Jean C. Willard

Unexplained symptoms in primary care: perspectives of doctors and patients

This study evaluated unexplained symptoms in primary care from the perspective of both patients and physicians. The data were obtained from two 1998 statewide surveys, one targeting Medicaid patients and the other all primary care physicians in the state. There were 439 patients who responded (45% response rate) and 280 primary care physicians who responded (33% response rate). Half of the patients and half of the physicians were in non-metropolitan counties. Half of the patients reported unexplained symptom usually or always, and 75% of whom sought help for these symptoms. Fifty-two percent of these patients believed their physician was very concerned about their unexplained symptoms. Eighty percent of them rated their physician as providing the best possible care compared to only 49% of patients whose physician did not care about their unexplained symptoms (P=.001). Among the physicians, only 14% reported very good or excellent satisfaction with managing unexplained symptoms as compared to 44% who claimed similar satisfaction in managing psychological problems. Physicians who saw themselves as more effective in dealing with somatoform symptoms were more likely to be in solo practice (P<.005), or in the same location for at least five years (P=.04). Residence in a nonmetropolitan county did not affect patient reporting of symptoms, patient perception of physician concern about symptoms, or physician satisfaction in managing these symptoms. These results indicate the prevalence and importance of unexplained symptoms in the Medicaid population and the comfort of physicians in managing these symptoms. There is an unmet need among primary care physicians to learn how to manage patients with unexplained symptoms.

The Impact of the Iowa S-SCHIP Program on Access, Health Status, and the Family Environment

OBJECTIVES To determine the effect of the Iowa Separate State Child Health Insurance Program (S-SCHIP) on need for services, utilization and access to care, child health status, and the family environment. METHODOLOGY A longitudinal pretest-posttest panel survey was used to evaluate differences in childrens access to health care, health status, and family environment at the beginning of the program and after 1 year. Written surveys with telephone follow-up calls were used to collect the data. Pre- and postquestionnaire results for 463 children were matched and compared using the McNemar test for correlated proportions and the Wilcoxon signed rank test. Approximately 71% of families responded to both surveys. PRINCIPAL FINDINGS Similar rates of perceived need for each of 6 service areas were found after being in the program for a year as before. Unmet need was significantly reduced among those needing services: medical care (27% before, 6% after), specialty care (40% before, 13% after), dental care (30% before, 10% after), vision care (46% before, 12% after), behavioral and emotional care (42% before, 18% after), and prescription medications (21% before, 13% after). Overall health status was rated significantly better (ie, excellent: 37% before, 42% after). Ninety-five percent of families reported a reduction in family stress, and there was significantly less worry about the ability to pay for their childs health care (92% before, 57% after). The activities of fewer children were limited because of potential health care costs. CONCLUSIONS The Iowa S-SCHIP program improved access to care and the family environment for children enrolled during the first year without a change in perceived need for services.

Factors Affecting Primary Care Physician Participation in Medicare

OBJECTIVES This study investigates the levels of participation and the relative association of economic and noneconomic factors on primary care physician participation in the Medicare program. METHODS Demographic information, participation in Medicare, and attitudes toward both the Medicare program and Medicare patients were collected in a written survey mailed to half the primary care physicians in Iowa. Ordinary least squares and logistic regression analyses were conducted to determine factors associated with the percentage of Medicare patients in a practice and the acceptance of all new Medicare patients, respectively. RESULTS Two thirds of physicians were accepting all new Medicare patients, whereas 16% were accepting no new Medicare patients. Factors associated with having a higher percentage of Medicare patients in a practice were as follows: (1) a larger proportion of Medicare recipients in the county, (2) practice as a general internal medicine physician, (3) more years in practice at the current location, (4) greater enjoyment treating elderly patients, (5) less concern about having too many Medicare patients, and (6) a stronger belief that the Medicare program respects their professional judgment. Physicians less concerned about having too many Medicare patients in their practice and physicians in counties with a higher percentage of Medicare patients were significantly more likely to accept all new Medicare patients. CONCLUSIONS These results suggest that as Medicare reforms are discussed, careful consideration of the impact of these reforms on noneconomic issues is important to ensure adequate physician participation and access for elderly patients through the Medicare program.

CAHPS in practice: the Iowa demonstration.

This article evaluates the usefulness of the Consumer Assessment of Health Plan Study (CAHPS®) surveys and reports in a demonstration and evaluation with three health care purchasers in Iowa. The CAHPS survey detected significant differences between health plans in several domains of health care. Both paper- and Web-based consumer reports were developed and distributed to consumers and stakeholders. There was some agreement on the value of these reports, but areas for improvement were noted.