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Biomedical subjects

H Tabenkin

Publications and source records attributed to H Tabenkin.

At least 37 records · Page 2Linked to original sources
PubMed2000

[What do primary care physicians think of Israel's health policy reform?].

Opinions of the National Health Insurance (NHI) Law held by primary care physicians were surveyed. A questionnaire was submitted (April-July 1997) to 930 primary care physicians employed by sick funds, including general practitioners, family physicians, pediatricians and internists. Response rate was 86%. They supported the main components of the NHI law. It was considered desirable "to a great" or "very great extent" to allocate funds to sick funds based on age and number of members (76%), to require them to accept all applicants (72%), to designate a uniform basket of services (65%), to allow members to transfer freely between funds (63%), and to allow sick funds to sell supplemental insurance (59%). However, only 41% were satisfied with the implementation of the law. Multivariate analysis showed that employment by Maccabi, Meuhedet, or Leumit sick funds had an independent effect on low satisfaction with the law as implemented, and on negative opinions about the uniform basket of services, the accepting of all applicants, and allocation of funding based on age and number of members. Those employed by the Maccabi and Meuhedet funds were in favor of allowing sick funds to sell supplemental insurance. The findings of the study have implications for policy-makers interested in increasing support for national health reform by physicians. It is important to examine possibilities of developing direct channels of communication between national policy-makers and physicians, as well as institutionalizing mechanisms that involve physicians directly in formulation of national policy.

Adult↗
PubMed2000

[Physicians' opinions about the patient rights law--a qualitative study].

A qualitative analysis of the question "what is your general opinion of the Patient Rights Law?" showed that most physicians think it a good law that contributes to improved relations with patients. Physicians surveyed raised several issues relating to implementation of the law: conditions, time required to implement it and problems with language and comprehension. Fears were expressed about possible abuse of the law by patients and their lawyers, which could put medicine on the defensive. Nevertheless, most physicians think the law positive, that it has not negatively affected their work, and contributes to improved relationships with patients. They recommend that working conditions be improved in order to fully implement the law.

Attitude of Health Personnel↗
PubMed1999

[Knowledge and practice of primary care physicians relating to the treatment of streptococcal pharyngitis].

Knowledge and practice of primary care physicians as to diagnosis and treatment of group A, b-hemolytic streptococcal pharyngitis, and the degree to which they agreed with the medical literature and current clinical guidelines were examined. The study was conducted in a group of 195 general physicians, pediatricians, and family medicine specialists and residents. The data were collected using questionnaires which included personal information and questions relating to b-hemolytic streptococcal pharyngitis and were analyzed by chi-square and t-tests, and logistic regression, as appropriate. A new dependent variable, good clinical practice (GCP), was defined as the total number of correct answers to the questions in the questionnaire. 147 of the 195 eligible physicians returned completed questionnaires, a compliance rate of 76%. 96.6% cited penicillin V as the drug of choice at a daily dosage of 1 g (43.7%) or 2 g (25.4%), for 10 days (90%). 133 physicians (90%) stated that the goal of penicillin therapy for b-hemolytic streptococcal pharyngitis is to prevent late complications. 116 physicians (82%) cited rheumatic fever as a complication of group A b-hemolytic streptococcal pharyngitis, preventable by appropriate antibiotic therapy. However, only 84 (59%) cited glomerulonephritis as a preventable complication. When the knowledge and attitudes of the respondents was analyzed in terms of the new variable, GCP, a significant association (p < 0.001) was found between physicians' attitudes and variables such as where they had studied medicine, and work seniority. Those with less seniority and or medical graduates of the Americas demonstrated greater knowledge and better clinical judgment than their more senior colleagues and graduates of European and Asian medical schools. Most primary care physicians in northern Israel treat group A b-hemolytic streptococcal pharyngitis as recommended in the medical literature. The level of medical studies in Israel and the Americas and the quality of training of residents in family medicine and pediatrics, have a positive influence on the degree of knowledge of as common a subject as b-hemolytic streptococcal pharyngitis. Emphasis should be placed on continuing medical education among primary care physicians, particularly veteran general physicians and those who studied in European or Asian medical schools.

Adult↗
PubMed1999

A case-control study of malignant melanoma in Israeli kibbutzim.

BACKGROUND: Incidence rates for malignant melanoma in Israel are rising steadily, and the kibbutz population is at increased risk for this malignancy. OBJECTIVES: To assess the risk factors for malignant melanoma among kibbutz members compared to matched healthy controls. METHODS: We conducted a case-control study of 168 malignant melanoma patients and 325 healthy controls, matched by age and gender. Data were collected on three categories of risk: demographic, personal (e.g., skin, eye and hair color), and environmental/behavioral (e.g., sun exposure, use of sunscreens). RESULTS: There were no differences between the groups regarding sociodemographic data. Significantly more patients than controls had fair, vulnerable skin (P < 0.001), light eyes (P < 0.05), and fair hair (P < 0.001). There was no difference in family history of malignant melanoma or other cancers. Patients with malignant melanoma had significantly more additional skin lesions (e.g., keratoses) (P < 0.001). More patients than controls recalled having been exposed to the sun for long periods when they were 6-13 years of age. A conditional logistic regression analysis showed that fair hair, fair vulnerable skin, and additional skin lesions were independently associated with malignant melanoma (P < 0.01). CONCLUSIONS: The main target population for interventions to reduce the incidence of malignant melanoma among kibbutz members should be individuals with these risk factors. A history of increased exposure to the sun from age 6 to 13 should also be taken into account as an independent risk factor.

Adult↗
PubMed1998

Patients' views of direct access to specialists: an Israeli experience.

CONTEXT: Surveys carried out among users of medical services can be a useful tool for health care organizations in designing proper services. Specifically, patients' views of direct access to specialists can be useful to health organizations considering the gatekeeper model. OBJECTIVE: To assess patients' opinions about direct access to specialists and referral to specialists through their primary care physician. DESIGN: An intercept survey, in which patients were interviewed at the randomly selected service provision sites, was carried out in 3 districts in Israel during 1995. A total of 1445 and 1289 patients were interviewed in primary care and specialty clinics, respectively. SETTING: Primary care and specialty clinics in 3 regions in Israel serving 750000 members of Kupat Holim Clalit, Israel's largest sick fund. PARTICIPANTS: Hebrew-speaking members of Kupat Holim Clalit who visited the primary care or specialty clinics in the 3 regions during the study period. MAIN OUTCOME MEASURES: Rate of preferences for direct access to specialists and preferences for referral through primary care physician. RESULTS: Fifty-two percent of the respondents preferred direct access to specialists, while 48% preferred a referral from their primary care physician. Multivariate logistic regression analysis indicated that the preference for direct access was significantly lower among patients older than 45 years (odds ratio [OR], 0.75; 95% confidence interval [CI], 0.62-0.91); patients whose primary care physician was a specialist in family medicine (OR, 0.80; 95% CI, 0.67-0.97); and patients who were satisfied with their primary care physician (OR, 0.34; 95% CI, 0.27-0.44). Preference for direct access was significantly higher among more highly educated patients (OR, 1.38; 95% CI, 1.16-1.65) and patients residing in Jerusalem (OR, 2.46; 95% CI, 2.05-2.95) and those younger than 45 years who were dissatisfied with their family physician or a primary care physician who was not board certified. If direct access was not available, 33% of respondents would leave the sick fund and 48% would remain; 19% did not know. CONCLUSIONS: Informing sick fund members, particularly the younger and more educated among them, about the advantages of consulting with the primary care physician, as well as providing specialty training in family medicine to primary care physicians, may reduce patients' preference for direct access to specialists.

Adult↗
PubMed1998

[Primary care physicians in Israel--compared with European countries].

This study compares Israeli primary care physicians with those of European countries. In Israel a larger proportion of those in primary care are women. The Israeli physicians see many patients a day, but almost never make home visits. They also report for work the fewest hours a day, but spend 21 hours a month in continuous medical education. (more than Europeans?) The Israeli primary care physician scores high in screening for breast cancer and blood cholesterol level, but very low in the fields of minor surgery and alcohol and smoking prevention, contraception, nutrition counseling and normal pregnancy follow-up. Residency training and education may be inadequate, and more emphasis has to be put on the health system and recognizing environmental influences.

Education, Medical, Continuing↗
PubMed1998

[Patients' opinions of the role of primary care physicians and the organization of health care services].

Patients' opinions of the role of the primary care physician were studied. The study population consisted of Hebrew-speaking members of the Clalit Sick Fund, aged 18+, who visited primary care and specialty clinics. Interviews took place during January-March 1995 in the Emek and Jerusalem, and during August-October 1995 in Beer Sheba. A total of 2,734 interviews were conducted, and the response rate was 88%. 64% of the respondents preferred the primary care physician as the first address for most problems occurring during the day. Multivariate analysis revealed that the variables predicting this reference were: being over age 45, having completed less than 12 years of schooling, being satisfied with the physician, and when a child's illness was involved. Whether the physician was a specialist had only a marginal effect. The findings also show that among those who did go directly to a specialist for the current visit, 49% would still prefer the primary care physician to be the first address for most problems. However, half of the respondents initiated the current visit to the specialty clinic themselves. The findings also showed that a preference for the primary care physician to be the first address had an independent and statistically significant effect on the following aspects of service consumption: taking the initiative to go to a specialist, the intention to return to the primary care physician or to the specialist for continuing care, and the patient's belief that referral to a specialist was needed. The findings of the study may be of assistance to policy-makers on the national level and to sick funds in planning the role of the primary care physician, so that it corresponds, on the one hand, to the needs of the sick funds and the economic constraints in the health system, and on the other, to the preferences of the patient.

Adult↗
PubMed1998

Referrals of patients by family physicians to consultants: a survey of the Israeli Family Practice Research Network.

OBJECTIVE: We aimed to analyse factors influencing referral of patients by primary care physicians to specialist consultants at the beginning of the era of direct access to specialists in Israel. METHODS: We carried out a study of referrals by family physicians to specialists over a continuous period of 3 months. Twenty-four certified family physicians filled in a questionnaire detailing referrals during the study period. All patients were referred for consultation to a specialist at regional speciality clinics or hospital out-patient departments. RESULTS: Ten physicians met the study conditions. In 1140 of 10896 (10.5%) visits, patients were referred to specialist consultants. The percentage of referral ranged from 7.4 to 15.9%. The difference between the physicians with the lowest and highest rates of referral was statistically significant (P < 0.0001). The variance in referral rates was not explained by significant differences in physician or practice variables. The types of specialists to whom the most referrals were made were orthopaedic surgeons, ophthalmologists, dermatologists, ear, nose and throat, general surgeons and plastic surgeons. There was a significant correlation between the type of specialist and the age of the patient. Older patients were referred more frequently to urologists, cardiologists and ophthalmologists, while younger patients were referred more frequently to ear, nose and throat specialists and gynaecologists (P < 0.01). CONCLUSIONS: The results of this study can be used as an aid for decision makers in the health services for determining policy. Direct access to some specialties might be appropriate, but not to all. Adoption of a policy based on these findings could lead to reduced health care costs by reducing the burden on hospital emergency rooms. It might also increase patient satisfaction in that the patients will have greater freedom of choice. On the other hand, more appropriate training of family physicians and more extensive self- and peer-quality assurance will increase the primary physician's knowledge and ability to diagnose and treat a broad range of problems and improve the level of care.

Adult↗
PubMed1996

Preventive medicine in primary care in Israel: findings from a national survey.

OBJECTIVE: Primary care physicians are ideally placed in the health care system to implement programs for prevention and early detection of disease, and to promulgate health education. The purpose of this study was to examine the extent of preventive activities undertaken by primary care physicians in Israel, and to identify differences in the performance of these activities, based on personal and organizational characteristics, and on the breadth of general medical activities. STUDY SELECTION: A mail survey of a stratified random sample of primary care physicians was conducted. Questionnaires were received from 677 of 872 eligible physicians in the sample, for a response rate of 77.6%. Descriptive statistics and logistic regression were used to analyze the relationship between personal and organizational characteristics of physicians, and their performance of preventive activities. RESULTS: The results of the study indicate that 68.2% of the physicians screened for hypertension, and that smoking and diet education were performed by 78% and 68%, respectively. Cholesterol screening and breast examinations were performed by between 40% and 59%, respectively. Specialists and residents in family medicine, women physicians, physicians who treat a wide range of problems without referral, physicians who participate in 22+ hours of continuing medical education per month, and physicians aged 30-54 engaged in more preventive activities. Physicians with large patient lists and who worked with nurses performed more preventive activities with specially-invited groups of patients. CONCLUSIONS: There is wide variation in the performance of preventive activities in primary care in Israel. The findings indicate the positive role of training in family medicine, teamwork with nurses, and continuing medical education for the performance of preventive activities.

Adult↗
PubMed1995

[The general practitioner as physician of first contact with health problems].

An aim of this study was to determine the extent to which general practitioners (GPs) are their patients' physicians of first contact (PFCs) for specific health problems. It was also designed to explain the differences between physicians who treat these problems, and those who do not, by the type of problem presented, the characteristics of the physician, and the characteristics of the environment in which the physician works. The study is based on data collected in a nationwide mail survey in 1993 among 677 GPs working in 1 or more of Israel's 4 health insurance funds. They were asked if they were their patients' PFC for 27 health problems. There was great variation in the responses to this question according to the type of health problem presented. Thus for problems such as abdominal pain or chest pain, 85% of the GPs reported being the PFC, compared with only 50% for problems of suicidal thoughts or alcohol dependence. Multivariate analysis revealed that those more likely to report being their patients' PFC for the majority of problems presented were specialists in family medicine (p < 0.001), physicians under the age of 55 (p < 0.01) and rural physicians (p < 0.05). Our findings support the model which proposes that characteristics of the physician, the type of problem presented, and characteristics of the environment influence the likelihood of the GP being the patient's PFC. The findings have implications for GP training programs designed to enable GPs to cope with the wide range of problems encountered in general practice and to provide high quality care at reasonable cost.

Abdominal Pain↗
PubMed1995

A peer review programme to audit the management of hypertensive patients in family practices in Israel.

We introduced and evaluated a self-audit and peer review programme for the management of hypertension in eight urban and rural family medicine practices in northern Israel between January 1991 and December 1992. Changes in the level of blood pressure control and the effect of peer review and self-audit on physicians' management of hypertension were evaluated. Participating physicians were provided with feedback throughout the course of the study. Six hundred and seventy-four hypertensive patients from a total adult population of 4445 patients (15%) were identified in eight practices and followed for two years. The percentage of uncontrolled hypertensives (blood pressure > or = to 160/95 mmHg) decreased from 46.8% at the beginning of the sstudy to 34.3% at its conclusion (P = 0.01). Data on prevalence of hypertension were analysed by participating clinics (prevalence range 8.5-24.6%) and by type of community (rural or urban). In rural communities 50% of the hypertensives were > or = to 70 years of age, compared with 39.5% in the urban practices. Differences in prescribing practices among participating physicians were discussed during peer review group meetings and changes in prescribed medications for hypertension were evaluated. We conclude that this method of self-audit and peer review is effective in improving the management of patients with hypertension in family medicine practices. It was implemented at a minimal cost, is feasible in busy practices and can be generalized to the management of other chronic diseases in the community.

Adult↗
PubMed1994

[Microalbuminuria and ischemic heart disease in noninsulin-dependent diabetes].

Prospective studies showed that hypersecretion of albumin in the urine of patients with type 2 diabetes mellitus is associated with high morbidity and mortality from cardiovascular disease and nephropathy. 65 type 2 diabetes from 6 family medicine practices were studied. Microalbuminuria was found in 37% and was significantly more common in men than in women (53% and 23%, respectively; p < 0.02). Uncontrolled blood glucose levels were also more common in men (p < 0.03). Using logistic regression with microalbuminuria as the dependent variable, a significant correlation was found with male gender, fasting blood glucose 155 mg/dl or more, and systolic blood pressure 159 mm Hg or higher. Among those with microalbuminuria, ischemic heart disease was significantly more common in those 65 years or older than in those younger (p = 0.02). This study strengthens the assumption that type 2 diabetics with microalbuminuria might be at greater risk for developing ischemic heart disease. Strict detection and control are recommended.

Adult↗
PubMed1994

Single-dose fosfomycin trometamol versus 5-day cephalexin regimen for treatment of uncomplicated lower urinary tract infections in women.

A randomized study was conducted to assess the clinical and microbiological efficacies of a single 3-g dose of fosfomycin trometamol for the treatment of uncomplicated lower urinary tract infections in women compared with a 5-day regimen of cephalexin at 0.5 g four times daily. One hundred twelve women, all of whom had documented infections with bacteria sensitive to both antibiotics, were included. Fifty-eight women received fosfomycin trometamol, and 54 women received cephalexin. The two groups did not differ in age, severity, or duration of current urinary tract infection, menstrual status, sexual activity, or use of contraceptives. Ninety percent of pathogens in the fosfomycin trometamol group and 81% in the cephalexin group were Escherichia coli (the difference is not significant [NS]). A clinical evaluation at the 5-day follow-up showed that 91% of the women in each group were free of symptoms, while five women in each group were considered therapy failures and were treated by another antibiotic course. A microbiological evaluation at the 5-day follow-up showed a 91% eradication rate in the fosfomycin trometamol group and an 83% eradication rate in the cephalexin group (NS). At the 1-month follow-up, a clinical evaluation demonstrated prolonged resolution in 86 and 78%, respectively, of the participating women (NS). A microbiological evaluation at 1 month demonstrated prolonged eradication in 47 (81%) women treated with fosfomycin trometamol and in 37 (68%) women treated with cephalexin (NS). Three and six women, respectively, had relapsed. No adverse reactions were reported by the fosfomycin trometamol-treated women, while three women treated with cephalexin reported mild adverse reactions but completed the study period. Fosfomycin trometamol in a single 3-g dose is as effective as a 5-day regimen of cephalexin for the treatment of uncomplicated lower urinary tract infection in women.

Adolescent↗
PubMed1994

Double-blind study comparing 3-day regimens of cefixime and ofloxacin in treatment of uncomplicated urinary tract infections in women.

This double-blind randomized study compared 3-day regimens of cefixime (400 mg once daily) and ofloxacin (200 mg twice a day) in the treatment of urinary tract infections in women. The respective clinical cure rates for the two groups of women were 89 and 92% after 7 days and 81 and 84% after 4 weeks. The respective microbiological cure rates (free of bacteriuria) for the two groups of women were 83 and 86% after 7 days and 77 and 80% after 28 days. A 3-day cefixime regimen seems to be as efficient as a 3-day ofloxacin regimen in the treatment of uncomplicated cystitis in women.

Adolescent↗