Polling questions. Gallup accuses Scully of intimidation, collusion.
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Centers for Medicare and Medicaid Services, U.S.↗
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Living kidney donation. Attitudes outside the transplant center.
Many transplant centers are opposed to the use of living unrelated kidney donors and donors at added risk. To see how the public and nontransplant physicians view these issues, we surveyed samples of these groups in Rochester, NY. We found that the majority of respondents supports the use of unrelated donors and believes that donors should be allowed to accept added risk. Our findings were confirmed by a Gallup Poll of a random sample of the US adult population. It appears that many transplant centers are out of step with public opinion, as well as that of other members of the medical profession. We hope our data will induce the centers to become more attuned to public attitudes and give donors a greater voice in determining their own suitability. If this occurs, more donors will likely become available and the number of patients with end-stage renal disease receiving transplants will increase.
Adult↗
The role of physician specialty board certification status in the quality movement.
The Institute of Medicine's reports and discussions on quality of medical care have focused on a systems-based approach to quality improvement. Our objective is to summarize evidence and theory about the role of a physician's current board certification status in quality improvement. The first body of evidence includes the validity of board certification demonstrated by the testing process, the relationship of examination scores with other measures of physician competence, and the relationship between certification status and clinical outcomes. The second body of evidence involves the adaptation of error prevention theory to medical care. Patient safety is enhanced when problem-solving uses readily accessed habits of behavior, the same behavior necessary to achieve board certification. The third body of evidence, obtained through a Gallup poll, demonstrates that certification and maintenance of certification are highly valued by the public. The majority of respondents thought it important for physicians to be reevaluated on their qualifications every few years and that physicians should do more to demonstrate ongoing competence than is currently required by the profession. We conclude that a physician's current certification status should be among the evidence-based measures used in the quality movement.
Physician's Role↗
Subspecialization, recruitment and retirement trends of American urologists.
PURPOSE: Trends of urology workforce, subspecialization, recruitment practices, retirement planning, practice characteristics and managed care impacts in the United States were assessed. MATERIALS AND METHODS: In February 1996 the executive interviewing branch of The Gallup Organization selected randomly and interviewed by telephone 507 practicing urologists in the United States who had provided urological patient care for more than 20 hours per week, practiced in 1995 and completed a urological residency program. RESULTS: Several important issues emerged. Urologists think we may be training too many urologists, subspecialty board certification would be a divisive issue to urology as a whole and 90% of urologists have an active retirement plan, although 23% are not funding the plan fully. CONCLUSIONS: The American Urological Association Gallup Poll, as refined by the Health Policy Survey and Research Committee, continues to be a unique and valuable tool in assessing practice patterns, gathering demographic data and measuring opinions of the American urologist. This information will help us chart our way to the twenty-first century.
Adult↗
Thoughts on improving the public's knowledge of ophthalmology and eye care.
A Gallup poll taken in September--October 1979, revealed that only 55% of the nation's adults knew the difference between an ophthalmologist and an optometrist. Other important attitudes toward eye care revealed in the survey lead to the conclusion that ophthalmologists have not been very successful in educating the public as to their role in the health delivery system. Serious and objective examination of the strengths and weaknesses in past efforts at public education should be undertaken. Continued reliance upon methods proven to be unsuccessful may be a waste of resources. Innovative approaches may be called for to achieve success.
Health Education↗
Managed care: impact on pharmacy personnel selection.
OBJECTIVE: To review how managed care is changing the traditional practice of pharmacy and the selection of pharmacy personnel. DATA SOURCES: Pharmacy practice journals and health care management journals were reviewed. Search terms included managed care, case management, pharmacists and Gallup Poll, drug use review, and patient compliance. STUDY SELECTION: References were used based on their relevance to describing managed care-driven changes in pharmacy and the potential threats and opportunities associated with these changes. DATA SYNTHESIS: The literature reviewed confirms that managed care is an increasing presence in the health care delivery system and that its influence is spreading to pharmacy. Health care practitioners, including pharmacists, are realigning and redefining their scope of practice to remain viable within the evolving system. CONCLUSION: As the drug delivery system changes, the expectations and roles of its practitioners are changing. The practice of pharmacy is changing from a distributive function to a cognitive one. This change will affect all pharmacy practice sites and will necessitate the hiring of pharmacists who are well qualified to deal with additional requirements. Failure to select qualified personnel may well exclude pharmacy from a major portion of the health care delivery system.
Humans↗
Death, democracy and public ethical choice.
The Danish Council of Ethics...believed that the brain-death criterion should not be accepted without public education and debate. Following the introduction of a spectrum of educational and related activites, a Gallup poll found that 98% of the survey population was aware of the debate over brain-vs-heart criteria and that 80% favoured the adoption of a supplemental brain-death standard... This raises the fundamental question of decisionmaking in pluralist democratic societies, of the limits of democratic involvement in such choices, and of the role of bodies like the Danish Council of Ethics... It must be part of the mission of a governmental bioethical body to use its peculiar expertise to teach and to lead -- to build a popular consensus out of confusion. But in doing so, such a Commission will be steering a dangerous course....
Advance Directives↗
Trends in illicit drug use in the United States: conflicting results from national surveys.
Data from several national studies lead to divergent conclusions regarding trends in illicit drug use in the United States. Two major population studies point to a downturn in drug use dating to the late 1970s. However, a study of drug-related deaths and hospital emergency room visits shows increases in these events in recent years. Studies also show drug use, especially cocaine, continuing to increase among criminals. Additionally, drugs were identified as the most important problem facing the nation in a Gallup poll conducted during the summer of 1989. This paper offers some possible explanations for the divergent trends. Most notably, we suggest that methodological differences in the studies being compared, and lags between trends in the general population and certain subgroups, account for most of the variation in the trend estimates. The paper concludes that illicit drug use is decreasing in the United States.
Adolescent↗
Directed blood donation: a matter of public trust.
Trust is the key issue in blood treatment with respect to public policy. Public trust in the blood system in Canada continues to be exceedingly low. According to the February, 1996 Gallup poll conducted by Janssen-Ortho Inc., 89% of those surveyed chose alternatives to the Red Cross (volunteer) blood. Strategies directed at improving the safety of the blood system will fall short of this goal unless public knowledge and consumer participation are considered. Consumers need to participate in decision making for themselves with the physicians, as well as in the decision making process at the level of public policy. Consumer involvement would contribute to an overall plan of rebuilding public trust. Canadian health care consumers have been significantly affected by the blood tragedy of the 1980s. Public perception of blood safety has been characterized by misunderstanding and fear. The search for alternate methods of transfusion, such as directed donation, are based on a lack of trust of the current blood system. As introducing a program of directed blood donation would not increase safety or decrease the expense of blood transfusions, such a program should not be introduced in Ontario at this time.
Blood Banks↗
Substance abuse coverage provided by employer medical plans.
In summary, substance abuse is a serious problem in America. In fact, a Gallup poll ranked drug use as the Nation's number one problem. As a rapidly accelerating component of health care costs, charges for alcohol and drug abuse treatment are helping to drive up medical care expenses. The substance abuse crisis is also affecting employers, both public and private, who are struggling to provide needed health benefits while controlling spiraling plan costs. Despite the upward pressure on health costs, the problem is so serious that there has been a steady increase in the incidence of coverage for substance abuse treatment in employer-provided medical care plans, to the point that virtually all plans now provide some benefits. Nevertheless, health plans typically cover substance abuse treatment on a more restrictive basis than other illnesses. This may change, however, as the interest in, and the need for, comprehensive substance abuse treatment benefits grows.
Data Collection↗
[Aterial hypertension and cardiovascular risk factors associated with diabetes. Report of the PHARE survey in general practice].
OBJECTIVE: To evaluate the characteristics of diabetic hypertensive patients (Pts), in term of associated cardiovascular risk factors and blood pressure control in a representative population issued from a survey "PHARE" conducted in general practice in France in 1999. DESIGN AND METHODS: PHARE survey was conducted in a sample of 225 GPs representative of the French medical population included in a gallup poll. GPs had to include all patients > 18 years old over a period of one week. Pts were considered as hypertensives (HP) if the mean of two recorded BP measurements was = 140/90 mmHg and/or < 140/90 mmHg if they were under antihypertensive treatment. Patients were considered as diabetics if they were previously known and/or if they received a medication for diabetes. Hypertensives were considered as controlled if their BP levels were overall < 140/90 mmHg or at the recommended threshold < 130/85 mmHg under treatment. RESULTS: 877 diabetic Pts (7%) among 12.342 Pts and 5.190 HP were included in the study. When compared to normotensives, diabetic HP had more frequently associated risk factors with hypertension and diabetes: overweight 71% vs 45%, dyslipidemia 61% vs 34%, sendentarily 73% vs 63%, tobacco consumption 27% vs 20%. The BP control at 140/90 mmHg threshold among treated diabetic HP was 21%, and only 8% at 130/85 mmHg. Regarding WHO classification, 79% of these diabetics had a high or very high cardiovascular risk. The were no difference in antihypertensive drugs used in HP diabetics and non diabetics and 50% of them received ACEI. CONCLUSIONS: 8 from 10 diabetics taken in charge in general practice are hypertensives and 8 from 10 have a very high cardiovascular risk due to a poor BP control and associated cardiovascular risk factors.
Activities of Daily Living↗
[About the relationship between medicine and social sciences: the French Foundation for the Study of Human Problems or Carrel Foundation (1941-1945)].
Nobel Prize winner for medicine in 1912, author of a widely acclaimed best seller which was published in English and in French in 1935, Man, the Unknown, Alexis Carrel was Regent of the French Foundation for the Study of Human Problems from 1942 to 1944, during the Second World War in France. The Foundation, known as the "Carrel Foundation", was created as a financially autonomous public establishment with full legal status and had a dual mission: to stkudy "all possible means of safeguarding, improving and developing the French population" (1) and to "synthesize efforts undertaken by its own members or by others and to develop the science of man" (2). Considering its short official existence and the exceptional circumstances of the period, the scientific work of the Foundation is impressive: the demographical analyses undertaken by R. Gessain, P. Tincent, and J. Bourgeois; the pioneer work of J. Sutter in nutrition; J. Merlet's work on group settings; the Gallup polls undertaken by J. Stoetzel's team; and the work and publications of the F. Perroux Department of Bio-Sociology, without failing to mention the study carried out on a group of one hundred thousand children. Amongst the effects of the Foundation, one must mention the National Institute of Demographic Studies (INED) and with it, the establishment of one of the most active and productive research groups in the Social and Human Sciences in France. There are other initiatives and activities which form part of the Foundation's inheritance: the creation in 1947 by Dr A. Gros, former Vice-regent of the Foundation, of the group of "Advisers in Synthesis"; the jkoint creation ten years later by D Gros and G. Berger of the group and the publication "Prospective"; the wide multidisciplinary study undertaken by the (DGRST) "Délégation Générale à la Recherche Scientifique et Technique" undertaken in 1960 thanks to the initiative of R. Gessain and of J. Sutter; and the Monaco Forums on Social Sciences, not to mention the contribution of former Foundation members to the establishment at the international level of medicine of work and the encouragement given to ergonomic studies.
Eugenics↗
The development and history of the poverty thresholds.
In recent years there has been renewed interest in the United States in the definition and measurement of poverty. In early 1992, the Committee on National Statistics of the National Academy of Sciences began a 30-month study requested by Congress that includes an examination of statistical issues involved in measuring and understanding poverty. Some 2 years earlier, in January 1990, the Administration had approved an initiative on improving the quality of economic statistics. The current poverty measure was one of several dozen statistical series examined as part of that initiative. In April 1990, Urban Institute economist Patricia Ruggles published a book that urged the revision of the poverty line to reflect changes in consumption patterns and changing concepts of what constitutes a minimally adequate standard of living. In July 1990, two private organizations concerned with the poor and the elderly issued a report reviewing current poverty measurement procedures and describing a Gallup poll in which a nationally representative sample of Americans set an average dollar figure for the poverty line that was higher than the current official poverty line. In view of these and other examples, it may be useful to reexamine the development and subsequent history of the current official poverty thresholds.
Age Factors↗
[Prevalence of anal incontinence in adults].
Inquiries were conducted to determine the prevalence of anal incontinence in a) the general population over 45 by a gallup poll studying 1,100 persons (A); b) 3,914 patients seen by their general practitioner or their gastroenterologist during the same week (B); c) 500 patients consulting for urinary stress incontinence (C1); d) 1,136 neurological patients suffering from micturation disorders (C2); and e) 10,157 elderly persons living in retirement homes or in hospital (D). In the general community (A), the prevalence of anal incontinence, including gas and stool incontinence, was 11 percent, the prevalence of fecal incontinence, 6 percent, the prevalence of daily or weekly fecal incontinence, 2 percent; prevalences were respectively 15.5 percent, 7.9 percent, and 3.2 percent in group B, and 27 percent, 9 percent and 3.8 percent in group C1. The prevalence of fecal incontinence was 18 percent in group C2 and 33 percent in group D. Prevalence did not depend on age in group A and C1, but was twofold higher in group C1 than in group A. The prevalence increased with age in groups B and D.
Adult↗
The epidemiology and occurrence of insomnia.
Although the definitions of insomnia have changed over the last decade to include the perceptions of patients and the effects of disturbed sleep on daytime function, no clear measure exists for isolating the scope of the problem within the general population. A 1979 Gallup poll survey showed that 95% of the adult population had experienced insomnia. The current literature maintains consistently that approximately one third of all people have sleep problems in any given year. Of those, only half consider the problem serious enough to seek medical advice. Sleep disorders appear to effect women more often than men, and the complaints increase with age. Younger people tend to have trouble falling asleep, while older people have difficulty maintaining sleep. The many varieties of sleep disorders and the diverse etiologies underlying them make it crucial that the individual sleep problem be understood clearly. An accurate diagnosis should drive treatment.
Adult↗
[An estimation of the future demand in orthodontic needs and of the appropriate number of orthodontists for the period 1989-1999].
The present study is a repetition of two previous orthodontic Gallup polls (Gehrig et al. 1981 and Roh et al. 1986). It was conducted with the goal to reactualize the orthodontic workload in Switzerland in 1989 and to produce prognostic figures for 1994 and 1999. 1092 questionnaires have been sent out and 53.1% were returned duly completed. The number of orthodontic specialists, 79 in 1984, has increased to 104 in 1989. Despite this augmentation and the additional factor of an increase from 152 to 173 new cases per year per specialist, all specialists together treated only 29.5% of the newly started cases. This figure was 22.6% in 1984. The total of Switzerland's orthodontic needs is still not covered and it will therefore be necessary to train 29 new specialists until 1994 and 34 additional specialists in the period 1994 to 1999. This means that 4 to 5 new specialists have to be trained in Switzerland per year over the next ten years.
Forecasting↗
Physicians' and the public's attitudes on communication about death.
We studied the preferences of physicians and the public as to how physicians should inform a family of a patient's unexpected death. When the family had to be reached by telephone, 72% of our 150 physician-respondents preferred telling the family that the patient was critically ill and asking the family to come to the hospital immediately (critical notification [CN]); 25% of the physicians preferred announcing the death over the telephone (death notification [DN]). When the news had to be announced in person, 58% of physicians preferred immediately announcing it (IA), and 33% preferred gradual announcement (GA). A Gallup poll commissioned by us showed that 64% of the adult population in the United States preferred CN, 26% DN, 79% IA, and 17% GA; CN and IA were preferred in all the demographic subgroups examined. We discuss our findings, the reasons for them, and their ethical and practical implications.
Adult↗
Death in practice.
For a nationwide study of terminal care, Gallup Polls took a sample of 950 general practitioners. Fourteen questionnaires could not be delivered; 376 doctors (40 per cent of the register) returned forms; 313 doctors (33.4 per cent) provided information on 301 home deaths and 292 hospital deaths and responded also to statements about care of the dying.The patients who died at home were well supported by the general practitioner and the family and neighbourhood network. Control of pain was perceived to be better at home. Patients dying at home were more likely to be aware of their impending death. General practitioners usually discussed the imminence of death with relatives, but few relatives and patients raised the question of terminating life. All the available major services were under-used. There was support for more hospices and for more spending on social services. Postgraduate medical education on care of the dying was considered to be inadequate.
Adolescent↗