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Biomedical subjects

S A Rosenbluth

Publications and source records attributed to S A Rosenbluth.

At least 19 recordsLinked to original sources
PubMed2000

Assessing managed care's role in promoting preventive care.

The current trend of managed health care systems opens the door to more effective control of chronic diseases through preventive care. The goal of this study was to assess managed care's role in promoting preventive care. A mail survey was conducted of a national sample of 1,200 directors, associated with preventive care, in managed care organizations (MCOs) in the U.S. Data was obtained on perceived effectiveness, degree of importance, and likelihood of support for implementation of strategies recommended (case management, utilization review programs, selective contracting, and cost sharing) for ensuring appropriate utilization of preventive services. Also, information was collected on interventions perceived effective in encouraging plan members to utilize and providers to offer preventive services. Response rate was 17.3%. Case management and prospective and concurrent utilization review programs were perceived most effective, important, and likely to receive support for implementation while cost sharing (using deductibles and coinsurance) and retrospective utilization review programs ranked low on all dimensions. Plan member-directed interventions perceived effective in encouraging utilization of preventive services included telephone and mail reminders while computer-generated reminders and medical record audits with feedback were perceived effective in encouraging providers to offer such services. Results identified preferred MCO strategies and interventions for ensuring appropriate utilization of preventive services. Further research is needed to develop methods to encourage people at high risk for chronic diseases not currently utilizing preventive services to receive such services.

Case Management↗
PubMed2000

The relationship of disease severity, health beliefs and medication adherence among HIV patients.

The objective was to investigate the relationship of disease severity, health beliefs and medication adherence among HIV/AIDS patients. A survey was administered to 72 patients in three different stages of HIV/AIDS (CDC clinical categories A, B, C). Multivariate analyses revealed that there were no significant differences in patients' perceptions of the severity of HIV/AIDS or perceptions of the benefits and barriers for the treatment across three disease stages. However, the most severely ill patients (in stage C) perceived a higher risk of complications if they did not take their medicine as prescribed compared to asymptomatic patients (stage A) (p = 0.01). Also, patients in stages B and C were more adherent to their medications compared to patients in stage A (p = 0.007). Finally, perceived susceptibility-inaction was positively related to medication adherence (p = 0.005) and difficulty in following doctors' instructions was negatively related to patients' medication adherence (p = 0.009). In conclusion, patients' illness experiences are associated with their beliefs about the chances of developing complications if they do not adhere to their medications. Patients who have experienced more complications perceive a stronger relationship between medication non-adherence and AIDS-related complications, and are also more adherent to their medication regimen when compared to patients with no prior complications.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Predictors of childhood immunization completion in a rural population.

Despite the availability of effective vaccines, immunization rates among two-year old children continue to be low in many areas of the United States including rural West Virginia. The goal of this study was to identify barriers to childhood immunization in rural West Virginia and determine factors that were important in the completion of the childhood immunization schedule. A telephone survey was used to collect data from a randomly selected sample of 316 mothers, of two-year olds, from 18 rural counties of West Virginia. Results indicated that two-thirds or 65% of the children in the study sample had completed their recommended immunizations by two years of age. Immunization barriers identified in this study include: living in health professional shortage areas, lack of health insurance, negative beliefs and attitudes regarding childhood immunizations, problems accessing the immunization clinic, and a perception of inadequate support from the immunization clinic. Results of the structural equation modeling, using LISREL-8, indicated that 20% of the variation in immunization completion (R2 = 0.197) was explained by attitude towards immunization and perceived support received from the immunization clinic. Furthermore, 42% of the variation in attitude towards immunization (R2 = 0.419) was explained by immunization-related beliefs, and 28% of the variation in immunization-related beliefs (the R2 = 0.277) was explained by general problems faced during immunization and perceived clinic support. The study concluded that positive immunization-related beliefs and attitudes, support from the immunization clinic, and ease of the immunization seeking process are important factors in the timely completion of the childhood immunization schedule.

Child↗
PubMed1999

Barriers and facilitators to providing common preventive screening services in managed care settings.

Despite increasing emphasis on disease prevention and health promotion, and ample evidence demonstrating the effectiveness of preventive services, such services are underutilized in the United States. The current trend of health care toward health maintenance organizations and other managed care systems opens the door, perhaps to more effective control of heart disease, cancers and other chronic diseases through preventive care. This warrants attention to the barriers/facilitators to the provision/utilization of preventive screening services in such settings. Overall goal of this study was to assess barriers/facilitators to the provision/utilization of preventive services in managed care organizations (MCOs). This was accomplished by a) identifying barriers/facilitators to the provision/utilization of three common preventive screening services (cholesterol screenings, mammograms, and Pap smears); and b) profiling typical MCO recipients of these three preventive screening services. A self-administered, mail questionnaire was used to obtain information from a national sample of 1,200 Directors of MCOs associated with preventive care. A total of 175 usable responses were received resulting in a 17.3 percent net response rate. The strongest barrier to the provision of all three screening services is the inability of them to generate short term savings for the MCO. Other barriers include high disenrollment rates, conflicting recommendations about effectiveness (for mammograms and cholesterol screenings), and patients' fears of getting a positive result (for mammograms and Pap smears). The improved health status as a result of early intervention, high consumer awareness (for mammograms and Pap smears), and long term savings are important facilitators to the provision/utilization of these screening services. Comparing barriers and facilitators across the three services shows the stronger barriers affecting the provision/utilization of mammograms. For all three screening services, typical managed care recipients are those in the high income groups with greater education levels. However, with the increasing enrollment of Medicaid beneficiaries into managed care, MCOs may find themselves selectively targeting these high risk low income and less educated individuals to receive the preventive screening services. Study findings should be useful to health planners, policymakers and researchers at all levels in their efforts to encourage and promote healthier lifestyle choices among U.S. residents. Future studies should address receipt of preventive services by Medicaid and Medicare beneficiaries in managed care settings.

Adult↗
PubMed1998

Persuasive messages. Development of persuasive messages may help increase mothers' compliance of their children's immunization schedule.

Effective immunization campaigns can be designed by determining which persuasion strategy is most effective in attracting the attention of mothers of preschoolers. The authors assess the impact of three persuasional strategies: fear-arousal, motherhood-arousal, and rational messages, on mothers of preschoolers who are late for their immunizations. The fear-arousal message was found to be most effective, followed by the motherhood-arousal, and then the rational message, in attracting mothers' attention to their child's immunization status.

Child↗
PubMed1978

Long-term effects of a cancer awareness program for community pharmacists.

A continuing education program resulted in a 52% improvement in the specified professional behaviors of community pharmacists within one month. However, surveyed effects were not permanent and decreased significantly within 18 months. Following a simple mailing of specially designed literature, desired behaviors again underwent significant improvement comparable to that attributed to the original continuing education program. A better understanding of professional behaviors as functions of time and different educational modes would be invaluable to educators in both academic and postgraduate programs.

Education, Pharmacy, Continuing↗
PubMed1976

Nursing attitudes toward oral liquid unit dose packaging.

Nurses' attitudes toward three types of oral liquid unit dose packages--glass, plastic and aluminum--were determined. Thirty nurses who previously had not used unit dose packaging on their units were asked to evaluate the three types of packaging. The nurses preferred both aluminum and plastic over the glass containers; there was no significant difference in attitude toward the plastic and aluminum packages.

Aluminum↗
PubMed1976

Medication maintenance of mentally ill patients by a pharmacist in a community setting.

The use of a community pharmacy as a facility for medication maintenance services usually provided by a mental health center was evaluated. The project pharmacist was affiliated with the community mental health center, the community pharmacy facility was borrowed for purposes of this study. Records and prepackaged medication were transported by the pharmacy-clinic. Medication histories were taken and maintained by the pharmacist. Problems such as medication noncompliance, drug side effects, drug interactions and minor alterations in the patients mental status were handled by the pharmacist. Telephone consultations with a psychiatrist were also available. Twenty-two patients were involved in the study over an eight-month period. The evaluation consisted of a patient acceptance questionnaire and a retrospective chart review analyzing the clinical response of patients. Data suggest that selected stabilized psychiatric patients can be safely maintained in the community pharmacy. A carefully structured program and a pharmacist with special competencies are felt to be prerequisites for this type of service.

Attitude↗
PubMed1975

The pharmacy college as a pharmacy service "corporation".

A program of providing contract pharmaceutical services to health care facilities by a college of pharmacy is described. Services are provided to ten facilities: five hospitals, three mental health centers, a free-standing cancer clinic and a primary care center. The initial development of the concept, the lines of authority between the college and the facilities, the nature of the contractual agreements, and the benefits of the program are discussed. Among the benefits are the development of advanced drug distribution systems and clinical services, secure positions for clinical faculty members, the availability of the college's resources to the health care facilities, training and employment opportunities for students, and the good will created by improved health services.

Education, Pharmacy↗
PubMedDate not supplied

Pharmacists and immunizations: a national survey.

OBJECTIVES: To obtain information about pharmacists' current involvement in and willingness to provide immunization services, and to assess perceived barriers to providing immunization services. DESIGN: Cross-sectional mail survey. SETTING: National. PATIENTS OR OTHER PARTICIPANTS: Random sample of 5,342 pharmacists from chain, independent, mass merchandiser/grocery, primary care clinic, and health maintenance organization settings. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Responses to survey on pharmacy-based immunization services--current involvement, willingness to get involved, perceived obstacles, and patients' interest. RESULTS: Three mailings yielded a response rate of 25.3% (1,348 responses). Only 53.1% of respondents knew correctly whether their state allowed pharmacists to administer immunizations. Although a significant number of pharmacists were involved in immunization activities, such as counseling and promotion, only 2.2% and 0.9% of respondents were involved in actual administration of adult and childhood immunizations, respectively. In general, men, independents, owners/partners, and pharmacists who had attended immunization-related educational programs were more willing to provide immunization services than were women, chain and staff pharmacists, and educational program nonattendees. Pharmacists who had attended immunization-related educational programs also perceived pharmacist- and patient-related factors as less problematic for pharmacy-based immunization services than did nonattendees. CONCLUSION: This survey provides a baseline measure of the nature and extent of pharmacist involvement in immunizations that can be used now and in future years. The profession can use the findings on pharmacists' willingness to provide immunization services and their perception of obstacles to such services as a basis for targeted educational and promotional programs and materials.

Adult↗