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Biomedical subjects

R J Halbert

Publications and source records attributed to R J Halbert.

32 records · Page 2Linked to original sources
PubMed1999

Compliance with US asthma management guidelines and specialty care: a regional variation or national concern?

The objective of this study was to examine the compliance with the National Asthma Education Program (NAEP) guidelines among asthmatic members of eight health plans (regions) in seven states, as well as the factors related to the compliance. Information was gathered by means of a cross-sectional survey in a managed care environment. The participants were 6703 respondents (ages 14-65) with moderate or severe asthma. The main outcome measures were compliance with the NAEP guidelines on the use of inhaled steroids, inhaled beta2-agonists, peak flow measurement, and allergy evaluations. Among the results of this survey we found that although these health plans are located from the West Coast to the East Coast and the socioeconomic status of their members varied greatly, compliance with the NAEP guidelines was low among asthmatic members across all geographical regions. The major areas of low compliance identified were inappropriate pharmacological therapy, lack of objective measurement of lung function through peak flow meter, and insufficient environmental trigger control. The regression analyses indicated that the effect of the health plan explained little of the variation in compliance across these regions (only 0.3% at maximum). Low compliance was associated with young age, smoking, moderate asthma, being asthmatic for a few years, currently working, and being treated by a generalist rather than a specialist. In conclusion, this study showed that the compliance with the national guidelines for asthma care was consistently low across different geographical regions in the nation. Improvement in care for asthmatics will require greater commitment and involvement by all stakeholders including physicians, patients, health plans, and employers. We suggest a need for a national strategy to disseminate clinical guidelines not only to the medical community but also to patients themselves.

Adolescent↗
PubMed1999

Effect of multiple patient reminders in improving diabetic retinopathy screening. A randomized trial.

OBJECTIVE: To determine whether multiple mailed patient reminders can produce an increase in the rate of diabetic retinal examinations (DRE) over that seen with a single reminder. RESEARCH DESIGN AND METHODS: All diabetic members > or = 18 years who were enrolled in a large network-based health maintenance organization (HMO) in California from August 1996 to July 1997 were identified using claims and pharmacy databases. Members who had no record of DRE in the HMO's claims database were then randomized into two groups. Both groups received mailed educational materials and a reminder to obtain the examination. Their physician groups also received a letter explaining the program, current guidelines for DRE, and a list of their diabetes patients with their DRE status. The single intervention group received no additional reminders. The multiple intervention group received additional reminders at 3, 6, and 9 months after baseline if they continued with no record of service, as determined from the claims database. RESULTS: The study cohort comprised 19,523 diabetic members, which were randomized into single (n = 9,614) and multiple (n = 9,909) intervention groups. There was an increase in monthly DRE rates after the intervention in August 1996 for both intervention groups. After the second reminder was sent to the multiple intervention group, the percentage of diabetic members receiving DRE was higher than the single intervention group. Rates before and after the third intervention were not significantly different, nor were monthly differences found. There was a significant difference in overall annual DRE rates between the groups (P = 0.023). CONCLUSIONS: Multiple patient reminders are more effective than single reminders in improving DRE rates in a managed care setting. However, the improvement noted was clinically small and appeared only after the second reminder; no incremental improvement was seen with additional reminders. Resources used for multiple reminders aimed at diabetic retinopathy might better be spent on other approaches to reducing complications of diabetes.

Adult↗
PubMed1998

Traffic-related injury hospitalizations among California elderly, 1994.

Traffic-related injuries among the elderly are a growing concern in most developed and many developing countries. To better understand injuries sustained by the elderly in the traffic environment, hospitalizations for traffic-related injuries among those aged 64 and over in California in 1994 were examined to determine incidence and characterize injuries. Both injury incidence and injury severity increased as age increased over 64. Males were more likely to be injured as drivers of motor vehicles, but females were more likely to be injured as passengers. Fractures and internal injuries represented 72.3% of all primary diagnoses, and total hospital charges exceeded $140 million. Efforts to reduce traffic-related injuries in the elderly and to reduce injury severity will be increasingly important as the elderly comprise a larger proportion of the population.

Accidents, Traffic↗
PubMed1998

Competencies for population-based clinical managers. A survey of managed care medical directors.

BACKGROUND: The evolution of American health care into integrated systems of delivery and finance requires a specialized set of population-based skills for physicians. The field of preventive medicine represents one source of this expertise. Specific competencies for the emerging area of managerial medicine have not been well delineated. METHODS: Using concept documents from the Residency Review Committee for Preventive Medicine and the American Board of Preventive Medicine, a list of proposed competencies for managerial medicine was identified. Surveys were mailed to medical directors of all members of the American Association of Health Plans and to a random sample of diplomates of the American Board of Preventive Medicine. Respondents were asked to rate the importance of these competencies for a population-oriented clinician manager. RESULTS: Areas rated highly by medical directors included health services research (including outcome research), quality assurance and improvement, health risk assessment and reduction, programmatic skills, and clinical preventive skills. Responses from preventive medicine specialists were similar, but placed lower emphasis on these skills. CONCLUSION: Despite its limited response rate, this survey may be useful in the implementation of specialty training in managerial medicine. Residency training programs may choose to emphasize specific content area that reflect the priorities expressed by physicians actively involved in management.

Attitude of Health Personnel↗
PubMed1988

Logistics of medical care in rural Afghanistan.

The logistics of maintaining and supplying underground clinics located in war-torn rural Afghanistan are presented. Medical supplies are transported by pack animals over mountainous terrain, and must be specially packaged for the rigorous journey. Twenty percent of supplies are lost en route due to attacks or accidents. Medical and surgical equipment, some of which had to be specially designed, must be lightweight and durable. The system of monitoring clinic efficacy is also discussed.

Afghanistan↗
PubMed1988

Surgical theatre in rural Afghanistan.

We discuss the establishment of underground surgical theatres in resistance-held, rural Afghanistan by the IMC. The limitations of working in facilities without electricity or modern surgical equipment or even adequate suction are discussed, and the methods we have implemented to deal with these limitations are presented.

Afghanistan↗
PubMed1988

Surgical training model for advanced emergency medics in Afghanistan.

A surgical training model developed and implemented by the IMC for the training of advanced surgically capable medics operating in resistance-held rural Afghanistan is presented. Existing training programs for medics and midlevel health care workers are discussed, but these offer little or no surgical training and depend on a tiered system of referrals that is not possible in resistance-held Afghanistan. Details of the medics' training, enabling them to diagnose and treat 75% of war-related injuries in the rural population, are presented, as is the rationale for development of the model, based on data from other conflicts.

Afghanistan↗
PubMed1988

Sterilization techniques in underground surgical units in Afghanistan.

Sterilization equipment and techniques available to forward surgical units in modern conflicts past and present are sophisticated and generally taken for granted. Underground surgical units operating in rural Afghanistan must function without electricity or petroleum-powered generators and, with few exceptions, are unable to use sterilization equipment that produces intense heat for prolonged periods. We discuss the equipment and techniques developed for use by the IMC to sterilize surgical instruments, gowns, gloves, rubber goods, and sutures in the 42 clinics operating in resistance-held Afghanistan. These techniques may have application to other similar primitive conditions.

Afghanistan↗
PubMedDate not supplied

Misdiagnosis of COPD and asthma in primary care patients 40 years of age and over.

Chronic obstructive pulmonary disease (COPD) is often misdiagnosed as asthma, leading to inappropriate treatment and suboptimal patient outcomes. As part of a prospective study of patients with a history consistent with obstructive lung disease, we compared prior diagnostic labels with a study diagnosis based on spirometric results. We enrolled persons 40 years of age or older with prior diagnoses or medications consistent with obstructive lung disease. Patients were recruited via random mailing to primary care practices in Aberdeen, Scotland, and Denver, Colorado. Prior diagnoses of chronic bronchitis or emphysema (CBE) and asthma were reported by the subjects. Participants underwent pre- and post-bronchodilator spirometry. A study diagnosis of COPD was defined using post-bronchodilator forced expiratory volume in 1 second/forced vital capacity (FEV(1)/FVC) < 0.70. Spirometric examination was complete in 597 patients, of whom 235 (39.4%) had a study diagnosis of COPD. Among subjects with a spirometry-based study diagnosis of COPD, 121 (51.5%) reported a prior diagnosis of asthma without concurrent CBE diagnosis, 89 (37.9%) reported a prior diagnosis of CBE, and 25 (10.6%) reported no prior diagnosis of obstructive lung disease. Despite the availability of consensus guideline diagnostic recommendations, diagnostic confusion between COPD and asthma appears common. Increased awareness of the differences between the two conditions is needed to promote optimal patient management and treatment.

Adrenal Cortex Hormones↗
PubMedDate not supplied

Improving the management of chronic obstructive pulmonary disease.

As the fourth leading cause of death in the United States, chronic obstructive pulmonary disease (COPD) represents a major burden to the healthcare system and society at large. Underdiagnosis and undertreatment lead to an increased economic burden, with exacerbations being a key driver of costs. COPD symptoms compromise quality of life (QOL), which affects both patients and caregivers. Appropriate management decreases healthcare utiization and improves QOL. This article provides an overview of COPD and promotes understanding of opportunities to optimize patient health and outcomes for those with the disease. Specific interventions that have been demonstrated to improve clinical and economic outcomes for COPD include improved implementation of guidelines, optimized pharmacologic treatment, and risk-factor reduction.

Cost of Illness↗