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Biomedical subjects

R H Brook

Publications and source records attributed to R H Brook.

At least 217 records · Page 12Linked to original sources
PubMed1985

Career orientations of medical and pediatric residents.

Educators have expressed concern about the declining percentage of graduating residents who choose an academic career. This study identifies characteristics of postgraduate physicians that are associated with intentions to pursue an academic career or a full-time private practice. Data were obtained from 299 residents in pediatrics and internal medicine at five academic medical centers in Southern California, using self-report questionnaires. Preference for an academic career was strongest among residents who were most satisfied with their work, were frequently sponsored by faculty, had published, or who either lived alone or were married to another professional. The likelihood of full-time private practice was strongest among residents who were less frequently sponsored by faculty, had not published, lived with others, were from certain medical schools, or were females. Training programs may wish to consider some of these factors in the selection of residents and in program development.

Academic Medical Centers↗
PubMed1985

General medical care and the education of internists in university hospitals. An evaluation of the teaching hospital general medicine group practice program.

Fifteen general internal medicine group practices in university teaching hospitals were studied to evaluate their primary care services and education. Data were collected over 9 months from physicians, patients, and medical records, and by observation. All institutions had closed their general medical clinics. Many patients being treated in group practices were very sick; 57% had hypertension; 21% were diabetic; and 45% could not work. Most were satisfied with their care. Care for acute problems from a health care provider in the practice was available quickly; regular physicians were harder to see. House staff and faculty spent little time in the practices. Few practices used teams; most used traditional attending and house staff models. Practice physicians could not easily determine when patients were seen in the institution's emergency department or were hospitalized. Quality of care standards were not uniformly met. Finally, the structure of academic centers appeared to inhibit the practices' performance, suggesting a need for further appraisal of relationships between university hospitals and their ambulatory care units.

Appointments and Schedules↗
PubMed1985

Persuasive communication and medical technology assessment.

Assessments of medical technologies with respect to their efficacy, safety, and cost-effectiveness are expected to influence clinical practice, but they are often lost in an avalanche of medical information. We developed a conceptual model that may aid understanding of the potential impact on clinical practice of new medical information in general and assessment information in particular. The model identifies aspects of medical communication that may influence an assessment's subsequent impact, including sources, messages, channels, audiences, and settings. We reviewed the literature on how medical information diffuses to physicians and highlighted those factors likely to heighten physicians' awareness and decisions to incorporate recommended medical advances. We outlined implications for educational interventions and promising research directions.

Humans↗
PubMed1985

Consequences of cost-sharing for children's health.

Do children whose families bear a percentage of their health care costs reduce their use of ambulatory care compared with those families who receive free care? If so, does the reduction affect their health? To answer these questions, 1,844 children aged 0 to 13 years were randomly assigned (for a period of 3 or 5 years) to one of 14 insurance plans. The plans differed in the percentage of their medical bills that families paid. One plan provided free care. The others required up to 95% coinsurance subject to a +1,000 maximum. Children whose families paid a percentage of costs reduced use by up to one third. For the typical child in the study, this reduction caused no significant difference in either parental perceptions of their child's health or in physiologic measures of health. Confidence intervals are sufficiently narrow for most measures to rule out the possibility that large true differences went undetected. Nor were statistically significant differences observed for children at risk of disease. Wider confidence intervals for these comparisons, however, mean that clinically meaningful differences, if present, could have been undetected in certain subgroups.

Child↗
PubMed1984

Consensus methods: characteristics and guidelines for use.

Consensus methods are being used increasingly to solve problems in medicine and health. Their main purpose is to define levels of agreement on controversial subjects. Advocates suggest that, when properly employed, consensus strategies can create structured environments in which experts are given the best available information, allowing their solutions to problems to be more justifiable and credible than otherwise. This paper surveys the characteristics of several major methods (Delphi, Nominal Group, and models developed by the National Institutes of Health and Glaser) and provides guidelines for those who want to use the techniques. Among the concerns these guidelines address are selecting problems, choosing members for consensus panels, specifying acceptable levels of agreement, properly using empirical data, obtaining professional and political support, and disseminating results.

Decision Making↗
PubMed1983

Does free care improve adults' health? Results from a randomized controlled trial.

Does free medical care lead to better health than insurance plans that require the patient to shoulder part of the cost? In an effort to answer this question, we studied 3958 people between the ages of 14 and 61 who were free of disability that precluded work and had been randomly assigned to a set of insurance plans for three or five years. One plan provided free care; the others required enrollees to pay a share of their medical bills. As previously reported, patients in the latter group made approximately one-third fewer visits to a physician and were hospitalized about one-third less often. For persons with poor vision and for low-income persons with high blood pressure, free care brought an improvement (vision better by 0.2 Snellen lines, diastolic blood pressure lower by 3 mm Hg); better control of blood pressure reduced the calculated risk of early death among those at high risk. For the average participant, as well as for subgroups differing in income and initial health status, no significant effects were detected on eight other measures of health status and health habits. Confidence intervals for these eight measures were sufficiently narrow to rule out all but a minimal influence, favorable or adverse, of free care for the average participant. For some measures of health in subgroups of the population, however, the broader confidence intervals make this conclusion less certain.

Adolescent↗
PubMed1983

Who is the primary physician?

Several studies have concluded that specialists form a hidden system for primary-care delivery. However, these studies assume that a specialist who provides the majority of care is the primary-care physician. Using data for a one-year period from 2752 people enrolled in the Rand Health Insurance Experiment, we examined the validity of this conclusion. We compared the effects of three different definitions of a primary-care physician on identification of the primary-care provider: the physician who delivered the "majority of care" (34 per cent were specialists), the physician designated by the patient to receive the results of a multiphasic-screening examination (12 per cent were specialists), and the physician who treated common problems (9 per cent were specialists). Use of the "majority-of-care" criterion to define primary care overestimated by threefold the contribution specialists make to this activity. Definitions of a primary-care physician must be more specific and should include the tasks frequently associated with primary care, as well as patients' perceptions of the physician who provides their primary care.

Appointments and Schedules↗
PubMed1983

Effects of being overweight.

Based on cross sectional data from a general population of 5,817 people aged 14 to 61, objective overweight is compared with perceived overweight, and information is provided on morbidity due to being overweight, and on what people are doing to try to lose weight. We found that 10 percent of this population are moderately overweight and 12 per cent are severely overweight (although 41 per cent perceive they are overweight). Being overweight is associated with poorer functional status (e.g., overweight is given as the main reason for functional limitations by 13 per cent of people with such limitations) and with considerable pain, worry, and restricted activity because of this condition (e.g., 88 per cent of people who believe they are overweight worry at least a little about it). Only about 7 per cent of those who perceive they are overweight are under a doctor's care to lose weight. If physicians wish to assume a larger role in caring for overweight people, the nature of their role must be carefully evaluated.

Adolescent↗
PubMed1982

Psychosocial problems in chronically ill children: physician concern, parent satisfaction, and the validity of medical records.

This study concerns the psychosocial aspects of treatment for chronically ill children. The English-speaking parents of 44 children 5-13 years of age being seen at five specialty clinics at a large county hospital in Los Angeles, and their attending physicians, were the subjects in this study. The parents were interviewed concerning their expectations for the current visit, and the doctor-patient interaction was tape-recorded. Identical categories of information were abstracted from the tape recording and from a chart review of the patients' medical records. Although parents expected 76% of the psychosocial aspects of care to be covered by the doctor, only one fourth were actually discussed in the visit. These unfulfilled expectations were associated with lower satisfaction with medical care received (r = .47, p less than 0.01). Finally, while doctors recorded about 80% of discussions of symptoms and physical examinations in the patient's medical record, they recorded only 25% of discussion of psychosocial problems.

Adolescent↗
PubMed1981

Some interim results from a controlled trial of cost sharing in health insurance.

A total of 7706 persons are participating in a controlled trial of alternative health-insurance policies. Interim results indicate that persons fully covered for medical services spend about 50 per cent more than do similar persons with income-related catastrophe insurance. Full coverage leads to more people using services and to more services per user. Both ambulatory services and hospital admissions increase. Once patients are admitted to the hospital, however, expenditures per admission do not differ significantly among the experimental insurance plans. In addition, hospital admissions for children do not vary by plan. The income-related cost sharing in the experimental plans affects expenditure by different income groups similarly, but adults' total expenditure varies more than children's. Sufficient data are not available on whether higher use by persons with free care reflects overuse, or whether lower use by those with income-related catastrophe coverage reflects underuse. Both may well be true.

Ambulatory Care↗