摘要:

When adults become ill they typically use more than just medical care services. They often miss time from work or incur periods of short term disability. In some cases, they also use workers' compensation, occupational health or long term disability programme services and, in some situations, sick employees may attend work but be substantially less productive. Disease management programme vendors can enhance their services by managing the full spectrum of health and productivity programme services that people use, not just medical care services.Health and productivity management (HPM) refers to the coordination of the many types of services that employees use. These services include medical care, disability programmes, workers compensation programmes, employee assistance programmes, absenteeism and occupational safety programmes. HPM also refers to activities meant to enhance on-the-job productivity. HPM requires that disease management programme managers take a broader view of health and disease management than is typical. These programme activities may include deciding which disease(s) to address as priorities; developing treatment guidelines that focus on more than just clinical care; choosing appropriate and relevant outcome measures to address; implementing interventions that enhance productivity, improve health, and limit unnecessary medical care use; and supporting continuous quality improvement efforts.Considering these activities under an HPM umbrella requires a focus on productivity and quality of life that will add substantial value to the services offered by disease management programmes. The HPM approach will be more costly initially, but should prove more cost effective in the long term, since it considers a much wider array of potential benefits from health and disease management.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS

摘要:

Despite the public health importance of alcohol misuse by early problem drinkers, treatment efforts for those with alcohol problems have focused largely on individuals with already established alcohol dependence. This article discusses screening tools commonly used to identify a variety of early problem drinkers, biological markers of heavy drinking and a framework by which to approach alcohol misuse. The results of 4 meta-analyses of brief intervention are also summarised. While all meta-analyses showed that some type of brief intervention decreased alcohol consumption for all, or a subset of, early problem drinkers, it is yet to be agreed as to what type of drinker can benefit from what type of brief intervention.The implementation of these research findings into clinical practice has been inconsistent as physicians often fail to identify alcohol problems in their patients. Compared with other chronic medical illnesses, physicians do not diagnose or treat addictive disorders with the same accuracy or effectiveness. Barriers to the implementation of screening and brief interventions by the physician include a lack of time and diagnostic skills, negative attitudes and the perception that diagnosing problem drinkers is not part of the physician's role.As research determines which subgroups of drinkers are most likely to respond best to specific types of brief intervention, this approach is likely to gain a more stable and defined place in the behavioural healthcare system. Nonetheless, incorporating existing findings into the healthcare professional's practice remains a challenge.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS

摘要:

Successful disease management programmes embrace continuous quality improvement (CQI) to assure adherence to best medical practices. This review discusses the concept of dynamic assessment as an adjunct to CQI. Whereas CQI focuses on refining the performance of disease management with respect to a fixed body of knowledge, dynamic assessment refers to endowing disease management programmes with the ability to adapt to changes in medical knowledge and changes in the clinical status of patients. The complementary nature of CQI and dynamic assessment are illustrated through the description of an ideal disease management programme for coronary heart disease.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS

摘要:

Smoking accounts for significant morbidity and mortality and has major economic consequences for healthcare delivery throughout the world. Government policy such as increasing taxes and restricting advertising go some way to reduce smoking, but the social and economic factors that affect target populations will impact on the success of any strategy.Public health interventions can also contribute to increasing cessation rates. The most successful interventions appear to be those characterised by personalised advice and assistance, repeated in different forms over the longest feasible period of time. Pharmacological aids, which are important components of a cessation programme, include nicotine replacement therapy in the form of chewing gum, patches, nasal spray, oral inhaler or sublingual tablets; bupropion (amfebutamone) has been approved for use in some countries. As the community pharmacy is the major point of supply of such products, the pharmacist is in a key position to encourage and support clients who wish to stop smoking.A number of studies have examined the role of the community pharmacist in assisting smokers through the so-called ‘cycle of change’. These studies have utilised a model that offers individualised advice through a motivational technique to encourage a change in behaviour; nicotine replacement therapy is optional. Follow-up is an essential part of these programmes to monitor progress and to provide additional support. Evaluations of these pharmacy-based initiatives have confirmed the importance of a multifaceted approach in achieving success in smoking cessation, i.e. behaviour modification, nicotine replacement therapy and client support.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS

摘要:

ObjectiveTo determine the economic impact of an asthma education programme.Design and settingThe study was population-based and used claims data to determine changes in the resources used by identified patients with asthma 9 months before (January 1997 to September 1997) and 9 months after (January 1998 to September 1998) the implementation of the asthma education programme. Direct medical costs and frequency of use of services for asthma treatment before and after implementation of the asthma intervention programme were compared to evaluate the impact of the programme on medical treatment costs.PerspectiveThird-party payer.PatientsPatients who were diagnosed with asthma at least 12 months prior to the implementation of the intervention were included; all patients were members of a union health and welfare fund, located in the northeastern part of the US. Of the 5527 patients, 2235 were included in the intervention group and 3292 patients served as the control group.InterventionThe asthma education focused on asthma prevention and treatment, recognition and elimination of asthma triggers, and compliance with asthma medications. The programme also included therapy management intervention with physicians, drug product selection and compliance intervention when needed.Main outcome measures and resultsThe total asthma treatment cost decreased from $US499 to $US415 per patient (a 17% reduction; p = 0.0142) in the intervention group and decreased from $US227 to $US217 in the control group (a 4% decrease; p = 0.6172) [1997 values]. The decrease in the intervention group was significantly greater than that in the control group after controlling for the differences in treatment costs before the intervention (p = 0.0001). The average cost per patient associated with hospitalisation, emergency room visits, physician visits and asthma medications decreased by 13%, 29%, 36% and 18%, respectively, after the intervention in the study group. There was a 9% reduction in the frequency of hospitalisations, a 27% reduction in emergency room usage, a 27% reduction in physician office visits and a 6% reduction in the number of prescriptions per patient for asthma medications after the intervention in the study group.ConclusionsSignificant reductions in overall asthma treatment costs were observed after the implementation of the asthma education programme. Therefore, intense patient education and management should be advocated to reduce treatment costs in patients with asthma.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS