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Biomedical subjects

D Gemmel

Publications and source records attributed to D Gemmel.

9 recordsLinked to original sources
PubMed1994

Agreement between telephone survey and medical record data for the elderly patient.

OBJECTIVE: This study compares agreement between telephone survey and ambulatory medical record data for an elderly patient population. METHODS: Medical records and telephone survey responses are used to compare health status (chronic medical condition, symptomatology, and functional status) of 142 elderly patients randomly selected from a family practice residency and a geriatric fellowship practice. Chart abstraction was performed by two resident and two faculty physicians after a training period designed to assure high inter-reviewer reliability. Telephone surveys were completed by two professional interviewers. Health status measures were taken from standard, published instruments. The kappa statistic was used to measure the agreement between medical record and survey data. RESULTS: Overall, there is little agreement between the medical record and the telephone survey results on chronic medical condition, symptomatology, and functional status. CONCLUSIONS: Medical records abstractions and telephone survey methodologies did not yield comparable health status data when applied to the same elderly patient population. Functional status assessment and symptomatology are particularly problematic, but even the presence or absence of chronic diseases is often inconsistent in the two data sources.

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PubMed1993

Attitude of healthcare personnel regarding influenza immunization.

OBJECTIVES: To survey the attitudes of healthcare personnel regarding influenza immunization. DESIGN: A questionnaire was given to all hospital employees. SETTING: A 650-bed community teaching hospital. INTERVENTION: Employees were offered an in-service regarding influenza immunization in October 1991. Influenza immunization was given free of charge by Employee Health Services from October to December 1991. One thousand fifty-six employees (30.2%) received influenza vaccines. Survey forms were distributed with paychecks to all employees during the second half of January 1992. Completed survey forms were returned during the next 2 weeks. RESULTS: One thousand two hundred three of the 3501 (34.3%) questionnaires were returned. Some of the survey forms were not completely filled out. A total of 28.1% of male employees (202/717) and 35.4% of female employees (987/2783) (p < .01) responded. Mean years employed were 11.35 +/- 7.57 for respondents and 9.30 +/- 7.39 for all employees (p < .001). Four hundred sixty-one respondents (38.4%) received the influenza vaccine and 734 (61.4%) did not. Among the respondents, employees who were older or working full time were more likely to receive the vaccine. Proportionally, more respondents who received the vaccine attended the in-service, although only 8.7% of those immunized attributed their receiving influenza vaccine to the in-service. More physician respondents were vaccinated. The respondents who received influenza vaccine were more likely to have received the vaccine during the past 2 years (p < .001). The major reasons given for not receiving the vaccine were "bad side effects" and "do not like shots." The major side effect of influenza immunization was a "sore arm." Multivariate analysis suggested that the in-service was not associated with obtaining the vaccine. CONCLUSIONS: The in-service regarding influenza immunization seemed to have a negligible influence. Most employees who received the vaccine had previous influenza immunization. There were no major side effects of influenza immunization. "Bad side effects" and "do not like shots" were major reasons given for not receiving influenza vaccine.

Adult↗
PubMed1993

The effect on retirees of losing retirement and health insurance benefits.

BACKGROUND AND OBJECTIVES: The recent economic downturn has led to instability in the private health insurance industry. Although loss of medical benefits is assumed to have a negative effect on health, documentation is lacking. LTV Corporation (Ling-Temco-Vought) filed for bankruptcy and interrupted medical insurance for its retirees for six months. METHODS: Using a structured interview format, we surveyed community-living LTV retirees whose medical insurance had been interrupted. We sought to predict health status using a variety of measures. RESULTS: The vast majority of retirees were generally unaffected by the loss of medical benefits. Of the 191 LTV retirees from Youngstown, Ohio, who were interviewed shortly after health benefit loss, 13.8% reported longer-term health effects (continued decline in subjective health status), whereas 8.5% had short-term effects (decline followed by return to good or excellent health status). Although 10.5% of workers experienced serious health problems during the crisis, only one worker was unable to pay for health care as a result of the benefits loss. A discriminant analysis yielded excellent results in predicting longer-term deteriorating health status. CONCLUSIONS: Implications for community-oriented primary care service models are discussed, as well as the utility of demographic targeting for retirees losing health benefits.

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PubMed1992

Worried wellness: how meaningful is the concept in managing elderly patients?

The concept of "worried wellness" is poorly defined for research purposes, and little is known about the worried-well elderly. To study the incidence of worried wellness in the elderly and define the clinical utility of the term, researchers conducted a structured interview with 733 independently living community elderly and 250 elderly patients from a family practice residency-teaching practice. The interview combined standard subjective health questions with specific additional measures of worry to form a "worry" scale. The worry data were cross-tabulated with "wellness" parameters that included symptomatology, presence of chronic medical conditions, use of medical equipment, and activities of daily living. A wide range of prevalences for worry were found, depending on the measure used. Wellness data were more consistent: though the vast majority of elderly were fully functional, 9 out of 10 subjects had at least one medical condition. Cross-tabulation based on individual items from the worry and wellness measures yielded a prevalence of one-third or less, depending on the measure used. However, composite analyses for both liberal and conservative measures of worry disclosed very few cases of worried wellness in the patient or community samples. This finding points to a very low incidence of the phenomenon among the elderly and raises significant doubt about the clinical utility of the term "worried wellness."

Activities of Daily Living↗
PubMed1991

Long-term health impacts of forced early retirement among steelworkers.

BACKGROUND: Previous studies of the health impacts of retirement have not investigated the effects of forced early retirement following plant closings. METHODS: Using a geriatric database representative of elderly people, the health impacts on employees forced to take early retirement from steel mills in the Youngstown, Ohio, area were assessed. A study group of forced early retirees was compared with two control groups: (1) regular steel industry retirees, and (2) regular retirees from jobs outside the steel industry. Utilizing multivariate analysis techniques, the effects of retirement on a number of different health measures were isolated. RESULTS: Over the long term, the health of forced retirees does not seem adversely affected by sudden job loss and unexpected retirement, at least in the steel industry. CONCLUSIONS: Continuity theories of retirement--that workers do not experience abrupt catastrophic changes in lifestyle and in health--best explain the lack of negative health impacts.

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PubMedDate not supplied

Community hospital experience with recombinant tissue plasminogen activator in acute myocardial infarction.

Clinical features, outcomes, and hospital charges of 51 consecutive patients who had had acute myocardial infarction (MI) and who had received intravenous tissue plasminogen activator (TPA) at a community teaching hospital were reviewed retrospectively. The overall mortality rate was 22%, including four patients (8%) who had died of hemorrhagic complications, three of whom (6%) had had intracerebral hemorrhages. Despite similar mean ages and lengths of hospital stay, TPA patients had had significantly higher total hospital charges and ancillary charges than had had concurrent MI patients who had not received TPA (p less than 0.0001). In a community hospital setting, older patients may be at higher risk for intracranial hemorrhage when treated with TPA, especially in the presence of other risk factors.

Aged↗
PubMedDate not supplied

Assessing the denominator problem in community-oriented primary care.

Determination of health care needs is an essential cornerstone of community-oriented primary care (COPC). Many physicians, lacking research resources, may generalize their own patient registry data to the community. But practice populations are likely to differ significantly from community populations. This study compared demographics, health status, and medical care utilization in a sample of 990 elderly living in the community and 250 elderly patients registered at the St. Elizabeth Hospital Family Health Center in Youngstown, Ohio. The community survey and patient registries were comparable on key demographic characteristics. But statistically significant differences were observed for functional status and a number of chronic medical conditions. Comparisons of symptomatology, use of health aides, subjective health status, depression, and stress produced no significant differences. Overall health care utilization patterns were similar. The elderly family health center patients were more representative of the non-institutionalized elderly in the community than expected. And although the clinical significance remains uncertain, these findings suggest that this practice sample may be used with caution for COPC planning. But considerably more research must be undertaken in a variety of practice settings before the use of practice populations for COPC planning is widely applied.

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PubMedDate not supplied

Health and poverty among elderly persons: a community-oriented primary care survey.

Providing health care for independent-living elderly persons is important, yet family physicians often lack accurate information about needs and access to care. The Community-Oriented Primary Care (COPC) approach and health status models from health services research provide a framework for assessing need and access to care. Personal interviews were conducted with 990 noninstitutionalized elderly persons in Youngstown, Ohio. Results showed that poverty, gender, and race were not strongly related to health status as measured by numbers of symptoms, functional status, or subjective health status. In addition, elderly persons had fewer health care needs and greater access to care than expected. Simple models of health status, need, and access do not seem to apply. The study shows the usefulness of COPC in planning health services; however, more effort is needed to refine measures of health status, need, and access.

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