ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

Specialty pharmacy service (SPS) companies are filling a new niche in the expanding role of chronic disease management (DM). These companies distribute expensive biotechnology drugs to patients who have relatively uncommon but very expensive chronic diseases. Although there are considerable differences among the competitors, some of the SPS companies have evolved into organizations that have built data systems and processes rivaling those offered by dedicated DM companies. These data systems and processes will allow several of the companies to demonstrate improved medical outcomes.Since the SPS companies can fashion contracts where they do not charge a separate fee for the DM portion of their services, this model is especially attractive to managed-care organizations (MCOs) [both preferred provider organizations and health maintenance organizations] and to third-party administrators that operate in self-insured or administrative services only environments. These companies can also reduce the administrative burden for MCOs and the ‘hassle factor’ for physicians and patients by performing delegated prior-authorization functions for the MCO.Pharmaceutical companies have played a key part in advising and assisting the development of the unique role of SPS companies. Future challenges and opportunities for this sector include: integration of comorbid conditions; publication of outcome results; customization of educational material to individual patient needs; and accreditation. MCOs and investors will recognize the development of an integrated, proven DM, outcome-driven business model as a key differentiation factor in this niche industry.

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

This article contrasts trends in addressing work productivity in severe mental illnesses (SMI) such as schizophrenia and in affective disorders. Citations from searches of 8 reference databases were reviewed.The negative impact of SMI on employment is indisputable, as is the fact that people with these disorders could be employed more frequently than is the case. For those with SMI, work rehabilitation treatment models have been developed, but their implementation in disease management programs has lagged behind those of other diseases. In contrast to the situation with SMI, treatment outcomes in affective and anxiety disorders have been defined primarily in terms of symptom relief and interpersonal functioning. Attention to work productivity has emerged more recently as employers have become important stakeholders in healthcare decision making. Since most patients with affective disorders are already in the work force, some work productivity initiatives and outcomes developed for SMI may not be appropriate for patients with affective disorders. Attention to work productivity has not been systematically incorporated into treatment planning for affective disorders, and specific work-related psychiatric interventions are not yet available.In conclusion, the cost effectiveness of work productivity interventions in psychiatry requires their integration into comprehensive disease management programs. In making resource allocation decisions, appropriate incorporation of work productivity within a larger ethical framework of healthcare decision making is essential. The furtherance of work productivity initiatives in psychiatry requires collaboration among numerous stakeholders in professional education, service delivery and research.

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

With increasing efforts to put evidence-based medicine into daily practice, it has become apparent that currentad hocimplementation strategies do not result in desired outcomes. There is a need to evaluate and further develop evidence-based implementation strategies that are effective and efficient. To begin this effort, the authors recognize the importance of integrating implementation into program development rather than treating it as an afterthought to be achieved through promotion and encouragement. Reviewing three empirical frameworks, derived from experience with continuous quality improvement (CQI) programs, guideline and practice change implementation, and disease management programs, the authors identify four key factors for successful program development and implementation. The four factors are: aligning the program with the strategic goals of the organization; obtaining active senior leadership commitment, including allocated resources; securing the appropriate infrastructure to facilitate integration of recommended actions into daily practice; and setting up systematic communications with all involved stakeholders. The authors reviewed randomized clinical trials that compared single and combined implementation approaches to determine whether experimental results would confirm the empirical findings. The results of these clinical trials demonstrated that when organizational commitment, in the form of allocating sufficient resources and/or providing a facilitating infrastructure, is lacking, programs are not successfully implemented. The studies did not explicitly evaluate the concept of strategic alignment of goals or communication strategies. Considering these findings, the authors wonder whether it is worthwhile to develop programs in settings that lack the major success factors, since they are likely to fail to be implemented widely. Before reaching this conclusion, they recommend more research to identify more clearly the nature of the success factors and their relative importance in achieving the desired outcomes of disease management programs.

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

Smoking cessation continues to be one of the most cost-effective preventive measures for work-site disease management. The US Public Health Service Clinical Practice Guideline, entitled ‘Treating Tobacco Use and Dependence,’ provides guidance for evaluating and choosing smoking cessation programs for work sites.Smoking cessation interventions can be characterized by the resource intensity of the effort, the format and methods of interacting with patients and the focus and objectives of the content. These features are compared with typical group, phone and Internet-based program options. Pharmacotherapy treatment recommendations are reviewed as well as characteristics of first-line nicotine replacement therapy (NRT) medications (e.g. nicotine patch, gum, spray and inhaler) and bupropion.It is suggested that work-site recruitment and participation campaigns may fail for a variety of reasons including:too narrowly cast recruitment messages;inadequate exposure to campaign messages;lack of immediate and accessible enrollment mechanisms; andpassive rather than active outreach.Four broad issues to consider when comparing outcomes data from potential smoking cessation programs are:at what follow-up point(s) is the quit rate measured?;is there a comparison group?;how was quit status determined?; andhow is the status of participants who are lost to follow-up calculated in the outcomes data?

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

BackgroundAlthough information technology applications are part of all disease management programs, most programs involve extensive nurse interventions.ObjectiveTo present clinical and financial outcomes data from One Health Plan's technology-based program(s), which provide asthma, diabetes mellitus, and cardiovascular care to over 90 000 participants.MethodsThe programs are designed to support the health plan's patient population with asthma, diabetes, congestive heart failure, and coronary artery disease. Data from the health plan's medical and pharmaceutical claims were used to identify the total patient population. The program(s) use extensively mail, Internet, and Interactive Voice Response (IVR) services with only limited nurse interventions to engage the patients and intervene in their care.Patient engagement consisted of an introductory mailing supported by follow-up mailing. The objective was for the targeted patient to respond by completing a survey on paper, over the Internet, or via IVR. The CareResultsSMprogram, uses participant-reported information to risk stratify the population and to track patients progress as part of the measurements of the program's results. The risk stratification algorithm scores the participant's clinical status and ability to self-manage their care. Both dimensions impact the participant's risk score, which in turn determines the follow-up activities. CareResultsSMmails a personalized feedback booklet as part of a care kit to educate the participant on the current treatment protocols. The goal is to help the participant recognize good healthcare and teach them to work with their physicians to achieve this.ResultsThe programs demonstrate that improved outcomes can be rapidly achieved for a large number of participants without costly nurse interventions. One Health Plan offered the program to over 250 000 members in the year 2000 and had over 93 000 elect to participate. Improved clinical outcomes were demonstrated for asthma, diabetes, and the cardiovascular diseases. Highlights include a 55.2% increase in candidates with diabetes receiving glycosylated hemoglobin A1ctest, and a 27% self-reported increase in the use of low-dose aspirin for participants with a cardiovascular condition. Financially, current analysis comparing 1999 costs to 2000 costs indicates that the program's per member per year net savings ranged from $US300 to $US1000 depending on the specific disease state. In all cases, the programs demonstrated a significant positive gross saving.ConclusionOne Health Plan's experience demonstrates that the technology-based CareResultsSMprogram produces positive financial and clinical results without significant nurse interventions.

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

ObjectiveTo identify patterns of care and associated costs for typical patients with chronic obstructive pulmonary disease (COPD) in a US managed-care setting.DesignRetrospective analysis of administrative data from a proprietary managed-care research database.Patients6371 patients with COPD.MethodsA ‘core’ population of enrollees was identified who were continuously eligible for healthcare services (including prescription medications) for at least 12 months and who actively utilized services. From this core population, patients with two or more claims listing International Classification of Diseases, nineth edition, Clinical Modification diagnosis codes for COPD were selected as the COPD study population. The core and COPD study databases were then analyzed to quantify healthcare utilization and charges over the period from October 1995 through September 1996.ResultsApproximately one-half of patients with COPD were in the 45- to 64-year age group. The average total healthcare charge for patients with COPD was $US1109 per month (1995/1996 values), compared with $US179 per month for the average patient with healthcare claims. Although only 19% of patients with COPD were hospitalized for COPD, 58% of COPD-attributed healthcare charges were for hospitalizations. Physician visits and tests accounted for another 23% of COPD-attributed healthcare charges, and medications for 9%. Over 25% of patients with COPD had an emergency room visit, compared with 10% of all patients with claims. 40% of patients with COPD received at least one prescription for a respiratory medication during the year. 15% received anticholinergic bronchodilators, 30% received β2-agonist inhalers, 13% received xanthine bronchodilators, and 14% received inhaled corticosteroids. Patients with COPD had over twice as many medical conditions for which they sought healthcare compared with the average patient with claims.ConclusionsAlthough COPD has been viewed as a disease of the elderly, it also significantly affects the quality of life of the ‘not so elderly’, and represents a significant cost exposure to commercial health plans in the US. Despite the availability of acceptable clinical guidelines, there are many opportunities to optimize healthcare utilization and the standard of care for patients with COPD, including ensuring that patients receive those medications considered to be first-line treatment for COPD.

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