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Biomedical subjects

S E Radecki

Publications and source records attributed to S E Radecki.

At least 37 records · Page 2Linked to original sources
PubMed1990

Effect of on-site facilities on use of diagnostic radiology by non-radiologists.

This study uses self-reports from a nationwide sample of 5447 physicians in ten medical and surgical specialties to assess the impact of on-site facilities on the use of radiologic examinations by non-radiologists. Data from 169,559 patient visits show that when on-site radiologic facilities are available to non-radiologists, radiographs increase by a factor of 1.2 (internal medicine) to 1.7 (pediatrics). Use of radiologic examinations is up to four times greater for hospitalized compared with nonhospitalized patients and is slightly higher for hospital-based physicians and for younger physicians.

Analysis of Variance↗
PubMed1990

Family medical care: who provides it, who receives it?

A national survey of physicians was used to examine the extent to which they provide family care. Care of other family members was noted for 64.9% of patients of family physicians, 33.9% of patients of general internists, and lesser percentages for patients of medical subspecialists and surgeons. Family physicians in office-based practice and those in rural areas show the highest percentages of family care. Family care is more likely to be noted for patients receiving obstetrical and preventive care and least likely for patients receiving care for psychosocial problems. Family care is most common for children 10 years and under and for older adults, and least common for males 21-30 years of age.

Adolescent↗
PubMed1989

End-stage renal disease and the practice of nephrology.

Data from a national survey of 336 nephrologists who provide dialysis care on capitation reimbursement show differences in practice activity associated with the proportion of patients with end-stage renal disease (ESRD). On the average, ESRD patients account for 53% of patients seen by these physicians. Nephrologists who have the majority of their visits with ESRD patients average more than 120 patient encounters per week, approximating the practice workloads of primary care physicians. Nephrologists spend comparable amounts of time providing treatment for ESRD and non-ESRD patients in the same settings, schedule additional office visits for facility dialysis patients, and provide treatment and advice for problems not related to dialysis. Whereas care for acute renal failure patients is primarily based on consultations and involves a narrow focus, treatment for ESRD involves the provision of comprehensive primary medical care by nephrologists to their patients being treated with dialysis.

Ambulatory Care↗
PubMed1989

Dialysis for chronic renal failure: comorbidity and treatment differences by disease etiology.

A national sample of dialysis physicians was used to obtain data for a comparison of patient characteristics, comorbid conditions and treatment patterns associated with the five leading causes of end-stage renal disease (ESRD). The data are used to assess trends in physician care for ESRD patients and likely changes in program costs. The analysis shows that patients with glomerulonephritis are the youngest. Those with hypertensive nephropathy are the oldest, and include the highest proportion of blacks, while those with polycystic kidney disease include the lowest proportion of blacks. Patients with diabetic nephropathy have the most problems noted at the time of physician contact, the most emergent and severe problems, the highest number of diagnostic tests utilized, the most complex treatments required and the longest physician time spent per encounter. Patients with 'other interstitial nephritis' are significantly more likely to have infections, musculoskeletal disorders, chronic obstructive pulmonary disease and neoplasms noted as comorbid conditions. They also have the highest number of therapeutic procedures and the greatest percentage of referrals for consultations. Survey data highlight the evolving nature of Medicare's ESRD program. With increasing numbers of elderly and diabetic patients, more physician time will be required for the overall care of the dialysis patient, and increasing costs associated with necessary diagnostic tests and referrals can be expected.

Cohort Studies↗
PubMed1989

Use of clinic versus private family planning care by low-income women: access, cost, and patient satisfaction.

Use of private physicians versus public family planning facilities by poverty level and near poverty level women was examined by means of a sample survey conducted in low-income areas of Los Angeles County. Utilization differed by race/ethnicity, with Hispanics more likely to go to federally subsidized family planning clinics (primarily county-run), Whites and Blacks to private physicians. Private family planning offers easier access, greater convenience, and higher satisfaction, albeit at almost double the cost. Clinic usage is influenced by lack of a regular source of medical care and lack of insurance coverage more than poverty level per se. Clinic patients report greater patient education regarding contraceptive methods, but less general medical care during clinic visits. They are more likely than private patients to express a desire for a different source of family planning care.

Adolescent↗
PubMed1988

Case-mix and treatment in end-stage renal disease: hemodialysis v peritoneal dialysis.

The University of Southern California School of Medicine conducted a nationwide survey of 336 nephrologists to obtain demographic and clinical data on 6,411 patients with end-stage renal disease (ESRD). Patient demographic data, along with ESRD etiology and comorbid conditions noted by the physician, were compared across various modalities of dialysis. Characteristics of the treatment provided were differentiated by the mode of dialysis and the location of the patient encounter. Results of the analysis show that patients on peritoneal dialysis are more likely to be female and have higher rates of diabetes compared with hemodialysis (HD) patients. Statistically, patients on intermittent peritoneal dialysis are older, more likely to be black, and have a higher incidence of cardiovascular conditions. Continuous ambulatory peritoneal dialysis patients have greatest problem severity and require more physician time and more complex services, whereas home HD patients require the greatest number of diagnostic tests and therapeutic procedures. Hospital inpatient care shows greater case-mix severity and more intensive treatment, but this does not differ by the mode of dialysis. Finally, patients of freestanding dialysis facilities are more likely to have hypertensive renal disease, whereas patients at hospital-based facilities are older, more likely to be seen in the hospital, have more urgent and severe problems during dialysis rounds, and require more physician time, more complex services, and more diagnostic tests and therapeutic procedures.

Age Factors↗
PubMed1988

Do physicians spend less time with older patients?

In view of the additional time that older persons require for giving and receiving information, as well as for the examination process, it is important for manpower and reimbursement planning to better understand the nature of the physician-patient encounter with the elderly. We examined a series of national surveys of physicians' professional activities and found that physicians tend to spend less time with their older patients and also that encounter time by physicians in different specialties varies widely. Internists and cardiologists spend substantially more time with patients compared with general and family practitioners. For 65-74-year-old ambulatory patients, the average visit lengths are 18.3 minutes for internists, 18.0 for cardiologists, 11.2 for general practitioners, and 12.1 for family practitioners. Compared with ambulatory visit lengths for patients aged 45 to 64 years, average encounter times for 75-year-olds with family physicians were 0.8 minutes shorter, with general practitioners 1.2 minutes shorter, with internists 2.3 minutes shorter, and with cardiologists 3.0 minutes shorter. However, when all characteristics of the visit were considered, the effect of patient age remained significant only for general practitioners. A multivariate analysis of factors related to physician time for ambulatory care showed that more time is associated with multiple problems, problem severity, and the use of diagnostic testing. For general and family practice, the greater the number of previous visits for a problem, the shorter the encounter time is. Additional characteristics associated with shorter physician-patient encounter times include the volume of patients per week and the use of physician assistants within the practice. These findings have implications for medical education and manpower projections.

Age Factors↗
PubMed1988

Are physicians sensitive to the special problems of older patients?

The sensitivity of primary care physicians to the health care needs of older patients was explored by means of an analysis of the use of diagnostic tests and therapeutic procedures during ambulatory visits. Survey data on a total of 28,265 visits to internists, family and general practitioners were examined to determine possible age-related differences in care. The study found that diagnostic testing falls off significantly for patients 75 years of age or older and that internists use substantially more tests for each age group than do family and general practitioners. The pattern of use of diagnostic tests in this secondary analysis does not address the issue of "appropriateness" but does suggest a pattern that makes little sense based on the known distribution of disease and functional disability in aging populations.

Age Factors↗
PubMed1988

Diagnostic radiology usage in ambulatory and hospital care.

Data from a nationwide survey of physicians show that there were a total of 214 million medical radiologic examinations performed in the United States in 1977, or just under one for each member of the resident population. Approximately 58% of these procedures were performed in ambulatory patients (including those in hospital outpatient departments) and 42% were in hospitalized patients. Data for the number of visits with (single or multiple) radiologic examinations produced an estimate of 184 million annual visits with one or more diagnostic radiographs. These estimates provide a comprehensive measure of national use of diagnostic radiology at the time the data were collected, as well as a basis of comparison for analyses of contemporary patterns of utilization of radiologic procedures.

Ambulatory Care↗
PubMed1986

Patient counselling by primary care physicians: results of a nationwide survey.

The rate of patient counseling in primary care medicine is a pivotal element of inter-specialty differences in styles of care. Using national data on patient care provided in both ambulatory care settings and in the hospital, this study examines the use of counseling by general and family practitioners, pediatricians, internists, and obstetrician/gynecologists. The findings show substantial differences based on physician specialty, with highest rates of counseling for family practitioners and internists, and rates of patient education for these two specialties almost three times that for general practitioners. The data also show generally higher counseling rates for hospital care and for first encounters with patients, and a tendency for office-based pediatricians and solo general practitioners to use less patient counseling compared to their institution-based counterparts. Projections of annual visit rates for the United States show that general practice and internal medicine account for a disproportionate amount of patient counseling compared to other primary care specialties, based on patient volume.

Counseling↗
PubMed1986

Patient counseling by specialists in internal medicine: results of a nationwide survey.

An analysis of patient care data from a national sample of physicians in ten subspecialties of internal medicine was undertaken to determine rates of patient counseling in specialized medical care. The analysis, which was based on 91,226 patient encounters in both ambulatory and hospital settings, revealed that medical specialists employ patient education counseling in 12.3% of encounters, family/social/sexual counseling in 2.7%, and therapeutic listening/reassurance in 14.0%--rates that are 2 to 3 times those for primary care physicians. Among subspecialties, cardiologists have the highest rates of patient education and family/social/sexual counseling, and the second highest rates of therapeutic listening. (Rheumatology is highest in the latter category). Rates of patient education and therapeutic listening are higher for office-based physicians and for ambulatory care (especially ambulatory care provided by board-certified physicians). Patient education is more frequent for ambulatory first visits and consultations, whereas therapeutic listening is more frequent for 'principal care' patients seen in either ambulatory settings or in the hospital. Highest rates of family/social/sexual counseling occur for ambulatory first visits with nephrologists and ambulatory consultations with cardiologists.

Counseling↗
PubMed1984

The relative complexity of primary care provided by medical specialists.

Utilizing national data on patient care provided by family practitioners, general internists, and subspecialists in internal medicine, this study examines the complexity of care provided by generalist physicians versus subspecialty physicians on a disease-specific basis. Limiting the analysis to "principal care" provided by office-based physicians, the study finds the complexity of care provided by cardiologists for heart disease and by endocrinologists for diabetes mellitus to be somewhat greater than that provided by family practitioners and general internists, though the magnitude of the differences is not large. For chronic obstructive pulmonary disease, however, pulmonary disease specialists are shown to provide care that is substantially more complex than that provided by their generalist colleagues. For all disease and specialties, hospital care is substantially more complex than ambulatory care.

Adolescent↗
PubMed1982

Manpower for obstetrics-gynecology. III. Contributions to total female medical care.

This final report from the cooperative manpower study of the University of Southern California and The American College of Obstetricians and Gynecologists describes the development of a female data file that outlines the care of women patients by all specialties. Obstetrician-gynecologists are compared to other specialists; they see 300,000 women per day in the United States and provide a wide range of care. Preventive care plays a larger role than in other major specialties, patient counseling and education are emphasized, and obstetric care is a major commitment. Nonetheless, acute and serious surgical and medical diagnoses are an important component of the practices of obstetrician-gynecologists.

Adolescent↗
PubMed1982

Neurosurgical manpower: the physician's viewpoint.

This paper reports a national study of physicians in 24 medical and surgical specialties, and reveals the opinions of neurosurgeons and their professional colleagues with regard to the adequacy of the supply of neurosurgical manpower. Among neurosurgeons, 30.4% believe the supply to be excessive, 60.1% think it is about right, 7.5% believe that there is a shortage, and 2.0% have no opinion. Neurologists' opinions do not differ significantly from those of neurosurgeons, but physicians and surgeons in 22 other specialties are significantly less likely to regard the supply as excessive and are more likely to perceive a shortage. Primary care physicians, as a group, are most likely to perceive a shortage, and least likely to indicate an excess. Among the 24 specialties studied, 9.3% of physicians believe the supply of neurosurgeons to be excessive, 55.1% think it is about right, 22.9% believe that there is a shortage, and 12.8% have no opinion.

Attitude of Health Personnel↗
PubMed1981

Neurosurgery in the United States: a log-diary study.

The Division of Research in Medical Education and of the University of Southern California, with the cooperation and assistance of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons, has conducted a national study of the professional activities of neurological surgeons in the United States. One of a series of 24 surveys of medical and surgical specialties, the survey obtained information on patient workloads, the allocation of physician time, the characteristics of patients and the circumstances under which they were seen, patient diagnoses, and the care that was provided--including whether an operation was performed. This paper provides a selection of the findings deemed most relevant to manpower issues in neurosurgery. A later paper will examine regional differences in patient care, including the frequency with which selected surgical procedures are used for different clinical conditions.

Commission on Professional and Hospital Activities↗
PubMed1979

A national study of internal medicine and its specialties: I. An overview of the practice of internal medicine.

A nationwide study of 24 medical and surgical specialties has been conducted by the University of Southern California School of Medicine, Division of Research in Medical Education. This article is the first in a series reporting findings for general internal medicine and 10 subspecialties of internal medicine. Populations for these 11 specialties are defined and enumerated, and the specialties are compared in terms of demographic and geographic distribution. Practice comparisons are presented based on characteristics such as workload, allocation of professional time, location of encounters with patients, distribution of primary problem diagnoses, and projections of annual patient encounters. Forthcoming specialty-specific articles will present highly detailed information for general internal medicine and for the subspecialties of cardiology, gastroenterology, pulmonary disease, allergy, hematology, endocrinology, nephrology, medical oncology, rheumatology, and infectious diseases.

California↗
PubMed1979

A national study of internal medicine and its specialties: II. Primary care in internal medicine.

A nationwide study of practitioners in 24 medical and surgical specialties was conducted by the University of Southern California School of Medicine, Division of Research in Medical Education. In this second report of a series presenting findings for internal medicine, general internal medicine and 10 subspecialties of internal medicine are compared using a care classification scheme designed for the study. On the basis of characteristics of the individual patient encounter, this care classification scheme distinguishes several dimensions associated with the concept of primary care. Five empirically derived types of care rather than a simple "primary" or "non-primary" dichotomy are described, and the distributions of each type for the 11 subspecialties examined are noted. Types of care (according to the care classification) are examined by the time per patient, the complexity of physician services, the severity and chronicity of problems, and the degree of specialization associated with providing different types of care. Estimates of the number of annual encounters, and the number of annual encounters for three of the five types of care, with the proportion of each accounted for by each subspecialty, are given.

Consultants↗