PubMed · 10128042
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J Greene. 1993-09-06. Fla. backs down on data collection rule.. https://pubmed.ncbi.nlm.nih.gov/10128042/
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Naltrexone was approved by the US Food and Drug Administration (FDA) in December 1994. Although it is one of only two medications for alcohol rehabilitation approved in the US, naltrexone is not frequently prescribed. This paper examines the factors limiting physicians' use of naltrexone. Data were collected through a survey of US physician members of two addiction medicine professional associations. Logistic regression analysis was conducted with the dependent variable being any prescription of naltrexone. Independent variables consisted of physician practice characteristics, physician ratings of naltrexone's attributes (e.g. efficacy), physicians' patient characteristics, and physicians' exposure to information about naltrexone. On average, addiction medicine physicians prescribed naltrexone to 13% of their alcoholism patients. The two main self-reported reasons why physicians did not prescribe the medication to more patients were that patients refused to take the medication or comply with prescribing regimes (23%), and that patients could not afford the medication (21%). Multivariate results indicated that physician perceptions of naltrexone's effectiveness and safety were significantly associated with prescribing. Physicians who had more exposure to information about the product (e.g. by reading more journal articles about naltrexone) were more likely to prescribe it. In summary, multiple factors are contributing to the relatively low naltexone prescription rate.
BACKGROUND: For decades, reformers argued that medical groups can efficiently provide high-quality care and a collegial professional environment. The growth of managed care and the movement to improve quality provide additional reasons for physicians to practice in groups, especially large groups. However, information is lacking on recent trends in group size and the benefits of and barriers to group practice. OBJECTIVES: To identify benefits of and barriers to large medical group practice, and to describe recent trends in group size. DESIGN, SETTING, AND PARTICIPANTS: Information on benefits and barriers was obtained from 195 interviews conducted during round 3 (2000-2001) of the Community Tracking Study with leaders of the largest groups, hospitals, and health insurance plans in 12 randomly selected metropolitan areas. Information on recent trends in group size was obtained from more than 6000 physicians in private practice in 48 randomly selected metropolitan areas via Community Tracking Study telephone surveys in 1997-1998, 1998-1999, and 2000-2001. MAIN OUTCOME MEASURES: Benefits of and barriers to large group practice, as perceived by interviewees, and changes in percentages of physicians in groups of varying sizes. RESULTS: Gaining negotiating leverage with health insurance plans was the most frequently cited benefit; it was cited 8 times more often than improving quality. Lack of physician cooperation, investment, and leadership were the most frequently cited barriers. Survey data indicate that 47% of private physicians work in practices of 1 or 2 physicians and 82% in practices of 9 or fewer, and that the percentage of physicians in groups of 20 or more did not increase between 1996 and 2001. CONCLUSIONS: Current payment methods reward gaining size to obtain negotiating leverage more than they reward quality. However, barriers to creating large medical groups are substantial, and most private physicians continue to practice in small groups, although the size of these groups is slowly increasing.
With a view to verifying, quantifying and analyzing the use of vignettes as a strategy for data collection, the authors investigated how this strategy has been used for research data collection, in the MEDLINE and LILACS systems, in the period from 1966 to 2000. Five hundred eighty-two research works were found, 57 (9.8%) of which were published in nursing journals or contained studies about nursing professionals and/or students. Among these, 4 (7.0%) were published in the 1980s; 49 (86%) in the 1990s and 4 (7.0%) in 2000. The study proposals were: to explore attitude/behavior 20 (35.1%); to explore knowledge/attitude/behavior 14 (24.6%); to evaluate 12 (21.1%); to explore knowledge level 6 (10.5%); to conduct methodological studies 3 (5.3%) and to attribute responsibility 2 (3.5%). The prevailing theme was nursing care. The United States of America presented 34 (59.6%) publications, while the United Kingdom presented 16 (28.1%). One work was found which originated from Latin America.