Recent Scientific Papers &
Computer Modelling Study
By   Lewis Mehl-Madrona, M.D., Ph.D.
 
Index pf papers, from Dr. Mehl-Madrona's website:
Abstract of the last paper:
 
Objectives: Frequent users of primary care have not been adequately characterized. The unique characteristics of this population was sought--why they come so often, what their care costs, and if psychosocial factors play a role in their high utilization
 
Methods: The billing sysem of a rural primary care clinic in northern New England was used to find the frequency of visits for all patients attending the clinic for the previous 12 months. The 211 most frequent visitors were selected. A comparison group of 250 random users was generated from the billing software using a random number generator. Chart review was done to compare diagnoses (by frequency of occurence), number of procedures used, amount billed for care; amount received from those billings; number of psychotropic medications prescribed, and response to medication. A subgroup of each group was interviewed to confirm chart review findings and to inquire about personal reasons for coming to the clinic.
 
Results: Frequent users had more patients at the younger and older age groups. Frequent users averaged significantly more emergency department visits and visits to other specialists than random users (p<0.0001). Mental health diagnoses occurred more often among frequent users (p < 0.01) with 27% of patients also carrying psychiatric diagnoses compared to 9% of randomly selected users. Psychiatric diagnoses did not emerge among the ten most common diagnoses of randomly selected users, but did for frequent users. Frequent users had significantly more Medicaid insured persons and fewer persons insured by Medicare. Randomly selected visits had more detailed office visits, venipunctures, urinalyses, cholesterol determinations and lab handling charges. Frequent users received twice as much psychotherapy (of one hour and of one-half hour duration) and had a higher percentage of problem-focused office visits. Chart audit and interview of selected patients revealed that many non-medical reasons were related to visits along withpsychosocial stressors.
 
Conclusions:   Non-medical factors are important among the most frequent utilizers of a primary care clinic. Proposals to improve care for frequent users should consider the psychosocial needs of this population.
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The following is the abstract of a paper submitted for publication and presented at the annual meeting (1997) of the National Institute for the Clinical Application of Behavioral Medicine.
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Faith in treatment influences efficacy among AIDS patients
Lewis E. Mehl-Madrona, M.D.,Ph.D. and Beth Chan, Ph.D.
California Institute of Integral Studies
San Francisco, California
 
Abstract:
 
Objective:   To determine the extent to which patients' faith in a treatment influences its efficacy.
 
Method:   One hundred, forty men, requesting an alternative therapy for AIDS, consisting of repeated injections of typhoid vaccine, were enrolled in a treatment program by a San Francisco AIDS Clinic and also agreed to participate in this independent study of other factors which might affect treatment efficacy. Patients were interviewed before entry into the protocol and at intervals of every 2 months for two years while in the protocol. The patient's "faith in treatment" was assessed at each contact. Clinic physicians made weekly ratings of the patients' sense of subjective improvement. CD4 cell count and white blood cell count were measured regularly.
Results:   Faith in treatment was associated with treatment efficacy. A fall in "faith in treatment" among those who initially responded very positively to the vaccine preceded by 4-6 months the development of a life-threatening infection and a deterioration in clinical course. The ten patients who continued to respond to the vaccine at the end of one year and two years were those who continued to have a high "faith in treatment."
Conclusions:  An effect of faith in treatment upon the course of AIDS was demonstrated. Faith may be important regardless of the efficacy of a treatment and may be the mediating variable which renders statistically ineffective treatments highly effective for those who believe in them.
 
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Note: Mehl-Madrona's article, "Computer Simulation Modeling and Birth Outcome," is listed separately. Click here to view it.
 
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