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Biomedical subjects

D L Rabin

Publications and source records attributed to D L Rabin.

At least 37 records · Page 2Linked to original sources
PubMed1991

Frequency and thoroughness of STD/HIV risk assessment by physicians in a high-risk metropolitan area.

The US Preventive Services Task Force recommends that all primary care physicians assess the sexually transmitted disease/human immunodeficiency virus (STD/HIV) risk of all adolescent and adult patients. To determine whether factors amenable to change through continuing medical education are associated with frequent and thorough STD/HIV risk assessment, a telephone survey of primary care physicians in the Washington, DC metropolitan area was conducted (n = 961). Thirty-seven percent of physicians reported regularly asking new adult patients about their sexual practices; 60% asked new adolescent patients. STD/HIV risk questioning was associated with physicians' confidence in their ability to help prevent HIV, comfort with discussing patients' sexual practices, and perception of a large STD/HIV problem in their practice. These findings suggest that continuing medical education should target improvement in physicians' sexual practice questioning skills.

Attitude of Health Personnel↗
PubMed1987

Growth and change in the funding and provision of home care for the elderly.

Home care has been promoted as an alternative to acute and long-term care in hospitals and nursing homes in the interests of controlling the high and rising costs of institutional care. This has resulted in legislative and regulatory changes to public programs, of which the elderly are the main beneficiaries. Consequently, there has been major growth and change in the home care industry with Medicare being the largest third-party payor and primary income source for many home care agencies. The industry is now coming under closer scrutiny as a result of the increasing public expenditures, and concerns regarding public accountability and the cost-effectiveness of care delivered by this fragmented and relatively unregulated sector have been expressed. There is now increasing evidence that industry expectations of future growth may not be met from publicly funded home care programs for the elderly as currently conceived, regulated, and reimbursed. Changes are likely to result in an expanded role for the physician in home health care planning and supervision.

Aged↗
PubMed1984

Use of sedatives and hypnotics prescribed in a family practice.

The subsequent misuse and abuse of sedatives and hypnotics prescribed to 190 patients of the family practice program at the Medical University of South Carolina was investigated by medical record abstract and patient interviews. Results indicated little misuse and no abuse, with most respondents indicating they took fewer doses than directed. Concerns about dependence were widespread and were most likely in patients who said they never took fewer doses than directed. These patients were also more likely to have side effects. Ten percent of respondents said they had shared their sedative or hypnotic with others, usually relatives. Because of the nature of the population, mostly female and with an average age of 50 years, the results are likely to underrepresent misuse and abuse and to overrepresent concerns with dependence as compared with the general patient population. The results indicate the need for a prospective study to determine the process of becoming a misuser and factors associated with dependency fears.

Adult↗
PubMed1981

Presidential address: preventive medical practice.

Review of national programs in the past decade suggests that there is a developing consensus regarding the need for preventive services, but the proportion of them that physicians provide is decreasing. As teachers of preventive medicine, we should have a particular concern with the physician's performance in providing preventive services. Specialization, practice organizations, and comprehensiveness of payment ofr medical care appear to be related to the volume of preventive services provided. Organized primary care practice sites, where other health professionals are available, seem especially well-suited to providing preventive services. A review of several effective preventive activities involving physicians (child and adult immunizations, early detection and treatment of PKU infants, and stroke prevention) indicates that current prevention practice is less than desirable. Better performance can be attained through successful national and community programs of consumer and physician education. Implications of these observations for medical undergraduate and graduate education in prevention are discussed.

Education, Medical↗
PubMed1980

Delegation potential of primary care visits by physician assistants, medex and primex.

In order to determine the appropriate level of any support for primary care new health practitioners (NHP) programs, an estimate needs to be made of the demand for these programs; the degree to which primary care NHPs can substitute for physicians' services will have an impact on this demand. Using community-wide data on the nature and volume of care provided by physicians in their ambulatory practices, the authors estimated the proportion of care that three common types of primary care NHPs could handle: Primex nurse practitioners, 2-year physician assistants and Medex. Panelists with expert knowledge of each NHP type assessed primary care abstracts to determine if the NHPs could have handled all, some or none of the visit. Overall, the three groups considered collectively were deemed capable of assuming all or some responsibility for a large proportion of primary care--92 per cent. Differences among NHP type were found with regard to the morbidity each could handle, with 2-year physician assistants capable of handling the broadest spectrum of care. Community-wide estimates made regarding the number of NHPs employable by physician specialty showed general practitioners and pediatricians having the practice volume and type of morbidity sufficient to most easily employ NHPs.

Allied Health Personnel↗
PubMed1980

Racial differences in encounter rates for otitis media.

In 1975-1976, an experiment was performed at three sites of an HMO to investigate the effect of a protocol on drug prescribing for otitis media. A large and unexpected difference in encounter rates for otitis media was found among the sites. In the first 6 months of 1975, the rate of children less than 15 years with at least one encounter for otitis media at site EI was 155 per 1000 children, compared to 15 per 1000 at site EII. During the study period, most of the patients at site EII were black. The purpose of this paper is to alert readers to factors that affect the rates of disease in clinical practice, to encourage others to suggest reasons for the difference, and to encourage research. Several explanations were investigated to explain the differences: (1) miscoding; (2) age differences; (3) payment status; (4) diagnostic style; (5) differences in encounters per episode; and (6) social differences. Encounters of purulent otitis media were probably not systematically miscoded. The age distribution within the sites was almost identical. The difference in the encounter rates was even greater for children less than 15 years when only the enrolled population was examined. National incidence rates of otitis media showed rates for all ages for whites were 4.1% and for blacks 2.5%. The average number of encounters per episode was 1.4 at all of the study sites. Enrolled children at site EI had higher encounter rates for all reasons than children at site EII. Differences in diagnostic style may account for part of the difference in otitis media between the sites. Differences in encounter rates may also be due to real differences in disease occurrence between blacks and whites, differences in the perception of ear infection, and differences in the tendency to visit a physician for ear problems.

Adolescent↗
PubMed1979

Evaluation of a drug therapy protocol in an HMO.

Effective means of affecting physician prescribing behavior must be developed if the quality of health care is to be improved. A drug therapy protocol for otitis media, containing a rationale for drugs, doses and days of therapy by patient age, was developed by a physician panel at one site (EI) of an HMO, and implemented at both EI and a second site (EII); a third site was a control. A comparison of prescribing during two phases, before and after implementation of the protocol, suggested that the protocol had a greater influence at site EI than site EII, and that it had a greater influence on the panel physicians than on other prescribers at site EI. Questionnaire responses indicated that clinical experience and personal involvement were the most important protocol use influences. If participation is critical to protocol compliance, the protocol method to improve the quality of health care is severely limited.

Adolescent↗
PubMed1976

Who's using nonprescribed medicines?

A household survey investigated the nonprescribed medicine use of 3,481 persons in the Baltimore SMSA in 1968-69. Of respondents, 30 per cent used a nonprescribed morbidity-related medicine in two days. Rates of use are higher for adults, females and whites in all economic classes, and do not increase with increasing severity of morbidity in any economic class. A hypothesis that nonprescribed substitute for prescribed medicines is supported: ill nonprescribed medicine users are less likely to use prescribed medicines or to have visited a physician than nonusers; rates of nonprescribed medicine use are lower for those with a physician visit, and use of both prescribed and nonprescribed medicines for the same purpose is negligible. Lower out-of-pocket costs for visits and prescribed medicines do not lower rates of use. Nonprescribed medicine use is high among healthy and ill suggesting that physicians should inquire into patients' use when evaluating symptoms and before prescribing.

Acute Disease↗
PubMed1975

Who's using medicines?

Data derived from 1968-69 household survey of 3,481 persons in the Baltimore Standard Metropolitan Statistical Area revealed rates of medicine use and characteristics of users. In the 2 days before interview, 56% of the study population used one or more medicines. Users of prescribed medicine (33%) averaged 1.8 different kinds, and users of nonprescribed medicine (36%) averaged 1.4 kinds. Among users of prescribed medicine, 39% were also self-medicating. Pain relivers, vitamins, and cough and cold medicines were the most frequently used types. Two-thirds of physician visits were associated with an injection, immunization, medicine, or prescription. Rates of use for both prescribed and nonprescribed medicine were higher in females and varied with age, with nonprescribed varying less than prescribed. Nonwhites were less likely than whites to use either prescribed or nonprescribed medicines in all social status categoreis. Use of prescribed medicine increased with the increasing severity of acute and chronic illness, but use of nonprescribed medicine varied little with morbidity. Use of prescribed or nonprescribed medicine did not vary with economic class. Differences in use by age, sex, and race could not be accounted for by differences in morbidity, physician visits, or use of oral contraceptives.

Adolescent↗
PubMed1975

Medicaid, morbidity, and physician use.

Medical programs which provide services for low-income persons who have high medical needs have been criticized for high costs and have raised questions about overuse of physician services. A Baltimore SMSA household interview of use of health services permitted comparison of use of physician and preventive services controlled for morbidity by Medicaid recipients and two other income groups. Medicaid recipients were sickest and had higher physician use. They were more likely to have visits suggested by a physician, to be asked to return, and to be given injections. Physician visit rates were higher for each morbidity category, particularly for Medicaid healthy, who also used more preventive services in two weeks. Higher use of services by Medicaid recipients is accounted for by higher morbidity and increased need and demand for preventive services. Constraints on the use of physician services now most directly affect use of preventive services by those of low income without Medicaid benefits in the Baltimore SMSA.

Acute Disease↗