Biomedical subjects
Publications and source records attributed to A L Giachello.
Outcomes research studies the impact of the health and medical interventions on the health status and quality of life of the population. This paper discusses some of the issues and challenges involved in conducting health and medical outcomes research on the Latino population in the U. S., and also provides some solutions or strategies to overcome some of the most common problems in studying this population.
This study explores provider adherence to national guidelines in treating Latino and African-American asthmatics. We hypothesized that there would be more variations in asthma treatment existing for minorities as a result of variation in physician's adherent to the guidelines. A 96-item survey was administered to 138 Latino and African-American asthmatics attending a hospital emergency department. Data were obtained on demography, severity, access, patient satisfaction, and patient's assessment of physician asthma management. Results were analyzed by ethnicity, gender, practice site of regular provider, and severity. Variation in physician practice was found in these variables. Asthma treatment received by Latino and African-American respondents was deficient compared to guidelines. Regression analyses showed that Latinos fared more poorly on the number of prednisone bursts taken, use of written crisis plans and dispensation of peak flow meters controlling for gender, practice site and severity. African-Americans expressed less dissatisfaction in obtaining services, while both groups expressed high degrees of satisfaction with their providers.
UNLABELLED: Non-insulin-dependent diabetes mellitus (NIDDM) is a major health problem among Latinos, yet the quality of diabetes treatment among them has not been fully examined. GOALS: A pilot study was conducted with adult diabetic patients for the purposes of describing their diabetes-related knowledge and behaviors and evaluating whether these patients were receiving effective outpatient care. METHODS: Demographic data, health knowledge, and behavioral information was collected using face-to-face interviews with 101 patients diagnosed for at least 1 year at three primary care clinics. The medical record of each interviewee was abstracted for evidence that medical follow-up was being conducted with the recommended frequency. RESULTS: Most respondents spoke only or mostly Spanish, yet 14% of these patients reported that they had received instruction about diabetes in English alone. A majority of patients exhibited a basic understanding of their disease, and more than half reported positive health behaviors within the past year. Nonetheless, 54% of Puerto Rican Americans and 26% of Mexican-Americans had been admitted to the hospital or had used the emergency room for diabetes-related conditions. Recommended medical procedures were infrequently documented in clinic records. CONCLUSIONS: Diabetes education was available in Spanish, and patients appeared to have a basic knowledge of the disease process. However, recommended clinical follow-up was not uniformly provided. The large number of diabetes-related hospitalizations may be related to sub-optimal management among at least some of these patients.
This article provides a practical perspective of the issues, challenges and the opportunities involved in establishing a Latino Health Research Center in an academic institution. This article will use as an illustration the experiences related to the establishment of a Center on Latino Medical Treatment Effectiveness Program at a large public academic institution in Chicago. Some of the sociopolitical processes of establishing the Center's structure, and the recruitment and training of a multi-disciplinary core research staff are summarized, while simultaneously pursuing an ambitious research and training agenda. The article ends by suggesting a series of strategies in meeting the multiple and, at times, conflicting demands of the academic institution, the funding sources and the community, as well as the lessons learned.
Any approach to America's fast growing Hispanic cohort must overcome the presumption of homogeneity, if we are ever to develop sound health policy for prevention--or anything else. Elegantly, this article orients us to the diversity and particularly of the several unique components of Hispanic America.
This article examines the relationship between selected self-care practices during an episode of illness and the use of formal medical care. Stimulated by conflicting evidence and assertions, the general question addressed is: "Is self-care a substitute, a supplement, or a stimulus for use of formal medical care services?" Multiple Classification Analysis was used in a secondary data analysis of a 1976 nationwide study on access to medical care. The results suggest that self-care users may visit the physician less often and stay fewer days in the hospital, and thus they are expected to have lower expenditures for hospital and physician services. Therefore, the self-care activities examined appear to be substitutes for, rather than supplements or stimuli to, health services utilization. The results must be viewed with some caution due to limitations in the data. However, the results also argue for a greater research emphasis on self-care.
The 1980 Census data provide a valuable resource for health services research on Hispanics. Hispanics are the fastest growing minority group in the United States and yet there is a paucity of large-scale empirical research on their health care and access needs. This paper describes how the census can assist in: 1) estimating the overall health care needs of this group, 2) identifying target groups within the Hispanic population who may have special health care problems (e.g., children, elderly, pregnant women, etc.); and 3) using other data sources to improve the quality of studies carried out on Hispanics. It also discusses problems in using the census for Hispanic health services research and some strategies for dealing with these problems.
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The most current research literature on the access of Hispanics to medical care is reviewed, and data from a 1982 national survey by Louis Harris and Associates on access to health care are presented to document current levels of access to health care of the Hispanic population. Through telephone interviews, 4,800 families were contacted, yielding a total sample of 6,610 persons. According to the survey's data, the ability of Hispanics to obtain health services is hampered by relatively low incomes, lack of health insurance coverage, and ties to a particular physician. However, Hispanics do not differ significantly from whites in their use of hospitals, physicians, or outpatient departments and emergency rooms. Hispanics are less satisfied than whites on a host of measures describing the most recent medical visit. These levels of dissatisfaction with the visit are similar to those of blacks. The recession and public care service cutbacks did not appear to result in a substantial reduction in the volume of medical care received by Hispanics and blacks. Still, the services available to minorities are viewed by them as less effective in meeting their needs in comparison with how whites view the services they receive. Further, the 1982 survey reveals particular difficulties and barriers for Hispanics in obtaining needed medical services. More than one-fifth of the Hispanic families had one or more significant problems in obtaining needed services.