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Biomedical subjects

R R Zeitler

Publications and source records attributed to R R Zeitler.

7 recordsLinked to original sources
PubMed1990

Patient age, visit purpose, and the ordering of consultations in a primary care clinic.

In this study we examine what factors determine whether patients seen in a Veterans Administration primary care clinic will be referred to specialty clinics. It is based on a 25% sample of all patients seen by the medical residents in one clinic over an 18-month period. Our dependent variable is whether the patient was referred for a consultation or not. We performed separate regression analyses for patients who visited the clinic with acute complaints, with chronic-flareup complaints, and with chronic-routine complaints. Within each of these three categories, we further subdivided our sample into patients under and over 65. In each of the six regression equations we controlled for the medical diagnosis and for each resident's work load, residency year, and training. Work load and residency year had opposite (and unpredicted) effects for patients over the age of 65 compared to those under the age of 65. Higher work loads were associated with higher consultation rates for patients over 65 and with lower rates for those under 65. Residency year had a negative effect on referrals for patients over 65 and a positive effect for patients under 65.

Age Factors↗
PubMed1990

Queues and care: how medical residents organize their work in a busy clinic.

How do medical residents organize their work in settings where queue demands are heavy and resources are limited? Under such conditions, a queue theory would predict the delivery of care that is indifferent to clients' needs or that gets rid of clients as quickly as possible. In an exploratory case study of medical residents in a Veterans Administration outpatient clinic, we found instead that the medical residents' work was characterized by a high level of professional commitment: they provided thorough medical examinations and attempted to expedite patient care in other ways. We attribute the residents' professional ethos to opportunities provided in the VA hospital to learn the craft of routine medicine and to be directly responsible for patient care; such opportunities were not available in other settings.

Decision Making↗
PubMed1988

Cost effectiveness. How should it be determined?

The purpose of this article is to compare three commonly used indices of cost-effectiveness: the cost-effectiveness ratio, the cost-benefit ratio, and net benefit. We show that these indices can be interpreted to be consistent with one another and consistent with the traditional economic definition of cost-effectiveness. Further, we show that the relative cost-effectiveness of competing strategies cannot be determined by simply comparing their respective cost-benefit or cost-effectiveness ratios, but can be determined by comparing their respective net benefits. Finally, we show that cost-effectiveness ratios cannot be properly interpreted without consideration of the dollar value of health benefits.

Abstracting and Indexing↗
PubMed1984

An outbreak of community-acquired Legionnaires' disease pneumonia.

In October 1981, an outbreak of 29 cases of community-acquired pneumonia occurred among adult residents of Johnson County, Iowa. Retrospective study revealed 12 cases (41 per cent) had laboratory evidence of Legionnaires' disease (LD). No significant differences in clinical or epidemiological features were found between LD cases and the other pneumonias in the outbreak. All LD cases received erythromycin; one case died for a case-fatality rate of 8 per cent. The outbreak's focus could not be identified.

Adult↗
PubMedDate not supplied

Influenza vaccination of health care workers: evaluation of factors that are important in acceptance.

BACKGROUND: We evaluated the associations between putative occupational and epidemiologic determinants and influenza vaccine acceptance among health care workers during two consecutive seasons. METHODS: Multiple logistic regression models were developed to identify predictors of vaccine acceptance during 1991-1992, then validated in the subsequent year. A combined repeated-measures regression model using generalized estimating equations was fit to examine workers' vaccine acceptance over the 2-year period. RESULTS: Nearly one-third of hospital employees received influenza vaccine each year [2,364 of 7,320 (32%) in 1991-1992 vs 2,679 of 8,632 (31%) in 1992-1993]. Independent predictors among nurse clinicians included older age, higher salary, longer employment, and minimal absenteeism. Female sex, marriage, higher salary, and employment duration were independent predictors for professional support staff. Older age was the only independent predictor among nonprofessional staff. CONCLUSIONS: We conclude that older individuals, those with higher socioeconomic status, and those employed longer are more likely to accept the influenza vaccine. Sex, marital status, and prior work absenteeism are also important predictors in specific groups of health care workers.

Adult↗
PubMedDate not supplied

Variation in physician opinion about scheduling of return visits for common ambulatory care conditions.

OBJECTIVE: To determine whether there is consensus about intervals between visits for adult general medicine patients with common ambulatory care conditions. DESIGN: Survey of practicing physicians and residents. SETTING: Ambulatory care at a hospital clinic, a group practice, and a physician office. PARTICIPANTS: 153 physicians, including residents, fellows, and staff from The University of Iowa Hospitals and Clinics, internists and family practitioners from three Iowa towns, and internists from Atlantic City, New Jersey. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: There was wide variation in responses, with greater consensus for more acute conditions than for chronic conditions or preventive care. CONCLUSIONS: 1) Wide variation exists in proposed intervals between visits for care of patients with common ambulatory conditions. 2) Variation occurs within the same geographic area and is unassociated with year of graduation from medical school, year in training, or academic appointment 3) Further study is needed to assess the significance of this variation.

Adult↗