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PubMed2001

Physician characteristics in relation to cardiovascular drugs commonly prescribed for hypertension in Nova Scotia.

BACKGROUND: Cardiovascular drugs are the most frequently prescribed class of drugs in Canada. Among them, drugs used to treat hypertension are the single largest component. Variability in how these drugs are prescribed should be based on the specific characteristics of patients. However, some evidence shows that physician characteristics can also play a substantial role in prescribing trends. Such variation is also associated with varying beneficial and adverse patient outcomes. PURPOSE: To determine whether prescribing patterns of drugs used to treat hypertension in elderly patients in Nova Scotia varied by physician characteristics. METHODS: A retrospective, population-based descriptive study was done using the Nova Scotia Pharmacare program data for the fiscal year 1995/96. The unit of analysis was the individual physician. All drugs indicated in the management of hypertension were included for the analysis. RESULTS: Of 1466 physicians included in the analysis, 1004 were family physicians (FPs) and/or general practitioners (GPs), 155 were internal medicine specialists and 307 were other specialists. Fifty-eight per cent of 103,193 eligible senior citizens received at least one of the study medications. FPs and/or GPs prescribed 95.9% of all the study drugs. Internists prescribed proportionately fewer angiotensin-converting enzyme inhibitors, thiazides and other diuretics compared with the FPs and/or GPs but more beta-blockers and calcium channel blockers. A large proportion of the FPs and/or GPs (55.3%) prescribed less than 10% of the total day's supply of drugs, whereas a small proportion of FPs and/or GPs (16.3%) prescribed 52.6% of all the study drugs. There was no variation in the distribution of the types of antihypertensives prescribed based on physician age, sex or volume of prescribing. A slight variation in prescribing was seen with location of practice. CONCLUSIONS: Patterns of prescribing cardiovascular drugs used to treat hypertension were remarkably unaffected by physician characteristics. This finding counters other evidence in the literature that has raised concerns over prescribing patterns of certain types of physicians. Prescribing patterns may vary for other drug classes, but for this group of antihypertensives, little variability was found.

Adult↗

PubMed1989

[Computer survey of the rehabilitation data and social conditions of children with motor disabilities in Györ-Sopron and Baranya Counties].

To investigate the occurrence of motor disability a pilot study was carried out in the total children's population of Györ-Sopron county and in 57% of the children of Baranya county by computer-based questionnaires. The data of the 492 motor handicapped children were analysed by 55 computer programs. These programs are constructed for the analysis of the somatic and mental health, schooling, rehabilitation possibilities, social background, care of these children and their further needs for specialists and institutions. This procedure is suitable for national and longitudinal data collection and for the complex registration of the status of these children.

Adolescent↗

PubMed2004

The Impact of Arthritis on Canadian Women.

HEALTH ISSUE: Arthritis is one of the most prevalent chronic conditions in Canada and a leading cause of long-term disability, pain, and increased health care utilization. It is also a far more prevalent condition among women than men. Information was obtained primarily from the 1998-99 National Population Health Survey and the Canadian Joint Replacement Registry. KEY FINDINGS: In 1998, the overall prevalence of self-reported arthritis or rheumatism in Canadian women was 20.0%. This rate increased to 55.6% among women over 75 years of age. Compared to women with chronic conditions, women with arthritis were more likely to experience long-term disability; report worse health; experience more pain; be dependent upon others and consult general practitioners, specialists, and physiotherapists more frequently. While men and women with arthritis under-utilize total joint replacement surgery, the degree of under-use was over three times greater for women. DATA GAPS AND RECOMMENDATIONS: There is a lack of detailed information on the use of health care services by women with arthritis. There are also no systematic data available on the prescribing of medications, access to services such as assistive devices or exercise programs, or use of community support, self-management strategies, or rehabilitation services. The burden of arthritis both on women and on society is expected to increase as the population ages. A comprehensive health strategy to reduce the impact of arthritis is required to ensure that health and support services are available in a timely manner and provided in such a way to meet the needs of Canadian women.

Journal Article↗

PubMed2004

The view from two sides: a qualitative study of community and medical perspectives on screening for colorectal cancer using FOBT.

BACKGROUND: Population-wide screening for people at average risk of colorectal cancer (CRC) by faecal occult blood test (FOBT) is under consideration in Australia. METHODS: Qualitative methods were used to examine the views of community members who did (n = 18) or did not (n = 12) participate in a pilot program of FOBT screening. In addition, views were obtained from general practitioners (GPs) and specialist gastroenterologists directly involved in the implementation of the program. Two focus group sessions were conducted with screening participants and interviews were conducted with nonparticipants, GPs and gastroenterologists. RESULTS: The findings suggest that CRC screening by FOBT distributed to households by mail was well accepted by the community and by the medical practitioners involved in its implementation. The trial had little negative effect on general practice. Both medical practitioners and consumers raised concerns about the efficacy of FOBT screening. Medical practitioners were also concerned about the potential burden mass screening could place on the public (government-funded) health care sector. CONCLUSIONS: It would seem that CRC screening using FOBT will not enjoy unqualified support from the community or from medical practitioners involved in the continuum of screening. Information about the objectives of screening programs, in general, and the efficacy of FOBT screening in particular, needs to be provided to the community to ensure informed individual choice.

Aged↗

PubMedDate not supplied

The patient level cost of asthma in adults in south central Ontario. Pharmacy Medication Monitoring Program Advisory Board.

OBJECTIVE: To assess the annual cost of asthma per adult patient from the perspectives of society, the Ontario Ministry of Health and the patient. DESIGN: Prospective cost of illness evaluation. SETTING: Ambulatory out-patients residing in southern central Ontario. POPULATION STUDIED: Nine hundred and forty patients with asthma over 15 years of age studied between May 1995 and April 1996. OUTCOME MEASURES: Direct costs, such as respiratory-related visits to general/family practitioners, respiratory specialists, emergency rooms, hospital admissions, laboratory tests, prescription medications, dispensing fees, devices and out-of-pocket expenses, were calculated. Indirect costs, such as absences from work or usual activities, and travel and waiting time, were studied. MAIN RESULTS: Unadjusted annual costs were $2,550 per patient. Hospitalizations and medications each accounted for 22% of the total cost and indirect costs 50% of the total costs. More severe disease, older age, smoking, drug plan availability and retirement were significant predictors of costs. Annual costs per patient varied from $1,255 (95% CI $1,061 to $1,485) in young nonsmokers with no drug plan and mild disease to $5,032 (95% CI $4,347 to $5,825) in older smokers with drug plans and severe disease. Clinically important reductions in the quality of life occurred with increasing severity. CONCLUSIONS: Interventions aimed at reducing productivity losses, admissions to hospital and medication costs may result in savings to society, the provincial government and the patient. The quality of policy and allocation decisions may be enhanced by cost of illness estimates that are comprehensive, precise and incorporate multiple perspectives.

Absenteeism↗

PubMed1994

Preventive cardiology in primary care.

Primary care physicians play a pivotal role in the successful implementation of the National Cholesterol Educational Program (NCEP) guidelines for both population and high-risk approaches to reduce blood cholesterol levels in children and adults. Increasingly, in this era of health cost containment, the primary care physician is recognized as (1) the main and sometimes the only source of health care for large numbers of individuals; (2) the affordable physician and (3) the gatekeeper for referral to medical specialists. Achievement of NCEP guidelines for cholesterol reduction, American Heart Association (AHA) guidelines for prevention of cardiovascular disease, and Year 2000 National Objectives for Health Promotion and Disease Prevention will all rely heavily on the active cooperation and support of practicing internists, pediatricians, and family/general practitioners in providing patient education, risk factor evaluation and intervention. Although the majority of primary care physicians intuitively support the concept of preventive cardiology and generally have a high level of knowledge of cardiovascular risk factors, a significant gap remains between physician knowledge and attitudes and the actual practice of preventive cardiology in clinical practice. Despite these limitations in implementation of clinical guidelines, significant progress has been made in the past decade in reaching NCEP and Year 2000 goals for population-wide cholesterol reduction.

Adult↗

PubMed2004

[Prescription of drugs in family medicine: on the trail of efficiency].

OBJECTIVE: To analyse the effect of various factors on the efficiency of drug prescription by general practitioners (GPs). DESIGN: Descriptive, cross-sectional study. SETTING: Primary care in Murcia, Cartagena, and Lorca, in which 535 GPs work in the care of 921,281 people. Murcia Region (Spain).Participants. Prescriptions issued by the 288 GPs who were working constantly and continuously in May-June 1998 and who were away from work for no longer than 10% of the time (53.8%). MAIN MEASUREMENTS: We measured their efficiency with two general indicators--potential saving (PS) and prescription of generics (PG)--and 3 specific indicators: efficiency of prescription of omeprazole (EO), enalapril (EE), and ranitidine (ER). We analysed their relationship with structural-organisational factors and with the population attended, the doctor and his/her action. Bivariate and multivariate analyses (logistic regression) were used. RESULTS: There was an association with programmed consultation (PC); a weak inverse relationship with age of doctor, years qualified, pensioners allocated, case load and inter-consultations conducted; and a direct correlation with the length of the consultation. PG was related to rural environment, being non-permanent, specialist in family medicine, belonging to a primary care team. In the multivariate analysis PC was related to all the indicators: PS (OR=1.96), PG (OR=2.10), EO (OR=2.63), ER (OR=2.84), EE (OR=2.06); and the inter-consultations conducted with general efficiency of PS (OR=1.70), PG (OR=1.91). Rural environment was the worst for PS (OR=2.43). CONCLUSIONS: The main factors related to the efficiency of GPs prescription can be changed. The most important is the existence of PC. A lot of inter-consultations and working in a rural environment means worse general efficiency.

Adult↗

PubMed2003

[Quality management of treatment of rheumatoid arthritis in a rheumatological setting].

Rheumatoid arthritis is a chronic inflammatory rheumatic disease affecting about 1% of the general population world-wide. It is characterised by severe pain and a reduction of functional capacity leading to a reduced quality of life. The initiation of an early, effective, continuous and long-term treatment is essential for preventing or delaying progression of disease as long as possible. The implementation of a comprehensive and structured quality management program including both general practitioners and specialists in rheumatology will help to support structural, procedural and outcome quality based on special indices that can be used for benchmarking. The Swiss Clinical Quality Management (SCQM) and the regional model project of the Regional Co-operative Rheumatology Centre in Hanover, Germany (Regionales Kooperatives Rheumazentrum Hannover e.V.) are two examples for total quality management (TQM) of inflammatory rheumatic diseases.

Arthritis, Rheumatoid↗

PubMed1996

[Medical subspecialties in Chile: current status].

There is no reliable registry of medical subspecialists in Chile According to the records of the Autonomous National Corporation for Certification of Medical Specialties (CONACEM), the largest number of certifications is in internal medicine (n = 681), followed by cardiology (n = 153), respiratory medicine (n = 106), gastroenterology (n = 93), endocrinology (n = 77), rheumatology (n = 55), hematology (n = 50) nephrology (n = 50), and infections diseases (n = 31). Over 55% of those certified in internal medicine and 70% of those certified in medical subspecialties (except nephrology) live in the metropolitan area of Santiago. Almost 80% of university-trained internists have received their training at the University of Chile (1952-1995), whereas 52% of university-trained subspecialists have been trained at the Catholic University of Chile. A sizeable number of nonofficial specialist-training programs are conducted at some universities at variance with their own official training policies. In internal medicine, a larger number of specialists have been trained by the universities than are certified by CONACEM, whereas the converse is true for medical subspecialists. More than 80% of the internists in Chile work for the Ministry of Health, who cares for 70% of the country's population. The best internist: population ratio is in Arica and Valdivia, and the poorest one in Arauco and in Viña del Mar/Quillota. According to estimations done by the Santiago Medical Society (Chilean Society of Internal Medicine) and its subspecialty affiliate societies, an adequate proportion of internists would be 1 for every 10,000 inhabitants, and for subspecialists, 1 for every 100,000 inhabitants. More information is needed about the ideal number of specialists and subspecialists required, and about their ideal distribution throughout the country. CONACEM needs to be strengthened, the universities should be able to certify non-university training centers, and the migration of subspecialists out of Santiago should be encouraged.

Chile↗

PubMed2003

Mental health. Sentence structure.

Mental health issues are endemic in prisoner populations, with many trusts struggling to provide specialist intervention. Before the inreach team at Bullwood Hall prison was put in place, most of its work was left to non-specialist healthcare workers.

Female↗

PubMed1988

Developing POPTRAN, a population modelling package.

"Collaboration between subject matter specialists, computer programmers and educational technologists has resulted in the reproduction of POPTRAN, a computer assisted learning package designed to teach the basic concepts of population studies. Its evaluation in developing countries, with both naive and specialist users, and subsequent revision, has produced a package of both academic quality and teaching effectiveness."

Demography↗

PubMed2006

Eruption of supernumerary permanent teeth in a sample of urban primary school population in Genoa, Italy.

AIM: The aim of this epidemiological study was to describe the incidence and distribution of hyperdontia in the primary school population in Genoa (Italy) and to check its influence on the development of orthodontic problems in children. The collected data should also help to find out what is the best age range among children to direct a program for early diagnosis and prevention of malocclusion and oral diseases related to hyperdontia. METHODS: The participating children (total number 1577, 814 males and 763 females, between 6 and 10 years of age) chosen in 19 public primary schools in Genoa have been examined by the same specialist through year 2004. Erupted permanent teeth, presence, position and form of supernumerary teeth, malocclusion presence and class, presence of orthodontic devices, age and sex have been noted down for each child. RESULTS: The global percentage of hyperdontia was 0.38%, more frequent in males (0.49%) than in females (0.26%). The most common kind of supernumerary tooth was mesiodens (83%). A significant increase of hyperdontia prevalence (from 0.64% to 1.06%) was noticed in children 9 years old. The incidence of malocclusion among children presenting hyperdontia was 83.3%, while the global incidence of malocclusion was 40%. An orthodontic treatment had been planned and started for 20% of children presenting malocclusion. CONCLUSION: The study has revealed an incidence of hyperdontia much more frequent in males than in females (2:1). The most common site of eruption of supernumerary teeth is maxillary anterior region. Hyperdontia is strictly related with dental malocclusion. The best age range to direct a program of early diagnosis and prevention of malocclusion and hyperdontia is 9 years old children.

Child↗

PubMed1994

Private sector hiring and use of retirees: the firm's perspective.

This article examines the hiring and utilization of retiree workers among U.S. firms with 20 or more employees (e.g., the hiring process, worker history with the company, scheduling, task assignment, relationship with other employees). Over 46% of private sector firms in this population hire retirees. Few firms, however, have a written policy or formalized program directed at hiring retirees. While assignment of retiree workers to regularly performed operational tasks is universal, the larger the firm, the more likely that a substantial proportion of these employees work in white-collar fields. Study results have practical implications for employment counseling services, private sector firms, and human resource specialists.

Aged↗

PubMedDate not supplied

Identifying program preferences through conjoint analysis: illustrative results from a parent sample.

PURPOSE: The purpose of this article is to illustrate the application of conjoint analysis, a consumer research technique, using data from a survey of parents' preferences for prevention programs. DESIGN: This study utilized a one-time, cross-sectional telephone survey. SETTING: Data were collected from subjects living in economically disadvantaged rural midwestern counties. SUBJECTS: Subjects were 202 randomly selected parents with preadolescents who indicated interest in family-focused prevention programs. MEASURES: Conjoint analysis software was employed in computer-assisted telephone interviews to evaluate relative preferences for 39 individual features of family-focused prevention programs falling under 11 categories (e.g., program meeting time, facilitator background). The software also guided computer simulations of parent choices among four types of programs. RESULTS: Findings indicated that meeting time was the most important category of program features. Strongly preferred individual features included meetings scheduled on weekday evenings, instruction by child development specialists, and programs based on extensive research. Two multiple-session programs evaluated via computer simulations incorporated several preferred features and received higher ratings than did single-session programs. Estimated variance z-tests indicated limited differences in perceived importance of program feature categories across sociodemographic subgroups. CONCLUSIONS: Findings highlight a) differences in the relative value parents place on various features of prevention programs in the surveyed population and b) the importance of practical aspects of program delivery.

Adolescent↗

PubMed1994

Physician reimbursement in Medicare risk contracting.

The Medicare population remains largely unmanaged despite its increasing cost burden. With a few notable exceptions, health maintenance organizations (HMOs) have historically avoided serving this expensive segment. In many cases, the inability to control costs results from failing to understand the importance of specialist reimbursement mechanisms. This article examines the importance of these mechanisms and describes how to successfully capitate specialty physicians in a Medicare risk program. The article also includes a case study on a successful capitation agreement between an HMO and a specialty group.

Aged↗

PubMed1996

Managed care in reconstructive pelvic surgery and urogynecology.

While demographic changes in future decades should expand the need for subspecialists in reconstructive pelvic surgery and urogynecology, managed care will probably limit access of patients to specialists in this field. Much of the evaluation and treatment for women with prolapse and incontinence will be provided by primary care providers.

Aged↗

PubMed1988

Hypertension Control Program of the Negev: evaluation after two years of intervention.

In 1981 a nationwide effort to control high blood pressure was implemented. One of the first programs was the "Hypertension Control Program of the Negev." The program's major objective was to introduce early detection and improve diagnostic, treatment, and follow-up procedures to 27 primary-care clinics of the area. The evaluation was based on the program's three levels of intervention: (a) basic training program and written protocol, containing guidelines for diagnosis, treatment, and follow-up; (b) additional consultation in the primary-care clinics by internal medicine specialists from the regional medical center, and (c) additional consultation in the primary-care clinics by the hypertension unit's medical team. In 1981 (prior to any intervention) a random sample of 5,717 medical records of the target population (30 years or older) was reviewed. High blood pressure was found in 1,032 patients (18%); however, a written diagnosis of hypertension was recorded in only 57% of these cases, and of these only 37% were being regularly treated for high blood pressure. In 1983, a second, independent random sample of 7,791 records was reviewed. High blood pressure was again found in 18% (1,428) of the cases, but 69% of these had a recorded high blood pressure diagnosis (a relative increase of 21% from 1981), and 85% of these were treated for high blood pressure (a relative increase of 130%). Improved performance in the steps of care provided for high blood pressure was observed in all the clinics. Surprisingly, the percentage of well-controlled patients increased only in those clinics where the staff gave consultation services.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2004

Clinical nurse specialist as leader of a bariatric program.

Bariatric surgery is an appropriate intervention for the treatment of morbid obesity. Using the National Association of Clinical Nurse Specialist's "spheres of influence" model, the clinical nurse specialist (CNS) is able to lead in the development and maintenance of an effective hospital-based bariatric program. The three spheres include the patient/client, the nurse/nursing practice, and the organization. The CNS is vital in guiding the education and support for patients and hospital staff. S/he is also instrumental as a leader in developing an environment that is conducive to supporting the bariatric patient population. By employing the three spheres in the program, everyone involved will benefit and positive patient outcomes can be expected.

Bariatrics↗