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Biomedical subjects

S J Spann

Publications and source records attributed to S J Spann.

28 records · Page 2Linked to original sources
PubMed1986

A statewide university hospital-based family medicine referral service.

A statewide university hospital-based family medicine referral service was established at the University of Oklahoma in July 1983. During the first six months of operation, 14 percent of all patients admitted to the family medicine inpatient service were referred by outside physicians. Referral patients had more diagnoses coded per admission (2.25) than continuity patients (1.56) (P less than .05). In referral patients, 23.3 percent of diagnoses fell into the 52 most common diagnostic cluster described by Rosenblatt et al compared with 50.9 percent in continuity patients (P less than .0005). Specialty consultations, invasive diagnostic procedures, surgical procedures, and average length of hospital stay were compared in the subgroup of patients with medical, pediatric, surgical, and gynecological principal diagnoses. Referred patients averaged 0.974 consultations per admission compared with 0.578 in continuity patients (P less than .01). An average of 1.237 invasive diagnostic procedures per admission were performed in referral patients compared with 0.626 in continuity patients (P less than .0005). Referral patients averaged 0.145 surgical procedures per admission compared with 0.123 in continuity patients (not significant). The average length of stay for both continuity and referral patients was 9.68 days per admission. A survey of the referring physicians indicated that both the physicians and the patients whom they referred were generally satisfied with the care provided by the service.

Diagnosis-Related Groups↗
PubMed1983

Impact of spirometry on the management of chronic obstructive airway disease.

A simple spirometer was tested in an outpatient family practice to determine whether its use increased detection of chronic obstructive airway disease (COAD) in patients at risk, more accurately identified patients with reversible bronchospasm, and helped to make the most of their bronchodilator therapy. Three (17 percent) of 18 patients at risk, previously unlabeled, were found to have COAD. Of 28 patients with a previous COAD diagnosis, 5 (18 percent) had the diagnosis deleted, and 5 who had previously been classified as "reversible" were reclassified as having "irreversible" bronchospasm (P less than .025). Of 46 patients studied, bronchodilator therapy was changed in 18 (39 percent); 12 of these improved symptomatically according to a subjective score (P less than .02). A few patients demonstrated a significant improvement in 1-second forced expiratory volume.

Adult↗
PubMedDate not supplied

Preferences of husbands and wives for prostate cancer screening.

The benefits of screening for prostate cancer are uncertain. Outcomes of treatment are particularly important to couples because they challenge the most intimate aspects of a couple's relationship. This study used clinical decision analysis to explore the preferences of 10 couples for prostate cancer screening. The decision-analytic model found that 7 of 10 husbands preferred the no screening strategy, while 9 of 10 wives preferred screening for their husbands. Wives associated little burden with complications of treatment, preferring to maximize their husbands' quantity of life regardless of complications. The issue of who is the decision maker is paramount in the case of prostate cancer screening. Optimal screening strategies may differ for husbands and wives. Guidelines for prostate cancer screening and management should consider assessing preferences on an individual couple basis.

Adult↗
PubMedDate not supplied

A randomized controlled trial of shared decision making for prostate cancer screening.

OBJECTIVE: To evaluate a patient-educational approach to shared decision making for prostate cancer screening. DESIGN: Randomized controlled trial with preoffice visit assessment and 2-week follow-up. SETTING: University-based family practice center. PATIENTS: Men aged 45 through 70 years with no history of prostate cancer or treatment for prostate disease (N = 160). Two patients were unavailable for follow-up. INTERVENTION: Twenty-minute educational videotape on advantages and disadvantages of prostate-specific antigen (PSA) screening for prostate cancer. MAIN OUTCOME MEASURES: A measure of patients' core knowledge of prostate cancer developed for this study, reported preferences for PSA testing, and ratings of the videotape. RESULTS: Patients' core knowledge at baseline was poor. At 2-week follow-up, subjects undergoing videotape intervention showed a 78% improvement in the number of knowledge questions answered correctly (P = .001), and knowledge increased about mortality due to early-stage prostate cancer, PSA screening performance, treatment-related complications, and disadvantages of screening. No overall change was observed for control subjects. At follow-up, 48 (62%) of 78 intervention patients planned to have the PSA test compared with 64 (80%) of 80 control patients (18.5% absolute reduction; 95% confidence interval, 4.6%-32.4%; P = .009). Intervention subjects rated favorably the amount of information provided and the clarity, balance, and length of the videotape and would recommend the videotape to others. CONCLUSIONS: Patient education regarding the potential benefits and harms of early detection of prostate cancer can lead to more informed decision making. Incorporating the PSA videotape into the periodic health examination for asymptomatic men aged 50 years and older is recommended.

Aged↗
PubMedDate not supplied

Population-based time preferences for future health outcomes.

CONTEXT: Time preference (how preference for an outcome changes depending on when the outcome occurs) affects clinical decisions, but little is known about determinants of time preferences in clinical settings. OBJECTIVES: To determine whether information about mean population time preferences for specific health states can be easily assessed, whether mean time preferences are constant across different diseases, and whether under certain circumstances substantial fractions of the patient population make choices that are consistent with a negative time preference. DESIGN: Self-administered survey. SETTING: Family physician waiting rooms in four states. PATIENTS: A convenience sample of 169 adults. INTERVENTION: Subjects were presented five clinical vignettes. For each vignette the subject chose between interventions maximizing a present and a future health outcome. The options for individual vignettes varied among the patients so that a distribution of responses was obtained across the population of patients. MAIN OUTCOME MEASURE: Logistic regression was used to estimate the mean preference for each vignette, which was translated into an implicit discount rate for this group of patients. RESULTS: There were marked differences in time preferences for future health outcomes based on the five vignettes, ranging from a negative to a high positive (116%) discount rate. CONCLUSIONS: The study provides empirical evidence that time preferences for future health outcomes may vary substantially among disease conditions. This is likely because the vignettes evoked different rationales for time preferences. Time preference is a critical element in patient decision making and cost-effectiveness research, and more work is necessary to improve our understanding of patient preferences for future health outcomes.

Adolescent↗
PubMedDate not supplied

Physicians' risk attitudes, laboratory usage, and referral decisions: the case of an academic family practice center.

Individual differences in physicians' laboratory use and referral rates are important aspects of practice variation that have real financial and health consequences. A way to explain these differences is needed. In this empirical study, physicians' risk attitudes (measured on a multidimensional scale) are shown to be good predictors of use rates for certain specific laboratory procedures, but not good predictors of physicians' referral rates. A 15-item survey form that measured risk-taking attitudes in the financial, health, social, and ethical domains was administered to all clinical faculty at an academic family practice center (n = 14). Each physician's utilization rates for the 17 most frequently ordered laboratory procedures were calculated for all patient visits for one calendar year. Overall referral rates were calculated for the same period. Physicians' risk attitudes (12 completed the survey) accounted for over 50% of the variance for several of the laboratory procedures. For example, the rank-order correlation between the complete blood count utilization rate and a Likert-scale item measuring physicians' propensity to take physical risks was 0.91 (p less than 0.001). The details of these findings help to explain an important component of practice variation.

Academic Medical Centers↗
PubMedDate not supplied

Family practice in the tropics.

A one-week practice experience in a remote tropical rain forest area of Colombia is described. Frequency of diagnoses by ICD-9 category are compared between this practice setting and the author's university family medicine residency-based practice in Oklahoma. Implications of the similarities between the practices, as well as the differences, are discussed.

Colombia↗