The influence of physician specialty on housecalls
Article Abstract:
The number of frail elderly patients is increasing, and the number of physicians willing to make housecalls has declined. Although nurses may substitute for physicians, Medicare regulations often limit nursing visits to episodes of acute illness and recovery. The American College of Physicians has encouraged internists to participate more in all aspects of home care, but their attitudes and home visit patterns have not been determined. This study of 389 internists, subspecialists, general practitioners, and family practitioners compared their housecall practices and attitudes. Home visits were rare among all physicians; for physicians making housecalls, the average was two per month. All specialists considered a fair fee for a housecall to be more than double the usual rate, with internists suggesting higher fees than family physicians or general practitioners. Family physicians and general practitioners were more likely than internists to increase the number of housecalls they were willing to make in return for higher payment. Internists were more likely to report that they did not enjoy housecalls, that housecalls were unnecessary, that they had never made one, and that they did not know how to go about home visiting. Subspecialty internists were even more likely not to have made a home visit, or to know how to go about it. Internists in general had more negative attitudes about housecalls, and were less likely to make them even for higher payments. The results of this study suggest that higher fees will induce some physicians, particularly general and family practitioners, to make more housecalls. However, in order to convince internists and subspecialists to make more housecalls, it will be necessary to determine how to change their attitudes as well. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Archives of Internal Medicine
Subject: Health
ISSN: 0003-9926
Year: 1990
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Alcohol problems increase while physician attention declines: 1967 to 1984
Article Abstract:
Excessive drinking increases the risk for several serious health problems, including cirrhosis or fatty accumulation in the liver, injuries, and suicidal behavior. It was estimated that 40 percent of hospital beds are occupied by patients with illnesses caused, either primarily or in part, by alcohol. Both the consumption of alcohol and heavy drinking have increased since the 1960s. However, most doctors do not recognize alcohol problems or do not intervene when alcohol problems are apparent. Physicians can play an important role in the prevention of alcohol abuse by patients, although the amount of medical attention given to problem drinking is not known. Three epidemiologic studies, conducted in 1967, 1979, and 1984, examined the drinking practices and problems of a nationally representative sample of American adults. The prevalence of multiple alcohol problems and at least one event of recent heavy alcohol consumption has increased over time in the general population. In addition, the probability that physicians will recommend to patients that they reduce their drinking has declined. This is mainly due to a sharp decline in physician medical advice to women with alcohol problems. However, among men with alcohol problems, physician recommendations to reduce drinking did not decrease between 1967 and 1984. The implications of these findings are discussed. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Archives of Internal Medicine
Subject: Health
ISSN: 0003-9926
Year: 1990
User Contributions:
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