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Biomedical subjects

R Brook

Publications and source records attributed to R Brook.

35 records · Page 2Linked to original sources
PubMed1991

Board certification and practice style: an analysis of office-based care.

BACKGROUND: The relationship between family practice certification and practice style has important health policy implications. We used data from the RAND Health Insurance Experiment to study the relationship between family practice certification and (1) patient characteristics including age and sex of patients, and (2) facets of practice style including probability of hospital admission, number of visits in an episode of care, number of physicians seen per episode, total charges per episode, charges per service category, and inputs per service category. METHODS: Data on health care service utilization by a sample of 5554 nonelderly individuals over a 1-year period were used to define episodes of care. Multivariate regression techniques were used to measure the association between family practice certification and patient characteristics and between family practice certification and practice style, controlling for the effects of patients characteristics. RESULTS: Patients of certified family physicians were an average of 3 years younger than patients of noncertified family physicians, but other demographic characteristics were similar. Certified family physicians had higher pathology services charges and inputs, but no statistically significant differences in other measures of charges and inputs. CONCLUSIONS: Certified and noncertified family physicians treat similar patients. Certification in family practice is not associated with major differences in total service charges, but is associated with differences in the use of laboratory diagnostic services.

Adolescent↗
PubMed1988

Management of patients on psychotropic drugs in primary care clinics.

While nonpsychiatrist physicians account for the majority of prescriptions written for psychotropic drugs, little is known about the quality of their drug management strategy. We studied this issue using data from 16 academic internal medicine group practices. Data on treatment, abstracted from medical records, were compared to criteria for quality care. Eighteen percent of patients used minor tranquilizers or antidepressants. The only individual factor independently associated with use of minor tranquilizers was mental health status. Nonwhites were less likely than whites to be diagnosed as depressed or receive antidepressants, even after controlling for baseline mental and physical health status. Mental and physical health status were also independently associated with antidepressant drug use. Quality of care was low for formulating a treatment plan for either drug group and for follow-up plans for antidepressants. Documentation of an adequate treatment plan for minor tranquilizers was poorest for patients who visited a house staff or nonphysician rather than a faculty member. For antidepressants, the patients with the poorest general health status tended to have the best documentation of treatment plans.

Adult↗
PubMed1986

The relationships among alcohol availability, alcohol consumption and alcohol-related damage in the Province of Ontario and the State of Michigan 1955-1982.

This study examines the relationships among the relative price of alcohol, per capita alcohol consumption and liver cirrhosis mortality rates over a 28 year period in Ontario and Michigan. A high, positive association between per capita consumption and liver cirrhosis mortality was observed for both jurisdictions. In both areas, changes in the relative price of alcohol were inversely related to changes in consumption and cirrhosis mortality. Although causal inferences from these data must be made with caution, the results are strong enough to suggest that policy initiatives concerning the economic availability of alcohol should consider public health consequences.

Alcohol Drinking↗
PubMed1986

Dental insurance and the oral health of preschool children.

Using data from the Rand Health Insurance Experiment, the effects of cost-sharing plans on the health of the primary teeth in 264 children aged 3 to 5 years were investigated. From six areas in the United States, families were assigned at random to different dental and medical insurance plans. The plans varied in the amount of required cost sharing. Families participated in the study for 3 (70%) or 5 (30%) years. Children covered by the plan (requiring no cost sharing) had significantly fewer decayed teeth and deft (decayed, extracted, and filled teeth) at the end of the study than did children covered by the cost-sharing plans. No differences existed among plans in the number of extracted and restored teeth. Children of middle- and low-income families benefited most from having access to free dental care.

Child Health Services↗
PubMed1986

Alcohol availability, alcohol consumption and alcohol-related damage. I. The distribution of consumption model.

One of the major approaches to alcoholism prevention is referred to as the distribution of consumption model. This prevention model can be summarized as a causal model whereby the availability of alcoholic beverages has a direct causal effect on the aggregate level of alcohol consumption in the population and, in turn, an indirect effect on the incidence and prevalence of alcohol-related damage. This article summarizes an application of a statistical technique known as the analysis of linear structural relations (LISREL) to a set of Ontario data concerning alcohol availability, alcohol consumption and alcohol-related damage. Results substantiated the existence of specific causal paths consistent with the model. Several procedures for assessing the overall goodness-of-fit of the model suggested that it adequately fit the data. The results provide reasonable statistical evidence that government policies restricting the retail availability of alcoholic beverages will reduce the per capita rates of alcohol consumption and, in turn, reduce the level of alcohol-related mortality and morbidity in the general population.

Adult↗
PubMed1985

Health status, sociodemographic factors, and the use of prescribed psychotropic drugs.

The relations among sociodemographic factors, health status, and use of prescribed sleeping pills and tranquilizers are examined. The data are from the Rand Health Insurance Experiment, which has a random sample of the nonaged, noninstitutionalized, civilian population in six U.S. sites. Information on sociodemographic factors, health status, and the use of prescribed psychotropic drugs during the previous 3 months was obtained from self-report questionnaires collected at enrollment. Mental and physical health status have large independent and significant effects on the probability of use of both prescribed tranquilizers (P less than 0.0001) and sleeping pills (P less than 0.0001), whether or not we remove the effects of sociodemographic factors. For the probability of tranquilizer use, there is no significant interaction between gender and mental health or between mental health and physical health. Age and gender have large and significant effects on the use of prescribed psychotropic drugs even after controlling for differences in health status and other demographic factors. The effects of site and socioeconomic status are modest compared with the effects of health, age, and gender.

Adult↗
PubMed1976

The relationship between oestrogen status and bone loss in post-menopausal women.

The relationships between the rate of change of metacarpal cortical width, urinary hydroxyproline/creatinine ratio, net absorption of calcium and maturation value of vaginal smear have been examined in normal post-menopausal women and crush fracture cases. Rapid bone loss, high bone resorption and low calcium absorption are shown to be associated with poor oestrogen status, with crush fracture cases presenting an exaggerated view of the normal post-menopausal situation.

Aging↗