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Biomedical subjects

G L Cafferata

Publications and source records attributed to G L Cafferata.

At least 19 recordsLinked to original sources
PubMed1992

Depression among caregivers of impaired elders.

Studies have reported that rates of depression among caregivers are higher than in the general population. However, these studies have been limited primarily to caregivers of cognitively impaired elders. Using the Center for Epidemiological Studies Depression (CES-D) Scale, this study investigated depression among caregivers for physically impaired elders. The authors found that one third of these caregivers reported depressive symptoms, a lower rate than for caregivers of cognitively impaired elders but still twice the rate for the general population. The data show that depressive symptoms are related primarily to health status but also to aspects of the caregiving situation, including both the negative impact of that care as well as the relationship of the caregiver to the frail elder. Depressive symptoms are not mediated by formal or informal support.

Adult↗
PubMed1990

Pathways to psychotropic drugs. Understanding the basis of gender differences.

Earlier studies have established substantial gender differences in the likelihood of obtaining a psychotropic drug prescription, and a correlation, especially among women, with such family characteristics as family responsibilities, marital separation, divorce or widowhood, and the presence of family stressors such as an ill spouse. However, the pathways to psychotropic drug use are not clearly understood. Data from the National Medical Care Expenditure Survey show that gender differences in obtaining a psychotropic drug can be accounted for by the greater likelihood of women to perceive illness, particularly mental illness and musculoskeletal conditions, diagnostic conditions that together account for roughly half of all psychotropic drug prescriptions. In relation to family responsibilities, employment significantly decreases the likelihood of a psychotropic drug prescription for both men and women. The greater likelihood of divorced, separated, or widowed women to obtain psychotropic drugs can be explained by their greater likelihood of episodes of illness, particularly those involving mental illness, and by their greater number of physician visits. The presence of all ill spouse is associated with psychotropic drug use only indirectly by increasing the likelihood of Medicaid coverage. Thus, differences between men and women in the likelihood of obtaining prescriptions for psychotropic drugs do not appear to result from different physician-patient interactions or from gender-determined treatment norms by physicians.

Adult↗
PubMed1989

Patient satisfaction and the use of health services. Explorations in causality.

Little research exists that examines the causal relationship between patient satisfaction and the use of health services. This study of a representative sample of low income families suggests that a relationship does exist. Furthermore, results reported indicate it is bidirectional and reciprocal in nature, and that it is highly related to the provider from which patients seek care. Analysis according to the five major area clinics that were main sources of medical care for an upstate New York community (two HMOs, two hospital-affiliated teaching clinics, and one continuity-of-care clinic) revealed that, in some providers, the association between use and satisfaction is positive, in others negative. Further evidence for a "patient provider" interaction hypothesis was found, suggesting that background characteristics, including health status and race, are related to use and satisfaction in different ways in different clinics. The findings provide evidence for the existence of a causal relationship between use and satisfaction, which is dependent on the context in which medical care is given, and also suggest structural characteristics that might be responsible for these effects. A final conceptual model of satisfaction is offered, permitting reciprocal causation with use and satisfaction with emphasis on patient provider interactions, and this model provides an identification of short- and long-term processes. Progress in this area might require a shift in perspective upward toward structural and systems variables or a shift downward toward "microanalytic" processes, which detail patient-provider interactions.

Consumer Behavior↗
PubMed1989

The caregiving role: dimensions of burden and benefits.

Rapidly increasing public expenditures for nursing home care raise the policy question of how to support community care of disabled elderly persons and postpone admissions to nursing homes. It is crucial that research clearly identify the burdens of community caregivers in order to devise appropriate support programs. Data from the Caregiver Survey of the 1982 Long Term Care Survey are used here to understand dimensions of caregiver burdens and benefits, to develop reliable scales, and to identify sources of variation in burden and benefits. Using factor analysis, two dimensions of caregiver burden were identified, including role strain and role conflicts indicated by items comprising Guttman scales. Caregiver characteristics associated with variations in total perceived caregiver burdens, role strain and role conflict include the extent of caregiving work (disabled person's ADL, IADL scores), caregiver resources (age, health status, employment), latent social characteristics (gender), and the need to make adjustments in living (e.g. among employed caregivers, having to change work schedule to care for the disabled person). Caregiver benefits of two types - help with tasks and socio-emotional support - related inversely to objective burden as well as to relationship to the caregiver (spouse/nonspouse, primary caregiver/other).

Activities of Daily Living↗
PubMed1987

Marital status, living arrangements, and the use of health services by elderly persons.

Although marriage has been shown to have important health-protective consequences, it is not clear to what extent these effects are due to marriage per se or to the fact that married people are less likely to live alone. The social support literature suggests that living with others may reduce the need for use of formal and informal health care services independently of marital status because of (a) the substitution of home care, and/or (b) enhancement of physical and mental health. This study of elderly persons, based on data from the National Medical Care Expenditure Survey (NMCES), examined the substitution hypothesis. The impact of marital status and living arrangements on the use of formal health services among persons 65 years of age and older was examined using path analysis. These data confirm a substitution effect whereby persons living with others are more likely to stay in bed, but less likely to see a doctor, than are persons who live alone.

Aged↗
PubMed1985

Family structure and children's use of ambulatory physician services.

The purpose of this article is to examine children's use of ambulatory physician services in relation to three dimensions of family life: maternal employment, single-parent versus two-parent households, and the presence of a nuclear or extended family. Data from the National Medical Care Expenditure Survey show that maternal employment has no relationship to children's experience of disability days, and although children of mothers employed full-time are less likely to have a physician contact than are other children, this is attributable to a lower probability of seeing a doctor for children in good health (i.e., no disability days). Multivariate analysis confirms that although maternal employment decreases the likelihood of an ambulatory physician visit (among children with no disability days), it does not affect the total number of ambulatory physician visits or the likelihood of a telephone consultation with the child's physician. Children in single-parent families are more likely to see a physician when they have no disability days, than are children in families with two parents present. Children in nuclear rather than extended families do not differ in patterns of use, even when the mother works. Aside from other characteristics that might be expected to affect use (e.g., age, health status, insurance coverage, a usual source of care), there is a clear relationship between likelihood and volume of use by mothers and children.

Ambulatory Care↗
PubMed1985

Private health insurance of the Medicare population and the Baucus legislation.

The appropriateness of the benefits associated with the private insurance coverage of the Medicare population has been the subject of considerable concern. Section 507 of the Social Security Amendments of 1980, also known as the Baucus legislation, reflects public concerns about the level of benefits in relation to premiums, duplicative coverage, the complexity and difficulty of insurance terminology, and marketing abuses. Data from the National Medical Care Expenditure Survey can provide useful baseline data on the distribution of Baucus-like plans. In 1977, private insurance held by the Medicare population was more likely to cover inpatient than outpatient services and to emphasize "first dollar" benefits for long-term care. Multivariate analyses show that the distribution of Baucus-like insurance policies is highly associated with health status, source of insurance, region, and place of residence. The importance of state regulations, suggested in other research, may account for these patterns.

Aged↗
PubMed1985

The elderly's private insurance coverage of nursing home care.

About 40 per cent of Medicare beneficiaries had private insurance coverage of skilled nursing facilities (SNF) in 1977. Data from the 1977 National Medical Care Expenditure Survey show that among such persons, about 85 per cent had full coverage of Medicare's Part A copayments for days 21-100 but only 15.7 per cent had maximum coverage of at least 365 days of care or a benefit of $100,000 or more. The most comprehensive benefits are found among persons with middle or high incomes; more generous first-dollar coverage is found in the North Central and South regions, and more generous maximums in the West.

Aged↗
PubMed1984

Knowledge of their health insurance coverage by the elderly.

Current legislative proposals to increase competition among private insurers assume that people are or can be well-informed about their insurance coverage. Evidence from the National Medical Care Expenditure Survey shows that among the population 65 years of age and older knowledge about health insurance coverage is substantial but generally lower than in the population younger than 65 years of age. Multivariate analysis is used to identify factors associated with high and low levels of knowledge. Although correct knowledge of coverage of particular services is highly associated with current experience of health problems, with use of these health services, and with the cost for private insurance, overall knowledge is lowest among some groups at high risk of serious illness, in particular, the old, nonwhites, and persons enrolled in Medicare but without Medicaid or private insurance supplements.

Aged↗
PubMed1979

Member and leader satisfaction with a professional association: an exchange perspective.

The theories of exchange and of collective action were used to guide a study of the sources of satisfaction of the participants in a medical specialty society. This survey of two groups of participants, leaders and members, showed that the leaders of this nationally recognized professional association were more satisfied than were the regular members; that even though leaders and members have similar professional interests, the two groups evaluated the association differently; and that the involvement of leaders in the activities of other professional associations affected their satisfaction with this association. These results indicate empirical support for exchange theory and for the distinction among kinds of rewards made by the theory of collective action. Structural sources of satisfaction and dissatisfaction are identified for future research.

Attitude of Health Personnel↗
PubMed1976

Survey of dentists' opinions on issues facing the profession.

Dentists in the Seventh District Dental Society of the State of New York were surveyed for their attitudes toward selected health policy issues to determine the extent of attitudinal consensus in the professional community, the bases of significant differences of opinion, and the agreement of the local dentists with official policies of the American Dental Association. Greatest agreement among dentists was found with respect to the issues of licensure and peer review; some significant differences of opinion were found about the existence of manpower problems, expansion of dental schools, recruitment of minorities, expanded-duty auxiliaries, and fee scheduling. Most dentists favored participation in continuing education courses without examination as a requisite for licensure and even more favored peer review by the local dental society. Agreement between opinions of local dentists and official ADA policies was high on all issues except fee posting, for which local opinion was evenly divided. The formation of national policies with regard to fee posting should proceed carefully.

Adult↗
PubMed1975

Continuing education: attitudes, interests, and experiences of practicing dentists.

This study was designed to examine the determinants of interest in formal continuing education courses of two different types, clinical and practice oriented. Major findings were (1) practice-oriented and clinically oriented courses differed in attractiveness among different segments of the dental profession, (2) interest in courses of a clinical nature was higher and more widespread throughout the proffession than was interest in management courses, and (3) half of the dentists supported mandatory continuing education for renewal of licenses, but 56% opposed a requirement that examinations in those courses be successfully completed. Interest in practice-related courses was related to age, income, use of allied health personnel, journal reading, and participation in study clubs. Clinically related courses were slightly more attractive to the sample than were practice-oriented courses, but current offerings of this type are less attractive to specialists than to general practitioners. Clinical courses generally appeal to the more active segments of the profession, and interest is associated with journal reading, participation in study clubs, and attendance at dental meetings. The appeal of clinical titles was more universal than that of management titles. Few background and practice characteristics were correlated with desire to keep up with the field, and those correlations that existed were smaller than those relating these variables to interest in practice; the only exception was specialization, as was noted above. Support for mandatory continuing education without examination as a requirement for relicensure was substantial. Further, no significant cleavages on this issue could be associated with any of the background or practice characteristics which were studied, a finding that indicate the existence of broad-based consensus in the sample.

Age Factors↗