Scott Kellerman

Physician response to surveys. A review of the literature.

OBJECTIVE Physician-specific surveys are a frequently used tool in health services research, but attempts at ensuring adequate response rates are rarely reported. We reviewed literature of survey methodology specific to physician surveys and report those found to be most effective. DATA SOURCES Studies were identified by searching MEDLINE and PSYCHInfo from 1967 through February 1999. We included all English-language studies that randomized physician survey respondents to an experimental or control group. The authors independently extracted data from 24 studies examining survey methodology of physician-specific surveys. We included Mantel-Haenszel chi-squares comparing treatment groups, if present. If not, these were calculated from study data. RESULTS Pre-notification of survey recipients, personalizing the survey mailout package, and nonmonetary incentives were not associated with increased response rates. Monetary incentives, the use of stamps on both outgoing and return envelopes, and short questionnaires did increase response rates. Few differences were reported in response rates of phone surveys compared with mail surveys and between the demographics and practice characteristics of early survey respondents and late respondents. CONCLUSIONS We report some simple approaches that may significantly increase response rates of mail surveys. Surprisingly, the response rates of mail surveys of physicians compared favorably with those from telephone and personal interview surveys. Nonresponse bias may be of less concern in physician surveys than in surveys of the general public. Future research steps include specifically testing the more compelling results to allow for better control of confounders.

Prevalence of Chronic Hepatitis B and Incidence of Acute Hepatitis B Infection in Human Immunodeficiency Virus–Infected Subjects

We determined incidence and risk factors for acute and chronic hepatitis B virus (HBV) infection and HBV vaccination rates among human immunodeficiency virus (HIV)-infected subjects from the Adult/Adolescent Spectrum of HIV Disease Project, during 1998-2001. Among 16,248 HIV-infected patients receiving care, the incidence of acute HBV was 12.2 cases/1000 person-years (316 cases), was higher among black subjects (rate ratio [RR], 1.4; 95% confidence interval [CI], 1.0-2.0), subjects with alcoholism (RR, 1.7; 95% CI, 1.2-2.3), subjects who had recently injected drugs (RR, 1.6; 95% CI, 1.1-2.4), and subjects with a history of AIDS-defining conditions (RR, 1.5; 95% CI, 1.2-1.9) and was lower in those taking either antiretroviral therapy (ART) with lamivudine (RR, 0.5; 95% CI, 0.4-0.6), ART without lamivudine (RR, 0.5; 95% CI, 0.3-0.7), or >/=1 dose of HBV vaccine (14% of subjects) (RR, 0.6; 95% CI, 0.4-0.9). Prevalence of chronic HBV was 7.6% among unvaccinated subjects. HBV rates in this population were much higher than those in the general population, and vaccination levels were low. HBV remains an important cause of comorbidity in HIV-infected persons, but ART and vaccination are associated with decreased disease.

HIV testing within at-risk populations in the United States and the reasons for seeking or avoiding HIV testing.

Objectives: We determined proportions of high‐risk persons tested for HIV, the reasons for testing and not testing, and attitudes and perceptions regarding HIV testing, information that is critical for planning prevention programs. Methods: Cross‐sectional interview study of persons at high risk for HIV infection (men who have sex with men [MSM]; injection drug users [IDUs]; and heterosexual persons recruited from gay bars, street outreach, and sexually transmitted disease clinics) among six states participating in the HIV Testing Survey (HITS) in 1995 to 1996 (HITS‐I) and 1998 to 1999 (HITS‐II). Results: Overall testing rates were lower in the HITS‐I (1226/1599 [77%]) than in the HITS‐II (1375/1711 [80%]) (p = .01). Persons <25 years old tested less frequently than those >25 years old (HITS‐I: 71 % vs. 78%, respectively, p = .007; HITS‐II: 63% vs. 85%, respectively, p < .001). The main reasons for testing and not testing were the same in both surveys, but the proportions of reasons for not testing differed (e.g., “unlikely exposed to HIV” [HITS‐I (17%) vs. HITS‐II (30%), p < .0001], “afraid of finding out HIV‐positive” [HITS‐I (27%) vs. HITS‐II (18%), p < .0001]). Attitudes regarding HIV testing differed among tested and untested respondents, especially among MSM. Conclusions: HIV testing rates were higher in the HITS‐II, but testing rates decreased among the youngest respondents. Denial of HIV risk factors and fear of being HIV‐positive were the principal reasons for not being tested. Availability of new HIV therapies may have contributed to decreased fear of finding out that one is HIV infected as a reason to avoid testing. The increased proportion of persons at risk who did not test because they believed they were unlikely to have been exposed highlights the need for prevention efforts to address risk perceptions.

The economic burden of HIV in the united states in the era of highly active antiretroviral therapy : Evidence of continuing racial and ethnic differences

Background:Assessing the economic burden of HIV/AIDS can help to quantify the effect of the epidemic on a population and assist policy makers in allocating public health resources. Objective:To estimate the economic burden of HIV/AIDS in the United States and provide race/ethnicity-specific estimates. Methods:We conducted an incidence-based cost-of-illness analysis to estimate the lifetime cost of HIV/AIDS resulting from new infections diagnosed in 2002. Data from the HIV/AIDS Reporting System of the Centers for Disease Control and Prevention were used to determine stage of disease at diagnosis and proportion of cases by race/ethnicity. Lifetime direct medical costs and mortality-related productivity losses were estimated using data on cost, life expectancy, and antiretroviral therapy (ART) use from the literature. Results:The cost of new HIV infections in the United States in 2002 is estimated at

Outbreak of Hepatitis A among Men Who Have Sex with Men: Implications for Hepatitis A Vaccination Strategies

36.4 billion, including

Bloodstream infections in home infusion patients : The influence of race and needleless intravascular access devices

6.7 billion in direct medical costs and

The cost of selected tuberculosis control measures at hospitals with a history of Mycobacterium tuberculosis outbreaks.

29.7 billion in productivity losses. Direct medical costs per case were highest for whites (

Use of urokinase in pediatric hematology/oncology patients ☆ ☆☆ ★

180,900) and lowest for blacks (

APIC and CDC survey of Mycobacterium tuberculosis isolation and control practices in hospitals caring for children Part 1: Patient and family isolation policies and procedures

160,400). Productivity losses per case were lowest for whites (

Observational study of the use of infection control interventions for Mycobacterium tuberculosis in pediatric facilities

661,100) and highest for Hispanics (