摘要:

The Seattle Prepaid Health Care Evaluation Project is a comparative study designed to assess the care received by persons enrolled in either a large prepaid group practice (PGP) or in a prepaid, independent practice setting in which physicians are reimbursed on a fee-for-service basis (IPP). As part of the study we assessed the patterns of surgical care for hysterectomy, cholecystectomy, appendectomy, and tonsillectomy/adenoidectomy. Overall, there were 215 such procedures with an exposure adjusted rate being five times higher in the IPP than in the PGP. After eliminating 43 per cent of procedures in the IPP and 22 per cent in the PGP which did not meet specified criteria for either necessary, appropriate or justifiable surgery, the exposure-adjusted rate differential was 3.9 times higher in the IPP with the difference in the rates being mainly attributable to hysterectomy and tonsillectomy/adenoidectomy.We conclude there were more unnecessary procedures in the IPP, but the fact that a significant difference in the incidence of surgery persisted even after elimination of such cases suggests that the differences in rates of surgery between the IPP and PGP cannot be solely attributed to a higher rate of inappropriate surgery in the IPP.

ISSN:0025-7079    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

Factors affecting delay were studied in patients seeking treatment for the first time for a particular symptom at clinics in a major, innercity hospital. On the basis of the patients' retrospective report, the total time from first noticing a symptom to the seeking of treatment was divided into three sequential stages: 1) appraisal delay—the time the patient takes to appraise a symptom as a sign of illness; 2) illness delay—the time taken from deciding one is ill until deciding to seek professional medical care; and 3) utilization delay—the time from the decision to seek care until the patient goes to the clinic and uses its services. The variables used to predict the length of delay for each of the three stages and for total delay included reports on concrete, sensory perceptions and abstract, conceptual beliefs about one's symptoms, behavioral factors such as strategies for self-appraisal and techniques for coping with illness, emotional reactions, negative imagery elicited by the illness threat, situational barriers, and socio-demographic factors. Patients experiencing a very painful symptom and patients who did not read about their symptom had a short appraisal delay. Patients with old symptoms and those who imagined possible, severe consequences of their illness had long illness delays. Utilization delay was shortest for persons who were not concerned about the cost of treatment, who had a painful symptom, and who were certain that their symptom could be cured. Patients who had short total delays were persons who did not have a competing personal problem and who had a painful symptom. AH of these predictors were significantly correlated with the measure of delay at or beyond the p = .01 level. It was concluded that different factors mediate delay in each of the three stages and that studies which use only a single measure of total delay are likely to be of limited value in understanding delay.

ISSN:0025-7079    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

Patient education provides a vehicle for increasing the self-management of chronic illness and promoting modifications of life styles, which are considered important strategies for prevention. Evaluating the impact of such programs is complex and poses a number of methodologic and technical problems. Outcome measures of patient education programs are defined and reviewed in terms of the existing evaluation literature and our own studies utilizing diabetes as a prototype condition. Important dimensions of adaptation are outlined and indices to measure it discussed in an effort to examine aspects of educational programs directed at facilitating coping and maintaining quality of life. Factors which influence outcome variables are identified and include: patient factors (e.g., age, ethnic, socioeconomic, cultural, personality, and emotional), disease factors (e.g., severity of illness, age of onset, length of illness, mode of therapy), system factors (e.g., patient's location in the health care system, relation of teaching program to other health care providers). The effects of these factors are described including their implications for research design.

ISSN:0025-7079    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

Critical to policy planning for a program of national health insurance or a National Health Service is an understanding of the strengths and weaknesses of current federally-supported health programs. One program which has been subjected to criticism is Medicaid. A major problem facing Medicaid is the high proportion of physicians who refuse to participate in the program, thus preventing the target population from obtaining access to medical care. A telephone survey was conducted to assess the attitudes and behavior of a stratified random sample of physicians regarding their participation in a Medicaid program. Physicians were asked to identify major advantages and disadvantages of the program to individual patients, to society and to their medical practice. Non-participants were asked to identify the major reasons why they did not participate in the program. Medical specialty was the only significant demographic determinant of participation. Inadequate reimbursement, excessive paperwork, patient abuses of the program and bureaucratic complexity were among the most prominent factors contributing to nonparticipation. Implications of these findings are discussed with respect to the role of primary care providers' perceptions in the planning of future national health programs.Associate Professor, Department of Health Care Administration, School of Pharmacy, The University of Mississippi, University, Mississippi.

ISSN:0025-7079    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

Space Technology Applied to Rural Papago Advanced Health Care (STARPAHC), is a large-scale telemedicine project, sponsored jointly by the Indian Health Service (IHS), NASA, and the Papago tribe, and in operation on the Papago Indian Reservation outside Tucson Arizona, for the past two years. STARPAHC uses a mobile health unit (MHU), staffed by non-M.D. providers and linked by two-way television, radio, and remote telemetry to an IHS hospital up to 100 miles away, to make medical care available in remote areas of the reservation. Over a two-year-period beginning in January, 1975, 47 individual providers, including 21 physicians, were interviewed, at five intervals, to determine their receptivity to and acceptance of telemedicine; because of staff turnover, not all providers were interviewed at each different interval. Data suggests that television equipment was considered costly and in some cases inconvenient to M.D. providers; it was not considered always essential for providers to be able to diagnose and treat patients. The major problems providers cited were the unreliability of equipment and the time required for television consultations. The major benefit cited was improved access to health care for a population not previously receiving such care near their homes. Non-M.D. providers considered the link they were provided to physicians via television and voice communications from remote areas to be a major benefit.

ISSN:0025-7079    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

The purpose of this study is to describe quantitatively the primary health care system of a defined population. The ambulatory care services of private practices and institutions in Durham County, North Carolina were sampled four times during 1975–1976 to determine the relative contributions to primary care made by specified types of practice and sources of care. All the institutions and 96 per cent of practicing physicians participated. Utilization of primary care services was analyzed by race, sex, age and health insurance status. One striking finding is the predominant role in the delivery of primary care played by the private specialists practicing in the community in contrast to the relatively small role of the university teaching hospital. Another important finding is the low proportion of blacks and Medicaid patients served by these community physicians. Thirdly, removal of legal and financial barriers has made little impact as yet on the patterns of health care delivery established before the institution of mandatory integration of health services. Since these findings have broad implications for health care delivery, this study warrants replication in other settings.

ISSN:0025-7079    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

Both interns and residents and practicing physicians express substantial support for physicians' organizing for collective bargaining and striking. These findings, from 1146 respondents to a 1976 survey of the alumni of the Albert Einstein College of Medicine, indicate that profound changes have occurred in physicians' views on these issues. Although the greatest support for striking came from interns and residents, with 67 per cent of them indicating they think physicians should be allowed to strike, the survey found an increasing pattern of militancy commencing with 1964 graduates. Physicians in private practice and those who spent two-thirds or more of their time in direct patient care were the most likely to support strikes by physicians (60 per cent), while the least support came from those fulltime on medical school faculties (39 per cent). No differences in support for striking were found in relation to sex, religion or size of community in which physicians practice. A longitudinal examination of the medical school Class of 1975 at matriculation, at graduation and during internship training reveals that a major growth of support for striking occurred between matriculation and graduation.

ISSN:0025-7079    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

A Patient Satisfaction Questionnaire was developed using factor analytic techniques. The 19-item questionnaire uses a five-point Likert scale, has a coefficient alpha of .972, and consists of three factors. Validity was assessed using correlations with specific criterion items.

ISSN:0025-7079    

出版商:OVID    

年代:1979

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1979

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1979

数据来源: OVID