Lawrence S. Linn

Physician and Patient Satisfaction as Factors Related to the Organization of Internal Medicine Group Practices

The present study compares patient satisfaction scores with job satisfaction scores of the physicians providing their care in 16 general internal medicine teaching hospital group practices. Practice sites with more satisfied patients were also more likely to have more satisfied housestaff and faculty physicians. Additionally, higher satisfaction scores for both physician groups and patients were consistently associated with a greater percentage of patients experiencing continuity of care, lower patient no-show rates, more efficient use of ancillary staff in providing direct patient care, and more reasonable charges for a routine follow-up visit. These findings suggest that improving physician and patient satisfaction may have economic as well as psychological and social benefits.

Differences in Health Status Between Older and Younger Homeless Adults

The Institute of Medicine has placed a priority on determining the special health‐care needs of elderly homeless persons. As part of a community‐based study of 521 homeless adults in two beach communities of Los Angeles, we compared the demographic characteristics and health of older (age range, 50–78, n = 61) and younger (age range, 18–49, n = 460) homeless individuals. Compared with younger adults, older adults were more likely to be white (85% versus 61%), veterans (59% versus 27%), retired (36% versus 3%), and living in a vehicle (21% versus 8%). Older adults were more likely to report having a chronic disease (69% versus 49%), functional disabilities, no informal social contacts during the previous month (49% versus 27%), observed high blood pressure (42% versus 22%), elevated creatinine (11% versus 2%), and elevated cholesterol (57% versus 36%). Older adults were less likely to have a toothache (3% versus 30%), report psychotic symptoms (25% versus 42%), and to be illegal drug users (15% versus 55%). Although they are chronologically younger, the constellation of health and functional problems of older homeless adults resemble those of geriatric persons in the general population. We suggest that geriatricians could play a significant role in training other primary‐care providers to evaluate and treat socially isolated older homeless adults in a more comprehensive way than is currently standard in practice (e.g., interdisciplinary team care and emphasis on functional status, rehabilitative medicine, and assessment for sensory impairment).

The Effect of Screening, Sensitization, and Feedback on Notation of Depression.

Medical records of 150 medical ambulatory care patients randomly assigned to groups in which screening for depression, physician sensitization about depression, and informational feedback to physicians were systemically varied were reviewed for physician notations about depression and its treatment. Forty-two percent of the 100 patients screened with the Zung self-rating depression scale had scores outside the normal range. Chart notation about depression was effectively and appropriately increased by feedback and sensitization from 8 to 25 percent, but these procedures were less effective in increasing treatment interventions, which were noted for 12 percent of the entire sample. Physicians responded to patient information about depression presented to them in the format of a laboratory test, and such previsit screening devices may increase physician attention to psychological problems in general medical settings.

Reduction of high-risk sexual behavior among heterosexuals undergoing HIV antibody testing: A randomized clinical trial.

BACKGROUND We evaluated the effect of HIV antibody testing on sexual behavior and communication with sexual partners about AIDS risk among heterosexual adults at a clinic for sexually transmitted diseases. METHODS We randomized 186 subjects to receive either AIDS education alone (the control group) or AIDS education, an HIV antibody test, and the test results (the intervention group). These subjects were then followed up 8 weeks later. RESULTS At follow-up, mean number of sexual partners decreased, but not differently between groups. However, compared with controls, HIV antibody test intervention subjects, all of whom tested negative, questioned their most recent sexual partner more about HIV antibody status (P less than 0.01), worried more about getting AIDS (P less than 0.03), and tended to use a condom more often with their last sexual partner (P = 0.05): 40% of intervention subjects vs 20% of controls used condoms, avoided genital intercourse, or knew their last partner had a negative HIV antibody test (P less than 0.005). CONCLUSION HIV antibody testing combined with AIDS education increases concern about HIV and, at least in the short term, may promote safer sexual behaviors. Additional strategies will be necessary if behaviors risky for HIV transmission are to be further reduced.

Demographic differences in health status of homeless adults

Objective:To determine how the physical health of homeless adults varies by the demographic characteristics of age, gender, ethnicity, lifetime length of homelessness, and work status.Participants:A community-based sample of 529 homeless adults.Study design:In multivariate analyses, the authors studied the independent contributions of five demographic groups to variations in 12 physical health measures (based on self-reports from face-to-face interviews, screening physical examinations, and venous blood samples).Measurements and main results:Older persons were more likely to have a functional disability (p<0.001), chronic disease (p<0.001), and greater risk of dying (p<0.001), but less likely to abuse substances (p<0.001). Men were more likely than women to be substance users (p<0.001) and to have a greater risk of dying (p<0.001). Whites and blacks were less likely than respondents in other ethnic groups to have an abnormal blood test (p<0.001). Persons homeless longer were more likely to be substance users (p<0.001) and to have experienced trauma (p<0.001). Working for pay was not related to any of our health measures.Conclusions:Age and gender contributed most to the understanding of differences in health status among homeless adults. Since the homeless have a wide variety of physical, mental, social, and substance-abuse problems, primary care providers are in the best position to provide the broad-based care needed by such persons.

Factors Associated With Life Satisfaction Among Practicing Internists

The present study explored the relationship between satisfaction with life in general among 211 practicing internists and characteristics of their work, health, and life styles. Using a forced stepwise multiple regression analysis, 67% of the total variance in life satisfaction was accounted for by study variables. More satisfied physicians were more likely to be older, married, engaged in sexual intercourse more often, argued with or emotionally withdrew from family or friends less often, had fewer health problems, were less anxious and depressed, and experienced less job stress and more job satisfaction. Characteristics of the work setting type of work activity (teaching, research, or patient care), number of patients seen, or hours worked per week were unrelated to satisfaction with life. The findings point to the importance of studying family life, mental health, and social relations in addition to work-related variables in order to understand and assess the quality of life among physicians.

Psychological Distress among Homeless Adults

Recent studies have reported a high prevalence of mental illness among the homeless. As part of a community-based survey of 529 homeless adults, we developed and tested a model to increase our understanding of the factors related to their psychological distress. Using a previously validated and reliable scale of perceived psychological distress, we found that homeless adults were more likely to report psychological distress than the general population (80% vs. 49%). Distress levels were not associated with most demographic or homeless characteristics or general appearance. However, distress was related to unemployment, greater cigarette and alcohol use, worse physical health, fewer social supports, and perceived barriers to obtaining needed medical care. Since mental, physical, and social health are strongly related among homeless adults, alleviating distress among them may be most effectively done by implementing a broad-based health services package coupled with employment programs provided in an accessible service delivery setting.

Recognition of depression and anxiety by primary physicians

Abstract Ninety-five patients completed rating scales for anxiety and depression prior to their first visit to a primary care physician. Test scores were provided selectively to the physicians, and the medical charts were checked later for entries relating to anxiety or depression. Two thirds of the patients scored in the abnormal range on at least one scale. Physicians noted depression on charts at appropriate levels (27% of patients), but anxiety was much less frequently noted (9%). Chart notations (primarily of depression) were much more common for patients scoring high in both anxiety and depression. Informing physicians of either anxiety or depression scores did not change their rate of recognition of these problems. However, those informed of scores on both rating scales made substantially fewer chart notations.

Physician Characteristics and Attitudes Toward Legitimate Use of Psychotherapeutic Drugs

The present study found that physicians held a range of attitudes toward the appropriate use of two widely prescribed psychotherapeutic drugs, Dexedrine and Librium. It was also found that their evaluations of such drug use were more likely to be related to characteristics reflecting values, social position, or social background than characteristics reflecting medical or scientific background. The findings strongly suggested the need to investigate further the role and importance of such social factors in the prescribing habits of physicians.

Evaluation of Ambulatory Care Training by Graduates of Internal Medicine Residencies.

In 1984, 154 physicians who had completed residencies in internal medicine at 15 major teaching hospitals in 1982 evaluated their residency training in ambulatory care. A majority of the physicians would have liked more experience in practical areas related to career planning and office management, more input from subspecialties such as orthopedics and dermatology, greater knowledge about the management of psychosocial problems, and more information about exercise and nutrition. Although many physicians also wanted more time devoted to several other topics, less than 20 percent recommended spending less time on 26 of the 27 topics being evaluated. Since these recommendations are similar to those reported in evaluation studies published over the past 25 years, it appears that training programs in internal medicine have not been successful in restructuring their curricula to meet many of the needs of practicing physicians.