摘要:

The development of disease management programmes requires a systematic planning approach that considers disease characteristics and the structure and operations of the health plan. Well designed disease management programmes offer the potential to meet patient and plan needs while promoting a more cost effective approach to patient care.A disease management programme should meet specific organisational goals, improve coordination of care, take a holistic view of health and be based on a comprehensive environmental assessment. The programme should have clear objectives that meet documented population needs. Programme interventions and implementation methods should be evidence-based and compatible with the plan's policies, operations, information system capabilities and environment. The evaluation plan should include a variety of end-points and consider noncausal explanations for results. All programme components should be acceptable to plan administration, providers, practitioners and patients.

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

摘要:

Depression is one of the most common psychiatric disorders. Since World War II, major changes in the epidemiology of depression have included an increase in the overall rates and a significant shift toward an earlier age of onset. The literature reveals point prevalence rates between 3 to 4%, 1-year rates between 2.6 to 6.2% and lifetime rates varying widely from 4.4 to 19.5%. A significant number of individuals with depression remain either undiagnosed, misdiagnosed and/or suboptimally managed. The main treatment options for the management of depression include: (i) antidepressant pharmacotherapy; and/or (ii) non-pharmacological techniques, inclusive of electroconvulsive therapy and psychotherapy. This article reviews the tolerability, efficacy and effectiveness of these interventions.

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

摘要:

This article gives practical guidance to those relatively unacquainted with the task of managing hyperlipidaemia. It primarily addresses doctors but can be easily read by a wider audience. Management starts with assessing the individual risk, which can be done without difficulty for men aged between 35 and 65 years. If the individual has a total serum cholesterol level between 6.0 and 7.8 mmol/L, their risk may be more precisely estimated after measuring serum high density lipoprotein cholesterol level and considering smoking status, blood pressure and signs of manifest arteriosclerotic disease. An algorithm for this is suggested. In addition, family history concerning early cases of coronary disease should be considered. Advice is then given for evaluating risks for women and for the elderly. Finally, data from the literature concerning cost effectiveness and burden of illness are summarised.

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

摘要:

The chronic nature of type 2 (non-insulin-dependent) diabetes mellitus, and the importance of monitoring and regulating blood glucose levels in order to minimise development of serious and costly diabetic complications, make the disease a prime target for disease management programmes. Although diet and lifestyle modifications are the mainstay of management of type 2 diabetes, fewer than 10% of patients are able to achieve long term glycaemic control without pharmacological intervention.Acarbose is an &agr;-glucosidase inhibitor which delays entry of glucose into the bloodstream after ingestion of complex carbohydrates and disaccharides, by delaying enzymatic breakdown of these foods in the intestine. This results in attenuation of postprandial plasma glucose and insulin peaks and a smoothing of diurnal plasma glucose profiles.In patients with type 2 diabetes managed with diet alone or diet plus other antidiabetic agents, acarbose lowers postprandial plasma glucose levels by approximately 2.2 to 3.3 mmol/L (40 to 60 mg/dl). Glycosylated haemoglobin (HbA1c) is usually lowered by 0.5 to 1%, although the magnitude of the reduction appears to depend on baseline levels, and larger increases have been reported. These changes are accompanied by modest reductions in fasting blood glucose (0.6 to 1.1 mmol/L: 10 to 20 mg/dl), triglyceride and/or total cholesterol levels in some patients. Acarbose may lower HbA1cto a lesser extent than sulphonylureas and metformin, although a small number of studies have indicated similar efficacy. Acarbose has been used successfully in combination with sulphonylureas, metformin and insulin.Acarbose is well tolerated systemically, but causes gastrointestinal disturbances (flatulence, meteorism/borborygmi, diarrhoea) in approximately two-thirds of patients. These symptoms may be marked at the beginning of treatment but can be minimised by careful dosage titration and also tend to subside over time. This relatively benign profile of adverse events is particularly advantageous in patients in whom other oral antidiabetic agents are contraindicated, although some patients may be unable to tolerate the gastrointestinal effects. In contrast to sulphonylureas and insulin, acarbose does not raise plasma insulin levles or promote bodyweight gain and does not cause hypoglycaemia when used as monotherapy.Thus, acarbose is a first-line therapy which can be used in a wide range of patients, in conjunction with diet or with other antidiabetic agents. It may provide an alternative to metformin in patients in whom biguanides are contraindicated and an alternative to sulphonylureas in patients, such as the elderly, in whom hypoglycaemia is particularly dangerous.

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS