Determinants of prostate-specific antigen test use in prostate cancer screening by primary care physicians.

OBJECTIVE: To identify determinants of prostate-specific antigen (PSA) test use in prostate cancer screening by primary care physicians. DESIGN: Self-administered, confidential surveys were mailed to 800 Ohio primary care physicians. A second mailing to nonrespondents was sent a month later. Surveys included questions on beliefs, attitudes, knowledge, and reasons for PSA prostate cancer screening. RESULTS: The response rate of usable surveys was 51% (n=408). More than half (55%) of the respondents reported using the PSA test for screening often or always. Multiple regression analysis showed physicians' reported belief that PSA screening is the standard of care in one's community was the strongest direct predictor of use (beta=.32; P<.001). Other direct predictors of PSA test use included physician feeling about the test (beta=.28; P<.001), patient requests for the test (beta=.19; P<.001), age of patient (beta=.11; P< or =.003), and recommendation of specialty or other organizations (beta=.12; P=.001). CONCLUSIONS: Although PSA prostate cancer screening has yet to be proved definitely effective in decreasing mortality or morbidity from the disease, more than half of Ohio primary care physicians surveyed reported regular screening. The rationale for such screening seems to be multifaceted, and, thus, changes in physician behavior probably will be difficult to achieve.

The physician decision-making process in transferring nursing home patients to the hospital.

BACKGROUND: Each year more than 25% of nursing home patients are transferred to the emergency department or hospital for evaluation and treatment of infection. These transfers may have an adverse impact on the quality and cost of patient care. This study examined physician assessment and management of acute infections in the nursing home. METHODS: A cross-sectional study was conducted of all acute urinary tract infections and lower respiratory tract infections occurring from February through June 1991 in eight randomly selected urban nursing homes. The numbers of transfers to the emergency department of hospital were recorded along with identification of the clinical, psychosocial, and institutional factors that influenced the physician's decision to transfer. RESULTS: Three hundred fifty-nine patients had 258 urinary tract infections and 219 respiratory tract infections. Eighty-one (17%) of these events resulted in transfer to a hospital for evaluation (16/81) and/or admission (65/81). Less than one third (30.4%) of the events caused the patient to be examined in the nursing home by a physician before the decision to transfer to the hospital. The mean time between the staff notification of an acute event and physician response by telephone was 5.12 hours. Independent mobility (P < or = .05), a transfer to the hospital during the previous 6 months (P < or = .01), and fewer nursing home laboratory tests and treatments (P < or = .01) were all associated with hospital transfer. CONCLUSIONS: In this sample of acutely ill nursing home patients, physicians collected limited clinical data before the decision to transfer. Although some transfers may be appropriate, a reduction in the transfer rate may reduce health care costs and limit the risk of iatrogenesis, thus improving the outcome of acute illnesses occurring in the nursing home.

The health beliefs of health fair participants.

The motivations and health beliefs of adults who participate in community-based health promotion were studied through a survey of 303 adults attending five community health fairs. Subjects were predominately female (69.9%), over age 60 (66.8%), and had at least yearly contact with a family physician (85.3%). Obtaining laboratory testing services was the sole reason for attendance for 47% of participants, was thought to be of much greater importance than health educational materials also offered at the health fair, and identified as providing a sense of control over personal health care. Receiving their own normal test results was perceived as assuring a "healthy" future for 86% of participants and few used these results to support erroneous health beliefs. A theme of "positive health feedback", identified through factor analysis of survey responses, may prove useful for family physicians to incorporate into more directed and useful health promotion efforts for enhanced patient participation and satisfaction.

The value of a new family practice center patient to the academic medical center.

BACKGROUND: Family practice centers are important contributors to the financial viability of academic health centers, although they often are not the direct beneficiaries of their own labor. The greater time commitment and lower costs of most primary care creates significant financial hardships for departments of family medicine in university centers. This study describes the use of inpatient and outpatient health care services by new patients at a university family practice center. METHODS: A sample of 215 new adult enrollees at a university family practice center were examined for a 1-year period after their initial visit to the center. Total billings by the university hospital, specialty services, and the family practice center were tabulated by insurance type. RESULTS: Medicare patients generated the highest average charges (+2501 per patient per year); self-indemnity patients generated the lowest average charges (+301 per patient per year). The largest portion of health services charges was generated by the university hospital inpatient service, which was responsible for approximately 60 cents of every dollar billed to patients in this study. Conversely, the Family Medicine Department billings generated only 17% of the total charges. CONCLUSIONS: The findings of this study indicate that university-based family practice centers are significant contributors to the financial and educational base of the academic health center. If family medicine and associated primary care centers are forced to reduce their size or services because of financial difficulties, the impact will be felt by the university hospitals and by other specialty departments.

Nonverbal expressions of anxiety in physician-patient interactions.

NONVERBAL expressions of anxiety were analyzed during patient presentation of conflicted emotional topics (i.e., hidden agendas) while consulting with family medicine practitioners. It was hypothesized that underlying anxiety would be revealed in higher frequencies of specific types of nonverbal behavior. As predicted, hand-to-body self-touching occurred significantly more often during presentation of anxiety-producing topics, while frequencies of speech-illustrative gestures did not differ for type of agenda presented. Applications for these findings are discussed with reference to medical and psychotherapy encounters.

Effect of phentolamine in controlling temperature and acidosis associated with cardiopulmonary bypass.

This study assessed the effects of phentolamine on rewarming patterns and metabolic acidosis in 37 patients subjected to hypothermia during cardiopulmonary bypass for the performance of aortocoronary bypass grafting. An additional 16 patients undergoing the same surgery received no phentolamine and served as a control group. In all patients, sodium bicarbonate (44.6 mEq) was administered only when the negative base excess was 3.0 mEq/L or greater. Sixty-eight percent of the patients receiving phentolamine and 56% of the control patients exhibited a uniform rewarming pattern in which the rectal, hand, and foot temperatures increased in parallel. In 32% of the patients receiving phentolamine and in 44% of the control patients, rectal and hand temperatures increased more than foot temperature during rewarming. Analysis of base excess values in the subgroups of patients with similar rewarming patterns indicated that base deficits were significantly decreased in patients receiving phentolamine. Phentolamine administration was also associated with significantly lower blood lactate levels and sodium bicarbonate requirements, as well as improvements in overall appearance and mental status. These data suggest that the routine use of phentolamine in patients undergoing cardiopulmonary bypass may be associated with more uniform body cooling and rewarming and improved tissue perfusion.

Beyond the library walls: use of slow-scan television.

The Telecommunications Information Network (TIN) was an applied research project that evaluated the ability of slow-scan television to provide medical information on demand to health-care professionals at hospitals far from any urban area. This paper reviews the TIN project, describes its use, and discusses system advantages and disadvantages. System evaluation encompasses (1) project benefits; (2) technical barriers to implementation and utilization; (3) the replication of services and the technology utilized; and (4) cost factors.