No abstract

OBJECTIVES: This study examined the impact of duration of physician-patient ties on the processes and costs of medical care. METHODS: The analyses used a nationally representative sample of Americans 65 years old or older who participated in the Medicare Current Beneficiary Survey in 1991 and had a usual source of care. RESULTS: Older Americans have long-standing ties with their physicians; among those with a usual source of care, 35.8% had ties enduring 10 years or more. Longer ties were associated with a decreased likelihood of hospitalization and lower costs. Compared with patients with a tie of 1 year or less, patients with ties of 10 years or more incurred $316.78 less in Part B Medicare costs, after adjustment for key demographic and health characteristics. However, substantial impacts on the use of selected preventive care services and the adoption of certain healthy behaviors were not observed. CONCLUSIONS: This preliminary study suggests that long-standing physician-patient ties foster less expensive, less intensive medical care. Further studies are needed to confirm these findings and to understand how duration of tie influences the processes and outcomes of care.

Buprenorphine is an effective long-term opioid agonist treatment. As the only pharmacological treatment for opioid dependence readily available in office-based settings, buprenorphine may facilitate a historic shift in addiction treatment from treatment facilities to general medical practices. Although many patients have benefited from the availability of buprenorphine in the United States, almost half of current prescribers are addiction specialists suggesting that buprenorphine treatment has not yet fully penetrated general practice settings. We examined factors affecting willingness to offer buprenorphine treatment among physicians with different levels of prescribing experience. Based on their prescribing practices, physicians were classified as experienced, novice, or as a nonprescriber and asked to assess the extent to which a list of factors impacted their prescription of buprenorphine. Several factors affected willingness to prescribe buprenorphine for all physicians: staff training; access to counseling and alternate treatment; visit time; buprenorphine availability; and pain medications concerns. Compared with other physicians, experienced prescribers were less concerned about induction logistics and access to expert consultation, clinical guidelines, and mental health services. They were more concerned with reimbursement. These data provide important NIH Public Access

The body of literature exploring neighborhood effects on health has increased rapidly in recent years, yet a number of methodological concerns remain, including preferred methods for identification and delineation of study neighborhoods. In research combining census or other publicly available data with surveys of residents and/or street-level observations, questions regarding neighborhood definition take on added significance. Neighborhoods must be identified and delineated in such a way as to optimize quality and availability of data from each of these sources. IMPACT, a multi-level study examining associations between features of the urban environment and mental health, drug use, and sexual behavior, utilized a multi-step neighborhood definition process including development of census block group maps, review of land use and census tract data, and field visits and observation in each of the targeted communities. Field observations were guided by a pre-identified list of environmental features focused on the potential for recruitment (e.g. pedestrian volume); characteristics commonly used to define neighborhood boundaries (e.g. obstructions to pedestrian traffic, changes in land use), and characteristics that have been associated in the literature with health behaviors and health outcomes (such as housing type, maintenance and use of open spaces). This process, implemented in February through July 2005, proved feasible and offered the opportunity to identify neighborhoods appropriate to study objectives and to collect descriptive information that can be used as a context for understanding study results.

Within the cohort of women aged 75 and older, more advanced age and impaired functional status both substantially reduce the likelihood of mammography use. The extent to which this reflects patients' informed decisions, physicians' judgments, or other factors remains to be explored.