Medical care
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Physicians are moving into organized settings where their autonomy is more constrained and where management has more responsibility for physician satisfaction. The relationship of management practices to physician autonomy and satisfaction was explored in a survey of 185 psychiatrists in the State of Hessen in the Federal Republic of Germany (FRG). Analysis revealed that controlling for physician and institutional characteristics, management practices in relationship to participative activities, supportive communication, and peer review activities were the most important predictors both of perceived clinical autonomy and of work satisfaction. ⋯ Perceived clinical autonomy was an important factor in explaining satisfaction, whereas a few other physician and institutional characteristics were significant in predicting satisfaction. Unexpectedly, there was more perceived clinical autonomy among psychiatrists in larger, less well funded, more managerially constrained, state institutions than in smaller, community general hospitals and private organizations. Implications for further research are discussed.
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We evaluated the usefulness of commonly ordered routine admission laboratory tests in 301 patients admitted consecutively to the internal medicine wards of a university teaching hospital. Using a consensus analysis approach, three Department of Medicine faculty members reviewed the charts of admitted patients to determine the impact of the test results on patient care. ⋯ Twelve percent of these routine tests were abnormal, 5% led to additional laboratory testing, but only 0.5% led to change in the treatment of patients. We conclude that the impact of routine admission laboratory testing on patient care is very small and that there is little justification for ordering tests solely because of hospital admission.
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All professionally active certified registered nurse anesthetists (CRNAs) in four geographically representative states were surveyed by mail and telephone in 1981, and response rate of greater than or equal to 70% was obtained for each state. CRNAs who worked with anesthesiologists (Group I) were compared with those who worked in hospitals with no anesthesiologists (Group II). ⋯ Nearly 50% of Group II had no standing consulting relationship with an anesthesiologist. A consultation network supported by telecommunications deserves consideration as a means of providing CRNAs who work independently in small rural hospitals with a cost-effective team approach to anesthesia care.
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The Citicare program was implemented in Jefferson County, Kentucky, between July 1982 and June 1983. Approximately 40,000 AFDC-related Medicaid recipients were enrolled. Granted federal waivers, the program established a primary care network with capitation payment and physician sharing of savings. ⋯ There was, however, a 40% reduction in hospital emergency room use and a shift in the locus of care from doctors' offices to health centers and clinics. Recipients' perceptions of the quality of care received in health centers and clinics increased, but declined for care in physicians' offices. Although the program met most of its objectives, it did not gain physician support and was terminated by a new governor.
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Research on both adult patients and parents of pediatric patients has demonstrated that satisfaction with medical encounters predicts such important outcomes as compliance with medical regimen. The authors developed a questionnaire to measure parent satisfaction with children's medical encounters, administered it to 104 parents of pediatric patients (field trial 1), and revised it. The revised Parent Medical Interview Satisfaction Scale (P-MISS) was then tested on a new sample of parents whose medical visits were videotaped (field trial 2). ⋯ The four factor-based subscales identified by field trial 1 showed high alpha reliabilities on field trial 2: physician communication with the parent (0.81); physician communication with the child (0.93); distress relief (0.85); and adherence intent (0.86). With the exception of the distress relief subscale, the subscales appear to measure distinct dimensions of satisfaction. Objective ratings of physicians' interpersonal skills to parents during medical interviews correlated significantly with parents' total satisfaction scores as well as with all four satisfaction subscale scores, providing preliminary evidence of the construct validity of the P-MISS.