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Biomedical subjects

N Korsen

Publications and source records attributed to N Korsen.

6 recordsLinked to original sources
PubMed2001

Travelers' diarrhea.

Explore the source record for details and available documents.

Anti-Bacterial Agents↗
PubMed2000

Improving the precision of primary care physician self-report of antidepressant prescribing.

BACKGROUND: Methods to select physicians most likely to benefit from educational interventions to improve the outcome of depression have not been adequately developed. OBJECTIVE: The purpose of this study was to identify a combination of primary care provider (PCP) self-report questions to improve the precision of PCP estimates of actual antidepressant prescribing as a potential tool for PCP selection. METHODS: The total number of new and refill antidepressant prescriptions written by 124 PCPs and actually filled at pharmacies over a 2-year period were matched with telephone survey results of these PCPs completed before the 2-year period. Multiple regression techniques were used to identify a set of variables that improved upon PCPs' self-report of prescriptions. RESULTS: The mean for PCP-reported antidepressant prescriptions written in the last week was 7.8 (+/-11.2). The average weekly prescriptions actually filled was 6.72 (+/-5.65). Most survey variables were significantly correlated with antidepressant prescriptions. The final model included 6 variables that explained 52% of the variance in prescriptions. In addition to PCP-reported number of antidepressants prescribed, average number of primary care patients seen per week and number of patients covered by managed care were directly related to the volume of prescriptions. PCP age, percentage of patients referred immediately without treatment, and mental health services being too far away were inversely related. CONCLUSIONS: PCP self-reports on antidepressant prescribing are reasonably accurate proxies of actual prescribing. The precision of estimates of actual prescribing can be improved by considering practice structural and financial characteristics.

Antidepressive Agents↗
PubMed1999

The need for a system in the care of depression.

BACKGROUND: Many problems have been identified in the usual care of patients with depression, including lack of identification, overreliance on medications, and inadequate treatment and follow-up. Most of these problems can be attributed to an absence of depression care systems in primary care practice. We collected information from a group of practices to assess the need for and acceptability of such systems. METHODS: We conducted 4 focus groups with primary care physicians and their staffs to identify attitudes and perceived behaviors for depression problems and to determine the participants' level of acceptance of alternative systematic approaches. We also surveyed clinicians and a sample of patients who recently visited their practices. RESULTS: Systematic screening was viewed unfavorably, and many barriers were identified with collaborative care with mental health clinicians. Participants did support involvement of other office staff and more systematic follow-up for patients with depression. The patient survey suggested that some patients with depressive symptoms were unrecognized and undertreated, but the key finding was considerable variation in care among practices. CONCLUSIONS: These findings suggest that a more systematic approach could improve the problems associated with treatment of patients with depression in primary care and would be acceptable to physicians if introduced appropriately. There are at least 2 promising approaches to introducing such changes. One involves external feedback of data about their care to the practices, followed by offering a variety of systems concepts and tools. The other involves an internal change process in which a multiclinic improvement team collects its own data and develops its own systematic solutions using rapid-cycle testing.

Attitude of Health Personnel↗
PubMedDate not supplied

Management of patients with depression by rural primary care practitioners.

OBJECTIVE: To investigate the extent to which variations in treatment and referral patterns for adult patients with diagnosed symptoms of depression seen in primary care practices are explained by practitioner characteristics, such as training, years in primary practice, sex, and knowledge about depression; practice characteristics, such as size, patient volume, and payer mix; and service area characteristics, such as availability of specialty mental health services and rural location. DESIGN: A 41-item telephone survey of primary care practitioners (PCPs) in Maine, including family and general practice doctors of medicine and doctors of osteopathy, general internists, nurse practitioners, and physician assistants (n = 267). MAIN OUTCOME MEASURE: The degree to which PCPs treat patients with depression themselves, rather than refer them to a mental health specialist. RESULTS: There is no significant (P = .10) urban-rural difference in the number of patients with depression seen as a percentage of total patient volume. Major barriers to referral to a mental health provider, as reported by the PCP, are long wait for an appointment, lack of available services, patients' unwillingness to use services, and reimbursement issues. Multivariate analyses indicate that PCP characteristics measuring knowledge and attitudes, as well as the lack of available services, are significantly related to treatment and referral patterns while practice characteristics and mental health provider supply are not. CONCLUSION: The treatment of rural patients with symptoms of depression is more likely to be improved by targeting PCPs' medical education than by efforts to increase the supply of specialty mental health providers in rural areas.

Community Mental Health Services↗