Biomedical subjects

Donald Bradley

Publications and source records attributed to Donald Bradley.

3 recordsLinked to original sources

PubMed2004

Trust in insurers and access to physicians: associated enrollee behaviors and changes over time.

OBJECTIVE: Most studies of trust in the medical arena have focused on trust in physicians rather than trust in health insurers, and have been cross-sectional rather than longitudinal studies. This study examined associations among trust in a managed care insurer, trust in one's primary physician, and subsequent enrollee behaviors relating to source of care. The study also documents changes in trust in the study population following the disclosure of physician incentives. STUDY SETTING: A medium-sized (300,000 member) HMO, located in the southeastern United States. DATA COLLECTION: One to two years after baseline, we randomly resurveyed a quarter (n = 558) of the initial study population of a large intervention study designed to measure the impact of disclosing HMO financial incentives on patient trust. This follow-up study was also designed to measure the effects of trust on source of care. ANALYSES: Multivariate regression analyses of survey data examined associations between baseline levels of trust and subsequent enrollee behaviors such as using a non-PCP physician without a PCP referral, as well as changes in trust since baseline. RESULTS: High baseline insurer trust was associated with a lower probability of a patient seeking care from a non-PCP physician (OR = 0.55, 95 percent CI: 0.33, 0.91). No long-term effects of prior disclosure of financial incentives were observed. Overall, there was a slight increase in overall trust in the insurer (1.8 percent, p < .05) but no change in trust in one's primary physician. The increase in insurer trust was primarily restricted to 23 percent of the enrollees who had changed their PCPs following the baseline survey (6.6 percent, p < .01). In multivariate analyses, changing physicians was the most significant predictor of increased insurer trust (OR = 2.17, 95 percent CI: 1.37, 3.43). CONCLUSIONS. Trust in one's insurer seems to change over time more than trust in one's primary physician, and is predictive of enrollee behaviors such as seeking care from other physicians. The ability to change physicians seems to increase trust in the insurer.

Adult↗

PubMed2003

Development of an immunosensor based on pressure transduction.

Traditional strategies for signal transduction in immunosensors are based on piezoelectric, thermometric, electrochemical, magnetic and optical methods. The use of pressure as a signal transduction method in immunosensors has not been reported previously. An immunosensor incorporating the detection of a change in pressure as the signal-transducing mechanism was investigated. A commercially available ultra-low pressure sensor was used in conjunction with a sealed chamber to assess the feasibility of this strategy. A key feature of the current approach is the use of a thin membrane (or film) in which to perform an immunoassay and subsequently to detect production of gas. The thinness contributes to efficient gas evolution and minimizes the effect of liquid acting as a "sink" for gas molecules. This feature also simplifies measurement of evolved gas, which traditionally was based on the use of bulk solutions, shaking and pH changes to "release" dissolved gas (especially carbon dioxide). Gas generation in the current approach is achieved by the coupling of catalase to haptens or antibodies for use in competitive or sandwich immunoassays, respectively. Hydrogen peroxide is used as the substrate. Performance characteristics of the sensor apparatus were assessed in several ways. Injection of various volumes of air from a gas-tight syringe produced an essentially linear relationship from 0.2 to 2.0 microl of injected volume, with a slope of approximately 5 V/microl. Depending on the duration of the sampling period, specific signals in excess of 2 V have been obtained for 0.01 units of catalase (approximately 0.4 ng of protein). Development and use of this sensing apparatus will be described for both competitive and sandwich immunoassays.

Aflatoxins↗

PubMedDate not supplied

How disclosing HMO physician incentives affects trust.

Opinions are deeply divided over whether rewarding physicians for lowering costs decreases trust in physicians or insurers. To explore the effects of disclosing physician payment methods in HMOs, members of two similar HMO plans were randomized to intervention and control groups, and the experimental arm was told how the HMO paid their primary care physician. Separate disclosures were developed for each plan, one describing primarily capitation payment, and the other (mixed-incentive plan) describing fee-for-service payment with a bonus that rewards cost savings, satisfaction, and preventive services. The disclosures pointed out more of the positive than the negative features of these incentives. We found that the disclosures doubled the number of subjects with substantial knowledge of the physician incentives and halved the number with no knowledge. Nevertheless, the disclosures had no negative effects on trust of either physicians or insurers. The capitated plan disclosure had a small positive effect on trust of physicians. Disclosing the positive and negative features of incentives and increasing knowledge of these incentives does not, in the short term, reduce trust in physicians or insurers and may have a mild positive impact on physician trust, perhaps as a consequence of displaying candor and increasing understanding of positive features.

Adult↗