摘要:

Patients with health insurance do not make the most cost conscious healthcare decisions since they bear only a fraction of the total cost of medical care. Managed care advocates point to financial incentives as a way to reduce wasteful resource use. However, physicians with managed care contracts feel financial pressures designed to reduce waste may also limit medically necessary services and adversely impact the quality of patient care. In light of a growing public and professional distrust of the motives behind offering financial incentives, the economic theory of agency is used to illustrate how financial contracts designed to reduce wasteful resource use influence physician behavior.A review of the literature was conducted to determine the effects of financial incentives on resource use, cost and the quality of medical care. The method used to undertake this literature review followed the approach set forth in the Cochrane Collaboration handbook. This review revealed that much of the empirical evidence on the effect of managed care on physician behavior compared the experiences of traditional indemnity plan enrollees with health maintenance organization enrollees.Published studies are outdated and are influenced by statistical problems including both patient and physician selection bias. With respect to the newer types of managed care organizations, there is a paucity of information on the effects of financial incentives on physician behavior. Despite the lack of empirical evidence, the perception remains that managed care financial incentives are perverse in that they induce physicians to take actions that compromise quality of care. To evaluate the legitimacy of these concerns, research on how physician contractual arrangements influence the cost and quality of care in the newer types of plans is needed. In the absence of such research, political rhetoric bent by anecdotal evidence will continue to influence public policy and undermine managed care.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

Health improvement planning models exist to support strategic management of health improvement efforts and to guide program administrators in taking a comprehensive approach to health promotion planning from problem identification to program evaluation and diffusion. This article outlines a model which follows four simple steps to program design and four simple steps to program evaluation.The first phase is characterized as the 4-Ss of program design, which includes size, scope, scalability, and sustainability.The second phase is characterized as the penetration, implementation, participation and effectiveness (PIPE) Impact Metric. Penetration refers to the proportion of the target population that is reached with invitations to engage in the program or intervention. Implementation refers to the degree to which the program has been implemented according to the design specifications and the associated work plans. Participation refers to the proportion of invited individuals who enroll in the program according to program protocol. Effectiveness refers to the rate of successful participants. It is considered in the context of programming conducted in the real-world setting. The product of all elements of the PIPE Impact Metric can be calculated to represent the impact from a program administration perspective, while the product of participation and effectiveness can be calculated to represent the impact of the program from a user/consumer perspective.The model is designed to inform program administrators about opportunities for improvement. First, administrative impact can be compared with user/consumer impact. Secondly, the PIPE Impact Metric total score, as well as its individual subscores, should be considered in the context of the 4-Ss of program design.This model has been derived from work conducted in the applied setting, however it is based on scientific theory and appears congruent with findings from existing, but more complicated, models. The results of the application of the model indicate the presence of a simple set of rules related to critical health improvement program design and evaluation features. Whereas additional experience with the model will allow for further modifications and evolution, early experience indicates it serves program planners and administrators well in terms of systematic program improvement and documentation of effort and impact.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

The epidemiological burden of diabetes mellitus is changing the classical model of diabetes management, in which a specialist center delivers care based on registration, recall and regular review. Primary care services are progressively assuming a crucial role in screening, prevention and management of the disease. It therefore becomes critical to improve the performance of primary care providers by suitable organizational interventions. The current advances in information technology (IT) and communications technology provide new ways for coping with organizational problems, and provide the opportunity to implement complex, multifaceted interventions in a cost-effective manner. Moreover, IT enables patients to exploit new modalities of access to healthcare services.This review highlights the current situation in the implementation and delivery of IT solutions for diabetes care, and describes the trends towards more advanced and innovative IT-based services.A large number of electronic patient records (EPRs), decision support tools and telemedicine solutions have been proposed and studied but a relatively low number of them have been fully exploited in clinical practice. The main reasons for this limited dissemination are related to the complexity of establishing and evaluating interventions that have a strong impact in the process of care. However, the need for a large scale reorganization of chronic care is now pushing towards the integration of the newest IT tools with new models of diabetes management.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

ObjectiveThe purpose of this study was to evaluate the treatment patterns and success rates with antidepressants utilized by patients in a managed care organization (MCO).MethodsData were extrapolated from a claims database from an MCO with 225 000 members. Treatment patterns were determined by creating episodes of care for each patient. Successful treatment was defined as a therapeutic dose for at least 180 days of continuous therapy. Success rates were stratified by the type of antidepressant used. Depression-related and total healthcare costs were analyzed in relation to whether a patient's treatment was successful.ResultsA minority of patients received continuous therapeutic doses for 180 days for their first treatment episode (26.5%) or all treatment episodes of depression (32.9%). Monotherapy was the most common treatment pattern. Treatment with a selective serotonin reuptake inhibitor (SSRI) was associated with a significantly higher success rate than treatment with a tricyclic antidepressant (TCA), in patients with depression (36.6 vs 13.3%). In patients with depression who were receiving SSRIs, the success rates were 37.2% with fluoxetine, 36.2% with paroxetine, and 36.1% with sertraline; there were no significant differences in the success rates among the SSRIs. Patients completing a successful treatment episode were associated with higher pharmacy, depression-related, and total healthcare costs.ConclusionsOnly a minority of patients with depression attained a satisfactory treatment episode with their antidepressant therapy. SSRI therapy was associated with a significantly higher success rate than TCAs. Although monotherapy regimens were the most commonly used treatment strategy, the multivariate analysis reveals that multiple regimen changes (defined as complex in this analysis) may be required to achieve successful treatment. Physicians and MCOs need to monitor patients and be open to necessary regimen changes. Physicians and MCOs must also work together to develop improved strategies to monitor and detect patients with depression who do not comply with their antidepressant regimen.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

IntroductionMen are less likely to use preventive services than women, perhaps because of a perceived lack of timely access to healthcare. This paper reports the results of the Men's Health Screening Program offered by Lockheed Martin Aeronautical Systems in Marietta, Georgia, USA.MethodsVolunteer male employees were screened at the work site for prostate cancer, benign prostatic hyperplasia (BPH), and erectile dysfunction (ED). Prostate-specific antigen (PSA) tests and digital rectal examination (DRE) were used to detect prostate cancer. DRE and a urologic health questionnaire were used to detect BPH. An erectile dysfunction questionnaire was used to screen for ED.ResultsOf the 4877 eligible male employees, 317 (6.5%) participated in the medical screening program. Two were found to have prostate cancer, one of whom had a previous diagnosis of prostate cancer. Using the results from both a urologic health questionnaire and the DRE test, 46 men were found to have BPH; however, only 30 noted a prior diagnosis of BPH. 273 men completed the ED questionnaire; 22−44 of the ED respondents reported frequent difficulties with one or more aspects of the sexual experience, but only 13 had sought prior treatment. 300 participants completed a short satisfaction survey, and 40 of these respondents were randomly selected for analysis. Of these 40 respondents, 60% said the program was either ‘good’ or ‘great’, and 95% agreed that the program had a beneficial impact on their ability to work.ConclusionsSome unmet need for care was noted. To address this, disease management professionals can help employers bring preventive care to the work site, at little or no cost to the employee, with benefits accruing to employers and employees alike.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

Insulin lispro is a recombinant insulin analog with transposed amino acids (proline and lysine) at positions 28 and 29 near the C-terminus of the B-chain. The most prominent practical advantage of insulin lispro over human soluble insulin lies in its very rapid onset of action. This property allows it to be injected immediately before meals and minimizes the demands made on patients with type 1 diabetes mellitus, and those with type 2 disease who require insulin, by the ongoing need for careful meal planning and timing. Numerous clinical studies have shown significant improvements in postprandial glycemic control, with some evidence of reduced rates of severe or nocturnal hypoglycemia, relative to conventional human insulin in patients receiving lispro-based insulins.Quality-of-life studies show consistent preferences by patients for and increased treatment satisfaction with insulin lispro over human soluble insulin, particularly with variations of the Diabetes Treatment Satisfaction Questionnaire. Willingness of patients and taxpayers to pay additional costs for insulin lispro or a premixed lispro-based formulation over conventional human insulins, and cost benefits favoring formulary inclusion, have been shown in well designed studies carried out in Australia and Canada. Spanish data suggest cost effectiveness in terms of episodes of severe hypoglycemia avoided, and preliminary German resource utilization data indicate cost savings related to reduced hospitalization and general practice costs, with insulin lispro relative to human soluble insulin.Conclusions: Insulin lispro and premixed formulations of lispro-based insulins offer quality-of-life improvements relative to conventional human insulins in patients with diabetes mellitus. Participants in well designed studies have expressed a preference for lispro-based insulins and have been shown to be willing to pay for the advantages they offer, and current cost-benefit data favor the inclusion of these insulins in formularies and their reimbursement by third party payers. Further research into the pharmacoeconomic implications of insulin lispro use in the long term is needed, particularly with respect to effects on indirect costs and those associated with complications of diabetes mellitus.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS