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Biomedical subjects

D K Freeborn

Publications and source records attributed to D K Freeborn.

At least 37 records · Page 2Linked to original sources
PubMed1985

Physicians' use of laboratory, radiology, and drugs in a prepaid group practice HMO.

Use by physicians of medical care resources to treat similar patients and morbidities has implications for the efficiency and effectiveness of medical care. This study examined the variation in primary care physicians' use of outpatient laboratory, radiology, drugs, and hospital admissions; the relationships among the uses of these resources by physicians; and uses of these resources by physicians over time. The setting was a large HMO and the physicians were internists (n = 30), pediatricians (n = 20), and obstetrician/gynecologists (n = 17). Resource use was a dollar rate for laboratory, radiology, and drug, and an admission rate per contact for the hospital. The physicians' use rates were derived from the computerized utilization record of a sample of HMO members for 1976-1978. Substantial variation occurred in the rates of use of each resource by physicians in each specialty. The relationships among the resource rates were similar for internists and pediatricians, and were somewhat stronger than expected clinically. There were also substantial consistencies over time in the levels of use of laboratory and drugs by internists and pediatricians. Findings suggest a potential for more judicious use of ambulatory care resources by primary care physicians in this setting.

Adolescent↗
PubMed1984

Physicians' attitudes toward an expanded role for pharmacists in an HMO.

The study examines the attitudes of physicians in a large HMO toward expanded activities for pharmacists and attempts to determine the physicians and their practice characteristics that account for these attitudes. The setting was the Oregon Region of the Kaiser-Permanente Medical Care Program. The data were obtained from a survey of the physicians serving the membership. The findings indicated that about two of every three physicians favored expanded activities for pharmacists. The specific activities most favored were those least threatening to physicians' roles. Their attitudes were most strongly related to whether they favored prescribing privileges for physician assistants and nurse practitioners. The physicians and their practice characteristics accounted for a small amount of the variation in physicians' attitudes. Large HMOs may be favorable settings for expanding the activities of pharmacists.

Attitude of Health Personnel↗
PubMed1982

A study of HMO physicians' receptivity to special programs for sociomedical and behavioral problems.

The purpose of this study was to determine HMO physicians' receptivity to special organized programs dealing with sociomedical and behavioral problems. The study population consisted of full-time physicians in a large prepaid group practice HMO, and the data were obtained in 1977 by means of a self-administered structured questionnaire. Most physicians favored special organized services for alcoholism, drug abuse, obesity, disturbances in sexual relations, and the like. Except for alcohol and drug abuse, favoring organized services for one problem did not correlate highly across problem areas. Specialty, AMA membership, and political orientation were the main characteristics that differentiated physicians on their receptivity to organized programs for sociomedical problems. Social background and professional training and experience may be more important than the practice setting in influencing physicians' receptivity to these types of services.

Attitude of Health Personnel↗
PubMed1981

Client satisfaction in a health maintenance organization: providers' perceptions compared to clients' reports.

This study seeks to compare clients' reports of satisfaction/dissatisfaction with an HMO and its medical care program to providers' perceptions of client satisfaction. The main conclusion is that providers are fairly aware of medical care system attributes with which clients are highly satisfied and dissatisfied. Those with direct patient contact, especially physicians and nurses, are most accurate in their perceptions. Personnel without direct patient contact are about equally accurate in their perceptions of client satisfaction, though personnel without patient contact perceive relatively more dissatisfaction than clients report. Most approaches to medical care evaluation examine costs and efficiency and, more recently, the technical quality of care. Less attention has been given to the assessment of client satisfaction, and almost no attention has been given to what providers perceive as the assessment of clients. Clearly, HMOs' viability is determined largely by their ability to identify and correct major problems affecting their enrollments.

Attitude of Health Personnel↗
PubMed1981

Effect of coverage on use of an HMO alcoholism treatment program, outcome, and medical care utilization.

Two-hundred-fifty alcoholics were randomly assigned to a full benefit of 50 per cent copayment group before entering an HMO (health maintenance organization) alcoholism treatment program. Data on use of treatment services, use of medical care services, and drinking behavior were collected for one year after intake. The medical care utilization and drinking behavior data were compared to data for the year before intake. The two coverage groups were comparable on sociodemographic characteristics and baseline drinking behavior, but the full benefit group tended to have higher utilization rates for the year prior to intake and significantly more treatment contracts than those having the 50 per cent copayment requirement. Changes in use of medical care services were similar in both groups. Both payment groups improved, but the full benefit group tended to be somewhat more improved. Regression analysis supported the relative unimportance of extent of alcoholism coverage in affecting outcome and subsequent medical care utilization.

Adult↗
PubMed1979

The effect of length of membership upon the utilization of ambulatory care services. A comparison of disadvantaged and general membership populations in a prepaid group practice.

The relationships between duration of membership and the use of outpatient medical care services for disadvantaged and general membership groups in a prepaid group practice were analyzed. The effects of duration of membership upon utilization rates during a six-year study period were estimated by retrospective cohort analyses. Rates were computed for successive three-month intervals. There were no significant start-up effects on use for new enrollees in either study population. This finding is in contrast to what has been reported in other studies. New HMOs or existing HMOs with many new members may not require the additional resources previously thought necessary. Average cohort utilization rates were higher for the disadvantaged cohorts, with the exception of young males 0 to 14 years old. We also examined the persistence of utilization patterns over time. Consistently high users and nonusers were found in both populations. In general, these findings suggest that length of time does not affect ambulatory care use. Age, sex, socioeconomic background and health status are more important than duration of membership in accounting for differences in utilization.

Adolescent↗
PubMed1979

The effect of outreach workers' educational efforts on disadvantaged preschool children's use of preventive services.

A special program of outreach services was implemented to assist a poverty population to appropriately use health services in the Kaiser-Permanente Medical Care Program. A study was conducted to determine the effect of outreach workers' intervention on the use of preventive services by this population. Intially, families were divided into two groups, one with and one without outreach workers. Outreach workers (neighborhood health coordinators) were trained in prevention and health education. They were then assigned to specific subgroups of the poverty population to teach the importance of preventive services and to motivate persons to use these services. This paper focuses on the effect of outreach workers' services on the use of selected preventive care services (immunizations and tine test) by preschool children from poverty families. Preschool children in families with coordinator services had higher use rates for preventive care. The sub-group for which outreach workers were specially trained to focus on preventive procedures for the pre-school group had markedly higher use rates for preventive care. The findings suggest that special intervention programs, using indigenous and nonprofessional outreach workers, can increase preventive service utilization by poverty groups.

Child, Preschool↗
PubMed1978

The effect of outreach workers' services on the medical care utilization of a disadvantaged population.

An original goal of the Kaiser-Permanente Neighborhood Health Center Project was to organize the project so that a medically indigent population would be able to utilize fully and appropriately the services of a complex medical care program. A special program of outreach services was designed as the principal means to achieve this goal. This study was made to determine the effects of these outreach services on (1) the use of or nonuse of ambulatory care services; (2) the volume and type of services used; (3) the patterns of use; and (4) the appointment-keeping behavior of the project population for a 12-month period. Outreach and medical care services were provided to an average of 7,000 persons in 1,500 low-income families who were enrolled as health plan members in the Kaiser-Permanente Medical Care Program. Project participants were randomly divided into two groups, one with and one without services, and utilization data were collected from their medical and administrative records. The findings suggest that outreach intervention had a positive effect on access to care. Persons who received outreach services were more likely to contact the medical care system; these persons also showed a substantial difference in the volume of services they used, when compared to those without outreach services. Outreach workers were less successful in changing utilization patterns, although slight differences were found in the direction of more appropriate use. Persons with outreach services were more likely to have made contacts with their regular physician, to have made a smaller proportion of walk-in contacts, to have had a higher proportion of regularly scheduled contacts, and to have made a higher proportion of continuing visits. Outreach workers also had little or no effect on appointment-keeping behavior.

Adolescent↗
PubMed1977

Health status, socioeconomic status and utilization of outpatient services for members of a prepaid group practice.

When evaluating the effectiveness of medical care programs, one concern is whether receipt of care is based upon health care needs or upon socioeconomic status. This study describes the relation between health status and socioeconomic status and attempts to determine which has the greater effect on ambulatory care utilization. The study setting was an operating HMO serving a cross-sectional membership of nearly 200,000 persons. Outpatient utilization data were derived from the medical records of a five per cent sample of health plan members for 1969 and 1970. Social, economic, situational, and attitudinal data were provided by 2,603 respondents in a household interview survey. Since a population's perceived health status may reflect health need, information from the survey provided measures of health status that ranged from specific symptoms and complaints to a general measure of perceived health status. Although the findings varied somewhat according to which variables were considered, they generally showed health status to correlate more highly than socioeconomic factors with the utilization of services in this medical care system. An exception was the use of preventive services, which was not significantly related to health status measures but rather, for women, to education and, to a lesser extent, income.

Absenteeism↗