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Biomedical subjects

Michael L Parchman

Publications and source records attributed to Michael L Parchman.

13 recordsLinked to original sources
PubMed2006

Suboptimal medication use and mortality in an older adult community-based cohort: results from the Hispanic EPESE Study.

BACKGROUND: Numerous methods have been used to evaluate medication management quality in older adults; however, their predictive validities are unknown. Major medication quality indicators include polypharmacy, drug-drug interactions, and inappropriate medication use. To date, no study has attempted to evaluate the three approaches systematically or the effect of each approach on mortality in a Hispanic population. Our objective was to evaluate the relationship between polypharmacy, drug-drug interactions, and inappropriate medication use on the mortality of a community-based population of Mexican American older adults. METHODS: We used a life table survival analysis of a longitudinal survey of a representative sample of 3,050 older Mexican Americans of whom 1,823 were taking prescription and over-the-counter medications. RESULTS: After adjustment for relevant covariates, use of more than four different medications (polypharmacy) was independently associated with mortality. The presence of major drug interactions and the use of inappropriate medications were not significantly associated with mortality in our study sample. CONCLUSION: Polypharmacy (>4 medications) is significantly associated with mortality in Mexican American older adults. This community-based study is the first to demonstrate a direct association between polypharmacy and mortality in this population.

Aged↗
PubMed2005

Primary care attributes, health care system hassles, and chronic illness.

BACKGROUND: Patients with a chronic illness are likely to report difficulties in their encounters with the health care system. Although most patients with a chronic illness are managed by primary care clinicians, little is known about how the attributes of primary care might be related to health care system hassles. OBJECTIVE: We sought to examine the relationship between attributes of primary care and health care system hassles among veterans with one or more chronic illnesses. RESEARCH DESIGN: This was a cross-sectional mailed survey. SUBJECTS: We included veterans with one or more chronic illnesses who were cared for in the South Texas Veteran's health care system. MEASURES: The Components of Primary Care Instrument was used to measure 4 attributes of primary care: accumulated knowledge of the patient by the clinician, coordination of care, communication, and preference for first contact with their primary care clinician. A 16-item health care systems hassles scale was constructed and demonstrated good face validity and reliability with a Cronbach's alpha of 0.94. RESULTS: Of the 720 surveys administered by mail, 422 (59%) were returned. Patients with multiple chronic illnesses reported a higher level of hassles than patients with a single chronic illness. After controlling for patient characteristics, primary care communication and coordination of care were inversely associated with patient hassles score: as communication and coordination improved, the reported level of hassles decreased. CONCLUSIONS: Effective delivery of primary care to patients with one or more chronic illnesses may be important in decreasing the level of hassles they experience as they interact with the health care delivery system.

Chronic Disease↗
PubMed2004

Association between self-monitoring of blood glucose and glycemic control in patients with type 2 diabetes mellitus.

PURPOSE: The relationship between the self-monitoring of blood glucose (SMBG) and glycemic control in patients with type 2 diabetes mellitus in a Veterans Affairs (VA) medical center was studied. METHODS: Laboratory, inpatient, outpatient, and demographic data for patients with type 2 diabetes mellitus who were seen for three years continuously or receiving their care regularly from a single Texas VA facility between October 1, 1999, and September 30, 2002, were obtained. Local pharmacy data were used to identify patients who received blood-glucosemonitoring strips. Patients were assigned to one of four mutually exclusive groups: those who did not receive monitoring strips at all, those who received strips in fiscal year (FY) 2002 only, those who received strips in FYs 2001 and 2002, and those who received strips during all three years (FYs 2000, 2001, and 2002). Frequency of monitoring and case-mix scores were measured. Nonparametric statistics were used to compare the demographic and clinical characteristics of the four groups. Robust regression was used to analyze the relationships between SMBG and glycemic control in FY 2002. RESULTS: Of the 1185 patients who received oral hypoglycemic medications during all three fiscal years, 976 patients met the criteria for inclusion in one of the four groups. There were no significant differences among the four groups in baseline hemoglobin A1c (HbA1c) values, body mass index, or case-mix scores. The Kruskal-Wallis test found no significant difference among the four groups in the number of laboratory blood glucose tests conducted, but there were significant differences in the number of HbA1c tests conducted among the groups. CONCLUSION: SMBG was not associated with glycemic control in VA patients with type 2 diabetes mellitus managed on oral hypoglycemic medications.

Aged↗
PubMed2004

The patient-physician relationship, primary care attributes, and preventive services.

BACKGROUND: The importance of a sustained relationship between patients and physicians is a defining characteristic of family medicine. This study examined whether there is an association among the length of the patient-physician relationship, various attributes of primary care, and the delivery of clinical preventive services to Medicare beneficiaries. METHODS: The data source for this study was the 1993 Medicare Current Beneficiary Survey. Primary care attribute scales were developed by conducting a factor analysis of 17 survey questions. Three clinical preventive services were measured as outcomes: influenza vaccination, mammography, and an eye examination for diabetics. Path analyses were used to test the relationships between length of relationship, primary care attributes, and delivery of clinical preventive services. RESULTS: As the length of the relationship increased, scores on communication, accumulated knowledge of the patient by the physician, and trust all improved. Length of relationship and communication predicted accumulated knowledge of the patient by the physician, accumulated knowledge predicted trust, and trust predicted delivery of preventive services. CONCLUSIONS: Among elderly Medicare beneficiaries, the ability to develop a sustained relationship with a provider is related to the realization of other important attributes of primary care. Trust was associated with delivery of important clinical preventive services. Efforts should be made to protect the ability of patients and physicians to sustain a relationship over time.

Aged↗
PubMed2004

Family support and diet barriers among older Hispanic adults with type 2 diabetes.

BACKGROUND AND OBJECTIVES: Diet plays an important role in the management of diabetes, and a suboptimal diet is a commonly identified problem. Family support may be important in overcoming barriers to good diet. We conducted this study to examine the role of the family in overcoming barriers to diet self-care among older Hispanic patients with diabetes. METHODS: We performed a cross-sectional survey of 138 older Hispanic adults seeking care at an outpatient university clinic. Patients reported on their perception of family functioning, family support for diet, and barriers to diet self-care. RESULTS: Level of family functioning was related to family support for diet self-care, and family support for diet was related to perceived barriers to diet self-care. Scores for family support were higher for those who perceived their family as functional compared to those who perceived their family as mildly dysfunctional or dysfunctional. As family support for diet increased, perceived barriers to diet self-care decreased. CONCLUSIONS: To fully understand difficulties encountered by older Hispanic adults with adherence to a diabetic diet, primary care physicians should explore the role of family support and family functioning. For those with poorly functioning families or low levels of family support, family-level interventions may need to be considered.

Cross-Sectional Studies↗
PubMed2003

The association between cotton and prevalence of rural childhood asthma.

In the United States, asthma now ranks as the most prevalent chronic disease among children. Within rural cotton-producing regions, a popular belief is that cotton production increases the prevalence of asthma. This case-control study was conducted to determine if the prevalence of asthma is higher in children living in rural cotton-producing countries than in children where cotton production is negligible. No evidence was found to support the belief that cotton production increases the rural childhood prevalence of asthma (P = .12). More importantly, this study did reveal a significantly higher prevalence of asthma among the fifth graders in rural West Texas than the prevalence predicted by the Centers for Disease Control and Prevention (P < .0001).

Asthma↗
PubMed2002

Continuity of care, self-management behaviors, and glucose control in patients with type 2 diabetes.

BACKGROUND: The influence of continuity of care on outcomes of care for patients with type 2 diabetes is poorly understood. OBJECTIVE: To examine the relationships between continuity, glucose control, and advancement through stages of change for self-management behaviors. DESIGN: Prospective cohort study. SETTING: Five community health centers on the Texas-Mexico border. SUBJECTS: A random sample of 256 adults, 18 years of age and older with an established diagnosis of type 2 diabetes. MEASURES: Stage of change for diet and exercise were assessed during two patient interviews, averaging 18.9 months apart. Phlebotomy was performed at each interview to measure glycosolated hemoglobin (HbA1C). Medical records were abstracted for ambulatory care utilization. A continuity score was calculated based on the number of visits and number of providers seen. RESULTS: Patients who advanced one or more stages of change for diet had higher levels of continuity. As continuity improved, the change in HbA1C was smaller. (r = -0.25; P <0.001) This relationship remained significant after controlling for number of visits, months since diagnosis, number of days in the study, duration of diabetes, and advancement in stage of change for diet. Advancement through stage of change for diet explained a significant amount of the variance in the relationship between continuity and HbA1C (t test = -11.33; P <0.01). CONCLUSIONS: Continuity of care with a primary care provider is associated with better glucose control among patients with type 2 diabetes. This relationship appears to be mediated by changes in patient behavior regarding diet.

Adult↗
PubMed2002

Geography and geographic information systems in family medicine research.

Understanding spatial relationships between determinants and outcomes of health care is important as the concept of population-based health care gains acceptance. A wide range of tools for understanding these spatial relationships is available to the family medicine researcher through the use of Geographic Information Systems (GIS). The power of GIS lies in its ability to display the spatial distribution of a health-related predictor or outcome. These maps can then be used to either generate or test hypotheses that would not have otherwise occurred to the investigator without visualizing the spatial relationships. The type of GIS application used is dependent on the type of data the researcher has and the research question. The three most common types of data are point or event data, lattice data, and geostatistical data. Point or event data can be displayed using a technique known as geocoding. Lattice data is most commonly displayed as shaded or colored areas where the shading represents rates or counts. Geostatistical data provides counts or numbers at a given location. The analytic techniques used for analyzing spatial data depend on the type of data. Maps tell powerful stories and display relationships that may not be obvious using other techniques.

Environmental Exposure↗
PubMedDate not supplied

Handheld computer use in U.S. family practice residency programs.

OBJECTIVE: The purpose of the study was to evaluate the uses of handheld computers (also called personal digital assistants, or PDAs) in family practice residency programs in the United States. STUDY DESIGN: In November 2000, the authors mailed a questionnaire to the program directors of all American Academy of Family Physicians (AAFP) and American College of Osteopathic Family Practice (ACOFP) residency programs in the United States. MEASUREMENTS: Data and patterns of the use and non-use of handheld computers were identified. RESULTS: Approximately 50 percent (306 of 610) of the programs responded to the survey. Two thirds of the programs reported that handheld computers were used in their residencies, and an additional 14 percent had plans for implementation within 24 months. Both the Palm and the Windows CE operating systems were used, with the Palm operating system the most common. Military programs had the highest rate of use (8 of 10 programs, 80 percent), and osteopathic programs had the lowest (23 of 55 programs, 42 percent). Of programs that reported handheld computer use, 45 percent had required handheld computer applications that are used uniformly by all users. Funding for handheld computers and related applications was non-budgeted in 76percent of the programs in which handheld computers were used. In programs providing a budget for handheld computers, the average annual budget per user was 461.58 dollars. Interested faculty or residents, rather than computer information services personnel, performed upkeep and maintenance of handheld computers in 72 percent of the programs in which the computers are used. In addition to the installed calendar, memo pad, and address book, the most common clinical uses of handheld computers in the programs were as medication reference tools, electronic textbooks, and clinical computational or calculator-type programs. CONCLUSIONS: Handheld computers are widely used in family practice residency programs in the United States. Although handheld computers were designed as electronic organizers, in family practice residencies they are used as medication reference tools, electronic textbooks, and clinical computational programs and to track activities that were previously associated with desktop database applications.

Data Collection↗
PubMedDate not supplied

Stage of change advancement for diabetes self-management behaviors and glucose control.

PURPOSE: This study was conducted to evaluate whether patients with type 2 diabetes who participated in diabetes education advanced through stages of change for self-management behaviors and to determine if movement was related to glucose control. METHODS: A cohort of 428 patients with type 2 diabetes participated in a traditional diabetes education program in a large urban center in the Southwest. The sample was predominantly female with less than a high school education, a mean age of 52 years, and a mean duration of diabetes of 7 years. Two interviews were conducted approximately 9 months apart, at 1 to 4 weeks before the educational program and at 6 months after completing it. Blood specimens were collected at each interview to measure hemoglobin A1C (A1C) levels. RESULTS: Most of the patients advanced 1 or more stages of change for at least 1 self-management behavior. Those with diabetes for less than 2 years were significantly more likely to advance at least 1 stage of change for diet and exercise than those with diabetes for more than 2 years. Such advancement was significantly associated with a decline in A1C. CONCLUSIONS: Patients with type 2 diabetes who participated in diabetes education advanced through stages of change for self-care behaviors. The intervention was more effective for those with a shorter duration of diabetes.

Blood Glucose↗
PubMedDate not supplied

Family support, diet, and exercise among older Mexican Americans with type 2 diabetes.

PURPOSE: The purpose of this study was to examine the relationship between diabetes-specific family support and other psychosocial factors with regard to diet and exercise self-care behavior among older Mexican Americans with type 2 diabetes. METHODS: Adults aged 55 years and older who presented for care in a primary care clinic for type 2 diabetes (N=138) completed a survey to assess family support specific to diabetes, barriers to self-management, self-efficacy, and diabetes self-care activities. Multivariate regression analyses were conducted to evaluate the relationship between family support and self-care activities for diet and exercise. RESULTS: Higher levels of perceived family support and greater self-efficacy were associated with higher reported levels of diet and exercise self-care. As the barriers to exercise increased, the levels of exercise self-care decreased. Living with family members (more than just a spouse or significant other) was associated with higher levels of diet self-care, as was older age. CONCLUSIONS: Family behavior is associated with diet and exercise self-care. Diabetes educators and healthcare providers should consider involving the entire family in the management of older patients with type 2 diabetes. Interventions designed to improve diabetes self-management should address family support specific to diabetes, self-efficacy, and barriers to self-care.

Diabetes Mellitus, Type 2↗
PubMedDate not supplied

Encounters by patients with type 2 diabetes--complex and demanding: an observational study.

PURPOSE: We wanted to examine the relationships between quality of diabetes care delivered, the type and length of encounter, and time to the next follow-up encounter. METHODS: The content of the physician-patient encounter was directly observed in 20 primary care clinics for 211 patients with type 2 diabetes mellitus. The quality of diabetes care was measured as the percentage of the 5 following services delivered during the encounter if they had not been offered in the previous year: foot examination, referral for an eye examination, a glycosylated hemoglobin (HbA1c) measurement, a lipid panel, and a urine microalbumin test. RESULTS: All indicated services were performed in 33% of encounters. Compared with encounters for an acute illness, patients visiting for chronic disease follow-up were 4.8 (95% CI, 1.95%-12.01%) times more likely to receive 100% of all indicated services. Length of encounter was associated with percentage of services delivered, but only during chronic disease follow-up encounters (P = .02). Encounters during which 100% of all indicated services were delivered had a mean length of 19.4 minutes. The time to the next scheduled encounter was shorter if fewer services were delivered during the observed encounter (P = .009). CONCLUSIONS: Competing demands during primary care encounters require patient and physician to prioritize services delivered and defer indicated services to subsequent visits. Current models of patient care in primary care settings are inadequate to address the multitude of tasks facing clinicians, especially among patients with complex chronic illnesses. Innovative approaches and new models are needed to improve the quality of diabetes care.

Acute Disease↗