摘要:

Teledermatology can provide both accurate and reliable specialist care at a distance. This article reviews current data on the quality of care that teledermatology provides, as well as the societal cost benefits involved in the implementation of the technique. Teledermatology is most suited to patients unable to access specialist services for geographical or social reasons. Patients are generally satisfied with the overall care that teledermatology provides. Real-time teledermatology is more expensive than conventional care for health services. However, significant savings can be expected from the patient’s perspective due to reduced travel. Appropriate patient selection, improved technology and adequate clinical workloads may improve both the quality and cost effectiveness of this service.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

Disease management programs have been implemented into the German healthcare system. According to recent legislation they must include structured treatment and teaching programs for patients with diabetes mellitus and/or hypertension. This paper provides an overview of the current situation in Germany. Office-based physicians have been remunerated for providing structured treatment and teaching programs for outpatients with diabetes mellitus since 1991. Four different programs have been implemented into the German healthcare system up until now. Over 80% of the physicians rated the training courses as ‘very good’ or ‘good’ and 90% rated the teaching material as ‘very good’ or ‘good’. Remuneration amounts were up to 130 euros per patient and completed course. Data collected on patients with diabetes mellitus or hypertension demonstrate the effectiveness of these programs at the treatment level. The results also demonstrate the practicability and effectiveness of the implementation of programs as an integral part of disease management in routine primary healthcare for patients with diabetes mellitus or hypertension.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

Asthma morbidity remains high worldwide despite the introduction of national guidelines for management and the increase in specially trained asthma nurses. Current interventions have not led to a demonstrable reduction in hospitalizations and emergency department visits in adult asthma. The role of the asthma nurse must include addressing issues of compliance as part of a more holistic approach to asthma management.Previous studies have demonstrated that the asthma nurse can play a pivotal role in educating and supporting the patient in self-management strategies and the hospital setting has been shown to be an appropriate setting in which to target those with poor symptom control. Issues of compliance must be addressed within the domains of patients’ perception of their asthma, accurate assessment of prior knowledge, education to promote changes in behavior and appropriate self-management strategies, as well as giving consideration to influences such as culture on self-management behavior.The asthma nurse is ideally placed to accurately assess and educate patients with asthma on how to manage their symptoms. However, education must be an ongoing process for both patient and educator. Any interventions offered must be based on up-to-date evidence with proven clinical effectiveness if improved long-term outcomes are to be achieved.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

Culture influences all spheres of human life. It defines health, illness, and the search for relief from disease or distress. With increased mobilization of people across geographical and national borders, multicultural trends are emerging in many countries. This is reflected in the cultural diversity presenting to clinicians in their daily practice. With these presentations, patients bring their own world views, expectations, norms and taboos to the clinical transaction. Cross-cultural transactions occur when two or more of the participants are culturally different.Although it is impossible to be conversant with all cultures, clinicians should be sensitive to the role culture plays in their practice without stereotyping patients. Culture influences help-seeking or care pathways, and may bias the process of assessment and choice of management. The interplay of patient culture, clinical setting and clinician culture can pose significant challenges experienced against a backdrop of other factors such as age, gender, religion, and acculturation.Language, even when shared, does not ensure skillful clinician–patient communications as there are different culture codes for interpersonal relationships, disclosure, privacy, and non-verbal communication. Linguistic difficulties can be partially overcome with the use of an interpreter, a triangular relationship with its own dynamics requiring skill and sensitivity.The cultural matching of patient and therapist is complex and may be complicated by the emergence of other differences that may be equally challenging. However, awareness of this should serve to reduce the number of differences.Cultural sensitivity in patient care is associated with a number of positive health outcomes, including improved patient satisfaction.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

IntroductionSuboptimal management of patients with chronic renal insufficiency (CRI) is thought to contribute to the high morbidity and early mortality seen after the onset of end-stage renal disease (ESRD), and may therefore impact on healthcare costs associated with patients with ESRD. The objective of this study was to investigate the effects of pre-dialysis patient care on hospital days during the 6 months after hemodialysis initiation.Study DesignData were obtained from Group Health Cooperative in Seattle, Washington, USA, a staff model health management organization with an established, active, CRI management program, and were analyzed retrospectively. Patients who started long-term hemodialysis between 1 January 1997 and 31 January 2000, and who were referred to the Group Health Cooperative CRI management program, were included in the study.MethodsDemographic and baseline clinical characteristics, details of interventions received by patients prior to dialysis, and hemoglobin (Hb) levels during the 6 months prior to the onset of ESRD were recorded. The numbers of days that each patient spent in hospital during the baseline (1 year to 6 months pre-dialysis), pre-dialysis (180 days pre-dialysis), and post-dialysis initiation (180 days following dialysis initiation) periods were recorded. Hospital days during the post-dialysis initiation period were associated with patient characteristics and pre-dialysis interventions received, and were compared with national data from the US Renal Data System (USRDS).ResultsWhen calculated similarly to data from the USRDS, the mean number of hospital days for patients in this study was lower than that for the national hemodialysis population (9.4 vs 13.9 days). Temporary vascular access and inadequate nephrology visits prior to dialysis were the key factors increasing the risk of a greater number of hospital days. The use of a catheter for initial dialysis significantly increased patients’ risk of hospital days compared with the use of a fistula or graft (median 4 vs 2 days; odds ratio [OR] 2.5); lack of pre-dialysis nephrology visits had a similar effect. Patients’ Hb levels prior to dialysis were also important: a clinically significant decrease in Hb levels (≥1 g/dL), or a decrease resulting in Hb levels <10 g/dL at dialysis initiation, increased hospital days (median 2 vs 3 days; OR 2.0).ConclusionEarly, active management of patients with CRI can reduce hospital days and associated costs in the early months after hemodialysis initiation.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

IntroductionInfluenza is associated with illnesses such as pneumonia and other respiratory conditions and in severe cases leads to death. The prevalence of these illnesses and deaths fluctuates with the seasons during the year, even in the absence of influenza. Although many studies have focussed on mortality associated with influenza epidemics, and some have examined hospitalizations in elderly patients, there are very few studies that have examined the effect of influenza epidemics on adults or children. This study seeks to determine the association between general practitioner (GP) consultations for influenza-like illnesses and hospital admissions of adults and children associated with influenza epidemics.MethodsStructural Time Series Models with stochastic trend and seasonal components were developed for two age groups (children aged 0–15 years, and adults aged 16–50 years). Data from the Swiss Sentinel Surveillance Network on GP consultation rates for influenza-like illnesses, and data from Swiss hospital admissions, were obtained for the period 1987–1996. The explanatory variables (i.e., the percentage of GP consultations for influenza-like illnesses and a 1-week lag of this variable) were modeled against hospital admission rates for pneumonia and influenza and other respiratory conditions. Excess hospitalizations were calculated as the difference between predicted hospital admissions during influenza epidemics and expected hospital admissions in the absence of influenza epidemics.ResultsIn these two age groups, there was an annual average of 1452 (range: 1000–1700) hospital admissions directly associated with influenza epidemics. Excess admission rates were substantially higher in children (pneumonia and influenza: 4.77 per 10 000 children per year, and other respiratory conditions: 2.29 per 10 000 children per year) compared with adults (pneumonia and influenza: 0.86 per 10 000 adults per year and other respiratory conditions: 0.68 per 10 000 adults per year). The models explained 56–84% of the variation in hospital admissions. The seasonal patterns were stable over the 10 years modeled and the variances of the trends were small.ConclusionThe structural time series models is an ideal approach to model influenza-related hospitalizations as the models capture trends, seasonal variation, and the association with exogenous factors.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

The rapid expansion of disease management continues. A multitude of stakeholders and marketplaces are now involved in providing cost-effective quality healthcare for individuals and populations. To help you keep up-to-date with the very latest developments in disease management, this section of the journal brings you information selected from the disease management and pharmacoeconomic reporting servicePharmacoEconomics & Outcomes News Weekly.1The following reports are selected from the very latest to be published across a broad range of literature sources.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS