Postal surveys of physicians gave superior response rates over telephone interviews in a randomized trial

BACKGROUND AND OBJECTIVES: To compare general practitioner (GP) response to a telephone interview with response to a postal survey with three reminders in a randomized controlled trial. METHODS: GPs were randomly assigned to either a telephone interview or a postal survey. GPs in the telephone group were mailed a letter of invitation and asked to undertake a telephone interview. GPs in the postal group were mailed a letter of invitation and questionnaire. Non-responders were sent up to three reminders, the final by registered post. Response rates were calculated for each group. RESULTS: 416 GPs were randomized to the telephone interview and 451 to the postal survey. Eighty-six in the telephone group and 30 in the postal were ineligible. One hundred thirty-four GPs completed the telephone interview with a response rate of 40.6% (95% confidence interval [CI]: 35.3%, 46.1%). Two hundred fifty-two GPs completed the postal survey with a response rate of 59.9% (95%CI: 55.0%, 64.6%). The difference in response was 19.3% (95%CI: 12.2%, 26.3%). CONCLUSIONS: These results show that postal surveys with three reminders can have superior response rates compared with a telephone interview.     

Theory-based strategies for improving contraceptive use: a systematic review

Background

Theories and models help explain how behavior change occurs. We systematically reviewed randomized controlled trials that examined theory-based interventions for improving contraceptive use.

Study Design

We searched electronic databases for eligible trials. Primary outcomes included pregnancy and contraceptive use. We calculated the odds ratio for dichotomous outcomes and the mean difference for continuous data.

Results

Of 14 included trials, 10 showed positive results for a theory-based group: 2 of 10 studies with pregnancy or birth data, 4 of 9 addressing contraceptive use (for contraception) and 5 of 9 with condom use (to prevent HIV/sexually transmitted infections). An experimental group had favorable results for six of seven trials based on Social Cognitive Theory, two based on other social cognition models and two using motivational interviewing. Most interventions focused on adolescents and involved multiple sessions.

Conclusions

Effects were not consistent across outcomes and comparisons. The field could benefit from thorough use of single theories and better reporting on intervention implementation.     

Physician peer review surveys: a management tool for improving quality of patient care

An increasing number of patients are presenting multiple medical problems requiring the collaboration of two or more physician specialists or subspecialists for effective treatment. The quality of care delivered to multiple-problem patients depends greatly on how well the physician specialists interact with one another. The Cleveland Clinic Foundation (CCF) has developed and implemented a physician peer review survey that enables physicians to receive anonymous feedback on the service they provide to their colleagues. The survey has been implemented in both medical and surgical departments. Colleagues have identified areas for improvement to increase collaboration and enhance effectiveness in treating multiproblem patients. The data have led to a variety of specific service-related improvements and changes in physician behavior. Though originally conceived as a quality improvement technique, the physician review survey has become an internal marketing and management tool for physician managers.     

Methodologies used in cost-effectiveness models for evaluating treatments in major depressive disorder: a systematic review

Background

Decision makers in many jurisdictions use cost-effectiveness estimates as an aid for selecting interventions with an appropriate balance between health benefits and costs. This systematic literature review aims to provide an overview of published cost-effectiveness models in major depressive disorder (MDD) with a focus on the methods employed. Key components of the identified models are discussed and any challenges in developing models are highlighted.

Methods

A systematic literature search was performed to identify all primary model-based economic evaluations of MDD interventions indexed in MEDLINE, the Cochrane Library, EMBASE, EconLit, and PsycINFO between January 2000 and May 2010.

Results

A total of 37 studies were included in the review. These studies predominantly evaluated antidepressant medications. The analyses were performed across a broad set of countries. The majority of models were decision-trees; eight were Markov models. Most models had a time horizon of less than 1 year. The majority of analyses took a payer perspective. Clinical input data were obtained from pooled placebo-controlled comparative trials, single head-to-head trials, or meta-analyses. The majority of studies (24 of 37) used treatment success or symptom-free days as main outcomes, 14 studies incorporated health state utilities, and 2 used disability-adjusted life-years. A few models (14 of 37) incorporated probabilities and costs associated with suicide and/or suicide attempts. Two models examined the cost-effectiveness of second-line treatment in patients who had failed to respond to initial therapy. Resource use data used in the models were obtained mostly from expert opinion. All studies, with the exception of one, explored parameter uncertainty.

Conclusions

The review identified several model input data gaps, including utility values in partial responders, efficacy of second-line treatments, and resource utilisation estimates obtained from relevant, high-quality studies. It highlighted the differences in outcome measures among the trials of MDD interventions, which can lead to difficulty in performing indirect comparisons, and the inconsistencies in definitions of health states used in the clinical trials and those used in utility studies. Clinical outcomes contributed to the uncertainty in cost-effectiveness estimates to a greater degree than costs or utility weights.     

Facets of career satisfaction for women physicians in the United States: a systematic review

Women make up a growing proportion of the physician workforce, and their career satisfaction may affect their health. The authors hypothesized that many facets adversely affecting career satisfaction in women physicians were extrinsic, therefore, preventable or modifiable. The authors conducted a systematic review of the literature in English published through February 2010 to examine facets of career satisfaction of U.S. women physicians. The authors used the women physician AND job satisfaction OR career satisfaction Medical Subject Headings (MeSH) terms, and reviewed bibliographies of key articles to ensure inclusion of relevant studies. The authors used the "Strengthening the Reporting of Observation Studies in Epidemiology" quality tool. Of an initial 1,000 studies, only 30 met the inclusion criteria. Facets reported most frequently to influence career satisfaction for women physicians were income/prestige, practice characteristics, and personal/family characteristics. Overall, career satisfaction for women and men physicians was 73.4% (range = 56.4% to 90%) and 73.2% (range = 59% to 90%), respectively. When compared with men, women physicians were more concerned with perceived lack of time for relationships with patients, colleagues, and family; less satisfied with mentoring relationships and support from all sources; and less satisfied with career-advancement opportunities, recognition, and salary. Career satisfaction can affect health, as well as health and safety of patients. Many factors adversely affecting career satisfaction for women physicians are extrinsic and, therefore, modifiable.     

Response rates and response bias for 50 surveys of pediatricians

RESEARCH OBJECTIVE: To track response rates across time for surveys of pediatricians, to explore whether response bias is present for these surveys, and to examine whether response bias increases with lower response rates. DATA SOURCE/STUDY SETTING: A total of 63,473 cases were gathered from 50 different surveys of pediatricians conducted by the American Academy of Pediatrics (AAP) since 1994. Thirty-one surveys targeted active U.S. members of the AAP, six targeted pediatric residents, and the remaining 13 targeted AAP-member and nonmember pediatric subspecialists. Information for the full target samples, including nonrespondents, was collected using administrative databases of the AAP and the American Board of Pediatrics. STUDY DESIGN: To assess bias for each survey, age, gender, location, and AAP membership type were compared for respondents and the full target sample. Correlational analyses were conducted to examine whether surveys with lower response rates had increasing levels of response bias. PRINCIPAL FINDINGS: Response rates to the 50 surveys examined declined significantly across survey years (1994-2002). Response rates ranged from 52 to 81 percent with an average of 68 percent. Comparisons between respondents and the full target samples showed the respondent group to be younger, to have more females, and to have less specialty-fellow members. Response bias was not apparent for pediatricians' geographical location. The average response bias, however, was fairly small for all factors: age (0.45 years younger), gender (1.4 percentage points more females), and membership type (1.1 percentage points fewer specialty-fellow members). Gender response bias was found to be inversely associated with survey response rates (r=-0.38). Even for the surveys with the lowest response rates, amount of response bias never exceeded 5 percentage points for gender, 3 years for age, or 3 percent for membership type. CONCLUSIONS: While response biases favoring women, young physicians, and nonspecialty-fellow members were found across the 52-81 percent response rates examined in this study, the amount of bias was minimal for these factors that could be tested. At least for surveys of pediatricians, more attention should be devoted by investigators to assessments of response bias rather than relying on response rates as a proxy of response bias.     

Increasing response rates in physicians'' mail surveys: an experimental study.

It is becoming increasingly difficult to obtain high response rates in physicians' mail surveys. In 1983-84, we tested the effectiveness of two techniques among 604 Quebec physicians who had not responded to an initial letter. A handwritten thank you note at the bottom of the letter accompanying the questionnaire and a more personalized mailout package increased response rates by 40.7 per cent and 53.1 per cent, respectively, compared to control groups.     

Enhancing response rates in physician surveys: the limited utility of electronic options

Objective. To evaluate the utility of offering physicians electronic options as alternatives to completing mail questionnaires. Data Source. A survey of colorectal cancer screening practices of Alabama primary care physicians, conducted May–June 2010. Study Design. In the follow‐up to a mail questionnaire, physicians were offered options of completing surveys by telephone, fax, email, or online. Data Collection Method. Detailed records were kept on the timing and mode of completion of surveys. Principal Findings. Eighty‐eight percent of surveys were returned by mail, 10 percent were returned by fax, and only 2 percent were completed online; none were completed by telephone or email. Conclusions. Offering fax options increases response rates, but providing other electronic options does not.     

Impact of payment method on behaviour of primary care physicians: a systematic review

OBJECTIVE: To review the impact of payment systems on the behaviour of primary care physicians. METHODS: All randomised trials, controlled before and after studies, and interrupted time series studies that compared capitation, salary, fee-for-service or target payments (mixed or separately) that were identified by computerised searches of the literature. Methodological quality assessment and data extraction were undertaken independently by two reviewers using a data checklist. Study results were qualitatively analysed. RESULTS: Six studies met the inclusion criteria. There was considerable variation in the quality of reporting, study setting and the range of outcomes measured. Fee-for-service resulted in a higher quantity of primary care services provided compared with capitation but the evidence of the impact on the quantity of secondary care services was mixed. Fee-for-service resulted in more patient visits, greater continuity of care, higher compliance with a recommended number of visits, but lower patient satisfaction with access to a physician compared with salary payment. The evidence of the impact of target payment on immunisation rates was inconclusive. CONCLUSIONS: There is some evidence to suggest that how a primary care physician is paid does affect his/her behaviour but the generalisability of these studies is unknown. Most policy changes in the area of payment systems are inadequately informed by research. Future changes to doctor payment systems need to be rigorously evaluated.     

Increasing response rates in community health surveys administered by telephone

This paper reports the effects of two methods used to increase response rates in a community health survey administered by telephone. Converting refusals resulted in an increase of 3.7% in the final response rate, while the investigation and identification of indeterminate telephone numbers increased the response rate by an additional 6.1%. Together, these methods resulted in an increase of 9.8%, from an initial response rate of 70.1% to a final lower-bound response rate of 79.9%. The use of these methods helped to reduce non-response bias at a minimal cost.     

Methodologies for assessing contextual exposure to the built environment in physical activity studies: A systematic review

Growing research has integrated Global Positioning Systems (GPS), Geographic Information Systems (GIS), and accelerometry in studying effects of built environment on physical activity outcomes. This systematic review aimed to summarize current geospatial methods of assessing contextual exposure to the built environment in these studies. Based on reviewing 79 eligible articles, methods were identified and grouped into three main categories based on similarities in their approaches as follows: domain-based (67% of studies), buffer-based (22%), and activity space-based (11%). Additionally, technical barriers and potential sources of uncertainties in each category were discussed and recommendations on methodological improvements were made.     

The prevalence and incidence of musculoskeletal symptoms among hospital physicians: a systematic review

Objective  

Physicians are exposed to a range of work-related risk factors that may result in occupational diseases. This systematic review aims at shedding light on the prevalence and incidence of musculoskeletal complaints among hospital physicians.