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Biomedical subjects

J E Rohrer

Publications and source records attributed to J E Rohrer.

At least 19 recordsLinked to original sources
PubMed2004

Prevalence and correlates of paediatric asthma and wheezing in a largely rural USA population.

OBJECTIVE: The prevalence of asthma among children has been increasing in the United States and it is estimated that there are approximately 5 million children with asthma. This cross-sectional survey sought to estimate the prevalence of asthma and asthma symptoms and potential risk factors among children aged 16 and younger, in a largely rural population in the USA. METHODS: This study was a telephone survey of 1500 households in the South Plains/Panhandle region of Texas. Parents of children were interviewed with a response rate of 64%. Having been diagnosed with asthma by a physician and a report of wheezing in the last 12 months were used as dependent variables in multivariate logistic regressions with several sociodemographic and environmental factors as potential confounders. RESULTS: The age-adjusted prevalence of asthma and wheezing among children were approximately 15 and 18%, respectively. The prevalence of asthma was highest (20%) among children aged 11-16 (P < 0.001). Living in urban areas was associated significantly with asthma and wheezing. Non-Hispanic blacks reported significantly increased odds of asthma in their children (adjusted odds ratio (OR) = 2.04, 95%CI 1.02-4.08), whereas Mexican-Americans reported significantly reduced odds of asthma (adjusted OR = 0.48, 95%CI 0.29-0.78) and wheezing (adjusted OR = 0.58, 95%CI 0.37-0.89) in their children. The odds of asthma (adjusted OR = 1.78, 95%CI 1.09-2.92) and wheezing (adjusted OR = 2.45, 95%CI 1.52-3.95) was highest among children in the highest body mass index quartile. No significant association with pet ownership and exposure to second-hand smoke with asthma and wheezing was observed in this study. CONCLUSION: Urban residence, non-Hispanic black and Mexican-American race/ethnicity, and being overweight were significantly associated with the increased risk of asthma and/or wheezing.

Adolescent↗
PubMed2002

Duration of heart disease visits by elderly patients: productivity versus quality.

A balance should be reached between physician productivity and clinical quality, since the first comes at the expense of the second. The study described here used the National Ambulatory Medical Care Survey (NAMCS) to demonstrate that visit length for elderly heart disease patients is related to both appropriate (i.e. clinical) patient differences and to less justifiable factors. Both demand management and managerial control strategies should be considered.

Aged↗
PubMed2001

Rural residence and migration for specialty physician care.

This article describes why rural residents migrate or travel outside their local market area for specialty physician care. Data were collected through a random mail survey of persons residing in Iowa's rural counties. The results imply that migration for specialty care is not simply a function of a low perceived availability of local specialty physicians. Managers of rural and urban health care systems may need to rethink the extent to which specialty physician services should be distributed across rural markets.

Catchment Area, Health↗
PubMed2001

Rural hospitals and the adoption of managed care strategies.

This research examined the performance of rural hospitals engaged in different levels of managed care activities and identified factors related to performance and competition that affected rural hospitals' likelihood of pursuing managed care as a strategy. The sample studied consisted of 139 rural hospitals in Iowa and Nebraska. Results showed that a relatively high percentage of hospitals were engaged in managed care activities, mainly through contractual arrangements. The study found that high competition in the marketplace increased the likelihood of hospitals pursuing managed care strategies, while high demand markets had a negative association with the likelihood of pursuing a managed care strategy. No significant relationship was detected between poor performance and pursuing a managed care strategy.

Bed Occupancy↗
PubMed2000

The long-term effect of outpatient commitment on service use.

The long-term effect of outpatient commitment on service use was evaluated in 81 patients with serious and persistent mental illness. An increased number of outpatient visits and a decreased number of hospital admissions, total hospital days, and lengths of stay were observed during commitment periods of greater than 1 year relative to levels of use in the same patients over the 12-month period preceding commitment. This study provides support that outpatient commitment improves compliance with outpatient treatment and reduces hospital use in patients who are on outpatient commitment to a single treatment agency for periods up to 5 years.

Adolescent↗
PubMed2000

Why rural residents migrate for family physician care.

Several studies have examined why rural residents bypass local hospitals, but few have explored why they migrate for physician care. In this study, data from a random mail survey of households in rural Iowa counties were used to determine how consumers' attitudes about their local health system, health beliefs, health insurance coverage and other personal characteristics influenced their selection of local vs. nonlocal family physicians (family physician refers to the family practice, internal medicine or other medical specialist providing an individual's primary care). Migration for family physician care was positively associated with a perceived shortage of local family physicians and use of nonlocal specialty physician care. Migration was negatively associated with a highly positive rating of the overall local health care system, living in town, Lutheran religious affiliation and private health insurance coverage. By understanding why rural residents prefer to bypass local physicians, rural health system managers, physicians and policy-makers should be better prepared to design innovative health organizations and programs that meet the needs of rural consumers.

Adult↗
PubMed2000

Relationship between service effectiveness and satisfaction among persons receiving Medicaid mental health services.

Relationships between service satisfaction, life satisfaction, and self-reported mental health status were examined for Iowa Medicaid mental health service recipients. Of the 16,579 persons who received services in 1993, a mail-out survey was sent to 2,520 persons and returned by 815 (32.3 percent). Persons with schizophrenia reported greater service satisfaction and life satisfaction than persons with other diagnoses, and their ratings of their mental health were higher. A relationship between service satisfaction and current life satisfaction was observed for persons with schizophrenia, affective disorder and adjustment disorder, but not for persons with anxiety disorder.

Adult↗
PubMed2000

Acceptability of telepsychiatry to a rural population.

Sixty-seven residents of a rural Midwestern state were surveyed by telephone to determine which factors influence their willingness to receive mental health services through live, two-way audio and video transmission. Two-thirds of the survey respondents were willing to participate in telepsychiatry. Many expressed reluctance, however. They were concerned about maintaining confidentiality, and they perceived telepsychiatry as impersonal. Medicare enrollees and older survey respondents were less willing than younger respondents to endorse the use of telemedicine.

Adult↗
PubMed2000

Health status and health professional visits in a rural area.

Visits to physicians (MDs), physician assistants (PAs) or nurse practitioners (NPs) by residents of a rural county in the upper-middle west of the United States were analysed in this study. A telephone survey yielded 250 responses. The dependent variable was the natural logarithm of the number of times the respondent had seen a health professional (MD, PA or NP) in the past two years. Predisposing, enabling and medical need variables were tested as potential predictors of visits. Self-rated health status, being unable to perform usual activities, and feeling upset or 'down in the dumps' proved to be important predictors, as was having a usual source of care. Health insurance coverage and family income was not, however. Unexpectedly, smokers also reported more visits. The implications for policy and future research are discussed.

Adult↗
PubMed2000

Limitations of secondary data for strategic marketing in rural areas.

Market research is an important element of the strategic marketing process. By understanding the healthcare needs of a market area, hospital and health system managers can set priorities for new services and allocate resources appropriately. The process of market research often begins with an evaluation of health status and socioeconomic indicators collected from secondary sources. Unfortunately, indicators that have been recommended in the literature may not be feasible for use in rural markets because of their lack of statistical precision or inability to differentiate healthcare service needs. This study evaluated the statistical precision and variability of 79 secondary health status and socioeconomic measures reported at the county level in Iowa, USA, a largely rural state. Our findings suggest that many readily available health status and socioeconomic indicators do not discriminate need among rural health care markets. Only six health status and two socioeconomic indicators met our statistical precision and variability criteria. These findings have important implications for managers planning health services in rural localities. Managers of rural health systems may need to employ alternative market research methods, such as analysis of claims-based utilization rates or community health surveys.

Data Collection↗
PubMed1999

Follow-up contact bias in evaluation of substance abuse treatment programs.

This study examined the problem of follow-up contact bias in evaluation of substance abuse treatment programs using administrative data sets. Completed discharges in Iowa were compared to clients contacted 6 months after treatment. The percent of clients reporting no substance use doubled between admission to treatment and follow-up. Unemployment, arrests, and number of days of work or school missed declined. However, clients included in the follow-up sample were significantly different in terms of risk factors for adverse outcomes. The authors conclude that improvements in social functioning 6 months after discharge cannot be generalized to the entire population of clients treated, since those not found have a different combination of risk factors.

Adult↗
PubMed1999

Identifying high-users of medical care in a farming-dependent county.

In the future, demand management will be required of health care organizations that become at-risk for the cost of care. Methods for identifying market segments composed of high users need to be adopted and routinely employed. The study reported here is an example of such an effort. Physician visits in a farming-dependent county in the upper-middle west were assessed via postal questionnaire in this study. A 15-percent random sample of households yielded 327 surveys. The frail elderly, low-income elderly, low-income adults, and recently hospitalized middle-aged and elderly persons were identified as market segments disproportionately composed of high users. Demand management programs might fruitfully be targeted at these groups. Judicious clinic expansions might reduce medical office visits.

Adult↗
PubMed1999

Improvements in the performance of local public health agencies.

Local health agencies in Iowa were surveyed in 1995 and 1997 to ascertain their performance in the areas of assessment, policy development, and assurance. Some improvements were noted in the assessment function. However, development of health plans and a policy agenda as well as evaluation of programs remain weak. Structural changes may be needed to increase the effectiveness of small, rural, public health agencies. Options discussed in this article include increases in funding, consolidation into districts, specialized training, a shift of responsibilities to the state level, and a merger with local hospitals.

Data Collection↗
PubMed1999

Client satisfaction with substance abuse treatment.

A survey of 15 publicly-funded treatment agencies in Iowa was conducted to identify correlates of satisfaction with substance abuse treatment for voluntary clients. We used stratified least-squares regression analysis to identify program characteristics that were associated with greater satisfaction levels. In order to investigate satisfaction among voluntary clients, we stratified the data using three measures of client choice. These were self-reports of the extent to which the respondent felt pressured by the threat of jail, legal action, or family demands. Women tended to be more satisfied than men. Satisfaction scores for clients who indicated they were in treatment by choice were correlated with judgements about program characteristics. Phone availability, time with counselor, counselor skill, and sensitivity were associated with greater levels of satisfaction in all three models. Parking, privacy and cleanliness were significant in two out of three models.

Adult↗
PubMed1998

Arthritis health service utilization among the elderly: the role of urban-rural residence and other utilization factors.

OBJECTIVE: To compare the impact of urban-rural residence and other factors on the utilization of any type of arthritis-related physician care and on rheumatologist utilization. METHODS: A population-based random sample of adults 65 years of age or older with self-reported arthritis from 10 urban and 12 rural Iowa counties were surveyed by telephone interview. We estimated the arthritis prevalence and health service utilization in this sample and evaluated the effects of predisposing, enabling, and need factors on utilization and satisfaction. Health care utilization was defined as ever having visited specific types of providers for arthritis-related care. RESULTS: A total of 488 individuals participated: 227 from urban counties and 261 rural respondents. Urban respondents more commonly reported having received a diagnosis of osteoarthritis from their physicians but were less likely to report rheumatoid arthritis. A greater proportion of urban versus rural respondents had utilized any physician for arthritis care (50.7% versus 41.0%, P = 0.032) and had more often seen an orthopedist (18.1% versus 9.6%, P = 0.006) or general internist (18.5% versus 8.8%, P = 0.002). A diagnosis of rheumatoid arthritis, younger age, living with another person, higher income, and further distance from an arthritis provider were significantly associated with prior rheumatologist utilization. The strongest adjusted predictor of any physician visit for arthritis care was whether older adults drove themselves to their provider. For rheumatologist utilization, a diagnosis of rheumatoid arthritis and age were independently associated. CONCLUSIONS: The most striking finding was the consistent association of need factors (such as the desire for medical advice), joint swelling, and the presence of a diagnosis of rheumatoid arthritis with physician utilization. We identified significant urban-rural variations in factors both enabling and predisposing to arthritis care, although urban-rural status did not appear to independently influence arthritis physician utilization. In a rural state with a relatively small number of rheumatologists, deleterious enabling factors such as greater distance from the doctor and lack of supplemental insurance did not provide significant obstacles to either rheumatologist or generalist utilization.

Aged↗