Assessments of managed care organizations in the Greater Baton Rouge area by physicians and physicians' office managers.

Health care quality assessment under managed care organizations is usually derived from two sources: (1) consumer satisfaction surveys, and (2) The Health Plan Employer Data Information Set reports. There is little published data regarding physicians' critiques. This study surveyed physicians and office managers as to the quality of healthcare under 10 managed care organizations in the Greater Baton Rouge area. Performance indicators in the physician questionnaire focused on personal satisfaction, perception of patient satisfaction, and mental health coverage. The office managers' checklist included payment and certification issues, telephone time spent gaining certification, level of knowledge among plan enrollees of their benefits, appeal process, and adequacy of reimbursement. Means were calculated for each performance indicator and managed care organizations were ranked. Tukey-Kramer's post-hoc multiple comparisons test was used to confirm rank order validity. Significant differences were found among companies. Significant rank-order agreement by both physicians and office managers was evident. The usefulness of such surveys and performing them annually is discussed.

Perceptions and attitudes toward organ procurement and transplantation: a medical community survey analysis.

The practitioner who recognizes and facilitates donor referral plays a pivotal role in the donor process. Mechanisms that help to identify and resolve issues for these practitioners are crucial. To identify barriers and issues that the community perceives as important, a survey to elicit the perceptions, attitudes, and ethical values of its respondents-specifically with regard to the donor process-was commissioned. The main components of the instrument included perceived problems, attitudes and ethical values, knowledge of consent process, medical and legal knowledge of brain death, organ procurement organization problems and suggestions for improvement, future education recommendations, and socio-demographic characteristics of the respondent. The survey confirmed issues of concern and brought to surface issues that have an underlying negative influence on the donor process.

Louisiana neurosurgeons and the organ procurement shortage: a comparative analysis of perceptions, attitudes, and ethical values.

The supply of transplantable organs continues to fall behind demand. Knowledge of the perceptions, attitudes, and ethical values held by health care workers involved in the process is critical. This is particularly true of neurosurgeons because of their pivotal role in the procurement process. Survey data are used to compare neurosurgeons (n = 59) with emergency physicians (n = 125), critical care nurses (n = 267), and other physicians (n = 445). Analysis revealed that attitudes among those health care workers regularly involved with organ procurement and transplantation--neurosurgeons, emergency physicians and critical care nurses--tend to be similar. While there is general satisfaction and confidence in Louisiana's organ procurement and transplantation system, there are concerns. Perceived problems cited were: lack of support by the medical and lay community, high costs, potential profiteering, and conflict of interest. Other contentious issues include: organ request strategies, incentives for organ donations, racial bias, and presumed consent legislation. Debate and professional education in these areas are indicated.

A self-image profile analysis of spina bifida adolescents in Louisiana.

With the growing number of spina bifida children reaching adolescence and adulthood and the national thrust toward "mainstreaming" disabled children, there is increasing need for research on the problems of social and psychological adaptation. The goal of this study was to obtain a normed, psychosocial self-image profile of Louisiana's adolescent spina bifida population. Offer's self-image scale was administered to a sample of 50 Louisiana spina bifida adolescents, ranging from 11 to 21 years of age. The sample's self-image profile was statistically compared to a normal profile, as a group, by age, by gender, and by level of vertebral disability. With the exception of the sexuality dimension, which was significantly below normal, especially in females, 10 of the 11 dimensions were statistically within normal limits. Correlations of self-image subscales with gender, age, and disability revealed several curious and potentially important findings.

The right to die: public perceptions and attitudes in metropolitan Baton Rouge.

The right to die movement is gaining momentum. Forty states, including Louisiana, have passed living will statues. Survey results indicate that relatively few people have accurate knowledge of the living will concept, and less than 4% have actually executed a living will. When informed of their rights, nearly two thirds of the sample would consider executing a living will or appointing a health care agent. Specific kinds of medical procedures desired in hypothetical terminal care situations vary considerably, and vary also according to certain socioeconomic characteristics. situations vary considerably, and vary also according to certain socioeconomic characteristics.

An uncontrolled evaluation of inpatient and outpatient cognitive-behavior therapy for bulimia nervosa.

Inpatient (n = 27) and outpatient (n = 22) cognitive-behavior therapy programs for bulimia nervosa were evaluated in an uncontrolled experiment. Both treatment conditions included exposure with response prevention and cognitive restructuring. Inpatient treatment had a mean length of stay of 5 weeks. Outpatient treatment lasted 15 weeks. Both groups were followed after the end of treatment. The results showed that both programs were effective in reducing problems associated with bulimia nervosa. The inpatient program led to very rapid progress, whereas the outpatient program led to more gradual improvement. There was, however, a trend toward relapse for inpatients. Other psychological disturbances, (e.g., depression) were improved after inpatient, but not outpatient, treatment. These data were discussed in terms of their implications for treatment planning for cases of bulimia nervosa.