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Biomedical subjects

T S Inui

Publications and source records attributed to T S Inui.

At least 109 records · Page 6Linked to original sources
PubMed1980

High-yield referral criteria for posttraumatic skull roentgenography. Response of physicians and accuracy of criteria.

We evaluated a list of high-yield criteria (HYL) as a means of reducing posttraumatic skull roentgenograms and as a diagnostic test for skull fractures. Physicians requested roentgenograms for 76.9% of head trauma patients in a four-month control period, but for only 46.1% during a four-month experimental period, a relative decrease of 40%. When the experiment ended, roentgenogram use increased to 72% of head trauma patients. The HYL accurately classified 92.5% of the patients with and 84.5% of the patients without pathological conditions. The HYL displayed substantial differences in sensitivity and specificity from HYLs used previously. Clinicians disliked the HYL, believing it was inaccurate and a monitoring device. We conclude that criteria lists can effectively decrease requests for roentogenograms and should be carefully evaluated as diagnostic tests for accuracy and adverse outcomes.

Concurrent Review↗
PubMed1980

Effect of a self-care book on physician visits. A randomized trial.

A self-care book that guides patients in seeking home care or physician care for 63 medical problems was assessed in three randomly selected groups of families to determine the book's effect on the number of visits to physicians. The first group was given the book and an optional seminar on its use; the second group was identical to the first but each family was promised $50 if their visits to physicians dropped by one third; the third group was a control group (total, 699 families). The book had no significant effect on the number of physician's visits during six- and 12-month study periods even though one half of the families read most or all of the book, and more than one third used it for a specific medical problem. Large-scale distribution of this self-care book therefore did not result in significantly less dependence on physicians for treatment of acute medical problems.

Activities of Daily Living↗
PubMed1980

Communication failure in primary care. Failure of consultants to provide follow-up information.

In a two-physician general practive within 80 km of two university medical centers, there were 4,367 patient visits in six months, from which 233 referrals (5.3%) were made to consultants. All referred patients were accompanied by referral material and a request for follow-up information. The overall rate of receiving follow-up information was 62%. Private specialists provided substantially more follow-up information (78%) than either university-affiliated emergency rooms (48%) or university-affiliated specialty clinics (59%). Patients requiring continuing medical supervision from the referring physician also fared poorly: follow-up information for them was provided only 54% of the time. The timeliness and method of providing follow-up information were examined and believed to be satisfactory when follow-up information was returned.

Academic Medical Centers↗
PubMed1980

Needs assessment for hospital-based home care services.

Careful needs assessment is a prerequisite to addressing issues of health care program effectiveness and program planning from a population-based perspective. Home care program evaluation literature is lacking in examples of strategies for such assessment. A nurse-screening of admissions was conducted at an acute care general hospital to estimate need for hospital-based home care (HBHC) services among the 2,613 patients discharged from medical and surgical services over a 5-month period. After careful delineation of inclusion and exclusion criteria for identifying HBHC patients and participant-observer training, the nurse's judgments on patient appropriateness for HBHC care were shown to agree reliably with those of the HBHC staff (k = + .45). In the study hospital under current conditions, an estimated 64% of discharged patients appropriate for home care do not receive these services. A comparison of the incidence according to service of HBHC-appropriate patients and patient-referral rates to HBHC suggests that one service over-refers (neurology), but most under-refer. Screening nurse salary expenditures constitute the major costs of this approach to home care needs assessment, which is recommended only for addressing major, infrequent programmatic policy issues.

Adolescent↗
PubMed1980

Variations in patient compliance with common long-term drugs.

An indirect measure of adherence to drug regimens was developed from pharmacy records of prescription refills. This measure was validated by demonstrations of significant relationships between compliance with hydrochlorothiazide and propranolol and expected physiologic effects of these drugs (decreased blood pressures and decreased pulse rates, respectively). The measure was used to survey compliance with 20 common drugs prescribed to 419 outpatients for long-term administration on regular schedules. Eight of the study drugs showed very low levels of compliance, suggesting "take-as-needed" (PRN) use, in spite of medical record, pharmacy record, and label instructions for regular administration. For the whole survey population, 12 truly "non-PRN" drugs showed showed a considerable gradient in mean compliance rates, ranging from digoxin (76.6 per cent) to hydralazine (50.4 per cent). Within-patient differences in mean compliance with different drugs were shown (e.g., hydrochlorothiazide 61.2 per cent versus potassium chloride 41.2 per cent mean compliance, p < 0.001). Correlations between compliance rates with different drugs in a single regimen were sometimes strikingly low. We conclude that 1) chart and prescription directions for regular administration are not sufficient to identify "non-PRN" drugs in compliance studies; 2) when compliance is an outcome measure in health care trials, drug mix is an important confounding variable; 3)in outpatient clinical settings, it may be appropriate to be inherently more suspicious of noncompliance with some drugs than others; and 4) patients may comply at different rates with individual drug components of a single regimen.

Angina Pectoris↗
PubMed1980

Dropouts and broken appointments. A literature review and agenda for future research.

Patient dropouts create inefficiencies for medical providers, threaten the validity of clinical research and may themselves suffer unnecessary morbidity. A review of literature concerning patient dropouts and broken appointments was undertaken in an effort to identify correlates of the behavior, assess proposed interventions and identify issues for the content and methodology of future research. While the bulk of existing reports deal with psychiatric and pediatric populations, studies of general adult clinics report missed appointments rates of 15 to 33 per cent and often emphasize demographic features of the patient. Other factors, such as patient beliefs, sociobehavioral characteristics, aspects of the disease and its therapy, patient-provider interactions and organizational features of the providing facility are less well studied, but probably more important. Organizational features exert a strong influence and are particularly amenable to modification. Patient surveys suggest that forgetting and administrative oversights are common problems, and the success of mailed appointment reminders supports this notion. Such surveys have often suggested successful intervention strategies. Future investigations should emphasize more consistent methodology, improved analysis techniques, identification of better predictors and development of a conceptual model for this patient behavior. These efforts may suggest new intervention methods, which should be evaluated for cost effectiveness and the feasibility of individualized application.

Appointments and Schedules↗
PubMed1980

Regionalization in the Veterans Administration health care system: rhetoric and realities.

Criticisms of the Veterans Administration health care system have centered in part on the ability of the system to reallocate resources in response to the changing needs of veterans. VA hospitals use traditional budgeting and planning processes; new programs and projected increases in workload are added to the previous year's budget to yield the budget for the succeeding year. Since these activities occur on an individual institution bases, there is little effort to plan cooperatively between hospitals or to reassess the fundamental allocation of resources based on veteran needs. Over the past two years, the VA has devised a program of regionalized budgeting and planming. The publicity surrounding VA regionalization reflects the idealized potential of shared resources and joint planning within each of the newly created VA medical districts. The reality of the program, however, when examined on a national basis and illustrated by an in-depth study of five hospitals in one district, indicates that there has been little use of resource allocation methodology and that few planning resources have been allocated to this effort. As a result, the district program is a collation of individual hospital budgets, and plans to yield the district budget and plans. Regionalization is unlikely to succeed in any meaningful manner within the VA unless further changes occur in district resource allocation methods.

Age Factors↗
PubMed1979

Hospital screening for tuberculosis: a quality assurance trial.

A quality assurance trial which dealth with tuberculin testing and isoniazid prophylaxis for tuberculosis infection among hospitalized patients was undertaken at a short-term, general hospital of the Indian Health Service. Standards for care were developed by the hospital staff using questionnaire and Delphi process techniques. Following the demonstration of baseline deficiencies in clinical performance, tuberculin testing became a standing admission order. Subsequent changes in the completeness of tuberculosis screening and in physician response to a positive tuberculin skin test were demonstrated. Among hospitalized patients of unknown tuberculin reactivity, PPD screening coverage increased from 45 per cent to 87 per cent (p less that 0.005). Improvement in the appropriate initiation of isoniazid prophylaxis was demonstrated. The absence of simultaneous changes in other health surveillance activities suggests that the improvement in tuberculosis screening was attributable to the quality assurance intervention and not to the other intervening variables. An approach to selecting alternatives for remedial action when quality assessment has documented a deficiency is presented and disucssed.

Hospitals, Federal↗
PubMed1979

Effects of a self-administered health history on new-patient visits in a general medical clinic.

Self-administered health history questionnaires (SAHHQs) are widely used in ambulatory care settings to save provider time and to assure completeness of the clinical data base. A controlled, prospective study was undertaken in a general medical clinic to evaluate the impact of an extensively pretested, highly reliable, 120-item self-administered health history questionnaire developed for new patient visits. Seventy-seven patients were randomly assigned to the SAHHQ or control groups. Time analyses were performed on audiotapes of the encounters. Patients' charts were scored on explicit criteria for data completeness. Problem recognition was determined by comparison of pre-encounter and postencounter problem lists. SAHHQ and control visits did not differ significantly in total encounter time (44.7 versus 48.3 minutes, respectively). Less time was spent in SAHHQ encounters on data base questions (2.5 versus 3.9 minutes, p = .003). Chart data were more complete for SAHHQ patients (p less than .001). The completeness of senior staff charts was more affected by the presence of the SAHHQ than residents' charts (p = .03). Physicians tended to recognize more new problems in SAHHQ visits. Mutual (physician and patient) recognition of problems occurred more often in the SAHHQ visits (p = .05). Carefully designed SAHHQs increase recorded data base completeness and may increase problem recognition, but do not result in major time savings.

Attitude of Health Personnel↗
PubMed1979

Validity and reliability of a self-administered health history questionnaire.

A self-administered, health history questionnaire devised for routine use in a general medical clinic is completed without the assistance of clinic personnel and used, unedited, by the providers. The reliability and validity of the responses of 23 patients to this questionnaire were tested statistically. In our setting, more than 90 percent of the patients referred for care are capable of completing the questionnaire. The 23 patients averaged 32 minutes to complete the questionnaire. An average of 34 minutes of encounter time is required to obtain the same historical data by interview. Test-retest reliability of patients' responses to the questionnaire was 90 percent. More than 92 percent of the patients' written responses to health history items agreed with the data obtained in a blinded fashion by internists in the traditional interview. The questionnaire accurately obtains items of history frequently missing from the recorded ambulabory care data base, and in some instances obtains items of history more effectively than the interviewing physician. The study results showed a low incidence of false positive (1.8 percent) and false negative (2.8 percent) responses to questionnaire items.

Adult↗
PubMed1979

Recognition of depression in a university-based family medicine residency program.

Physicians diagnosed depression in 4.5 percent (59/1,321) of all patient encounters in this study conducted in a university based family medicine residency program. A subset of residents permitted the investigators to interview those patients who were diagnosed as depressed or who were judged to be at high risk for a missed diagnosis of depression. Of the six patients whom the residents diagnosed as depressed and who agreed to be interviewed, two did not meet the criteria for depression but in neither case was this discrepancy judged clinically significant. Of the 24 patients at high risk for a missed diagnosis who agreed to be interviewed, four met the diagnostic criteria and three of these four missed diagnoses were judged as possibly of clinical significance. While the physicians in this study diagnosed depression more frequently than in previous similar studies, this does not appear to represent over-diagnosis, although the small number of patients interviewed requires that interpretations be made cautiously. The authors suggest that if a primary care physician diagnoses depression in less than 2 percent of patient encounters, he or she should consider the possibility of missed diagnoses.

Academic Medical Centers↗
PubMed1976

Clinical manifestations of Bancroftian filariasis in a suburb of Calcutta, India.

Interviews and physical examinations for filarial disease were conducted in Howrah near Calcutta, West Bengal, India, in a study area where long term quantitative entomological studies have disclosed high intensity, year round exposure to Wuchereria bancrofti. Little elephantiasis or other serious filariasis-related disease was noted, but half the males over 20 years of age had genital lesions of various types. Ninety-two percent of households had at least one resident with microfilaremia or presumptive clinical evidence of filarial disease.

Adolescent↗
PubMed1976

Improved outcomes in hypertension after physician tutorials. A controlled trial.

Physicians working at the General Medical Clinic of the Johns Hopkins Hospital entered into tutorials to improve their effectiveness as managers and educators of patients with essential hypertension. After exposure to a single teaching session, tutored physicians allocated a greater percent of clinic-visit time to patient teaching than did control physicians, achieving increased patient knowledge and more appropriate patient beliefs regarding hypertension and its therapy. Patients of tutored physicians were more compliant with drug regimens and had better control of blood pressure than patients of untutored physicians. The personal physician, if he is provided with strategies for identifying the noncompliant patient and for intervening in that behavior, can apply a stimulus to his patients that results in improved compliance and better control of hypertension.

Education, Medical, Continuing↗