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Biomedical subjects

L L Dickey

Publications and source records attributed to L L Dickey.

16 recordsLinked to original sources
PubMed2001

Evaluating the teaching of clinical preventive medicine: a multidimensional approach.

BACKGROUND: A study was undertaken to determine the amount, methods, and adequacy of instruction in clinical preventive medicine topics in the medical school curriculum at the University of California, San Francisco (UCSF) in the 1996-1997 academic year. METHODS: A protocol of 35 clinical preventive medicine topics was developed. The preclinical (Years 1 and 2) curriculum was evaluated by reviewing all syllabi and other printed materials for the presence and quantity of instruction in the specific clinical preventive medicine topics. The clinical curriculum (Years 3 and 4) was evaluated by asking students on completion of eight clinical clerkships to answer a questionnaire. Clerkship directors were also asked to answer the same questionnaire. RESULTS: In the preclinical curriculum, clinical preventive medicine topics were found to receive 63.3 hours of instruction (4.2% of total instruction hours). Counseling and screening topics received the most hours (31.3 and 20.5, respectively) with immunization/prophylaxis and prenatal care receiving considerably less (4.0 and 2.4 hours, respectively). In the clinical curriculum, students reported receiving an average of 118.5 hours of instruction in preventive medicine (5.9% of total instruction hours). Clerkship directors reported more than twice as many hours of instruction (330.8) as students. Overall, only 50% of students reported that a topic had been covered in a clerkship when the clerkship director reported that it had been covered. Both students and clerkship directors reported that exposure to clinical preventive medicine topics was in general inadequate. CONCLUSIONS: Instruction in clinical preventive medicine constituted a relatively modest percentage of the total instruction time in both the preclinical and clinical curricula at UCSF. Some topics were only minimally covered in the curriculum, and instruction during the clinical years was variable across students and clerkships. The disparity in the amount of instruction in clinical preventive medicine reported by students and faculty illustrates the importance of using multiple methods, including student input, to evaluate curriculum content.

Clinical Clerkship↗
PubMed1999

Office system interventions supporting primary care-based health behavior change counseling.

CONTENT: This article reviews the literature on the effectiveness of office system interventions to improve behavior-change counseling in primary care. These instructions consist of two principle components: tools and teamwork. Tools have been developed to assist providers with health risk assessment (questionnaires, health risk appraisals), prompting and reminding (chart stickers, checklists, flow charts, reminder letters), and education (manuals and handbooks). Teamwork entails the coordination and delegation of tasks between providers and staff. CONCLUSIONS: A number of clinical trials, particularly in the area of smoking cessation, have demonstrated the effectiveness of tools and teamwork for increasing counseling rates and counseling effectiveness. Although no one type of tool or method of teamwork is consistently more effective than another-with effectiveness varying according to practice, provider, and patient characteristics-the use of different tools and teamwork approaches leads to additive improvements in counseling and patient behavior-change rates. More high-quality research is needed, particularly in the areas of health risk assessment and electronic reminder systems, to develop effective office interventions that can be readily implemented into a wide variety of primary care practices.

Counseling↗
PubMed1995

Putting prevention into practice. Impact of a multifaceted physician education program on preventive services in the inner city.

BACKGROUND: Physicians' prevention practices often differ from guidelines published by national authorities. Effective preventive services are most needed in inner city settings that suffer disproportionately from preventable diseases. This study examined the impact of a multifaceted physician prevention education program on the provision of preventive services in an inner city municipal hospital. METHODS: The study used a controlled intervention comparative design at two inner city municipal hospitals--Harlem Hospital Center, New York, NY (intervention site) and Kings County Hospital, Brooklyn, NY (comparison site)--serving predominantly African-American patient populations. The intervention site received prototype materials for physicians, patients, and the office setting from the US Public Health Service's Put Prevention Into Practice campaign and a series of prevention lectures from November 1991 through April 1992. Change in physician prevention practices and knowledge was assessed by self-administered questionnaires and change in patients' reports of preventive services received was assessed by structured interviews. RESULTS: Physicians at Harlem Hospital Center reported a greater postintervention increase in prevention practices and demonstrated a greater increase in prevention knowledge in comparison with physicians at Kings County Hospital. Patients at Harlem Hospital Center reported receiving increased preventive services from physicians after the intervention, while patients at Kings County Hospital did not report any significant change in preventive services received. CONCLUSIONS: A multifaceted physician education program using prototype materials from the Put Prevention Into Practice campaign with prevention lectures significantly increased the prevention knowledge and practices reported by physicians and the preventive services reported received by patients at an inner city municipal hospital.

Adult↗
PubMed1994

Put prevention into practice: implementing preventive care. U.S. Department of Health and Human Services.

Delivery rates for many preventive services are low in the U.S., often falling below 50%. Many factors contribute to this shortcoming, a number of which are within the control of the practicing clinician. This section discusses two important aspects of the delivery of clinical preventive services--establishing a preventive care protocol and implementing it in practice--and reviews basic principles of screening, immunization, and counseling. The references serve as a basic bibliography on the implementation of preventive services in primary care settings.

Adult↗
PubMed1993

Promoting preventive care with patient-held minirecords: a review.

UNLABELLED: Although patient involvement is essential for the success of all types of preventive care, patient involvement in clinical prevention has been limited. Patient-held minirecords have recently received support from public health authorities, providers and the public as a means to improve patient involvement in preventive care for adults. This paper reviews the history and current developments in patient-held minirecord use for preventive care. METHODS: A literature review was performed using sources obtained from electronically searching the Medline database from 1966 to the present and using reference lists to obtain secondary sources. The author's collection of privately and governmentally produced minirecords was also utilized. FINDINGS: Patient-held minirecords have been widely and successfully employed to improve preventive care for children, particularly with regard to immunizations. They have not been widely used to promote adult preventive care. Several clinical trials have found that their use can lead to improved preventive care for the general adult population. Potential advantages of patient-held minirecords include: improved performance rates of preventive care, improved continuity of preventive care, low cost and improved practice promotion for prevention-oriented providers. Potential barriers to the use of patient-held minirecords include: the traditional power relationship of physicians and patients, physicians' reticence to share records with patients and time and effort costs. The optimal characteristics of a patient-held minirecord for adult preventive care remain to be delineated by research and evaluation. SIGNIFICANCE: A patient-held minirecord is an inexpensive, practical intervention that can help build patient involvement and improve the quality of preventive care for adults as well as children.

Evaluation Studies as Topic↗
PubMed1992

A patient-held minirecord to promote adult preventive care.

BACKGROUND: Compliance with guidelines for preventive service delivery to adults is inadequate. Patient-held minirecords have been successfully used to promote pediatric preventive care, and they hold promise for promoting adult preventive care as well. The objective of this project was to evaluate provider acceptance of a patient-held minirecord and the effect of this minirecord on compliance with a comprehensive set of adult preventive care guidelines. METHODS: The patient-held minirecord was distributed to all patients in two practice groups of a residency-affiliated family medicine clinic over a 4-month period. Patients in a comparison group practice in the same clinic did not receive the minirecord. Provider acceptance was evaluated by a survey completed by the intervention group providers at the end of the 4-month period. The effect of the minirecord on compliance with preventive care guidelines was evaluated by a chart review that compared baseline compliance rates for individual patients and individual preventive services with compliance rates after 6 and 18 months. RESULTS: Responses on the provider survey indicated a high rate of acceptance by intervention group providers of using the patient-held minirecord. It was believed to improve knowledge about and performance of preventive services without requiring significant additional effort or time commitment. The chart review found that provider compliance (defined as either ordering or performing a preventive service) was significantly improved for intervention group patients after 6 and 18 months. The intervention was beneficial for the delivery of a broad range of preventive services. CONCLUSIONS: Use of a patient-held minirecord for adult preventive care can be well accepted by providers and lead to improvements in compliance with guidelines for adult preventive care.

Adult↗
PubMedDate not supplied

Primary care physicians' use of office resources in the provision of preventive care.

OBJECTIVES: To assess (1) the extent to which office resources (eg, chart aids, educational materials, office staff) are used by primary care physicians in the provision of preventive care; (2) the characteristics of physicians associated with this use; and (3) the relationship of office resource use to reported preventive service provision. DESIGN: Survey. SUBJECTS: Randomly selected active members of the American Academy of Family Physicians, Kansas City, Mo, American Academy of Pediatrics, Elk Grove Village, III, American College of Obstetricians and Gynecologists, Washington, DC, and American College of Physicians, Philadelphia, Pa. MALE OUTCOME MEASURES: Use rates for each of 14 types of office resources, and scores for total office resource use, total preventive service provision, and counseling, screening, and immunization provision. RESULTS: Most types of office resources were used by less than 50% of the physicians. Physicians in small private practices reported less use of resources than those in other settings. The chart flow sheet was the resource that was most strongly and consistently related to preventive service provision. For all organizations, the total resource use score was significantly correlated with scores for total preventive service provision, and counseling and immunization provision. For most organizations, the total resource use score was more highly related to total preventive service provision than was the age or sex of the physician, the percentage of patients uninsured or with Medicaid coverage, or community size. CONCLUSIONS: The use of office resources is an important factor in the provision of preventive care. Intervention efforts to improve office resource use may benefit from targeting by resource type, practice setting, physician specialty, and other physician and practice characteristics.

Adult↗
PubMedDate not supplied

Acceptance and use of Put Prevention into practice materials at an inner-city hospital.

Many studies indicate that physicians' prevention practices frequently differ from published guidelines. Put Prevention into Practice (PPIP) consists of a variety of paper-based materials for providers, patients, and the office setting designed to enhance the delivery of clinical preventive services. Prototype PPIP materials were distributed to physicians and patients at the Harlem Hospital medical clinic in conjunction with a series of prevention lectures for physicians. Acceptance and use of these materials were assessed through self-administered questionnaires for physicians and structured interviews for patients. A regression analysis was conducted to assess correlates of physician use of PPIP materials. Physicians reported a high degree of use of and satisfaction with PPIP materials. Multiple regression analysis indicated that the physicians' perceived self-efficacy in their ability to provide preventive counseling to patients at baseline was significantly associated with increased use of PPIP materials. When controlling for baseline physician self-efficacy, physicians whose self-efficacy increased during the study period were more likely to have used the materials. A majority of patients (53%) reported that the main patient-based component of the program-a pocket-sized booklet providing health education information and record-keeping of preventive tests and procedures-was very useful. Results from this study indicate a high degree of acceptance of prototype PPIP materials by physicians and patients at an inner-city hospital. Educational programs for physicians that enhance physician self-efficacy may be more effective in helping practitioners to adopt office-based prevention resources. Medical Subject Headings (MeSH): prevention, primary care, preventive health services, clinical practice patterns.

Female↗