摘要:

Diabetic eye disease is the most common cause of new cases of blindness in the Western world. If the disease is detected early then proper treatment can be provided to prevent loss of vision. Regular screening can reduce the incidence and prevalence of blindness due to diabetic retinopathy. Health personnel, optometrists and primary care providers can perform the screening using digital nonmydriatic fundus cameras. Digital data can be archived, stored, manipulated and sent via telecommunication networks, e.g. the Internet, to ophthalmologists for diagnosis and second opinions.Easy-to-operate, low cost and portable digital fundus cameras and intuitive software are necessary to perform cost-effective screening of rural, remote and underserved communities using trained lay personnel. Several feasibility studies of telemedicine screening for diabetic retinopathy have been reported. These studies demonstrate the enormous usefulness of this technology for communities living in rural and remote areas. Further studies are needed to prove the cost benefit of telemedicine technology for diabetic retinopathy screening.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

The Internet has changed healthcare practice and has just begun to influence pharmaceutical consumers and providers. The Internet firstly affects the pharmaceutical consumer through the five main functions it offers to all consumers of care. These functions are:to provide and distribute information;to support informed decision making;to promote health;to provide a means for information exchange and support (the community concept) and;to increase self care and manage the demand for health services, thus, lowering direct medical costs.Secondly, the Internet influences the pharmaceutical consumer by enhancing the move to consumer empowerment. Thirdly, it offers increased self-care capabilities to consumers through pharmaceutical information gathering and pharmaceutical products and services purchasing using Internet pharmacies. Finally, the Internet affects the pharmaceutical consumer by enhancing efficiency in the medical management of patients. It does this by providing the means for telemedicine and telepharmacy, by changing the healthcare professional-patient relationship, and by providing a tool for registering adverse drug events. Disease management benefits include:access to care for remotely located consumers;the possibility of peer consultation and of access to diagnostic and therapeutic Internet information for healthcare providers; andcontinuity of care via virtual community networks, integrated health systems, interconnected, real-time, virtual healthcare teams, and virtual unified electronic health records.The Internet's effect of increasing knowledge of illicit and unregulated drugs, which may change drug use behavior and drug culture, though, makes the medical management of patients less efficient.The effects of the Internet on the pharmaceutical provider firstly relate to technological and managerial changes. The Internet, secondly, induces changes in the provision of pharmaceutical care by offering the means for telemedicine, telepharmacy, and e-commerce, for advertising, promotion, and communication with consumers, and for supporting drug safety and pharmacovigilance.The Internet's positive influence on pharmaceutical consumers and providers, however, mainly will depend on whether proper solutions can be found for the privacy/security and confidentiality problems existing in pharmaceutical information gathering and pharmaceutical products and services purchasing. Special focus should be placed on ensuring the privacy of consumer information and on the secure transmission of financial information. The best defenses will be adequate, national, international, and global laws and regulations which ensure privacy/security and confidentiality on a global level.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

Most people with Alzheimer's disease and other dementias do not receive ongoing, intentional medical management for these conditions, and effective coordination of medical and non-medical care is rare. Many published guidelines and consensus statements provide recommendations for identification, diagnosis and ongoing management of key issues, including cognitive decline, behavioral and psychiatric symptoms, depression, safety, family caregiver support and use of community services. These recommendations provide a strong basis for the development of disease management approaches that could improve medical outcomes and quality of life for people with these conditions and their families. In the US, a demonstration project (Chronic Care Networks for Alzheimer's Disease) is testing an innovative model of coordinated medical and non-medical care that incorporates many of the recommendations.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

IntroductionDisease management programs often strive to enhance patient outcomes through improvements in the process of care. The purpose of this study was to determine the relationship of diabetes care process measures with self-rated health and patient satisfaction among managed care patients with diabetes mellitus, while controlling for the influence of demographics, co-morbidities and severity of illness.Study design and methodsThis study was an integrated analysis of cross-sectional survey and retrospective claims data. The sample included 300 adult patients with diabetes mellitus enrolled in an Independent Practice Association−model health maintenance organization. Analyses consisted of two multiple regression models with self-rated health (100-point scale, higher score = better health) and patient satisfaction (9-point scale, higher score = greater satisfaction) being the dependent variables, respectively. Predictor variables in both models included: demographics (age, gender, education, income), severity of illness (insulin use, duration of diabetes mellitus), number of co-morbidities, receipt of foot and eye exams, diabetes mellitus education, lipid tests, microalbumin tests, frequency of self-monitoring of blood glucose and the frequency of tests for glycosylated hemoglobin (HbA1c) and blood glucose.ResultsMean (SD) for self-rated health and patient satisfaction scores were 49.8 (25.0) and 7.8 (1.8), respectively. The squared multiple regression coefficients (R2) for model 1 (self-rated health) and model 2 (patient satisfaction) were 0.20 and 0.10, respectively. Significant predictors of self-rated health included co-morbidities (standardized regression coefficient [β] = −0.12), income (β = 0.27), and HbA1ctests (β = 0.19). Significant predictors of patient satisfaction included co-morbidities (β = −0.16), foot exams (β = 0.16), and diabetes mellitus education (β = 0.16).ConclusionWhen controlling for demographics, co-morbidities and severity of illness, those patients who received more frequent HbA1cmonitoring reported better health, and patients who received foot exams and diabetes education were more satisfied with the care they received for diabetes mellitus. Thus, disease management initiatives that optimize the education and monitoring of patients with diabetes mellitus are likely to produce better patient-reported outcomes.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

ObjectiveThis study developed and validated a claims-based algorithm for identifying patients with irritable bowel syndrome (IBS) and investigated the characteristics of patients associated with a correct identification.MethodsUsing a classification tree procedure, a claims-based algorithm was developed and tested against medical chart findings. Patients’ medical charts were reviewed to verify diagnoses. The classification tree separated the patient population into 12 mutually exclusive subgroups and had an overall positive predictive value (PPV) of 70%.Setting and ParticipantsClaims data were obtained for adults aged 18 years or older who were enrolled in a large health maintenance organization in California, USA, during the study period (January 1 1997 to June 30 1999) and who had at least one claim with a primary International Classification of Diseases Ninth Revision Clinical Modification (ICD-9-CM) diagnosis of 564.1 (irritable colon) in 1998. In October 2000 this code description was revised to ‘irritable bowel syndrome’.ResultsThe PPVs of end nodes of the tree varied (18 to 100%) depending on the demographic, type of resource utilized, and diagnoses characterizing the 12 groups. Younger patients (aged <50 years) and those with several claims with a 564.1 ICD-9-CM code were more likely to be patients with IBS. The PPV for each of these 12 subgroups could be used as a covariate in regression models that predict outcomes of IBS and its management.ConclusionsClaims databases provide an efficient and effective tool for conducting health services research on large patient populations. Medical record validation of claims-based algorithms is an important step in improving the reliability and utility of these databases.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

ObjectiveThe aim of this research was to develop an empirically derived methodological model for the development of disease management programs in general practice. The model was developed applying the example of hypertension.MethodsUsing a rapid appraisal framework, empirical investigations, which included structured panel discussions, face-to-face structured interviews and formal presentations, were conducted to design, test and confirm the disease management model. A broad range of stakeholders were consulted from general practice, other health providers, industry, federal government and consumers.ResultsThe outcome of the research was a testable definition of disease management for hypertension, and the Australian Disease Management Approach to Hypertension in General Practice (ADAGE) for patients at low to high risk of major cardiovascular events. The central platform of this program is an information, communication technology package for risk assessment and management, plus access to a dietician commissioned by the program and a tailored suite of audiovisual and written material.ConclusionThis study used hypertension to demonstrate a model for the development of theoretically sound disease management models for application in general practice. The ADAGE program is currently under evaluation in a cluster randomized trial of 76 general practices in South Australia and Victoria in both metropolitan and rural settings. It is anticipated that this model will contribute to the development of other disease management programs for addressing chronic disease.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS