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Biomedical subjects

Christopher B Forrest

Publications and source records attributed to Christopher B Forrest.

At least 19 recordsLinked to original sources
PubMed2006

Immunization disparities in older Americans: determinants and future research needs.

BACKGROUND: Marked racial disparities persist in influenza and pneumococcal vaccinations among Medicare beneficiaries. This study sought to assess the contribution that patient, physician, health system, and area-level characteristics make to these racial disparities in immunization. METHODS: Cross-sectional and decomposition analyses were performed on a nationally representative sample of 18,013 non-institutionalized Medicare beneficiaries who responded to the Medicare Current Beneficiary Survey (MCBS) in 2000 to 2002. The physician characteristics of interest included specialty type, accessibility, information-giving skills, perceived quality, and continuity of care. Health system characteristics included HMO enrollment and numbers of primary care physicians per elderly. The outcomes were receipt of influenza vaccine in the past year and ever having received a pneumococcal vaccine. RESULTS: Immunization rates were below recommended levels for all Medicare beneficiaries. Disparities between white and black beneficiaries in the receipt of vaccinations were large-an absolute 17% difference for each vaccine. After adjusting for patient, physician, health system, and area-level characteristics, white beneficiaries had significantly higher odds of vaccination than did black beneficiaries: adjusted odds ratio (aOR) = 1.52 (95% confidence interval [CI] = 1.35-1.71) for influenza vaccination, and aOR = 1.82 (95% CI = 1.61-2.07) for pneumococcal vaccination. Beneficiaries with a usual physician that they rated as having good information-giving skills and whose practice was more accessible, had higher immunization rates. Beneficiaries with a primary care generalist as their usual physician had higher odds of immunization than those with a specialist as their usual physician. At the county level, a higher number of primary care physicians per elderly resident was associated with higher odds of immunization. Only 7% of the racial disparity in influenza immunization was explained by the measured characteristics of beneficiaries and their health systems. CONCLUSIONS: Despite similar insurance coverage and presence of a usual physician, black beneficiaries were significantly less likely than their white counterparts to receive influenza and pneumococcal vaccinations. The implications for future research are discussed, including the need for system-based interventions that make the offering and discussion of vaccination routine.

Aged↗
PubMed2006

Perceived health status and use of healthcare services among children and adolescents.

BACKGROUND: The aim of the present study was to analyse the use of healthcare services according to health status in a population of children and adolescents, taking into account family socio-demographic characteristics and characteristics of the proxy respondent. METHODS: A total of 836 interviews of proxy respondents for children aged 5-14 years from the Barcelona Health Interview Survey carried out in 2000 were included. Dependent variables were visits to a healthcare professional, visits to the emergency room, and hospitalization. Independent variables were: report of medical conditions, health status of the child measured by the Child Health and Illness Profile-Child Edition, Parent Report Form (CHIP-CE/PRF), the educational level of the head of household, social class, child's healthcare coverage, and proxy-related variables [mental health status by means of the General Health Questionnaire-12 items version (GHQ-12), and other]. Logistic regression analysis was used to estimate prevalence ratio (PR) to compare the use of healthcare services among different categories of independent variables. RESULTS: Children having worse health status were more likely to have visited a healthcare professional [PR = 1.68; 95% confidence interval (95% CI) = 1.09-3.83], whereas children with a reported medical condition were more likely to have made a visit to the emergency service (PR = 1.47; 95% CI = 1.27-2.55) and were hospitalized more frequently (PR = 2.50; 95% CI = 1.12-5.57). Higher likelihood of visits to the emergency room was associated with children having both public and private coverage and a proxy respondent scoring 3 or higher on the GHQ-12. CONCLUSIONS: Use of healthcare services differed by health needs but not by social class. Double healthcare coverage and mental distress of the proxy respondent influenced the use of emergency services.

Adolescent↗
PubMed2006

Validity of the health-related quality of life assessment in the ADORE study: Parent Report Form of the CHIP-Child Edition.

OBJECTIVES: To examine the cross-sectional reliability and validity of the Parent Report Form of the Child Health and Illness Profile-Child Edition (CHIP-CE), a generic measure of health-related quality of life (HRQoL), in children with ADHD in the pan-European ADHD Observational Research in Europe (ADORE) study. METHODS: Parents of children with ADHD (aged 6-18 years) in 10 European countries completed the CHIP-CE at the baseline visit (n=1,477; data missing for one patient). Analyses included determination of internal consistency reliability, ceiling and floor effects, factor analysis, and Pearson's correlations between CHIP-CE and other scales used to measure ADHD severity, problems and family strain. RESULTS: Internal consistency reliability was good-to-excellent (Chronbach's alpha>0.70) for all CHIP-CE domains and subdomains, and almost no ceiling and floor effects were observed. Factor analysis of the subdomains yielded a 12-factor solution. The domainlevel factor analysis identified six factors, the four domains of Satisfaction, Comfort, Resilience and Risk Avoidance. The two subdomains of Achievement domain, Peer Relations and Academic Performance, were separate factors in this sample. There were moderate-to-high correlations between the CHIP-CE scales and measures of ADHD and family factors. The HRQoL of children in ADORE was dramatically lower than that of community youth,with mean CHIP-CE scores almost 2 standard deviations below community norms. CONCLUSIONS: The validity and reliability of CHIP-CE to measure HRQoL in children with ADHD across Europe was confirmed.

Adolescent↗
PubMed2005

Disparities despite coverage: gaps in colorectal cancer screening among Medicare beneficiaries.

BACKGROUND: Despite its effectiveness in reducing mortality, colorectal cancer (CRC) screening rates are low, especially among low-income and minority groups; however, physician recommendation can increase screening rates. METHODS: We performed a multilevel analysis of the Medicare Current Beneficiary Survey data linked to Medicare claims and the Area Resource File to identify determinants of racial and socioeconomic disparities in CRC screening among 9985 Medicare Parts A and B beneficiaries with a usual physician. Recent CRC screening was defined as receipt of either a home fecal occult blood test, flexible sigmoidoscopy, or colonoscopy at recommended intervals. RESULTS: Unadjusted rates of screening were 48% for white and 39% for black beneficiaries (P<.001). Racial differences in CRC screening receipt were eliminated after adjustment for socioeconomic status as measured by income and education. Socioeconomic status disparities decreased but remained significant after adjustment for personal and health system factors. Awareness of CRC (adjusted odds ratio, 2.76; 95% confidence interval, 2.29-3.33) and having a primary care generalist (vs another specialist) as one's usual physician (adjusted odds ratio, 1.31; 95% confidence interval, 1.12-1.53) were associated with higher odds of screening, controlling for other factors. The odds of screening were also higher among those whose usual physician was rated more highly on information-giving skills. CONCLUSIONS: Racial differences in CRC screening rates among Medicare beneficiaries with a usual physician are explained by differences in socioeconomic status. Beneficiaries with a primary care generalist as their usual physician had higher rates of CRC screening receipt. Increased efforts to make Medicare beneficiaries aware of the benefits of CRC screening may capitalize on the associations found in this study between CRC knowledge, physician information giving, and timely screening.

Aged↗
PubMed2005

Does community-governed nonprofit primary care improve access to services? Cross-sectional survey of practice characteristics.

This study compared community-governed nonprofit and for-profit primary care practices in New Zealand to test two hypotheses: (1) nonprofits reduce financial and cultural barriers to access; and (2) nonprofits do not differ from for-profits in equipment, services, service planning, and quality management. Data were obtained from a nationally representative cross-sectional survey of GPs. Practices were categorized by ownership status: private community-governed nonprofit or private for-profit. Community-governed nonprofits charged lower patient fees per visit and employed more Maori and Pacific Island staff, thus reducing financial and cultural barriers to access compared with for-profits. Nonprofits provided a different range of services and were less likely to have specific items of equipment; they were more likely to have written policies on quality management, complaints, and critical events, and to carry out locality service planning and community needs assessments. The findings support the shift to nonprofit community governance occurring in New Zealand and elsewhere.

Community Health Services↗
PubMed2004

Adjusting for case mix and social class in examining variation in home visits between practices.

OBJECTIVES: The purpose of this study was to investigate whether adjusting for clinical case mix and social class explains more of the variation in home visits between general practices than adjusting for age and sex alone. METHODS: The setting was 60 general practices in England and Wales taking part in the 1 year Fourth National Morbidity Survey. The participants comprised 349 505 patients who were registered with one of the participating general practices for at least 180 days, and who had at least one consultation during the period. The outcome measure is whether or not a patient received a home visit in that year. A clinical case mix category (morbidity class) based on 1 year's diagnostic information was assigned to each patient using the Johns Hopkins Adjusted Clinical Groups (ACG) Case Mix System. The social class measure was derived from occupation and employment status and is similar to that of the 1991 UK census. Variations in home visits between practices were examined using multilevel logistic regression models. The variability between practices before and after adjusting for clinical case mix and social class was estimated using the intracluster correlation coefficient (ICC). RESULTS: The overall percentage of patients receiving a home visit over the 1 year study period was 17%, and this varied from 7 to 31% across the 60 practices. The percentage of the total variation in home visits attributable to differences between practices was 2.5% [95% confidence interval (CI) 1.4-3.2%] after adjusting for age and sex. This reduced to 1.6% (95% CI 1.1-2.4%) after taking into account morbidity class. The results were similar when social class was included instead of morbidity class. Morbidity and social class together reduced variation in home visits between practices to 1.5% (95% CI 1.1-2.2%). CONCLUSIONS: Age, sex, social class and clinical case mix are strong determinants of home visits in the UK. Adjusting for morbidity and social class results in a small improvement in explaining the variability in home visits between practices compared with adjusting for age and sex alone. There is far more variation between patients within practices; however, it is not straightforward to examine the factors influencing this variation. In addition to morbidity and social class, there could also be other unmeasured factors such as varying patient demand for home visits, disability or differences in GP home visiting practice style that could influence the large within-practice variability observed in this study.

Adolescent↗
PubMed2004

The Parent Report Form of the CHIP-Child Edition: reliability and validity.

BACKGROUND: Valid, comprehensive instruments to describe, monitor, and evaluate health from childhood through adolescence are almost nonexistent, but are critical for health resource planning, evaluation of policy, preventive, and clinical interventions, and understanding trajectories of health during this important period of life. OBJECTIVES: The objectives of this study were to describe the development, testing, and final versions of the Parent Report Form of the Child Health and Illness Profile-Child Edition (CHIP-CE/PRF), designed to measure the health of children 6 to 11 years old from the caregiver perspective. METHODS: Parents (N=1049) completed a version of the CHIP-CE/PRF in 4 locations in the United States, either in clinic waiting rooms or their homes. They differed in race/ethnicity, socioeconomic level, and native language. RESULTS: The Parent CHIP-CE is feasible; parents with a 5th-grade reading level complete the 76-item PRF in 20 minutes. Its domains (Satisfaction, Comfort, Risk Avoidance, Resilience, and Achievement) measure structurally distinct, interrelated aspects of health. Domain reliability is high: internal consistency=0.79-0.88; retest reliability (ICC)=0.71-0.85. Validity is supported. The scale scores are sensitive to predicted age, gender, and socioeconomic status differences in health. CONCLUSION: The CHIP-Child Edition/Parent Report Form is a psychometrically sound, conceptually based measure of child health that works well in diverse populations. It produces scores that parallel those of children on the CHIP-CE/CRF and adolescents on the CHIP-AE and allows health to be consistently assessed from childhood through adolescence. It should meet many needs for describing, monitoring, and understanding child health and evaluating outcomes of interventions.

Adult↗
PubMed2004

The Child Report Form of the CHIP-Child Edition: reliability and validity.

BACKGROUND: There is increasing recognition of the importance of obtaining children's reports of their health, but significant challenges must be overcome to do so in a systematic, population-based manner. OBJECTIVE: The objective of this study was to present the initial tests of the Child Report Form of the Child Health and Illness Profile-Child Edition (CHIP-CE/CRF), a self-report health status instrument for children 6 to 11 years old. METHODS: Three studies iteratively evaluated revisions of the CHIP-CE/CRF in 4 geographic locations in the United States. Children (N=1708) whose families represent the low to middle socioeconomic strata and predominant U.S. racial/ethnic groups were involved. RESULTS: The final CHIP-CE/CRF includes 5 domains: Satisfaction (with self and health), Comfort (emotional and physical symptoms and limitations), Resilience (positive activities that promote health), Risk Avoidance (risky behaviors that influence future health), and Achievement (of social expectations in school and with peers). The internal consistency and test-retest reliability of the domains are good to excellent, with a definite age gradient such that younger children's responses are less reliable although still acceptable. Validity is supported through criterion and construct validity tests and structural analyses. Standard scores (mean, 50; standard deviation, 10) were established. CONCLUSIONS: Health status can be reliably and validly assessed directly from children 6 to 11 years old on the CHIP-CE/CRF. In combination with the CHIP-AE, self-reported health status can now be obtained from youth 6 to 18 years old using a consistent conceptual framework. This can greatly improve the precision and comparability of health assessments of youth, enhancing the validity of outcome research and longitudinal studies across childhood and adolescence.

Adaptation, Psychological↗
PubMed2004

Predictors of children's healthcare use: the value of child versus parental perspectives on healthcare needs.

OBJECTIVE: The objective of this study was to examine the relationship between healthcare use and children's healthcare needs as assessed from the perspectives of children themselves, parents, and healthcare practitioners. RESEARCH DESIGN: We conducted a prospective cohort study in which service use was monitored for the 12 months before and after administration of a health survey. SUBJECTS: We studied 384 parents and children aged 6 to 11 years enrolled for 2 years in a northern California health maintenance organization or a Medicaid managed care program in Rhode Island. MEASURES: Child and parent perspectives on needs were determined using the Child Health and Illness Profile, Child Edition (CHIP-CE). Plan administrative data were used to develop a treated morbidity index, which was based on diagnosis codes recorded by practitioners during the year before the survey and to obtain prospective measures of service use. RESULTS: For both child- and parent-respondents, low satisfaction and comfort scale scores from the CHIP-CE were significant predictors of number of visits. CHIP-CE domain scales unrelated to future use were risk avoidance, resilience, and achievement. Multivariable regression using CHIP-CE information collected from children explained more variation in total physician visits than models that used parent-respondent data. The treated morbidity index was a weaker predictor of physician visits than the CHIP-CE scale scores. None of the domain scales were significant predictors of any emergency department use or any specialist use; however, the treated morbidity index was associated with any specialist use. CONCLUSIONS: A child's sense of well-being and burden of symptoms predict future use. Perceived healthcare needs, as assessed by the CHIP-CE, is a better predictor of children's service use than evaluated needs as assessed by physician-diagnosed disorders. Our results support the validity of using the responses of children aged 6 to 11 years as a measure of need for future health care.

Adaptation, Psychological↗
PubMed2004

Outcomes research on children, adolescents, and their families: directions for future inquiry.

Children have been poorly represented in clinical studies and health services research. However, this situation is changing rapidly, and the number of research studies focusing on child outcomes is steadily increasing. The special characteristics of childhood related to health care-developmental change, dependency on adults, different disease epidemiology from adults, and unique demographic characteristics-pose methodologic challenges to researchers. These characteristics also argue for an expanded concept of outcomes research that is centered on a child-specific model of the production of health, its determinants, and its relationship to healthcare services. This article proposes priorities for future inquiry, including developing new measures specific to children; examining the influence of medical, public health, and other community interventions on children's long-term health trajectories; increasing attention to risk behaviors and resiliency factors that influence children's future health status; reconsidering the value of routine child healthcare and pediatric specialty care; examining the financing and organization of children's health care; exploring the importance of family influences on child and adolescent health; and addressing optimal treatment strategies for managing common childhood health problems.

Adolescent↗
PubMed2004

Adoption of liquid-based cervical cancer screening tests by family physicians and gynecologists.

OBJECTIVE: To examine reasons for the adoption of liquid-based cervical cancer screening tests. DATA SOURCES/STUDY SETTING: A mailed survey of 250 family physicians and 250 gynecologists in Maryland in 2000. Additional data were obtained from the AMA Master File of Physicians. STUDY DESIGN: Key outcome variables in this cross-sectional survey were early adoption of a liquid-based test by the end of 1997 and overall adoption by the time of the survey. Adoption was viewed in terms of a supply and demand theoretical framework with marketing influencing physician and patient demand as well as supply by insurance companies and laboratories. DATA COLLECTION: Random samples of family physicians and gynecologists were selected from the AMA Master File of Physicians. The overall response rate was 61.9 percent. PRINCIPAL FINDINGS: By 2000, 96 percent of gynecologists and 75 percent of family physicians in Maryland were using liquid-based cervical cancer screening tests, most commonly the ThinPrep Pap Test. Gynecologists were more likely than family physicians to have been early adopters (34 percent versus 5 percent, p<.01). Part of this variation in adoption was due to aggressive marketing to gynecologists, who were more likely than family physicians to receive information in the mail from the test manufacturer (89 percent versus 56 percent, p<.01) and to have been informed by the manufacturer that a patient had inquired about physicians' use of the test (22 percent versus 8 percent, p<.01). CONCLUSIONS: The rapid diffusion of liquid-based cervical cancer screening tests occurred despite general agreement that the Pap smear has been one of the most successful cancer prevention interventions ever. Commercial marketing campaigns appear to contribute to the more rapid rate of diffusion of technology among specialists compared with generalists.

Clinical Competence↗