Rohrer, James E.

Objectives: Poor mental health is a major source of distress, disability, and social burden in older adults. The objective of this study was to determine if activity limitation and healthcare access are associated with frequent mental distress (FMD) in adults 65 years and older. Methods: Of the 123 427 study participants aged 65 years or older, 120 445 participants responded to the Behavioral Risk Factors Surveillance System (BRFSS) survey question on number of mentally unhealthy days. Participants who reported having 14 or more mentally unhealthy days during the past 30 days were considered as having FMD. Activity limitation, avoidance of medical care due to cost, and availability of personal doctor were examined for their association with FMD in multivariable logistic regression analysis. Age, sex, race/ethnicity, marital and employment status, emotional support, and life satisfaction were included as potential confounders. Results: The prevalence of FMD in this study population was 6.5% (95% CI = 6.3-6.8) with estimates significantly greater among women (7.2%, 95% CI = 6.9-7.6) as compared to men (5.5%, 95% CI = 5.1-6.0). The odds of FMD were more than 2-fold elevated for those who reported activity limitations due to physical, mental, or emotional problems (adjusted OR = 2.59, 95% CI = 2.33-2.87), and among those who reported health care cost as a barrier to see a doctor (adjusted OR = 2.14, 95% CI = 1.75-2.61). There was no significant relationship between availability of personal doctor and FMD observed in the study. Conclusions: The findings of this study showed that activity limitation and cost of medical care are associated with FMD in the US elderly population.

Objective: The objective of this study was to investigate the importance of immigration as a risk factor for self-reported frequent mental distress (FMD) among black respondents to an Internet survey. Method: Snowball sampling was used to obtain Internet survey responses from immigrant and non-immigrant black adults in the United States. Multiple logistic regression analysis was used to control for the effects of personal characteristics ( N = 301). Results: In this sample of black adults, 13.3% had FMD. Being an immigrant was not associated with FMD in this sample (adjusted odds ratio [OR] = 0.75, P = .53). However, more drinking days was an independent risk factor (OR = 1.07, P < .01). Conclusions: Being an immigrant was not an independent risk factor for FMD in this sample of black adults. However, drinking more days per month was a significant risk factor. Primary care providers should be alert for FMD and alcohol consumption in this population. Directing health education about hazardous drinking toward high-risk individuals should be considered.

The family history is used as a screening tool to identify persons who may be at risk for a heritable disorder. Primary care providers sometimes do not thoroughly gather and document the family history. This pilot study was undertaken to determine whether having a genetic counselor on site at our family medicine clinic 2 days a week for 3 months would improve the quality of the family history field in patient records. We compared 7 elements in the family history field for patients seen before and after the genetic counselor was on site. Documentation of 1 of the 7 elements (major disease) improved significantly after the intervention period ( P = .02). Changing provider behavior with regard to gathering and documenting family history of major disease may be facilitated by tools to help collect the family history and by using the increasing number of available genetic tests.

Health promotion programs may target a variety of behaviors including weight loss, exercise, stress, nutrition, or other risk factors. Comparing the outcomes of diverse programs is hampered by the absence of a common metric. Overall self-rated health has been used as a health outcome measure in population studies and in some primary care studies, but its potential use to monitor the outcomes of health programs is unexplored. The purpose of this study was to compare the outcomes of 4 health promotion programs using change in overall self-rated health as a common metric. Program-specific metrics used were weight change, change in minutes of exercise, change in stress management activities, and change in healthy nutrition practices. We found that, although all of our lifestyle interventions positively affected the program-specific metrics, only the weight loss and exercise programs showed improvement in specific metrics correlated with improvements in overall self-rated health. ( Population Health Management 2010;13:91–95)

As medical providers seek new ways to control costs, online visits have begun to receive serious consideration. The purpose of this study was to compare the odds of being a cost outlier during a 6-month period after either an online visit or a standard drop-in visit in a conventional medical office setting. Medical records of primary care patients (both adults and children) seen in a large group practice in Minnesota in 2008 were analyzed for this study. Two groups of patients were studied: those who had an online visit ( N = 390) and a comparison group who had regular office care for same-day, acute visits ( N = 376). Case types were classified as either complex or common, with common being defined as treatment for pinkeye, sore throat, viral illness, bronchitis, or cough. Outliers were defined as patients for whom standard costs exceeded the 75 th percentile during a 6-month period after the index visit. Multiple logistic regression analysis was used to adjust for differences between groups. The percentage of online visitors who were cost outliers was 21.2 (versus 28.5 in the standard visit group). Median standard costs were $161 for online visits and $219 for same-day acute visits. The adjusted odds of being a cost outlier was lower for the online visit group than for the standard visit group (odds ratio [OR] 0.52, 95% confidence interval [95% CI] 0.35–0.77) after adjusting for number of visits in the previous 6 months, age, sex, and case type. Outpatient visits in the previous 6 months were positively related to outlier status (OR 1.23, 95% CI 1.17–1.29). Online visits appeared to reduce medical costs for patients during a 6-month period after the visit. ( Population Health Management 2010;13:59–63)

Retail medicine clinics have become widely available. However, few studies have been published that compare retail clinic costs of care to standard medical visits for similar patients. The purpose of this study was to compare standard medical costs during a 6-month period after visiting a retail medical clinic to care received in a conventional medical office setting. Medical records of primary care patients (both adults and children) seen in a large group practice in Minnesota in 2008 were analyzed for this study. Two groups of patients were studied: those who used a retail walk-in clinic (N = 141) and a comparison group who used regular office care for same-day, acute visits (N = 137). Patients treated for 5 common conditions (pink eye, sore throat, viral illness, bronchitis, and cough) were selected. The dependent variables were standard costs using federal rates and the rank of standard costs. Multiple linear regression analysis was used to adjust for differences between groups. Median costs did not differ between sites ($126.30 for usual care and $88.10 for retail, P = 0.139); mean cost ranks were 132.5 for usual care and 115.6 for retail ( P = 0.088). After adjusting for previous visit history, age, and sex, patients who received care in the retail setting had lower standard costs and lower cost rank than patients who received usual care (b = −52.9 [ P = 0.006] and b = −24.5 [ P = 0.021], respectively). After selection of cases with common conditions and adjustment for unequal variances, age, sex, and number of office visits in the previous 6 months, our retail clinic appeared to reduce medical costs for patients during the 6-month period after the index visit. ( Population Health Management 2009;12:333–335)

Aim The purpose of this study was to compare return visits in 2 weeks experienced by patients using a retail nurse-practitioner clinic to similar patients using standard drop-in clinic located in a medical office. Background Retail medicine clinics have become widely available. However, their impact on return visit rates compared to drop-in medical office visits for similar patients is unknown. Methods Medical records of primary care patients (both adults and children) seen in a large group practice in Minnesota in 2008 were analyzed for this study. Patients treated for five common conditions were selected (pink eye, sore throat, viral illness, bronchitis, and cough, n = 279). Two groups of patients were studied: those using a retail walk-in clinic staffed by nurse practitioners ( n = 142) and a comparison group using regular office care for same-day visits ( n = 137). The dependent variable was a return office visit within 2 weeks. Multiple logistic regression analysis was used to adjust for case mix differences between groups. Findings The percent of office visits within 2 weeks for these groups was 20.4 for retail drop-in patients and 27.7 for same-day medical office patients, respectively ( P = 0.15). After adjustment for age, gender, visit reason, and number of office visits in the previous 6 months, no significant difference in risk of early return visits in comparison to an office-based drop-in clinic was found (odds ratio 0.83, confidence interval 0.43–1.63). Our retail nurse-practitioner clinic appeared to increase access without increasing early return visits.

The purpose of this study was to assess whether the relationship between obesity and use of medical visits is different for geriatric patients than for other adults. A retrospective analysis was conducted using medical records drawn from a large group practice in Rochester, Minnesota. Adult patients ( n = 1715) were sorted into 2 groups (frequent visitors and others). Separate multiple logistic regression models were estimated for geriatric and non-geriatric patients. Patients who were 65 years of age or older with moderate comorbidity had elevated odds of being frequent visitors (odds ratio [OR] = 6.13, confidence interval [CI] = 3.27–11.49), compared to patients with no comorbidity. Body mass index (BMI), gender, and marital status were unrelated to visit frequency in the geriatric group. Younger patients with a BMI ≥ 35 kg/m 2 had greater odds of being frequent visitors compared to patients with normal body mass, after adjusting for comorbidity, age, marital status, and gender (OR = 1.96, CI = 1.31–2.92). ORs also were significantly greater for subjects with low (OR = 2.13, CI = 1.51–3.01) and moderate comorbidity (OR = 3.32, CI = 2.32–4.76) versus no comorbidity. In our sample of family medicine patients who were referred to specialists, BMI ≥ 35 kg/m 2 is an independent risk factor for frequent utilization of medical visits among adults who are younger than age 65, but not among geriatric patients. Comorbidity is strongly related to visit frequency among both older and younger adult patients. (Population Health Management 2008;11:255–259)