Biomedical subjects

Janice C Probst

Publications and source records attributed to Janice C Probst.

At least 19 recordsLinked to original sources

PubMed2006

Medically unnecessary emergency medical services (EMS) transports among children ages 0 to 17 years.

OBJECTIVES: Estimate the prevalence of medically unnecessary Emergency Medical Services (EMS) transports among children. METHODS: We linked EMS and emergency department (ED) billing records for all EMS-to-hospital transports of children originating in three counties in South Carolina between January 1, 2001 and March 31, 2003. EMS responses resulting in no transport, transports to destinations other than the ED, or multiple trips for the same child in a single day could not be linked to ED data and were excluded. Medically unnecessary transports were identified with an algorithm using pre-hospital impressions, ED diagnoses and ED procedures. After exclusions, 5,693 transports of children between 0 and 17 years were available for study. RESULTS: Sixteen percent (16.4%) of all transports were medically unnecessary. Among children through age 12, upper respiratory and viral problems were the most common diagnoses associated with medically unnecessary transports; among older children, behavioral problems such as conduct disturbance or drug abuse were common. In multivariable analysis, the odds of an unnecessary transport were higher among younger children, non-white children, rural children, and children insured by Medicaid. CONCLUSIONS: The proportion of EMS transports which may be medically unnecessary is relatively modest compared to previous studies. However, many questions remain for future research. Further investigation should include examination of primary care availability and occurrence of unnecessary EMS use, existence of race-based disparities, and transports involving conduct disturbance and other behavioral conditions among children.

Adolescent↗

PubMed2006

Racial and ethnic disparities in potentially avoidable delivery complications among pregnant Medicaid beneficiaries in South Carolina.

OBJECTIVES: To examine race and ethnicity differences in accessibility and effectiveness of health care during pregnancy. METHODS: Data were 26,866 year 2000 Medicaid-insured deliveries from the South Carolina Office of Research and Statistics, and Area Resource File. The access indicator was Potentially Avoidable Maternity Complications (PAMCs). PAMC risks can be reduced through prenatal care, such as infection screening and treatment, and healthy behaviors it promotes. We compared PAMC risks of Blacks, Hispanics, and Whites. Analyses included PAMC rates, Chi-square, t-tests, multilevel logistic regression. Risks were estimated for ages 10-17, and 18+. RESULTS: At ages 10-17 (n=2,691), Blacks and Hispanics had notably higher unadjusted and adjusted PAMC risks (adjusted odds ratios, ORs, 2.26, p < .001; 3.29, p < .05, respectively). At ages 18+, adjusted odds for Hispanics were about half those of Whites (p < .05). Adjusted odds for adult Blacks and Whites did not differ. This may be due to controlling for many risk factors that are more prevalent among Blacks: Single, disabled, poverty, diabetes, hypertension, rurality; however, unadjusted PAMC prevalence also did not differ greatly (3.9 for Blacks, 3.4 for Whites, p < .1). Adjusted risks were high for adults with diabetes (OR 2.40, p < .001) and all rural women (teen OR 4.02, p < .05; adult OR 1.83, p < .001). CONCLUSIONS: Young Blacks and Hispanics have notably higher risks of delivery outcomes indicating less access to prenatal care of reasonable quality. Policies to reduce PAMCs in Medicaid should address needs of young Blacks and Hispanics; enhance diabetes treatment for adult women; and address rural access barriers for all women.

Adolescent↗

PubMed2006

Expected annual emergency miles per ambulance: an indicator for measuring availability of Emergency Medical Services resources.

CONTEXT: To ensure equitable access to prehospital care, as recommended by the Rural and Frontier Emergency Medical Services (EMS) Agenda for the Future, policymakers will need a uniform measure of EMS infrastructure. PURPOSE AND METHODS: This paper proposes a county-level indicator of EMS resource availability that takes into consideration existing EMS resources (ambulances), population health and demographics, and geographic factors. The indicator, the EXpected annual emergency miles per AMBulance (EXAMB), provides a basis for comparing ambulance availability across counties within states. A method for calculating the EXAMB indicator is demonstrated using data from 5 states. FINDINGS: The EXAMB indicator was negatively correlated with ambulance availability per 100,000 population in 4 of the 5 states in the study. The indicator was positively correlated with rurality in 3 states. In Mississippi, South Carolina, and Wyoming, whole-county health professional shortage areas had median EXAMB values 45%-81% higher than those of the non-health professional shortage areas counties. CONCLUSIONS: Future research should explore the relationship of the EXAMB to EMS outcomes, with the ultimate goal of developing a nationally recognized indicator of "adequate" EMS resource availability.

Ambulances↗

PubMed2006

Exploring physician and staff perceptions of the learning environment in ambulatory residency clinics.

BACKGROUND AND OBJECTIVES: Investigations of teaching quality in ambulatory clinics have generally focused on faculty and medical student perspectives. We investigated the association of learning and organizational environment variables with faculty, resident, and nursing staff perceptions of quality of teaching and with a measure of resident learning in ambulatory residency clinics. METHODS: Annually over 5 years (1998-2002), we distributed learning and organizational environment surveys to faculty, residents, and staff in three ambulatory clinics of the Wayne State University Department of Family Medicine. We assessed internal reliability of the surveys' 11 scales and then compared responses of employee groups across sites. We then conducted a multiple regression analysis to determine the association of learning and organizational environment variables with faculty, resident, and staff perceptions of quality of teaching. We also compared the mean change in residents' In-training Examination (ITE) scores at our clinic teaching sites over the years of the study. RESULTS: Nine of 11 survey scales demonstrated acceptable internal reliability. Staff views were significantly lower than residents' views on all scales and were significantly lower than faculty's on all but one scale. Opinions about availability of learning opportunities for residents explained the most variance (35.2%) in the overall assessment of teaching quality. The addition of job satisfaction brought the explained variance up to 46.4%. The mean change in ITE scores was higher for residents at the site with higher learning and organizational environment assessment scores but not significantly so. CONCLUSIONS: Nine learning and organizational environment scales were found internally reliable and useful to measure faculty, resident, and staff perspectives on ambulatory teaching sites. Two areas of focus for improvement were found. First, learning opportunities should be structured so that residents are oriented to the ambulatory clinic, have their knowledge assessed regularly, are helped to meet individual goals, are given appropriate levels of responsibility, and see an adequate number, mix, and continuity of patients. Second, prioritizing efforts to improve job satisfaction for all employees is important because of the association between job satisfaction and employee perceptions of quality of teaching. We recommend that research into the educational climate in ambulatory clinics include perspectives of the full range of clinic personnel who can contribute to resident learning.

Ambulatory Care Facilities↗

PubMed2006

Rural-urban differences in depression prevalence: implications for family medicine.

BACKGROUND AND OBJECTIVES: Rural populations experience more adverse living circumstances than urban populations, but the evidence regarding the prevalence of mental health disorders in rural areas is contradictory. We examined the prevalence of depression in rural versus urban areas. METHODS: We performed a cross-sectional study using the 1999 National Health Interview Survey (NHIS). In face-to-face interviews, the NHIS administered the Composite International Diagnostic Interview Short Form (CIDI-SF) depression scale to a nationally representative sample of 30,801 adults, ages 18 and over. RESULTS: An estimated 2.6 million rural adults suffer from depression. The unadjusted prevalence of depression was significantly higher among rural than urban populations (6.1% versus 5.2% ). After adjusting for rural/urban population characteristics, however, the odds of depression did not differ by residence. Depression risk was higher among persons likely to be encountered in a primary care setting: those with fair or poor self-reported health, hypertension, with limitations in daily activities, or whose health status changed during the previous year. CONCLUSIONS: The prevalence of depression is slightly but significantly higher in residents of rural areas compared to urban areas, possibly due to differing population characteristics.

Adolescent↗

PubMed2005

Insurance, acculturation, and health service utilization among Korean-Americans.

This study describes the pattern and predictors of ambulatory care utilization among Korean Americans (KAs) living in Los Angeles. Data were gathered via a mail survey. Analysis employed a two-part model: logit model for factors affecting any health care use and truncated negative binomial model for frequency of use given one visit. Use of ambulatory care among KAs was low (2.80 visits during prior 12 months), compared to their counterparts in South Korea and the U.S. population. Variables associated with higher utilization included old age, health needs, and health insurance. Income had a positive effect on health care utilization decisions among the uninsured. Acculturation appeared to be neither a strong nor consistent predictor of ambulatory care utilization among KAs. Of particular concern is the finding that KAs suffer from inadequate access to care due to lack of employment-based health insurance.

Acculturation↗

PubMed2005

More may be better: evidence of a negative relationship between physician supply and hospitalization for ambulatory care sensitive conditions.

OBJECTIVE: To conduct an empirical test of the relationship between physician supply and hospitalization for ambulatory care sensitive conditions (ACSH). DATA SOURCES/STUDY SETTING: A data set of county ACSH rates compiled by the Safety Net Monitoring Initiative of the Agency for Healthcare Research and Quality (AHRQ). The analytical data set consists of 642 urban counties and 306 rural counties. We supplemented the AHRQ data with data from the Area Resource File and the Environmental Protection Agency. STUDY DESIGN: Ordinary least squares regression estimated ACSH predictors. Physician supply, the independent variable of interest in this analysis, was measured as a continuous variable (MDs/100,000). Urban and rural areas were modeled separately. Separate models were estimated for ages 0-17, 18-39, and 40-64. DATA EXTRACTION METHODS: Data were limited to 20 states having more than 50 percent of counties with nonmissing data. PRINCIPAL FINDINGS: In the urban models for ages 0-17, standardized estimates indicate that, among the measured covariates in our model, physician supply has the largest negative adjusted relationship with ACSH (p<.0001). For ages 18-39 and 40-64, physician supply has the second largest negative adjusted relationship with ACSH (p<.0001, both age groups). Physician supply was not associated with ACSH in rural areas. CONCLUSIONS: Physician supply is positively associated with the overall performance of the primary health care system in a large sample of urban counties of the United States.

Adolescent↗

PubMed2005

Delivery complications associated with prenatal care access for Medicaid-insured mothers in rural and urban hospitals.

CONTEXT: Pregnancy complications affect many women. It is likely that some complications can be avoided through routine primary and prenatal care of reasonable quality. PURPOSE: The authors examined access to health care during pregnancy for mothers insured by Medicaid. The access indicator is potentially avoidable maternity complications (PAMCs). Potentially avoidable maternity complications are often preventable through routine prenatal care, such as infection screening and treatment. The authors examined the risks of potentially avoidable maternity complications among rural and urban hospital deliveries for groups of mothers defined by race or ethnicity. METHODS: Data are from the year 2000 Nationwide Inpatient Sample (NIS). The stratified sample represents all discharges from 20.5% of community hospitals in the United States. The Nationwide Inpatient Sample identifies hospital locations, but not patients' areas of residence. Analyses, which accounted for the sample design, included calculation of potentially avoidable maternity complication rates by race or ethnicity, chi2, t tests, and multivariate logistic regression. FINDINGS: Within groups defined by race or ethnicity, unadjusted rates for potentially avoidable maternity complications did not differ significantly by hospital location. Holding other factors constant, potentially avoidable maternity complications were less common in rural hospitals than in urban hospitals (odds ratio, 0.78; CI, 0.62 to 0.99). In rural hospitals, African Americans had notably higher risk for potentially avoidable maternity complications than did non-Hispanic whites (odds ratio, 1.72; CI, 1.26 to 2.36). In urban hospitals, risk of potentially avoidable maternity complications was not significantly higher for African Americans. Hispanics and Asians had notably lower risks of potentially avoidable maternity complications in urban hospitals than did non-Hispanic whites. CONCLUSIONS: Providers and policymakers should work to reduce the risks of potentially avoidable maternity complications for African American women in rural areas who are insured by Medicaid.

Adolescent↗

PubMed2005

Update: health insurance and utilization of care among rural adolescents.

CONTEXT: Adolescence is critical for the development of adult health habits. Disparities between rural and urban adolescents and between minority and white youth can have life-long consequences. PURPOSE: To compare health insurance coverage and ambulatory care contacts between rural minority adolescents and white and urban adolescents. METHODS: Cross-sectional design using data from the 1999-2000 National Health Interview Survey, a nationally representative sample of US households. Analysis was restricted to white, black, and Hispanic children aged 12 through 17 (8,503 observations). Outcome measures included health insurance, ambulatory visit within past year, usual source of care (USOC), and well visit within past year. Independent variables included race, residence, demographics, facilitating/enabling characteristics, and need. RESULTS: Across races, rural adolescents were as likely to have insurance (86.8% vs 87.7%) but less likely to report a preventive visit (60.1% vs 65.5%) than urban children; residence did not affect the likelihood of a visit or a USOC. Minority rural adolescents were less likely than whites to be insured, report a visit, or have a USOC. Most race-based differences were not significant in multivariate analysis holding constant living situation, caretaker education, income, and insurance. Low caretaker English fluency, limited almost exclusively to Hispanics, was an impediment to all outcomes. CONCLUSIONS: Most barriers to care among rural and minority youth are attributable to factors originating outside the health care system, such as language, living situation, caretaker education, and income. A combination of outreach activities and programs to enhance rural schools and economic opportunities will be needed to improve coverage and utilization among adolescents.

Adolescent↗

PubMed2005

Recruitment and retention of emergency medical technicians: a qualitative study.

Emergency medical technicians (EMTs) are critical to out-of-hospital care, but maintaining staff can be difficult. The study objective was to identify factors that contribute to recruitment and retention of EMTs and paramedics. Information was drawn from three focus groups of EMT-Basic, EMT-Intermediate, and EMT-Paramedic personnel recruited from participants at an annual conference. Thoughts and feelings of EMTs and paramedics were investigated using eight questions designed to explore entry into emergency medical services, what it is like to be an EMT or paramedic, and the EMT educational process. Data were analyzed at the group level for common themes using NVivo. For a majority of respondents, emergency medical services was not a primary career path. Most respondents entered the industry as an alternate or replacement for a nursing career or as a second career following military medic service. The majority of respondents believed the job was stressful yet rewarding, and although it negatively affected their personal lives, the occupation gave them a sense of accomplishment and belonging. Respondents expressed a preference for EMT education resulting in college credit or licensure versus professional certification. Job-related stress produced by numerous factors appears to be a likely contributor to low employee retention. Recruitment and retention efforts should address study findings, incorporating key findings into educational, evaluation, and job enhancement programs.

Adolescent↗

PubMed2004

Obesity and physical inactivity in rural America.

CONTEXT AND PURPOSE: Obesity and physical inactivity are common in the United States, but few studies examine this issue within rural populations. The present study uses nationally representative data to study obesity and physical inactivity in rural populations. METHODS: Data came from the 1998 National Health Interview Survey Sample Adult and Adult Prevention Module. Self-reported height and weight were used to calculate body mass index. Physical inactivity was defined using self-reported leisure-time physical activity. Analyses included descriptive statistics, chi 2 tests, and logistic regression. FINDINGS: Obesity was more common among rural (20.4%, 95% CI 19.2%-21.6%) than urban adults (17.8%, 95% CI 17.2%-18.4%). Rural residents of every racial/ethnic group were at higher risk of obesity than urban whites, other factors held equal. Other predictors of obesity included being male, age 25-74, lacking a high school diploma, having physical limitations, fair to poor health, and a history of smoking. Proportionately more rural adults were physically inactive than their urban peers (62.8% versus 59.3%). Among rural residents, minorities were not significantly more likely to be inactive than whites. Males and younger adults were less likely to be inactive. Rural adults who were from the Midwest and South, had less than a high school education, had fair to poor health, and currently smoked were more likely to be inactive compared to their respective referent group. CONCLUSIONS: The high prevalence of obesity and inactive lifestyles among rural populations call for research into effective rural interventions.

Adolescent↗

PubMed2004

Disparities in access to care among rural working-age adults.

CONTEXT: Nationally, minority population disparities in health and in the receipt of health services are well documented but are infrequently examined within rural populations. PURPOSE: The purpose of this study is to provide a national picture of health insurance coverage and access to care among rural minorities. METHODS: A cross-sectional analysis using the 1999-2000 National Health Interview Surveys examined insurance status and receipt of ambulatory care during the past year. Multiple logistic regression was used to measure factors influencing the odds of insurance coverage and a provider visit. FINDINGS: Among rural minority adults, 32% of blacks, 35% of "other" race persons, and 45% of Hispanics were uninsured compared to 18% of whites. Differences in insurance status were not significant for rural blacks and Hispanics after resources such as education, income, and employment were held constant. Examining use, 37% of rural Hispanics and 27% of blacks, versus 20% of whites and 19% of persons of other race, had not made a health care visit in the past year. When resources were held constant, blacks and persons of other race/ethnicity no longer differed from whites, but differences among Hispanics persisted. CONCLUSIONS: A comprehensive approach to the health needs of rural working age adults must consider the unique characteristics of rural communities and populations, requiring cultural as well as financial creativity in the design of health delivery systems. The importance of resources such as education and employment points to the need to link health problems to area-specific rural economic development.

Adolescent↗

PubMed2004

Person and place: the compounding effects of race/ethnicity and rurality on health.

Rural racial/ethnic minorities constitute a forgotten population. The limited research addressing rural Black, Hispanic, and American Indian/Alaska Native populations suggests that disparities in health and in health care access found among rural racial/ethnic minority populations are generally more severe than those among urban racial/ethnic minorities. We suggest that disparities must be understood as both collective and contextual phenomena. Rural racial/ethnic minority disparities in part stem from the aggregation of disadvantaged individuals in rural areas. Disparities also emerge from a context of limited educational and economic opportunity. Linking public health planning to the education and economic development sectors will reduce racial/ethnic minority disparities while increasing overall well-being in rural communities.

Ethnicity↗

PubMed2003

Anxiety and anger among family practice residents: a South Carolina family practice research consortium study.

PURPOSE: To study the dimensions of anxiety and anger experienced by a statewide sample of South Carolina family practice residents. METHOD: A total of 350 family practice residents from seven programs participated. Each resident completed the Beck Depression Inventory, the State-Trait Anxiety Inventory, the Profile of Mood States, the Hassles Scale, the Maslach Burnout Inventory, and the State-Trait Anger Expression Inventory (STAXI) on at least one occasion. We analyzed reported anxiety and anger by gender, year of training, race, marital status, type of program (community hospital versus university), location of program, and season of the year. RESULTS: Residents reported lower levels of anxiety and anger across most dimensions compared with the adult populations on which the tests were standardized and with other resident and practicing physician populations. The residents did not demonstrate excessive levels of anger as a trait or in response to situations, nor did they significantly suppress anger. Although the residents reported a higher frequency of hassles than did normal populations, they did not consider these hassles severe. A higher than normal level of depersonalization was found among male, Caucasian, and third-year residents. CONCLUSIONS: These family medicine residents did not experience excessive levels of anxiety or anger during residency training either as a trait, state or somatic response. Extensive social and emotional "in-house" support, attention to stress-management skills, and the moderate personality characteristics of family practice residents help explain these findings. Initial assessment of psychological functioning and early remediation and program support during training may significantly reduce the potential for residents' impairment.

Adult↗

PubMed2003

The National Health Service Corps and Medicaid inpatient care: experience in a southern state.

BACKGROUND: Since 1970, the National Health Service Corps (NHSC) has worked to increase primary care access among underserved groups. This study examined whether NHSC alumni physicians were likely to treat a high proportion of Medicaid patients in their practices. METHODS: Using licensure files and hospital discharge data, we identified all physicians practicing in South Carolina who attended at least one discharge in 1998, excluding physicians who graduated before 1969, residents, and current NHSC-obligated physicians. The outcome studied was ranking in the highest quartile for Medicaid participation. RESULTS: Former NHSC participants, after adjustment for personal characteristics, education, and specialty, were nearly twice as likely to fall into the category of high Medicaid participation. NHSC physicians were more likely to practice in community health centers and to locate in areas with a health professions shortage and counties with high percentages of minorities and people living in poverty. CONCLUSION: NHSC alumni make career choices leading them to serve low-income patients.

Black or African American↗

PubMed2003

Potentially preventable care: ambulatory care-sensitive pediatric hospitalizations in South Carolina in 1998.

OBJECTIVE: We examined pediatric hospitalizations to assess personal and community factors affecting potentially preventable ambulatory care-sensitive condition (ACSC) hospitalizations. METHODS: Data came from the South Carolina 1998 Hospital Inpatient Encounter Database, which yielded 10,156 ACSC discharges among 81,808 pediatric hospitalizations. Analyses were performed at three levels: ACSC as a percentage of all hospitalizations, ACSC patients compared with other patients, and county ACSC rates. RESULTS: Younger, male, and nonwhite children; children with Medicaid insurance coverage; and children living in rural areas, health professional shortage area-designated counties, and poorer counties with fewer heath care resources were more likely to be hospitalized with ACSCs. A high percentage of children living in poverty and an absence of federally qualified community health centers were predictive of high county ACSC rates. CONCLUSION: Poverty and the absence of a provider serving low-income children increase ACSC rates. Monitoring changes in ACSC rates can be a tool for studying the effects of policy change.

Adolescent↗

PubMed2003

The impact of resident physician coverage on emergency department visits in South Carolina.

BACKGROUND: This study examines emergency department (ED) visits to assess the potential impact on rural and minority patients if the practice of resident moonlighting was limited. METHODS: Billing data from all South Carolina ED visits in 1998 were linked to the physician licensure file. Logistic regression analysis was performed to determine patient characteristics predictive of being seen by a resident physician. RESULTS: Resident physicians attended 3.4% of visits for patients residing in rural areas and 1.4% of those from urban areas. The odds of being treated by a resident were higher among persons living in health professional shortage-designated or rural areas, minorities, and persons with government insurance. CONCLUSION: Patients from vulnerable populations have greater odds of being seen by a resident physician for an ED visit. These populations may be placed at risk for reduced access to health care services if limitations on resident physician moonlighting impair the ability of rural hospitals to staff EDs.

Adult↗

PubMed2003

Prenatal care and infant birth outcomes among Medicaid recipients.

Infant morbidity due to low birth weight and preterm births results in emotional suffering and significant direct and indirect costs. African American infants continue to have worse birth outcomes than white infants. This study examines relationships between newborn hospital costs, maternal risk factors, and prenatal care in Medicaid recipients in an impoverished rural county in South Carolina. Medicaid African American mothers gave birth to fewer preterm infants than did non-Medicaid African American mothers. No differences in the rates of preterm infants were noted between white and African American mothers in the Medicaid group. Access to Medicaid services may have contributed to this reduction in disparities due to race. Early initiation of prenatal care compared with later initiation did not improve birth outcomes. Infants born to mothers who initiated prenatal care early had increased morbidity with increased utilization of hospital services, suggesting that high-risk mothers are entering prenatal care earlier.

Adult↗