摘要:

Pulmonary rehabilitation programs aim to improve the health of elderly patients disabled by lung disease. Despite the widespread application of these programs limited scientific data is available on the subject, except in chronic obstructive pulmonary disease (COPD). This review presents an overview on outcomes of pulmonary rehabilitation programs in elderly patients with COPD. Statistically significant improvements can be found for functional and maximal exercise capacity, as well as for health-related quality of life (HR-QOL). However, clinically relevant improvements are mainly found for functional exercise capacity and especially for HR-QOL. Rehabilitation programs including elderly patients with COPD also showed clinically relevant improvements in dyspnea and fatigue and an enhancement of the patient’s control over their condition. Therefore, rehabilitation is an important form of treatment and one of the main components of the management of COPD in elderly patients.

ISSN:1173-8790    

出版商:ADIS    

年代:2004

数据来源: ADIS

摘要:

When considering the trends in disease management, the focus of healthcare in the US has shifted from communicable diseases, which can most often be managed successfully, to chronic diseases, which are currently not managed very well. Chronic diseases, such as diabetes mellitus, become a lifelong health problem for the individual, the family, and in the workplace. Currently, there is no vaccine to prevent diabetes and no cure for diabetes once acquired. In order to improve the quality of care for diabetes, national performance measures have been developed to provide a unified set of diabetes-specific performance and outcome measures.The Diabetes Quality Improvement Project (DQIP) founded in 1997 through a partnership between the Center for Medicare and Medicaid Services, the National Committee for Quality Assurance, and the American Diabetes Association, established a single, standardized set of performance measures for diabetes care quality improvement and accountability in the US, which were published in 1998. The DQIP measures are noteworthy as a model for many other chronic diseases. Indeed, the DQIP represents the first widely adopted comprehensive performance measurement standards, not just for diabetes but for any single chronic disease. This is of further significance since it was developed by a coalition of public and private entities in the US.In order to prevent long-term complications from diabetes, there needs to be a physician-coordinated treatment plan involving a team approach to the problem. When such a physician-coordinated treatment plan is developed in conformance with the comprehensive performance measures, the prospects for a greater impact on diabetes might be enhanced.Overall, national performance measures for diabetes care have been widely adopted into health plan quality initiatives and have resulted in increased efforts to promote preventative screening and testing. Better compliance has lead to more stringent glucose control and helped to educate the public on the utility of the glycosylated hemoglobin level test for finding those at risk for microvascular and neuropathic complications. While more Americans with diabetes are receiving the recommended standards of care as a result of the implementation of national performance measures, diabetes management remains suboptimal but achievable.The authors concluded from this review that national performance measures have provided health plans and providers with objective tools to measure quality; however, these measures now need to move to prevention standards and initiatives. Policy development for diabetes care must continue to move from managing chronic illness to preventative screening of pre-diabetes through to identification and modification of lifestyle risk factors.

ISSN:1173-8790    

出版商:ADIS    

年代:2004

数据来源: ADIS

摘要:

Corporations have engaged in sponsorship of health management programs and, more recently, disease management programs to facilitate healthy and productive work environments. The purpose of this review is to examine the health and financial outcomes from these corporate-sponsored disease management programs. This article focuses on seven diseases or chronic conditions (arthritis, asthma, cancer, depression, diabetes mellitus, heart disease, and migraine) that potentially impact employee productivity (both in time away from work and in loss of effectiveness at work) and health status including medical and pharmaceutical utilization and costs.Corporate-sponsored disease management programs typically focus on education and screening for selected diseases or chronic conditions. Partnerships have been formed with health plans and third-party program providers to reach employees with interventions and treatment. The typical outcome measures from these programs have primarily been clinical indicators and medical utilization. Measures of productivity need to be incorporated as important outcome measures for disease management programs.The estimated financial opportunity for the corporation is a reflection of the cost differential for a given disease and the prevalence of that disease within the employee population. Primary diseases, chronic conditions, and health risks contribute to increased medical utilization and decreased productivity within the corporation. Promoting programs that focus on the whole person, including health risks, chronic conditions, and diseases, will likely increase the possibility of success in helping the employee to better self-manage their health conditions and consequently provide gains for both the individual and the corporation.

ISSN:1173-8790    

出版商:ADIS    

年代:2004

数据来源: ADIS

摘要:

BackgroundSuccess in treating hypertension is greater in clinical trials than in actual practice. To prospectively study real-world antihypertension treatment patterns, therefore, naturalistic studies are essential.ObjectiveThe primary objective of the Caring for Hypertension on Initiation: Costs and Effectiveness (CHOICE) study was to evaluate the feasibility of performing a naturalistic study in patients with newly diagnosed hypertension in terms of enrollment, adequacy, and the timeliness of data collection and study procedures.MethodsThe CHOICE study prospectively collected actual practice data from physicians, who were blind to the study purpose and hypotheses, treating newly diagnosed hypertensive patients. The initial therapy was randomly assigned to either Group 1 (diuretics or β-adrenoceptor antagonists) or Group 2 (calcium channel antagonists or ACE inhibitors). The protocol made no demands on usual medical care in scheduling visits and changing treatment during follow-up. Only a final visit at 5 ± 1 months was mandated. Direct involvement of the CHOICE study team was minimized using a remote study monitoring system to collect data and communicate with study sites.ResultsWithin 30 weeks, a total of 55 physicians enrolled 512 patients with a mean age blood pressure of 158/99mm Hg. In all, 46 different antihypertensive medications were prescribed and 2554 office visits (range 1–16 visits per patient) were attended. Other medical resource use was low during the study period. A final, clean database was ready for analysis 30 days after the last patient visit.ConclusionThe results of this pilot study demonstrate that CHOICE is a feasible framework within which the real-world effectiveness and cost effectiveness of initial therapy for patients with newly diagnosed hypertension can be studied. Protocol flexibility and a novel electronic data entry system are core elements of this naturalistic design.

ISSN:1173-8790    

出版商:ADIS    

年代:2004

数据来源: ADIS

摘要:

Lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) are common among older men, and can reduce their quality of life considerably. The disease also has substantial economic implications for healthcare providers and society in general, particularly in view of the aging of populations in developed countries.The management of patients with LUTS associated with BPH can include watchful waiting, medical therapy, or surgery, and disease management programs may use shared care approaches that involve both primary and secondary providers. Patient preference is important when making treatment decisions, and many patients will prefer medical treatment over surgery. This form of treatment is often managed within the primary-care setting.Among medical therapies, the α1-adrenoceptor antagonists are the preferred option for patients requiring rapid symptom relief. The efficacy of these drugs is sustained over a number of years. Generally, α1-adrenoceptor antagonists provide better symptom relief than 5α-reductase inhibitors, and although they do not reduce the long-term risk of acute urinary retention or need for prostatic surgery (in contrast to 5α-reductase inhibitors), they do delay the time to acute urinary retention, and are likely to reduce referrals to secondary care.Although generally well tolerated, hypotension-related events are the most common adverse events for most α1-adrenoceptor antagonists. Compared with the other drugs in its class, tamsulosin appears to have a lower propensity to interfere with blood pressure regulation, particularly in the elderly. This may reduce the amount of monitoring by physicians required during the initial period of treatment, and also the risk of hypotension-related falls and associated secondary care.The increasing importance of pharmacologic interventions in the long-term management of BPH, together with the efficacy and tolerability profile of tamsulosin, suggest that the drug may be useful as part of a disease management program, although the long-term economic impact of tamsulosin remains to be determined.

ISSN:1173-8790    

出版商:ADIS    

年代:2004

数据来源: ADIS