Specialist physicians' knowledge and beliefs about telemedicine: a comparison of users and nonusers of the technology.

Telemedicine as a technology has been available for nearly 50 years, but its diffusion has been slower than many had anticipated. Even efforts to reimburse providers for interactive video (IAV) telemedicine services have had a limited effect on rates of participation. The resulting low volume of services provided (and consequent paucity of research subjects) makes the phenomenon difficult to study. This paper, part of a larger study that also explores telemedicine utilization from the perspectives of referring primary care physicians and telemedicine system administrators, reports the results of a survey of specialist and subspecialist physicians who are users and nonusers of telemedicine. The survey examined self-assessed knowledge and beliefs about telemedicine among users and nonusers, examining also the demographic characteristics of both groups. Statistically significant differences were found in attitudes toward telemedicine between users and nonusers, but in many respects the views of the two groups were rather similar. Physicians who used telemedicine were aware of the limitations of the technology, but also recognized its potential as a means of providing consultation. Demographic differences did not explain the differences in the knowledge and beliefs of user and nonuser consultant physicians, although some of the differences may be explained by other aspects of the professional environment.

Barriers to quality care for dying patients in rural communities.

CONTEXT: Barriers to providing optimal palliative care in rural communities are not well understood. PURPOSE: To identify health care personnel's perceptions of the care provided to dying patients in rural Kansas and Colorado and to identify barriers to providing optimal care. METHODS: An anonymous self-administered survey was sent to health care personnel throughout 2 rural practice-based research networks. Targeted personnel included clinicians, nurses, medical assistants, chaplains, social workers, administrators, and ancillary staff, who worked at hospice organizations, hospitals, ambulatory clinics, public health agencies, home health agencies, and nursing homes. FINDINGS: Results from 363 completed surveys indicated that most health care personnel were satisfied with the palliative care being provided in their health care facilities (84%) and that most were comfortable helping dying patients transition from a curative to a palliative focus of care (87%). Yet, many reported that the palliative care provided could be improved and many reported that family members' avoidance of issues around dying (60%) was a barrier to providing optimal care in rural health care facilities. CONCLUSIONS: Findings suggest that health care personnel perceive they are effective at providing palliative care in their rural health care facilities, yet face barriers to providing optimal end-of-life care. Results of this study suggest that differences in training and experience may influence health care personnel's perceptions of the existing barriers. It may be important in rural areas to customize interventions to both the professional role and the site of care.

The effect of FDA approval of a generic competitor to OxyContin (oxycodone HCl controlled-release) tablets on the abuse of oxycodone.

Controversy exists concerning whether abuse of oxycodone will increase after the introduction of generic controlled-release (CR) oxycodone. We evaluated the effect of FDA approval of generic CR oxycodone on the misuse/abuse of oxycodone, hydrocodone, methadone and morphine utilizing data from eight poison control centers (PCC). PCC intentional exposure (IE) reason codes were used as measures of abuse. Opioid-specific quarterly IE rates (per 100,000 population and per 10,000 patients) were calculated for 1 year before and after approval (March 24, 2004). Changes in regression slopes (1 year before to 1 year after) and in IE rates (1 quarter before to 1 quarter after) were analyzed using Poisson regression. The regression slopes for oxycodone, methadone and morphine did not change after approval but decreased significantly for hydrocodone. None of the prescription opioids' IE rates significantly increased after approval. When changes in oxycodone's IE rates were compared to the other opioids, no statistically significant differences were found, indicating a lack of time-opioid interaction. These results did not vary when population rates or patient rates were used. PCC data indicate that approval of generic CR oxycodone was not followed by an immediate unfavorable effect on the misuse/abuse of oxycodone.