scholarly journals Provider Supply, Utilization, and Infant Health: Evidence from a Physician Distribution Policy

2019 ◽  
Vol 11 (3) ◽  
pp. 156-196
Author(s):  
Bladimir Carrillo ◽  
Jose Feres
Keyword(s):  
Primary Care ◽  
Birth Weight ◽  
Prenatal Care ◽  
Primary Care Physicians ◽  
Infant Health ◽  
Age Groups ◽  
Doctor Visits ◽  
Provider Supply ◽  
Physician Distribution ◽  
Number Of Visits

We analyze a policy that substantially expanded the supply of primary care physicians in Brazil. The program increased doctor visits across all age groups and led to greater utilization of doctors for prenatal care. However, these physicians replaced nurse visits for prenatal care without increasing the overall number of visits women receive. We find no evidence of gains in widely used metrics of infant health, including birth weight, gestation, and infant mortality. Together, these findings provide suggestive evidence that physicians and nurses may be good substitutes in the production function of infant health. (JEL I11, I12, I18, J13, J16, J44, O15)

scholarly journals Nationwide study of antipsychotic use among community-dwelling persons with Alzheimer's disease in Finland

2011 ◽  
Vol 23 (10) ◽  
pp. 1623-1631 ◽  
Author(s):  
Marja-Liisa Laitinen ◽  
J. Simon Bell ◽  
Piia Lavikainen ◽  
Eija Lönnroos ◽  
Raimo Sulkava ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Primary Care ◽  
Alzheimer's Disease ◽  
Primary Care Physicians ◽  
Social Insurance ◽  
Psychological Symptoms ◽  
Conditional Logistic Regression ◽  
Age Groups ◽  
Community Dwelling ◽  
Limited Effectiveness

ABSTRACTBackground: Antipsychotics continue to be widely used in the treatment of behavioral and psychological symptoms of dementia despite their limited effectiveness and well-known risks, including increased mortality. Our aim was to investigate the national pattern of antipsychotic use among community-dwelling persons with and without Alzheimer's disease (AD) in Finland.Methods: The Social Insurance Institution of Finland (SII) identified all persons with a verified diagnosis of AD in Finland on 31 December 2005. A control for each person with AD, matched in terms of age, sex and region of residence, was also identified. Data on reimbursed drug purchases in 2005 were extracted from the Finnish National Prescription Register. Conditional logistic regression analysis was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the use of antipsychotics.Results: The study population comprised 28,089 matched pairs of persons with and without AD (mean age 80.0 years, SD 6.8, 32.2% men). The annual prevalence of antipsychotic use was higher among persons with than without AD (22.1% vs. 4.4%, adjusted OR = 5.91; 95% CI 5.91–6.31). Among persons with AD, the prevalence of antipsychotic use was similar across all age groups. Of the antipsychotic users, 85.2% with AD and 51.3% without AD purchased second generation antipsychotics. Most antipsychotic prescriptions – 67.8% in the AD and 62.9% in the non-AD group – were generated in primary care situations.Conclusion: One-fifth of persons with AD used antipsychotic drugs. Antipsychotic use was six times more prevalent among persons with AD than without AD. Most antipsychotics were prescribed by primary care physicians.

The Effects of Domestic Violence During Pregnancy on Maternal and Infant Health

2002 ◽  
Vol 17 (2) ◽  
pp. 169-185 ◽  
Author(s):  
Alissa C. Huth-Bocks ◽  
Alytia A. Levendosky ◽  
G. Anne Bogat
Keyword(s):  
Domestic Violence ◽  
Birth Weight ◽  
Prenatal Care ◽  
Infant Health ◽  
Health Problems ◽  
Maternal And Infant Health ◽  
Violence During Pregnancy ◽  
Maternal Social Support ◽  
Infant Birth ◽  
The Impact

The present study examined the impact of domestic violence on maternal and infant health by assessing maternal health during pregnancy and infant health at two months postpartum. Two hundred and two women (68 battered and 134 non-battered) were recruited from the community and completed both pregnancy and 2-month postpartum interviews. Results revealed that domestic violence during pregnancy was associated with numerous health problems for mothers and infants including more health problems during pregnancy, more likelihood of premature labor, later entrance into prenatal care, lower infant birth weight, greater utilization of health care resources, and more prenatal substance use. After income was controlled, the relationship between violence and timing of prenatal care and infant birth weight became nonsignificant. Maternal social support was found to protect against the effects of violence for several health outcomes. The current findings suggest the need for domestic violence screening during pregnancy, as well as clinical interventions for battered, pregnant women in order to prevent serious physical and emotional problems for both mothers and their infants.

scholarly journals CLINICAL AND SOCIAL IMPACT OF BRAZILIAN TEENAGE PREGNANCY

2014 ◽  
Vol 2 (2) ◽  
Author(s):  
Fabiana Sarpa de Castro Peixoto Sampaio ◽  
Maressa Santos Novais ◽  
Vanessa Ferrari Oliveira ◽  
Milena Bastos Brito
Keyword(s):  
Young Adults ◽  
Birth Weight ◽  
Prenatal Care ◽  
Low Birth Weight ◽  
Teenage Pregnancy ◽  
Maternal Age ◽  
Social Impact ◽  
Age Groups ◽  
Care Program ◽  
Prenatal Visits

Objectives: To verify the correlation between low birth weight, prematurity, number of prenatal visits and type of delivery and maternal age (Adolescents versus young adults), in the city of Salvador – Bahia, Brazil; and in the whole Brazilian territory, in 2011. Methods: Population based study, descriptive and comparative, based on secondary data available in the database of the Information System on Live Births (SINASC), which was generated by the Department of the Health System of Brazil (DATASUS). The group analyzed comprises all the newborn children of parturients aged between 10 and 34 years. The variables were categorized as: maternal age (10-14; 15-19 and 20-34 years-old); delivery route (vaginal or cesarean); birthweigh (< 2,500g; between 2,500g and 3,999g; ≥ 4000g); number of prenatal visits (None, 1 to 6, ≥ 7). Results: There was a downward trend in vaginal delivery, in Salvador and in Brazil, among the three groups analyzed. Prematurity rates (<37 weeks) as well as low birth weight rates (< 2,500g) in Salvador were higher than those in Brazil in both age groups studied. In Brazil, the rates of individuals who attended the ideal minimum number of prenatal care program were 42.1% among adolescents (10-14 years old) and 65.4% among young adults (20-34 years old) women. In Salvador, those rates were 15% and 19%, respectively. Conclusion: Pregnant adolescents from Brazil, and Salvador also, had higher rates of prematurity, low birth weight and lower adherence to prenatal care program compared with women in the age range considered ideal for pregnancy.

scholarly journals Impact of financial incentives for primary care to give long acting reversible contraceptive advice

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
R Ma ◽  
E Cecil ◽  
R French ◽  
A Bottle ◽  
S Saxena
Keyword(s):  
Primary Care ◽  
Financial Incentives ◽  
Primary Care Physicians ◽  
Pay For Performance ◽  
Age Groups ◽  
Step Change ◽  
Practice Research ◽  
Care Practice ◽  
Clinical Practice Research Datalink ◽  
Long Acting

Abstract Background Long acting reversible contraceptives (LARC) are cost-effective but uptake remains poor even in high income settings. In 2009/10, a pay-for-performance (P4P) scheme in the United Kingdom was introduced for primary care physicians to offer advice about LARC to women attending for contraceptive care. We examined the equity and impact of this scheme on LARC uptake and abortions Methods We examined records of women aged 13 to 54 years registered with a primary care practice in the UK Clinical Practice Research Datalink from 2004/05 to 2013/14. We used interrupted time series analysis to examine trends in annual LARC and non-LARC hormonal contraception (NLHC) uptake and abortion rates, stratified by age, region and deprivation groups, before and after P4P was introduced in 2009/10. Results LARC uptake among women of all ages increased immediately after P4P with step change of 5.36 per 1,000 women (95% CI 5.26 to 5.45). Largest increase was in women aged 20 to 24 years (8.40, 8.34 to 8.47). NLHC uptake fell in all women with a step change of -22.9 (-24.5 to -21.2). Among LARC methods, contraceptive injection and implant had the greatest increase after P4P; step changes were 1.68 (1.67 to 1.70) and 1.64 (1.63 to 1.65) respectively. Abortion rates fell across all 12 regions in UK and in all women immediately after P4P with a step change of -2.28 (-2.99 to -1.57). The largest falls occurred in women aged 13 to 19 years (step change -5.04, -7.56 to -2.51) and women from the most deprived group (step change -4.40, -6.89 to -1.91). Conclusions Pay-for-performance scheme for primary care physicians to give LARC advice to women attending for contraception was associated with desirable impact and equity of LARC prescriptions and abortion. LARC uptake increased in women of all ages, especially 13-19 and 20-24 years. Abortion rates fell in all UK regions and age groups, particularly 13-19 and 20-24 years and those from deprived quintile. Key messages Pay-for-performance scheme for primary care practitioners to give LARC advice to women attending for contraception was associated with desirable impact and equity of LARC prescriptions and abortion. LARC uptake increased in women of all ages, especially 13-19 and 20-24 years. Abortion rates fell in all UK regions and age groups, particularly 13-19 and 20-24 years and those from deprived quintile.

scholarly journals THE ROLE OF THE PRIMARY DOCTOR IN THE EARLY DIAGNOSIS OF ENDOCRINE DISEASES IN CHILDREN.

2019 ◽  
Vol 19 (4) ◽  
pp. 25-28
Author(s):  
I.I. Redko ◽  
E.N. Chakmazova
Keyword(s):  
Primary Care ◽  
Sexual Development ◽  
Primary Care Physicians ◽  
Age Groups ◽  
The State ◽  
Family Doctors ◽  
Endocrine Diseases ◽  
Anthropometric Indicators ◽  
Pediatric Endocrinologist ◽  
Primary Care Doctors

In the context of the reform of modern medicine, endocrine pathology is encountered not only by pediatric endocrinologists, but also by doctors of other specialties, primarily primary care doctors - pediatricians and family doctors. Currently, there is a tendency to increase the prevalence of endocrine pathologists in all age groups of the children's population of Ukraine. Purpose of the study. To assess the frequency of detection of the most common endocrine diseases in children by primary care doctors and the timeliness of referral to a pediatric endocrinologist. Materials and methods. In the conditions of children's outpatient clinics, 4273 children were consulted and examined, aged from 0 to 18 years. Children were evaluated anthropometric indicators, the state of the thyroid gland and sexual development. Examination of all children for the presence of endocrine pathologists and confirmation of the diagnosis were carried out on the basis of the Order of the Ministry of Health of Ukraine No. 254 of 04/27/2006. "On the approved protocol for the medical support of children for the specialty" Child endocrinology ". Results. Among the total number of children consulted, endocrine pathology was manifested in 36.7%. The diagnosis of newly diagnosed endocrine pathology was first confirmed in 29, 9% of children. Among endocrine pathologists, perovism is occupied by obesity - 39.9%, the second - thyroid pathology - 36.4%, the third - impaired growth - 18.3%, the fourth - impaired sexual development - 7.4%. In 40% of cases, a violation of sexual development is combined with a violation of growth. It has been established that primary care doctors in 40-50% of cases do not perform anthropometry for children at all, the state of sexual development is not evaluated in 70% of cases, which leads to an untimely referral to a pediatric endocrinologist and complicates further treatment. Findings. A high percentage of children with first diagnosed endocrine pathology at the stage of primary care and the late delivery by doctors of children to a pediatric endocrinologist was established, which is due to the lack of primary care physicians' assessment of anthropometric indicators of the child’s physical development, thyroid and sexual development.

scholarly journals Abdominal obesity in primary care

2017 ◽  
Vol 4 (4) ◽  
pp. 915 ◽  
Author(s):  
Sethu Prabhu Shankar ◽  
Golepu Kartikeya
Keyword(s):  
Primary Care ◽  
Primary Care Physician ◽  
Abdominal Obesity ◽  
Primary Care Physicians ◽  
Age Groups ◽  
Cross Sectional Study ◽  
Care Physician ◽  
Abdominal Circumference ◽  
Age Group ◽  
Cross Sectional

Background: Obesity is one of the important challenge in primary care. Abdominal obesity is associated with future cardiovascular disease when compared to non-obese individuals. The objective was to study the prevalence of abdominal obesity in patients attending primary care physician and to analyse abdominal obesity across different age groups and gender.Methods: The study was done as cross-sectional study at primary care centres in and around Pondicherry. Patients visiting primary care physician were included in the study. All adult patients of age more than 18 years, of both sexes visiting the primary care physician were included in study. Pregnant women, patients with abdomen diseases and patients those who are not willing to give written consent for participation in the study were excluded from the study. Demographic profile, anthropometric measurements were recorded. Abdominal circumference of all patients were recorded using a standard measuring tape. Abdominal obesity was diagnosed when the abdominal circumference was more than 90 centimetres in male and more than 80 centimetres in female.Results: A total number of 1030 patients were included in the study. There were 189 patients in age group 60-69. Females 535 outnumbered males 484. In the age group 50-59, 33 (40%) of males and 45 (44%) of females had increased abdominal circumference more than 90 centimetres in males and 80 centimetres in females. Across all age groups 121 (24%) males had abdominal circumference more than 90 centimetres in the study and 147 (28%) females had abdominal circumference more than 80 centimetres.Conclusions: Abdominal obesity is common at primary care level. The prevalence of abdominal obesity is more in females when compared with males. Hence all primary care physicians have to be stressed about the importance of abdominal obesity. 

scholarly journals The Use of Sucking Time to Establish Models to Estimate Breastmilk Intake of One Breastfeeding Session for 1-12-Month Infants: A Cross-sectional Study

2021 ◽  
Author(s):  
Ni Jia ◽  
Mengxue Xu ◽  
Meixian Zhang ◽  
Jianhua Gong ◽  
Lu Zhao ◽  
...  
Keyword(s):  
Birth Weight ◽  
Infant Health ◽  
Multilevel Models ◽  
Age Groups ◽  
Northern China ◽  
Feeding Practice ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Weighing Method ◽  
Infant Birth

Abstract BackgroundObservation method of assessing breastmilk intake (BI) by observing medical indices has less interference in breastfeeding than test-weighing method, but for the calculation certain influential predictor variables had not been recognized and needed to be further studied. MethodInfants between 1 and 12 months were enrolled in a hospital of Shenzhen city in northern China. A cross-sectional survey was conducted in a sample of mother-infant dyads. A breastfeeding session of each participating mother subject was observed in the clinic. 150 mother-infant dyads were adopted for data analysis. BI was measured by test-weighing method. Sucking time (ST), Information of maternal and infant health, maternal breast, and infant feeding practice were collected. ResultsThere was a relationship between sucking time and breastmilk intake per breastfeeding session (r=0.57, p<0.05). In the 4 multilevel models (r>0.6, p<0.05) established to estimate breastmilk intake the best fit multilevel model was to estimate breastmilk intake per kg (infant weight) for 1-4-month infants (R2=0.53, p<0.05). Sucking time as the key variable and other factors including infant birth weight/ birth weight, breast side, maternal BMI, maternal vocation significantly had effect on breastmilk intake and those factors that remained significant varied according to different age groups. ConclusionsSucking time had a significant association with breastmilk intake in a breastfeeding session. Establishing multilevel models based on sucking time to estimate breastmilk intake per infant weight for specific age group of infants greatly improved the effectiveness. But the accuracy of the estimation needed to be improved for further application in telemedicine.

Fool’s Gold: Psychologists Using Disingenuous Reasoning to Mislead Legislatures into Granting Psychologists Prescriptive Authority

2003 ◽  
Vol 29 (4) ◽  
pp. 489-524
Author(s):  
Brent Pollitt
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
Nurse Practitioners ◽  
Primary Care Physicians ◽  
American Psychological Association ◽  
The United States ◽  
Psychotropic Medications ◽  
American Psychological ◽  
Training Requirements ◽  
Prescriptive Authority

Mental illness is a serious problem in the United States. Based on “current epidemiological estimates, at least one in five people has a diagnosable mental disorder during the course of a year.” Fortunately, many of these disorders respond positively to psychotropic medications. While psychiatrists write some of the prescriptions for psychotropic medications, primary care physicians write more of them. State legislatures, seeking to expand patient access to pharmacological treatment, granted physician assistants and nurse practitioners prescriptive authority for psychotropic medications. Over the past decade other groups have gained some form of prescriptive authority. Currently, psychologists comprise the primary group seeking prescriptive authority for psychotropic medications.The American Society for the Advancement of Pharmacotherapy (“ASAP”), a division of the American Psychological Association (“APA”), spearheads the drive for psychologists to gain prescriptive authority. The American Psychological Association offers five main reasons why legislatures should grant psychologists this privilege: 1) psychologists’ education and clinical training better qualify them to diagnose and treat mental illness in comparison with primary care physicians; 2) the Department of Defense Psychopharmacology Demonstration Project (“PDP”) demonstrated non-physician psychologists can prescribe psychotropic medications safely; 3) the recommended post-doctoral training requirements adequately prepare psychologists to prescribe safely psychotropic medications; 4) this privilege will increase availability of mental healthcare services, especially in rural areas; and 5) this privilege will result in an overall reduction in medical expenses, because patients will visit only one healthcare provider instead of two–one for psychotherapy and one for medication.

1566: BPH Management in an HMO Setting: Differences between Primary Care Physicians and Urologists

2007 ◽  
Vol 177 (4S) ◽  
pp. 517-517
Author(s):  
John M. Hollingsworth ◽  
Stephanie Daignault ◽  
Brent K. Hollenbeck ◽  
John T. Wei
Keyword(s):  
Primary Care ◽  
Primary Care Physicians
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