Patient pain in primary care: factors that influence physician diagnosis

BACKGROUND: The accurate recognition of patient pain is a crucial, but sometimes difficult, task in medical care. This study explored factors related to the physician's diagnosis of pain in primary care patients. METHODS: New adult patients were prospectively randomized to care by primary care providers at a university medical center clinic. Study participants were interviewed prior to the initial visit, and their level of self-reported pain was measured with the Visual Analog Pain Scale and the Medical Outcomes Study Short Form-36. The medical encounter was videotaped in its entirety and later analyzed using the Davis Observation Code to characterize physician practice style. Patient satisfaction was measured immediately after the visit. A review of the medical record was used to assess physician recognition of patient pain. RESULTS: For all patients (N = 509), as the amount of pain increased, the percentage of patients having pain diagnosed by the physician also increased. Female patients reported a greater amount of pain than male patients. When women were in severe pain, they were more likely than men to have their pain accurately recognized by their physician. The correct diagnosis of pain was not significantly related to patient satisfaction. Physician practice styles emphasizing technically oriented activities and health behavior discussions were strongly predictive of the physician diagnosing patient pain. CONCLUSIONS: The diagnosis of pain is influenced by the severity of patient pain, patient gender, and physician practice style. If the routine use of pain assessment tools is found to be effective in improving physician recognition and treatment of patients' pain, then application of these tools in patient care settings should be encouraged.     

Home care or long-term care facility: factors that influence the decision

In order to answer the research question--What factors determine if a long-term care client will be cared for at home or in a long-term care facility?--data were collected in five provinces in Canada in urban and rural sites, through focus groups with community care coordinators. A questionnaire provided information about the 89 participants and their workload. Factors are grouped under organizational, system, client, informal provider, formal provider, and case manager factors. Discussion focuses on changes needed to foster more long-term care in the home.     

Study of factors that influence the use of ambulances in Japanese prefectures

PURPOSE: The objective of this study was to clarify the factors that influence the rate of patient-carriage by ambulances in Japanese Prefectures. METHOD: The study was conducted using data on cases of patients with mild conditions carried by ambulances in Japanese prefectures in 1993, concentrating the factors that influence the rate of usage. The cases were analyzed focusing on three major types of medical emergencies (accounting for 93.4% of the total): sudden illnesses, traffic accidents and general injuries. SPSS for Windows was used for statistical analysis. RESULTS AND DISCUSSION: Data analysis by age group and type of medical emergency showed a positive correlation (r > 0.7) for the rate of cases with mild conditions carried by ambulances in all age groups (early childhood, adolescence, adult and senior) and the three major types of medical emergencies. Particularly, a strong correlation (r > 0.9) was observed with regard to patients suffering from sudden illnesses and general injuries. Multiple regression analysis showed that the rate for patients with mild cases carried by ambulances was higher in prefectures where; (1) there were more cases of administrative litigation related to individuals' rights, and (2) there were many nuclear families that tended to lack the capacity for family care. In addition, it also became evident that the rate for patients with mild injuries from traffic accidents was higher in prefectures where; (1) the rate for male-driver license holders for small- and medium-size cars was higher, and (2) the ratio of numbers of vehicles to total roadway area was higher. CONCLUSIONS: The findings suggest that factors unrelated to medical emergencies have a major influence on use of ambulance. Reevaluation of policy in order to promote appropriate utilization is necessary.     

Program factors that influence utilization of adult day care.

Health planners, policymakers, and providers urgently require methods and information that explain the factors that affect health services utilization. This information is especially critical for planning programs that are effective in maintaining the burgeoning elderly population in community care. In this study, correlation and regression analyses examined the characteristics of adult day care (ADC) centers that were associated with utilization as operationalized by demand for and actual attendance in 822 centers. Community, client population, services and activities, and structural characteristics were associated with demand per center whereas the social environment of the ADC center was not. The attendance rate was most strongly affected by services and activities and structural characteristics. The significance of the study, its limitations, and future directions for research are discussed.     

Disparities in primary care for vulnerable children: the influence of multiple risk factors

OBJECTIVES: To analyze vulnerability as a profile of multiple risk factors for poor pediatric care based on race/ethnicity, poverty status, parent education, insurance, and language. Profiles are used to examine disparities in child/adolescent health status and primary care experience. DATA SOURCES: Cross-sectional data on 19,485 children/adolescents 0-19 years of age from the 2001 California Health Interview Survey. STUDY DESIGN: Multiple logistic regression models are used to examine risk profiles in relation to health status and three aspects of primary care: access (physician and dental visit; access surety), continuity (regular source of care), and comprehensiveness (i.e., health promotion counseling). PRINCIPAL FINDINGS: About 43 percent of (or 4.4 million) children in California have two or more risk factors (RF). Controlling for age and gender, more RFs is associated with poorer health status (i.e. percent reporting "excellent/very good" health: no RFs=81 percent, 1=71 percent, 2=57 percent, 3=45 percent, 4=35 percent, 5=28 percent, all p<.001). Controlling for health status, higher risk profiles is associated with poorer primary care access and continuity, but greater comprehensiveness of care. For example, higher risk profile children are less likely to have a regular source of care: one RF (prevalence ratio [PR]=0.92, confidence interval [CI]: 0.86-0.98), two (PR=0.77, CI: 0.69-0.84), three (PR=0.55, CI: 0.46-0.65), and four or more (PR=0.31, CI: 0.22-0.44), all p<.001. CONCLUSIONS: This study demonstrates a dose-response relationship of higher risk profiles with poorer child health status, access to, and continuity of primary care. Having gained access, however, adolescents with higher risk profiles are more likely to receive health promotion counseling. Higher profiles appear to be associated with greater barriers to accessing primary care for children in "fair or poor" health, suggesting that vulnerable children who have the greatest health care needs also have the greatest difficulty obtaining primary care.     

Attitudes and factors that influence decision-making in adoption from care in Northern Ireland

This is a small-scale local study aimed at exploring the thinking and attitudes that inform or influence decision-making around proceeding to adoption. It also sought to explore or establish practitioners' views of potential tensions in this area and potential supports. It included open questions, attitudinal questions and required respondents to consider and then give qualitative responses to case studies/vignettes. Issues considered included the age of the child, the implications of contact with birth parents/families, resource implications and the impact for the child(ren) for further disruption.     

基本药物制度对江西五所基层医疗卫生机构合理用药的影响

随机抽取江西省5家基层医疗卫生机构2009-2011年6月份的处方各100张,对其进行合理用药的分析,包括:平均处方用药数、抗生素处方使用比例、抗生素处方使用种类、注射剂处方使用比例、激素处方使用比例以及药品通用名使用比例等,通过合理用药的分析,反映基层医疗卫生机构实施基本药物制度前后合理用药的现状,为完善政策提供建议.     

Measuring factors that influence the utilisation of preventive care services provided by general practitioners in Australia

Background  

Relatively little research attention has been given to the development of standardised and psychometrically sound scales for measuring influences relevant to the utilisation of health services. This study aims to describe the development, validation and internal reliability of some existing and new scales to measure factors that are likely to influence utilisation of preventive care services provided by general practitioners in Australia.     

Factors that influence the receipt of eye care

Objectives: To better understand what factors influence the receipt of eye care so that screening and education programs can be designed to promote early detection and treatment. Methods: Twenty focus groups were conducted. Analyses entailed debriefing sessions, coding, and interpreting transcribed data. Results: Attitudes about eyesight and eye exams influence the receipt of preventive eye care. Limited knowledge about certain eye diseases and conditions was reported. Participants stated that their primary care providers did not communicate information with them about eyesight nor did they conduct basic eye screenings. Conclusions: Improving provider-patient interactions and developing public health messages about eye diseases and preventive eye care can facilitate increased use of appropriate eye care services.     

Sub-standard factors in primary obstetric care

OBJECTIVE: Investigating the frequency and nature of sub-standard care factors in non-complicated pregnancies in primary obstetric care. DESIGN: Retrospective investigation of medical files. METHOD: Data concerning obstetric care in 3 midwifery practices in the Delft area (Pijnacker, Nootdorp, Den Hoorn and Schipluiden), the Netherlands, from 1989-1999 were gathered from the primary National Obstetrics Register. Of the 8362 pregnancy records, 72 were selected at random. Using a checklist containing criteria based on the Obstetrics Indication List, the Cochrane Pregnancy and Childbirth Database, and from an expert panel, the records were analysed for the frequency of occurrence of sub-standard factors in perinatal care. RESULTS: Of the 72 pregnancy records, only 1 was found to contain no sub-standard factors. On average 1.7 sub-standard factors were seen with a maximum of 7. Most frequently found were: too few check-ups during the first trimester (39%), no testing for proteinuria at the first visit (26%) and no administration of prophylactic vitamin K1 (43%). Less frequently found sub-standard care factors were: no ultrasound despite indication (11%), no referral to secondary care in the event of foetal distress (6%), no consultation with secondary care in the event of hypertension (3%), or in the case of membranes ruptured for more than 24 hours (1%). Frequently the circumstances surrounding the departure from the main checklist criteria were found to justify the action. CONCLUSION: Sub-standard care factors were demonstrated in many of the pregnancies investigated. A limited number of these factors gave reason to question whether guidelines for good quality perinatal care are being properly applied.     

An exploration of factors that influence the regular consumption of water by Irish primary school children

Background Inadequate hydration has been linked to many factors that may impact on children’s education and health. Teachers play an important role in the education and behaviour of children. Previous research has demonstrated low water intake amongst children and negative teachers’ attitudes to water in the classroom. The present study aimed to explore teachers’ knowledge about water and the perceived barriers to allowing children access to water during lesson time. Methods In‐depth interviews were conducted with 12 teachers from primary schools in the Midlands of Ireland. Interviews were continued until there was saturation of the data. Thematic analysis of the data was conducted. Results Participants had a poor knowledge of hydration requirements and the associated health benefits and effect on concentration. Low water intake amongst teachers and pupils, and barriers such as disruption to class and increased need to urinate, were reported. Teachers identified the hydration effect on learning as the education message most likely to influence the decision to allow water in the classroom. Conclusions The issues, opinions and perceived barriers raised by teachers as part of this qualitative research provide a basis for future health promotion around water.