Women in jail: is substance abuse treatment enough?

OBJECTIVES: This study examined the self-reported needs of women in jail who indicated a need for drug abuse services. METHODS: A total of 165 interviews were conducted of women held in a large, urban county jail in Ohio in May 1999. RESULTS: Drug-abusing women were more likely to report a need for housing, mental health counseling, education, job training, medical care, family support, and parenting assistance when released from jail. CONCLUSIONS: The provision of drug abuse treatment referrals to women in jail may not break the continual cycle of drug use and incarceration if other needs cannot be addressed.

Computer reminders improve on-time immunization rates.

OBJECTIVES: This study examines the effectiveness of computer-generated telephone reminders in improving infants receiving on-time immunizations. A computer called parents at home, reminded them of their child's visit, and asked if they could keep the appointment. If parents either canceled or failed to honor the appointment, the computer called back a few days later and asked them to reschedule. METHODS: A medical assistant recruited 124 consecutive mothers to receive automated computer reminders. These mothers' infants were younger than 6 months, were being seen at an outpatient clinic for a first visit, and were patients of three attending physicians and three nurse practitioners. These infants were compared to 89 infants from the same clinic, in the same age range, who were being seen for the first time during the same period by the same providers but not contacted by the medical assistant. Subjects were selected from mothers who brought their infants for their first visit in an outpatient urban clinic that serves predominantly minority clients. A research assistant reviewed patients' medical records and collected the infants' birthday, mothers' age, race, source of payments, and the immunization record of the infants. Immunization was considered to be late if, at the time of the first visit, it was more than 30 days past due for any of the recommended immunizations of the American Academy of Pediatrics, except for Hepatitis B vaccine which was not recommended at the time of the study. The dependent variable was on-time immunization. The independent variables were age of the mother at baseline, age of the child at baseline, and membership in either the comparison or the experimental group. Chi-square tests and logistic regression were used to analyze the data. RESULTS: The participation rate for appointments for the experimental group was 82%, as compared to a 69% overall participation rate for the clinic providers. The on-time immunization rate for experimental subjects was 67.8%, whereas the comparison group had an on-time immunization rate of 43.4% (differences were significant at alpha levels less than 0.01). CONCLUSIONS: Computerized reminders sent to the parents led to an increase in participation rate at the clinic and an increase in on-time immunization for their infants.

Serum cholesterol: attitudes and behavior of family practice residents.

BACKGROUND: Given the current health promotion efforts regarding coronary artery disease, more information is needed about residents' attitudes and behaviors that relate to identification and management of patients with elevated serum cholesterol levels. METHODS: Family practice residents from eight US programs (N = 128) were surveyed in 1989 to assess their attitudes and reported practice patterns. Resident survey data were compared, when feasible, to published data from 1986 and 1990 surveys of practicing physicians performed by the National Heart, Lung, and Blood Institute. RESULTS: The use of faculty "key contacts" resulted in a 90% response rate (N = 115). Both residents and practicing physicians attributed a high degree of importance to cholesterol as a risk factor. Residents reported more frequent routine screening of middle-aged men than the routine screening rate of practicing physicians in 1986 (P less than .01). Residents reported less frequent screening of younger and older adults than of middle-aged men (P less than .001). Residents' threshold for the use of cholesterol-lowering medication was lower than that of practicing physicians surveyed in 1986, but higher than that of physicians surveyed in 1990. Compared with practicing physicians, residents did not believe they were as well prepared to counsel patients about dietary change or as successful when they tried to help patients make changes; residents reported a significantly higher rate of referral to dietitians (P less than .01). CONCLUSIONS: Residents may need more education regarding screening guidelines for children and young adults. A health promotion skills gap may exist that explains reported discrepancies between self-report and actual behavior and indicates that residency educators may need to pay more attention to fostering dietary assessment and counseling skills in their residents.

Health and illness behavior of Type A persons.

The complex and controversial relationship of type A behavior to myocardial infarction and other illnesses may be mediated through health habits and illness behavior. We hypothesized that type A persons tend to reject the sick role, delay in seeking medical care, seek convenient medical care facilities, are impatient for recovery, return to work before they have fully recovered, and are less likely to engage in positive health habits. A cross-sectional survey was conducted at a large corporation in Cleveland, Ohio. A detailed questionnaire that examined health-promoting and illness behaviors was sent to 385 managers, 54% of whom responded. Models tested using path analysis supported the hypotheses that type A persons are more likely than are type B employees to reject the sick role, delay in seeking medical care, be impatient for recovery, and return to work before a full recovery. The study findings imply that type A employees may be less likely to miss work for minor illnesses, but they may be prone to adverse outcomes from illnesses that require early care or assumption of the sick role. The hypothesis that type A persons are less likely to engage in positive health-habits behavior was not supported.

Characteristics of inner-city women giving birth with little or no prenatal care: a case-control study.

Lack of prenatal care has been identified as an important risk factor for poor perinatal outcomes. A case-control study was conducted to identify risk factors for inadequate prenatal care. Records of women giving birth at an inner-city hospital who had fewer than three prenatal visits (cases) were compared with those of women giving birth at the same hospital who had more adequate prenatal care (controls). The final sample contained 120 women in each group. Women in the case group were more likely to be multiparous, to be less educated, and to have no telephone in the home. Tobacco and drug abuse were recorded significantly more often among these women. There was no difference in racial distribution between the case and control groups. Infants of women with minimal or no prenatal care had a lower mean birthweight and a higher frequency of prematurity. In logistic regression analysis, higher parity, age less than 30 years, single status, smoking, drug abuse, and residence in one of two statistical planning areas in the city were independently associated with increased odds of not receiving prenatal care. To be effective, prenatal outreach programs for inner-city women must be based on knowledge of the characteristics and needs of this population.

Prediction of motivation and behavior change following health promotion: role of health beliefs, social support, and self-efficacy.

Dimensions of health beliefs (perceived risk of behavior and benefit of behavior change), social support (family and others' support for change), and self-efficacy (magnitude and strength) were examined in 215 patients undergoing a prospective trial of health promotion in a primary care medical practice. Discriminant analyses were performed to evaluate how well these dimensions predicted motivation for change and lifestyle behavior change. These relationships were examined for six lifestyle areas: cigarette smoking, dealing with stress, amount and type of food eaten, use of seat belts, and exercise habits. The analyses demonstrated a statistically and clinically significant prediction of motivation by one or more health belief and self-efficacy dimensions for most lifestyle areas. The strongest single predictors were perceived benefits and self-efficacy strength, which were each significant predictors of motivation in four lifestyle areas (P less than 0.05). Support dimensions, as measured, were not shown to have predictive value in most areas. Behavior change was poorly predicted by beliefs, support, and self-efficacy for most lifestyle areas. However, adding motivation to the discriminant function equation resulted in significant predictions in all six lifestyle areas (P less than 0.05), with an average correct classification rate of 71%. This finding strongly suggests that motivation is a very important intervening variable when evaluating health promotion and resulting behavior change.

Patient perceptions of humanism in physicians: effects on positive health behaviors.

Although humanism has emerged as an important issue in medical education and practice, there is no standardized definition of humanism or an instrument that measures patients' perceptions of their physician's level of humanism. This study addressed these three issues: 1) A definition of physician humanism was developed based on the current literature; 2) an instrument was designed that measured patients' perceptions of humanism in their family physicians; and 3) health outcome variables were measured relative to these perceptions. The design was a cross-sectional survey of 185 randomly selected patients from two family practice sites. The questionnaire consisted of a humanism scale, in addition to items to assess patient satisfaction and patients' adherence to medical advice regarding exercise, diet, and smoking cessation. A positive association was found between perceived physician humanism and patient satisfaction. Greater success in patients' attempts to quit smoking was associated with higher physician humanism. The implications of these findings for evaluation and training of health care providers and patients' use of health care services are discussed.

Continuity of care in a family practice residency program. Impact on physician satisfaction.

One of the primary benefits of continuity of care is its influence upon patient and physician satisfaction. This prospective pilot study involved a cohort of 14 second- and third-year family practice residents and 4 full-time faculty at a community hospital-based family practice residency in Cleveland, Ohio. Rates of continuity that physicians experience were calculated using the usual provider continuity (UPC) measure of continuity, and were correlated with physician satisfaction with outpatient care using a practice satisfaction scale (PSS) developed specifically for this purpose. Residents and faculty were also asked to rank order the importance of several aspects of outpatient care, including continuity of care. The results indicate that both residents and faculty value continuity of care highly compared with other aspects of outpatient care. The average continuity rates were 59% for second-year residents, 54% for third-year residents, and 82% for faculty. The UPC continuity measure correlated highly with the PSS scores (corrected r2 = .55; P less than .001). The data support the hypothesis that continuity of care with patients is an important determinant of resident and faculty physician satisfaction with their outpatient experience.

Immigration, health status, and physician visits in a Puerto Rican community.

A pilot study was undertaken to explore the effects of geographic migration and exposure to new cultural values and attitudes on rates of physician office visits in a Puerto Rican population in a major Northeastern urban area. A cross-sectional survey study of an immigrant community was performed, using a questionnaire developed to assess the degree of immigrants' adaptation to the dominant culture, self-perceived health status, levels of stress and social support, and attitudes toward Western medical care. A convenience sample of 93 respondents was obtained. Analysis of the data showed that adaptation to the dominant culture, as measured in this study, is as good an independent predictor of high levels of physician office visitation as self-reported health status. In addition, it has a small but significant effect on perceived health. These results suggest that further exploration of the effect of cultural adaptation on health behaviors would be productive for clinicians and health resource managers.

Physician managers: personal characteristics versus institutional demands.

This article presents results of a survey of 169 physician managers and addresses what influences their task performance--organizational demands or personal characteristics?

The frequency of sexual problems among family practice patients.

Two hundred-twelve patients attending a family practice center participated in a questionnaire study of their sexual identity and function. Using conservative definitions of problems, 75% were identified as having at least one specific sexual problem area. Most of these problems were functional in nature and involved desire, arousal, or orgasm. While the frequency of sexual problems was high in both sexes among all age groups, identity problems were primarily seen among the young, and desire problems among older adults. The prevalence rate of reporting sexual problems did not differ significantly by sex. However, females reported more specific sexual problems than males. Only 26% of the subjects summarized their overall sexual lives as problematic and the vast majority of patients thought their family physicians were able to help with such problems. This study reaffirms the high prevalence of sexual disorders in the population. Given adequate training, family physicians may be the ideal providers of assistance for these problems.

Urgent care centers: what does "urgent" really mean?

This study examines patient perception of symptom urgency as it affects the choice of whether to utilize an urgent care center, to attempt to contact a family doctor, or to seek help at an emergency room, given similar symptoms. Three groups of patients were studied: 144 family practice patients who had not visited an urgent care center; 220 family practice patients who had visited one of three urgent care centers; and 180 other urgent care center patients. The findings suggest that people do have varying perceptions of urgency for the same symptoms and that physicians might benefit from considering this when scheduling hours. The analysis also shows a discrepancy among patients as to problems they perceive as appropriate for urgent care centers. The results can be used to provide a profile of patients who are using urgent care centers and to show how family practice physicians can better accommodate patients who might seek medical care elsewhere.