Specialty Care (specialty + care)

Distribution by Scientific Domains


Selected Abstracts


Practice Characteristics and HMO Enrollee Satisfaction with Specialty Care: An Analysis of Patients with Glaucoma and Diabetic Retinopathy

HEALTH SERVICES RESEARCH, Issue 4 2003
Josť J. Escarce
Background. The specialist's role in caring for managed care patients is likely to grow. Thus, assessing the correlates of patient satisfaction with specialty care is essential. Objective. To examine the association between characteristics of eye care practices and satisfaction with eye care among working age patients with open-angle glaucoma (OAG) or diabetic retinopathy (DR). Subjects/Study Setting. A total of 913 working age patients with OAG or DR enrolled in six commercial managed care health plans. The patients were treated in 144 different eye care practices. Study Design. We used a patient survey to obtain information on patient characteristics and satisfaction with eye care, measured by scores on satisfaction subscales of the 18-item Patient Satisfaction Questionnaire. We used a survey of eye care practices to obtain information on practice characteristics, including provider specialties, practice organization, financial features, and utilization and quality management systems. We estimated logistic regression models to assess the association of patient and practice characteristics with high levels of patient satisfaction. Principal Findings. Treatment in a practice with a glaucoma specialist (for OAG patients) or a retina specialist (for DR patients) was associated with higher satisfaction, whereas treatment in a practice that obtained a high proportion of its revenues from capitation payments or in a group practice where providers obtained a high proportion of their incomes from bonuses was associated with lower satisfaction. Conclusions. Many eye care patients prefer to be treated by specialists with expertise in their conditions. Financial arrangement features of eye care practices also are associated with patient satisfaction with care. The most likely mechanisms underlying these associations are effects on provider behavior and satisfaction, which in turn influence patient satisfaction. Managed care plans and provider groups should aim to minimize the negative impact of managed care features on patient satisfaction. [source]


Introduction to the Geriatrics-for-Specialists Initiative: Geriatrics Specialty Care at the Tipping Point

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2010
David H. Solomon MD
No abstract is available for this article. [source]


Specialty care and education associated with greater disease-specific knowledge but not satisfaction with care for chronic hepatitis C

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 3 2009
L. A. BESTE
Summary Background, Little is known about differences among hepatitis C virus (HCV) patients managed by generalists vs. specialists with respect to patient-centred outcomes, such as disease-specific knowledge, health-related quality of life (HRQoL) and satisfaction with care. Aim, To examine selected patient-centred outcomes of HCV-related care provided in primary care, specialty care or both. Methods, A total of 629 chronic HCV patients completed a survey including an HCV knowledge assessment and validated instruments for satisfaction and HRQoL. Multivariable linear regression was used to compare outcomes between groups. Results, Adjusted total HCV knowledge score was lower among patients who did not attend specialty care (P < 0.01). Primary care and specialty patients did not differ in adjusted general HRQoL or satisfaction. Sixty percent of specialty patients underwent formal HCV education, which was associated with 5% higher knowledge score (P = 0.01). General HRQoL and patient satisfaction did not differ between primary care and specialty groups. Disease-specific knowledge and care satisfaction were independent of mental illness, substance abuse, socio-economic variables, history of antiviral treatment, formal HCV education and duration of time between last visit and survey completion. Conclusions, Primary care patients with chronic HCV have lower adjusted disease-specific knowledge than specialty patients, but no difference in general HRQoL or patient satisfaction. [source]


The psychosocial burden of childhood atopic dermatitis

DERMATOLOGIC THERAPY, Issue 2 2006
Sarah L. Chamlin
ABSTRACT:, Atopic dermatitis is an extremely common childhood disease of increasing prevalence that greatly affects the quality of life of afflicted children and of their families. The disease alters the emotional and social functioning of the affected child and their family. The complex multidimensional effects of atopic dermatitis in children and families have been described qualitatively and measured quantitatively with quality of life instruments. Emotional effects on both the child and parents are predominant. The burden of atopic dermatitis can be improved by targeting parents and caregivers with education, psychosocial support, and specialty care. [source]


Headache Triggers in the US Military

HEADACHE, Issue 5 2010
Brett J. Theeler MD
(Headache 2010;50:790-794) Background., Headaches can be triggered by a variety of factors. Military service members have a high prevalence of headache but the factors triggering headaches in military troops have not been identified. Objective., The objective of this study is to determine headache triggers in soldiers and military beneficiaries seeking specialty care for headaches. Methods., A total of 172 consecutive US Army soldiers and military dependents (civilians) evaluated at the headache clinics of 2 US Army Medical Centers completed a standardized questionnaire about their headache triggers. Results., A total of 150 (87%) patients were active-duty military members and 22 (13%) patients were civilians. In total, 77% of subjects had migraine; 89% of patients reported at least one headache trigger with a mean of 8.3 triggers per patient. A wide variety of headache triggers was seen with the most common categories being environmental factors (74%), stress (67%), consumption-related factors (60%), and fatigue-related factors (57%). The types of headache triggers identified in active-duty service members were similar to those seen in civilians. Stress-related triggers were significantly more common in soldiers. There were no significant differences in trigger types between soldiers with and without a history of head trauma. Conclusion., Headaches in military service members are triggered mostly by the same factors as in civilians with stress being the most common trigger. Knowledge of headache triggers may be useful for developing strategies that reduce headache occurrence in the military. [source]


Use of Outpatient Care in Veterans Health Administration and Medicare among Veterans Receiving Primary Care in Community-Based and Hospital Outpatient Clinics

HEALTH SERVICES RESEARCH, Issue 5p1 2010
Chuan-Fen Liu
Objective. To examine differences in use of Veterans Health Administration (VA) and Medicare outpatient services by VA primary care patients. Data Sources/Study Setting. VA administrative and Medicare claims data from 2001 to 2004. Study Design. Retrospective cohort study of outpatient service use by 8,964 community-based and 6,556 hospital-based VA primary care patients. Principal Findings. A significant proportion of VA patients used Medicare-reimbursed primary care (>30 percent) and specialty care (>60 percent), but not mental health care (3,4 percent). Community-based patients had 17 percent fewer VA primary care visits (p<.001), 9 percent more Medicare-reimbursed visits (p<.001), and 6 percent fewer total visits (p<.05) than hospital-based patients. Community-based patients had 22 percent fewer VA specialty care visits (p<.0001) and 21 percent more Medicare-reimbursed specialty care visits (p<.0001) than hospital-based patients, but no difference in total visits (p=.80). Conclusions. Medicare-eligible VA primary care patients followed over 4 consecutive years used significant primary care and specialty care outside of VA. Community-based patients offset decreased VA use with increased service use paid by Medicare, suggesting that increasing access to VA primary care via community clinics may fragment veteran care in unintended ways. Coordination of care between VA and non-VA providers and health care systems is essential to improve the quality and continuity of care. [source]


The Effects of Health Sector Market Factors and Vulnerable Group Membership on Access to Alcohol, Drug, and Mental Health Care

HEALTH SERVICES RESEARCH, Issue 3p1 2007
Susan E. Stockdale
Objective. This study adapts Andersen's Behavioral Model to determine if health sector market conditions affect vulnerable subgroups' use of alcohol, drug, and mental health services (ADM) differently than the general population, focusing specifically on community-level predisposing and enabling characteristics. Data Sources. Wave 2 data (2000,2001) from the Health Care for Communities study, supplemented with cases from wave 1 (1997,1998), were merged with area characteristics taken from Census, Area Resource File (ARF), and other data sources. Study Design. The study used four-level hierarchical logistic regression to examine access to ADM care from any provider and specialty ADM access. Interactions between community-level predisposing and enabling vulnerability characteristics with individual race/ethnicity, age, income category, and insurance type were explored. Principal Findings. Nonwhites, the poor, uninsured, and elderly had lower likelihoods of service use, but interactions between race/ethnicity, income, age and insurance status with community-level vulnerability factors were not statistically significant for any service use. For ADM specialty care, those with Medicare, Medicaid, private fully managed, and private partially managed insurance, the likelihood of utilization was higher in areas with higher HMO penetration. However, for those with other insurance or no insurance plan, the likelihood of utilization was lower in areas with higher HMO penetration. Conclusions. Community-level enabling factors explain part of the effect of disadvantaged status but, with the exception of the effect of HMO penetration on the relationship between insurance and specialty care use, do not modify any of the residual individual-level effects of disadvantage. Interventions targeting both structural and individual levels may be necessary to address the problem of health disparities. More research with longitudinal data is necessary to sort out the causal direction of social context and ADM access outcomes, and whether policy interventions to change health sector market conditions can shift ADM treatment utilization. [source]


Practice Characteristics and HMO Enrollee Satisfaction with Specialty Care: An Analysis of Patients with Glaucoma and Diabetic Retinopathy

HEALTH SERVICES RESEARCH, Issue 4 2003
Josť J. Escarce
Background. The specialist's role in caring for managed care patients is likely to grow. Thus, assessing the correlates of patient satisfaction with specialty care is essential. Objective. To examine the association between characteristics of eye care practices and satisfaction with eye care among working age patients with open-angle glaucoma (OAG) or diabetic retinopathy (DR). Subjects/Study Setting. A total of 913 working age patients with OAG or DR enrolled in six commercial managed care health plans. The patients were treated in 144 different eye care practices. Study Design. We used a patient survey to obtain information on patient characteristics and satisfaction with eye care, measured by scores on satisfaction subscales of the 18-item Patient Satisfaction Questionnaire. We used a survey of eye care practices to obtain information on practice characteristics, including provider specialties, practice organization, financial features, and utilization and quality management systems. We estimated logistic regression models to assess the association of patient and practice characteristics with high levels of patient satisfaction. Principal Findings. Treatment in a practice with a glaucoma specialist (for OAG patients) or a retina specialist (for DR patients) was associated with higher satisfaction, whereas treatment in a practice that obtained a high proportion of its revenues from capitation payments or in a group practice where providers obtained a high proportion of their incomes from bonuses was associated with lower satisfaction. Conclusions. Many eye care patients prefer to be treated by specialists with expertise in their conditions. Financial arrangement features of eye care practices also are associated with patient satisfaction with care. The most likely mechanisms underlying these associations are effects on provider behavior and satisfaction, which in turn influence patient satisfaction. Managed care plans and provider groups should aim to minimize the negative impact of managed care features on patient satisfaction. [source]


Cooperative Dementia Care Clinics: A New Model for Managing Cognitively Impaired Patients

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2006
Mary Lessig BS
Cooperative health care clinics (CHCCs), or shared medical appointments, are a healthcare innovation that can improve access and expand physicians' capacity to manage common geriatric conditions. This report describes a pilot program and working model for extending CHCCs to patients with dementia. Three cooperative dementia care clinics (CDCCs) met monthly for up to 1 year, drawing participants from a dementia clinic roster of patients and caregivers who had required continued specialty care for at least 3 months. Twenty-six of 33 eligible patient,caregiver dyads expressed interest, and 21 enrolled; five whose clinical status changed during the year withdrew and were replaced with new members. Brief introductory socialization, individualized clinical management, and an educational focus selected from problems of patients and caregivers were common to all sessions. Most participants required several types of clinical intervention and educational support. One group ended after reaching a natural termination point, and two others are ongoing at the request of participants. CDCCs can be a viable approach to increasing dementia care capacity in health systems. Formal service intervention trials to evaluate the generalizability and comparative effectiveness and economic viability of this model versus usual care are an appropriate next step. [source]


Effect of Psychiatric and Other Nonmotor Symptoms on Disability in Parkinson's Disease

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2004
Daniel Weintraub MD
Objectives: To examine the effect of depression and other nonmotor symptoms on functional ability in Parkinson's disease (PD). Design: A cross-sectional study of a convenience sample of PD patients receiving specialty care. Setting: The Parkinson's Disease Research, Education and Clinical Center at the Philadelphia Veterans Affairs Medical Center. Participants: One hundred fourteen community-dwelling patients with idiopathic PD. Measurements: The Unified Parkinson's Disease Rating Scale (UPDRS); Hoehn and Yahr Stage; Mini-Mental State Examination; Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, depression module; probes for psychotic symptoms; Hamilton Depression Rating Scale; Geriatric Depression Scale,Short Form; Apathy Scale; and Epworth Sleepiness Scale. Disability was rated using the UPDRS activity of daily living (ADL) score and the Schwab and England ADL score. Multivariate analysis determined effect of depression and other nonmotor symptoms on disability. Results: The presence of psychosis, depressive disorder, increasing depression severity, age, duration of PD, cognitive impairment, apathy, sleepiness, motor impairment, and percentage of time with dyskinesias were related to greater disability in bivariate analyses. Entering these factors into two multiple regression analyses, only the increasing severity of depression and worsening cognition were associated with greater disability using the UPDRS ADL score, accounting for 37% of the variance in disability (P<.001). These two factors plus increasing severity of PD accounted for 54% of the variance in disability using the Schwab and England ADL score (P<.001). Conclusion: Results support and extend previous findings that psychiatric and other nonmotor symptoms contribute significantly to disability in PD. Screening for nonmotor symptoms in PD is necessary to more fully explain functional limitations. Further study is required to determine whether identifying and treating these symptoms will improve function and quality of life. [source]


Primary care mental health: a new frontier for psychology

JOURNAL OF CLINICAL PSYCHOLOGY, Issue 3 2009
William B. Gunn
Abstract The medical system in this country is divided into primary care and specialty care. Mental health is for the most part a specialty service dependent on referrals, often from primary care providers. The authors propose a new model where psychologists work in collaboration with primary care medical teams. This integrated, coordinated model enables psychologists to help patients they would not otherwise see in a mental health system. Examples of patients in this category are seniors, those with somatizing disorders, and those experiencing the challenges of dealing with a chronic illness. This model also enables psychologists to provide consultation to the medical teams. In this article, the authors discuss the world of the primary care medical team and present the rationale for integration or collaboration. They describe the barriers to collaborative practices and ways to overcome these barriers. Finally, they present practical strategies that psychologists can use on a regular basis to increase their collaboration with primary care. These strategies can be used by those who work in colocated practices as well as those who work in separate locations. © 2009 Wiley Periodicals, Inc. J Clin Psychol 65:1,18, 2009. [source]


Application of Telemedicine in a Pain Clinic: The Changing Face of Medical Practice

PAIN MEDICINE, Issue 4 2000
Rouzanna Burton MS
Telemedicine systems aim to provide quality health care services to persons whose access is otherwise restricted by geography and environment. The military medical department has a unique mission to provide all medical care for the battlefields and peacekeeping missions anywhere in the world. In addition, the medical department has to ensure the health of all soldiers, family members, and retirees during peacetime. Hospital closures coupled with a decreased number of military physicians have left many health care beneficiaries without readily available specialty care. They face long waiting lists or incur high out-of-pocket expenses in order to see medical specialists. As a result of the establishment of a virtual Telepain clinic, 56,400 miles were saved in patient and clinician travel. Use of technologies in the emerging field of telemedicine has lead to the creation of numerous military and civilian medical applications such as virtual dermatology, virtual psychiatry, virtual cardiology, virtual nuclear medicine/radiology, virtual pharmacology, and in future, virtual dentistry and ophthalmology. [source]


Evaluation of a screening interview for restless legs syndrome

ACTA NEUROLOGICA SCANDINAVICA, Issue 1 2009
C. C. Bourguet
Objectives,,, We evaluated a fully structured interview for restless legs syndrome (RLS) for potential use in primary care settings and in epidemiological research. Methods,,, Seventy-four veterans were recruited at Veterans Affairs outpatient clinics. The interview was administered telephonically by trained non-clinicians (time 1) and readministered face to face (time 2). A physician conducted gold standard examinations. We calculated sensitivity, specificity and reproducibility. Results,,, Reproducibility was low (, = 0.34, P < 0.01), but was higher for interviews repeated within 1 year (, = 0.55, P < 0.01). Including those reporting ,3 symptoms as cases, sensitivity ranged from 63% (time 1) to 75% (time 2). Specificity ranged from 88% to 71%. Conclusions,,, The sensitivity and specificity reported here are lower than previously reported in specialty care. This interview for RLS might be useful for preliminary screening of patients with related complaints if followed by additional diagnostic maneuvers or might be used in observational epidemiological research. [source]