Improving physician compliance with preventive medicine guidelines.
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
P Franks
Publications and source records attributed to P Franks.
Patient and physician perspectives of work-related illness in family practice.
A questionnaire survey was administered to 362 patients at a family medicine center to define the occupational characteristics of the patient population. Thirty-eight percent of patients reported current health problems related to their work. A chart review of a random sample of 100 of these patients revealed no documented differences between those who reported and those who did not report work-related health problems. Forty-one charts had no occupational data recorded. Only five charts had any record of hazardous exposures, whereas 60 of these patients had reported hazardous exposures. It is concluded that work is commonly perceived as an important determinant of health status and that family physicians currently tend to overlook this fact. The introduction of some formal occupational health teaching in family medicine residencies is needed, with particular emphasis on preventive aspects.
Adult↗
Effectiveness of tuberculin skin test screening in a rural family practice.
Tuberculin skin tests were performed on 1,146 patients out of an active patient population of 3,112 patients over a ten-year period in a rural western New York State family practice. There were 19 new positive tuberculin reactions and six cases of active tuberculosis discovered in the population. All but two of the patients with new positive tuberculin reactions and all of the patients with new cases of active tuberculosis were members of at least one of the following high-risk groups: (1) contract with an individual with active tuberculosis, or a positive family history of the disease; (2) immigrants to the United States; (3) a history of alcohol abuse; (4) having lived in an institutional setting; (5) health care personnel; and (6) having signs and symptoms of tuberculosis (cough, anorexia, weight loss, positive chest roentgenogram). All new cases of active tuberculosis were diagnosed because of symptoms. No asymptomatic person with a positive tuberculin test developed active disease during the study period. The positive predictive value of using risk factors to prescreen for the tuberculin skin test was 16 percent. The negative predictive value of not screening people without risk factors (because they will have a negative tuberculin test) was 99.8 percent.
Adolescent↗
Patterns of utilization, disposition, and length of stay among stroke patients in a community hospital setting.
This retrospective descriptive study of stroke patients in a community hospital examined the relationship of discharge disposition and length of stay to sociodemographic variables and use of hospital services. Age-related patterns emerged. Younger patients were more ambulatory, more frequently discharged to home or rehabilitation units, and used more diagnostic services. Older patients were discharged more frequently to nursing homes and used more social services. Next to level of clinical impairment at discharge, age and admission from home had the greatest effect on whether a patient was discharged to their home. Clinical conditions and the need to await placement in a rehabilitation facility or nursing home correlated with longer lengths of stay.
Aged↗
The treatment of acute bronchitis with trimethoprim and sulfamethoxazole.
Sixty-seven previously healthy patients with acute bronchitis were randomized and treated with either a fixed dose of trimethoprim and sulfamethoxazole or placebo for seven days. All outcomes examined showed a trend favoring the use of antibiotic, with statistically significant differences for cough, night cough, mean temperature, and use of antihistamines or decongestants. Night cough occurred on 84 percent of nights in the control group vs 56 percent in the antibiotic group (P = .003). Cough occurred on 99 percent of days for patients in the control group vs 93 percent of days for patients in the antibiotic group (P = .05). Mean temperature over the seven nights was 37.3 degrees C in the control group vs 36.9 degrees C in the antibiotic group (P = .004). The use of antihistamines and decongestants was reduced from 32 percent of days in the control group to 6 percent of days in the antibiotic group (P = .005). Patients in the antibiotic group worked 73 percent of days vs 55 percent of days for patients in the control group, which was significant when patients were stratified by the appearance of their sputum on Gram stain (P = .006). Smoking history was not found to help predict the response to antibiotic therapy.
Acute Disease↗
Family medicine research. Status at the end of the first decade.
In a national survey of family medicine university units and residencies, 549 MD and 135 PhD faculty pursuing family medicine research were identified. Resources available for research were assessed, as were practice data system characteristics. The practice base nationally of programs pursuing research included 2.6 million patients from 1 million families, making 5.1 million visits per year. Common major impediments to research reported by programs included lack of faculty time (78%), lack of funding for faculty (61%) or staff, equipment and supplies (48%), and lack of research skill (45%) and role models (43%). The annual amount of all research grants received for calendar year 1979 was $3.4 million, of which $2.6 million was from federal government sources. This represented 0.06% of the federal health research effort. Continued development of family medicine research will require increased funding support both for research and research training.
Academic Medical Centers↗
Breech: vaginal delivery or caesarean section?
Explore the source record for details and available documents.
Breech Presentation↗
Psychosocial bias in the diagnosis of obesity.
This study explores demographic and psychosocial variables associated with the assignment of the diagnosis of obesity in a family medicine residency model practice. Three groups of adult patients seen during 1978 were studied: a random sample of active patients, patients diagnosed as obese during 1978, and those never diagnosed as obese. While the prevalence of true obesity (greater than 20 percent above ideal body weight) was similar for men (58 percent) and women (47 percent), more women were diagnosed (222 women vs 87 men) and were more likely to be diagnosed within a year of entering the practice (42 percent women vs 10 percent men). Diagnosed obese women were older, had more psychological problems, and visited the practice more often than nonobese women. Diagnosed obese men were older, more frequently had psychological problems, visited the practice more often, and were more likely to be married than nonobese men. Undiagnosed obese men, however, had fewer psychological problems than nonobese men. The results suggest that physician education should address problems with diagnostic labeling and that researchers should anticipate subtle selection biases in retrospective studies when sampling methods depend on diagnosis.
Adult↗
Screening guidelines in a family medicine program: a five-year experience.
An audit of charts of 112 adult patients at the University of Rochester Family Medicine Program was conducted to determine the effect of screening guidelines introduced into the practice in 1975. Beyond the initial educational effort when the guidelines were introduced and a verbal explanation of the guidelines printed in each patient record given to new providers as they entered the program, no continuous encouragement was offered. Over the next five years, provider compliance fell short of the guideline recommendations for all 10 screening tests. Depending on the test, 10 to 100 percent of patients received no screening over that period. Tests performed by nursing personnel were completed more frequently than those performed by physicians (P=0.05). Frequency of screening by physicians correlated with the frequency of complete physical examination (P less than 0.0001) and sex (P less than 0.02), and screening by nurses correlated with complete physical examination frequency (P less than 0.0001), visit rate (P less than 0.0001), and patient age (P less than 0.0001). Awareness of screening recommendations was insufficient to result in provider compliance with them. Strategies for improving screening compliance are discussed.
Adolescent↗
Educational status and health.
Some of the problems with the traditional measures of socioeconomic status include (1) the loss of information resulting from combining different factors that have varying associations with health problems; (2) the reverse causal pathway that exists from health and illness to income and occupation; and (3) a number of particular problems with deriving socioeconomic status from census tract information. In contrast there are clear advantages to using educational status as the primary socioeconomic index. A wide variety of literature is reviewed pointing to a strong positive relationship between years of schooling and health. Three models that attempt to account for this association are described. It is suggested that the educational status of patients should be part of their data base.
Adolescent↗
Are symptoms of anxiety and depression risk factors for hypertension? Longitudinal evidence from the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study.
OBJECTIVE: To test the hypothesis that symptoms of anxiety and depression increase the risk of experiencing hypertension, using the National Health and Nutrition Examination I Epidemiologic Follow-up Study. DESIGN: A cohort of men and women without evidence of hypertension at baseline were followed up for 7 to 16 years. The association between 2 outcome measures (hypertension and treated hypertension) and baseline anxiety and depression was analyzed using Cox proportional hazards regression adjusting for hypertension risk factors (age; sex; education; cigarette smoking; body mass index; alcohol use; history of diabetes, stroke, or coronary heart disease; and baseline systolic blood pressure). Analyses were stratified by race and age (white persons aged 25-44 years and 45-64 years and black persons aged 25-64 years). SETTING: General community. PARTICIPANTS: A population-based sample of 2992 initially normotensive persons. MAIN OUTCOME MEASURES: Incident hypertension was defined as blood pressure of 160/95 mm Hg or more, or prescription of antihypertensive medications. Treated hypertension was defined as prescription of antihypertensive medications. RESULTS: In the multivariate models for whites aged 45 to 64 years, high anxiety (relative risk [RR], 1.82; 95% confidence interval [CI], 1.30-2.53) and high depression (RR, 1.80; 95% CI, 1.16-2.78) remained independent predictors of incident hypertension. The risks associated with treated hypertension were also increased for high anxiety (RR, 2.36; 95% CI, 1.73-3.23) and high depression (RR, 1.89; 95% CI, 1.25-2.85). For blacks aged 25 to 64 years, high anxiety (RR, 2.74; 95% CI, 1.35-5.53) and high depression (RR, 2.99; 95% CI, 1.41-6.33) remained independent predictors of incident hypertension. The risks associated with treated hypertension were also increased for high anxiety (RR, 3.24; 95% CI, 1.59-6.61) and high depression (RR, 2.92; 95% CI, 1.37-6.22). For whites aged 25 to 44 years, intermediate anxiety (RR, 1.62; 95% CI, 1.18-2.22) and intermediate depression (RR, 1.60; 95% CI, 1.17-2.17) remained independent predictors of treated hypertension only. CONCLUSION: Anxiety and depression are predictive of later incidence of hypertension and prescription treatment for hypertension.
Adolescent↗
Racial and ethnic disparities in perceptions of physician style and trust.
CONTEXT: While pervasive racial and ethnic inequalities in access to care and health status have been documented, potential underlying causes, such as patients' perceptions of their physicians, have not been explored as thoroughly. OBJECTIVE: To assess whether a person's race or ethnicity is associated with low trust in the physician. DESIGN, SETTING, AND PARTICIPANTS: Data were obtained from the 1996 through 1997 Community Tracking Survey, a nationally representative sample. Adults who identified a physician as their regular provider and had at least 1 physician visit in the preceding 12 months were included (N = 32,929). MAIN OUTCOME MEASURE: Patients' ratings of their satisfaction with the style of their physician and their trust in physicians. The Satisfaction With Physician Style Scale measured respondents' perceptions of their physicians' listening skills, explanations, and thoroughness. The Trust in Physician Scale measured respondents' perceptions that their physicians placed the patients' needs above other considerations, referred the patient when needed, performed unnecessary tests or procedures, and were influenced by insurance rules. RESULTS: After adjustment for socioeconomic and other factors, minority group members reported less positive perceptions of physicians than whites on these 2 conceptually distinct scales. Minority group members who lacked physician continuity on repeat clinic visits reported even less positive perceptions of their physicians on these 2 scales than whites. CONCLUSIONS: Patients from racial and ethnic minority groups have less positive perceptions of their physicians on at least 2 important dimensions. The reasons for these differences should be explored and addressed. Arch Fam Med. 2000;9:1156-1163
Adolescent↗
Deafness and mortality: analyses of linked data from the National Health Interview Survey and National Death Index.
OBJECTIVE: To examine the association between age at onset of deafness and mortality. METHODS: The authors analyzed National Health Interview Survey data from 1990 and 1991--the years the Hearing Supplement was administered--linked with National Death Index data for 1990-1995. Adjusting for sociodemographic variables and health status, the authors compared the mortality of three groups of adults ages > or = 19 years: those with prelingual onset of deafness (< or = age 3 years), those with postlingual onset of deafness (> age 3 years), and a representative sample of the general population. RESULTS: Multivariate analyses adjusted for sociodemographics and stratified by age found that adults with postlingual onset of deafness were more likely to die in the given time frames than non-deaf adults. However, when analyses were also adjusted for health status, there was no difference between adults with postlingual onset of deafness and a control group of non-deaf adults. No differences in mortality were found between adults with prelingual onset of deafness and non-deaf adults. CONCLUSIONS: Adults with postlingual onset of deafness appear to have higher mortality than non-deaf adults, which may be attributable to their lower self-reported health status.
Adult↗
Community leg ulcer clinics: cost-effectiveness.
This study investigates the cost-effectiveness and efficacy of a new service provided by community leg ulcer clinics, and compares it with treatment in existing hospital-based venous ulcer care clinics. Data were provided prospectively from district nurses and retrospectively from patients. Success in treatment was assessed as a percentage of ulcers completely healed after 12 weeks of treatment, analysed by the up-table method. Treatment success of 22% at 12 weeks using existing methods compared with 80% in community clinics. Costs were estimated to be 433,600 pounds and 169,000 pounds respectively. These findings indicate that community leg ulcer clinics were more effective and less expensive than the previous system of care.
Aged↗
Effectiveness of telephone reminders in improving rate of appointments kept at an outpatient clinic: a randomized controlled trial.
BACKGROUND: Clinic appointments in which patients do not appear (no-show) result in loss of provider time and revenue. Previous studies have shown variable effectiveness in telephone and mailed reminders to patients. METHODS: We conducted a randomized controlled trial of telephone reminders 1 day before the scheduled appointments in an urban family practice residency clinic. Patients with appointments were randomized to be telephoned 1 day before the scheduled visit; 479 patients were telephoned and 424 patients were not telephoned. RESULTS: The proportions of patients not showing up for their appointments were 19% in the telephoned and 26% in the not-telephoned groups (P = .0065). Significantly more cancelations were made when telephoning patients before their visit, 17% compared with 9.9%. The opened scheduling slots were used for appointments for other patients. This additional revenue offset the cost of telephone intervention in our cost analysis. CONCLUSION: Reminding patients by telephone calls 1 day before their appointments yields increased cancelations that can be used to schedule other patients. Telephone reminders provide substantial net revenue, but the results may be population specific.
Adolescent↗
Clinical trials.
Clinical trials are a relatively underused form of investigation in family medicine. This paper presents an overview of those considering conducting or assessing a clinical trial. A bibliography for further reading is also provided. Topics covered include aspects of: the development of a protocol; design such as randomization and binding; the special role of non-drug studies in family medicine; measurement--especially combating bias; analysis--particularly the management of drop-outs; and, the problem of generalizability.
Clinical Protocols↗
Social inequities in health: Rochester, New York.
This paper reports an investigation of social inequities in the distribution of low birth weight risks and mortality rates for Rochester, N.Y., a community reported to have relatively good access to medical care. The prevalence of low birth weight and no prenatal care were lower for each race/education group than those observed in comparable national data. Mortality rates were higher in the poorer areas for each sex, race, age group, and disease category. The excess mortality in the poorer areas declined significantly over the period studied for conditions amenable to medical care but not for conditions not amenable. In minorities, however, the excess mortality increased significantly for amenable conditions with no change for nonamenable conditions. The results are consistent with the hypothesis that the socially disadvantaged suffer an excess burden of morbidity and mortality. Access to medical care may make a significant contribution to reducing these inequities, but major barriers to equitable health and health care remain, particularly for minorities. This is an important but neglected area of concern for family medicine, and the implications are discussed.
Cross-Sectional Studies↗
Programming for the neurologically disabled patient in a psychiatric setting.
Explore the source record for details and available documents.
Activities of Daily Living↗