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Biomedical subjects

K B Wells

Publications and source records attributed to K B Wells.

At least 127 records · Page 7Linked to original sources
PubMed1987

Somatization in the community: relationship to disability and use of services.

We tested the hypotheses that an abridged somatization construct that we had developed would be associated with use of health services, preferential use of medical over mental health services, and an index of disability. These hypotheses were tested using structured interview data from 3,132 randomly selected community respondents. We found that: respondents meeting criteria for somatization reported a heavier use of health services than non-somatizers; of those respondents meeting criteria for a psychiatric diagnosis, somatizers preferentially used medical over mental health services whereas non-somatizers reported the opposite trend; and somatizers were more likely than non-somatizers to report recent sick leave or restricted activity.

Adult↗
PubMed1987

Cost-sharing and the use of general medical physicians for outpatient mental health care.

Many patients with emotional disorders receive their mental health care from general medical physicians. In this article, we examine differences in costs and style between mental health care delivered by mental health specialists and that provided by general medical physicians, and the sensitivity to insurance of the patient's choice of mental health care provider. We use data from a randomized trial of cost-sharing, the RAND Health Insurance Experiment. Even when all outpatient mental health care was free (up to 52 visits a year), one-half of the users of outpatient mental health services visited general medical providers only. This half accounted for only 5 percent of outpatient mental health care expenditures, because the treatment delivered by general medical providers was much less intensive than that delivered by mental health specialists. Mental health status, at enrollment, was similar for those who received their mental health care from either provider group. Despite the large difference in cost of care, the choice of provider (mental health specialist versus general medical provider) was not sensitive to the generosity of insurance.

Adult↗
PubMed1987

Medical students' expectations for encounters with minority and nonminority patients.

The authors examined the expectations of firstyear medical students (n = 139) at the University of California, Los Angeles, School of Medicine in regard to interacting with black, Latino, Asian, and white patients. Using slides and a questionnaire, the results indicated that students expected to be significantly less comfortable interviewing blacks than other patients and to view blacks and Latinos as less likely to comply with treatment than whites and Asians. Black and Hispanic students were significantly more likely than white and Asian students to expect black and Hispanic patients to comply with treatment.

Adolescent↗
PubMed1987

Comparison of use of outpatient mental health services in an HMO and fee-for-service plans. Sensitivity to definition of a visit.

Whereas previous authors have used a variety of strategies to identify use of mental health services, the sensitivity of estimates to the definition of a visit has been little studied. The authors examined the sensitivity of estimates of use of outpatient mental health services in both HMO and fee-for-service plans to the method of identifying outpatient mental health visits. The HMO and fee-for-service plans had identical benefits (i.e., free care). Data were from the Rand Health Insurance Study. Mental health visits were identified using two definitions: presence of a mental health diagnosis or procedure; and presence of a mental health procedure, diagnosis, or prescription for psychotropic medication in the absence of physical disorders requiring such medications. The major policy conclusions about lower levels of use in the HMO compared to fee-for-service plans were insensitive to the definition of a visit. Nevertheless, estimates of use of general medical providers were higher when psychotropic medications were included in the definition of a mental health visit; this sensitivity to definition was significantly greater for fee-for-service than HMO participants (P less than 0.05). Further, conclusions about the comparability of enrollment mental health status of patients treated by general medical providers in HMO and fee-for-service plans were somewhat sensitive to the definition of a visit.

Data Collection↗
PubMed1986

How cost sharing affects the use of ambulatory mental health services.

The less generous insurance coverage for mental health care has generated some controversy. The major unresolved question is how the demand for outpatient mental health care responds to cost sharing. We used data from a randomized trial of fee-for-service health insurance for the nonelderly to address this question. The study enrolled 5809 persons. The results are based on 19 819 person-years of data. One hundred thirty-three percent more is spent on outpatient psychotherapy when care is free to patients than when they pay 95% of the fee, subject to an annual catastrophic limit. But, the absolute level of expenditure is low on all plans; $32 per person per year with free care. The response to psychotherapy services to cost sharing is insignificantly larger than that for outpatient general medical services. We found no evidence that more generous coverage for outpatient psychotherapy decreases total health expenditures.

Ambulatory Care↗
PubMed1986

Sociodemographic factors and the use of outpatient mental health services.

What are the effects of sociodemographic factors on the use of outpatient mental health services when different demographic groups have identical health insurance coverage? The authors answer this question using data from the Rand Health Insurance Experiment. Health insurance was randomly assigned to families representative of the nonaged, noninstitutionalized civilian population in six U.S. sites. Income has no significant total effect on use when all income groups have the same coverage. When the effects of variables correlated with socioeconomic status are removed, users with higher socioeconomic status are significantly more likely to choose a mental health specialist rather than only general medical providers for their mental health care (P less than 0.05); among those who visit mental health specialists, those with higher socioeconomic status incur significantly greater expenses (P less than 0.10). Women use significantly more mental health services than men (P less than 0.05), who in turn use significantly more mental health services than children (P less than 0.05), even after controlling for demographic factors, health status, and insurance coverage. Similarly, there are large differences (roughly sixfold) by site in outpatient mental health expenses even when all sites have identical coverage.

Adolescent↗
PubMed1986

A comparison of the effects of sociodemographic factors and health status on use of outpatient mental health services in HMO and fee-for-service plans.

The authors compared the effects of age, sex, socioeconomic status, and mental and physical health status on the use of outpatient mental health services in one well-established health maintenance organization (HMO) and in fee-for-service plans. In the Seattle site of the Rand Health Insurance Study (HIS), families were randomly assigned to HMO or fee-for-service coverage. Adults incur much greater expense for outpatient mental health services than children in both an HMO and a fee-for-service plan with identical coverage (i.e., free care). However, the difference in use between adults and children is significantly greater for the fee-for-service plan than the HMO (P less than 0.01). Similarly, education has significantly greater effects on use for the fee-for-service than the HMO plan. Increased income has a significant negative effect on use in both the HMO and fee-for-service plans. Mental and physical health status have similar large effects on use in both fee-for-service and HMO plans.

Adult↗
PubMed1986

Planning and integrating a behavioural sciences curriculum.

This paper describes methods of planning and integrating an introductory course in human behaviour for first-year medical students, from a primary care perspective. The conceptual model is based on a synthesis of the literature on stress, stress responses and human development. An experiential component integrates didactic material and clinical experience. The teaching methods are based on formats, such as grand-rounds, used by postgraduate doctors. Specific techniques are described to integrate the diverse components of the curriculum: timing of learning experiences; training of academic staff; preparation of patient volunteers; and use of student representatives.

Attitude of Health Personnel↗
PubMed1986

Use of outpatient mental health services by a general population with health insurance coverage.

Characteristics of use of mental health services by 4,254 persons enrolled in the Rand Health Insurance Study were analyzed in an attempt to predict patterns of use by a general population with assigned insurance coverage. Families in the study, whose members ranged in age from birth through 62 years, were randomly assigned to one of 14 insurance plans covering a wide variety of services by all licensed provider groups. During a one-year period less than 4 percent of the enrollees visited a mental health specialist, and only 7.1 percent saw any provider for mental health care. About half of those receiving outpatient mental health care visited general medical providers only. Annual outpatient mental health expenses per enrollee were about $25 (1983 dollars). The authors compare their findings with those of other studies and discuss their implications for insurance coverage of mental health services.

Ambulatory Care↗
PubMed1986

The practices of general and subspecialty internists in counseling about smoking and exercise.

We compared the practices of subspecialists and general internists in counseling about smoking and exercise, using data from a study of recent graduates of United States training programs in internal medicine. Information on the characteristics of physicians and their clinical practices was obtained from self-report questionnaires. The internists most likely to counsel smokers regardless of the presence or absence of diseases associated with smoking are cardiologists, pulmonary specialists, nephrologists, and generalists trained in a primary care residency funded by the Robert Wood Johnson Foundation or Health Resources Administration. Most internists practice tertiary prevention by counseling a high percentage of smokers with heart or lung disease. Rheumatologists counsel a higher percentage of all patients with poor exercise habits but a lower percentage of such patients with heart disease than do other internists. The differences in counseling related to training are not explained by different levels of involvement as a primary care physician. Rather, these differences appear to reflect training and subspecialty-specific priorities for counseling.

Adult↗
PubMed1986

Which first-year medical students expect to practice in an inner-city or ghetto setting.

The authors examined the expected practice location of first-year medical students at UCLA School of Medicine using self-administered questionnaires. The response rate was 94 percent. About 24 percent of students are from underserved minority groups. Compared with nonminority students, minority students are significantly older, of lower socioeconomic status, and more likely to have been raised in an inner-city or ghetto environment (each P<.05). While the average nonminority student expected to practice in a noninner-city, urban, or suburban environment, the average minority student expected to practice in an inner-city or ghetto environment (P<.0001). Differences in expected practice location due to ethnicity remained after controlling for sociodemographic factors. Students with previous medical experience and those from poorer sociodemographic backgrounds are also more likely to expect to practice in ghetto environments, regardless of ethnic background (each P<.05).

Adult↗
PubMed1986

Use of outpatient mental health services in HMO and fee-for-service plans: results from a randomized controlled trial.

Does a prepaid group practice (PGP) deliver less outpatient mental health care than the fee-for-service (FFS) sector when they serve comparable populations with comparable benefits? To examine this issue, we used data from the Rand Health Insurance Study, which randomized families into a prepaid group practice or FFS insurance plans. Participants in a FFS plan with no cost sharing (i.e., free care) are equally likely to visit a mental health specialist in a year, but incur 2.8 times the costs of prepaid participants (p less than .05). This difference is due to fewer visits per user, substitution of psychiatric social workers for psychiatrists and psychologists, and reliance on group rather than individual therapies in the prepaid plan. Because of the experimental design, these differences are due to institutional and incentive differences rather than adverse selection. We found no evidence of appreciable or significant adverse selection into or out of the prepaid group practice. A full evaluation of the desirability of prepaid or fee-for-service care requires data on health outcomes, which are not presented here.

Adult↗
PubMed1986

Quality of care for psychotropic drug use in internal medicine group practices.

To evaluate the care given by internists in group practices at 16 academic medical centers to patients who used minor tranquilizers or antidepressants, data were abstracted from medical records and compared with specific criteria for quality care.Of 1,532 continuing care patients, 18% used minor tranquilizers and 7% used antidepressants. Almost 90% of antidepressants were prescribed for depression and 50% of minor tranquilizers were prescribed for mental health problems. The group practice internists performed well on concrete aspects of care, such as avoiding giving minor tranquilizers intravenously or intramuscularly and scheduling follow-up visits. Relatively few patients, however, had an adequate treatment plan noted in the chart. About 25% of users of minor tranquilizers did not have an acceptable indication for the drug noted in the chart. Less than 10% of users of minor tranquilizers had a plan for discontinuing the drug use; yet, 35% had long-term regular use.

Group Practice↗
PubMed1985

A model for teaching the brief psychosocial interview.

A technique to teach first-year medical students to conduct brief interviews that focus on how medical illness affects the daily life of patients is described. The technique includes a conceptual model of the interview and an explicit teaching method for instructors and students. With the conceptual model, the structure, goals, and techniques of interviewing are identified, and an operational definition of empathic interviewing is provided. The teaching methods include a manual and a seminar for faculty members, a syllabus for students, workshops for students using live patient volunteers, and evaluations of the students' interviews based on the conceptual model.

Education, Medical↗
PubMed1985

Career orientations of medical and pediatric residents.

Educators have expressed concern about the declining percentage of graduating residents who choose an academic career. This study identifies characteristics of postgraduate physicians that are associated with intentions to pursue an academic career or a full-time private practice. Data were obtained from 299 residents in pediatrics and internal medicine at five academic medical centers in Southern California, using self-report questionnaires. Preference for an academic career was strongest among residents who were most satisfied with their work, were frequently sponsored by faculty, had published, or who either lived alone or were married to another professional. The likelihood of full-time private practice was strongest among residents who were less frequently sponsored by faculty, had not published, lived with others, were from certain medical schools, or were females. Training programs may wish to consider some of these factors in the selection of residents and in program development.

Academic Medical Centers↗
PubMed1985

Health status, sociodemographic factors, and the use of prescribed psychotropic drugs.

The relations among sociodemographic factors, health status, and use of prescribed sleeping pills and tranquilizers are examined. The data are from the Rand Health Insurance Experiment, which has a random sample of the nonaged, noninstitutionalized, civilian population in six U.S. sites. Information on sociodemographic factors, health status, and the use of prescribed psychotropic drugs during the previous 3 months was obtained from self-report questionnaires collected at enrollment. Mental and physical health status have large independent and significant effects on the probability of use of both prescribed tranquilizers (P less than 0.0001) and sleeping pills (P less than 0.0001), whether or not we remove the effects of sociodemographic factors. For the probability of tranquilizer use, there is no significant interaction between gender and mental health or between mental health and physical health. Age and gender have large and significant effects on the use of prescribed psychotropic drugs even after controlling for differences in health status and other demographic factors. The effects of site and socioeconomic status are modest compared with the effects of health, age, and gender.

Adult↗