摘要:

The authors attempted to determine the perceptions of Canadian family physicians and general practitioners regarding their effectiveness in identifying and treating abused female patients. A national sample of 963 family physicians and general practitioners were surveyed by questionnaire concerning their knowledge, attitudes, detection, treatment, and continuing medical education needs regarding this issue. Most respondents estimated that 15% of their female patients are victims of wife abuse; more than 50% believed that they failed to identify 30% of cases or more. Physician age and sex differences did not correlate with detection rates, but did correlate with treatment options. Finally, although the most common reasons cited for failing to detect cases were patients' unresponsiveness, lack of initiative, or infrequent visits, a majority of the physicians wanted more continuing education concerning wife abuse.

ISSN:0025-7079    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The relationship between glycemic control and health-related quality of life was examined in patients with non-insulin-dependent diabetes mellitus (NIDDM). Within the context of a randomized controlled trial, 275 patients with NIDDM receiving primary care from a Veteran's Administration general medical clinic were enrolled and monitored for 1 year. Glycemic control (glycosylated hemoglobin levels) and health-related quality of life (Medical Outcomes Study Short-Form 36-item Health Survey [SF-36]) were assessed at baseline and at 1 year. Multivariate regression modeling using baseline and change scores during a 1− year period did not find a linear or curvilinear relationship between glycosylated hemoglobin and SF-36 scores (P= .15); this was true even after controlling for five covariates identified a priori (insulin use, number of diabetic complications, duration of diabetes, education, number of hyper-, or hypoglycemic episodes during the preceding month). Health services researchers and clinicians alike need to be aware that these two important outcomes may not be directly related. This lack of association could contribute to the high noncompliance rates observed among patients prescribed complex diabetic regimens. Unless patients perceive a benefit from following such regimens, good glycemic control may continue to be an elusive therapeutic goal, especially in patients with long-standing disease.

ISSN:0025-7079    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

There has been increasing interest in using patient satisfaction as an indicator of quality of care by the purchasers of health plans, as well as the basis for marketing by competing plans. Few studies have examined if availability and utilization of health promotion programs are associated with patient satisfaction with the health plan. Data from the Bay Area Business Group on Health 1992 Employee Medical Plan Satisfaction Survey were used to examine these relationships. The findings indicate that persons enrolled in staff-model health maintenance organizations are much more likely to be offered health promotion programs by their plan or physician compared with persons enrolled in independent practice association-model health maintenance organizations and indemnity plans. However, regardless of plan type, employees who have been offered stop-smoking programs, stress management programs, weight-control programs, cholesterol screening and blood pressure screening, or any health promotion program by their plan or physician are more satisfied with their health plan than whose who have not. In addition, employees who have participated in a health promotion program also are more satisfied than employees who have not participated in such a program. The findings have important implications for designing and restructuring health plans to better meet consumer preferences.

ISSN:0025-7079    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The effectiveness and costs of care for hypertension are examined in a stratified random sample of 3,087 patients from a network of 32 Veterans Affairs Hypertension Screening and Treatment Clinics (HSTP). During 2.5 years of follow-up, 66% and 88% of patients, respectively, had mean diastolic blood pressure (DBP) levels of 90 or 95 mm Hg or less; 73% remained fully in care; and the mean cost of ambulatory care per patient-year was $647 in 1989 dollars. Higher follow-up DBP levels were found in patients who were younger, had higher DBP levels, or were receiving medication on their first visits to a clinic, were receiving more intense treatment regimens at the beginning of the follow-up period, or had been under the care of the clinic for shorter periods. Patients who were more likely to remain in care were older, received more intense treatment regimens, had prior cardiovascular complications, or had been under the care of the clinic for a longer time. Higher annual costs were associated with higher entry DBP levels, shorter durations of care, more intense regimens, and prior cardiovascular complications. Overall, patient characteristics explained 13% of the variance in mean follow-up DBP, and 31% of variance in costs. Wide variations were found among clinics in clinical outcomes and costs. After controlling for differences in patient characteristics, clinic characteristics associated with better blood pressure control were more frequent clinic visits, shorter waiting times, more time spent in patient counseling, having therapists who had a single supervisor, and better staff satisfaction. Greater success in keeping patients in care was achieved by clinics that scheduled more frequent visits, sent reminders after broken appointments, held regular staff meetings, had more clinic visits per full-time equivalent, prescribed fewer medications per patient, treated DBP levels only if they were 95 mm Hg or higher, and exhibited better staff satisfaction. Lower costs, with no evidence of adverse effects on clinical outcomes, were associated with shorter visits, less frequent blood chemistry tests, and less involvement by the clinic director in direct patient care.

ISSN:0025-7079    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The authors conducted two studies of routine medical visits, investigating the relation of physician gender, patient gender, and physician age to patient satisfaction, and the correlations between communication behaviors and satisfaction separately for different combinations of patient and physician gender. Study 1 was based on videotaped visits to a hospital-based internal medicine practice (n = 97 visits). Study 2 was based on audiotaped visits to 11 different community and hospital-based practices in the United States and Canada (n = 524 visits). In both studies, patients examined by younger physicians, especially younger female physicians, reported lower ratings of satisfaction. These findings were true for male and female patients; however, in both studies, the lowest satisfaction in absolute terms was among male patients examined by younger female physicians. The effects were not explained by patient and physician background characteristics or by measured communication during the visit. Correlations between verbal and nonverbal communication and satisfaction for different combinations of physician and patient gender suggested that gender-related values and expectations influence patients' reactions to physicians' behavior. There also was evidence that patient satisfaction is reflected in the patient's affective behavior during the visit.

ISSN:0025-7079    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Although more than 1,000 medical practice guidelines have been developed, there have been few evaluations of their use in clinical practice or information to judge whether practice guidelines can be used to reduce health care costs. For this reason, the authors conducted a prospective controlled clinical trial with an alternating-month design at a large teaching community hospital to study the use of a practice guideline to promote early transfer of patients admitted to a hospital with congestive heart failure (CHF) from the coronary care unit (CCU) and intermediate care unit to unmonitored beds. The practice guideline was supported by locally derived risk information and recommended consideration of early “step-down” transfer of low-risk patients with CHF 24 hours after hospital admission. Physicians caring for patients identified as “low risk” received concurrent personalized written and verbal reminders concerning the guideline recommendation. Study subjects were patients admitted to a hospital CCU and intermediate care unit between November 1, 1991 and April 30, 1993 with a diagnosis of CHF or pulmonary edema. Ninety patients with CHF were identified as low risk according to the guideline during the study period. Feedback of the practice guideline recommendation wasnotassociated with a significant increase in physician adoption of the guideline or shorter lengths of stay in the CCU or intermediate care unit. Physicians may have compensated for statistically insignificant reductions in monitored lengths of stay by increasing the length of stay in unmonitored beds (1.80 ± 2.32 to 4.02 ± 4.09 days,P= .002) and the total length of stay (4.73 ± 2.43 to 6.71 ± 5.44 days,P= .03). Quality of patient care, patient outcomes, and patient satisfaction were not affected by the guideline. Our study results suggest that implementation of a locally derived practice guideline for patients with CHF did not result in adoption of the guideline by physicians. The complexity of implementing the guideline, changes in physician practice before the study, and the failure of the guideline to address the continuum of patient care across monitored and unmonitored beds may have accounted for rejection of the guideline. Our experience demonstrates that practice guidelines, whenever possible, should be evaluated in prospective trials before they should be disseminated for widespread use.

ISSN:0025-7079    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1994

数据来源: OVID