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To examine whether the frequency of four screening tests during prenatal care conforms to evidence of effectiveness. We estimated rates of urine culture, anemia screening, oral glucose tolerance test (OGTT), and urinalysis during prenatal care. To do this, we used national probability samples of office visits to physicians (National Ambulatory Medical Care Survey) and to hospital outpatient departments (National Hospital Ambulatory Medical Care Survey) from 2001 to 2006. We compare observed rates to recommendations from the U.S. Preventive Services Task Force (USPSTF). On average, women received a urine culture in less than half of pregnancies. Women received just over one anemia screening on average per pregnancy. From 2001-2003, women received an average of 5.6 urinalyses per pregnancy; the average dropped to 4.3 urinalyses per pregnancy in 2004-2006. On average, women received just under one OGTT per pregnancy. Minorities and older women tend to get more anemia screenings, urine cultures, and OGTTs than white women and younger women. Compared to USPSTF recommendations, too few women are receiving a urine culture during prenatal care. In contrast, women receive far too many urinalyses, but the rate appears to be falling. Anemia screening conforms closely to recommendations. The USPSTF does not recommend for or against universal diabetes screening using OGTT. Women appear to receive OGTT routinely. Keywords Screening * Prenatal * Pregnancy * Evidence-based care, Introduction Prenatal care is one of the most common reasons for a physician visit by women in the U.S., accounting for about 22 million visits a year [1]. The content [...]

Summary Health boards in Scotland are challenged with reducing emergency department (ED) attendances against a backdrop of year-on-year increases. It is often assumed that patients who attend EDs with non-urgent [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2009.03.013 Byline: Nicolas Bertholet (a)(b), Kim Dukes (c), Nicholas J. Horton (d), Tibor P. Palfai (e)(f), Alison Pedley (c), Richard Saitz (a)(f) Keywords: Stages of Change Readiness and Treatment Eagerness Scale; Factor structure; Medical inpatients; Unhealthy alcohol use Abstract: The Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES), a 19-item instrument developed to assess readiness to change alcohol use among individuals presenting for specialized alcohol treatment, has been used in various populations and settings. Its factor structure and concurrent validity has been described for specialized alcohol treatment settings and primary care. The purpose of this study was to determine the factor structure and concurrent validity of the SOCRATES among medical inpatients with unhealthy alcohol use not seeking help for specialized alcohol treatment. The subjects were 337 medical inpatients with unhealthy alcohol use, identified during their hospital stay. Most of them had alcohol dependence (76%). We performed an Alpha Factor Analysis (AFA) and Principal Component Analysis (PCA) of the 19 SOCRATES items, and forced 3 factors and 2 components, in order to replicate findings from Miller and Tonigan (Miller, W. R., & Tonigan, J. S., (1996). Assessing drinkers' motivations for change: The Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). Psychology of Addictive Behavior, 10, 81-89.) and Maisto et al. (Maisto, S. A., Conigliaro, J., McNeil, M., Kraemer, K., O'Connor, M., & Kelley, M. E., (1999). Factor structure of the SOCRATES in a sample of primary care patients. Addictive Behavior, 24(6), 879-892.). Our analysis supported the view that the 2 component solution proposed by Maisto et al. (Maisto, S.A., Conigliaro, J., McNeil, M., Kraemer, K., O'Connor, M., & Kelley, M.E., (1999). Factor structure of the SOCRATES in a sample of primary care patients. Addictive Behavior, 24(6), 879-892.) is more appropriate for our data than the 3 factor solution proposed by Miller and Tonigan (Miller, W. R., & Tonigan, J. S., (1996). Assessing drinkers' motivations for change: The Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). Psychology of Addictive Behavior, 10, 81-89.). The first component measured Perception of Problems and was more strongly correlated with severity of alcohol-related consequences, presence of alcohol dependence, and alcohol consumption levels (average number of drinks per day and total number of binge drinking days over the past 30 days) compared to the second component measuring Taking Action. Our findings support the view that the SOCRATES is comprised of two important readiness constructs in general medical patients identified by screening. Author Affiliation: (a) Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA (b) Clinical Epidemiology Center, Institute of Social and Preventive Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland (c) DM-STAT Inc., Malden, MA, USA (d) Department of Mathematics and Statistics, Smith College, Northampton, MA, USA (e) Department of Psychology, Boston University, Boston, MA, USA (f) Youth Alcohol Prevention Center and Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA

In this paper we present results on the effect of medical experience on the economic evaluation of health policies utilizing the method of discrete choice experiments. Subjects in two split samples were asked about choice situations involving alternative profiles defined by the attributes of an innovative program for cervical cancer screening. The first sample was formed by expert medical practitioners who were familiar with the illness and its potential treatments. A second sample was formed by young undergraduate students in social sciences who were not familiar with the illness or with the potential benefits of screening programmes. The statistical comparison between both subsamples utilizes a robust method for discrete choice models which shows that there are no significant differences in the structural models and the parameter estimates. The main implication is that background medical information and familiarity with the process of illness might not have a relevant impact on the valuation of health policies with discrete choice experiments. Keywords: Cervical cancer; Discrete choice experiments; Health values; Information; Medical experience.

Objective: To predict the likely impact of adding human papillomavirus (HPV) triage for minor abnormalities on participation in the English cervical cancer screening program. Method: Contingent valuations of the existing Pap program and a possible HPV-augmented screening program, obtained from questionnaires completed by 1141 women in east-central England. Results: The value of participating in Pap screening was negatively associated with age, positively associated with educational level, and positively associated with the level of household income. Higher levels of worry about cervical cancer were associated with higher valuations of screening. Adding HPV-based triage to the Pap program lowered the value of screening participation for only two women, whereas for the sample as a whole, it increased the average valuation by about 47 per cent. Supposedly-negative characteristics of HPV testing, when described, were expected to trigger psychosocial concerns in respondents and thereby give rise to significant decreases in valuations of participating in a Pap-plus-HPV program. For most women, however, such information changed their valuations of participation in screening little, if at all. Conclusions: Accepting the proposition that higher contingent valuations indicate stronger behavioural preferences, our results offer insubstantial grounds for believing that the inclusion of HPV triage would detrimentally affect participation in Pap screening for cervical cancer. doi: 10.1300/J013v43n02_02 [Article copies available for a fee from The Haworth Document Delivery, Service: 1-800-HAWORTH. E-mail address: Website: KEYWORDS. Cervical cancer, contingent valuation, human papillomavirus, Pap test, screening