How valid are medical records and patient questionnaires for physician profiling and health services research? A comparison with direct observation of patients visits

OBJECTIVES: This study was designed to determine the optimal nonobservational method of measuring the delivery of outpatient medical services. METHODS: As part of a multimethod study of the content of primary care practice, research nurses directly observed consecutive patient visits to 138 practicing family physicians. Data on services delivered were collected using a direct observation checklist, medical record review, and patient exit questionnaires. For each medical service, the sensitivity, specificity, and Kappa statistic were calculated for medical record review and patient exit questionnaires compared with direct observation. Interrater reliability among eight research nurses was calculated using the Kappa statistic for a separate sample of videotaped visits and medical records. RESULTS: Visits by 4,454 patients were observed. Exit questionnaires were returned by 74% of patients. Research nurse interrater reliabilities were generally high. The specificity of both the medical record and the patient exit questionnaire was high for most services. The sensitivity of the medical record was low for measuring health habit counseling and moderate for physical examination, laboratory testing, and immunization. The patient exit questionnaire showed moderate to high sensitivity for health habit counseling and immunization and variable sensitivity for physical examination and laboratory services. CONCLUSIONS: The validity of the medical record and patient questionnaire for measuring delivery of different health services varied with the service. This report can be used to choose the optimal nonobservational method of measuring the delivery of specific ambulatory medical services for research and physician profiling and to interpret existing health services research studies using these common measures.     

The physician perspective of health psychologists in medical settings.

Examined physician attitudes and utilization of psychologists in medical settings by administering a 15-item questionnaire to 397 26–78 yr old physicians (84% male) practicing family/general practice, surgery, internal medicine, or miscellaneous clinical medicine. Although differences in attitudes were associated with age, sex, and specialty, generally favorable attitudes toward psychologists were found among Ss. Results show a recognition by the majority of Ss of the role that psychological factors play in medical disease and an appreciation of clinical psychological skills by a large majority. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Characteristics of patient visits to nurse practitioners and physician assistants in hospital outpatient departments

Amprolium was successfully used to induce cerebrocortical necrosis (CCN) in dromedary racing camels, only when they were fed on a barley diet. Camels which were fed on hay ad libitum did not suffer form CCN, although their thiamine pyrophosphate (TPP) reached similar levels as in camels fed on barley. The reason for this phenomenon is discussed. Five camels which suffered from CCN had TPP values of 80-115% and were euthanized on humane grounds when they were in lateral recumbency. Pathohistological investigations revealed a polioencephalomalacia of the dorsal cerebral cortex with oedema and status spongiosus. Cerebral autofluorescence was observed under ultraviolet light. The major clinicopathological changes were a slight anemia and a decreased potassium value whereas glucose, muscle enzymes, leucocyte counts and differential counts were elevated. A TPP effect of 12% was found during this study in healthy dromedary racing camels and symptoms were observed when TPP values reached 80-115%. The test is now being widely used during the camel racing season.     

Attachment style as a predictor of behavior in group counseling with preadolescents.

This study investigated the role that attachment style plays in preadolescent behavior in group counseling. The study population consisted of 77 preadolescents referred to counseling services in their schools in Israel. They were treated in 11 small counseling groups led by novice counselors. Variables included self-disclosure, client behavior in therapy, and responsiveness to other group members--all assessed based on transcribed sessions. Participants also completed attachment questionnaires. The analyses were performed with hierarchical modeling (mixed) nesting individuals within groups. Results indicated differences on all dependent variables among the three attachment styles: secure, preoccupied, and avoidant. Secure adolescents showed the highest rates of self-disclosure, productive client behavior, and responsiveness to others, whereas avoidant participants showed the lowest scores on all measures. Gender, age, and group size showed little effect. The discussion focuses on implications for group therapists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender in medical encounters: An analysis of physician and patient communication in a primary care setting.

The relation of physician and patient gender to verbal and nonverbal communication was examined in 100 routine medical visits. Female physicians conducted longer visits, made more positive statements, made more partnership statements, asked more questions, made more back-channel responses, and smiled and nodded more. Patients made more partnership statements and gave more medical information to female physicians. The combinations of female physician–female patient and female physician–male patient received special attention in planned contrasts. These combinations showed distinctive patterns of physician and patient behavior, especially in nonverbal communication. The relation of the results to gender differences in nonclinical settings, role strains in medical visits, and current trends in medical education are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist behavior as a predictor of black and white caregiver responsiveness in multisystemic therapy.

This study examined whether (a) therapist behaviors thought to enhance family treatment predicted caregiver in-session responses, and (b) caregiver race, racial match between caregiver and therapist, and family financial hardship moderated the relationships between therapist and caregiver behavior. Observers coded caregiver and therapist behavior during one session of multisystemic therapy for substance abusing adolescents. Therapist teaching, focusing on strengths, making reinforcing statements, problem solving, and dealing with practical family needs predicted caregiver engagement and/or positive response, regardless of race, racial match, or financial hardship. Caregiver race, financial hardship, and therapist–caregiver racial match occasionally moderated the relationship between other therapist and caregiver behaviors. Findings suggest both commonalities and differences in how therapist behavior may function to engage caregivers in family treatment, depending on diversity-related factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patients' opinions of their health status and the results of medical care

Anonymous questionnaires were distributed among patients of treatment and prophylaxis inpatient and outpatient institutions in the city of Irkutsk. Analysis of responses helped detect the causes responsible for the unfavorable initial health status of patients and decreasing the probability of favorable outcomes after treatment.     

Temperament as a predictor of behavior during initial dental examination in children

Temperament refers to children's behavioral style, or the manner in which they interact with their environment. Temperament has been quantified into nine temperament categories and five temperament constellations by Thomas and Chess. Temperament categories and constellations of children can be measured using one of several parental questionnaires, each of which focuses on age-appropriate behavior. For this study the Behavioral Style Questionnaire (BSQ) was administered to the parents of 50 healthy children (mean age 48.8 months) receiving initial dental examinations. The examinations were videotaped and The Ohio State Behavior Rating Scale (OSUBRS) was used to rate each child's behavior into one of four behavioral categories: 1) quiet; 2) crying only; 3) disruptive movement only; and 4) crying and disruptive movement. For data analysis the percentage duration of each behavioral category was calculated. Using one-way ANOVA, significant differences between constellations were found for quiet (P = 0.03) and combination behavior (P = 0.03). Using a stepwise linear regression, the temperament category of approach/withdrawal was found to predict the percentage of quiet (multiple R = 0.42357, R2 = 0.17941, and P = 0.002), crying (multiple R = 0.42124, R2 = 0.17744, and P = 0.002), and combination behaviors (multiple R = 0.30008, R2 = 0.09005, and P = 0.03). Additionally, significant regressions were found with temperament categories predicting behavioral categories depending on the child's age. The results of this pilot study suggest that the BSQ temperament constellations and categories appear to be modest predictors of a child's specific behaviors in the dental environment. Knowledge of a child's temperament may prepare the clinician to predict patient behaviors in the dental environment.     

Self-rated health as a predictor of ischemic heart disease development

The study objective was to analyse the association between self-rated health and the incidence of fatal and non-fatal coronary heart disease in a Danish cohort followed up over 16 years. The study included 1052 men and women born in 1936. During the 16 years' follow-up 50 cases of coronary heart disease were registered either with the Danish register of deaths or the register of hospital admissions. Univariate analysis showed the following relative risks of coronary heart disease in the four self-rated health groups: "extremely good": 1.0, "good": 4.0, "poor": 5.8, "miserable": 12.1 (p = 0.02). After control for the conventional coronary risk factors and a substantial number of other potential confounders the relative risks were: 1.0, 4.2, 6.5, and 18.6 (p = 0.02) respectively. Self-rated health was an independent predictor of coronary heart disease in this recent cohort. If confirmed, the association between self-rated health and coronary heart disease may lead to new insights into psychosocial processes leading to this disease.     

Keyes's model of mental health with personal growth initiative as a parsimonious predictor.

This research addressed issues at the heart of counseling psychology: operationalizing mental health and identifying parsimonious ways of predicting levels of mental health. The primary purpose of the study was to investigate the replicability of the structure of C. L. M. Keyes's (2002) model of mental health in 2 samples of college students (total N = 244 women and 223 men). Results of confirmatory factor analyses supported this 3-factor model of psychological, social, and emotional well-being, consisting of 14 subdimensions. Furthermore, this model was found to be invariant for men and women in both samples. The secondary purpose was to assess the effectiveness of personal growth initiative (PGI; C. Robitschek, 1998) as a parsimonious predictor (i.e., 1 predictor for many outcomes) of these multiple dimensions of mental health. Results of structural equation modeling supported PGI as a parsimonious predictor of Keyes's multidimensional mental health model for men and women in both groups. Limitations are discussed, and implications for research and practice in counseling psychology are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A conversation with a physician and a cancer patient. Interview by Judith D Burke

The influence of Ca2+ on the growth, antibiotic production and differentiation of Streptomyces albogriseolus 444 was studied. Consumption of the calcium ions by the strain was followed up. It was shown that Ca2+ changed the dynamics of the biomass accumulation and had no significant effect on the antibiotic production. Calcium present in the medium was assimilated more intensively during the first 24 hours of the strain growth. The own antibiotic nigericin exogenously added to the medium increased the calcium assimilation. In the presence of Ca2+ the nigericin stimulation of the strain differentiation was higher.     

A note on the MMPI as a suicide predictor.

Offers comments on C. V. Leonard's (1977) article on the MMPI as a suicide predictor. Her appraisal of former studies and her consideration of the differences between individuals with different suicidal behaviors are critically evaluated. It is suggested that future research should emphasize the development of useful MMPI indices of suicidal risk and should recognize the need to cross-validate these indices. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Addiction Severity Index as a predictor of the use of mental health care.

The Addiction Severity Index (ASI) has been extensively used in the United States and Europe as an indicator of the problems of substance abuse patients. Several studies have shown the ASI to be a reliable and valid instrument, but lately doubt has arisen regarding its validity and reliability. The article focuses on a specific scale of the ASI-the Psychiatric Status scale-and its strength in predicting the use of mental health care. A group of 1,027 heroin patients in Rotterdam, the Netherlands, who participated in a methadone program were the subjects. Three indices have been used: the evaluation index, the clinical index, and the composite scores. It appears that no matter which indices are used, the Psychiatric scale does discriminate between those who will have contact with mental health care and those who will not. However, the percentage of false positives is high. None of the indices predicts the intensity and duration of the mental health care treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The MMPI as a primary differentiator and predictor of behavior in prison: A methodological critique and review of the recent literature.

Evaluated 71 investigations of MMPI usage in prison work. Additional studies were examined to provide a methodological basis for the comparisons of the research, which were made within sections on (a) sampling procedures, (b) sources of variance and their effects on test results, (c) protocol validity, and (d) methods of profile interpretation. Several methodological shortcomings and various differences in procedure across studies limit the generalizability of the findings. Research in the hostile-assaultive section, however, has produced preliminary MMPI indicators for a type of violently aggressive behavior pattern that is otherwise difficult to detect. Other areas in which the MMPI shows promise include homosexuality, recidivism, and the classification of psychopathologic behavior. More research is needed in the areas of institutional adjustment and suicide. Recommendations for future investigations prescribe adequately controlled sampling procedures, modifications in the interpretation of protocol validity, investigation of certain methodological questions in their own right, consideration of more than one aspect of profile data, the use of base-rate probabilities in predictive studies and the pursuit of longitudinal studies with thorough follow-up procedures. (3? p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patients' sexual behavior and sexual harassment: A survey of clinical supervisors.

How do clinical supervisors respond to supervisees' reports of sexualized or sexually harassing behaviors by patients? A survey of experienced supervisors was conducted to answer this question and to determine the incidence of such reports. A substantial number of participants reported receiving at least 1 report of patient sexual harassment of a supervisee. Reports ranged from persistent inappropriate sexual comments to physical sexual assaults. Supervisors' responses ranged from supervisory discussions to active interventions. Clinical supervisors must acknowledge the potential for supervisees to be sexually harassed by patients and incorporate strategies to deal with harassment in their training programs. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Psychologist–physician partnership in a medical specialty screening clinic.

Describes the development of a headache screening clinic in which psychologists participate with neurologists in the initial patient evaluation, using brief screening questionnaires and interviews. The majority of patients assessed in this clinic experienced clinically significant emotional distress, although only a minority of these patients felt a need for psychological intervention. By combining psychological screening with initial medical evaluation, emotionally disturbed individuals who present with physical complaints can be rapidly identified and their defensiveness about referral for psychological/psychiatric intervention can be minimized. Psychologists' psychometric screening instruments and their interviewing skills can contribute significantly to optimal utilization of health care services. Three case examples are given. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between patient income and physician discussion of health risk behaviors

CONTEXT: The US Preventive Services Task Force recommends that physicians assess patients' health risk behaviors, addressing those needing modification. OBJECTIVE: To examine the relationship between patient income, health risk behaviors, the prevalence of physician discussion of these behaviors, and the receptiveness of patients to their physicians' advice. DESIGN: Employee survey. PARTICIPANTS: A random sample of 6549 Massachusetts state employees in 12 health plans. MAIN OUTCOME MEASURES: Data were obtained using a patient-completed mail survey. Trend tests were used to discern differences in the prevalence of health risk behaviors, physician discussion of these behaviors, and patient receptiveness to discussions by patient income. RESULTS: Although unhealthy behaviors were common among all income groups, physician discussion of health risk behaviors fell far short of the universal risk assessment recommended by the US Preventive Services Task Force. Low-income patients were more likely to be obese and smoke than high-income patients and were less likely to wear seat belts and exercise. In contrast, stress and alcohol consumption increased with income, while the proportion of heavy drinkers did not vary significantly. Physicians were more likely to discuss diet and exercise with high-income patients in need of these discussions than with low-income patients, but were more likely to discuss smoking with low-income patients who smoked than with high-income patients who smoked. Among patients with whom discussions occurred, low-income patients were much more likely to report attempting to change their behavior based on physician advice. CONCLUSIONS: Physician counseling of patients regarding health risk behaviors should be greatly improved if the US Preventive Services Task Force recommendations are to be fulfilled. Improvement is especially needed in regard to alcohol consumption, safe sex, and seat belt use. Physicians also need to be more vigilant in properly identifying and counseling low-income patients at risk in regard to diet and exercise and high-income patients who smoke.