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PubMed2003

Characteristics of physically inactive older adults with arthritis: results of a population-based study.

BACKGROUND: Arthritis is the most prevalent chronic condition among persons age 65 and older in North America. Physical inactivity in this population is linked to functional limitations, increased risk for cardiovascular disease, diminished quality of life, and disability. The purpose of this study was to identify risk factors for inactivity. METHODS: National data for 6256 community-dwelling older adults with arthritis from the 1996-1997 Canadian National Population Health Survey were examined using logistic regression analyses. The independent variables included sociodemographic characteristics, health status, psychosocial factors, health behaviors, and medication use. RESULTS: Inactive persons were significantly (P < 0.05) more likely to be women, older (75+), have functional limitations, be underweight (BMI < 20) or overweight (BMI > 25), have severe pain, or not have prescription drug insurance coverage. The same group was less likely to be unmarried, well educated, from western provinces, attend church frequently, consume alcohol infrequently, have higher levels of social support, have better self-rated health, or use pain medication. CONCLUSIONS: The profile presented in this study should be fully considered by health care providers when educating patients with arthritis about the adverse health effects of sedentary behavior. Prescription drug insurance coverage may facilitate activity among elders with arthritis.

Aged↗
PubMed2000

Sociodemographic predictors of adherence to annual cervical cancer screening in minority women.

The Papanicolaou (Pap) test is an effective screening mechanism for reducing morbidity and mortality from cervical cancer. Nevertheless, Pennsylvania ranks fifth in national cervical cancer incidence and fourth in national cervical cancer mortality, with a significant number of cases contributed by Philadelphia. Substantial subgroups of American women, specifically ethnic minorities, the elderly, the uninsured, and the poor, have not been screened or are not screened at regular intervals. A secondary data analysis was conducted to test whether age, income, insurance coverage, marital status, level of education, and number of persons living at home could predict whether a woman among convenience sample of 204 black and Hispanic women adhered to annual Pap testing. A woman was considered adherent to annual Pap testing if she reported undergoing a Pap smear in the 14 months preceding her enrollment in the study. African American woman who were high school graduates and had insurance coverage were more likely to be adherent to annual Pap testing. Hispanic women older than 50 years and born outside the mainland United States were less likely to be adherent to annual Pap testing. Findings suggest that cancer nurses working to promote cervical cancer screening in Philadelphia should continue to target at-risk populations, specifically uninsured and less-educated black and Hispanic women older than 50 years who were born outside the mainland United States.

Adolescent↗
PubMed2003

Factors associated with uncontrolled hypertension in an affluent, elderly population.

OBJECTIVE: To explore demographic, economic, and treatment-related associations with uncontrolled hypertension in a relatively affluent, community-dwelling population. METHODS: Two home surveys of 655 and 432 subjects with a diagnosis of hypertension were completed in 1995 and 1999, respectively. Trained surveyors recorded medication history plus demographic and socioeconomic variables, as well as several measurements of blood pressure in the home. Uncontrolled hypertension was defined according to guidelines set forth by the Sixth Report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Odds ratios for observing an elevated blood pressure given the patients' medication history, income, insurance coverage, demographic variables, and concomitant disease were estimated using multivariable logistic regression. RESULTS: On both occasions, >60% of the study population had an average blood pressure that was above recommended levels. Diuretic therapy alone (1995 survey) or in combination with an angiotensin-converting enzyme inhibitor (1999 survey) decreased the odds ratio for uncontrolled hypertension by 39% (p = 0.027) and 62% (p = 0.005), respectively. Lack of prescription drug insurance and a history of arthritis had negative effects, increasing the odds ratio for uncontrolled hypertension by more than twofold (p < 0.05). CONCLUSIONS: Uncontrolled hypertension occurs commonly among elderly patients notwithstanding a relatively high standard of living. The choice of medication, presence of concomitant disease, and availability of insurance may be important factors influencing blood pressure control.

Aged↗
PubMed2006

Access to health care among Hispanic or Latino women: United States, 2000-2002.

OBJECTIVE: This report presents national estimates on access to health care for the following five subgroups of Hispanic or Latino women aged 18 years and over in the United States: Mexican, Puerto Rican, Cuban, Central or South American, and other Hispanic. For comparison, estimates are also presented for non-Hispanic white women and non-Hispanic black women. METHODS: Data for persons of all ages in the U.S. civilian noninstitutionalized population are collected each year in the National Health Interview Survey (NHIS), which is conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics. Each year, data are collected for approximately 100,000 persons in 40,000 households. In the 2000-2002 surveys combined, data were collected for 54,763 women aged 18 years and over (9,082 Hispanic or Latino women), with an overall response rate of 73.4%. Estimates in this report are presented as annual estimates, averaged over the 3 survey years. Estimates were age adjusted to the 2000 U.S. standard population to permit comparison among the various race and ethnic subgroups. RESULTS: Among the 33.4 million Hispanic or Latino women in the United States, 31% lacked health insurance coverage at the time of interview, 20% had no usual place to go for medical care during the past year, and 22% experienced unmet health care needs during the past year due to cost. Of the five subgroups of Hispanic or Latino women, Mexican women (35%) and Central or South American women (36%) were more likely than Puerto Rican women (14%) and Cuban women (23%) to lack health insurance coverage. Mexican women (78%) and Central or South American women (78%) were less likely to have a usual place to go for health care compared with Puerto Rican women (90%), Cuban women (82%), and other Hispanic women (90%). The percentage of Hispanic or Latino women who had an unmet medical need due to cost was highest among Mexican women (24%) and lowest among Cuban women (14%). Lack of access to health care was most prevalent among Hispanic or Latino women who had poor or near poor poverty status, had less than a high school diploma, or were foreign born. CONCLUSION: Access to health care varied among subgroups of Hispanic or Latino women. Understanding these subgroup differences may help community-based programs improve access to care among Hispanic or Latino women.

Adolescent↗
PubMed2000

Cost analysis of pancreatic carcinoma treatment.

BACKGROUND: Pancreatic carcinoma is a major health issue and financial burden to society. To improve the quality and efficiency of care delivered, it is essential for health care providers to have a good understanding of the cost of treatment. METHODS: The authors examined the facility-based costs and survival of 103 patients with pancreatic carcinoma who were treated at the Karmanos Cancer Institute between January 1992 and September 1998. Longitudinal cost data for each patient were obtained, and from those data, 6-month, 1-year, and lifetime total treatment costs were calculated. RESULTS: The average 6-month, 1-year, and lifetime total treatment costs were $37,327, $42,218, and $48,803, respectively, and the median survival was 7 months. In univariate analyses, the disease stage at diagnosis was a highly significant predictor of total cost. Patients with metastatic disease had the lowest cost, and patients with resectable disease had the highest cost. In multivariate analyses controlling for disease stage, treatment strategies and dual insurance coverage were also important predictors of costs but patient age, race, and gender were not predictive. Disease stage also was highly predictive of survival. In a multivariate analysis controlling for disease stage, chemotherapy and radiation therapy were correlated with longer survival, whereas resection and palliative bypass surgery were not. CONCLUSIONS: The costs of treating patients with pancreatic carcinoma are considerable, even though survival duration typically is short. Disease stage was the most dominating factor determining costs and survival. After controlling for disease stage, chemotherapy, surgery, and dual insurance coverage were also significantly associated with higher cost of care. However, in survival analyses, only chemotherapy and radiation therapy were associated with a significant increase in patient survival.

Aged↗
PubMed2003

Appendicitis, 2002: relationship between payors and outcome.

As the status of health-care insurance changes in the United States, studies have indicated that uninsured patients are less likely to receive timely and quality health care. Previous studies of appendicitis have shown that insurance status may effect the stage of presentation and outcome. However, these studies were based on databases lacking information regarding stage of presentation, timeliness of diagnosis and treatment, and character of hospitalization (length of stay, duration of antibiotic therapy, hospital costs). We accomplished a case control study, retrospective analysis of 975 patients treated for acute appendicitis between January 1996 and December 1999. Times to operation, number of preoperative outpatient visits, number of studies, severity of presentation, length of antibiotics and hospital stay, and hospital costs were analyzed [analysis of variance (ANOVA) techniques, P < 0.05 significant]. We sought answers to the following: (1) Did insurance status affect the timeliness of diagnosis and treatment? (2) Did insurance status affect the stage of presentation? (3) Did insurance status affect hospitalization, as measured by length of stay, duration of antibiotic therapy, and hospital costs? (4) Did age affect outcome independent of insurance status? There were no correlations between insurance status and timeliness of diagnosis or severity of presentation. Length of stay and hospital costs were also not different between insurance categories. Pediatric patients (< 12 years old) and the elderly (> 65 years old) presented with more advanced appendicitis, independent of insurance category. In contrast to previously published data, the treatment of acute appendicitis is not affected by insurance coverage in the sample community. Age and timeliness of presentation were the only factors correlating to outcomes.

Adult↗
PubMed1996

Variability in length of hospitalization for stroke. The role of managed care in an elderly population.

OBJECTIVES: To measure hospital stay for acute stroke care and to describe health services and demographic factors associated with longer length of stay (LOS). DESIGN: Observational, retrospective consecutive case series. SETTING: Large tertiary-care teaching hospital in Massachusetts. PATIENTS: The patient population comprised 745 patients aged 65 years and older admitted with ischemic stroke from 1982 through 1995. MAIN OUTCOME MEASURES: Hospital LOS (1-5, 6-10, and >10 days) as well as total charges and discharge location. RESULTS: Median LOS was 7 days (range, 1-289 days), and median total charges were $8740 (range, $522-$135172); LOS explained 62% of the variance in total charges. Insurance status was a major factor in determining LOS: after possible confounders were controlled for, patients enrolled in a health maintenance organization were significantly less likely to have long hospital stays (odds ratio [OR], 0.45; 95% confidence interval, 0.31-0.66) than were conventional Medicare enrollees, while the LOS of patients with other insurance coverage was no different from that of Medicare patients. Longer LOS was significantly associated with greater comorbidity (OR, 1.52 for a Charlson comorbidity index >2), institutionalization prior to hospital admission (OR, 1.83), and unmarried status (OR, 1.37) and was inversely associated with year of admission (OR, 0.30 in years 1991-1995 vs 1982-1986). Age, sex, and race were not associated with LOS. Discharge to a nursing home or inpatient rehabilitation site was not associated with type of insurance coverage (OR, 1.10; 95% confidence interval, 0.72-1.69 for patients in a health maintenance organization vs conventional Medicare patients). CONCLUSIONS: There is marked variability in length of hospital stay for ischemic stroke among the elderly, even after underlying patient differences are controlled for. Managed care may result in increased efficiency of in-hospital care and improved discharge planning for these patients; further study of the ultimate clinical outcomes of such care is needed.

Aged↗
PubMed1990

Early prenatal care in urban black and white women.

If the ultimate success of efforts to improve pregnancy outcome depends on assurance that prenatal care begins in the first trimester, it is important to identify potentially modifiable factors associated with the start of care as well as the groups in which it is most likely to be late. This topic was explored in a population-based study of low birthweight in 766 black women and 462 white women who gave birth in Alameda County, California, in 1987. Variables related to insurance coverage and financial status showed the greatest difference between early and late attenders at prenatal care in both groups. At virtually every level of almost every variable studied, black women were less likely than white women to begin prenatal care in the first trimester. The data suggested that some of the difference in the timing of prenatal care may be due to lack of awareness of, or failure to pay attention to, the signs of early pregnancy. We conclude that, although addressing problems of insurance coverage and financial status is critical to the solution of the problem of late initiation of prenatal care, as financing difficulties are solved, attention should be paid to women's internal factors such as depression and denial as modifiers of the earliness of seeking prenatal care.

Adolescent↗
PubMed2005

Racial and ethnic disparities in early childhood health and health care.

BACKGROUND: Racial/ethnic disparities in health care have received much national attention recently, but few studies have focused on disparities among children. We studied disparities in early childhood health and health care. METHODS: We analyzed data for 2608 children, 4 to 35 months of age, from the 2000 National Survey of Early Childhood Health, a nationwide household survey. The overall response rate was 65.6%. Survey questions addressed health, health care, and interactions with health care providers. RESULTS: Hispanic and black children were significantly less likely than whites to be in excellent/very good health (72%, 79%, and 90%, respectively) and were more likely to be uninsured (31%, 18%, and 9%, respectively). Only 60% of Hispanic and 77% of black parents would recommend their child's provider to others, compared with 84% of white parents. Minority parents more often reported that providers never or only sometimes understood their child-rearing preferences, and Hispanic parents most often reported that providers never or only sometimes understood their child's needs. Minority parents more often were asked about violence, smoking, drinking, and drug use. Hispanic and black parents averaged significantly fewer telephone calls to doctors' offices than did whites (2.0, 3.1, and 4.3 calls, respectively). Providers significantly less often referred Hispanic and black children to specialists (11% and 17%, respectively, compared with 22% for whites). Most disparities persisted in multivariate analyses, and several disparities were found between children with parents who completed surveys in Spanish and those with parents who completed surveys in English. CONCLUSION: Young minority children experience multiple disparities in health status, insurance coverage, topics discussed during pediatric visits, parents feeling understood by providers, parental satisfaction, and referrals to specialists.

Black or African American↗
PubMed2001

Correlates of actual and perceived knowledge of prostate cancer among African Americans.

While digital rectal examination, prostate-specific antigen, and transrectal ultrasound have been identified as effective means of early detection of prostate cancer, African American men tend to underuse these services as compared to white men. Using a nonrandom sample of 108 African American men, the authors conducted an exploratory investigation of the effects of education, income, age, and health insurance coverage on actual and perceived knowledge of prostate cancer. The extent to which the use of prostate cancer screening services may be attributed to actual and perceived knowledge of prostate cancer was also explored. Respondents demonstrated a poor knowledge of prostate cancer and less than 40% reported having had prostate cancer screening as part of their annual physical examination. The results of the study also revealed that (a) there was a moderately strong correlation between actual and perceived knowledge of prostate cancer, (b) use of prostate cancer screening service was positively associated with actual and perceived knowledge of the disease, (c) actual knowledge of prostate cancer was negatively correlated with education, age, and income, and (d) actual and perceived knowledge of prostate cancer were both correlated with having health insurance coverage.

Adult↗
PubMed1999

Survey of multiple sclerosis in northern California. Northern California MS Study Group.

A random sample of 493 multiple sclerosis (MS) patients registered with the Northern California Chapter of the National MS Society was surveyed by mail and subsequently interviewed with regard to their MS, life style, diet, medical treatment, family history, and insurance coverage. Of this sample, 168 patients (34%) returned completed questionnaires. The answers on the questionnaire were entered into a database and scores on the extended disability status scale (EDSS), the neurologic rating scale (NRS), the ambulation index (AI), and the mean disability scale (MDS) were determined from the patient's answers to a portion of the questionnaire using a previously validated conversion program. This survey population of 168 patients seemed to represent well both the random sample and the frame population from which it was drawn. Patients commonly experienced symptoms for which there are medical treatments currently available such as bladder symptoms, fatigue, spasticity, pain, and depression. Surprisingly, however, with the exception of spasticity, patients were only infrequently treated for these complaints. In addition, despite the recent approval of the beta-interferons and copolymer I in the treatment of MS, only 74% of the appropriate candidates for such treatment had these options discussed with them and only 45% ever actually received such treatment. Certain clinical features and dietary habits were strongly associated with both EDSS scores and total disability. Not unexpectedly, either a progressive disease course or the presence of neurological dysfunction in any one of a number of functional areas (e.g. bladder, vision, cognitive change, etc.) correlated with higher EDSS scores and greater total disability. Fatigue was also strongly correlated with disability. Indeed, fatigue accounted (in whole or in part) for 65% of the disability experienced by patients; an observation which only underscores the fact that fewer than one third of the patients who experience fatigue have ever been tried on medications. Interestingly, the only factors associated with lower EDSS scores and less total disability were exercise and alcohol consumption. Such associations from a single survey, however, do not establish causation. It is the purpose of this study to establish a baseline level of function within this survey population so that future surveys in the same set of individuals can allow a prospective assessment of how health outcome has influenced different aspects of the patient's medical care, lifestyle, and insurance coverage.

Adult↗
PubMedDate not supplied

Conflicting national recommendations and the use of screening mammography: does the physician's recommendation matter?

BACKGROUND: This study evaluated whether women's perceptions of the conflicting recommendations for breast cancer screening were associated with decreased use of mammography. METHODS: We conducted a random-digit-dial telephone survey of 1024 women in four communities of western Washington State. In addition to collecting data for demographics, beliefs about mammography, and insurance coverage, we inquired whether the respondents were aware of any conflicting recommendations about when to begin or how frequently to perform screening mammography, whether their physicians had recommended a mammogram, and whether they were likely to do what their physicians recommended. After grouping women according to whether they perceived conflicting recommendations, we used chi-square statistics to compare the distribution of proportions of women by age, race, household income, education, and insurance coverage. To estimate the odds of their having a mammogram in the previous 2 years (yes or no), we used multivariate logistic regression and included the above variables as covariates. RESULTS: Sixty-two percent of eligible women completed the survey, and 49 percent (479 of 985) perceived conflicting recommendations. The association between perceiving conflict and mammography use was not significant. Eighty-three percent of women who perceived conflicting recommendations reported being more comfortable using their own judgment about getting the procedure. After controlling for whether women perceived conflicting recommendations and all other factors, women who said they followed their physician's advice but did not recall their physician recommending mammography were 71 percent less likely to have received a recent mammogram than were women who reported their physician did recommend it (odds ratio 0.29, confidence interval 0.16-0.51). CONCLUSIONS: The conflicting recommendations surrounding breast cancer screening are not influencing women's choices about mammography. The physician recommendation and women's self-reported likeliness to follow it are the most important factors associated with mammography use.

Aged↗
PubMed2005

A national profile of health care utilization and expenditures for children with special health care needs.

OBJECTIVES: To provide the first nationally representative data on total health care expenses, out-of-pocket health care expenses, and information on the extent to which out-of-pocket expenses are financially burdensome for families of children with special health care needs (CSHCN). To also compare utilization and expenditure patterns for children with and without special health care needs. DESIGN: We used data from the 2000 Medical Expenditure Panel Survey (MEPS). We present univariate, bivariate, and multivariate statistics on utilization and expenditures adjusted for the complex sample design. PARTICIPANTS: The 2000 MEPS data set contains 6965 children younger than 18 years. Using the CSHCN definition adopted by the federal Maternal and Child Health Bureau and operationalized using the CSHCN Screener, 949 children (15.6%) were identified as children with special health care needs. MAIN OUTCOME MEASURES: Compared with other children, CSHCN had 3 times higher health care expenditures (2099 dollars vs 628 dollars; P<.01). The 15.6% of CSHCN accounted for 42.1% of total medical care costs (excluding dental costs) and 33.6% of total health care costs (including dental costs) attributed to children in 2000. Families of CSHCN were best protected against inpatient hospital care expenses and most exposed to dental care expenses. Families of CSHCN experiencing high out-of-pocket expenses (exceeding 5% of family income) were approximately 11 times more likely to be from households with incomes below 200% of the federal poverty level (odds ratio, 10.9; 95% confidence interval, 3.55-33.76) than to be from families with incomes at or above 400% of the federal poverty level. CONCLUSIONS: Families with CSHCN experience much higher expenditures, including out-of-pocket expenditures, than other children. Insurance plays an important protective role for families of CSHCN, but it still provides incomplete protection. Health policy changes that would extend the breadth and depth of insurance coverage are needed to ensure that all families of CSHCN are protected against burdensome expenses.

Adolescent↗
PubMed1993

Organ transplantation and the inevitable debate as to what constitutes a basic health care benefit.

The need for health care reform is an economic reality. The urgency with which it must be pursued is apparent. The direction it will take is clear. The implications it has for transplantation are ambiguous. Managed competition will take time to implement, but managed care is here now and will surely become more prevalent. Thus, it is timely to examine the future of transplantation from the perspective of managed care. Foremost among our concerns is just how transplantation will factor into the debate as to what constitutes a basic health care benefits package. The National Cooperative Transplantation Study (NCTS) was undertaken to address a variety of clinical, economic, social, ethical, and quality-of-care issues. Based on a random sample of all transplants performed in the United States in 1988, individual assessments were made of charges for kidney, heart, liver, heart-lung, and pancreas transplantation. Insurance coverage and reimbursement policies and practices were also analyzed. In 1988 dollars Medicare procedure charges from date of transplant through date of initial discharge were as follows: kidney, $39,625; heart, $91,570; liver, $145,795; heart-lung, $134,881; and pancreas, $66,917. Both patient charges and outcomes were adversely affected by the patient's status prior to surgery, and by the need for retransplantation. The associations among transplant program activity, procedure charges, and patient outcomes varied. While insurance coverage for transplantation has steadily improved, hospital reimbursement is often well below billed charges, as a result, access for some patients may be limited. Organ transplantation is often criticized as too costly, given other health care needs. A recent report indicates that the total first-year charges for transplantation continue to increase. Estimated charges in 1993 dollars are as follows: kidney, $87,700; heart, $209,100; liver, $302,900; heart-lung, $246,000; pancreas, $65,000; and lung, $243,600. Although expensive, transplantation can be equally if not more cost-effective than other accepted therapeutic approaches for the treatment of catastrophic disease. Nonetheless, under managed care and capitated payment it will be essential that the high cost of transplantation be addressed. To reduce charges, enhance patient outcomes, and improve access patient selection policies must be reconsidered. Currently, those patients who are least likely to benefit, yet whose treatment cost the most, are given priority for transplantation. While this approach may be clinically indicated, it is socially unacceptable. Managed care and managed competition will force physicians and surgeons to adopt a more conservative and cost-efficient practice style. The patients who stand to benefit most are those whose needs are consistent with the principles of cost effectiveness.(ABSTRACT TRUNCATED AT 400 WORDS)

Cost Allocation↗
PubMed2006

Predictors of healthcare utilization among older Mexican Americans.

OBJECTIVE: To examine the effects of predisposing, enabling, and need factors on physician and hospital use among older Mexican Americans. DESIGN: A two-year prospective cohort study. SETTING: Five Southwestern states: Texas, New Mexico, Colorado, Arizona, and California. PARTICIPANTS: A population-based sample of 1987 non-institutionalized Mexican American men and women age > or =65 years. MAIN OUTCOMES MEASURES: Physician and hospital utilization. Predictor variables included predisposing, enabling, and need factors. Ordinary least square and logistic regression analysis were used to model the effects of predictor factors specified in the Andersen model of health service use on physician and hospital use. RESULTS: After two years of follow-up, predisposing and enabling factors accounted for <5% of the variance in physician and hospital use. Need factors explained 21% of the variance in physician use and 7% of the variance in hospital use. Older age; being female; insurance coverage; having arthritis, diabetes, heart attack, hypertension, stroke, or cancer; and number of medications were factors associated with higher physician utilization. Subjects with arthritis, diabetes, hip fracture, high depressive symptoms, activities of daily living (ADL) disability, or high number of medications increased the odds of having any hospitalization. Subjects with diabetes, heart attack, hip fracture, ADL disabled, and high number of medications had a greater number of hospital nights than their counterparts. CONCLUSIONS: Older age, female sex, insurance coverage, and prevalent medical conditions are determinants of healthcare use among older Mexican Americans.

Aged↗
PubMed2000

Patient characteristics and ICU organizational factors that influence frequency of pulmonary artery catheterization.

CONTEXT: Hemodynamic monitoring of patients with a pulmonary artery catheter is controversial because there are few data confirming its effectiveness, and patient and intensive care unit (ICU) organizational factors associated with its use are unknown. OBJECTIVE: To determine pulmonary artery catheter use in relationship to type of ICU organization and staffing, and patient characteristics, including severity of illness and insurance coverage. DESIGN, SETTING, AND PATIENTS: Retrospective database study of 10,217 nonoperative patients who received treatment at 34 medical, mixed medical and surgical, and surgical ICUs at 27 hospitals during 1998 (patients were enrolled in Project IMPACT). MAIN OUTCOME MEASURES: Pulmonary artery catheter use based on severity of illness measured by the Simplified Acute Physiology Score, resuscitation status at ICU admission, and ICU organizational variables, including type, size, and model. RESULTS: A pulmonary artery catheter was used for 831 patients (8.1%) in the ICU. In multivariate analysis adjusted for severity of illness, age, diagnosis, and do-not-resuscitate status, full-time ICU physician staffing was associated with a two-thirds reduction in the probability of catheter use (odds ratio [OR], 0.36; 95% confidence interval [CI], 0.28-0.45). Higher catheter use was associated with white race (OR, 1.38; 95% CI, 1.10-1.72) and private insurance coverage (OR, 1.33; 95% CI, 1.10-1.60). Admission to a surgical ICU was associated with a 2-fold increase in probability of catheter use (OR, 2.17; 95% CI, 1.70-2.76) compared with either medical or mixed medical and surgical ICUs. CONCLUSION: Organizational characteristics of ICUs, insurance reimbursement, and race, as well as clinical variables, are associated with variation in practice patterns regarding pulmonary artery catheter use. Understanding such influences, combined with studies measuring clinical and economic outcomes, can contribute to the development of policies for the rational use of pulmonary artery catheters. JAMA. 2000;283:2559-2567

Adult↗
PubMed2000

Why rural residents migrate for family physician care.

Several studies have examined why rural residents bypass local hospitals, but few have explored why they migrate for physician care. In this study, data from a random mail survey of households in rural Iowa counties were used to determine how consumers' attitudes about their local health system, health beliefs, health insurance coverage and other personal characteristics influenced their selection of local vs. nonlocal family physicians (family physician refers to the family practice, internal medicine or other medical specialist providing an individual's primary care). Migration for family physician care was positively associated with a perceived shortage of local family physicians and use of nonlocal specialty physician care. Migration was negatively associated with a highly positive rating of the overall local health care system, living in town, Lutheran religious affiliation and private health insurance coverage. By understanding why rural residents prefer to bypass local physicians, rural health system managers, physicians and policy-makers should be better prepared to design innovative health organizations and programs that meet the needs of rural consumers.

Adult↗
PubMed2003

Direct costs of allergic rhinitis in the United States: estimates from the 1996 Medical Expenditure Panel Survey.

BACKGROUND: Previous estimates of the cost of allergic rhinitis predate the substantial increase in the use of second-generation antihistamines and intranasal corticosteroids. OBJECTIVE: We sought to update estimates of the direct costs of allergic rhinitis in the United States and to estimate prescription medication expenditures by type of insurance coverage. METHODS: Data from the 1996 Medical Expenditure Panel Survey were used in a cross-sectional analysis of resource use and costs. RESULTS: Approximately 7.7% of the population are estimated to have had allergic rhinitis in 1996. The total direct medical cost of allergic rhinitis was estimated at $3.4 billion, with the majority attributable to prescription medications (46.6%) and outpatient visits (51.9%). Fifty-one percent of the prescription medication expenditures were for second-generation antihistamines, 25% for intranasal corticosteroids, and 5% for first-generation antihistamines. Fifty-eight percent of patients with allergic rhinitis received 1 or more prescription drugs for its treatment during the study year. Among these patients, mean prescription expenditures were $131 (95% CI, $119-$143), of which $50 (95% CI, $43-$56) were paid out of pocket. The mean prescription medication expenditure was $103 (95% CI, $70-$136) for persons with Medicaid, $155 (95% CI, $140-$169) for private insurance, $213 (95% CI, $0-$521) for other insurance, and $69 (95% CI, $57-$80) for no prescription drug insurance. CONCLUSION: The direct costs of allergic rhinitis have increased substantially since the introduction of second-generation antihistamines and intranasal corticosteroids, especially costs attributable to prescription medications. Individuals with no insurance coverage have higher total out-of-pocket prescription expenditures than those with coverage.

Ambulatory Care↗