The adherence to published guidelines for diagnosis and treatment of Attention-Deficit Hyperactivity Disorder (ADHD) by primary care pediatricians (PDs) and family practice physicians (FPs), particularly those in rural areas, has not been well documented. This study examined survey responses from PDs and FPs who serve southern Appalachia (northeast Tennessee, southwest Virginia and Kentucky, and western North Carolina) regarding key practice parameters in line with the current American Academy of Pediatrics guidelines. Results showed that both PDs and FPs reported adhering to most of the diagnosis and treatment guidelines. PDs were more likely than FPs to report using both parent and teacher input in diagnosis and reported prescribing different medications for ADHD to some degree. Both practice areas reported ongoing access to continuing medical education, which is a means to enhancing care of ADHD patients. Implications for primary care are given with attention to the limited availability of PDs in rural areas and future areas of research in rural mental healthcare are suggested.

Close textual analysis of the four extant film versions of Invasion of the Body Snatchers reveals that each film modifies the original story such that it reflects changing societal attitudes toward physicians and the medical profession, as well as depictions of military and government in the science fiction genre. The changing depictions of characters and events in these films respond to changes in medical history, social history, and the science fiction genre across five decades. Each film reflects the contemporary anxieties of its time and the perceived ability of physicians to relieve those anxieties. Doctors are important semantic elements of the science fiction genre, and their position within the syntax of a film helps to determine its meaning. By focusing on the physician character, this study finds that in addition to being a metaphor for threats such as Communism, Invasion of the Body Snatchers also reflects concerns about disease and other medical threats.

Objective: To evaluate factors influencing excessive weight gain during pregnancy and changes in eating patterns from the pre-pregnancy period among low-income women (<185% poverty level). Design, Setting, & Participants: Low-income women who were at least 7-months pregnant and gained excess weight (n= 14) or normal weight (n=15) were interviewed. Questions pertained to previous nutritional knowledge, eating patterns, and sources for obtaining nutrition information. Outcome Measures and Analysis: Transcripts were coded independently by two researchers, with any differences reconciled. Common themes were discussed and tallied to determine the most commonly re-occurring topics reported in the interviews. Results: Most of the excess weight gainers (EWG) and recommended weight gainers (RWG) had a heightened awareness of their eating patterns and became more concerned about the impact their diet had on their fetus' health during (vs. before) pregnancy. EWG and RWG received limited nutrition- and weight-related advice from their doctors, and relied on alternate sources of information, such as pregnancy books and online websites. The most noted difference between the groups was that RWG reported more accurate nutrition knowledge than EWG.Conclusions and Implications: Nutrition knowledge indirectly affects the amount of weight women gain during pregnancy. EWG and RWG received minimal nutritional and weight-related advice from doctors during or after pregnancy. This suggests the need for increased counseling efforts by doctors in providing appropriate nutrition and weight-related advice to their patients or providing outside referrals to registered dietitians.

This is the history of those noble women who came into the territory, struggling to relieve the burden of poor medical service. This is an account of how well or how poorly they conducted the art of midwifery. From the first year the pioneers entered the region in 1847, down to 1896 when statehood was achieved, though there were male physicians in the field of medicine, Utah depended on its women. This is a study of their contribution.

Introduction The U.S. South has higher rates of unintended pregnancy than other regions of the nation. Rurality and limited supply of medical providers and reproductive health services contribute to these disparities. Layered on this are restrictive reproductive health policies that are changing rapidly. Many rural areas in the South are "maternity care deserts” with no OB/GYNs, midwives, or obstetric care. In these areas, family physicians are often the only providers of reproductive health services. While family physicians commonly counsel about and prescribe oral contraceptives, little is known about their counseling practices for long-acting reversible contraception (LARC), including intrauterine devices (IUDs) and contraceptive implants. This study examines attitudes and practices of family physicians in two Southern states related to counseling for IUDs and implants. Methods Statewide representative surveys of family physicians (FPs) were administered in South Carolina and Alabama in 2018. The survey questionnaire, informed by in-depth interviews with providers and a systematic literature review, collected data about providers’ knowledge, attitudes and practices related to contraceptive counseling and provision. The questionnaire was pilot tested, revised and finalized. Random samples of FPs from each state were selected, with oversampling of rural providers. Sampled providers were web traced and phone screened to verify eligibility and contact information. The IRB-approved survey protocol involved mixed-mode administration (electronic and mail surveys), participation incentives for providers and office managers, and extensive follow-up with non-respondents. Survey data were weighted to account for the sampling design and to generate robust estimates. Data were cleaned and analyzed in STATA using t-tests and chi-square tests for independence. Results Five hundred and ten (510) FPs responded to the survey. The majority of FPs (70%) were in private medical practice and one-fourth in rural areas. Among FPs in Alabama, 39.3% reported not counseling any of their reproductive-aged female patients in the past year about IUDs, and 53.1% reported not counseling about the implant. Prevalence of counseling did not differ significantly between AL and SC providers. While a majority of FPs in both states (88.7%) reported general training in contraceptive counseling during their formal education, fewer reported training specific to IUDs (61.7%) and implants (43.9%), and only 28% had received recent training in contraceptive counseling in the past 2 years. Risk perceptions of providers varied. Contrary to medical eligibility criteria, the majority of FPs considered IUDs unsafe for women who had an STI (sexually transmitted infection) in the past 2 years (62.4%) and unsafe immediately post-partum (69.4%). Contraceptive training was positively associated with counseling provision, whereas risk perceptions were negatively associated with counseling provision. Conclusion Substantial training gaps and needs were noted among FPs. While the scope of practice of FPs is broad and demanding, their engagement in comprehensive contraceptive counseling is essential for their patients’ health and well-being. This is particularly true in the U.S. south where contraceptive services are not always available or accessible. FPs must be supported through evidence-based training programs and clinic-level interventions that facilitate their contraceptive counseling and, ultimately, their patients’ contraceptive choices and outcomes.

This dissertation focuses on three different aspects of physician pricing. The first is the use of the assumption in formal modeling that physicians have the same type of costs for different types of patients. The second aspect of physician pricing investigated here is physicians’ ability to change the name of a service in response to a fee cap without actually changing the price of the service. The third aspect investigated in this dissertation is the effect of posting physician prices on patient-initiated demand for physician services. All three of these aspects have potential implications for the discussion on health care reform. In Chapter One, I examine physician price response to fee ceilings set by third party payers. I use the realistic assumptions that physician’s have the same cost function for all their patients and physicians have increasing marginal cost. Using these assumptions, I find that, in theory, a third party payer that uses fixed fees benefits from including every physician in the community. In chapter two, I use the medical claims data from a Fortune 500 firm (Firm) to evaluate physician pricing response to the Firm’s institution of fee ceilings. I find that physicians who are constrained by the fee ceiling systematically record a more expensive office visit code than physicians who were not constrained by the fee ceiling. This result has implications for private insurers as well as government programs that fix physician fees. In chapter three I use a model of patient-initiated demand under uncertainty to examine the effect of posting physician prices on the demand for physician services. I find that requiring physicians with monopoly power to post all or some of their prices has no effect on the total patient cost associated with physician consultations, including the cost of untreated disease. If physicians compete in a Bertrand fashion, then requiring a physician to post the prices of all types of consultations results in lower total patient cost than posting only some prices. / Ph. D.

This study investigated the effects of gender, both patient and physician, on how a medical complaint is perceived and acted upon by health professionals. A 2 x 2 factorial design was used, with gender of physician and patient as the two factors, respectively. The participants were physicians (M.D.s) who were recruited by approaching local hospitals/clinics and requesting their participation in the research. They were asked to respond to a patient vignette and a questionnaire assessing the physician's beliefs about and intentions toward the patient. Using a 2 x 2 ANOVA with a specified .05 significance level, no statistically significant differences were found in the assessment of the perceived seriousness of a medical complaint, in the aggressiveness of the work-up provided, and in the diagnoses given to patients. The findings from this study are of value in exploring the existence of gender bias in the medical setting. The absence of gender bias, as it occurred in this study, is an encouraging finding for members of the health care community.

Background: Critical care nurses (CCNs) provide end-of-life (EOL) care for critically ill patients. CCNs face many obstacles while trying to provide quality EOL care. Some research has been published focusing on obstacles CCNs face while trying to provide quality EOL care; however, research focusing on family behavior obstacles is limited.Objective: To determine if magnitude scores (obstacle item size x obstacle item frequency of occurrence) have changed since previous magnitude score data were first gathered in 1999.Methods: A random geographically dispersed sample of 2,000 members of the American Association of Critical-Care Nurses (AACN) was surveyed. Responses from quantitative Likert- type items were statistically analyzed for mean and standard deviation for size of obstacle and how frequently each item occurred. Current data were then compared to similar data gathered in 1999.Results: Six items’ magnitude scores significantly increased over time. Four of the six items related to issues with families including families not accepting poor prognosis, interfamily fighting about continuing or stopping life-support, families requesting life-sustaining measures contrary to the patients’ wishes and, families not understanding the term “life-saving” measures. Two other items included nurses knowing patients’ poor prognosis before families knows and unit visiting hours that were too liberal.Seven items significantly decreased in magnitude score over time, including two items specifically related to physician behavior such as physicians who would not let patients die from the disease process or physicians who avoid talking to family members. Other items which significantly decreased were poor design of units, visiting hours that were too restrictive, no available support personnel, and when the nurse’s opinion regarding direction of care was not valued or considered.Conclusions: EOL care obstacles emphasized in 1999 are still valid and pertinent. Based on magnitude scores, some EOL obstacles related to families increased significantly, whereas, obstacles related to ICU environment and physicians have significantly decreased. Based on this information, recommendations for areas of improvement include improved EOL education for families and nurses.

The United States health care expenditures are higher than any other developed country. Due to this, physician payment reform is moving from fee-for-service (FFS) to a value-based model, with a focus on prevention and quality. The purpose of this quantitative study was to measure the effect of a series of data delivery interventions associated with the quality scorecards and which method increased the quality scores at a medical teaching practice in Tennessee. Data were gathered via the Physician Quality Scorecard, an internally developed instrument. Each quarter, a different data delivery intervention was performed, and scorecard data were analyzed for comparison. The study population included all living faculty and resident physicians who practiced medicine between quality years 2018-2020. Statistical procedures included one-way ANOVA, independent t-test, and Pearson correlation coefficient. Data analyses revealed that the data delivery intervention of email only was more likely than other interventions to yield the most positive change in quality scores in the years 2018-2020. However, the classroom training data delivery method generated the most positive change and email only generated the least positive change in the quality year 2019 only. The quality year 2018, yielded the best quality year overall. It is important to note that data collected in 2020 may have limitations due to the COVID-19 pandemic.

Indiana University-Purdue University Indianapolis (IUPUI) / At the end of the nineteenth century, the African-American population of Indianapolis increased, triggering a need for health care for the new emigrants from the South. Within the black population, some individuals pursued medical degrees to become physicians. At the same time, advances in medical treatment—especially surgical operations—shifted the most common site of care from patients’ homes to hospitals. Professionally trained nurses, mostly white, began to replace family members or untrained African-American nurses who previously delivered care to Black patients. Barriers of racial segregation kept both the Black doctors and Black nurses from practicing in the municipal City Hospital in Indianapolis. To remedy this problem, the city's African-American leaders undertook establishing healthcare institutions with nurse training schools during the first few years of the twentieth century. This thesis argues that the healthcare institution-building that occurred in the early twentieth century offered opportunities for the practice of self-help in the Black community. The institutions also created a bridge for Black-white relations because the Black hospitals attracted the support of prominent white leaders. Good health and health care for the sick or injured were necessary to achieve racial uplift, and healthcare consumption became an indicator of social status and economic success. Racially segregated institutions afforded doctors and nurses a chance to increase their expertise and prove they were capable of functioning in the public hospital system. After a decade of working in separate institutions, the Black community prepared to push for full access to the city's tax-supported City Hospital as a civil right.