Biomedical subjects

Shlomo Vinker

Publications and source records attributed to Shlomo Vinker.

32 records · Page 2Linked to original sources

PubMed2005

Quality of diabetes care in the community: a cross-sectional study in central Israel.

BACKGROUND: Good care of the diabetic patient reduces the incidence of long-term complications. Treatment should be interdisciplinary; in the last decade a debate has raged over how to optimize treatment and how to use the various services efficiently. OBJECTIVES: To evaluate the quality of care of diabetic patients in primary care and diabetes clinics in the community in central Israel. METHODS: We conducted a retrospective cross-sectional study of a random sample of 209 diabetic patients in a district of the largest health management organization in Israel. Patients were divided into two groups - those treated only by their family physician and those who had attended diabetes clinics. Data included social demographics, medications, risk factors, quality of follow-up, laboratory tests, quality of diabetes and blood pressure control, and complications of diabetes. RESULTS: Of the 209 patients 38% were followed by a diabetes clinic and 62% by a family physician. Patients attending the specialist clinic tended to be younger (P= 0.01) and more educated (P= 0.017). The duration of their diabetes was longer (P < 0.01) and they had more diabetic microvascular complications (P= 0.001). The percentage of patients treated with insulin was higher among the diabetes clinic patients (75% vs. 14%, P= 0.0001). More patients with nephropathy received angiotensin-converting enzyme inhibitors in the diabetes clinic (94% vs. 68%, P= 0.02). Follow-up in the specialist clinic as compared to by the family physician was better in the areas of foot examination (P< 0.01), fundus examination (P= 0.0001), and hemoglobin A1c testing (P= 0.01). On a regression model only fundus examination, foot examination and documentation of smoking status were significantly better in the diabetes clinic (P< 0.05). CONCLUSION: There is still a large gap between clinical guidelines and clinical practice. Joint treatment of diabetic patients between the family physician and the diabetes specialist may be a proposed model to improve follow-up and diabetes control. This model of treatment should be checked in a prospective study.

Aged↗

PubMed2004

Primary care follow up of patients discharged from the emergency department: a retrospective study.

BACKGROUND: The visit to the emergency department (ED) constitutes a brief, yet an important point in the continuum of medical care. The aim of our study was to evaluate the continuity of care of adult ED visitors. METHODS: We retrospectively reviewed all ED discharge summaries for over a month 's period. The ED chart, referral letter and the patient's primary care file were reviewed. Data collected included: age, gender, date and hour of ED visit, documentation of ED referral and ED discharge letter in the primary care file. RESULTS: 359 visits were eligible for the study. 192 (53.5%) of the patients were women, average age 54.1 +/- 18.7 years (mean +/- SD). 214 (59.6%) of the visits were during working hours of primary care clinics ("working hours"), while the rest were "out of hours" visits. Only 196 (54.6%) of patients had a referral letter, usually from their family physician. A third (71/214) of "working hours" visits were self referrals, the rate rose to 63.5% (92/145) of "out of hours" visits (p < 0.0001). The ED discharge letter was found in 50% (179/359) of the primary care files. A follow-up visit was documented in only 31% (111/359). Neither follow up visit nor discharge letter were found in 43% of the files (153/359). CONCLUSIONS: We have found a high rate of ED self referrals throughout the day together with low documentation rates of ED visits in the primary care charts. Our findings point to a poor continuity of care of ED attendees.

Adult↗

PubMed2004

[Community care of diabetic patients--in the family practice, in specialized diabetic clinics or in cooperation?].

Type 2 diabetes is a common chronic illness with many complications, entailing enormous expenditures health services. In the Western world, diabetes is the most common cause of amputations of the lower limb, end stage renal failure and blindness amongst 18-65 year olds. The care of the diabetic patient is multi-faceted and the long term compliance of the patient is essential. In the last decade there is an ongoing heated debate regarding how treatment and care should be provided to diabetics and by whom. "Shared care" between the family physician and the specialist diabetes clinic is becoming more popular in an attempt to raise standards of care while reducing costs. The aim of the current review is to evaluate management modalities of the diabetic patient and its' applications to the Israeli health system.

Adult↗

PubMed2003

Usefulness of electronic databases for the detection of unrecognized diabetic patients.

BACKGROUND: Even mild hyperglycemia is associated with future acute and chronic complications. Nevertheless, many cases of diabetes in the community go unrecognized. The aim of the study was to determine if national electronic patient records could be used to identify patients with diabetes in a health management organization. METHODS: The central district databases of Israel's largest health management organization were reviewed for all patients over 20 years old with a documented diagnosis of diabetes mellitus (DM) in the chronic disease register or patient file (identified diabetic patients) or a fasting serum glucose level of >126 mg/100 ml according to the central laboratory records (suspected diabetic patients). The family physicians of the patients with suspected diabetes were asked for a report on their current diabetic status. RESULTS: The searches yielded 1,694 suspected diabetic patients; replies from the family physicians were received for 1,486. Of these, 575 (38.7%) were confirmed to have diabetes mellitus. Their addition to the identified patient group raised the relative rate of diabetic patients in the district by 3.2%. CONCLUSION: Cross-referencing existing databases is an efficient, low-cost method for identifying hyperglycemic patients with unrecognized diabetes who require preventive treatment and follow-up. This model can be used to advantage in other clinical sites in Israel and elsewhere with fully computerized databases.

Journal Article↗

PubMed2003

Patient and family physician preferences for care and communication in the eventuality of anthrax terrorism.

BACKGROUND: The threat of bioterrorism consequent to the September 11, 2001 attack in the USA generated suggestions for improved medical response mainly through hospital preparedness. OBJECTIVES: The aim of the present study was to investigate the impact of this period of tension on patients' first choice for care and for receiving relevant information, and on primary care doctors' feelings of responsibility in the eventuality of an anthrax attack. METHODS: During October 11-31, 2001, 500 patients from 30 clinics throughout Israel were asked to complete a questionnaire on their awareness of the anthrax threat, measures taken to prepare for it, and preferred sources of care and information. Their 30 physicians, and an additional 20, completed a questionnaire on knowledge about anthrax and anthrax-related patient behaviours and clinic visits. RESULTS: The outstanding finding was the low rate (30%) of patients who chose the hospital emergency department as their first choice for care or information if they were worried about an anthrax attack or the media communicated that an attack was in progress. The other two-thirds preferred their family doctor or the health authorities. Most of the physicians (89%) felt it was their responsibility to treat anthrax-infected patients and that they should therefore be supplied with appropriate guidelines. CONCLUSION: This study suggests that in Israel, a country with a high degree of awareness of civil defence aspects, both patients and primary care doctors believe that family physicians should have a major role in the case of bioterrorist attacks. This must be seriously considered during formulation of relevant health services programmes.

Anthrax↗

PubMed2003

Prevalence of and change in the prescription of methylphenidate in Israel over a 2-year period.

INTRODUCTION: The use of methylphenidate for the treatment of attention deficit-hyperactivity disorder (ADHD) has increased dramatically in the past decade in some countries in Europe and North America. In response to a public debate in Israel, several Knesset members introduced a legislative initiative that aims to limit the prescription of methylphenidate by physicians. The objective of this study was to examine the rate methylphenidate prescriptions dispensed for the treatment of ADHD in children in northern and central Israel in 1999 and 2001. PATIENTS AND STUDY DESIGN: The population included all children aged 0-18 years living in central or northern Israel and insured by the largest national health management organisation who were prescribed methylphenidate at least once in 1999 or 2001. This was a population-based prevalence study comparing the two timepoints using data from the health management organisation and descriptive statistics. RESULTS: The overall 1-year prevalence of methylphenidate prescriptions dispensed to children was 1.01% in 1999 and 1.22% in 2001 (relative risk [RR] 1.21, 95% CI 1.15-1.26), an increase of 21%. Seventy-seven percent of those prescribed methylphenidate were boys. The prescription rate ranged from 0.2% (RR 1.24, 95% CI 0.76-2.05) in Arabic cities to 5.99% (RR 1.19, 95% CI 1.09-1.30) in kibbutzim; this wide variation by type of residence apparently involved cultural, racial and economic factors. CONCLUSION: Israel shows no unusual or unexpected patterns in methylphenidate prescriptions dispensed to children and a lesser increase over time than other developed countries. This suggests that limiting physician freedom to prescribe methylphenidate to children may not be justified.

Adolescent↗

PubMed2003

Awareness of personal healthcare and menopause in menopausal women in Israel.

BACKGROUND: Menopause affects women's health and well-being, but their knowledge of proper care and maintenance is uncertain. OBJECTIVE: To assess the attitude and approach of the healthy, low risk, postmenopausal population in Israel to personal healthcare and menopause. METHODS: The study population comprised 500 menopausal women attending community outpatient primary care clinics. All women completed a 20-item questionnaire covering personal healthcare habits, lifestyle, knowledge about menopause, and attitude and approach to menopause and use of hormone replacement therapy. RESULTS: The patients' mean body mass index was 25.8 +/- 4.1 kg/m2; more than half the women were overweight, 28% engaged in regular sports activity, and 11.2% smoked; 74% had a positive attitude towards their age; 60% underwent yearly screening mammography; 74% had had Pap smear, and 86% had lipid profile measurements during the last year; self-examination of the breast was regularly performed by only 49%. HRT is currently being used by 27% and had been used in the past by another 16%. The primary reasons for stopping therapy were irregular bleeding in 38% and apparent ineffectiveness in 35%. There was a positive significant correlation between level of education and both undergoing regular medical screening and engaging in regular sports activity. HRT current utilization was negatively associated with age and being a housewife. CONCLUSIONS: A relatively high percentage of the study population safeguards its health and regularly uses HRT. We believe that stronger efforts are needed in Israel to promote good healthcare habits and positive attitudes toward menopause and HRT use.

Body Weight↗

PubMed2003

[Driver drowsiness--are physicians at a special risk?].

BACKGROUND: Sleepiness at the wheel is the main cause of approximately a fifth of road traffic accidents. The driver will often feel drowsy before the accident, therefore preventive measures can be taken in order to stay alert. AIM: To estimate sleepiness among sleep deprived drivers and to explore methods they use to stay alert. METHODS: We choose three professions at increased risk of sleepiness: physicians working night shifts, night shift nurses and hi-tech workers who work 12 hours or more a day at least twice a week. The subjects answered an anonymous questionnaire concerning past involvement in road accidents or "near misses", known risk factors for road accidents and methods used to fight sleepiness, as well as some demographic data. RESULTS: A total of 115 drivers (38 physicians, 37 nurses and 40 hi-tech workers) participated in this study. The average age was 36.0 + 7.9 years and 53% males. Thirteen percent had been involved in road accidents as drivers in the last year, 53% of them remember that the accident was due to sleepiness or fatigue. Thirty-seven percent remember at least one occasion of "near accident" due to sleepiness. Driving in the "dangerous" hours was positively associated with "near accidents" (69% vs. 29%, p < 0.001) and in accidents (17% vs. 11% P = NS). Physicians were involved in "near accidents" (p < 0.005) more often. The most frequent methods used to overcome sleepiness were: listening to the radio (86.1%), opening the window (65.2%) and turning on the air conditioning in the car (57.4%). CONCLUSION: Driving whilst sleepy is an important contributor to road accidents. It seems that sleep deprived workers and especially physicians working in shifts, are at an increased risk. This issue should receive a higher priority as part of preventive medicine among physicians themselves and their patients.

Accidents, Traffic↗

PubMed2003

[Healthcare costs--does family physician training make a difference?].

BACKGROUND: There are many patient dependent factors that determine health care costs. However, it is not clear if the family physicians' background and training affects health care costs. AIM: To investigate if the family physicians background and training affect their costs. METHODS: Included in the study were all the family physicians of Clalit Health Services, Central District according to the following criteria: at least two years work on the same patient list of at least 450 patients, doctors either with specialization in family medicine or with no specialization. The annual costs for treating 1,000 normalized patients (NP) were calculated for each doctor. The doctors' socio-demographic backgrounds were recorded including the country in which they graduated from medical studies, seniority, place of work and managerial position. RESULTS: A total of 137 doctors treating 268,453 NP were investigated. The average age of the doctors was 47.4 +/- 8.0 years and on average they had 22.7 +/- 8.2 years of work experience as doctors. Most had graduated in the former USSR (57%), or Israel (20%). Forty percent were specialists in family medicine. We found an 8.7% reduction in health care costs for 1,000 NP over a year when comparing specialists in family medicine to non-specialists (p < 0.01). In multiple regression, the following factors were associated with lower costs: a country practice and specialization in family medicine. CONCLUSION: The health care costs are reduced by specialists in family medicine when compared to non-specialists. It also appears that costs are lower in non-urban practices. These findings should affect decision makers in the health system in encouraging specialization in family medicine.

Costs and Cost Analysis↗

PubMed2003

[Improvement of early detection of diabetic retinopathy--a primary care intervention study].

BACKGROUND: Annual screening for diabetic retinopathy is highly recommended. The early detection of background retinopathy and laser treatment can prevent most of the diabetes related blindness. However patient compliance is relatively low. AIM: We aimed to raise the performance of annual fundus examination among diabetic patients, and to evaluate the rate of undetected severe diabetic retinopathy. METHODS: The study took place in an urban primary care clinic located in an average socio-economic neighborhood. The intervention program was based on implementation by the clinic staff with no additional external resources. The program included: locating the diabetic population, extending telephone invitation, and establishing cooperation with ophthalmologists. RESULTS: In 2000, the year prior to the intervention, 42% (177/420) of our diabetic patients had a fundus examination. In 2001 the rate increased to 76% (318/420), an increase of 80%. In 17% (55/318) of the patients the ophthalmologic examination was positive, including 33 cases of background retinopathy. Patients with retinopathy had a significantly higher HbA1c levels and hypertension was more common. Twenty cases had an early diabetic retinopathy, while the other 13 were immediately sent for laser treatment. In the laser treatment group, the male to female ratio was almost double (69% vs. 35%, p = 0.06). Diabetes duration was longer (15.6 + 4.9 years vs. 8.4 + 5.6, p < 0.001) and they had a significantly higher rate of diabetic foot and peripheral vascular disease. CONCLUSION: An intervention that involved primary care clinic staff without external resources increased compliance with annual fundus examination and detected diabetic retinopathy in a preventable stage.

Aged↗

PubMed2002

Erectile dysfunction--the effect of sending a questionnaire to patients on consultations with their family doctor.

BACKGROUND: Erectile dysfunction (ED) is a common problem among male adults that generally has been ignored by family practitioners. OBJECTIVE: Our aim was to assess the effect of a mailed questionnaire about ED on the readiness of patients to raise the subject with their family doctor. METHODS: The study population included all men aged 40 years and over on the patient list of a family practitioner. A control group made up of males of similar ages was chosen in another family practice. The patient files were reviewed for ED. Anonymous questionnaires including questions about sexual dysfunction and satisfaction with sex life, as well as demographic and medical details, were sent to the study population. Patients who suffered from ED were invited to visit their family doctor. In the following 2 months, the study and control group populations' visits to the family practitioner were monitored for complaints of sexual dysfunction. RESULTS: In the 2 years prior to the study, 14/205 (6.8%) of the study population had complained to their family practitioner of ED in comparison with 6/205 (2.9%) in the control group (P = NS). In the 2 months following the sending of the questionnaire, 23 patients consulted their family practitioner with ED, 19 of whom had not discussed their problem with the family practitioner previously; only a further two patients went to discuss ED in the same period in the control group (P < 0.001). A total of 85/205 (41.5%) patients returned the questionnaire and 35/85 (42.5%) said they suffered from ED. Of 35 patients who reported ED, 15 had been for a consultation; only six of them consulted their family doctor. CONCLUSION: ED is reported infrequently to family doctors. Sending an anonymous questionnaire on the subject increases awareness of the problem and in turn increases the number of cases that can be treated.

Aged↗

PubMed2002

The role of family physicians in increasing annual fecal occult blood test screening coverage: a prospective intervention study.

BACKGROUND: Colorectal cancer is the second leading cause of cancer mortality in israel. Unfortunately, compliance with annual fecal occult blood testing is very low. OBJECTIVE: To assess the effectiveness of interventions to increase FOBT screening in primary care clinics in Israel. METHODS: A prospective, randomized study included all 50-75 year old enrollees of six family physicians in two primary care clinics. The register of two physicians, one from each clinic, was allocated to one of three groups. Two FOBT reminder strategies were tested: a physician reminder (753 patients), and a patient reminder that was either a phone call (312 patients) or a letter (337 patients). The control group (913 patients) of physicians continued administering their regular level of care. The main outcome measure was the percentage of patients undergoing FOBT screening in each study arm at the conclusion of the one year study period. RESULTS: In the intervention groups 14.3% (201/1,402) were screened using the FOBT over the course of the study year. Using an intent-to-screen analysis, the screening rate in the physician and patient reminder groups was significantly higher than in the control group (16.5 and 11.9%, vs. 1.2% respectively, P < 0.0001). Phone reminders were significantly more effective than letters (14.7 vs. 9.2%, P = 0.01). CONCLUSIONS: Various reminder systems for FOBT are beneficial, especially those centered around the family physician. Further research should focus on this area, in conjunction with other novel approaches.

Aged↗

PubMed2002

[Family practitioners' knowledge and attitudes towards various fields of non-conventional medicine].

BACKGROUND: The common feature of the different varieties of non-conventional medicine (NCM) is the lack of recognition, complete or partial, given to them by the institutions of conventional medicine. Treating all varieties in the same way can cause confusion. AIM: To investigate the knowledge and attitudes of family practitioners (FP) in the methods of NCM that are most commonly practiced in Israel. METHODS: Anonymous questionnaires were used that tested knowledge and probed attitudes about FP about acupuncture, homeopathy, shiatsu and reflexology. RESULTS: 130 FP participated in the study (response rate 91%). In-depth training of any one of the NCM methods was rare (3-7%). Overall, a very minimal level of knowledge of all four methods was found--58% did not manage to answer even one knowledge question correctly, and the best result was five correct answers out of eight. Most of the doctors recognized NCM as legitimate, and thought that conventional and non-conventional medicine should co-exist side by side. Over 30% saw the possibility of integrating all four NCM methods within the institutions of conventional medicine. No significant difference was found in the doctors' attitudes towards the different methods. Better knowledge was associated with more positive attitudes towards NCM (p < 0.05), and a greater likelihood of referring patients (p < 0.1). CONCLUSION: Since attitudes towards NCM seem to be shaped by knowledge to a certain extent, educators should consider teaching more about these treatments both in medical schools and as part of CME.

Acupressure↗

PubMedDate not supplied

Primary care clinic size and patient satisfaction in a military setting.

Patient satisfaction is a fundamental parameter of quality in health care. Identification of aspects of care that influence patient satisfaction may be used to design changes in health delivery systems, thus improving quality of care. The objective of this study was to examine the relationship between the patient's assessment of quality of health care and the size of primary care clinics (PCCs) (measured as number of monthly patient visits) as well as the physician workload (measured as number of visits per physician per month). This study was a cross-sectional study using PCCs' characteristics and patient satisfaction surveys. One hundred one PCCs were evaluated. There was a negative correlation between all satisfaction indices and the number of primary care physicians in the clinic and the number of monthly visits to the clinic. In contrast, there was no significant correlation between the actual workload per physician. In general linear models, clinic size correlated significantly and negatively with patient satisfaction even after correction for other factors. The study concluded that patient satisfaction in the medical settings of the Israel Defense Forces is adversely affected by large clinic size but is not affected by physician workload.

Adolescent↗