Effects of a faculty prepaid group practice in a pediatric primary care clinic

Medical student and resident education at a hospital-operated pediatric primary care clinic (PPCC) was threatened by chronic financial deficits and by a state mandate that all patients receiving medical care through the state Aid to Families with Dependent Children program be enrolled in a health maintenance organization (HMO). To comply with the mandate, the PPCC was reorganized in 1984 as a faculty-operated prepaid group practice independent of the hospital. The new PPCC contracted with an HMO to provide care, with reimbursement based on capitation. The PPCC continues to serve the same patient population as before the reorganization, continues its teaching activities, and no longer has financial deficits. The experience at this clinic shows that converting to a faculty prepaid group practice can be cost-effective, promote efficiency, and improve faculty-hospital relations. Such a group practice is an appropriate organization for maintaining medical education programs while providing care in a capitation payment system.     

Variations in methadone treatment practices. Results from a national study.

OBJECTIVE--To examine the extent to which outpatient methadone maintenance treatment units are engaging in treatment practices that previous research indicates are ineffective (eg, inadequate dose levels); to examine factors that may be related to variation in methadone treatment practices. DESIGN--Survey of unit directors and clinical supervisors. SETTING--The study includes units that vary in terms of ownership (public, private for-profit, or private not-for-profit) and setting (eg, hospital-based, mental health center-based, or free-standing facility). PARTICIPANTS--A national random sample of 172 units participated, for an 82% response rate; the data were weighted to ensure that they were nationally representative. MAIN OUTCOME MEASURES--Clients' awareness of and influence on doses; units' use of take-home dosages; upper limits on doses; average dose levels; unit emphasis on decreasing dosages; time when clients are encouraged to detoxify; average length of treatment. RESULTS--The data indicate that many units have treatment practices such as low average dose levels that are not effective according to the majority of previous studies. Units with higher average dose levels have longer average lengths of time in treatment. CONCLUSIONS--Steps should be taken to monitor and, if necessary, change the treatment practices of methadone units that are providing inadequate dose levels with little client input.     

Physician use of the HIV antibody test. The need for consent, counseling, confidentiality, and caution

The author, a physician at the AIDS Service of Chicago's Cook County Hospital, examines some of the potential harms to patients of indiscriminate HIV antibody testing. He maintains that physicians have a responsibility to educate themselves about the meaning, appropriate use, and adverse consequences of the test and to encourage voluntary HIV antibody testing for persons at risk. Tests should be preceded by informed consent after full disclosure of risks and benefits, accompanied by counseling regarding HIV and AIDS transmission and prevention, and followed by post-test counseling. Strict confidentiality should be maintained at every step in the procedure. Sherer cautions physicians about confirming positive results and the occurrence of false negative tests and urges counseling concerning behavioral change for all at-risk persons irrespective of test results.     

A prepaid medical plan. Cost, use, and effects in a retirement home

A model experience of a prepaid medical plan for a group of people is analyzed. No-barrier cost and physician access lead to altered use characteristics. Among these are increased physician, nurse, and nursing home use, and decreased hospital use. The overall cost is increased. Any comprehensive health-care plan that would propose comprehensive first-dollar coverage would likely encounter similar use characteristics.     

Prevalence and significance of group B Streptococcus in a large obstetric population.

Between Jan. 1 and Dec. 31, 1985, vaginal swabs were obtained for culture for group B beta-hemolytic Streptococcus (GBS) from 3078 women admitted for labour and delivery to Regina General Hospital. Seventy-one women had positive results; thus, the colonization rate was only 2.3%. The charts of the 71 women and their 73 babies were analysed. Of the 58 babies from whom swabs were obtained, 20 had GBS at one or more sites; the transmission rate was therefore 34%. Early-onset GBS disease developed in one infant. Two infants died within the first month; however, death was not directly attributable to GBS. Higher rates of preterm delivery and of low birth weight were noted among the babies of the colonized women than among the babies of all women admitted for labour and delivery in 1985. Given the low rate of GBS disease in our centre, we suggest that emphasis be placed on GBS as a possible source of obstetric complications such as preterm labour.     

Changes in methadone treatment practices: results from a national panel study, 1988-2000

Context  Results from several studies conducted in the early 1990s showed that the majority of US methadone maintenance programs did not use treatment practices that met established standards for the care of heroin users. Effective treatment for heroin users is critical given the upsurge in heroin use and the continued role of injection drug use in the human immunodeficiency virus and hepatitis C epidemics. Objectives  To examine the extent to which US methadone maintenance treatment programs have made changes in the past 12 years to provide adequate methadone doses and to identify factors associated with variation in program performance. Design, Setting, and Participants  Program directors and clinical supervisors of nationally representative methadone treatment programs that varied by ownership (for-profit, public, or private not-for-profit) and setting (eg, free-standing, hospital-based) were surveyed in 1988 (n = 172), 1990 (n = 140), 1995 (n = 116), and 2000 (n = 150). Main Outcome Measures  Percentage of patients in each treatment program receiving methadone dosages of less than 40, 60, and 80 mg/d. Results  The percentage of patients receiving methadone dosage levels less than the recommended 60 mg/d has decreased from 79.5% in 1988 to 35.5% in 2000. Results also show that programs with a greater percentage of African American patients are especially likely to dispense low dosages, while programs with Joint Commission on Accreditation of Healthcare Organizations accreditation are more likely to provide adequate methadone doses. Conclusions  Efforts to improve methadone treatment practices appear to be making progress, but many patients are still receiving substandard care.      

Breast feeding practices among families of armed forces personnel in a large cantonment

Background: There seems to be a gap in the available literature and scientific knowledge about breast-feeding practices among families of armed forces personnel in our country, which needs to be studied.     

某大学不同国籍一年级新生正畸就诊意识与自身治疗指征的初步调查

目的 了解重庆地区中国、印度、尼泊尔籍大学生的正畸就诊意识、治疗指征,探讨种族、性别、经济文化差异的影响.方法 对468名18～22岁的重庆医科大学不同国籍大一新生进行正畸就诊意识相关问卷调查,并依照牙齿健康(DHC)标准给予检查、记录,应用SAS 9.13软件行卡方检验、FISHER精确概率分析.结果 三国大学生的正畸就诊意识、就诊率(35.82%)均较低,中国的大于印度、尼泊尔的,男大于女,各收入组间差异无统计学意义.不同国籍间、性别间的治疗指征差异无统计学意义(P>0.05);DHC等级:中国的大于印度、尼泊尔,女大于男,中等收入组较高.该群体牙齿错位、深覆比例较高,且中国大于尼泊尔大于印度、女大于男.结论 重庆地区中国、印度、尼泊尔籍大学生的正畸就诊意识偏低,与人群治疗指征相关性较差,有必要强化口腔正畸知识宣教.