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Biomedical subjects

G H DeFriese

Publications and source records attributed to G H DeFriese.

At least 55 records · Page 3Linked to original sources
PubMed1983

An evaluation of subsidized rural primary care programs: I. A typology of practice organizations.

The design of a comprehensive evaluation of subsidized rural primary care programs on a large national scale is described, Its major purpose is to derive data whose analysis will answer major policy questions about the factors influencing the outcome of the major types of such programs in different communities. This first paper also delineates a typology which was developed of five principal organizational forms of these programs. This classification appears to provide suitable operational definitions of forms of rural practice as a basis for evaluating the differential impact of alternative types of primary care programs.

Data Collection↗
PubMed1983

The hospital and medical practice: a study of physician staff appointments among specialists and generalists.

The names, specialties, and appointment status of physicians with privileges in 161 North Carolina hospitals were obtained and compared to the file of licensed, active, patient-care physicians practicing in the State for the year 1978. The listings were examined to determine the number of physicians without a hospital privilege by age, race, sex, specialty, and geographic location. Overall, only 11 percent of all active physicians did not have some form of hospital appointment. Among family and general practitioners, 29 percent had either a restricted hospital privilege or no hospital appointment at all. A greater number of nonwhite and female physicians were also without privileges. These data have implications for the training of physicians in a system that emphasizes hospital care and includes inpatient treatment within the purview of primary care.

Adult↗
PubMed1981

Child health care and "the new morbidity": toward a model for the linkage of private medical practice and the public schools.

A renewed, and somewhat overdue, emphasis on programs for children has become a widespread concern of the health and human services fields. This paper addresses the problems and potentials of achieving a greater degree of coordination of the child-oriented human services through an examination of the response and the interaction of the (largely private) medical care and the (largely public) educational systems with respect to the special situation of children with learning-related handicapping conditions. The perspectives and particular interests of each of these complex systems are described along with their special role in the detection, assessment, and intervention with regard to children with learning-related problems. A description is provided of the process through which children are placed in educational programs that give special recognition to their learning difficulties. Particular note is taken of those places where medical care providers can have an effective influence on the educational placement of the child. The paper concludes with four recommendations that should help to insure the interaction of child health and educational services for children with learning-related handicapping conditions.

Child↗
PubMed1981

New health practitioners in rural satellite health centers: the past and future.

Data from a 1975 and a follow-up 1979 survey of 44 rural, satellite health centers staffed by new health practitioners (NHPs)are compared to determine what changes have taken place in these centers during this period when the number of physicians in the United States has markedly increased. Of the surveyed clinics, 8 closed and 12 converted to having physicians on their staffs by 1979. The remaining 24 NHP-staffed centers realized growth in staff size and budget, patient utilization, and proportion of budget generated by revenues from patients. (Despite these positive changes, most of these 24 clinics expressed concern about their financial situations-a reflection of the considerable room for further improvement.) The general growth of the 24 NHP-staffed satellites, however, was not as substantial as that achieved by the 12 clinics staffed by physicians in 1979. The rapidly increasing supply of physicians in the United States and the potential effects of this trend on NHP-staffed rural satellite centers are discussed. Possible reasons why these satellites may continue to be of value in making primary care available in rural areas are enumerated.

Community Health Centers↗
PubMed1981

Estimating dental manpower requirements on a statewide basis.

The North Carolina Dental Manpower Study undertook to use epidemiological data on dental disease, data on practice productivity, and estimates of treatment needs to arrive at more useful measures of dental manpower requirements on a statewide and substate regional basis. As in all attempts to plan for health manpower, the North Carolina study relied upon a measure of subjective judgment pertaining to the treatment/services required to deal with certain dental conditions. These judgments, however, were representative of the conventional standards of practice in North Carolina at the time of the study. Though certain important factors necessary to a complete assessment of dental manpower requirements were not directly measured in the study (e.g., consumer demand), estimates of the volume increase in dental-office practice-productivity were derived for the major categories of dental procedures and conditions. In North Carolina this technic is thought to represent a more meaningful approach to dental manpower planning than the conventional manpower-to-population ratio.

Dental Care↗
PubMed1981

The program implications of administrative relationships between local health departments and state and local government.

A typology of organizational arrangements between state and local public health agencies was used as a framework within which the organizational environment of the local health department was studied for its effects on program development and implementation by local public health departments. Data collected in a national sample of local health officers were used in measuring the effect of four different patterns of administrative relationships on the selected characteristics of local health department programs. Important differences were observed among the four organizational types with regard to constraints on programs and program priorities, and health officers' perceptions of the primary functions of local health departments and sources of local health department funding. These findings were then used as a baseline from which to consider the possible impact of recent federal health budgetary proposals (specifically, block grants) both on existing patterns of intergovernmental relations and on the funding and operation of local health department programs. It was determined that the most likely general development arising from these proposed changes in federal budgetary policy is that the administrative control of state health agencies over those at the local level is likely to be enhanced. Other likely developments include changes in the programs and priorities of local health departments related to reductions in overall funding levels for human services and forced competition for fewer dollars by an enlarged constituency.

Community Health Services↗
PubMed1981

An agenda for health services research in primary care.

The federal government has assisted universities with the development of interdisciplinary research centers that focus on health care delivery problems. The North Carolina center has sponsored and conducted a variety of studies on dozens of health issues.

Health Services Research↗
PubMed1977

Physician receptivity to nurse practitioners: a study of the correlates of the delegation of clinical responsibility.

A survey to measure physician receptivity to nurse practitioners was conducted in North Carolina in 1973. All North Carolina physicians were asked to rate a list of 35 clinical tasks of varying levels of difficulty and responsibility according to their willingness to delegate these tasks to nurse practitioners. Using eight items from this list that were good discriminants of physician attitudes towards delegating responsibility, task delegation scores were correlated with physician characteristics and their responses to questions about recruitment, training, reimbursement, and willingness to hire nurse practitioners. Thirty-four per cent of the respondents would hire a nurse practitioner, whereas 52% approved of the concept but would not hire one. Physicians who had previously worked with a nurse practitioner were more willing to hire one and had a higher task delegation score. Sixty-eight per cent of respondents would share their load with nurse practitioners in their offices, while 6% would have them work in satellite clinics away from the physicians' offices. Most physicians wanted their own nurse trained as a nurse practitioner in a program that combined a didactic course at a medical center with on-the-job training. The authors conclude that there is a potential demand for nurse practitioners in North Carolina and that the training program must prepare the nurse practitioners for the tasks physicians are willing to delegate to them.

Attitude of Health Personnel↗
PubMed1977

A survey of local public health departments and their directors.

In 1974 a questionnaire was mailed to the nation's local health officers. Responses were received from 1,345, at least 68 per cent of all local health departments. The present paper presents selected summary data from respondents concerning the health departments, their jurisdictions, organization, finance, functions, staffing, and about the training, salaries, and other characteristics of local health officers. Health departments are extensively involved in rendering health services, including direct personal services (25 per cent of all departments). For many services the health department is the sole provider of essential services in the area of jurisdiction. These services include ambulatory care (8 per cent), maternal and child health (48.5 per cent), home care (44.8 per cent), and family planning (38 per cent). The major constraints to improvement and expansion of programs are perceived as limited financial support, insufficient staff, and inadequate facilities.

Administrative Personnel↗
PubMed1977

Statutory authorizations for the work of local health departments.

A study of public health statutes of the 50 states identifies 44 specific services or functions that are assigned to local health departments by all or some of the states. Authorizations are most commonly assigned conjointly both to local and state health departments; exceptions are identified. Data suggest striking inconsistencies between what local health departments are authorized to perform and the services they actually render with regard to a selected group of programs that involve personal health services. The full scope of authorizations for local health departments is not revealed by examination of public health statutes. For this reason, among others, development of up-to-date health codes for all states would be beneficial.

Humans↗