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Biomedical subjects

L R Fischer

Publications and source records attributed to L R Fischer.

29 records · Page 2Linked to original sources
PubMed1983

Transition to grandmotherhood.

This exploratory study examines grandparenthood as a role relationship. Grandmothers, in describing the transition to grandparenthood, tended to emphasize emotional/symbolic investment in grandchildren rather than instrumental/interactional dimensions of relationships. The data suggest that grandparental role conceptions are modified by family network variable: Ambiguity in the grandmother role is magnified by geographical distance and by paternal (rather than maternal) grandmotherhood.

Adult↗
PubMed1975

Psychiatric nursing: a view from within.

There are several recurrent themes that reflect the concerns of nurses who seek entry into graduate programs in psychiatric nursing. Four of the themes that will be presented are an emphasis on mental health, a desire to seek varied points to entry into health care, increased interaction with other health workers and participation in social change. The themes are interrelated and reflect a view of nursing responsibilities and an awareness of the needs for a comprehensive approach to health care. These views are typical of a range of concerns within the nursing profession. Although nursing comprises the largest number of prepared health care workers, nursing is a marginal group within the system. There is considerable discussion of a need for revision of health care systems and of need to utilize manpower resources most effectively. System change is a difficult process and one can only speculate about the outcomes. It is difficult to predict whether the beliefs and values of nurses and nursing a marginal group, can be shared within the health care system.

Career Mobility↗
PubMedDate not supplied

Pharmaceutical care for patients with chronic conditions.

OBJECTIVE: To assess factors associated with participation in pharmaceutical care and the benefits of participation--in terms of amount of information about medications, administration of medications, and awareness of side effects. DESIGN: Quasi-experimental design, with a control group. Medication Survey, administered 6 months after pharmaceutical care intervention to participants, refusers, and controls. Logistic regression analyses. SETTING: Three staff clinic pharmacies and three contract clinic pharmacies affiliated with a health maintenance organization (HMO). PATIENTS AND OTHER PARTICIPANTS: Patients with chronic health conditions (asthma, chronic obstructive pulmonary disease, or heart disease) enrolled at six intervention sites, identified through the HMO's electronic pharmacy database. Control sample with the same chronic health conditions, without access to pharmaceutical care (n = 210 participants, 162 refusers, and 368 controls; overall adjusted response rate = 72%). INTERVENTION: Pharmaceutical care, in the form of a comprehensive drug therapy management program. MAIN OUTCOME MEASURES: Predictors of participation, amount of information about medications, use of reminder methods, and awareness of side effects. RESULTS: The following variables were significantly associated with the probability of participating in pharmaceutical care (P < .05): number of medications, employment, income, health status, education, and living situation. Participants were more likely than controls to say they received "a lot of information" from their pharmacist about all aspects of medications (odds ratio [OR], 1.75 to 2.68). Participants were more likely to report leaving their medication container in a visible place and using two or more reminder methods (OR, 1.87 to 1.48). There were no significant differences in the probability of missing doses. Participants were more likely to report experiencing "symptoms or problems" associated with prescription medications (OR, 1.81). CONCLUSION: Pharmaceutical care appears to increase the information given to patients about medications, promote more effective self-administration of medications by encouraging patients to use systematic reminders, and increase awareness of medication side effects.

Chronic Disease↗
PubMedDate not supplied

A CQI intervention to change the care of depression: a controlled study.

CONTEXT: Although new strategies for managing depression in primary care (e.g., nurse telephone calls, collaborative care) have been shown to be effective, no models are available for their systematic implementation in the "real world." OBJECTIVE: To test whether a continuous quality improvement (CQI) intervention could be used to implement systems in primary care clinics to improve the care and outcomes for patients diagnosed with depression. DESIGN: Before-after study with concurrent controls. INTERVENTION: A multidisciplinary team from the three intervention clinics developed and implemented a graded set of five care management options, ranging from watchful waiting (nurse telephone call in 4 to 6 weeks) to mental health management, which clinicians could order for their patients with depression. SETTING: 9 primary care clinics in greater Minneapolis-St. Paul, Minnesota. PATIENTS: Outpatients 18 years of age and older whose primary care clinic visit included an International Classification of Diseases, 9th revision, code for depression and who completed baseline and 3-month follow-up surveys before and after the intervention. MAIN OUTCOME MEASURES: Measures of process of care (follow-up depression visits to physician, mental health visits, follow-up telephone calls) and outcomes of care (improved depression symptoms over 3 months, satisfaction with care). RESULTS: Although the CQI team appeared to function well, only 30 of the 257 patients identified from depression-coded visits for this study were referred to the new system during the 3-month evaluation period. In both the intervention and control clinics, follow-up visits, mental health referrals, and follow-up telephone calls did not improve significantly from the preintervention levels of about 0.5 for a primary care visit, 0.4 for a mental health visit, or 0.1 for a follow-up phone call per person. The same was true of patient outcomes: The proportion of patients in the intervention and control clinics who had improved depression symptoms and those who were very satisfied with their depression care did not change significantly from the preintervention levels of 43% and 26%, respectively. CONCLUSIONS: Our attempt to improve the primary care management of depression failed because physicians used the new order system so infrequently. Whether a greater leadership commitment to change or a different improvement process would alter our findings is an open question.

Adolescent↗