Characteristics of Physicians with Participatory Decision-Making Styles

Kaplan, Sherrie H.

doi:10.7326/0003-4819-124-5-199603010-00007

Cited by 544 publications

(352 citation statements)

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“…Determining whether provider bias, patient or family preference, co-morbid conditions or residual socioeconomic or geographic confounders are responsible for the preponderant use of HD in black children with ESRD will require studies which address these possible confounders more precisely, and directly examine the interactions and "participatory decision making" 21 between patients and their physicians. Our cross-sectional analysis could lay the groundwork for a prospective study to examine more precisely clinical, cultural or socioeconomic factors responsible for the discrepancy in access to care for children with ESRD.…”

Section: Discussionmentioning

confidence: 99%

Racial Differences in Choice of Dialysis Modality for Children With End-stage Renal Disease

et al. 1997

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ABSTRACT. Objective. Black-white disparities in the use of specific medical and surgical services have been reported in adult populations. Such disparities are not well documented in children. We sought to determine whether racial disparities in the use of medical services exist among children with chronic illness who have similar health insurance, specifically the choice of dialysis modality for individuals with end-stage renal disease.Design. National cross-sectional study. Setting. Outpatient dialysis facilities throughout the United States.Patients and Participants. All Medicare-eligible children (age, 19 years) undergoing renal replacement therapy in 1990 in the United States, using data from the Medicare ESRD registry.Outcome Measures. The odds of receiving hemodialysis versus peritoneal dialysis according to race. Adjustment was made for differences in age, gender, cause, and duration of end-stage renal disease, income, education, and facility chracteristics using multiple logistic regression.Results. In 1990, 870 white and 368 black children received chronic (>1 year) renal replacement therapy in the United States. In bivariate analysis, blacks were two times (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.7, 2.8) more likely than whites to receive hemodialysis versus peritoneal dialysis. After controlling for other patient and facility characteristics in multivariate analysis, black children were still significantly more likely than white children to receive hemodialysis (OR, 2.4; 95% CI, 1.7, 3.5).Conclusions. Black race is strongly associated with the use of hemodialysis in children. Family, patient, or provider preferences could account for the difference in choice of therapy by race. Pediatrics 1997;99(4). URL: http://www.pediatrics.org/cgi/content/full/99/4/e6; chronic renal failure, children; racial disparities, peritoneal dialysis, health insurance.ABBREVIATIONS. ESRD, end-stage renal disease; HD, hemodialysis; PD, peritoneal dialysis; RRT, renal replacement therapy.In 1990, the Council on Ethical and Judicial Affairs of the American Medical Association called for the elimination of racial disparities in medical treatment decisions in the United States.1 They urged physicians to examine their own practices and for the profession to "increase the awareness of racial disparities in medical treatment decisions through broad discussion of the issue."1 While black-white disparities in treatment options have been previously documented in adults, particularly in nephrology, 2,3 cardiology, 4 cardiac surgery, 5 obstetrics, 1 and general internal medicine, 6 this issue has not been explored fully in populations cared for by general or subspecialty pediatricians.7 Black-white disparities in use of medical services can be confounded by differences in health insurance status making this issue difficult to examine. One population in which primary health insurance differences do not exist is in end-stage renal disease (ESRD) patients covered by Medicare insurance.Recently, lower rates in initiation of p...

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Section: Discussionmentioning

confidence: 99%

Racial Differences in Choice of Dialysis Modality for Children With End-stage Renal Disease

et al. 1997

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“…This allows them to play a more active part in the delivery of their surgical care. [1][2] However, the level of understanding that patients have of their planned surgery and its associated complications has often been underestimated. [3][4] Conventional techniques of delivering education to patients through verbal, illustrative and leaflet-based instructions may not be effective enough to adequately explain the surgical procedure and potential postoperative complications.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of three-dimensional visualization in mobile apps for patient education regarding orthognathic surgery

Pulijala

Ju³

et al. 2016

International Journal of Oral and Maxillofacial Surgery

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Abstract'Sur-face', is an interactive mobile app illustrating different orthognathic surgeries and their potential complications. This study aimed to evaluate the efficacy of Sur-face by comparing two methods of delivering patients' information regarding orthognathic surgeries and their related potential complications: a mobile app with interactive 3D animations and a voice recording containing verbal instructions only. For each method, the participants' acquired knowledge was assessed using a custom designed questionnaire. Participants of the 'app' group performed significantly better (p<0.0034) than the 'voice' group and retained more knowledge, suggesting that interactive visualizations play a key role in improving the understanding of the orthognathic surgical procedure and its associated complications. This study emphasizes the impact of 3D visualizations in delivering information regarding orthognathic surgery and highlights the advantage of delivering validated patient information through mobile apps.

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“…The number and severity of diabetes comorbidities were measured using the components of the Total Illness Burden Index directly related to diabetes, a validated scale that ranges from 0 to 100 (13,20,21). In addition, we adjusted for VA health services use with two measures: whether respondents had received Ͼ80% of their health care at that VA facility in the past year and whether they had had more than two outpatient visits at that facility in the past year.…”

Section: Study Variablesmentioning

confidence: 99%

How Well Do Patients’ Assessments of Their Diabetes Self-Management Correlate With Actual Glycemic Control and Receipt of Recommended Diabetes Services?

et al. 2003

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OBJECTIVE -Although patient diabetes self-management is a key determinant of health outcomes, there is little evidence on whether patients' own assessments of their self-management correlates with glycemic control and key aspects of high-quality diabetes care. We explored these associations in a nationwide sample of Veterans' Affairs (VA) patients with diabetes.RESEARCH DESIGN AND METHODS -We abstracted information on achieved level of glycemic control (HbA 1c ) and diabetes processes of care (receipt of HbA 1c test, eye examination, and nephropathy screen) from medical records of 1,032 diabetic patients who received care from 21 VA facilities and had answered the Diabetes Quality Improvement Program survey in 2000. The survey included sociodemographic measures and a five-item scale assessing the patients' diabetes self-management (medication use, blood glucose monitoring, diet, exercise, and foot care [␣ ϭ 0.68]). Using multivariable regression, we examined the associations of patients' reported self-management with HbA 1c level and receipt of each diabetes process of care. We adjusted for diabetes severity and comorbidities, insulin use, age, ethnicity, income, education, use of VA services, and clustering at the facility level.RESULTS -Higher patient evaluations of their diabetes self-management were significantly associated with lower HbA 1c levels (P Ͻ 0.01) and receipt of diabetes services. Those in the 95th percentile for self-management had a mean HbA 1c level of 7.3 (95% CI 6.4 -8.3), whereas those in the 5th percentile had mean levels of 8.3 (7.4 -9.2). For every 10-point increase in patients' ratings of their diabetes self-management, even after adjusting for number of outpatient visits, the odds of receiving an HbA 1c test in the past year increased by 15% (4 -27%), of receiving an eye examination increased by 16% (7-27%), and of receiving a nephropathy screen increased by 13% (2-26%).CONCLUSIONS -In this sample, patients' assessments of their diabetes self-care using a simple five-question instrument were significantly associated both with actual HbA 1c control and with receiving recommended diabetes services. These findings reinforce the usefulness of patient evaluations of their own self-management for understanding and improving glycemic control. The mechanisms by which those patients who are more actively engaged in their diabetes self-care are also more likely to receive necessary services warrant further study. Diabetes Care 26:738 -743, 2003

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Characteristics of Physicians with Participatory Decision-Making Styles

Cited by 544 publications

References 0 publications

Racial Differences in Choice of Dialysis Modality for Children With End-stage Renal Disease

Racial Differences in Choice of Dialysis Modality for Children With End-stage Renal Disease

Efficacy of three-dimensional visualization in mobile apps for patient education regarding orthognathic surgery

How Well Do Patients’ Assessments of Their Diabetes Self-Management Correlate With Actual Glycemic Control and Receipt of Recommended Diabetes Services?

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