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Biomedical subjects

James J Diamond

Publications and source records attributed to James J Diamond.

13 recordsLinked to original sources
PubMed2005

Long-term retention of graduates from a program to increase the supply of rural family physicians.

PURPOSE: To determine the long-term retention of rural family physicians graduating from the Physician Shortage Area Program (PSAP) of Jefferson Medical College. METHOD: Of the 1,937 Jefferson graduates from the classes of 1978-1986, the authors identified those practicing rural family medicine when their practice location was first determined. The number and percent of PSAP and non-PSAP graduates practicing family medicine in the same rural area in 2002 were then identified, and compared to the number of those graduates practicing rural family medicine when they were first located in practice 11-16 years earlier. RESULTS: After 11-16 years, 68% (26/38) of the PSAP graduates were still practicing family medicine in the same rural area, compared with 46% (25/54) of their non-PSAP peers (p = .03). Survival analysis showed that PSAP graduates practice family medicine in the same rural locality longer than non-PSAP graduates (p = .04). CONCLUSIONS: These results are the first to show long-term rural primary care retention that is longer than the median duration. This outcome combined with previously published outcomes show that the PSAP represents the only program that has resulted in multifold increases in both recruitment (eight-fold) and long-term retention (at least 11-16 years). In light of recent national recommendations to increase the total enrollment in medical schools, allocating some of this growth to developing and expanding programs similar to the PSAP would make a substantial and long lasting impact on the rural physician workforce.

Area Health Education Centers↗
PubMed2004

Cholesterol-lowering effect of the Food for Heart Nutrition Education Program.

The objective of this prospective, randomized controlled trial was to assess the effectiveness of the Food For Heart Program patient nutrition tool in hypercholesterolemic outpatients. The setting for this study was an urban academic primary-care practice; 175 hypercholesterolemic adults not taking cholesterol-lowering medications were enrolled as subjects. The study intervention involved four monthly dietary counseling visits, using the Food For Heart Program, conducted by the study research assistant. The main outcome measures were fasting serum lipids (primary); body weight (secondary); and change in Dietary Risk Assessment score (intervention group only), analyzed using Student's t test. Our results showed that total and low-density lipoprotein cholesterol decreased 0.40+/-0.65 mmol/L and 0.32+/-0.58 mmol/L, respectively, in the intervention group (n=91), compared with 0.06+/-0.57 mmol/L and 0.0088+/-0.56 mmol/L in the control group (n=84) ( P <.001). There was no significant change in high-density lipoprotein cholesterol. Intervention subjects lost a small but statistically significant amount of weight, 2.2+/-7.4 pounds ( P <.01), and decreased their Dietary Risk Assessment score 5.9+/-6.5 points ( P <.001). Based on these findings, we concluded that total and low-density lipoprotein cholesterol, weight, and dietary risk for coronary heart disease decreased significantly in hypercholesterolemic patients counseled using the Food For Heart Program.

Adult↗
PubMed2004

Do physicians in Delaware follow national guidelines for tobacco counseling?

BACKGROUND: Despite national guidelines, studies across the country have shown that many physicians do not regularly engage in tobacco cessation behaviors such as assisting their patients with quitting. This survey study examined tobacco cessation behaviors among physicians in Delaware as part of the state's tobacco control program called Plan for a Tobacco-Free Delaware. METHODS: A self-administered questionnaire was mailed to all Delaware physicians in primary care and specialties that manage tobacco-related illnesses (cardiology, pulmonology, and allergy) in May of 2002 (n=890). RESULTS: Of the 156 survey respondents, most physicians reported regularly asking their adolescent patients (57.3%) and their adult patients (65.4%) about smoking and advising their smoking patients to quit (84%). Most physicians do not regularly assist patients in quitting (17.6%) or arrange follow-up (28.1%). Also, most physicians do not regularly prescribe nicotine replacement (12.9%) or bupropion (10.7%), nor do they regularly give written materials to help in quitting (16.3%) or refer patients to smoking cessation programs (14.7%). CONCLUSIONS: While most physicians in Delaware ask their patients about smoking and advise them to quit, most physicians do not adequately assist their smoking patients in accordance with national guidelines. Reasons include lack of time, lack of quick and easy tools to help patients quit, and inadequate reimbursement for physicians' tobacco cessation activities and medications. This article suggests ways that the state can assist physicians with tobacco cessation that can be incorporated into the Plan for a Tobacco-Free Delaware. In particular, ensuring adequate and universal reimbursement for physician visits related to tobacco cessation, for tobacco cessation programs, and for tobacco cessation medications is essential to increasing physician involvement in tobacco cessation activities.

Adult↗
PubMed2003

Urinary incontinence in primary care: a comparison of older African-American and Caucasian women.

Urinary incontinence is a common problem for aging women. Little is known about urinary incontinence in nonwhite populations. A telephone survey was used to compare the prevalence and severity of urinary incontinence as well as common risk factors for urinary incontinence in 194 African-American (AA) and Caucasian (C) women over the age of 50 who made a visit to a primary care practice within the prior 2 years. A high prevalence of UI was found among these women (62%AA, 67%C), though no significant difference was noted among the two groups. More Caucasian women than African-American women reported symptoms of stress incontinence. For both groups, the use of HRT was associated with reporting urinary incontinence. Higher body mass index and prior hysterectomy was associated with urinary incontinence for African-American women only. For both groups, low rates of 'botheredness' (28%AA, 32%C) and treatment seeking (39%AA, 52%C) were found.

Black or African American↗
PubMed2003

Primary care physician beliefs regarding usefulness of self-monitoring of blood pressure.

BACKGROUND: Recent studies suggest that the self-monitoring of blood pressure (SMBP) may improve the identification and control of hypertension. Although endorsed by the Joint National Committee VII guidelines, home monitoring is not currently part of the standard care of hypertension. OBJECTIVE: To assess community- and university-based primary care physicians' opinions of SMBP. METHODS: A written, 5-point, Likert-scale questionnaire was mailed to physicians in a primary care research network. RESULTS: We received completed surveys from 138 of 170 providers (81%). Physician ages ranged from 25 to 72 years. Half of the providers were female, and approximately half were residents. Most physicians (63%) reported having patients using SMBP. Physician opinions of SMBP were unrelated to age, gender and number of years in practice. Three key beliefs were expressed: SMBP could be useful, economical and problematic. Community-based physicians were more likely than university-based physicians to believe in the benefits of SMBP use, and to disagree that the use of SMBP could cause problems for them or their patients (P < 0.05). Compared with their peers, physicians with fewer than five patients using SMBP agreed more strongly with statements that SMBP use could cause problems for themselves and their patients in hypertension treatment. CONCLUSIONS: Overall, the providers responded that SMBP could be useful to them in managing hypertension but seem hesitant to endorse it fully at this time, possibly anticipating potential problems that could arise with SMBP use. Physicians with more patients using self-monitoring were more likely to endorse it.

Adult↗
PubMed2002

Physical activity curricula in medical schools.

Regular physical activity has many known health benefits, yet relatively few physicians counsel their patients about physical activity or exercise. The cited barriers to performing this type of counseling include lack of knowledge and skill, and data show that physicians are more likely to counsel patients about physical activity if they have adequate knowledge of the subject. Health promotion and disease prevention are watchwords in medical education today, yet with regard to these there are relatively few data on exercise or physical activity curriculum in medical schools. A recent survey showed that only 13% of U.S. medical schools provide a curriculum in physical activity. The authors discuss the need for changing the medical school curriculum to increase knowledge of the benefits of physical activity and develop counseling skills for modifying patients' behaviors.

Curriculum↗
PubMedDate not supplied

Validation of the dietary risk assessment food frequency questionnaire against the Keys score for saturated fat and cholesterol.

OBJECTIVE: The objective of this pilot study was to validate the Dietary Risk Assessment (DRA) food frequency questionnaire against the Keys score obtained from 2 2-day dietary recalls in a sample of subjects. DESIGN: Cross-sectional study design. SETTING: Urban university-based family practice. PARTICIPANTS: The 105 subjects included outpatients, medical students, and staff. MAIN OUTCOME MEASURE: Correlation between the DRA and Keys score. ANALYSIS: Pearson correlation analysis. RESULTS: We found that the correlation between the DRA and Keys score derived from the dietary recalls was .62 (P < .001). CONCLUSIONS AND IMPLICATIONS: The simplicity of the DRA and its correlation with dietary recall may make this a useful dietary analysis and nutrition education tool for both patients and physicians.

Adult↗
PubMedDate not supplied

The reliability of patient self-reported blood pressures.

Self-monitoring of blood pressure actively involves patients in hypertension management. However, the usefulness of self-monitoring of blood pressure may be limited by inaccurate patient reporting. The study objective was to assess reliability of patient blood pressure reporting over 6 months. Forty-nine subjects with Joint National Committee stage 1 or 2 hypertension were enrolled. Unaware that the monitors electronically store readings, the subjects were asked to check and record outpatient blood pressures twice weekly. Stored and written readings were compared. On average, patient-recorded blood pressures were equivalent to stored monitor values 80% or more of the time. Reliability of patient self-reporting was sustained over the 6-month study period. Notably, patients did not selectively report lower blood pressure readings. The overall mean self-reported and stored monitor blood pressures were nearly identical: blood pressure (+/-SD) 134+/-16.8/78+/-11.6 mm Hg and 135+/-19.6/80+/-13.3 mm Hg, respectively. The reliability of self-reporting of blood pressures for many patients supports the potential usefulness of self-monitoring of blood pressure in hypertension management.

Adult↗
PubMedDate not supplied

Impact of provider continuity on quality of care for persons with diabetes mellitus.

BACKGROUND: Many patients with diabetes fail to receive recommended monitoring tests. One reason might be inadequate continuity of care. This study examined the association between provider continuity and completion of monitoring tests for patients with diabetes mellitus. METHODS: A cross-sectional analysis was conducted on claims data from a private national health plan for 1 year (January 1, 1999, through December 31, 1999). Participants had a diagnosis of diabetes mellitus and at least 2 outpatient visits during the study year (N = 1,795). The association was measured between continuity of care with an individual provider and completion of 3 diabetes monitoring tests: a glycosylated hemoglobin test, a lipid profile, and an eye examination. RESULTS: Eighty-one percent of patients had a glycosylated hemoglobin test, 66% had a lipid profile, and 28% had an eye examination during the study year. After controlling for demographics, number of diabetes visits, case mix, and diabetes complications, provider continuity was not significantly associated with the receipt of a glycosylated hemoglobin test (odds ratio [OR] = 0.61, 95% confidence interval [CI], 0.32-1.16), a lipid profile (OR = 0.97, 95% CI, 0.57-1.64) or an eye examination (OR = 0.60, 95% CI, 0.30-1.19). When continuity was measured only among primary care providers, there was no significant association for receipt of a glycosylated hemoglobin test (OR = 0.73, 95% CI, 0.41-1.33), a lipid profile (OR = 0.88, 95% CI, 0.53-1.47) or an eye examination (OR = 0.70, 95% CI, 0.35-1.36). CONCLUSIONS: This study found no association between provider continuity and completion of diabetes monitoring tests in a national privately insured population. Whereas continuity might benefit other aspects of health care, it does not appear to benefit improved monitoring for diabetes.

Adult↗
PubMedDate not supplied

Accuracy of screening for diabetic retinopathy by family physicians.

BACKGROUND: We wanted to examine the accuracy of family physicians' screening for diabetic retinopathy using standardized criteria and a nonmydriatic ophthalmoscope. METHODS: Eleven family physicians assessed 28 standardized patients with diabetes mellitus using the PanOptic ophthalmoscope. Their assessments of whether the patients required referral to an ophthalmologist were compared with the reference standard of retinal diagrams. RESULTS: The mean sensitivity for the family physicians was 87% (95% confidence interval [CI], 83%-91%) with a specificity of 57% (95% CI, 46%-68%). Overall agreement was moderate, with a mean kappa = .43 (95% CI, 0.39%-0.47%). CONCLUSIONS: Using standardized criteria and a nonmydriatic ophthalmoscope, family physicians were fairly accurate in screening patients for diabetic retinopathy. Whereas this technique is not sufficiently accurate to replace routine referral for all patients with diabetes, it can be used to improve care for those patients who fail to get routine eye screenings.

Diabetic Retinopathy↗