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PubMed1988

The dental appointment and patient behavior. Differences in patient and practitioner preferences, patient satisfaction, and adherence.

Although the quantity and, in many cases, the quality of research on the practitioner-patient interaction has improved over the last 10-15 years, many related topics remain largely unexplored. The relationship of the similarity of practitioner and patient preferences to treatment adherence has not been carefully investigated, either in a medical or dental setting. This paper presents a study of patient and practitioner preferences for a dental appointment, and assesses the impact of their similarity on patient satisfaction with the appointment and adherence to the recommended treatment regimen. Results indicate that the similarity of patient and dental student preferences for an appointment is a very significant predictor of patient satisfaction with the appointment, reported improvement in oral hygiene behavior, and actual improvement in objective dental health. Patient satisfaction was, in turn, an independent predictor of reported behavior change and objective improvement in dental health. Similarity of patient and practitioner preferences for appointments should be studied more carefully in future doctor- and dentist-patient interaction research, as it is a critical variable for understanding how the interaction experience is translated into patient behavior.

Adolescent↗
PubMed1989

Does the dissemination of comparative data on physician fees affect consumer use of services?

The purpose of this study is to empirically examine the effect of disseminating physician-fee information on consumer behavior. Using an experimental design, the effect of access to physician-fee information on rates of doctor-office visits, expenditures for ambulatory care, and costs per visit are examined. The study includes two research samples: a random sample of 658 state government employees and a random sample of 717 Medicare Part B enrollees. Respondents in each sample were randomly assigned to experimental and control groups, with members of the experimental groups receiving a directory listing the fees charged by local physicians for common procedures. Longitudinal archival and survey data are used in the analysis. Findings reveal that the dissemination of fee data does not yield significant reductions in utilization or expenditures. Policy and research implications are discussed.

Adult↗
PubMed1993

Patterns of obstetrical care in single-hospital, rural counties.

This study used logistic regression to identify differences in community-level characteristics of small, rural hospitals that provided obstetrical services compared to those that did not. The hypothesis was that community characteristics, such as demographics, geographic location, and socioeconomic status influence the ability of rural hospitals to sustain obstetrical services locally. The sample included small (fewer than 100 beds) non-federal, general, acute-care hospitals that were the only hospitals in their nonmetropolitan counties with fewer than 50,000 people in 1989 (n = 963). Data came from the Area Resource File and the American Hospital Association 1989 Survey. The results suggest that: 1) hospitals in the South are much less likely to offer obstetrical services; 2) hospitals in counties with higher socioeconomic status, measured by unemployment rate and percentage of the population who are white, have an increased likelihood of providing obstetrics; 3) hospital ownership has a relatively strong association with the provision of obstetrical services; and 4) the same characteristics that predict a hospital has obstetrical services do a poor job at predicting which hospitals do not offer those services. These results encourage researchers to examine areas where hospitals do not provide obstetrical care, and to investigate the dynamic between community characteristics and provider and consumer behavior. This study suggests to policymakers that targeting vulnerable communities and promoting regional and alternative modes of delivering obstetrical services may be effective means to ensuring that rural women have equitable access to obstetrical care.

Catchment Area, Health↗
PubMed2000

Consumer and market use of antibacterials at home.

In this increasingly complex, time-constrained world, consumers will continue to look for solutions that promise them peace of mind. A large component of this peace of mind is perceived as personal safety against infectious agents. Manufacturers have a responsibility to provide sound advice and to develop solutions to consumers' questions. Through working with leaders in the infection control field, as well as governmental organizations like the Centers for Disease Control and Prevention, the Food and Drug Administration and the Environmental Protection Agency, manufacturers can develop faster and more effective disinfectant and antimicrobial products. Targeted education programs are needed that clearly and effectively communicate proper infection control techniques and prudent use of antibacterial products to both the consumer and the health professional. Manufacturers should also work closely with the media to educate the public about the potential benefits and risks of their products. Finally manufacturers of household and personal cleaning products should help set guidelines for regulatory monitoring, including correct definition and use of common terms such as antibacterial, antimicrobial, antiviral and sanitization, as well as the extent of protection the consumer can expect from the product.

Centers for Disease Control and Prevention, U.S.↗
PubMedDate not supplied

Citizens' role in health services: satisfaction behavior: Kano's model, Part 2.

Kano's approach, besides providing a theoretical model for the behavior of consumer satisfaction, makes it possible to convert theory into practice by creating instruments (questionnaires) designed to study consumer preferences and to find out how a given service feature or attribute will behave in terms of consumer satisfaction. In the second part of this article (part 1 is also in this issue), we describe the technical aspects of developing and using this type of questionnaire and the implications of applying Kano's model.

Consumer Behavior↗
PubMed2006

Experimental evaluation of different methods of limiting the maximum output of hearing aids.

OBJECTIVE: A series of experiments designed to test the preferences of people with moderate to profound hearing losses for limiting the output of hearing aids by using peak clipping (PC), fast compression limiting (FCL), PC and FCL, and these three methods in combination with slow compression limiting (SCL) was conducted. DESIGN: Nineteen participants with moderate to profound sensorineural or mixed losses were recruited. In the first experiment, preferences for either PC or FCL were tested in a field trial in the participants' usual environments.A second experiment examined the acceptance of PC, FCL, and FCL + PC, using paired comparisons in a laboratory setting. The third experiment involved further paired comparisons in the laboratory to evaluate whether participants preferred PC, FCL, PC and FCL combined, or the three methods when combined with SCL. RESULTS: The participants showed no statistically significant preferences for either peak clipping or fast compression limiting in the field trial. In the laboratory trial, both FCL + PC and FCL were significantly preferred over PC alone, and the addition of FCL to PC was most advantageous to participants who required the lowest maximum limiting output. The most dramatic laboratory result was the convincing preference in paired comparison testing of combining SCL with PC and/or FCL. CONCLUSIONS: Slow compression limiting appears to be a desirable feature in hearing aids for clients with a moderate to profound hearing loss. Preferences were not as pronounced when peak clipping, fast compression limiting, and peak clipping plus fast compression limiting were compared, but participants favored the condition that had the least amount of peak clipping.

Adult↗
PubMed2006

Workers who decline employment-related health insurance.

BACKGROUND: Families of workers who decline coverage represent a substantial share of the uninsured and publicly-insured population in the United States. OBJECTIVE: We examined health status, access to health care, utilization, and expenditures among families that declined health insurance coverage offered by employers using data from the Medical Expenditure Panel Survey for 2001 and 2002. RESULTS: We found differences in insurance status for adults and children among families with offers. We found that among low-income families with offers, children are less likely to have private insurance compared with adults. However, the majority of children who decline private insurance end up with public coverage, whereas most of adults who decline offers remain uninsured. Decliners are more likely to report poor health, yet they are also less likely to have high cost medical conditions. Families declining coverage have weaker preferences for insurance than families that take up. Although access to care is lower among the decliners who remain uninsured, decliners with public insurance have similar access to care as those with private insurance. Families turning down coverage are more likely to face high expenditure burdens as a percentage of income and more likely to have financial barriers to care. Families who decline coverage rely heavily on the safety net. Public sources and uncompensated care account for 72% of total expenditures among adults who decline coverage. CONCLUSIONS: Our results suggest that policy initiatives aimed at increasing take up among workers need to take into account the incentives workers face given the availability of care through public sources and uncompensated care.

Adult↗
PubMed1988

Hospital patients' responses to dissatisfaction.

Hospitalized patients' responses to dissatisfaction in the provision of services are analysed as a function of their perceptions of the severity of the service failure and their relative social power. The analysis is based on the responses of 384 patients in a general hospital who reported experiencing at least one disturbing problem in the receipt of hospital services. Three binary dependent variables were constructed based on three dimensions of intensity of complaint behaviours: passive vs. active, non-directed vs. directed, non-formal vs. formal. The four possible response combinations created an ordinal scale of intensity of response. The set of independent variables included: perceived severity of the problem, general measures of satisfaction with services, structural po wer discrepancies, personal and situational resources of social power, and self perception of social power. The results of multivariate analyses indicate that the perceived severity of the problem best explains the intensity of response. Personal and situational social power resources and self perception of power add to the explanation. Structural power discrepancies, however, do not relate to the intensity of patients' responses to dissatisfaction.

Behavior↗
PubMed2004

The Resident Choice Scale: a measure to assess opportunities for self-determination in residential settings.

BACKGROUND: A 26-item Resident Choice Scale was designed to assess service practices for promoting resident choice. METHOD: The staff working with 560 UK/Irish adults with intellectual disability were interviewed. Specific examples of practices promoting resident choice were requested and independently rated by the interviewer. RESULTS: The interrater reliability of Resident Choice items was found to be acceptable (subsample n = 50). The psychometric properties of the Resident Choice Scale total score and scores on eight subscales were also acceptable. Consistently strong associations were found between greater resident choice and greater resident ability and, to a lesser extent, fewer resident challenging behaviours. Few associations were found between resident choice and autism or mental health problems. Even when controlling for resident ability and challenging behaviour, consistent associations were found between greater resident choice and the concurrent variables of greater community presence, fewer institutional practices, and greater user self-reported satisfaction (subsample n = 50). CONCLUSIONS: Taken together, this pattern of results indicates that the Resident Choice Scale shows promise as a measure of the environmental opportunities available for adults with intellectual disability to exercise self-determination. Areas for future research testing the reliability and validity of the Resident Choice Scale are outlined.

Adult↗
PubMed2006

Self-monitoring: individual differences in orientations to the social world.

In their articles in this special section of the Journal of Personality, the authors have focused their attention on the role of individual differences in self-monitoring for a variety of interpersonal phenomena. In so doing, the authors have provided an overview of the theoretical and empirical contributions of the psychology of self-monitoring to the domains of interest: close relationships, consumer behavior, behavior in the workplace, and social interaction. As each of the contributing authors to this special section suggests, much more theoretical and empirical work is in order if the impact of individual differences in self-monitoring for the phenomena reviewed here is to be fully appreciated. Moreover, the four domains of interest represented in this special section by no means exhaust the areas to which theorists and researchers have applied or can apply the psychology of individual differences in self-monitoring. Given the large nomological network that currently exists involving the self-monitoring construct, it is anticipated that the breadth and depth of applications of the psychology of self-monitoring will only continue to expand as it has in the last 30 years since the appearance of the construct in the literature.

Cognition↗
PubMed2004

The effect of benefits, premiums, and health risk on health plan choice in the Medicare program.

OBJECTIVE: To estimate the effect of Medicare+Choice (M+C) plan premiums and benefits and individual beneficiary characteristics on the probability of enrollment in a Medicare+Choice plan. DATA SOURCE: Individual data from the Medicare Current Beneficiary Survey were combined with plan-level data from Medicare Compare. STUDY DESIGN: Health plan choices, including the Medicare+Choice/Fee-for-Service decision and the choice of plan within the M+C sector, were modeled using limited information maximum likelihood nested logit. PRINCIPAL FINDINGS: Premiums have a significant effect on plan selection, with an estimated out-of-pocket premium elasticity of -0.134 and an insurer-perspective elasticity of -4.57. Beneficiaries are responsive to plan characteristics, with prescription drug benefits having the largest marginal effect. Sicker beneficiaries were more likely to choose plans with drug benefits and diabetics were more likely to pick plans with vision coverage. CONCLUSIONS: Plan characteristics significantly impact beneficiaries' decisions to enroll in Medicare M+C plans and individuals sort themselves systematically into plans based on individual characteristics.

Aged↗
PubMed1998

Potential effects of managed care organizations in rural communities: a framework.

This article has provided a conceptual framework regarding the implications of a growing MCO presence in rural areas. This framework addresses factors likely to influence the degree of MCO presence in any given rural community, as well as the possible effects of that presence on rural consumers, employers, providers, and the uninsured. These factors vary across communities and will result in variation in the nature and importance of MCOs among rural communities. The arguments and considerations presented are based on analysis of MCO, employer, and consumer behavior, informed by research findings relating to MCOs in urban areas. The issues discussed raise a number of questions that deserve to be addressed through empirical research focused specifically on rural populations. The appendix contains a summary list of these questions. The next article reviews the results of existing research studies as they bear on these research questions and other issues raised in this article.

Catchment Area, Health↗
PubMed1992

Choice of toothbrush: a survey of dentists' personal preferences and recommendations for patients.

Data on dentists' choice of toothbrush brand/type for personal use and their recommendations for patients were obtained by means of a questionnaire. Seventy-nine per cent of dentists surveyed received free samples, with Oral-B comprising 33 per cent of all such samples, followed by Colgate (16 per cent) and Tek (13 per cent). Fifty-three per cent of dentists surveyed indicated they used all free samples received. Sixty-two per cent of dentists do not consider that different brushes differ significantly in their plaque-removing ability. Therefore, while an effective toothbrushing technique is important, selection of the 'correct toothbrush' from the wide range available may not be critical. The results of the present investigation provide information that is relevant to dental health education and can be applied at the chairside as well as at the broader community level.

Adolescent↗