摘要:

The National Service Framework for Older People (NSF), published recently by the Department of Health in England, represents a major initiative to improve services for this group of patients. It describes an ambitious 10-year plan to address ageism, person-centered care, hospital care, specialist care (in the core areas of stroke, falls and mental health), health promotion and medicines use. Successful implementation of the NSF will unequivocally improve access to key services for older people including specialist care and community services. However, considerable commitment and new resources will be required to realize the intentions of this complex initiative.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

Effective management of chronic obstructive pulmonary disease (COPD) is aimed at prevention of disease progression, relief of symptoms, improvement in exercise tolerance, improvement in health status, prevention of complications, prevention of exacerbations and reduction in mortality. Pulmonary rehabilitation, aimed at restoring patients with disabling disease to an optimally functioning state, is a relatively recent practice in pulmonary medicine and is classically described as a multidisciplinary program of ‘care’ for patients with chronic respiratory impairment.Health status assessment is a central feature of studies of COPD, since treatments for this condition, other than smoking cessation and long-term oxygen therapy, are largely symptomatic. Health status measurement quantifies the impact of disease on patients' daily life, health and well-being. General health- and disease-specific questionnaires have been designed to measure health status as well as health-related quality of life (HR-QOL).Published results provide a scientific basis for the overall pulmonary rehabilitation programs and, although with a lesser degree of evidence, for the specific components of these programs. The benefits of pulmonary rehabilitation include improvements in exercise tolerance, dyspnea and HR-QOL, and, to some extent, a decrease in healthcare usage. Pulmonary rehabilitation is effective in all settings including hospital inpatient, hospital outpatient, the community and home. However, more information is needed to ensure that the appropriate rehabilitation is given to the increasing number of patients with chronic respiratory diseases.Pulmonary rehabilitation is a costly process and patients should be carefully selected in order to save resources and obtain the maximum benefit. Although several questions remain unresolved, pulmonary rehabilitation programs should be included in the comprehensive treatment of patients with COPD.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

Today, privacy is a concern for many individuals. The United States has followed the path of other countries in strengthening the legislation to protect privacy. The Health Insurance Portability and Accountability Act (HIPAA) of 1996 was enacted to provide improved portability of health benefits and greater accountability in the area of healthcare fraud. The legislation is divided into five titles with title II addressing the prevention of healthcare fraud and abuse, and the promotion of administrative simplification and privacy. The far-reaching impact of the legislation will affect hospitals, payors and physicians' practices in every area of healthcare. HIPAA specifically governs (and identifies) all healthcare providers and payors, and clearinghouses maintain individually identifiable patient information. This legislation was in response to requested improvements including greater privacy of health information. The legislation defined some parameters but many areas remained undefined. Through the lack of definition, disease management entities were tasked with making assumptions as to the interpretation of the legislation. One of the areas that was difficult to determine was disease management. To provide more specificity, the Disease Management Association of America (DMAA) had repeatedly met with the Department of Health and Human Services to understand the intent and purpose behind the legislation.At the time of this article, the Department of Health and Human Services are collecting comments on the legislation and have already provided some updated information. The DMAA provided input to the Department of Health and Human Services regarding the application of HIPAA to disease management. The article addresses the new legislation and addresses how a disease management organization can apply the new legislation to its operation.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

Patient adherence to self-management strategies is a major issue in asthma, as in other chronic diseases. Adherence should not be defined exclusively in terms of medication use, but the more behavioral aspects of self-management such as avoidance of aggravating factors and risk behaviors, disease monitoring, alterations in therapy according to level of disease control and initiating emergency action when required, need to be considered. There are different forms of non-adherence and many patients undertake some form of cost-benefit analysis with respect to treatment. Furthermore, adherence is not an ‘all or none’ phenomenon and the level of adherence may vary between different aspects of management of a condition and over time.While asthma self-management strategies are undoubtedly effective, many patients make serious self-management errors during an attack and do not put into practice the self-management knowledge they possess. In asthma, adverse social, economic and psychological factors are common and these may have detrimental effects on self-management at different levels; health seeking behavior, in terms of the ability to benefit from self-management education, adherence to self-management strategies and in the ability to self-manage exacerbations of asthma. These adverse factors vary between patients and their influence may be subtle and insidious.Although a seemingly fundamental requirement for self-management, not all patients want an active role in disease management. The patient’s willingness to participate needs to be assessed and strategies adapted accordingly. Because of the variety of adverse influences, all strategies to improve adherence need to be individualized. Provision of appropriate pharmaceuticals and good quality ongoing medical care are necessary prerequisites to any self-management strategies. It is important for the healthcare professionals involved to recognize and taken into account, but not necessarily solve, the individual adverse social, economic and psychological factors when providing advice. An ongoing therapeutic alliance needs to be established between the patient and the healthcare professional; ‘the clinician as a good listener and teacher’. This involves ascertaining the patients concerns about their illness and its management, and addressing these issues. Self-management education (and self-management generally) needs to ascribe to the five R’s:Relevant to the individual,Realistic goals,Readily available,Reinforced andRefined over time. Optimal use needs to be made of the ‘teachable moment’ and involvement of a wide range of persons in management (including peers) needs to be considered. While the self-management strategies need to be individualized, they can be augmented by generic material.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

BackgroundDisease management has been shown to improve outcomes in patients with chronic diseases such as coronary artery disease (CAD). Yet Independent Practice Associations (IPA) have expressed concern with the promise of disease management (DM) to improve patient outcomes. Managed care initiatives promote the use of case management, DM, and the use of practice guidelines. However, some physicians think that this may impinge on their autonomy.ObjectiveTo demonstrate that integration of an independent DM company in conjunction with an IPA enhances compliance with guideline-recommended medications, reduces morbidity and improves quality of life in patients with CAD.DesignIPA physicians and an independent DM company were contracted with a health plan to provide care to patients with current or recent CAD. The DM company facilitated physician-ordered guideline implementations, provided member education, facilitated medication compliance, and collected all data, using a decision support software system. Collected data included: hospital utilization, quality of life, and reported medications and associated compliance rates.SettingA large IPA group in the Midwest region of the US.Study ParticipantsSixty-five high-risk patients with CAD who were active in the DM program as of April 2, 2002 and in the program for at least 180 days were included in the analysis.ResultsThe average age of the patients was 73.4 years and 54% were male. The mean duration in the DM program was 10 months (median = 7 months). For those patients (n = 54) with baseline and follow-up mental and physical quality-of-life (QOL) scores, mental QOL scores increased by 2.6% (not significant) and physical QOL scores increased by 11% (p < 0.05). In the 19 patients in the program for 12 months, a trend of reduced hospital admissions was observed. Medication compliance at baseline versus the most recent status for eligible patients was as follows: antihyperlipidemic therapy 59.7% versus 67.7%; β-adrenoceptor antagonist therapy post-myocardial infarction 60.0% versus 66.7%; and antiplatelet therapy was maintained at 98.4%.ConclusionsIn spite of the small sample size and relatively short study duration, these results indicate that an integrated DM program may enhance clinical outcomes for patients and reduce hospital admissions.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

ObjectiveTo determine whether vaccination against influenza in the Academic Medical Centre (AMC) of the University of Amsterdam, The Netherlands, may lead to an economic benefit by avoiding the loss in productivity associated with an outbreak of influenza illness among its employees.DesignA newly developed cost-benefit model from an employer's perspective was applied and several scenario and sensitivity analyses were performed.MethodsThe model inputs were vaccination-, personnel- and influenza-related elements, which were obtained from data specific to the AMC where possible, otherwise these were based on published literature. The output (net benefit) was defined as the difference between the benefits of vaccination due to reducing workplace absenteeism (productivity) of employees and the costs of vaccination, excluding campaign and administration costs. The net benefits of baseline, vaccination promotion and influenza-persistent scenarios were assessed and sensitivity analysis was performed.ResultsThe net benefits for all the scenarios was positive, being E120 000, E460 000 and E180 000 (2000 values) for the baseline, vaccination promotion and influenza-persistent scenarios, respectively. The vaccination compliance rate appeared to be the element with greatest impact on the net benefits.ConclusionAn influenza vaccination program in an institution with the characteristics of the AMC can be performed with an economic benefit for the organization. Our results suggest that vaccination of medical residents provides greater economic benefits than vaccination of other personnel.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS