摘要:

Screening programs for sickle cell disease, when effective, can reduce morbidity and mortality as a direct consequence of patient education and optimized clinical management. However, informed patient or parental consent is necessary prior to the screening process as a person's sickle status is genetic information which can, when poorly communicated to clients, lead to harm.Screening programs are at their most effective when the full process is linked, including pre-screening information for clients available in an appropriate format, continuing education for health professionals, and effective post-result education with specialist follow-up for those affected by sickle cell disease. Effective handling, storage and retrieval of results is important for patients and professionals alike, yet this remains a major problem in most healthcare organizations. This problem is maximized because of the great variety of settings, professionals and groupings that are involved in a comprehensive screening program.Managed care programs need to review the genetic risk relating to sickle cell disease for the populations they serve in order to consider whether to develop programs that are universal in coverage or targeted, depending on the most cost-effective approach. In areas where the population is almost solely of North European origin and therefore where the sickle gene is rare, targeted programs are appropriate with linkage for provision of educational materials and specialist follow-up to other centers with greater experience.

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

Neonatology has become a prime target for specialty care management or population management services. As the cost of caring for the neonatal intensive care unit (NICU) population steadily rises, with no accompanying increase in quality information, health plans and large self-insured groups have increasingly taken notice. Some plans have attempted to manage this challenging population on their own; others have sought outside solutions. One such program is that developed by Paidos Health Management Services, founded in 1996.This article identifies the key issues surrounding neonatology and medically complex newborns and suggests factors that need to be addressed by a comprehensive neonatal care management program. It explains elements of the Paidos program and how this model becomes operational. Using key program elements including a specific patient grouper system, clinical management guidelines, physician advisory boards, outcome measurements and family satisfaction, the success of the program is described.Wide variation in clinical practice is demonstrated by the duration of methylxanthine therapy with a 2-fold difference seen in various regions. The cornerstone of improvement in practice is the use of sound clinical management guidelines. As documentation that improvement can be made, a revised feeding guideline improved the time to first feeds by as much as 50% at certain gestational ages. Guideline compliance overall averaged greater than 90%. This success was achieved by developing these evidence-based guidelines in cooperation with practicing physicians.With a fully implemented program, cost savings can reach 10% but vary depending on hospital contracts. Absolute reduction in length of stay and leveling of care are components of cost reductions. For those health plans lacking different contracted levels, there exist opportunities in future contracting with the level-of-care approach. Timely discharge of an infant depends on competent, high quality home care services being available. The high degree of family satisfaction with the program indicates that measures to contain utilization as part of the care management process are not burdensome.There are significant barriers and challenges to overcome when establishing a neonatal care management program. These include the relatively closed practice style of neonatology, financial concerns of physicians and hospitals and the issues of ‘control’ over what is best for the patient. However, given the current climate of managed care, a comprehensive, integrated approach can offer a successful solution.

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

Schizophrenia is possibly the single most costly disorder in psychiatric or somatic medicine, despite a relatively low yearly incidence of about 10/100 000/ year. In many cases it is a life-long disabling disorder. Available treatments, including medication, psychotherapy and family treatments are largely palliative and seem to be of only limited value. This may be due to an apparent delay in providing treatment early in the course of the illness.Schizophrenia can be regarded as a disorder that develops in stages: premorbid, prodromal and psychotic. Research over the last few years indicates that early treatment for schizophrenia may improve the course of the disorder.Projects aimed at intervening in the prodromal phase of the disorder have shown that it may be possible to reduce the incidence in a catchment area (Buckingham, UK), or prevent the conversion of prodromal cases into fulminate psychosis (Melbourne, Australia).In Norway, the Early Treatment and Intervention in Psychosis (TIPS) project demonstrated that it was possible to reduce the duration of untreated psychosis within a catchment area from a mean of 114 weeks to 26 weeks, and thus dramatically reduce the total period of psychosis. There are also indications that earlier detection results in patients who present with less severe psychopathology.Earlier detection is possible through information campaigns which enhance the public's knowledge about serious psychiatric disorders, and aim to reduce the stigma associated with this disorder and change help-seeking behavior. Earlier intervention requires easy access to psychiatric health services, and early, comprehensive treatment programs.Early detection and intervention can be managed successfully ensuring patients are provided with treatment at an earlier point in the development of the illness. Such programs are relatively inexpensive, since it is a question of organizing the health services in a way that meets the population's needs.

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

BackgroundOsteoporosis is an exceedingly common, morbid, and potentially fatal disease. Efforts to improve the prevention, diagnosis and treatment of osteoporosis in people living in Central Pennsylvania were instituted in 1996 by the Geisinger Health System. With a catchment of over 2 million people, over 600 physicians and 50 primary care sites, this physician-led system of healthcare is uniquely positioned to influence the delivery of healthcare.ObjectiveTo determine whether the pilot Community Pharmacist Osteoporosis Education Program, a specific project of the osteoporosis disease management program by the Geisinger Health System, improved bone health behavior.MethodsThe Community Pharmacist Osteoporosis Education Program, focused on physician and allied healthcare provider guidelines, community intervention, bone density testing, and outcomes analysis, can improve bone health. A group of highly motivated community-based pharmacists were educated about menopause and osteoporosis prevention, diagnosis, and treatment. They were provided with a uniform educational program and held classes in the community. Baseline, satisfaction, and follow-up questionnaires were administered. High risk participants received a follow-up telephone encounter. Primary care physicians were notified about the program and their patients' participation.ResultsApproximately 350 women attended the classes. The mean age was 54 years, 99.4% were Caucasian, and 47% had some education beyond high school. One-third had a family history of osteoporosis or fracture. Participants were uniformly satisfied with the course content and class delivery: 74% rated the class as ‘excellent’, 26% as ‘good’. Follow-up questionnaires at 4 to 6 months demonstrated that of those who were not previously doing so, 58% began taking calcium supplements, 32% exercised more, 50% sought the counsel of their primary care physician, 29% obtained a test of bone density, and 33% started a prescription medication for osteoporosis therapy as a result of attending the class. High risk participants were more likely to obtain a test of bone density after the program than were low risk participants.ConclusionThis program demonstrates that community-based pharmacists can serve as a valuable member of the healthcare provider team. An organized program that provides a standard and consistent educational approach, physician communication, and a reminder system led to better bone health behavior in women in the community.

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

ObjectiveTo support policy-making for patients with diabetes mellitus we compared the costs and effectiveness of initiation of insulin therapy in patients with type 2 diabetes mellitus in 2 settings in The Netherlands.DesignRetrospective cohort study.SettingA shared-care setting and an outpatient care setting of a university hospital. Both settings are located in Amsterdam, The Netherlands.PatientsAll patients with type 2 diabetes mellitus above 40 years of age who were transferred to insulin therapy in 1993 in both settings.InterventionInitiation and monitoring of insulin therapy in patients with type 2 diabetes mellitus.Study perspectivehealthcare sector.Main outcome measuresBaseline and 12 months glycosylated hemoglobin (HbA1c) values and fasting blood glucose levels, and direct healthcare costs of insulin therapy. Costs were expressed in 1996 Dutch guilders (NLG) [NLG1 = 0.5 US dollars ($US)].ResultsIn the shared-care setting (n = 57) the per patient healthcare costs during 1 year of follow-up averaged NLG2467. In the secondary care setting (n = 45) healthcare costs averaged NLG2740. A sensitivity analysis demonstrated that healthcare costs per patient were in the same range in both settings, ranging from NLG2000 to about NLG3400 ($US1000 to $US1700). Mean HbA1cvalues fell from 9.1 to 7.9% (shared-care setting; p < 0.05) and from 10.2 to 8.2% (secondary care setting; p < 0.05). The percentage of patients with poor glycemic control (HbA1c>8.5%) decreased from 56 to 30% (shared-care setting) and from 76 to 36% (secondary care setting). The percentage of patients with good glycemic control (HbA1c<7%) increased from 4 to 23% (shared-care setting) and from 2 to 18% (secondary care setting).ConclusionsThe study shows that in the first year of insulin therapy in patients with type 2 diabetes mellitus, acceptable glycemic control (HbA1c<8.5%) can be attained in the majority of patients in both a shared-care and a secondary care setting, at comparable low average costs per patient.

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS