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Biomedical subjects

D K Freeborn

Publications and source records attributed to D K Freeborn.

At least 19 recordsLinked to original sources
PubMed2001

Drinking patterns, health care utilization, and costs among HMO primary care patients.

A survey of 8,034 primary care patients in a health maintenance organization examined the relationship between alcohol consumption and health care costs and service use. Costs were estimated from service use data for 1 year before and 2 years after study enrollment. No strong, consistent relationships were identified between multiple indicators of drinking patterns and either health care costs or service use. Compared with total costs among very light drinkers, former drinkers were higher, lifetime abstainers were similar, and persons in the higher drinking levels tended to have lower but not significantly different costs. Drinking patterns did not appear to be an important predictor of short-term health care costs or service use in this setting. Further study of former drinkers is warranted to examine the role of alcohol-related illnesses in the decision to quit drinking.

Alcohol Drinking↗
PubMed2001

Gender and alcohol use: the roles of social support, chronic illness, and psychological well-being.

Men and women differ in their use of alcohol, in their rates of chronic illnesses and psychological symptoms, and in the social support they receive. In this paper, we assess how the latter three factors are associated with alcohol use, and how these associations differ by gender. Respondents were 3,074 male and 3,947 female randomly selected Health Maintenance Organization members who responded to a mail survey in 1990. Hierarchical multiple regression analyses indicate that social support is associated with alcohol consumption in similar ways for both genders, yet the associations between some demographic, physical health/functioning, and psychological well-being measures are different for men and women. Men with fewer role limits due to physical health drank more, while women with better psychological well-being drank less. Poor psychological well-being may be a modifiable risk factor for increased alcohol use among women; practitioners should be alert for greater consumption among men with few functional limitations and good health.

Adolescent↗
PubMed2001

Satisfaction, commitment, and psychological well-being among HMO physicians.

OBJECTIVE: To identify the factors that predict professional satisfaction, organizational commitment, and burnout among physicians working for health maintenance organizations (HMOs). METHODS AND PARTICIPANTS: Data came from mail surveys of Kaiser Permanente physicians in the Northwest and Ohio regions. The average response rate was 80% (n = 608). RESULTS: The single most important predictor for all 3 outcomes was a sense of control over the practice environment. Other significant predictors included perceived work demands, social support from colleagues, and satisfaction with resources. The relative importance of these predictors varied, depending on the outcome under consideration. All 3 outcomes were also related to physician age and specialty. Older physicians had higher levels of satisfaction and commitment and lower levels of burnout. Pediatricians were more satisfied and committed to the HMO and were less likely to burn out. CONCLUSIONS: Physicians who perceive greater control over the practice environment, who perceive that their work demands are reasonable, and who have more support from colleagues have higher levels of satisfaction, commitment to the HMO, and psychological well-being. Interventions and administrative changes that give physicians more control over how they do their professional work and that enhance social supports are likely to improve both physician morale and performance.

Adult↗
PubMed2000

Screening and brief intervention for hazardous drinking in an HMO: effects on medical care utilization.

This study examined whether a brief intervention to reduce hazardous alcohol consumption among primary care patients reduced use of medical care. In a parent, randomized controlled trial, at-risk drinkers identified in HMO outpatient waiting rooms were randomly assigned to receive usual care or brief clinician advice plus a 15-minute motivational counseling session. The current study (n = 514) examined the groups' use of outpatient and inpatient medical services during two years after intervention. Although the intervention reduced alcohol consumption at six-month follow-up, intervention and control groups made similar numbers of outpatient visits (M = 17.7 vs. 18.3, respectively; p = .47), were equally likely to be hospitalized (21.2% vs. 22.0%; p = .81), and among those hospitalized, had similar lengths of stay (4.7 vs. 6.6 days; p = .37). Although brief interventions to reduce hazardous drinking may potentially reduce medical care utilization, more evidence is needed to substantiate their practicality and cost-effectiveness.

Adult↗
PubMed1999

HMO physicians' use of referrals.

Clinical uncertainty is a source of variation in medical decision-making as well as a source of work-related stress. Increasing enrollment in organized health care systems has intensified interest in understanding referral utilization as well as issues such as physician dissatisfaction and burnout. We examined whether primary care physicians' affective reactions to uncertainty and their job characteristics were associated with use of referrals and burnout. Data came from mail surveys of primary care physicians practicing in two large group model health maintenance organizations (HMOs) in the USA. Consistent with past research, we found that younger physicians had higher referral rates than older physicians, and that general internists had higher rates than either family practitioners or pediatricians. Greater stress from uncertainty increased referrals and referrals were negatively correlated with heavier work demands (patient visits per hour). Greater stress from uncertainty, perceived workload (too high) and a sense of loss of control over the practice environment were associated with higher levels of burnout.

Adult↗
PubMed1998

Understanding physicians' imaging test use in low back pain care: the role of focus groups.

OBJECTIVE: To gain understanding about why a controlled intervention to reduce variability in lumbar spine imaging test use rates for low back pain patients was ineffective among internal medicine and family practice physicians in a large US health maintenance organization. DESIGN: We retrospectively analyzed data from focus groups that had been conducted prior to the implementation of the intervention. The physicians were asked about the factors that influence their decisions to order such tests. STUDY PARTICIPANTS: Internal medicine and family practice physicians in the intervention group. MAIN STUDY FINDINGS: Most of the variability in physicians' imaging test ordering appeared to occur in the care of patients with back pain of non-traumatic origin who had no radicular symptoms. Within that clinical context, nonclinical factors such as patient age and work status, time constraints, access problems and ambiguity about internal referral processes were important factors in physicians' decisions. Especially relevant were tensions and conflicts the physicians face as they attempted to meet conflicting role obligations in the health maintenance organization. These tensions raised issues of patient trust in their physicians and in medical care organizations, and it appeared that imaging test orders sometimes served social and symbolic functions in resolving them. CONCLUSION: Our findings suggest that gaining information from focus groups prior to designing physician behavior change interventions may aid the design of more effective interventions.

Cost Control↗
PubMed1997

Primary care physicians' use of lumbar spine imaging tests: effects of guidelines and practice pattern feedback.

OBJECTIVE: To reduce variability in primary care physicians' use of procedures for imaging the lumbar spine. DESIGN: Controlled intervention using clinical practice guideline and practice pattern feedback. STUDY SAMPLE: Sixty-seven internists and 28 family practitioners in a large, group-model HMO. MEASUREMENTS AND MAIN RESULTS: Intervention group physicians received the clinical practice guideline for low back pain, followed after 4 months by three bimonthly feedback reports on their current use rates for lumber spine x-rays and computed tomography and magnetic resonance imaging scans of the lumbar spine. Control group physicians received neither the guideline nor the feedback reports. Automated radiology utilization data were used to compare intervention and control group physicians' changes in use rates and variability in use rates over the course of the study period. Neither the guideline alone nor the guideline plus feedback was associated with a significant decrease in use rates or in the variability in use rates for the lumbar spine imaging procedures under study. CONCLUSIONS: Clinical practice guidelines and practice pattern feedback fail to achieve their goals when features of the practice setting and patient expectations and behavior are not identified and addressed.

Adolescent↗
PubMed1995

Gender differences in the relationship between social network support and mortality: a longitudinal study of an elderly cohort.

Despite well-recognized gender differences in patterns of social network support, few studies have explored whether the pathways by which social support affects mortality risk differ for men and women. In a 15-year follow-up study of elderly HMO members, we found that network size affected men's mortality risk indirectly, through their health status, while no such indirect effect was found for women. The data also suggested that network size had a direct protective effect on mortality risk for both men and women, with men gaining protection at a lower level of network size than women. These findings confirm the need for a gender-specific approach to further research on this subject, and suggest the need to measure variables that capture the different meaning and value of social network participation for men and women.

Aged↗
PubMed1995

Adolescent drug misuse treatment and use of medical care services.

Research on adults has documented that use of medical services decreases after initiation of treatment for alcohol problems, but little is known about this relationship among adolescents. We studied utilization and costs of care following participation in the Adolescent Chemical Health Program (ACHP) of Kaiser Permanente, Northwest Region, in 1986-88. Three groups of adolescents (and their parents) were identified: adolescents who were assessed and initiated treatment in ACHP (n = 561), adolescents who were assessed and recommended for treatment but did not return for treatment (n = 278), and adolescents with no known substance use problems (n = 381). Medical records were reviewed for 1 year pre- and 1.5 years postassessment. After adjusting for preassessment medical visits, severity of alcohol and drug use, gender, and age, analyses suggested that substance user treatment was not associated with reduced use of medical services or costs by either adolescents or parents.

Adolescent↗
PubMed1994

Physician burnout: recommendations for HMO managers.

If HMOs are to remain viable, they will have to control and eliminate conditions that contribute to the burnout of their physicians. Based on the belief that interventions should be based on a thorough understanding of how an HMO affects burnout, physicians in a large, prepaid group practice were asked to respond to objective and open-ended questions about their background and career, work conditions, professional autonomy, patient care, and stress and well-being. Findings about burnout prevalence, factors related to burnout, and burnout outcomes are presented and used as a starting point for a discussion of possible interventions.

Adult↗
PubMed1990

Consistently high users of medical care among the elderly.

This study identified consistently high and low users of medical care services in a group of older HMO members continuously enrolled for six years. Consistently high users made up 26% of the sample, but accounted for more than 50% of total outpatient contacts and hospital admissions. Average ambulatory care costs were more than four times greater for the high users compared with the low users. Consistently high users were older than consistently low users, but did not differ significantly in other sociodemographic characteristics. Compared with the low users, the high users reported more total medical conditions and were more likely to indicate they had arthritis, high blood pressure, heart conditions, and other chronic problems. They perceived themselves to be in poorer health and reported higher levels of psychologic distress. The low users tended to be less satisfied, but the two user groups were not significantly different regarding use of services outside the HMO.

Aged↗
PubMed1990

Smoking and consistently high use of medical care among older HMO members.

Smoking behavior of consistently high and low users of medical care services were compared in two groups of older health maintenance organization (HMO) members continuously enrolled for five years and a subgroup who were continuously enrolled for 10 years. Smokers and former smokers, combined, were more likely than never-smokers to be consistently high users of ambulatory services (52 percent vs 34 percent in the five-year group, and 45 percent vs 30 percent in the 10-year group).

Aged↗
PubMed1986

Utilization patterns and mortality of HMO enrollees.

Data from a 6-year follow-up period were used to analyze the mortality of adults who had been continuously enrolled in a prepaid group practice health maintenance organization (HMO) for the previous 7 years. Thirteen percent of the HMO members were classified as consistently high users of outpatient care. Even after adjustment for age, sex, and cigarette smoking, this high user group's mortality rates during the follow-up period were significantly greater than those of the other HMO enrollees. The HMO members as a whole had mortality rates marginally lower than the mortality of the general Oregon population. It can be concluded that HMO enrollees who consistently use high quantities of health care resources generally have significant medical problems in addition to psychosocial difficulties. Assuming that mortality reflects health, long-term HMO members as a group are not much healthier than ordinary Oregonians.

Adult↗
PubMed1986

Comparing HMO physicians' attitudes towards NPs and PAs.

This study examined the attitudes of physicians working in health maintenance organizations toward the use of nurse practitioners and physician assistants. It also explored some of the underlying reasons for these attitudes: effect upon quality of care, risk of malpractice, role threat and gender bias. The setting was a health maintenance organization serving 270,000 members. The data were derived from a survey of physicians' attitudes and behavior. Physicians from internal medicine, pediatrics and obstetrics-gynecology were the study population. Internists and pediatricians had favorable attitudes toward both nurse practitioners and physician assistants. Obstetrician-gynecologists had somewhat less favorable attitudes. Physicians in all three specialties favored nurse practitioners more than physician assistants. Physicians felt that nurse practitioners were more likely to increase the quality of care and less likely to increase the risk of malpractice. Nurse practitioners were not seen as a greater role threat. Some gender bias appeared to be present, but it did not appear to constrain the use of nurse practitioners. Large, multi-specialty, prepaid group practice health maintenance organizations may be favorable settings for nurse practitioners and physician assistants to practice primary care.

Attitude of Health Personnel↗
PubMed1986

Collaboration in health services research: on developing relationships between VA researchers and those in other institutions.

This article explores the potential for collaboration between investigators in institutions outside of the VA and those engaged in research within the VA. The focus is on the potential for collaborative work in health services research; our perspective is that of researchers in a freestanding HMO research center affiliated with the Veterans Administration's Northwest Health Services Research and Development Field Program. The paper begins with a review of the reasons that make collaboration between VA researchers and other health services researchers so appropriate at this time. An example of collaboration is presented, drawing on the experience of the Northwest Field Program and the Kaiser Permanente Center for Health Research. Finally, some difficulties inherent in collaboration between VA and other health services researchers are discussed.

Aged↗
PubMed1985

Utilization patterns among long-term enrollees in a prepaid group practice health maintenance organization.

Criteria used in this study established that 13% of long-term adult members of a prepaid group practice health maintenance organization (HMO) were consistently high users of outpatient medical care services. This population accounted for 31% of the total doctor office visits (DOVs), 35% of the hospital admissions, and 30% of the outpatient surgical services for long-term members. The most frequent reason for DOVs in this high user group was treatment and/or follow-up of chronic conditions. Patterns of utilization were unrelated to marital status, income, occupation, and perceived social class. Smoking and alcohol use also were not associated with utilization patterns. However, the consistently high users were more likely to perceive their health status as fair or poor and to report a higher number of physical symptoms. They were also more likely to be characterized by a higher degree of psychological distress, especially depression. Contacts with the HMO's mental health department constituted less than 1% of their total medical care contacts, and only 13% made at least one mental health contact over the study period. The findings are discussed in terms of their health and medical care implications.

Adult↗