Search

The Duke--UNC Health Profile (DUHP) was developed as a brief 63-item instrument designed to measure adult health status in the primary care setting along four dimensions: symptom status, physical function, emotional function and social function. Reliability and validity were tested on a group of 395 ambulatory patients in a family medicine center. Temporal stability Spearman correlations ranged from 0.52 to 0.82 for the four dimensions. Cronbach's alpha for internal consistency was 0.85 for emotional function. Guttman's reproducibility coefficients were 0.98 for physical function and 0.93 for social function, and the scalability coefficients were 0.89 for physical and 0.71 for social. Observed relationships between DUHP scores and demographic characteristics of the respondents correlated well with those predicted by the investigators (overall Spearman correlation 0.79). Convergent and discriminant validity was supported by strong associations between components of DUHP and those on the Sickness Impact Profile (SIP), the Tennessee Self-Concept Scale (Tennessee), and the Zung Self-Rating Depression Scale (Zung). DUHP with SIP monocomponent-heteromethod Spearman correlations ranged from 0.34 to 0.45, and those for DUHP with Tennessee ranged from 0.68 to 0.81. DUHP with Zung monoitem--heteromethod correlations ranged from 0.54 to 0.57. It is concluded that this evidence supports the reliability and validity of the DUHP as an instrument suitable for studying the impact of primary health care on the health outcomes of patients.

In four years, 218 pesticide exposures were reported among North Carolina children. Epidemiologic follow-up revealed 50 symptomatic cases with nine fatalities. Mean age of exposed children was 27 months; boys were involved twice as frequently as girls. Agents most often implicated were anticoagulant rodenticides (17%) and organophosphate insecticides (16%). Sixty-eight percent of exposures were to products intended for household use. Special characteristics of pesticides that contribute to morbidity include exceptional toxicity, dermal penetration, and frequent application as food baits. Exposure histories indicate that high petroleum distillate content often adds to product toxicity.

A model for improving physician prescribing that utilizes computerized feedback was studied in a family medicine residency practice. Resident and faculty physicians were stratified by level of experience and randomized into two groups. For 9 months the experimental group received monthly printouts identifying drugs they had prescribed by brand name with estimates of cost savings that might have been realized by prescribing generic drugs. The control group received no feedback. Prescription monitoring of both groups continued for 12 months after all feedback had ceased. Median weighted rates of generic prescribing for the experimental physicians were 14% for the baseline, 67% for the feedback, and 54% for the follow-up periods. Rates for the control physicians for the three periods were 32%, 37% and 31%, respectively. The increase in generic prescribing by physicians in the experimental group was significantly greater than for control physicians (P = 0.01). The feedback model improved rates of generic prescribing but should be evaluated for broader areas of physician prescribing.

With increasing scrutiny of the role of women in the medical profession, there has been speculation that women physicians provide more sensitivity and empathy to their patients. To compare the psychosocial awareness of female and male physicians, medical records were reviewed for 909 patient visits to six women and seven men who were first year family practice residents. Charts were audited for evidence of acknowledgement of 21 categories of psychosocial or sexual problems. Women physicians saw more patients than their male counterparts and had a higher percentage of visits from women patients (73 percent compared to 65 percent): Types of medical problems seen were similar for men and women physicians with 42 percent of patients noted to have at least one psychosocial or sexual problem. Recognition of problems did not differ significantly between men and women physicians. Women physicians found 44 percent of their female patients had at least one psychosocial problem compared to a 40 percent rate for men physicians seeing either male or female patients, but this small difference could have occurred by chance. When three family medicine faculty members were asked to rank the residents, their ratings were better predictors of psychosocial awareness than was the sex of the resident physician.

An outbreak of streptococcal and staphylococcal skin disease was discovered in a full-term nursery after the discontinuation of bathing infants with hexachlorophene. The epidemic was only temporarily controlled by conventional means and recurred despite reinstitution of hexachlorophene bathing. Measures that decreased infants' exposure to visitors and hospital personnel and enforced aseptic techniques in the nursery were more important than use of hexachlorophene soap in achieving and maintaining control.

Green tobacco sickness is an occupational illness of tobacco illness of tobacco harvesters that is thought to be caused by dermal absorption of nicotine from contact with green tobacco leaf. Wearing of rubberized nylon rainsuits effectively prevented nicotine absorption in volunteers who picked wet tobacco. Nicotine absorption was demonstrated in workers who wore clothing that was not waterproof.

Records of 87 hypertensive patients in a group family practice were reviewed to assess the validity of the process audit in determining medical care quality. Although a significant reduction in mean diastolic blood pressures was found at two follow-up intervals, physician performance scores showed no significant correlation with this outcome. Nor could an association between medical process and outcome be demonstrated when control of blood pressure to less than 95 mmHg was used as an outcome measure. The reliability between two chart auditors was poor, with complete agreement being achieved in only 29 percent of cases. Accurate quality assessment will require more practical methods of review which relate directly to patient outcomes.

Controversies surround the practice of prescribing potassium for ambulatory hypertensive patients who are being treated with diuretics. A chart review was conducted in a family medicine group practice to examine habits of potassium monitoring and supplement prescribing for patients receiving diuretic therapy for control of hypertension. Eighty-four percent of the 134 patients studied were monitored for serum potassium. For those with values obtained both before and after institution of diuretic therapy, mean potassium fell from 4.1 mEq/liter to 3.8 mEq/liter and 29 percent of patients had potassium levels fall to 3.5 mEq/liter or less. Almost half of patients received some type of potassium therapy, with diet enrichment and pharmacologic supplementation being the most common. When mean serum potassium values and percentage of patients with hypokalemia were compared for patients who were prescribed potassium therapy and for those who were not, there was little evidence that patients benefited from potassium prescribing.

All family practice residencies attempt to offer continuity experience to residents and patients as part of their model practices. However, every year one third of the most experienced resident providers leave the practice to be replaced by new, inexperienced residents. This study reports a randomized controlled trial in which a sample of reassigned patients was offered a free visit with their new physician. The free visit was a scheduled appointment with the patient's newly assigned physician during a two-month period for the purpose of meeting the new physician. The offer of a free visit succeeded in helping patients make the initial office contact with their new physician. However, during six months of follow-up the free visit offer did not have an impact on visit frequency or primary provider continuity. In this study the reassignment of patients to new physician providers did not affect overall visit frequency, but did have a negative impact on primary provider continuity.