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K Lobach

Publications and source records attributed to K Lobach.

2 recordsLinked to original sources
PubMed1997

Improving care for minority children with asthma: professional education in public health clinics.

OBJECTIVE: Recent studies have shown that lack of continuing primary care for asthma is associated with increased levels of morbidity in low-income minority children. Although effective preventive therapy is available, many African-American and Latino children receive episodic treatment for asthma that does not follow current guidelines for care. To see if access, continuity, and quality of care could be improved in pediatric clinics serving low-income children in New York City, we trained staff in New York City Bureau of Child Health clinics to provide continuing, preventive care for asthma. METHODS: We evaluated the impact of the intervention over a 2-year period in a controlled study of 22 clinics. Training for intervention clinic staff was based on National Asthma Education and Prevention Program guidelines for the diagnosis and management of asthma, and included screening to identify new cases and health education to improve family management. The intervention included strong administrative support by the Bureau of Child Health to promote staff behavior change. We hypothesized that after the intervention, clinics that received the intervention would, compared with control clinics, have increased numbers of children with asthma receiving continuing care in the clinics and increased staff use of new pharmacologic and educational treatment methods. RESULTS: In both the first and second follow-up years, the intervention clinics had greater positive changes than control clinics on measures of access, continuity, and quality of care. For second year follow-up data these include: for access, greater rate of new asthma patients (40/1000 vs 16/1000; P < .01); for continuity, greater percentage of asthma patients returning for treatment 2 years in a row (42% vs 12%; P < .001) and greater annual frequency of scheduled visits for asthma per patient (1.85 vs .88; P < .001); and for quality, greater percentage of patients receiving inhaled beta agonists (52% vs 15%; P < .001) and inhaled antiinflammatory drugs (25% vs 2%; P < .001), and greater percentages of parents who reported receiving patient education on 12 topics from Bureau of Child Health physicians (71% vs 58%; P < .01) and nurses (61% vs 44%; P < .05). CONCLUSION: We conclude that the intervention substantially increased the Bureau of Child Health staff's ability to identify children with asthma, involve them in continuing care, and provide them with state-of-the-art care for asthma.

Black or African American↗
PubMed1987

Medication costs in different provider settings.

Comparison was made of the cost of medications between Shared Health Facilities (SHFs) or Medicaid Mills and a Neighborhood Health Center (NHC) for nine conditions in fields of adult medicine, pediatrics, and gynecology. A total of 10 cases from SHF reviews were matched by diagnosis, age, and length of time under care with those in the NHC. For otitis media and pharyngitis in children and questionable urinary tract infection and vaginitis in adult women, the average costs were significantly higher in the SHFs. Average costs for family planning services and vaginal bleeding were higher in the SHFs but not significantly so. Medication costs for children with asthma and adults with bronchitis and hypertension were approximately the same in both settings. The reasons for higher costs included greater use of more expensive antibiotics, concurrent use of decongestants and antihistamines for infectious conditions of childhood, and dispensing of medications on "shot-gun" basis without adequate diagnostic studies. The most striking difference was the additional average cost of $798 for hospitalization of the SHF patients with vaginal bleeding when D & C and surgery were performed. The NHC women had no hospitalizations as the recommended procedure of endocervical biopsy in the office was Center policy. Other quality inferences noted in the NHC, but not in SHFs, were routine performance of throat cultures for pharyngitis, wet smears for vaginitis, and deferral of treatment until cultures were received for urinary tract infection. The small number of cases for each condition and the large intersample variability were limiting factors in this study, but the findings do suggest that higher standards of care contribute to lower therapy costs.

Adult↗