Multiple Risk Factors and the Likelihood of Patient-Physician Communication and Health Maintenance Services in Medicare Health Plans.
ABSTRACT This study examined both individual and combined effects of race, education, and health-based risk factors on health maintenance services among Medicare plan members. Data were from 110 238 elderly completing the 2006 Medicare Health Outcomes Survey. Receipt of recommended patient-physician communication and interventions for urinary incontinence, physical activity, falls, and osteoporosis was modeled as a function of risk factors. Low education decreased the odds of receiving services; poor health increased odds. Race had little effect. Evidence suggested moderation among competing effects. While clinicians target services to most at-risk elderly individuals, patients with low education experience gaps. Synergies among co-occurring risks warrant further research.
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ABSTRACT: Implicit in "any willing provider" and "freedom of choice" legislation is the assumption that ongoing provider relationships lead to better patient outcomes on average. Although previous studies have identified associations of usual source of care with medical utilization, its relationship to patient lifestyle has not been examined. To determine the effect of having a usual physician on health behaviors. Data on 3,140 adults from the 1995 Mid-Life in the US study were used to estimate logistic regressions of the effect of having a usual physician on exercise, obesity, vitamin-taking, smoking quits, substance abuse behaviors, preventive medical visits, and respondent assessments of the ability to affect one's own health and risk of heart attacks and cancer. Respondents with a usual physician were 3 times as likely to have had a preventive medical visit during the past year. Among lower-income respondents, those with usual physicians were one-half as likely to report substance abuse behaviors. Instrumenting reduced the magnitude of the former but not latter effect. No other significant differences were found. Strategies designed to foster regular patient-provider relationships may affect certain health behaviors, such as preventive care visits and substance abuse. Yet in the absence of interventions to improve the effectiveness of these relationships, they are unlikely to be a powerful policy instrument for achieving widespread improvements in patient lifestyle choices.Medical Care 07/1999; 37(6):547-55. · 2.94 Impact Factor
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ABSTRACT: We evaluated the relationship between breast and cervical cancer screening and a variety of variables across race/ethnicity groups. Using logistic regression models, we analyzed data from the 1998 National Health Interview Survey to assess the relative importance of the independent variables in predicting use of cancer screening services. Having a usual source of care was the most important predictor of cancer screening use for all race/ethnicity groups. Health insurance was associated with an increased likelihood of cancer screening. Smoking was associated with a decreased likelihood of cancer screening. Regardless of race/ethnicity, most women follow mammography and cervical cancer screening guidelines. The identification of specific factors associated with adherence to cancer screening guidelines may help inform screening campaigns.American Journal of Public Health 05/2003; 93(4):618-23. DOI:10.2105/AJPH.93.4.618 · 4.23 Impact Factor
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ABSTRACT: We examined whether patients' perceptions of their relationships with primary care practitioners (PCPs) vary by vulnerability status and assessed the extent to which gatekeeping arrangements and primary care performance moderate potential disparities. We used the nationally representative 1996-1997 Community Tracking Study Household Survey as our data source. Whites reported better patient-practitioner relationships than minorities. Requirements that patients select a PCP and obtain referral authorization neither reduced nor exacerbated racial disparities in the patient-practitioner relationship. On the other hand, access to and continuity with a PCP substantively reduced disparities, especially for the most vulnerable group. Enhancing primary care performance may reduce some of the barriers to care experienced by vulnerable populations, thereby improving patients' relationships with their PCPs.American Journal of Public Health 02/2003; 93(1):138-44. DOI:10.2105/AJPH.93.1.138 · 4.23 Impact Factor