Gordon H. DeFriese

The Effects of Having a Regular Doctor on Access to Primary Care

The authors assessed the relationship between having a regular doctor and access to care, as measured by a set of preventive and primary care utilization indicators recommended by the Institute of Medicine. The 1987 National Medical Expenditure Survey was used in the analyses (n = 30,012). The results of the regression analyses suggest that individuals with any type of regular source of care had better access than those without a regular source of care. Persons with a regular doctor had better access to primary care than those with a regular site but no regular doctor. However, the apparent advantage of having a regular doctor over a regular site disappeared when only those individuals reporting a physicians office, clinic, or health maintenance organization as their regular source of care were compared. These results suggest that policies that promote the doctor-patient relationship will increase access, although the gains may be negligible for individuals who use mainstream primary care sites (physicians office, clinic, or health maintenance organization) versus sites such as walk-in clinics or emergency rooms.

The association of urinary incontinence with poor self-rated health

OBJECTIVES: To assess whether urinary incontinence (UI) and its severity are associated with poor self‐rated health in a national sample of community‐living older adults and whether this relationship persists after controlling for confounding attributable to functional status, comorbidity, and demographic factors.

Self‐Care Practices Used by Older Men and Women to Manage Urinary Incontinence: Results from the National Follow‐up Survey on Self‐Care and Aging

OBJECTIVES: To estimate the extent to which self‐care practices are employed by older adults with urinary incontinence (UI); to determine how demographic and functional status measures are associated with self‐care practice use; and to explore the relationship between contacting a doctor and disposable pad use.

The Economic Implications of Self-Care: The Effect of Lifestyle, Functional Adaptations, and Medical Self-Care Among a National Sample of Medicare Beneficiaries

OBJECTIVES Self-care includes actions taken by individuals to promote or ensure their health, to recover from diseases or injuries, or to manage their effects. This study measured associations between self-care practices (lifestyle practices, adaptations to functional limitations, and medical self-care) and Medicare expenditures among a national sample of adults 65 years and older. METHODS Regression models of Medicare use and expenditures were estimated by using the National Survey of Self-Care and Aging and Medicare claims for 4 years following a baseline interview. RESULTS Lifestyle factors (swimming and walking) and functional adaptations (general home modifications) were associated with reductions in monthly Medicare expenditures over a 12-month follow-up period. Expenditure reductions were found over the 48-month follow-up period for participation in active sports, gardening, and medical self-care. Practices associated with increases in expenditures included smoking, physical exercise (possibly of a more strenuous nature), and specific home modifications. CONCLUSIONS Certain self-care practices appear to have significant implications for Medicare expenditures and presumptively for the health status of older adults. Such practices should be encouraged among older adults as a matter of national health policy.

Urinary Incontinence and Risk of Death among Community-Living Elderly People Results from the National Survey on Self-Care and Aging

Objectives:The authors explored whether urinary incontinence (UI) is associated with higher mortality and, if so, whether adjustment for demographics, health, and functional status diminishes the association. Methods:The Cox proportional hazards model was used with a nationally representative sample of community-living elderly people (N= 3,485). Results:In an analysis adjusted for age, gender, education, and probability sampling design, participants with mild to moderate UI (hazard ratio [HR] = 1.51; 95% confidence interval [CI] = 1.09-2.08) and severe UI (HR = 1.54; 95% CI = 1.03-2.29) experienced a higher risk of death. Adjustment for health and functional status diminished the association of UI and risk of death (mild to moderate UI, HR = 1.20, 95% CI = 0.85-1.68; severe UI, HR = 0.91, 95% CI = 0.59-1.39). Discussion:The relationship between UI and mortality in older adults can largely be understood on the basis of increased frailty in incontinent individuals.

Childhood immunization programs: an analysis of policy issues.

Immunizations have been among the most successful of preventive interventions. However, concern exists in the United States that recent epidemics of vaccine-preventable diseases and low rates of childhood immunizations may signal the existence of major underlying problems in immunization policy. Additionally, the effectiveness of national, state, and local public health programs in administering these and other preventive services to children has been called into question. This article examines the current state of childhood immunizations in this country and offers a broad range of suggestions for policy modification.

Self-Care among U.S. Elderly Recent Developments

The self-care movement is discussed, with emphasis on programs for senior citizens. Self-care is defined and several conceptual classifications of self-care activities are reviewed. Among the aspects of the contemporary self-care movement reviewed are commercialism, professional dominance, potential of self-care groups as political interest groups, and program impact evaluation issues. From an inventory containing over 2000 programs and being constructed as part of a national study of self-care activities, 25 programs with a major focus on self-care training or self-help activities for the elderly were identified. From preliminary information available on these programs, a description is provided of the range within which self-care programs for the elderly vary with respect to five characteristics: (1) program sponsorship and setting, (2) target groups, (3) methods of program implementation, (4) type and size of staff, and (5) program goals and activities. Future directions for program development and research on self-care for the elderly are suggested.

Challenge to Child Health Services Research: Report From the Committee on Pediatric Health and Health Care Quality Measures

health is critical to assuring national well-being, now and in the future. However, monitoring the status of the health of children and adolescents and understanding the role of various factors in fostering optimal health have proven difficult. Of particular importance is the influence of the availability, use, and quality of health care services, especially for those with life-threatening conditions or special health care needs. Despite the presence of multiple data sets and measures, the United States currently has no national information system that can provide timely, comprehensive, and valid and reliable indicators of health and health care quality for children and adolescents. Although progress has been made in selected areas, the country lacks a comprehensive strategy to make better use of existing resources and identify the need for new indicators and methods.

Cost-benefit and cost-effectiveness analysis for health promotion programs.

Health promotion programs have been hailed as having great potential to help solve the problem of rapidly increasing health care costs. In order to assess whether health promotion programs are “worth it,” some kind of cost-benefit or cost-effectiveness analysis must be included as part of program evaluation. This article provides a basic introduction to the concepts of cost-benefit and cost-effectiveness analysis, compares them, and presents a simple procedure for performing a basic cost-effectiveness analysis. The potential for health promotion programs to impact on the rising costs of medical care is discussed.

Prospects for childhood immunization registries in public health assessment and assurance: initial observations from the All Kids Count initiative projects.

This article offers an overview of selected evaluation findings from the initial implementation year of the Robert Wood Johnson Foundations All Kids Count childhood immunization initiative in which demonstration projects were funded to develop community-based immunization registry and follow-up systems in 14 sites throughout the United States. The basic components of these systems, the process through which these registries were developed, efforts to secure the participation of private sector providers, the prospects for system success at the community level, and the potential for these immunization programs to influence other aspects of primary health care for children are addressed.