摘要:

Restrictions on the use of pharmaceuticals (such as those for low molecular weight heparins) are commonly imposed by healthcare organizations to combat rising health care costs. These restrictions can be system-based which are established by imposing specific coverage policies by insurance companies and payors or can be patient-based which are those that limit certain therapeutic agents to specified patient populations.Disease management (DM) programs are implemented by healthcare organizations to improve patient care while utilizing resources efficiently. From a payor perspective, restricted use of pharmaceuticals would conform to the goals of DM. However, from a practitioner's perspective, restrictions on the use of medications could sometimes be viewed as conflicting with their goal of providing appropriate patient care. Formularies and prior-authorization programs may sometimes impede physicians' clinical autonomy and may hinder physicians' willingness to participate in DM protocols with such drug restrictions. Furthermore, direct-to-patient advertisements and patient education are encouraging patients to participate actively in the drug selection process. When pharmaceutical restrictions prevent patients from receiving their drug of choice, patients may perceive that their treatment is suboptimal and unfavorable.Despite implementing a fine disease management protocol, imposing rigid drug-use restrictions could hinder physicians' and patients' buy-in of DM programs.

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

Patient compliance and techniques used with inhalation devices can strongly influence the effectiveness of inhaled medications but these issues are often poorly recognized and may be neglected when these products are prescribed. The extent of these problems and the success of differing education and training programs designed to improve inhaler technique have been evaluated by a review of the literature using Medline, EMBASE and Biosis Database from 1985 to date.Drug delivery to the airways to optimize clinical response and improve compliance is dependent on correct technique, which requires educational and motivational programs aimed at patients and healthcare providers. Written instructions alone are often insufficient; practical demonstration is also required. Frequent reassessments and re-education for patients and healthcare professionals are necessary, as correct technique usually deteriorates over time. This all necessitates dedicated resources, which may be a problem in the current cost-containment climate. Treating acute symptoms immediately provides feedback on technique, but the intensive learning needed to reinforce correct inhaler technique may make the use of inhalers problematic for short treatment courses of acute diseases. To maximize therapeutic benefit from inhaled medications, long term educational programs involving verbal and practical demonstrations must accompany inhaler use, and techniques should be frequently reassessed, particularly in children and the elderly.

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

Chronic diseases such as arthritis and related conditions have no ‘cure’, and thus require ongoing management. The long term nature of chronic disease gives the individual a crucial role, if not the most crucial role, in managing their condition. Day-to-day self-management is extremely important in achieving optimal health outcomes, and indeed, people with arthritis use a variety of strategies to relieve symptoms or manage disease consequences.This review identifies and discusses 6 different domains of arthritis self-management behaviors:medical management;joint protection strategies;physical activity and exercise;topical applications;complementary and alternative strategies; andstress and mind/body practices.Conceptualizing arthritis self-management in this manner enables a discussion of a range of practices that may be used to manage arthritis conditions.The literature on several established arthritis self-management programs that are designed to improve either self-care and/or exercise behaviors is also reviewed. Despite evidence of cost containment and improved health outcomes, these programs reach only a small percentage of people with arthritis who may benefit from them.Clinical intervention for people with arthritis may be enhanced if self-management is approached from a broad perspective and, if established, self-management programs are integrated into clinical interventions.

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

Migraine is a highly prevalent, nonfatal disorder typically characterized by recurrent episodes of headache associated with such symptoms as nausea, vomiting, photophobia, phonophobia and impaired functioning. The attacks may be infrequent and relatively mild; more often they are frequent, severe and disabling. They are 3 times more common in women than in men and occur most often between the ages of 25 and 45 years, the prime working years. As a result, the burden placed on employers and on society due to lost and impaired productivity is far greater than the not-inconsiderable costs of healthcare.A large variety of treatments are effective in aborting and in preventing or minimizing the attacks. Patients with migraine whose attacks are infrequent and mild do quite well on self-treatment with simple remedies. Those with attacks that are more frequent and severe require professional supervision and may need a long period of trial and error until a satisfactory regimen can be evolved. Unfortunately, a large proportion of patients with migraine, even some of those with severe attacks, have either not sought medical care or have been misdiagnosed and mismanaged. Particularly for these, disease management, an evolving strategy which features evidence-based treatment and continuing close collaboration between the patient with migraine and his/her physician, offers the best approach for control of this disease.Because of the high prevalence of migraine in the workforce and the burden of disruptions and/or impaired productivity that it places on the organization, the employer has a vested interest in using the workplace as an arena for activities (e.g. patient education and improving access to healthcare) that will contribute to the success of disease management in mitigating the impact of the disease.

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS