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Biomedical subjects

S H Gehlbach

Publications and source records attributed to S H Gehlbach.

At least 19 recordsLinked to original sources
PubMed1989

Functional versus structural social support and health care utilization in a family medicine outpatient practice.

Three hundred forty-three family-practice patients were surveyed by questionnaire and medical record audit to evaluate the relationships between social support and medical care utilization. Social support was not associated with laboratory test ordering. The mean number of office visits per year was higher for patients with low versus high confidant support (4.71 vs. 3.81, P less than 0.10) and affective support (5.21 vs. 3.60, P less than 0.05). Mean total charges in 1 year were higher for patients with low versus high confidant support ($232 vs. $148, P less than 0.05) and affective support ($244 vs. $154, P less than 0.05). Poor confidant and affective support were both associated with longer visits. Structural measures of social support were not related significantly to any utilization indicator. These findings were maintained in multiple-regression models controlling for physical health and seven demographic characteristics. Second-order regression models revealed interaction by race, employment status, and sex. Blacks showed no effect of confidant support on office visits. Poor confidant support resulted in $201 more in total charges for the unemployed (P = 0.003) versus $49 more for the employed (P = 0.15). Women with low affective support had $119 more in charges (P = 0.001) versus $16 less for men (P = 0.82). The results suggest that low functional social supports are important determinants of increased medical service utilization and that they may have differential effects by race, sex, and employment status, all of which should be considered independently in future studies.

Adolescent↗
PubMed1988

Caregivers and elderly relatives. The prevalence of caregiving in a family practice.

Persons 65 years and older are the most rapidly growing age group in the United States. As age increases, functional ability deteriorates and the need for help from another person escalates. Caring for elderly persons experiencing functional deterioration is stressful, creating hidden patients among caregivers. This study surveyed randomly selected active family practice patients 40 years and older to determine the prevalence and extent of the caregiving role and functional disability among elderly relatives. One in five patients (126/602) surveyed had caregiving responsibilities for noninstitutionalized relatives (total, 153 patients). One third of caregivers lived with the relative; most of the remaining two thirds visited their relative at least twice weekly. Caregivers reported some functional impairment in 60% of their relatives, and substantial impairment in 40%. The caregiving experience is common, and the potential for stress from managing an elderly relative's disability is substantial. Further research is needed to elaborate on the burden of the caregiver.

Activities of Daily Living↗
PubMed1988

Effect of prepaid health plans on a family practice residency.

The rapid growth of prepaid health care plans imposes clinical, financial, and educational changes on residency programs. In the study reported here, the authors examined some perceived and actual effects of such plans on a family medicine center associated with a family medicine residency training program. In the study, 37 residents and 19 faculty members completed a 5-point, 16-item survey covering the effect of the prepaid plans used at the center on the program's practice profile, cost-containment efforts, and education activities over a three-year period. Overall, the respondents agreed with the need for cost containment that accompanied participation in the prepaid plan and agreed that prepaid plans increased the number of patient visits and visits by family members. The residents and faculty members agreed that prepaid patients were more demanding and were seen more often for minor or inappropriate problems. Regarding the educational impact of the prepaid plans, the respondents agreed that they improved their clinical decision-making, and no significant concern regarding limitation of laboratory or consultations was noted. Some of the respondents' perceptions were corroborated by findings in the clinic data base that showed increased numbers of patient visits, more visits by members of the same family, and no significant change in outpatient consultation rates.

Attitude of Health Personnel↗
PubMed1988

The Duke-UNC Functional Social Support Questionnaire. Measurement of social support in family medicine patients.

A 14-item, self-administered, multidimensional, functional social support questionnaire was designed and evaluated on 401 patients attending a family medicine clinic. Patients were selected from randomized time-frame sampling blocks during regular office hours. The population was predominantly white, female, married, and under age 45. Eleven items remained after test-retest reliability was assessed over a 1- to 4-week follow-up period. Factor analysis and item remainder analysis reduced the remaining 11 items to a brief and easy-to-complete two-scale, eight-item functional social support instrument. Construct validity, concurrent validity, and discriminant validity are demonstrated for the two scales (confidant support--five items and affective support--three items). Factor analysis and correlations with other measures of social support suggest that the three remaining items (visits, instrumental support, and praise) are distinct entities that may need further study.

Adult↗
PubMed1988

Bacterial diseases of the colon.

Acute diarrhea of bacterial origin is discussed for seven enteric pathogens, and specific antimicrobial therapy based on positive identification is stressed. Selection of patients with self-limited disease not requiring antimicrobial therapy is emphasized in order to avoid costly laboratory tests. The role of daycare facilities in the spread of enteric pathogens in this country is discussed. This article includes a review of newer methods for treating infants and children with oral rehydration and rapid refeeding.

Adult↗
PubMed1988

Fever in children younger than three months of age. A pooled analysis.

Concern that febrile infants younger than 3 months of age are at high risk of serious infection has prompted a management policy of routine hospitalization with antibiotic administration. Ten published studies of febrile infants younger than 3 months of age were reviewed, and data were statistically combined to develop estimates of the risk of bacteremia and serious infection. Factors that predicted increased risk were similarly evaluated. Mean and median risk estimates included, respectively, 3.0 and 3.4 percent for bacteremia, 1.3 and 1.0 percent for septic meningitis, and 5.0 and 7.0 percent for pneumonia. These were no higher than comparable estimates for older infants. Clinical appearance was 92 percent sensitive in predicting bacteremia in 500 infants (23 of 25 cases). Younger age, higher fever, and elevated white blood cell count were associated with increased risk of serious infection. Data from these studies do not support the belief that febrile infants younger than 3 months are uniformly at greater risk of serious infection than older infants. Judicious evaluation of younger infants could lead to more selective, cost-efficient management.

Fever↗
PubMed1987

Family practice residents' evaluation of a competency-based psychiatry curriculum.

The authors report the formal evaluation of a competency-based curriculum in psychiatry in a family practice residency program at a community hospital five years after the program was implemented. In interviews, the 35 residents in the program in 1985 responded to a questionnaire on their understanding of and attitude toward the requirements of the competencies and the difficulties they encountered in documenting the competencies. All but two of the residents were aware of the nature of the curriculum, but only 43 percent had completed one or more of the 15 required competencies. The residents' attitude toward the requirements of demonstrating specific competencies in psychiatry during the residency were generally negative, although they were favorable toward required competencies in other disciplines. The results of the present study identify specific problems in implementing such a curriculum. Successful implementation may have been impeded by the novelty of the new educational format and a lack of reinforcement by faculty members.

Competency-Based Education↗
PubMed1985

Epidemiology for medical students: a controlled trial of three teaching methods.

Medical students taking a course in epidemiology for clinical practice were taught by either lectures, small group seminars or self-learning packages. Examination performances were no different for the three groups, but self-perceived mastery of learning objectives, and satisfaction with the course were higher for students who received self-learning packages. Sixty per cent of self instruction students found the teaching method was successful compared with 37% of the seminar students and only 19% who received lectures. A combination of self-instructional package and seminar would seem to hold most promise for a workable and effective course.

Education, Medical, Undergraduate↗
PubMed1985

Treatment of lower urinary tract infections with single-dose trimethoprim-sulfamethoxazole.

Two hundred three women from a primary care medical practice with symptoms of lower urinary tract infection and positive urine cultures were treated with trimethoprim-sulfamethoxazole. One hundred eleven women received a single dose and 92 were treated for ten days. Cure rates were 87 percent and 89 percent, respectively, one week after therapy. A narrow 95 percent confidence interval for the difference between the two cure rates (.02 +/- .09) suggests the treatments are equally effective. Patients were followed by chart audit and a self-reporting questionnaire. No difference in recurrence rates was found between the two groups six months after therapy. Single-dose trimethoprim-sulfamethoxazole is as effective as ten-day treatment in women with symptoms suggestive of lower urinary tract infection and has no greater relapse rate.

Adult↗
PubMed1985

Early termination of breast-feeding: identifying those at risk.

In a private pediatric practice, 94 infants who were breast-feeding were followed for the first 2 months of life in order to define the frequency of cessation of breast-feeding and to identify factors that would predict mothers and infants at risk for early cessation. At 8 weeks, 30% of the mothers had stopped nursing. Factors associated with cessation were: maternal lack of confidence in breast-feeding (P less than .001); anticipated duration of nursing less than 6 months (P = .002); ratings by the nursery staff of infant's excessive crying (P = .007), infant's demanding personality (P = .007), trouble with feeding (P = .001), and future trouble with feeding (P = .004). Together, these factors predicted 77% of the mothers who terminated breast-feeding. Supplementing with formula before the 2-week office visit also led to termination of breast-feeding by 8 weeks (P = .006). This decision was frequently made without medical advice. Nearly 64% (14/22) of the mothers who added formula within the first 2 weeks did so without contacting the pediatric practice.

Adult↗
PubMed1984

Implementation of guidelines for the use of skull radiographs in patients with head injuries.

Guidelines formulated by the Royal College of Radiologists' Working Party on the Effective Use of Diagnostic Radiology were introduced into an accident-and-emergency department to determine their effect on the use of skull radiographs in patients with head injuries and on the number of admissions for observation. After approval by senior staff and substitution of the routine casualty record with a head-injury casualty card, the guidelines were distributed throughout the department, and seminars on the suggested use of skull radiographs were held for junior medical staff. The proportion of new accident-and-emergency attenders having skull radiographs fell by 51%. The average number of skull examinations carried out in the department decreased from 373 to 189 per month, but there was no increase in the number of patients with head injuries admitted for observation.

Adolescent↗
PubMed1983

Newborn home visits.

A randomized controlled trial was conducted comparing home visits with office visits by physicians to families with newborns within the first two weeks of life. Results showed that physicians were significantly more satisfied and rated their relationship with the family significantly higher after home visits than after office visits. Fathers were present at 50 percent of the home visits compared with 26 percent of office visits (P less than .05). Mothers in the home visit group rated caring for their baby as significantly easier than the office visit group. There was no difference in infant immunization rate or number of well-child visits, although infants in the home visit group had significantly more visits to their own physician. The mean length of visit was 33 minutes (not including travel time) for home visits and 23 minutes for office visits. Physicians were better able to note home environment and family interactions during home visits. This study supports the view that home visits by physicians enhance the physician-family relationship.

Clinical Trials as Topic↗
PubMed1981

Improving hypertension control: impact of computer feedback and physician education.

Two interventions designed to help physicians manage hypertensive patients were evaluated in a controlled trial: 1) computer-generated feedback to facilitate identification of poorly controlled patients; and 2) a physician education program on clinical management strategies, emphasizing patient compliance. Four physician practice teams received either computer feedback, the education program, both, or neither. Feedback team physicians received seven monthly listings of the latest visits and blood pressures of their hypertensive patients. The self-administered learning program included written clinical stimulations and associated didactic material. Experimental and control physicians were similar in baseline knowledge, patient mix and level of training. All feedback team physicians requested appointments for listed patients, and their patients made twice as many visits as control patients during the intervention period (p less than 0.05). Education team physicians showed significant gains on a content-specific post-intervention test: mean score 84 per cent compared with 74 per cent for the control group (p less than 0.005). All patient groups showed improvement in blood pressure over the study period. However, no differences between intervention teams could be detected (p greater than 0.20). The probability of missing a 10 mm interteam difference in outcome diastolic pressure was 1 per cent (power of 0.99). Strategies for further improvement in outpatient hypertension management may need to come from outside the traditional medical model.

Clinical Trials as Topic↗