Prescription drug abuse is a continuing problem in the United States. Educating physicians on issues related to prescription drug abuse is a key factor in preventing and treating this problem. High variability has been found in substance abuse terminology in the literature, textbooks, and FDA-approved product labeling. This dissertation describes a survey study designed to address how the variability in substance abuse terminology, specifically package inserts, affects the prescribing decisions made by physicians.A random sample of 1008 physicians currently licensed and residing in the Commonwealth of Virginia received a letter of explanation, a self-administered questionnaire, and a follow-up reminder and thank you. To increase response rate, a second questionnaire was sent to non-responders. Prescribing decisions made by physicians were measured as three variables: comfort level with a prior physician's choice, likelihood of refilling the prescription, and likelihood of prescribing a drug or drug class as the first physician seeing a particular patient. Physicians were presented with four case scenarios which included package insert information and selected patient characteristics. Other factors affecting physicians' decisions in prescribing controlled substances include ideas about addiction, and characteristics of the physician, patient, disease state, and drug. The patient case scenarios and other items on the questionnaire addressed these covariates. Based on the number of deliverable questionnaires returned and included in analysis, the response rate was 32.3%. More physicians associated abuse, craving, drug-seeking behavior, psychological dependence, and withdrawal with addiction than with drug dependence, while more physicians felt that physical dependence and tolerance were necessary for drug dependence. The most frequently used sources for drug information were the Physicians' Desk Reference (PDR), package inserts, and pharmacists. Four linear regression models were created for physician prescribing decisions. Physician, patient and package insert characteristics were all significant (p

The expansion of health insurance through health care reform has reduced the number of uninsured. but access to providers has not been addressed. Understanding the relationship between practice choices and aptitude of health policy and delivery is essential to determine other factors or motivators that contribute to the development of health care access policies. This descriptive study explored the value-laden elements of health care reform, such as social constructions, to learn whether there are implicit ways to address the issue of access to health care in the United States. Schneider and Ingrams's conceptualization of policy making through social construction was used as the theoretical lens of this study. The research questions for the study examined the relationship between a provider's choices and their knowledge of health policy and delivery. This non-experimental, quantitative survey study used a convenience sample of 189 providers. The survey was a compilation of 4 existing instruments that were used to capture provider demographics and choices as well as scaled questions to assess knowledge. Data were analyzed through a series of chi-square tests. Significant relationships were found (p < .05) between the variables of specialty, medical licensure, and understanding of health policy and delivery concepts. This study contributes to social change by suggesting the need for health policy and delivery education programs geared towards providers. These changes could improve the level of provider engagement and be a catalyst for generating ideas of how the U.S. health care system could achieve the goal of providing efficient, high-quality care.

This study evaluates the roles of temperature variability and disease awareness in the emergence of Chagas disease (American trypanosomiasis). Chagas disease is endemic in Latin America and primarily spreads to humans directly via the triatomine vector. Hosts for most triatomine species are mainly rodents and occasionally dogs. The disease itself is caused by a parasitic protozoan, Trypanosoma cruzi (T. cruzi) which is found in the triatomine's feces and is often spread while the triatomine is consuming a blood meal. T. cruzi from feces enters the body via an abrasion on the skin, the mucous membranes, conjunctivae, or through consumption. To determine the risk of Chagas disease transmission one must define qualities that make the triatomine an effective disease vector as well as investigate the level of disease awareness among physicians and the population within the vector's range. This thesis maps triatomine species within the U.S. that harbor T. cruzi naturally and that exhibit qualities of domesticity. These qualities are defined by whether the species bites humans and dogs as well as reports that the species has been found in the domestic setting. Ranges illustrating temperature thresholds for increased triatomine activity for 2000 and 2030 are also depicted. Additionally, outcomes of a physician survey are presented to gauge the status of Chagas disease awareness in areas at higher risk for disease transmission. Results reveal limited consideration of Chagas disease in physician diagnosis despite the higher risk range which extends through the southern U.S. and is predicted to expand significantly by 2030. / Master of Science