Biomedical subjects

J B Fowles

Publications and source records attributed to J B Fowles.

14 recordsLinked to original sources

PubMed2000

Characteristics and experiences of parents and adults who want antibiotics for cold symptoms.

OBJECTIVE: To characterize people who want antibiotics for cold symptoms and to suggest reasons for antibiotic expectations. DESIGN: Cross-sectional telephone survey in the spring of 1997 (March 10 to May 16). SETTING: Three primary care clinics in metropolitan Minneapolis, Minn. PARTICIPANTS: Two hundred forty-nine parents of symptomatic children and 256 symptomatic adults contacting their medical provider (primary care physician, nurse practitioner, or physician assistant) for care of cold symptoms. MAIN DEPENDENT MEASURE: Wanting an antibiotic prescription for cold symptoms. RESULTS: Thirty percent of parents and 50% of symptomatic adults wanted an antibiotic prescription. Factors associated with desire for antibiotics differed between groups. Parents who wanted antibiotics for their children were more likely than other parents to report severe symptoms (odds ratio [OR], 2.11; 95% confidence interval [CI], 1.16-3.85), to want relief for their child (OR, 2.63; 95% CI, 1.34-5.46), and to believe that antibiotic therapy helps cold symptoms (OR, 1.95; 95% CI, 1.08-3.55). Symptomatic adults who wanted antibiotics were more likely than other symptomatic adults to report severe cold symptoms (OR, 2.10; 95% CI, 1.22-3.67) that have lasted too long (OR, 2.40; 95% CI, 1.31-4.49), to previously have recovered faster with antibiotic therapy (OR, 2.82; 95% CI, 1.65-4.89), and to be confident that they know how to treat the cold (OR, 1.79; 95% CI, 1.03-3.16). They were less likely to believe that too many people take antibiotics for a cold (OR, 0.57; 95% CI, 0.33-0.98). CONCLUSIONS: Parents may be amenable to clinical messages that other treatments may be more effective than antibiotics in managing cold symptoms. Experiences of symptomatic adults may conflict with this message. Previous cold-related medical management and drug resistance might need to be discussed with adult patients.

Adult↗

PubMed2000

Consumer responses to health plan report cards in two markets.

BACKGROUND: Health plans can compete on quality when consumers have helpful information. Report cards strive to meet this need, but consumer responses have not been measured. OBJECTIVES: The objectives of this study were (1) to compare consumer responses to report cards in 2 markets, (2) to determine how personal characteristics relate to exposure, and (3) to assess the perceived helpfulness of the report cards. RESEARCH DESIGN: A postenrollment survey was used. SUBJECTS: The study included 784 employees of Monsanto (St Louis, 1996) and 670 employees of a health care purchasing cooperative (Denver, 1997). DEPENDENT MEASURES: The dependent measures were (1) exposure, specifically remembering the report card, and intensity of reading it and (2) perceived helpfulness in learning about plan quality and in deciding to stay or switch. RESULTS: Except for remembering seeing the report card (Denver, 47%; St Louis, 55%), the 2 groups did not differ. Forty percent read most or all of the report card; 82% found the report helpful in learning about quality; and 66% found it helpful in deciding to stay or switch. Employees who used patient survey information in their plan decision were more likely to remember seeing the report card (odds ratio [OR], 4.85), to read it intensely (OR, 2.84), and to find it helpful in learning about plan quality (OR, 3.04) and deciding whether to stay or switch plans (OR, 2.64). CONCLUSIONS: Although the 2 samples differed markedly, their responses to report cards were similar. Exposure and helpfulness were related more to employee preferences for the type of information than to their health care decision needs.

Adult↗

PubMed2000

Patient beliefs about the characteristics, causes, and care of the common cold: an update.

BACKGROUND: Many people seek medical care for cold symptoms. The cold-related knowledge and beliefs of adults seeking medical care for themselves or their children may not correspond with current medical opinion. METHODS: A total of 249 parents of symptomatic children and 257 symptomatic adults who sought medical advice in the spring of 1997 from 1 of 3 primary care clinics in the Minneapolis-St. Paul, Minnesota, area were surveyed by telephone 48 to 96 hours after contact with the medical system. RESULTS: Of the adults seeking care for a child or themselves, 44% believed viruses alone cause the common cold: an additional 42% believed both viruses and bacteria play a role. Most thought rest (97%) and nonprescription medications (63%) were helpful for colds, which was consistent with published reports. Contrary to medical reports, however, most felt vitamin C (67%) and the inhalation of steam (70%) reduced cold symptoms, and 44% believed antibiotics help colds (chi2=19.57; P=.0002). But 85% believed colds could resolve on their own. CONCLUSIONS: Those adults seeking medical care for uncomplicated colds are misinformed about the primary cause of the common cold, the use of prescription medications for treating cold symptoms, and the effectiveness of some palliative care techniques. Care providers should address these perceptions rather than enabling overuse of antibiotics.

Adolescent↗

PubMed2000

Care-seeking behavior for upper respiratory infections.

BACKGROUND: Many recent efforts to reduce unnecessary medical services have targeted care of upper respiratory infections (URIs). We tested whether patients who seek care very early in their illness differ from those who seek care later and whether they might require a different approach to care. METHODS: We surveyed by telephone 257 adult patients and 249 parents of child patients who called or visited one of 3 primary care clinics within 10 days (adults) or 14 days (parents) of the onset of uncomplicated URI symptoms. Those who contacted the clinic within the first 2 days of illness were compared with those who made contact later. RESULTS: Although 28% of adults and 41% of parents contacted their clinic within the first 2 days of symptom onset, we found very few differences in the characteristics of the caller or patient between those who called early and later. The illnesses of those who called early were not more severe, and they did not have different beliefs, histories, approaches to medical care, or needs. The only clinician-relevant difference was that adult patients calling in the first 2 days had a greater desire to rule out complications (84.7% vs 64.1% calling in 3-5 days and 70.6% calling after 5 days of illness, P < or = .05). CONCLUSIONS: Those who seek medical care very early for a URI do not appear to be different in clinically important ways. If we are going to reduce overuse of medical care and antibiotics for URIs, clinical trials of more effective and efficient strategies are needed to encourage home care and self-management.

Adolescent↗

PubMed1999

The validity of self-reported diabetes quality of care measures.

OBJECTIVE: First, to test the validity of self-reported quality of care and treatment measures compared with medical records and administrative data for: eye examinations, hemoglobin A1C tests, and use of insulin and oral agents for adult patients with diabetes; and secondly to assess the consistency between medical record information and administrative data for the same measures plus microalbumin testing. DESIGN: Cross-sectional study using data from telephone survey, primary care medical and eye records, and administrative claims. SETTING: Statewide health maintenance organization in Minnesota, USA, 1995. STUDY PARTICIPANTS: Four hundred and forty adults with diabetes, aged 31-64 years. MAIN OUTCOME MEASURES: Validity++ of self-reported diabetes quality of care measures compared with a criterion standard combining information from primary care and eye records with information from administrative data; and reliability of medical record information compared with administrative data. RESULTS: Although the sensitivity of self-reported eye examination was high (89%), the specificity was low (65%). Self-report of hemoglobin A1C also had high sensitivity (99%) and a lower specificity than that of eye examination (28%). The two information sources (medical records and claims) used in the criterion standard each contained complementary and non-overlapping information. Reliability was highest for microalbumin testing (kappa, 0.75) and lowest for eye examination (kappa, 0.37). CONCLUSIONS: Quality of care measures for diabetes are often drawn from a variety of sources. To the extent that data sources are biased, the measures can be misleading. Self-report is likely to lead to an overestimate of eye screening and the measurement of hemoglobin A1C. Reported rates of quality of care should be inspected carefully. The 'same' rate taken from different sources may vary.

Adult↗

PubMed1998

Pneumococcal vaccine administration associated with splenectomy: missed opportunities.

BACKGROUND: The spleen defends against infection from encapsulated organisms. Patients who have had splenectomies are at risk for the development of overwhelming pneumococcal infections. Guidelines recommend that pneumococcal vaccine be given to all patients who have splenectomies. METHODS: This retrospective study was performed to evaluate compliance with the guidelines in patients from a large multispecialty group practice who had splenectomies between 1988 and 1991. Ninety-five patients were identified, and their clinic and hospital records were reviewed. RESULTS: Overall, 73.7% of patients who had splenectomies received the pneumococcal vaccine. No significant differences were found in the vaccination rates over time or among the surgeons. CONCLUSIONS: Improvement is needed in ensuring that patients who have splenectomies receive pneumococcal vaccine.

Adolescent↗

PubMed1998

Failure to immunize the elderly: a systems problem or a statement of personal values?

BACKGROUND: Despite the proven efficacy of the influenza vaccine in reducing the risk for pneumonia, hospitalization, and death and the potential savings in costs, most elderly persons do not receive annual immunizations. The study tested the influence of health care delivery system characteristics and individual personal values on the influenza immunization status. METHODS: The study involved a secondary data analysis based on the results of a mailed survey of 3,362 seniors 65 years of age and older enrolled in HealthPartners, a mixed-model health maintenance organization in Minnesota. The three care delivery systems in which respondents were enrolled varied in the intensity and consistency with which they addressed immunization. RESULTS: The immunization rate for this population (77.1%) was higher than the state rate (64%). After controlling for many variables historically known to influence the likelihood of immunization, both care delivery system characteristics and personal values remained significantly associated with immunization status. Elderly individuals getting care in delivery systems with well-developed immunization programs were more likely to be immunized. Those who avoided going to the physician and who practiced risky behaviors such as smoking were less likely to be immunized, regardless of the care delivery system they were enrolled in. DISCUSSION: Managed care can provide a number of system improvements to assist in meeting national health care objectives such as influenza immunization for the elderly. It has reduced some common barriers to immunization, such as cost and access. Yet to achieve the full benefits of a successful influenza immunization program, the role of individual values, as well as implementing systems solutions, needs to be addressed.

Aged↗

PubMed1998

Validation of claims diagnoses and self-reported conditions compared with medical records for selected chronic diseases.

This article assesses the validity of ambulatory administrative and encounter data and patient self-reported information compared with information contained in the ambulatory medical record for 17 chronic diseases. Using a sample of 213 adults (18 to 64 years old) and seniors (65 years and older) enrolled in a health maintenance organization and receiving care at multispecialty group practice in Minneapolis, Minnesota, sensitivity and specificity for claims and self-report were calculated for each chronic condition using the medical record as the criterion standard. The analysis was performed first by blinded review and then repeated with an unblinded review.

Adolescent↗

PubMed1998

Impact of report cards on employees: a natural experiment.

To determine the effect of survey-based, health plan report cards on employees as they selected their 1995 health plan, the authors surveyed two groups of Minnesota State employees, one of which received the report card and one that did not. Both groups were surveyed before and after their enrollment. The authors looked for report card effects on relative changes in the employees' knowledge of health plan benefits and their ratings of quality and cost attributes, as well as their plan choice, rates of switching plans, and willingness to pay higher premiums. The only report card effect found was an increase in perceived knowledge for employees with single coverage.

Consumer Behavior↗

PubMed1997

Comparing claims data and self-reported data with the medical record for Pap smear rates.

The objective of this study was to assess and compare the relative accuracy of claims data and patient self-reported information with medical records for Pap smear rates. A retrospective analysis of information obtained from administrative claims files, patient medical records, and a telephone survey was performed of 400 women age 19 through 75 years who were randomly selected for participation in the study. The data were obtained from a large multispecialty group practice in Minneapolis, Minnesota for the study years 1991 through 1993. Information from administrative claims regarding Pap smear status corresponded highly with information in the medical record (sensitivity 95% or higher; specificity 95% or higher; kappa 0.896 or better). Self-reported information from the telephone survey did not correspond well with medical record information nor with results in administrative claims.

Adult↗

PubMed1996

Employer-specific versus community-wide report cards: is there a difference?

This article describes preliminary results from a natural experiment that tested the impact of report cards on employees. As part of the 1995 enrollment process, some members of the State of Minnesota Employee Group Insurance Program received report cards on the plans offered to them, and others did not. Both groups of employees had a chance to review a second community-wide report card covering all Minnesota plans that had been distributed by an independent organization through local newspapers. Both groups were surveyed before and after they made their health plan selections. We compare the likelihood of seeing, the intensity of reading, and the perceived helpfulness of the first, employer-specific report card with the second, community-wide report card for consumers who make plan selections.

Analysis of Variance↗

PubMed1995

Agreement between physicians' office records and Medicare Part B claims data.

This article tests agreement between demographic, diagnostic, and procedural information from primary-care physicians' office records and Medicare Part B claims for Maryland Medicare beneficiaries. The extent of agreement depended on the category of information being compared. Demographics matched poorly, probably due to incomplete record samples. Important diagnoses were often missing from the medical record. When claims indicated presence of disease, the patient was likely to have the disease, but claims did not capture all people who have the disease. Additionally, many laboratory tests and procedures were missing from the primary-care record. The appropriate use of either of these data sources depends on the specific research question that is being asked.

Demography↗

PubMedDate not supplied

Are health risks related to medical care charges in the short-term? Challenging traditional assumptions.

PURPOSE: This study examines the association between self-reported health risks and short-term use of medical resources. DESIGN: Cross-sectional study comparing responses from a mailed survey with medical encounter and expenditure data. Bivariate analyses and multivariate linear and logistic regressions controlling for age, gender, and health status were conducted to illustrate the relationship between selected risk factors and resource use. SETTING: A group network model health maintenance organization (HMO) in Minneapolis, Minnesota. SUBJECTS: The study population was comprised of a randomly selected sample of nonsenior adults (18 to 64 years old, n = 3825) and seniors (65 years and older, n = 1955) who were enrolled in an HMO. The response rate was 72%. MEASURES: Five independent variables: smoking, alcohol use, obesity, lack of physical activity, and unhappiness were derived from a questionnaire designed to assess health status and health risks. Outcome measures were medical care charges and use of hospital services. RESULTS: Obesity, physical inactivity, and unhappiness were related to higher charges among seniors. These relationships dissipated to some degree after controlling for age, gender, and health status. Unexpected differences were found for alcohol use among both age groups, with those considered to be "not at risk" accruing higher charges and demonstrating a higher likelihood of using inpatient hospital services than those defined to be at risk. CONCLUSIONS: Bivariate and multivariate regression results demonstrated that traditional risk factors are weak and inconsistent predictors of short-term medical charges. Charging smokers and other high risk individuals a higher annual insurance premium than is offered for those at low risk raises questions about fairness when such risk factors are not necessarily good predictors of short-term resource use. The rationale for insurance cost-shifting should be supported with reliable data connecting risks to charges.

Adult↗

PubMedDate not supplied

Taking health status into account when setting capitation rates: a comparison of risk-adjustment methods.

OBJECTIVE: To compare performance of different health status measures for risk-adjusting capitation rates. DESIGN: Cross-sectional study. Health status measures derived from 1 year were used to predict resources for that year and the next. SETTING: Group-network health maintenance organization in Minnesota. PARTICIPANTS: Sample of 18- to 64-year-old (n=3825) and elderly (aged > or = 65 years; n=1955) members enrolled in a network-model health maintenance organization in Minnesota. MAIN OUTCOME MEASURES: Total expenditures in the year concurrent with the health status survey (July 1991 through June 1992) and total expenditures in the year following the survey (July 1992 through June 1993). RESULTS: Capitation adjustment based on demographic measures performed least well. Both self-reported health status measures and diagnoses predicted future expenditures twice as well as demographics. When predicting costs for groups of patients rather than individuals, the demographic model worked well for average groups but tended to overpredict healthier groups and underpredict sicker groups. Ambulatory Care Groups based on diagnoses performed better than self-reported health status both in the retrospective models and across healthier and sicker groups. CONCLUSIONS: Without risk adjustment, capitation rates are likely to overpay or underpay physicians for certain patient groups. It is possible to improve prediction using health status measures for risk adjustment. When selection bias is suspected and administrative data are available, we recommend a risk-adjustment method based on diagnostic information. If diagnostic data are not available, we recommend a system based on simple self-reported measures, such as chronic conditions, rather than complex functional status measures.

Adult↗