey.

OBJECTIVE: Individuals with peripheral arterial disease (PAD) have a 3- to 6-fold increased risk of coronary heart disease and stroke compared to those without PAD. We documented physician-reported practice behavior, knowledge, and attitudes regarding atherosclerotic risk factor reduction in patients with PAD. DESIGN: National physician survey. PATIENTS/PARTICIPANTS: General internists (N = 406), family practitioners (N = 435), cardiologists (N = 473), and vascular surgeons (N = 264) randomly identified using the American Medical Association's physician database. MEASUREMENTS AND MAIN RESULTS: Physicians were randomized to 1 of 3 questionnaires describing a) a 55- to 65-year-old patient with PAD; b) a 55- to 65-year-old patient with coronary artery disease (CAD), or c) a 55- to 65-year-old patient without clinically evident atherosclerosis (no disease). A mailed questionnaire was used to compare physician behavior, knowledge, and attitude regarding risk factor reduction for each patient. Rates of prescribed antiplatelet therapy were significantly lower for the patient with PAD than for the patient with CAD. Average low-density lipoprotein levels at which physicians "almost always" initiated lipid-lowering drugs were 121.6 +/- 23.5 mg/dL, 136.3 +/- 28.9 mg/dL, and 149.7 +/- 24.4 mg/dL for the CAD, PAD, and no-disease patients, respectively (P <.001). Physicians stated that antiplatelet therapy (P <.001) and cholesterol-lowering therapy (P <.001) were extremely important significantly more often for the CAD than for the PAD patient. Perceived importance of risk factor interventions was highly correlated with practice behavior. Compared to other specialties, cardiologists had lowest thresholds, whereas vascular surgeons had the highest thresholds for initiating cholesterol-lowering interventions for the patient with PAD. Cardiologists were significantly more likely to report "almost always" prescribing antiplatelet therapy for the patient with PAD than were all other physicians. CONCLUSIONS: Deficiencies in physician knowledge and attitudes contribute to lower rates of atherosclerotic risk factor reduction for patients with PAD. Reversing these deficiencies may reduce the high rates of cardiovascular morbidity and mortality associated with PAD.

Adult↗

PubMed2002

Vaginitis: case reports and brief review.

Vaginitis is the most frequently gynecologic diagnosis encountered by physicians who provide primary care to women. Accurate diagnosis can be elusive, complicating treatment. Most experts believe that up to 90% of vaginitis cases are secondary to bacterial vaginosis, vulvo-vaginal candidiasis, and trichomoniasis. The diagnosis of vaginitis is based on the patient's symptoms, the physical examination, the findings of microscopic examination of the wetmount and potassium hydroxide (KOH) preparations, and the results of the pH litmus test. Additional cultures and testing may be needed for difficult-to-diagnose cases.

Adult↗

PubMed2002

Specialty board certification and clinical outcomes: the missing link.

PURPOSE: Specialty board certification status is often used as a standard of excellence, but no systematic review has examined the link between certification and clinical outcomes. The authors evaluated published studies tracking clinical outcomes and certification status. METHOD: Data sources consisted of studies cited between 1966 and July 1999 in OVID-Medline, psychological abstracts (PsycLit), and the Educational Research Information Clearinghouse (ERIC). Screening criteria included: only U.S. patients and physicians used as subjects; verified specialty board certification status by an American Board of Medical Specialties' (ABMS') member board using the ABMS database or derivative sources; described selection criteria for patients and physicians; selected nationally recognized standards of care for outcomes; and nested patient data by individual physician. The computerized searches that were conducted in 1999 identified 1,204 papers; one author and a research assistant selected 237 papers based on subject relevance, and reduced the list to 56 based on study quality. The authors independently applied inclusion and exclusion criteria to identify 13 of the 56 papers containing 33 separable relevant findings. RESULTS: Of the 33 findings, 16 demonstrated a significant positive association between certification status and positive clinical outcomes, three revealed worse outcomes for certified physicians, and 14 showed no association. Three negative findings and one finding of no association were identified in two papers with insufficient case-mix adjustments in the analyses. Meta-analytic statistics were not feasible due to variability in outcome measures across studies. CONCLUSIONS: Few published studies (5%) used research methods appropriate for the research question, and among the screened studies more than half support an association between board certification status and positive clinical outcomes.

Accreditation↗

PubMedDate not supplied

E/M coding problems plague physicians, coders.

As the government turns its high beams on fraudulent billing, physician E/M coding is raising questions. With several studies spotlighting the difficulty physicians have in applying CPT E/M codes, the authors wanted to know if credentialed coders had the same problem. Here's what they found.

Diagnostic Services↗