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Biomedical subjects

K B Wells

Publications and source records attributed to K B Wells.

142 records · Page 8Linked to original sources
PubMed1984

Physicians' practices in counseling patients about health habits.

The authors developed and tested a model of two dimensions of physicians' behavior in counseling patients about four health habits (smoking, weight control, alcohol consumption, and regular exercise). The two dimensions are the indications for routine counseling and the aggressiveness of counseling style. To test these dimensions, a questionnaire was administered to a random sample of members of a Western County Medical Society in 1978. The response rate was 76%. Indications and Aggressiveness subscales were developed for each habit. Reliability and discriminant validity for all subscales was excellent. Descriptive results were consistent with expectations, e.g., physicians counseled more about smoking and weight control than about alcohol and exercise. The results support the dimensions and suggest that the questionnaire will be useful for future research on counseling behavior.

Alcohol Drinking↗
PubMed1984

Physicians' attitudes in counseling patients about smoking.

Attitudes of physicians toward counseling patients about their smoking habits may influence whether and how counseling occurs. In this paper, the authors develop and test a conceptual model of these attitudes. The model includes four attitude dimensions: physicians' motivations to counsel, perceived health risk of smoking, perceived skills in counseling, and perceived costs and benefits to the physician of counseling. A self-report questionnaire including a 40-item measure of these attitudes was delivered to a random sample of male general practitioners, internists, surgeons, and obstetrician-gynecologists who were members of a western county medical society in 1978. The response rate was 76%. Based on factor analyses, 10 subscales and 3 global scales were formed by summing items. The item contents of scales are consistent with the authors' model, and reliability and item-discriminant validity are excellent. The authors' model may be useful in understanding the factors that affect the process and outcomes of physician counseling about smoking.

Attitude of Health Personnel↗
PubMed1984

The sensitivity of mental health care use and cost estimates to methods effects.

The authors determined the sensitivity of estimates of the use and cost of outpatient mental health care to two methods effects: the definition of a mental health visit and strategies for allocating mental health care costs. They use data from the Rand Health Insurance Study, which has a random sample of the nonaged noninstitutionalized civilian population in six United States sites. Estimates of the use of mental health specialists are insensitive to alternative methods. However, estimates of the use and cost of the mental health care delivered by nonpsychiatrist physicians (e.g., internists) are quite sensitive to methods effects. Nevertheless, the cost of care from nonpsychiatrist physicians is so low that the total cost of outpatient mental health care is not meaningfully affected by methods effects.

Community Mental Health Services↗
PubMedDate not supplied

Treatment typically provided for comorbid anxiety disorders.

OBJECTIVE: To study whether the extent and type of treatment for comorbid anxiety disorders varies for patients with depression, hypertension, diabetes, and heart disease treated by general medical clinicians. METHODS: Data are from 2189 general medical patients with and without comorbid anxiety disorders in the Medical Outcomes Study. Treatment data were based on clinician reports of counseling provided during a visit and patient reports of recent medication use. RESULTS: Patients with comorbid anxiety disorders were more likely to receive treatments for anxiety disorders than those without anxiety disorders. Among those with anxiety disorders, the use of psychosocial counseling and psychotropic medication was greater for patients with depression than for patients without depression who had chronic medical conditions. Minor tranquilizers were used more commonly than antidepressants, regardless of the type of comorbid condition. Among patients with anxiety disorders, those visiting medical subspecialists were more likely to use minor tranquilizers than those visiting family practitioners or internists. Patients of family physicians with chronic medical conditions (but not with depression) were less likely than similar patients of internists to use minor tranquilizers whether or not anxiety disorders were present. CONCLUSIONS: Anxiety disorders co-occurring with another disease (medical illness or depression) increases the likelihood of counseling and the use of psychotropic medication in the general medical sector. Patients with a chronic medical illness with or without comorbid anxiety disorders visiting family physicians are less likely to use minor tranquilizers than those visiting subspecialists or internists.

Adult↗
PubMedDate not supplied

Quality of care for primary care patients with depression in managed care.

OBJECTIVE: To evaluate the process and quality of care for primary care patients with depression under managed care organizations. METHOD: Surveys of 1204 outpatients with depression at the time of and after a visit to 1 of 181 primary care clinicians from 46 primary care clinics in 7 managed care organizations. Patients had depressive symptoms in the previous 30 days, with or without a 12-month depressive disorder by diagnostic interview. Process indicators were depression counseling, mental health referral, or psychotropic medication management at index visit and the use of appropriate antidepressant medication during the last 6 months. RESULTS: Of patients with depressive disorder and recent symptoms, 29% to 43% reported a depression-specific process of care in the index visit, and 35% to 42% used antidepressant medication in appropriate dosages in the prior 6 months. Patients with depressive disorders rather than symptoms only and those with comorbid anxiety had higher rates of depression-specific processes and quality of care (P < .005). Recurrent depression, suicidal ideation, and alcohol abuse were not uniquely associated with such rates. Patients visiting for old problems or checkups received more depression-specific care than those with new problems or unscheduled visits. The 7 managed care organizations varied by a factor of 2-fold in rates of depression counseling and appropriate anti-depressant use. CONCLUSIONS: Rates of process and quality of care for depression as reported by patients are moderate to low in managed primary care practices. Such rates are higher for patients with more severe forms of depression or with comorbid anxiety, but not for those with severe but "silent" symptoms like suicide ideation. Visit context factors, such as whether the visit is scheduled, affect rates of depression-specific care. Rates of care for depression are highly variable among managed care organizations, emphasizing the need for process monitoring and quality improvement for depression at the organizational level.

Adolescent↗
PubMedDate not supplied

A model for predicting the counseling practices of physicians.

The authors present a conceptual model of the determinants of the counseling practices of physicians and an empirical test of the model. Seventy-six per cent of a 50% random sample of physicians in a western county medical society completed a questionnaire (n = 151). This instrument measures the aggressiveness, the indications and techniques used by physicians in counseling patients about smoking, exercise, weight control and alcohol use. The independent variables assessed by this instrument are motivations, perceived skills and barriers, medical specialty, and personal health habits. Significant associations were found between the counseling practices reported and physicians' personal health habits, attitudes and specialties. Non-surgeons counseled more patients, counseled more intensively, and used a greater variety of techniques than surgeons and obstetrician-gynecologists. In general, physicians who had poor health habits did not fully counsel patients about those habits; however, physicians attempting to improve poor habits counseled patients significantly more often than physicians who were not trying to change their own behavior. Health maintenance efforts among physicians may have a multiplier effect.

Alcohol Drinking↗
PubMedDate not supplied

Depression in general medical settings. Implications of three health policy studies for consultation-liaison psychiatry.

Prepaid or prospective reimbursement has implications for the consultation-liaison (C-L) psychiatrist. The author reviews results from three health policy studies that indicated 1) degree of reliance on general medical providers for mental health care is not affected by generosity of fee-for-service (FFS) coverage, but is greater in some prepaid health care systems; 2) psychological sickness of depressed outpatients visiting general medical providers is similar across prepaid and FFS systems of care; 3) prepaid care is associated with lower rates of detection of depression and counseling in the general medical sector; 4) depression outcomes in the general medical sector are similar under prepaid or FFS care; 5) quality of care for depressed patients is moderate to low in the general medical sector; and 6) depressed elderly inpatients receive higher quality of psychological care in psychiatric units, but they receive higher quality of physical care in general medical wards. The discussion emphasizes the C-L psychiatrist's role in educating general medical providers, improving outcomes for the sickest patients, and improving psychosocial care in prepaid practices.

Depressive Disorder↗
PubMedDate not supplied

The Quality Improvement for Depression collaboration: general analytic strategies for a coordinated study of quality improvement in depression care.

It is difficult to evaluate the promise of primary care quality-improvement interventions for depression because published studies have evaluated diverse interventions by using different research designs in dissimilar populations. Preplanned meta-analysis provides an alternative to derive more precise and generalizable estimates of intervention effects; however, this approach requires the resolution of analytic challenges resulting from design differences that threaten internal and external validity. This paper describes the four-project Quality Improvement for Depression (QID) collaboration specifically designed for preplanned meta-analysis of intervention effects on outcomes. This paper summarizes the interventions the four projects tested, characterizes commonalities and heterogeneity in the research designs used to evaluate these interventions, and discusses the implications of this heterogeneity for preplanned meta-analysis.

Adult↗
PubMedDate not supplied

Evidence-based care for depression in managed primary care practices.

This paper evaluates whether externally designed, evidence-based interventions for improving care for depression can be locally implemented in managed care organizations. The interventions were carried out as part of a randomized trial involving forty-six practices within six diverse, nonacademic managed care plans. Based on evaluation of adherence to the intervention protocol, we determined that local practice leaders are able to implement predesigned interventions for improving depression care. Adherence rates for most key intervention activities were above 70 percent, and many were near 100 percent. Three intervention activities fell short of the goal of 70 percent implementation and should be targets for future improvement.

Depressive Disorder↗
PubMedDate not supplied

A home-visit program for first-year medical students as perceived by participating families.

A program to train first-year medical students to identify the impact of chronic disease on family functioning consists of a lecture/demonstration, reading materials, and a family home visit for small groups of eight students and an instructor. The authors used a self-report questionnaire to evaluate 30 families (88% response rate) participating in the home visits. Although 28% of families reported they were uncomfortable sharing a family problem, 90% of families reported no tensions or problems as a consequence of the visit. Two-thirds of the families learned new information about their family and two families decided to visit a health professional as a result of the visit. Almost all families were willing to participate again, demonstrating that family home visits are feasible and have few adverse consequences in a well-supervised training program.

Curriculum↗
PubMedDate not supplied

Do physicians preach what they practice? A study of physicians' health habits and counseling practices.

We examined the relation of physicians' clinical specialty, personal health habits, and health-related beliefs to their practices in counseling about smoking, weight, exercise, and alcohol. We surveyed a random sample of members of a county medical society in selected specialties. Physicians with better personal health habits and more positive attitudes toward counseling counsel a broader range of patients and counsel more aggressively. Surgeons counsel less than nonsurgeons, even after controlling for differences in health-related attitudes and personal habits.

Alcohol Drinking↗