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Biomedical subjects

S J McPhee

Publications and source records attributed to S J McPhee.

At least 19 recordsLinked to original sources
PubMed1992

Misconceptions about cancer among Latinos and Anglos.

OBJECTIVE: To collect information regarding knowledge about and attitudes toward cancer in a sample of adult health plan members, self-identified as Latino or Anglo. DESIGN: Cross-sectional survey. SETTING: Prepaid health plan. RESPONDENTS: A random sample of 844 Latinos (mean age, 50.5 years) and 510 Anglos (51.8 years) completed the interview. MAIN OUTCOME MEASURES AND RESULTS: Latinos were significantly more likely than Anglos to think that sugar substitutes (58% vs 42%), bruises from being hit (53% vs 34%), microwave ovens (47% vs 23%), eating pork (31% vs 11%), eating spicy foods (15% vs 8%), breast-feeding (14% vs 6%), and antibiotics (32% vs 12%) could cause cancer (P < .001 for each). Compared with Anglos, Latinos more often misidentified constant dizziness (39% vs 25%) and arthralgias (35% vs 20%) as being symptoms of cancer. A higher proportion of Latinos believed that having cancer is like getting a death sentence (46% vs 26%), that cancer is God's punishment (7% vs 2%), that there is very little one can do to prevent getting cancer (26% vs 18%), that it is uncomfortable to touch someone with cancer (13% vs 8%), and that they would rather not know if they had incurable cancer (35% vs 23%; P < .001 for each). Latino ethnicity was a significant predictor of these knowledge and attitude items in multivariate logistic regression models adjusted for sex, education, age, employment, marital status, county of residence, and self-perceived health status. CONCLUSIONS: We conclude that misconceptions about cancer are more prevalent among Latinos than Anglos and that selected attitudes about cancer among Latinos fit a cultural theme of fatalismo. These data can enable development of culturally appropriate cancer control interventions for Latinos.

Adult↗
PubMed1992

Knowledge, attitudes, and practices of breast and cervical cancer screening among Vietnamese women.

The Vietnamese are the fastest-growing Asian/Pacific Islander ethnic group in California. Data from Vietnam and elsewhere suggest that cervical cancer and breast cancer are major contributors to cancer morbidity and mortality among Vietnamese women. However, little is known about the cancer knowledge and screening practices of Vietnamese women. Using a structured 57-item written questionnaire, we conducted a mailed survey of 400 randomly selected Vietnamese adult women in San Francisco. Overall, 107 women responded (31%). Of the respondents, 54 (52%) indicated that there was little one could do to prevent cancer. More than a third (39%) thought that breast or cervical cancer could be caused by poor hygiene, and about one-third (29%) thought that these cancers could be contagious. Although virtually all (97%) had heard of cancer, one-third did not know that a breast lump could be a sign of breast cancer (37%) or that abnormal vaginal bleeding could be a sign of cervical cancer (39%). Many (55%) did not know that family history was a risk factor for breast cancer and three-fourths (74%) did not know that having multiple sexual partners was a risk factor for cervical cancer. Fourteen (13%) had not heard of breast self-examination. Of 31 women aged > or = 40, 10 (34%) had never had a mammogram, and of 92 women aged > or = 18, 50 (54%) had never had a Papanicolaou test.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

The impact of clinical pharmacists' consultations on physicians' geriatric drug prescribing. A randomized controlled trial.

The impact of clinical pharmacists' consultations on geriatric drug prescribing was studied in a prospective randomized controlled trial of patients 65 years of age and over discharged on 3 or more medications for chronic conditions from a 450-bed community hospital. The pharmacists provided consultation to experimental patients and their physicians at hospital discharge and at periodic intervals for 3 months postdischarge. Using a standardized tool, a physician-pharmacist panel, blinded to study group assignment of patients, evaluated the appropriateness of prescribing for a random sample of 236 patients. Eighty-eight percent had at least one or more clinically significant drug problems, and 22% had at least one potentially serious and life-threatening problem. Drug-therapy problems were divided into six categories: 1) inappropriate choice of therapy; 2) dosage; 3) schedule; 4) drug-drug interactions; 5) therapeutic duplication; and 6) allergy. Experimental patients were less likely to have one or more prescribing problems in any of the categories (P = 0.05) or in the appropriateness (P = 0.02) or dosage (P = 0.05) categories. A summary score, measuring the appropriateness of the patient's total drug regimen, indicated that experimental patients' regimens were more appropriate than those of controls (P = 0.01). Results of this trial reveal that clinical pharmacists can improve the appropriateness of geriatric drug prescribing in outpatient settings.

Aged↗
PubMed1992

A systems model of clinical preventive care: an analysis of factors influencing patient and physician.

An ideal model for clinical preventive care must consider the physician, the patient and the many factors which influence each of them. In this paper, we review existing models, examining their strengths and weaknesses. We then propose a new model, the Systems Model of Clinical Preventive Care. This model is unique in its focus on the patient-physician interaction and details the factors impinging on each that promote or inhibit the completion of preventive care activities. These factors include patient and physician predisposing factors, such as health beliefs and attitudes; enabling factors, such as skills and resources; and reinforcing factors, such as social support. Additional factors include health care system organizational factors, such as access or availability; characteristics of the preventive activity, such as cost; and cues to action, such as symptoms or reminders. The proposed model contains components of behavioral, communication, health education and psychosocial theories. We then apply our model to mammography as an example of a screening activity. Finally, we describe the strengths and weaknesses of the proposed model, and identify areas for future research.

Delivery of Health Care↗
PubMed1991

Primary care physicians and AIDS. Attitudinal and structural barriers to care.

OBJECTIVE: To explore the extent to which primary care physicians are providing health care for people with human immunodeficiency virus (HIV) infection and to document barriers to HIV care giving. DESIGN: National random-sample mailed survey. PARTICIPANTS: Population-based random sample of 2004 US general internists, family physicians, and general practitioners in 1990. Response rate was 59%. MAIN OUTCOME MEASURES: HIV treatment experience, willingness to treat HIV-infected patients, negative attitudes toward homosexuals and intravenous drug users, fear of contagion of the acquired immunodeficiency syndrome (AIDS), perceived lack of information about AIDS, and time demands of HIV care. RESULTS: Most physicians (75%) had treated one or more patients with HIV infection. A majority (68%) believed that they had a responsibility to treat people with HIV infection, yet half (50%) indicated that they would not, if given a choice. Over 80% of respondents believed that they lacked information about AIDS and that caring for people with AIDS is time consuming. Further, 35% of respondents agreed that they "would feel nervous among a group of homosexuals" and 55% expressed discomfort about having intravenous drug users in their practice. Physicians who had treated 10 or more HIV-infected patients expressed less negativity toward members of these stigmatized groups who are likely to be HIV infected. CONCLUSIONS: These data suggest that many primary care physicians are responding professionally to the AIDS epidemic but that attitudinal barriers may be hindering some physicians from providing treatment to HIV-infected patients.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Do house officers learn from their mistakes?

Mistakes are inevitable in medicine. To learn how medical mistakes relate to subsequent changes in practice, we surveyed 254 internal medicine house officers. One hundred fourteen house officers (45%) completed an anonymous questionnaire describing their most significant mistake and their response to it. Mistakes included errors in diagnosis (33%), prescribing (29%), evaluation (21%), and communication (5%) and procedural complications (11%). Patients had serious adverse outcomes in 90% of the cases, including death in 31% of cases. Only 54% of house officers discussed the mistake with their attending physicians, and only 24% told the patients or families. House officers who accepted responsibility for the mistake and discussed it were more likely to report constructive changes in practice. Residents were less likely to make constructive changes if they attributed the mistake to job overload. They were more likely to report defensive changes if they felt the institution was judgmental. Decreasing the work load and closer supervision may help prevent mistakes. To promote learning, faculty should encourage house officers to accept responsibility and to discuss their mistakes.

Analysis of Variance↗
PubMed1991

Cancer screening by primary care physicians. Can we explain the differences?

BACKGROUND: Physicians perform cancer screening tests less often than recommended. METHODS: Forty primary care physicians were surveyed to assess their knowledge, attitudes, and experiences regarding cancer and cancer screening, and patients' medical records were reviewed to measure physicians' screening rates. RESULTS: Over 80% of physicians believed doctors should urge screening. On average, 23% of their patient visits were scheduled primarily for preventive care interventions. Screening performance scores expressed the percentage of compliance with the American Cancer Society's recommendations and demonstrated the low levels of compliance for six out of seven tests; however, there was substantial variance in performance among physicians. The best predictors of screening performance were (1) the percentage of visits scheduled primarily for prevention (mammography, and pelvic and breast examinations [P less than .05]); and (2) the number of medical journals read regularly (stool occult blood test [P less than .01], sigmoidoscopy [P less than .01], and Papanicolaou smear [P less than .02]). Also, female physicians performed more Papanicolaou smears (P less than .05) and scheduled more visits for preventive care (P less than .001). CONCLUSIONS: A small group of predictors explain large portions of the variance in cancer screening performance.

Adult↗
PubMed1990

Does quality influence choice of hospital?

In recent years, much information has been provided to the public and to physicians about hospital quality measured in terms of patient outcomes. To examine if, before these public data releases, quality influenced the attractiveness of a hospital to referring or admitting physicians and to patients, we estimated the influences of quality, charges, ownership, and distance on the choice of hospitals for patients with seven surgical procedures and five medical diagnoses in hospitals in three geographic areas in California in 1983. Greater distance and public or proprietary ownership consistently reduced the likelihood of selection while medical school affiliation increased the likelihood of selection. For five of seven surgical procedures and two of five medical diagnoses, hospitals with poorer than expected outcomes attracted significantly fewer admissions. The reverse held for two surgical procedures and one medical diagnosis. The results suggest that quality played an important role in choices among hospitals even before explicit data were widely available.

Aged↗
PubMed1990

Three strategies to promote cancer screening. How feasible is wide-scale implementation?

Many studies have tested the efficacy of intervention strategies for improving physicians' performance of cancer screening tests. Less attention has been paid to the feasibility of strategy implementation. Three important dimensions of feasibility are acceptability to the targeted audience, logistical difficulties, and cost and cost-effectiveness. We assessed the relative feasibility along these dimensions of three intervention strategies shown previously to be efficacious among 62 internal medicine resident physicians. Two strategies, medical record audit with feedback and computerized cancer screening reminders were aimed at physicians directly, and one, patient education, indirectly through their patients. While all three interventions were acceptable to the physicians, implementation of the audit with feedback intervention was logistically more difficult and more costly than either the cancer screening reminders or patient education interventions. The average cost per additional screening test (beyond the number that would have been performed without intervention) was $50.40 for audit with feedback, $18.19 for cancer screening reminders, and $51.20 for patient education. Overall, the cancer screening reminder intervention was the most feasible of the three strategies.

Attitude of Health Personnel↗
PubMed1990

Cancer risks and prevention practices among Vietnamese refugees.

Although Vietnamese refugees are the fastest-growing Asian minority in the United States, little is known about their health knowledge and practices, especially regarding cancer prevention. To address this problem, we interviewed a randomly selected sample of 215 Vietnamese adults living in the San Francisco Bay Area. Results indicated that 13% had never heard of cancer, 27% did not know that cigarette smoking can cause cancer, and 28% believed that cancer is contagious. Although hepatitis B-related liver cancer is endemic among Vietnamese, 48% had never heard of hepatitis B. Among men (n = 116), 56% were smokers (versus 32% in the general US population). Male cigarette smoking was significantly associated with incomes below the poverty level (P less than .01), residence in the US for 9 years or less (P less than .05), not knowing that smoking causes cancer (P less than .05), and limited English proficiency (P less than .01). Binge drinking was reported by 35% of men. Young Vietnamese of both sexes reported consuming diets higher in fat and lower in fiber than when they lived in Vietnam. Among eligible women, 32% had never had a Papanicolaou test (versus 9% of US women), 28% had never had a breast examination (versus 16%), and 83% had never had a mammogram (versus 62%). Education about cancer and its risk factors, smoking cessation, and cancer screening are high priorities for this population.

Adult↗
PubMed1989

Promoting cancer screening. A randomized, controlled trial of three interventions.

To determine effective methods of promoting routine cancer screening, we randomly assigned 62 internal medicine residents to receive cancer screening reminders (computer-generated lists of overdue tests at patients' visits), audit with feedback (monthly seminars about screening, with feedback about their performance rates), or no intervention (controls). Half of the residents in each group also were randomized to receive patient education (patients received literature and notices of overdue tests). We reviewed a sample of each physician's medical records to assess performance of seven tests during 9-month periods before and after initiating the interventions. Cancer screening reminders increased performance of six of seven tests; audit with feedback, four of seven tests; and patient education, one of two targeted breast cancer screening tests. The results indicate that the cancer screening reminders strategy was the most effective in promoting the performance of routine cancer screening tests.

Adult↗
PubMed1988

Community models for cancer prevention and detection.

Optimal community programs in cancer prevention and detection have as their goals the lowering of incidence, complications, and mortality from cancer in a population, and are characterized by efficiency, self-sustainability, and generalizability. Programs fall into three categories according to their degree of integration into the normal health-care system. "Extra-systemic" programs are temporary demonstration activities, which may have research goals. "Quasi-systemic" activities include public health department programs, worksite programs, and specialized centers such as breast screening centers. "Systemic" activities involve counseling and screening in routine medical practice. The greatest potential for reaching the indicated goals lies in facilitating systemic activities by allowing primary-care practitioners to define their own prevention goals, to make changes in their practices to address these goals, and to educate consumers of the need to demand preventive services.

Community Health Services↗
PubMed1988

Hospital competition and surgical length of stay.

The hypothesis that competitive pressures encourage hospitals to accommodate patient and physician preferences for longer lengths of stay was tested. Seven hundred forty-seven nonfederal short-term hospitals were divided in terms of the number of neighboring hospitals within a 24-km radius, and this measure of hospital concentration and competition was measured against length of stay for ten surgical procedures, using 1982 data on 498454 patient discharges. Patient, physician, and hospital characteristics associated with length of stay were controlled for. Competition-related percentage increases in length of stay were identified for all procedures, including total hip replacement (14.8%), transurethral prostatectomy (13.9%), intestinal operations (14.0%), stomach operations (14.7%), hysterectomy (6.9%), cholecystectomy (9.1%), hernia repair (10.5%), appendectomy (8.4%), cardiac catheterization (22.9%), and coronary artery bypass graft surgery (21.2%). It was concluded that there is a strong association between the number of hospital competitors in the local market and the average length of stay in US hospitals.

Catchment Area, Health↗
PubMed1988

Hospital volume and patient outcomes. The case of hip fracture patients.

Patients achieve better outcomes at hospitals that treat larger numbers of patients with certain diagnoses or who are undergoing particular procedures. However, the causal direction underlying this relationship is less well understood. Do patients treated at institutions with higher volumes of patients achieve better outcomes because the hospital staff and physicians have gained expertise by practice (the "practice makes perfect" hypothesis)? Do hospitals with a community reputation for excellent results attract higher volumes of patients because primary care physicians refer patients to specialists who practice there (the "selective referral" hypothesis)? Or, are both explanations important? This article addresses this question through a detailed analysis of patients with a particular diagnosis: hip fracture. In addition, two measures of patient outcomes are compared: long hospital stays as a proxy for in-hospital complications and in-hospital death.

Aged↗
PubMed1987

Training in a primary care internal medicine residency program. The first ten years.

We surveyed all 49 graduates of the University of California, San Francisco, residency program in primary care internal medicine to determine whether they chose careers as general internists and whether training in ambulatory care at the expense of hospital-based medicine is adequate preparation for general internal medicine practice. Graduates rated adequacy of training and relevance to their current clinical practice of 87 content and skill areas on five-point Likert scales. Of the 44 respondents, 39 (89%) chose careers as general internists and five (11%) as subspecialty internists. Training in nine of 11 internal medicine disciplines (eg, cardiology) was rated as highly adequate, and the areas as highly relevant. For ten of 15 non-internal medicine areas (eg, ear, nose, and throat), mean relevance scores significantly exceeded adequacy scores, suggesting training underemphasis. Mean relevance scores also significantly exceeded adequacy scores for seven of 11 basic knowledge/skill areas (eg, patient interviewing) and 13 of 14 areas related to clinical practice (eg, quality assurance). We conclude that the vast majority of graduates of the University of California, San Francisco, primary care residency program became general internists and that, rather than feeling deficient in training in hospital-based medicine, graduates reported unmet needs for ambulatory-care experiences and skills related to general internal medicine practice.

California↗