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Biomedical subjects

J Fleishman

Publications and source records attributed to J Fleishman.

18 recordsLinked to original sources
PubMed1996

Self-perceived unmet health care needs of persons enrolled in HIV care.

We examined the prevalence of, and factors associated with unmet health service needs among persons with HIV disease. Data were examined from 1,851 participants in the U.S. AIDS Cost and Service Utilization Study, drawn from 26 medical care providers in 10 cities. Geographic areas with large numbers of AIDS cases, and health care providers within them were chosen as study sites. After completing a screener questionnaire, potential participants at each site were stratifed by illness stage, HIV exposure route, and insurance status; a systematic random sample within those strata were selected for the study. Participants completed a comprehensive survey of HIV-related service use and costs, which also asked them to identify unmet health service needs. Analyses identified the relationship between unmet needs and: stage of illness, type of insurance, source of care, living arrangement, and AIDS prevalence of respondents' geographic region. At least one unmet need was reported by 20% of the sample. Needs for non-institutional services, e.g, dental care, mental health, and medications were more likely to be unmet than need for emergency room and hospital care. While most factors significantly affected the odds of having an unmet need, the greatest effects were found for private insurance and HIV asymptomatic status, both of which decreased the odds of unmet needs by approximately 50%. These findings suggest that insurance coverage for services required during the chronic phase of HIV illness is inadequate and should be augmented.

Acquired Immunodeficiency Syndrome↗
PubMed1996

The impact of housing status on health care utilization among persons with HIV disease.

This study sought to identify the prevalence of unstable housing situations, and for whom they occurred, and to examine differences in health care utilization by housing status. Housing status and inpatient and outpatient health care utilization of 1,851 HIV-infected individuals was ascertained through interviews. Nine percent of respondents were in unstable housing situations. Unstable housing was associated with significantly lower functional status. The unstably housed were more likely to visit an emergency room (p < 0.05) and had fewer ambulatory visits than persons with stable housing (p < 0.03). They incurred nearly five more hospital days and their average hospitalization was approximately 1.5 days longer than the stably housed, although these differences were not significant. Utilization of ambulatory care is lower among unstably housed persons with HIV disease, which may have led to their increased reliance upon emergency rooms and hospitals. Helping HIV-infected individuals maintain adequate housing could reverse this pattern.

Adult↗
PubMed1995

The structure of social engagement among nursing home residents.

This research tests the reliability and construct validity of social engagement, a new quality of life measure embedded in the federally mandated Resident Assessment Instrument (RAI) for the nursing home population. The sample consisted of 1,848 residents from 268 homes in 10 states with data collected by trained research nurses. Three resident groups were formed based on residents' cognitive and ADL functioning. Social engagement was significantly related to average time spent in activities across all three groups. We hypothesized a four-factor model with social engagement distinct from mood problems, conflicted relationships, and behavior problems. LISREL confirmatory factor analysis found the data to be consistent with this hypothesis (Fit Index > .98). Intercorrelations between factors showed that for high-functioning residents, engagement was negatively related to conflict but was positively related to conflict among the most impaired. The validity of the social engagement measure and its stability across types of residents suggest its potential utility as a marker of nursing home quality.

Activities of Daily Living↗
PubMed1992

Quality of life in persons with human immunodeficiency virus infection: measurement by the Medical Outcomes Study instrument.

OBJECTIVE: To assess the reliability and validity of the Medical Outcomes Study (MOS) Short Form Health Survey as an indicator for quality of life in patients infected with the human immunodeficiency virus (HIV). DESIGN: Patient interview survey. SETTING: The AIDS Health Services Program in seven sites: Newark and Jersey City, New Jersey; Nassau County, New York; Atlanta, Georgia; Dallas, Texas; Fort Lauderdale and Miami, Florida; New Orleans, Louisiana; and Seattle, Washington. PATIENTS: Patients (520) with HIV infection receiving health services at one of the above sites. MEASUREMENTS: All components of the MOS Short Form Health Survey were included in the interview. Minor modifications were made to adapt the survey to the particular circumstances of the study. Measured sociodemographic characteristics included age, sex, race, intravenous drug use, and education. Symptoms were assessed by closed-ended questions concerning memory, seizure, weakness or numbness, fever, chills, diaphoreses, dyspnea, diarrhea, and weight loss. Information on the frequency of symptoms was also collected. History of Pneumocystis carinii pneumonia and Kaposi sarcoma was noted. MAIN RESULTS: The sociodemographic characteristics resemble those of patients with the acquired immunodeficiency syndrome (AIDS) reported to the Centers for Disease Control (CDC): mean age, 36; men, 89%; nonwhite, 31%; intravenous drug use, 34%. Neurologic symptoms (memory trouble, seizures, weakness or numbness) occurred in 71% of patients; constitutional symptoms (fever, chills, night sweats, weight loss) in 69%; dyspnea in 50%; and diarrhea in 47%. Although older age, female sex, nonwhite race, and intravenous drug use were associated with lower MOS scores in several areas, the strongest single or adjusted indicator of lower MOS scores was the presence of symptoms. Finally, patients with HIV infection had significantly lower scores than did previously reported patients with other chronic medical conditions (P less than 0.001). CONCLUSIONS: The MOS survey is a reliable measure of quality of life for patients with HIV infection. These patients tend to have low scores, suggesting validity of the survey. The MOS survey is extremely sensitive to the effect of symptoms, which suggests that it might be useful as a quality-of-life indicator for AIDS clinical drug trials.

Adult↗
PubMed1992

Problems encountered in home health service delivery to persons with AIDS.

This paper discusses the problems encountered in delivering home health services to persons with AIDS (PWAs), based on telephone interviews conducted with administrators of 68 home care agencies located in 10 high AIDS prevalence areas nationwide. Lack of adequate insurance mechanisms was cited as a major barrier to serving PWAs. Some respondents indicated a greater potential for stress among staff treating PWAs, given the youth of this population, the intensity of illness manifestations, and the complexity of treatment regimens. Other difficulties that are especially prevalent among PWAs include the absence of informal caregivers, residence in unsafe areas, and patient and family drug abuse. Although many of the reported patient problems are not unique to PWAs, the frequency with which they occur in this population suggests a need for expanded public and private insurance coverage for custodial care, and for expanded availability of AIDS-specific housing, if excessive hospitalization is to be avoided.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Perceived need for dental care among persons living with acquired immunodeficiency syndrome.

Compromised oral health holds significant implications for the general health of medically vulnerable, HIV infected individuals. Past studies have reported that these individuals frequently suffer from oral opportunistic infections and have a tendency to develop severe periodontal disease. This study extends past research by examining the prevalence of oral infections according to patient characteristics and by reporting, for the first time, the level of perceived dental need in a large, multi-site sample of individuals with symptomatic HIV disease. Data for this study come from a survey of 857 clients of the Robert Wood Johnson Foundation's AIDS Health Services Program in 9 U.S. cities. More respondents (52%) reported a need for dental care than for any other service need. Multivariate analysis showed that clients who were white, in low-income groups, used intravenous drugs, or had a past history of oral opportunistic infections were more likely to report dental need. Relations between age, gender, insurance status, or disease status and perceived need were statistically nonsignificant. Forty-seven percent of the clients reported they had an oral opportunistic infection, the second outcome variable examined in this study. Statistically significant differences (P less than 0.05) were found in the prevalence of oral opportunistic infections among race and disease severity groups. Whites and the more severely ill were more likely to report an infection than their respective counterparts.

AIDS-Related Complex↗
PubMed1991

Patterns of survival with AIDS in the United States.

We examined patterns of survival with AIDS (acquired immune deficiency syndrome) using the Centers for Disease Control (CDC) "AIDS Public Information Data Set." Analyses used a census of 23,271 cases diagnosed between January 1, 1984 and December 31, 1986. Three Cox proportional hazards models were fit to the data. The first used clinical and demographic parameters only in an effort to replicate Rothenberg's analysis of survival for patients diagnosed in New York City prior to 1986. The second model included variables that capture the effect of time of diagnosis in order to determine whether temporal trends exist. The third model included variables indicating the geographic region from which the cases were reported. The results of these models support earlier findings of demographic and clinical survival correlates. Controlling for covariates, patients diagnosed during 1986 lived significantly longer than those diagnosed earlier; the difference was most profound when Pneumocystis carinii (PCP) was present. Last, we observed large regional differences; their implications for health services planning are discussed.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Differences in access to zidovudine (AZT) among symptomatic HIV-infected persons.

OBJECT: To evaluate socioeconomic factors that determine whether symptomatic HIV-infected persons are offered zidovudine (AZT). DESIGN: Cross-sectional survey conducted as part of the Robert Wood Johnson Foundation's AIDS Health Services Program. SETTING: Public hospital clinics and community-based AIDS organizations in nine American cities. PATIENTS: 880 HIV-seropositive outpatients interviewed between October 1988 and May 1989. MAIN RESULTS: Males were more likely to have been offered AZT than were females (adjusted odds ratio 2.99; 95% confidence interval 1.67 to 5.36), those with insurance were more likely to have been offered AZT than were those without (adjusted odds ratio 2.00; 95% confidence interval 1.25 to 3.21), and whites more likely to have been offered AZT than were non-whites (adjusted odds ratio 1.73; 95% confidence interval 1.11 to 2.69). Intravenous drug users were less likely to have been offered AZT than were non-drug users (adjusted odds ratio 0.44; 95% confidence interval 0.28 to 0.69). Persons who had had an episode of Pneumocystis carinii pneumonia were more likely to have been offered AZT than were persons who had AIDS and had not had Pneumocystis carinii pneumonia (adjusted odds ratio 2.95; 95% confidence interval 1.71 to 5.11). CONCLUSION: The authors conclude that traditionally disadvantaged groups have less access to AZT, the only antiretroviral agent demonstrated to increase survival of patients who have symptomatic HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

The use of formal prior directives among patients with HIV-related diseases.

OBJECTIVE: To examine the knowledge of, counseling about, and use of prior directives among patients with HIV-related disease. DESIGN: Cross-sectional survey with personal interviews that was part of the evaluation of a multi-site AIDS Health Services Program. SETTING: Outpatient clinics and AIDS community-based organizations. PATIENTS/PARTICIPANTS: To be eligible for the survey, subjects had to be at least 18 years of age and enrolled in the AIDS Health Services Program for at least one month. 1,031 clients were interviewed in nine communities. MEASUREMENTS AND MAIN RESULTS: Of those surveyed, 61% had thought a moderate or great amount about naming a proxy for health care decisions. The majority (68%) of the patients knew about prior directives, yet only 35% had been counseled and only 28% had a prior directive. Of those counseled, physicians had counseled only 11% (38/359). Gay/bisexual men were more likely to have been counseled and to have executed a prior directive than were others. Counseling was associated with having obtained a prior directive. Counseled subjects were 3.5 times more likely to have obtained a prior directive than were those not counseled. CONCLUSIONS: A gap exists between subjects' knowledge and implementation of prior directives. To help bridge this gap, the authors recommend that physicians not only attend to the technical aspects of patient care, but also determine patient values concerning life-sustaining therapy and counsel patients on prior directives.

Advance Directives↗