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Biomedical subjects

D C Cherkin

Publications and source records attributed to D C Cherkin.

67 records · Page 4Linked to original sources
PubMed1983

The content of ambulatory medical care in the United States. An interspecialty comparison.

Ambulatory care, accounting for over half a billion visits to physicians per year, is a major component of the health-care system and is the core of primary health care. This study uses data from the National Ambulatory Medical Care Survey to describe the most common problems seen in an ambulatory-care setting, to identify the medical specialties that provide the greater part of this care, and to characterize the major specialties in terms of the diagnoses in the patients who constitute their ambulatory practice. Fifteen diagnosis clusters account for 50 per cent of all ambulatory-care visits; only 8 of the 28 specialties account for a substantial amount (more than 25 per cent) of the ambulatory care rendered to patients with any of these 15 diagnoses. General and family physicians, general internists, and general pediatricians account for 65.9 per cent of all outpatient visits to physicians for the 15 most common problems; general and family physicians alone are responsible for more than half this total. The individual specialties differ markedly in the diagnostic and demographic variety of their outpatient workload. These differences have important implications for the training of physicians and the organization of their practices.

Ambulatory Care↗
PubMed1983

Diagnosis clusters: a new tool for analyzing the content of ambulatory medical care.

A clustering method for the analysis of ambulatory morbidity data is presented. This approach reduces spurious variations resulting from idiosyncratic diagnosis labeling and coding habits of physicians and facilitates the analysis of the content of ambulatory medical care through the use of aggregate morbidity data. The clusters provide a tool that allows for the comparison of the content of practice based on different factors such as provider training, practice organization, and patient characteristics. Ninety-two diagnosis clusters were derived using the 1977 and 1978 National Ambulatory Medical Care Survey (NAMCS). These clusters incorporate 86 per cent of all ambulatory visits to office-based physicians in the contiguous United States. The clusters were constructed based on the consensus of a group of clinicians including both generalists, as well as selected subspecialists representing the spectrum of ambulatory medical practice. The diagnosis clusters presented are compatible with the International Classification of Diseases (ICDA-8 and ICD-9-CM) and the International Classifications of Health Problems in Primary Care (ICHPPC and ICHPPC-2). Several applications demonstrating the utility of the method are presented, and directions for future applications are suggested.

Ambulatory Care↗
PubMed1982

A seed money grant program for family medicine research.

It appears that the seed money allocation process instituted by the University of Washington Department of Family Medicine one year ago has facilitated the launching of several pilot studies by removing small but significant financial barriers. Expressions of concern about the equitable allocation of departmental resources for research have abated, and energies have focused increasingly on how to do research and less on how to fund it. The funds and in-kind resources allocated have helped promote collaboration between community practitioners and academic researchers. The seed money program has assisted relatively inexperienced researchers to obtain valuable research experience which will make future applications for external grant support more credible and competitive.

Academic Medical Centers↗
PubMed1982

In search of a solution to the primary care denominator problem.

Before morbidity or utilization rates can be legitimately compared across practices or within a practice over time, it is necessary to know the number and age-sex distribution of individuals who are served by the practice in question. Estimating this "population at risk" has been referred to as the "denominator problem." Although a variety of methods for estimating practice denominators were proposed more than six years ago, none has been shown to be satisfactory, and no new ones have materialized. One method, however, has never been evaluated, and evidence is presented which suggests that this method may be capable of providing satisfactory estimates of practice denominators. Data from the US Health Interview Survey, the British National Morbidity Study, and other sources suggest that it may be possible to derive age- and sex-specific correction factors which, when applied to the age-sex distribution of visiting patients, would provide reasonable estimates on the practice denominator. This "correction factor method" would require only that practices maintain age-sex registers of their visiting patients. Further investigation is required before this method can be considered a satisfactory means of estimating practice denominators.

Adolescent↗
PubMed1980

The use of drugs for unlabeled indications.

A chart review of 500 drug uses during a three-month period in a family practice clinic showed that 46 (9.2%) were for indications not included in the Food and Drug Administration-approved labeling. Dipyridamole was the drug most frequently and consistently prescribed for unlabeled indications. On no occasion did the chart show that patients were informed that a drug was being prescribed for an unlabeled indication. Unlabeled indications most frequently encountered in the chart review were also frequently mistaken by family practice residents and faculty responding to a questionnaire as being included in FDA-approved labeling. The indications as listed in the manufacturers' literature (eg, package insert, Physician's Desk Reference) often do not reflect how drugs are used in clinical practice.

Drug Evaluation↗
PubMed1980

Factors influencing the physician market for primary care new health practitioners.

The relative importance of various constraints on the employment of New Health Practitioners (NHPs) by physicians is assessed. Primary care physicians in Washington State were surveyed regarding their familiarity with and perceptions of NHPs. Almost 90 per cent of respondents were familiar with NHPs, and 47 per cent had thought about how an NHP would affect their practices. Physicians generally believed NHPs would have a neutral or positive impact on most aspects of their practices, though more than half were concerned about patient acceptance, administrative problems and reimbursement for NHP services. Fifty per cent of the physicians preferred working with other physicians, compared with only seven per cent choosing an NHP as a first choice for dealing with an increasing patient volume. Despite the generally favorable opinion of physicians about NHPs, physician preference for working with other physicians in conjunction with a rapidly increasing supply of primary care physicians may greatly limit future employment opportunities for NHPs.

Allied Health Personnel↗
PubMedDate not supplied

How emergency physicians approach low back pain: choosing costly options.

To determine ways in which emergency physicians approach the diagnosis and treatment of the common presenting complaint of low back pain, responses of emergency physicians to a questionnaire dealing with three hypothetical patients with different types of low back pain were taken from a stratified national random sample of eight medical specialties. For severe acute (with and without sciatica) or chronic low back pain, physicians were asked which tests and consultants they would use in pursuit of the diagnosis, and which treatments and specialty referrals they would recommend in each of the three scenarios. For diagnosis in the acute cases (pain less than 1 week), up to 22% of emergency physicians recommended computed tomography (CT scan) and 36% recommended magnetic resonance imaging (MRI). Specialist consultation would be sought for 61% of the acute sciatica patients, 32% of the acute nonsciatica patients, and 47% of the chronic patients. In approaching treatment, over 75% of emergency physicians would advise bedrest for an average of 3.5 to 4.5 days. Between 16% and 40% suggested physical therapy for the acute patients. Referrals to surgical specialists (orthopedist or neurosurgeon) were highest (81%) for acute sciatica, compared with 52% for chronic low back pain, and 41% for acute nonsciatic low back pain. In conclusion, given that most cases of acute low back pain resolve with minimal intervention, diagnostic imaging, laboratory testing, and early specialist consultation favored by many emergency physicians would add little except expense to understanding its etiology. For treatment, emergency physician recommendations for bedrest were longer than necessary and, for physical therapy, of no proven benefit.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗