Family medicine faculty development fellowships and the medically underserved.

OBJECTIVE: This study measured the prevalence of service in federally designated medically underserved communities (FD-MUC) by Title VII-funded, full-time faculty development fellowship alumni. METHODS: A two-stage survey of alumni of full-time, family medicine faculty development fellowships was completed. Alumni were dichotomized as serving in an FD-MUC or not. RESULTS: Of the 105 fellowship alumni identified, 81% (n = 85) responded; 42% (n = 36) were serving in an FD-MUC. Of alumni serving in an FD-MUC, the mean full-time equivalent service time was 73%. Of the demographic variables measured, only race was significantly associated with FD-MUC service, and minorities were more likely to practice in an FD-MUC. Respondents serving in FD-MUCs were more satisfied with their relationships with nonphysician health professionals, salary and income, and their role in making organizational and administrative decisions than those not serving in FD-MUCs. CONCLUSIONS: Title VII has the broad policy objective of increasing access to medical care by improving the supply and distribution of physicians and recruitment of minority health professionals. Alumni of faculty development programs have a high service rate in FD-MUCs, and minority alumni are significantly more likely to practice in these sites.

Integrating prevention education into the medical school curriculum: the role of departments of family medicine.

Departments of family medicine--including departments of family and community medicine, departments of family and preventive medicine, and departments of family practice-at U.S. medical schools regularly participate in teaching prevention principles to students, using a variety of formats and methods. Required clinical experiences (i.e., clerkships and preceptorships), required nonclinical courses, and electives frequently include prevention content. Collaborative interdisciplinary clerkships, interdisciplinary nonclinical courses, and courses directed by other departments also enable family medicine faculty to teach prevention principles. This article describes examples of innovative educational programs in which family medicine faculty teach prevention content to medical students. Directions for future educational efforts by family medicine faculty in the prevention area are proposed.

Retention of family medicine faculty development fellows in academic medicine.

OBJECTIVE: This study measured the retention of family medicine faculty development fellows in academic medicine. METHODS: Surveys were sent, in two stages, to 1) fellowship program directors and 2) fellows. These surveys were about full-time faculty development fellowships with new or continued Title VII funding during the interval of 1993-1996. Retention as faculty was the primary outcome. Likelihood of leaving academics and service in a federally designated medically underserved area were secondary outcomes. RESULTS: The fellowship program directors survey produced an 88% response rate and identified 105 alumni. The survey of fellows yielded a response rate of 73% (n = 77). The retention rate of these newly graduated family medicine fellows in academic positions was 75% (n = 58). A total of 37% (n = 21) of alumni in full- and part-time teaching positions reported being likely to leave their current position within the next 2 years. CONCLUSIONS: Retention rates of newly graduated family medicine fellows in academic positions are similar to rates reported in the 1980s. This group anticipates a high job turnover within the next 2 years.

Linking claims and cancer registry data: is it worth the effort?

Insurance claims and cancer registries represent different sources of data, each with advantages and limitations insofar as describing severity of illness, cost, utilization, and outcome of care for cancer patients. Although registries typically are able to identify stage of disease and initial course of treatment, claims-based data include more detailed information on the cost and utilization of medical-care services. Moreover, claims data can provide critical information about the use and location of medical services prior to diagnosis of cancer. The purpose of this paper is to argue the advantages of merging claims with registry data by considering evidence and insights from the literature. We discuss the advantages and disadvantages of claims data, describe studies that compare claims and registry data, and highlight the advantages of linking both sources of data. The latter is accomplished by considering a major advantage of each source of data. Registry data contain useful measures of severity of illness (cancer stage, tumor size, and sites of metastasis), whereas claims data include a detailed history of the cost of medical service.

Can market-based solutions work for all of Medicare? Barriers to reform in the Medicare population residing in health professional shortage areas.

The proportion of the Medicare-eligible population living in health professional shortage areas (HPSAs), their demographics, and three health status indicators were examined in relationship to market-based reform proposals. Medicare-eligible residents of Georgia and Kentucky were classified as living in an HPSA (n = 154,812) or non-HPSA (n = 556,602). Chi-squares were computed for demographic variables and health status indicators. A Mantel-Haenszel summary chi-square was computed after stratification of health status indicators by poverty level. Elderly residents of HPSAs accounted for 22% of the study population. Significant differences in all demographic variables except sex were detected. HPSA residents were more likely to have a mobility limitation, self-care limitation, or both a mobility and self-care limitation. Elderly residents in HPSAs are significantly more likely to have poorer health status and mobility limitations. Physician supply in HPSAs may be inadequate to support market-based reforms.

Streptococcal diagnostic testing and antibiotics prescribed for pediatric tonsillopharyngitis.

BACKGROUND: This study examined a 1-year cross-sectional sample of Kentucky Medicaid claims for the use of streptococcal diagnostic tests for pediatric tonsillopharyngitis and the empiric use of antibiotics. METHODS: Subjects were individuals older than 3 and younger than 18 years old seen in an ambulatory setting for tonsillopharyngitis; 3478 individuals accounted for the 5067 separate outpatient and emergency room encounters for pediatric tonsillopharyngitis; 849 encounters coded as streptococcal sore throat were also examined. RESULTS: Diagnostic tests for group A streptococcal tonsillopharyngitis were performed in only 22% (n = 1130) of the tonsillopharyngitis encounters and 36% (n = 306) of the streptococcal sore throat encounters. Urban physicians were more likely than rural physicians to use a diagnostic test (P = 0.0001). Emergency room encounters and outpatient encounters were not significantly different in the likelihood of having a diagnostic test (P = 0.16). In encounters for tonsillopharyngitis antibiotics were prescribed in 72% of the total encounters and in 73% of the encounters without a diagnostic streptococcal test. In encounters for streptococcal sore throat, antibiotics were prescribed for 68% of the total encounters and 69% of the encounters without a diagnostic streptococcal test. CONCLUSIONS: Current practices in the Kentucky Medicaid program do not follow the American Academy of Pediatrics guidelines for streptococcal tonsillopharyngitis.

Is health status related to residence in medically underserved areas? Evidence and implications for policy.

This study sought to compare the health status of adult residents of medically underserved areas (MUAs) with adult residents of nonshortage areas (non-MUAs). A random digit dialing telephone survey was used. Respondents were subsequently classified by their county of residence as residing in an MUA or non-MUA. A sample of 421 adults (aged 18 years or older) residing in Kentucky during 1993 were included in the analysis. Health status was measured by the Medical Outcomes Study 20-item Short-Form Health Survey's (SF-20) six subscales. After controlling in the multiple regression for demographic variables there were no significant differences between residents of MUAs and non-MUAs for the physical functioning, role functioning, general mental health, self-perception of health, or pain subscales. The social functioning subscale was significantly related to the residence in an MUA. The demographic variable "education" was a consistent predictor of each of the health status subscales. Excepting the social functioning subscale, residents of MUAs do not have significant differences in health status when compared to residents of non-MUAs. Future policy may need to focus on other health services shortage area designators that are more highly associated with the health status of residents. Consideration should be given to including the education demographics of areas or populations in health services shortage designation criteria.

A comparison of health status between rural and urban adults.

The objective of the study was to examine and compare health status between rural and urban adults. The data are from a 1993 statewide probability-based telephone survey of adult Kentuckians (n = 662). Metropolitan Statistical Area (MSA) residents (n = 264) and nonMSA residents (n = 398) were compared using the Medical Outcomes Study, Short Form Health Survey (SF-20). Self-perceived urban (n = 406) and rural (n = 256) residents were also compared. Additional analyses were stratified by the age categories of 18-44, 45-64, and > or = 65 years of age. Few differences in health status existed between rural and urban adults. However, rural elders (> or = 65 years) had significantly poorer health status than urban elders. After controlling for demographic variables in multiple regressions, rural elders had significantly poorer functioning (all p < .05) than urban elders as measured by the SF-20 subscales of a) physical functioning, b) role functioning, c) social functioning, d) general mental health, and e) general health perceptions. No differences between rural and urban residents were noted for the pain subscale. Although the health status of rural and urban adults is generally similar, the rural elderly have significantly worse health status than their urban counterparts.

The relationship of health professional shortage areas to health status. Implications for health manpower policy.

OBJECTIVE: To compare the health status of adult residents of health professional shortage areas (HPSAs) with adult residents of non-HPSAs. DESIGN: A random-digit dialing telephone survey. Respondents were subsequently classified by their county of residence as residing in an HPSA or non-HPSA. PARTICIPANTS: A sample of 470 adults (18 years or older) living in Kentucky. MAIN OUTCOME MEASURES: Health status was measured by the Medical Outcomes Study 20-Item Short-Form Health Survey's six subscales. RESULTS: Controlling for demographic variables in the multiple regression analysis, there were significant differences between HPSAs and non-HPSAs for the social, mental health, and pain subscales. An interaction between age and HPSAs in relation to health status was observed for the physical, social, mental health, health perception, and pain subscales. After stratification by age (18 to 44 years, 45 to 64 years, or 65 years or older), HPSA-designated areas were associated with poorer health status in all but the youngest age strata. Elders in HPSAs had the poorest health status. CONCLUSIONS: Health professional shortage areas are associated with poorer health status in the older segments of the adult population. Future policy may need to focus on increasing access not only to primary care services but also to specific types of services that may promote better health status of elderly residents of HPSAs.

Progestin receptors from tissues either exhibiting or lacking estrogen response mechanisms. Comparison of conventional and high-performance liquid chromatography methodology.

Evidence from a variety of target organs has shown that progesterone receptor (PR) is induced by estrogen receptor (ER) in normal and neoplastic tissues. However, approximately 12% of the normal human uterine samples exhibit only PR with no measurable ER, suggesting the expression of both inducible and constitutive receptor isoforms. We investigated several molecular properties of PR from tissues either exhibiting or lacking ER. All studies were conducted in potassium phosphate buffer containing 10 mM sodium molybdate with a synthetic progestin, [3H]R5020 as the ligand. Radioinert R5020 was used as competitor to assess nonspecific association. Competition analysis showed that PR from both sources exhibited similar ligand specificities and affinities. Relative affinities were ORG 2058 greater than R5020 greater than medroxy-progesterone acetate greater than progesterone much greater than testosterone (Kd values ranged from 10(-9) to 10(-10) M; testosterone showed no specific competition). We utilized high-performance liquid chromatography in the size-exclusion (HPSEC) and ion-exchange (HPIEC) modes to probe the size and ionic properties of PR. HPSEC profiles showed that the PR isoform from both sources was eluted as a single, sharp peak greater than 75 A. HPIEC elution profiles indicated no differences in the surface ionic properties in that PR from both tissue types eluted with ca. 100 mM phosphate. These experiments show no difference between the inducible and the putative constitutive form of PR. Thus, some PR species may not require estrogen for their formation.