摘要:

Patients with epilepsy must be managed continuously to ensure that resources are used appropriately. The goal of this approach is to prevent complications and acute events, minimise long term health problems and avoid adverse effects of the condition or its treatment. Several different models of care may be used for patients with epilepsy. One model uses primary care physicians for most care; another risk-stratifies patients and assigns serious or unstable cases to specialists who act as their primary care physicians until the patients are stabilised adequately; a third integrates these 2 approaches, with the primary care physician and specialist jointly responsible for coordination of care and communication with the patient. All 3 approaches can be cost effective. With each approach, case management is critical to continuity of care in both inpatient and ambulatory settings.Managed care organisations must be committed to a systems approach that combines medical management and psychosocial support by healthcare professionals and a patient's family. Such a strategy will best identify and address problems in all areas of a patient's life - medical, behavioural, academic and work related. Pharmacotherapy in epilepsy must balance treatment efficacy, tolerability, safety, ease of use and cost. Decisions regarding the cost effectiveness of pharmacotherapy should consider not only the acquisition costs of drugs, but also efficacy and incidence of adverse events. Making a commitment to involving the patient as an educated partner in decision-making not only increases compliance but also reduces the costs of treatment.

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

摘要:

Benign prostatic hyperplasia (BPH) is an ever present threat to aging men. The gradual demographic shift of the population of the western world appears to be towards the elderly. The increasing burden on both individuals and the healthcare system, therefore, is going to increase in the foreseeable future. Although BPH is not a life-threatening condition, it can have serious consequences on the normal function of the lower urinary tracts. The overlap in terms of presentation exists with malignant prostatic disease and this needs to be considered when investigating these patients. The morbidity caused by BPH should not be underestimated for the sufferer, especially where there are ready treatments available and the opportunity to exclude other even more serious conditions.This article reviews the latest publications and papers looking at diagnosis and, in particular, identifying those at risk, the assessment of severity using symptom scores and discussing the methods and effectiveness of the various investigative tools. Controversy exists over the role of prostate-specific antigen (PSA) in detecting prostate cancer and the role of urodynamics versus symptom scores in the treatment and assessment of BPH patients with lower urinary tract symptoms. Investigations include the blood test for PSA to pick up those with carcinoma of the prostate, in addition, urodynamic studies, in particular flow rate and post-void residual volume, can diagnose and assess the severity of bladder outflow obstruction, assess and help exclude causes other than BPH.

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

摘要:

This article evaluates an outcome measure (glycated haemoglobin levels) and 5 process measures (retinal examinations, proteinuria, glycated haemoglobin, foot examinations and lipids) for diabetes care in both health maintenance organisation (HMO) and fee-for-service settings. The mean glycated haemoglobin levels were very similar in 3140 patients followed in a fee-for-service setting (9.59%) and 4449 patients seen in an HMO setting (9.51%).Studies in both settings where the upper limit of normal for the assay used was given showed that the mean glycated haemoglobin level in 5387 patients was 2.65% above this value. All process measures were far below the American Diabetes Association's (ADA) guidelines. The results were similar in HMO and fee-for-service settings but somewhat better, in general, in those Indian Health Service locations that have a specific structured diabetes programme in place. The level of diabetes care delivered is similar in fee-for-service and HMO settings but falls far short of ADA guidelines.

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

摘要:

Hospital waiting lists impose costs on society. These waiting lists could be eliminated by either increasing the price of the healthcare product to the patient or by increasing the capacity of the hospital. However, reducing the waiting list to zero is hardly defendable on distributional grounds in the first case and for reasons of efficiency in the second.This study estimated the economic burden of hospital waiting lists. All 149 patients waiting for knee-joint prosthetic replacement at Umeå University Hospital in December 1991 were sent a questionnaire by mail containing questions related to the costs which may appear as a result of a patient's waiting. Ultimately, 130 patients were included in the study.The patients in the waiting list had an average of 5.5 months left until their operation with a cost of SEK9290 during that time, i.e. SEK1740 to 2000 per month, due to their knee-joint problems. Over 60% of these costs were indirect costs (loss of production for patients and their relatives) and almost 30% were costs for home help. Drugs accounted for less than 5% of total costs. The most influential factors affecting costs were found to be the patient's age and marital status.

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

摘要:

The purpose of this exploratory study was to test the feasibility of applying the contingent valuation (CV) method to waiting lists in healthcare. Data for the study were collected by sending a postal questionnaire to all patients in the waiting list for a knee-joint prosthetic replacement operation at Umeå University Hospital in Sweden. The mean willingness-to-pay (WTP) for an operation within 2 weeks was substantial, but due to the exploratory nature of this study and to poor significance of the statistical model, this result is tentative at most. The dichotomous type of WTP questions worked better than the open-ended ones. Choosing the bid-vector (perhaps by a focus group or by a pilot study) and not having too small a population is of great importance. Further studies to test the validity of the CV approach to waiting lists in healthcare are needed.

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS