Biomedical subjects

Klea D Bertakis

Publications and source records attributed to Klea D Bertakis.

14 recordsLinked to original sources

PubMed2006

Association between obesity and patient satisfaction.

OBJECTIVE: To examine the relationship between BMI and patient satisfaction with health care providers using a nationally representative survey. RESEARCH METHODS AND PROCEDURES: This analysis examined the 9914 adult patients who completed the 2000 Medical Expenditure Panel Survey and had visited a health care provider within 12 months of the survey. Linear regression models were employed with patient satisfaction as the dependent variable. The patient satisfaction scale was based on ratings from five questions assessing the quality of provider interactions. The independent variable was BMI, with adjustments for the domains of demographics, social-economic status, health attitudes and behavior, health status, and health care use. BMI (weight in kilograms/square of height in meters) was classified as normal weight (18.5 to 24.9), overweight (25.0 to 29.9), or obese (>or=30.0). Hierarchical models were used to evaluate how each domain modified the BMI-satisfaction association. RESULTS: Obese patients reported significantly greater satisfaction with their health care providers than their normal-weight counterparts did (p < 0.05). There were no significant differences in satisfaction between normal-weight and overweight patients or between overweight and obese patients. The health status domain produced the largest modification in the BMI-satisfaction relationship. Examination of interaction effects revealed that the association between BMI and satisfaction was confined to older persons. DISCUSSION: In this nationally representative sample of individuals, obese persons were more satisfied than their normal-weight counterparts. This finding counters those of previous studies. Incomplete adjustments for health care use and insurance status may have led to those conclusions.

Adult↗

PubMed2006

Assessing resident's knowledge and communication skills using four different evaluation tools.

PURPOSE: This study assesses the relationship between 4 Accreditation Council for Graduate Medical Education (ACGME) outcome project measures for interpersonal and communication skills and medical knowledge; specifically, monthly performance evaluations, objective structured clinical examinations (OSCEs), the American Board of Family Practice in-training examination (ABFP-ITE) and the Davis observation code (DOC) practice style profiles. METHODS: Based on previous work, we have DOC scoring for 29 residents from the University of California, Davis Department of Family and Community Medicine. For all these residents we also had the results of monthly performance evaluations, 2 required OSCE exercises, and the results of 3 American Board of Family Medicine (ABFM) ITEs. Data for each of these measures were abstracted for each resident. The Pearson correlation coefficient was used to assess the presence or lack of correlation between each of these evaluation methods. RESULTS: There is little correlation between various evaluation methods used to assess medical knowledge, and there is also little correlation between various evaluation methods used to assess communication skills. CONCLUSION: The outcome project remains a 'work in progress', with the need for larger studies to assess the value of different assessment measures of resident competence. It is unlikely that DOC will become a useful evaluation tool.

Clinical Competence↗

PubMed2006

The influence of obesity, alcohol abuse, and smoking on utilization of health care services.

BACKGROUND AND OBJECTIVES: There is extensive evidence relating individual behavioral risk factors to adverse health outcomes and associated costs; however, more-comprehensive assessments have been limited. Our objective was to examine the relative effects of obesity, alcohol abuse, and smoking on health care use and associated charges. METHODS: New adult patients (n=509) were randomly assigned to primary care physicians, and their utilization of medical services was monitored for 1 year. Variables measured included sociodemographics, self-reported health status, Beck Depression Index, measured body mass index, Michigan Alcohol Screening Test results, and smoking history. RESULTS: Controlling for health status, depression, age, education, income, and gender, obesity was associated with the mean number of primary care visits, diagnostic services, and primary care clinic charges. Alcohol abuse was related to the mean number of emergency department visits and diagnostic services. Smoking was associated with the mean number of specialty clinic visits and hospitalizations. Smoking also predicted charges for emergency department visits, hospitalizations, and total health care charges. CONCLUSIONS: The economic burden of smoking is significant, even after only 1 year. Health care providers should focus attention on smoking prevention and cessation programs as an approach for managing medical costs.

Adult↗

PubMed2005

The impact of obesity on primary care visits.

OBJECTIVE: To investigate the influence of patient obesity on primary care physician practice style. RESEARCH METHODS AND PROCEDURES: This was a randomized, prospective study of 509 patients assigned for care by 105 primary care resident physicians. Patient data collected included sociodemographic information, self-reported health status (Medical Outcomes Study Short Form-36), evaluation for depression (Beck Depression Index), and satisfaction. Height and weight were measured to calculate the BMI. Videotapes of the visits were analyzed using the Davis Observation Code (DOC). RESULTS: Regression equations were estimated relating obesity to visit length, each of the 20 individual DOC codes, and the six DOC Physician Practice Behavior Clusters, controlling for patient health status and sociodemographics. Obesity was not significantly associated with the length of the visit, but influenced what happened during the visit. Physicians spent less time educating obese patients about their health (p = 0.0062) and more time discussing exercise (p = 0.0075). Obesity was not related to discussions regarding nutrition. Physicians spent a greater portion of the visit on technical tasks when the patient was obese (p = 0.0528). Mean pre-visit general satisfaction for obese patients was significantly lower than for non-obese patients (p = 0.0069); however, there was no difference in post-visit patient satisfaction. DISCUSSION: Patient obesity impacts the medical visit. Further research can promote a greater understanding of the relationships between obese patients and their physicians.

Adolescent↗

PubMed2005

Obesity and the use of health care services.

OBJECTIVE: This study investigated differences in the use of health care services and associated costs between obese and nonobese patients. RESEARCH METHODS AND PROCEDURES: New adult patients (N = 509) were randomly assigned to primary care physicians at a university medical center. Their use of medical services and related charges was monitored for 1 year. Data collected included sociodemographics, self-reported health status using the Medical Outcomes Study Short Form-36, evaluation for depression using the Beck Depression Index, and measured height and weight to calculate BMI. RESULTS: Obese patients included a significantly higher percentage of women and had higher mean age, lower mean education, lower mean health status, and higher mean Beck Depression Index scores. Obese patients had a significantly higher mean number of visits to both primary care (p = 0.0005) and specialty care clinics (p = 0.0006), and a higher mean number of diagnostic services (p < 0.0001). Obese patients also had significantly higher primary care (p = 0.0058), specialty clinic (p = 0.0062), emergency department (p = 0.0484), hospitalization (p = 0.0485), diagnostic services (p = 0.0021), and total charges (p = 0.0033). Controlling for health status, depression, age, education, income, and sex, obesity was significantly related to the use of primary care (p = 0.0364) and diagnostic services (p = 0.0075). There was no statistically significant relationship between obesity and medical expenditures in any of the five categories or for total charges. DISCUSSION: Obesity is a chronic condition requiring long-term management, with an emphasis on prevention. If this critical health issue is not appropriately addressed, the prevalence of obesity and obesity-related diseases will continue to grow, resulting in escalating use of health care services.

Adult↗

PubMed2004

Clinical faculty tracks and academic success at the University of California Medical Schools.

PURPOSE: To describe the five faculty series for medical school faculty in the University of California (UC) system, their criteria for advancement, associated challenges, and the different ways they are used by each school. METHOD: During 2001-02, the associate dean for academic affairs at each UC medical school was interviewed for information on the number of faculty in each academic series, the role of each series, and problematic issues associated with them. The averaged merit and promotion results for each series for 1999-2002 at the University of California, Davis, School of Medicine, were examined. RESULTS: The two clinical faculty series showed the most variability among the UC campuses for number of faculty, and strategy for appointment and advancement. The percentage of faculty in the Clinical X series varied from 8% to 39% at the five campuses. All campuses agreed that faculty in the Clinical X series must participate in applied or translational clinical investigation or educational investigation, and disseminate their work. All campuses required that the Ladder-Rank and In-Residence faculty devote the majority of their time to hypothesis-driven research. At University of California, Davis, the two clinical series had the highest approval rates for merits and promotion actions. The Ladder-Rank series had the highest denial rate for merits and promotion. CONCLUSIONS: Clinical series in the UC system are used differently at the five medical schools. Appointing junior faculty in series with minimal expectations as a "safe starting place" is favored for building long-term faculty. Faculty in all series tend to do well in the academic review process, indicating that these series define distinct expectations. Clinical faculty's accomplishments are increasingly understood, valued, and rewarded.

California↗

PubMed2003

Patient pain: its influence on primary care physician-patient interaction.

BACKGROUND AND OBJECTIVES: Heightened awareness of the importance of appropriate pain management in health care delivery has stimulated researchers to examine the impact of patient pain on medical encounters. In this study, we explored how patient pain might influence the physician-patient interaction during medical visits. METHODS: New adult patients (n = 509) were randomized to see primary care physicians in videotaped visits at a university medical center Self-reported patient pain was measured before the visit using the Visual Analog Scale and the Medical Outcomes Study Short Form-36 (MOS SF-36) pain scale; patient sociodemographics were also measured. Physician practice style during the visit was analyzed with the Davis Observation Code (DOC). RESULTS: Regression analyses revealed that patient pain during the medical visit was associated with the physician spending a greater portion of the visit on technical tasks and a smaller portion on preventive services and other activities designed to encourage the patients' active participation in their own health care. CONCLUSIONS: Patient pain may influence the physician-patient interaction and its outcomes. Primary care physicians should be aware that there may be less focus on patients' active involvement in their own care and less emphasis on providing disease prevention when treating patients who are experiencing pain.

Adult↗

PubMed2003

Effects of physician gender on patient satisfaction.

OBJECTIVES: To measure the impact of physician gender on patient satisfaction, controlling for confounding patient variables, and to examine the extent to which differences in satisfaction with male and female physicians can be explained by physician practice styles. METHOD: New adult patients (n=509) were randomized to see male and female primary care physicians at a university medical center outpatient facility. Patient sociodemographics and self-reported health status (using the Medical Outcomes Study Short Form-36) were measured before the initial visit, and satisfaction with the physician was measured immediately following the visit. The entire medical encounter was videotaped and physician practice style was later analyzed using the Davis Observation Code. RESULTS: Female physicians spent a significantly greater proportion of the visit on preventive services and counseling than male physicians did, and male physicians devoted more time to technical practice behaviors and discussions of substance abuse. Visit length was not significantly different for male and female physicians. Patients of female physicians were more satisfied than were those of male physicians, even after adjusting for patient characteristics, visit length, and physician practice style behaviors. CONCLUSION: Patient satisfaction with primary care physicians appears to be influenced not only by patient characteristics and physician behaviors, but also by the gender of the provider. Possible explanations for this may be that psychosocial aspects of the physician-patient interaction are different for male and female physicians. Patients may also bring expectations about female physicians to the encounter, presuming them to be more empathetic, nurturing, and responsive.

Adult↗

PubMed2003

Does time use in outpatient residency training reflect community practice?

BACKGROUND: The degree to which the ideals practiced during residency training persist amidst the pressures of community practice is unknown. Therefore, this paper compares time use during outpatient visits to family practice residents and experienced family physicians. METHODS: Visits of 244 new adult outpatients to 33 second- and third-year residents in a university clinic in Northern California were compared to 277 new adult outpatient visits to 92 community family physicians in Northeast Ohio, using the Davis Observation Code (DOC). The DOC uses observation to classify visit time into 20 different behavioral categories, reflecting different physician styles of interaction with patients. RESULTS: Controlling for patient mix, residents had longer visits, a less technical focus, and spent a greater percent of the visit on efforts to promote health behavior change, patient activation, preventive services, discussion of substance abuse, and counseling. CONCLUSIONS: Experienced family physicians provide more technical and less preventive and psychosocially oriented care than residents. This may reflect differences in patient mix, practice setting, physician experience, and the time and financial pressures of community practice. These findings may be used to modify residency training to better reflect actual community practice and to guide future studies of the effects of experience and different practice environments on physician style with patients.

Ambulatory Care↗

PubMed2002

Association of higher costs with symptoms and diagnosis of depression.

OBJECTIVES: We examined the relationships among depressive symptoms, physician diagnosis of depression, and charges for care. STUDY DESIGN: We used a prospective observational design. POPULATION: Five hundred eight new adult patients were randomly assigned to senior residents in family practice and internal medicine. OUTCOMES MEASURED: Self-reports of health status assessment (Medical Outcomes Study Short Form-36) and depressive symptoms (Beck Depression Inventory) were determined at study entry and at 1-year follow-up. Physician diagnosis of depression was determined by chart audit; charges for care were monitored electronically. RESULTS: Symptoms of depression and the diagnosis of depression were associated with charges for care. Statistical models were developed to identify predictors for the occurrence and magnitude of medical charges. Neither depressive symptoms nor diagnosis of depression significantly predicted the occurrence of charges in the areas studied, but physician diagnosis of depression predicted the magnitude of primary care and total charges. CONCLUSIONS: A complex relationship exists among depressive symptoms, the diagnosis of depression, and charges for medical care. Understanding these relationships may help primary care physicians diagnose depression and deliver primary care to depressed patients more effectively while managing health care expenditures.

Depression↗

PubMedDate not supplied

Physician gender, patient gender, and primary care.

BACKGROUND: Studies of the effects of physician gender on patient care have been limited by selected samples, examining a narrow spectrum of care, or not controlling for important confounders. We sought to examine the role of physician and patient gender across the spectrum of primary care in a nationally representative sample, large enough to examine the role of gender concordance and adjust for confounding variables. METHODS: We examined the relationships between physician and patient gender using nationally representative samples (the U. S. National Ambulatory Medical Care Surveys from 1985 to 1992) of encounters of 41,292 adult patients with 1470 primary care physicians (internists, family physicians, and obstetrician/gynecologists). Factors examined included physician (age, gender, region, rural location), patient (age, gender, race, insurance), and visit characteristics (diagnoses, gender-specific and nonspecific prevention, duration, continuity, and disposition). RESULTS: After multivariate adjustment, female physicians were more likely to see female patients, had longer visit durations, and were more likely to perform female prevention procedures and make some follow-up arrangements and referrals. Female physicians were slightly more likely to check patients blood pressure, but there were no significant differences in other nongender-specific prevention procedures or use of psychiatric diagnoses. Among encounters without breast or pelvic examinations, visit length was not related to physician gender, but length was longer in gender concordant visits than gender-discordant visits. CONCLUSIONS: Female physicians were more likely to deliver female prevention procedures, but few other physician gender differences in primary care were observed. Physician-patient gender concordance was a key determinant of encounters.

Adult↗

PubMedDate not supplied

On being new to an insurance plan: health care use associated with the first years in a health insurance plan.

BACKGROUND: We wanted to compare health care utilization and costs in the first year of being in a health insurance plan with those of subsequent years. METHODS: We used claims data from an independent practitioner association (IPA)-style managed care organization in the Rochester, NY, metropolitan area from 1996 through 1999. Cross-sectional and panel analyses of up to 4 years of claims data were conducted, involving 335,547 adult patients assigned to the panels of 687 primary care physicians (internists and family physicians). Multivariate analyses, adjusting for age, sex, case mix, and socioeconomic status derived from ZIP codes, examined the relationship between the first year of health insurance and Papanicolaou tests, mammograms in women older than 40 years, physician use, avoidable hospitalization, and expenditures. RESULTS: After multivariate adjustment, the first year of insurance was associated with a higher risk of not getting a mammogram, a higher risk of avoidable hospitalization, greater likelihood of visiting a physician, and higher expenditures, especially for testing. There was no relationship, however, between Papanicolaou test compliance and year of enrollment. CONCLUSIONS: The findings suggest there might be adverse clinical and financial implications associated with changing insurance.

Adult↗

PubMedDate not supplied

Patient pain in primary care: factors that influence physician diagnosis.

BACKGROUND: The accurate recognition of patient pain is a crucial, but sometimes difficult, task in medical care. This study explored factors related to the physician's diagnosis of pain in primary care patients. METHODS: New adult patients were prospectively randomized to care by primary care providers at a university medical center clinic. Study participants were interviewed prior to the initial visit, and their level of self-reported pain was measured with the Visual Analog Pain Scale and the Medical Outcomes Study Short Form-36. The medical encounter was videotaped in its entirety and later analyzed using the Davis Observation Code to characterize physician practice style. Patient satisfaction was measured immediately after the visit. A review of the medical record was used to assess physician recognition of patient pain. RESULTS: For all patients (N = 509), as the amount of pain increased, the percentage of patients having pain diagnosed by the physician also increased. Female patients reported a greater amount of pain than male patients. When women were in severe pain, they were more likely than men to have their pain accurately recognized by their physician. The correct diagnosis of pain was not significantly related to patient satisfaction. Physician practice styles emphasizing technically oriented activities and health behavior discussions were strongly predictive of the physician diagnosing patient pain. CONCLUSIONS: The diagnosis of pain is influenced by the severity of patient pain, patient gender, and physician practice style. If the routine use of pain assessment tools is found to be effective in improving physician recognition and treatment of patients' pain, then application of these tools in patient care settings should be encouraged.

Adult↗

PubMedDate not supplied

Physician-elder interaction in community family practice.

OBJECTIVE: To determine whether outpatient visits by elders seeing community family physicians differ in length or content from visits by younger patients; socioemotional preferences predict visit content; and satisfaction correlates with visit content differentially across age. METHODS: In a multimethod cross-sectional study of 84 community family practices in northeastern Ohio, 3453 adult patient visits with 138 community family physicians were observed; 2362 of these patients completed self-report questionnaires. Three age groups were compared: 18 to 64, 65 to 74, and over 74 years. Length and content of the physician-patient encounter was determined using the Davis Observation Code (DOC); satisfaction was assessed using the MOS 9-item Visit Rating Scale. RESULTS: Controlling for reason for visit and demographics, visit length averaged 10.7 minutes for each group. Visit content differed significantly on 13 of 20 DOC codes between one of the older groups and the younger group; in 4 instances, content varied between the 2 older groups. Although visit content varied as predicted by socioemotional theory, no consistent patterns of association between visit content and satisfaction emerged. DISCUSSION: Older patient visits differ from those of younger patients as might be predicted by socioemotional selectivity theory; however, there was little association of visit content with patient satisfaction.

Adult↗