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Biomedical subjects

W O Spitzer

Publications and source records attributed to W O Spitzer.

At least 127 records · Page 7Linked to original sources
PubMed1976

Nurse practitioners in primary care. VI. Assessment of their deployment with the Utilization and Financial Index.

The impact of multidisciplinary teams that incorporate nurse practitioners on total use of health services was measured with the new Utilization and Financial Index (UF-Index). The data from two studies, a randomized controlled trial and a before-and-after study, showed that, in spite of large increases in use of ambulatory services by practice populations served by family physician-nurse practitioner teams, the ultimate effect has been a substantial reduction in total use of health services. The effect was associated with major reductions in hospital care for the same populations. Such economic advantages to society proved feasible within a fee-for-service context and in settings where rigorous evidence demonstrated no concurrent deterioration in health status of patients or in quality of care.

Ambulatory Care↗
PubMed1976

Patterns of medical drug use - a community focus.

The pattern and extent of medical use of drugs was examined by survey in a rural Ontario community (Smithville) and a suburban (Burlington) family practice. Changes in established patterns of drug use that occur after the introduction of a nurse practitioner were also examined in the suburban practice. In both surveys 60% of respondents were using at least one medication and 30% were taking at least one medication prescribed or suggested by a doctor. There were consistently high rates of use of nonprescribed drugs at all ages, especially among females. Vitamins and tonics were the most commonly used drugs, and were taken by 25 to 28% of the respondents, 40% of whom used them on the advice of a physician. From 8.8 to 10.5% of respondents used sedatives or tranquillizers, and reduction in the prescribed use of these drugs was found among patients managed by the nurse practitioners. Self-medication is apparently unrelated to the frequency of medical consultation.

Child↗
PubMed1976

Medical manpower: criteria for surveillance.

A physician manpower surveillance project, undertaken in the Canadian province of Ontario, is presented as a feasible prototype, using five essential critera: 1. Personal data and population information must be linked. 2. Corresponding geographic jurisdictions must be small enough to permit the identification of manpower trends in catchment areas at the community level. 3. The type of practice must be distinguished into at least two categories: primary care physicians and second-line physicians. 4. Personal and educational data must be kept to a minimum. 5. Surveillance determinations must be made frequently, with prompt publication of data.

Canada↗
PubMed1976

Underreporting of cancer in medical surveys: a source of systematic error in cancer research.

Systematic errors occur in the reports of disease frequency derived from health surveys based on questionnaire interviews. Five hundred and thirty-three persons with clinically and histologically confirmed disease in a case-control study of cancer were interviewed in their homes by carefully trained interviewers using a standardized questionnaire interview schedule. Comparisons of the information obtained by interview about past history of cancer with cancer registry and hospital medical record information about the same people revealed serious underestimates of correct frequency and wide variation in the rates of correct reporting. The findings reported here and elsewhere add support to an essential requirement in medical survey research: the completeness and accuracy of responses in health interview surveys must be verified and the methods of verification must be reported before the results can be interpreted with confidence.

Carcinoma, Squamous Cell↗
PubMed1976

Comparison of a private family practice and a university teaching practice.

In March 1972 a private family practice in Hamilton, Canada, became a teaching practice of McMaster University. Subsequently a before-and-after study was conducted to compare characteristics of the patients and the impact of the change on the practice. There was a 34 percent reduction in practice size. There was a shift to younger patients and a substantial drop in mean patient income. Utilization rates of health services rose, particularly hospitalization, even though the average length of stay decreased. Profiles of complaints and diagnoses remained very similar. Quality of care scores were comparable with those of community controls before and after the change. Gross income from clinical earnings dropped, but the amounts per person per year were very similar in the two periods. It is concluded that the "transplanted private practice" which becomes part of a school of medicine is a realistic teaching resource in primary care.

Family Practice↗
PubMed1976

The arthritic complaint in primary care: prevalence, related disability, and costs.

Surveys conducted in five areas of Southern Ontario obtained clinical and service utilization data from 5,478 adults over 25 years of age. The two week period prevalence rates of arthritic and rheumatic (AR) complaints were 1.72 per cent and 2.14 per cent among two groups of users of primary care. In free-living general populations, the rates ranged from 6.23 per cent to 8.84 per cent. It was shown that only 25 per cent of complainants with AR symptoms sought health services. Of all adults seen by family physicians in one year, 28 per cent presented at least once with an AR complaint. While 20 per cent of all respondents reported some physical impairment, 43 per cent of those with AR complaints had impairment. The excess impairment was two per cent. Complaints with AR symptoms used health services at costs 78 per cent higher than the average expenditures in the same communities. The essential role of the primary care practitioner in the identification and control of AR disorders is strongly supported.

Adult↗
PubMed1975

The occupation of fishing as a risk factor in cancer of the lip.

To study the role of commercial fishing and related factors in the development of lip cancer, a project that included a case-control study and a cohort analysis was undertaken in Newfoundland. Household survey data were linked with cancer-registry and census data. In comparison with other males, fishermen had a probability of development of lip cancer that was 1.5 times higher (by the case-control method, P less than 0.05) or 4.4 times higher (by cohort analysis, P less than 0.001). Despite the effect of pipe smoking, "outdoorness" and age on the development of lip cancer in general, the occupation of fishing was an additional, independent contribution to the risk. Unexpectedly, using the mouth as a third hand to handle tar-coated nets seemed to protect fishermen from the disease. It was not possible to attribute the higher risk to a particular work activity, nor was a specific responsible carcinogen identified.

Adult↗
PubMed1975

Nurse practitioners in primary care iv. Impact of an interdisciplinary team on attitudes of a rural population.

Attitudes toward the expanded role of nurse practitioners in primary care (family practice nurses) have been determined for persons from a semirural area who chose as their principal souce of care an interdisciplinary family medical centre (FMC) incorporating two nurse practitioners, and those for whom the FMC was not the usual source of care. Data were obtaine using"before-and-after" structured interviews of a random sample of persons living in a southern Ontario township. Slowly evolving, nonsignificant trends of greater acceptance were observed among patiens who had dealth with family practice nurses. The greatest change observed was an increased acceptance of the nnurse by FMC users as the person who would be contacted as a second choice if theirfirst choice, usually a physician, could not be reached in specific worrry-inducing situations. FMC users depended more on nurses to provide information. A conclusion of increased general acceptance of the family practive nurse by FMC users is supported by a 34 per cent higher use of nurses by FMC patients compared to other persons of comparable characteristics living in the same community.

Delivery of Health Care↗
PubMed1975

Career choices of physicians 15 years after entering medical school.

The career status of 149 graduates of the University of Toronto faculty of medicine who entered in 1958 and graduated in 1962 was determined in 1973. The response rate to the mailed questionnaire was 96.6%. Of the graduates 4.7% were not practising medicine, 2.0% stated that medicine was not their primary gainful activity and 4.1% were untraceable or unknown. Of the 24 women in the class 17 (70.8%) were practising at least 76% of their time and 4 (16.7%) were practising 26 to 75% of their time. General practice or family medicine had been chosen by 39.0% of the class and a specialty by 55.7%; 5.4% were unknown or untraceable. The place of longest residence before entrance to university was a good predictor of ultimate location of practice but not of type of practice.

Adult↗
PubMed1975

Quality-of-care appraisal in primary care: a quantitative method.

A reproduceable method has been developed for measuring the quality of clinical care provided by physicians and nurse practitioners. The distinctive features of the method are the extended use of the tracer disease concepts, the evaluation of referrals, new procedures for probing the clinical operation of practices, a single blind design, emphasis on the use of the untouched medical record, the ability to compare results with measurements of concurrent outcome, and a relatively low cost. Three simultaneous approaches used in the method are described: surveillance of the management of indicator conditions, evaluation of clinical use drugs, and the assessment of referral decisions. The three approaches gave consistently similar results about the relative performances of the practices compared and were in agreement with concurrent outcome studies. The method was successfully implemented in a health care experiment.

Adolescent↗
PubMed1975

Unanswered questions about the periodic health examination.

The periodic health examination in its application as a screening procedure in asymptomatic, ostensibly healthy persons is explored with a focus on the following issues: (a) the impact on health, (b) the content of a beneficial health examination, and (c) the effect of the examination on the physician-patient relation. The application discussed is distinct from use of the examination as a tool for diagnosis, prognosis, or therapeutic planning for patients with a specific illness. The discussion also shows a relatively recent change in the goal for the clinical assessment. There has been a shift in emphasis from establishing a diagnosis as the main outcome event of the periodic "checkup" to the identification of an intervention of value to the patient. Evidence from various studies that throw some light on related questions is considered. Special ethical issues surrounding the unsolicited medical assessment are identified. Finally, some ground rules for decisions about the periodic health examination are proposed.

Adolescent↗