Information on a shoestring: a practical database at an adolescent pregnancy program.

Adolescent pregnancy programs provide services to a socially high risk population with complex and continuing needs. Data describing the characteristics of the patient population is useful for directing program efforts, examining program outcomes, and documenting the need for additional services. The Rochester Adolescent Maternity Program has developed a simple, inexpensive data collection system in which demographic, social and reproductive information is routinely collected on all program patients. Such a system could be of use to other adolescent maternity programs.

The impact of office cholesterol testing.

BACKGROUND: The role of portable cholesterol analyzers in the identification and management of hypercholesterolemia is controversial. This study investigated the effect of free office cholesterol testing on screening behavior and on blood cholesterol reduction in a family practice center. METHODS: After a baseline period of 5 months, an office cholesterol analyzer was made available for 1 year to two teams of patients and providers (study group), but not to the other two teams (control group). RESULTS: The percentage of patients screened increased from 28% to 52% in the study group, and from 29% to 42% in the control group (difference favoring study group, prevalence odds ratio = 1.47, 95% confidence interval [CI] = 1.33 to 1.62). Compared with those whose cholesterol tests were sent to outside laboratories, patients screened with the office analyzer were younger (mean age 36 years vs 42 years), and the barrier to those without insurance was reduced. There was no clinically or statistically significant effect on lowering cholesterol (difference favoring study group = 0.01 mmol/L, 95% CI = -0.15 to 0.17). CONCLUSIONS: The availability of free office cholesterol testing increased the prevalence of cholesterol testing, particularly for younger patients and those without insurance; however, the testing had no discernible effect of motivating patients to lower their blood cholesterol levels.

Racial differentials in the identification of hypercholesterolemia.

BACKGROUND: African Americans have higher rates of cardiovascular disease than white Americans. To address this differential, barriers to cardiovascular risk reduction need to be identified. This study examines the association of race with the likelihood of screening for and diagnosis of hypercholesterolemia. METHODS: Possible associations between demographic variables and screening for and diagnosis of hypercholesterolemia were examined on data gathered in a prospective fashion in an office-based family medicine residency training program in Rochester, New York. A consecutive sample of all patients seen between December 15, 1988, and April 15, 1990, about whom there was complete data collection (age, sex, insurance, race, and other cardiovascular risk factors) were included in the multivariate analyses (N = 4256). RESULTS: After controlling for age, sex, insurance status, socioeconomic status, number of visits, and other cardiovascular risk factors, it was found that minorities were less likely to have been screened for cholesterol levels than whites (adjusted odds ratio [AOR] = 0.84, 95% confidence interval [CI] = 0.98 to 0.72). The mean cholesterol level did not differ by race (mean cholesterol for whites, 204 mg/dL [5.28 mmol/L], and for minorities, 203 mg/dL [5.25 mmol/L], t = 0.7, P = .47). Among those screened, minorities were less likely than whites to have been diagnosed with hypercholesterolemia (AOR = 0.62, 95% CI = 0.86 to 0.44; and 0.47 (95% CI = 0.28 to 0.78] in those with a cholesterol level greater than 240 mg/dL [6.2 mmol/L]). CONCLUSIONS: Our data suggest that provider behavior in diagnosing hypercholesterolemia varies by the race of the patient.

Barriers to cholesterol testing in a rural community.

BACKGROUND: The purpose of this study was to investigate the factors that determine whether residents in a rural community have their cholesterol tested. METHODS: A population-based survey was conducted in 1987 as part of a community-oriented primary care project that sought to define and address the causes of and burden caused by increased cardiovascular disease in an economically depressed agricultural region of New York. All of the residents living in two towns in the region who were over 16 years of age and who lived in their homes year-round were surveyed. Demographic information was obtained from the participants, as well as information about previous cholesterol testing and their cardiovascular-risk knowledge and behaviors. The serum cholesterol of each participant was measured. RESULTS: Of the 557 households contacted, 508 (91%) households participated. A total of 1063 persons over 16 years of age were surveyed, and 973 (92%) were screened for cholesterol. Overall, 24% reported prior cholesterol testing. Logistic regression analysis identified several independent factors that were associated with a reduced likelihood of ever having had a cholesterol test. These factors included: (1) age under 45 years, (2) having less than 12 years of education, (3) having an income of less than $10,000, (4) not having health insurance, (5) not having visited a physician within the previous year, and (6) practicing three or more high-risk cardiovascular behaviors. The participants' cardiovascular knowledge made no independent contribution to having had their cholesterol levels tested. CONCLUSIONS: Many of the factors that prevent cholesterol testing are socially determined. The results of this study suggest that financial and social barriers are two of the major obstacles to residents of rural communities having their cholesterol levels tested.

In times of transition: an organizational change from a family systems perspective.

This article reports on observations of the implementation of a patient-centered care (PCC) work reorganization model in a community hospital setting. Analysis of videotape, direct observation, and interviews with key informants demonstrated the similarities between organizations and families in times of change. We propose a family systems framework for understanding some of the complex relationships and transitional experiences we observed.