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Biomedical subjects

W W Rosser

Publications and source records attributed to W W Rosser.

At least 19 recordsLinked to original sources
PubMed1992

Use of reminders to increase compliance with tetanus booster vaccination.

OBJECTIVE: To assess the effect of three computerized reminder systems on compliance with tetanus vaccination. DESIGN: Prospective randomized controlled trial. SETTING: Ottawa Civic Hospital Family Medicine Centre. PARTICIPANTS: Of 8069 patients 20 years of age or more who were not in a hospital or institution 5589 were randomly assigned, by family, to a control group, a physician reminder group, a telephone reminder group or a letter reminder group. The remaining 2480 patients were not included in the randomized portion of the study but were monitored. Results are presented for the 5242 randomized patients and the 2369 nonrandomized patients for whom there was no up-to-date record of tetanus vaccination at the start of the trial. INTERVENTIONS: For the patients in the physician reminder group the physician was reminded at an office visit to assess the patient's tetanus vaccination status and to recommend vaccination; those in the other two reminder groups received a telephone call or letter enquiring about their tetanus vaccination status and recommending a booster dose. MAIN OUTCOME MEASURE: Proportion of patients who received tetanus toxoid during the study year or who had a claim of vaccination in the previous 10 years. MAIN RESULTS: The rate of recorded tetanus vaccination in the randomized control group was 3.2%. The difference between that rate and those for the three reminder groups was 19.6% in the physician reminder group (95% confidence interval [CI] 17.1% to 22.2%, p less than 0.00001), 20.8% in the telephone reminder group (95% CI 18.3% to 23.5%, p less than 0.00001) and 27.4% in the letter reminder group (95% CI 24.8% to 30.2%, p less than 0.00001)). The letter reminders were more effective than either the telephone reminders (p = 0.00013) or the physician reminders (p less than 0.00001) in improving compliance. The cost to the practice per additional vaccination recorded was 43 for the physician reminders, $5.43 for the telephone reminders and $6.05 for the letter reminders. CONCLUSIONS: Although all three reminder systems increased the rate of recorded tetanus vaccination they fell far short of achieving complete population coverage. More intensive interventions would be required to approach that goal. However, such interventions do not appear to be justified given the rarity of tetanus.

Adult↗
PubMed1991

Use of reminders for preventive procedures in family medicine.

OBJECTIVE: To compare the effectiveness of three computerized reminder systems in the delivery of five preventive procedures in family practice. DESIGN: Prospective, randomized, controlled study. SETTING: Ottawa Civic Hospital Family Medicine Centre. PARTICIPANTS: Of 8502 patients 15 years of age or more who were not in a hospital or institution 5883 were randomly assigned, by family, to a control group, a physician reminder group (passive) or a telephone or letter reminder group (active). The remaining 2619 patients were not included in the randomized portion of the study but were monitored. INTERVENTION: During 1 year the patients in the active reminder groups received a telephone call or letter reminding them of any overdue preventive procedures; for those in the passive reminder group the physician was reminded at an office visit to provide any overdue service. OUTCOME MEASURE: Rates of completion of the preventive procedures required. MAIN RESULTS: All three reminder systems significantly improved the delivery of preventive services (p less than 0.001). The procedure completion rates were 42.0% in the letter reminder group, 42.0% in the telephone reminder group, 33.7% in the physician reminder group and 14.1% in the randomized control group. The use of a letter was more cost-effective than the telephone system, but the physician reminder system was the most cost-effective. CONCLUSION: Computerized reminder systems do improve the delivery of preventive services in family practice.

Adolescent↗
PubMed1991

Clinical research.

Explore the source record for details and available documents.

Community Medicine↗
PubMed1990

Do our patients receive maximum benefit from preventive care? A North American perspective.

Politicians, their constituents and family physicians believe that preventive medicine is essential if health care is to be improved. Family physicians believe that the majority of their patients are well cared for with preventive health care services but in reality preventive services are provided to less than half the population and some to fewer than 10%. Barriers to providing preventive care include the selection of procedures of unproven effectiveness, public unawareness of the benefits of the procedure and practical obstacles for physicians providing the services. Assessment of each of these barriers indicates how preventive care can be improved. Narrowing the gap between what we believe about preventive care and the level of preventive services we are providing could improve the health of our nations. However, the concept of primum non nocere must dominate the assessment of currently advocated preventive procedures and the consideration of new procedures.

Attitude of Health Personnel↗
PubMed1987

Bubonic plague.

Explore the source record for details and available documents.

Animals↗
PubMed1986

Computerization of family practice.

The primary focus of computer systems for family practice is on patient billing. Primary care physicians should be aware of the many other benefits that can and should be considered when planning a system for their practice. This article describes the type and extent of information that can be stored in a family practice data base and explores some of the applications in areas of practice and patient management, prevention and research.

Electronic Data Processing↗
PubMed1984

Is cimetidine being prescribed indiscriminately? An analytic survey of patients who present with symptoms of peptic ulcer disease.

An analytic survey was done to determine the influence of previously documented peptic ulcer disease (PUD) on the frequency of prescribing cimetidine to patients who present at a family medicine centre with symptoms of PUD. It was found that of 293 patients who presented with such symptoms over 1 year cimetidine was prescribed to 57 (19%). From the 236 patients who did not receive cimetidine 57 patients were selected at random for comparison. Information on these two groups of patients was obtained by chart review. The patients who received cimetidine were found to be significantly more likely (p less than 0.001) to have previously documented PUD than those who did not receive cimetidine. In patients in whom subsequent confirmation of PUD was not obtained, either because the results of investigations were negative or because the investigations were not ordered, cimetidine was prescribed to 63% of those who had previously documented PUD, compared with only 6% of those who did not. Of the patients who were investigated 73% of those with previously documented PUD had positive results, compared with 8% of those without previously documented PUD. The positive results were obtained by endoscopic examination in 88% of the patients with previously documented PUD, whereas upper gastrointestinal tract roentgenography was the definitive test in 73% of the patients without previously documented PUD. These findings suggest that previously documented PUD influences both the frequency of prescribing cimetidine and the investigations that are carried out.

Adult↗
PubMed1984

Institutional objectives for medical education that relates to the community.

The graduate of most medical schools in North America is described as an "undifferentiated physician", but there is no universally agreed upon definition of the term. With the proliferation of subspecialties during the past 30 years, each division or department has its own concept of the undifferentiated physician. The result is strong pressure on curriculum committees to increase curriculum content. The medical faculty of the University of Ottawa used an approach to developing institutional objectives for medical schools that was based on the premise that graduates should possess the knowledge, skills and attitudes of a primary care practitioner in the community, and they accepted an institutional goal and 10 institutional objectives after five revisions of the original proposal. An essential element in the development of the objectives was the use of a list of common medical problems, ranked in order of frequency, as guidelines. The resulting institutional objectives are relevant to current community needs and may be used to project the future needs of the community.

Academic Medical Centers↗
PubMed1984

The Ambulatory Sentinel Practice Network: purpose, methods, and policies.

The Ambulatory Sentinel Practice Network (ASPN) is a network of primary health care practices across the United States and Canada offering (1) a laboratory for the study of populations under the care of primary care providers, and (2) surveillance of primary care problems and services. This paper reports the methods and policies developed and used by ASPN to conduct studies and describes the initial sentinel practices.

Adolescent↗
PubMed1983

Using the perception-reality gap to alter prescribing patterns.

Thirty physicians in a university family medicine teaching practice were asked to estimate their rate of prescribing diazepam to six age/sex groupings of patients within their practice. Their actual prescribing rates as recorded by a computerized data collection system were not accurately perceived. After the physicians were informed of the gap between perceived and actual prescribing, significant changes in prescribing behavior occurred. Awareness of a perception-reality gap in primary care practice prescribing offers a method of continuing medical education that may significantly alter prescribing behavior in ways beneficial to patient care.

Adolescent↗
PubMed1982

The impact of routine advice on smoking cessation from family physicians.

Cigarette smoking continues to be a major health problem. Therefore, physicians have been asked to advise all their patients on the hazards of smoking. A controlled trial was undertaken to measure the impact of family physicians' advice to cigarette smokers during a routine office visit. No significant differences were found in the three measures used to determine outcome--desire to stop smoking, an attempt to stop and success in stopping--between the control and intervention groups. These results are discussed in relation to the health belief model, and suggestions are made on how to increase the impact family physicians could have on smoking cessation to their practices.

Health Education↗
PubMed1982

Benzodiazepine prescription to middle-aged women: it is done indiscriminately by family physicians?

It has been frequently suggested that physicians' indiscriminate prescribing has caused the high level of patient use of benzodiazepines. To determine whether this was true at Ottawa Civic Hospital's Family Medicine Centre, patient charts of women aged 45 to 65-the age-sex group that received the highest number of new prescriptions for diazepam (Valium) or oxazepam (Serax) - were studied. Middle-aged women who received a new prescription for one of these drugs visited the office significantly more often, had more marital problems, and experienced significantly more life crisis situation than a control group of nonrecipients. These results suggest that the high rate of prescribing is related to high levels of reported life stress in middle-aged women. Further studies in other centers are needed to conclusively disprove the popularly held idea that benzodiazepines are indiscriminately prescribed by physicians.

Age Factors↗
PubMed1981

Can we prevent an increase in the incidence of congenital rubella syndrome in the next decade?

The immunity to rubella of 115 girls aged 10 to 14 years was tested in 1978. The proportion of girls found to be immune was 80%, similar to rates in the prevaccination era. Nearly half of the immunity was from documented vaccination, and the other half was presumably from infection with wild rubella virus. The vaccination failure rate was 12%. Because of declining immunity to rubella of women of child-bearing age, detecting low levels of immunity in these women is becoming increasingly important. Immunization of 12- to 15-month-old children has not been effective. Vaccinating all girls 10 to 12 years old would likely be the most effective method of preventing an increase in the incidence of congenital rubella syndrome in the next decade.

Adolescent↗