摘要:

Recent changes in the healthcare system have prompted the growth and management of disease and health management strategies in the US. Most of the initiatives include a heavy emphasis on the pharmacotherapy component as it has been noted that effective therapies can lead to improvement in care and in some cases lower overall healthcare costs.As markets continue to move to increased integration, there will be a greater focus on traditional pharmacy and therapeutic committees to evaluate the impact of therapies on the overall care of and cost to their covered members. Additionally, pharmaceutical products will be evaluated as to their place in the overall health and disease management strategies that the plan offers to its payers and providers.A growing trend among pharmaceutical benefit designs is to offer various levels of coverage via patient copayments to reduce the growth of drug expenditures. This places a greater emphasis on provider communication and patient awareness and understanding of the value of pharmaceutical products as a means to improving health.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS

摘要:

Medical savings account (MSA) plans are a form of medical insurance that combine high-deductible medical insurance with a tax-free personal trust account (used to pay medical bills not covered by insurance). MSA-like plans have been in existence in US companies for over 10 years, in Singapore since 1984 and in South Africa since 1994. MSA plans have a distinct advantage over other forms of medical insurance in that the locus of medical decision making remains with the patient and doctor; in addition, market forces are brought to bear on cost, availability and quality of medical services.The concept of MSA plans has been criticised for only benefiting healthy and wealthy individuals, and for the potential difficulties individuals may encounter in making informed healthcare decisions. However, these criticisms have not been borne out by the US, Singapore or South Africa experiences. There are many distortions in the medical marketplace which MSA plans alone cannot address. These include price-fixing, mandated insurance benefits, onerous insurance regulations and government or employer-provided medical insurance. A free medical marketplace would include unrestricted MSA plans, individually owned and fully portable insurance, benefits decided by the patient, market-determined pricing, fee-for-service arrangements and minimal cost shifting.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS

摘要:

Asthma is a growing health problem that affects 4.8 million children in the US alone. This paper considers empirical studies from the past 20 years examining the relationship between psychosocial factors and asthma management and morbidity. Research indicates that psychosocial factors, including risk and protective factors in the social environment, and knowledge, attitudes and skills pertaining to asthma management, can play an important role in asthma management, adherence and morbidity. Caregiver and child mental health problems have been linked to increased asthma symptoms and poorer functional status. Family functioning, chronic stresses and social support have also been identified as potential risks and/or protective factors in the social environment.Of the asthma self-management skills, practical problem-solving skills have received increasing attention as an important, and potentially modifiable, psychosocial component. Families may also fail to adhere to medical recommendations because of concerns regarding their utility. Results from a recent individualised asthma intervention protocol provide a strategy for successfully addressing both environmental risk factors and asthma self-management skills to reduce asthma morbidity. Recommendations for healthcare providers include: (i) screening families for psychosocial risk and protective factors on an ongoing basis, including mental health concerns; (ii) engaging family members in dialogue to identify potential areas of confusion or disagreement with the treatment plan; and (iii) including non-medical specialists such as health educators and mental health practitioners as part of the treatment team.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS

摘要:

With increasing chronic disease and disability burden as a result of the aging of populations worldwide, cost estimates of disease and disability are important in determining:the most cost-effective methods in delivering healthcare in order to maximise resources; andhealth policies and resource allocation.Cost may be divided into direct, indirect and intangible costs. Economic evaluations include cost-benefit, cost-effectiveness and cost-utility studies. In obtaining data for these studies, a multidisciplinary effort is required. Data include epidemiological, healthcare utilisation and cost data (e.g. based on disease-related groups), outcome measures and national sickness, unemployment and productivity figures.Examples of cost-of-illness studies show that chronic diseases constitute a significant economic burden for societies, in terms of either direct or indirect costs. Using such data, healthcare policies may be formulated towards cost reduction, whether preventive or interventional. Decisions regarding choice of drug treatments or methods of service delivery may also be based on such information. Conflicting perspectives from healthcare providers, society or individual viewpoints may render decisions regarding resource allocation based on such estimates controversial.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS

摘要:

ObjectiveTo determine whether an educational programme could reduce the inappropriate use of albumin.Study design and settingA hospital albumin working group (San Carlos Clinical Hospital, Madrid, Spain) developed local guidelines for albumin prescribing. After the guidelines were disseminated, all albumin prescriptions were analysed according to these guidelines. Physicians who prescribed albumin for indications other than those in the guidelines were selected for a personalised face-to-face educational programme with a clinical pharmacologists. Adherence to the guidelines was then evaluated compared with an observational period with success being measured in terms of quality of prescribing and economic consequences. The effects of the intervention were assessed again during the intervention (7 months) and after the intervention (in the first 5-month period and in the subsequent year).Main outcomes measures and resultsIn the observational period, consumption was centralised in medical services and nearly 76% of prescriptions for albumin were inappropriate. During the intervention, the percentage of inappropriate albumin prescribing decreased to 38.8%. Albumin consumption decreased from 444 vials/month during the observational period to 249 vials/month during the intervention, and although the average monthly consumption increased slightly during the 17 months following the intervention, it was similar to that immediately after the intervention.Differences in albumin consumption and quality improvement between the observational period and during the intervention were statistically significant (p < 0.00001). These results led to cost savings of nearly 30% during the intervention and in the follow-up period.ConclusionsThis educational programme improved the quality of albumin prescribing and controlled local expenses related to albumin use in a general hospital.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS