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Biomedical subjects

C E Yesalis

Publications and source records attributed to C E Yesalis.

50 records · Page 3Linked to original sources
PubMed1981

Use and costs under the Iowa capitation drug program.

This article evaluates changes in the use of drug services and the corresponding costs when the conventional fee-for-service system for reimbursement of pharmacists under medicaid is replaced by a capitation system. The fee-for-service system usually covers ingredient costs plus a fixed professional dispensing fee. The capitation system provided a cash payment (which varied by aid category and season of the year) per Medicaid eligible the first of each month. We examined drug use and costs in two experimental rural counties during a 1-year preperiod in which the fee-for-service form of reimbursement was employed, as well as a 2-year postperiod in which the capitation system was used. We compared the results with use and cost patients in two other rural counties which remained on the fee-for-service system during the same 3-year period. Drug use was similar among control and experimental counties with the exception of nursing home patients; use in this category decreased under capitation and increased under fee-for-service. Using three measures of drug cost: 1) average cost of a day's drug therapy; 2) average drug costs per recipient; and 3) average Medicaid expenditures for drug services per recipient, we observed significant savings under the capitation reimbursement system as compared to the fee-for-service system. We attributed savings under capitation to shifts in prescribing and dispensing behavior, as well as changes in use by nursing home patients. Based upon these findings, the total savings resulting from implementing capitation would be approximately 16 percent compared to fee-for-service reimbursement.

Capitation Fee↗
PubMed1980

The effect of a group practice on rural health attitudes and behavior.

The opportunity to join a group practice has been identified as a successful inducement for physicians to locate in rural areas. Less is known of the effects of group practice on the health attitudes, behavior and status of the rural communities in which they are established. A random survey of households was conducted in 1972 in a rural Midwestern area, prior to the establishment of a community-sponsored multispecialty primary care group practice, and again on the same households in 1977, after establishment of this group practice (a total of 292 households representing 829 persons). Perceived access to health services before the establishment of the group practice did not significantly predict use of the group practice. Neither previous use of medical services nor health status measured by several indices was associated with eventual use of the group practice. The apparent impact on the community of the group practice was a significant improvement in access to physician services, shown by shorter average travel time to the place of primary care and a 62 per cent improvement in the ability to make a same-day appointment. Furthermore, a significant shift in the distribution of physician services was noted over the study period. The introduction of physician assistants significantly decreased the prior positive attitudes toward them. Despite improvement in access to care, no changes in population health status or receipt of preventive services were noted. Current users of the group practice appear similar to those utilizing conventional medical care sources in regard to access to services, use of services, as well as health status, attitudes and costs.

Adolescent↗
PubMed1980

Capitation payment for pharmacy services: impact on generic substitution.

This article evaluates changes in the rate of generic substitution as well as the appropriateness of such changes in dispensing behavior when the conventional fee-for-service system for reimbursement of pharmacists is replaced by a capitation system. The fee-for-service system under Medicaid usually covers ingredient costs plus a fixed professional dispensing fee. The capitation system provides a cash payment per Medicaid eligible at the first of each month, which varies by aid category and season of the year. The dispensing behavior of pharmacists in two experimental rural counties is examined during a 1-year preperiod in which the fee-for-service form of reimbursement was employed, as well as a 2-year postperiod in which capitation was used in lieu of fee-for-service payments. The results are compared with pharmacist behavior patterns in two other rural counties which remained on the fee-for-service system over the same 3-year period. The data indicate highly significant increases in both the rate of generic substitution as well as the dollar savings per substitution in the experimental counties after the institution of capitation reimbursement. Using explicit criteria, no substantial differences in the appropriateness of generic substitution were noted between the two financing schemes.

Capitation Fee↗
PubMed1980

Does chiropractic utilization substitute for less available medical services?

In Muscatine, Iowa, a medically underserved rural area, a cohort study of health care utilization was made before and after a significant increase in medical manpower. There was a slight increase, rather than a decrease, in the use of chiropractic services associated with the growth in the physician manpower pool. The level of access to physician services was not a significant predictor of chiropractice utilization.

Adolescent↗
PubMed1978

Selection of regression models for health care data.

We discuss several linear and nonlinear regression models and their appropriateness in modeling a set of data from a cohort study of the use of medical services in a prepaid medical plan. Although computational considerations once forced researchers to use linear models almost exclusively, modern computer hardware and efficient algorithms have made it possible to use nonlinear models almost as easily as linear ones. Thus, in choosing a regression model, a researcher should give strong consideration to how well the model reflects (presumed) intrinsic properties of the phenomena under study, even if the consideration leads to the choice of a nonlinear model. Modern computer programs for nonlinear minimization should be employed to fit the model. The model should be judged on how well it describes the data and how reasonably it predicts the future.

Health Maintenance Organizations↗
PubMed1976

The effect of duration of membership in a prepaid group health plan on the utilization of services.

This study concerns the changes in the use of medical care services as the duration of membership in a prepaid group plan increases. For each of ten cohorts of members of the prepaid group practice in Columbia, Maryland, the use of provider visits (for both "well" care and "problem-oriented" care), of inpatient hospital services, and of prescribed drugs were determined, and time trends for each type of service were developed. The rate of total provider visits (TPV's per member) and the proportion of "well" care visits declined during the first year of membership and were followed by stabilization during the second year in the Plan. Because of large variations in hospital days, but only a small total number of hospital days, no association between hospital use and duration of membership could be shown. The rate of new prescriptions filled (NPF's) also decreased as length of time in the Plan increased.

Drug Prescriptions↗
PubMedDate not supplied

Clinical risk assessment strategies for AIDS.

The CDC estimates that 1 to 1.5 million people in the United States are currently infected with the AIDS virus. With the increase in numbers of AIDS cases and infection rate, it is vital that health-care practitioners accurately assess a patient's risk status for AIDS. Two hundred clients from a free-standing birth center in the Washington, D.C., metropolitan area completed a questionnaire on AIDS. The respondents represented a homogeneous group of white, middle to upper-middle class, well-educated women. Five items on the questionnaire involved a self-assessment of the subject's risk status for AIDS. The results indicated that the question content strongly influenced the subjects' perception of their risk level for AIDS. Furthermore, a major discrepancy was found between the subject's perceived risk status (2.5% at risk to 29% at risk, depending on the question) and the fact that all respondents thought it unlikely that they currently had the AIDS virus or would contract it in the future. Such a discrepancy may reflect possible denial and indicate a need for educational efforts in this area. It was concluded that all known and probable risk factors for AIDS must be presented to the clients so that an accurate assessment of risk can be made. It is through such an assessment that clients can learn about risk behaviors that may need to be altered to avoid infection.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Health status of the rural elderly according to farm work history: the Iowa 65 + rural health study.

In a geographically defined survey of 3,097 rural Iowans who were at least 65 yr of age, we examined the association between prior farm experience (greater than or equal to 25 yr) and various measures of current health status; we controlled for age, current working status, and, where appropriate, smoking and alcohol consumption. Health status was indexed by self-reported morbid conditions, symptoms, and physical function. After controlling for smoking behavior, it was found that both men and women with previous farm exposure currently experience a greater prevalence of all nine respiratory symptoms employed in the study relative to non-farmers. Farm men report a lower prevalence of Parkinson's disease and prostate conditions, but report a greater prevalence of stroke and a lower level of self-perceived health status. Women with a farm work history experience a greater level of physical function and fewer symptoms associated with mental illness. Overall significant benefits as well as risks associated with a history of farm work were identified. However, of those who survived to age 65, extended exposure to farm work did not have a major impact on the overall current health status of men and women.

Activities of Daily Living↗
PubMedDate not supplied

Attitudes toward AIDS among a low-risk group of women.

A descriptive study presents the results of a 31-item questionnaire surveying the attitudes, fears, and perceived risks regarding acquired immunodeficiency syndrome (AIDS) of patients at a freestanding maternity center located in a Washington, DC, suburb. The nonprobability, convenience sample of 200 females consists primarily of a homogenous group of white, middle- to upper-middle-class, well-educated women. Results of the research indicate a need for an educational program on AIDS designed for this population of women.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Sports injuries at the 1985 Junior Olympics. An epidemiologic analysis.

The XIX Junior Olympic Games, hosted in Iowa City, Iowa, in August of 1985, involved 3,028 athletes who participated for 7 days in 13 different sports at 8 separate sites. Medical coverage for the Games was provided by the University of Iowa Sports Medicine Service. Staffing for the events involved approximately 75 physicians, 60 athletic trainers, and other health care personnel. A triage protocol was established prior to the Games whereby the athletic trainer would make first contact with the injured athlete and would evaluate and treat the injury based on standing orders. If in the judgment of the trainer, the athlete needed to be referred to a physician, one would be available, either on site or on call. During the Games, 1,113 medical encounters were recorded, 121 of those being deemed serious enough to withhold an athlete from competition pending further evaluation and treatment. The 121 significant injuries and illnesses involved 116 athletes (66% male, 34% female). Thirty-four percent of the significant injuries only required treatment by the trainer, while 46% were referred to an on site physician and 20% needed a specialty consultant. Seventeen percent of the significant injuries resulted in the athlete being medically disqualified for the remainder of the event. The most common injuries/illnesses were contusions (26%), sprains (21%), heat (17%), strains (9%), and other illnesses (12%). According to body region, 44% of the 121 injuries were to the lower extremity, 26% to the head, neck, and trunk, and 12% to the upper extremity.(ABSTRACT TRUNCATED AT 250 WORDS)

Athletic Injuries↗
PubMedDate not supplied

Quality assessment of athletic trainers.

This paper reports the first published assessment of the quality of services provided by athletic trainers. Medical coverage for the 1985 Junior Olympic Games was provided by certified athletic trainers (ATC), physicians, and other health care personnel. This study assessed the services of the 30 attending ATCs who managed 121 significant injuries. Standard injury information was collected by the ATCs and separately collected by their physicians. Nine months after the Games, phone interviews were conducted with the injured participants and assessment questionnaires were given to the attending physicians. Results revealed that young, injured, Junior Olympic participants generally did not inform their parents about their injuries or medical contact while at the Games. Athletes and physicians overwhelmingly agreed that they were positively impressed with the capabilities of the ATCs with whom they had contact. About 70% recovered from the symptoms and limitations of injury, as determined by the athlete, within the month following the Games. About 17% sustained some type of injury recurrence to the same body part, and at 9 months about 97% of the athletes had fully recovered from their injuries. These data not only indicate that athletic trainers can accurately identify minor athletic injury but signify the importance of long-term followup in our athletic populations. Multisport events, such as the Junior Olympic Games, impose considerable problems to a communication effort. The athletic trainer, as an ever-present figure in collegiate and professional circles, can be the central focus of an adequate communication effort regarding the patient care of other athletic populations.

Athletic Injuries↗
PubMedDate not supplied

Effects of capitation payment for pharmacy services on pharmacist-dispensing and physician-prescribing behavior: I. Prescription quantity and dose analysis.

This paper evaluates changes in quantities and appropriateness of dosages and quantities of prescription in capitation and control pharmacies. The data indicate that, under capitation, changes were made in the quantities of ingredients so that the quantities dispensed were significantly different from those prescribed. However, the number of such modifications to prescriptions was small, and the reader is cautioned against drawing broad conclusions. The analysis, then, considers changes in days' supply of prescription ingredients during the study period. There were significantly increases in the average day's supply of prescription ingredients for maintenance drugs dispensed under the capitation reimbursement scheme; however, no such differences were observed for non-maintenance drugs. Appropriateness of the dosages and quantities of prescriptions were then compared for capitation and fee-for-service pharmacies for the study period, and no significant differences were found. Thus, it is concluded that although capitation was associated with increases in the average days' supply of ingredients dispensed for maintenance prescriptions, such changes did not adversely affect the quality of drug therapy as measured by two sets of criteria.

Capitation Fee↗