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Biomedical subjects

G E Fryer

Publications and source records attributed to G E Fryer.

At least 55 records · Page 3Linked to original sources
PubMed1997

Predictors and profiles of rural versus urban family practice.

BACKGROUND AND OBJECTIVES: Much of rural Colorado has been designated a shortage area for primary care health personnel. The state's only medical school and its family practice residency programs are expected to address this long-standing problem. This study identified predictors of rural practice location and contrasted the service profiles of rural versus urban family physicians and general practitioners. METHODS: The Colorado Board of Medical Examiners mailed a questionnaire to all licensed Colorado physicians. Logistic regression analyses were conducted using variables determined to be significantly related to practice location (rural versus urban) by univariate statistical tests. Information from the 986 family physician and general practitioner respondents identified personal and educational variables strongly associated with choice of rural practice location and differentiated between practice tendencies of rural versus urban physicians. RESULTS: Having been raised in rural Colorado was the most powerful predictor of rural practice location in the state. Family physicians and general practitioners serving rural populations spent much more time weekly providing direct patient care and more often cared for Medicaid patients. CONCLUSIONS: Personal characteristics and background may be useful considerations in selecting among applicants for medical schools and family practice residency programs committed to reducing the severe shortage of health care service in rural areas.

Adult↗
PubMed1996

Randomized controlled trial of residents as gatekeepers.

BACKGROUND: Managed care advocates suggest that primary care gatekeepers may improve patient care and reduce costs. Training internal medicine residents in these gatekeeping functions has not been emphasized in most internal medicine programs. OBJECTIVE: To determine if residents could perform gatekeeper functions and if patient costs and satisfaction would be favorable. METHODS: Patients (n = 254) followed up by residents (n = 26) in continuity clinics at the Denver Veterans Affairs Medical Center in Denver, Colo, were divided into 2 groups. A control group of 128 was followed up by residents with no restrictions on appointments made for them. An intervention group of 126 patients were followed up by residents who had to approve all referrals made for their patients. A research nurse assisted with the approvals when the residents were rotating through other institutions. Utilization of resources, satisfaction with care, and health status were monitored over a 1-year period. RESULTS: A minor reduction of resource utilization was found in the intervention group, particularly in medication use. Significantly more visits were made to primary care providers in the intervention group (3.01 vs 2.59; P = .03). Patient satisfaction and health status were similar in both groups with a trend toward better satisfaction in the intervention group in some areas. CONCLUSIONS: Our study showed that residents can function as gatekeepers of highly complex patients and that satisfaction with care and utilization of resources does not suffer. Drug utilization and costs may be less when a gatekeeper exists.

Ambulatory Care↗
PubMed1996

Effects of a postdischarge clinic on housestaff satisfaction and utilization of hospital services.

This randomized, controlled clinical trial evaluated the effect of a postdischarge clinic on housestaff education and patient utilization of hospital services. Medicine housestaff were randomized either to attend a clinic once a week in which they saw all eligible patients they had recently discharged from the hospital, or to continue with usual discharge practices. We enrolled 751 patients, 312 on intervention teams and 439 on control teams. Intervention housestaff did not feel that the clinic took too much time and felt that they better knew how patients did after discharge. Fewer intervention patients had emergency room visits (28.0% to 20.8%, p = .03) in the 30 days after discharge. Length of stay, readmission rates, and mortality were similar for the two groups. We conclude that a postdischarge clinic can improve resident education and reduce postdischarge emergency room utilization.

Colorado↗
PubMed1996

Trends in a national sample of sexually abusive youths.

OBJECTIVE: To describe sociodemographic factors pertinent to sexually abusive youths, to define common characteristics of the offending behaviors and victims, and to identify issues relevant to treatment recommendations. METHOD: The Uniform Data Collection system (UDCS), developed by the National Adolescent Perpetrator Network, provided data from 90 contributors in 30 states on more than 1,600 juveniles referred to them for specialized evaluation and/or treatment following a sexual offense. The UDCS comprises four separate structured questionnaires that collect both factual information and clinical impressions. RESULTS: Physical and sexual abuse, neglect, and loss of a parental figure were common in these youths' histories. Twenty-two percent of the youths, who had been victims of sexual abuse, reported that the perpetrator of their own sexual abuse was female. The youths committed a wide range of sexual offenses, with twice as many of the referring offenses involving female victims than male victims. CONCLUSION: The discovery of sexually abusive youths across both urban and rural areas supports the need for comprehensive service delivery and a continuum of treatment services to be available in all communities.

Adolescent↗
PubMed1996

Functions of school nurses and health assistants in U.S. school health programs.

This paper reports results from a nationwide survey of a systematic random sample of school districts. Information obtained from 482 participating districts was used to contrast roles of nurses and health assistants in school health programs throughout the country. Most districts relied heavily on nursing personnel for technically involved clinical services, but often employed health assistants to administer medications and basic first aid. Litigation was somewhat more frequently filed regarding care provided by health assistants than care by nurses or classroom personnel. But in general, health assistants were performing satisfactorily, particularly in districts where registered nurses coordinated the services and activities of health program personnel. While use of health assistants increased the past three years, school nurses were not being displaced. Just 9% of districts had downsized their nursing staff during that period. Despite the modest expansion of nursing resources, nurses reportedly were underused in health education programs of most schools.

Health Education↗
PubMed1996

Shortening length of stay without increasing recidivism on a university-affiliated inpatient unit.

The impact of reducing length of stay on readmission rates was examined for privately insured patients treated on a traditional inpatient unit or in an alternatives program with a shorter stay and a continuum of acute care. Billing data were analyzed for length of stay and readmission rates for all admissions between 1985 and 1992 (N = 1,363). The traditional unit was reorganized in 1990 into the alternatives program. Although the program decreased mean length of stay from 20.2 days to 6.2 full-day equivalents, overall readmission rates did not increase (17.2 percent, compared with 18.6 percent for the traditional unit). Rates increased for a subgroup of patients with psychotic disorders (from 13.7 to 35.2 percent).

Adolescent↗
PubMed1995

A cluster analysis of detected and substantiated child maltreatment incidents in rural Colorado.

This paper reports the results of a cluster analysis of the incidents of detected and substantiated child maltreatment in 31 rural Colorado counties during the 5-year period (1986-1990). Mapping and statistical techniques employed revealed time-space clustering in the occurrence of child abuse and neglect in sparsely settled rural areas of the state. The study examined temporal-geographic patterns among all 830 confirmed incidents in the Colorado Child Abuse and Neglect Registry for counties of less than 10,000 population. These findings suggest that a first incident of abuse or neglect serves as a sentinel event, predicting a period of more frequent receipt and substantiation of maltreatment cases by child protection professionals in the county or community of occurrence. Clustering was apparent using 3-, 7-, 14-, 30-, and 60-day intervals of time; a scheme endorsed by the Centers for Disease Control for national study of the epidemicity of adolescent suicide. An agenda is proposed to review the appropriateness and adequacy of child protection policies and protocols in view of this phenomenon, and to pursue additional related research objectives.

Child↗
PubMed1994

A survival analysis of the revictimization of children: the case of Colorado.

This paper reports the results of a survival analysis of patterns of revictimization of children with records of confirmed cases of maltreatment in Colorado during the 4-year period 1986-1989. The study examined the cases of 24,507 children in that state's Child Abuse and Neglect Registry for evidence of their revictimization. Hazard rates for repeat offenses were highest immediately after the initial incident of abuse or neglect. Risk of revictimization was greater for younger children and for females, but those relationships were strongly mediated by the form of maltreatment. The rate of revictimization of physically neglected children exceeded that for other major types of maltreatment. Although abused and neglected children were most at risk immediately after their incident of abuse or neglect, they remained at greater risk of mistreatment for years thereafter.

Adolescent↗
PubMed1994

Geographic benefit from decentralized medical education: student and preceptor practice patterns.

The performance of area health education center (AHEC)-stimulated programs and decentralized education for medicine is not well understood. The Statewide Education Activities for Rural Colorado's Health (SEARCH)/AHEC project at the University of Colorado School of Medicine was examined to determine if the program had an effect on the practice location of its graduates. Practice location and specialty of graduates of the University of Colorado School of Medicine (UCSOM) classes 1980-1985 were compared for students who had participated in decentralized SEARCH/AHEC experiences versus students who had not. The majority of the graduates were practicing out of state in 1990. Non-Colorado doctors were more often practicing in rural (non-metropolitan statistical area [MSA]) counties and in towns of fewer than 2,500, 5,000 and 10,000 residents, respectively. In addition, of the 251 active patient care physicians practicing in Colorado communities of fewer than 10,000 in non-MSA counties in 1986, those who precepted UCSOM students on SEARCH rotations were more likely to have remained in their same practice location in 1992 (77.8% versus 62.1% for those who had not precepted students). This analysis of both student and preceptor practice patterns documents the value of decentralized medical education in addressing the geographic and specialty maldistribution of physicians. These results have important policy implications for funding medical education programs.

Area Health Education Centers↗
PubMed1994

Neonatal group B streptococcal sepsis during 2 years of a universal screening program.

OBJECTIVE: To assess the feasibility and efficacy of a protocol for universal screening for group B streptococci combined with selective intrapartum prophylaxis at a teaching hospital. METHODS: This is a descriptive study of experience with a standardized protocol in which patients were screened at 26-28 weeks with a rectal and genital culture placed directly in selective media. As risk factors, we used clinical chorioamnionitis, preterm birth, and rupture of the membranes greater than 12 hours. Participants were all women receiving prenatal care at our hospital. Major outcomes were compliance and neonatal sepsis due to group B streptococci. RESULTS: The prevalence of rectal and genital group B streptococci was 18.5% of 3721 screened women. Of culture-positive women, 35% developed risk factors (9% chorioamnionitis, 13% preterm birth, and 13% membrane rupture greater than 12 hours at term). With strict application of criteria, the compliance rate in administering indicated prophylaxis was 80.3%. Of women receiving prophylaxis, 42% had the first dose for 4 hours or less before delivery. There were five cases of group B streptococcal neonatal sepsis, resulting from either protocol violations, protocol failures, or both. Compared to the historic rate of group B streptococcal sepsis of 1.5 per 1000 births at our hospital, the rate in these 2 years was 1.0 per 1000 (1.6 per 1000 in the first year and 0.5 per 1000 in the second). CONCLUSIONS: It is feasible to conduct such a protocol, but compliance is only moderately good because the algorithm is complex. The protocol is not foolproof in preventing neonatal group B streptococcal sepsis, as there are protocol failures and violations.

Adult↗
PubMed1991

Physician assistants as members of social service child protection units.

A nationwide survey of county departments of social services revealed a need for medical services and consultation to child protection units. Over 92% of the 84 counties surveyed stated they had a problem meeting their medical needs and would be willing to hire a physician assistant as medical consultant to their county's child protection team. No county refused to consider a physician assistant, but 7% felt their medical requirements were being met. Needs the counties most commonly identified were providing parent education/anticipatory guidance (69%), interviewing (65.5%), interpreting medical information to a multidisciplinary child protection team (58.3%), review of medical records (45.8%), and physical examinations (42.9%). Over 17% of the counties had money to fund a full-time physician assistant, and over 60% of the counties could provide a partial salary, with 70.5% willing to share a salary with adjacent counties and 76.9% with the county's public health department.

Child↗
PubMed1990

A comparison of hospital and home assessment of parenting potential.

Factors influencing parenting were compared when assessments were done: (1) on the hospital postpartum ward and, (2) in the home. Thirteen factors thought to contribute to parenting potential and two items summing the risk for abuse/neglect were assessed. Items evaluating the mother's health and her ability to talk out problems provided more accurate assessment in the hospital; child focused items could be evaluated in either setting; the mother's isolation, and perception of herself were more accurately assessed in the home. Most mothers generated less concern at home. If postpartum assessment raises concerns for future parenting dysfunction, it is imperative to re-evaluate in the home and initiate appropriate referrals.

Child Abuse↗
PubMed1990

Prison mental health services: results of a national survey of standards, resources, administrative structure, and litigation.

The formation of adequate mental health systems within prisons has accelerated as a result of successful class action lawsuits. Our recent national survey questioned all state correctional departments about the existence of standards in each system, compliance with such standards, prevalence of class action lawsuits involving the issue of providing adequate mental health services for inmates, issues related to consent decrees, available mental health resources within the correctional system, and the administrative structure of the mental health system. Our purpose was to identify those factors correlated with certified class action lawsuits involving issues related to mental health services. Twenty-one states were involved in such litigation. Only the presence of psychiatric hospitals operated by the department of corrections correlated with the presence of certified class action lawsuits involving mental health services. Prison systems larger than 15,000 inmates were at higher risk for such litigation. Smaller systems having psychiatric hospitals run by the state mental health agency appeared to be at less risk for such litigation.

Jurisprudence↗