Characteristics and prognosis of alcoholic doctors.
(9/3874)
Five medically qualified women and 36 men who were being treated for alcoholism at a London postgraduate hospital were studied. Most were middle-aged and at an advanced stage of alcoholism. They had usually started drinking heavily in the wake of well-established drug dependence or other psychiatric disorder; as students or housemen; and in the armed forces. Thirty-six doctors were followed up for a mean of 63 months. Five doctors either killed themselves or died of cirrhosis, and nine persisted in almost continuous dependent drinking, while seven completely overcame their alcohol problem and 10 had only occasional relapses. Their prealcoholic careers had ranged from repeated failure to spectacular success, but of 29 doctors alive at follow-up only eight were practising satisfactorily. (+info)
Exposure of medical personnel to methylmethacrylate vapor during percutaneous vertebroplasty.
(10/3874)
The occupational exposure to methylmethacrylate (MMA) vapor during percutaneous vertebroplasty was determined. During five vertebroplasty procedures, air-sampling pumps were attached to medical personnel. MMA vapor levels in the samples were then quantified using gas chromatography. The samples collected yielded MMA vapor levels of less than five parts per million (ppm). The MMA vapor concentrations measured were well below the recommended maximum exposure of 100 ppm over the course of an 8-hour workday. (+info)
The role of private medical practitioners and their interactions with public health services in Asian countries.
(11/3874)
This paper aims to review the role of private practitioners and their interactions with public health services in developing countries, focusing largely on the Asian region. Evidence on the distribution of health facilities, manpower, health expenditures and utilization rates shows that private practitioners are significant health care providers in many Asian countries. Limited information has been published on interactions between public and private providers despite their co-existence. Issues related to enforcement of regulations, human resources, patient referrals and disease notifications, are examined. (+info)
The relationship and tensions between vertical integrated delivery systems and horizontal specialty networks.
(12/3874)
This activity is designated for physicians, medical directors, and healthcare policy makers. GOAL: To clarify the issues involved with the integration of single-specialty networks into vertical integrated healthcare delivery systems. OBJECTIVES: 1. Recognize the advantages that single-specialty networks offer under capitated medical care. 2. Understand the self-interests and tensions involved in integrating these networks into vertical networks of primary care physicians, hospitals, and associated specialists. 3. Understand the rationale of "stacking" horizontal networks within a vertical system. (+info)
Differences in physician compensation for cardiovascular services by age, sex, and race.
(13/3874)
The purpose was to determine whether physicians receive substantially less compensation from patient groups (women, older patients, and nonwhite patients) that are reported to have low rates of utilization of cardiovascular services. Over an 18-month period we collected information on payments to physicians by 3,194 consecutive patients who underwent stress testing an 833 consecutive patients who underwent percutaneous coronary angioplasty at the Yale University Cardiology Practice. Although the charges for procedures were not related to patient characteristics, there were large and significant differences in payment to physicians based on age, sex, and race. For example, physicians who performed percutaneous transluminal coronary angioplasty received at least $2,500 from, or on behalf of, 72% of the patients 40 to 64 years old, 22% of the patients 65 to 74 years old, and 3% of the patients 75 years and older (P < 0.001); from 49% of the men and 28% of the women (P < 0.001); and 42% of the whites and 31% of the nonwhites (P < 0.001). Similar differences were observed for stress testing. These associations were largely explained by differences in insurance status. (+info)
Physicians' views on capitated payment for medical care: does familiarity foster acceptance?
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Physicians' attitudes toward capitated payment have not been quantified. We sought to assess physicians' views on capitated payment and to compare the views of those who did and did not participate in such payment. A written survey was given to 200 physicians with admitting privileges at a 600-bed Ohio hospital; 82 (41%) responded and were included in this study. Among respondents, 21 (26%) were primary care physicians, 18 (22%) were medical subspecialists, and 18 (22%) were surgeons. Fifty-eight (71%) were providers for managed care plans, and 35 (43%) participated in capitated payment arrangements. Among physicians who did not participate in capitated care, 100% believed that there was a conflict of interest in capitated payment, and 77% (23 physicians) believed that participation in plans that reduce physician income in proportion to medical expenditures is not acceptable. Among those who did participate in capitated payment contracts, 95% (41 physicians) believed these plans posed a conflict of interest, and 72% (31 physicians) said this was not acceptable (P = 0.4 and 0.66 for each comparison). There was no trend toward the opinion that capitated payment arrangements are acceptable with greater levels of experience in capitated care (P = 0.5 by Spearman test). There were trends suggesting that compared with those who were not receiving capitated payments, those who received capitated payment were 50% more likely to have never discussed capitated payment with any patient (63% versus 42%, P = 0.08), were 70% more likely to very strongly oppose the use of capitation to pay their own family's physicians (49% versus 29%, P = 0.07), and were 30% more likely to believe that it is impossible to stay in the practice of medicine without participating in capitated payment plans (84% versus 65%, P = 0.06). None of the respondents reported that they had a contractual "gag clause," but 34% (27 physicians) said they would not speak publicly about any perceived risks of capitated payments anyway. Among this sample of physicians, those who participated in existing capitated payment managed care plans had views that were as negative, or more negative, on the acceptability of capitated payment as did those of nonparticipating physicians. Many were participating in capitated payment plans in spite of these negative views because they feared that to do otherwise would force them out of medical practice. The hypotheses generated by this study must be tested in larger, national studies. (+info)
Physicians' attitudes toward managed care: assessment and potential effects on practice behaviors.
(15/3874)
This study was designed to identify the key components of physicians' attitudes toward managed care and develop a tool to assess these components. We developed a questionnaire based on physicians' reactions to managed care, as reflected in the published literature. We mailed this questionnaire to a sample of 753 community physicians in the greater Sacramento area. A factor analysis of these data (n = 315) identified five unifactorial scales, which we labeled managed care quality, need to adapt to managed care, cost-containment effectiveness of managed care, personal knowledge of managed care, and inevitability of managed care. Physicians were most negative about the quality of managed care and most in agreement about the need to adapt to it. Correlations among these five scales, while statistically significant, were modest in size, suggesting that these physicians were quite discriminating in their evaluations. In comparison with medical/surgical specialists, primary care physicians rated the quality of managed care, their knowledge of it, and the inevitability of a national transition to managed care more positively. These measures predicted the physicians' intentions to alter their medical behaviors to comply with managed care practices. (+info)
Home healthcare orders: an assessment of service satisfaction by internists, surgeons, and medical subspecialists.
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We conducted a pilot study to evaluate the satisfaction of general internists, medical subspecialists, and surgeons with the quality of home health orders generated by home health agencies. Using a mail survey, we polled 69 physician specialists at Tulane University Medical Center. The percentage of physicians satisfied with the appropriateness of services for the level and type of care, consistency of medication with that prescribed, sufficiency of data on the certification form to assess service continuation, timeliness of orders, and overall health service delivery was 94%, 92%, 69%, 52%, and 88%, respectively. Compared with medical subspecialists and surgeons, general internists were more likely to report that the data on the form were sufficient. Physicians who were satisfied with at least one of the four measures of quality for home health orders were more likely to be satisfied with the overall delivery of services by home health agencies. Our results demonstrate, for the first time, that physicians overall are satisfied with home healthcare orders. However, level of satisfaction with orders is related to the physician's specialty. Areas that physicians were less satisfied with included timeliness of orders and sufficiency of data on the form to assess service continuation. Further studies using a larger population and more specific indicators of healthcare orders quality are recommended. (+info)