Search

BACKGROUND: Despite widespread use, the accuracy of community-based automated blood pressure machines has been questioned. We sought to determine if these machines are as accurate and reliable as those obtained by a clinician with a mercury manometer. METHODS: We randomly selected 25 pharmacies and compared blood pressure readings obtained from their automated machines with from a mercury manometer. We used 3 volunteers with arm circumferences at the low, medium, and high ends of the acceptable range of a normal adult cuff size. RESULTS: For the subject with the small arm size, store machines reported systolic pressure readings that were, on average, 10 mm Hg higher than those obtained by the clinician (P < .001) and diastolic pressures 9 mm Hg higher (P < .001). The mean systolic pressure readings for the subject with the medium arm size were not significantly different between the store machine and the mercury manometer, and the readings were only modestly different for diastolic pressure. For the subject with the large arm size, store machines reported diastolic pressure readings that were, on average, 8.3 mm Hg lower than those obtained using the mercury manometer (P < .001), but with no significant difference in the systolic pressure. CONCLUSIONS: We found that automated blood pressure machines from a representative community-based sample of pharmacies did not meet the accepted standards of accuracy and reliability. Accuracy of readings is especially uncertain for patients having arm sizes larger or smaller than average. [ABSTRACT FROM AUTHOR]

OBJECTIVE Our goal was to determine if increasing primary care physician supply was associated with lower incidence and mortality rates for colorectal cancer. STUDY DESIGN We performed an ecologic study of Florida's 67 counties, using data from the state tumor registry and the American Medical Association physician masterfile. POPULATION Florida residents were included. OUTCOME MEASURED We measured age-adjusted colorectal cancer incidence and mortality rates for Florida's 67 counties during the period 1993 to 1995. RESULTS Increasing primary care physician supply was negatively correlated with both colorectal cancer (CC) incidence (CC = -0.46; P < .001) and mortality rates (CC = -0.29; P =.02). In linear regression that controlled for other county characteristics, each 1% increase in the proportion of county physicians who were in primary care specialties was associated with a corresponding reduction in colorectal cancer incidence of 0.25 cases per 100,000 (P > .001) and a reduction in colorectal cancer mortality of 0.08 cases per 100,000 (P = .008). CONCLUSIONS Incidence and mortality of colorectal cancer decreased in Florida counties that had an increased supply of primary care physicians. This suggests that a balanced work force may achieve better health outcomes. [ABSTRACT FROM AUTHOR]

BACKGROUND. Policymakers question whether there is a relationship between the number and distribution of physicians and the outcomes for important health conditions. We hypothesized that increasing primary care physician supply would be related to earlier detection of colorectal cancer. METHODS. We identified incident cases of colorectal cancer occurring in Florida in 1994 (n = 8933) from the state cancer registry. We then obtained measures of physician supply from the 1994 American Medical Association Physician Masterfile and examined the effects of physician supply (at the levels of county and ZIP code clusters) on the odds of late-stage diagnosis using multiple logistic regression. RESULTS. For each 10-percentile increase in primary care physician supply at the county level, the odds of late-stage diagnosis decreased by 5% (adjusted odds ratio [OR] = 0.95; 95% confidence interval [CI], 0.92 - 0.99; P .007). For each 10-percentile increase in specialty physician supply, the odds of late-stage diagnosis increased by 5% (adjusted OR = 1.05; 95% CI, 1.02 - 1.09; P = .006). Within ZIP code clusters, each 10-percentile increase in the supply of general internists was associated with a 3% decrease in the odds of late-stage diagnosis (OR = 0.97; 95% CI, 0.95 - 0.99; P = .006), and among women, each 10-percentile increase in the supply of obstetrician/gynecologists was associated with a 5% increase in the odds of late-stage diagnosis (OR = 1.05; 95% CI, 1.01 - 1.08; P= .005). CONCLUSIONS. If the relationships observed were causal, then as many as 874 of the 5463 (16%) late-stage colorectal cancer diagnoses are attributable to the physician specialty supply found in Florida. These findings suggest that an appropriate balance of primary care and specialty physicians may be important in achieving optimal health outcomes. [ABSTRACT FROM AUTHOR]