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Biomedical subjects

A G Mainous

Publications and source records attributed to A G Mainous.

At least 19 recordsLinked to original sources
PubMed2000

An evaluation of statewide strategies to reduce antibiotic overuse.

BACKGROUND: The rapid increase of antibiotic resistance poses a significant threat to human health. Overuse of antibiotics has been linked to rates of antibiotic resistance. This study assessed the utility of two common interventions--1) practice profiling and feedback and 2) patient education materials--implemented to decrease antibiotic prescribing for pediatric upper respiratory infections (URIs). METHODS: Based on Medicaid regions in Kentucky, primary care physicians managing pediatric respiratory infections in Medicaid were randomized into four groups. Groups received either 1) performance feedback only, 2) patient education materials only, 3) both feedback and education materials, or 4) no intervention. Participating physicians had their antibiotic prescribing assessed for the period of July 1, 1996, to November 30, 1997, with an intervention in June 1997. The study included 216 physicians and 124,092 episodes of care. RESULTS: All groups increased in proportion of episodes with antibiotics between the pre-intervention and post-intervention periods. Prescribing in the patient education group and the patient education and feedback group increased at a significantly lower rate than in the control group. Physicians did not change their coding of illness to justify antibiotics after the intervention, and there was no significant generalization of effect of the pediatric intervention on prescribing for adult URIs. CONCLUSIONS: These interventions demonstrate little if any impact on promoting appropriate antibiotic prescribing. Antibiotic prescribing for viral respiratory infections continues to increase, suggesting concomitant increases in antibiotic resistance.

Adult↗
PubMed1999

Patient satisfaction with care in programs for low income individuals.

Although a variety of public and private programs provide care for low-income individuals, little is known about patient satisfaction across these programs. The objective of this study was to examine patient satisfaction across a variety of health insurance programs. A survey was conducted of randomly selected adults in Kentucky who had an outpatient visit in the past 12 months (616 with private insurance, 683 Medicaid recipients, 287 in private sector charity program for uninsured indigents). Patient satisfaction with multiple dimensions of their most recent outpatient visit was assessed. All insurance groups were generally satisfied with the care received in their most recent visit. For all 8 dimensions of patient satisfaction, the private insurance group was significantly higher than the other groups. In a model controlling for standard demographic and health status variables, higher overall satisfaction with the visit was positively related to higher income and higher mental health functional status. The insurance category variable had no significant relationship to overall satisfaction with the visit. Although patients receiving care through health insurance programs for low-income individuals are generally satisfied with the services, there is an indication that low-income individuals, regardless of insurance type, are less satisfied with the care they receive.

Adult↗
PubMed1999

Practice patterns for peptic ulcer disease: are family physicians testing for H. pylori?

BACKGROUND: Peptic ulcer disease (PUD) is a problem common in family medicine. Recent evidence of Helicobacter pylori as an etiological agent of PUD has led to National Institutes of Health recommendations for treatment to eradicate H. pylori through antibiotic therapy. The purpose of this study is to examine practice patterns of family physicians in treating PUD, their use of H. pylori testing, and knowledge of current recommendations for PUD. MATERIALS AND METHODS: A mail survey was sent to a random sample of 1,500 members of the American Academy of Family Physicians. Six hundred thirty useable surveys (49.1%) were available for analysis. Descriptive statistics were obtained, as were inferential statistics focusing on the relationship of physician background characteristics to practices. RESULTS: Thirty-eight percent of the respondents order diagnostic procedures for the majority (50% or more) of their suspected PUD cases. Of the physicians who reported ordering any diagnostic tests, 52% ordered the combination of upper gastrointestinal series and endoscopic gastroduodenoscopy. For patients with clinical diagnoses of PUD, 77% of doctors reported ordering a diagnostic test for H. pylori. Approximately 68% were aware that some kind of guidelines existed; only 11% reported that they were familiar with the National Institutes of Health recommendations for PUD. CONCLUSIONS: Although some of the practices of family physicians for treatment of PUD deviate from current recommendations, the majority of practices are consistent with current evidence.

Anti-Bacterial Agents↗
PubMed1999

Alcohol use in adolescent females: correlates with estradiol and testosterone.

This study investigated if self-reports of alcohol use correlated with estradiol and testosterone levels in adolescent females. Ninety-four female senior high school student volunteers from 2 schools completed a questionnaire regarding alcohol use. Twenty cc of blood was assayed for estradiol, testosterone, progesterone, and FSH. Total estradiol levels were higher in females who reported current alcohol use (p < or = 0.05), and females with higher levels of both testosterone and estradiol were more likely to be using alcohol currently (p < or = 0.05). Hormonal relationships associated with adolescent alcohol use may be related to future health risks of alcohol use and/or increased risk of alcohol use.

Adolescent↗
PubMed1999

Survey of clinical pharmacists' knowledge of appropriateness of antimicrobial therapy for upper respiratory infections and acute bronchitis.

We conducted a survey to assess clinical pharmacists' recommendation of antibiotics for upper respiratory infections (URIs) and acute bronchitis. A random sample of 752 members of the American College of Clinical Pharmacy were mailed a multiple-choice survey that presented four examples consistent with clinical symptoms of the two disorders. Respondents were asked what treatment they would recommend for each example. The response rate was 59%. Pharmacists recommended antibiotics for the treatment of both URIs and acute bronchitis significantly more if patients' symptoms included discolored discharge or sputum as opposed to clear discharge. Those who were board certified were less likely than nonboard-certified pharmacists to recommend antibiotics for URIs with discolored discharge. Pharmacists who specialized in either ambulatory care or infectious disease were less likely than those in other specialties to recommend antibiotics for acute bronchitis with discolored sputum. Clinical pharmacists are similar to patients and physicians in their belief that antibiotics are appropriate for URIs and acute bronchitis with discolored discharge. Considering the role that pharmacists play as clinical consultants to physicians, greater efforts should be made to educate them regarding appropriate prescription of antibiotics.

Acute Disease↗
PubMed1999

Access to care for the uninsured: is access to a physician enough?

OBJECTIVES: This study examined a private-sector, statewide program (Kentucky Physicians Care) of care for uninsured indigent persons regarding provision of preventive services. METHODS: A survey was conducted of a stratified random sample of 2509 Kentucky adults (811 with private insurance, 849 Medicaid recipients, 849 Kentucky Physicians Care recipients). RESULTS: The Kentucky Physicians Care group had significantly lower rates of receipt of preventive services. Of the individuals in this group, 52% cited cost as the primary reason for not receiving mammography, and 38% had not filled prescribed medicines in the previous year. CONCLUSIONS: Providing free access to physicians fills important needs but is not sufficient for many uninsured patients to receive necessary preventive services.

Adolescent↗
PubMed1999

Personality disorder traits: prevalence and effects on health status in primary care patients.

OBJECTIVE: Previous work in an academic setting has found that scoring in the higher ranges for selected personality disorders on an objective assessment tool was associated with increases in psychiatric co-morbidities, decreased satisfaction with health care, and diminished health related functional status. This study examines how often patients in primary care practices exhibit traits consistent with these selected disorders and what impact this has on their health related functional status and use of health care resources. METHODS: Thirteen family practices agreed to distribute questionnaires to 50 consecutive patients in the spring of 1997. Questionnaires contained instruments that assess risk for personality disorders, health related functional status, health resource use, demographics, and depression. The relationships between four specific personality disorders (borderline, dependent, schizoid and schizotypal) and other assessed variables were explored. RESULTS: Of the 250 patients returning completed survey instruments, 80 (32%) scored in the high range for traits consistent with one of the four target personality disorders. Patients in the high risk group also were noted to have more outpatient, emergency, and inpatient visits in the previous six months. Those in the high risk group also had significantly lower scores on seven of eight measures of health related functional status. CONCLUSIONS: Patients who have several traits for borderline, dependent, schizoid, and schizotypal personality disorders are common in primary care practices. These patients utilize services at higher rates than others and are more likely to screen in the positive range for depressive symptoms and have overall lower health related functional status.

Adolescent↗
PubMed1999

Commitment to a regular physician: how long will patients wait to see their own physician for acute illness?

BACKGROUND: Continuity of care with a physician is associated with better health outcomes and greater patient satisfaction. Having a "regular doctor" could lead to greater continuity of care, but only if the patient consistently seeks care from this physician. How long will a patient wait for care if their usual physician is not available? Our study explored factors related to a patient's decision to seek care from another professional. METHODS: We analyzed the results of a statewide random digit dialing telephone survey of 658 Kentucky adults. Our study focused on the 466 adults who indicated they usually seek care from the same physician. Respondents were asked about seeing an alternate provider if they had an acute, non-life-threatening condition and their usual physician was not available. RESULTS: Of the respondents, 48.6% indicated they would seek care from another professional the same day, 41.6% would wait 1 day or more, and 9.8% would not see another professional. Patients with asthma were significantly more likely to wait for care from their regular physician (P <.05), as were patients who usually visited a physician's office instead of a clinic (P <.05). In a multivariate model, seeking alternate care the same day was significantly more likely among patients who were older, nonwhite, and who would seek alternate care at their usual site of care (P <.05). CONCLUSIONS: Maintaining continuity of care with their usual physician is important to patients. Patient and practice characteristics may influence the decision to wait for care in an effort to maintain continuity.

Acute Disease↗
PubMed1999

Antibiotic use for the treatment of upper respiratory infections in a diverse community.

BACKGROUND: Previous studies have not addressed whether cultural factors influence beliefs and practices related to the treatment of upper respiratory infections (URIs). The purpose of our project was to assess beliefs, care-seeking behavior, use of antibiotics, and means of obtaining antibiotics for the treatment of URIs among different ethnic groups in an urban community. METHODS: A total of 192 adults completed a self-administered questionnaire indicating their likelihood of seeking care, the perceived effectiveness of treatment methods, and their usual use of treatment regimens for 2 scenarios consistent with uncomplicated URIs. Respondents were also asked about their use of antibiotics not prescribed by a physician for a URI. RESULTS: A majority of subjects reported a belief in the effectiveness of antibiotics for URIs and indicated they are likely to seek care for URIs. Many (26%) had obtained antibiotics from sources other than a physician's prescription (e.g., directly from pharmacists or a supplier outside the United States). Many (31%) believed that antibiotics should be available over the counter. Individuals who reported using antibiotics for a URI were more likely than those who did not to obtain them without a prescription (35% vs. 11%, P = .001). Subjects with a cultural background from countries where antibiotics are available over the counter are more likely to use antibiotics not prescribed by a physician than those from countries with variably enforced regulations or the United States (40%, 30%, and 20%, respectively, P = .049). CONCLUSIONS: Members of an ethnically diverse community believe antibiotics are effective for colds, are very likely to seek care for colds, and often obtain antibiotics without a prescription. The ease of antibiotic access worldwide may influence their use in some communities in the United States.

Adult↗
PubMed1999

Retention of family medicine faculty development fellows in academic medicine.

OBJECTIVE: This study measured the retention of family medicine faculty development fellows in academic medicine. METHODS: Surveys were sent, in two stages, to 1) fellowship program directors and 2) fellows. These surveys were about full-time faculty development fellowships with new or continued Title VII funding during the interval of 1993-1996. Retention as faculty was the primary outcome. Likelihood of leaving academics and service in a federally designated medically underserved area were secondary outcomes. RESULTS: The fellowship program directors survey produced an 88% response rate and identified 105 alumni. The survey of fellows yielded a response rate of 73% (n = 77). The retention rate of these newly graduated family medicine fellows in academic positions was 75% (n = 58). A total of 37% (n = 21) of alumni in full- and part-time teaching positions reported being likely to leave their current position within the next 2 years. CONCLUSIONS: Retention rates of newly graduated family medicine fellows in academic positions are similar to rates reported in the 1980s. This group anticipates a high job turnover within the next 2 years.

Adult↗
PubMed1998

Acute bronchitis.

Acute bronchitis is a lower respiratory tract infection that causes reversible bronchial inflammation. In up to 95 percent of cases, the cause, is viral. While antibiotics are often prescribed for patients with acute bronchitis, little evidence shows that these agents provide significant symptomatic relief or shorten the course of the illness. In a few small studies, bronchodilators such as albuterol have been found to relieve some symptoms of acute bronchitis. Increased attention is being given to the role of Chlamydia species in acute bronchitis and adult-onset asthma. Studies in progress may help to clarify the importance of these organisms in acute bronchitis and to determine whether early treatment can prevent or ameliorate asthma.

Acute Disease↗
PubMed1998

The importance of continuity of care in the likelihood of future hospitalization: is site of care equivalent to a primary clinician?

OBJECTIVES: This study examined the effect of continuity with clinicians and health care sites on likelihood of future hospitalization. METHODS: Delaware Medicaid patient data were analyzed. Logistic regression models supplied adjusted effects of continuity on hospitalization. RESULTS: Patients in the high clinician continuity group had lower odds of hospitalization than patients in the high site/low clinician continuity group (odds ratio [OR] = 0.75, 95% confidence interval [CI] = 0.66, 0.87). The latter group did not differ from the low site/low clinician continuity group (OR = 0.93, 95% CI = 0.80, 1.08). CONCLUSIONS: A location providing health care without clinician continuity may not be sufficient to ensure cost-effective care.

Adolescent↗
PubMed1998

Patterns of antibiotic-resistant Streptococcus pneumoniae in children in a day-care setting.

BACKGROUND: Streptococcus pneumoniae is one of the primary causes of illness and death among young children, and evidence suggests that the prevalence of antibiotic-resistant S pneumoniae is increasing. The purpose of this study was to investigate the prevalence of antibiotic-resistant S pneumoniae in a sample of children in day-care facilities in a region that includes both rural and urban communities. METHODS: Nasopharyngeal cultures were obtained from 104 children in eight day-care centers located in rural and urban central Kentucky in April and May, 1997. Thirty-five of the children produced isolates positive for S pneumoniae. Each isolate was tested for susceptibility to penicillin, trimethoprim-sulfamethoxazole, erythromycin, tetracycline, vancomycin, and cefotaxime. RESULTS: Of the children with S pneumoniae isolates, 54% had isolates that were resistant to penicillin and 40% that were resistant to trimethoprim-sulfamethoxazole. Twenty-one (60%) of the isolates had resistance to at least one of the six tested antimicrobials, with 15 (43%) having resistance to more than one of the antimicrobials. The mean age of children with isolates resistant to penicillin was significantly less (2.7 + 1.6) than those with penicillin-susceptible isolates (3.7 + 1.1, P = .02). There was no relation between resistance and rural or urban day-care location. CONCLUSIONS: A substantial proportion of S pneumoniae isolates in young children are resistant to antibiotics. Limiting the effect of S pneumoniae drug resistance may require a reexamination of outpatient treatment strategies for childhood respiratory tract infections.

Child↗
PubMed1998

Antibiotics for colds in children: who are the high prescribers?

OBJECTIVE: To examine physician characteristics associated with being a high prescriber of antibiotics for pediatric upper respiratory tract infections (URIs). DESIGN AND SETTING: Analysis of 34624 episodes of care for URIs in children (younger than 18 years) in the Kentucky Medicaid program from July 1, 1995, to June 30, 1996. PARTICIPANTS: Primary care physicians with at least 25 episodes of care (n=205). The proportion of patients with URIs receiving antibiotics stratified the sample into low (< or =25th percentile) and high (> or =75th percentile) antibiotic prescribers. MAIN OUTCOME MEASURES: Bivariate analyses were computed comparing the high and low prescribers. A logistic regression model was computed for likelihood of being a high prescriber by number of URI episodes, proportion of patients receiving antibiotics that were broad spectrum, years since medical school graduation, physician gender, rural/urban practice, and specialty. RESULTS: The high prescriber group (n=52) included data from 11899 episodes of care, with a mean prescribing rate of 80%. The low prescriber group (n=55) included data from 5396 episodes, with a mean prescribing rate of 16%. High prescribers were significantly more years away from medical school graduation (27 vs 19 years; P<.001) and had managed significantly more URI episodes than low prescribers (229 vs 98; P=.001). In the logistic regression, compared with pediatricians, the odds ratios of being a high prescriber were 409 (95% confidence interval [CI], 29-7276) for family practitioners and 318 (95% CI, 17-6125) for other primary care physicians. CONCLUSION: With the rise of antibiotic-resistant bacteria, more focused training regarding treatment of URIs is warranted in residency and in continuing medical education forums.

Adolescent↗