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PubMed2006

A prevalence study of faith-based healing in the rural southeastern United States.

BACKGROUND: Although prayer and other spiritual practices are common among residents of the rural south, the use of faith-based healers (FBH), or healers who use prayer as their primary healing modality, has not been explored in this population. METHODS: Secondary data analysis from a random digit dialing telephone survey of rural adults in eight southern states. RESULTS: Our overall response rate was 51% and 193 subjects (4.1%) had seen an FBH practitioner within the previous year. FBH use was significantly more common among younger respondents (OR 7.21, 95% Ci 2.00, 25.94), women (OR 1.49, 95% CI 1.03, 2.14), those reporting poorer health (OR 1.83, 95% CI 1.19, 2.83), and those who believed in avoiding physicians (OR 1.82, 95% CI 1.24, 2.67). A relationship between FBH use and delayed or foregone medical care, and cost as a barrier to obtaining care was not statistically significant after controlling for other factors. CONCLUSIONS: Prevalence of FBH use is low, but is significantly related to younger age, female gender, poorer health status, barriers to medical care and devaluing medical care. Clinicians may consider exploring FBH usage with their younger, female patients, and those in poorer health. Policy makers should consider how FBH usage is related to various indicators of health care services demand, utilization and access.

Adult↗

PubMed2006

Readmission to surgical intensive care increases severity-adjusted patient mortality.

BACKGROUND: This study aims to determine whether severity-adjusted outcomes including mortality are adversely impacted by readmission to a surgical intensive care unit (SICU) during the same hospital stay. METHODS: The study included all patients admitted to the 20-bed tertiary care SICU in an urban teaching Level I trauma center and multiorgan transplant center from January 1, 1996 to December 31, 2001. This was a prospective observational study with secondary data analysis. Acute Physiology and Chronic Health Evaluation (APACHE II) and Simplified Acute Physiology (SAPS) severity scores were calculated by a clinical information system. Outcomes were extracted from a computerized data warehouse. RESULTS: In-hospital mortality and SICU length of stay (LOS) were measured for patients admitted and readmitted to the SICU. Of 10,840 patients admitted to the SICU, 296 (2.73%) required readmission to the SICU during the same hospital stay. The length of the original SICU stay was 4.9 +/- 6.7 days for readmitted patients compared with 3.2 +/- 6.0 days for nonreadmitted patients (p < 0.001). Readmitted patients had a higher mean APACHE II score on the day of original SICU discharge compared with nonreadmitted patients, 15.7 +/- 6.7 versus 13.8 +/- 7.1 (p < 0.001). The average APACHE II score increased from 15.7 +/- 6.7 to 18.1 +/- 8.6 between the day of SICU discharge and readmission (p < 0.001) and SAPS increased from 12.2 +/- 4.8 to 13.5 +/- 5.4 (p < 0.001). The distributions of severity-adjusted hospital mortality for both APACHE II and SAPS revealed that readmission to the SICU significantly increased mortality independent of the admission severity score. CONCLUSIONS: Readmission to the SICU significantly increases the risk of death beyond that predicted by the APACHE II or SAPS scores alone. Higher APACHE II and SAPS scores upon discharge from the SICU and longer SICU LOS are associated with an increased incidence of readmission to the SICU on the same hospital stay. These results may be used to optimize the timing of SICU discharge and reduce the chance of readmission to intensive care.

APACHE↗

PubMed2002

Comparing oral health care utilization estimates in the United States across three nationally representative surveys.

OBJECTIVE: To compare estimates of dental visits among adults using three national surveys. DATA SOURCES/STUDY DESIGN: Cross-sectional data from the National Health Interview Survey (NHIS), National Health and Nutrition Examination Survey (NHANES), and National Health Expenditure surveys (NMCES, NMES, MEPS). STUDY DESIGN: This secondary data analysis assessed whether overall estimates and stratum-specific trends are different across surveys. DATA COLLECTION: Dental visit data are age standardized via the direct method to the 1990 population of the United States. Point estimates, standard errors, and test statistics are generated using SUDAAN. PRINCIPAL FINDINGS: Sociodemographic, stratum-specific trends are generally consistent across surveys; however, overall estimates differ (NHANES III [364-day estimate] versus 1993 NHIS: -17.5 percent difference, Z = 7.27, p value < 0.001; NHANES III [365-day estimate] vs. 1993 NHIS: 5.4 percent difference, Z = -2.50, p value = 0.006; MEPS vs. 1993 NHIS: -29.8 percent difference, Z = 16.71, p value < 0.001). MEPS is the least susceptible to intrusion, telescoping, and social desirability. CONCLUSIONS: Possible explanations for discrepancies include different reference periods, lead-in statements, question format, and social desirability of responses. Choice of survey should depend on the hypothesis. If trends are necessary, choice of survey should not matter however, if health status or expenditure associations are necessary, then surveys that contain these variables should be used, and if accurate overall estimates are necessary, then MEPS should be used. A validation study should be conducted to establish "true" utilization estimates.

Adult↗

PubMed2005

Prevalence of breastfeeding and acculturation in Hispanics: results from NHANES 1999-2000 study.

BACKGROUND: A more current estimate to evaluate ethnic and acculturation differences in breastfeeding is warranted, given the rapid growth of the Hispanic population in the United States and the proliferation of breastfeeding promotion programs. The study objective was to describe current national estimates of the prevalence of breastfeeding and evaluate differences in reasons not to breastfeed by acculturation status. METHODS: Secondary data analysis of the National Health and Nutrition Examination Survey (NHANES) 1999-2000 was performed on a nationally representative sample of non-Hispanic white women born in the U.S. and Hispanic women with at least one live birth. Acculturation status among Hispanics was assessed using a validated language scale, and prevalence of breastfeeding was based on maternal self-report. RESULTS: Prevalence of breastfeeding was higher in less acculturated Hispanic women (59.2%) than high acculturated Hispanic women (33.1%) and white women (45.1%). Less acculturated Hispanic women were more likely to cite their child's physical/medical condition as a reason not to breastfeed (53.1%), whereas whites and more acculturated Hispanics were more likely to cite their child preferred the bottle (57.5% and 49.8%, respectively). A logistic regression analysis revealed no significant differences in likelihood to breastfeed between non-Hispanic whites and Hispanics after controlling for education, age, and income. Higher acculturated women were less likely to breastfeed their children than low acculturated women (95% CI: 0.14-0.40) even after education, age, and income were taken into account. CONCLUSIONS: Acculturation differences in prevalence of breastfeeding and reasons not to breastfeed may be the result of attitudinal changes that occur due to acculturation. Further research into the acculturation process and its impact on breastfeeding may help to prevent the decline in breastfeeding that occurs as mothers become more acculturated. Meanwhile, patient education that addresses women's perceptions of the child's health condition and benefits of breastfeeding would be helpful.

Acculturation↗

PubMedDate not supplied

Korean male smokers' perceptions of tobacco control policies in the United States.

The purpose of this secondary data analysis is to report Korean male smokers' perceptions of tobacco control policies in the United States. Descriptive data from four focus groups held in New York City in 2003 are presented. Focus group interviews were used to collect data, and the two investigators independently analyzed all four recorded group sessions. Korean male immigrants living in New York City area were recruited, and 22 volunteered to participate. Exclusion criteria included immigration to the United States before age 12, no smoking history, and use of chemical substance other than tobacco. Korean men differed in perceptions of the policies based on smoking status and length of U.S. residency. Among current smokers, recent immigrants had difficulty understanding smoking restrictions, whereas longtime residents complained of price increases. Both groups suggested that policies target the tobacco industry and do not target smokers. In contrast, former smokers supported more regulation of public smoking and suggested use of more aggressive antismoking campaigns. Public policymakers should take into consideration cultural attitudes and beliefs about smoking behavior in the design and implementation of tobacco control policies that affect ethnic groups whose cultural and value orientations may differ from the mainstream.

Adult↗

PubMed2004

Prevalence of non-medical drug use and dependence among homosexually active men and women in the US population.

AIMS: The aim of this study was to compare patterns of drug use and dependence between homosexually experienced and exclusively heterosexually experienced individuals. DESIGN: We used a cross-sectional national household interview survey conducted in the United States. SETTING: Secondary data analysis of the 1996 National Household Survey on Drug Abuse was employed. PARTICIPANTS: Participants were sexually active individuals, aged 18 years and older, who reported the genders of their sexual partners in the past 12 months; included 174 homosexually experienced (98 men, 96 women) and 9714 exclusively heterosexually experienced (3922 men, 5792 women) respondents. MEASUREMENTS: Life-time, past 30 days and daily use of nine classes of drugs. Symptoms of dysfunctional use and dependence. FINDINGS: There were consistent patterns of elevated drug use in homosexually experienced individuals for life-time drug use, but these were greatly attenuated for recent use. Homosexually experienced men were more likely to report use of marijuana, cocaine and heroin, and homosexually experienced women more likely to report use of marijuana and analgesics than individuals reporting only opposite-sex partners. Both homosexually active men and women were more likely than exclusively heterosexually active respondents to report at least one symptom indicating dysfunctional drug use across all drug classes, and to meet criteria for marijuana dependence syndrome. The only difference between homosexually experienced men and women was that men were more likely to report any daily drug use. CONCLUSIONS: These data are consistent with surveys suggesting that there is a moderate elevation of drug, particularly marijuana, use and dependence in gay and bisexual men and women when compared to heterosexual men and women.

Adult↗

PubMed2006

Volume of alcohol consumption, patterns of drinking and burden of disease in the European region 2002.

AIMS: To describe the volume of alcohol consumption and patterns of drinking in the World Health Organization (WHO) European regions in 2002 and to estimate quantitatively the burden of disease attributable to alcohol in that year. METHODS: Secondary data analysis. Exposure data were taken from the WHO Comparative Risk Assessment, outcome data from the WHO Measurement and Health Information department, and used to derive three outcome measures: deaths, years of life lost (YLL) and disability adjusted life years (DALY) for 2002. All calculations were conducted according to age, sex and region. RESULTS: Alcohol consumption in the WHO regions for Europe was high, with 12.1 litres pure alcohol per capita, on average more than 100% above the global consumption. Alcohol consumption caused a considerable disease burden: 6.1% of all the deaths, 12.3% of all YLL and 10.7% of all DALY in all European regions in 2002 could be attributed to this exposure. Intentional and unintentional injuries accounted for almost 50% of all alcohol-attributable deaths and almost 44% of alcohol-attributable disease burden. Young people and men were affected the most. Geographically, the most eastern region around Russia had the highest alcohol-attributable disease burden. CONCLUSIONS: Interventions should be implemented to reduce the high burden of alcohol-attributable disease in the European regions. Given the epidemiological structure of the burden, injury prevention, including but not restricted to the prevention of traffic injuries, and specific prevention for young people should play the most important role in a comprehensive plan to reduce alcohol-attributable burden.

Adolescent↗

PubMed2006

Short birth intervals and the risk of school unreadiness among a Medicaid population in South Carolina.

BACKGROUND: Communities across the United States have become more involved in enhancing school readiness. Many of the predictors of school readiness relate to conditions prior to and following the birth of the child, including a child's birthweight. Shortened birth intervals are related to a variety of health and social consequences that affect child development, yet no formal research has examined the association between birth intervals and school readiness. METHODS: This study was a secondary data analysis of de-identified pregnancy-related vital record information, matched to selected items from the Department of Health and Human Services Medicaid records on mothers and children and to the Cognitive Skills Assessment Battery score in South Carolina for the year 2000 for the child of interest (N = 6915). Analysis of covariance and logistic regression were used to determine if there was a statistically significant relationship between birth interval and school readiness. RESULTS: Results showed that birth interval is a significant predictor of school readiness with a P-value <0.001 even after controlling for various socio-demographic factors. Children born with inadequate birth intervals (less than 24 months) are more likely to fail the Cognitive Skills Assessment Battery compared with those with adequate birth intervals. Potential implications of this research include promoting optimal birth spacing to improve the likelihood that future first graders will come to school ready to learn.

Adult↗

PubMed1996

Adjustment and social behaviour in older adults with chronic obstructive pulmonary disease: the family's perspective.

This study employed secondary data analysis to explore family perceptions of adjustment and social behaviour in older adults (n = 51) with chronic obstructive pulmonary disease (COPD) and their relationship to published norms and patient self-report. According to the Katz Adjustment Scale for Relatives, these COPD patients had significantly higher levels of belligerence, negativism, helplessness, withdrawal, psychopathology, nervousness and confusion than reports from relatives of older adults from the general population. No differences were found in performance, expectation or dissatisfaction with socially expected activities, or performance of free-time activities. However, family members of COPD patients were significantly more dissatisfied with their relative's free-time activities. Although family perceptions of socially expected activities corresponded to patient descriptions of general and physical functioning (Sickness Impact Profile), patient perceptions of psychosocial functioning were independent of the family's. The results supported the tenet that older adults with COPD have difficulties with adjustment that may adversely affect social relationships, but were not consistent with the belief that the performance of socially expected or free-time activities is more impaired than in others of this age group. The data also suggested there may be some perceptual discrepancy between family and patient views of social behaviour.

Adaptation, Psychological↗

PubMed2004

Using a Nursing Minimum Data Set with older patients with dementia in an acute care setting.

BACKGROUND: Many older people with dementia are admitted to acute care settings suffering from comorbidities. These and their treatments can lead to confusion in these patients, adding to their existing cognitive deficits, and this may not be recognized by care staff. The care of such patients is complex and requires multidisciplinary team input. The purposes of the Nursing Minimum Data Set are to describe the nursing care of patients in a variety of settings and to establish comparability of nursing data across clinical populations, settings and time. AIMS: This paper reports a study to describe the characteristics of hospitalized older patients with dementia and nursing diagnoses and nursing interventions for these patients, and to identify trends in the nursing care provided over a 3-year period using a Nursing Minimum Data Set from a community hospital in the United States of America. METHODS: Secondary data analysis was conducted in 2000 on a large clinical discharge data set containing Nursing Minimum Data Set elements. The sample included 597 elders with dementia among a total of 7772 older patients who were discharged between 1996 and 1998. RESULTS: The most common comorbidity was hypertension (n = 123, 21%), followed by cardiac dysrhythmias (n = 80, 13%). The most frequent nursing diagnoses were altered health maintenance (n = 419, 84%), knowledge deficit (n = 357, 71%), potential for injury (n = 242, 48%), potential for infection (n = 230, 46%), pain (n = 184, 37%), impaired physical mobility (n = 169, 34%), and altered thought process (n = 144, 29%). The most frequent interventions were discharge planning (n = 340, 68%), surveillance safety (n = 195, 39%), fall prevention (n = 175, 35%), teaching: disease process (n = 166, 33%), learning facilitation (n = 148, 30%), and infection protection (n = 147, 29%). CONCLUSIONS: The results provide a description of nursing diagnoses and interventions for elders with dementia in an acute care setting using the Nursing Minimum Data Set framework. They identify the need to develop staff education programmes for individualized care of older patients with dementia. In addition, they support the need for continued work on linkage of the nursing care elements of the Nursing Minimum Data Set, including nursing diagnoses, nursing interventions, and nursing-sensitive outcomes.

Aged↗

PubMed2005

Factors affecting the use of nursing information systems in Taiwan.

AIM: This paper reports a study to test a proposed model of factors (demographic variables, computer experience and perceived technology characteristics) influencing the efficient use of a computerized nursing care planning system by hospital clinical nurses. BACKGROUND: Although nursing information systems have been used in health care institutions, little research has explored the efficiency of computer use in nurses' daily practice. METHOD: A secondary data analysis was applied to focus on clinical nurses' daily computer use. The original data were collected from a medical centre in Taiwan to establish the reliability and validity of a scale to evaluate computerized nursing care plan systems. RESULTS: Younger nurses with more education, less computer knowledge and less usage pressure, and who perceived that they had less usage benefit, more education training and usability regarding system use, spent less time on the computerized nursing care plan. CONCLUSION: The results can be used for further organization of education programmes and as a reference for training strategies. Further examination and analysis of item content are suggested.

Adult↗

PubMed2005

Predictors of distress and depression in elders with arthritic pain.

AIM: The aim of this paper is to report the findings of a study testing a theory of chronic pain, with financial hardship added as a contextual stimulus. BACKGROUND: Arthritis is highly prevalent among older people, resulting in severe pain and suffering. A previous study testing a theory of chronic pain in elders with arthritis found that pain, disability and social support explained only 35% of the variance in their emotional distress. It is possible that demands, other than chronic pain, such as financial hardship, also contribute to these elders' stress and depression. METHOD: The theory was tested with 235 elders with arthritis using a secondary data analysis strategy. Data were obtained from the study of Ageing, Status, and Sense of Control carried out in 1998 in the United States of America. Variables were constructed from original questionnaires. RESULTS: The hypothesized model fitted the data only moderately well (chi2 = 40.04, d.f = 6, P < 0.0001; CFI = 0.88; NFI = 0.88). Disability and financial hardship positively predicted distress, while social support and age had a reverse impact on distress, which explained 24% of the variance in distress. This means that elders with higher levels of disability, more financial hardship, less social support or younger age are likely to have higher levels of distress. Distress alone explained 33% of the variance in depressive symptoms. A data-derived model was created with excellent fit (chi2 = 3; d.f. = 4; P = 0.56; CFI = 1.00; NFI = 0.99), showing that disability, social support, financial hardship and age predicted distress (R2 = 0.24). Pain, disability and distress predicted depression (R2 = 0.44). CONCLUSIONS: The results partially supported the theory. Exploring the possibility of using depression as part of the control process and removing gender as a residual stimulus may lead to further refinement of the theory. The findings allow nurses to have a better understanding of the experiences of elders with arthritis, and thus to offer appropriate care to meet their needs.

Age Factors↗

PubMed2006

The relationship between exercise, Body Mass Index and menopausal symptoms in midlife Australian women.

The main objective of the study was to examine the relationship between physical activity and Body Mass Index (BMI) on menopausal symptoms in Australian midlife women. This study is a secondary data analysis of the Queensland Midlife Women Health Study (2001), which included a randomized, population-based postal survey with a questionnaire. Selected women completed a questionnaire, which included measurement of sociodemographic factors (age, employment and education attainment), general health, use of hormone replacement therapy, smoking, exercise pattern and BMI. The measures that are reported in this paper include menopausal symptoms, BMI and exercise. After adjusting for confounding variables, significant multivariate difference was still found for most menopausal symptoms, including a significant relationship between somatic symptoms, psychological symptoms, depression and anxiety. No significant relationship was seen, however, between vasomotor symptoms, sexual function and exercise. In conclusion, the study showed that exercise was effective in relieving somatic and psychological symptoms, including depression and anxiety. These findings are promising news for women who are interested in using non-pharmacological interventions for relieving menopausal symptoms.

Anxiety↗

PubMed2004

Does health service utilisation vary by remoteness? South Australian population data and the Accessibility and Remoteness Index of Australia.

OBJECTIVE: To compare rates of self-reported use of health services between rural, remote and urban South Australians. METHODS: Secondary data analysis from a population-based survey to assess health and well-being, conducted in South Australia in 2000. In all, 2,454 adults were randomly selected and interviewed using the computer-assisted telephone interview (CATI) system. We analysed health service use by Accessibility and Remoteness Index of Australia (ARIA) category. RESULTS: There was no statistically significant difference in the median number of uses of the four types of health services studied across ARIA categories. Significantly fewer residents of highly accessible areas reported never using primary care services (14.4% vs. 22.2% in very remote areas), and significantly more reported high use (> or =6 visits, 29.3% vs. 21.5%). Fewer residents of remote areas reported never attending hospital (65.6% vs. 73.8% in highly accessible areas). Frequency of use of mental health services was not statistically significantly different across ARIA categories. Very remote residents were more likely to spend at least one night in a public hospital (15.8%) than were residents of other areas (e.g. 5.9% for highly accessible areas). CONCLUSION: The self-reported frequency of use of a range of health services in South Australia was broadly similar across ARIA categories. However, use of primary care services was higher among residents of highly accessible areas and public hospital use increased with increasing remoteness. There is no evidence for systematic rural disadvantage in terms of self-reported health service utilisation in this State.

Adolescent↗

PubMed2006

Nutrition and physical activity behaviours among Mäori, Pacific and NZ European children: identifying opportunities for population-based interventions.

OBJECTIVES: To describe how the prevalences of nutrition and physical activity behaviours vary by ethnicity, while controlling for other socio-demographic characteristics, and to identify appropriate points of intervention for defined ethnic populations of New Zealand children. METHODS: Secondary data analysis of the 2002 National Children's Nutrition Survey. RESULTS: Few ethnic differences were significant for fruit and vegetable consumption and indicators of physical activity. Where ethnic differences in physical activity were significant, Mäori children and Pacific children were more active than New Zealand European/Other (NZEO) children. Pacific children and, Mäori children were significantly more likely to skip meals than NZEO children. Pacific children and Mäori children were significantly more likely to buy some/most of the food they consumed at school from the tuckshop or dairy while NZEO children were more likely to bring their school food only from home. Likewise, Pacific children and Mäori children were significantly more likely to be high consumers of some fatty and sugary foods than NZEO children. CONCLUSIONS AND IMPLICATIONS: Meal skipping and purchasing food away from home were common for Mäori children and Pacific children; school-based programs that aim to improve access to and subsidise the price of healthy foods, including breakfast, could greatly benefit Mäori and Pacific students. Efforts to improve fruit and vegetable consumption and physical activity should be more universally applied and made culturally appropriate for all children.

Adolescent↗

PubMed2004

Impacts of informal caregiver availability on long-term care expenditures in OECD countries.

OBJECTIVE: To quantify the effects of informal caregiver availability and public funding on formal long-term care (LTC) expenditures in developed countries. DATA SOURCE/STUDY SETTING: Secondary data were acquired for 15 Organization for Economic Cooperation and Development (OECD) countries from 1970 to 2000. STUDY DESIGN: Secondary data analysis, applying fixed- and random-effects models to time-series cross-sectional data. Outcome variables are inpatient or home heath LTC expenditures. Key explanatory variables are measures of the availability of informal caregivers, generosity in public funding for formal LTC, and the proportion of the elderly population in the total population. DATA COLLECTION/EXTRACTION METHOD: Aggregated macro data were obtained from OECD Health Data, United Nations Demographic Yearbooks, and U.S. Census Bureau International Data Base. PRINCIPAL FINDINGS: Most of the 15 OECD countries experienced growth in LTC expenditures over the study period. The availability of a spouse caregiver, measured by male-to-female ratio among the elderly, is associated with a $28,840 (1995 U.S. dollars) annual reduction in formal LTC expenditure per additional elderly male. Availability of an adult child caregiver, measured by female labor force participation and full-time/part-time status shift, is associated with a reduction of $310 to $3,830 in LTC expenditures. These impacts on LTC expenditure vary across countries and across time within a country. CONCLUSIONS: The availability of an informal caregiver, particularly a spouse caregiver, is among the most important factors explaining variation in LTC expenditure growth. Long-term care policies should take into account behavioral responses: decreased public funding in LTC may lead working women to leave the labor force to provide more informal care.

Adult↗

PubMed2006

Access to health care services for the disabled elderly.

OBJECTIVE: To determine whether difficulty walking and the strategies persons use to compensate for this deficit influenced downstream Medicare expenditures. DATA SOURCE: Secondary data analysis of Medicare claims data (1999-2000) for age-eligible Medicare beneficiaries (N=4,997) responding to the community portion of the 1999 National Long Term Care Survey (NLTCS). STUDY DESIGN: Longitudinal cohort study. Walking difficulty and compensatory strategy were measured at the 1999 NLTCS, and used to predict health care use as measured in Medicare claims data from the survey date through year-end 2000. DATA EXTRACTION: Respondents to the 1999 community NLTCS with complete information on key explanatory variables (walking difficulty and compensatory strategy) were linked with Medicare claims to define outcome variables (health care use and cost). PRINCIPAL FINDINGS: Persons who reported it was very difficult to walk had more downstream home health visits (1.1/month, p<.001), but fewer outpatient physician visits (-0.16/month, p<.001) after controlling for overall disease burden. Those using a compensatory strategy for walking also had increased home health visits/month (0.55 for equipment, 1.0 for personal assistance, p<.001 for both) but did not have significantly reduced outpatient visits. Persons reporting difficulty walking had increased downstream Medicare costs ranging from 163 US dollars to 222 US dollars/month (p<.001) depending upon how difficult walking was. Less than half of the persons who used equipment to adapt to walking difficulty had their difficulty fully compensated by the use of equipment. Persons using equipment that fully compensated their difficulty used around 300 US dollars/month less in Medicare-financed costs compared with those with residual difficulty. CONCLUSIONS: Difficulty walking and use of compensatory strategies are correlated with the use of Medicare-financed services. The potential impact on the Medicare program is large, given how common such limitations are among the elderly.

Activities of Daily Living↗

PubMed2006

Comparing United States versus international medical school graduate physicians who serve African- American and White elderly.

OBJECTIVE: To examine the relationship that international medical school graduates (IMGs) in comparison with United States medical school graduates (USMGs) have on health care-seeking behavior and satisfaction with medical care among African-American and white elderly. DATA SOURCES: Secondary data analysis of the 1986-1998 Piedmont Health Survey of the Elderly, Established Populations for the Epidemiological Study of the Elderly, a racially oversampled urban and rural cohort of elders in five North Carolina counties. STUDY DESIGN: Primary focus of analyses examined the impact of the combination of elder race and physician graduate status across time using a linear model for repeated measures analyses and chi2 tests. Separate analyses using generalized estimating equations were conducted for each measure of elder characteristic and health behavior. The analytic cohort included 341 physicians and 3,250 elders (65 years old and older) in 1986; by 1998, 211 physicians and 1,222 elders. DATA COLLECTION/EXTRACTION METHODS: Trained personnel collected baseline measures on 4,162 elders (about 80 percent responses) through 90-minute in-home interviews. PRINCIPAL FINDINGS: Over time, IMGs treated more African-American elders, and those who had less education, lower incomes, less insurance, were in poorer health, and who lived in rural areas. White elders with IMGs delayed care more than those with USMGs. Both races indicated being unsure about where to go for medical care. White elders with IMGs were less satisfied than those with USMGs. Both races had perceptions of IMGs that relate to issues of communication, cultural competency, ageism, and unnecessary expenses. CONCLUSION: IMGs do provide necessary and needed access to medical care for underserved African Americans and rural populations. However, it is unclear whether concerns regarding cultural competency, communication and the quality of care undermine the contribution IMGs make to these populations.

Black or African American↗