Relative Impact of Patient and Clinic Factors on Adherence to Primary Care Preventive Service Guidelines

Ramsey, Scott D.; Cheadle, Allen; Neighbor, William E.; Gore, Ed; Temple, Patricia; Staiger, Thomas O.; Goldberg, Harold I.

doi:10.1097/00005650-200109000-00008

Cited by 18 publications

(14 citation statements)

References 12 publications

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“…However, it is unclear to what extent provider factors contribute to the quality of care in either domain after adjusting for clustering within health systems and patient characteristics. When these adjustments are performed, the association between provider characteristics and quality of care may be reduced (12,22,23). This may be because physicians in the same practice tend to see similar patients or because physicians in different medical groups may have different access to health care resources (12,22,23).…”

Section: Discussionmentioning

confidence: 99%

“…When these adjustments are performed, the association between provider characteristics and quality of care may be reduced (12,22,23). This may be because physicians in the same practice tend to see similar patients or because physicians in different medical groups may have different access to health care resources (12,22,23). After such adjustment, provider factors such as these and provider sex may play a less prominent role (24).…”

Section: Discussionmentioning

confidence: 99%

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Does Diabetes Care Compete With the Provision of Women’s Preventive Care Services?

et al. 2005

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OBJECTIVE -Care for chronic diseases may compete with preventive health care. To test this hypothesis, we examined the association between diabetes-related processes of care and preventive care in women.RESEARCH DESIGN AND METHODS -Using data from a prospective cohort study of diabetes care in managed care settings, we reviewed the care 540 diabetic women received from 355 primary care providers within 14 provider groups from one health plan. Of the 540 women, 278 were eligible to receive mammograms and 314 were eligible to receive Pap smears. Mammography performance was measured as at least one mammogram over a 2-year period and Pap performance was measured as at least one Pap smear over a 3-year period. To assess the association between diabetes-related processes of care and preventive services, we used hierarchical logistic regression models, accounted for clustering within provider groups, and adjusted for patient age, race, income and education level, diabetes treatment and duration, and health status, as well as physician age, sex, years of practice, and specialty. Diabetes-related processes of care were defined as dilated retinal examinations, urine microalbumin/protein testing, foot examinations, lipid and HbA 1c testing, recommendations to take aspirin, and influenza vaccinations received over a 1-year period.RESULTS -In this cohort, 73% of eligible women received mammograms and 56% received Pap smears. After adjustment of models, better diabetes-related processes of care, better health status, and non-Medicaid insurance were associated with mammography performance. Better diabetes-related processes of care, younger patient age, and any visit to a gynecologist were associated with Pap performance.CONCLUSIONS -Better processes of diabetes care were associated with better women's preventive health care. Diabetes management did not compete with sex-specific screening. Diabetes Care 28:2644 -2649, 2005I n the U.S., diabetes affects Ͼ9 million women over age 20 years (1). Many of these women receive suboptimal preventive care (2). Although there are many reasons for this deficiency, one unexplored explanation is that the provision of diabetes care interferes with preventive health care services. More specifically, the large number of diabetes-related services that need to be provided during a health care visit may compete for resources, and the demands of diabetes care may decrease the time available for preventive services (3). Some studies (4,5) have suggested that diabetic women may undergo sex-specific cancer screening (i.e., mammogram and Pap smear) less frequently than nondiabetic women. Suboptimal sex-specific screening in diabetic women may have serious implications in light of the increased risk for breast cancer in diabetic women (6) and the increased risk for breast and cervical cancer in overweight women (7).The characteristics associated with the performance of mammograms and Pap smears among diabetic women have not been well studied. Also, to our knowledge, no studies have examined the associat...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Does Diabetes Care Compete With the Provision of Women’s Preventive Care Services?

et al. 2005

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“…La ubicación de la vivienda (urbano-rural) se ha relacionado a la adherencia al tamizaje, señalando que las mujeres que viven fuera de la ciudad adhieren menos (8,10,32). El acceso limitado a la atención sanitaria, debido a la poca cantidad de médicos y centros de salud existentes en estas zonas, podría ser la explicación de este hallazgo.…”

Section: Determinantes Intermediarios (Tabla Ii)unclassified

“…La presencia de seguro de salud es un factor que determina una mayor adherencia al tamizaje (6,8,11,13,19,22,31,32,(34)(35)(36). En el estudio de Cook y cols (31) dicha asociación varió según la edad, siendo mayor en mujeres menores de 45 años.…”

Section: Determinantes Intermediarios (Tabla Ii)unclassified

“…Al respecto la literatura es contradictoria. Al comparar grupos de mujeres de diferentes rangos etarios, a menor edad mayor adherencia al PAP (5,11,12,14,(18)(19)(20)(21)(22)(23)(27)(28)(29)(31)(32)(33)37,43,52), sin embargo algunas investigación señalan lo contrario (13,15,53). Se plantea que la edad es un factor que influye en la integración cultural de mujeres inmigrantes (27), siendo mejor en las mujeres jóvenes, quienes buscan integrarse al sistema de salud por temas de planificación familiar, adoptando conductas preventivas y por lo tanto mejorando la adherencia.…”

Section: Determinantes Intermediarios (Tabla Ii)unclassified

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Adherencia al tamizaje de cáncer cérvicouterino: Una mirada desde el modelo de determinantes sociales de la salud

Urrutia

Gajardo

2015

Rev. chil. obstet. ginecol.

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Financiamiento: Proyecto financiado por CONICYT. FONDECYT 11130626. RESUMENAntecedentes: Los Determinantes Sociales (DS) consideran "características del contexto social que afectan la salud, así como también los mecanismos por los cuales las condiciones sociales se traducen en impactos en salud". Las intervenciones cuyo objetivo son reducir la enfermedad serán exitosas solamente cuando consideren adecuadamente los DS de salud. Objetivo: Analizar, en base a la literatura existente, el modelo de determinantes sociales de la OMS y su aplicación a la adherencia al tamizaje de cáncer cérvi-couterino (CC). Resultados: Son variados los estudios que establecen la relación entre los determinantes estructurales e intermediarios y la adherencia al tamizaje. Si bien hay estudios contradictorios, es relevante la asociación positiva entre determinantes estructurales y mayor adherencia: un mayor nivel educacional, la presencia de empleo y un mayor ingreso familiar determinan una mayor adherencia al tamizaje. Como determinantes estructurales, son varios los factores reportados, entre los que se encuentran las características del hogar, el tiempo de permanencia, las características del sistema de salud, su disponibilidad y contacto con profesionales de la salud, factores de riesgo para CC, conocimiento acerca de la enfermedad así como también las creencias, entre otras. Conclusión: Es necesario considerar la prevención de CC desde una perspectiva mucho más amplia, con un enfoque que va mas allá de los fenómenos biomédicos que la falta de adherencia al tamizaje conlleva, sino como una problemática social que explica dicho comportamiento en salud. Se sugiere que las campañas de prevención de CC consideren el enfoque de DS.PALABRAS CLAVE: Cáncer del cuello uterino, Papanicolaou, determinantes sociales de la salud SUMMARY Background: Social Determinants consider "characteristics of the social context that affect health, as well as the mechanisms by which social conditions translate into health impacts". Interventions aimed at reducing diseases will be successful only when properly considered the social determinants of health. Objective: Analyze, based on the existing literature, WHO's Social Determinants of health model and its application to cervical cancer (CC) screening adherence. Results: There are many studies that establish the relationship between structural and intermediate determinants and adherence to screening. Even though there are contradictory studies, it is important the positive association between structural determinants and greater adherence: a higher education, employment and the presence of increased house holding come determine a greater adherence to screening. As structural determinants, several factors are reported, including house hold characteristics, residence time, characteristics of the health system, availability and contact with health professionals, risk factors for cervical cancer, knowledge and beliefs of the disease,

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Screening for Proteinuria in US Adults

Boulware

Jaar²,

Tarver-Carr

et al. 2003

JAMA

325

272

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Context Chronic kidney disease is a growing public health problem. Screening for early identification could improve health but could also lead to unnecessary harms and excess costs.Objective To assess the value of periodic, population-based dipstick screening for early detection of urine protein in adults with neither hypertension nor diabetes and in adults with hypertension. Design, Setting, and PopulationCost-effectiveness analysis using a Markov decision analytic model to compare a strategy of annual screening with no screening (usual care) for proteinuria at age 50 years followed by treatment with an angiotensinconverting enzyme (ACE) inhibitor or an angiotensin II-receptor blocker (ARB).Main Outcome Measure Cost per quality-adjusted life-year (QALY). ResultsFor persons with neither hypertension nor diabetes, the cost-effectiveness ratio for screening vs no screening (usual care) was unfavorable ($282818 per QALY; incremental cost of $616 and a gain of 0.0022 QALYs per person). However, screening such persons beginning at age 60 years yielded a more favorable ratio ($53372 per QALY). For persons with hypertension, the ratio was highly favorable ($18621 per QALY; incremental cost of $476 and a gain of 0.03 QALYs per person). Costeffectiveness was mediated by both chronic kidney disease progression and death prevention benefits of ACE inhibitor and ARB therapy. Influential parameters that might make screening for the general population more cost-effective include a greater incidence of proteinuria, age at screening

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Relative Impact of Patient and Clinic Factors on Adherence to Primary Care Preventive Service Guidelines

Abstract: Patient characteristics were much less important than the clinic for predicting whether patients received primary care preventive services. Our results suggest that case mix adjustment is unlikely to explain away discrepancies in performance between clinics or provider groups.

Cited by 18 publications

References 12 publications

Does Diabetes Care Compete With the Provision of Women’s Preventive Care Services?

Does Diabetes Care Compete With the Provision of Women’s Preventive Care Services?

Adherencia al tamizaje de cáncer cérvicouterino: Una mirada desde el modelo de determinantes sociales de la salud

Screening for Proteinuria in US Adults

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