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Biomedical subjects

R G Frank

Publications and source records attributed to R G Frank.

At least 127 records · Page 7Linked to original sources
PubMed1988

Pain management in rheumatoid arthritis patients. A cognitive-behavioral approach.

To examine the effectiveness of a cognitive-behavioral pain management program for patients with rheumatoid arthritis, three patient groups were studied: a cognitive-behavioral group (CB), an attention-placebo group, and a control group. The CB group received a comprehensive, 12-month pain management program that taught coping strategies such as problem-solving techniques, relaxation training, strategies for attention diversion, and training in family dynamics and communication. Dependent measures included pain, coping strategies, psychological status, functional status, and disease status. Data analysis at 12 months revealed benefits for the CB group in the area of enhanced coping strategies. Specifically, the CB subjects showed significantly greater use of coping strategies and significantly more confidence in their ability to manage pain. The findings are discussed in terms of the importance of enhanced self-efficacy and personal control for patients with rheumatoid arthritis.

Adaptation, Psychological↗
PubMed1988

The decision to seek an exemption from PPS.

This paper examines the receipt of exemptions from Medicare's Prospective Payment System (PPS) for distinct part psychiatric units of general hospitals. A logit model of the exemption status of 1,045 psychiatric units is estimated using 1984 data. The results suggest that units that were expected to profit from a change in payment method (cost based on PPS) were least likely to obtain an exemption from PPS.

Data Collection↗
PubMed1988

Age as a factor in response to spinal cord injury.

Previous studies examining the role of age in the mediation of psychological response to a catastrophic injury, such as spinal cord injury, have yielded equivocal results. To further examine the role of age in the response to catastrophic injury, 53 patients with spinal cord injury were administered a battery of tests assessing life stress, depression and general psychological functioning. Two groups were derived from negative ratings of life events and subject's age. Younger patients, who reported higher levels of life stress, also reported more depressive symptomatology; younger patients with lower levels of life stress reported fewer depressive symptoms. Both young and old patients with high stress reported higher levels of depressive symptomatology. Psychological disturbance was greater in the high life stress group as indicated by significant elevations on the global severity index of the Symptom Checklist-90 and elevations on somatization, obsessive compulsive, interpersonal sensitivity, depression, anxiety and psychoticism subscales. Age effects were not found for the Symptom Checklist-90.

Adaptation, Psychological↗
PubMed1988

Use of mental health services and persistence of emotional distress. An exploratory analysis.

This article probes the relationship between use of ambulatory mental health services and the persistence of mental problems. The analysis focuses on the difficulties in obtaining empirical estimates of the relationship between usage and persistence. A two-step estimator is used to take into account unobserved determinants of both usage and mental health status. This estimator is compared with a single equation model and a two-stage least-squares estimator. The study makes use of a community survey designed to estimate the prevalence of major mental disorders over a 12-month period. The survey consisted of three waves of interviews over the study year. The results indicate a significant decrease in the likelihood of mental problems persisting when treatment is received.

Adolescent↗
PubMed1988

Psychiatry under prospective payment: experience in the first year.

The authors present data on changes in resource use by Medicare psychiatric patients in general hospitals after the introduction of the prospective payment system in 1984. Length of stay and charges per discharge during fiscal year 1984 fell 13.8% and 15.9%, respectively, after the new system began, even though 31.8% of the discharges for Medicare psychiatric cases were from exempt psychiatric units. The decrease in length of stay was considerably larger (23.2%) in hospitals with no psychiatric units, which were not exempt from prospective payment.

Fees and Charges↗
PubMed1988

Factors affecting Medicaid patients' length of stay in psychiatric units.

The structure of the Medicaid program varies widely among the States. Examined in this article is the relationship between certain characteristics of the State Medicaid programs and the length of stay of patients who are discharged from psychiatric units in general hospitals. It has been found that setting limits on the number of reimbursable days leads to shorter lengths of stay and that, after controlling for region, length of stay is not influenced by utilization review or State rate setting.

Adolescent↗
PubMed1988

The early effects of Medicare's prospective payment system on psychiatry.

In this paper, we study the effects on psychiatry of Medicare's prospective payment system (PPS) during 1984, as PPS was implemented. We examined data on psychiatric discharges before and after PPS from three kinds of hospitals--those with psychiatric units exempt from PPS, those with nonexempt units, and those that treated psychiatric patients in scatter beds--as well as data on all hospital discharges. We conclude that the providers of psychiatric services responded to the incentives inherent in PPS much the way hospitals as a whole did--with significantly reduced lengths of stay. Of the three kinds of hospitals that rendered psychiatric care, those that treated patients in scatter beds had the greatest reduction in length of stay. Using readmission rates as a gross indicator of quality, we conclude that quality did not suffer because of the shortened stays.

Data Collection↗
PubMed1988

Patients with rheumatoid arthritis at high risk for noncompliance with salicylate treatment regimens.

Recent studies indicate the adherence of many patients with rheumatoid arthritis (RA) to their treatment regimens is poor. Management of this problem depends on identification of noncompliant patients, followed by interventions to increase their level of adherence. In this study, 63 patients with RA receiving salicylate drugs completed a questionnaire during an outpatient visit. The questionnaire contained items believed to be predictive of future compliance, including patient self-predictions regarding future compliance, ratings of behavior in similar situations and barriers to compliance, such as ease of transportation to the clinic. Compliance was estimated via a salicylate assay that was taken during a subsequent outpatient appointment. Multivariate analyses of our data revealed that significant predictions could be made regarding future compliance, with 75% of the noncompliant patients correctly identified. Variables contributing significantly included behavioral self-predictions and a measure of current behavior in similar situations, as assessed by a salicylate assay that was collected during the 1st outpatient visit.

Arthritis, Rheumatoid↗
PubMed1988

Antidepressant analgesia in rheumatoid arthritis.

Forty-seven patients with definite rheumatoid arthritis (RA) were treated in a 32 week, double blind, crossover trial of amitriptyline, desipramine, trazodone, and placebo. All drug regimens produced significant changes on pain measures relative to baseline, but only amitriptyline exceeded placebo. Amitriptyline was associated with a significant reduction in the number of painful/tender joints. Our study supports the efficacy of a moderate dose of amitriptyline as an adjunct drug for the treatment of pain in both depressed and nondepressed patients with RA.

Aged↗
PubMed1988

Depression in rheumatoid arthritis.

Operationalized diagnostic criteria for depression were used to assess 137 (76% male, 24% female) patients with rheumatoid arthritis (RA). Forty-two percent met criteria for some form of depression. Discriminant function analysis revealed a significant relationship between the presence or history of depression and higher levels of pain, but not between current depression and common indicators of RA activity or severity. These results suggest that depression is a frequent disorder among persons with RA. The importance of patient appraisal of disease and assessment of repeated depressive episodes is discussed. Attention to specific interventions for depression in conjunction with the treatment of the RA is suggested.

Arthritis, Rheumatoid↗
PubMed1987

Economic rents derived from hospital privileges in the market for podiatric services.

This study examines the relative impacts of human capital and market conditions on the economic rents associated with hospital privileges in the market for footcare. An empirical model of hospital privileges for podiatrists is formulated based on the Pauly-Redisch model of hospital behavior. The privilege model is then incorporated into a model of podiatrists' earnings via a selection adjustment as proposed by Heckman and Lee. The results indicate the persistance of economic rents even after controlling for unobserved 'quality' factors.

Data Collection↗
PubMed1987

Technical and allocative efficiency in production of outpatient mental health clinic services.

This paper presents an analysis of production of ambulatory mental health services in free standing outpatient clinics. The study empirically addresses several issues including: the nature of returns to scale, the impact of differing organizational forms on the volume of service produced and the efficiency of staffing patterns used by psychiatric clinics. An appraisal of two popular production functions is offered based on predictive performance. The results suggest the existence of decreasing returns to scale; input hiring decisions that depart from cost minimization; and the potential important of a decentralized clinic organization for expansion of access to mental health services.

Community Mental Health Centers↗
PubMed1987

Elective foot surgery: relative roles of doctors of podiatric medicine and orthopedic surgeons.

We examined the roles of Doctors of Podiatric Medicine (DPMs) and orthopedic surgeons in the provision of foot surgery by analyzing the 1982 computerized claims of over 1.1 million federal employees, retirees, and family members. We found that DPMs provided over 60 per cent of all elective insured foot surgery. Without being able to adjust for the severity of the patient's underlying condition or the appropriateness and outcome of the surgery, the average per procedure charge submitted by an orthopedist was 17 per cent higher than that of a DPM; orthopedists were five times as likely to perform a procedure on an inpatient basis, and admitted patients to a hospital had longer stays; DPMs perform a greater number of procedures per episode, but their overall charges during the average foot surgery episode were 30 per cent lower, primarily because of their lower hospitalization rates. The possible impact of recent changes in health care delivery on the DPM/orthopedist practice comparison are discussed as are several questions regarding the quality and need of the care provided by these two groups.

Aged↗
PubMed1987

Life stress and psychologic adjustment following spinal cord injury.

Previous research on psychologic adjustment following spinal cord injury has not systematically investigated the impact of negative life events from contemporary perspectives. In order to examine the effects of life stress on adjustment, 53 spinal cord injured patients were assessed by the Symptom Checklist-90, Beck Depression Inventory, and a measure of life events. Patients who were experiencing higher subjective levels of life stress displayed more distress than those reporting lower levels of life stress. The findings were not mediated by the passage of time since injury.

Adaptation, Psychological↗
PubMed1986

Multidimensional health locus of control in a rehabilitation setting.

In an attempt to replicate a recent report of the factorial structure of the Multidimensional Health Locus of Control Scale, a sample of rehabilitation patients (N = 107) were studied. Analyses in the present study failed to validate the previously reported three-dimensional structure, which indicates a need for careful interpretation of this scale when used with certain populations. An alternative factor structure and possible future directions are proposed.

Adult↗