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R C Burack

Publications and source records attributed to R C Burack.

23 records · Page 2Linked to original sources
PubMed1983

The predictive value of the presenting complaint.

The relationship between the presenting complaint and the principal problem identified during 103 new patient visits was assessed in an academic primary care setting. Complaints and problems were classified by content as somatic, psychosocial, or health maintenance and compared by category. The presenting complaint correctly identified the category in 76 percent of somatic but only 6 percent of psychosocial principal problems (sensitivity of 76 percent and 6 percent, respectively). The likelihood of a same-category principal problem (positive predictive value) ranged from 53 percent for somatic to 100 percent for psychosocial presenting complaints. A specific underlying motivation for the visit other than the presenting complaint was noted by the primary provider in 42 percent of the encounters and was most frequent in those encounters characterized by a lack of concordance between complaint and problem. The presenting complaint introduces the clinical encounter, but its value is limited in specifically identifying the principal problem.

Adolescent↗
PubMedDate not supplied

Detroit's avoidable mortality project: breast cancer control for inner-city women.

Mammography remains substantially under-used in low-income minority populations despite its well-established efficacy as a means of breast cancer control. The Metropolitan Detroit Avoidable Mortality Project is a 2-year controlled clinical trial of coordinated interventions which seek to improve the use of early breast cancer detection services at five clinical sites providing primary health care services to inner-city women. Baseline assessment for two of the five participating clinic populations demonstrated that only one-quarter of women who visited these clinics were referred for mammography in 1988, and only half of those who were referred were able to complete the procedure. Patient characteristics including age, marital status, ethnicity, and insurance status were not associated with use of mammography during the baseline period. Each of the project's intervention components is a cue to action: a physician prompt for mammography referral within the medical record of procedure-due women, a reminder postcard for scheduled appointments, and a telephone call to encourage rescheduling of missed appointments. The interventions are initiated by a computerized information management system in the existing network of health care services. The patient's out-of-pocket mammography expense has been eliminated in three of the five sites. Although their efficacy as individual interventions has been well established, a controlled trial of computer prompts to physicians, reduced expense for patients, and patient appointment reminders as an integrated system in inner-city medical care settings has not been previously described. We have implemented the prompting, facilitated rescheduling procedures, and eliminated patient expense for mammography at three of five eventual clinical sites. This report provides an overview of the study's design, data management system, and methodology for evaluation.

Adult↗
PubMedDate not supplied

Interrelationships of general internal medicine and preventive/community medicine.

Clinical preventive medicine, efforts by clinicians to prevent disease in individual patients, is an important component of preventive medicine as a whole. Yet clinicians, including internists, apparently do not provide many preventive services of established effectiveness. This paper describes one approach to improving the practice of clinical preventive medicine: increased cooperation between general internists--one of the nation's largest groups of primary care physicians--and specialists in preventive/community medicine. The paper summarizes a larger report prepared by two societies representing these disciplines: the Society for Research and Education in Primary Care Internal Medicine and the Association of Teachers of Preventive Medicine. It was found that the two disciplines have many common goals, and much to offer each other, but do not often collaborate. The report concludes with 14 recommendations for improving the practice of clinical preventive medicine, which suggest that such improvement can be achieved in part through strengthening working relationships between general internists and preventive/community medicine specialists.

Internal Medicine↗