Background. Primary care residents are expected to provide lifestyle counseling and preventive services for patients with chronic diseases; also, physicians’ personal lifestyle practice impacts patient care. The purpose of this article is to assess healthy lifestyle behaviors and attitudes to engage in lifestyle counseling and preventive services among residents and fellows in different training levels and specialty. Methods. A cross-sectional pilot study was conducted on medical residents and fellows (n = 57). Surveys collected information on lifestyle behaviors and perceptions of lifestyle counseling and preventive services. Comparisons of study measures were made across residents’ specialty and training levels. Fisher’s exact and analysis of variance tests were used for statistical analysis. Results. There were several significant differences in perceptions of counseling and screening by specialty and training level. There were no significant differences in personal lifestyle behaviors between all resident specialties and training levels. Conclusion. Our findings suggest that there are opportunities to improve healthy lifestyle behaviors and perceptions of lifestyle counseling and preventive services among residents in different specialties and training levels. This knowledge can inform development of training programs in lifestyle and preventive medicine practice during residency and fellowship.
This study compares diagnosis, staging, and treatment of newly diagnosed breast cancer cases over a several-year period. The study design was a retrospective, multiyear comparison between new breast cancer cases diagnosed in 1995 (n = 827) and 1997 (n = 815). Cases were identified through claims data, and medical record abstraction was used to verify each case and to identify clinical staging and type of treatment. All medical records were reviewed by one physician to maximize internal reliability. Both cohorts were predominantly 40 and older, white, married, and postmenopausal. The latter cohort (1997) had a higher proportion of women aged 70 to 79 and a lower proportion of women aged 40 to 49. In both cohorts, women age 40 and older were likely to be diagnosed with breast cancer at the time of mammographic screening, while women younger than 40 were more likely to be diagnosed by clinical breast examination. In logistic regression analyses, controlling for confounding factors such as age, undergoing mammographic screening increased the likelihood of having a low cancer stage at diagnosis by more than three and a half times. Mammographic screening was statistically significantly positively associated with having eligibility for breast-conserving treatment (BCT); however, although an increase in BCT eligibility was observed, actual use of BCT did not change. Mammography leads to a lower clinical stage as well as a greater likelihood of BCT eligibility at time of breast cancer diagnosis, but may not have a substantial effect on treatment choice (lumpectomy vs. mastectomy). Between 1995 and 1997, a trend was observed toward downstaging of disease at diagnosis; further research is warranted to observe whether this trend continues over time.
Objectives: The Medicare population accounts for majority of chronic obstructive pulmonary disease (COPD) hospitalizations in United States (US). Integrated care models and Hospital Readmissions Reduction Program have raised concerns due to lack of best practices. Monitoring of healthcare utilization prior to a COPD hospitalization may identify potential predictors of admission. The objective was to examine healthcare utilization of COPD Medicare beneficiaries 3 months prior to a COPD hospitalization compared to those without. MethOds: Using Medicare Current Beneficiary Survey data set from 2006-2011, beneficiaries were diagnosed with COPD if they had a COPD hospitalization or COPD claim(s) (ICD-9-CM codes). The cohorts of COPD patients with at least one COPD hospitalization and without were followed 3 months prior to a COPD hospitalization and a randomly assigned date respectively. Cohorts were compared on healthcare utilization (physician visits, inpatient visits, emergency room visits, home health care episodes, skilled nursing facility (SNF) stays, and COPD prescription fills). Covariates assessed were patient characteristics, access to care and socioeconomic factors, comorbidities, COPD severity, and health behaviors. Results: The sample of 236 beneficiaries with COPD hospitalization and 1,546 beneficiaries without had 51.7% and 48.8% male beneficiaries respectively. There was a significant difference (p< 0.001) for those with COPD hospitalization vs. without for median (interquartile range) emergency room visits (1.
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