摘要:

The increased availability of genetic information has the potential to dramatically change the practice of medicine. Health insurers, in their role of evaluating medical appropriateness while controlling costs, are struggling with the incorporation of the genetic paradigm into clinical practice. Tremendous progress has been made in the understanding of genetic causes of single gene disorders. This has led to more sophisticated diagnostic approaches but, with few exceptions, has not led to innovative therapies. Tremendous sums of money are being spent in the emerging field of pharmacogenomics, but little return on this investment has been seen to this point. The ‘Holy Grail’ of the new genetics is to understand the genetic factors that predispose to common disease that will eventually lead to individualized preventive care, rather than prevention based on population tendencies. There are enormous obstacles to overcome if this goal is to be realized, including identification of genetic variation, quantification of variant effect, environmental interactions, and development of interventions based on variation and cost analysis to ensure that this type of approach is feasible within the current economic environment. It must also be recognized that genomics may not be the answer to any of the above questions, given that each of the approximately 30 000 genes in the genome produces, on average, 3.7 proteins. The new field of proteomics may supplant genomics as the guide to accomplishing the goals above.Insurers do not have the luxury to wait for the outcome of this debate. They must act now to analyze the new genetic technologies, and incorporate those that demonstrate value. This will necessitate involving geneticists in technology assessment and utilization decisions, as well as adding these specialists to the provider network. In addition, they will need to partner with educators and researchers to ensure that the next generation of providers is genetically competent, as well as to help establish the evidence base for interventions developed from genetic insight.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

Telemedicine applications, i.e. the use of telecommunication technologies to deliver health services over a distance, have demonstrated dramatic growth over the past decade. Reimbursement has emerged as a crucial issue as projects attempt to evolve from the demonstration stage to a mainstream component of health delivery. Payors around the world, both public and private, are currently evaluating telemedicine and making funding decisions. As summarized in this article, conclusive evidence regarding the clinical and/or cost effectiveness of telemedicine does not support generalizations regarding outcomes for telemedicine. However, further discussion in this paper demonstrates that this may not preclude payors from deciding to reimburse for services delivered via these technologies. Research from the US and the UK points to other significant historical contributors toward payor reimbursement decisions, such as consumer and market demand and payor mission.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

As the population of elderly people worldwide continues to grow, successful aging has risen to the top of the health policy agenda. The definition of successful aging includes the maintenance of physical and mental function, as well as continued social engagement. Given this definition, maintaining health-related quality of life (HR-QOL) should be a key goal for nutrition and physical activity programs targeted toward the elderly. HR-QOL encompasses physical functioning necessary for unassisted living, as well as broader domains of mental functioning and overall life satisfaction. This review examines the relationship between health parameters and HR-QOL, and assesses the degree to which these relationships are addressed in existing screening and promotion programs. In many cases, nutrition screening and evaluation tools have focused on biomedical measures, such as bodyweight, body fat, or plasma lipids, without taking QOL into account. While HR-QOL has been considered in a few health promotion campaigns, a more balanced perspective on wellness and health among the elderly is needed for the design of effective policies and programs. Successful aging can depend on such factors as race, ethnicity, education, and access to economic and social resources. Intervention programs reviewed include those that address nutritional status, physical activity, and mental health issues among community-dwelling elderly. A comprehensive approach to promoting health in aging would incorporate indicators of wellbeing, and would specifically address nutrition and physical activity issues alongside HR-QOL. Public health policies reviewed here are designed to create an infrastructure to promote healthy aging and offer support to the growing elderly population.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

Chronic obstructive pulmonary disease (COPD) is a long-term illness. As the disease progresses, it become more complex and spirals into an abstract complex of interrelated physical, emotional and psychosocial problems. Patients are in a constant process of learning as they endure, manage and adapt to the changing nature of the disease. It has recently been proposed that self management should be a part of the standard care for patients with COPD.This review presents a comprehensive and critical evaluation of the international literature with respect to the benefits of disease-specific self-management programs on health status and the use of health resources in patients with advanced COPD.This review screened all English-language studies indexed in Medline that investigated patient education and self management in patients with COPD, and were published in peer-reviewed journals between 1966 and 2003. Randomized controlled trials of self management in COPD were included in this review if health status or the use of health resources were measured.A best-evidence synthesis was conducted and ten studies were selected for this review. It was found that there was extreme variation between the studies in terms of the content and intensity of self-management programs, continuum of the patient program, follow-up visits, and support provided to patients. Of the ten studies, four reported a significant improvement in health status for patients in the self-management groups compared with usual-care groups. Physician visits (acute) were significantly reduced in the self-management group compared with the usual-care group in two out of four studies in which it was assessed. Self management was also associated with a reduction in emergency room visits in one out of two studies and a reduction in hospital admissions or duration of hospitalization in one out of five studies.The findings of this review reveal new evidence that disease-specific self management can improve patients’ health status and reduce physician visits and hospital use. Self-management programs that are coupled with a supervised exercise-training program would probably be more effective in improving dimensions of health status. Programs combined with communication from a trained health professional could be integrated into standard medical practice and support full population access. However, there are still many unanswered questions that need to be addressed with respect to the specific components of effective education for patients with COPD, methods to adjust self-management programs to suit the needs of individual patients, and long-term maintenance strategies.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

Acute stroke affects large numbers of people worldwide. It causes significant morbidity and mortality. Data support the hypothesis that the public is not familiar with either the risk factors or the signs of stroke. Educating the public about stroke may result in a lower incidence of the disease as individuals modify their risk factors, and in improved outcomes as a result of reductions in delays to treatment. There is clear and convincing evidence that reducing delays to treatment of patients with acute stroke results in improved outcomes. Public education programs should be broad-based, tailored to individual audiences, and carry a common theme.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

AimTo determine whether participation in a six-session behavioral medicine group program was associated with a post-intervention decrease in health costs among participants.Healthcare utilization for both groups was measured for two epochs: the 12 months before the referral and the 12 months following the referral for the control group, or the 12 months following completion of the program for the PHIP group.MethodsA retrospective study conducted in a convenience sample of 295 high utilizers of healthcare at a health maintenance organization in northeast USA. High utilizers were considered to be those patients with at least $US1500 in utilization costs (excluding eye care, dental services and pharmacy services) in the 12 months prior to the course. Five patients with $US20 000 or more in utilization costs for any 6-month period were excluded from the analysis because of the occurrence of severe acute medical illnesses. The intervention group comprised 114 patients who completed at least four of six behavioral medicine group sessions in the Personal Health Improvement Program (PHIP). The comparison group (n = 176) consisted of those patients who were referred but declined participation.Healthcare utilization for both groups was measured for two epochs: the 12 months before the referral and the 12 months following the referral for the control group, or the 12 months following completion of the program for the PHIP group.ResultsThe PHIP course significantly decreased utilization from an average of $US4079 prior to course participation to an average of $US2462 in the 12-month period after the course, a decrease of $US1616 (p < 0.0001). Utilization in the comparison group decreased by $US608 (from $US4347 before referral to $US3739 12 months after referral). Post-intervention health costs were $US1008 less than those observed in the control group during the same time period. There was a mean decrease in costs from baseline of 25% for the PHIP group and less than 1% for the control group (p = 0.031, one-tailed).ConclusionThis cost saving, if attributable to a direct impact of PHIP on morbidity and a subsequent reduction in healthcare utilization, would represent roughly a 25% saving in health costs. The study was limited by the non-random assignment to condition and the resulting potential for selection bias, as well as other possible confounds. However, the present finding of lower health costs after PHIP participation is consistent with earlier studies showing reductions in ambulatory visit rates following PHIP. Taken together, these findings suggest that the integration of behavioral medicine group programs into primary care will benefit patients and clinicians as well as help to control health costs.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

The rapid expansion of disease management continues. A multitude of stakeholders and marketplaces are now involved in providing cost-effective quality healthcare for individuals and populations. To help you keep up-to-date with the very latest developments in disease management, this section of the journal brings you information selected from the disease management and pharmacoeconomic reporting servicePharmacoEconomics & Outcomes News Weekly.1The following reports are selected from the very latest to be published across a broad range of literature sources.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS