Skip to main content
SpringerLink
Log in

Factors Affecting Use of Resources for Asthma Patients

  • Original Paper
  • Published:
Journal of Medical Systems Aims and scope Submit manuscript

Abstract

Objective: This study aims at exploring the variance in resources used for management and treatment of asthma disease and analyzing the impact of patient and physician characteristics on total test expenditures and the number of drugs prescribed as resource utilization variables.

Study setting: The study was undertaken in Hacettepe University Chest Diseases Polyclinic and Allergy Unit. 387 asthma patients visiting the unit between August 2000 and March 2001, were included in the study.

Results: The regression analysis showed that patient characteristics did not have a statistically meaningful impact on total test expenditures (p > 0.05). The laboratory test expenditures for patients who referred to academicians (professors and associate professors) were higher compared to patients who referred to their counterparts (p < 0.05). Similarly, the laboratory test expenditures for patients referred to two physicians in the allergy unit were higher and statistically meaningful (p < 0.05) than patients who referred to 8 physicians in the chest diseases polyclinic. When factors affecting the number of drugs prescribed is analyzed it was found that duration of treatment, severity of disease, quality of life, frequency of referral to a physician in the last 6 months were meaningful (p < 0.05).

Conclusions: The variances in total test expenditures for different academic careers and specialties indicate the need to standardize the treatment process for asthma and to reconsider medical education.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bernard, A. M., Shapiro, L. R., and McMahon, L. F., The influence of Attending Physician Subspecialization on Hospital Length of Stay. Med. Care 28(2):170–174, 1990.

    Article  Google Scholar 

  2. McGuire, A., Measuring Performance in the Health Care Sector: The Hows. In Andersen, T. F., and Mooney, G (eds.), The Challenges of Medical Practice Variation. The Macmillan Press Ltd, pp. 95–116, 1990.

  3. Eisenberg, J. M., Physician Utilization: The State of Research About Physicians’ Practice Patterns. Med. Care 23(5):461–483, 1985.

    Article  Google Scholar 

  4. Gibson, R. M., Waldo, D., and Levit, K., National Health Expenditures. Health Care Financ. Rev. 5:1–30, 1980.

    Google Scholar 

  5. O’Connor, K., Management Implication of Physician Practice Patterns: Strategies for Managers. Hospital & Health Serv. Admin. 38(4):572–577, 1993.

    Google Scholar 

  6. Wilensky, G. R., and Rossiter, L., The Relative Importance of Physician-Induced Demand for Medical Care. Milbank Mem. Fund. Q. 61:252–277, 1983.

    Article  Google Scholar 

  7. Omachonu, V. K., Physician Practice Patterns and Hospital Efficiency. In: Total Quality Productivity Management in Health Care Organizations. Industrial Engineering and Management Press, pp. 227–243, 1991.

  8. Kinder, K., Assessing the Impact of Payment Method and Practice Setting on German Physicians’ Practice Patterns. J. Ambul. Care Manage 24(2):11–18, 2001.

    Google Scholar 

  9. Chilingerian, J. A., Evaluating Physician Efficiency in Hospitals: A Multivariate Analysis of Best Practices. Eur. J. Oper. Res. 80:548–574, 1995.

    Article  MATH  Google Scholar 

  10. O’Neill, L., and Kuder, J., Explaining Variation in Physician Practice Patterns and Their Propensities to Recommend Services. Med. Care Res. Rev. 62(3):339–357, 2005.

    Article  Google Scholar 

  11. Long, M. J., An explanatory model of medical practice variation: a physician resource demand perspective. J. Eval. Clin. Pract. 8(2):167–174, 2002.

    Article  Google Scholar 

  12. Eddy, D. M., Clinical Decision Making: From Theory to Practice. JAMA 263(2):287–290, 1990.

    Article  Google Scholar 

  13. Rethans, J., and Saebu, L., Do General Practitioners Act Consistently in Real Practice When They Meet The Same Patient Twice? Examination of Intraphysician Variation Using Standardized (Simulated) Patients. BMJ 314:1170–1173, 1997.

    Google Scholar 

  14. Ibrahim, S. A., Whittle, J., Mayberry, B. B., Kelley, M. E., Good, C., and Conigliaro, J., Racial/Ethnic Variations in Physician Recommendations for Cardiac Revascularization. Am. J. Public Health 93(10):1689–1693, 2003.

    Google Scholar 

  15. Wennberg, J. E., Variations in Medical Practice and Hospital Costs. Conn. Med. 49(7):444–453, 1985.

    Google Scholar 

  16. Burns, L. R., and Wholey, D. R., The Effects of Patient, Hospital, and Physician Characteristics on Length of Stay and Mortality. Med. Care 29(3):251–271, 1991.

    Article  Google Scholar 

  17. Dutton, D., Financial, Organizational and Professional Factors Affecting Health Care Utilization. Soc. Sci. Med. 23(7):721–735, 1986.

    Article  Google Scholar 

  18. Bertakis, K. D., Helms, L. J., Azari, R., Callahan, E. J., Robbins, J. A., and Miller, J., Differences between Family Physicians’ and General Internists’ Medical Charges. Med. Care 37(1):78–82, 1999.

    Article  Google Scholar 

  19. Blanc, P. D., Katz, P. P., Henke, J., Smith, S., and Yelin, E. H., Pulmonary and Allergy Subspecialty Care in Adults With Asthma: Treatment, Use of Services, and Health Outcomes. West J. Med. 167(6):398–407, 1997.

    Google Scholar 

  20. Cherkin, D. C., Rosenblat, R. A., Hart, L. G., Schneeweiss, P., and LoGerfo, J., The Use of Medical Resources by Residency-Trained Family Physicians and General Internist: Is There A Difference? Med. Care 25:455–469, 1987.

    Article  Google Scholar 

  21. Greenwald, H. P., Peterson, M. L., Garrison, L. P., Hart, G., Moscovice, I. S., Hall, T. L., and Perrin, E. B., Interspecialty Variation in Office-Based Care. Med. Care 22(1):14–29, 1984.

    Article  Google Scholar 

  22. Gillespie, K. N., Romeis, J. C., Virgo, K. S., Fletcher, J. W., and Elixhauser, A., Practice Pattern Variation Between Two Medical Schools. Med. Care 27(5):537–542, 1989.

    Article  Google Scholar 

  23. Elpstein, A. M., Colin, B. D., and McNeil, B. I., The use of ambulatory testing in prepaid and fee for service group practices. N Engl. J. Med. 314:1089–1094, 1986.

    Article  Google Scholar 

  24. Hillman, A. L., Pauly, M. V., and Kerstein, J. J., How Do Financial Incentives Affect Physicians’ Clinical Decisions and The Financial Performance of Health Maintenance Organizations? The New Engl. J. Med. 321:86–92, 1989.

    Article  Google Scholar 

  25. Hlatkey, M. A., Lee, K. L., Botvinick, E. H., and Brundage, B. H., Diagnostic Test Use in Different Practice Settings: A Controlled Comparison. Arch. Int.l Med. 143:1886–1889, 1983.

    Article  Google Scholar 

  26. Greenfield, S., Nelson, E., Zubkoff, M., Manning, W., Rogers, W., Kravitz, R. L., et al., Variations in Resource Utilization Among Medical Specialties and Systems of Care: Results from The Medical Outcomes Study. J. Am. Med. Assoc. 267(12):1624–1630, 1992.

    Article  Google Scholar 

  27. Luft, H., Variations in patterns of care and outcomes after acute myocardial infarction for Medicare beneficiaries in F-F-S and HMO settings. Health Ser. Res. 38(4):65–79, 2003.

    Google Scholar 

  28. Fihn, S. D., Physician Specialty, System of Health Care, and Patient Outcomes. JAMA 274(18):1473–1474, 1995.

    Article  Google Scholar 

  29. Bareford, D., and Hayling, A., Inappropriate use of laboratory services: long term combined approach to modify request patterns. BMJ 301:1305–1307, 1990.

    Article  Google Scholar 

  30. Davidoff, F., Goodspeed, R., and Clive, J., Changing test behavior: a randomized controlled trial comparing probabilities reasoning with cost-containment education. Med. Care 27:45–48, 1989.

    Article  Google Scholar 

  31. Gama, R., Nightingale, P. G., Broughton, P. M. G., et al., Modifying the request behavior of clinicians. J. Clin. Pathol. 45:248–249, 1992.

    Article  Google Scholar 

  32. Barnes, P. J., New Approach to The Treatment of Asthma. The New Engl. J. Med. 321(22):1517–1526, 1989.

    Article  Google Scholar 

  33. Kemp, J. P., Approaches to Asthma Management. Arch. Int. Med. 153:805–812, 1993.

    Article  Google Scholar 

  34. Juniper, E. F., Guyatt, G. H., Epstein, R. S., Ferrie, P. J., Jaeschke, R., and Hiller, T. K., Evaluating of Impairment of Health Related Quality of Life in Asthma: Development of A Questionnaire for Use in Clinical Trials. Thorax 47:76–83, 1992.

    Google Scholar 

  35. Christian, R. D., Health Resources Use and Outcomes in Patients With Asthma. Doctoral Thesis, The University of Michigan, U.S.A, 1997.

  36. Glaxowellcome. Avrupa’da Astım İçyüzü ve Gerçeği. GlaxoWellcome, 1999.

  37. U.S. Department of Health and Human Services. Practical Guide for the Diagnosis and Management of Asthma. National Institute of Health Publication, No: 97, 1997.

  38. Stuart, M. E., and Steinwachs, D. M., Patient-Mix Differences Among Ambulatory Providers and Their Effects on Utilization and Payments for Mayland Medicaid Users. Med. Care 31(12):1119–1137, 1993.

    Article  Google Scholar 

  39. Horn, S. D., Horn, R. A., and Moses, H., Profiles of Physician Practice and Patient Severity of Illness. Am. J. Public Health 76(5):532–535, 1986.

    Article  Google Scholar 

  40. Horn, S. D., Sharkey, P. D., Buckle, J. M., Backofen, J. E., Averill, R. F., and Horn, R. A., The Relationship Between Severity of Illness and Hospital Lenght of Stay and Mortality. Med. Care 29(4):305–317, 1991.

    Article  Google Scholar 

  41. Jones, K. R., Predicting Hospital Charge and Stay Variation: The Role of Patient Teaching Status, Controlling for Diagnosis-Related Group, Demographic Characteristics, and Severity of Illness. Med. Care 23(3):220–235, 1985.

    Article  Google Scholar 

  42. Lezzoni, L. I., Ash, A. S., Shwartz, M., and Mackiernan, Y. D., Differences in Procedure Use, In-Hospital Mortality, and Illness Severity by Gender for Acute Myocardial Infarction Patients. Med. Care 35(2):158–171, 1997.

    Article  Google Scholar 

  43. Panniers, T. L., Severity of Illness, Quality of Care, and Physician Practice As Determinants of Hospital Resource Consumption. QRB 13(5):158–165, 1987.

    Google Scholar 

  44. Forthman, M. T., Dove, H. G., Forthman, C. L., and Henderson, R. D., Beyond Severity of Illness: Evaluating Differences in Patient Intensity and Complexity for Valid Assessment of Medical Practice Pattern Variation. Man. Care Q. 13(4):9–17, 2005.

    Google Scholar 

  45. Garber, A. M., Fuchs, V. R., and Silverman, J. F., Case Mix, Costs, and Outcomes. The New Eng. J. Med. 310:1231–1237, 1984.

    Article  Google Scholar 

  46. Feinglass, J., Martin, G. J., and Sen, A., The Financial Effect of Physician Practice Style on Hospital Resource Use. Health Serv. Res. 26:183–205, 1991.

    Google Scholar 

  47. Sox, H. C., Margulies, I., and Sox, C. H., Psychologically Mediated Effects of Diagnostics Tests. Ann. Int. Med. 95:680–685, 1981.

    Google Scholar 

  48. Meterko, M., and Rubin, H. R., Patient Judgments of Hospital Quality: Taxonomy. Med. Care 28:10–14, 1990.

    Article  Google Scholar 

  49. Garg, M. L., Mulligan, J. L., Gliebe, W. A., and Parekh, R. R., Physician Specialty, Quality and Cost of Inpatient Care. Soc. Sci. Med. 13:187–190, 1979.

    Google Scholar 

  50. www.tcmb.gov.tr.

Download references

Acknowledgements

We gratefully acknowledge Dr. Fuat Kayoncu and their colleagues at the Hacettepe University Chest Diseases Polyclinic and Allergy Unit, for their assistance throughout the project.

Author information

Authors and Affiliations

  1. School of Health Administration, Hacettepe University, 06100, Ankara, Turkey

    Bayram Şahin & Mehtap Tatar

Authors
  1. Bayram Şahin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mehtap Tatar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bayram Şahin.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Şahin, B., Tatar, M. Factors Affecting Use of Resources for Asthma Patients. J Med Syst 30, 395–403 (2006). https://doi.org/10.1007/s10916-006-9024-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10916-006-9024-1

Keywords

Search

Navigation