Physician perceptions of primary prevention: qualitative base for the conceptual shaping of a practice intervention tool.
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BACKGROUND: A practice intervention must have its basis in an understanding of the physician and practice to secure its benefit and relevancy. We used a formative process to characterize primary care physician attitudes, needs, and practice obstacles regarding primary prevention. The characterization will provide the conceptual framework for the development of a practice tool to facilitate routine delivery of primary preventive care. METHODS: A focus group of primary care physician Opinion Leaders was audio-taped, transcribed, and qualitatively analyzed to identify emergent themes that described physicians' perceptions of prevention in daily practice. RESULTS: The conceptual worth of primary prevention, including behavioral counseling, was high, but its practice was significantly countered by the predominant clinical emphasis on and rewards for secondary care. In addition, lack of health behavior training, perceived low self-efficacy, and patient resistance to change were key deterrents to primary prevention delivery. Also, the preventive focus in primary care is not on cancer, but on predominant chronic nonmalignant conditions. CONCLUSIONS: The success of the future practice tool will be largely dependent on its ability to "fit" primary prevention into the clinical culture of diagnoses and treatment sustained by physicians, patients, and payers. The tool's message output must be formatted to facilitate physician delivery of patient-tailored behavioral counseling in an accurate, confident, and efficacious manner. Also, the tool's health behavior messages should be behavior-specific, not disease-specific, to draw on shared risk behaviors of numerous diseases and increase the likelihood of perceived salience and utility of the tool in primary care. (+info)
Physical activity among older Filipino-American women.
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Filipino women (N = 530, mean age 63 years, predominantly low income) were recruited through various community based organizations and churches in Los Angeles County. All women were randomly invited to attend a single group session with a Filipino health educator to discuss breast and cervical cancer screening or the health benefits of exercise. At 3 months after the group session, the exercise assessment tool used in the National Health and Nutrition Examination Survey III was completed by 487 women (92 percent retention rate). This paper describes the pattern of physical activity among older Filipino-American women and a physical activity intervention specifically designed for this group. (+info)
Employing persons with serious mental illness.
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Data from various national surveys find that approximately half the population with mental disorders is gainfully employed across the entire range of occupations; such persons have an employment rate of about two-thirds that of the general population. More than a third of persons with serious mental illness also work, and many hold high-status positions. Among those with schizophrenia, a diagnosis associated with high impairment, only slightly more than a fifth are at work, and 12 percent are working full time. Approximately two-thirds are enrolled in federal disability insurance programs. Our analyses indicate considerable diversity of jobs among persons with various mental disorders. Most persons with mental illness want to work, and some with even the most serious mental disorders hold jobs requiring high levels of functioning. Educational attainment is the strongest predictor of employment in high-ranking occupations among both the general population and persons with mental disorders. (+info)
Health-related quality of life measurements and studies in rheumatoid arthritis.
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BACKGROUND: Rheumatoid arthritis (RA) is a major cause of disability and impairment of health-related quality of life (HRQOL) in the United States. Increasingly, HRQOL assessments are becoming part of a package of materials reviewed by managed care providers in making formulary and reimbursement decisions. OBJECTIVE: To help managed care administrators understand how to interpret and apply the results of HRQOL assessment scales. METHODS: Several patient-reported instruments in common use in RA were reviewed, including the Health Assessment Questionnaire (HAQ), Modified HAQ, Arthritis Impact Measurement Scale, and the 36-item Short-Form Health Survey. RESULTS: These self-assessment scales help improve patient/physician communication and thus enable better treatment decision-making. The scales can also aid managed care administrators in evaluating the efficacy and the financial benefits of therapies. The HAQ was one scale that stood out as being short, easy to administer, and disease-specific for RA. CONCLUSIONS: Self-assessment reports, such as the HAQ, provide key data on disability and HRQOL from the patient's perspective. The information so gained enables the clinician to select the most cost-effective therapies and interventions that slow disease progression, maintain functional status, and improve HRQOL. (+info)
Quality of life of women with recurrent breast cancer and their family members.
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PURPOSE: Little information is available about the effects of recurrent breast cancer on the quality of life of women and their family members. The present study assessed patients' and family members' quality of life within 1 month after recurrence, and effects of multiple factors on quality-of-life scores. PATIENTS AND METHODS: Patient/family member dyads (N = 189) participated in this study. A stress-appraisal model guided selection of person factors, social/family factors, illness-related factors, appraisal factors, and quality of life, measured with psychometrically sound instruments. Quality of life was measured with both generic (Medical Outcomes Study SF-36) and cancer-specific (Functional Assessment of Cancer Therapy) scales. RESULTS: Patients reported significant impairments in physical, functional, and emotional well-being. Family members reported significant impairments in their own emotional well-being. Structural equation modeling revealed that self-efficacy, social support, and family hardiness had positive effects on quality of life, whereas symptom distress, concerns, hopelessness, and negative appraisal of illness or caregiving had detrimental effects. Study variables accounted for a sizable amount of variance in patients' and family members' physical and mental dimensions of quality of life (72% to 81%). Contrary to findings observed in studies of newly diagnosed breast cancer patients and spouses, little relationship was found between recurrent patients' and family members' quality of life. CONCLUSION: Women with recurrent breast cancer are in need of programs to assist them with the severe effects of the disease on their quality of life. Programs need to include family members to help counteract the negative effects of the recurrent disease on their mental health, and to enable them to continue as effective caregivers. (+info)
Comparing the satisfaction of low back pain patients randomized to receive medical or chiropractic care: results from the UCLA low-back pain study.
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OBJECTIVES: This study examined the difference in satisfaction between patients assigned to chiropractic vs medical care for treatment of low back pain in a managed care organization. METHODS: Satisfaction scores (on a 10-50 scale) after 4 weeks of follow-up were compared among 672 patients randomized to receive medical or chiropractic care. RESULTS: The mean satisfaction score for chiropractic patients was greater than the score for medical patients (crude difference = 5.5; 95% confidence interval = 4.5, 6.5). Self-care advice and explanation of treatment predicted satisfaction and reduced the estimated difference between chiropractic and medical patients' satisfaction. CONCLUSIONS: Communication of advice and information to patients with low back pain increases their satisfaction with providers and accounts for much of the difference between chiropractic and medical patients' satisfaction. (+info)
Auricular acupuncture, education, and smoking cessation: a randomized, sham-controlled trial.
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OBJECTIVES: This study examined the effect of acupuncture alone and in combination with education on smoking cessation and cigarette consumption. METHODS: We prospectively studied 141 adults in a quasi-factorial design using acupuncture, sham acupuncture, and education. RESULTS: All groups showed significant reductions in smoking and posttreatment cigarette consumption, with the combined acupuncture-education group showing the greatest effect from treatment. The trend continued in follow-up; however, significant differences were not maintained. Greater pack-year history (i.e. the number of years smoking multiplied by baseline number of cigarettes smoked per year, divided by 20 cigarettes per pack) negatively correlated with treatment effect. Trend analysis suggested 20 pack-years as the cutoff point for this correlation. CONCLUSIONS: Acupuncture and education, alone and in combination, significantly reduce smoking; however, combined they show a significantly greater effect, as seen in subjects with a greater pack-year history. (+info)
Acupuncture outcomes, expectations, patient-provider relationship, and the placebo effect: implications for health promotion.
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OBJECTIVES: To explore whether treatment outcomes are associated with a patient's degree of general hopefulness, expectations regarding treatment, attributions of health status, beliefs about mind-body dualism, and patient-provider relationship factors, I studied acupuncture patients' goal attainment. METHODS: Sixty-two acupuncture patients were interviewed before and after acupuncture regarding goal attainment, mind-body beliefs, hopefulness, and attributions of health status. Demographics, acupuncture treatment, and health care usage information was also collected. Acupuncturists provided 3 months of treatment. RESULTS: Patients reported treatment goal attainment from acupuncture. Their perceived outcomes were not associated with previous treatment, patient demographics, or the expected and actual numbers of needle insertion. Successful outcomes were related positively to number of different CAM treatments used in the past year but negatively to patients' expectations and the "Powerful Others" health locus of control dimension. CONCLUSIONS: Perceived acupuncture outcomes seem not to be related to placebo effects and patient expectations, but rather to client-practitioner relationship factors. (+info)