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Biomedical subjects

L A Maiman

Publications and source records attributed to L A Maiman.

At least 19 recordsLinked to original sources
PubMed2000

Long-term effects of asthma education for physicians on patient satisfaction and use of health services.

This randomized clinical trial evaluated the long-term impact of an interactive seminar for physicians based on principles of self-regulation on clinician behaviour, children's use of health services for asthma, and parent's views of physician performance. Seventy-four general practice paediatricians, and 637 of their asthma patients aged 1-12 yrs, were randomized to treatment or control. Children and parents were blind to physicians' participation. Data were collected at baseline and follow-up through self-administered surveys (paediatricians), telephone interviews (parents) and medical records. The seminar focused on development of communication and teaching skills and use of therapeutic medical regimens for asthma as outlined in the National Asthma Education and Prevention Program guidelines. Approximately 2 yrs postintervention, treatment group physicians were more likely than control physicians to: use protocols for delivering asthma education (odds ratio (OR) 4.9, p=0.2), write down for patients how to adjust medicines when symptoms change (OR 5.7, p=0.05), and provide more guidelines for modifying therapy (OR 3.8, p=0.06). Parents scored treatment group physicians higher than control physicians on five specific positive communication behaviours. Children seen by treatment group physicians had fewer hospitalizations (p=0.03) and those with higher levels of emergency department (ED) use at baseline had fewer subsequent ED visits (p=0.03). No differences regarding the number of office visits were noted. There were no significant differences found between treatment and control group physicians in the amount of time spent with patients during office visits (26 versus 29 min) or in the number of patients treated with anti-inflammatory medicine. It is concluded that interactive asthma seminars for paediatricians had significant long-term benefits for their asthma care.

Adult↗
PubMed1997

A scale for Assessing Health Care Providers' Teaching and Communication Behavior regarding asthma.

Partnership between health care providers and patients is important for controlling illness. A limited number of studies show how to assess health professionals' communication and partnering behavior. The relationship between these aspects of professional behavior and enhanced management of disease by patients has received little empirical study. The research reported here developed a Health Care Providers' Teaching and Communication Behavior (TCB) scale for assessing the teaching and communication behavior of clinicians treating patients with asthma. Such a tool is needed for research related to provider-patient relationships and for evaluation of professionals' performance.

Adult↗
PubMed1992

Improving referral compliance after public cholesterol screening.

BACKGROUND: Noncompliance with referral to a physician for retesting and diagnosis is a concern in public cholesterol screening. METHODS: Participants (n = 2109) were referred by a health professional or lay communicator and randomly assigned to a coupon offer, referral reminder letter, or control group. A questionnaire was completed at screening, and a telephone interview was conducted 5 months later. RESULTS: Physician visit rates showed no professional or lay differences. For "no history" subjects, the behavioral interventions were effective compared with controls (coupon = 60.7% and reminder = 57.7% vs control = 46.1%). With professional counseling, only the coupon was effective; for lay counseling, both coupon and reminder yielded higher visit rates. Adjusted for sociodemographics, heart disease risk factors, and health perceptions, the intervention effects remained (professional-coupon offer: odds ratio [OR] = 1.94, 95% confidence interval [CI] = 1.21, 3.09; professional-reminder letter: OR = 1.04, 95% CI = 0.67, 1.63; lay-coupon offer: OR = 2.52, 95% CI = 1.52, 4.18; and lay-reminder letter: OR = 3.10, 95% CI = 1.83, 5.22). CONCLUSIONS: For unaware participants, lay counselors and referral follow-up efforts tailored to specific cholesterol risk groups are indicated.

Adult↗
PubMed1989

Deuterium oxide as a tracer for measurement of compliance in pediatric clinical drug trials.

We tested the hypothesis that a deuterium oxide (D2O) tracer could discriminate among patterns of clinically significant, imperfect compliance during drug trials. A model was developed to predict deuterium concentration during multiple dose regimens. After developing a regression equation to predict one of the model parameters for children, we selected healthy children (N = 20) at random to receive one of five 10-day D2O regimens. Five urine samples were obtained from each child during 15 days and analyzed for deuterium level by mass spectrometry. Each child's height, weight, age, and the first four urinary deuterium levels were used to estimate the amount and timing of deuterium administration. These estimates were compared with the five regimens to determine the closest match between estimate and regimen. The closest matching regimen was the regimen actually administered to 19 (95%) of the 20 children. Two of these children had D2O administration estimates that could be confused with another regimen. The correlation between the model's predicted levels and the measured levels of all urine samples was 0.96. We conclude that a D2O tracer shows excellent promise as a quantitative method of assessing compliance with liquid medications under specified conditions.

Child↗
PubMed1989

Recruitment of a large community of pediatricians in a collaborative research project.

To investigate the effects of an educational program on the compliance-enhancing behavior of pediatricians and the subsequent regimen adherence of their patients, it was necessary to enlist the participation of a large number of pediatric practitioners. The physicians had to be motivated to attend two evenings of tutorial training; to enroll their patients in the project; and to complete detailed study documents. Ultimately, 90 of the 97 pediatricians practicing in the community took part. The following factors are felt to have contributed to the widespread participation of the pediatricians: 1) the subject was interesting and of relevance to clinical practice; 2) the study was designed so as not to interfere with office routine; 3) major demands were not made on the patients; 4) due consideration was given to the value of the physicians' participation; and 5) communication between the investigators and the practitioners was facilitated by a liaison pediatrician.

Humans↗
PubMed1988

Improving pediatricians' compliance-enhancing practices. A randomized trial.

Previous evaluations of continuing medical education (CME) have yielded conflicting results regarding its effects on physician knowledge, performance, and subsequent patient outcomes. Poor adherence by mothers to prescribed pediatric regimens is a separate, but well-documented, problem. In the present study we assessed the ability of CME to: (1) increase the knowledge of pediatricians about compliance-enhancing strategies; (2) increase the performance of these practices by pediatricians; and (3) improve mothers' compliance with antibiotic regimens for their children's otitis media. Ninety pediatricians were randomly assigned to either a control group or one of two CME interventions: tutorial plus printed materials or mailed printed materials only. Following the interventions, data on compliance and on reported behaviors of pediatricians were gathered from a random sample of mothers (N = 771) whose children were being treated for otitis media. Findings indicated that CME increased physician knowledge and compliance-enhancing practices and resulted in improvement in mothers' adherence to therapy.

Child↗
PubMed1986

Correlates of mothers' use of medications for their children.

This study examines the extent, determinants and quality of mothers' independent use of medications for treating their children's symptoms. Data on mother-initiated medication behavior (MIMB) were obtained from a stratified systematic random sample of 500 mothers of children presenting for a well child visit at two pediatric ambulatory care sites. Six expert pediatric judges each rated every reported medication use (N = 3908) along three dimensions (usefulness, correctness and harmfulness or helpfulness) and also evaluated the overall appropriateness of each mother's MIMB. Results indicate that: (1) mothers keep available and use for children a considerable variety of different medications and medical applicances; (2) a positive linear relationship exists between mothers' socioeconomic status (SES) and degree of MIMB; (3) mothers' attitudes toward medications and toward their children's health are associated with the number of categories of medications and applicances they possess and use; (4) the combination of SES and attitudinal characteristics accounts for substantial portions of the variance in MIMB; and (5) judges' ratings show only minimal-level support of MIMB (extending to mothers in all SES groups) and are linearly related to SES (P less than 0.001). These findings emphasize the need for health care providers to review MIMB, and to provide advice concerning use and misuse of mother-initiated treatments.

Adult↗
PubMed1985

How mothers treat their children's physical symptoms.

An important area of concern in community health is the widespread practice of individuals undertaking courses of treatment in the absence of medical advice or direction. This is especially a problem when it involves the administration of medicines to children. This study examines the extent, determinants, and quality of the independent use by mothers of medications for treating their children's symptoms. Data on mother-initiated medication behavior (MIMB) were obtained from a random sample of 500 mothers of children at two pediatric ambulatory care sites. Six expert pediatric judges rated every reported medication use (N = 3,908) along three dimensions (usefulness, correctness, and harmfulness/helpfulness) and also evaluated the overall appropriateness of each mother's MIMB. Results indicate that: 1) mothers keep available and use for their children a considerable number of different medications; 2) clear relationships exist between mothers' socioeconomic status and the different categories of medications they employ; 3) mothers' perceptions of their children's vulnerability to specific illnesses, and of the efficacy of over-the-counter medications for treating those illnesses, were related to the possession and use of relevant medications; and 4) judges' ratings indicated little enthusiasm for the mothers' therapeutic actions. These findings suggest the need for pediatricians to become aware of the medications their patients may be ingesting as a result of MIMB, and to educate mothers concerning use and misuse of over-the-counter (and other) treatments.

Attitude to Health↗
PubMed1984

Spouse concordance of smoking patterns: the Minnesota Heart Survey.

Spouse concordance of smoking patterns and other lifestyle factors was examined in data provided by 560 married couples from the Minnesota Heart Survey. Married pair concordance was measured against a standard of concordance based on the frequencies in surrogate spouse pairs. Smoking patterns are found to be significantly concordant for married pairs. More married pairs than surrogate pairs tended to both smoke or both not smoke. Among smokers, married pairs are more similar than surrogate pairs in daily number of cigarettes smoked. Among ex-smokers, married pairs are more similar than surrogate pairs in the year they quit smoking. Younger couples with the least amount of education were most concordant and showed the greatest smoking rate. Five additional lifestyle factors showed an increased level of concordance for married over surrogate pairs. Concordance in these factors was not correlated with smoking concordance. It is suggested that married couples respond similarly to a shared environment made up of daily practices, social life, and leisure activities. Further, smoking intervention directed toward the married couple should be considered.

Adult↗
PubMed1980

Strategies for enhancing patient compliance.

Patient noncompliance is a substantial obstacle to the achievement of therapeutic goals. This paper reviews a number of practical interventions with demonstrated efficacy in enhancing patient adherence, including (1) improving patients' levels of information concerning the specifics of their regimens, reinforcing essential points with review, discussion, and written instruction, and emphasizing the importance of the therapeutic plan, (2) taking clinically appropriate steps to reduce the cost, complexity, duration, and amount of behavioral change required by the regimen and increasing the regimen's convenience through "tailoring" and other approaches, (3) obtaining a compliance-oriented history of the patient's prior experiences and present health beliefs and, where necessary, employing strategies to modify those perceptions likely to inhibit compliance, (4) improving levels of patient satisfaction, particularly with the provider-patient relationship, (5) arranging for the continued monitoring of the patient's subsequent compliance to treatment, (6) increasing staff awareness of the magnitude and determinants of the noncompliance phenomenon and attempting to develop an "active influence orientation" in each member of the health care team, (7) using such techniques as patient-provider contracts to involve the patient in therapeutic decisions and in the setting of treatment objectives and creating incentives (through rewards and reinforcements) for achieving these objectives, (8) arranging for as much continuity of provider (and other staff) as possible, (9) establishing methods of supervising the patient, including involvement of the patient's social support network, and (10) involving fully the assistance of all available health care providers, assigning specific roles and responsibilities for activities directed at improving adherence to treatment.

Attitude to Health↗
PubMed1979

Education for self-treatment by adult asthmatics.

A prospective experimental design evaluated the ability of a series of educational and motivational interventions to enhance self-treatment by adult asthmatics and to reduce use of emergency department services for asthma attacks. After treatment for an asthma attack, subjects were randomly assigned to the following sequential interventions: (1) reinforcement by interpersonal similarity at the time of the emergency visit, (2) recepit of positive written appeals, and (3) follow-up telephone reinforcement. The asthmatic nurse educator was generally more effective in achieving short-term reduction of emergency department visits. Although the usefulness of the positive written appeal increased when employed by the asthmatic nurse, there were no substantive independent effects of the written message on emergency department use.

Activities of Daily Living↗
PubMed1979

Attitudes toward obesity and the obese among professionals.

Negative attitudes toward obese patients by health professionals have been attributed to termination of weight reducing attempts. This study measured attitudes concerning the obese held by professional participants in a continuing education conference on causes and treatment of obesity. Substantial variation was found on items comprising obesity-related belief dimensions: (a) Disparaging image of the obese; (b) causes of obesity; and (c) ways to lose weight. Evidence is presented for the association among measures of these dimensions. While background and educational characteristics and conditions of practice were not related to such attitudes, the professional's personal experience with successful weight reduction was the best predictor of favorable attitudes.

Attitude of Health Personnel↗
PubMed1978

Effects of threatening communications and mothers health beliefs on weight change in obese children.

A field experiment was designed to test the effects on weight change in obese children of (1) communications varying in threat and (2) health beliefs of the child's mother, in terms of perceived vulnerability to health threats, the efficacy of taking actions, and barriers to acting. Treatments involved messages containing more or less threatening material regarding obesity, plus a control (no communication) condition. Beliefs were assessed by means of personal interviews. All mothers and children received dietary counseling and were scheduled for four follow-up visits, which included weighing. The 182 participants were from low-income areas served by a large hospital pediatric clinic. High-threat messages yielded the most consistent weight loss, followed by low threat and control. In addition, both general beliefs concerning health and specific beliefs about obesity and dieting predicted weight loss. Both messages and mothers' beliefs acted together on keeping appointments and making efforts to comply. Results are discussed in terms of the effects of threats and health belief-behavior linkages.

Adolescent↗
PubMed1978

Walk-out patients in the hospital emergency department.

Four hundred twenty-six patients walked out of The Johns Hopkins Hospital Adult Emergency Department before being treated between April 1976 and March 1977. Of these, 179 were matched for sex, race, age, shift and presenting complaint with controls to identify the distinguishing characteristics of walk-out patients. Walk-out patients have recent onset of symptoms, report a great deal of pain and discomfort at the time of initial visit, and wait a relatively short period of time before walking out. They are, however, likely to report little continuing pain or discomfort one to two weeks after followup, although they believe that they still need care. Walk-out patients do not seem to be exposed to objectively worse treatment in the emergency departemnt but seem to have less subjective tolerance for waiting.

Adolescent↗