Lifetime costs for preventive medical services: a model.

BACKGROUND: Cost effectiveness and other issues relating to preventive health services have been widely discussed, but a computer search of the literature elicited no reports in which the lifetime cost of a patient's preventive services was calculated. The purpose of our study was to calculate the total lifetime cost of preventive medical services for idealized versions of male and female patients. METHODS: We used the preventive screening recommendations of the US Preventive Services Task Force as our standard. We developed a model using idealized patients who were asymptomatic, had no risk factors, and lived healthful lifestyles. We determined the typical charges in a specified marketplace for the office visits, procedures, laboratory tests, and purchases required to comply with the screening recommendations. RESULTS: Lifetime charges ranged from $5432.60 to $7529.60 for men and from $15,307.10 to $18,525.10 for women. CONCLUSIONS: Knowledge of the lifetime costs of preventive services may influence the decisions of patients, physicians, and insurance plans when purchasing or providing these services.

Determining the costs of a required third-year family medicine clerkship in an ambulatory setting.

PURPOSE: To help elucidate the costs of clinical education in ambulatory settings by determining the costs of one ambulatory family medicine clerkship. METHOD: Prospective, ongoing, strict cost and time accountings for a required four-week, third-year family medicine clerkship were carried out from January 1995 to July 1996. Volunteer community preceptors' expenses were estimated using average family physicians' salaries as documented in the literature. RESULTS: The costs of this clerkship per student ranged from $959 when no clinical office teaching time was reimbursed to $2,713 when all clinical office teaching time was reimbursed. CONCLUSIONS: This study documents, in detail, the costs of a mandatory family medicine clerkship. Questions arise about the reimbursement of volunteer community preceptors. The blueprint developed for assessing costs can be used with modifications by other schools and clerkships.

Counseling adolescents about sexuality.

The nurturing of the adolescent patient's emerging sexuality can form the foundation for a lifelong ability to form intimate and trusting relationships. Teen pregnancy and sexually transmitted infections, the consequences of teen sexuality in crisis, impact the adolescent and our society. Psychosocial developmentally-appropriate counseling in the primary care physician's office must be part of each visit. A nonjudgmental, empathic approach is instrumental in the prevention of adolescent morbidity and mortality.

Costs of preceptors' time spent teaching during a third-year family medicine outpatient rotation.

PURPOSE: To quantify the cost of teaching a student in a family physician's office in terms of the time a preceptor spends teaching or of the possible decrease in a preceptor's productivity, as reflected in a smaller number of patients seen per day. METHOD: During July and August 1995 data were collected from 26 different preceptor-student pairs (the third-year students were attending the University of Cincinnati College of Medicine). A single research assistant was used to time the actions of the students and the preceptors and to record every activity (under one of four categories) of the preceptors that related to the students. Also recorded were the numbers of patients seen by the preceptor with and without the student and, if the preceptor was in a partnership or group practice, the number of patients seen by the preceptor's partner on the same day in the same office. RESULTS: For ten preceptors with partners, there was no significant difference between the number of patients seen by the preceptor and the number seen by a non-teaching partner. The preceptors averaged 0.17 hours listening to the students' presentations of patients, 0.51 hours waiting for the students to finish seeing a patient, 2.55 hours seeing patients with the students in the examination room, and 0.56 hours giving mini-lectures or testing the students' knowledge, for a total of 3.79 hours per day in student-related activities. CONCLUSION: Much of the 3.79 hours the preceptors spent with the students was spent seeing patients who would have been seen even if the preceptors had not been teaching. The best estimate of "extra" time spent by the preceptors would be the time spent lecturing or testing plus the time spent listening to presentations plus an estimated 20% of the time spent seeing patients with the students, a total of 1.23 hours. At $60 per hour, the cost of extra preceptor time would be $73.80 per day, or $1,254.60 per student for a typical four-week rotation.

Mentoring for medical students interested in family practice.

Formal mentoring programs have been suggested as one strategy to increase student interest in primary care. Mentoring has long been a part of the business world but has only recently become a formal part of family medicine training. This paper reviews the literature on mentoring and provides applications to family practice. Mentoring has been found to develop a deeper relationship than role modeling or preceptoring and should benefit the student and mentor. The mentor's roles and functions are varied and numerous; the mentor guides, assists, and counsels students longitudinally through their development as professionals. Mentoring is based in the present but is directed toward the future. Mentors need to have charisma, leadership and motivational skills, inspiration, competence, compassion, empathy, and willingness to share with the student. Strategies used when developing a mentoring program need to incorporate the positive qualities of mentoring while minimizing the negative components, as described in this paper. The tasks of mentoring are of less importance than the personal characteristics of the mentor. Mentors should not be involved in formally evaluating the student. Faculty development and monitoring of the relationships on a regular basis are important aspects of a successful program.

Do tobacco companies avoid proper use of warnings in magazine ads?

By law, cigarette advertisements in magazines must contain one of four surgeon general's warnings and these warnings must be rotated quarterly. This study surveyed the top 13 magazines by paid subscription in the United States that accept cigarette advertising to determine if cigarette companies are compliant with this law. All issues of these magazines published during 1990 were surveyed yielding 1329 ads. Goodness of fit chi-square was used to compare observed distributions of each warning with the expected distribution. There were no significant differences in the number of times each warning appeared over the year or in each magazine. The tobacco industry as a whole appears to follow the guidelines of the Comprehensive Smoking Education Act, though 2 of 6 companies and 8 of 32 brands appear to advertise more heavily when using certain warnings and less heavily when other warnings are utilized.

Dietary prevention and treatment of disease.

Diet is a major factor in five of the 10 leading causes of death in the United States and is a contributing factor in many other diseases and health conditions. Certain diseases can be prevented and general health can be maintained or improved if patients are willing to follow advice about nutrition. Hence, nutrition-related consideration of fiber, cholesterol, carbohydrates and energy should be integral to the management of health conditions.

Evaluation of an advertising method for a university family practice center.

Advertising by physicians has become accepted by the public and is practically mandatory in today's competitive marketplace. This study evaluated the feasibility and effectiveness of a specific method of advertising a university family practice center by using fliers targeted to nearby neighborhoods. The fliers were inexpensive handbills describing the center's location and services, distributed to 23,000 households. Six months after distribution of the fliers, a randomized survey of 100 of these households was conducted to determine the fliers' success at increasing consumers' awareness of the center's location and altering consumers' attitudes and behavior concerning using the center's services. In 27% of the households, someone recalled receiving the flier. Half of these still had the fliers in their possession. Two thirds of those who remembered it thought the flier made them consider using the center, and half had called or visited the center. The results show that this technique was effective.

Prevalence of all types of tobacco use in the state of Ohio.

Since 1962, cigarette smoking has received a tremendous amount of attention while other forms of tobacco use have not. This survey attempted to determine the prevalence of all forms of tobacco use in Ohio. A randomized statewide telephone poll of 941 persons was conducted to determine the statewide prevalence of cigarette smoking, cigar smoking, pipe smoking, chewing tobacco use and snuff use. Prevalences of each of these tobacco types are reported as related to age, sex, race and occupation. Prevalences are also reported in terms of adult users to be more comparable to other large scale surveys.

Sucralfate vs. placebo for the treatment of aphthous ulcers: a double-blinded prospective clinical trial.

Aphthous ulcers are common, painful lesions that affect the oral mucosa and for which no successful treatment has been found. Sucralfate, which acts by locally binding with the proteins at the base of an ulcer to provide a protective covering, has been suggested as a treatment for aphthous ulcers. Forty-five subjects with active aphthous ulcers were recruited into this double-blind study designed to compare treatment of aphthous ulcers using sucralfate or placebo in a powdered spray. Measures of ulcer diameter and area were recorded before and after four days of treatment and the subjects completed a daily log measuring subjective response to the treatment. Sucralfate, as used in this study, was not found to be effective in the treatment of aphthous ulcers.

Allergic vaginitis, a possibly new syndrome. A case report.

A patient with a long history of recurrent vaginal discharge had no evidence of infection. A temporal relation between the appearance of the discharge and vaginal exposure to topical spermicidal agents was determined. Examination of the vaginal discharge revealed an abundance of eosinophils, suggesting a localized intravaginal allergic reaction. This case possibly indicates a hitherto undefined clinical syndrome, allergic vaginitis.

Smokeless tobacco use. A dangerous nicotine habit.

Much attention has been focused on cigarette smoking and its health implications. Numerous campaigns have been launched to help people stop smoking or prevent them from starting. While smoking has been receiving this attention, use of smokeless tobacco has been increasing at an alarming rate. Smokeless tobacco exposes the user to all the nicotine effects of cigarette smoking. Oropharyngeal cancer and erosive effects on the oral structures are known hazards, but the long-term total-body effects have yet to be determined. Physicians need to identify patients who use smokeless tobacco so that intervention strategies can be employed. Preventive techniques, especially those aimed at children, may be the most effective means of controlling this health threat.

Marital satisfaction among military and civilian family practice residents.

Physicians have a lower divorced rate than the general population, but evidence suggests there are many potential sources of stress in medical marriages, particularly during postgraduate training. This investigation was undertaken to survey the degree of marital satisfaction among third-year family practice residents, to compare the level of marital satisfaction of military with civilian residents, and to identify variables that correlate with resident marital satisfaction. Results indicate that most residents are happily married and that marital satisfaction is no different for residents training in military programs than it is for residents in civilian programs. Correlations between marital satisfaction and indexes of potential sources of marital stress show that factors enhancing medical marriages are similar to factors enhancing marriages among other professional groups and the general public.