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Biomedical subjects

J Hickner

Publications and source records attributed to J Hickner.

8 recordsLinked to original sources
PubMed1997

Evaluation of suspected urinary tract infection in ambulatory women: a cost-utility analysis of office-based strategies.

BACKGROUND: The purpose of this study was to determine the most cost-effective strategy for managing suspected urinary tract infections in otherwise healthy adult women presenting to their primary care physician with dysuria and no symptoms or signs of pyelonephritis. Several office-based management strategies are considered: empiric therapy, use of dipstick analysis, use of complete urinalysis, and several strategies using office or laboratory cultures. METHODS: We constructed a decision tree using model probabilities obtained from the literature. Where published probabilities were unavailable, we used extensive sensitivity analyses. Utilities were obtained from the Index of Well-Being. We obtained costs by surveying hospitals, physicians, and pharmacies. RESULTS: The most cost-effective strategy is to treat empirically ($71.52 per quality-adjusted life month, QALM). When the cost of antibiotics exceeds $74.50 or if the prior probability of having a UTI is under 0.30, then treatment guided by the results of a complete urinalysis is preferred. While it was the preferred strategy, other strategies (complete urinalysis, culture and treat, and dipstick testing only) were associated with greater utility. The marginal cost-effectiveness of these strategies compared with empiric therapy ranged from $2964 to $48,460 per additional QALM. CONCLUSIONS: The preferred strategy of empiric therapy is robust over a wide range of sensitivity analyses. While empiric therapy is associated with the best cost-utility ratio, doing a culture yields the greatest utility at greater incremental cost per QALM. Many primary care physicians already treat UTIs empirically with antibiotics. This study confirms that empiric therapy, while frowned upon by some, is a cost-effective strategy. Other strategies may be considered, but at greater marginal cost. Ultimately these findings need to be confirmed in clinical trials.

Adolescent↗
PubMed1995

The changing characteristics of rural GPs.

AIM: Rural regions of Australia remain relatively underserved by general practitioners. The capacity to make sensible policy depends on a deeper understanding of who rural general practitioners are. METHOD: 454 NSW rural general practitioners were surveyed with a 65% return rate. Our sample was intentionally skewed to greater rurality. RESULTS: Women remain under represented in rural practice. 37% of our sample were aged under 40, with over 90% Australian graduates. Rural doctors continue to do significant amounts of training overseas. Some doctors in rural practice drifted there without planning, and 25% of those under 40 are intending to leave. Young doctors provide a number of procedural services to their patients, including anaesthetics and obstetrics, but this is strongly influenced by town size. Doctors with a rural upbringing are no more likely than those without a rural background to practice in more rural areas. CONCLUSION: Australian rural general practitioners are relatively young and providing a broad range of services to their patients. A number of rural practitioners have not planned for rural practice and may require further training after arrival. Australian graduates continue to train overseas, suggesting that procedural experience in Australia is inadequate. Town size is a strong predictor of procedural skills being available to patients.

Adult↗
PubMed1991

Physician follow-up of a community cholesterol-screening project.

We report the results of physician follow-up of a group of community cholesterol-screening participants with hypercholesterolemia two years after the initial screening. Of 443 participants in a 1987 screening program, 51 (12%) had a cholesterol greater than the program cutoff of 7.16 mmol/L (277 mg/dL). In 1989, follow-up data from office records review and patient questionnaires were available on 48 (94%) of the 51 participants. Forty-three participants (90%) had consulted with a physician as advised. Twenty-five participants (66%) of the charts reviewed) had lipid profiles performed subsequent to the 1987 screening. Of the 43 participants consulting their physicians, twenty-six (60%) were prescribed a lipid-lowering regimen. Twenty-two were prescribed diet alone, fourteen also received prescriptions for medication, and two were advised to exercise more. Thirty subjects had had cholesterol levels checked in 1989, two years after the screening program. This group experienced an average decrease of 1.32 mmol/L (51 mg/dL), but several confounding factors may have contributed to this 16%-mean decline in cholesterol. Men were underrepresented throughout the screening and follow-up process. This community cholesterol-screening project in a small rural community achieved a high physician follow-up rate.

Adult↗
PubMed1984

Effect of pregnancy on smoking behavior: a baseline study.

The trend of increased smoking among young women has leveled off, yet 22 to 28 percent of pregnant women smoke. Aside from the usual risks of smoking, these women expose their fetuses to increased risk when they are pregnant. Pregnancy may motivate women to stop smoking because of potential adverse effects on their babies' health. A public health survey supported this claim, but no family practice studies have been reported. This is a retrospective study describing women's smoking behavior during pregnancy and at least six months after delivery. Self-administered questionnaires were given to 66 women in three family practices. Women were questioned regarding the number of cigarettes smoked before and during pregnancy and were asked their current level of smoking. Twelve women (18 percent) stopped smoking completely during pregnancy; however, of these 12, only seven (11 percent) were still not smoking at the time of the survey. Twenty-eight women (42 percent) cut down their smoking at least one-half pack per day during pregnancy. Six months to five years after delivery, only 18 of these 28 women were still smoking at least one-half pack per day less. Further study is needed to determine whether intensive antismoking efforts during routine prenatal care would be more effective and long-lasting.

Adolescent↗
PubMed1983

Oral fluoride supplementation: improving practitioner compliance by using a protocol.

Despite its proven benefit, oral fluoride supplementation has received little attention in the family practice literature. This study describes how one academically affiliated family practice, staffed by physicians knowledgeable in fluoride supplementation, failed to prescribe fluoride appropriately until a specific protocol was developed. Initially a pilot study consisting of a chart review and a mail and telephone survey was performed. The results indicated a compliance problem involving the physicians as much as the patients. Next, a detailed protocol for improving fluoride supplementation was developed that delegated responsibilities not only to the physicians but also to the receptionists, the nurses, and a physician's assistant. The protocol was initiated in July 1982. From July to October 1982, 40 at-risk children visited the clinic for assorted health care needs. A follow-up chart audit on these children revealed that 23 (58 percent) were currently taking fluoride, and 27 families (79 percent) had had their wells checked for fluoride. This study demonstrates the advantage of using a protocol with a team approach for increasing compliance with respect to oral fluoride supplementation.

Administration, Oral↗
PubMedDate not supplied

Smoking cessation during pregnancy: strategies used by Michigan family physicians.

This study reports the attitudes and strategies of members of the Michigan Academy of Family Physicians about their antismoking interventions for pregnant smokers. Of the 978 physicians surveyed, 607 (62 percent) returned completed questionnaires. Three hundred twenty-three (53 percent) were not practicing obstetrics. The remaining 284 physicians currently practicing obstetrics constituted the study group. Ninety-four percent of these physicians routinely assessed smoking status at the first prenatal visit. Ninety-eight percent advised pregnant smokers to quit smoking during pregnancy. The most frequently used method of intervention was personal counseling (97 percent), followed by referral to smoking cessation clinics (40 percent), and behavior modification (20 percent). Fifty-seven percent of the physicians reported using antismoking pamphlets, and 30 percent used antismoking posters designed for pregnant women. Only 11 percent of the physicians surveyed were generally satisfied with the effectiveness of their current methods. Nonetheless, 97 percent were convinced that the benefits of smoking cessation during pregnancy merited their efforts. The physicians in this sample consistently have advised their pregnant smokers to quit, but most believe there is a need for more effective smoking cessation methods.

Behavior Therapy↗
PubMedDate not supplied

First coitus for adolescents: understanding why and when.

BACKGROUND: Correlates of initiation of coitus for teenagers were examined, and participants were asked their reasons for initiating or postponing the onset of coitus. METHODS: Questionnaires were completed privately by 218 patients aged 13 to 18 years. Questions explored the reasons adolescents cite for their sexual decisions and the role of peer influence in these decisions. RESULTS: Correlation was noted in young teenagers between perception of peer sexual behavior and participant's initiation of coitus. Reasons stated for engaging in first intercourse reflect both active choices and loss of control. Reasons for refraining included fear of pregnancy and sexually transmitted diseases, lack of developmental readiness and opportunity, and social sanctions. Morality was cited infrequently as a reason for postponing sexual behavior. CONCLUSIONS: Results suggest that sexuality education should address the direct and curious questions of younger teenagers about sexuality, help youth define strategies that they can use to evaluate and resist peer pressure, and give more generalized attention to ways of helping youth feel competent. Physicians and other health educators might focus on helping older youth define how and when they know they are ready to have intercourse, consider ways of expressing sexuality that do not jeopardize health, and improve communication skills when talking with friends and potential partners about sexual issues.

Adolescent↗