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R L Perkel

Publications and source records attributed to R L Perkel.

12 recordsLinked to original sources
PubMed1996

Ethics and managed care.

Managed care presents physicians with potential ethical dilemmas different from dilemmas in traditional fee-for-service practice. The ethical assumptions of managed care are explored, with special attention to the evolving dual responsibilities of physicians as patient advocates and as entrepreneurs. A number of proposals are described that delineate issues in support of and in opposition to managed care. Through an understanding of how to apply basic ethics principles to managed care participation, physicians may yet hold on to the basic ethic of the fiduciary doctor-patient relationship.

Beneficence↗
PubMed1996

A house call program as an essential component of primary care training.

Despite the decline in the frequency of house calls by physicians during the twentieth century, such activities generally have been accepted as valuable and desirable by physicians and continue to be a feature of primary care practice. As the economic basis of health care undergoes significant changes in the era of managed care, the future viability of home visits by medical practitioners similarly hangs in the balance.

Adult↗
PubMed1996

The importance of advance directives in primary care.

The advance directive has been acknowledged widely by patients and physicians as a desirable tool to promote patient autonomy at the end of life. Rates of completion of advance directives, however, remain low among all segments of the population. Significant patient and physician barriers to completion of advance directives are considered. Legal and ethical principles of advance directives, as well as some practical means of overcoming barriers to these important discussions, are reviewed.

Advance Directives↗
PubMed1994

Relationship of advance directives to hospital charges in a Medicare population.

OBJECTIVE: There is a growing demand both for respect for patient autonomy regarding the use of sophisticated technology and for consideration of health care expenditures at the end of life. The major objective of this study was to assess the relationship between the documentation of a discussion of advance directives and hospital charges for Medicare patients during the last hospitalization of the patient's life. DESIGN: Multivariate analysis of a retrospective cohort. SETTING: Large (700+ beds), private university, tertiary care hospital. PATIENTS: All 474 patients who had Medicare listed as their primary insurer and who died in the hospital between January 1 and June 30 in 1990, 1991, or 1992. MAIN OUTCOME MEASURE: Total inpatient charges. RESULTS: The mean inpatient charge for the 342 patients without documentation of a discussion of advance directives was more than three times that of the 132 patients with such documentation ($95.305 vs $30,478). This relationship remained statistically significant after controlling for severity of disease, use of an intensive care unit, and number of procedures. Demographics, length of stay, admitting service, admitting diagnosis, and previous admission to the study hospital did not contribute to the predictive model. CONCLUSIONS: During discussions of advance directives, patients often opt to limit the extent of care they desire in certain situations. Although the most appropriate setting for developing advance directives is not clear, the results of this study imply that an enormous cost savings to society may be realized if such discussions take place, while, at the same time, autonomous patient choice will be respected.

Advance Directives↗
PubMed1988

Follow-up study of an urban family medicine home visit program.

A home visit program was established by a large urban family practice in an academic setting. At the program's inception, 198 patients were randomly assigned to either an experimental group, to be eligible for home visits, or a control group, to continue receiving only office-based care. Two years after this randomization, follow-up data were obtained on 194 of the 198 subjects to assess the program's effectiveness. Fifty-one of the subjects had died. There were an increased number of deaths in the experimental group (30 percent) compared with the control group (21 percent), although this difference was not statistically significant. No statistically significant differences were found between the remaining 143 experimental and control group patients in function or well-being. Patients in the experimental group had a significantly higher number of hospitalizations, although there was no difference in the number of days spent in the hospital. Although methodologic considerations limit the ability to draw policy conclusions from this follow-up study, this home visit program did not have a measurable sustained impact on health outcomes or utilization of health services.

Adolescent↗
PubMedDate not supplied

Physician compliance with mammography guidelines: a retrospective chart review.

Annual mammography is recommended by the American Cancer Society as an effective technique for the early detection of breast cancer in women aged 50 and older. This paper reports on a study conducted in a large group family practice in an urban academic setting to examine the frequency with which physicians were ordering mammograms for one age-appropriate group of female patients. The charts of a random sample of 88 females over age 55 who had been patients in the practice for at least five years were abstracted for information on mammography and breast examination as well as background clinical history. Within this sample, 56% had no mammograms recorded over the five-year study period, and only 19% had a mammogram within the most recently completed year. The average interval between mammograms over five years for subjects with one or more mammograms was 3.5 years. For 18% of all ordered mammograms the results could not be located in the chart. These findings suggest that family physicians need to improve adherence to recommended guidelines for mammography and to improve documentation of screening activities in the medical record.

Breast Neoplasms↗